U.S. Cancer Outcomes Network
Dr. Bhatia serves on a committee to Implement personalized pathways for cancer follow-up care in the United States.
Featured Speaker:
Smita Bhatia, MD, MPH
Smita Bhatia, MD, MPH, is a distinguished pediatric oncologist with a strong interest in cancer outcomes across all diagnoses and all age groups. She joins Children's of Alabama and the University of Alabama at Birmingham (UAB) to tackle the health challenges cancer survivors face during and after treatment. As a professor in the UAB Department of Pediatrics, Bhatia will hold new positions as director of the Institute for Cancer Outcomes and Survivorship in the UA School of Medicine, vice chair for outcomes in the Department of Pediatrics, and associate director for cancer outcomes research at the UAB Comprehensive Cancer Center. She will also join the Children’s of Alabama medical staff and be the co-director of the Center for Outcomes and Effectiveness Research and Education. Bhatia comes to Birmingham from the City of Hope in Duarte, Calif., where she established the Department of Population Sciences and serves as its chair. While at City of Hope, she became the inaugural holder of the Ruth Ziegler Chair in Population Sciences. During her 18 years at City of Hope, Bhatia made several significant scientific contributions. She ensured comprehensive follow-up of all patients undergoing hematopoietic cell transplantation, identifying chronic health issues among the survivors. She developed multidisciplinary survivorship clinics for cancer survivors, providing these individuals with state-of-the-art comprehensive follow-up care in the setting of clinical research. Bhatia also furthered cancer etiology and outcomes by recruiting world-renowned investigators with the goal of reducing the burden of cancer across all segments of the population through collaborative, multidisciplinary initiatives. Some specific findings have been especially meaningful to Bhatia. Through her work, she discovered an increased risk of radiation-related breast cancer among girls exposed to chest radiation during adolescence for the treatment of Hodgkin’s lymphoma. This resulted in a reduction in the dose of radiation used for managing Hodgkin’s lymphoma in girls during their teenage years. She is currently leading a multi-institutional trial to develop risk-reduction strategies for girls treated with chest radiation. She has identified the role of specific genes that interact with anthracycline chemotherapy in increasing the risk of heart failure in childhood cancer survivors. She has also demonstrated the critical role for adherence to oral chemotherapy in preventing relapse in children with acute lymphoblastic leukemia, and is now leading a national trial to enhance adherence to oral chemotherapy. One of Bhatia’s positions at UAB will be as co-director of the UAB Center for Outcomes and Effectiveness Research and Education. Bhatia is a member of the American Society of Hematology, American Society of Clinical Oncology, American Society of Pediatric Hematology/Oncology, American Association of Cancer Research, American Society for Blood and Marrow Transplantation, and American Society for Clinical Investigation. In 2012, she was elected to the ASCO board of directors. She serves as the associate chair for the Children’s Oncology Group, coordinating survivorship research across 200 pediatric oncology institutions in the United States. She is the recipient of many awards and honors, including the Frank H. Oski Lectureship Award from the American Society of Pediatric Hematology/Oncology to honor outstanding investigation in pediatric hematology/oncology. Bhatia has published more than 160 peer-reviewed articles in journals such as the New England Journal of Medicine, Journal of Clinical Oncology, Blood, Nature Cancer Reviews, Lancet, Lancet Oncology and Nature Genetics, among others. She has served on the editorial boards for Cancer Epidemiology Biomarkers and Prevention, Biology of Bone Marrow Transplantation, and Journal of Clinical Oncology, and also serves as the section editor for Cancer. Bhatia has also served as principal investigator or co-investigator on substantial research grants funded by the National Institutes of Health, Leukemia Lymphoma Society and St. Baldrick’s Foundation, among others. She sits on several NIH /National Cancer Institute grant review panels and committees. Born in India, Bhatia received her medical degree from the All India Institute of Medical Sciences in 1984 and completed fellowships in blood banking, pediatric hematology/oncology and bone marrow transplantation at the University of Minnesota. She also received a master’s degree in public health in epidemiology from the University of Minnesota. She comes to UAB with her husband, Ravi Bhatia, M.D., who will be the new director of the UAB Division of Hematology and Oncology and the deputy director of the Cancer Center. Transcription:
U.S. Cancer Outcomes Network
Dr Cori Cross (Host): Welcome to Peds Cast, a podcast brought to you by Children's of Alabama. I'm pediatrician, Dr. Cori Cross.
