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December 2009 Archives

By Sarah Watson, Staff Writer

Where can you:
A) Discover nuggets of M. D. Anderson history?
B) Be inspired by stories of courage and generosity?
C) Look up individual donors by name?
D) Find ways to get involved in Making Cancer History®?
E) Make your own financial contribution to the institution?

Three newly installed donor recognition kiosks on M. D. Anderson's main campus and south campus offer all of the above and more.

Launched recently as a project of our Development Office, the kiosks are standalone stations designed primarily to recognize the generosity of those who donate their time, energy and financial resources to M. D. Anderson.

Kiosk_Demo.jpgRecognition categories include the:
• Nine giving levels of the Annual Fund
• Anderson Assembly
• Monroe Dunaway Anderson Society
• Advance Team
• University Cancer Foundation Board of Visitors
• Creators of endowed positions

You'll find the kiosks on Floor 2 of Alkek Hospital near Kim's Place, Floor 2 of Mays Clinic next to the aquarium across from the Blood Donor Center, and at the cafeteria entrance in South Campus Research Building II. Each is equipped with comfortable seating, computer keyboards and interactive monitors with 20-inch screens. At the top of each kiosk is a large screen displaying video footage from M. D. Anderson's advertising campaign.

The kiosk computer application resides on a secure environment on M. D. Anderson's network. While it's not set up for surfing the World Wide Web, it does afford users access to information about M. D. Anderson's donors and the research and patient care initiatives they support, links to publications and the opportunity to donate online. The Alkek Hospital installment is a double unit with room for two people to access the system at once.

The kiosks' design includes several interactive elements such as the ability to subscribe to M. D. Anderson publications, make an online donation and send the online giving link to a personal e-mail account.

The kiosks also have a feature that allows users to search for donors by name or giving category and to identify companies with matching gift policies. Users can learn about M. D. Anderson by perusing a historical timeline of institutional milestones. They also can read about our research and patient care programs as well as access updated stories of patients, donors and volunteers. A clickable donor giving map is available for a quick glimpse of donor contributions and number of patients M. D. Anderson has served, state by state.

The online credit card process is the same as the online donation form at www.mdanderson.org/gifts. Kiosk users may e-mail the link to a personal e-mail account from the kiosk or pick up a donation envelope at the kiosk and drop the donation in the mail.

By Sara Farris, Staff WriterBrocail_small.jpg

The holiday season is a special time of the year for families, which is why the Children's Cancer Hospital tries to create an experience that lifts the spirits of those families who must stay at the hospital during this time.

This year, pediatric patients received a special visit by Houston Astros players, Doug Brocail and Humberto Quintero. The players passed out teddy bears in the clinic and inpatient unit, posing for photographs and signing autographs along the way.

Following the Astros visit, Adam's Angels hosted an "Alice in Winter Wonderland" party in the PediDome for patients and families. The annual holiday party included characters from the Disney movie who entertained guests with a variety of activities. The highlight was a visit by Santa Claus who sat for photos with the patients and made a list of their many gift requests.




Throughout the year, the Child Life Program and Volunteer Services at M. D. Anderson partner with community groups to put on a variety of events that distract patients from their hospital stay and bring a little cheer to their day. Other organizations and groups donate toys, money and other items that contribute to a fun and welcoming atmosphere at the Children's Cancer Hospital.

Winging It Home for the Holidays

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airplane.jpgNo one can doubt the value of a trip home for a patient and caregiver who have made the sacrifice to come to M. D. Anderson from far away, especially during the holidays.

But for patients who make sacrifices to leave their homes and families for treatment, for sometimes months at a time, the financial and emotional strain can be great.

Through a program with Continental Airlines OnePass, frequent travelers on Houston's hometown airline can donate their miles to our eligible patients and their caregivers when flying domestically and internationally to M. D. Anderson for treatment. Since the program began in June 2008, more than 7.4 million miles have been deposited in M. D. Anderson's account.

If you would like to donate your OnePass miles for patient travel, please visit http://www.continental.com/web/en-US/apps/onepass/donate/donateMiles.aspx.

A limited number of donated OnePass miles are available, based on available flights and type of airline service needed. M. D. Anderson's Department of Social Work assesses patients' needs to determine if they meet the criteria for travel assistance and Patient Travel Services, which provides travel agency services to assist patients and families, coordinates the redemption of OnePass miles. The donated miles may be used by a patient and one accompanying caregiver.

Like many families, M. D. Anderson has its signature holiday traditions.

The festive decorations for Christmas, Hanukkah and Kwanzaa, the community choirs in the hospital lobby and the Holiday Tree Decorating Contest remind all that the holidays are here, but it's M. D. Anderson's patient-focused programs that inspire the true spirit of the giving season.  

For many M. D. Anderson staff working in departments that don't have direct involvement in patient care, the holiday programs such as Adopt-A-Family and the Annual Wreath Auction provide a way to touch patients and impact their families. For clinical staff, the season adds a new dimension to compassionate care, and for M. D. Anderson volunteers, who reach out to patients as if every day was a holiday, it's a time to put their natural cheer into overdrive.

One of M. D. Anderson's oldest holiday traditions is Adopt-A-Family, a program supervised by Social Work. This year, 352 patients and their families were adopted by employees in 130 departments and raised $93,800 with creative fundraisers. The adopted patients and families will get a cashier's check to take care of expenses that are most pressing to their household, whether it's rent, utilities, groceries or child care, or the opportunity to buy gifts without added burden.

Adopt-A-Family began formally around 1993 when 106 patients received assistance, but even in the 1980s, clinics and departments collected food donations and gifts for patients in need.

