Inquiry in Action
Improving Quality of Life After Cancer
Drs. Scott Baker and Eric Chow are on a mission to help survivors of childhood cancer live their healthiest possible lives.
Drs. Scott Baker and Eric Chow are determined to find ways of preventing the heart attacks and other cardiovascular problems that are leading causes of illness and death among long-term survivors of childhood cancer.
In 2011, Baker and Chow spearheaded research that could help diagnose these problems at their earliest stages and lead to new therapies that could overcome them.
This innovative research positions Seattle Children’s as a leader in the emerging field of survivorship at a crucial time, as improvements in cancer treatment are leading to unprecedented numbers of survivors.
"Children’s bodies are still developing when they receive treatment, which can lead to health issues you might not see in adults," Baker says. "Our goal is to understand those issues and help survivors lead longer, healthier lives."
Unraveling cardiovascular problems
Baker started investigating survivor issues more than a decade ago, when he was one of the first to research how bone marrow transplants affected patients’ long-term health. Together with Chow, Baker is making key contributions to the ongoing nationwide Childhood Cancer Survivor Study (CCSS). Among the CCSS findings: about two-thirds of survivors suffer from at least one chronic health condition and about one-third have a life-threatening condition. He is now leading an ambitious effort to explain why those problems occur.
A study Baker completed in 2011 found that bone marrow transplants often lead to insulin resistance, which increases the risk of diabetes, high blood pressure, heart disease and other problems. He has also found that, surprisingly, many survivors who appear to be height-weight proportionate are actually clinically obese according to the ratio of their body fat to lean tissue.
"For some reason, the transplant process leads to muscle loss and that muscle is replaced by fat," says Baker, who directs the Children’s Cancer Survivor Program and the Fred Hutchinson Cancer Research Center Survivorship Program. "Our next step is to find out if you can actually change that ratio of muscle mass to body fat or if it’s a permanent scar."
Baker is now studying what causes the body to lose muscle, and he plans to investigate whether existing interventions — like drug therapies, diet and exercise regimens — can overcome survivors’ insulin resistance and reduce their cardiovascular risks.
Though these treatments can lead to dramatic improvements in people who haven’t suffered cancer, there’s no guarantee of similar results in survivors.
Finding problems earlier
Dr. Eric Chow is developing a risk calculator that could quickly and easily identify which cancer survivors are at greater risk of suffering heart problems.
Inspired by the Framingham risk score, which helps predict heart disease in adults, Chow’s tool will help primary care and oncology providers know what to screen for. They will be able to enter a few key pieces of a patient’s information, such as their age and the types of treatment they received. The tool will then calculate the treatments’ cumulative effect and compute a score indicating a patient’s risk of developing specific problems.
"In research, sometimes you can forget that each statistic represents a tragedy in someone’s life," says Chow, the medical director of Children’s Cancer Survivor Program. "By detecting problems earlier, we have a better opportunity to limit their negative effects."
"In research, sometimes you can forget that each statistic represents a tragedy in someone’s life. By detecting problems earlier, we have a better opportunity to limit their negative effects." ~ Dr. Eric Chow