Jeffery Ross, 6, a three-year cancer survivor, and his mother Teresa visit Sadhna Shankar, M.D., for a checkup in the Hematology/Oncology clinic.
photo by Dana Johnson
‘Survivorship’ programs grow as pediatric cancer patients live longer
Advances in treatment for childhood cancers are creating a welcome new challenge for pediatric oncology researchers and clinicians — the dire need to understand, predict and address the long-term implications for children and families after facing a cancer diagnosis and therapy.
Vanderbilt's Childhood Cancer Program, part of the Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt-Ingram Cancer Center, is positioning itself as a leader in this increasingly active field known as “survivorship.”
“Today, three of every four children who develops cancer can expect to be a long-term survivor,” said James Whitlock, M.D., Craig-Weaver Professor of Pediatric Oncology and chief of the division.
“That's encouraging news, but it also means that we have to work even harder to understand how to ensure that these children not only live but that they also live as well as they possibly can. It is imperative that we learn more about the effects of cancer and cancer treatment on physical health, learning and memory, psychological and emotional well-being, reproductive health and so on.”
Steps being taken to build a comprehensive childhood cancer survivorship program include:
• Development of a pediatric clinical psychology research program under the leadership of Bruce Compass, Patricia and Rhodes Hart Professor of Psychology and Human Development. The subsequent recruitment of psychologists Debbie van Slyke and Frances Niarhos has enabled Vanderbilt to join a Children's Oncology Group study, involving a select group of institutions, on the neurocognitive effects of acute lymphocytic leukemia (ALL).
• Successful application to join the Children's Oncology Group (COG) Late Effects Consortium, a group of about 10 centers to collaborate on research in this area.
• Development of a proposal for a late-effects, or long-term follow-up, clinic to follow childhood cancer survivors for physical, cognitive, psychosocial, reproductive and other issues related to their disease and its treatment.
This proposal has received seed funding of $90,000 from the Vanderbilt Children's Fund and the clinic is expected to open this fall. Sadhna Shankar, M.D., assistant professor of Pediatrics, will serve as medical director of the clinic.
“Sadhna has a special interest in cancer survivorship and brings strong experience and passion to this endeavor,” Whitlock said. “She has been active in the late effects group of the Children's Oncology Group and served as co-chair of its task force on cardiovascular side effects following therapy. In that role, she was instrumental in revising and updating the existing guidelines for follow-up for cardiovascular disease in survivors of childhood cancers.”
In collaboration with Smita Bhatia, M.D., chair of COG's Late Effects Committee, Shankar recently published a manuscript in the journal Pediatrics about the health-related quality of life among childhood cancer survivors.
She also has authored a chapter on late effects of therapy for a textbook about lymphoid cancers that is in publication.
The childhood cancer team is also working closely with Vanderbilt-Ingram colleagues who treat and study adult cancers to develop a comprehensive cancer survivorship initiative. This effort includes the creation of an endowed chair for cancer epidemiology, cancer control and survivorship/late effects and recruitment of a senior investigator with expertise in cancer survivorship to fill this position.
This group is also collaborating on a grant application for submission to the Lance Armstrong Foundation.
“Addressing survivorship issues is such a critically important area and its importance will only continue to grow as research and treatment advances add more and more people to the ranks of long-term cancer survivors,” Whitlock said.
“It is very gratifying to find this synergy and common purpose among colleagues who work with both childhood and adult cancer survivors and their families. With that and the institutional commitment from the Children's Hospital and the Cancer Center, I'm very optimistic that we will make great strides in this area.”