 

The Wreath Auction is a newer tradition that donates all proceeds to the Adopt-A-Patient/Family Program. This year, individuals and teams from clinics and departments designed and decorated 145 original wreaths, bringing in more than $8,000 in the silent online auction. With the wreaths displayed on the Mays Clinic skywalk throughout December, the themes ranged from breast cancer awareness to the hope of survivorship to the rivalry between The University of Texas and Texas A&M, and a tribute to the troops.


The wreaths are a point of pride among not only the employees who design and decorate them, but also those who aggressively bid for their favorites. 


Resources
Local Holiday Wreaths Up for Auction

Tidings of Comfort and Joy

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GailChristmas.jpg'Tis the season and if there was ever one when I could have thrown in the towel, this would have been it. However, that's not my style and so I find myself in the midst of the perfect Christmas storm.

Take a walk through my house -- it looks like the elves have had a heyday there. The kitchen counter is covered with all manner of tags and wrapping paper and bags and tape. The dining room table is covered with wrapped gifts going on to friends and Dallas family. One son, who has acquired a wife, left an empty bedroom behind that's now filled with the tubs of décor from the attic. Another son evacuated years ago to Seattle, and his room has gifts yet to be wrapped in it. My daughter's former room has the bags with all the stocking goodies and sacks -- lots of sacks.

The living room has a tree (with lights on it!) shoved into a corner. But the end table, lamp and rocker that used to be where the tree now is are still in the middle of the room. There also is garland strewn around on the floor. Oh, and some ornaments waiting to be hung are on that end table that's still in the middle of the floor.

But, back to what we're about here -- because this is the holiday season after all -- the mess and the hustle and bustle are just a part of a crazy time of year. However, the real meaning of this holiday is to remember the hope that comes with Christmas. It's a time to stop and count your blessings and to be grateful for the family and friends who gather near.

I'm truly lucky to have had many blessings over the past months. I would never have thought that being diagnosed with a brain tumor would be one of these, but it is. This illness has shown me that I am very fortunate to have loved ones around me who support and care for me. Thanks to all of them and to my medical team at M. D. Anderson, I'm here to celebrate the season once again. They are all my tidings of comfort and joy.

There's More to Life Than Cancer

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I grew up in Baton Rouge, La., where the holidays for our family included my dad, a fanatic LSU fan, counting down to the announcement of the college bowl game schedule. It also meant my birthday, days off from school, nightly work on the live nativity scene at church, two-a-day choir practices and sitting around the kitchen table making homemade Christmas cards.

How important are family holiday traditions? They help define beliefs and customs, and more importantly, determine the extent of the family unit. For kids age 1 to 92, traditions provide a sense of belonging and being loved. Ernest Burgess, a sociologist at the University of Chicago, studied how traditions provide families a heritage of attitudes, sentiments and ideals that he has termed "family culture."  

I remember when my mother was diagnosed with cancer and the whole family was celebrating Christmas in Pennsylvania. We all flew home early and my dad flew back after the holidays and drove the car home alone. But my mother never let her 15-year cancer journey become her or the family's whole life. I can hear her saying, "There is more to my life than my cancer."

Since being diagnosed with prostate cancer three years ago, I wake up with her passion for life and the realization that I can make the choice each day to have more than cancer in my life. The holiday season has been a great time for me to engage in those activities that reinforce the family culture. They give me so much love and strength to live each day with more than just cancer.

What holiday traditions are important for you and your connection to love and life? I'm writing this in Burlington, Vt., where we're spending a pre-Christmas vacation with a good friend and his family. Today we drove out to a tree farm and let Sophie the golden lab loose and all the kids from age 7 to 80 run around to pick out the Christmas tree. We drove home singing carols and spent the last few hours decorating the tree. Tonight we are having a dinner party with a group of good friends and will no doubt share memories of past holidays, laugh a lot, and go to sleep tonight with smiles a mile wide and deep.

If you're like our empty nest family, our holidays usually are built around trips where the kids rule and the spirit of the holidays aren't just present, but LOUD. There have been Thanksgivings and Christmases when we stayed in Houston and worked as volunteers helping to feed the hungry, wrap and hand out presents to the needy, or sing carols at senior living centers. Maybe it's a holiday cruise or travel to Mexico. Several Christmases ago, we spent a wonderful two weeks in Hawaii.

My hope is that while you've been reading about some of my holiday traditions and experiences, you've started a mental list of holiday activities that are important to you. Remember that holiday traditions can help you strengthen your connections to family culture, love and life. May your holiday season be full of the traditions that remind you there is more to life than cancer.

By: Jerah Thomas, M.P.H., Peiying Yang, Ph.D., Richard Lee, M.D., and Lorenzo Cohen, Ph.D.

Antioxidants_small.jpgThe National Cancer Institute defines an antioxidant as: "a substance that protects cells from the damage caused by free radicals (unstable molecules made by the process of oxidation during normal metabolism)."  

Antioxidants neutralize the electrical charge of free radicals, which damage DNA by taking electrons from other molecules. Free radical damage has been linked to aging and a number of diseases including the development of cancer. Antioxidants may slow or possibly protect against cancer.

Laboratory studies have reported evidence supporting the role of antioxidants in cancer prevention. However, clinical trials have shown no benefit of antioxidant supplementation. The Women's Health Study (WHS) and The Physicians' Health Study II concluded Vitamins E and C did not protect against cancer development. The Selenium and Vitamin E Cancer Prevention Trial not only reflected similar results, but also reported a slight non-significant increase in prostate cancer incidence among the men in the study who were taking vitamin E supplements. Similarly, the role of antioxidants in augmenting the effects of chemotherapy or radiation therapy remains controversial.

