The Britton Center
everything under one roof

by Joanne Shaw

Grasping an IV pole in one hand and a teddy bear in the other, a little boy anxiously toddles down the hallway to greet a visitor. Down another corridor, a teenage girl hastily wraps a turban around her bald head before leaving the hospital, while another younger girl readjusts the scarf that slides easily down her smooth scalp.

These children have cancer. They also have broad smiles of hope provided in large part by treatment from Health Science Center physicians at a unique, comprehensive pediatric cancer center.

This unique facility and the extraordinary talents of physicians and researchers from the Health Science Center combine to form a powerful force in fighting the disease that strikes approximately 11,000 children each year in the United States. At the Howard A. Britton, MD, Children's Cancer and Blood Disorders Center at Santa Rosa Children's Hospital in San Antonio, everything is under one roof--inpatient and outpatient care, development of new drugs, bone marrow and stem cell transplants, child and family counseling and a pharmacy used exclusively for dispensing chemotherapy agents.

"What we really have is a unique opportunity to provide almost a medical home for these children and their families where they see everybody--doctors, nurses, case managers--on the eighth floor of the hospital," said Anthony J. Infante, MD, PhD, professor and head of the hematology, oncology and immunology division of the department of pediatrics. With the goal of providing as normal a child-life experience as possible, especially for inpatients, the Britton Center also has a special play area for young children, a teen room with computers donated by San Antonio Spurs players Vinny Del Negro and Avery Johnson, a parents' lounge and a hospice room named Casa de Mariposa (Butterfly House).

"For many childhood cancers the odds are in the children's favor, especially compared to what they were 30 years ago," Dr. Infante commented. "For some forms of childhood cancer the long-term survival rates are as high as 90 percent."

"The hospice room at the children's hospital reflects the fact that not all childhood cancers can be cured," added Javier R. Kane, MD, assistant professor of pediatrics and medical director of the pediatric hospice program at Santa Rosa Children's Hospital. "In palliative care and hospice, children with a terminal illness receive comprehensive medical care, addressing the child and his/her family's experience of suffering, with its multiple physical, psychological, social and spiritual components."

When The University of Texas South Texas Medical School (now The University of Texas Health Science Center at San Antonio) opened in 1968, Thomas E. Williams, MD, then a faculty member in the department of pediatrics and pioneer in chemotherapy treatments for childhood malignancies, and Howard A. Britton, MD, then a hematologist in private practice, started the clinic which now bears his name. "We decided that rather than have two or three different programs all around town, we would concentrate our resources in one place," said Dr. Britton. "The center's a prototype in a way--a marriage of university staff, physicians and other health professionals who can work together to benefit the patient, the community, science and research. And the marriage has lasted 30 years."

Dr. Britton, now a professor in the Health Science Center's department of pediatrics, heads the department's hematology and hemophilia programs. The Britton Center contains one of three federally granted hemophilia centers in Texas. There are 164 nationwide.

The Health Science Center's multifaceted effort helps bring pediatric oncology to the fore around the world, particularly in the area of drug development. (See related story on page 4.) All too often, according to Celia I. Kaye, MD, PhD, chairman of the department of pediatrics, children have been given cancer-fighting drugs that have gone through the initial stages of development for cancers usually found only in adults. "If a new drug were developed for throat cancer, a disease that mostly affects adults," she explained, "it might be tried on children without having undergone any comparable research of the drug's effect on children's cancers. Children's cancers are very different from those of adults."

Dr. Infante explained that adults more often develop cancers of the digestive and respiratory systems and the skin. Environmental components, such as smoking which is linked to lung cancer, and sun exposure which is linked to skin cancer, are more often found in adults, he added. In children, more cancers are found in the blood, bone marrow, liver, kidneys, bones and brain.

"The fear is that when you are testing agents against a set of adult cancers, either in a lab where you're looking at cells and tissues, or in the patient, you may be rejecting agents that may be quite potent against childhood cancers," said Dr. Infante. "Or you may be selecting agents that look very promising in adults but really are of little use in treating childhood cancer. A good recent example is taxol, which is used effectively for adult cancer. So far, the clinical trials in pediatrics have shown that taxol is not a very effective agent for childhood cancer."

The Britton Center is a member of the Pediatric Oncology Group (POG), a national consortium of research institutions that run large-scale clinical trials for different childhood cancers. While drugs (chemotherapy) are used primarily, certain childhood cancers also are treated with surgery and/or radiation. Specialist physicians in these areas also are members of the Britton Center team. According to Dr. Kaye, children being treated for cancer are usually a part of a study, so that attending physicians can have access to nationwide protocols (treatment plans) which are intended to maximize the possibility of benefit to the patient.