Osteosarcomas, Ewing sarcomas, and rhabdomyosarcomas comprise 10% of malignancies in children and young adults and require intensive and costly treatment regimens that often span a year or more.   

Lars M. Wagner, MD, division chief of Duke’s Pediatric Hematology-Oncology Division and co-author of a study on the evolutionary framework for treating pediatric sarcomas published in Cancer in June 2020, says treatment for sarcomas is extremely challenging for patients—not just physically but emotionally, as well.

In this Q&A, he describes how the combination of Duke’s expert medical care, psychosocial programs, and participation in clinical trials provides a comprehensive treatment environment for children and their families struggling with the disease and its far-reaching effects.

Q: What is Duke’s approach to caring for children and teenagers with sarcomas?

Wagner: A diagnosis of a childhood sarcoma is a life-changing event for parents and children, and treatment is a long and scary process. Because of this, we treat the disease in the context of the family and across multiple specialties. We combine the expertise of radiologists, surgeons, pathologists, and oncologists to develop a comprehensive medical care plan, but we also involve social workers, psychiatrists, and psychologists to offer the best possible emotional and psychological supportive care to a family. With this approach we’re well positioned to help patients complete their therapy and help families get through it in the best shape possible.

Q: What are some specific examples of the emotional and psychiatric support patients and families receive?

Wagner: We now have a specialized teen and young adult oncology program, which is a Duke Cancer Institute initiative that includes a patient navigator and program manager who facilitate complete family services. With this team approach, we’re not only providing medical care and making surgical decisions, but we’re offering extra psychological care with age-specific counselors to address emotional issues.

Another area we’ve done a lot of work in over the past year is developing an onco-fertility program. Many patients with sarcoma who receive chemotherapy are at risk for fertility issues later in life. Through this program, we focus on fertility-sparing options such as sperm, ovarian tissue, and egg preservation, and we facilitate connections with resources to help families obtain financial support and find ways to make these options practical.

Q: What is the typical prognosis for children with sarcomas?

Wagner: For certain types of bone sarcomas, up to 75% of children can survive long term. For patients whose tumors have metastasized, outcomes are usually very poor, but the majority of pediatric sarcomas can be successfully treated, and survival rates are improving. It’s frustrating that we haven’t seen any big advances in cures such as those we’ve seen with leukemia, but Duke gets involved in as many novel therapies and trials as possible so we can work to improve available therapies and find new ones.

Q: Is Duke currently participating in any clinical trials for sarcomas?

Wagner: Yes, the Duke Cancer Institute is participating in two immunotherapy trials for recurrent Ewing sarcoma, and we are opening a third for recurrent osteosarcoma. We are also enrolling patients on a novel oral chemotherapy medication that has shown exciting benefits in the laboratory. In the past, some trials were open either to adults or to children, but with these studies, we’re working to increase access to cutting-edge therapies for both populations. Hopefully, with these trials and others, we’ll help find new ways to harness the immune system and identify novel strategies for treating patients with recurrent sarcomas.