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Dana-Farber/Brigham and Women's Cancer Center
Massachusetts General Hospital Cancer Center
Boston, Massachusetts
Dana-Farber/Brigham and Women's Cancer Center 877-DFCI-BWH
Massachusetts General Hospital Cancer Center 877-789-6100
www.dfbwcc.org
www.massgeneral.org/cancer

Pediatric Oncology Services

Introduction

Pediatric oncology services are provided through a collaborative program between Dana-Farber Cancer Institute and Children's Hospital Boston. This more than 60-year old partnership, known as Dana-Farber/Children's Hospital Cancer Care, offers the combined strengths of one of the nation's leading cancer research and treatment institutions and one of the premier pediatric medical centers to provide state-of-the-art care for children, adolescents and young adults with cancer. Outpatient care is provided at Dana-Farber's Jimmy Fund Clinic, while inpatient care and certain outpatient procedures occur at Children's. These two neighboring institutions function as one to provide continuity of care for children with cancer.

The pediatric oncologists at Dana-Farber and Children's have expertise in the management of all childhood cancers and are world-renowned experts in the areas listed below.

Special Expertise

• Acute Lymphoblastic Leukemia

• Bone Marrow/Stem Cell Transplantation - malignant and non-malignant disorders, immunodeficiencies, and inherited disorders like Fanconi anemia

• Bone Tumors - Ewing's Sarcoma and Osteosarcoma

• Brain Tumors

• Clinical Trials and Research

• Germ Cell Tumors

• Graft-vs.-Host Disease

• Histiocytosis

• Late Effects and Childhood Cancer Survivorship

• Lymphomas - Hodgkin's Disease and non-Hodgkin's Lymphoma

• Solid Tumors - Rhabdomyosarcoma, other soft tissue sarcomas, Neuroblastoma, Wilms' Tumor, head and neck tumors of childhood

• Psychosocial Services

• Radiation Oncology

General Information

Location

Boston, Massachusetts

Referral/Consult Line

Dana-Farber/Children's Hospital Cancer Care - 888.PEDI.ONC (733.4662)

Pediatric Patient Coordinators

General Oncology - 617.632.5508

Stem Cell Transplant - 617.632.3961

Neuro-Oncology - 617.632.2680

Survivor Center - 617.632.5124

Physical Plant

Dana-Farber's Jimmy Fund Clinic is specifically designed for the comfort and convenience of pediatric cancer patients and their families, including a playroom and separate infusion rooms (chemotherapy and stem-cell support) for young children and teens. Three units at Children's are dedicated to pediatric oncology, one each for:

1) patients undergoing stem-cell transplantation

2) those with brain tumors

3) patients with all other types of cancers

In 2008, the stem cell transplantation unit added a special room for neuroblastoma patients receiving MIBG treatment.

Each unit has its own activity room, staffed by a Child Life Specialist.

Children's also has an intraoperative MRI, enabling neurosurgeons to perform image guided surgeries for hard to resect brain tumors.

Ages Treated

New patients must be under 18; there are no age restrictions on existing patients.


Travel Assistance

A resource specialist or social worker helps families deal with practical issues, from financial matters, housing, and travel assistance to referrals for community resources.

Lodging

Social workers assist in coordinating rates and lodging arrangements for families. A Ronald McDonald House, which provides housing for general oncology and stem cell transplant patients, is nearby. Dana-Farber/Children's Hospital Cancer Care also offers housing for out-of-state families through Children's Devon-Nicole House, located just blocks from the hospital.

Social Support

Patients are assigned a social worker and/or psychologist upon admission. Child life specialists support both inpatient and outpatient activities. Resource centers provide educational materials about a variety of topics such as support groups, information about cancer topics, and internet access. Specialists also offer counseling, tutoring, and psychosocial support groups.

Home Health Care

Home health care is arranged. The Dana-Farber/Children's Hospital Cancer Program supplements traditional home health care by offering home visits for newly diagnosed patients. This service, called Hospital to Home, helps patients and families adjust to managing care at home. Home Hydration is also offered for eligible patients providing an alternative to long inpatient stays.

