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November 2009 Archives

By Deborah E. Thomas, Staff Writer

Tibetan Bon meditation comes from Tibet's oldest Buddhist tradition. A mind-body practice, it uses the breath to first calm the mind and body, then working with your breath lets you form sacred sounds to release obstacles and permit centering. Sound acts as a connector, allowing dialogue between the mind and body, explains Alejandro Chaoul, Ph.D., adjunct assistant professor in the Integrative Medicine Program at M. D. Anderson.

Chaoul says the vocalized sounds are called sacred because they are "a way of connecting to yourself in a deeper way." They help to clear away obstacles to achieve a more balanced life. The idea is to clear away the uncomfortable relationship one has with these obstacles, acknowledging, but not judging them.



Once that space has been created, there is room for nurturing to move in, taking the form of love, joy, compassion, etc. The next step is to bring the qualities gained from the meditative practice into one's own everyday life, where it is needed most.

Chaoul teaches Tibetan Bon meditation with sacred sounds at M. D. Anderson's Place ... of wellness.


Resources
Ligmincha Institute

Meditation may potentially alleviate cancer-related cognitive impairment

Four new approaches to treating lymphoma and chronic lymphocytic leukemia (CLL) will move from the lab to early clinical trials under a federal grant to M. D. Anderson. The grant brings together basic and translational scientists, clinical investigators, hematopathologists and biostatisticians on four projects.

Project director and principal investigator Anas Younes, M.D., says "translating these promising targeted therapies into the clinic extends our progress toward developing drugs that are more effective and gentler on our patients.


What is a SPORE?
Specialized Programs of Research Excellence (SPORE) grants from the National Cancer Institute are designed to advance basic and preclinical discoveries into early stage clinical trials, a difficult step in drug development. Translational research is a strength at M. D. Anderson, which now has 12 SPOREs, the most of any institution.


Epigenetic therapy for Hodgkin lymphoma
Epigenetic factors regulate gene behavior without altering or damaging the gene's DNA by adding or removing chemical groups that attach to genes like bookmarks. Younes and co-principal investigator Yong-Jun Liu, M.D., Ph.D., chair of the Department of Immunology, hypothesize that epigenetic therapy could affect Hodgkin lymphoma two ways: directly by inhibiting growth of malignant cells and indirectly by triggering an anti-tumor immune response.  

They will test several new drugs that regulate gene expression by targeting enzymes that chemically alter histone and non-histone proteins for safety and efficacy in relapsed and resistant Hodgkin lymphoma. The same drugs also will be tried in combination with another epigenetic drug that turns on genes by stripping methyl groups from them. The team will conduct lab experiments to design second-generation combination clinical trials.

Testing a novel agent for CLL and lymphoma
Scientists at M. D. Anderson and Northwestern University have developed a unique drug that will be the first of its type to be tested in the clinic. Varsha Gandhi, Ph.D., professor in M. D. Anderson's Department of Experimental Therapeutics, has developed an RNA nucleoside analogue, an artificial version of one of the building blocks of RNA. The drug inhibits synthesis of messenger RNA, which is produced by genes to tell a cell's protein-making machinery which protein to make.  

Clinicians on the project, led by co-principal investigator Peter McLaughlin, M.D., professor in the Department of Lymphoma and Myeloma, will conduct a Phase I clinical trial for patients with chronic lymphocytic leukemia. The team will use biomarkers to evaluate the drug's activity and staying power, develop rationales for clinical trials combining the drug with other agents and test it in lymphoma cell lines for translation into a lymphoma clinical trial.

Activating an important tumor suppressor
The protein p53 stifles cancer development by ordering abnormal cells to kill themselves. It is silenced in more than half of blood cancers by overexpression of the HDM2 gene. The research team has shown that inhibiting HDM2/p53 interaction causes programmed cell death in Hodgkin and non-Hodgkin lymphomas, and in acute myeloid and chronic lymphocytic leukemias when the p53 gene is not mutated.

A team led by principal investigator Michael Andreeff, M.D., Ph.D., professor in the Department of Stem Cell Transplantation, and co-principal investigator Susan O'Brien, M.D., professor in the Department of Leukemia, will test the effects of Nutlin 3a, a small-molecule inhibitor of HDM2, in a Phase I clinical trial for CLL. They also will identify the mechanisms of programmed cell death induced by the drug in lymphoma and CLL.

Targeted therapy in peripheral T-cell lymphoma
T-cell and natural killer cell lymphomas have poor clinical outcomes with current treatment but are so rare that only small studies have been performed to understand the disease. In this project, researchers at the University of Nebraska Medical Center will conduct gene expression profiling on samples from 1,320 cases contributed by an international consortium they have assembled.

Genome expression profiling will be used to define the molecular characteristics of both types of lymphoma, identify pathways that may contribute to lymphoma development and evaluate novel treatments based on their findings. The project, led by principal investigator John Chan, M.D., professor of microbiology and pathology, and co-principal investigator Julie Vose, M.D., professor of internal medicine, will then perform clinical trials in patients with relapsed T-cell and NK-cell lymphomas using agents that hit the  cancer-causing pathways.



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Gina Kolata of the New York Times wrote "M. D. Anderson Cancer Center has a mission statement, and everyone who works there, from the president to the cleaning crews, can state it like a catechism: to eliminate cancer in Texas, the nation and the world."

This is even more true for employees like Annie Orsak, oncology nurse on the P11 inpatient unit; Laura James, team leader in Health Information Management; and Raymond Meyn, Ph.D., professor in the Department of Experimental Radiation Oncology. These three have one very special thing in common -- they each signed on as employees and keepers of the mission in 1969. This year M. D. Anderson honors them for 40 years of service and dedication.

