Chapter 07: Survivorship: A New Section of Pediatrics II

Chapter 07: Survivorship: A New Section of Pediatrics II

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Description

Dr. Jaffe explains that he was recruited to MD Anderson to expand the solid tumor section in the Department of Pediatrics and to develop new initiatives to work with survivors of childhood cancer, based on his previous work at the Dana-Farber Institute. He lists complications that patients develop after cancer treatment: reproductive issues, effects on growth and cognitive function (for children given head and neck treatments). He notes that the new survivorship initiative at MD Anderson produced twenty publications, and that it was a unique entity, an entirely new section of pediatrics.

Identifier

JaffeN_02_20120817_C07

Publication Date

8-17-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Contributions to MD Anderson; Joining MD Anderson; Influences from People and Life Experiences; The Researcher; The Clinician; Contributions; Building/Transforming the Institution; Definitions, Explanations, Translations

Transcript

Tacey Ann Rosolowski, PhD:

And so you arrived at MD Anderson in 1978.

Norman Jaffe, MD :

Correct.

Tacey Ann Rosolowski, PhD:

And what did you see yourself setting out to do?

Norman Jaffe, MD :

I was recruited to MD Anderson Cancer Center in the pediatric department for two particular reasons. Dr. van Eys wanted me to take over Sutow’s positions and to expand the section on solid tumors. In fact, I was given the title Chief of the Solid Tumor Service, and also he asked me to expand the late survivor situation as well. I had already started a late survivor investigation and follow-up clinic at the Dana-Farber Cancer Institute. That clinic was already in existence at the Pediatric Department at the MD Anderson Cancer Center, but it was not very well developed at that time. It was running along quite smoothly, but it required a great deal of effort and industry to expand it and to expand all the aspects of solid tumors rather than just simply to see follow-up patients who were cured of these tumors, because these patients were now developing complications. They were developing problems related to the chemotherapy, problems related to their survival and so on, and it needed to open up a new avenue of research. And in fact, I immediately set upon creating a grant for that particular aspect, which was, incidentally, very well received, but unfortunately, funding at that particular time was at a low ebb, so it could not be funded satisfactorily. But we continued to expand on it, and Dr. Hugh Ried, who was in charge of that clinic, was maintained as the individual to be in charge, and I supervised him together with another person, Hallie Zietz, who was a nurse practitioner, a very, very competent woman. And between Dr. Ried, Hallie Zietz, and myself, we expanded that very, very well, to the extent that I think we published approximately twenty publications on our work in the follow-up clinic of long-term survivors. But my main emphasis was on expanding and developing the solid tumor section from Wataru Sutow, which I did.

Tacey Ann Rosolowski, PhD:

Just a quick question about that funding for the survivorship initiative—was funding in general difficult to get at that time for all research, or was it survivorship? I was just curious if there was less interest in survivorship for some reason.

Norman Jaffe, MD :

There was, actually. That’s quite correct. It was only in its embryonic stage at that stage, but I had actually started the first long-term survivor clinic at the Dana-Farber Cancer Institute. In fact, Dr. Fred Li, who unfortunately developed several complications, I think he developed a stroke at some stage in his career and could no longer continue his work, but he and I started the long-term survivor clinic at the Dana-Farber Cancer Institute, and I think one of the first publications, if not the first publication, I published on long-term survivor complications from chemotherapy.

Tacey Ann Rosolowski, PhD:

I think it was in 1975, because I noticed how early— It was so early.

Norman Jaffe, MD :

But there was no recognition of the problems and difficulties and complications which could occur in long-term survivors at that time because, quite frankly, long-term survivors were a new entity. People did not expect patients to survive to be cured of their cancers, the children, at that particular time.

Tacey Ann Rosolowski, PhD:

Now, did you notice that children developed secondary effects or side effects more quickly than adults who were survivors?

Norman Jaffe, MD :

Well, I can’t tell you about adults because I didn’t treat adults, but I began to recognize these long-term complications quite soon as I saw them in their followup, and as a consequence of that I published—I think it must have been the first paper on long-term effects from chemotherapy and radiation therapy in long-term survivors of childhood cancer.

Tacey Ann Rosolowski, PhD:

I’m sure we’ll come back to this, but just quickly, so we have an idea right now, what were some of those effects that you saw?

Norman Jaffe, MD :

There were problems in growth and development. There were problems in reproductive function. There were problems in intellectual issues, patients who had received radiation to the head. Practically every organ or system in the body could be tainted with a long-term complication. This developed more and more, so much so that when Melissa Hudson, who was my fellow at the MD Anderson Cancer Center some ten or fifteen years later, was doing her fellowship and I interested her in this—and she has made a remarkable development and published numerous publications on the long-term survivor complications in childhood cancer, and it’s been recognized now as a unique entity in this. Most of the pediatric publications, journals and so on, talk about quality of life, talk about long-term complications and things of that nature.

Tacey Ann Rosolowski, PhD:

So it was really groundbreaking.

Norman Jaffe, MD :

Absolutely, it’s an entirely new section of pediatrics.

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Chapter 07: Survivorship: A New Section of Pediatrics II

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