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Joseph V. Simone, MD An Innovator in Pediatric Cancer Care

Joseph V. Simone, MD, is best known for leading the research efforts that resulted in the first curative com- bination treatment for certain pediatric patients with acute lymphoid . Under his leadership, the St. Jude Children’s Research Hospital in Memphis, Tennessee, was designated the first and only National Cancer Institute cancer center dedicated to children. He was honored in the Pediatric category with a 2017 Giants of Cancer Care® award.

A Legacy of Hope for Young Leukemia Patients

BY ANGELICA WELCH

IN THE 1960S, PROGRAMS for treating the kids will understand. It’s tricky, though, to find cures for more children. “When you get leukemia were few and far between—especially because you can scare them, the parents are one like that, you get very, very anxious to get for children. The disease was just beginning scared—and sometimes I am scared. But I think more. That pushed us on,” he says. to be understood, and rules and regulations [having] that group—parents, doctor, our superb for taking care of both adult and pediatric nurses, and the patients involved—is something A MENTOR patients were underdeveloped and inefficient, [for which] we do not provide enough training When asked about the great strides made in as the first treatment for systemic had for people,” Simone admits. the 1960s and 1970s for childhood leukemia, been developed only a decade earlier. St. Jude’s prominence grew with Simone’s Simone credits his mentor, Donald Pinkel, MD. A key player who emerged during those reputation. After one year, he had reorganized Pinkel was the first director of St. Jude and has early years of pediatric cancer care was Joseph the clinic and laid the foundation for the repu- been cited as one of the preeminent physicians V. Simone, MD. Most notably, he chaired the tation of efficient, personalized, patient-based in the fight against childhood cancers. Department of Hematology and served as asso- care that St. Jude is revered for today. “He was there before the building was ciate director for clinical research at St. Jude Patients are what drove Simone to make built—he was already putting in the structure Children’s Research Hospital before becoming the St. Jude a home away from home. Situated on for taking care of patients,” Simone says of director and CEO of the hospital from 1983 to 1992. the Mississippi River that serves as the state Pinkel. “He helped all of us youngsters learn The Chicago native began his career in medi- border, many of his patients lived in Arkansas how to conduct clinical trials so that we could cine as a resident at Presbyterian-St. Luke’s and had to travel by bus or ask for a ride from find out what kind of treatment was better for Hospital. Initially studying internal medicine, neighbors just to get the treatment they needed. that particular leukemia.” Simone soon discovered his interest in hema- To alleviate this emotional and economic pres- Simone’s philosophies, medical and other- tologic diseases. That led him to the Pediatric sure, Simone and his colleagues developed a wise, have been formed by watching others. Department at the University of Illinois, which program where the hospital would pay for the He cites working with seasoned physicians, had a big commitment to blood disorders and families to stay in nearby hotels. This philos- listening to parents of children with cancer, was conveniently located down the block. ophy is demonstrated in the roots of St. Jude’s and treating patients as the best lessons After years of training in hematology and current financial assistance policy for which it is learned throughout his career. oncology, Simone left Chicago to take a job at highly praised. The hospital vows to never turn One of the medical philosophies he followed the St. Jude Children’s Research Hospital in away a patient because of the inability to pay. came from Pinkel, which Simone said was best Memphis, Tennessee—a position suggested by One of these patients who lived “across the described as an attitude. Pinkel had a certain a friend who had passed on the opportunity. river” in Arkansas was one of Simone’s first attitude regarding how physicians should Until this point, almost all children with patients who was cured. At 10 years old, the handle and treat patients and their families, leukemia died of their disease. But by culti- boy appeared to be cured, but Simone and his stating that both hope and truth are essential vating a communication model to better reach colleagues were careful to warn the mother components of pediatric care. the patients, Simone began to see the difference that this may not be permanent. Simone Simone went on to serve as the associate in treating children versus treating adults. continued to follow the patient’s progress on a director for clinical research. Together with The level of complexity of the treatment regular basis, and the boy continued to move his colleagues, Simone made great strides in changes when speaking with a child rather than along, developing as a normal child would. the research field. Most notably, he developed to an adult, so “we use words and concepts that This case inspired Simone, motivating him the first curative combination treatment for