In each of their stories, they note that the needs of patients and their own personal desire to help are what drive them to do their best every day.

Phyddy_Nov.jpgLast week we talked about the importance of learning to take care of yourself in the midst of your expanded caregiver role.

I asked you to take care of your body, with exercise and good food, feed your mind by controlling stress and negative thinking, and feed your soul through mediation and prayer.

Below are the next three steps you can take, starting today, that will make a difference for you.


4. Self-Care: Preserving Your Energy


"My whole life has changed. I have no time for myself."

When possible, learn to unplug yourself from your patient and replug into something that will energize you and bring a greater sense of peace and pleasure. It's important to get away from cancer to recharge your battery so that you can come back refreshed and fortified to tend to your patient. Sometimes, just carving out 10 minutes for yourself can help rejuvenate and restore.

You have a very hard job. You likely are doing everything you reasonably can to take care of your loved one. Begin to learn to run on "premium caregiver fuel" by feeding your mind, your body and your soul with thoughts and activities that build, nurture, comfort and strengthen. This will conserve your energy over the long run.

Be good to yourself. You have the right and the responsibility to take care of yourself. This is not selfish, it's self-care. Taking short breaks now will give you the energy and strength to stay in this for the long haul.

This is exceedingly important, but difficult for caregivers to give themselves permission to do. Many caregivers may feel guilty when they leave the patient's bedside, when medically appropriate, to go do something pleasurable for themselves. However, research studies show that caregiver self-care is medically necessary for you to stay mentally and physically healthy and strong.

5. Self-Care: Evaluating Your Priorities

"I started to become realistic. I didn't cause this cancer.
I can't cure it or control it."


Becoming realistic can be a mind-altering experience. Starting from there, consider letting go of the idea that you are Superman or Superwoman.

•     Practice being clear in your mind about what your job really is. Are you over-functioning for your patient? Are you doing things that your loved one is capable of doing for himself/herself? This is not unusual, especially in the beginning. Be clear in your own mind what's really happening right now, not what "might" happen. Set reasonable limits with your loved one. Determine what self-care tasks he/she can do. A gentle reminder may be: Don't do for your patient what he/she is capable of doing for himself/herself.

•     Take stock of the things that are really important that "must" be done, not what "should" be done. As one caregiver said: "I made a list of the things that I absolutely had to do, like organize medications, schedule appointments, etc. I made another list of things that I was doing that just didn't really matter in the big picture. I just let those things slide off my back."

•     If possible, delegate some responsibilities. Recruit others to help you.

•     Learn some practical problem-solving techniques, such as how to manage medication side effects, organize a medication sheet, and develop strategies for symptom control of pain, nausea or fatigue.

6. Self-Care: Finding Your Strengths

"I've been able to do things that I never in a million years thought I could do."

    •     Identify your strengths. Some caregivers have a hard time doing this. Your personality is unique and you bring talents and gifts to this demanding role of caregiving. What is it that you bring to the table that strengthens this situation that no one else can, or is willing, to do? What have you learned through this experience?    

Other caregivers have identified their strengths and you can, too. Focus on what you're good at doing.

By Dawn Dorsey, Staff Writer

In science, both as a discipline and as a career, collaboration and connections are key.

sm_McCrea_Hong2.jpgWant to test that hypothesis? Just ask Ji Yeon Hong, a doctoral student in the Graduate School of Biomedical Science (GSBS) program at M. D. Anderson.

Hong, a student researcher in the lab of Pierre McCrea, Ph.D., recently co-authored a study that was published as a full article in the journal Nature. McCrea is a professor in the Department of Biochemistry and Molecular Biology..

"Fun and strange connections happen frequently in science," McCrea says. "For example, one might suddenly come to realize the research at hand is somehow intimately connected to earlier seemingly distinct work. Through collaboration and making the most of connections, these young researchers made a discovery that wasn't on anyone's radar screen."

Partnership Spawns New Interests

When Hong came to M. D. Anderson in 2005, she met Jae-il Park, Ph.D., then a GSBS student in McCrea's lab. They worked together for five months, developing a friendship and strong professional relationship.

Park moved on to a post-doctoral position at Stanford University, where he studies telomerase, a riboprotein complex that protects the integrity of chromosome ends. Defective telomerase may contribute to aging diseases and cancer.

From his graduate work at M. D. Anderson, Park knew the Wnt signaling pathway is central in development of cancer. Then, during his Stanford postdoctoral work in the lab of Steven Artandi, M.D., Ph.D., Park discovered the telomerase protein component TERT (telomerase reverse transcriptase) interacts with the gene BRG1 to activate Wnt- dependent gene promoters in cultured cells and mice.

To strengthen his findings, Park asked his friend and former colleague Hong to perform his experiments in frogs.

"I was a little worried his previous results might not be shown in frogs," Hong admits. "But when I finally got the data, I was so happy that I immediately ran to Dr. McCrea's office and showed him the results."

Although McCrea's lab doesn't usually study telomerase, this research opened a new avenue of scientific investigation for Hong.

"The Wnt signaling pathway is a very interesting topic, and it plays several roles in the development of cancer," she says. "I want to study more about it while I'm at M. D. Anderson, as well as during my future career."

Communication Is Essential

Hong and Park soon will submit another paper in which she's first author and he's second. McCrea says the friendship and scientific collaboration between the young researchers has opened new doors for both of them.

"Graduate school is a great time to develop relationships of this kind," he says.

