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Pediatric Oncology Services

Introduction

Lucile Packard Children's Hospital at Stanford (LPCH) is a tertiary care referral center and community hospital devoted exclusively to the care of children and expectant mothers. The hospital opened in 1991 adjoining the east wing of Stanford University Hospital on the Stanford campus in Palo Alto, California and is now ranked as one of the nation's top ten pediatric hospitals by U.S. News & World Report. Packard Children's offers patients locally, regionally, and nationally a full range of health-care programs and services-from preventive and routine care to the diagnosis and treatment of serious illness and injury. Associated with Stanford School of Medicine, LPCH provides pediatric and obstetric medical and surgical services, including Pediatric Intensive Care, Hematology/Oncology, Pediatric Surgery, and Pediatric Transplant Surgery.

The pediatric oncology program at Lucile Packard Children's Hospital is renowned for delivery of comprehensive, multidisciplinary care to children and adolescents with cancer. Pediatric oncologists incorporate the expertise of multiple specialists such as pediatric surgeons, pediatric radiation therapists, pediatric rehabilitation, pediatric radiologists, child play therapists, school liaisons, and nurse practitioners. This multidisciplinary team is dedicated to providing comprehensive physical and psychosocial care to families learning about and living with the illness.

The pediatric oncology faculty is highly trained in translational and laboratory research as well as state-of-the-art clinical care, and is internationally renowned for helping to promote advances in the understanding and treatment of childhood cancer. Diagnostic evaluation and therapeutic management plans for children with malignant diseases include but are not limited to the following conditions:

• Brain Tumors

Ewing's Sarcoma

• Germ Cell Tumors

• Hodgkin's Disease

• Leukemia

• Liver Tumors

• Neuroblastoma

• Non-Hodgkin's Lymphoma

• Osteosarcoma

• Rhabdomyosarcoma

• Wilms' Tumor


Special Expertise

• Brain Tumors

• Hodgkin's Disease

• Late Effects/Long-Term Survivorship

• Leukemia

• Non-Hodgkin's Lymphoma

• Resistant Cancer and New Agents

• Sarcomas of Bone and Soft Tissue

• Stem Cell Transplantation

General Information

Pediatric Referrals

650.497.8953
Nights and weekends: 650.497.8000

Location

Palo Alto, California

Facility Description

Lucile Packard Children's Hospital at Stanford is a 264-bed hospital with 2,074 employees, 704 staff physicians, and more than 2,300 volunteers and auxiliary members who strive every day to make this center a safe haven for sick children. Built in a circular design around a central courtyard, the hospital has numerous gardens and outdoor play areas, including a spacious roof garden.

Lucile Packard Children's Hospital at Stanford is a state-of-the-art facility with a Hematology/Oncology unit dedicated to inpatient cancer care. The unit is staffed by individuals trained in the specialized needs of pediatric cancer patients and includes appropriate isolation rooms for children undergoing stem cell transplantation.

The hospital also includes a Day Hospital serving children requiring specialized medical treatment such as intravenous infusions and chemotherapy that does not necessitate an overnight stay.

Travel Assistance

Lucile Packard Children's Hospital offers travel assistance and coordinates transportation. For more information, please contact the Housing Program at

650.498.2569.

Lodging

Social workers assist in lodging arrangements for families.

Ronald McDonald House at Stanford provides a "home-away-from-home" and support for families of children receiving treatment at Lucile Packard Children's Hospital or Stanford Medical Center. As medical treatments evolve, an increasing number of children stay at the House as outpatients while receiving treatment. All requests for housing families can be made directly to Ronald McDonald House by calling
650.470.6000. Priority is given to families living over 30 miles away.

The Homes With a Heart Program was established to provide temporary housing-when the Ronald McDonald House is full-to family members of children receiving treatment at Lucile Packard Children's Hospital. The program brings out-of-town patient families together with volunteer hosts who live near the hospital. The Hotels with a Heart program places parents whose children are suffering from life-threatening illnesses in hotels on a complimentary basis. Families are selected for placement based upon financial need and distance traveled. For more information, please contact the Housing Program at 650.498.2569.

Social Support

Extensive psychological and social support is offered to pediatric cancer patients and their families. Every family of a pediatric cancer patient is assigned to a social worker. There is a school within Lucile Packard Children's Hospital and teachers also offer bedside teaching for students unable to attend classroom sessions.

Apple and Hewlett Packard computers are available for student use in the classrooms and at the bedside. Activities include word processing, educational programs, and some recreational programs. There is also an active Child Life program and a summer camp for Bay Area children with cancer.

A chaplain is available to provide spiritual and emotional support to LPCH inpatients and their families 24 hours a day, seven days a week.

International Medical Services (IMS) offers special services for patients and their families who come from outside of the United States for care and assures that international patients receive personalized services during and after their visits.

Lucile Packard Children's Hospital offers timely medical interpretation and translation services for all non-English speaking patients and families. Services for Spanish and other languages are provided in person and/or by phone, 24 hours a day, seven days a week. Sign language and third language interpretation services are offered by the LPCH Language Bank.

Financial Assistance

Financial counselors assist patients and families with financial matters related to medical care.

Home Health Care

Social workers offer crisis intervention, information, and referral to community agencies and other services.

Ages Treated

Children and young adults of all ages are treated.

Clinical and Research Information

Director, Hematology/ Oncology Stem Cell Transplantation

Michael P. Link, MD

Multidisciplinary Teams

All members of the Lucile Packard Children's Hospital staff are specially trained to meet the needs of children and families. Every team member is dedicated to the philosophy of caring for the whole child, including his or her physical, emotional, developmental, and social needs. Each patient has an assigned attending physician, social worker, and nurse practitioner who work with the child and family from diagnosis through long-term follow-up. Surgeons and radiotherapists are an integral part of this care.

