My research has focused primarily on cancer outcomes, with a special emphasis on the long-term health and well-being of cancer survivors. As chair of the Children’s Oncology Group Late Effects Committee between 2000 and 2008, I have been responsible for facilitating and promoting research relating to complications following childhood cancer among patients placed on COG therapeutic trials. As director of the bone marrow transplant long-term follow-up program at City of Hope, I have been responsible for ensuring complete follow-up of all patients undergoing hematopoietic cell transplantation, and identifying chronic health issues among the survivors. As director of the Center for Cancer Survivorship, I have assumed the responsibility of developing multidisciplinary survivorship clinics for cancer survivors – providing these individuals with state of the art comprehensive follow-up care in the setting of clinical research.
Highlighted below are some of the specific projects that are currently ongoing under my supervision:
Long-term Follow-up of Hematopoietic Cell Transplantation (HCT) Survivors (Director: Dr. Bhatia)
- As director of the Long-term Follow-up Core, I am responsible for ensuring complete follow-up of all patients undergoing HCT at City of Hope.
- Secondary myelodysplasia and acute myeloid leukemia (t-MDS/AML) occurs in some patients following therapy with alkylating agents or topoisomerase II inhibitors, and among patients undergoing autologous transplants for lymphoma. We are evaluating prospectively, among patients with non-Hodgkins Lymphoma (NHL) and Hodgkin lymphoma (HL) undergoing chemotherapy and autologous transplantation, the sequence of acquisition of genetic and hematopoietic defects, that result in the development of overt therapy-related MDS/AML. The goal of this study is to determine the utility of genetic markers as biomarkers of risk of therapy-related MDS/AML after chemotherapy and autologous bone marrow transplantation for NHL/HL. Funding Source: Leukemia and Lymphoma Society Translational Research and the National Cancer Institute (NCI).
I have successfully completed the development of a comprehensive self-report instrument designed to assess HRQOL among survivors of childhood cancer, and am in the process of validating an age-appropriate extension of this tool to cover older populations (ages: 21 to 55). Funding source: NCI.
Outcome of Children with Acute Lymphoblastic Leukemia (Principal Investigator: Smita Bhatia, M.D., M.P.H.)
I have demonstrated that children with ALL have significant differences in survival by ethnicity. In order to understand the underlying causes for these differences, I have received funding from the NCI to explore whether there are ethnic/racial differences in the disease biology, pharmacogenetics and compliance of therapy that could possibly account for the differences in survival. I have shown that non-adherence is prevalent in children with ALL, and that non-adherence to oral 6MP impacts relapse risk. I have now developed a clinical trial to examine whether an intervention can successfully improve adherence.
Key Adverse Events after Childhood Cancer – Role of Genetic Susceptibility (Principal Investigator: Smita Bhatia, M.D., M.P.H.)
I have established a mechanism within COG to identify key adverse events developing in survivors of childhood cancer and obtain blood samples from these patients. The key adverse events of interest include congestive heart failure, ischemic stroke, avascular necrosis and subsequent malignant neoplasms. We are testing the hypothesis that patients who develop these key adverse events after treatment for childhood cancer may have a genetic susceptibility to do so. Funding source: Lance Armstrong Foundation, Leukemia and Lymphoma Society and the NCI.
Development of Guidelines for Follow-up of Childhood Cancer Survivors
I have been responsible for facilitating the development of risk-based, exposure-related guidelines for long-term follow-up care of pediatric cancer survivors. These guidelines were developed with the goal of early identification of exposure-related late complications, potentially allowing for early intervention with resultant increased quality of life and decreased complication-related health-care costs. Screening recommendations are organized by therapeutic exposure and accompanied by targeted health education materials; all are available free of charge at http://www.survivorshipguidelines.org/.
COG Long-term Follow-up Center (Chairs: Smita Bhatia, M.D., M.P.H., and Dennis Deapen, Dr.P.H.)
We have established a childhood cancer Long-term Follow-Up Center (LTFC) that will perform long-term follow-up for all patients seen at the Children’s Oncology Group (COG) centers in the United States. The LTFC is located in the Department of Preventive Medicine of the Keck School of Medicine at the University of Southern California (USC). The LTFC performs annual follow-up with COG patients, utilizing a variety of techniques to maintain currency of contact information and employs other available resources to re-establish contact with patients (or their parents) for whom contact has been lost. The LTFC is a national resource, creating the capacity for clearer understanding of childhood cancer survivorship issues and providing many research opportunities, including: I) Minimizing losses to follow-up, which provides more reliable survival statistics; ii) Minimizing losses to follow-up, which provides more reliable protocol results; iii) Patients can be readily recontacted to address new hypotheses arising during or after completion of protocols; iv) The presence or absence of late effects can be documented; and v) Highly efficient quality-of-life studies with maximal sample sizes can be conducted. This contact mechanism is also available for both routine and protocol-specific COG-approved data collection initiatives.
Center for Cancer Survivorship (Director: Smita Bhatia, M.D., M.P.H., Clinical Director: Wendy Landier, Ph.D., R.N., C.P.N.P.)
The overall goal of the Center for Cancer Survivorship is to provide specialized long-term follow-up care for cancer survivors. Through the Center for Cancer Survivorship, the cancer center provides unique, comprehensive follow-up care for cancer survivors in a clinical research setting. The center will support the following activities:
- Comprehensive long-term follow-up services for (1) childhood cancer survivors (Landier, Karla Wilson, R.N., M.S.N., Saro Armenian, D.O., M.P.H., and Bhatia), and (2) prostate cancer survivors (Ms. Smith and Laura Crocitto, M.D.). Care will be provided as a consultative service in collaboration with the patient’s primary care provider and oncologist. Most patients will be seen for yearly comprehensive assessments; however, one-time consultations will also be available. All patients will be offered the opportunity to participate in ongoing research through the center.
- The Center for Cancer Survivorship provides unique opportunities for collaborative clinical research across populations of survivors, involving researchers from multiple disciplines such as medicine, nursing, psychology, cancer genetics and epidemiology/etiology. Clinical research is the foundation from which we gain new knowledge regarding potential long-term complications of cancer treatment as well as the optimal follow-up care and education for cancer survivors. All survivors participating in the center will be offered opportunities to participate in clinical research.
- The center will offer a structured training program in cancer survivorship for clinicians (physicians, nurse practitioners and physician assistants) and researchers (physicians, nurses, epidemiologists and others) planning careers in the cancer survivorship field. In addition, the center will offer periodic seminars and workshops on cancer survivorship issues for healthcare professionals.
- Health education personalized for each survivor based on his/her diagnosis, treatment and current medical condition will be provided during follow-up visits at the center. In addition, the center will house a patient education/resource library and will host periodic educational seminars for survivors and their families, as well as educational outreach programs for the community.
City of Hope Biospecimen Repository (Smita Bhatia, M.D., M.P.H., Peiguo Chu, M.D., Ph.D., and Joyce Niland, Ph.D.)
The City of Hope Biospecimen Repository serves as a repository for banking tumor and other biological specimens from patients diagnosed with benign or malignant tumors at City of Hope. The repository makes tissue available to City of Hope investigators who apply for the use of this material for research purposes. All proposals for research using banked tissue are reviewed by City of Hope's institutional review board using the expedited review process. The proposals are prioritized by the repository committee. The City of Hope Biospecimen Repository has been established to provide a centralized biological specimen repository system and to ensure that specimens retained for research purposes are collected, processed, stored, released and tracked in an effective, cost-efficient method in compliance with human subjects protection regulations.