I'm Dr. Tara Suntum, and I'm a pediatric hematologist
and oncologist at MedStar Georgetown University Hospital.
The patients I see range from newborns all the way
up to young adults in their 30s.
And we treat patients who have blood disorders, meaning
they have problems with their red cells, their white cells, or their platelets.
And we also take care of patients that are affected by cancer and that can
range from leukemias and lymphomas to sarcomas and other solid tumors.
And I also take care of patients
after they finish their cancer treatment in our survivorship program.
My philosophy for treating my patients is really to treat them how myself
or my family members would want to be treated.
And to me, that means really having open
communication with them and forming a partnership in their care.
So, for me, I really take the time during each visit to listen
to the patient's concerns and understand what the issues
are and and try my best to answer all of their questions.
And if there's something I can't answer,
I make sure to get them to someone who can.
And then as far as being a partner in their care,
I really think of us as a team and we discuss everything,
including diagnostic workup that's going to happen
and the treatment options that they may have.
And we come to a decision as a team.
And then I also try to advocate for them outside of our department
when they need to see other subspecialists or have other studies done.
I really try to work with them to make sure
all of those things can happen and take a little bit of the burden off of them.
Pediatric hematology oncology
is always an exciting field because there is a lot of research
going into the cancer treatments and supportive care for these patients.
And the pediatric hematology
oncology global field is really collaborative.
And there are a lot of clinical trials going on and a lot of clinical trial
participation by the patients.
So we're able to gain knowledge of different
research questions that we have and make advances in the field
at a relatively quick pace compared to some other medical fields.
We have a wonderful team here at MedStar Georgetown,
especially our pediatric hematology and oncology department,
where we also take care of adolescent and young adult patients.
And it's really every level of provider in our department
that really focuses on patient and family centered care.
We are a very close knit division, and we make sure that we take
a comprehensive approach to each patient.
And we do multidisciplinary meetings where we assess each patient
and their needs and
make sure that they're connected with the support services they need.
And then we also have the resources of the Comprehensive Cancer Center,
and the services that the adult oncology team has access to,
including a lot of clinical trials,
both on the adult side as well as the pediatric side.
I feel truly fortunate to be able to take care of these patients.
I think we become like a primary care provider for them,
and we see them so frequently.
We get to know their life stories and become like close, close family to them.
And I really think that's a big privilege.
And I really, truly love getting to know the patients and their families
and to help walk the journey of their treatment
with them and get them to the other side.
The definition of a cancer survivor is one that can be interpreted
in many different ways, but the standard definition is actually
once a patient is diagnosed with cancer, they become a cancer survivor.
And as they are living with the diagnosis and going through treatment,
they are a cancer survivor.
And then they move into a different phase after their treatment is finished.
And then they're a cancer survivor for the rest of their lives.
And for some patients, that is a tricky concept to come to terms with,
and they don't feel like they're a cancer survivor
until they've completed their treatment,
and I think that's okay
that every patient comes to their own meaning of what that means to them.
And that's what we help them get to as their providers as well.
The transition to survivorship care
does depend on what type of cancer that patients were diagnosed with
and any complications that they are facing during and after their treatment.
But generally, patients will transition around two to five years
after therapy to a survivorship clinic.
Our survivorship program here at MedStar Georgetown focuses on the whole patient.
And by that, I mean we focus on their physical, psychological
and social needs for every patient that comes through our clinic.
We create a personalized treatment care plan for them, and that includes
details of all their treatment that they had for their cancer,
including any surgeries, any radiation and any chemotherapy.
And based on the treatment they received, we tailor the recommendations
for follow up with the particular studies, including lab tests or imaging studies
or other specialists that may need to be involved in their care.
We also have a multidisciplinary care team for our survivor
patients, which includes a psychologist, social worker
and other supportive care services, including integrative medicine specialist.
And we're able to tailor and you tailor
those specialties for each patient, depending on what their needs are.
We've had several patients
that have benefited from our integrative medicine specialists
with their neuropathy or their nerve pain that they develop from cancer treatment.
