January 11, 2014 | by Elizabeth Stewart
Every child fighting cancer is unique — and deserves treatment that recognizes differences in age, developmental stage, background and the cancer he or she is battling. City of Hope conducts groundbreaking research and practices compassionate care that addresses the needs of each child, tailoring treatment to overcome disease.
Our commitment to help children fight cancer
City of Hope is committed to helping children fight cancer, even when prior treatments have failed. In 2013, our physicians saw 143 new pediatric patients, with a total of 11,847 clinic visits by children battling cancer.
Thanks to community outreach efforts at our new clinics around Los Angeles County, we saw an increase in primary patients, for whom City of Hope was a first destination for care. Clarke Anderson, M.D., assistant clinical professor of pediatrics, leads these efforts and travels around Los Angeles and Antelope Valley to care for children in underserved communities. He is able to provide City of Hope’s lifesaving care while sparing families the trip to our campus in Duarte, Calif.
Identifying new ways to treat a deadly cancer
Neuroblastoma, a type of nervous system tumor, is the most common cancer in infants and children, with nearly half of all cases occurring in children younger than two. Many children are diagnosed after the cancer has spread to lymph nodes, liver, bone and bone marrow — and only half of those children survive.
Linda Malkas, Ph.D., deputy director of basic research, is applying her research in DNA repair mechanisms to find ways to fight neuroblastoma. Her lab has identified a novel protein that is not expressed in healthy cells but is expressed in high levels in cancer cells including neuroblastoma.
Malkas is working with Theresa Harned, M.D., staff physician in the pediatrics program, to identify ways to target the protein as well as the mechanisms the protein uses to repair and replicate DNA. They have designed a compound that targets the protein, and they are using the compound to further understand the mechanisms involved, with a goal of designing powerful new therapies to block DNA replication in cancer cells.
Tailoring treatment for children battling cancer
Acute lymphoblastic leukemia is the most frequently diagnosed cancer in children. Treatments for children with this cancer have improved, but still leave traces of disease, increasing the risk that cancer will return. Tests used to measure residual cancer cells and understand how a child is responding to treatment are invasive and not always accurate — subjecting children to harsh procedures with questionable benefit.
Joseph Rosenthal, M.D., Barron Hilton Chair in Pediatrics and chief of pediatric hematology/oncology, is exploring a sensitive new molecular test called high-throughput sequencing. This test is 1,000 times more sensitive than current methods, creates virtually no false positives, and relies on noninvasive blood sampling — making it an ideal new alternative.
Rosenthal is working with Yun Yen, M.D., Ph.D., chair and professor in molecular pharmacology, associate director for translational research and the Dr. & Mrs. Allen Y. Chao Chair for Developmental Cancer Therapeutics, on clinical trials to compare methods of testing in children. With this new test, physicians may be able to detect remaining traces of cancer and treat children so that cancer does not return.
Testing new treatments
As many as 30 percent of children diagnosed with Ewing’s sarcoma, the second most-common primary bone tumor in children, are not cured with conventional therapies. These children need more effective treatments.
Anna Pawlowska, M.D., professor of pediatrics
and director of the Pediatric Hematopoietic Stem Cell Transplantation Program, in collaboration with other physician-scientists from the departments of radiology and radiation oncology, is pursuing this goal with her study of whole-body magnetic resonance imaging-guided radiation therapy.
By using whole-body MRI, physicians can identify — and treat — bone tumors at an earlier stage of growth, and target them more precisely. Pawlowska's clinical study has been approved and is ready to enroll patients. She aims to enroll 15 patients between the ages of 6 and 40 with relapsed, refractory and/or high-risk Ewing’s sarcoma. City of Hope is the first medical center in the United States to test this approach.
Finding the best prosthetics for children
When a child is battling musculoskeletal cancer located in a leg, the growth of the limb can be severely impacted, and sometimes amputation is necessary. For many children, limbs can be spared and reconstructed with internal prosthetic devices that are designed to expand noninvasively with the child’s growing body.
