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Transfusions with packed red blood cells (PRBCs) are commonly used when children treated for cancer develop anemia (low red blood cell count). PRBC transfusions carry iron that can be deposited in various body tissues, such as the heart. The body cannot remove this iron overload by itself, and if it stays in the heart, it can cause damage (cardiomyopathy). At this time, we do not know how often patients have extra iron in their heart after PRBC transfusions. This study uses a magnetic resonance image (MRI) test that can measure iron and learn about other things that might affect the heart, such as anthracycline chemotherapy and what effect iron-related cardiomyopathy has on daily life. The overall goal is to increase the length and quality of survival for people successfully treated for cancer during childhood.

Adolescents with cancer experience many symptoms resulting from their disease and its treatment. Recognizing and managing these contributes to improved quality of life during treatment and on into survivorship. This study uses an approach that allows adolescents to identify clusters describing their symptom experience from their perspective. The purpose is to develop and test the use of a computer-based tool exploring symptom clusters among adolescents with cancer. The goal of these findings is to provide data to support use of the tool in a larger group of adolescents and to enhance communication between them and healthcare providers.

While currently 70% of children with brain tumors survive beyond 5-years from diagnosis, radiation to the brain and spine are cornerstones of therapy. The cost of this treatment is impaired neuro-cognitive function, premature heart problems, stroke, and impaired quality of life in many. The role of injury to the heart and vascular system from radiation has not been previously studied in childhood brain tumor survivors. While killing tumor cells, radiation may lead to narrowing and stiffening of the vessels in the brain. Stiffening of the aorta is a progressive with normal aging in the lifespan. This project studies stiffness in the aorta and its relation to flow in the vessels in the brain among children who received radiation therapy, a novel attempt to link the heart and the brain following childhood cancer. 

Children with brain tumors and acute lymphoblastic leukemia are at risk for developing learning and memory problems as a result of their disease and treatments. Since we currently cannot prevent this, difficulties are addressed after they appear, with only modest improvements. A computerized cognitive training program, easily used at home with little oversight from parents or professionals, has been tested in survivors of pediatric cancer with memory problems; this project tests it on children during treatment, before the problems develop. If effective, the program has considerable potential to improve the quality of life in pediatric cancer patients.

Generously sponsored by Markit. Treatment for acute lymphoblastic leukemia can be particularly devastating to a child's developing brain, leading to deficient short-term memory and attention or more serious events like seizures or strokes. This research focuses on how the cough medicine dextromethorphan may help reverse severe, stroke-like neurotoxicity among children treated with chemotherapy drug methotrexate and could possibly also prevent such side effects before they occur. The most promising drugs will be rapidly advanced into clinical trials for children with leukemia, designed to decrease the neurotoxic effects of chemotherapy.

Little is known about the long-term impact of communication about prognosis on children with cancer and their families. The goal of this project is to increase parents' ability to make value-driven decisions for care of their children with cancer and to adjust to this life-changing event in the best way possible. A longitudinal observational study evaluates long-term outcomes, using questionnaire-based parent interviews to assess parental decision- making and psychological and medical outcomes of disclosure. The cohort involves 194 children diagnosed between April 2003 and May 2005, so long-term assessment of their outcomes is now possible. Dr. Mack is funded by P.A.L.S. Bermuda with funds raised through the St. Baldrick's Foundation.

Fatigue is a pervasive, distressing symptom for children and teens with cancer. Decreasing fatigue and improving physical activity are important to provide energy for the normal activities of childhood that are important to ongoing development. A small, cost-effective device called the FitBit measures motion and provides daily feedback to the wearer. Children ages 6 to 18 in maintenance treatment for acute lymphoblastic leukemia use the FitBit, and researchers determine if it is accurate, if it helps childhood cancer patients to be more active, and if more active patients have less fatigue when getting steroids during treatment.

Cancer affects every part of patients and their families' lives. Self-image, thinking clearly, anxiety, depression, social isolation and fear of recurrence are all problems that teens and young adults with cancer face, while resuming normal development and being monitored for many problems caused by cancer and its treatment. This research is to create developmentally sensitive information and make it available through touch-screen technology, connecting teens and young adults with their health care team and community resources in real-time. This helps identify, communicate and maximize the benefits of clinical care while helping them reintegrate into school and work.