THE UNITED STATES 9/28/81

STATEMENT BY GIULIO J. D'ANGIO, M.D.

MY NAME IS GIULIO J. D'ANGIO, DIRECTOR OF THE CANCER RESEARCH
CENTER OF CHILDREN'S HOSPITAL OF PHILADELPHIA. I AM CHAIRMAN OF THE
NATIONAL WILMS' TUMOR STUDY COMMITTEE, PAST-PRESIDENT OF THE PHILADELPHIA
CANCER COORDINATING ASSOCIATION, AND PAST-CHAIRMAN OF THE RADIATION
THERAPY COMMITTEE OF THE CHILDREN'S CANCER STUDY GROUP, PAST-CHAIRMAN OF
THE CANCER CLINICAL INVESTIGATION REVIEW COMMITTEE OF THE NATIONAL
CANCER INSTITUTE, AND PAST-CHAIRMAN OF THE SECTION ON ONCOLOGY-HEMATOLOGY

OF THE AMERICAN ACADEMY OF PEDIATRICS.

I HAVE KNOWN DR. KOOP FOR 35 YEARS, FIRST WATCHING HIS WORK WITH
ADMIRATION FROM AFAR, AND ONLY RELATIVELY RECENTLY—IN 1976-—NORKING

WITH HIM IN THE SAME INSTITUTION.

MY OWN FIELD.IS THE STUDY OF CHILDHOOD CANCER, AND I WOULD LIKE TO
LIMIT MY REMARKS TO THIS PARTICULAR INTERFACE BETWEEN ME AND DR. KOOP.

A
CHILDHOOD CANCER IS,RARE DISEASE. MANY ARE SURPRISED TO LEARN THAT

/\
CHILDREN CAN DEVELOP CANCER. IT NONETHELESS IS THE LEADING CAUSE OF
DEATH FROM DISEASE IN AMERICAN CHILDREN, IT CLEARLY THEREFORE IS A
MAJOR MEDICAL PROBLEM FOR THE YOUNG, AND THEREFORE FOR THE PEOPLE OF THE

UNITED STATES BECAUSE THE FUTURE OF THIS COUNTRY DEPENDS ON ITS YOUTH.

MAJOR STRIDES HAVE BEEN MADE IN THE CURE OF THE SEVERAL KINDS OF
MALIGNANT DISEASES THAT AFFLICT CHILDREN. A FEW DECADES AGO, VIRTUALLY
EVERY CHILD WITH LEUKEMIA WAS DEAD WITHIN 12 MONTHS: NOW, MORE THAN 50Z
SURVIVE FOR FIVE OR MORE YEARS, AND MANY CAN BE CONSIDERED TO BE CURED.

INDEED, MORE THAN 60% OF CHILDREN WITH CANCER SURVIVE THE DISEASE AS A
RESULT OF MODERN TREATMENTS. THESE TREATMENTS HAVE THEIR ACUTE AND
CHRONIC COMPLICATIONS, HOWEVER. SOME OF THEM ARE OBVIOUS LIKE THE LOSS
OF AN ARM OR A LEG; OTHERS ARE MORE SUBTLE AND TAKE MANY YEARS TO DEVELOP.
EXAMPLES ARE TREATMENT-ASSOCIATED CANCERS, WHICH MAY -TAKE EIGHT OR MORE
YEARS BEFORE THEY BECOME MANIFEST, OTHERS ARE CHRONIC PULMONARY PROBLEMS
AND HEART DISEASE OCCASIONED BY SOME OF THE CHEMOTHERAPEUTIC AGENTS WITH
OR WITHOUT THE USE OF RADIATION THERAPY. WHEN ONE CONSIDERS THAT——
BECAUSE OF OUR SUCCESS IN THERAPY--ONE PERSON AGED 20 IN EVERY 1000 IN
THE UNITED STATES WILL BE A CURED CANCER PATIENT BY 1985 OR 1990. TO

PUT THIS FIGURE IN PERSPECTIVE: IT IS ABOUT THE SAME FREQUENCY AS THOSE
WHO MIGHT HAVE CONTRACTED POLIO IN THE DAYS WHEN THAT DISEASE WAS RAMPANT.
CLEARLY, POLIO WAS A PUBLIC HEALTH PROBLEM IN ITS ENDEMIC AS WELL AS

EPIDEMIC FORM. CANCER TREATMENT HAS CREATED A NEW ENDEMIC CONDITION;

NAMELY, THE CURED CANCER PATIENT.

