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February 2010 Archives

By DeDe DeStefano, Staff Writer

Our patients are inspirational, courageous fighters. With each one, I am reminded of the journey I made alongside my mother 11 years ago, as if it were yesterday. Each July we celebrate the end of her treatment as much as we do the day she was born.

On Feb. 18, I had the opportunity to work at an M. D. Anderson event honoring cancer patients everywhere -- celebrating with those who survived their cancer and mourning with family and friends of those who did not. Some of these patients are my colleagues. Some are friends. And some I'd just met. Some told their stories. Others listened and applauded. Everyone cried.



These patients are my heroes. They are why I love my job. Although I am not in direct patient care, I have the honor of telling their stories. Sometimes in the middle of the night I wake up and worry about them, just like I know their care teams do, and I think it's like that with everyone here.

The evening's purpose was to thank the philanthropic donors who have made a difference in the lives of our patients and announce that M. D. Anderson is raising $1 billion to continue that work. Although the celebration thanked donors, the focus was not on the donors themselves, but rather the reason behind the gifts. Testimony after testimony was given -- some planned, others not. From Jeff Wigbels, a non-smoking athlete who learned he had stage IV metastatic lung cancer the day before his son was born, to "America's Got Talent" lymphoma survivor Barbara Padilla, whose operatic voice brought down the house, there was not a dry eye in the room.

In his opening remarks, M. D. Anderson President John Mendelsohn, M.D., paid tribute to Bob Mosbacher, who recently lost his battle with cancer. Mosbacher was the only person to chair M. D. Anderson's Board of Visitors twice. "Bob worked hard to bring national attention and critically needed resources to M. D. Anderson, and did so with the modesty and quiet charm for which he is so admired. He was a great personal friend to Anne and me, and we miss him terribly," he told the audience, which included members of Mr. Mosbacher's family.

Originally slated to serve as master of ceremonies, CNN's Sanjay Gupta, M.D., had to regretfully cancel due to his participation in the earthquake relief efforts in Haiti. Former Miss America Phyllis George stepped in graciously and offered her own personal story with the institution, though we did not know she had one when we asked her to take part. A dear friend was misdiagnosed elsewhere (twice) and ultimately came to M. D. Anderson, where he survived six years. "If he had come to M. D. Anderson first, I have no doubt he'd still be alive today," she said tearfully. She then paid tribute to the patients in the room whose stories were told in the campaign brochure, including Patsy Bodie who struggled with pancreatic cancer for 10 years. The entire room of 600 held a moment of silence for Patsy, who lost her battle with the disease 22 days before the event.    

The tribute continued with the spectacular voices of the Houston Five Tenors' performance of "Amazing Grace" joined by St. Thomas' Episcopal School Pipe Band's bagpipes.

Memorial Drive Presbyterian senior pastor Rev. Dave Peterson offered his own testimonial before delivering the invocation. He spoke about his young daughter who, just weeks after getting married, was diagnosed with breast cancer. She came to M. D. Anderson for treatment.

After dinner, Board of Visitors Chair Nancy Loeffler welcomed board and Advance Team members and campaign chair Harry Longwell encouraged guests to spread the word about the need for philanthropic funding for cancer research programs.

After an extraordinary performance of "Ave Maria" by Barbara Padilla, eight patients on eight miniature stages around the room's perimeter gave a moving tribute to cancer patients everywhere as the program's finale. One by one, they were spotlighted, each telling his or her story and each physically striking out the word "cancer" on a screen behind him or her. Barbara Padilla struck hers out on the main ballroom stage and gave a closing rendition of "The Prayer" with one of the five tenors, Ken Gayle.

All in all, it was an evening of hope. Not everyone has survived cancer, but everyone had such an extraordinary story of what this terrible disease does. So many people are fighting cancer, and so many more are fighting with all they have to cure it, whether that means in a lab, in a clinic or with a checkbook.

It was hopeful and moving and quite honestly one of the best evenings I've ever had the privilege to be a part. I think everyone left the event with an understanding of the urgency of the problem of cancer and the compelling desire to do more.

Web site - www.makingcancerhistorycampaign.org
Facebook - The Campaign to Transform Cancer Care


These are the stories of the eight finale participants.

