Professor Audrey Evans, paediatric oncologist known as ‘the Mother of Neuroblastoma’ – obituary

Professor Audrey Evans, who has died aged 97, was a Yorkshire-born paediatric oncologist who went on to be a major figure in the US and globally in the field of paediatric cancer, becoming known as “the Mother of Neuroblastoma”; but she considered her finest achievement to be establishing a network of homes around the world supporting sick children and their families.

Recognising the huge disruption families face when their children are undergoing treatment, she worked with McDonalds to create the first Ronald McDonald House, in Philadelphia, a home away from home for families who live long distances from the hospital treating their children. There are now four such houses in Philadelphia and more than 300 worldwide; there is even one in a remote part of China.

Audrey Elizabeth Evans was born in York on March 6 1925, the second of three children. Her father, Leonard, was from a large Congregational family and ran a pub with her mother, Phyllis. He had wanted to study medicine but was seriously wounded in the First World War, so joined the firm in York his father worked for that made paper bags and pioneered the manufacture of what became Sellotape.

Audrey attended boarding school in Bristol until the outbreak of the Second World War, when she went home and attended the Mount School. During her childhood she had a serious accident which resulted in scalp burns and she missed a considerable amount of school; she also had a year out with tuberculosis. But she did well enough to be admitted to medical school in Edinburgh – a rare female student there.

She qualified in 1950, and after two years’ training at the Royal Infirmary in the city she was awarded a Fulbright scholarship to further her career at Boston Children’s Hospital (under Sidney Farber, known as the father of modern chemotherapy) and Johns Hopkins University in Baltimore.

In 1964 she moved to the University of Chicago as a paediatric oncologist and began to develop her reputation as an outstanding physician. In 1972 Everett Koop, a paediatric surgeon and future US Surgeon General, recruited her to set up a cancer unit at the Children’s Hospital of Philadelphia, where she remained for the rest of her career.

It was an exciting time for those working with children who had cancer. Overall survival was only around 20 per cent, but new chemotherapy drugs were being tried and study groups were being set up around the world.

There were some astonishing successes, and very soon there was real hope that cures might be possible. Audrey Evans recognised the need for a rigorous scientific approach to the development of new treatments, especially the management of neuroblastoma, the commonest of the solid tumours of childhood, that develops from immature nerve cells .

It was clear that some children could receive little treatment and survive, whereas others did very poorly despite treatment. Her analysis of large numbers of children led to the recognition of prognostic factors which could be associated with outcome.

The Evans classification of neuroblastoma enabled clinicians to share their treatment results and undertake clinical trials, helping to determine which treatments would be most effective. Although an agreed international classification system was later developed, Stage 4 of the Evans system, which charts the spread of the cancer to distant parts of the body, is still used today.

In 1975 she organised the first biannual international meeting on Advances in Neuroblastoma Research. It was held in Philadelphia but has subsequently travelled the world.

The Children’s Hospital of Philadelphia became a magnet for aspiring paediatric oncologists, and many of those leading the profession today owe a huge debt to the inspiration and support they received in Audrey Evans’s clinic and laboratory. Over the last 50 years the survival rate for children suffering from neuroblastoma has gone from 25 per cent to 75 per cent.

For all her pioneering clinical achievements, she was most proud of her role in creating homes for young cancer sufferers and their families. The first Ronald McDonald House was established following an unlikely partnership between Audrey Evans, McDonalds and the Philadelphia Eagles American football team.

In the early 1970s Fred Hill, a tight end for the Eagles, had a young daughter who was being treated for leukaemia, and the team was inspired to raise $100,000, which they gave to Audrey Evans. She said she needed $32,000 more to buy a house for young sufferers, and as one of the Eagles team had been endorsing McDonalds’ “Shamrock Shakes”, the fast-food chain agreed to donate the proceeds from the product as long as the new home bore the company’s name.

Ronald McDonald House duly opened in Philadelphia in October 1974, the UK’s first following 15 years later; there are now Houses in 64 countries. In 2021 the 12 houses in the UK supported 3,916 families living an average of 62 miles from the treating hospital for an average of 16 nights.

Honours came Audrey Evans’s way in the US and across the world but she was most proud of her honorary Fellowship of the Royal College of Physicians of Edinburgh, her alma mater, and in 2018, aged 93, travelled with her husband to Scotland in the depths of winter to receive it in person.

Audrey Evans had a love of horses dating back to her childhood in Yorkshire and she was an accomplished rider. She started with a small cart pony, and with no instruction rapidly became proficient.

During her early career this passion fell by the wayside but once she was more settled she found opportunities in Pennsylvania to pursue her love of dressage. She was keen on encouraging young riders and was skilled in buying top-class horses on which they could compete. One of these, Dusky Moon, was the mount for the Dutch rider Eddy Stibbe – riding for the Netherlands Antilles – in the three-day eventing at the Athens Olympics, which she attended.

A biopic of Audrey Evans, Audrey’s Children, centring on the story of the first Ronald McDonald House and reportedly starring Natalie Dormer of Game of Thrones fame, is slated for release next year.

In 2011 – by now in her late eighties – Audrey Evans set up a school for disadvantaged children in Philadelphia, declaring: “These kids need help too.”

She remained single until the age of 79, when she married her close colleague Giulio J “Dan” D’Angio, a paediatric radiation oncologist; their wedding ceremony was at 7am so they could both be at work at 8.30. They travelled widely, mentoring young physicians to improve the lives of children with cancer.

Giulio D’Angio died in 2018.

Audrey Evans, born March 6 1925, died September 29 2022