The growing number of pediatric and adolescent patients with cancer at Monroe Carell Jr. Children’s Hospital at Vanderbilt will soon have access to expanded and upgraded space for outpatient cancer infusion treatments and clinic visits, as well as updated inpatient space — a project made possible through the generous support of individuals and businesses in the community.

The expansion and renovation, part of a philanthropic initiative, “A Campaign Against Childhood Cancer,” will also help support research and training efforts.

“When the opportunity arose to envision a space dedicated entirely to clinical care for pediatric and adolescent cancer, allowing us to accommodate even more patients and families in a more age-appropriate way, philanthropic supporters truly rallied around Monroe Carell to meet this critical need and make this vision a reality,” said Meg Rush, MD, MMHC, President of Monroe Carell. “We are so very grateful to the many individuals, families and businesses in the community who gave generously to support our children and families through this project.”

Currently, outpatient infusion happens in two large rooms on the sixth floor of Monroe Carell’s Doctors’ Office Tower (DOT), with patients of all ages seated side by side in recliners. The renovation will provide private infusion rooms and dedicated, tailored space for young children, teenagers and young adults, all of whom have different needs. Some infusion rooms will have partitions that can be lowered when patients want to interact with each other.

“We see somewhere between 250 to 300 new patients with cancer each year, and we have about 13,000 provider visits each year,” said Debra Friedman, MD, MS, director of the Division of Pediatric Hematology/Oncology and holder of the E. Bronson Ingram Chair in Pediatric Oncology.

“To put that into perspective, when I came here in 2008, we saw 90 (new patients each year), and we have been in the same space since then. The timing is right to expand to accommodate our growing community and patient population.”

Two years ago, Monroe Carell had a record number of visits in the Division of Pediatric Hematology/Oncology, with last year’s number being about the same.

The new outpatient space will occupy the entire sixth floor of the DOT — currently it inhabits a little less than half of that floor, with the remaining half occupied by other specialties who have relocated to the eighth floor.

This current renovation is the final of a three-phase expansion that also included moving the pediatric primary care clinic from DOT to a newly constructed clinic space at Vanderbilt Health One Hundred Oaks and renovating the eighth floor of DOT to prepare for the move of medical specialties.

Besides the side-by-side infusion chairs, the prior outpatient space on the sixth floor of DOT had three private infusion rooms and 10 exam rooms for clinic visits.

The renovations will include 25 individual infusion spaces, with two rooms set up for patients who are getting partial exchanges of blood cells (apheresis), and 25 exam rooms.

“With each of the patients in their own infusion area, there will no longer be a young adult seated next to a 2-year-old. They’ll each have their own space but will have the ability to walk around the infusion area if they want to,” Friedman said.

“On the other hand, if there are siblings getting infusions at the same time, or kids who have become friendly with each other and want to hang out while they are getting infusions, the partition can come down so they can talk to and see each other.”

There will also be a designated consult room and a designated room where Child Life Services can meet with patients, or where patients can watch a movie or play with toys while they are getting infusions. An expanded nutrition area will be incorporated in the space with snacks and an ICEE machine.

“The new area is really patient- and family-centric and also allows us to be much more efficient in our clinic. Our growing number of patients won’t be waiting so long to be seen because we have more exam rooms to seat them,” Friedman said.

Patients and families were instrumental in planning the new space, she noted.

“We listened to what they told us. We met with them to ask if we were going to redesign this space, what would be important to them. We did this when we created the teen lounge on the sixth floor of the inpatient unit,” Friedman said. “When we talked about individual infusion rooms, we heard from several parents that they often scheduled infusions on the same day as a friend so the kids could sit next to each other and talk. Individual infusion rooms would take that away, so designing some of the rooms with the glass partition was a direct response to what we heard from multiple patients and their families.”

Lighting and decor were also chosen based on patient and family recommendations.

In addition to the outpatient space, the 31 existing rooms on 6A and 6B of the pediatric hematology/oncology area of the hospital are currently being renovated. The rooms are being updated with renovated cabinetry and an updated sleeping area for parents. There will be brighter lighting and updated hallways. Wallpaper is being removed, and the flooring will be uniform throughout.

“It will be a brighter, more modern and positive environment for our patients and families, particularly for those who have repeated visits or long inpatient visits,” Friedman said.

Many patients with cancer treated at Monroe Carell are participating in clinical trials where tests and imaging are required. The new DOT space will provide more room to accommodate this.

Part of the community’s philanthropy will also support research and training initiatives, developing the next generation of leaders who will contribute to the overall field — ultimately improving outcomes for all patients.

“All of the advances we have made in treating children with cancer have come from discovery brought to patients,” Friedman said. “Donor support allows us to have funds to further ongoing research led by faculty here at Monroe Carell and to recruit new faculty who contribute to our research, educational and patient care missions.”

Allison DeMarcus, who co-chaired this campaign with Kailey Hand, said she hopes the renovation will help both patients and their families deal with a cancer diagnosis. DeMarcus and Hand are both Monroe Carell Advisory Board members and longtime supporters of the hospital and its programs. DeMarcus is former chair of the board.