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select children with acute lymphoid leukemia, Jude, Simone was recruited to be the physi- which led to the first patient with the disease cian-in-chief of Memorial Sloan Kettering JOSEPH V. to be successfully taken off therapy. Cancer Center. From there his career path SIMONE, MD Success did not come without its challenges. took him to the Huntsman Cancer Institute at Reflecting on his work, Simone recalls finding the University of Utah, where he was the first American Cancer Society Award and curative treatments. He shared his findings senior clinical director, and then moved on to Lecture, American Society of Clinical 2010 during a national meeting and was met with the Shands Cancer Center at the University of Oncology and the American Cancer resistance from the community. This, he says, Florida. During these appointments, he also Society was because the subject of leukemia was taboo served as an external adviser for cancer centers Distinguished Service Award, Associa- 2008 in the community; suggesting that there was a such as Moffitt Cancer Center, University of tion of American Cancer Institutes cure for these patients was unheard of. However, Southern California Norris Comprehensive Public Service Award, American Society this did not stop Simone and the team at St. Jude. Cancer Center, Cleveland Clinic, and University 2006 of Clinical Oncology “We pushed on, and we got some terrific of California San Diego Moores Cancer Center. results over the next several years, and people Simone reflects on his time building these 1999 Stritch Medal, Loyola University started calling us, saying that they wanted to cancer centers with a chuckle, stating, “I come to St. Jude to see how we did this,” Simone assume I did a good job because they paid me.” Award of Excellence, Ronald McDonald House Charities says. “We had a whole trail of people from Germany, Poland, Japan—all over the world— AWAY FROM THE CLINIC LeRoy Hoeck, MD Lecturer and Award who wanted to see how we could possibly get Away from the clinic, Simone has also shaped 1993 of Academic Excellence, Children’s that result. That is really how it exploded.” practice within the larger oncology commu- National Medical Center One of the biggest challenges of a pediatric nity. He led the development of the American Maurice Grimes Lecturer, Canadian oncologist, Simone says, is working with the Society of Clinical Oncology’s Quality Oncology 1987 Cancer Society patients and their families to understand the Practice Initiative, which is an oncologist-led, Lecturer, 18th Annual Dr. George illness and outcome. “You must adapt,” he practice-based program. Additionally, he served 1984 Waterman Cancer Dialogue says. It is the doctor’s responsibility to help the on the editorial board for Journal of Clinical patient understand that he or she is trying to Oncology from 1982 to 1983, before serving as Myron Karon Memorial Lecturer, 1982 help them, not hurt them. Additionally, Simone an associate editor from 1984 to 2001. Children’s Hospital of Los Angeles says, a large part of treating a child is coun- Other notable positions he has held over his Wadsworth lecturer, Rush-Presbyterian- seling the parents and cultivating the skill in career were medical director and chair of the St. Luke’s Medical College which to do that effectively. He has seen this National Comprehensive Cancer Network, pres- Paul Shonfeld Memorial Visiting very challenge drive people away from the ident of the Association of American Cancer 1981 Professor, Children’s Memorial Hospital field, but it is this relationship that he feels is Institutes, and vice chair of the Pediatric Oncology integral to truly treating a child with cancer. Group. He has also served on the board of direc- Richard and Hinda Rosenthal Memorial In 1983, under Simone’s leadership, the tors for the American Society of Clinical Oncology. 1979 Award, American Association for Cancer hospital was designated as the first and only Although mostly retired, Simone currently Research National Cancer Institute cancer center dedi- serves as the president of Simone Consulting, Healing Arts Award, Memphis Chapter cated entirely to children. The following which provides services including strategic plan- 1971 of the National Hemophilia Foundation year, St. Jude established what is now the ning, program structure, quality assessment, world’s largest long-term follow-up clinic recruitment, and physical facilities. He continues interacting with the patients he has treated. geared specifically toward pediatric cancer to write his own column, “Simone’s OncOpinion,” Being able to watch his former patients go on to survivors. Other successes during his direc- about his observations of the current oncology high school, college, and marriage is worth more torship included researchers’ finding the space, with advice for physicians in the field. than any medal, trophy, or ribbon. first 2 specific translocations known to cause Simone has undoubtedly left a mark on A day has not passed when Simone has pediatric acute lymphoblastic leukemia and the pediatric cancer world during his career. regretted his decision to leave internal medi- developing individualized chemotherapy regi- From his time as a resident at the University cine to treat children with cancer. “There is no mens based on patient tolerance. of Illinois and director of St. Jude Children’s question in my mind that my biggest impact in By the end of Simone’s time at St. Jude, the Research Hospital to his directorship of the my career was developing treatments for child- once-dismal survival rate for acute lympho- Shands Cancer Center, Simone has parlayed hood leukemia. Everything is dwarfed against blastic leukemia had reached 73%. Currently the his expertise in the laboratory and the clinic that,” he says. “I think that having become a survival rate for children with acute lympho- into leading the charge on building up cancer pediatric oncologist was a godsend for me.” blastic leukemia sits in the 90% range. centers around the . Although he says that his entry to pediatric Simone’s success in building St. Jude as a With over 50 years in oncology, Simone has had oncology was a “quirk,” he knew that he could cancer center had institutions knocking at a professional career that has filled his garage make the biggest impact on children dealt the his door to help them do the same. After St. with awards but he says nothing compares with unluckiest of hands. n

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