Virtual pediatric lecture series: A whirlwind tour of the current state of AYA cancer

CHOC’s virtual pediatric lecture series continues with “A whirlwind tour of the current state of adolescent and young adult cancer.”

This online discussion will be held Wednesday, April 14 from 12:30 to 1:30 p.m. and is designed for general practitioners, family practitioners and other healthcare providers.

Dr. Jamie Frediani, pediatric oncologist at CHOC’s Hyundai Cancer Institute, will discuss several topics, including:

  • Unique challenges to adolescent and young adult (AYA) cancer patients, including accessing optimal treatment
  • Helping AYA patients navigate the health care system as a primary care provider
  • Supporting the AYA population during treatment by implementing key tenets of multidisciplinary care in your practice
  • The survival gap seen in AYA oncology patients

This virtual lecture is part of a series provided by CHOC that aims to bring the latest, most relevant news to community providers. You can register here.

CHOC is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians and has designated this live activity for a maximum of one AMA PRA Category 1 Credit™. Continuing Medical Education is also acceptable for meeting RN continuing education requirements, as long as the course is Category 1, and has been taken within the appropriate time frames.

Please contact CHOC Business Development at 714-509-4291 or BDINFO@choc.org with any questions.

Multidisciplinary Approach to Pediatric Cancer Treatment Benefits an Underserved Young Adult Population

As one of the most robust adolescent and young adult (AYA) pediatric cancer programs in the nation, CHOC’s AYA program offers more than comprehensive oncology care to an underserved teen and young adult population — it’s a model for other AYA programs in the country to build upon.

“In the last 15 years or so, we’ve realized there is a huge survival gap in the AYA population, everyone from the age of 15 to 39 years old, whereas over the past 30 to 40 years, we’ve seen significant survival gains in pediatric patients and older adults,” says Dr. Jamie Frediani, pediatric oncologist at the Hyundai Cancer Institute at CHOC. “The AYA population has had very few survival gains, and we believe this is because of a multitude of reasons. They are much less likely to enroll in clinical trials or have access to clinical trials, they do not have the same access to novel new experimental treatments that can improve their survival, their tumor biology is likely different and then there’s a whole host of psychosocial reasons. AYA patients really are their own unique population, and the AYA program at CHOC aims to address that survival gap and to address it from a multipronged approach.”

The multipronged CHOC AYA program focuses on education, research and psychosocial support to increase survivorship within the AYA population.

“Our patients really want to know more about their disease,” Dr. Frediani says. “They want to know more about how their condition impacts their lives whether they’re in treatment or survivorship, such as fertility and sexual education, for example. Our team of experts have education nights with patients to talk about any topics they want to discuss. We have peer mentorship so patients can talk through the highs and lows they experience with someone who’d been through the same thing they’re going through.”

From a research standpoint, Dr. Frediani says the goals of the program are getting more of the AYA patients into clinical trials, knowing where the clinical trial enrollment gap exists and building relationships with adult counterparts to find the best hospitals where AYA patients can be treated.

“We know pediatric diseases do better if a patient is treated at a pediatric hospital. Finding where these patients will do best and forming those relationships to get the most appropriate care is critical. It’s also about finding everything else they need — the supportive medicine, other drugs and different dosing, clinical trials and research projects.”

Addressing AYA patients’ psychosocial needs is the third prong of CHOC’s AYA program.

“I’m a firm believer that multidisciplinary psychosocial supports plays a huge role,” Dr. Frediani says. “Mental health plays a significant role in the treatment of our AYA patients, and I have to believe that affects their outcomes. AYA patients are at a critical juncture in their lives where they’re trying to seek independence. A lot of them are having kids, getting married, starting new jobs, going to college — all these critical life transitions are happening. When you put cancer on top of that, the natural order of this time in their lives is completely disrupted. Social workers, child life specialists, psychologists, case managers, music therapists — all of our resources help our patients know we truly understand their feelings and needs and are here to help them in every way we can.”