As clinical trials of antioxidant supplementation are inconsistent, and the efficacy during treatment is still being debated, we recommend obtaining antioxidants through food sources. Research suggests that diets containing antioxidant-rich fruits and vegetables may lower the risk of certain cancers

Some recommended antioxidant-rich foods:

Foods containing antioxidant-based vitamins and minerals
•    Beta-carotene - typically found in orange-colored foods such as sweet potatoes, carrots, squash and mangos. Spinach, kale, broccoli, and collard and turnip greens also are good sources.
•    Selenium - brazil nuts and seafood such as tuna and cod.
•    Vitamin A - leafy greens such as spinach and kale, carrots and cantaloupe.
•    Vitamin C (ascorbic acid) - citrus fruit such as oranges, grapefruit, red and green peppers, kiwifruit, broccoli and strawberries.
•    Vitamin E (alpha-tocopherol) - wheat germ, sunflower seeds, almonds and cooked tomatoes (tomato paste, tomato products, etc.).

Foods rich in naturally bioactive antioxidants
•    Polyphenols (flavanoids, catechins and anthyocyanidines) - soy, green tea, dark chocolate, plums, cranberries, blueberries, black raspberries, blackberries, strawberries, apples and nuts (hazelnut, pecans and pistachios).
•    Glucosinolates (isothiocyanates, thiocyanates and nitriles) - cruciferous vegetables such as watercress, broccoli, cabbages, cauliflower, brussel sprouts, and kale.
•    Resveratrol (phytoalexin) - grapes, cranberries, blueberries and peanuts.
•    Lutein - leafy greens such as spinach, kale and collard greens, broccoli, kiwi and red grapes (high in lutein).
•    Lycopene - cooked tomatoes (tomato paste, tomato products, etc.), water melon and apricots.

Resources

Office of Dietary Supplements: Dietary Supplement Fact Sheets

Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? (NCI)

Impact of antioxidant supplementation on chemotherapeutic toxicity: a systematic review of the evidence from randomized controlled trials

Antioxidants and other nutrients do not interfere with chemotherapy or radiation therapy and can increase kill and increase survival

Antioxidants and other nutrients do not interfere with chemotherapy or radiation therapy and can increase kill and increase survival, Part 2.

By Rakhee Sharma, Staff Writer/Videographer

For patients in the Children's Cancer Hospital at M. D. Anderson, their journeys are being chronicled by the Beads of Courage program.

Beads of Courage was created to help children keep an active journal of their treatments, without having to write anything down. By collecting a string of beads, each representing a different treatment or procedure, children have a way to honor milestones along their path. The string is a visual marker that helps kids, as well as families, cope with what they're going through and make it more understandable to others.



The program was created at Phoenix Children's Hospital by a nurse, Jean Baruch, who saw the benefits of resilience-based intervention for children receiving care for cancer or blood conditions. Since its inception here in August 2008, Beads of Courage has grown steadily in popularity.

New patients are invited to become a Beads of Courage member and given a bead color guide with a detachable membership card. A string and colorful beads that spell the patient's name is the start of the chronicle. Beads are given throughout treatment to add to the string. Some children have strings several feet long, and it's not uncommon to see a string 15 feet long tied to an IV pole in the hallway.

Sarah Odom, clinical nurse in G9 West, often is approached by children clamoring for their beads. "A lot of times even before the procedure, the kids need to know what bead they'll get once it is over," Odom says.

The program has helped strengthen the bond between care provider and patient. "We start talking to them about beads, leading to conversations about what the next part of treatment will be. It opens a dialogue," Odom remarks. "It gives us something to talk about besides chemo, something to look at rather than the actual treatment. And kids need that. It's how they cope."

By Sara Farris, Staff Writer

Every day, pediatric patients, families and their health care teams put on their armor to fight childhood cancer in the Children's Cancer Hospital at M. D. Anderson. While patients are receiving their treatment at the hospital, research teams are working in laboratories to find better ways to combat childhood cancer.

Recently, researchers from the Children's Cancer Hospital were selected to present their newest lines of defense at the 51st American Society of Hematology (ASH) Annual Meeting. Their weapons come in the form of drugs and antibodies, and the soldiers carrying the weapons are the patients' own immune cells.

Weapons Against Cancer

Having a children's hospital within a large cancer center benefits pediatric oncologists and patients by giving them access to an arsenal of new agents being investigated in adult cancers. This allows researchers to investigate and get the drugs to pediatric patients sooner.

Three posters presented at ASH from Children's Cancer Hospital researchers dealt with anti-cancer agents: valproic acid (VPA), amrubicin and decitabine.

•    Joya Chandra, Ph.D., and Joy Fulbright, M.D., presented their study findings on anthracyclines and their relation to cardiotoxicity in patients.
•    Shiguo Zhu, Ph.D., and Dean Lee, M.D., Ph.D., discovered that valproic acid is a STAT3 phosphorylation inhibitor. The discovery of this function may allow researchers to use VPA to target additional cancers that rely on STAT3 for growth.
•    Lisa Kopp, D.O., and Lee found a drug commonly used against acute leukemia had a negative impact on a patient's immune cells when given in high doses. They are now investigating the best dosage of this drug that will kill the leukemia while minimizing harm to the patient's immune cells.

An Army of Cancer Fighters

Historically, cancer therapies have consisted of administering drugs to a patient's body that kill any quickly growing cells, both normal and cancerous. This has resulted in many side effects and long-term effects for survivors.