McCrea's lab, which has been student-based for several years, includes five GSBS students and one post-doctoral researcher. High on the list of skills he imparts to them is effective professional communication. They write publications, organize figures and respond point-by-point to reviewer comments after submitting articles to journals. All under his watchful eye, of course.

"Fifty percent of being a good scientist is communication," he says. "One of the big lessons of graduate school is that you ultimately will be trying to put yourself in a competitive position, and effective communication is a big part of that."

Hong describes McCrea as a supportive, patient and active mentor.

"When I first joined this lab, I asked Dr. McCrea to tell me the most important thing that I need to learn during my Ph.D. degree," she says. "He told me it's critical thinking and the ability to see the big picture in my projects.

"Whenever I lose my critical thinking, have a failed experiment or blame my technique for an unsuccessful experiment, he guides me to think about my hypothesis and finally see the big picture."

Phase I clinical trials of patients with advanced cancers indicate that testing their tumors for a cancer-promoting genetic mutation is feasible in clinical practice and could be used to guide treatment.

Early results also show promising signs of an improved response rate among patients treated with drugs that inhibit the molecular pathway that is switched on by a mutation in the PI3CA gene.

Filip Janku, M.D., a fellow in M. D. Anderson's Department of Investigational Cancer Therapeutics, presented new findings on the PI3CA gene this week at the a major conference in Boston - the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

Mutations in the gene turn on the PI3K-AKT-mTOR pathway, which is often abnormally activated in cancer cells.  

Of 117 tumors tested from people with various late-stage cancers, 14 had the mutation and 10 of those were treated with PI3K-AKT-mTOR inhibitors based on that genetic analysis. Four of those 10 had partial responses, a high rate for a Phase I clinical, yet Janku notes the trial numbers are too small to draw conclusions now.

"These results need to be confirmed in a larger number of patients," Janku says. "We will have that opportunity as we continue to offer PI3K screening to patients considering a phase I clinic trial."  So far, responses were observed in patients with endometrial cancer, ovarian cancer, and breast cancer.

The American Association for Cancer Research highlighted Janku's presentation in its news media program. The meeting is a combined effort of the AACR, the National Cancer Institute, and the European Organisation for Research and Treatment of Cancer.


Reprogramming Genes as Cancer Therapy

Jean-Pierre Issa, M.D., professor in the Department of Leukemia, and a leader in the field of epigenetics, discusses this very different approach to cancer therapy in a podcast from the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

"Cancer is as much an epigenetic disease as it is a genetic disease," Issa notes. Epigenetic factors cause changes of gene expression and cellular behavior in cancer that are quite apart from those caused by genetic mutations or damage. 

Issa studies these chemical influences on genes at the basic science level and has successfully translated his findings into the clinic. The podcast addresses the challenge of translational research as well as the case for epigenetic therapy.

Resources:

Read the News Release from AACR

November 18 Teleconferences and Podcast Recordings


If you're a caregiver, in the midst of your expanded role carrying intense emotions and challenges, it's vital that you learn to take care of yourself.


Many caregivers feel guilty taking time to do something for themselves while their loved one is ill. You may need to first give yourself permission to do so. In light of the approaching holidays, this may become even more important.

What can you do, starting today, that will make a difference for you? You have lived all your life to come to this day, to this moment. There may be different ways to travel this road that will help you maintain your physical and mental health over the long run.

Here are three steps to start with. We will cover three additional steps next week.


1. Self-Care: Feeding Your Body

"My body is literally my caregiving machine. I have to take
care of it."


•     Exercise -- pump up your body by walking at least 10 minutes a day.
•     Sleep -- rest your body for 6-8 hours a night.
•     Eat right -- feed your body, nutritionally and regularly, including breakfast. Eat lots of vegetables, fruit and whole grains.
•     Drink plenty of water.


2. Self-Care: Feeding Your Mind

"I was scared all the time until I learned that the definition of fear is "Future Events Appearing Real." As long as I focus on the present, I keep from getting scared."

In part, our energy and mood are direct products of what we think about. During this time of stress, it's vital to control your thoughts to focus on today. Otherwise, thoughts may spin out of control with worry about what tomorrow might bring, creating a sense of chaos, fear, anxiety and uncertainty. Our thoughts are like tools; they can be used for building up our confidence or tearing it down. Only you, not circumstances or other people, can control what you think about.

Some caregivers find writing in a journal a good way to sort thoughts and feelings. It can serve as a soothing process to empty the mind of stress. Support groups also are useful as they provide a safe place to sort things out and to balance one's perception of reality. Others use reading, music or meditation for thought control.


3. Self-Care: Feeding Your Soul


"Where is God in all of this?"

Living a life with cancer at the forefront carries three dimensions: physical, emotional and spiritual. Searching for spiritual sustenance is one of the exercises that many caregivers experience in their quest to make sense of this time in their lives. As their spiritual life begins to broaden in searching for meaning and deeper understanding, many find that their priorities become rearranged. What was thought to be important before cancer -- such as striving for material goods or worldly success -- may now seem trivial and unimportant. What may emerge is the growing awareness and appreciation of the importance of faith and relationships with loved ones.

Pray and meditate -- feed your soul. Seek spiritual sustenance. Learn from one caregiver who prays, this prayer.

"Even though my loved one has this cancer, help me to learn to live, really live, this day


Basic Steps for Caregiver Self Care Part 2


mammogram.jpgIf you're a woman or a spouse or loved one of a woman -- and that likely covers most people we know -- you may be struggling with how to interpret some new guidelines on breast cancer screenings that were issued today by the U.S. Preventive Services Task Force. You're probably very surprised to read their recommendations to push back initial mammograms to age 50 and conduct follow-ups every two years.

