You wouldn’t think a pediatric oncology department would be a laughter-filled place, but nurse Sarit David, second-in-command of the inpatient department, says, “People in the department laugh a lot. It’s strange to the outsider, but the department has a lot of laughter. During the horrible times, there are many light moments. 

“That’s what makes the team stay. The children are suffering so much. It’s a difficult time. We laugh and cry with them. We love it!”

The Pediatric Oncology Unit at Hadassah University Medical Center in Jerusalem’s Ein Kerem has had its share of controversy, but today, with a new team of 10 doctors and 40 nurses in place, the hospital is once again equipped to handle pediatric cancer and hematological diseases of all kinds.

Some 18 months ago, Prof. Ze’ev Rothstein, general manager of Hadassah, recruited Dr. Gal Goldstein from Tel Hashomer, Israel’s largest hospital, located in Ramat Gan. Goldstein, who now serves as the head of the Department of Pediatric Hemato-Oncology, together with Prof. Yosef Laver, Pediatric Cancer Center director at Hadassah, went on fill the ranks with experienced, dedicated doctors, completely reinventing the unit. Some of the department’s 40 nurses, including David, stayed on through the transition. 

Today, the unit sees 100 new oncology cases a year and treats approximately 200 patients at a time. According to Goldstein, “We can diagnose and treat any kind of cancer in children anytime. We have the ability – in manpower, skills and resources – to treat any type of cancer. With hi-tech cutting-edge technologies, we are having good success directing the right treatment to the right cases.”

One unique case that Goldstein is particularly proud of involved an 18-month-old boy who presented with “a huge mass on his arm.” The team sent the tumor to an overseas lab that discovered the specific gene that caused this tumor. As a result, instead of using chemotherapy, they were able to prescribe a specific drug to treat this specific gene. “This kid is getting better,” Goldstein enthused. He also cautioned, “Usually we don’t find drugs that interact with a specific pathway of a tumor, and usually we have to use chemotherapy [which is a comparatively low-tech treatment]. 

“Cancer is more complex than just knowing the genes. We cannot find the specific causative pathway in many tumors,” notes Goldstein.

He explains that in many cancer centers in the United States, every tumor is analyzed, but that takes resources and money that Israel lacks, so only the difficult tumors are sent out for analysis. To improve care for their patients, the department established a collaboration with the Memorial Sloan Kettering Cancer Center. Sloan Kettering sent a team to Israel to assess the new department. A successful collaboration is moving ahead. 

“For instance, we started a protocol in Ewing’s Sarcoma, on which children from Hadassah are receiving the same contemporary protocol as at Sloan Kettering,” explains Goldstein.

Hadassah invested a lot of energy, time and money to reestablish the department. Much of the credit goes to Goldstein and Laver. Goldstein was born in Israel, attended Tel Aviv University and earned a bachelor’s degree in biology. He went on to medical school, graduating in 1999. In 2003, he began a fellowship at Sheba Medical Center, Tel Hashomer and rose to a senior faculty position, specializing in pediatric bone marrow transplant. In May 2017, he was recruited to reinvent the department at Hadassah. Laver is a graduate of the Technion School of Medicine, did his residency in pediatrics at Assaf Harofeh Medical Center and completed a fellowship in New York. He has vast experience in pediatric hemato-oncology, with a special interest in pediatric lymphoma. For many years he worked at different medical institutions in North America, such as Memorial Sloan Kettering Cancer Center and St. Jude’s Children Research Hospital.

Goldstein reflects that pediatric oncology is a “very delicate and emotional field.” When you’re treating a child with cancer, you’re also treating the parents who, understandably, exhibit a great deal of anxiety. Goldstein says that, in this way, what he and his team do is “different from adult oncology.” Another difference is that of the approximately 30,000 new cases of cancer each year in Israel, only 400 to 500 of them are pediatric cases. On the one hand, that’s something to be happy about. On the other hand, because there are fewer cases, some hi-tech treatments are not commercially viable to develop. With adults, there is more of a financial incentive to develop treatments other than chemotherapy because of the larger demand for those kinds of solutions. 

For example, Goldstein explains that the oncology world has understood that when it comes to certain abdominal tumors known as neuroblastomas, there is a target molecule that can be treated in addition to chemotherapy. But because there are so few pediatric abdominal tumors, that alternative treatment was not developed until seven or eight years ago. For other tumors, there isn’t any specific solution except chemotherapy. The consequence is that many children are left without targeted, hi-tech treatment. 

Nevertheless, he notes that in the Western world, 85% of children who have cancer survive. By contrast, only 50% to 60% of adults survive a cancer diagnosis. The department is well positioned to take care of children with different leukemias and solid tumors, as well as brain tumors and a variety of hematology disorders. Dr. Dan Harlev primarily treats children with blood disease such as anemia, white blood cell abnormalities and problems of coagulation (blood clotting) that are not cancer. He also treats cases of kidney or liver tumors, as well lymphomas. 

Dr. Sigal Weinreb mainly treats patients with leukemia and lymphoma. Acute Lymphoblastic Leukemia is the most common type of cancer seen in children. Goldstein points out that “in 1960, these children all died.” Today, this type of leukemia is treated with chemotherapy and 85% of the patients are eventually cured. It’s not an overnight cure. Treating leukemia in children requires six to seven months of intensive outpatient hospital treatment and an additional 18 months of maintenance oral treatment. 

Dr. Dror Raviv focuses mainly on solid tumors, which can appear in almost every part of the body. This past summer, Raviv spent three months at Sloan Kettering, enhancing his skills and deepening his knowledge base. Goldstein explained that tumors in adults generally have some connection to environment. For example, colon cancer in adults is related to dietary choices, melanoma is related to the amount of exposure to the sun and so forth.

“In children,” he continues, “it’s very different. In most of the cases, we do not know what causes cancer in children. Though we suspect genes in many cases, we can find a specific cancer predisposing gene in only 10% to 15% of the pediatric cases. Still, if a child develops cancer, their siblings have a slightly higher risk of also developing cancer."

Treating children with brain tumors presents a special challenge. Most of these children are being treated by Dr. Rakefet Sidlik-Muskatel and Dr. Hodayah Cohen. Goldstein characterizes brain tumors as a “stepchild in oncology” and explains that the success rate in treating brain tumors is only 60% to 65%, compared to an 85% success rate with leukemia. “They are solid tumors. They respond worse to chemotherapy. Most chemo doesn’t get into the brain,” he explains. Since it’s very difficult to remove tumors without damaging healthy brain tissue, it’s necessary to have exceptionally skilled brain surgeons.

Goldstein recalls a case where a child came to the department with a brain tumor. After surgery, she needed a specific kind of radiology, so the team referred her to a hospital in Memphis, Tennessee. But that’s rare; Goldstein estimates that only 1% to 2% of cases require a technology not available in Israel. “Some families prefer to go abroad because they think the care is better there. But it’s important to note that if [the necessary treatment] could be done in Israel, the health funds won’t cover treatment elsewhere.

“In Israel, we can treat as well as other countries,” Goldstein asserts. He also confirms that there are no special risks or anything that distinguishes pediatric cancer care here from the rest of the Western world.