Nina Kadan-Lottick, MD, treats seriously ill children, but she is often optimistic. Cure rates for pediatric cancer patients are about 82 percent overall, and for acute lymphoblastic leukemia, her area of special interest, the latest trial showed a cure rate of more than 90 percent for children ages 1 to 10. “It’s often held up as the modern medical miracle, where you can see how cooperation and multidisciplinary research can make all the difference,” she said.
The success in treating pediatric cancer has created somewhat of a conundrum for Dr. Kadan-Lottick and her colleagues. Children with cancer are surviving, but treatment exposures during childhood can cause problems later in life that may be clinically silent at first, but can become serious.
Dr. Kadan-Lottick cautioned one young Hodgkin’s survivor that although he was only 18, he was at increased risk of heart failure and heart attacks because of the chemotherapy and radiation he had received. She instructed him to go to a doctor immediately if he experienced chest pain or shortness of breath that was out of the ordinary. A few months later, he was playing in a college basketball game and had chest pain. His coach urged him to get back on the court, but he called Dr. Kadan-Lottick instead. When she met him in the emergency room it turned out he was having a heart attack.
The Yale’s HEROS program, which was one of the country’s first childhood cancer survivorship clinics when it opened in 2003. As director, Dr. Kadan-Lottick screens patients for hormone deficiencies, cardiac ailments, learning problems, osteoporosis and other conditions that sometimes result from childhood cancer treatments.
While these are treatable conditions, they don’t usually develop until adolescence and young adulthood, when patients and their parents are no longer thinking there’s any need for special medical follow-up. But Dr. Kadan-Lottick would like to change that. She believes that it may be more appropriate to think of childhood cancer as a chronic disease; once it’s kept under control, there might be other health issues arising later that need to be considered. “That’s changing a paradigm so I think it will be gradual,” she said.
In order to mitigate the collateral damage caused by cancer treatment, Dr. Kadan-Lottick aims for the least toxic, evidence-based cure, followed by early surveillance to catch problems early. Follow-up is the key to avoiding health problems down the road. “I feel like I’m on a mission to convince my fellow physicians and my patients that an ounce of prevention is equal to a pound of cure,” she said.
More about Dr. Kadan-Lottick
Name: Nina Kadan-Lottick, MD
Title: Associate professor of pediatrics (hematology/oncology); medical director, HEROS Program
Area of expertise: Pediatric oncology and childhood cancer survivorship
Place of birth: Elgin, IL
Age: 43
College: Johns Hopkins University
Med School: Johns Hopkins University School of Medicine
Training: Residency in pediatrics at Johns Hopkins Hospital; fellowships in pediatric hematology/oncology at The Children's Hospital, University of Colorado Health Sciences and cancer epidemiology at the University of Minnesota
Family: Husband: Adam Lottick, MD, cardiologist (electrophysiology); Children: twins Samantha and Kadan, 12; Antrim, 10
What is most challenging to you in academic medicine? Finding the time for all the different passions I have in medicine, especially maintaining excellence simultaneously in both clinical care and grant-funded research.
What is most rewarding? Helping children get better. It’s a privilege to be a part of that. I’m always visualizing what I can do to better help children in the future, whether it’s the child I have in front of me or others who can benefit down the road with our research projects.
What do you like most about your practice? My colleagues, who are very supportive and keep me on my toes in terms of keeping my level of practice high and thinking critically about patients.
Personal interests or pastimes:Reading, hiking, spending time with my children.
Last book read: A Red Herring Without Mustard, by Alan Bradley.
What would you do to improve our clinical environment if you had a magic wand? I wish our practice could run more like a private practice in terms of optimizing how it works for our patients. This means everything from free and easy parking to having point people who patients can turn to when they want to solve a problem.