N E S W

Children’s Cancer Hospital
NEWSLETTER
FROM THE DIVISION OF PEDIATRICS AT THE UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER • • • • • SEPTEMBER • 2007
Children’s Cancer Hospital
at The University of Texas
M. D. Anderson Cancer Center:
The George Foreman Pediatric
and Adolescent Inpatient Unit
Robin Bush Child and
Adolescent Clinic
B E H A V I O R A L
P E D I A T R I C S
...Treating the Whole Child
Kim’s Place
R. E. (Bob) Smith
Research Facility
Our Mission
is to treat the whole child,
not just the cancer.
Each patient has a team of treatment
specialists to address any cancerrelated issues, whether they are
medical, psychological or developmental. Treatments are designed for
minimal interference to your child’s
normal routine. Because a familiar
face means so much to a child,
they will see the same physician
throughout their treatment. Patients
and families always know who “their”
doctor is. We also make sure that
life after cancer is the best it can be.
Follow-up programs monitor and
manage any side effects of cancer
or its treatments. Counseling and
support groups help the parents and
the child overcome any fears and
concerns.
At the Children’s Cancer
Hospital, kids rule–not cancer.
We wouldn’t have it any other way.
Contact us at 713-792-5410
8 a.m. – 5 p.m. (M–F)
and after hours at 713-792-7090
Request the On-Call
Pediatric Oncology Attending
We’re on the Web!
www.mdanderson.org/children
T
reating children with cancer is not
limited to treating the disease. Instead,
we recognize that children, adolescents
and young adults with cancer have special
psychosocial needs and challenges that can
best be met by a multidisciplinary team of
professionals acting together.
• • • • • • • • • • • • • • • • • • • • • •
In the Children’s Cancer Hospital, Behavioral Pediatrics works to minimize the impact of cancer on the
child and family and to prepare them for a return
to normal life. Most children diagnosed with cancer
today can look forward to a very long future. Our job
is to help them through the cancer experience, give
them hope and prepare them to live that life.
Our team is comprised of more than 30 specialists
in clinical psychology and psychiatry, neuropsychology, child life, education, social work, chaplaincy and
language assistance. Patients in the Children’s Cancer
Hospital also benefit from music and art therapy and
enrichment opportunities. These disciplines interact
in a synergistic manner, planning programs and
patient care at weekly meetings and rounds.
continued
Bernadette Aylor, a coordinator in the clinical
research program, interacts with a young patient
during a neuropsychological assessment.
Behavioral Pediatrics
continued from page 1
T
he main “job” of children is to grow
physically, academically, socially and
emotionally. Ordinary illnesses are a normal
part of childhood; cancer is not. We strive to
normalize our young patients’ lives as much
as possible with school, field trips and fun
activities in the PediDome and Kim’s Place
and during the annual summer camps
organized by Linda Blankenship, program
manager. Before a child participates in many
of these activities, we meet with each
disease-specific clinical team to assess
psychosocial needs and issues that may
affect their treatment plan.
Bart Moore, Ph.D., head of the Behavioral Pediatrics group,
meets with his team to discuss issues that might affect
patient treatment plans.
Janet Ruffin, art teacher for both elementary and secondary
levels, uses art to encourage children’s imaginations.
PSYCHOLOGY SERVICES
Clinical psychologists Martha Askins, Ph.D.,
and Rhonda Robert, Ph.D., and psychiatrist
Estela Beale, M.D., specialize in addressing
the psychological and emotional needs of
children and their families during and after
treatment for cancer. Children with cancer
experience physical changes or losses in
appearance and function that commonly
provoke anxiety. Parents must often learn
how to best help their child succeed with
medical procedures or hospitalization, while
at the same time managing their own fears
and concerns. Our solution to this is a
Maternal Problem Solving Program, which
assists parents in the challenges they face.
Siblings may also need help adjusting to
changes in family life when parents are
intermittently absent or daily routines change.
The psychologists and psychiatrist are
available from the time of diagnosis to help
minimize distress and foster adjustment as
quickly as possible.
