Cancer Care (Oncology)

Top-Notch Care Gives Our Acute Lymphoblastic Leukemia (ALL) Patients the Very Best Chance at Life

The most common pediatric cancer diagnosis here at Nemours and nationwide is acute lymphoblastic leukemia (ALL), a type of cancer that affects the body’s white blood cells, which help fight infection and protect the body against disease.

Thanks to advances in therapy and clinical trials, the outlook for kids with ALL (also called acute lymphocytic leukemia) is extremely promising. And at Nemours we’re doing whatever it takes to help kids with cancer live—and live better and longer.

From 1994 to 2004, we’re proud to say that at Nemours Children’s Clinic, Jacksonville our overall 5-year survival rate (that’s the number of kids alive 5 years after diagnosis and the start of their treatment) was far better than the national average of 80%.

Of course, every child’s disease, prognosis, and treatment plan are different. But we treat each and every patient we see with the same level of high-quality care to get them the very best outcome we can.

How We Do It

When you bring your child to any of Nemours’ Divisions of Hematology/Oncology you can rest assured that you’re getting the very best cancer care available.

In addition to our highly skilled, experienced oncology care teams devoted to childhood cancer, we’re part of a worldwide group of children’s cancer specialists and institutions called the Children’s Oncology Group (or COG). That means every child treated for cancer at Nemours has access to state-of-the-art treatments proven to be the most effective—and clinical trials of promising new therapies that aim to reduce side effects and improve kids’ quality of life.

Nemours cancer specialists and team members also regularly meet as a group (called a “tumor board”) to discuss complex and unusual cases. While reviewing the cases in detail, the team members learn from each other and come up with the very best treatment plans for each child. This collaboration ensures that your child benefits from the combined knowledge and strength of cancer specialists in the Nemours health system. It’s like getting a second or third opinion without making an appointment at another medical facility.

Our Established Cancer Experience

When combining our patient numbers from our many Nemours locations in the North and South, we’re proud to say that we have one of the largest pediatric hematology/oncology programs in the country. In 2008 and 2009, we saw nearly 9,000 children with various illnesses at all of our locations offering hematology/oncology combined. Parents from all over the country and the world entrust our division with their children’s care.

But it’s not just about the numbers of patients we see. It’s about our commitment to using our expertise and experience to best serve all of the children who need us as if they were our very own— whatever it takes.

A Cure: Your Hope and Ours

At the Nemours Center for Childhood Cancer Research (NCCCR) our vision is to build one of the nation’s top childhood cancer research centers. We aim to become a leader in pediatric cancer research, developing innovative strategies to improve prevention, screening, diagnosis, and treatment of childhood cancers.

Opened in January 2008, with a $4-million investment from the Nemours Foundation, our new facility is located on the campus of the Nemours/Alfred I. duPont Hospital for Children (AIDHC) in Wilmington, DE. But our hope-filled efforts extend well beyond the doors of our facility.

The Director of the NCCCR, Ayyappan K. Rajasekaran, PhD, has established a framework of research focused on three key areas that are critical to attaining a 100% cure rate of childhood cancers with minimal side effects:

• identifying diagnostic biomarkers (biological features that can be used to measure the progress of a disease or treatment effects) for childhood cancers
• developing drug delivery approaches
• discovering new drugs to treat childhood cancers

“These areas of research are well developed for adult cancers but are at their infancy for childhood cancers,” says Dr. Rajasekaran. “Focusing on these research areas should make a difference in childhood cancer diagnosis and treatment, as well improve the quality of life of childhood cancer survivors.”

Our team of doctors and scientists (at Nemours’ locations throughout the DelawareValley and Florida) work together to increase our understanding of cancer. We collaborate with our clinical colleagues at Nemours Blood and Bone Marrow Transplant Programs (BBMT) and oncology (cancer care) clinics in Wilmington, DE, as well as Jacksonville, Orlando, and Pensacola, FL. Together we form a vast collection of experts dedicated to bringing new discoveries from the laboratory bench to the patient’s bedside.

But our expansive team approach to helping children with cancer doesn’t stop there. Our cancer clinicians, researchers, and students from the departments of Hematology/Oncology and Research at all four Nemours sites in Delaware and Florida meet monthly to share ideas and information on developments in the diagnosis and treatment of childhood cancers. 

Our shared goal is to discover new ways to improve the lives and futures of children with the disease (particularly the most common – central nervous system/brain tumors, leukemia, and lymphoma). We combine what we learn in the laboratory with what we see, every day, through treating kids with cancer in the hospital and at our clinics.

We aim to do “whatever it takes” to support research into finding new, better treatment options.   That’s why we’re striving to establish ourselves as a National Cancer Institute-designated center, where scientists, doctors, patients, families, and the community can come together to improve children’s health.

Pooling All of Our Resources to Help Kids

Nemours is proud to be part of a groundbreaking collaboration called the Delaware Health Sciences Alliance (or DHSA). This alliance allows our staff to use the vast resources at both Thomas JeffersonUniversity and the University of Delaware – where faculty members in Wilmington are on staff as instructors and professors at the academic institutions and where researchers have access to both universities’ research facilities. Through the alliance, our researchers work together to conduct clinical trials at the Christiana Care Helen F. Graham Cancer Center for adult cancers that affect families. And our team has access to the Delaware Biotechnology Institute’s state-of-the-art technology and instrumentation.

