Pediatric Oncology
Enhancing the lives of cancer's youngest patients
By Debra Ruder and Saul Wisnia
Adams Fenelon, 4, cruises down a hallway at the Jimmy Fund Clinic as his nurse, Amy Gage, RN, cheers him on.
When Sidney Farber, MD, envisioned a Boston-based pediatric cancer institute in the 1940s, childhood leukemia was uniformly fatal. From the moment of diagnosis, all that families could hope for was minimal suffering in the remaining months of a child's life.
Today, more than 80 percent of children treated at Dana-Farber Cancer Institute for acute lymphoblastic leukemia (ALL) — the most common childhood cancer — are cured. This dramatic change stems from various forms of chemotherapy, pioneered by Farber and refined by subsequent generations of physician-scientists. At the same time, the quality of life for pediatric patients has markedly improved, thanks to advances in technology and a greater understanding of the challenges faced by cancer patients and their families.
"We're as poised to take basic research findings and translate them into new concepts and new therapies as any place in the world."
— Stuart Orkin, MD
Since its formation in 1974, the Pediatric Oncology Department at DFCI has been at the forefront of numerous innovations through its outstanding research, clinical, and training programs. Its roughly 250 physicians, nurses, fellows, psychologists, technicians, and other staff treat and investigate all forms of pediatric cancer — including leu-kemias, brain tumors, and other solid tumors — while probing the biological mechanisms behind them.
"We're as poised to take basic research findings and translate them into new concepts and new therapies as any place in the world," states Department Chair Stuart Orkin, MD. "Our fellowship program has trained many leaders in the field, and patients seen in our Jimmy Fund Clinic receive superb, compassionate care from day one."
Pediatric cancer is rare. Of the nearly 1.3 million new cancer diagnoses likely to occur in the United States during 2002, only 9,100 are expected in children 14 and younger, according to the American Cancer Society. These figures are a mixed blessing for caregivers.
"One of the greatest things about being a pediatric oncologist is that there are not that many children with cancer," says Holcombe Grier, MD, associate chief of pediatric clinical oncology at DFCI. "However, it's much harder to conduct a clinical trial because you don't have as many human subjects. Our ability to answer scientific questions is severely curtailed."
With a gallery of pediatric patient photos behind them, Patricia Branowicki, MS, RN (right), of Children's Hospital Boston and Dana-Farber, confers with Brittany Hardiman, BSN, RN, CPON, an oncology staff nurse at Children's.
Despite its small size compared to adult oncology, however, pediatric oncology plays a large role in the overall field of cancer medicine.
"Our discipline is critical because so many of the breakthroughs in cancer research have had their origins in pediatric oncology," observes David E. Fisher, MD, PhD, whose work at Dana-Farber on pigment cells appears to shed light on melanoma and bone metabolism in both children and adults. Another example of shared knowledge is Alan D'Andrea, MD's, exploration of the rare childhood condition Fanconi anemia, which has yielded insights into breast cancer — a major cause of cancer death among women.
"On the therapy side, pediatrics is leading the way as well," Fisher adds, "because of what we learn from successfully treating tumors. Although children are generally more resilient than adults and their diseases are different, many of the treatments given to adults are built upon protocols first found to work in children."
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