Brain development can be affected by certain
types of chemotherapy and radiation
treatments, resulting in learning and
cognitive difficulties. Our neuropsychology
team assesses patients for difficulties in
language, memory, intellectual, visual
perceptual and attention skills. All children
with brain tumors are evaluated, as well as
children undergoing bone marrow transplantation. This team works closely with the
education team to evaluate a child’s
strengths and weaknesses to ensure that
they can attain their maximum academic
potential, in spite of their cancer treatment.
Askins, who heads the Cognitive Training
Research Program, provides a 20-week
course for patients who are at-risk for
cognitive difficulties associated with their
treatment. By incorporating some techniques
used to remediate the problems in victims of
traumatic brain injury, our at-risk patients
Sandra Medina, pediatric research investigator, engages
her patient in the cognitive training research program.
may be spared some of the cognitive
problems commonly associated with cancer
and its treatments.
CHILD LIFE PROGRAM
Renee Hunte, M.A., CCLS, leads the Child Life
Program in the Children’s Cancer Hospital.
Under her direction, six trained specialists
help children and their families understand
and manage stressful life events and health
care experiences during the course of their
treatment. All of our specialists are nationally
certified and have college or advanced
degrees in child development, Counseling,
Education, Family Studies or Therapeutic
recreation. Their goal is to provide opportunities for optimal growth and development in
the child despite the rigors of cancer
treatments. Their friendly and caring faces
are usually the first a child encounters when
coming to the Children’s Cancer Hospital.
Child life specialists help prepare children for
diagnostic tests, surgery and other medical
procedures that are frightening or painful.
They also engage in medical play and
education about procedures using special
dolls and medical equipment and teach the
child stress reduction techniques. All of these
help the child have a feeling of personal
control. Our child life specialists provide
support services for all pediatric patients
regardless of age. Some young children
regress emotionally and need help to remain
on track developmentally. Older children and
teens have different needs and are engaged
in fun activities in Kim’s Place or in support
groups with other teens with similar
emotional and social needs. Siblings are not
neglected — they often are included in field
trips, summer camps and other activities with
their sister or brother.
Children of adult patients with cancer often
go under the radar screen, despite obvious
needs. Martha Aschenbrenner, program
Claudine Simpson, Ph.D., a teacher in the Children’s Cancer Hospital education
program, works with a patient to keep him on level with his peers.
manager directs our Kids Need Information,
Too (KNIT) Program that helps these children
understand their parent’s illness and treatment. And, when the outcome is poor, she
provides help in preparation and in grieving.
SCHOOL PROGRAM
Under the direction of Carla Hart, MSEd., our
education program consists of state certified
elementary, secondary and special education
teachers as well as educational liaisons.
Academic instruction is held in classrooms
and offered bedside when needed. In addition,
we provide academic enrichment such as field
trips, a fitness program, music and creative
arts. For older patients, we also offer career
planning and vocational guidance. Our school
program provides hope, preparation for life,
normalization and comfort for our patients.
Hope - Going to school gives the child the
idea that we expect them to get better; we’re
not giving up on them.
Preparation for Life - We DO expect our
patients to survive and so it is important that
they emerge from their cancer ready to rejoin
their peers in school and get on with their
lives.
Normalization - Going to school gives our
patients a feeling of normalcy in the chaos of
cancer treatment.
Comfort - Participation in school activities
also provides a diversion from pain and
discomfort, as well as providing a means of
social support.
Our educational liaisons have advanced
degrees and are trained in education law and
regulations. They consult with schools either
by conference call or through school visits.
Community teachers are given information
about the child’s diagnosis and treatment
plan, anticipated absenteeism, medications
and the side effects of treatment, especially
those that may impact learning. Classmates
Young campers enjoy the water at Camp A.O.K., a summertime
adventure that offers a relief from hospital treatment.
are educated on their peer’s specific cancer,
myths about cancer and what to expect once
their friend returns to the classroom.
Dick Maddox, from Chaplaincy & Pastoral Education,
has been instrumental in forming a networking group
for Muslim parents.
Our school has current technology that
allows for live, video conferencing. For
schools that also have this technology, our
patients can go to their community classroom
virtually — they can see their classmates, be
seen by them and interact verbally just as if
they were present physically. This technology
is also used for children in isolation so that
they may maintain their academic curriculum
until their isolation is lifted.