Host: Today, we'll be speaking with Dr. Smita Bhatia. In this episode, we'll be discussing personalizing the followup care for cancer patients, moving toward a more individualized approach tailored to patients' specific circumstances. Dr. Bhatia is a leading expert in this field and recently joined Children's of Alabama to tackle the health challenges cancer survivors face during and after treatment. She is Director of the Institute of Cancer Outcomes and Survivorship in the UAB B School of Medicine. She is the Vice-Chair for Outcomes in the Department of Pediatrics, and she is the Co-director of the Center of Outcomes and Effectiveness Research and Education at the UAB B School of Medicine. Dr. Bhatia, thank you for joining us.
Dr. Smita Bhatia: Thank you for having me, Cori.
Host: So Dr. Bhatia, reading your resume and the studies you've done to advance the understanding this field of, well, basically life after chemo, right? Radiation and cancer treatment. Your resume is truly remarkable. And I'd like to start with discussing a little bit of what you've done, so that our audience can get a better sense of what we're talking about. Tell us a little bit about how you realized and then studied that teen girls treated for Hodgkin's Lymphoma with chest radiation ended up with an increased risk of radiation-related breast cancer, and how studying this changed the treatment plans for teen girls with Hodgkin's across the country.
Dr. Smita Bhatia: You know, most of the academic careers start with a simple word called serendipity. So as I was receiving my training at the University of Minnesota, my then mentor and who's continued to be my mentor for the past 35 years, introduced me to this very rich dataset. This was from 14 institutions across the world, and that dataset allowed me to analyze the data, which showed us that girls who had received radiation for Hodgkin's lymphoma were at increased risk for breast cancer and that the risk was higher amongst those who had received higher doses of radiation. This was published in a fairly high impact journal, the New England Journal of Medicine, and because of this caught the eye of most oncologists who then decided that they needed to reduce the doses of radiation, especially to the girls.
Host: And that's had profound impact in changing their followup and their down-the-line risk factors. So, this type of research that you're doing really does change the outcome for patients because it's one thing for us to get them through the cancer that they're dealing with and the current disease. But, you know, these kids go on to live long lives and we have to think about what's coming down the line.
Now, you've also done research in patient's genetic makeup and how their genes play a role in interacting with the medications that we give them in their chemo treatment. and I was wondering if you could speak to this a little bit about how you use genes and a person's specific genetic makeup to decide how to treat them and how to follow them up
Dr. Smita Bhatia: Absolutely. So, this stems from the fact that if you give the same dose of a particular kind of chemotherapy or radiation to a hundred people, about 10 to 20 will develop the complication and the rest won't. And then, the question arises, why not? And so, that's why we and several other people have started exploring the genetic makeup of our childhood cancer patients and used their genetic makeup in order to understand, which particular genes interact with chemotherapeutic agents, for example, anthracyclines here and increase the risk of cardiotoxicity or heart failure in a subgroup of patients. And what we want to do at the end of the day is to have this as a simple blood test that would tell us upfront that your patient, who you are going to treat with this high dose of treatment is at high risk for cardio and, therefore, you might want to use a different dose or you might want to use a different drug.
Host: I mean that makes sense and it's becoming easier and easier to do that type of blood test that you're saying. So, I think even knowing not just the bad effects that the chemo can have, but also what chemo might be more effective and work better. All of this, I think, will change and it'll become much more personalized as these tests become more easily available at the different institutions.
Dr. Smita Bhatia: Exactly.
Host: So, personalized followup sounds important to all patients after cancer treatment. But I mean, as a pediatrician, I see it as particularly important in pediatrics, and I see that for two reasons. Let me know if this is sort of the way you approach it. When you're in your 60s or 80s and you develop cancer and you are lucky enough to survive it, you are looking at, you know, 20 years, maybe 25 tops down the line really to see what the effects are of that treatment. But when you're looking at a five or a 15-year-old that you're treating, you're looking at a life of 80 years, hopefully plus, down the line. And then, the other thing that's different about children and adults is that children aren't just little adults, their bodies are in a completely different stage of development where they're growing and the susceptibility of their body to this treatment is different, right?
Dr. Smita Bhatia: You have completely hit the nail on the head for all of the issues that we face in terms of taking care of children with cancer. They are indeed not little adults, you know. So when they're receiving a particular medication, a chemotherapeutic agent, we have to keep in mind that their organs are developing, they're not fully formed. And therefore, the effects that that chemotherapeutic agent will have on developing organs is different from what it would be in a fully formed organ in an adult. Plus, as you said, the decades of life that are there available to these individuals to enjoy need to be kept in mind. And therefore, the need to absolutely personalize the followup of our childhood cancer survivors in order to identify, "Okay, Johnny is at risk for A, B and C. Therefore, we will do A, B and C in order to make sure that we detect these complications early, prevent them from developing and to make sure that he enjoys an absolutely normal life the same way as somebody who didn't have cancer.
