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 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)
- The Long-term Follow-up (LTFU) core supports complete long-term follow-up of all patients receiving HCT according to the various protocols of this Program Project. As Director of the LTFU Core, I am responsible for ensuring complete follow-up of all patients undergoing HCT at City of Hope. Funding source: NCI
- Through collaboration between the City of Hope Cancer Center and the University of Minnesota, I have constructed a large cohort of patients who have undergone HCT at these centers and have survived at least two years. This comprehensive BMTSS aims to describe outcomes of HCT by merging extensive demographic, ethnic and treatment data, and data on the prevalence of long-term complications and second cancers, with data on quality of life in survivors of HCT through an R01-funded mechanism. Funding source: NCI
- Secondary myelodysplasia and acute myeloid leukemia (t-MDS/AML) occurs in some patients following therapy with alkylating agents and among patients undergoing autologous transplants for lymphoma. We aim to evaluate prospectively, among patients with non-Hodgkin’s Lymphoma (NHL) and Hodgkin lymphoma (HL) undergoing chemotherapy and autologous transplantation the sequence of acquisition of genetic and hematopoietic defects, from genotoxic insult to the development of overt therapy-related AML/MDS. 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/HD. Funding Source: Leukemia and Lymphoma Society Translational Research and the 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 (PI: Dr. Bhatia)
I have recently 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 through the R01 mechanism (PI, S Bhatia), and propose 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. Funding source: NCI
Key Adverse Events after Childhood Cancer – Role of genetic susceptibility (PI: Dr. Bhatia)
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, myocardial infarction, ischemic stroke, avascular necrosis and subsequent malignant neoplasms. We propose to test 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
Development of Guidelines for Follow-up of Childhood Cancer Survivors
As Chair of the COG Late Effects Committee, 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 healthcare 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/ . The guidelines were reviewed and scored by a 16-member multidisciplinary panel of experts in the late effects of pediatric cancer treatment. Funding source: NCI
COG Long-term Follow-up Center (Chairs: Dr. Bhatia, Dr. Deapen)
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 more than 200 Children’s Oncology Group (COG) centers in the United States. A web-based centralized process is currently utilized for rapid, highly efficient patient enrollment at the COG Statistics and Data Center in Arcadia, California. The LTFC will be located in the Department of Preventive Medicine of the Keck School of Medicine at the University of Southern California (USC). The LTFC will perform annual follow-up with COG patients, utilizing a variety of techniques to maintain currency of contact information and will employ other available resources to re-establish contact with patients (or their parents) for whom contact has been lost. The LTFC will be 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 will provide more reliable survival statistics; ii) Minimizing losses to follow-up, which will provide more reliable protocol results; iii) Patients can be readily re-contacted to address new hypotheses arising during or after completion of protocols; iv) The presence or absence of late effects can be documented; v) Highly efficient quality of life studies with maximal sample sizes can be conducted. This contact mechanism will also be available for both routine and protocol-specific COG-approved data collection initiatives.
Center for Cancer Survivorship (Director: Dr. Bhatia, Clinical Director: Wendy Landier)
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 will provide 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 (Ms. Landier, Ms. Wilson Dr. Kurian, Dr. Armenian, and Dr. Bhatia), (2) prostate cancer survivors (Ms. Smith and Dr. Crocitto), and (3) breast cancer survivors (Dr. Mortimer, Dr. Hurria and Dr. Palomares). 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 will provide 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, 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 (PIs: Dr. Bhatia, Dr. Yen and Dr. Weiss)
The overall goal is to create a City of Hope Biospecimen Repository (COHBR), which will serve as a repository for banking tumor and other biological specimens from patients diagnosed with benign or malignant tumors at City of Hope National Medical Center. The COHBR will make 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 will be reviewed by the City of Hope Institutional Review Board (IRB) using the expedited review process. The proposals will be prioritized by the COHBR Committee. The COHBR is being 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.