ADDITIONAL SUPPORT PROGRAMS
Social workers Lisa DeLeef, Sarah Stone and
Heather DeRousse play an integral role in our
Behavioral Pediatrics team. They are an
invaluable resource for families and provide
counseling to parents from diagnosis through
end of treatment, as well as practical
information to make the logistics of cancer
treatment go more smoothly. Social workers
assist with financial, transportation and
housing issues and provide community
resources. They are always on hand to
provide emotional support during times of
high stress.
Chaplain Dick Maddox and his associates
are available to support our patients and
their families, regardless of their faith. And,
because our patients are often from other
countries, language assistants Maria Elana
Leighton and Magda Sadek are often called
upon to help translate during psychosocial
activities. Their language fluency and
clinical insight ensures that nothing is
“lost in translation.”
Music and art therapy have been shown to
have therapeutic benefits to patients with
chronic illness. In the Creative Arts Program,
Janet Ruffin, artist-in-residence, is a
professional artist, arts educator and poet
who helps patients express themselves
artistically at bedside, in clinic treatment
rooms, the outpatient clinic playroom, the
hospital playroom, the teen room and Kim’s
Place. She uses different mediums to inspire
creativity, such as drawing, acrylic, tempera,
watercolor, printmaking, digital photography
and sculpture. Michael Richardson, M.T.-BC,
is a music therapist who transforms his love
of music into a therapeutic tool to help
pediatric patients of all ages express
themselves through a variety of musical
outlets. His enthusiasm and engaging
personality lift the spirits of patients and
helps them get through challenging times.
A
lthough the Behavioral Pediatrics team at
the Children’s Cancer Hospital consists
of professionals from all of these distinct
disciplines, we do not act in isolation. Each
discipline is in close communication with the
others, and we learn from each other’s
different perspectives and approaches. We
share insight, information and suggestions on
how to best care for our patients so that their
psychosocial needs are fully met. Fighting
cancer is hard work for everyone — our goal
is to make the going easier and to prepare
our children for the rest of their lives.
Uttesha Lumpkin, child life specialist, works as she “plays” with patients,
building a trusting relationship to help them understand their medical treatments.
Patients get the rhythm as they sing along
with Michael Richardson, music therapist.
Doctor, lawyer,
teacher — these
were all early
goals of Carla
Hart, MSEd.,
new director of
the Education
Program in the
Children’s Cancer
Hospital.
An Apple for the Teacher
As it’s turned out, she has successfully melded elements of all these fields as she takes the reins of the
education program in the Children’s Cancer Hospital at M. D. Anderson Cancer Center.
With a B.S. in audiology and speech from Florida State University and an MSEd. in special
education from George Mason University, Hart is armed with the tools she needs to make certain that
the potential of her staff and her program is not wasted.
Hart explains that her decision to join the Children’s Cancer Hospital was based on her belief
that “this is a place that breeds people who think outside the box. I have always been interested in the
program here. The opportunities I could see and the reputation of the institution attracted me.”
“There are all kinds of ways to grow the education program,” she says. “The quality of the staff, the
coordination between the departments and my feeling that everyone is interested in the same goal
— all of this makes me feel very supported. We can blend our educational system and our medical
system and use the past to look into the future to determine what is most needed for our patients.”
Prior to joining the Children’s Cancer Hospital, Hart spent time at Phoenix Children’s Hospital
and at St. Luke’s Children’s Hospital in Boise, ID where she developed the first school program for the
hospital. She is the president elect of the Association for the Education of Children with Medical
Needs, which had brought her to visit M. D. Anderson’s Children’s Cancer Hospital several times.
Hart anticipates a lot of observing at the start but has plans for one-on-ones with her staff and
meeting with parents to learn about their ideas and concerns.
Speaking after only one week on the job, Hart was already issuing gold stars. “I am impressed
by the respect I see from everyone to everyone,” she says. “In the future, it’s all about changing the
mindset of what has been done in the past and changing the mindset of what can be done in the
future. But, I have a lot of experience in getting changes made — it’s a strength of mine.”
