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Childhood Cancers: Expert Q&A

Childhood Cancers: Expert Q&A


The following is a paid
program from UChicago Medicine. About 70,000 young people are
diagnosed with cancer each year in the United States. Pediatric oncologist James
LaBelle and Jennifer McNeer join us to discuss the latest
advances in cancer treatments and care for teens and young
adults with this disease. You’ll also hear from a patient
and first baseman Anthony Rizzo, who were both
diagnosed with Hodgkin’s lymphoma in their late teens. And remember, we’ll take your
questions live on the air. That’s coming up now on
At the Forefront Live. [MUSIC PLAYING] And joining us today, we
have Dr. Jennifer McNeer. And Dr. James. Labelle we want to remind
our viewers that we’ll take as many questions as we
possibly can over the next half hour, but this program
is not designed to take the place of a
visit with your physician. Welcome to the program. Thank you. Thank you. If we can start off at first,
just have each one of you tell us a little
bit about yourself and what you do here
at UChicago Medicine. And Dr. McNeer, if we
can start with you. I am Dr. Jennifer McNeer. I’m a pediatric hematologist
an oncologist here at UChicago Medicine. My focus is on children,
adolescents, and young adults who have hematologic
malignancies, such as leukemia and lymphoma. Dr. LaBell. Yes. And I am Dr. LaBelle. I am also a pediatrician,
a pediatric oncologist, at the UChicago
Medicine and specialize in young children who need
stem-cell transplantation and other cellular therapies. OK, Let’s start off
and talk a little bit about some of the programs we
have here at UChicago Medicine. One that was particularly
interesting to me– and I found out a little bit
about this when we were talking with you for an
interview a little while back– is the AYA program, which
is for Adolescents and Young Adults. What exactly is that, and
why is that so important? So the Adolescent and Young
Adult Oncology Program here at UChicago Medicine was
started about seven years. Ago and we bring together
medical oncologists and pediatric oncologists
into the same space to take care of adolescent
and young adults who have cancer generally
between the ages of 13 and 39. And in addition to bringing
together physicians, we have nurse
practitioners, Fellows , and then we also have a
number of supportive staff, such as psychologists, social
workers, physical therapists, and pharmacists, who
help us out as well. So we talked to Anthony
Rizzo and Anthony Bendy, and you’ll see a couple
of clips from them later on in the program. They’re both great
guys and a lot of fun to get to know both of them. And it was a
chuckle on this one. Every time I think of
Anthony Bendy, the young man that you treated, he’s got
this full head of hair now, and he’s very proud of that. His mother was a little bit– she wasn’t as
excited about them. But he’s doing great. And I think it’s a great example
of how the program can really impact in a positive way
these young people that are going through this situation. Dr. LaBelle, I don’t
know if you want to comment a little
bit on Anthony and just the program in general. Yeah. I first met Anthony
after he had actually relapsed from his disease and
was under Dr. McNeer’s care. And it was clear at
that point that Anthony needed a stem-cell transplant. And we worked really closely
with Dr. McNeer and her team to sort of orchestrate
that and to continue on with Anthony’s therapy. And he was quite a force
when I first met him. He was really an amazing,
and continues to be, a really amazing young man. And we learned a lot from him. And it’s wonderful, as you said,
to see him doing so well now. I see him in the hallway now,
and I kind of chuckle with him. But no, he’s doing fantastic. One of my favorite
parts when he came to visit with Anthony
Rizzo, the baseball player– they both have the same
disease Hodgkin’s lymphoma– and they took some time
out, talked with the kids in the play room at Comer. And it was just so neat to
see both of them interacting. And of course, Anthony Rizzo– the young people
knew who he was. But Anthony Bendy, as
well– he stood up there, and he gave them
some great advice. And it was just really
a powerful moment. I thought it was just great
to see the two of them. And he’s a good guy. When we talk about
young people, you said the age between 13 and 39– correct– for the AYA program? Why is that bridge so important? Because it seems
like a lot of times, when we talk about
treating patients, you talk about pediatrics,
and you talk about adults. But with cancer, maybe it’s
a little bit different. Is that correct? Yeah, it really is. These patients are not
necessarily pediatric anymore, yet they are not adults. They are generally at
a time in their life where they are trying to
navigate becoming more autonomous, they are
trying to figure out where they’re going
in terms of education, maybe they are
starting new jobs. They may be navigating
some of their first adult relationships. And all of a sudden, cancer
comes in and takes over for a little bit of time. And so a lot of our
focus is on making sure that we are really
up to date on how to treat their particular cancer
because we know the biology is different in this age group. But we also have to take