Thanks to the efforts of the American Cancer Society, Komen for the Cure, Avon, many other advocacy groups and even M. D. Anderson's own Public Education Office, it's likely that most women and their physicians would answer "40 years old" to the question: At what age should you get your first mammogram? Furthermore, we'd expect to hear "every year" in response to the question of how often to have this test.

Based on practices in our Cancer Prevention Center and the risk-based guidelines for breast cancer screenings, M. D. Anderson is standing by those recommendations.  

If you're of average risk, M. D. Anderson recommends you get your first mammogram at age 40 and return every year after that for regular screenings. If you aren't sure how to assess your risk, we recommend setting up time with your physician.

"We believe the benefits of an annual mammogram outweigh the risks for women, starting at age 40," says Therese Bevers, M.D., professor and director of M. D. Anderson's Cancer Prevention Center.

M. D. Anderson has studied the effectiveness of breast cancer screening and M. D. Anderson faculty contributed to the modeling analyses used by the Preventive Services Task Force to make its recommendation.   

Ongoing dialog and research on this topic are very important in the lives of many women. We'll assess these findings and others in the annual evaluation of our guidelines in March 2010.

The task force, and M. D. Anderson, are united in our emphasis on developing risk-based,  specific breast cancer screening guidelines. We'll continue to seek evidence that benefits women by catching this disease in its earliest stages.

"Doctors need to have more discussion about the risks and limitations of breast cancer screening with patients so they can participate in decision-making," Bevers says. "There have been huge successes in teaching American women about the benefits of screening mammography, but women have not been educated about the limitations of screening -- which is why many women believe that there is no harm in screening and if one test is good, two tests are better and more frequent testing with both is the best."

Read more about this discussion on twitter hashtag - #mammogram40

http://tweetchat.com/room/mammogram40

Transcript from Houston Chronicle MedBlog Live Chat Event
 

By Deborah Thomas, Staff Writer

The M. D. Anderson Circle of Sisters program and the Center for Research on Minority Health helped sponsor a visit to M. D. Anderson for Native American women from the Alabama-Coushatta Reservation. During the visit the women received instruction on breast cancer prevention and free mammography screening. They also spent time learning about the role nutrition plays in cancer prevention, the importance of breast cancer screening, and easy ways to relieve stress and stay healthy.




Deborah Scott, of the Native American Health Care Coalition, says, "In the native community breast cancer is a big problem, because many women are diagnosed late." According to The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved, American Indian/Alaska Native women have the lowest incidence of breast cancer yet have the poorest five-year survival rates.

Event Sponsors:
National Center for Minority Health and Health Disparities (NCMHD)
Native American Health Coalition

M. D Anderson Health Disparities Research, Center for Research on Minority Health
M. D Anderson Mobile Mammography Program
M. D. Anderson Place of... Wellness


By Lora Shea, MD Anderson Staff Writer

MDAnderson recently updated its cancer screening recommendations. While the new guidelines focus on a person's chances of developing cancer, they also reveal when screening may no longer necessary. 

What's great about screening exams are that they have the potential to find cancer at its earliest stage, when the disease is most likely to be cured. For most of us, the benefits of getting a cancer screening exam outweigh the risks. However, there are some who may not benefit from having these tests. Therese Bevers, M.D., professor in the Department of Clinical Cancer Prevention, explains more.



Visit our website to review our cancer screening guidelines. To make an appointment in the Cancer Prevention Center at M. D. Anderson for these and other preventative cancer screenings simply fill out our patient self referral form

Do you get tests to check for cancer, such as a mammogram or colonoscopy? What do you think about cancer screening?

In addition to her titles of vice president for nursing, chief nursing officer and chair of M. D. Anderson's new Department of Nursing, Barbara Summers, Ph.D., R.N., is now a Fellow in the prestigious American Academy of Nursing.

One of only two AAN fellows at M. D. Anderson and one of 1,500 nationally, Summers was inducted into the prestigious organization during a formal ceremony over the weekend in Atlanta. She was one of 97 new inductees into the academy, an organization that monitors and advances health care policy and develops solutions to challenges facing the nursing profession. Selection as a Fellow in AAN is considered nursing's highest honor.

Despite Summers' stellar career as a nurse executive, teacher, mentor, administrator, advocate and researcher, she says she thinks of herself primarily as an oncology nurse.

"Oncology nurses are the secret weapons in the war we are winning against cancer," Summers says. "They're the critical thinkers, the caring partners and the constants in every patient's personal journey, and it is my privilege every day to lead and work on their behalf -- and to be one of them."

Summers, who is from a family of nurses, is driven by not only her respect and love for nursing but the desire to build a culture that gives to all M. D. Anderson nurses the same inspiration, joy and reward that she reaped as an oncology nurse early in her career.

"Down deep with all of my leadership, advocacy and management experience, I'm still an oncology nurse at heart," she says. "To this day, I remember caring for a little boy who received a bone marrow transplant and the relationship I built with his family. It's an incredibly proud calling to be an oncology nurse, especially at M. D. Anderson."

Summers came to M. D. Anderson in 1997 as clinical administrative director of the hematology clinical program, one the institution's largest services. Leading up to her current position, she also has worked as associate vice president for clinical programs and vice president for outpatient services at M. D. Anderson.

Prior to coming to Houston, Summers was with the National Institutes of Health where she was manager of critical care. She has worked as a clinical nurse at hospitals in Virginia, Washington, D.C., and Maryland.

