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Pediatric Oncology

Introduction

The Vanderbilt Childhood, Adolescent and Young Adult Cancer Program is a collaboration of the Vanderbilt-Ingram Cancer Center and the Monroe Carell Jr. Children's Hospital at Vanderbilt, a free-standing children's hospital which opened in 2004. Its faculty are cancer center members and fully integrated in center programs and initiatives. The Division Director, Dr. Debra Friedman as well as several of the faculty participate in several Vanderbilt-Ingram Cancer Center (VICC) committees and in the clinical trials program. Drs. Friedman also serves as the co-leader of the VICC Cancer Health Outcomes and Control Research Program.

Special Expertise

  • Phase I, II and III Clinical Trials
  • Leukemia and Lymphoma
  • Bone and Soft Tissue Sarcomas
  • Solid Organ Malignancies
  • Brain and spinal cord tumors
  • Retinoblastoma
  • Stem Cell Transplantation
  • Immunodeficiency
  • Cancer Survivorship
  • Adolescent and Young Adult Cancer


General Information

General Information

615.936.1762

www.vanderbiltchildrens.com/cancer

Referring Physician Line

615.936.1762

Location

Nashville, Tennessee

Physical Plant

Clinical care is delivered in the Monroe Carell Jr. Children's Hospital at Vanderbilt, a free-standing children's hospital opened in 2004 that includes a 19-bed unit self-contained HEPA-filtered wing that includes family gathering and patient play areas.

Lodging

Close relationship with the Ronald McDonald House, located just a few blocks from the hospital, and the American Cancer Society's Hope Lodge.

Social Support

Cancer patients and families have access to all of the support services of the Children's Hospital, including the Junior League Family Resource Center, Child Life Services, Hospital School Program, and a School Re-entry Program.

The psychosocial team is composed of 2 social workers, 2 child life specialists, a child psychologist and the Children's Hospital chaplain. There is also a dedicated pediatric palliative care team available to our patients and families. Specialized neuropsychological testing is also provided by the child psychology team in support of the brain tumor and survivorship programs.

Home Health Care

Vanderbilt Children's Home Care Program offers a variety of home care services. For patients and families who are not in the Vanderbilt Home Care catchment area, our nurse case managers assist with finding local services.  All home care services cater to the individual needs of patients.

The quality and level of care is in complete agreement with Children's Hospital standards, ensuring safe and effective treatment with all the benefits of home. As an affiliate of Vanderbilt University Medical Center, we offer family-centered care with a team approach to infants and children who require specialized services.

  • Children's Home Care Team-Our clinical staff is trained in the home care of pediatric patients and provides care under physician order.
  • Nursing-Hands-on care in the home is provided by nurses who teach parents and children about care in the home, based on their individual needs.
  • Rehabilitation Services-Physical, speech and occupational therapists establish and carry out rehabilitation programs.
  • Medical Social Services-Services that enhance medical treatment and support, with goals to maximize the psychosocial functioning and adjustments of children and their parents at home.
  • Reimbursement Specialists-These specialists work closely with families and payers to minimize financial concerns.
  • Referral Process-One telephone call to Vanderbilt Home Care is all that is required to initiate service. Our intake staff will verify benefits and begin the process of admitting the patient for services.
  • Quality Improvement-Vanderbilt Home Care adheres to strict practice standards in providing pediatric home care services, enabling your patients to receive consistent quality care. Our internal quality improvement programs are based on standards set forth by state, federal and professional organizations.

Patient and Family Education-Pediatric home care nurses and rehabilitation therapists provide initial assessment, home care instruction and ongoing visit support. We assist our patients and families to overcome their fears and concerns about being at home. Working with the hospital staff, we aid the discharge process before the patient arrives home. All of these efforts are done with one goal in mind: a positive outcome for the patient and their family

Ages Treated

0-30

We work collaboratively with our medical and surgical oncologists in the care of our young adult patients and can treat older patients, particularly with pediatric cancers

 

Clinical and Research Information

Director, Vanderbilt Childhood Cancer Program

Debra L. Friedman MD, MS, Director, Division of Pediatric Hematology/Oncology, E. Bronson Ingram Chair in Pediatric Oncology.

 

Multidisciplinary Teams

A multidisciplinary team of the following specialists addresses the complex needs of young patients and their families before, during, and after treatment. This includes

  • Physicians
  • Nurses
  • Nurse Practitioners
  • Nurse Case Managers
  • Pharmacists
  • Nutritionists
  • Social Workers
  • Educational Specialists
  • Clergy
  • Psychologists
  • Child Life Therapists
  • Palliative Care Specialists
  • Surgeons
  • Pediatric subspecialists
  • Pathologists

Several multidisciplinary/multispecialty tumor conferences are held weekly.