into account the big picture. And how can we help these
adolescents and young adults take a pause and
then continue on with where they were going
so that they can continue to be the successful people
that they were destined to be? And there’ve been studies–
and I think you were telling me this earlier when we
met a few weeks ago– that show that survival
rates for young people that go through a program
like this are higher. It’s true. When you’re treated
in a program that does specialize in
adolescents and young adults, you have treatment teams who
are really up to date on, as I mentioned
before, the biology of their particular diseases. Are there therapies that
might be better tailored to treat those diseases? And furthermore, how can we
optimize things with compliance with appointments and adherence
to medication regimens at home? Because we’re also
asking these folks to do a lot in terms of
being at the hospital frequently for appointments,
taking medications at home. And really partnering
with them to make sure that they are adhering to that
is hugely important in terms of achieving high cure rates. So Dr. LaBelle, you
treated Anthony Bendy when he needed the stem cell,
or bone-marrow transplant. How exactly does it work? So there’s multiple
different ways in which a stem-cell transplant works. And in Anthony’s case, we needed
to harvest Anthony stem cells, sort of to provide
a rescue after he got very high-dose
chemotherapy to allow him the best chance of
survival after his after his chemotherapy. And so we actually
collected his stem cells prior to the
stem-cell transplant. And after giving him
high-dose chemotherapy, we actually infused those
stem cells afterwards, allowed his immune system
to come back strong enough so he could continue on
with his therapy afterwards. And actually, one of
the unique features of the UChicago Medicine
AYA program here, as led by Dr. McNeer,
is that we work really symbiotic early with the
patients in the same clinic. So those patients like
Anthony are actually seen both by their primary
oncologists, as well as the stem-cell-transplant group. And our
stem-cell-transplant group is also made up of physicians,
nurse practitioners, social workers that
actually specialize in stem-cell transplantation. But we don’t do it separately
than his primary oncology team. It’s actually very
quite symbiotic. And that’s one of the need
features of Anthony’s care as it relates to the AYA clinic. I may sound like a little bit
of a broken record on this because we talk about
this almost every program. But one of the things that
I think that I just see it over and over again
with the physicians here at UChicago Medicine, which
I think is just so important, is just this team effort. And it seems like
every step of the way, no matter what the
prognosis, diagnosis is, we see our physicians
working together with all the caregivers. And it really makes
a big difference. And as you as you put together
the care plan, how important is that to you to
be able to talk to other physicians,
other caregivers as you work through
that care plan? It’s hugely important. This is a long and
complex process. And if we’re not working
together from day one, then we’re not really going
to be able to facilitate proper care for these patients. So it’s not just us clinicians
who need to work hand-in-hand, but it’s our pathologists,
our radiologists, all these other specialists
who may be behind the scenes, as far as the patients
are concerned. But it’s just hugely
important in terms of delivering the best care. Could we talk a little
bit about immunotherapy because that’s something we
hear a lot about recently, and it seems like
it’s gaining traction in the treatment of patients. How important that
is that for when you deal with these AYA patients? Immunotherapy is really
becoming an integral part of their treatment. So we’re learning more about
what proteins may be expressed on the surface of
these cancer cells that we can target
with a treatment that brings chemotherapy or
other therapy right up to the cancerous cells. We’re finding that
these therapies are very successful in
treating patients who have relapsed
disease or disease that’s resistant to upfront treatment. And so now we’re trying to
bring that into upfront therapy to see if we can push those
cure rates even higher. And Dr. LaBelle, I don’t know
if you can speak to this, but I know it’s also very
important that we’re part of an academic institution. We do a lot of
research, there are a lot of clinical trials
and things like that. How important is that when
you look at treatments for these patients? It’s imperative, actually
and particularly, when we think about
immunotherapy. The oldest form of immunotherapy
is stem-cell transplantation. So it’s the oldest
and most truest form. The problem is that there
are biologic problems with any kind of therapy like. That so stem-cell
transplantation has other issues that
we need to deal with. And so this advent
of immune therapy is actually using the
person’s immune system to actually target their own
cancer cells by unlocking that veil of non-reactivity. And this has only been done
through academic relationships. And now, really,
we’re at a new dawn, as far as being able
to treat patients with refractory
disease or patients who conventional chemotherapy
has not provided them with cure. And the only way we can