Researchers are investigating cell therapy, which harnesses the power of a patient's own immune system, or the transfused immune cells of a donor, to attack tumors without harming healthy cells. At this year's ASH meeting, researchers from the Children's Cancer Hospital presented ways of training these armies of immune cells to be better fighters.

•    Lenka Horton and Laurence Cooper, M.D., Ph.D., have developed a laboratory procedure that supercharges T cells (immune cells) to be infused into cancer patients that could potentially decrease the risk of harsh side effects.
•    Jeffrey Friesen and Lee have designed a way to put an antibody in natural killer cells that directs the immune cells to attack acute myelogenous leukemia cells.
•    Srinivas Somanchi, Ph.D., and Lee have used a similar method to insert a different antibody into natural killer cells that directs them to attack neuroblastoma.
•    Harjeet Singh, Ph.D., and Cooper have been able to genetically modify T cells using a chimeric antigen receptor that increases the ability of T cells to last longer and grow more rapidly.
•    Cecele Denman and Lee have found a way to generate 100 times the amount of natural killer cells than the traditional, time-intensive apheresis method starting from just eight teaspoons of the donor's blood.

A Defense Strategy

With a range of therapies coming down the pipeline, pediatric oncologists are continuously studying which patients might respond best to the various options available.

Patrick Zweidler-McKay, M.D., Ph.D., from the Children's Cancer Hospital, has found a prognostic factor, absolute lymphocyte count (ALC), which may further assist physicians in strategizing what treatments to prescribe. His study, presented at ASH, looked at ALC data along with another prognostic factor, minimal residual disease, and predicted prognosis even more efficiently than using either factor alone.

Prepared for Battle
Fighting cancer requires deploying an offense from a variety of angles. The Children's Cancer Hospital has specialists dedicated to basic, translational and clinical research who report their progress at annual meetings such as ASH so that others can learn from their experience. All of the research presented is incorporated to provide patients, families and their health care teams with an arsenal of therapies and state-of-the-art technologies to face cancer and combat it head on.

Read the Full American Society of Hematology (ASH) 2009 Recap

By Gary Whitman, Professor, Diagnostic Radiology

Two reports at the CTRC-AACR San Antonio Breast Cancer Symposium highlighted the role of bevacizumab in the treatment of metastatic and/or locally recurrent breast cancer.

Bevacizumab is an angiogenesis inhibitor, a therapy designed to inhibit the formation of new blood vessels. The rationale for the use of angiogenesis inhibitors like bevacizumab is based on the understanding that tumor cells require a constant blood supply to receive oxygen and nutrients.

The RIBBON 2 study showed that adding bevacizumab to chemotherapeutic agents for the treatment of HER2 negative metastatic breast cancer led to a significant increase in overall survival. The AVADO study demonstrated that adding bevacizumab to docetaxel resulted in a significant increase in progression-free survival in patients with metastatic breast cancer, without affecting toxicity. These results lead one to ask if bevacizumab should be given throughout the course of treatment in patients with metastatic breast cancer.

In addition, we should consider using MRI to monitor response and angiogenesis inhibition in patients receiving bevacizumab therapy. While MRI may be limited in analyzing small volumes of residual disease (such as small cell clusters), MRI can assess tumor perfusion and vascular leakiness in patients with residual disease.

Furthermore, we have the tools to extract parameters from the MRI dynamic contrast enhancement curves and correlate those parameters with evidence of response to therapy.

pam jones.jpg

Representatives from all continents gathered at the Inflammatory Breast Cancer World Alliance meeting, held on Dec. 9 at the CTRC-AACR San Antonio Breast Cancer Symposium. The meeting was chaired by Massimo Cristofanilli, M.D.

Clinical and pre-clinical investigators and advocates from 30 countries have joined forces to find more effective treatment of this most aggressive type of breast cancer. In rare cancers such as IBC, an international collaborative is particularly important to create a large pool of patient data to draw conclusions.

IBC prevalence has been reported in North America, much of Europe and parts of Africa. These studies have contributed to the estimates that IBC makes up 1% to 5% of breast cancers. Published data have indicated that IBC may be more prevalent among women in North Africa (20% of breast cancers) and African-Americans (up to 10% of breast cancers).

Little is known about the prevalence of IBC among other ethnicities. To address this, the alliance has established an international registry trial that links epidemiologic data and patient tissue and blood samples from multiple centers around the globe. Members of the alliance will use the banked patient samples to explore the proteomics, genomics and immunobiology of the disease.

The 2010 inflammatory breast cancer scientific conference will be held on Oct. 5-7 in Marseilles, France, immediately preceding the European Society of Medical Oncology meeting in Milan. Patrice Viens, M.D., Institut Paoli-Calmettes, Marseilles, France, World Alliance member, is the program director. The first call for abstracts will be issued in early 2010.

The Inflammatory Breast Cancer World Alliance is committed to improving outcomes of women worldwide affected by IBC.

For information on joining the Inflammatory Breast Cancer World Alliance or the 2010 conference, contact ibcp@mdanderson.org.
 

By Sharon Giordano, Associate Professor, Department of Breast Medical Oncology

Giordano.jpg

Results from several important studies on adjuvant hormonal therapy for breast cancer were presented Thursday at the CTRC-AACR San Antonio Breast Cancer Symposium.

The TEAM study compared the outcomes of over 9,000 post-menopausal women with hormone receptor positive breast cancer who were randomized to either a) five years of exemestane or b) tamoxifen for 2½-3 years followed by exemestane for a total of five years of treatment. With a follow-up of just over five years, the survival of both groups of women was virtually identical, although side effects were a little different. These results show that either up-front treatment with an aromatase inhibitor or a switching strategy results in equivalent outcomes.