Victoria Johnson

Victoria Johnson is a survivor of more than 11 years of stage IV breast cancer with metastases to all major organs, including her brain. After being extremely conscientious for years about annual mammograms and additional precautionary ultrasounds, Victoria was diagnosed with the late-stage cancer and told that she had approximately 1½ years to live. Searching for hope, Victoria came to M. D. Anderson. She has since had seven brain tumors successfully removed and credits ongoing Herceptin® treatments with enabling her to live a full life. Victoria has repeatedly given her awe-inspiring testimonial to audiences at M. D. Anderson events. Passionate about enjoying each cherished day, she appeared in the CNN video "Taming the Beast," quoting her grandmother: "It's time to use the good china. Enjoy life!"

Nikita Robinson

An M. D. Anderson employee for five years, Nikita is a senior research coordinator in the Department of Health Disparities. She also is a four-year colon cancer survivor and a contributing member of the Employee Cancer Support Group. Nikita says her illness has influenced her perspective of her work, and she is eager to educate others about the institution. Within months of diagnosis, her mother was diagnosed with stomach cancer and her grandfather was diagnosed with pancreatic cancer. Neither survived. Nikita says that her insight gained as a patient and employee enabled her to be a vessel of support for her loved ones through their own cancer battles. Nikita says, "I am a real survivor, and for them -- to honor them -- I have to do this. I feel so honored to represent all the survivors at this institution."

Kenneth Woo

Kenneth is a 17-year Hodgkin's lymphoma survivor, and a 6 /2-year acute myelogenous leukemia and stem cell transplant survivor. Kenneth has many ties with
M. D. Anderson. He is a longtime volunteer with the Anderson Network and routinely supports its members in their time of need. Kenneth chaired the 2009 Anderson Network steering committee and will chair the 2010 Anderson Network Living With, Through and Beyond Cancer Conference. Thoughtfully helping others touched by cancer is a priority in Kenneth's life, and he is quiet but passionate about doing so, helping not only other patients but also their caregivers. Because of Kenneth's cancer experience, he, wife Clara, and daughters Ashley and Kimberly have made the words "be a channel of blessings to others" their family motto.

Janice Duplessis

Janice is a 10-year breast cancer survivor and three-year metastatic cancer survivor. Soft-spoken and serene, she chaired Anderson Network's 2007 annual patient conference of 500 attendees while going through radiation treatments for brain metastasis. She adopted the conference theme, Power of Hope, to describe herself: "We who have cancer must believe in the power of hope. M. D. Anderson has given me hope for the strongest and longest survivorship." Janice volunteers at various conferences, with the Telephone Outreach Program for Breast Cancer and with the American Cancer Society. She and her husband, Rogers, have three sons. Janice credits Rogers, who established the Lean on Me Caregivers Group to support others who care for loved ones facing cancer, with being her strength.

Nadia Jones

Nadia Jones may only be 5 years old, but she's an experienced driver of a pint-sized pink power-wheels Ford Mustang, which she thoroughly enjoys. She is being treated for rhabdomyosarcoma in the Children's Cancer Hospital at M. D. Anderson, and attends kindergarten in Richmond, Texas. Nadia's mother, Brandie, says that despite the numerous obstacles Nadia has encountered since birth, she has always managed to maintain an extremely positive outlook on life.

Jason Connelly    

Diagnosed with stage IV melanoma in 2006, Jason has been a survivor for three years. He generously and passionately shares his story of diagnosis, intense treatment and survival, emphasizing the importance of philanthropic funds and their role in advancing the therapy that helped save his life. Jason was one of three cancer patients honored as Person of the Week on "ABC World News" in 2008. The joy of Jason's life is his adorable son, Jacob, 5. "I'm happier now than I have ever been. I'm happier now than I was before I got sick," Jason says.

Jaime Ramirez

Diagnosed in Mexico at age 4, Jaime had osteosarcoma that returned every two years for 17 years. His parents brought him to Houston when he was 7, and after other hospitals could do no more, Jaime, by then a teenager, came to M. D. Anderson. Jaime survived 18 surgeries on his leg, often enduring hospital stays alone while his mother returned home to South Texas to care for his nine brothers and sisters. Jaime has been cancer-free for 22 years, beginning in 1988, when he became an M. D. Anderson employee. "They saved my life, so as long as I'm alive, I will be part of this team's mission to end cancer," he says. Jaime also volunteers on M. D. Anderson's Diversity Council, as an Anderson Network Ambassador and as a caring guide to pediatric patients faced with losing a limb.

