The Hematology/Oncology Division: A diverse, but focused group

 

The Division has 20 team members and benefits from having Canada’s first pediatric intra-operative magnetic resonance imaging (MRI) system. In addition to providing outstanding medical care, the Division is dedicated to ensuring that the psycho-social needs of its young patients are met. The Childhood Cancer Care Program includes psychologists; art, massage and music therapists; psychiatrists; nutritionists; child care workers; social workers; pharmacists; chaplains and specialized nurses. They help coordinate a comprehensive care plan for each child. The Neurosurgery-Oncology Clinic provides continuity of care and follow-up for patients with brain and spinal tumours. This team consists of neurosurgeons, neuro-oncologists and a radiation-oncologist.

 

As with many departments, nurses play a critical role. “Our nurses are extraordinary in juggling both day-to-day care, and liaising with outpatients,” says Ann Marie Suess, head nurse of the Hematology/Oncology Division. “They work with children in the hospital, in the community, as well as working with CLSCs and organizations such as Leucan to ensure patients and families receive the best possible care. Our nurses’ skills have been recognized through FACT (Foundation for the Accreditation of Cellular Therapy) accreditation. This means they have met requirements which demonstrate their commitment to controlling every aspect that impacts the quality of products and therapeutic care.”

 

Joshua benefited from the Childhood Cancer Care program and from the Division’s clinical expertise. Because his tumour was in such a vulnerable area, it could only be partially removed. Thanks to the intra-operative MRI, which gives immediate feedback during surgery, the majority of the malignancy was excised. This procedure alleviated the pressure on Joshua’s optic nerve and his vision was spared. The expertise present at the MCH starting with the seasoned neurosurgeons performing the surgery, the anesthesiologists who put the children to sleep through an often lengthy and delicate procedure and the radiologists who are available at all times to help interpret the images and advise on further surgery as needed in real time, make the program unique and a major asset in treating children with brain tumours within this institution.

 

“The Division is unique and strong,” says Dr. Whittemore. “Each of our teams is well trained, respected and plays very important roles in the management of the family and the patient.”

 

“We have a great interdisciplinary team that thinks outside the box,” agrees Ms. Suess. “For example we are continually looking for alternative paths that help families cope with the stress of diagnosis, whether it is meditation, pet therapy or helping children focus with personalized stones. Findings from our recent patient satisfaction survey confirm the extraordinary work that all team members do, from the nurses and the physicians to the pharmacists.”  

 

 

“People think that cancer is one word, one thing,” says Dr. Nada Jabado, a Montreal Children’s Hospital researcher and clinician, who studies brain tumours. “The truth is there are many different cancers. In particular, it is important to note that pediatric cancers are not at all the same as adult malignancies. There are differences in their biology and their responses to treatment.”

 

Researchers such as Dr. Jabado and her colleagues are investigating why therapies sometimes fail. “We are targeting those tumours which are resistant to treatment or relapse following treatment. This is where basic research has a huge role.”

 

Her work involves understanding the molecular events and pathways responsible for the formation of pediatric astrocytomas - the most common pediatric brain tumour. “We know tumours undergo cycles of growth. We want to know what is driving this and how to specifically target it with chemotherapy.”

 

Recently, Dr. Jabado and her colleagues made a major genetic breakthrough that could change the way pediatric cancers are treated in the future. The researchers identified two genetic mutations responsible for up to 40 per cent of glioblastomas in children - a fatal cancer of the brain that is often unresponsive to chemo and radiotherapy treatment.

 

"This research helps explain the ineffectiveness of conventional treatments against cancer in children and adolescents – we've been failing to hit the right spot," says Dr. Jabado. “It is clear now that glioblastoma in children is due to different molecular mechanisms than those in adults, and should not be treated in the same way. Importantly, we now know where to start focusing our efforts and treatments instead of working in the dark”.

 

Other MCH researchers, such as Dr. Janusz Rak, are studying the formation of the blood vessels (angiogenesis), which supply tumours. He believes by inhibiting the growth of these vessels, the tumour won’t receive necessary nutrients and will be starved. “This is a new way of treating cancer,” he says. Québec Science readers selected Dr. Rak's research as Discovery of the Year in 2008.

 

Determining the right therapy for various pediatric malignancies is a major challenge, as most drug testing is conducted on adults. According to Dr. Jabado, there are not many initiatives designed to find drugs for children, as clinical testing is difficult. Also, there are not enough children with specific types of cancers to allow trials that will provide statistically meaningful results.