In Florida, we also collaborate closely with a wealth of renowned academic and health institutions in our research efforts. Our faculty members serve as instructors at FloridaState University in Pensacola and at the Mayo Clinic in Jacksonville, where we’re also working on several childhood cancer studies together. Nemours faculty members are able to be part of the teaching staff at the University of Central Florida as well. Plus, our collaboration with the University of Florida is enhancing our efforts toward a new brain tumor treatment.

We’ve also teamed with Supporting Kidds (an organization dedicated to helping grieving children and their families) to study the psychological stress in children who have siblings with cancer. And we’re working toward developing interventions designed to help all children cope when their families are touched by cancer.

Using Technology to Our Advantage

Our team members literally have at their fingertips a powerful resource tool called NemoursOne, which electronically connects our services and programs across all Nemours sites and contains a database of all patient medical records. The system also houses all of our research protocols, applications, letters, and communications with investigators.

NemoursOne allows clinicians to communicate – in real time – and view clinical notes, test results, and lab reports simultaneously. NCCCR investigators mine the wealth of valuable clinical data contained in NemoursOne to support their research projects.

A Glimpse at Our Many Endeavors

In our ongoing effort to provide hope and cutting-edge cures for cancer patients we’re constantly exploring research in a multitude of areas.

Among the most trailblazing discoveries by our clinicians and researchers was determining one of the causes of solid tumors. While studying the mechanisms involved in the conversion of normal cells to cancer cells, a team headed by NCCCR director Ayyappan K. Rajasekaran, PhD, found an early event in solid tumors: a malfunction of the pump that normally pumps sodium out of cells. This breakdown causes an increase in sodium inside the cell, which is believed to then set off a series of events that lead to the development of cancer. The implications are vast. The discovery provides new potential targets for therapy, which could mean better cancer detection and treatment.

Also putting us at the forefront of children’s cancer research is our pediatric tumor bank – one of only a few in the United States. Called the Nemours Tissue Procurement Laboratory (NTPL), our pediatric tumor bank allows our researchers to analyze tumor fragments from all Nemours Children’s Clinic locations in order to identify special signs that can help diagnose cancers early, predict how they may progress, and track the outcomes of treatment.

Yet another way we’re ahead of the curve, even in our center’s infancy, is our new lab with one clear, very important goal: to discover new drugs for childhood cancers. Although kids’ cancers are inherently different from those commonly seen in adults children are treated with drugs developed for grown-ups. Although these medications have saved the lives of many children, their side effects can be severe, often affecting the patient’s health and development well beyond childhood. That’s where our “High-Throughput Screening and Drug Discovery Laboratory” comes in.

The “high-throughput screening” (or HTS) technology enables the lab to quickly test thousands of chemical compounds to identify which ones can be developed into drugs, particularly ones to treat leukemia. Whereas conventional manual methods allow testing of just a few compounds at a time, HTS uses robotic equipment to screen thousands of potential drugs in a short time.

Leading the effort is Andrew Napper, PhD, who comes to Nemours from the University of Pennsylvania, where he was the Director of High-Throughput Screening for the Penn Center for Molecular Discovery, one of the original 10 centers established as part of the National Institutes of Health’s (NIH) Roadmap initiative. This roadmap provides a framework of the priorities NIH must focus upon in order to produce the most important and efficient research.

Whatever kind of research we’re working on at any given time, everyone involved in the Center feels proud to be part of such a promising vision and mission. “I think as a laboratory scientist there are resources here [at Nemours] that are harder to come by at other institutions. The foundation’s and the organization’s commitment to research is fantastic,” says E. Anders Kolb, MD, Director of the Blood & Bone Marrow Transplant Program (BBMT) and Head of the Cancer Cell Therapy Laboratory at AIDHC. “The growing excitement about the cancer research effort is fun to be a part of — it’s a good thing to be a part of on the ground floor.”

Resources from Nemours KidsHealth.org

• Cancer Center for Parents
• Cancer Center for Kids
• Cancer Center for Teens
• Childhood Cancer (for Parents)
• Some Kinds of Cancer Kids Get (for Kids)
• What Is Cancer? (for Kids)

Treatment

• Chemotherapy (for Parents)
• Is a Clinical Trial Right for Your Child? (for Parents)
• Radiation Therapy (for Parents)
• Steroids for Treating Cancer (for Parents)

Parent Support Services

• Alex’s Lemonade Stand
• B.A.S.E. Camp Children’s Cancer Foundation (Florida)
• Camp Boggy Creek (Florida)
• Candlelighters Childhood Cancer Foundation (CCCF)
• Caring Bridge
• Cure Search National Childhood Cancer Foundation (NCCF)
• Make-a-Wish Foundation
• Nemours’ Family Advisory Council
• Ronald McDonald House of Delaware
• Supporting Kidds
• Tom Coughlin Jay Fund Foundation
• Wings of Hope (Pensacola, FL)
• GetWell Network