And we also have a nutritionist who's also been very valuable
for our survivor patients.
At each survivorship
visit, we actually contact their primary care doctor
and any other specialists
that are actively still involved in their care
and to make sure that they have the treatment summary
that we've generated for the patient and understand what the recommendations
are for any surveillance that they may need for late effects.
And we also recommend that patients themselves carry
the treatment summary with them to other appointments that they may have
or even keep it on their phone, just something accessible
so that when they're seen, other doctors
are aware of their cancer history and what treatment they had
and what potential lead effects they may have from their treatment.
And this is really to provide them with the best care as they're
getting evaluated for other other things that may come up in the future.
Cancer treatment can cause infertility for patients,
and it really will depend on what type of cancer
treatment that the patient received.
Radiation is one of the treatments that can cause infertility
if it was near or to the reproductive organs.
If patients had surgeries involving their reproductive organs,
that will also be a factor in potential fertility and then chemotherapy.
There are some chemotherapy drugs that do increase the risk for infertility.
So, these are all things we take into account
when we're doing what we call a fertility risk assessment for patients.
And we do this before
they start treatment and then also after they've completed treatment.
And before treatment,
we always have a discussion with the patients
and their families about the potential risk for infertility,
and we work with them to identify resources within the community
if they desire options to try to ensure
that they have the ability to have a family in the future.
After the treatments complete, we do a fertility risk assessment again,
where we look at all the treatment that they have received
and we risk stratify them of their potential risk of infertility.
And it's always important
that we make sure that they know that this is not absolute,
but we work with them to
decide when and if they want to undergo
some fertility testing to see if they are able to start a family.
And we provide them with resources in the community to help them do so.
Once children finish their cancer treatment or young adults
finish their cancer treatment,
there certainly can be some effects on their functioning in the school,
their work environment, and this can be from a lot of different factors.
Some of the chemotherapy that they receive will
potentially cause what we call some neuropsychological side effects.
And this can vary a lot depending on the patient.
Sometimes it can be with their ability to concentrate in school or at work,
sometimes it can be with problem solving and sometimes it can be with memory.
And so we make sure to talk with patients and parents about all the concerns
and with the school about things that they're seeing.
And we advise patients and their families to undergo neuropsychological testing.
It can be really helpful for patients to have this.
And this is where they go through a lot of specialized testing
and look at how they function in different environments.
And by doing so, they're able to understand where their strengths are
and where their limitations are.
And with this information, they're able to have the best way to approach
school and work so that they function to the best of their ability.
And then the other thing is that we also make sure that they have
appropriate psychosocial support, because a lot of factors
with going back to school or to work is the anxiety and the stress that they feel.
So by having good support, that can also ensure
good integration back into those environments.
There are a lot of things that cancer survivors can do to stay healthy,
and they are particularly motivated
to stay healthy after having been through cancer treatment.
One of the biggest things that we tell not only cancer survivors,
but the general public
is eating a good, healthy diet is a very good way to stay healthy.
And this includes
lots of fruits and vegetables and also maintaining a healthy weight.
And there also has been research that shows that moderate exercise for
about 150 minutes or two and a half hours a week
is also very beneficial for the health.
And this reduces not only things like diabetes and hypertension
and heart disease, but it also reduces stress and anxiety.
So, these are all very important things for patients to try to
fit into their lifestyle once they finish their treatment.
And then in addition to those things, they're the things that we also counsel
everyone about is if they are smoking, you know, they need to stop smoking,
and we can work with them to help them do so
If they're having trouble.
Limiting alcohol intake is also another thing that they can do
for their health.
And then staying on top of all of their their regularly scheduled visits
with their primary care doctor,
going for regular dental exams, seeing the eye doctor regularly
keeping up with their vaccinations that are recommended.
Those are all really important for their health,
and by making sure that they're keeping up
with all those things, we can catch anything as soon as symptoms or
other issues arrive and we can intervene early.
Adolescent and young adult oncology or, what we say, AYA
oncology means patients who are between the ages of 15 and 39 years old.
