Anne-Marie LangevinProfessor of pediatrics and Greehey Chair in Pediatric Oncology, UT Health San Antonio
Anne-Marie Langevin, of the South Texas Pediatric Minority/Underserved NCI Community Oncology Research Program site in San Antonio, won the 2018 Harry Hynes Award, which is given annually to the PI who reflects the outstanding contribution to clinical trials and community research.
Langevin, professor of pediatrics and the Greehey Chair in Pediatric Oncology at UT Health San Antonio, is the PI at the only NCORP focused on pediatric underserved populations. The NCORP has enrolled over 2,000 children, adolescents and young adults on clinical trials. Altogether, 68 percent of the site’s enrollment is minority, primarily Hispanics.
She has an interest in drug development and is a member of the Pediatric Oncology Experimental Therapeutics Investigators. During her leadership, Langevin created an NCI navigator program to provide access to Hispanic pediatric oncology patients near the borders of Texas and Mexico.
NCORP funding covers four independent pediatric programs. The award provides $740,000 per year, plus intermittent supplements) for five years from 2014-2019.
The NCORP’s Harry Hynes award recognizes local community researchers who embody the attributes of the leadership and commitment demonstrated by Harry Hynes, an Irish native who came to Wichita, Kan., in 1960 and went on to be a pioneer in developing one of the nation’s first Clinical Community Oncology Programs in 1983.
Langevin spoke with Paul Goldberg, editor and publisher of The Cancer Letter.
Congratulations. It’s great that you got the recognition.
I was very surprised. I was, actually, shocked. I don’t do what I do for recognition.
I do it because I like what I do. We all have good days and bad days, but as a whole it’s all good.
Every so often I ask myself: Would I ever do anything differently, and the answer is always the same. No.
The day I stop loving it will be the day I will move out of the field.
You are Canadian, I notice in your bio. Texas is far from Montreal.
I am Canadian. I was born and raised in Montreal, educated in French, then did my adult hematology, but then decided that I really liked pediatric oncology, and I applied to do full training at the Hospital for Sick Children in Toronto.
I did that, did an additional year in drug development, got a job back in Montreal, met my husband, and ended up in San Antonio.
You couldn’t really make that kind of connection. It looks all bizarre.
You are dealing with patients who are probably the most vulnerable and underserved. It’s very far from Canada.
You know what, I’ve been in San Antonio now for 26 years. It is home now. I am invested in the population, I feel very comfortable here. I am very used to the Spanish language, a mixture of Tex-Mex, the culture. It really is home. I was born in Montreal, speaking French, but the cultures are very similar in many ways.
You are dealing with border communities, real disparities…
We are. Correct.
When I came here in 1992, my chief of division, Rick Parmley, had applied for a minority CCOP and got the first grant in 1990, and it has kept going since then.
We had affiliations—and still do—with Corpus Christi, and they have a fantastic outreach program and network connected to the hospital, and they have single EMR, and a transport system.
They have ambulances and planes—the hospital owns five planes.
Because there is so much distance, we have to move providers to work with the patients.
That must be quite a territory.
It is quite a territory. Currently, we cover over 90,000 square miles, and it covers the entire South Texas and covers Central Texas.
With the renewal, we are adding El Paso Children’s Hospital, and that basically expands the coverage area to 143,000 square miles, which is basically a little over half of Texas.
And we will be covering the entire Texas-Mexico border.
What kind of challenges do these kids face?
We have COG institutions that are hubs for these patients. The biggest challenge is distance, of course, and how we get patients in.
Pediatric oncology is super-specialized in the world of medicine. The families will travel to those sites, and those institutions have housing for them.
There is Ronald McDonald, there is philanthropy that will cover it. Medicaid is covering transportation.
In what other ways does your practice differ from anyone else’s? Must be incredibly different.
Our patients have a lot of needs. We have a Hispanic population, and we also have adolescents and young adults.
And there is an age where resources are not as plentiful as they are for children. And that is challenging.
We do have organizations geared for AYAs. These patients have a lot of needs in terms of financial counselling to help with insurance, to help with support. It is an area of need, and it takes a lot of social worker help, a lot of case management. That gets kind of intense.
Every doc I know has a story about a patient who taught them something about life. Who is yours?
They are so resilient—every patient is telling us something.
But there is one who is still in my mind. He was an adolescent, and basically a young adult. He actually was a gymnast. He had an osteosarcoma, and he lost some function of his arm.
He was able to do handstands with one arm. He got his pilot’s license, and was able to move on. He actually got married to a physical therapist, who was in the military and is now in Korea.
I have this other patient, another young adult, who was diagnosed with ALL, very difficult to put back into remission. Finally went into remission with a new medication, a targeted therapy, and then went off treatment.
He almost died at induction, His family is here in San Antonio, they don’t have a whole lot of money; he takes classes online. He went into remission, he actually ran a marathon in December. He has an incredible outlook on life, and he is very humble.
How helpful is the NCORP program to you?
The NCORP program provides the ability to maintain a core of research personnel so necessary for conducting clinical trials.
Without that support, we wouldn’t be able to open studies, follow-up patients, consent patients for study and bring access to the best treatment possible.
NCORP makes it possible for us to have enough support staff.
Also, it provides funds to allow our investigators to travel to research base meetings. It’s so essential to meet with other colleagues, to trade ideas, to hear first-hand progress reports on studies we have patients enrolled on. This is essential. For those institutions, the biggest problem is not having travel money to send your investigators to your research base meetings.
NCORPs allows us to budget this money—and it has been extremely helpful and valued by all our investigators.
Also, the grant allows us to budget salary support at each site. We don’t do per-case reimbursement. We realize that we deal with rare cancers. So just waiting for per-case reimbursement would not be enough to sustain the infrastructure.
The grant allows stabilization. And it has helped hospital administration to actually budget, so there is less fluctuation—and it’s greatly appreciated.