Drug Therapy Corner – Susannah E. Koontz, Pharm.D., BCOP
Risperdal® Gains Approval for Treatment of Two Psychiatric
Conditions in Children and Adolescents
O
n August 22, 2007, the FDA announced
the approval of Risperdal® (risperidone)
for the treatment of two psychiatric
conditions in young patients. Janssen’s product
is now labeled for use in the treatment of
schizophrenia in patients ages 13-17 years and
for the short-term management of manic or
mixed episodes of bipolar I disorder in children
and adolescents ages 10-17 years. This action
by the FDA marks the first time an atypical
antipsychotic drug has been approved for either
condition in young patients. Prior to this time,
only lithium has been approved to manage
bipolar disorder in adolescents ages 12 years
and older, and no therapy has been approved
for treatment of schizophrenia in pediatric
patients.
The efficacy of Risperdal® in children for the
indications mentioned above was demonstrated in
multiple short-term, double blind, controlled trials.
In the two trials evaluating therapy in patients
with schizophrenia, patients treated
with Risperdal® generally had fewer symptoms
including a decrease in hallucinations and
delusional thinking. Similar findings were
observed in the multicenter trial investigating
Risperdal® for the treatment of manic or mixed
episodes in children with bipolar I disorder —
patients generally experienced fewer
disease-associated symptoms.
Risperdal® was first approved for use in
the United States in 1993 for the treatment of
schizophrenia in adults. The drug later won
approval for the short-term treatment of acute
manic or mixed episodes associated with
bipolar I disorder in adults and the treatment of
irritability associated with autistic disorder in
pediatric patients ages 5-16 years. Commonly
reported side effects associated with the use
of Risperdal® include: nausea, dry mouth,
drowsiness, dizziness, fatigue, increased
appetite, anxiety, tremor and rash.
Patients from the Children’s Cancer
Hospital had a sweet treat in July.
The children made cookie trains
and jewelry with the help
of staff from the Cookie Jar Bakery.
Many of the decorated treats were eaten
before the icing even had time to dry.
It’s summer and that means it’s time for camp!
• • • • • • • • • • • • • • • • • •
Star Trails, for patients ages 5 to 12 and their siblings, is
3Camp
held at the Camp For All facility in Burton, Texas. Fishing, canoeing,
swimming, arts and crafts and other traditional camp activities are
all part of the fun. Camp closes each year with a poignant “Wish
Boat” ceremony that involves all the campers.
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
5
Every summer, pediatric patients and
survivors pack their bags for a fun educational
trip to San Antonio. While in San Antonio, patients
visit the Alamo, SeaWorld, the Institute of Texan
Cultures and many other San Antonio sights.
The trip is sponsored by the Children’s Cancer
Hospital, the Children’s Art Project, Southwest
Airlines and SeaWorld.
• • • • • • • • • • • • • • • • • • • • • • •
3For those who weren’t able to attend Camp
Star Trails this summer, the Child Life staff and
Smart MultiMedia, Inc. joined forces to host the
“Rockin’ in the Rainforest” inpatient camp.
Thanks to collaborations with the Houston
Museum of Natural Science, the Houston Zoo,
Landry’s Restaurants and more, patients had
daily lessons about the rainforest and created
a variety of jungle-themed craft projects such
as spider hats, wooden snakes, Model Magic
poison dart frogs, masks and rainsticks.
The camp’s faux campfire was the center of
attention during snack-time.
Cesar Nunez, M.D., instructs his patient
to “Say Ahhhhhhhhhhh.”
Lymphocyte Count Found to be a Predictor of
Survival for Young Patients with Leukemia
DIVISION OF PEDIATRICS
Academic Office: 713-792-6620
Division Head
Eugenie Kleinerman, M.D.
Deputy Division Head
Robert Wells, M.D.
Researchers from the Children’s Cancer Hospital at M. D. Anderson Cancer Center
have found that one simple blood test could predict relapse or survival for children
and young adults with acute leukemias.
A
review of young leukemia patients
over the past decade has shown that
the absolute lymphocyte count (ALC), a
measure of normal immune cells found
on every complete blood count report, is
a powerful predictor of survival for young
patients with leukemia.