Cooperative Group Membership

All oncologists are members of the Children's Oncology Group (COG); all patients are eligible for treatment protocols used by this national cooperative group.

Cooperative Group Activities

Investigators hold leadership positions in COG.

Average Number of Pediatric Clinical Trials

75

Pediatric Clinical Trials Coordinator

Debon Cochrane, CCRA
650.736.7798

Research Efforts

Examples of studies in progress are:

• to determine whether new drugs will improve survival in children with osteosarcoma

• to find novel ways to treat children with brain tumors

• to optimize outcomes for children requiring bone marrow transplantation

• to investigate possible environmental causes of childhood cancer

• to learn more about the psychosocial impact of childhood cancer on the family and the best way to provide support for cancer survivors

• to investigate mechanisms that allow cancer cells to escape killing by chemotherapy drugs and mechanisms of cancer cell growth to find new approaches to interrupting this cycle

Special Expertise

Brain Tumors

A multidisciplinary team of experts in Neuro-Oncology, Neurosurgery, Radiotherapy, and Neuroradiology have established a nationally recognized program for children with brain tumors. These physician scientists are key investigators for innovative therapeutic studies from the Children's Oncology Group, Pediatric Brain Tumor Consortium, and other regional groups. At Lucile Packard Children's Hospital, this physician team meets weekly for the region's only pediatric-dedicated Neuro-Oncology Tumor Board. The service's Neuro-Oncology clinic provides comprehensive care to address physical, educational, social, and emotional needs of children affected by brain tumors and their therapies.

Hodgkin's Disease

Investigators at Stanford are recognized internationally as experts in the treatment of Hodgkin's disease. Management of children with low-dose radiation combined with chemotherapy was pioneered at Stanford and has become the standard around the world. Innovative new therapies designed to minimize toxicity for children with favorable prognosis and intensifying therapy for those with less favorable clinical features are the focus of current studies.

Late Effects/Long-Term Survivorship

The pediatric group at Stanford/LPCH is part of a national study of 25,000 survivors of childhood cancer and places special emphasis on the assessment of cardiac, pulmonary, and neurocognitive late effects.

Leukemia

Investigators at Stanford are leaders in dissecting the immunology of acute lymphoblastic leukemia and in discerning the molecular events that underlie leukemogenesis. Researchers are nationally recognized for studies directed at reversing multi-drug resistance in leukemia and applying these findings to the treatment of children with refractory leukemia and those with newly diagnosed acute non-lymphocytic leukemia.

Non-Hodgkin's Lymphoma (NHL)

Investigators from Stanford are internationally recognized experts in the management of non-Hodgkin's lymphomas in children. Stanford faculty have played a key role in the development of cooperative group protocols for children with NHL and have coordinated efforts in early stage NHL for the past 15 years.

Resistant Cancers and New Agents

Stanford has an NIH-funded pediatric clinical research center that is dedicated, in part, to testing new therapies for children with advanced refractory cancer. Novel anti-cancer agents including monoclonal antibodies or immunotoxins specifically directed against leukemias, differentiating agents to induce tumor growth arrest, targeted radiotherapy, and other new cancer chemotherapeutic drugs are administered to children with refractory cancer. In addition, important laboratory/clinical efforts directed at elucidating and overcoming mechanisms of drug resistance is an important part of the Pediatric Oncology program.

Sarcomas of Bone and Soft Tissue

Physicians at Stanford have established multidisciplinary programs in sarcomas of bone and soft tissue led by international experts in Pediatric Oncology, Radiation Oncology, Orthopedic Oncology, and Pathology. There is a strong commitment for optimal individualized tumor management with preservation of maximum function. Investigators from Stanford have had major leadership roles in important trials in malignant bone tumors, demonstrating the role of adjuvant chemotherapy in the treatment of osteosarcoma, the safety of reducing the volume of radiotherapy in treating Ewing's sarcoma, and the efficacy of intensified regimens for the treatment of Ewing's sarcoma and osteosarcoma.

Investigators from Stanford have played leading roles in the Intergroup Rhabdomyosarcoma Study Group (IRSG) and have major input in the design of biologic and therapeutic studies for children with Rhabdomyosarcoma. Studies of the IRSG enroll almost all children with Rhabdomyosarcoma in the United States and Canada.

Stem Cell Transplantation

Stanford has a very active pediatric stem cell transplantation program specializing in transplants for hematologic malignancies, solid tumors, and genetic disorders. The program provides transplants using a variety of stem cell sources including autologous, purged autologous with tumor cell removal, unpurged peripheral blood stem cells, autologous transplants including both bone marrow and peripheral blood stem cells from related and unrelated donors, partial mismatches with stem cell manipulation, and cord blood transplants.

Diseases treated include malignancies such as acute or chronic leukemia, Hodgkin's or non-Hodgkin's lymphoma, and selected pediatric solid tumors such as neuroblastoma and rhabdomyosarcoma.

Lucile Packard Children's Hospital is a designated CCS Bone Marrow Transplant Center and Center of Excellence. The pediatric BMT service is an approved transplant center for Children's Oncology Group protocols.

Statistics

Percent of children treated in each age range

Age Range

0-1

2-5

6-12

13+

Percent Treated

12%

27%

29%

33%

Pediatric Oncology Program, 2005

No. of Inpatient Beds

No. of Oncologists

No. of Admissions

Average Length of Stay (days)

No. of New Outpatients

Total Outpatient Visits

No. of Bone Marrow Transplants

16

10

1,028

7.3

159

11,447

23