A Conversation With Dr. Anna Meadows

Anna T. Meadows, MD, a pediatric oncologist who led the way for survivorship studies of children with cancer during her 40 year career at Children’s Hospital of Philadelphia (CHOP), was awarded the Ellen L. Stovall Award and Lecture for Advancement of Cancer Survivorship Care by the American Society of Clinical Oncology (ASCO), at its Cancer Survivorship Symposium on Jan. 27 — the first award of its kind.

“This is particularly touching for me,” said Meadows. “I knew Ellen Stovall, for whom this award is named, from the very beginning. She herself survived three cancers. It was Ellen who lobbied the National Institutes of Health to establish the very first Office of Cancer Survivorship, which I would lead.” 

In fact, Dr. Meadows’ prolific, distinguished career is highlighted by a series of ‘firsts’: In the mid-70s, she and CHOP colleagues were the first ever to investigate the later effects of childhood cancer. “I was a psychologist, I studied children, I connected with children, and I was a parent to three children!” said Meadows. It was that awareness and concern that lead to her first breakthrough: In 1974, as a Fellow in pediatric oncology at CHOP, she published a paper in Seminars of Oncology, Late effects of cancer treatment: methods and techniques for detection, the first to recognize treating children with cancer could cure them, but could also have long-term health consequences.

Meadows was also among the first to stop, or reduce brain radiation used to treat kids with leukemia, after studies showed it could damage learning and cause brain cancer down the road. 

Through her friend Ellen, Dr. Meadows became the first director of the Office of Cancer Survivorship in 1996, when the National Cancer Institute (NCI) established it. And, recognizing CHOP needed to devote expertise and resources to children whose medical care allowed them to grow up, she formed the country’s first Cancer Survivorship Program, to both study this cohort and address its special needs.

As a natural outgrowth, she was also the first to set up transition clinics at the Hospital of the University of Pennsylvania for kids who outgrew pediatric care, yet still needed treatment as adults.

In the years Dr. Meadows has been practicing medicine, much has changed. Once, 2 in 10 children survived cancer — now it’s 8 in 10. There are now more than 388,000 children in this country who are childhood cancer survivors.

Yet, there is work to do as physician-scientists work toward treatments with more specificity and fewer side effects. An estimated 70 percent of childhood cancer survivors have chronic side effects, and about one-third of those are severe or life-threatening.

Meadows is now 85 years old, has been retired for six years, and is an avid tennis player.

With her unique vantage point of nearly a half century in medicine, CHOP spoke to Dr. Meadows for a look at where we’ve been, and where we’re going in pediatric oncology and survivorship.

First, Dr. Meadows, with such an impressive resume and long list of accomplishments, what should we know about you?

Meadows: I went to medical school after age 30 when I had three small children. I went on to become a Professor, and the Chief of Pediatric Oncology at CHOP, the top-rated Children’s Hospital in the world. I also recruited some of the best physician-scientists in the world, many of whom are still there. In 2010, an annual lecture series at CHOP was initiated in my name.

Dr. Meadows, you’ve won many awards in your distinguished 40+ year career in pediatric oncology. What does receiving ASCO’s first-ever Ellen. L. Stovall Award and Lecture for Advancement of Survivorship Care mean to you?

Meadows: It means a great deal to me. It caps my career dedicated to research and figuring out the appropriate care for children we were able to cure. I was really one of the first people to use the word ‘cure’ back in the early 90s, after working in pediatric oncology for nearly two decades. Cancers in children aren’t the same as those that develop in adults. Children get cancers of developing organs, not lung cancer, breast cancer, GI cancers. Once we can block those developing organs from making the cells they’re not supposed to make — you get rid of the bad guys —those cancers often don’t come back. The children survive, but what we saw was the treatment that cured the child could cause serious problems down the road.

Let’s talk about your research. Since your seminal study in 1974, Late effects of cancer treatment: methods and techniques for detection, you’ve authored more than 200 publications. What stands out to you as your most significant research contribution?

I would say it’s the article Pediatric Cancer Survivorship: Research and Clinical Care, published in 2006 in The Journal of Clinical Oncology. It was published 10 years ago, and yet   everything I said then, is true today. It wasn’t until the adult oncologists realized they had so many patients who’d been treated for cancer as children, that the survivors’ movement took hold. Our clinical trial programs developed in the 60s and 70s enabled kids to be cured. Because children with cancer had different diseases than the adults, they responded to chemotherapy and radiation, affecting extraordinary changes. But those therapies also had consequences as survivors went through the normal aging process. I said it then, I’ll say it now: We must continue to improve cure rates, but reduce the radiation, and lower doses of drugs that have potential long-term toxicity.

I go back to the early days. We HAD to think a cure was possible. The headline is, understanding the negative effects of our primary tools — chemotherapy and radiation — continues to allow researchers to modify therapies, to target therapies, so the awful, late side effects would no longer affect large numbers of those cured. An example, a strong anti-cancer agent we were using, topoisomerase inhibitors, we saw these drugs curing children, but also causing secondary cancers. We learned to modify their use and find alternatives less leukemogenic. Radiation: We knew radiation caused cancer. When we recognized radiation to the heads of kids with leukemia was bad, CHOP opted out of the clinical trial testing it. We reduced or eliminated its use in some cancers. Our work in retinoblastoma taught us a critical lesson: You didn’t have to give a lot of a drug to save lives, and eyes in children. In other cancers, we learned a drug cocktail could be effective, but you didn’t need the third drug in children.

In oncology communities, a common complaint is pediatric cancers don’t get nearly the attention and resources of adult cancers. Yet, here we have an entire population of patients who had childhood cancers, and have grown up. What do we need to consider going forward?

Cancer is a disease of aging. When you look at the enormity of the cancer problem in adults, cancer rates increase as people get old, the pediatric numbers pale, this is true. But we have to think about cancer, and its abnormal cell growth, throughout a lifespan. We’re doing tremendous work understanding genes and gene therapies: Genes operate at all ages!

It’s still hard in the drawing rooms where clinical trials are being created, to mandate part of the trial includes studying cancer survivors 5 - 10 years after treatment, but we must.

We also need to help childhood survivors navigate the health system: How do they get treated after they get cured? By primary physicians, or oncologists? We need to think in terms of a lifelong treatment course.

Going back to Ellen. I like the word ‘thriver’ instead of survivor. It implies we’re looking forward and not looking back.