Host: So, tell us a little bit about this summit that I understand happened in 2018 between the American Cancer Society and the American Society of Clinical Oncology. My understanding was it was convened to discuss how to develop an approach to triage patients for personalized care. Can you tell us about this?
Dr. Smita Bhatia: So, this has been something that we have been trying to develop for many, many, many, many years. And this focus not only on pediatric but adult cancers with a major focus on adult cancer. And the premise here is that everybody would want to continue to be followed in specialized clinics after they're diagnosed with cancer. Everybody would, because they developed this really unique and strong relationship with their treating oncologists. However, a treating oncologist does not, or nor does the hospital, the cancer center, have the bandwidth to keep all patients forever in their hospital, in their clinics. So, we need to have a system, which is a triaged system, so those that are at the lowest risk of developing any long-term morbidity are taken care of in the community by the primary care providers. Those that have the other extreme of being highly complex, for example, allogeneic bone marrow transplant recipients or brain tumor survivors need to be in the specialized long-term followup centers, in the cancer centers or in the academic institutions. And then, everything in between falls in different categories.
So, that's what the summit was trying to do. And that is something that we are constantly trying to develop evidence for so that we can have policies and guidelines as to who can be safely discharged to the community with the primary care providers, of course, with long-term communications between the specialized center and the PCP, and who needs to be kept close to the center because of the complexity of the treatment and the long-term complications they could develop.
Host: And I would imagine being a pediatrician myself, that with developing this comes developing algorithms that when the patients are given to the primary care pediatricians to be the person who's going to follow them up and, you know, do tests and make sure that nothing is coming up that we didn't anticipate, that they're following an algorithm, that they're not just figuring this out on their own because they're not experts. So, I would assume then that part of this isn't just doing the studies to show that this is an effective and cost effective way of dealing with patients post-cancer, but also developing all of the tools that the primary care pediatricians would need to rely on to be able to take care of these patients in their practices.
Dr. Smita Bhatia: Absolutely. So Cori, we've developed what our called Children's Oncology Group followup guidelines, long-term followup guidelines. And these guidelines actually have a very nicely detailed roadmap for a patient who received this treatment for this particular diagnosis. This is what needs to be done in terms of followup for these particular complications that could develop, and this is the frequency that they need to have these tests done. So, it's a really nicely detailed roadmap or algorithm that we then summarize in what are called survivorship care plans, which we ask the patients to take to their PCPs for them to be able to access and then avail of the details in them.
Host: Wonderful. And when we talk about the patients are then kept close to the best, close to the facilities and the doctors that they, you know, were working with while they were going through their treatment. Not all facilities are equipped to manage and deliver personalized followup care, although they might be okay with, and you know, really successful at doing the cancer treatment, they might not have the multi-pronged multidisciplinary approach and facility needed to do the followup care. Tell us what's special about Children's Alabama.
Dr. Smita Bhatia: So first of all, I have to tell you that we have a whole list of all the specialized long-term followup centers in the country, which are taking care of children who've survived cancer. Children's of Alabama is one of them. And it's unique in the way that here we have a long-term followup survivorship clinic called TLC, Taking on Life After Cancer. And in this clinic, what we do is we take survivors who finished treatment and are two years off therapy and then using a risk-based algorithm from the Children's Oncology Group followup guidelines. We then have a complete and comprehensive visit with a nurse practitioner or a physician, but also with a social worker and, if needed, a dietician and a neuropsychologist. And in this visit, we not only give them all the necessary materials in terms of their survivorship care plans and all help links and other material for them to keep with them and read. But we also go over all the testing that needs to be done, which is what we call anticipatory testing based on what they might be at risk for, and we want to catch it early, so echocardiograms or a DEXA scan or pulmonary function tests in order to detect the complications early if they're at risk for those. And then, we call them back annually. The big thing is that we don't stop when they turn 18. Our oldest patient here with us is in their 50s. So, that's the beauty of this clinic. We keep them close to the best.
Host: That's amazing. I'm sure it feels good as a physician to be able to continue to monitor these patients that you've developed such close relationship with. But I can also imagine that that feels amazing for the patients to know that they're not bouncing from doctor to doctor in there with someone that they trust.