do this, particularly in the pediatric
and AYA population, is through academic
basic science, and then bringing
that basic science to the patient’s bedside. What about
fertility-preservation options? Because again, for young
people, that’s very important. What’s going on there? Yeah, So it is very important
because as I mentioned before, what we want to do
is really stress that this time is
a pause in life, and life will go
on after treatment and in the survivorship time. We know that a lot of our
therapies can impact fertility, and some patients are
infertile after they’re done with treatment– not all
of them, but some of them are. And so we talk with our
adolescent and young-adult patients about various
options that exist for males and for females. We refer them to the
proper specialists to help with that process. And sometimes, it
means holding off on starting treatment
for a couple of weeks in order to allow
that to happen. And as long as it’s safe
for the patient to do, it’s so important
for them to have that safeguard or
that guarantee, and I think, too, that
feeling that we are looking to the future and that we do
anticipate them being parents one day if they would like to. Could we talk about
Teen Cancer America and what our partnership there
means and how that helps kids? Yeah Teen Cancer America
is a fantastic organization that is really partnering
with various medical centers across the country to help
bring a focus to teenagers and young adults
who have cancer, and in creating programs that
will support these patients, and also, creating some
spaces in the hospital that are really
geared towards them. We were fortunate to receive
a grant from Teen Cancer America several years ago. We’ve used that money to create
an adolescent and young adult lounge in our waiting room. And this is a place
where are our teens and our young adults
can go to hang out when they’re getting
their therapy, or waiting for various
parts of their appointments. We hope that they can connect
with each other in that room and maybe find somebody
who they really can identify with who’s
going through something similar to them. And then we’ve also
used part of that grant to support a
program-coordinator role. And what we’re
doing with that is having somebody who can put
together various programming opportunities for
these patients– so whether they are
support groups, some of it has been mindfulness
and breathing sessions, there’s been some
nutrition education. We’re bringing people
some financial counseling opportunities and
things like that. All right. We’ve heard a lot about Anthony
Bendy and Anthony Rizzo. We’ve talked a little
bit about them. We prepared a video that
we want to show now, so we’re going to go
ahead and roll that, and then we have an interview
with the two of them right now. [VIDEO PLAYBACK] [MUSIC PLAYING] – What’s up, brother? – Hey, how are you? – How you doing? – Good. It’s good to see you again. – Everything good? – Yeah. – Got hair now? – Right? A little bit too much. My mom likes to say. – How long have you
been in remission for? – I’ve been in
remission for a year. But I just finished my
chemo, or my immunotherapy, which was like a small– – It was like maintenance? – Yeah. It was all brentuximab. – Feel good, though? – Yeah, I feel good. – Nice. – And I feel really, good. – That’s awesome. – It’s cool to see you again. – You too. – That was special because
we were so close in age when we had it, same
treatment, same type of cancer, and same first name,
and he’s somebody I already looked up to. And the fact that
he got through it, and then now, he’s one of the
best professional athletes and one of the best people
I’ve ever met, is amazing. – 2008– I had
Hodgkin’s lymphoma. And I remember sitting in
the hospital room talking to my mom, my parents
about maybe one day, start our own foundation. Getting back to– I was in
the minor leagues at the time so, my dream was to make
it to the big leagues and play major league
baseball, and on top of that, was to open up a foundation
to help kids going through cancer because
it’s really not fun to go through it alone. – I believe that the foundation
can bring that support and togetherness whether it’s
to the staff or to the family, and just really create
that backbone for people so they don’t feel
like they’re alone, and they’re not having
to do it on their own. – Well, obviously, when
he went through chemo, everything fell out. And now, he’s got a very
curly head of hair, which is– if he wants to keep
it, he keeps it. But he might need a– – He’s not keeping it. – –to groom it maybe
just a little bit. But overall, it’s great. – (WHISPERING) It’s awful. – Like I said, he kept
a very positive outlook, and recognized that this
was an interruption in life, but always knew he would get
back to his college classes, back to his athletics, and
back to being who he was. – I have never met
doctors, nurses– from the top to the
bottom, everyone has taken such good
care of Anthony. He’s alive today because
of the people here. I have no doubt in
my mind about that. – It’s good to know
that you he’s kind of moving on with
his life, and going to school still, and getting
his degree, and having a job. And it will be fun to see kind
of where the future takes him after. – He was never alone. We were team Bendy, and team
