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Hematology and Oncology

The Institute for Cancer Outcomes and Survivorship Focuses on Key Quality-of-Life Issues


As more patients—adult and pediatric—become long-term cancer survivors, it becomes ever more imperative to identify ways to prevent, or at least manage, long-term complications from the cancer and its treatment.

Just how to do that forms the cornerstone of the research conducted at the University of Alabama at Birmingham (UAB) School of Medicine through its Institute for Cancer Outcomes and Survivorship (ICOS). “We are interested in developing a strong base of researchers who are focused on studying cancer outcomes long-term and identifying the issues cancer survivors face,” said ICOS Director Smita Bhatia, M.D., MPH. “We are continually striving to improve the quality of life of cancer survivors.”

Diverse Group

A diverse group of researchers from UAB participates in ICOS, including epidemiologists, physician scientists, behavioral scientists, molecular biologists and nurse scientists. They come from numerous departments, including radiation oncology, medical and pediatric oncology, and surgical oncology. Within ICOS, they have access to a state-of-the-art infrastructure that supports outcomes research, thus facilitating the transitional research that is integral to the Institute’s mission.

“The overarching goal of the ICOS is to conduct cutting-edge research in cancer outcomes across the age spectrum,” Bhatia said.

Since its founding in 2015, Institute researchers have received more than $10 million in grants from the National Institutes of Health and private foundations, and published more than 250 papers in peer-reviewed journals, a third of them high-impact journals.

Asking the Right Questions

All research studies start with asking the questions that no one has asked before, Bhatia said. “Questions are definitely going to move the field forward and make people’s lives better,” she noted.

For instance, a current study is examining long-term morbidity in pediatric cancer survivors, 60 percent of whom will eventually develop complications related to their cancer treatment. “We are systematically studying the molecular basis of these long-term complications,” Bhatia said.

Questions include: Why does radiation increase the risk of other cancers? How does a child’s DNA make them more prone to radiation-related cancers? Are there ways to predict children who are more likely to develop  treatment-related conditions and find alternative treatments to attack their cancer?

The Institute is also studying adherence to oral chemotherapy. “We find that children with acute lymphoblastic leukemia (ALL) often don’t take their medications as directed,” increasing their risk of relapse, Bhatia said. “We are now testing strategies to improve adherence to oral chemotherapy.”

To explore the impact of radiation and chemotherapy on the developing brain, researchers are using MRI to identify cellular signs of “chemo brain” and looking for ways to protect the brain during treatment.

“When a new patient comes in with cancer, the first thing we have to do is get rid of that cancer,” Bhatia said. That typically means using agents known to increase the risk of neurocognitive deficits. “So we have to develop methods to reverse or halt these complications.”

Several other research questions are under investigation, including ways to:

  • Expand the HPV vaccination rates in childhood cancer survivors
  • Determine the burden of morbidity older cancer survivors experience
  • Understand the best way to treat older patients with cancer without causing undue toxicity
  • Improve end-of-life experiences for cancer patients

Understanding ICOS Research
Learn more about ICOS research and watch an interview with Smita Bhatia, M.D., MPH.

Hematology and Oncology

A Holistic Approach to Childhood Cancer Survivorship


Significant improvements in pediatric cancer management means that an estimated 84 percent of children and adolescents diagnosed with cancer will become long-term survivors. However, while they may have overcome their original malignancy, they have a high risk of complications, including impaired growth, heart and lung problems, secondary cancers, learning disabilities and vision or hearing problems.

Yet, said Smita Bhatia, M.D., MPH, who directs the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham (UAB) School of Medicine, “Research shows that primary care physicians are reluctant to take care of cancer survivors because these survivors have so many treatment-related complications. Often, these kids fall through the cracks.”

That’s where the Taking on Life After Cancer (TLC) survivorship program comes in. It focuses on improving the health and well-being of childhood cancer survivors and is the only clinic of its kind in Alabama.

“There is an increased need to provide care tailored to the long-term survivors of pediatric cancer,” said the program’s Medical Director Kimberly Whelan, M.D., MSPH. Not only are they at increased risk for numerous medical problems, she said, but they also often experience neurocognitive issues that can impact their schooling or job performance. “We strive to look at them holistically and see how they’re doing physically, emotionally and mentally, and give them the tools they need to succeed in life.”

When the clinic began in 2004, patients were seen just once starting two years after their last treatment. Today, patients are seen annually. “We learned that following them long term is important because the issues they face two to three years after treatment are different than the ones they may face five or 10 years after therapy,” Whelan said.

Wendy Landier, Ph.D., RN, CRNP, manages the clinical aspects of a patient’s visits. During the one-day visit, patients and their families see a physician or nurse practitioner who specializes in survivorship care, as well as a social worker to help with any issues related to costs and insurance. A neuropsychologist screens for problems with school or job performance. “The visit is tailored to meet the individual needs of each survivor,” she said. “For instance, educational materials are personalized so they address the specific treatment that each survivor received, as well as the potential complications that can arise as a result of that treatment.”

Patients also have the opportunity to participate in research studies designed to advance knowledge about survivorship issues. “We’re trying to learn more about why some survivors have certain complications and others don’t, and to develop mechanisms to reduce those complications,” Whelan said.

All visits are tailored to the individual child, their cancer and previous treatments. So a child who previously received radiation therapy to the chest, for instance, will undergo tests to assess lung and heart function. Other children may need their bone health checked regularly.

One task the clinic doesn’t do is screen patients for any recurrence of the original cancer, Whelan said. “So maintaining their relationship with their primary oncologist is important,” she said.

Patients are referred by their primary care physician or self-refer, Whelan said. Either way, the patients’ primary doctor receives summary reports. “We would love to partner more with the primary care physicians in the care of these patients,” she said.

The clinic currently follows about 500 patients, with another 100 added each year. All can be seen for the rest of their lives, regardless of age. “Our goal is to make sure they stay healthy,” Whelan said.

Dealing With a Cancer Diagnosis
Learn about Children’s of Alabama’s Hope and Cope Psychosocial Program.