According to the American Cancer
Society, the average rate of survival
for pediatric patients with acute
myelogenous leukemia (AML) is close
to 50 percent. However, researchers
discovered that using the ALC count
on day 15 after initial chemotherapy
treatment can significantly predict
which patients are likely to relapse
and those who will not.
This prediction may help physicians
decide how aggressively to treat a
leukemia patient. In addition, it may
direct researchers in developing
therapies to increase a patient’s ability
to battle the leukemia cells.
“Possibly by tweaking the immune
system through chemotherapy, immune
modulators or oral supplements, we
could help a patient’s body better fight
leukemia,” says Patrick Zweidler-McKay,
M.D., Ph.D., assistant professor of
pediatrics at the Children’s Cancer
Hospital. “This ALC test could also help
us identify patients who would benefit
from less chemotherapy.”
The results from the study of 171
young leukemia patients showed
that AML patients who had a low
lymphocyte count on day 15 of treatment had a five-year overall survival
chance of only 28 percent. However,
patients with higher lymphocytes on
day 15 had a much better overall
survival rate of 85 percent.
For patients with acute lymphoblastic
leukemia (ALL), the most common
form of childhood leukemia, researchers
found that those children and young
Patrick Zweidler-McKay, M.D., Ph.D., has one of his young patients try out his stethoscope.
adults with a high ALC count on
day 15 had an 87 percent six-year
overall survival rate while those with a
low lymphocyte count had a 55 percent
overall survival rate.
Researchers at the Children’s Cancer
Hospital plan to continue their study by
following newly diagnosed patients and
have begun another study that analyzes
the subsets of lymphocytes to see
which ones have the most impact on
prognosis. They hope their findings will
be used to help physicians worldwide
make decisions on how aggressively to
treat their patients.
“Many developing countries lack the
latest technologies and treatment
options that we have here in the
United States,” says Zweidler-McKay.
“A complete blood count test is a
universal, inexpensive test. There is
the potential for physicians worldwide
to look at the ALC count to help
determine whether the patient needs
additional treatment options that aren’t
available in every center.”
In addition to pediatric acute leukemias,
these researchers have found that ALC
predicts survival in young patients with
non-Hodgkin’s lymphoma and a bone
cancer, Ewing’s sarcoma. These findings
suggest that this simple test may redefine
the way physicians treat a range of
different cancers.
A paper on this study was presented at
the 2007 Annual Meeting of the
American Society of Pediatric
Hematology/Oncology and will be
published in the journal CANCER.
Children’s Cancer Hospital
Collaborates with Sister Institutions
The mission at
M. D. Anderson does
not stop at eliminating
cancer in Texas.
Our goal is to eliminate
cancer for the entire
world, and one way to
accomplish this is
through collaborations
with sister institutions.
The third annual Sister Institution Conference
at M. D. Anderson took place June 5–8, 2007.
The Sister Institution’s primary objective is to strengthen
M. D. Anderson's network of institutions and affiliates
by facilitating collaborations focusing on patient care,
research, prevention and education.
This year was the first year that pediatric oncology was
represented at the conference, and faculty from the
Children’s Cancer Hospital played a large role in the
specific interest discussions. Johannes Wolff, M.D., Peter
Anderson, M.D., Demetrios Petropoulos, M.D., Cesar
Nunez, M.D., and Joya Chandra, Ph.D., represented the
Children’s Cancer Hospital through presentations related
to their specialties.
“We have now started setting the framework for collaboration in pediatric oncology,”
says Nunez, assistant professor of pediatrics. “Through these interactions, we can create
standard processes and regulations that will allow for international clinical trials.”
Nunez believes that the collaborations will be instrumental in getting basic research and
clinical research in pediatric oncology moving at a quicker pace.
“We have a survival rate of nearly 90 percent in childhood leukemia in the United States,
but that’s not the case elsewhere in the world,” says Nunez. “By partnering with other
institutions, we can work together to conduct basic research clinical trials and get the
marker moving on cure rates outside of the U.S.”