She earned her Ph.D. in health care administration, master's degree in oncology nursing and bachelor's degree in nursing from George Mason University. She has held faculty appointments at her alma mater as well as at Georgetown University and Catholic University.

One of Summers' goals at M. D. Anderson and as a recognized national advocate for the nursing profession is to continue to drive home the messages that nurses are invaluable resources to their health communities and that nursing has changed for the better in the last decade. Every day, Summers and her team strive "to build a community of exceptional nurses engaged in extraordinary practice," a theme that captures the essence of her goals for the department.

A Lesson Learned

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I've been an employee at M. D. Anderson Cancer Center for almost 10 years. Not long after I began working here, I learned about the well-woman exams given through the Cancer Prevention Center - a mammogram, a pap smear and a good ol' general going-over was included, along with the bonus of an official blue M. D. Anderson patient card. At that time, it seemed to me that this card might be a handy thing to have in my hip pocket - just in case, you know.

Really and truly, I never dreamed that it would be me who would become an "employee with cancer." Why on earth would something like that happen to a nice girl like me? I had no notion that it ever would, but sure enough, it did.

In truth, it wasn't that coveted blue card that got me in the doors of M. D. Anderson. It was just a simple call for an appointment. Rumor has it that it's impossible to become a patient in this cancer center, but I'm here to tell you that this isn't so.

If you have cancer, and I will always pray that this doesn't happen to you, M. D. Anderson is the place you want to be. M. D. Anderson is currently (and consistently) ranked by U.S. News & World Report as the No. 1 cancer center in the country - really in the world. M. D. Anderson knows all about cancer - the doctors, nurses and other staff here will give you the latest and greatest treatments available. Bottom line, you can count on M. D. Anderson.

Gail_Post2I must be honest, my cancer journey has definitely been paved by my many friends here at the institution. But, it's an entirely different experience to walk through the front doors of Clark Clinic as a patient versus as an employee.

I'll never forget the first time I did that. I was greeted by a volunteer who I loved. She threw her arms out wide to hug me and said, "Ohhhhhhhh, Gail." I walked a few steps forward and ran into my favorite UT policeman, James. "Miss Gail, what's this I've been hearing about you?" he asked. Then, the other person in the elevator on the ride up to the Brain and Spine Clinic was another friend. My family was astonished and couldn't believe that I knew all of these people. M. D. Anderson is a huge place, you see.

But, if you want to know the truth, M. D. Anderson is a warm, caring family. The folks here usually take care of you like one of their own. Like I said before, brain cancer was never something that I expected to happen to me, but it's been a great way to expand my list of loved ones.

Max - imize Yourself ...

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petermaxRenowned artist Peter Max will donate a custom portrait to benefit the Children's Art Project at M. D. Anderson Cancer Center.

Peter Max, who capitalized on the psychedelic '60s and is still painting today, loves to combine his passions for painting and astronomy. In November, he will jet his way to the Off the Wall Gallery in the Houston Galleria where a special selection of his recent works, "Colors of a Better World," will be on display.

Max, who was born in Germany, still finds himself fascinated by his original interest in the universe and astronomy. He explains that the comparison of the size of a person to the size of the earth is an incredible thought. "I'm just amazed at this universe and still wonder how it happened," he says.

However, a chance invitation to attend art school got in the way of his desire to be an astronomer. "I went to art school and got the bug," Max explains. However, his artwork is filled with suns and moons and stars, all astronomical images.

Based in New York City, Max says that he can't wait to get to work each morning and always hates to leave. Fortunately, he lives near his studio where he comes in daily to paint.

Along the way, Max also discovered his philanthropic side. To that end, he's donating the painting of a custom portrait to a lucky bidder in a silent auction at the Off the Wall Gallery. Bids may be placed at the Houston gallery beginning Saturday, Nov. 7, and continuing through Saturday, Nov. 14, at 8 p.m.

The winner of the portrait will be notified at the event or by phone on Monday, Nov. 16. All proceeds from this auction will go directly to the Children's Art Project at M. D. Anderson Cancer Center to help make life better for children with cancer. Through worldwide sales of young cancer patients' original artwork featured on seasonal note cards and gifts as well as through generous donations, the project has funded offerings from the Children's Cancer Hospital such as educational programs, college scholarships, summer camps, ski trips, the Child Life program and other exciting activities that benefit cancer patients and their families.

Don't miss this chance to see the recent work of Peter Max. Previews of the art begin Nov. 7 at the Off the Wall Gallery in the Houston Galleria. Max himself will be at the gallery on Saturday, Nov. 14, 6-9 p.m. and Sunday, Nov. 15, 1-4 p.m. The gallery would appreciate an RSVP, 713-871-0940, if you plan to come by.

NYT_VirginiaMThe New York Times article by Gina Kolata -- Forty Years' War, A Place Where Cancer Is the Norm -- made my heart swell with pride to be part of the M. D. Anderson team and my eyes well with tears for those whose struggles she wrote about.

I think about the thousands of patients I have had the honor to care for over the last 30 years. I wish Kolata could have met my patient Dorothy.

Flashback to 1979, I was a new oncology nurse at M. D. Anderson when I met this 38-year-old, petite and strikingly beautiful brunette who had advanced cervical cancer. Her doctors at home told her that she had only one year to live.

