It is widely accepted that young age at the time of a cancer diagnosis is a risk factor for poorer neurocognitive development. Tumours and cancer treatments that impact the central nervous system are believed to disrupt the brain growth and development that uniquely characterizes the first few years of life. These concerns have led to clinical trials focused upon modifying treatment protocols to decrease CNS-related insults while maintaining survival rates. However, comparison-controlled prospective studies of the neurocognitive development of infants with cancer are scarce and empirical investigations of interventions to address the poorer developmental outcomes of those diagnosed and treated for cancer during infancy are even more rare. This presentation will provide a review of the current literature regarding neurodevelopmental outcomes and interventions for infants with cancer. It will also summarize current gaps in our knowledge and provide suggestions for moving research and clinical care forward for this special population.
Melissa A. Alderfer, PhD
Senior Research Scientist, The Center for Healthcare Delivery Sciences
Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, DE
Associate Professor of Pediatrics
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
Dr. Alderfer completed a doctorate degree in clinical psychology at the University of Utah and a post-doctoral fellowship in pediatric psychology in the Division of Oncology at The Children’s Hospital of Philadelphia (CHOP). After fellowship, she stayed on in the Division of Oncology at CHOP and joined the standing faculty in the Department Pediatrics at Perelman School of Medicine at the University of Pennsylvania. She rose to the level of associate professor before transitioning in 2013 to her current position as a senior research scientist in the Center for Healthcare Delivery Sciences within Nemours Children’s Health System. Under the broad umbrella of healthcare delivery science, her program of research focuses on how childhood chronic illness impacts families, how families adapt and learn to manage illness and the healthcare system, and how we can intervene to improve the experience. Her research has been funded by the National Institutes of Health, American Cancer Society, and various other cancer foundations. She currently has 92 peer-reviewed manuscripts and chapters.
Furqan Shaikh, MD, MSc, FRCPC
Staff Oncologist, Solid Tumour Section, Haematology/Oncology
Project Investigator, CHES, Research Institute
Director, Fellow’s Continuity Clinic
The Hospital for Sick Children, Toronto, ON
Assistant Professor, Paediatrics
University of Toronto, Toronto, ON
Dr. Furqan Shaikh received his medical degree from Queen’s University in 2003. He completed his pediatrics residency at the Children’s Hospital of Eastern Ontario in Ottawa and a fellowship in Paediatric Haematology/Oncology at The Hospital for Sick Children in Toronto. Dr. Shaikh is a paediatric oncologist in the Solid Tumour Program within the Division of Haematology/Oncology at The Hospital for Sick Children, and an assistant professor of paediatrics at the University of Toronto. He is a member of the Germ Cell Tumor subcommittee of the Children’s Oncology Group.
While survival rates for childhood cancer have improved considerably, the diagnosis of cancer in a child remains dreadful for caregivers. Psychosocial reactions are especially intense during the first few months of treatment. Caregivers experience negative moods, depression and symptoms of post-traumatic stress disorder. They are distressed. These normal reactions potentially limit caregivers’ ability to advocate for their child and family. This presentation provides an overview of the development of an evidence-based intervention called Bright IDEAS designed to teach coping skills we hypothesized would alleviate distress in caregivers. Bright represents optimism and feeling empowered, and IDEAS represents: Identify the stressor, Define your options, Evaluate your options, Act out your plan, and See if it worked. The presentation traces findings across three randomized clinical trials using Bright IDEAS consistently showing: 1. acceptability to caregivers, 2. Efficacy, 3. teaching coping skills leads to less distress, and 4. no harm. Most significantly, data showing effects after treatment ends are also presented. Current efforts to disseminate within the pediatric oncology community will be discussed in the context of standards of care and training psychosocial professionals, as well as efforts to disseminate to additional cohorts of caregivers (sickle cell, pediatric rehab medicine).
