Teresa J. Vietti, MD: Pioneer Pediatric Oncologist

“At a time when care for children with cancer was only compassion, Teresa Vietti almost single-handedly developed the approach of laboratory-based studies, translational research and clinical trials. She was truly the mother of multimodality cancer treatment."

Teresa J. Vietti, MD

A recent report released by the Center for Disease Control announced “since the mid-1970s, cancer death rates among children and adolescents in the United States showed marked declines.” In the last 15 years alone cancer death rates for all persons under the age of 19 have dropped nearly 20 percent. In particular leukemia, which historically had been the leading cause of pediatric cancer deaths, has dropped to second. According to Sally Curtin, lead author of the report, who said in an interview with Reuters, “Forms of leukemia that generations ago were almost universally fatal are now almost universally curable.”

These great advances toward reducing cancer mortality can be attributed to a variety of medical breakthroughs, but it is their systematic evaluation during clinical trials which translates these discoveries into life-saving therapies. In particular sophisticated studies have led to the increased effectiveness of these therapies by investigating their use in combination.

The successes of the last 40 years lead back to one person who not only made Washington University School of Medicine one of the leaders in the development and evaluation of pediatric cancer therapies, but whose influence resulted in saving many thousands of children throughout the world.

“At a time when care for children with cancer was only compassion, Teresa Vietti almost single-handedly developed the approach of laboratory-based studies, translational research and clinical trials. She was truly the mother of multimodality cancer treatment,” said Alan L. Schwartz, PhD, MD, the past chair of the Department of Pediatrics and former pediatrician-in-chief of St. Louis Children’s Hospital.

Theresa J. Vietti, MD joined the faculty of Washington University School of Medicine and the staff of St. Louis Children’s Hospital in 1961. Her focus was on cancers of the soft tissues, the sympathetic nervous system, and especially leukemia which in comparison with other cancers was so deadly as there was no possibility of a surgical intervention even if found early. She threw herself into investigating all therapeutic options available coordinating with colleagues throughout the world and in doing so pioneered outcome-based clinical trials. The enormous success of this rigorous approach has contributed to many other fields of clinical medicine. But even as she led the way to saving thousands of children’s lives she carried her own personal loss which she would never be able to fully resolve.

Teresa J. Vietti and her identical twin sister Eleanor Ardel Vietti were born on November 5, 1927 in Fort Worth, Texas. Daughters of a scientist, they decided to become doctors at a very early age. Both Teresa and Ardel went to Rice University as undergraduates. Teresa Vietti studied medicine at Baylor University College of Medicine while Ardel attended the University of Texas Medical Branch in Galveston. Teresa, who entered medical school in 1949, recalled that women made up only 5 percent of her class. “Some of my teachers actually said they didn’t believe women should become physicians,” she said.

Vietti with other residents and staff of Children's Hospital, circa 1955.

Teresa Vietti first came to St. Louis Children’s Hospital in 1953 for her pediatric training. She was considering entering private practice when she was chosen to be chief resident. This experience convinced her of the importance of academic medicine. After residency she held a fellowship in Hematology/Oncology in Detroit, was the director of the Hematology Laboratories at the Texas Children’s Hospital in Dallas, and was a visiting physician in Ankara, Turkey. When she returned in 1961 she rejoined the staff at St. Louis Children’s Hospital and became an assistant professor of pediatrics at Washington University School of Medicine. Teresa became an associate professor in 1965 and a full professor in 1972.

Regina Waldman presents a check to Teresa J. Vietti.

Inspiring as a teacher she would train a generation of leaders in pediatric oncology. As she took on more academic and administrative responsibilities she looked to advance the careers of her students and trainees. She involved junior investigators in clinical trials and encouraged them to join national committees. She contributed over 200 peer-reviewed publications and nearly 30 books and book chapters, but this could easily have been doubled. She often removed her name from publications ensuring the young researchers would be acknowledged for their work.

Her influence was international. She became the first chair of the independent pediatric clinical trials group – Pediatric Oncology Group (POG) – from 1980 until 1993. During her leadership the clinical trial cooperative group grew to include more than 100 institutions and more than 1500 physicians and researchers in the USA and Canada. It has since merged with several other pediatric cooperative groups to form the Children's Oncology Group (COG). Vietti was also involved in the development of pediatric intergroup studies. Results from these large group collaborations would be more rapidly accepted, immediately improving outcomes for children and adolescents with cancer worldwide.

She was editor of the Journal of Pediatric Hematology and Oncology and co-editor of Clinical Pediatric Oncology. She co-authored “Clinical Pediatric Oncology,” which, over the four editions she edited, was the premier text in its field. Among her many honors are the UNICO Award (1976), the American Society of Pediatric Hematology/Oncology’s Distinguished Career Award (1994), the Leukemia Society of America’s Return of the Child Award (1999), and the American Cancer Society Spirit of Health Award (2001).

Vietti’s photograph was featured on the cover of Cancer Reseach, September 1996.

Teresa Vietti retired and became professor emerita of Pediatrics in 1998. When she moved from her office she left behind for her colleagues something that had meant a great deal to her. She had kept in her desk two portraits, one of her and the other of her twin sister Eleanor Ardel taken when they were toddlers.

After graduating from medical school Teresa continued on the track of academic medicine while her sister, who preferred her middle name, Ardel, chose to become a medical missionary. After her residency, Ardel Vietti took an appointment at the Ban Me Thuot Leprosarium in Darloc Province, South Vietnam run by the Christian and Missionary Alliance. It was a 35 bed hospital for people in advanced stages of leprosy with additional facilities for patients with other maladies. The hospital was not in the city of Ban Me Thuot, but 9 miles away in dense jungle. In 1961 Teresa visited Ardel at the Leprosaium. “We drove all over Vietnam,” Teresa recalled. “Ardel would say, ‘We can’t go down that road because the Viet Cong have that road.’ The amazing thing is, she didn’t feel frightened at all.”

In April of 1962 Ardel had a chance to visit Teresa at St. Louis Children’s Hospital when she returned to the United States for additional training including a crash course in cleft-palate repair. Ardel was taken by the contrasts. “She only had 35 beds in her hospital, and she had 1,200 outpatients,” Teresa remembered. “Her remark to me was, ‘You spend more on one patient in a day than I spend in a month on all my patients.’ ”

Shortly after her return to Vietnam the Viet Cong destroyed the bridges on the only road to the Leprosarium. The decision was made to evacuate many of the missionary staff except for the medical personnel. On the night of May 30, 1962 the Viet Cong entered the hospital grounds and ordered everyone out into the center of the complex. They then left taking Ardel by bayonet point along with two other missionary staff, Dan Gerber and Archie Mitchell, and medical supplies including every sheet off of the hospital beds. Ardel and the other two missionaries have never been found.

To this day Ardel Vietti remains the only American woman whose whereabouts are unknown from the Vietnam War.

Ardel Vietti, left, and Teresa Vietti.

Teresa J. Vietti died on January 25, 2010. Alan L. Schwartz summed up her life when he said, “Hundreds of thousands of children with cancer and their families worldwide have experienced life when none would have been possible were it not for Teresa Vietti.”