SIOP 2010 Research
For the first time in 17 years, the United States was the host site for the Annual Congress of the International Society of Pediatric Oncology (SIOP). Several physicians and researchers from MD Anderson Children's Cancer Hospital were selected to present at this year's meeting. The following is a summary of some of the research highlights from MD Anderson.
Thursday, October 21
Problem-Solving Skills Training Helps Mothers of Newly Diagnosed Patients Cope with Stress
Mothers who have children diagnosed with cancer now have a better approach to address and cope with stresses associated with their child’s disease. A new certified intervention, called Problem-Solving Skills Training (PSST), has proven to be more effective long term compared to other psychological methods, such as reflective listening.
PSST consists of eight, one-hour individual sessions between mother and therapist, in which they identify the mother’s primary stressors, brainstorm solutions, weigh the benefits and costs associated with each solution, implement one of the solutions and evaluate its effectiveness. Three months after their child’s initial diagnosis, the stress levels of mothers receiving PSST had decreased twice as much as mothers who had no intervention. Researchers from The University of Texas MD Anderson Children’s Cancer Hospital hope to adapt this training to an online program that parents can access from home or when psychological support is unavailable.
Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma
Radiation oncologists from The University of Texas MD Anderson Cancer Center have found a way to safely alleviate symptoms in patients with diffuse intrinsic pontine glioma, an aggressive and fatal pediatric brain cancer. Pontine glioma accounts for 10 to 15 percent of pediatric brain tumors and usually targets children ages 5 to 9 years old. The median survival for this disease is less than one year, and patients are subject to a high volume of pain as a result.
Standard treatment for pontine glioma is radiation alone or in combination with chemotherapy. Combination therapy tends to achieve a better response initially, but eventually the tumor returns. Radiation specialists at MD Anderson have found that giving additional rounds of radiation after relapse is not only feasible, but it also helps decrease painful symptoms while delaying the progression of the tumor.
Saturday, October 23
Factors Influencing Adherence to Follow-Up Care in Childhood Cancer Survivors
Nearly 80 percent of children survive their cancer, but two-thirds of those survivors experience late effects from their treatment. Despite their increased risk for late effects such as heart disease, diabetes and secondary cancers, nearly half of childhood cancer survivors at The University of Texas MD Anderson Children’s Cancer Hospital did not continue follow-up care seven years after their diagnosis.
In their study, MD Anderson Children’s Cancer Hospital researchers found that patients treated with only surgery were highly less likely to return for follow-up care five years after treatment. Survivors of central nervous system cancers or solid tumors other than bone cancers were less likely to adhere to follow-up standards as well as survivors over the age of 18 without private health insurance. At five years post-diagnosis, African-Americans were significantly less likely to not return for follow-up care. The findings from the study showed the primary factors that influenced compliance to follow-up care.
As a result, a more in-depth analysis of a larger survivor population will be studied. All patients will receive a survivor’s guide from MD Anderson called Passport for Care that will include essential information needed for follow-up care. More education will also be given to patients and families before the child’s 18th birthday in regards to the importance of continuity of insurance coverage.
Health Behaviors and Preferences of Childhood Cancer Survivors
Approximately 40 percent of childhood cancer survivors are overweight or obese. Although the growing trend in America is alarmingly similar, cancer survivors are at a higher risk for heart disease, diabetes and other late effects as a result of treatment. Researchers at The University of Texas MD Anderson Children’s Cancer Hospital recently studied the health behavior and preferences of its survivors to determine what can be done to encourage healthier lifestyles.
The study showed that childhood cancer survivors who were overweight or obese were significantly less likely to view their health as good and were much more likely to be worried about their cancer. Overall education about late effects and the importance of exercising healthy behaviors was low for all survivors, but those who were overweight expressed interest in weight control and getting in shape. Of the 157 survey participants, most preferred a computer-based intervention. As a result, the Children’s Cancer Hospital is planning a web-based diet and exercise intervention targeting survivors.
Prognostic Factor Discovered for Pediatric Bone Cancer Survival and Ways to Lower Costs of Care
A recent study from The University of Texas MD Anderson Children’s Cancer Hospital has shown the importance of the absolute lymphocyte count (ALC) in predicting the prognosis of pediatric bone cancer patients. This is built on previous studies of other pediatric populations at MD Anderson confirming ALC as a prognostic factor.
Researchers discovered that pediatric osteosarcoma patients with a high ALC after two weeks of chemotherapy had a 92 percent survival rate compared to patients with a low ALC who had a 33 percent survival rate. For Ewing’s sarcoma patients with a high ALC at two weeks, their overall survival was 68 percent compared to an overall survival of 32 percent for patients with a low ALC. Dexamethasone is often given as an anti-nausea regimen to bone cancer patients. Since it has shown to possibly reduce ALC recovery, MD Anderson clinicians have recommended using other anti-nausea medications that won’t affect the ALC negatively.
Also as a part of their study, researchers adapted inpatient regimens to outpatient care and found that outpatient treatment for osteosarcoma and Ewing’s sarcoma was 25 to 35 percent lower in cost than having the chemotherapy given inpatient.
Comparison Shows Inpatient Chemotherapy More Costly Than Outpatient Delivery
Improvements in the delivery of anti-nausea medication and fluid hydration have allowed for some chemotherapy regimens to be administered in an outpatient setting. Although surveys have shown patients prefer outpatient care compared to inpatient care, a new study conducted by The University of Texas MD Anderson Children’s Cancer Hospital has further quantified the benefits of outpatient care.
The study showed that the costs associated with administering some outpatient chemotherapy are significantly less than delivering the same therapy in the inpatient setting. Nursing interventions and paperwork were also significantly cut down in the outpatient setting. The finding was that some chemotherapy can be delivered to outpatients safely while cutting down on overall hospital costs.
Sunday, October 24
Signaling Pathway Impacts Spread of Bone Cancer and Overall Survival
Researchers have identified an important signaling pathway that, when blocked, significantly decreases the spread of pediatric bone cancer.
In their pre-clinical study, researchers at The University of Texas MD Anderson Children’s Cancer Hospital found that blocking the Notch pathway in mice decreased metastases in the lungs 15-fold. Their research showed that the Notch pathway and Hes1 gene play a key role in promoting the metastasis of osteosarcoma, the most common form of bone cancer in children.
In addition to Notch and Hes1’s role in metastasis, the study unveiled that Hes1 expression can be correlated with a patient’s prognosis. The researchers conducted a small retrospective study looking at patient samples, and 39 percent of patients with high expression levels of Hes1 survived 10 years versus the 60 percent survival rate for patients who had lower levels.