Dorothy came to M. D. Anderson searching for treatment that would allow her to live to see her 10-year-old daughter graduate from high school. She entered a clinical trial receiving intra-arterial chemotherapy using a then-new drug named Cisplatin. Dorothy received this drug for four months. It wasn't for the weak of heart. She lost her hair, vomited and was exhausted for two weeks after the chemotherapy was completed. Just as she began to feel "normal," it was time for the next round of therapy. Then the treatment regimen was complete. 

For the next five years or so, I saw Dorothy when she returned for her doctor's visits. We'd share stories about our families while she anxiously awaited her test results. After her doctor would give her the results of yet another "clean" CT scan, she would give us a hug and huge sigh of relief.

Dorothy beat her cancer with what I think Kolata would call "unconventional treatment." For Dorothy, this was a clinical trial.  

Cancer eludes, suppresses or subverts the body's immune system to survive and grow. Scientists at M. D. Anderson have found that the helper T cell Th17 awakens the immune system to attack and destroy tumors with custom-made killer T cells. Professor of Immunology Chen Dong, Ph.D., and colleagues report their findings online today in the journal Immunity.  

Working with a mouse model of metastatic human melanoma tumors, the researchers show that the absence of Th17 led to virulent growth of melanoma in the lungs, while injecting Th17 cells prevented melanoma development and destroyed existing tumors. Th17 secretes the inflammatory protein interleukin-17 (Il-17), which launches the immune system response. 



"While there is much work to be done, these preclinical findings imply the possibility of taking a patient's Th17 cells, expanding them in the lab, and then re-infusing them as treatment," Dong says. Development of a vaccine to stimulate Th17 cells would be another possible application.

Dong is co-discoverer of Th17, one of only four known types of T helper cells that guide adaptive immune system response. His team also established that Th17 produces interleukin-17 and further showed that overexpression of IL-17 causes both autoimmune and inflammatory diseases.  

Th17's involvement in autoimmune disease is probably why it's able to recognize and attack cancer, which is also self tissue. "So a key to developing therapy will be to use Th17 cells that only recognize tumor antigens but do not react to normal tissue," Dong says.

Read the full news release
AAI Honors Chen Dong for Breakthrough T Lymphocyte Research


NYT_MindyL.jpgIt's a matter of time. I have no doubt about it. The human will, determination and intellect that invented electricity, the phone, the radio, airplanes, the polio vaccine and penicillin, and that put a man on the moon, will definitely find the cure for cancer. Yet, I agree with most, including those who expressed their frustration in the recent New York Times article, that the war on cancer is taking too long to win. It's a war that we have to win. 

According to the American Cancer Society (ACS), 1,479,350 people in the United States will be diagnosed with cancer this year, and it's expected that 562,340 will die from it. In fact, cancer is the second most common cause of death in the U.S., accounting for 23% of all deaths. This means that one of four people living in the U.S. will eventually die of cancer.


These numbers are even more dreadful when you consider the global impact. The World Health Organization predicts that the number of people worldwide living with cancer will rise from about 28 million today to about 75 million in 2030. The challenge is so big, and those of us on the front lines have no illusion of what we're facing. The New York Times article clearly articulated this challenge.

But to balance these dismal statistics, one has to keep in mind that more and more people survive cancer every year. In 2005, the ACS estimated that more than 11 million cancer survivors were in the United States, and this number continues to increase. 

In my own subspecialty, there are many success stories. For example, over the past decade, the expected survival of patients with indolent lymphoma has increased from an average of eight years to 15 years. For mantle cell lymphoma, it increased from 1.5 years to more than five years, and for Hodgkin's lymphoma the cure rate improved from 30% in 1960 to almost 80% today.  

More broadly, after almost three decades of a stalemate, cancer mortality is starting to slowly decrease. Furthermore, our knowledge of the basic molecular and genetic structure of cancer cells has exploded, identifying new therapeutic targets. A decade ago, only a few drugs were in development for cancer. Today, there are more than 800 drugs, with more coming. So I'm confident that we're on the right track, and it's only a matter of time until we find the cure.

So how do we speed up the process? In my opinion, one of our biggest challenges is the inadequate participation of patients in innovative clinical trials. The public is rightly expressing frustration on the slow progress. But to demand and expect speedy development, they also have to actively participate in clinical trials. With an average of less than 10% of cancer patients participating in clinical trials in the U.S., one shouldn't be surprised that the field is moving forward at a slow pace. 

When I read the New York Times article, I was concerned that, despite the challenges that we all face in the war on cancer, a message of hope may have been unintentionally missed. So I posted the article on my Facebook page and asked my followers, many of whom are patients and cancer survivors, to comment.

To lead the discussion I stated, "While I agree that there is so much work to be done, the article should have provided a more balanced picture of the many patients who are cured of cancer and are living a normal life with their loved ones. I also think that we need to move away from the currently available harsh treatments that are debilitating. We need to develop more gentle targeted therapy that are effective but maintain a good quality of life ..." And here are some of the comments that were posted:

"I can see and understand your point of view, Dr. Younes. At the same time, I'm also glad that the author expressed the gravity of the cancer battle. Too often these days, I think, people who haven't been touched by the disease assume that modern science has evolved to the point that cancer is uniformly curable with one shot. That belittles the gravity of the malady and the fight patients wage each and every day. If this article informs that viewpoint, I'm grateful. That said, I do agree with you that there is great hope, and that's what we must focus on to advance treatment and management of cancer. Thank you, speaking from my heart and as a survivor, for your efforts on that front!"

"I could not agree more Dr. Younes - the article really focuses on the most difficult cases ... but that is why the people with difficult cases come to MD Anderson - b/c MDA will stop at nothing and will always give you hope ..."