Cooperative Group Membership

  • Children's Oncology Group (COG)
  • Pediatric Blood and Marrow Transplant Consortium
  • Center for International Bone and Marrow Transplant Research
  • Sarcoma Alliance for Research through Collaboration
  • Therapeutic Advances in Childhood Leukemia and Lymphoma
  • Neuroblastoma Medulloblastoma Translational Research Consortium

Activities in Cooperative Group

Several of our faculty have committee and other leadership positions, have led and participate in the development of clinical trials in these cooperative groups.  All of our faculty participate in the conduct of clinical trials.

Average Number of Pediatric Clinical Trials

100

Research Efforts

Scott Borinstein, MD, PhD, is the director of the pediatric sarcoma and Adolescent and Young Adult (AYA) oncology programs. His research interests are designed to improve the treatment and outcomes of children, teenagers, and young adults with cancer, translating discoveries from the bench to the clinic. His laboratory investigates the epigenetics of Ewing Sarcoma. Dr. Borinstein is involved in the development and implementation of clinical trials for sarcoma and AYA cancer patients, with a goal of integrating new drugs and protocols into our current cancer therapies that will improve the care of our patients.

James Connelly, MD, is the director of our immunohematology program, the Vanderbilt Comprehensive Hematology, Immunology, Infectious Disease Program which evaluates patients who have complex known or unknown syndromes that cross these disciplines. He is a member of our stem cell transplant team and specializes in transplant for nonmalignant disease. His research is focused on cancer and primary immunology as well as the long-term outcomes for stem cell transplant.

Michael DeBaun, MD, MPH, is the vice chair for clinical and translational research in the Department of Pediatrics, and directs the Vanderbilt-Meharry Sickle Cell Center of Excellence, as a leader in the care of children with sickle cell disease. His research has focused on understanding cerebrovascular injury, or stroke, in children with sickle cell disease, and improving management of their care. DeBaun's work is also focused on better defining the impact and biological reasons asthma increases sickle cell disease morbidity and mortality. He is principal investigator numerous NIH and foundation studies in this area. DeBaun is also an expert in genetic cancer predisposition syndromes. His work defined the natural history and biological basis of malformation and cancer in Beckwith-Wiedemann syndrome (BWS) as an epigenetic syndrome, related to the expression of DNA through cell division, or phenotype, rather than the structure of DNA itself. 

Adam Esbenshade, MD, MSCI, focuses on cancer control, brain and spinal tumors and survivorship. Areas of active investigation include prevention and treatment of obesity and metabolic syndrome in survivors, infectious disease complications during therapy, as well as clinical trials that focus on targeted therapy for central nervous system tumors.

Debra Friedman, MD, MS, is the Director of the Division of Pediatric Hematology/Oncology and has expertise in the area of hematologic malignancies and retinoblastoma. She is the co-leader of the VICC Cancer Health Outcomes and Control Research Program. Her research interests lie in the outcomes for pediatric and adult cancer survivors, as well as in the design of novel therapeutic protocols for childhood cancer, designed to decrease adverse long-term effects of therapy. She is a principal or co-investigator on grants funded by the NIH and several foundations and is an internationally recognized expert in cancer survivorship, participating in projects evaluating best practices and models of care. She is investigating a diverse group of physiologic and psychosocial outcomes among patients and long-term survivors of pediatric cancer, hematopoietic stem cell transplant and medical oncology. 

Richard Ho, MD, MSCI, is a member of our stem cell transplant team. His research, funded by the NIH and foundations, focuses on the molecular mechanisms by which drug transporters contribute to overall chemotherapy disposition and interindividual response to drug therapy in pediatric oncology. Drug transport proteins have important roles in regulating the absorption, distribution, and excretion of many medications as well as endogenous substances.  Another area of major focus is cancer pharmacogenetics, the study of the role of inheritance in the individual variation in chemotherapy response.  Projects are primarily laboratory based with translational promise and rely on background knowledge in the fields of molecular biology and clinical pharmacology. 

Howard Katzenstein, MD, is the Medical Director for the program and conducts clinical research in liver tumors, neuroblastoma, and innovative therapies for recurrent and resistant solid tumors.  In particular, he is interested in developing clinical trials for these disorders.  He currently serves as study chair for the COG trial for children with hepatoblastoma. 

Carrie Kitko, MD, is the Director of the Stem Cell Transplant Program and has expertise in the use of stem cell transplant for malignant disease and is a member of our immunohematology program. Her research focuses on the prevention, early detection, and novel treatment of graft versus host disease. With participation in multiple consortia funded by federal agencies and foundations, Dr. Kitko leads studies in biomarkers, photopheresis, and novel biologic agents for graft versus host disease. 

Heather McDaniel, MD, leads the thrombosis program and focuses on prevention and treatment of thrombosis in cancer and non-cancer patients. Her work also includes bone marrow failure syndromes, where she participates in clinical trials and is a member of the immunohematology program.