Leadership

Chairman of Pediatric Oncology

Stuart H. Orkin, MD

Clinical Director of Pediatric Oncology

Lisa Diller, MD

Director, Pediatric Oncology Clinic

Lewis Silverman, MD

Medical Director, Pediatric Oncology Outpatient Clinic

Kimberly Davies, MD

Director, Pediatric Neuro-Oncology

Mark W. Kieran, MD, PhD

Stem Cell Transplant Program Director

Leslie Lehmann, MD

Clinical and Research Information

Multidisciplinary Teams

To ensure continuity of care, patients and their family members have one primary team of providers. This multidisciplinary team is led by a pediatric oncologist and includes a pediatric oncology fellow or nurse practitioner, pediatric oncology registered nurses, a social worker, child life specialist and other pediatric specialists such as radiation oncologists, oncologic surgeons, and psychologists as needed.

The pediatric cancer team meets regularly to discuss each patient's condition and recommends a personalized treatment plan. Our pediatric cancer team practices family-centered care. Therefore, parents and family members are an integral part of the treatment team and are encouraged to be involved as much as possible.

Cooperative Group Membership

• Children's Oncology Group (COG) - Phase I Center

• Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium

• Histiocyte Society

• Pediatric Blood and Marrow Transplant Consortium

• Pediatric Brain Tumor Consortium (PBTC), participating member

• Pediatric Oncology Experimental Therapeutics Investigators Consortium (POETIC)

• New approaches to Neuroblastoma Therapy (NANT)

Activities in Cooperative Group

Our physicians participate in the following committees through the Children's Oncology Group:

• Bone and Soft Tissue Sarcoma

• Bone Marrow/Stem Cell Transplant

• Brain Tumor

• Leukemia

• Non-Hodgkin's Lymphoma

• Retinoblastoma

• Late Effects Group

• Lymphoid Relapse

• Myeloid Disease

• Neuroblastoma and Epidemiology

• Phase I Subcommittee on New Agents

• Pharmacology, Psychology, Radiation Oncology, Surgical Discipline, Germ Cell Tumor, and Wilms' Tumor Committees

Average Number of Pediatric Clinical Trials

60

Research Efforts

Major research initiatives are underway in the following areas:

• Anti-angiogenesis in the treatment of pediatric brain tumors

• Brain stem tumors or gliomas

• Brain tumors – recurrent or progressive

• Brain tumors – recurrent or progressive Medulloblastoma

• Cancer Genetics

• Ependymoma

• Ewings

• Gene therapy

• Hodgkin disease and Non-Hodgkin lymphoma

• Immunology

• Leukemia – Precursor B Cell

• Low-grade pediatric brain tumors, including astrocytoma

• Medulloblastoma

• Neuroblastoma

• Osteosarcoma

• Pediatric low-grade astrocytoma

• Progeria

• Quality of Life Outcomes

• Renal tumors

• Retinoblastoma

• Rhabdomyosarcoma

• Solid tumors

• Stem cell transplantation: autologous transplant for brain tumors and neuroblastoma, including the use of MIBG, management of post-transplant pulmonary complications, the role of double umbilical cord blood transplant and reduced-intensity transplants for aplastic anemia.

Special Expertise

Acute Lymphoblastic Leukemia

Treatment programs for acute lymphoblastic leukemia cover newly diagnosed and relapsed patients. Dana-Farber Cancer Institute leads a cooperative group in the investigation of newly diagnosed acute lymphoblastic leukemia and is the recipient of a program project grant from the National Cancer Institute for these endeavors. The Acute Lymphoblastic Leukemia program has numerous publications and is considered a model for the world.

Bone Marrow/Stem Cell Transplantation

The Stem Cell Transplantation program at Dana-Farber and Children's is one of the oldest and largest programs in the nation. It remains a pioneer in areas such as the treatment of high-risk solid tumors, infant transplantation, and other specialized protocols. Types of conditions treated include:

• bone marrow failures, including Fanconi anemia

• Leukemias: acute lymphocytic leukemia, acute myelogenous leukemia, chronic myeloid leukemia

• lymphomas

• primary immunodeficiencies, including severe combined immunodeficiency syndrome

• inherited blood disorders, such as sickle cell disease, and

• solid tumors, including neuroblastoma, brain tumors and Wilms' tumor, among others.