I GIVE YOU THAT BACKGROUND SO THAT YOU WILL UNDERSTAND THE ENORMOUS
CONTRIBUTION THAT DR. KOOP HAS MADE OVER THE YEARS TO THE HREALTH AND
WELFARE OF CHILDREN WITH CANCER. HE WAS ONE OF THE PIONEERS. HE DID
MORE, HOWEVER, THAN TO DEVISE NEW AND INNOVATIVE TECHNIQUES——-WHICH HE
DID--FOR THE SURGICAL MANAGEMENT OF THESE CHILDREN. "RATHER, HE EXTENDED
HIS TALENTS TO THE STUDY OF THE DISEASE, AND THE WAY LT EVOLVES IN THESE
YOUNG BODIES. ONE OF THE TUMORS THAT ATTRACTED HIS ATTENTION EARLY WAS
THE NEUROBLASTOMA, HIS OBSERVATIONS REGARDING THE EXTRAORDINARY CLINICAL
EVOLUTION OF THIS TUMOR WAS STUDIED BY ALL THOSE INTERESTED IN THE

WELFARE OF CHILDREN, AND THE LESSONS THAT COULD BE LEARNED FROM THESE

OBSERVATIONS COULD BE EXTENDED TO AN UNDERSTANDING OF “MANY OTHER MALIGNANT
CONDITIONS. HIS INFLUENCE WAS SPREAD NOT ONLY THROUGH HIS PUBLICATIONS,

AND THROUGH THE MANY SURGEONS HE TRAINED, BUT ALSO BECAUSE OF THIS

ORGANIZING ABILITY AND FORESIGHT. DR. KOOP ORGANIZED THE FIRST INTERNATIONAL
CONFERENCE ON NEUROBLASTOMA, WHERE EXPERTS FROM ALL AROUND THE WORLD

WERE INVITED TO PARTICIPATE AND TO SHARE THEIR KNOWLEDGE. HE WAS. ONE OF

THE FOUNDING MEMBERS OF THE JOURNAL OF PEDIATRIC SURGERY, WHERE THE
PROCEEDINGS OF THAT MEETING, AND SEVERAL OTHER OF HIS CONTRIBUTIONS

APPEARED AND WERE THUS WIDELY DISSEMINATED THROUGHOUT THE WORLD.

IT CAN BE SEEN THAT IN THIS AREA ALONE, DR: KOOP BAS MADE A CONTRIBUTION
TO THE PUBLIC WELFARE--A CONTRIBUTION THAT HAS BEEN MANIFEST OVER MANY .-
DECADES, AND THAT HAS AFFECTED THE LIFE AND WELL-BEING OF LITERALLY

THOUSANDS OF PATIENTS AND THEIR FAMILIES.

"THIS LATTER ASPECT HAS NOT ESCAPED DR. KOOP’S ATTENTION. HE HAS
‘BEEN CONCERNED ABOUT THE QUALITY OF LIFE OF THE SURVIVOR. HE HAS HAD A
DIRECT INTEREST IN THE REHABILITATION OF PATIENTS “HO MIGHT SUFFER
DEFICITS BECAUSE OF THE TREATMENTS ADMINISTERED--DEFICITS THAT MIGHT BE >
PSYCHOLOGICAL OR SOCIAL AS WELL AS THOSE THAT CAN BE MEASURED IN BODY

FUNCTION.