Dr. Smita Bhatia: What you said is absolutely correct, what happens is that we eventually become what are called coordinators. Suppose we find that they have some cardiac problem, which is emerging, we make sure that they see a cardiologist. And then, we educate the cardiologist if needed or bring them up to speed on what the child might have had or that might have caused this cardiac problems. If they need an endocrinologist, we followup on that and then we bring back all this information digested and provided to the patient, so they understand and are able to simulate it properly.
Host: That's an amazing service that you're providing to both the patients and their families. So, I'm really grateful that, you know, my patients have access to these types of facilities, because you do, you feel like they become part of a family and that feels special.
So Dr. Bhatia, wrap this up for us. What else would you like our listeners to know? Is there anything we missed? Or in summary, why is personalized followup care the way that we need to go in the future?
Dr. Smita Bhatia: Why do we need to do this? First of all, our survival rates for children with cancer are exceeding 85%, so cure is an expected outcome. However, it comes at a price, because the burden of morbidity that they bear a long, long-term is pretty high, but it's also dependent on the types of treatments they've got, so different kinds of morbidity based on different kinds of treatment. Hence, the need for specialized risk-based care life-long for our childhood cancer survivors. But the most important thing is that we do it in partnership with the pediatricians in the community and as the children grow older with the primary care providers because no one person can take care of all the patients. It's the village that does that. Thank you, Cori.
Host: Oh, thank you. I mean, this has been eye-opening and I think our listeners will really appreciate hearing what the future has to offer and seeing where we're going in this field. I think it's uplifting to know that we are going to be able to deliver more personalized care and really make sure that we're following up the patients that we need to and not doing excessive testing on the patients that we don't. As a pediatrician, I'm very excited by this. So, thank you for joining us.
Dr. Smita Bhatia: Thank you.
Host: For more information or to refer patients to Children's of Alabama, visit childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for other topics that might be of interest to you. Please remember to subscribe, rate, and review this podcast. Thanks for listening to this episode of Peds Cast. I'm your host, Dr. Cori Cross.
U.S. Cancer Outcomes Network
Dr Cori Cross (Host): Welcome to Peds Cast, a podcast brought to you by Children's of Alabama. I'm pediatrician, Dr. Cori Cross.
Host: Today, we'll be speaking with Dr. Smita Bhatia. In this episode, we'll be discussing personalizing the followup care for cancer patients, moving toward a more individualized approach tailored to patients' specific circumstances. Dr. Bhatia is a leading expert in this field and recently joined Children's of Alabama to tackle the health challenges cancer survivors face during and after treatment. She is Director of the Institute of Cancer Outcomes and Survivorship in the UAB B School of Medicine. She is the Vice-Chair for Outcomes in the Department of Pediatrics, and she is the Co-director of the Center of Outcomes and Effectiveness Research and Education at the UAB B School of Medicine. Dr. Bhatia, thank you for joining us.
Dr. Smita Bhatia: Thank you for having me, Cori.
Host: So Dr. Bhatia, reading your resume and the studies you've done to advance the understanding this field of, well, basically life after chemo, right? Radiation and cancer treatment. Your resume is truly remarkable. And I'd like to start with discussing a little bit of what you've done, so that our audience can get a better sense of what we're talking about. Tell us a little bit about how you realized and then studied that teen girls treated for Hodgkin's Lymphoma with chest radiation ended up with an increased risk of radiation-related breast cancer, and how studying this changed the treatment plans for teen girls with Hodgkin's across the country.
Dr. Smita Bhatia: You know, most of the academic careers start with a simple word called serendipity. So as I was receiving my training at the University of Minnesota, my then mentor and who's continued to be my mentor for the past 35 years, introduced me to this very rich dataset. This was from 14 institutions across the world, and that dataset allowed me to analyze the data, which showed us that girls who had received radiation for Hodgkin's lymphoma were at increased risk for breast cancer and that the risk was higher amongst those who had received higher doses of radiation. This was published in a fairly high impact journal, the New England Journal of Medicine, and because of this caught the eye of most oncologists who then decided that they needed to reduce the doses of radiation, especially to the girls.
Host: And that's had profound impact in changing their followup and their down-the-line risk factors. So, this type of research that you're doing really does change the outcome for patients because it's one thing for us to get them through the cancer that they're dealing with and the current disease. But, you know, these kids go on to live long lives and we have to think about what's coming down the line.