Another study of aromatase inhibitors also was presented Thursday morning. The IES study compared the outcomes of postmenopausal women who were treated with 2-3 years of tamoxifen and then were randomized to either finish a total of five years of tamoxifen or switch to exemestane for the last 2-3 years. In contrast to the previous study, the women who switched to an aromatase inhibitor had superior disease free and overall study. However, this analysis excluded some of the women who were originally enrolled in the study but were later found to have hormone receptor negative breast cancer. Despite this limitation, the study shows that post-menopausal women who start on tamoxifen have better outcomes if they switch to an aromatase inhibitor after 2-3 years. 

A third study of aromatase inhibitors also had some very interesting findings. Dr. Goss presented a sub-analysis of the previously reported MA.17 study. The original study had compared the outcomes of women who were treated with five years of tamoxifen and then were randomized to either letrozole or placebo for five additional years. At the time of randomization, all women were required to be post-menopausal.

The original trial showed improved outcomes for the women who received letrozole. The analysis evaluated whether women who were pre-menopausal at cancer diagnosis but who went through menopause during the years of tamoxifen treatment benefited from letrozole. The findings were striking -- the women who became post-menopausal during treatment with tamoxifen had a large benefit of subsequent treatment with letrozole. These findings are very relevant as many women undergo menopause as a result of cancer treatment, and information about the effectiveness of aromatase inhibitors in this group has been limited. 


Now doctors and patients can feel more confident about the activity of aromatase inhibitors in this population of women. 

 

By DAVID SERVAN-SCHREIBER, LORENZO COHEN and DONALD I. ABRAMS

Op Ed Posted in the Houston Chronicle 12/06/2009

The debate about how often and at what age women should have mammograms or men PSA tests has become a national conversation. However, a major issue is being missed in the back and forth argument about costs and individual medical freedom. The reason the U.S. Preventive Services Task Force issued new guidelines is because of a ground shift in the very understanding of cancer.

Cancer is not the ominous downhill process it has been feared to be for several decades. Yes, cancer starts with genetically abnormal cells that begin to grow wildly. The evidence now shows, however, that many small collections of cancer cells may be perfectly well contained by our body's natural defenses, and often even disappear on their own. Cancer, we now know, is not a one-way street. In some cases, small tumors may appear, grow a bit and then stop, or even go away.

What this means is that lifestyle choices that weaken or strengthen the natural defenses that protect us against cancer may play a major role in whether some early tumors develop, or not, into a dangerous disease.

Yet, over the past 30 years, "early detection" has been the primary and almost exclusive mantra of our medical institutions when it comes to breast and prostate cancer prevention. The recommendation for these rather expensive mammograms and biopsies were based on the assumption that cancer inevitably progresses, and had become a largely unchallenged practice. Even though most experts have known for some time that the benefits of these screenings have limits, and that the downsides of overtreatment are significant, they have been frustrated by lack of an alternative strategy for prevention.

Missing from this debate is the fact that modifiable lifestyle factors are known to prevent and/or reduce the risk of a majority of cancers. Most experts now agree that over 50% of cancer is preventable through appropriate lifestyle choices.

Read the Entire Article

By Marjorie Green, Associate Professor, Department of Breast Medical Oncology

Over 190,000 women will be diagnosed with breast cancer in the United States during 2009. Research efforts are designed to not only improve the treatment of breast cancer but also to help evaluate methods that can prevent breast cancer development. At the 32nd annual CTRC-AACR San Antonio Breast Cancer Symposium, researchers will be presenting data from multiple studies examining the use of a commonly prescribed class of medicines -- bisphosphonates.

Bisphosphonates are medications that interfere with the normal remodeling (breakdown and then rebuilding) of bone that occurs in all people. Our bones are constantly being taken apart by cells called osteoclasts and then rebuilt by cells called osteoblasts. Bisphosphonates stop osteoclasts from destroying bone so there is less bone loss and bone can be rebuilt. 

Bisphosphonates are commonly used to treat bone loss in women -- both osteopenia (early bone loss) as well as osteoporosis (severe bone loss). Unfortunately, many women who receive therapy for breast cancer either already have bone loss at the time of their cancer diagnosis or their medical therapies used to treat breast cancer put them at risk for accelerated bone loss.

Z-FAST trial

At the meeting, Adam Brufsky, M.D., presented data regarding the Z-FAST trial where patients received an antiestrogen therapy for breast cancer, letrozole. Letrozole is an anti-estrogen medication that lowers the body's production of estrogen and is commonly used to treat breast cancer. Lowering estrogen levels can, unfortunately, accelerate bone loss. The Z-FAST study was designed to see if starting the bisphosphonate zoledronic acid at the time of initiation of letrozole could help prevent bone loss.

Patients on this study were randomized to start both letrozole and zoledronic acid together (the "upfront group") or to start letrozole and have their bone health followed (the "delayed group"). If patients in the delayed group who were not started on zoledronic acid developed severe worsening of bone loss or developed a fracture in the bone, then zoledronic acid was started. 

Patients in the upfront group of combined letrozole and zoledronic acid were found to have marked increase in bone strength at the end of five years of therapy when compared to women who were started on the letrozole only. Patients in the delayed group started on letrozole alone actually lost bone strength.

The patients who started the zoledronic acid later did rebuild their bone when zoledronic acid was finally started. The study describes a slightly higher number of fractures in the group who delayed initiation of zoledronic acid (12.4%) versus those who started immediately (10.7%). However, it isn't certain that starting zoledronic acid at the beginning of anti-estrogen therapy is necessary for all patients. Other studies (example: the ATAC study) have shown that women with normal bone strength at the beginning of anti-estrogen therapy don't develop osteoporosis from their breast cancer treatment, even though there is some bone loss seen.