THE PHYCHO-SOCLO-ECONOMIC ASPECTS OF THE DELIVERYOF MEDICAL CARE
HAVE ALSO BEEN AMONG HIS CONCERNS. HE HAS BEEN ONE OF THE MAJOR FORCES
IN REDUCING THE STAY OF HOSPITALIZED CHILDREN, HELPING TO INITIATE THE
DAY-HOSPITAL CONCEPT SO THAT CHILDREN CAN BE AT HOME WITH THEIR FAMILTES

WHERE THEY BELONG, RATHER THAN IN HOSPITALS.
HIS ORGANIZING ABILITY WITHIN THE CHILDREN’S HOSPITAL AND WITHIN
THE LARGER FRAMEWORK OF HIS SPECIALTY ARE MATTERS OF RECORD. ‘HAT HE
HAS BEEN A CONSUMMATE TEACHER IS CLEAR FROM THE MANY SURGEONS HO NOW
HAVE THEIR OWN DEPARTMENTS IN COUNTRIES AROUND THE WORLD. MORE THAN
THAT, HE EARLY SAW THE NEED FOR A SERVICE WITHIN THE CHILDREN’S HOSPITAL
OF PHILADELPHIA THAT WOULD DEAL SPECIFICALLY WITH CANCER IN CHELDHOOD.
I WORKED WITH HIM AT THAT TIME IN HELPING TO RECRUIT AN OUTSTASDING
PEDIATRIC ONCOLOGIST, DR. AUDREY EVANS. HE WILLINGLY AND UNSTEXITINGLY
TURNED OVER TO HER THE PRIME RESPONSIBILITY FOR THE MANAGEMENT ©F THESE
CHILDREN, SOMETHING;HADOcCUPIED HIS TIME AND ATTENTION OVER THE YEARS.
THIS DEMONSTRATES HIS ABILITY TO ORGANIZE, HIS CLEAR VISION, AND HIS
READINESS TO STEP ASIDE AND ALLOW A NEW PROGRAM TO BE BUILT FOR THE

GREATER GOOD OF THE CHILDREN CONCERNED.

I THINK IT IS CLEAR FROM THESE REMARKS THAT IN DR. KOOP WE HAVE A
MAN WITH BROAD VISION, SUPERIOR ORGANIZING ABILITIES, AND INTERESTS AND
‘INFLUENCES THAT GO FAR BEYOND THE OPERATING ROOM. “HIS SCHOLAREY WORK
HAS AFFECTED THE LIVES OF THOUSANDS OF CHILDREN WHO HAVE SINCE BECOME
ADULTS AND HENCE THE POPULACE OF OUR COUNTRY. “HIS INFLUENCE AND IMPACT
ON THE DISEASE THAT KILLS MORE CHILDREN THAN ANY OTHER HAS BEEN ENORMOUS.
HIS INTEREST IN CURED CANCER PATIENTS, AND THEIR DIFFICULTIES, DEMONSTRATE
THE CLEAR VISION OF THE MEDICAL SCHOLAR WHO LOOKS BEYOND THE IMMEDIATE
CLINICAL PROBLEM. “THAT THE PATIENTS I HAVE BEEN DISCUSSING, WO ARE
ONLY A FRACTION OF THOSE SEEN BY A BUSY SURGEON SUCH AS DR. KOOP,

NONETHELESS ADD UP TO NUMBERS THAT HAVE IMPORTANT IMPLICATIONS REGARDING

THE SOCIAL FABRIC,
I HAVE NO DOUBT THAT DR. KOOP WILL ASSUME HIS POST WITH THE SAME
ENERGY, ORGANIZING ABILITY, AND DEEP CONCERN FOR THE BROADER ISSUES THAT

HE HAS DEMONSTRATED THROUGHOUT HIS MEDICAL CAREER.

Dictated by Dr. D'’Angio, but not read.