CINDY ELLEN RUSSELL / CRUSSELL@STARBULLETIN.COM
Dr. Robert W. Wilkinson, pediatric oncologist at Kapiolani Medical Center, recently received the St. George National Award from the the American Cancer Society.
Physician has seen leaps
in cancer treatment
for childrenWhat did you do to be honored with American Cancer Society's St. George National Award?
Dr. Robert W. Wilkinson
>> Position: Pediatric oncologist at Kapiolani Medical Center for Women and Children; professor of pediatrics at the University of Hawaii's John Burns School of Medicine.
>> Award: Recipient of the St. George National Award, the American Cancer Society's highest award. It is presented to a division volunteer who has provided distinguished service in achieving the society's strategic goals.
It was given for my longtime involvement in caring for patients with cancer. My field is children's oncology. I've been here since 1974, so I presume it's been for working for the American Cancer Society, but also a career lifetime award for working in children's cancer oncology.
What percent of the tumors in the children you work with end up being malignant?
Virtually all of them are malignant tumors. So I'd say about 98 percent are malignant. We're delighted when we have a benign tumor and can take it out and the patient is fine.
What are the most common forms of pediatric cancer?
Leukemia is probably the most common form, which makes up probably 40 percent, and then lymphomas make up another 10 percent. Then, probably, 25 percent are brain tumors. So 75 percent of children's cancers are made up of leukemias, lymphomas and brain tumors.
Why do they get cancer at such a young age?
The current theories are there's probably a genetic predisposition to many types of cancers, and there needs to be some kind of genetic amount or injury that causes the child to develop a malignancy. Perhaps its' a viral infection, perhaps it's an environmental toxin or, perhaps, it's just bad luck.
How treatable are they and what percent of children overcome them?
The childhood cancers are very treatable and now 80 percent of kids survive and become long-term survivors. The key is catching it early with very aggressive therapy and usually a team approach. Patients are referred to a regional center, and there's a cooperative team approach. We also participate in clinical trials. I think over the last 30 years that's been the big difference. We are in the business of curing patients, not in the business of palliation (making a patient feel comfortable with the time he or she has left). Our goal every time when we see children is to cure them. We're extremely aggressive and don't waste any time. We're advocates of clinical trials and try to have virtually all the kids participating in a clinical trial. That way, you're guaranteed getting the standard of care and you also might have access to something that's a great breakthrough and offers an improvement in survival.
What type of American Cancer Society programs have you implemented for children with cancer?
The biggest program myself and the other team put together at Kapiolani Hospital is we implemented access to clinical trials throughout the whole country. So the therapy became very standard that when a child developed cancer in Hawaii, he'd get the same treatment as a child would in Boston, Florida, Los Angeles or Portland -- all the big cities. When a child is diagnosed with cancer, the whole team jumps up to find out what kind of cancer the patient has, where it is and what is the latest treatment. We participate in this national network that's a children's oncology group and there's almost 300 hospitals in this network. So the kids are able to get the most advanced state-of-the-art therapy. That's probably been the single most important thing. Then, setting up our oncology program at Kapiolani. It's a tertiary center. We have the oncologist, nurses, pathologists and a pharmacist to help us. It's setting up an intensive team approach.
I understand that you also offer camps?
That's part of taking care of the whole patient and the family. It's just not enough to cure the child of cancer. There are lots of issues, and this childhood cancer exists in the family. It's important for them to get time off and a break and to take care of the family. So, with the American Cancer Society, we established a camp for the kids to get a break. There's one for the little kids, one for the adolescents, and last week we had one for the families.
What type of symptoms should parents look out for with their children?
The major symptoms of a child with cancer are probably a fever, bleeding problems or swelling some place. There seems to be a peak of childhood cancers between 3 and 5 years of age and then the number of cancers starts to rise in late adolescence -- 16, 17, 18.
What got you interested in oncology and how long have you been at Kapiolani?
I was born and raised here and came back to the islands in 1974. I've been back almost 29 years now. I did all my training on the mainland and I was at Los Angeles County General Hospital and in 1974 finished my training in children's cancer. That's when the whole country started to make these advances in survival rates and the same thing happened here that happened all over the country. When I got into it, it was a very exciting area of medicine. It's a very interesting thing about what causes tumors and genetics. It was a very intellectually, interesting part of medicine, and it was an area I felt I could make an impact. When I started in children's oncology, only 30 percent of children were cured. Now, through team effort and clinical trials, it's 80 percent. It's a stunning change. I can't think of a more intellectually and exciting time. When you look at the kinds of diseases kids have, it's an area where you can really make an impact to cure a child of cancer. It's undescribable the feeling you get when you can cure a child in cancer and see how well they look and see the parents' relief from the grief and agony of their child having a life-threatening illness. Those kinds of reward you can't buy.
How difficult is it emotionally to deal with the children and the parents?
It used to be very painful, very difficult, because most of the children died, 70 percent died. It was very difficult to understand it and grasp why this is happening and what's wrong. Now, we're able to cure 80 percent, and when you're successful at something -- and it takes a lot of hard work if it's childhood cancer -- it's extremely rewarding when the child has received therapy for cancer for two or three years and then you see them 15 or 20 years later. You've very bonded to that patient and the family.
What type of treatment do you use?
The biggest impact has been chemotherapy, but frequently we use surgery and radiation therapy.
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