Other studies

Recently, there has been evidence that bisphosphonates may have another role in addition to helping strengthen the bone, and that is possibly to interfere with the growth and development of breast cancer. An Austrian study evaluating the use of the bisphosphonate zoledronic acid as treatment of young women with breast cancer found that zoledronic acid not only prevented bone loss, but it also lowered the risk of breast cancer recurrence and development of new breast cancers.

At the  meeting, two studies will be presented that suggest that bisphosphonates used to treat bone loss may also help to prevent breast cancer development. The Women's Health Initiative study describes that use of bisphosphonates lowers the risk of developing breast cancer by more than 30%, and a similar reduction in the risk of developing breast cancer will be described by a group from Israel (Rennert et al). These studies were not specifically designed to determine if using a bisphosphonate will prevent the development of breast cancer. The results are observations comparing women who took bisphosphonates primarily for bone health reasons, compared with women who did not take bisphosphonates. Regardless, the findings are very exciting and will likely lead to additional research to determine if these medications can be used to prevent development of breast cancer in women.

Denosumab

Finally, newer medications have been developed that may help preserve bone strength and prevent complications from having breast cancer that has spread to the bone better than the bisphosphonates. Denosumab is an antibody that prevents osteoclasts from developing and thus prevents the destruction of bone. More than 2,000 patients with breast cancer that had spread to the bone were treated with either denosumab or the bisphosphonate zoledronic acid. Denosumab appears to lower the risk of fractures in the bone from cancer more effectively than zoledronic acid. Ongoing studies will help to clarify the role of this medication.

New drugs and new combinations under development bring a targeted approach to improving care for chronic lymphocytic leukemia (CLL) and for overcoming drug-resistant chronic myeloid leukemia (CML).

"It's an optimistic time for us," says William Wierda, M. D., Ph.D., associate professor in the department of Leukemia, during a video interview about CLL with Andrew Schorr of Patient Power

CLL Therapy Increasing Survival from Patient Power® on Vimeo.

In separate interviews, Wierda and Michael Keating, M.D., discuss new drugs, clinical trials and how M. D. Anderson doctors work with referring physicians to manage patient care.


An Expert's Perspective on the Latest CLL News from Patient Power® on Vimeo.

A class of drugs called tyrosine kinase inhibitors has increased five-year survival for CML patients from 50 percent to 90 percent in recent years.  Yet for some patients, their CML does not respond or becomes resistant over the course of treatment.

In second video interview with Schorr, Jorge Cortes, M.D., professor in the department of Leukemia, discusses drugs in clinical trials that show promise against resistant CML.

Fighting Drug Resistance in CML from Patient Power® on Vimeo.


Both interviews occurred at the 51st Annual Meeting of the American Society of Hematology in New Orleans Dec. 5-8.

Other M. D. Anderson interviews on Patient Power can be viewed at  www.mdanderson.org/patientpower

The world's only comprehensive cancer prevention conference opened Sunday in Houston.

The eighth annual American Association for Cancer Research Frontiers in Cancer Prevention Research Conference brings together prevention researchers in all disciplines striving to understand and prevent cancer.

 "This meeting represents the full spectrum of prevention research -- from the study of molecular pathways to clinical applications, behavioral and social aspects, all the way to population level research," says conference chairperson Ernest Hawk, M.D., vice president for cancer prevention and head of the Division of Cancer Prevention and Population Sciences at M. D. Anderson Cancer Center.

About 600 scientists are attending 29 topical sessions with 270 posters being presented during two evening sessions.

The top 10 abstracts were chosen for inclusion in their relevant sessions, two by scientists from the lab of Xifeng Wu, M.D., Ph.D., professor in M. D. Anderson's Department of Epidemiology. Post-doctoral fellow Xiaofan Zhang, Ph.D., presents on genetic variations related to micro RNA (miRNA) and how they reflect the risk of recurrence for head and neck cancer patients and the likelihood that they will develop a second cancer. Meng Chen, Ph.D., presents on genetic variations in the sonic hedgehog pathway and clinical outcomes in bladder cancer.

Keynote speaker Sunday was Waun Ki Hong, M.D., head of M. D. Anderson's Division of Cancer Medicine and a pioneer in the field of cancer chemoprevention. Hong showed how current research on personalized treatment for lung cancer patients will lead to personalized chemoprevention.

By Dawn Dorsey, Staff Writer

Cynthia Pettett photo FA1_edit.jpgCynthia Pettett admits she probably would still be smoking if she hadn't gotten cancer of the larynx (voicebox). After all, she started when she was 15. Even now, when she sits down with her morning coffee, that itch for a cigarette flashes across her mind.

When she was diagnosed in 2002, Pettett made the decision to travel from her home in Kentucky to M. D. Anderson, where she participated in a study that looked at treating larynx cancer with chemotherapy alone, rather than the conventional protocol that combines chemotherapy and radiation.

"When they asked me if I wanted to try to treat the cancer with chemotherapy, I jumped at the chance," she says. "I just felt like I couldn't handle the radiation."

Biopsy confirms cancer

Pettett and her husband are from Illinois, but they retired early to a scenic lake region of Kentucky, where they ran a marina for 20 years before she got cancer and they retired again -- this time for real.

Before she was diagnosed, Pettett didn't feel sick, but she was hoarse and lost a lot of weight. When she got down to 94 pounds, she knew something was seriously wrong. Still, she put off going to the doctor because a new otolaryngologist (ear, nose and throat doctor) was scheduled to come to Murray, Ky., where her primary care doctor is.

