Supporting Our Cancer Patients, and Supporting All Kids
March 2025
In a ¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾«Æ· Children’s operating room last week, a healthy little girl lay peacefully unconscious as doctors extracted marrow from her pelvic bone. It is not something a child would be excited to do over spring break, but she had agreed eagerly. The procedure offered the only remaining chance to save her brother’s life.
Stem cell transplant is not the first line of defense for leukemia — far from it. But the boy had already been through chemotherapy and immunotherapy. The cancer kept coming back.
This type of stem cell transplant offers about a 75% chance of survival for a relapsed cancer patient. Those are not ideal odds, but they are the only ones on offer.
The following morning, the boy sat in a recliner as an IV delivered his sister’s stem cells into his arm. As I write this, he is still in the hospital, recovering and waiting for his body to make new blood cells. So far, so good.
What makes a procedure like this successful? It helps that the boy had a healthy, genetically matched sibling to donate, and certainly the ¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾«Æ· clinicians and lab technicians are skilled and experienced.
But if you ask ¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾«Æ· pediatric oncologist Dr. Ellen Fraint (pictured), who oversaw this and many other transplants, the answer is more complicated.
In general, patients tend to do better, she says, when they have a good support system behind them. This patient, for example, had healthy and employed parents who could physically and financially care for him. They had health insurance. They had a community of friends and family to support them emotionally and logistically through the boy’s months-long hospitalizations. Not every family has those things.
When a child is sick with a disease as life-threatening as cancer, every single element of their health makes a difference.
It matters if they don’t have enough healthy food to eat or reliable transportation to get to appointments, or if they are stressed by not feeling safe at home. Imagine how hard it would be if they didn’t have a place to live, or if a parent was incarcerated. Families without health insurance may not even take their sick kids to see a doctor until a disease has reached an advanced stage.
This is reality for many people in America, including some of our cancer patients. Our social work teams in oncology do an incredible job helping families fill in the gaps with whatever they need — food, transportation, mental health support, connections with community aid groups — because we want a child to focus on one thing: getting better.
This is the essence of Whole Child Health. Health is more than just medical care. It’s everything in a child’s world that supports their health and overall well-being.
A disease like cancer raises the stakes very high and is an enormous stress test on any support system. Cancer is, of course, not always predictable, and even kids with the healthiest support systems don’t always make it. But it’s easy to see how an unhealthy environment could tip such a precariously balanced scale.
Most people don’t realize that unhealthy environments also have major life-limiting effects on kids who appear to be perfectly healthy.
Children are resilient, but there are limits to that resiliency as the years pass. Unhealthy habits accumulate. Children with significant trauma may turn to substance use or self-harm. The American health system has spent too long kicking the can down the road, waiting to take action until as adults they begin to show up with obesity, cancer, heart disease, and type 2 diabetes. And they are doing that younger and younger.
At ¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾«Æ·, we want to treat the relapsed cancer patient with the most advanced treatments available in medicine and the most compassionate, supportive care. We want to be equally supportive of kids who see us once a year for their well visits, and their classmates who may not even be our patients. That’s because whether you are part of a health system, a school, a community group, or just your own family, everything we do to support children’s health today helps them reach adulthood.
¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾«Æ· will do its part to build healthy communities so that together, we can create the healthiest generations of children.
About Dr. Moss
R. Lawrence Moss, MD, FACS, FAAP is president and CEO of ¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾Ã¾«Æ· Children’s Health. Dr. Moss will write monthly in this space about how children’s hospitals can address the social determinants of health and create the healthiest generations of children.