‘Adolescent cancer care would be better if it was centralised’

The outcomes for older teenagers and young adults with cancer could be better if their care was centralised at Our Lady's Children's Hospital in Crumlin, according to one of the country's most highly regarded consultants in childhood and young adolescent cancer.

Consultant paediatric haematologist Prof Owen Smith was speaking after research confirmed the outcome for children treated for leukaemia at the hospital is the best in Europe.

Smith was last month made an Honorary CBE (Commander of the Most Excellent Order of the British Empire) in acknowledgment of his outstanding contribution to the care of children and adolescents with cancer.

The research, by Charles Stiller from the University of Oxford, published in September, was called Childhood Cancer Mortality in the UK and Internationally, 2005-2010.

“Essentially it shows our results [at Our Lady’s in Crumlin] to be the best in terms of acute lymphoblastic leukaemia and acute myeloid leukaemia throughout Europe,” Smith says.

In addition, the most recent review of clinical trials for acute lymphoblastic leukaemia found a 94 per cent survival rate.

Outcome ‘less good’

Leukaemia is one of the most common forms of cancer in children and young people and Smith has called for 16-24 year olds (with those cancers that occur more frequently in childhood and adolescence) to also be treated at the hospital.

Currently, the hospital treats children only under 16. “The progress that has been made in the treatment of childhood cancer has been a remarkable success story,” he says.

“From being an almost lethal disease 40 to 50 years ago, more than 80 per cent of children with cancer are now being cured. This progress has been the result of basic research and the testing of new knowledge through multi-institutional and multinational randomised peer-reviewed clinical trials.”

A number of clinical trials that include different types of chemotherapy are ongoing at Our Lady’s Hospital. “Prospective randomised peer-reviewed cancer clinical trials have been one of the most significant advances in cancer medicine over the past 50 years,” says Smith.

“Essentially, these trials supply scientific method to clinical problem-solving and, in doing so, they provide the mechanism for obtaining, with as little bias as possible, answers to important clinical biological questions that could not be obtained in any other way. They remain the gold standard.”

However, the older children, who are treated at other hospitals, do not take part in as many trials and Smith feels this contributes to the outcomes for them “being less good”.

The 16-24 year olds “occupy a unique place in the cancer community due to the challenges they face”, such as the requirement to be under 16 to be admitted to Crumlin, as well as the lack of participation in clinical trials at the centres where they are attending.

Lack of collaboration

There are about 80 cases of the child and young adult cancers seen in the 16-24 age group each year in Ireland. The reason the outcomes are “less good” are multiple, according to Smith, but he says that participation in clinical trials is the lowest of all the age groups.

The low rate is due to a lack of awareness and willingness of patients to take part in trials as well as there being fewer trials for the age group, he believes.

It also highlights the lack of collaboration between paediatric and adult trial groups.

Smith is the principal investigator at the National Children's Research Centre, Crumlin, and the Institute of Molecular Medicine, Trinity College Dublin.

He is also a special adviser on the new children’s hospital.

He wants adolescent and young adult cancer patients to have their care “centralised here at Our Lady’s Children’s Hospital in Crumlin and then at the new children’s hospital, in a hub-and-spoke model of care”.

“The hub being the children’s hospital and the spokes being any number of the eight designated cancer centres.”

He stresses that both the hub and spokes in this model need to have age and psycho-socially appropriate environments for this group of cancer patients. “This would allow for their entry into clinical trials when available and also facilitate shared-care follow-up relating to survivorship, and all of this will translate into a better outcome.

“For this to happen we will need new consultants such as haemato-oncologists, oncologists and advanced nurse practitioners who are specially trained in adolescent cancer medicine,” he says.