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Chair Report

Fiscal 2009 Chair Report (selected text)

Mark Greenberg, OC, MB, ChB, FRCPC, FAAP Professor of Paediatrics and Surgery POGO Chair in Childhood Cancer Control University of Toronto Senior Oncologist, Hospital for Sick Children

The POGO Chair in Childhood Cancer Control at the University of Toronto is unique by virtue of its link to the position of Medical Director of the Pediatric Oncology Group of Ontario (POGO). This convergence enables creation of cross-institutional academic endeavours, both research and educational. Since POGO is the official advisor to the Ministry of Health and Long-Term Care with respect to childhood cancer, it also enables rapid translation of evidence derived from research findings into policy and implementation at a clinical level - thus fulfilling the mandate of improving childhood cancer control. The academic goals of the Chair and of its incumbent are primarily focused on dimensions of research and knowledge translation/education that reach across disciplinary boundaries, and on creating an interdisciplinary environment, actual and virtual, in which such scholarly activities can thrive. These goals place particular emphasis on the resource provided by the unique population database established by the POGO collaboration, and its potential for linkage studies consistent with the role of a designated entity under the Protection of Health Information Protection Act (PHIPA, 2004).

The last year has seen considerable further development of the research infrastructure, with expansion and enhancement of the population database. Scientific strength has been enhanced and personnel added. Research activities across an interdisciplinary spectrum have been productive and led to professional advancement for trainees and new grant money. Highly acclaimed interdisciplinary knowledge transfer and educational events have been created, and significant numbers of presentations and publications have occurred.

Highlights of activity over the last year include:

Personnel Enhancement

The recruitment of personnel to facilitate both in-house and collaborative database research was identified early as an important priority. The following personnel have been added to the POGO Research Unit:

• Scientist
• Associate Scientist
• Health Care Analyst

Thus, a well functioning nucleus of infrastructure uniquely placed to execute population-based collaborative research has been established.

Research Collaborations

• Central America/AHOPCA: POGO has been actively involved in developing research capability in Central America through an international collaboration between POGO, St. Jude Children’s Research Hospital, the University of Monza, Italy, and the AHOPCA collaboration encompassing 7 Central American countries. This has led to considerable development of research capacity within these countries, and collaborations on issues of access, survival, and determinants of care. Additionally, the devolved care model, created by the Chair and POGO, has been adapted and adopted in several of the countries.

• Cancer in Young People in Canada (CYP-C): The Chair continues to guide the national surveillance program of the Public Health Agency of Canada as a member of its steering committee, as a principal participant in the creation of its database, and with the analysis of the ensuing data.

• British Columbia: The synergy between the activities in academic pediatric hematology/oncology in Ontario and British Columbia has continued to be developed. The model of survivor care initiated in Ontario has been implemented in B.C. and deployment of the POGONIS database has been initiated, creating the opportunity for collaborative research and validation of outcomes.

Awards

The O Harold Warwick prize of the NCIC/Canadian Cancer Society, awarded for outstanding research contributions to cancer control, has been awarded only twice to pediatric oncology academics: the incumbent Chair of the Board of POGO, Dr. Ronald Barr of McMaster University (in 2009) and the POGO Chair (in 2007). Both individuals have done a significant proportion of their research through the POGO Research Unit.

Creation of Research Funding and Execution Opportunities

• Fellowship Program: There have been three Fellows over the last year:

• Jillian Baker MD - A Master's student in Clinical Epidemiology, she is studying the impact of delays in diagnosis and treatment on outcomes in pediatric ALL and Hodgkin’s lymphoma
• Talar Misakyan PhD - Completed her PhD thesis entitled “Identification and regulation of emotions in children treated for benign or malignant tumors of the cerebellum”
  

• Argerie Tsimicalis PhD(c) - Is completing her PhD on the financial impact on families of a diagnosis of cancer - an assessment in the first three months after diagnosis

• Seed Grants: A seed grant competition was offered again in the past year. Four grants were made:
• A Feasibility Pilot Test Study of Group Therapy for Bereaved Siblings - M. Barrera, et al.
  

• Atypical Development Prior to Diagnosis of Acute Lymphoblastic Leukemia: Incidence and Neurocognitive Outcomes - L. Janzen, et al.

• Developing a Questionnaire to Measure Job Satisfaction and Work-Related Stress and Burnout in Pediatric Oncology Staff - A. Klassen and D. Dix

• ChIMES – Understandability and Content Validity - L. Sung and D. Tomlinson. [ChIMES: Children’s International Mucositis Evaluation Scale]

• Open Operating Grant: An opportunity has been created and launched for research focused on provincial programs that involve multi-site Ontario investigators, which would catalyze collaborative research with policy implications, not readily fundable by the classical agencies. The first such grant has been awarded to a consortium of the POGO hospitals to evaluate the applicability and consistency of a screening tool for psychosocial distress. The primary investigator is Dr. Maru Barrera.

International Development and Consultation

Two jurisdictions in particular have benefited over the last year from consultation and development assistance from POGO and the Chair:

• AHOPCA (Asociacion de Hematologia-Oncologia Pediatrica Centroamericana) - has developed a research partnership with POGO, but most recently sent a delegation representing all seven constituent countries to further develop both research collaboration and public policy development. In particular, in an attempt to reduce one of the most preventable of contributions to early mortality, abandonment of therapy, AHOPCA has adopted and adapted the model of devolved care developed by POGO.

• Children’s Cancer Hospital of Egypt (Cairo) - The Chair has been involved in consulting and advising on the development of this newly constituted institution in Cairo. Originally framed as the creation of a children’s cancer hospital, the undertaking expanded, on the Chair’s recommendation, to the development of a system of childhood cancer care and a model for the initiation of an infrastructure for standardized care and clinical trials protocols. The implementation of this model is underway.

Looking Ahead

With increasing precision and a widening array of tools, POGO will be in a position to identify, target, and study outcomes of childhood cancer at the clinical, functional, and system levels and translate those studies into policy and practice, bringing increased evidence to the development of cancer control. The on-going commitment of the Ministry of Health and Long-Term Care to the evidence-based and research backed advice of POGO and the ability to link that advice to the leaders of the pediatric and pediatric oncology programs of the Academic Health Science Centres and to community organizations will ensure continuing optimization of Ontario’s childhood cancer system, and its export to other jurisdictions.

We have had great success in attracting substantial funds from the CIHR, and from the CCS to enable further optimization of the POGONIS resource, and to applied population-based research via database linkage and other epidemiologic methodologies. We expect to complete a wide range of on-going studies, to launch both in-house and collaborative studies with external associate researchers focused on the priorities already identified, and to bring to fruition the studies of system efficacy and utility. We will also begin studies of determinants of outcomes for adolescents and young adults (AYA) in collaboration with our adult colleagues, with the anticipation of improving outcomes for this neglected group of cancer patients.