The Military Health System’s six pediatric cancer specialty centers provide care that produces high survival rates for children, young adults, and active duty service members with a childhood cancer.
“I think we are fortunate to be able to provide comprehensive, multidisciplinary care for all types of pediatric cancers because of the resources we have at our fingertips,” said U.S. Air Force Lt. Col (Dr.) Rich Zanetti, pediatric hematology and oncology service chief at the John P. Murtha Cancer Center at Walter Reed National Military Medical Center in Bethesda, Maryland.
“Universal coverage is one of the benefits to treatment within the MHS but support from the military units is another element leading to better outcomes for patients,” Zanetti said.
In 2023, patients with a pediatric cancer have about an 80% chance of surviving more than five years. Fifty years ago, childhood cancers were mostly considered incurable.
Pediatric cancers are rare, accounting for only 1-3% of all cancers diagnosed in the United States in a year; however, more than 1,800 children, teens, and young adults lose their lives to cancer each year, according to the National Cancer Institute.
The six MHS pediatric cancer specialty centers are:
Each center is linked by a “collaborative pediatric oncology consortium to streamline care for all patients and families in our military community,” Zanetti said. “This is a very helpful resource as we determine what is the best care available, as well as where that care should geographically be located because family support is a key aspect of care. With the military population having frequent permanent changes of station, this also enables streamlined care transfers,” he noted.
Pediatric Treatment Regimens and Active Duty Service Members
Half of the type of pediatric cancer patients at Brooke Army Medical Center on Fort Sam Houston in San Antonio, Texas, are active duty service members, said U.S. Army Maj. (Dr.) Kristen Romanelli, the chief of pediatric hematology-oncology. The MHS treats pediatric cancers to age 28.
For sarcomas, acute lymphomas, and leukemias, “there are several active late-stage clinical trials in pediatrics recognized as the standard of care, so these tend to be the active duty service members we treat more frequently,” Zanetti explained.
Active duty service members with pediatric cancers sometimes do better with a pediatric treatment regimen, which can be more aggressive in going after cancer than an adult treatment regimen, according to Romanelli and Zanetti.
For a patient under the age of 26, active duty or not, “I typically try to have a conversation with the adult oncologist and patient on what makes the most sense for that patient,” Zanetti explained. An adult oncologist could use a pediatric treatment protocol, but a pediatric oncologist “would be the only one who'd be able to enroll them in a clinical trial.” BAMC also facilitates the use of standard pediatric protocols by its adult colleagues when feasible, Romanelli said.
For a clinical trial offering a novel medication or treatment, “if there's more experience or more comfort, or even sometimes if somebody might do a little bit better in pediatrics in that 18–26 age group … those are all kind of the discussions that we'll try and have … to make sure we are taking care of these patients in the right place,” Zanetti said.
Each of the six MHS pediatric cancer centers participates in the National Cancer Institute-supported Children’s Oncology Group, the largest organization devoted exclusively to childhood and adolescent cancer research.
The Children’s Oncology Group network has nearly 100 active clinical trials open at any given time, and these include front-line treatments, studies determining the underlying biology of these diseases, and trials involving new and emerging treatments, supportive care, and survivorship.
The MHS cancer network also collaborates with the National Institutes of Health and the National Cancer Institute to increase resource availability. The NIH clinical center offers cutting-edge, experimental treatments.
Support for Survivors of Cancer
Pediatric cancer patients who survive their initial diagnosis and treatment can develop serious health problems after months or years. These are known as late effects, so survivors must be screened for life.
The MHS pediatric cancer centers have dedicated adolescent and young adult programs that provide multidisciplinary pediatric subspecialty support and follow-up care. The survivor programs focus on peer and psychosocial support from social workers and care navigators addressing finances, education, occupational impacts, and the transition to independence, as well as fertility preservation through care by endocrinologists.
They also have child life specialists, art therapists, and facility and therapy dogs. Ryan Mackey, a 13-year-old who’s being treated at Murtha, said this about his care and the facility dog Ellie Mae and recently participated in an honorary promotion for Truman, a facility dog. At BAMC, honorary U.S. Air Force Maj. McAfee the facility dog, often rounds with his handler, US. Air Force Maj (Dr.) Scott Penney, a pediatric hematologist-oncologist.
These programs also offer discussions about expectations of a new, non-MHS provider when the child ages out of TRICARE, health insurance needs, and identifying a provider who is accessible and willing to follow the young adult.
Murtha follows 80–100 pediatric cancer survivors at any one time, Zanetti said, BAMC follows 30–50, although they rotate because of permanent changes of station, Romanelli said.
Children and adolescents treated in more recent decades may have lower risks of late effects due to reduced exposure to radiation therapy and chemotherapy, increased efforts to detect late effects, and improvements in supportive care with medications that can mitigate late effects of chemotherapy, Romanelli said.
Research is Crucial
“We need more research. We’re very good with bread-and-butter pediatric cancers, but refractory or relapsing cases are still hard to treat,” Romanelli said. BAMC is the biggest medical education center within Department of Defense. “We also keep attuned and well-versed in rare cancers,” she added.
“We’ve made great strides with pediatric cancer cure rates in the last several decades; however, we still have a long way to go, and ongoing funding for research and development of new therapeutics is always the challenge in pediatric oncology,” Zanetti said.
With the Children’s Oncology Group protocols and studies, the “big thing we’re working on is immunotherapies that detect and kill cancer cells and moving toward a standard of care,” Romanelli said.
Katalea Mier, a two-year-old cancer patient with a relapsed germ cell tumor, gets a visit on Sept. 6, 2023, from honorarily commissioned U.S. Air Force Maj. McAfee, one of the facility dogs at Brooke Army Medical Center in Antonio, Texas. Mac’s visit coincided with the pediatric hematology-oncology team rounds during one of Katalea’s admissions for chemotherapy. The impact Mac has had on Katalea’s treatment is immeasurable. (Photo by U.S. Air Force Maj. (Dr.) Scott Penney, Brooke Army Medical Center)One Child’s Story
Families of children with cancer have their lives turned inside out and upside down.
U.S. Army veteran Jean-Paul LaRue’s son, Aaron, asked him about death before his fifth birthday. “How do you answer that question,” LaRue said.
LaRue is a former U.S. Army military policeman who now works as a health care administrator at Reynolds Army Health Clinic in Fort Sill, Oklahoma.
“This question broke me as a parent because with everything going on with Aaron’s cancer, it was possible [he’d die], and I told him, ‘You could, that’s why we’re going to all the appointments.’ I think deep down Aaron knew what was going to happen, and because of this chose to live life the best he could,” LaRue recounted.
LaRue said Aaron, then 4-and-a-half years old, was diagnosed with stage 3 rhabdomyosarcoma in January 2015 after he was initially treated for a suspected simple ear infection. Aaron died of cancer complications later that year.
Rhabdomyosarcoma is the most common soft tissue sarcoma in children. Aaron’s cancer began with a mass in his ear canal that caused pain. Stage 3 rhabdomyosarcoma is a rare and aggressive form of that cancer. At the time Aaron was diagnosed, he was one of only three children in Oklahoma with rhabdomyosarcoma, LaRue said.
“As a parent, I would like the Military Health System community and other families to know not to ignore the signs or symptoms when their child says something is wrong,” LaRue said. “I would also like families to know they are not alone in this fight, and the support is there.”