CHOC’s AYA program was developed around 2014 and was one of the only AYA programs in the nation to offer such a comprehensive range of services. Dr. Frediani notes that while some AYA programs in the United States today have a heavier focus on treatment, nurse navigation and clinical trials, others are more support-group focused. CHOC is unique because its program is a hybrid of both.

“Our AYA program has a depth that most programs do not. We have this very robust psychosocial support and clinical trial programming around ours. I think we are unique in the amount of resources we provide for our AYA patients. Addressing cancer from our multipronged approach with a multidisciplinary team ends up being so important.”

The strength of CHOC’s AYA program is rooted in the institution’s values and commitment to providing comprehensive cancer care.

“CHOC comes from a community-based model of medicine,” Dr. Frediani says. “We value the bedside relationships with patients, spending time with them and taking care of not just their medical disease, but everything else around it. I see that across our team, from our nurses to our physicians to our social workers to our child life specialists. Everyone is here to stand with our AYA patients and to help them live whatever life they want to live, in whatever way that means. Other physicians should know CHOC wants to help their AYA patients in any way we can, from offering second opinions to helping with fertility preservation to checking on the availability of a clinical trial. I want to make sure there’s not a person in this age range who goes without these critical resources, without knowing this program is here for them.”

Our Care and Commitment to Children Has Been Recognized

CHOC was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the cancer specialty.

Learn how CHOC’s pediatric oncology treatments, expertise and support programs preserve childhood for children in Orange County, Calif., and beyond.

HPV Roundup: Resources to share with families

CHOC has published a lot of information for parents about human papilloma virus, or HPV, that is informative, straightforward and useful for families with children of all ages.

There are several common misconceptions providers encounter about HPV, including who is at risk, who should receive the vaccine and the risks associated with an untreated infection.

Please feel free to share these resources with families:

Can HPV really lead to cervical cancer?

An adolescent medicine specialist at CHOC offers HPV facts and explains its link to cervical cancer.

Does my child really need the HPV vaccine?

HPV affects nearly all sexually active men and women at some point in their lives. The HPV vaccine is more effective the younger it is given.

The HPV vaccine: a pediatrician’s perspective

A CHOC pediatric resident discusses some of parents’ most frequently asked questions about the HPV vaccine and children.

HPV at a glance on choc.org

See facts and figures, an FAQ, vaccine information, common myths debunked and a pediatrician finder tool where families can learn more and get their child the vaccine.

Vaccinating your preteen

The American Academy of Pediatrics presents answers to FAQs about important adolescent immunizations, including a walk through the purpose of each, the proper timing and an in-depth look at the HPV vaccine.

CHOC pediatrician talks adolescent sleep hygiene on SiriusXM’s “Doctor Radio” show

CHOC pediatrician Eric Ball, M.D., was a guest on SiriusXM’s Doctor Radio show to discuss sleep hygiene among adolescents—an often misunderstood topic.

Dr. Eric Ball, Pediatrics

“As a pediatrician, I have this conversation several times per day,” says Ball. “Many people don’t realize teens need more sleep than the average adult.”

Dr. Ball explained that adolescence is a tricky time in terms of sleep habit changes. Puberty transforms the average teen from a morning person to a night owl, and their sleep schedules need to reflect that.

Part of the issue, he says, is that schools have not yet adjusted to reflect this need; 43% of American high schools start before 8 a.m., he notes, but that ideally should be 8:30 a.m. or later. Dr. Ball has advocated for California state legislation that would mandate such a start time among high schools.

On the show, Dr. Ball also shared a few tips to help teens improve their sleep hygiene.

7 ways pediatricians can help parents manage their teen’s sleeping habits:

  1. Encourage parents to limit screen time after dark
    “I’m happy my kids are involved in their culture and keeping in touch with friends,” says Dr. Ball. “But bright light tells your brain it’s noon and not 10 p.m., so there’s no melatonin surge telling your brain it’s time for bed.” Blue light glasses may help, but it’s much safer and healthier to simply shut off the screens and focus on relaxation once the sun goes down.