“We are thrilled that Monroe Carell will be able to offer children with cancer this renovated and expanded space for their clinic visits and infusions,” DeMarcus said. “The children treated here already receive the best care available, but they deserve to receive those treatments in a space that is as comfortable and inviting as we can possibly make it for them. It’s unbelievably hard for families to go through the experience of a child having cancer, but due to the generosity of individuals and businesses in our community, we will soon be able to offer this wonderful space as one small thing we can provide to make their experience a little easier and a little brighter.”

Friedman said the new space will be a win for everyone.

“Providing care in an atmosphere that’s more spacious and bright affects everyone’s morale — the patients, their families, and our staff and faculty. Our donors recognized that, and also the cost of those renovations, and were very generous so we were able to really do this well for our patients and families.”

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Appendiceal cancer is a rare cancer without standardized screening guidelines, risk factors or tumor classifications — a situation that often results in late diagnosis and poor prognosis.  

Up to 1 of every 2 patients is diagnosed with distant metastatic disease, and five-year survival rates vary between 10% and 63%. A team of experts has identified six key research priority areas to deliver a fundamental understanding of appendiceal tumors and to improve treatments and outcomes for patients. Research to advance treatments for this rare cancer is critical.

The recommendations published Feb. 13 in Nature Reviews Cancer are the result of a concerted focus by the Appendix Cancer Pseudomyxoma Peritonei (ACPMP) Research Foundation to better understand the disease that afflicts an estimated 3,000 new patients across all age groups each year. The incidence could be higher because of the challenges accurately diagnosing the disease and identifying the tumor type, the researchers noted.

“The rising burden of appendiceal cancer has illuminated the rudimentary knowledge gaps — spanning from genomes to generations — in our understanding of this rare cancer. By establishing this first-ever research ‘road map’ for appendiceal tumors, we aim to drive collaborative and transformative research discoveries that ultimately will lead to improvements in disease detection, diagnosis, treatments and outcomes for our patients,” said Andreana Holowatyj, PhD, MSCI, assistant professor of Medicine at Vanderbilt University Medical Center and chair of the Scientific Advisory Board for the ACPMP Research Foundation, the article’s lead author.

The recommendations arose from the inaugural ACPMP Research Foundation Scientific Think Tank, sponsored by ACPMP and chaired by Holowatyj at Vanderbilt-Ingram Cancer Center in December 2023. The Think Tank showcases the benefits for scientific collaborations, for robust investments in rare cancer research, and for informing evidence-based medicine. The ongoing effort continues to be a catalyst for revolutionizing the field of research for appendix cancer.

Twenty leading experts on appendiceal cancer met at the Think Tank, and a study group from that meeting are authors of the article.

“This Think Tank and the subsequent publication mark a watershed moment for appendix cancer research,” said Deborah Shelton, JD, Executive Director of ACPMP Research Foundation and co-author of the article. “For far too long, appendix cancer has remained underfunded and underresearched, leaving patients with limited options. These research priorities provide a clear path forward, and ACPMP is committed to ensuring the necessary funding and resources to propel these efforts.”

The six research priorities:

• Refining histopathological classification – Appendix tumors are not a single entity. Variability of terminology for appendix tumor classification is a challenge due to the rarity of the cancer and supports the need for expert pathology review of appendix tumors among all patients. Consistent application of tumor classification and grading, digitizing histology for tumor detection, and leveraging computational approaches to refine tumor diagnosis are needed.
• Molecular characterization of appendix tumors – The discovery of appendix tumor cells most often occurs postappendectomy when the entire appendix has been removed prior to cancer diagnosis. Preserving and molecular profiling of this tissue are necessary to establish a composite multiomics view of appendiceal tumors.
• Defining the appendiceal tumor microenvironment – A better understanding of the dynamic ecosystem surrounding tumor cells will yield new information for treating appendiceal cancer as well as understanding tumor evolution and disease progression. This information should also be used to contribute to a molecular atlas for appendix tumors.
• Development of disease-specific models – The number of appendix tumor models is extremely limited. Research continues on developing patient-derived organoids to support preclinical testing of new therapeutic drugs.
• Clinical studies of appendix tumors – Collaborative, multicenter efforts — such as the Genetics of Appendix Cancer (GAP) Study at Vanderbilt-Ingram, as well as the development of clinical trials in appendix tumors will yield evidence-based, clinically impactful advancements in this rare cancer.
• Appendix cancer on a population level – Population studies will help researchers identify potential risk factors and/or exposures associated with appendix tumors and address distinct care needs of patients with appendix tumors. These studies will deliver key data to establish early detection strategies, support clinical trials, improve clinical practice and impact public policy.

The study’s other authors include Michael Overman, MD, Konstantinos Votanopoulos, MD, PhD, Andrew Lowy, MD, Patrick Wagner, MD, Mary Kay Washington, MD, PhD, Cathy Eng, MD, Wai Chin Foo, MD, Richard Goldberg, MD, Mojgan Hosseini, MD, Kamran Idrees, MD, MSCI, MMHC, Douglas Johnson, MD, MSCI, Ardaman Shergill, MD, Erin Ward, MD, and Nicholas Zachos, PhD.

Their work was supported by the ACPMP Research Foundation, Vanderbilt-Ingram Cancer Center and NIH/NCI (P50CA236733).

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