Commentary: traversing hurdles: the future of collaborative pediatric oncology research.

The authors contributing to this section have identified a number of strengths, struggles, and future directions for research in the broad area of pediatric oncology. In their paper, Armstrong and Reaman focus on the past, present, and future of multicenter cooperative groups, which, in the United States, have primarily culminated in the formation of the Children’s Oncology Group (COG). Last, Grootenhuis, and Eiser focus on reviews of childhood cancer research published between 1985 and 2000 and consider mainly English-language contributions made to the literature from three primary geographic areas: North America, Europe, and Australia. Much can be learned from both of these papers about where the field has been with respect to collaboration, as well as where we might be headed. As a young investigator, I find myself entering the field at a time when medical science has experienced many successes with respect to increasing survivorship among children diagnosed with cancer. Much of this success can be attributed to cooperation among collaborative groups in sharing knowledge gleaned first through clinical experience and then through solid scientific research. We have arrived at a time in which we are beginning to see childhood cancer survivors complete postgraduate education. Whereas 30 years ago many of these children would not have survived their initial diagnosis and treatment, survival rates have increased so that the majority of children diagnosed with cancer now meet or exceed the 5-year standard for survivorship. Although this increased survivorship is certainly something to celebrate, we must bear in mind that survivorship does not translate into absence of consequences of these illnesses and their treatments. Collaborative research helps us address the acute and ongoing needs of childhood cancer survivors on a much larger basis and allows us to ask a much broader range of questions. In doing so, we are able to better identify similarities, differences, and disparities among children who come from various geographic locations, ethnic and racial groups, and socioeconomic backgrounds. Large cooperative groups help by providing an infrastructure on which member institutions can capitalize. As addressed by Armstrong and Reaman, sometimes the networking that is provided through this framework leads to broadly based and widely disseminated research efforts (i.e., groupwide trials), and other times it leads to smaller, more narrowly focused, yet equally important (and often foundational) studies (e.g., limited-institution studies, rapid pilot intervention studies). In addition, present-day technology such as e-mail, teleconferencing, and videoconferencing enhances our abilities to collaborate with others within the cooperative groups and around the globe. Considering data on published studies, such as those provided by Last, Grootenhuis, and Eiser, we are better able to identify successes and failures in taking advantage of these technological opportunities. The bottom line appears to be that we can still work to improve our global collaboration efforts a great deal; through enhanced collaboration, perhaps we can help alleviate or even eliminate many of the disparities that occur across groups and across the world. We can, and I believe have an obligation to, better utilize technology available to us to ensure that the work we are doing can be accessible worldwide. We truly have the opportunity to create multicenter, multinational, and transdisciplinary research agendas, but we must get past certain hurdles, each of which I will illuminate briefly.