Now, you've also done research in patient's genetic makeup and how their genes play a role in interacting with the medications that we give them in their chemo treatment. and I was wondering if you could speak to this a little bit about how you use genes and a person's specific genetic makeup to decide how to treat them and how to follow them up
Dr. Smita Bhatia: Absolutely. So, this stems from the fact that if you give the same dose of a particular kind of chemotherapy or radiation to a hundred people, about 10 to 20 will develop the complication and the rest won't. And then, the question arises, why not? And so, that's why we and several other people have started exploring the genetic makeup of our childhood cancer patients and used their genetic makeup in order to understand, which particular genes interact with chemotherapeutic agents, for example, anthracyclines here and increase the risk of cardiotoxicity or heart failure in a subgroup of patients. And what we want to do at the end of the day is to have this as a simple blood test that would tell us upfront that your patient, who you are going to treat with this high dose of treatment is at high risk for cardio and, therefore, you might want to use a different dose or you might want to use a different drug.
Host: I mean that makes sense and it's becoming easier and easier to do that type of blood test that you're saying. So, I think even knowing not just the bad effects that the chemo can have, but also what chemo might be more effective and work better. All of this, I think, will change and it'll become much more personalized as these tests become more easily available at the different institutions.
Dr. Smita Bhatia: Exactly.
Host: So, personalized followup sounds important to all patients after cancer treatment. But I mean, as a pediatrician, I see it as particularly important in pediatrics, and I see that for two reasons. Let me know if this is sort of the way you approach it. When you're in your 60s or 80s and you develop cancer and you are lucky enough to survive it, you are looking at, you know, 20 years, maybe 25 tops down the line really to see what the effects are of that treatment. But when you're looking at a five or a 15-year-old that you're treating, you're looking at a life of 80 years, hopefully plus, down the line. And then, the other thing that's different about children and adults is that children aren't just little adults, their bodies are in a completely different stage of development where they're growing and the susceptibility of their body to this treatment is different, right?
Dr. Smita Bhatia: You have completely hit the nail on the head for all of the issues that we face in terms of taking care of children with cancer. They are indeed not little adults, you know. So when they're receiving a particular medication, a chemotherapeutic agent, we have to keep in mind that their organs are developing, they're not fully formed. And therefore, the effects that that chemotherapeutic agent will have on developing organs is different from what it would be in a fully formed organ in an adult. Plus, as you said, the decades of life that are there available to these individuals to enjoy need to be kept in mind. And therefore, the need to absolutely personalize the followup of our childhood cancer survivors in order to identify, "Okay, Johnny is at risk for A, B and C. Therefore, we will do A, B and C in order to make sure that we detect these complications early, prevent them from developing and to make sure that he enjoys an absolutely normal life the same way as somebody who didn't have cancer.
Host: So, tell us a little bit about this summit that I understand happened in 2018 between the American Cancer Society and the American Society of Clinical Oncology. My understanding was it was convened to discuss how to develop an approach to triage patients for personalized care. Can you tell us about this?
Dr. Smita Bhatia: So, this has been something that we have been trying to develop for many, many, many, many years. And this focus not only on pediatric but adult cancers with a major focus on adult cancer. And the premise here is that everybody would want to continue to be followed in specialized clinics after they're diagnosed with cancer. Everybody would, because they developed this really unique and strong relationship with their treating oncologists. However, a treating oncologist does not, or nor does the hospital, the cancer center, have the bandwidth to keep all patients forever in their hospital, in their clinics. So, we need to have a system, which is a triaged system, so those that are at the lowest risk of developing any long-term morbidity are taken care of in the community by the primary care providers. Those that have the other extreme of being highly complex, for example, allogeneic bone marrow transplant recipients or brain tumor survivors need to be in the specialized long-term followup centers, in the cancer centers or in the academic institutions. And then, everything in between falls in different categories.
So, that's what the summit was trying to do. And that is something that we are constantly trying to develop evidence for so that we can have policies and guidelines as to who can be safely discharged to the community with the primary care providers, of course, with long-term communications between the specialized center and the PCP, and who needs to be kept close to the center because of the complexity of the treatment and the long-term complications they could develop.
Host: And I would imagine being a pediatrician myself, that with developing this comes developing algorithms that when the patients are given to the primary care pediatricians to be the person who's going to follow them up and, you know, do tests and make sure that nothing is coming up that we didn't anticipate, that they're following an algorithm, that they're not just figuring this out on their own because they're not experts. So, I would assume then that part of this isn't just doing the studies to show that this is an effective and cost effective way of dealing with patients post-cancer, but also developing all of the tools that the primary care pediatricians would need to rely on to be able to take care of these patients in their practices.
