Smita Bhatia, M.D., M.P.H. Research Focus


My research has focused primarily on cancer outcomes, with a special emphasis on the long-term health and well-being of cancer survivors. As chair of the Children’s Oncology Group Late Effects Committee between 2000 and 2008, I have been responsible for facilitating and promoting research relating to complications following childhood cancer among patients placed on COG therapeutic trials. As director of the bone marrow transplant long-term follow-up program at City of Hope, I have been responsible for ensuring complete follow-up of all patients undergoing hematopoietic cell transplantation, and identifying chronic health issues among the survivors. As director of the Center for Cancer Survivorship, I have assumed the responsibility of developing multidisciplinary survivorship clinics for cancer survivors – providing these individuals with state of the art comprehensive follow-up care in the setting of clinical research.

Highlighted below are some of the specific projects that are currently ongoing under my supervision:

Long-term Follow-up of Hematopoietic Cell Transplantation (HCT) Survivors
 
As director of the Long-term Follow-up Core, I am responsible for ensuring complete follow-up of all patients undergoing HCT at City of Hope and identifying chronic health conditions among the survivors. Funding source: Leukemia Lymphoma Society Translational Research and National Cancer Institute (NCI)

Role of Genetic Susceptibility in the Development of Secondary Myelodysplasia: Secondary myelodysplasia and acute myeloid leukemia (t-MDS/AML) occurs in some patients following therapy with alkylating agents or topoisomerase II inhibitors, and among patients undergoing autologous transplants for lymphoma. In collaboration with Ravi Bhatia, I am evaluating prospectively, among patients with non-Hodgkin Lymphoma (NHL) and Hodgkin lymphoma (HL) undergoing chemotherapy and autologous transplantation, the sequence of acquisition of genetic and hematopoietic defects, that result in the development of overt therapy-related MDS/AML. The goal of this study is to determine the utility of genetic markers as biomarkers of risk of therapy-related MDS/AML after chemotherapy and autologous bone marrow transplantation for NHL/HL. Funding Source: Leukemia and Lymphoma Society Translational Research and the National Cancer Institute (NCI).


Outcome of Children with Acute Lymphoblastic Leukemia
 
I have demonstrated that children with ALL have significant differences in survival by ethnicity. In order to understand the underlying causes for these differences, I am exploring whether there are ethnic/racial differences in the disease biology, pharmacogenetics and compliance of therapy that could possibly account for the differences in survival. I have shown that non-adherence is prevalent in children with ALL, and that non-adherence to oral 6MP impacts relapse risk. I have now developed a clinical trial to examine whether an intervention can successfully improve adherence. Funding Source: National Cancer Institute and St. Baldrick’s Foundation.


Role of Genetic Susceptibility in the Development of Treatment-related Adverse Events
 
I have established a mechanism within the Children’s Oncology Group to identify key adverse events developing in survivors of childhood cancer and bank DNA and RNA from these patients. These key adverse events include congestive heart failure, ischemic stroke, avascular necrosis and subsequent malignant neoplasms. I am testing the hypothesis that patients who develop these adverse events after treatment for childhood cancer may have a genetic susceptibility to do so. Funding source: Leukemia and Lymphoma Society and the National Cancer Institute .


Development of Guidelines for Follow-up of Childhood Cancer Survivors
 
As part of the guidelines core committee, I have facilitated the development of risk-based, exposure-related guidelines for long-term follow-up care of pediatric cancer survivors. These guidelines were developed with the goal of early identification of exposure-related late complications, potentially allowing for early intervention with resultant increased quality of life and decreased complication-related healthcare costs. Screening recommendations are organized by therapeutic exposure and accompanied by targeted health education materials; all are available free of charge at http://www.survivorshipguidelines.org/.


Childrens Oncology Group Long-term Follow-up Center (Chairs:  Smita Bhatia, M.D., M.P.H., and Dennis Deapen, Dr. P.H.)
 
We have established a childhood cancer Long-term Follow-Up Center (LTFC) that performs long-term follow-up for all patients seen at the Children’s Oncology Group (COG) centers in the United States. The LTFC is located in the Department of Preventive Medicine of the Keck School of Medicine at the University of Southern California (USC). The LTFC performs annual follow-up with COG patients, utilizing a variety of techniques to maintain currency of contact information and employs other available resources to re-establish contact with patients (or their parents) for whom contact has been lost. The LTFC is a national resource, creating the capacity for clearer understanding of childhood cancer survivorship issues and providing many research opportunities.


Center for Cancer Survivorship (Director: Smita Bhatia, M.D., M.P.H., Clinical Director: Wendy Landier, Ph.D., R.N., C.P.N.P.)
 
The overall goal of the Center for Cancer Survivorship is to provide specialized long-term follow-up care for cancer survivors. Through the Center for Cancer Survivorship, the cancer center provides unique, comprehensive follow-up care for cancer survivors in a clinical research setting. The center supports the following activities:
 
 
  • Clinical Care: Comprehensive long-term follow-up services for (1) childhood cancer survivors (Saro Armenian, D.O., M.P.H. [Medical director], Karla Wilson, R.N., M.S.N., Landier, and Bhatia), and (2) prostate cancer survivors (Ms. Smith and Laura Crocitto, M.D.). Care is provided as a consultative service in collaboration with the patient’s primary care provider and oncologist. Most patients are seen for yearly comprehensive assessments; however, one-time consultation is also available.
  • Research: The Center for Cancer Survivorship provides unique opportunities for collaborative clinical research across populations of survivors, involving researchers from multiple disciplines such as medicine, nursing, psychology, cancer genetics and epidemiology/etiology. Clinical research is the foundation from which we gain new knowledge regarding potential long-term complications of cancer treatment as well as the optimal follow-up care and education for cancer survivors. All survivors participating in the center are offered opportunities to participate in clinical research.
  • Patient/Family/Community Education: Health education personalized for each survivor based on his/her diagnosis, treatment and current medical condition is provided during follow-up visits at the center.