And this is a group of patients that was identified
as being kind of lost between the pediatric and the adult worlds
and losing out on things like access to clinical trials and other resources.
And now programs across the country
are developing programs to specifically focus on the needs of these patients.
And MedStar Georgetown is one of them.
You know, we really aim to have a place where these patients can have access
to both pediatric and adult oncologists so that we can help
decide the best treatment for them.
Sometimes that may be that they're treated
on a pediatric treatment protocol, because we know that for certain types
of cancer, that young adults do do better on pediatric protocols.
And sometimes that might mean that they're treated on adult protocols.
But it's important for us that we work together
and we come up with the best treatment
regimen for the patient, depending on their cancer type that they have.
And it also means access to a lot of psychosocial services, because
the patients that are in this age range have a lot of unique psychosocial needs.
And so we have our multidisciplinary team,
including social workers and psychologists and psychiatrists that can help
assess their needs and support them through their their treatment.
Our AYA program here at MedStar Georgetown includes
oncologists within the pediatric hematology department,
and then we also collaborate with the adult oncologists in Lombardi.
So, we evaluate patients and then we discuss them
at multidisciplinary conferences where we can elicit opinions
from other providers, whether that be the adult oncologists or the surgeons
or the radiation therapists.
We have a really collaborative department
where we look to find the best treatment options for patients.
And we also have services, including
psychology, that are dedicated specifically to our AYA population,
And if patients desire to go elsewhere, they help to plug patients
into the community, to the services that they need.
We also have an integrative medicine specialist for these patients and has been
very helpful in helping manage symptoms that arise from cancer treatment.
We also have a nutritionist who is able to consult
on all of our patients and provide them with recommendations
to stay healthy and to help with symptoms they may be having from their treatment.
We also have wonderful social workers who work with each
and every one of our patients and really get to know them
and our patients, trust them, and are able to confide in them
problems that they may be having, and
our social workers have access to a lot of different resources to be able
to help our patients.
The multidisciplinary care team at MedStar Georgetown involves
a lot of different providers. And for discussing the treatment
that's best for the patient, that includes oncologists
from both the pediatric and the adult side, as well as the surgical specialties.
And that is different for each patient. For patients
that have bone tumors, for example, that will involve the orthopedic doctor
and for patients that have brain tumors, that will involve the neurosurgeon.
The other provider that's present is the radiation oncologist
to help provide insight into whether radiation would be
a beneficial treatment depending on the patient's cancer type.
And we have detailed discussions for each patient to take into account
what type of cancer they have, where their where their cancer is located,
and what the patient's goals are for their treatment.
And so we all discuss those factors into the decision and help
come up with the best treatment plan for patients.
And we also have our multidisciplinary care team that focuses on the patient
each step of the way going through the treatment.
And that involves a lot of different people
and that involves our social workers, our psychologists, our therapists,
our nurses, our nursing coordinator,
our child life specialists, and our integrative medicine specialists.
And we are fortunate to all work really closely together,
and we meet on a regular basis to make sure that we are aware
of all of our patients' needs and are addressing all of them.
And we can do so from a lot of different
angles, depending on what is arising for each patient.
And I think the opportunity to have integrative medicine consultation
is really unique to our program and has been very helpful
for a lot of our patients to help support them with symptoms
they may be having from from their treatment.
When an AYA patient is diagnosed with cancer,
I think it is really important for them to find the right place to be treated.
And by that, I think it's important to go to a place
that has experience treating these patients.
Being at a place that has both pediatric and adult oncologists
brings together the knowledge of the treatment options
going on in both worlds and also allows us
to figure out what would be best for that patient.
Being at a place that also has access to clinical trials is important
because that helps advance the
the field of oncology, as well as give them the options
of the latest therapy that's going on for their cancer.
I think it's also important to be at a location where they have access
to a lot of different resources, including psychology,
integrative medicine, nutrition, physical therapy, occupational therapy.
And those are all things
that we can provide within our AYA program at MedStar Georgetown.