Inside Pediatrics Fall/Winter 2023-2024

“If you give the same dose of a particular kind of chemotherapy or radiation to 100 people, about 10 to 20 will develop the complication, and the rest won’t,” she said. “Then the question arises, why not? That’s why we have started exploring the genetic makeup of childhood cancer patients to understand which particular genes interact with chemotherapeutic agents—anthracyclines, for example—and increase the risk of cardiotoxicity or heart failure in a subgroup of patients.” The goal is to develop a blood test that will indicate in advance that a patient is at high risk for complications, so the physician can use a different dose or a different drug. Genetic information is also important to developing personalized long-term follow-up care for patients. “Everybody would want to continue to be followed in specialized clinics after they’re diagnosed with cancer because they develop this really unique and strong relationship with their treating oncologists,” Bhatia said. “However, a treating oncologist does not, nor does the hospital or cancer center, have the bandwidth to keep following all patients forever. We need a triaged system, so those who are at the lowest risk of developing any long-term morbidity are taken care of in the community by the primary care providers. Those that have the other extreme of being highly complex—for example, allogeneic bone marrow transplant recipients or brain tumor survivors—need to be in the specialized long term follow-up centers, such as cancer centers or academic institutions.” One step is to develop policies and guidelines as to who can safely be cared for in the community by primary care providers. Such a plan would require long-term communication between the specialized center and the physician because of the complexity of the treatment and possible long-term complications. Bhatia, as associate chair of the Children’s Oncology Group, has coordinated survivorship research across 200 pediatric oncology institutions in the United States

SURVIVAL RATES

for children with cancer now EXCEED 85% so a cure is expected

in the past and has worked to develop such long term follow-up guidelines. “We have a detailed road map or algorithm that we summarize in survivorship care plans, which we ask the patients to take to their primary care physicians,” she said. Children’s is a specialized facility with a multipronged, multidisciplinary approach needed to provide long-term follow-up care. One part of that approach is the Taking on Life After Cancer, or TLC, clinic, which follows cancer survivors who have finished treatment and have been off therapy for at least two years. TLC is one of several multidisciplinary survivorship programs at UAB and is led by Bhatia. Wendy Landier, Ph.D., RN, serves as the clinical coordinator of survivorship clinical activities, and Kimberly Whelan, M.D., serves as the medical director. The clinic provides detailed information for survivors and their families, including the patient’s risks for late effects. Patients are screened for possible treatment related complications and also receive psychosocial evaluation and support, along with referrals to other specialists, as needed. “The big thing is that we don’t stop when they turn 18,” Bhatia said. “Our oldest patient is in their 50s. So, that’s the beauty of this clinic. We keep them close to our hearts.

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Inside Pediatrics | Children’s of Alabama