Gregory J. Aune, MD, PhD
Greehey CCRI, Director of Communications and Community Engagement
Research and Advocacy for Childhood Cancer Survivors.
Long-term survivors of childhood cancer are a growing population. Approximately two-thirds of survivors are afflicted with a severe health condition that is directly related to their previous exposure to cancer therapies. Emerging research suggests that these individuals exhibit a phenotype of premature aging, as indicated by substantially higher rates of cardiac dysfunction, ovarian failure, neurocognitive deficits, neurosensory deficits, and second cancers. Our overall goal is to use preclinical laboratory models to elucidate the underlying mechanisms of organ damage caused by pediatric cancer treatment
Pediatric Cancer Survivorship – Clinical care of long-term survivors of pediatric cancer.
Cardiac Disease in Long-term Survivors
Cardiac disease is the second leading cause of late mortality in childhood cancer survivors, and the cumulative incidence of cardiac disease by age 50 is approximately 20%. With the childhood cancer survivor population in the U.S. expected to reach 400,000 by 2020, the number of affected individuals is large and growing
Gaps in Research and Preclinical Models
Clinical studies aimed at understanding the pathophysiology of cardiac disease in childhood cancer survivors have significant limitations:
- the decades-long latent period between exposure to therapy and the development of cardiac disease;
- very low rates of long-term follow-up;
- In the heart, it is not feasible to study changes at the tissue and cell level. Mouse models can overcome these limitations due to a shorter life span and the ability to expose pediatric animals to chemotherapy and serially sample heart tissue.
Childhood Cancer Advocacy
Survivorship is under-researched and underfunded. Dr. Aune is a leader in national and international efforts to increase awareness, enact legislation, and raise funds for research.
Clinical Survivorship & Research
Studying the basic science of cancer treatment late effects. Building the clinical programs to translate findings and impact cancer survivors in South Texas. Over the past 60 years, research in pediatric oncology has made remarkable progress. In the 1950s, a pediatric cancer diagnosis carried a dismal prognosis, with fewer than 10% of children surviving. Today, approximately 75% of all children receiving a diagnosis of cancer survive longer than five years. With the dramatically improved success rates, survivors are challenged with a variety of life-threatening and chronic late health effects related to their cancer therapy. These include cardiovascular disease, infertility, neurocognitive deficits, and a variety of endocrine problems. During the first decade of the 21st century, epidemiologic research has clearly defined the severity of the late effects problem we face in pediatric oncology. A seminal paper published in the New England Journal of Medicine in 2004 by Oeffinger et al. reported that 67% of all long-term survivors of pediatric cancer suffer from at least one late effect. More alarming, Oeffinger’s study reported that 25% of cancer survivors suffer from a life-threatening late effect such as coronary artery disease, congestive heart failure, multiple second malignancies, or stroke. In the United States, there are approximately 325,000 survivors of pediatric cancer, and the State of Texas has as many as 30,000. As our national research efforts continue to improve cure rates for all pediatric cancers, the number of survivors in the U.S. and Texas will continue to increase. In 2012, the National Cancer Institute had a proposed budget of $5.8 billion. The vast majority of these earmarked funds will be tumor-focused and aimed at understanding the biology and basic science of cancer and the development of novel treatments. Only a small fraction will be available to fund survivorship research, and an even smaller fraction will support research aimed at understanding the underlying biological effects chemotherapy and radiation have on healthy tissues. The unparalleled success of the previous 60 years of pediatric oncology research has ushered in a new era. We must begin to understand the cellular and molecular mechanisms leading to severe late effects. In this current era of rapidly advancing biomedical research technology, focusing some of our resources on the problem of late effects has the potential to fundamentally transform the practice of pediatric oncology over the coming decades. Successful endeavors will lead to novel therapies, decreased morbidity in survivors, and the creation of formal institutional programs aimed at expanding efforts to understand the basic science of late effects. The mission of the Aune Laboratory is composed of three core goals.
- Conducting high-quality basic science that increases our knowledge of how chemotherapy and radiation affect healthy tissues and lead to late health effects in long-term pediatric cancer survivors
- Translating laboratory findings into the clinic to allow pediatric oncologists to identify high-risk patients and to lay a foundation for the development of novel strategies to prevent healthy tissue damage occurring during exposure to standard chemotherapy regimens
- Educate patients and our local community about the growing public health problem of late effects in pediatric cancer survivors. Via these efforts, we will raise awareness and promote fundraising to establish Greehey CCRI as a national leader in the effort to solve the problem of pediatric cancer late effects
- Texas Public Radio: “Fighting childhood cancer in San Antonio” (Aune) September 8, 2023
- Journal of Clinical Oncology: The Childhood Cancer Data Initiative: Using the Power of Data to Learn From and Improve Outcomes for Every Child and Young Adult With Pediatric Cancer (Aune Co-author) June 5, 2023
- Thrombosis Research: A cohort study on blood coagulation in childhood cancer survivors (Aune) May 5, 2023
Community Awareness & Fundraising
There are upwards of 30,000 long-term survivors of pediatric cancer that reside in the State of Texas. By using the 2010 census data, it is estimated that as many as 3,000 citizens in the South Texas region are survivors of pediatric cancer. Currently, the South Texas Cancer Survivorship Program actively follows approximately 400 patients. Furthermore, surveys of adult medical practitioners indicate a fundamental lack of knowledge regarding the severity of late effects in pediatric cancer survivors. Therefore, there is a large population of patients at high-risk for life-threatening health effects that are not receiving the comprehensive expert care their medical condition requires. To improve the lives of these patients, we must educate survivors, medical providers, and our surrounding community. We must strengthen our medical systems to provide consistent and cutting edge long-term care. To accomplish these tasks, community awareness and fundraising are a top-priority of the Aune laboratory.