The new doctor performed a throat biopsy and told Pettett she had cancer of the larynx. Since their daughter lived in Bryan, Texas, about 90 miles from Houston, Pettett and her husband loaded up the car and drove to M. D. Anderson.

Texas treatment begins

At M. D. Anderson, she had six rounds of chemotherapy, each round lasting three days. The chemo was intense and required frequent blood tests to be sure her kidneys were functioning at the right level.

The treatment required a lot of energy; when it started in the late afternoon it lasted until the early morning hours. The Pettetts stayed at a hotel close to M. D. Anderson and between treatments drove back to Bryan so she could recover.

"A protocol nurse was assigned to me, and that really helped," Pettett says. "I could call her when I had any problems with side effects."

Side effects were bothersome

Although they weren't life threatening, there were several unpleasant side effects. Among them were nausea, helped by a pill before each treatment, and anxiety -- although Pettett says she never was frightened of the treatment.

"I was so restless I would walk the halls of the hospital with my IV pole while I was getting chemo," she remembers. "I was too anxious to sleep at night, but a sleeping pill really helped."

Although the chemo didn't make her hair fall out, Pettett did shave her head.

"The chemo really made my scalp hurt," she says. "That was the worst side effect. One of the nurses told me to have my daughter shave my head. What a relief! It felt so much better after that."

One of the most inconvenient parts of the treatment from her point of view was having to drink 7-8 bottles of water each day.

"I've never been much of a water drinker," she says. "My poor husband had to make me drink the water."

She knew she was improving

At first doctors weren't sure the treatment would be successful.

"But I knew it was working," she says. "I can't explain, but something was different and my voice was stronger. Then they did a biopsy at the next session, and sure enough I was right. It was working."

Treatment pays off

Now cancer free for five years, Pettett returns to M. D. Anderson every year.

"Things are back to normal now, and I'm so glad I had the treatment," she says. "If the cancer comes back, which of course I hope doesn't happen, I can always have another type of treatment later."

Related article:
Q&A: Treating Larynx Cancer With Chemotherapy Alone


M. D. Anderson resources:
Laryngeal cancerl

Head and Neck Center



Additional resources:
All About Laryngeal and Hypopharyngeal Cancer (American Cancer Society)

Throat (Laryngeal and Pharyngeal) Cancer (National Cancer Institute)

In certain cases, cancer of the larynx (voicebox) can be treated successfully with chemotherapy alone, according to a recent study at M. D. Anderson.

Chris Holsinger, M.D., associate professor in the Department of Head and Neck Surgery, was co-author of the study, which is the first of its kind in the United States. He answers questions about this groundbreaking research that may provide hope for some patients.

How has the treatment for larynx cancer evolved over the past few decades?

Thirty years ago, the only option for cancer of the larynx, also called laryngeal cancer was surgical removal of part of the larynx. In the 1970s, treatment moved away from surgery and more toward radiation. Then we began to combine radiation and chemotherapy.


What are some of the disadvantages of treating cancer of the larynx with radiation?


Radiation can have side effects, especially long-term toxicity. In many patients, the cancer returns.

Sometimes, radiation therapy saves the larynx and trachea (windpipe), but they do not work as well. This requires some patients to have a tracheotomy (a surgical procedure that makes an incision in the trachea to open a direct airway) or gastrostomy (surgical opening into the stomach).

If patients who have radiation need surgery later, they often have more surgical complications and lower survival rates.

What inspired you to look at treating larynx cancer with chemotherapy?

While the treatment of larynx cancer was evolving in the United States, another story was unfolding in Paris. Two doctors, Henri Laccourreye and his son, Olivier, were treating larynx cancer with chemotherapy alone and having amazing results.

It was controversial and experimental, but they published a paper in 1996 that showed a third of their patients had complete recovery.

In the first year of my fellowship at M. D. Anderson, Olivier spoke here. I was in the back of the room, but what he said captured my imagination.

I received a Fulbright Scholarship and went to Paris to study with them for four months. It was an incredible watershed experience in my life.

What are some of the advantages of treating larynx cancer with chemo only?

The most important advantage is that all options are still on the table. If the chemo does not succeed, the patient usually still can have radiation or surgery. And, if we can treat the tumor with chemotherapy, patients usually function better.

What was your objective with this study?

We wanted to determine if chemotherapy alone or followed by voice-sparing surgery would achieve lasting remission for certain patients. Voice-sparing surgery also is called CLS (conservation laryngeal surgery), and it maintains the ability for speech and swallowing.

How did you carry out the research?

We recruited 31 patients with stage II to IV laryngeal cancer who had not been treated. All the patients were eligible for CLS.

Each patient received 3-4 cycles of TIP chemotherapy, which contains:

•    Cisplatin
•    Mitoxana® (ifosfamide)
•    Taxol® (paclitaxel)

Patients who had a complete response received three more cycles of TIP and no other treatment.

Patients who had a partial response had CLS.

What were the results?

One patient was not able to finish treatment, but all other patients responded to treatment.

Eleven patients (37%) had a complete response. Ten of these patients remain cancer-free five years later.

Nineteen (63%) of the patients treated with chemotherapy alone had a partial response.

We were able to save the larynx in 83% of the patients. Five patients required postoperative radiation therapy. No patient required a gastrostomy or tracheotomy.

Can you put these results into perspective?

While these results are promising, we want to emphasize that further multi-institutional Phase II validation is required before this approach is widely used. This approach should be done with great care and only in the setting of a clinical trial.

