‘Some Kids Do Die’: Cancer, Reality and Optimism

A few weeks ago, Dr. Holcombe Grier was contemplating a sad truth in a side hallway of the children's ward at Dana-Farber Cancer Institute in Boston. The rest of the ward was bright and cheery, filled with fish tanks and Disney paintings, but this hall was more subdued. On the wall was a mural made of more than 100 pieces of clay, each of them sculpted by the family of a young patient who had passed away. In 1996, when the mural was designed, not everyone at Dana-Farber wanted to put it up: it was at odds with the ward's purposefully upbeat atmosphere. But Grier was one of its proponents. He didn't want to gloss over the tragedy that can be part of his job. "Some kids do die," he said, looking at the mural. Then he went back to the business of making sure that many more of them live.

In the past few years, much of the news coming out of pediatric-cancer research has been happy. Some forms of childhood cancer now have cure rates of 80 percent, an astonishing improvement on the 20 percent that was standard when Grier was starting his career three decades ago. As clinical director of pediatric oncology at Dana-Farber and Children's Hospital Boston, he is one of the nation's top researchers on childhood cancer; his work has saved many lives. He has also made a point of encouraging colleagues to share their data and ideas—an openness that underlies almost all the recent success in the field. "Pediatric cancer is rare," he says, "and the only way to study rare tumors is in a big collaborative group." In a trial he published five years ago on drugs for Ewing's sarcoma, he had to rely on 14 coauthors from institutions all over the country just to find enough patients to study. The results were worth it: in patients whose disease was caught early, 69 percent who got the experimental therapy were alive and disease-free after five years. The standard therapy's rate was 54 percent.

For all his success, Grier's job is becoming harder. In the same period that he and other researchers have managed to cure so many children, they have also found themselves strapped for cash. Private fund-raising has contributed enormously to pediatric-cancer research, but lately government money is hard to come by. Funding for the Children's Oncology Group, a nationwide scientific network, has been "flat for 10 years," Grier says. "That doesn't allow us to do anything." Some promising trials have run out of money and shut down. Meanwhile, Grier is worried that the field has taken its current cancer drugs about as far as they can go. There might not be much more progress until scientists invent new ones, he says: "I think we may be slamming up against what we can do with classic chemotherapy."

Grier's job in the lab, then, is to do the same thing he does in the clinic: to balance optimism with realism, hope with heartbreak. He's so jolly that it's become a cliché at Dana-Farber to compare him to Santa Claus—he wears a bow tie, plays the banjo and greets almost everyone he knows with a signature handshake—but he's also straight with his young patients. One of them, Valerie Bradley, was diagnosed two years ago with osteosarcoma in her left leg. She started ninth grade in a wheelchair. Today the tumor is gone, and she can run. She showed off recently for Grier, jogging down the hall of the hospital. A few minutes later, the two of them were examining a CT scan as her mother looked on with concern. A radiologist had seen a mysterious nodule on the scan, but Grier was unfazed. He'd keep an eye on it, but it probably wasn't anything serious, he told Bradley: "If I was worried, I'd tell you." Bradley left the clinic with a smile. So did Grier, who straightened his bow tie and moved on to his next patient.

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