Children's Oncology Group's 2023 blueprint for research

Abstract

Pediatric oncology in 2023 is a study in contrasts. Decades of multiinstitutional clinical trials have led to dramatic increases in 5-year survival rates across broad categories of childhood cancers. The number of survivors of childhood cancer continues to increase, estimated to be 500,000 in the United States as of 2020. 1 The genomic landscape of most pediatric malignancies has been defined through comprehensive sequencing projects, leading to refinements in risk stratification and identification of more specific targets for potential therapeutic intervention. Precision treatment, beyond traditional cytotoxic chemotherapy, radiation, and surgery, has become a reality for some pediatric cancers. Regulatory changes have provided significant incentives to pharmaceutical companies to include children in clinical trial research with innovative therapies.However, each of these modern-day successes widens the gulf between challenges that remain. Improvements in outcome have not been uniform across all malignancies. The impressive gains seen in acute lymphoblastic leukemia and Hodgkin lymphoma stand in stark contrast to the absolute lack of progress in metastatic sarcomas and diffuse intrinsic pontine glioma. Although 5-year survival is a convenient benchmark, its use obscures two important issues. First, 5-year survival is not the same as 10-or 20-year survival. 2 Too many 5-year pediatric cancer survivors will still succumb to their primary malignancy. Second, early survival is not without cost. Standard treatments carry a substantial burden of acute and chronic severe and potentially fatal complications, including accelerated cardiovascular disease,

Providing Groceries and Transportation to Poverty-Exposed Pediatric Oncology Families

“…Equally important, we demonstrate the feasibility of a centrally delivered intervention a priori designed for scalability. Owing to the rarity of childhood cancer, most US children receive treatment via multicenter clinical drugs trials that accrue at more than 200 centers to achieve adequate samples sizes for statistical power . Evaluation of disease-specific health equity intervention efficacy in pediatric oncology can only be accomplished in this multicenter trial setting, requiring interventions designed to scale with minimal site burden.…”

“…Owing to the rarity of childhood cancer, most US children receive treatment via multicenter clinical drugs trials that accrue at more than 200 centers to achieve adequate samples sizes for statistical power. 4 Evaluation of disease-specific health equity intervention efficacy in pediatric oncology can only be accomplished in this multicenter trial setting, requiring interventions designed to scale with minimal site burden. This pilot study was unable to detect statistically significant differences in HMH between arms.…”

Children with cancer: Are we healing the body & missing the mind?

“…There is a worrying trend of a lesser percentage of children diagnosed with cancer participating in clinical trials over the years, and experts have called for multidisciplinary, multinational collaborations 11 . A recent situation analysis published by the Indian Council of Medical Research highlighted that the majority of children’s cancer facilities are clustered around big cities 12 .…”

Clinical trial recruitment of people who speak languages other than English: a Children’s Oncology Group report

“…Clinical trial participation among diverse patients representing the US population is a high priority for the National Cancer Institute (NCI)–funded Children’s Oncology Group (COG) ( 21 ). Though clinical trial participation has historically been higher in pediatric oncology than in adult oncology, lower participation rates have been reported among Hispanic patients and those who speak languages other than English, especially as pediatric patient grows older ( 22-24 ).…”