Bendy fought it together. [MUSIC PLAYING] [END PLAYBACK] And welcome back. Joining me now is Anthony
Bendy and Anthony Rizzo. We have two Anthonys. First time we’ve ever had
two Anthonys, I think, on the program. Welcome, guys. Oh, it’s good to be here. How’s it going? How are you? Great. You guys had kind of
a similar journey. And this is a pretty neat
story because you go back about a year or so
when you first met. And I know Anthony Rizzo– you did something really
nice for Anthony Bendy. And Anthony, I’m going to have
you tell us about it first. Well, before you
we ever even met, Anthony had sent me a
picture, to my mom actually, through email, through the
Anthony Rizzo foundation, and it said, “Get well,
Anthony,” from Anthony. But it was just a nice
lift of the spirits, especially– it was
my first day of chemo. So it was something
to help me get my mind off of the fact of
everything that was going on. Well, the timing couldn’t
have been better on that. Oh, yeah, no. And so Anthony Rizzo,
why’d you do that? Why are you so involved
with young people that are going through this? Well, I’ve been through it. And it’s not fun when you’re
going through it for anyone. For me, it wasn’t fun, for
my family, it wasn’t fun, for my friends,
everyone around me. So I think that whenever
you can lift someone up in the smallest ways– playing for the Cubs and wearing
the Cubs uniform all the time– brings a lot of joy
to a lot of people here in Chicago, and really, the
country if you’re a Cubs fan. So for a player that’s been
through it to reach out, I think– I mean, it helped Anthony. So it makes me feel good
to know that it is making a little bit of a difference. And we did something
just a few minutes ago that I thought was pretty neat. We’ll roll some video of
this one when it comes time. But you got to meet
with– both of you got to meet with
some of the kids over at Comer
Children’s Hospital. And it was really
kind of touching to me when you both gave them
advice on how to move forward. And I don’t know if you want
to share a little bit of that and what that meant
to you as well. I think it’s really important– your life after cancer
because it’s a difficult time. And it’s a difficult time for
you and everybody around you. And a lot of people just
wanted to quit and roll over, but it’s important
to continue to do the things you want to do
and continue to believe in yourself, I think. It’s a huge part of why I’m
here and what’s going to take me where I’m going for
the rest of my life. Anthony, in your role,
in your position in life, you meet a lot of people, and
a lot of people look up to you. So when you do those
situations like that, it means, obviously, a
tremendous amount to the kids there and their parents. But what does it
mean to you to be able to be participate
in that kind of thing? Well I love it. It kind of just
brings me back to when I was sick and sitting in my
hospital room thinking about– at the time, it
was 2008, so I was a really big fan of Lance
Armstrong and LIVESTRONG Foundation and
everything they’ve done just with their
little yellow wristbands. So sitting there and talking
to my parents, saying, you know, one day, I’m
going to overcome this, I’m going to play
major league baseball, and I’m going to be able to
start our own foundation. And 10, 11 years later, we have
started our own foundation. And we’ve really been able
to help out and just escape reality for a little bit. Just because you’re going
through this terrible time of sickness, there’s still
light at the end of the tunnel. Even on the darkest days, the
light’s going to come out. So it feels good to just
be able to help and make people smile for a little bit. You know, it’s interesting
to me because you both had the exact
same disease, correct? Yeah. Hodgkin’s lymphoma. So you both had
Hodgkin’s lymphoma. You’ve been about
a year out now. Yeah. And you’re almost 11 years out. Yeah. And it’s just amazing because
I met you a year ago as well. It’s nice to see
the changes with you and the full head of
hair, if one thing. Yeah. But you’re very active again. Obviously, professional–
athletes you’re very active as well. This didn’t get you down,
though, either one of you guys. No. And then that’s the thing is
that fortunately, enough– unfortunately and
fortunately enough– unfortunately, that cancer
is just everywhere now. Fortunately, there’s
so many amazing doctors that will explain to you
kind of the process of what it’s going to take. And once you kind of
get that diagnosis and they tell you, OK, this
is kind of what it’s going to be like, I took it full on– full head on. And so did Anthony
from everything he said and his attitude. So there’s a couple
of ways through it. You can be all mopey,
or you can be positive. And I think the positivity and
being strong is most important. Speaking of being
positive, one of the things I’ve noticed about you
is you smile constantly. And that’s something that
the doctor said as well, and the nurses that worked
with you, your family. They said they never
came in your room and you didn’t have
a smile on your face, even going through
these rough times. Attitude is very important,
as is having that family support and the togetherness. Well, that’s the one thing
you control is your attitude and how you handle
the situation at hand. You can’t control having
