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The trickle-up effect of pediatrics research

Because I spend so much time writing about children with serious medical problems, I'm acutely aware of one of the most challenging problems facing really sick kids: the rarity of severe pediatric illness.

Most children are extremely healthy, and while that's great for them, it can leave the ones who do get really sick in a bind. Often, their conditions are so uncommon that treatment is a sort of Jerry-rigged version of adult medicine. As a result, pediatricians are forced to give children medications that have not been thoroughly tested in their age group, use oversized surgical tools designed for adults or adapt medical equipment, such as MRI scanners, to suit smaller patients.

The irony of this is that what's better for kids often proves help in treating adults. This concept was first explained to me by Sanjeev Dutta, MD, a pediatric surgeon at Lucile Packard Children's Hospital who does a lot of minimally-invasive laparoscopic surgery. Surgical-tool manufacturers are reluctant to adapt their instruments for pediatric care, since so few children need surgery relative to adults. But once someone does make a smaller tool for kids, surgeons quickly discover that it helps perform certain tasks better in adult patients, and suddenly they're clamoring for it.

In a new version on this trickle-up theme, the American Society for Clinical Oncology recently released new guidelines (.pdf) for the care of cancer survivors, which draw heavily on principles established in pediatric cancer patients. As a story I wrote for Stanford Medicine explained, cancer survivorship has been studied in kids for more than two decades. This makes sense because when a child survives cancer, as most kids with cancer now do, he or she has decades of life ahead. It's logical that doctors would put a lot of energy into figuring out how to make those years as healthy as possible.

But now, more and more adults are surviving cancer; there are a total of more than 13 million cancer survivors alive in the U.S. today. Physicians are increasingly realizing that just getting them through the disease isn't enough. Cancer survivors grapple with a host of challenges that can necessitate specific medical attention. I'm really glad to see that the principles pediatricians have gleaned from studying the youngest cancer patients are now being applied to benefit all cancer survivors.

Previously: Report forecasts U.S. cancer survivors to increase to 18 million in a decade, How pediatrics could help adult medicine improve quality of care for patients and Cancer’s next stage: A report from Stanford Medicine magazine

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