What's next for your research?

We would like to study new chemotherapy regimens, which may give even better results.

Our ultimate goal is true personalization of therapy for cancer of the larynx. In the future, other studies may identify biomarkers that will help identify who will benefit from chemotherapy alone. Then, we'll be able to do a biopsy, and study tumors and genes to find the best method of treatment for each patient.

We hope to identify those patients who do not need to have this delicate organ -- so important to social function -- altered.

Related article:
Chemotherapy Alone Works for Larynx Cancer Patient

M. D. Anderson resources:
Head and Neck Center


Additional resources:

MDABCC_Night.jpgLeaders from M. D. Anderson and Banner Health broke ground today on the M D Anderson Banner Cancer Center. An event to mark the occasion took place on the campus of Banner Gateway Medical Center in Gilbert, Ariz.

Targeted to open in fall 2011, the new center will deliver cancer care to patients in Arizona through M. D. Anderson's collaboration with Banner Health, the state's leading nonprofit health care system.

"Banner Health is proud to join forces with M. D. Anderson to fight the battle against cancer," says Peter S. Fine, Banner Health president and CEO. "This groundbreaking marks a major milestone in the vision of our two organizations to provide access to a new level of cancer care in Arizona."

Announced in May, M. D. Anderson Banner Cancer Center will include a 120,000-square-foot, three-story building dedicated to outpatient services including physician clinics, medical imaging, radiation oncology, infusion therapy and many support services. It's this building that began construction today. The center will treat inpatients on two floors inside Banner Gateway Medical Center.

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"Breaking ground on this facility is exciting and real evidence of the commitment that our combined teams have made to those afflicted with cancer in Arizona," says John Mendelsohn, M.D., president of M. D. Anderson. "It's exciting to see our big plans show tangible progress as we prepare for the real work ahead -- reducing the burden of this disease."

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M. D. Anderson Banner Cancer Center will support the multidisciplinary care approach pioneered at M. D. Anderson, which includes individual areas for specific cancers. It also will feature many of the healing environment concepts upon which Banner Gateway Medical Center was built in 2007, along with the most advanced technology and electronic recordkeeping systems.

The center represents a $107 million project funded by nonprofit Banner Health through bonds. In addition, the Banner Health Foundation will engage the community in a fundraising campaign to support this project.




By Rachel Winters, Staff Writer

mature_couple_sitting_edit2.jpgA couple's ability to maintain a healthy relationship post-cancer relies, in part, on their ability to interact, relate and be intimate as the patient makes the challenging and life-affirming transition to breast cancer survivor.

"The majority of the women whom I see say that their partners are very understanding throughout their treatment," says Mary Hughes, a clinical nurse specialist in M. D. Anderson's Department of Psychiatry. "Some of the women who are further out from their treatment, however, have trouble with intimacy due to the appearance of their breast(s), or they say they would like to be more interested in sex."

Conquering body image together

Once a woman has had a mastectomy, regardless of her decision about whether to have breast reconstruction, she may develop a poor body image due to the appearance of the new or missing breast or because of scarring.

While some women are comfortable with letting their partner see the scar, others want to hide their breasts. Although it is perfectly natural to have a difficult time accepting any change to the body, it is extremely important that women not project their own negative images onto that of their partners.

"What a woman needs to remember is that she usually is more upset about the changes to the breast(s) than her partner," says Leslie Schover, Ph.D., professor in the Department of Behavioral Science.

"I've talked to a lot of partners, and the truth is that they're just happy that the woman they love is alive," Hughes says. "They're not concerned about the scar or an imperfect breast. A woman shouldn't think her partner isn't ready. It's her that might not be."

Bringing life back into the bedroom

Women who have had a mastectomy often lose sensation in their breast(s) due to nerve tissue damage. While their breasts were once erogenous zones, they now lack sensitivity, which can interrupt or change patterns of sexual behavior.

Some young women may have trouble due to the early onset of menopause as a result of chemotherapy, which lowers their estrogen levels. This can lead to severe vaginal dryness, pain with intercourse and a loss of elasticity in the vaginal walls.

"Without understanding how to avoid pain, many women lose interest in sex because it is traumatic and painful," Schover says.

Partners of women who are experiencing such side effects need to be understanding and know that with time and work, the woman's libido will return.

Expert tips on intimacy for breast cancer survivors:
 
•    Build self-esteem by doing things that are good for your body, like eating good food, exercising and making an effort to look your best.

•    Wear a tank top or a camisole when making love if it makes you feel more sexual, or invest in sexy lingerie that hides the scar.

•    Spend more time engaging in foreplay.

•    Schedule weekly sexual encounters at times that you are less tired and make a commitment to your "special time." This will cut down on wondering about when the next encounter will be and help both parties relax.

•    Invest in both a water-based lubricant and an over-the-counter vaginal moisturizer. Incorporate the lubricant into your sexual routine, and insert the moisturizer into the vagina a few times a week to help counteract the effects of chemotherapy.

•    Don't be in a hurry or try to force your intimate relationship.

•    You may also consider seeking professional help or counseling.

"Remember that regaining a powerful sexual relationship with your partner isn't a race," Hughes says. "It's like a train ride. It's a journey. Be creative, and do what feels natural."
 
Related articles:
Improving Intimate Relationships for Cancer Survivors

Sexuality and the Cancer Patient (webcast)

Q&A: Sexual Relationships and Cancer


M. D. Anderson resources:
Sexuality and Cancer


Additional resources:
Join the YSC Community (Young Survival Coalition)
www.youngsurvival.org

Exploring Self-Esteem and Intimacy (American Cancer Society)

 

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