The 13-bed transplant unit combines state-of-the-art filtration and infection control with comfort for patients and parents. In 2008, the unit added a lead-lined room used for neuroblastoma MIBG treatments. Patients have their own television and computers, with easy access to the hallway area, nurse's station, and playroom. All patient rooms are equipped with a bed and closet so one parent can always stay with their child.

Bone Tumors-Ewing's Sarcoma and Osteosarcoma

An accomplished multidisciplinary team, consisting of an orthopedic surgeon, two pediatric oncologists, and a radiotherapist, provides comprehensive care for patients with bone tumors. Each member of this team also leads efforts with the Children's Oncology Group.

Brain Tumor /Neuro-Oncology Program

Dana-Farber and Children's Brain Tumor program is the largest in the region. World-class neurosurgical staff use the latest technologies, including operating with microscopes, the latest MRI techniques, and new focal radiotherapy procedures. Children's also offers the Intraoperative MRI, which is used to optimize tumor resection. Stereotactic radiotherapy used to treat small tumors more precisely. The team offers multiple Phase I studies, including investigator-initiated studies as well as those offered through collaborative research groups, such as the Pediatric Oncology Experimental Therapeutics Investigators Consortium (POETIC). After treatment, Dana-Farber's Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic provides specialized care for patients dealing with long-term effects caused by treatments, including the Back to School program.

Germ Cell Tumors

A multidisciplinary team of oncologists, pediatric surgeons and pediatric gynecologists provides treatment of germ cell tumors. Treatment protocols are generally those used by the Children's Oncology Group.

Graft-vs.-Host Disease

Research expertise in immunology and the effects of immuno-suppression drugs are applied to bone marrow and stem cell transplant reactions. Patients are seen in a multidisciplinary clinic focused on chronic GVHD and on late effects and follow-up.

Late Effects

Dana-Farber Cancer Institute operates an extensive quality of life/late effects clinic for young cancer survivors called The David P. Perini, Jr. Quality of Life Clinic. This multidisciplinary clinic offers the expertise of pediatric oncologists, radiation oncologists, endocrinologists, cardiologists, dentists, psychologists, advanced practice nurses, and many other experts to evaluate and provide aid for patients who have previously received treatment for childhood cancers. Research efforts include the long-term side effects of many drugs including anthracyclines and cyclophosphamide. Recently the team also published two Transition to Survivorship notebooks, which offer patients and families post-treatment guidelines.

In addition, the neuro-oncology team offers a separate clinic for pediatric brain tumor survivors, called the Stop & Shop Family Pediatric  Neuro-Oncology Outcomes Clinic. This program provides specialized care for patients dealing with long-term effects caused by treatments, including the Back to School program.

Lymphoma-Hodgkin's and non-Hodgkin's Lymphoma

A multidisciplinary team supervises the care of all patients with Hodgkin's disease and non-Hodgkin's lymphoma. This team consists of pediatric oncologists, radiation oncologists, and surgeons, all nationally prominent in the care of patients with lymphomas.

Non-Bone Solid Tumors-Rhabdomyosarcoma, Neuroblastoma, and Wilms' Tumor

A multidisciplinary team is dedicated to the care of patients with non-bone solid tumors. The team consists of a pediatric oncologist, a dedicated oncologic surgeon, and a radiation oncologist.

Psychosocial Services

Psychologists, social workers, and resource specialists offer a wide range of supportive services to help patients and families manage the emotional and practical challenges raised by a cancer diagnosis and its treatment. Psychosocial experts work closely with the child's medical teams, as well as with other staff members involved in caring for the child and family. Services are available on a short or long-term basis throughout the child's treatment, including: individual and family therapy, play therapy, behavioral interventions and strategies to manage anxiety, pain, or stress, support groups, consultation with schools, information about insurance and other financial matters, and psycho-education.

Radiation Oncology

This program offers state-of-the-art technologies, some available at only a few medical centers in the nation. These include a unique two-headed linear accelerator for total body irradiation given prior to transplantation. a radiation simulator, which allows radiation treatment to be carefully mapped out in advance for optimum treatment with minimum exposure, and a unique two-headed linear accelerator for total body irradiation given prior to transplantation. If needed, pediatric anesthesiologists provide procedural sedation. The team may also prescribe proton beam therapy, when necessary.