"My time at MDA was the best medical experience I've ever had. Ironic, given it was related to the worst diagnosis I've ever had. Thanks for sharing!"

Having worked at M. D. Anderson for the past 16 years, I know that the message of hope prevails on everyone's face and is implanted in everyone's soul. I see it on the faces of everyone who works here, from the president to the cleaning crews. After all, it's this spirit of optimism, dedication and hope that will help us eliminate cancer in Texas, the nation and the world.

By Tomise Martin, Staff Writer

When Patrick Williams was diagnosed with an aggressive form of brain cancer called glioblastoma multiforme, the three constants he'd always cherished -- family, laughter and colleagues -- helped him cope.

williams11_09.jpgA 27-year veteran of the fire department in Ocean Spring, Miss., he recalls feeling lightheaded and unable to find his balance one day after a staff meeting.

"I couldn't focus, and I needed to brace against a wall for support," Williams recalls. "All I wanted was to go home and take a nap."

Luckily a friend and colleague, trained as a registered nurse, noticed Williams' difficulty and quickly reacted.

"Initially, he and I joked about me slowing everyone down," Williams says. "The banter turned to concern once he heard my symptoms."

As the colleague was taking him to a local hospital, Williams had a seizure. Tests showed he had a brain tumor and would need surgery. It was unknown whether the tumor was cancerous or non-cancerous.

"When anyone mentions cancer, my family thinks of M. D. Anderson," Williams says. "There was no question about my next step."

His first appointment
Days later, surrounded by a group of friends and family, Williams arrived for his first M. D. Anderson appointment.

His surgeon, Sujit Prabhu, M.D., associate professor in the Department of Neurosurgery, told him the tumor was stage IV glioblastoma multiforme, the most common form of brain cancer, and was located in his right parietal lobe. Prabhu explained that the side effects from surgery could include blurry vision, impaired spatial orientation and headaches.

Three days later, Williams emerged from surgery unable to see images to the far left.

"If a board read 'nurse manager,' I would only see 'n rs  m nager,'" Williams says.

Although Prabhu described the possible side effects very clearly, Williams felt unprepared for the outcome. He still considers the experience unreal.  

Multidisciplinary care

With a team of brain cancer experts, including a neurosurgeon, neuro-oncologist and a radiation oncologist, Williams benefited from M. D. Anderson's multidisciplinary approach to cancer care.

After surgery, he met with Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology. She checked his neurological functions and discussed the remaining treatment options -- chemotherapy, radiation and clinical trials.

"With chemotherapy and radiation still available, I had no desire to try the third option," Williams says.

Loghin prescribed Temodar® (temozolomide), an oral therapy found to be effective for some patients with glioblastoma multiforme, and referred Williams to Anita Mahajan, M.D., associate professor in the Department of Radiation Oncoloy, for radiation therapy.

To complete his radiation treatments, Williams moved to Houston. While the side effects of treatment were hair loss and nausea, his spirits stayed high with frequent family outings and dining at his favorite restaurants.

Try, try again
During a follow-up appointment with Loghin about six weeks later, Williams learned that the brain cancer had not responded to chemotherapy. As a result, he chose to join a Phase II clinical trial studying the effectiveness of XL184, an investigational drug, on glioblastoma multiforme.

In January 2009, he received the good news that some tumors had disappeared or stopped growing.

Life as a brain cancer survivor
Life has changed. Williams has retired as fire chief of the Ocean Springs fire department and his energy level has dropped. But his vision has cleared enough so he's able to drive again on a limited basis.

"I plan activities with their needed recovery time," Williams says. "One day of fishing is followed by two days of rest."

But he doesn't let these new details hamper life. He's usually cracking jokes or surrounded by his friends and family. A brother-in-law always accompanies him to follow-up appointments, which are every four weeks.

"I'm fortunate to have the love and support of my family," Williams says. "Life is what you make of it. I choose to live mine filled with laughter and surrounded by my loved ones."

Related article:
Q&A: Coping With a Brain Cancer Diagnosis and Treatment

M. D. Anderson resource:

Brain and Spine Center

Additional resources:
Brain Tumors (American Cancer Society)

Brain Tumor (NCI)


A cancer diagnosis can be a shock. But a brain cancer diagnosis is even more challenging. A malignant brain tumor can impact patients' thoughts, speech and communication, and motor skills, and perhaps their ability to financially support themselves or their families.

Brain cancer is a rare disease that originates in the brain, spinal cord or nerves. According to the American Cancer Society, more than 22,000 people will be diagnosed and nearly 13,000 will die from brain cancer in 2009.

Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology at M. D. Anderson, answers questions on how to deal with a diagnosis and cope with the side effects of both the cancer and its treatment.

What can I expect during my first appointment?
During the first appointment, I always discuss the patient's diagnosis and treatment options. Many patients, however, feel overwhelmed during this appointment and may choose not to discuss details about treatment. In this case, I advise them to take it one step at a time and only gather information that they're able to cope with during their first visit. I suggest having a loved one present during appointments. They can provide emotional support through this process and be an extra pair of ears.

Here are some key questions to ask at a first appointment:
•    Is this a definitive diagnosis?
•    What type of tumor do I have?
•    What are my treatment options?
•    What support services are available to assist during my treatment?

What are the treatment options?
Depending on your diagnosis and type of cancer, a combination of the following treatments could be available:
•    Surgery
•    Radiation
•    Chemotherapy

Each treatment and the associated side effects are discussed with the specialist managing a patient's care.

As a neuro-oncologist, I manage the patient's chemotherapy. We discuss the side effects and concerns the patient or caregivers may have regarding therapy.

