Childlike Hopes

Your Stories: Conquering Cancer

In this episode of Your Stories, Dr. Applebaum shares the hopeful news about conquering childhood cancers with fellow oncologist Dr. Douglas Yee and gives doctors’ orders for how all patients with cancer and their families can face every phase of a diagnosis with childlike hopes.

Dr. Mark Applebaum, a kid at heart, uses every trick in the coloring books he shares with his young patients to improve the often long and brutal treatments they face. In this episode of Your Stories, Dr. Applebaum shares hopeful news about conquering childhood cancers with fellow oncologist Dr. Douglas Yee. He gives doctors orders for how all patients with cancer and their families can face every phase of a diagnosis with childlike hopes.

So I'm a medical oncologist. I take care of breast cancer patients. So back when I was in medical school and training, I really wanted to be an all-purpose physician that took care of people. When I was thinking about that I said, well, maybe I would like to be a pediatrician. I went to do my pediatrics rotation.

The thing that didn't work for me was that most of your patients really don't want to see you. In other words, kids either in a well baby check or if they're sick or anything, they don't want to see you, much less talk. So, obviously, it appealed to you.

Yeah, I mean, the reality is I'm a large child. When I was in college, and even in medical school, I just gravitated towards working with kids. It's just more fun. Our rooms are more highly decorated.

I get to watch magicians when I'm on rounds because they happen to be in the child's room. I can't tell you how many art projects I've gotten to watch and participate in just because that's what my patient was doing when I was seeing them. And it keeps you young and it keeps you sprightly.

And the good news is for pediatric oncology, I mean, for the vast majority of children with leukemia, we cure those kids. And that's fantastic. My specialty is not leukemia I do research on a disease called neuroblastoma, which is one of more common pediatric cancers. It's a disease that affects nerve tissue.

And I try to research better cures and try to find different ways of identifying patients who are more likely to have better or worse disease and really figure out how we can precisely treat those kids. So we're working towards those goals.

But kids keep it young and fun. And the pediatric oncologists within pediatrics, we're sort of a special breed because there are a lot of pediatricians who don't want to work with the sick kids. Well child checks are more fun. We deal with the issues of life and death. And that's a struggle, but it's an honor.

I think it's very hard for me early on in my career because I see some success, I see some failure in my research and with my patients. But I don't have that long view. And one of the things I see from my senior colleagues is they love nothing more than hearing from their patients 20 years later. They love nothing more than looking back and saying, this is where things were 20, 30 years ago. This is where they are now. Look at what I've contributed to. What is your perspective on that?

I think on the individual level, it's really always gratifying. And you don't, like you said, sometimes you don't think about a patient's perspective completely. But when a patient will tell me that, well, you know, I never thought I was going to see my child graduate or get married.

And so in some respects that's extraordinarily gratifying on a personal level. But the other aspect is how do you as an individual help make that happen more often than not? And how do you then really try to set the field up so that things are changing a little more rapidly?

As you know, the struggles that my dad has had with advanced prostate cancer, and he is at the phase where he's just running out of options basically. I mean, from that perspective, it's been both fascinating and heart wrenching to interact with the medical oncology community.

I mean, you're at an academic center, and I am as well. And I think the first thing we always think about is, how can I get my patient on a study? How can I find something better than standard of care if standard of care just isn't good enough?

It is always the challenge when there's barriers between what we in the academic world perceive as optimal care and what people are getting. And as somebody who sees a referral practice, I see that a lot.

When we train practitioners, we need to make sure we train them in a way that they're always curious. Now, you don't necessarily have to be a leader in research, but you certainly have to stay on top of things.

So culturally, I think we just need to train more physicians who come with that background. I tell patients and everybody that today's ceiling is tomorrow's floor. If you're practicing at the top of your game today, 5, 10, 2 years from, now it's not going to be that way anymore. So we have to make sure that everybody in the health care system understands that. As you said, pediatrics is a best case example.

I think what we've always benefited from in pediatrics is our patients have to come to an academic center. And we've always had to pool resources because we deal in nothing but rare diseases. The only reason we've made advances is because we have a strong focus on research.

I don't think it's just research that, though, has been a struggle. It's also been supportive care. As my dad has been progressing, his symptoms are becoming more severe. And unfortunately, he's having a harder time mobilizing. And I had to encourage my family to fight to get palliative care services, which to me, in my practice, it's a no-brainer.

If I've got somebody with metastatic disease, like the day they're diagnosed, I call my palliative colleagues, and I say, hey, can you help me with symptom management here? We need to make them do well. But we also need to make sure that they're-- in my case, in pediatrics-- going to school, seeing their friends, acting like children. That's so important.

That's what I was told on day 1 of fellowship. Yes, it's terrifying to start taking care of children with cancer. And you're not trained for it yet. And you're going to be taking the call at the middle of the night from somebody who needs to talk to somebody who knows something about pediatric oncology. But just remember, no matter what you do, if the patient is first, you will not be wrong.

My patient, she's now 10 years old, and she's been battling with high-risk neuroblastoma for a couple of years. And her mom gave a very, very moving speech about everything that she has gone through in the past couple of years. And it's very emotional for me to hear as her physician.

We don't, I think, as doctors always think about what my patient is doing on a day-to-day basis because we think about sort of our patients as a whole. And where is this person in treatment? And what do I need to make sure that this treatment keeps marching on?

But seeing it from that sort of one person's side and all the ups and downs of cancer treatment, and seeing all the pictures and hearing the stories of how their family had to rally through good and bad, it was really quite touching. And it really brought home, I think, the importance of what we do. It was pretty amazing to hear that.

Conquer Cancer funded Dr. Applebaum's early research, which he says helped lay the foundation for every discovery he's made to treat children with neuroblastoma. To learn more about his research, visit conquer.org.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.