Devang Pastakia, MD, focuses on central nervous system tumors, participating in trials of standard and novel agents to improve outcomes. His research focuses on outcomes for brain tumor patients, working collaboratively with our surgical and psychosocial outcomes researchers.

Emmanuel Volanakis, MD, is interested in the genetic and epigenetic events that contribute to the pathogenesis and progression of acute leukemia and also conducts research in the pulmonary complications of sickle cell disease.

Allison Wheeler, MD, MSCI, focuses on bleeding disorders and leads our coagulation and blood bank efforts in pediatric oncology.

Special Expertise

Pediatric Stem Cell Transplant Program

Led by Carrie Kitko, MD, and staffed by dedicated oncologists, pediatric nurse practitioners, nurse coordinators and case managers, social workers and clinical pharmacists, this program provides comprehensive transplantation services, including allogeneic and autologous stem cell transplants, immunotherapy and treatment for graft versus host disease for children, adolescents and young adults with malignant and non-malignant disorders. A 19-bed HEPA-filtered stem cell transplant unit is located within the Children's Hospital. The program is an active participant in the National Marrow Donor Program, the Center for International Bone and Marrow Transplant Research and the Pediatric Blood & Marrow Transplant Consortium. The Pediatric Stem Cell Transplant Program is approved by the National Marrow Donor Program, the Bone Marrow Transplant Committee of COG and the Foundation for the Accreditation of Cellular Therapy (FACT), and is recognized as a Center of Excellence.

Pediatric Cancer Therapies Program

Led by Debra Friedman MD, MS, and Howard Katzenstein, MD, Vanderbilt participates in clinical trials of standard and novel agents through Children's Oncology Group, Pediatric Blood and Marrow Transplant Consortium, Center for International Bone and Marrow Transplant Research, Sarcoma Alliance for Research through Collaboration, Therapeutic Advances in Childhood Leukemia and Lymphoma and the Neuroblastoma Medulloblastoma Translational Research Consortium as well as through industry-sponsored trials. Research trials are integrated with standards of care to provide state of the art, cutting edge therapies to all patients, supported by our team of The team includes dedicated oncologists, nurse practitioners, nurse coordinators and case managers, social workers and clinical pharmacists.

The following unique programs incorporate in the same specialty program, surgical and pediatric oncology care:

Pediatric Brain Tumor Program

Led by Adam Esbenshade, MD, MSCI, and Devang Pastakia, MD, this program provides multi-disciplinary care for children with tumors of the primary central nervous system.  The team includes dedicated oncologists, neurosurgeons, nurse practitioners, nurse coordinators and case managers, social workers and clinical pharmacists.

Pediatric Retinoblastoma Program

Led by Debra Friedman, MD, MS, this program provides multi-disciplinary care for children with retinoblastoma, including localized ophthalmic treatment, intravenous, intra-arterial and intra-vitreous chemotherapy.  The team includes dedicated oncologists, ocular oncologists, ocular surgeons, ophthalmologists, interventional neuro-radiologists, nurse practitioners, nurse coordinators and case managers, social workers and clinical pharmacists.

Pediatric Bone and Soft Tissue Tumor Program

Led by Scott Borinstein. MD, PhD, this program provides multi-disciplinary care for children with tumors of the primary central nervous system.  The team includes dedicated oncologists, orthopedic surgical oncologists, nurse practitioners, nurse coordinators and case managers, social workers and clinical pharmacists.

The following programs represent specialized areas of collaboration with medical oncology:

REACH for Survivorship Childhood Cancer Survivorship Program

Led by Debra Friedman, MD, MS, this program, representing collaborative programs from the Vanderbilt-Ingram Cancer Center, the Department of Pediatrics, the Department of Medicine and the Vanderbilt University Medical Center, provides a full range of follow-up care designed to meet the unique health care needs of each survivor, serving survivors of both childhood and adult onset cancers. The team consists of oncologists and nurse practitioners who see patients and families for dedicated evaluations. In addition to the evaluations provided by the survivorship clinic, referrals are made for evaluations in other specialty clinics. The clinical services are coordinated with research opportunities in the VICC Cancer Health Outcomes and Control Program.

Adolescent and Young Adult Cancer Program

Led by Scott Borinstein, MD, PhD, the program represents a collaboration with the Vanderbilt-Ingram Cancer Center, Monroe Carell Jr. Children’s Hospital at Vanderbilt and multiple groups focused on adolescent and young adult cancer (Critical Mass, NCCN, Teen Cancer America, COG) to focus on the unique needs of this population of patients (ages 15 – 39) by enhancing access to clinical trials, providing psychosocial and financial support and developing specialized teams of clinical and research expertise

Statistics

Pediatric Oncology Program

No. of Inpatient Beds

No. of Admissions

Total Outpatient Visits

No. of Bone Marrow Transplants

No. of Oncologists

19-bed HEPA filtered myelosuppression unit plus additional oncology beds on adjacent units

1200

18,000

30

12