Taking it to heart

Researcher felt cancer firsthand

Gregory Aune, M.D., Ph.D., is pictured with his wife, Christine Aune, M.D., and his children: 10-year-old twins Emma and Noah (seated) and 5-year-old twins Sophia and Elijah (standing).

Nevertheless, that’s where he finds himself today, with a special focus on survivorship issues: specifically, the cardiac problems that can plague cancer survivors decades after a recovery.

More than 20 years after the sports-loving high school kid was diagnosed with Hodgkin’s disease, Gregory Aune, M.D., Ph.D., is a pediatric oncologist in the Long School of Medicine at the UT Health Science Center San Antonio. He’s establishing a lab that approaches chemotherapy-induced heart problems from two perspectives: that of pediatric oncologist and laboratory cancer scientist. He is also the first graduate of the pediatric hematology-oncology fellowship made possible by the Greehey Pediatric Fellowship in Hematology Oncology endowment.

Things would have been different for Dr. Aune without that diagnosis. He might have gone into coaching or journalism instead of medicine. He would not have donated sperm in anticipation of the harsh cancer treatments that would destroy his fertility, and he would not have the two sets of twins who romp with him and his wife, neonatologist Christine Aune, M.D.

But as a 16-year-old he suffered through 10 months of chemotherapy, losing 80 pounds and a year of school. He developed severe abdominal pain from chemotherapy-induced paralytic ileus, a serious shutdown of his digestive system.

Dr. Aune says he behaved like many teenagers receiving cancer therapy and was not eager to talk about his symptoms. He waited a week to tell anybody about the abdominal pain. After that he had to receive his nutrition intravenously for several months.

So over time, as much as Dr. Aune had once wanted to get away from that environment, “all that toxicity got me thinking that there has to be a better way to do this.”

It’s also given him a deeper understanding of what his young patients are going through, even when they try to keep it inside.

“I’m saying, ‘What’s going on in there? I know you’re not telling me stuff.’”

Dr. Aune focused on medical research throughout college, medical school, and graduate school. Later, when he gave a talk during his pediatric residency at Johns Hopkins on the health problems related to cancer survivorship, he was stunned at how many people approached him to say they hadn’t thought about those issues before. With 13 million adult and pediatric cancer survivors in the United States today and 20 million projected by 2022, both groups face significant and special health issues. To Dr. Aune it was obvious.

He continued his work, coming to the Health Science Center in 2008 to begin fellowship training in pediatric hematology-oncology. About that time he began to suffer from increasing exhaustion and shortness of breath. For a while he blamed his fatigue on the demands life puts on two busy physicians with four small children. Then he was diagnosed with critical aortic valve stenosis.

During the pre-surgical work-up to replace his aortic valve, his cardiologist insisted his coronary arteries would be clear because of his young age of 35. But with his knowledge of survivorship studies, Dr. Aune was not surprised to learn he also was suffering from severe coronary artery disease.

That life-threatening experience steered Dr. Aune’s research from experimental cancer therapeutics into an area of emerging importance – the basic science of cardiac disease in pediatric cancer survivors. But building momentum for this new area of research is challenging in a world focused on cures.

“The world of oncology and cancer research is set up to keep doing what it’s doing now, and what drives it is developing new medications to treat cancer,” Dr. Aune said. “That has worked fantastically well in pediatric cancer – survival rates are so much higher now – but there needs to be some thought about the huge numbers of survivors.

“With a more basic understanding of how chemotherapy damages normal tissues such as the heart, we can begin to develop new medicines that protect vulnerable organs from the damage that results in late health effects in survivors.”

Dr. Aune’s lab has developed a method to use advanced echocardiography to study the hearts of pediatric mice. He and his fellow researchers will use this as a tool to study cardiac function in mice that are given chemotherapy at a young age. “This is our model for the cardiac problems we see in childhood cancer survivors,” he said.

It’s easy for Dr. Aune to talk about survivorship as a scientist and a physician. It’s harder to think about the health risks from a personal perspective. It would almost be better, he said, if he didn’t know.

“But I think it takes someone with that perspective to actually change how we practice.”