Top Docs Q&A: Lisa Diller
This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, current research, and life as a doctor.
Name: Lisa Diller
Hospital Affiliation: Dana-Farber Cancer Institute
Title: Chief medical officer of Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, clinical director of pediatric oncology, and the medical director of David B. Perini, Jr. Quality of Life Clinic
Field: Pediatric hematology-oncology
Specialty: Cancer survivors-late effects of therapy, neuroblastoma, pediatric solid tumors
As a leading expert in studying survivors of childhood cancer, what would you say is the biggest challenge survivors face?
When we treat children, we use therapies that can often affect the way a child develops. That can mean when we use radiation, the bones targeted might not fully grow. So depending on the therapy used, more often than not, a child doesn’t go through puberty normally. Because of this, when the patient grows into a young adult and wants to start a family of their own, they often realize that, yes although they have been cured of their childhood cancer, they are unable to have biological children of their own.
You’ve been studying how childhood cancers survivors often face infertility. What have you found so far?
We’ve been studying data from female childhood cancer survivors that are now adults and are trying to get pregnant or have gotten pregnant. We are finding that when a patient used radiation on or near their ovaries, or if they were given high doses of medicine, they were unable to make eggs. So now that we know what the risk factors are for these treatments and pregnancy, we need to find alternative treatments.
Since child cancer treatments have such lingering effects as they mature, are you currently looking for a more non-invasive treatment?
One of the wonderful things about being a pediatric cancer specialist is that I can really learn, over time, what the long-term effects are in cancer therapies that were used in the 70s and 80s, and I am able to get rid of some of those therapies. We are currently learning alternative treatments to high radiation. So that can mean limiting the exposure of normal tissue to radiation, or not using it at all. We are learning and researching how a low dosage of radiation or medicine can get the same survival rate to cure the cancer as the current dosage does.
Your current research also suggests that these cancer treatments can cause congestive heart failure as a childhood cancer survivor matures. What is the reasoning behind this?
One of the things we know about congestive heart failure is a certain type of drug, called anthracycline, is very effective in a variety of childhood cancers but those drugs have long-term cardiology effects, particular when used in large dosages or with radiation. And with this drug, patients need to get screened yearly because they have such a high chance for being at risk. Because of this, we are researching how to screen for congestive heart failure in a way that will reduce the chance of mortality, but is also cost effective and feasible for our patients.
So this all goes back to needing to find a more targeted therapy for the patients that are children?
Exactly, we need to research more targeted therapies that will not affect the organs, the heart, ovaries, and bones. This way the patients can be free of their cancer and free of the risk of a later disease.
You’re currently in the early stages of studying neuroblastoma in children, what is this research going to look like?
When I’m not wearing my hat as a doctor that takes care of survivors, but as a doctor who takes care of children with cancer, I focus on neuroblastoma. It’s a disease that occurs in very young children and can be very difficult to treat. So we are currently identifying children and families throughout the United States that were treated with modern therapies and are long-term survivors of this disease. By identifying the survivors, and how they are doing now, we can really learn a lot about the disease because this is a disease that didn’t use to have survivors at all.