Robert B. Noll, PhD
Children’s Hospital of Pittsburgh, Pittsburgh, PA
Professor of Pediatrics, Psychiatry, and Psychology
University of Pittsburgh School of Medicine, Pittsburgh, PA
Robert Noll completed a doctorate in clinical psychology and did his clinical specialty training in pediatric psychology at Michigan State University following completion of his undergraduate degree and five years of military service as a naval aviator. Upon completion of his doctorate, he accepted a faculty position at Michigan State University in the Department of Pediatrics and Human Development. Dr. Noll subsequently went to Cincinnati Children’s Hospital Medical Center where he served as the director of psychosocial services in the division of hematology/oncology. From 2004-2011, he served as the medical director for behavioral health, and division director of developmental and behavioral pediatrics at Children’s Hospital of Pittsburgh. He served from 2006-2016 as chair of the Behavioral Science Committee within the Children’s Oncology Group. He has published extensively on psychosocial issues in pediatric oncology, notably documenting psychosocial difficulties for caregivers and subsequently developing evidence-based interventions. He is the author of more than 150 peer-reviewed publications and his pediatric oncology research has received funding from the National Cancer Institute, Alex’s Lemonade Stand, St. Baldrick’s Foundation and the American Cancer Society.
The use of ultrasound and other diagnostic modalities have permitted the diagnosis of many fetal conditions, including fetal tumours. This presentation will review the options for managing prenatally-diagnosed surgical conditions, including the use of a variety of fetal surgical interventions.
Jacob C. Langer, MD
Professor of Surgery
University of Toronto, Toronto, ON
Attending Pediatric Surgeon
The Hospital for Sick Children, Toronto, ON
Dr. Jacob C. Langer was educated and trained at the University of Toronto and The Hospital for Sick Children in Toronto. He did research fellowships at the University of California, San Francisco, and McMaster University, funded by the Ontario Ministry of Health, the Medical Research Council of Canada and the McLaughlin Foundation
Dr. Langer was assistant professor of surgery and pediatrics at McMaster University and a pediatric surgeon at the Children’s Hospital at Chedoke-McMaster from 1989 to 1992. He then moved to St. Louis and became associate professor of surgery and pediatrics at Washington University and a pediatric surgeon at St. Louis Children’s Hospital from 1992 to 1999. He came back to Canada in 1999 to become professor of surgery at the University of Toronto, and chief of the division of general and thoracic surgery at The Hospital for Sick Children, a position he held until 2012. He was also the inaugural holder of the Robert M. Filler Chair in Pediatric Surgery. Dr. Langer has travelled widely to operate, and to lecture on a variety of topics in pediatric surgery. He has received many prestigious honours, is widely published in peer-reviewed journals, and has authored many book chapters on a variety of subjects.
Regardless of whether an anti-cancer drug is in development or has been used in the clinic for over 50 years, the current approaches used to select a drug dosage for infants often lead to increased risk of morbidity and poor tumour control. This current dosing paradigm, which has grown out of an absence of data, normalizes adult dosages according to age, body weight or body surface area. However, the continued use of such practices in infants is contrary to current knowledge that maturation and development affect drug disposition and exposure-response relationships. This is particularly pertinent to infants with brain tumours. Contemporary treatment for infants with brain tumours has used craniospinal irradiation (CSI) to substitute or delay intensive chemotherapy to avoid the long-term morbidity associated with CSI. For many of the drugs used in these studies, the evaluation of the PK and PD has been inadequate, suffering from low numbers of subjects and heterogeneous populations. Therefore, it is crucial that comprehensive PK and PD studies are conducted of drugs used to treat infants with brain tumours as well as to study the pharmacologic response (e.g., toxicity, efficacy and long-term effects) to these drugs in a large controlled population.
Clinton Stewart, PharmD
Member, Pharmaceutical Department
St. Jude Children’s Research Hospital, Memphis, TN
Dr. Clinton Stewart completed his Doctor of Pharmacy at the University of Tennessee Health Science Center, Memphis. After completing a postdoctoral fellowship at St. Jude under the mentorship of Dr. William E. Evans, Dr. Stewart joined the University of Tennessee College of Pharmacy faculty as an assistant professor and was promoted to associate professor. In 1991, he joined the St. Jude faculty as an assistant member (equivalent of assistant professor) and has moved through the ranks to full member (equivalent of full professor).
He is an active member of the American Society of Clinical Oncology and the American Association of Cancer Research. His research efforts are focused in the area of pediatric clinical pharmacology, addressing clinically relevant problems of cancer therapeutics in infants and children. Current research efforts include the use of preclinical models to enhance design of clinical trials of new agents in children with cancer, and the use of pharmacokinetics (PK) and pharmacodynamics (PD) to optimize drug exposure in children with cancer. Dr. Stewart has authored or co-authored more than 275 peer-reviewed articles and book chapters. He is presently the co-chair of the Pharmacology Committee of the National Institutes of Health-funded Pediatric Brain Tumor Consortium.