The collaborations aren’t just beneficial to international institutions. Nunez noted that
there are technologies, processes and anti-cancer agents in other countries that hospitals
in the United States could use to improve cancer care.
More than 300 international participants from 20 countries attended the conference,
representing medical institutions in Argentina, Brazil, Chile, China, Egypt, France,
Germany, Hungary, India, Japan, Korea, Lebanon, Mexico, Norway, Peru, Saudi Arabia,
Spain, Taiwan and the United Kingdom. The Children’s Cancer Hospital is in the initial
stages of working with institutions in France, Brazil and Turkey.
Adolescent/Young Adult
Michael Rytting, M.D.
Martha Askins, Ph.D.
Bone Marrow Transplantation
Laurence Cooper, M.D., Ph.D.
Dean A. Lee, M.D., Ph.D.
Laura Worth, M.D., Ph.D.
Demetrios Petropoulos, M.D.
Brain/Neural Tumors
Joann Ater, M.D.
Johannes Wolff, M.D.
Vidya Gopalakrishnan, Ph.D.
Endocrinology
Steven Waguespack, M.D.
Hematology
W. Keith Hoots, M.D.
Deborah Brown, M.D.
Nydra Rodriguez, M.D.
Late Effects
Joann Ater, M.D.
Alan Fields, M.D.
Winston Huh, M.D.
Leukemia/Lymphoma
Seth Corey, M.D., MPH
Joya Chandra, Ph.D.
Anna Franklin, M.D.
Patrick Zweidler-McKay, M.D., Ph.D.
Cesar Nunez, M.D.
Michael Rytting, M.D.
Robert Wells, M.D.
Nephrology
Joshua Samuels, M.D., MPH
Neurology/Neurofibromatosis
Bartlett Moore, Ph.D.
John Slopis, M.D., MPH
Non-Neural Solid Tumors
Peter M. Anderson, M.D., Ph.D.
Cynthia Herzog, M.D.
Winston Huh, M.D.
Eugenie Kleinerman, M.D.
Dennis Hughes, M.D., Ph.D.
Peter Zage, M.D., Ph.D.
Critical Care
Alan Fields, M.D.
Rodrigo Mejia, M.D.
Regina Okhuysen-Cawley, M.D.
Jose Cortes, M. D.
Pediatric Surgery
Richard Andrassy, M.D.
Kevin Lally, M.D.
Charles Cox, M.D.
Andrea Hayes-Jordan, M.D.
Neurosurgery
Raymond Sawaya, M.D.
Fred Lang, M.D.
Jeffrey Weinberg, M.D.
Psychology
Martha Askins, Ph.D.
Bartlett Moore, Ph.D.
Rhonda S. Robert, Ph.D.
New Patient Line: 713-792-5410
After Hours: 713-792-7090
D
esigners of the 2007 Holiday
Collection for the Children’s Art
Project, all patients or former
patients, were introduced and honored
at the annual CAP Card Announcement
this summer. Straight from these
talented children’s imaginations to cards,
ornaments, ceramics, t-shirts and more,
the colorful works of art will be featured on
CAP seasonal note cards and gift items this
season. The project has contributed more
than $23 million dollars to fund programs
that benefit cancer patients and their
families in both the Children’s Cancer
Hospital and M. D. Anderson. For more
information, visit www.childrensart.org.
• • • • • • • • • • • • • • • • • • • • • •
A Few Products...
The Children’s Cancer Hospital Newsletter is an
educational resource for physicians interested in the treatment, research
and prevention of pediatric cancers, produced quarterly from the Division
of Pediatrics at The University of Texas M. D. Anderson Cancer Center.
The University of Texas
M. D. Anderson Cancer Center
Division of Pediatrics
1515 Holcombe, Unit 853
Houston, Texas 77030
ADDRESS CORRECTION REQUESTED
David B. Coe, Division Administrator
Gail Goodwin & Sara Farris, Managing Editors
We welcome your questions and suggestions.
Change of address or other communication regarding this newsletter may be directed
to David Coe at 1515 Holcombe Blvd., Unit 087, Houston, TX 77030; 713-792-6620.
Non-Profit Org.
U.S. Postage
PAID
Permit No. 7052
Houston, TX