Sep 11, 2020
In this episode of Your Stories, Dr. Applebaum shares the hopeful news about conquering childhood cancers with fellow oncologist Dr. Douglas Yee and gives doctors’ orders for how all patients with cancer and their families can face every phase of a diagnosis with childlike hopes.
Dr. Mark Applebaum, a kid at heart, uses every trick in the coloring books he shares with his young patients to improve the often long and brutal treatments they face. In this episode of Your Stories, Dr. Applebaum shares hopeful news about conquering childhood cancers with fellow oncologist Dr. Douglas Yee. He gives doctors orders for how all patients with cancer and their families can face every phase of a diagnosis with childlike hopes.
So I'm a medical oncologist. I take care of breast cancer patients.
So back when I was in medical school and training, I really wanted
to be an all-purpose physician that took care of people. When I was
thinking about that I said, well, maybe I would like to be a
pediatrician. I went to do my pediatrics rotation.
The thing that didn't work for me was that most of your patients
really don't want to see you. In other words, kids either in a well
baby check or if they're sick or anything, they don't want to see
you, much less talk. So, obviously, it appealed to you.
Yeah, I mean, the reality is I'm a large child. When I was in
college, and even in medical school, I just gravitated towards
working with kids. It's just more fun. Our rooms are more highly
decorated.
I get to watch magicians when I'm on rounds because they happen to
be in the child's room. I can't tell you how many art projects I've
gotten to watch and participate in just because that's what my
patient was doing when I was seeing them. And it keeps you young
and it keeps you sprightly.
And the good news is for pediatric oncology, I mean, for the vast
majority of children with leukemia, we cure those kids. And that's
fantastic. My specialty is not leukemia I do research on a disease
called neuroblastoma, which is one of more common pediatric
cancers. It's a disease that affects nerve tissue.
And I try to research better cures and try to find different ways
of identifying patients who are more likely to have better or worse
disease and really figure out how we can precisely treat those
kids. So we're working towards those goals.
But kids keep it young and fun. And the pediatric oncologists
within pediatrics, we're sort of a special breed because there are
a lot of pediatricians who don't want to work with the sick kids.
Well child checks are more fun. We deal with the issues of life and
death. And that's a struggle, but it's an honor.
I think it's very hard for me early on in my career because I see
some success, I see some failure in my research and with my
patients. But I don't have that long view. And one of the things I
see from my senior colleagues is they love nothing more than
hearing from their patients 20 years later. They love nothing more
than looking back and saying, this is where things were 20, 30
years ago. This is where they are now. Look at what I've
contributed to. What is your perspective on that?
I think on the individual level, it's really always gratifying. And
you don't, like you said, sometimes you don't think about a
patient's perspective completely. But when a patient will tell me
that, well, you know, I never thought I was going to see my child
graduate or get married.
And so in some respects that's extraordinarily gratifying on a
personal level. But the other aspect is how do you as an individual
help make that happen more often than not? And how do you then
really try to set the field up so that things are changing a little
more rapidly?
As you know, the struggles that my dad has had with advanced
prostate cancer, and he is at the phase where he's just running out
of options basically. I mean, from that perspective, it's been both
fascinating and heart wrenching to interact with the medical
oncology community.
I mean, you're at an academic center, and I am as well. And I think
the first thing we always think about is, how can I get my patient
on a study? How can I find something better than standard of care
if standard of care just isn't good enough?
It is always the challenge when there's barriers between what we in
the academic world perceive as optimal care and what people are
getting. And as somebody who sees a referral practice, I see that a
lot.
When we train practitioners, we need to make sure we train them in
a way that they're always curious. Now, you don't necessarily have
to be a leader in research, but you certainly have to stay on top
of things.
So culturally, I think we just need to train more physicians who
come with that background. I tell patients and everybody that
today's ceiling is tomorrow's floor. If you're practicing at the
top of your game today, 5, 10, 2 years from, now it's not going to
be that way anymore. So we have to make sure that everybody in the
health care system understands that. As you said, pediatrics is a
best case example.
I think what we've always benefited from in pediatrics is our
patients have to come to an academic center. And we've always had
to pool resources because we deal in nothing but rare diseases. The
only reason we've made advances is because we have a strong focus
on research.
I don't think it's just research that, though, has been a struggle.
It's also been supportive care. As my dad has been progressing, his
symptoms are becoming more severe. And unfortunately, he's having a
harder time mobilizing. And I had to encourage my family to fight
to get palliative care services, which to me, in my practice, it's
a no-brainer.
If I've got somebody with metastatic disease, like the day they're
diagnosed, I call my palliative colleagues, and I say, hey, can you
help me with symptom management here? We need to make them do well.
But we also need to make sure that they're-- in my case, in
pediatrics-- going to school, seeing their friends, acting like
children. That's so important.
That's what I was told on day 1 of fellowship. Yes, it's terrifying
to start taking care of children with cancer. And you're not
trained for it yet. And you're going to be taking the call at the
middle of the night from somebody who needs to talk to somebody who
knows something about pediatric oncology. But just remember, no
matter what you do, if the patient is first, you will not be
wrong.
My patient, she's now 10 years old, and she's been battling with
high-risk neuroblastoma for a couple of years. And her mom gave a
very, very moving speech about everything that she has gone through
in the past couple of years. And it's very emotional for me to hear
as her physician.
We don't, I think, as doctors always think about what my patient is
doing on a day-to-day basis because we think about sort of our
patients as a whole. And where is this person in treatment? And
what do I need to make sure that this treatment keeps marching
on?
But seeing it from that sort of one person's side and all the ups
and downs of cancer treatment, and seeing all the pictures and
hearing the stories of how their family had to rally through good
and bad, it was really quite touching. And it really brought home,
I think, the importance of what we do. It was pretty amazing to
hear that.
Conquer Cancer funded Dr. Applebaum's early research, which he says
helped lay the foundation for every discovery he's made to treat
children with neuroblastoma. To learn more about his research,
visit conquer.org.
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