Judith Sato, M.D., director of the Musculoskeletal Tumor Program, Dominic Femino, M.D., chief of orthopedic surgery, and George Calvert, M.D., assistant clinical professor of orthopaedic surgery, have been studying the outcomes of such devices for more than 10 years. They recently presented significant results on the performance of one of these devices to physicians and researchers from around the world at medical conferences in Bologna, Italy; San Francisco and Lake Tahoe.
They are also preparing to publish the results, and continue to study new prosthetic devices and the best approaches to treat children with musculoskeletal cancers.
Addressing the needs of a special patient group
Julie Wolfson, M.D., M.S.H.S., assistant professor of pediatrics and population sciences, is studying a phenomenon termed the “AYA gap,” which refers to the lack of progress in cancer treatment for adolescent and young adult (AYA) patients, ages 15 to 39.
To understand possible causes of the AYA gap, Wolfson is analyzing data from the Los Angeles cancer registry on children and young adults diagnosed between 1998 and 2008 with the most common AYA cancers. Wolfson recently presented findings that children with central nervous system tumors such as brain tumors are more likely to survive their cancer than young adults, and that patients cared for at cancer centers fare better than patients receiving cancer care at community clinics or hospitals.
She also uncovered factors that impacted care for patients ages 19 to 39 years: Those with public or no insurance, those in a low socioeconomic group, and those who even live more than five miles away from the nearest cancer center had a much lower likelihood of receiving care at a cancer center. Wolfson’s research could drive the development of strategies to reduce these disparities in outcomes and eliminate the AYA gap.
Helping children thrive into adulthood
Anthracyclines are used in treatment for as many as 50 percent of childhood cancers. These powerful drugs increase risk for cardiomyopathy, a weakening of the heart muscle, in children, according to research led by Smita Bhatia, M.D. M.P.H., Ruth Ziegler Chair in Population Sciences and director of City of Hope’s Center for Cancer Survivorship.
After identifying genetic markers that indicate whether children are at high risk for developing cardiomyopathy as a result of treatment, Bhatia and her team are now designing tests to detect these markers. In addition, Saro Armenian, D.O., M.P.H., medical director of the Pediatric Survivorship Clinic at City of Hope, aims to find new ways to address the needs of thousands of childhood cancer survivors who remain at risk for developing cardiomyopathy due to exposure to anthracyclines.
In an ongoing multicenter study, Armenian is investigating whether a low dose of the drug carvedilol can reduce the risk of cardiomyopathy in such at-risk survivors.
Using technology to pinpoint patient needs
City of Hope's younger patients now have access to a pediatric version of SupportScreen, the tablet touchscreen device created at City of Hope that helps patients communicate their needs and concerns to their medical teams.
Nicole Karras, M.D., assistant clinical professor in pediatrics, collaborated with the Department of Supportive Care to create these new SupportScreen modules for City of Hope patients from 8 to 20 years old. The pediatric modules include a questionnaire that homes in on issues such as chronic pain, depression, anxiety, social stressors and trouble with school work. The program then triggers action from physicians, social workers, child life specialists and others to address these issues before they hinder treatment.
City of Hope is also tracking responses to determine if interventions improve over time, and to compare patient and caregiver responses.
Creating a place for our young adult patients
The Pediatric Cancer Program recently transformed the Teen Room on the pediatrics wing into an Adolescent and Young Adult Room. This inviting community room provides a space outside patient rooms for young adults over the age of 13 to spend leisure time and socialize with each other.
With patient feedback, the computer, desk and printer were removed and replaced with an air hockey table. The DVD and gaming collection was also updated with age-appropriate selections, and gaming systems were purchased that can be checked out by older patients who aren’t being treated on the pediatric wing. This room makeover was an important step in making the space more inviting for young adult patients.
Bringing joy to children
The Department of Pediatrics hosted several events for patients in 2013. These gatherings provided opportunities to socialize with other patients and families, and they lift the spirits of young patients by helping them to remember that there is joy that transcends illness.