Audrey Evans, oncologist and founder of Ronald McDonald House, dies

Until the middle of the 20th century, doctors could do little for children in cancer wards except try to comfort them. “There wasn’t much else to do but worry about it,” Audrey Evans recalls of when she first started studying for a career as a pediatric oncologist.

The British-born doctor arrived in Boston in 1953 on a Fulbright scholarship to work at Boston Children’s Hospital with Sidney Farber, an oncologist who had begun to gain international recognition for his use of chemotherapy. The children of his studies had managed to beat leukemia into remission – the first major victory over what had long been an almost universally fatal disease.

One of his most promising proteges, Dr. Evans went on to conduct groundbreaking cancer studies and established the first protocol to accurately diagnose neuroblastoma, a cancer of immature nerve cells that is the most common type of cancer. in infants. Among other advancements, Evans’ staging system spared children who did not need chemotherapy and radiation therapy their brutal and long-lasting side effects.

Over the decades of Dr. Evans’ career, deaths from neuroblastoma fell by half; today, about 80 percent of affected children survive the disease. “More than anyone else in the past three decades, she has transformed our thinking about neuroblastoma,” the journal Cancer Research said in 2000.

She also co-founded the first Ronald McDonald House in 1974, which provides affordable housing for families of seriously ill children.

Dr. Evans, 97, a renowned scientist, medical administrator and children’s advocate, died Sept. 29 at her home in Philadelphia. His death was announced by the Ronald McDonald House Charities. The cause was not immediately available.

In Boston and later as chief of pediatric oncology at Children’s Hospital of Philadelphia, Dr. Evans embraced what is now called “total care” to meet the physical and emotional needs of patients and their families. She allowed frightened children to bring parakeets, rabbits and hamsters into the oxygen tent or radiation chamber.

In her office, Dr. Evans kept pictures of the children she saved and those she couldn’t.

“I learned to speak [to children] what death looks like,” she told the Philadelphia Inquirer. “One of the best things you can do is be there and share.”

She assured a girl, for example, that there would be flowers in heaven. She stayed up with a boy until 4 a.m., granting her last wish for chocolate cake.

During this time, she and other pioneering Farber colleagues were testing new ways to treat pediatric cancer patients. A seminal 1948 study by Farber had demonstrated the ability of chemotherapy to fight blood cancers, and he hoped to prove that the chemicals could also eradicate solid tumors.

At Farber’s request, Dr. Evans and Giulio D’Angio, a colleague who later became her husband, co-authored a 1959 study of the effects of radiation and a chemical antibiotic in children with type of kidney cancer. Their study provided the first evidence that chemotherapy could fight metastatic solid tumors.

Their research also helped prove one of Farber’s key theories, a concept that forms the basis of modern cancer treatment in children and adults: Chemotherapy and radiation therapy are most effective when combined.

Dr. Evans was head of the hematology-oncology unit at the University of Chicago when C. Everett Koop recruited her in 1968 from Children’s Hospital of Philadelphia. The future American surgeon general was then chief of surgery at the Philadelphia Medical Center and was intrigued by her research on neuroblastoma.

As Koop had hoped, Dr. Evans succeeded in standardizing the treatment of neuroblastoma. Using index cards, she began recording data that would help doctors determine the extent of the disease: a small tumor classified a child as stage 1 or low risk; many widespread tumors considered a stage 4 child and requiring aggressive treatment. She published her staging system in 1971.

Neuroblastoma was rarely studied before Dr. Evans became interested in the disease, which in some cases resolves spontaneously without treatment. Today, physicians use an international staging system that maintains key elements of Dr. Evans’ initial parameters taking into account tumor size, location, and spread.

The stratification system included survival rates and allowed some children to skip chemotherapy altogether. Perhaps more importantly, it has helped standardized clinical trials around the world.

During her early years at Children’s Hospital of Philadelphia, where she spent most of her career, Dr. Evans set up a floor-to-ceiling birdcage filled with finches to entertain her patients.

She “got away with it,” she told a Ronald McDonald House Charities publication, because few hospital administrators were willing to visit the pediatric oncology ward, a depressing and growing place. more crowded.

“Families ended up staying in the hospital – in the hallways and in the rooms,” Dr. Evans told The Associated Press in 1984. “There were people everywhere.”

She occasionally used her personal credit card to book hotel rooms for exhausted relatives. She sent the mothers to the YWCA and the fathers to a hostel, but she “needed a house where I could send the moms and dads together”, she later told an interviewer.

Dr. Evans envisioned a bed-and-breakfast where families could retire from hospital and stay for months with other families in the same predicament. A large Edwardian house near the hospital caught his eye.

At the time – in the early 1970s – the 3-year-old daughter of Philadelphia Eagles tight end Fred Hill was being treated for leukemia at a nearby hospital. Hill’s teammates held a few fundraisers and then heard about Dr. Evans’ program. They gave him a check for $100,000.

“I accepted gratefully but said, ‘What I really need is money for a house,'” she later told the Philadelphia Inquirer.

Jim Murray, the team’s general manager, had established a sponsorship relationship with McDonald’s and offered to promote the fast-food chain’s “shamrock” mint milkshakes in exchange for profits.

McDonald’s agreed in return for naming rights, and “Ronnie’s House” opened in 1974. More than 300 Ronald McDonald House programs exist today, providing long-term rooms near hospitals for modest donations , or nothing at all.

Audrey Elizabeth Evans was born in York, England on March 6, 1925. Determined from a young age to become a doctor, she assembled a homemade first aid kit of bandages, cotton balls and a small bottle of antiseptic, which she lugged around her Quaker school. Her parents “believed that girls should do as well as boys,” she once told an interviewer, and encouraged her in her upbringing.

Hospitalized for a year with tuberculosis, she missed months of boarding school in Bristol but was nevertheless admitted to the medical school her older sister attended, the Royal College of Surgeons of Edinburgh, Scotland.

As the only woman at the Royal Infirmary University Hospital, she was barred from the cafeteria and male dormitory and slept in a room in a tower block. But she had to share the men’s lockless bathroom, where she remembered singing loudly to ward off intruders.

Dr. Evans moved to Boston in 1953, landing a position on Farber’s inpatient ward, where she met D’Angio, a radiation oncologist known as “Dan.” She became godmother to her sons, and in 2005, after the death of his first wife, they got married. She was first married at age 79. D’Angio died in 2018.

Survivors include two stepsons, Carl D’Angio of Rochester, NY, and Peter D’Angio of Covington, Ky.; two grandchildren; and four great-grandchildren.

After Dr Evans retired in 2009, she took up horse riding, herding sheep and scuba diving. But she said she “missed the kids” and felt depressed – until she found a new project.

Getting involved in her Episcopal Church’s summer program at a closed house of worship in North Philadelphia, she helped raise funds to reopen the church as a college. She and her pastor co-founded a private school, St. James, in 2011. She was a regular presence on campus, where she could be seen walking arm in arm with students.

“I take care of kids here, and I used to take care of kids with cancer,” she said in a video from St. James’s School. “These children also need help.”

For his 90th birthday, Dr. Evans created a gift registry. On the list: money for books in the school library, for heat, for science equipment — and $250 for turkey meatloaf, his favorite dish, for the kids.

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