cancer, but you can control how you react to it. I know when I first
got diagnosed, I was really, really scared. And I didn’t– because it
was something I’d never gone through– really understood completely. I didn’t really even
know what chemo was. I didn’t even know
that it was just IV. I thought maybe
you went in a room and all this stuff happened. But, you know, once I got
over that initial fear of the unknown, I set my mind
to what I was trying to do, and I never let myself get down. That was really important to me. And I felt like
it was something, when my family would
come to see me, It was something that would help
them see, OK, he’s still doing, he’s still smiling,
he’s still fighting. So I thought that was important. And Anthony Rizzo, you
received your treatment at the University of Miami. Is that correct? Yep. And how important was it
to you to be at a place– because it’s comprehensive
cancer center if I’m not mistaken– how
important was it to be at a place that
was on the cutting edge of that kind of technology? Yeah, it was amazing. So I got diagnosed in Mass
General Hospital in Boston. And my first
treatment is up there, and then we went
down to Florida. So it was amazing to be at home
and so close to the Sylvester Center in Miami to
where we would just go down every other week
and get our treatment. And I’ve seen the
Sylvester Center in Miami grow so much over
the last 10 years– how much better
it has gone, too. But all the resources
there– everything you need is right there. So it’s like kind of a home away
from home for a little while because you spent
so much time there. And here at the
University of Chicago, we’re also a comprehensive
cancer center, which is important for our patients. And can you talk a little
bit about your treatment here and your caregivers,
what they were like? Yeah, they were awesome. They always made sure I knew
what was happening, what was going to be the next step. And that was part
of why I always felt like I was ready
for what was next. They would tell
me what to expect. They wouldn’t sugarcoat it. Maybe it was my age, and maybe
it was because I told them to. But they wouldn’t sugarcoat
anything, and I appreciated it. And it helped me be
prepared for everything I was going to be going through. So Anthony Rizzo, your
foundation– very active with these patients. And what do you hope to
accomplish as you move forward in the future? Well, we just want to help out
as many families as we can. And our biggest
thing right now is paying a lot of
bills for families so a family doesn’t have
to decide whether they’re going to save
their child’s life, or pay their mortgage,
or their bills. And it’s important to us
because it’s a stressful time. I remember– I keep going
back to when I was sick– but the Red Sox– I was with the Boston
Red Sox at the time. They paid for all
my medical bills. And if not, I
don’t know where we would be in a financial state– my parents and myself then– so to be able to do that. And then we have a lot of– oh, my gosh– a lot of
workers that we are hiring now to go in and
explain to patients, like Anthony, hey, this is what
you’re going to go through. This is what a lot of
patients have gone through. Everyone’s different,
but they’ll walk you through what’s going
on and your specific cancer and your specific
treatment to help out. And that’s amazing for us. And to have social
workers working for us has done so much help and so
much good from all the feedback we’ve been getting. And in part, also,
some of the things that are happening with this campaign
and with your foundation is providing research funding
for just the work that happens in the labs, and we do
some of it here at UChicago. And that’s also very important. Very important. And we do donate a lot
of money, especially down to the Miami
Sylvester Center– Dr. Lossos down there. And he actually has brought
my parents in a few times to his lab, and has it all
written out on actually where it’s all going– the money. And it’s really cool to research
that these doctors can do. And they don’t get a lot
of funds to be honest. So everything that they get
goes directly to the research. So Anthony Bendy, let’s talk
about your plans for the future because I know you’re
busy guy right now. You’re going to school,
you’re wrestling, you’re growing your hair. Your mom loves that. Yeah. But you got big
plans for the future, and you’re just moving forward. And I just– I’m impressed. I mean, I see you, and
my hat’s off to you. I’m just impressed. Yeah. And I’m excited for the future. I know there’s a lot to do. There’s a lot that I can do. And I’m not letting the
things that happen to me hold me back, or
distract me, or make myself think that I can’t do
something just because of that. If anything, you’re
the kind of guy that can probably do
just anything now. Mm-hmm. It’s weird to say, in
a very strange way, I’m happy that it
happened to me because I learned a lot from it, and it
made me who I am right now. And it’s a huge
motivator for me. Fantastic. Well, guys, thanks very
much for doing this. We really appreciate it. Of course. Thanks for having us. A lot of fun. All right, we’ll be back
here in just a minute. Comer Children’s Hospital at the
University of Chicago Medicine is at the forefront
of kids health, shaping national
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