Dr. Smita Bhatia: Absolutely. So Cori, we've developed what our called Children's Oncology Group followup guidelines, long-term followup guidelines. And these guidelines actually have a very nicely detailed roadmap for a patient who received this treatment for this particular diagnosis. This is what needs to be done in terms of followup for these particular complications that could develop, and this is the frequency that they need to have these tests done. So, it's a really nicely detailed roadmap or algorithm that we then summarize in what are called survivorship care plans, which we ask the patients to take to their PCPs for them to be able to access and then avail of the details in them.
Host: Wonderful. And when we talk about the patients are then kept close to the best, close to the facilities and the doctors that they, you know, were working with while they were going through their treatment. Not all facilities are equipped to manage and deliver personalized followup care, although they might be okay with, and you know, really successful at doing the cancer treatment, they might not have the multi-pronged multidisciplinary approach and facility needed to do the followup care. Tell us what's special about Children's Alabama.
Dr. Smita Bhatia: So first of all, I have to tell you that we have a whole list of all the specialized long-term followup centers in the country, which are taking care of children who've survived cancer. Children's of Alabama is one of them. And it's unique in the way that here we have a long-term followup survivorship clinic called TLC, Taking on Life After Cancer. And in this clinic, what we do is we take survivors who finished treatment and are two years off therapy and then using a risk-based algorithm from the Children's Oncology Group followup guidelines. We then have a complete and comprehensive visit with a nurse practitioner or a physician, but also with a social worker and, if needed, a dietician and a neuropsychologist. And in this visit, we not only give them all the necessary materials in terms of their survivorship care plans and all help links and other material for them to keep with them and read. But we also go over all the testing that needs to be done, which is what we call anticipatory testing based on what they might be at risk for, and we want to catch it early, so echocardiograms or a DEXA scan or pulmonary function tests in order to detect the complications early if they're at risk for those. And then, we call them back annually. The big thing is that we don't stop when they turn 18. Our oldest patient here with us is in their 50s. So, that's the beauty of this clinic. We keep them close to the best.
Host: That's amazing. I'm sure it feels good as a physician to be able to continue to monitor these patients that you've developed such close relationship with. But I can also imagine that that feels amazing for the patients to know that they're not bouncing from doctor to doctor in there with someone that they trust.
Dr. Smita Bhatia: What you said is absolutely correct, what happens is that we eventually become what are called coordinators. Suppose we find that they have some cardiac problem, which is emerging, we make sure that they see a cardiologist. And then, we educate the cardiologist if needed or bring them up to speed on what the child might have had or that might have caused this cardiac problems. If they need an endocrinologist, we followup on that and then we bring back all this information digested and provided to the patient, so they understand and are able to simulate it properly.
Host: That's an amazing service that you're providing to both the patients and their families. So, I'm really grateful that, you know, my patients have access to these types of facilities, because you do, you feel like they become part of a family and that feels special.
So Dr. Bhatia, wrap this up for us. What else would you like our listeners to know? Is there anything we missed? Or in summary, why is personalized followup care the way that we need to go in the future?
Dr. Smita Bhatia: Why do we need to do this? First of all, our survival rates for children with cancer are exceeding 85%, so cure is an expected outcome. However, it comes at a price, because the burden of morbidity that they bear a long, long-term is pretty high, but it's also dependent on the types of treatments they've got, so different kinds of morbidity based on different kinds of treatment. Hence, the need for specialized risk-based care life-long for our childhood cancer survivors. But the most important thing is that we do it in partnership with the pediatricians in the community and as the children grow older with the primary care providers because no one person can take care of all the patients. It's the village that does that. Thank you, Cori.
Host: Oh, thank you. I mean, this has been eye-opening and I think our listeners will really appreciate hearing what the future has to offer and seeing where we're going in this field. I think it's uplifting to know that we are going to be able to deliver more personalized care and really make sure that we're following up the patients that we need to and not doing excessive testing on the patients that we don't. As a pediatrician, I'm very excited by this. So, thank you for joining us.
Dr. Smita Bhatia: Thank you.
Host: For more information or to refer patients to Children's of Alabama, visit childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for other topics that might be of interest to you. Please remember to subscribe, rate, and review this podcast. Thanks for listening to this episode of Peds Cast. I'm your host, Dr. Cori Cross.