  2. Suggest parents develop a “digital curfew”
    It is much easier to limit screen time if parents replace that time with something fun. Suggest family meditation or a starting a membership to a meditation app that teens can use on their own, if they prefer. If parents have a young child prone to waking up during the night, encourage them to try guided imagery to teach their child to put themselves back to sleep.




  3. Help parents start a sleep diary
    Sleepfoundation.org has a sleep diary function parents can easily introduce to their kids. It is a quick and simple way to keep track of sleeping habits, see where problems arise and work alongside their child to improve those habits.

  4. Have parents to work backwards to find the best bedtime
    Parents can start by figuring out what time their teen needs to wake up to get to school on time. Work backwards from there to find an appropriate bedtime. Then, keep working backwards to see how to fit in after-school necessities like homework, sports, social time and family time. The key is making bedtime the priority.

  5. Make sure parents focus on weekend sleep hygiene, too
    Sleeping in a little on weekends is fine, says Dr. Ball, but teens should avoid sleeping hours into the day. Helping adolescents develop more consistent sleep hygiene throughout the week and weekend is critical.

  6. Tell parents to avoid melatonin unless necessary
    Sometimes kids with autism spectrum disorder or who have attention deficit hyperactivity disorder require the aid of melatonin, but in other cases, says Dr. Ball, it’s best for doctors to use it as a last resort. “If teens have poor sleep hygiene, there’s not enough melatonin in the world to fix that,” he says. “It becomes a crutch, and then you’re treating the symptoms—not the cause.”

  7. Urge parents to prioritize sleep
    Adolescents in competitive schools or programs tend to prioritize just about everything other than sleep, but no amount of studying will prepare a kid to perform their best the way good sleep will. Remind busy and high-achieving kids that sleep is not a luxury but a necessity, and that an extra half hour of studying likely won’t make the difference that eight hours of sleep will.

CHOC’s AYA Cancer Efforts Earn National Attention

The adolescent and young adult cancer movement has helped define patients by age rather than disease and raise awareness of the population’s unique needs, Dr. Leonard Sender, medical director of the Hyundai Cancer Institute at CHOC, tells “The Huffington Post.”

Dr. Sender’s and CHOC’s leadership role in the adolescent and young adult cancer movement were prominently featured recently on the popular online news site that covers a range of topics such as health care, technology, business, politics and entertainment.

The three-part series was centered on the recent Society of Adolescent and Young Adult Oncology (SAYAO) conference held in partnership with CHOC’s Cancer Institute.

The first piece featured an interview with Dr. Sender who is also the director of the Cancer Institute’s adolescent and young adult program and developed SAYAO. Dr. Sender discussed the movement’s achievements, its ongoing priorities and goals, as well as its future.

“I believe the movement as a whole is going to help define four big age groups of people getting cancers, and that we are going to start addressing cancer in terms of what it means for those age groups,” he said. “So, what does it mean for a geriatric patient who is different from an adult who is different from an AYA who is different from a pediatric patient?”

CHOCThe series’ second installment, “Advances in the Young Adult Cancer Movement: Why SAYAO Is a Big Deal,” discussed the origins of SAYAO and its efforts to create an academic space for medical professionals to discuss and educate one another on the specific topics relevant to this patient population.

The article also provided an overview of the two-day conference held in October.

The series’ third piece, “New Innovation in the AYA Cancer Movement: The Future is Here,” detailed new technology discussed at the conference that could factor in future treatment of adolescents and young adults with cancer.

For example, My Bridge 4 Life, an organization whose products use technology to help people improve healthcare management, developed the Infusionarium at CHOC’s Cancer Institute. The Infusionarium, which ran as a pilot in 2013, incorporated sensory elements and media to help combat the isolation, boredom and stress often felt by patients during cancer treatment.

Also, My Bridge 4 Life and SeventyK announced a new video survival guide and eBook for adolescents and young adults with cancer.