The selection of chemotherapy is based on the type of tumor and functional status of the individual diagnosed with the disease. If a patient is physically or mentally impaired, I choose a therapy with low toxicity. In addition, monitoring the individual's health during treatment is very important. When discussing treatment options with the patient, I share my reasons for choosing the chemotherapy, the side effects and any support M. D. Anderson offers.

What are the side effects of chemotherapy?
The usual side effects of therapy are:
•    Nausea
•    Constipation
•    Vomiting

How will treatment impact daily life?
Because chemotherapy impacts each patient differently, it's challenging to anticipate how each one will respond to treatment.

For some patients, chemotherapy may not impact their lives. They can continue working full time and maintain their full neurological functions. This isn't always the case, however. Those receiving treatment may be unable to continue working, which could impact their ability to financially support their families.

My goal is to help patients and family members cope with potential changes in their lives. I explain that treatment can leave patients unable to complete tasks that were once easy for them. They may not be able to think as quickly as before. When psychological effects like these arise, I involve our psychiatry team. The psychiatry team can help those diagnosed and their family members cope with these changes.

At M. D. Anderson, we have an education clinical pharmacologist on staff help monitor  each person's care. Every eight weeks, I evaluate patients' responses to treatment and the impact on their health. These evaluations allow me to make any necessary changes to the treatment schedule. If patients are responding to treatment, we discuss whether or not they can return to work -- or do so on a part-time basis.

What services can patients and caregivers seek to help them adjust and cope?
•    Look for social workers in your community. They can assist with transportation, parking or support at home. If patients exhibit neurological deficits, social workers can evaluate patients' at-home needs through home health support.
•    Sometimes a therapist can help patients and caregivers cope with a cancer diagnosis and the emotional side effects from treatment.
•    Many communities have support groups available to patients and their caregivers. These groups offer support and guidance from others who are facing or have overcome similar challenges.

Related article:
Love and Support Help Gulf Coast Resident Cope With Brain Cancer (November Cancerwise FA1)

M. D. Anderson resources:

Monica Loghin, M.D.

Brain and Spine Center at M. D. Anderson

Additional resources:

Brain Tumors (American Cancer Society)

Brain Tumor


By Bayan Raji, Staff Writer

Neuropathy_edit.jpgFor some cancer patients, reactions to certain medications and treatments create tingling sensations -- similar to when you sit on your foot too long -- that don't go away.

This tingling, known as neuropathy, typically begins on the palms of the hands or the soles of the feet. Eventually, it may become painful and debilitating.

About half of cancer patients who receive chemotherapy drugs experience neuropathy. In about one-eighth of patients, the pain may become chronic.

Drugs may play a role


Neuropathy can be caused by radiation, surgery or chemotherapy drugs, including taxanes, platinum, Oncovin® (vincristine) and Thalomid® (thalidomide). It often is irreversible and even may worsen over time.



Common symptoms of neuropathy include:
•    Numbness
•    Tingling
•    Prickling
•    Burning, shooting or pinching pain
•    Cramping

Patrick Dougherty, Ph.D., professor in the Department of Anesthesia and Pain Medicine at M. D. Anderson, says patients should bring these symptoms to the attention of their doctors.  

Cause may be elusive

Some doctors believe neuropathy is caused when the interaction between nerve endings and the surrounding tissue is affected during chemotherapy. However, no concrete evidence exists to explain the origins of the neuropathy some cancer patients experience.

"The cause may be difficult to determine because these drugs are very different from one another, and they work differently to kill the cancer cells," Dougherty says.

Trial and error may be necessary

Allen Burton, M.D.,chair of the Department of Pain Medicine, says doctors may try several methods to reduce neuropathy symptoms.

"When the symptoms are acute, and the patient is receiving, or has recently finished, chemotherapy, the oncologist may lower the dose or extend the time between doses of the drug that are suspected of causing neuropathy," Burton says. "Often, the problem drug is a component of a combination chemotherapy regimen."

Drugs used to treat severe or chronic neuropathy cases include:
•    Opioids (pain medications)
•    Anticonvulsants such as Neurontin® (gabapentin) and Lyrica® (pregabalin)
•    Antidepressants such as Cymbalta® (duloxetine) or Elavil (amitriptyline)

These medications, in conjunction with physical therapy, often help reduce pain and restore the patient's ability to function, Burton says. Occupational therapy may be useful if the patient's hands are affected by neuropathy.

Alternative therapies may help

In addition to medication, doctors may advise patients to try integrative medicine approaches. These may include:

•    Physical therapy
•    Acupuncture
•    Aromatherapy
•    Heat therapy

Dougherty recommends patients work down the list to find therapies that work for them. The most helpful place to access information to these and other alternative therapies is a multidisciplinary pain center, he says.

"It's important to note that certain methods may work really well for some patients but make the pain worse for others," Dougherty says.

Risk isn't clear

Doctors aren't able to determine fully who is at risk for neuropathy. Dougherty says his general impression is that younger patients are more likely to experience it than older patients, but no real explanation exists.

Clinicians at M. D. Anderson are working to develop a pain level chart to better categorize the sensations of neuropathy.

In addition, researchers are conducting several clinical trials for patients with or at risk for neuropathy. Contact askMDAnderson at 1-877-632-6789 for information.

Related articles:

Bridging the Divide (Conquest)

Cancer and Neuropathy (Patient Power webcast)


M. D. Anderson resources:
Peripheral Neuropathy

Department of Pain Medicine


Additional resource:
Peripheral Neuropathy Caused by Chemotherapy (American Cancer Society)


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