Dr Randall on the Need for Precision Survivorship Care in Pediatric and AYA Sarcoma

"Children, adolescents, and young adults that are cured from [diseases such as] osteosarcoma and Ewing sarcoma often face decades of cardiopulmonary, endocrine, psychosocial, and musculoskeletal late effects."

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopedic Surgery, chair of the Department of Orthopedic Surgery, and a professor at the University of California (UC) Davis Comprehensive Cancer Center, spotlighted key prospective research evaluating standards for sarcoma survivorship and outcomes as relates to guideline-concordant care that is being conducted by his colleague Elysia Marie Alvarez, MD, MPH.

Although survival rates for pediatric bone sarcomas, such as osteosarcoma and Ewing sarcoma, have seen modest improvements over the past few decades, the quality and equity of survival have not improved similarly, Randall highlighted. Adolescents, young adults, and children who are cured often experience decades of late effects, including musculoskeletal, endocrine, cardiopulmonary, and psychosocial issues. Randall emphasized that these serious burdens fall unevenly on patients facing racial and socioeconomic adverse circumstances, despite the fact that treatment exposures are largely identical across all affected populations.

Alvarez, who is a pediatric oncologist at UC Davis Comprehensive Cancer Center and lead in the Children's Oncology Group, recently received an NIH K08 award from the National Cancer Institute to conduct prospective research and investigate these disparities. Her work aims to observe how sarcoma survivors experience outcomes after receiving similar therapies, Randall explained. The primary objective is to predict and prevent differences among patients, specifically looking at outcomes for those who receive guideline-concordant care and those who do not. Alvarez’s research is now beginning to examine the systemic and biologic reasons underlying these existing disparities to inform a platform for precision survivorship care.

The overarching goal of this research is to move survivorship science away from being purely descriptive toward a mechanistic understanding. This involves identifying the biological contextual drivers responsible for recurrence and late toxicity. By gaining this insight, investigators can personalize long-term follow-up care for survivors. Randall noted that the framework is built on the reality that even when patients receive guideline-concordant care, some still experience worse outcomes. The vision is to establish a comprehensive precision framework for survivorship by uniting three disciplines: molecular profiling, population-level analytics, and health equity frameworks.