Kay Rogers
 
Kay is a 38-year breast cancer survivor and 21-year colorectal survivor. She has inspired others through 34 years of volunteer service with new volunteers, the Children's Art Project card program and the children's Health Adventures program. She is a motorcyclist and began the Ride for Life for Anderson Network's annual patient conference, served 18 years on the Pediatric Brain Tumor Foundation's Ride for Kids task force and supports the Harley's Angels calendar fundraiser. Kay is retiring soon from her accountant position at Northwest Honda but plans to continue her active lifestyle. Recently, she skydived and hopes to jump again with her husband for her 80th birthday next month. Kay lost her daughter, Patricia Rahl, one year ago to endometrial cancer and today honors her along with all those who did not conquer cancer, yet contributed greatly to the mission to eradicate it.

 

By: Isabelle Bedrosian, M.D., F.A.C.S.

"What about the other breast?" This is a question newly-diagnosed breast cancer patients are asking with increasing frequency. However, providing them with an appropriate answer has never been easy.

We've known for some time that removal of the opposite healthy breast, a procedure called contralateral prophylactic mastectomy (CPM), reduces the likelihood of a second breast cancer event (a contralateral breast cancer) down the road. The question we haven't been able to answer for our patients is whether this actually makes a difference in their survival.

If CPM reduces the odds of a contralateral breast cancer, then why might it not have any impact on survival? Why would there be a disconnect between reducing the likelihood of a second breast cancer and survival?

There are a number of reasons for this:

• For some women, there's a greater risk of dying of the cancer they currently have than of developing a contralateral breast cancer.

• Even if a contralateral breast cancer develops, in many cases it's caught early and is highly curable, thereby having no effect on survival.

• As women get older, other medical conditions may predominate and become more life-threatening than breast cancer.

• With newer dugs, especially anti-estrogens that are administered to a majority of breast cancer patients, the risk of contralateral breast cancer is diminished.

To provide patients with breast cancer more information about potential survival benefit of CPM, we undertook a study specifically focusing on the question of survival. We were able to demonstrate that for a small group of women, those diagnosed before age 50 with stage I or stage II, estrogen receptor negative breast cancer, there was a small, but measurable improvement in five-year breast cancer specific survival associated with undergoing CPM. For the rest of the study population, no similar benefit was seen.

How should these results be interpreted?
I believe they should bring to bear greater certainty to the recommendations, both for and against the procedure. For women who fall into the group where we detected a survival benefit, physicians should initiate a discussion about CPM. For the remainder of the breast cancer population, physicians should be able to state with greater certainty that CPM is not necessary to improve odds of survival from breast cancer.

At the national level, current recommendations for CPM among women who aren't BRCA mutation carriers, are largely vague and broadly derived. At the personal level, the decision to proceed with CPM is highly subjective, and greatly influenced by personal biases and fears. With the objective findings of our study, we hope that national guidelines may be made more precise and that for individual patients, the decision to proceed with CPM can be made more objectively and less out of fear.

Although this new data can help tailor more precise recommendations for CPM, the results shouldn't be interpreted as a mandate either for or against CPM. CPM is an irreversible procedure, so for some women, a 5 percent survival benefit may not be worth the potential emotional, psychosocial and quality of life issues that occasionally arise following CPM.

Conversely, among women where we saw no survival benefit associated with CPM, individual factors in the personal history of such women may make CPM a reasonable option to consider.

Listen to Isabelle Bedrosian , M. D. Ande George Chang M.D. discuss research on CPM on Cancer Newsline


Raymond DuBoisRecent findings published in the Journal of Clinical Oncology suggest that aspirin may play a role in reducing the recurrence of breast cancer in women who have been treated for that disease.

 

Dr. Michelle Holmes of Brigham and Women's Hospital in Boston and her colleagues studied self-reported data from 4,164 nurses who had an earlier diagnosis of breast cancer. They found that nurses who reported taking aspirin two to five days a week (often for problems unrelated to breast cancer) were 60% less likely to have a recurrence of breast cancer than their counterparts who did not take it, and 71% less likely to die from the disease.

 

Based on this study, scientists can't confirm a direct cause-effect relationship between lower breast cancer recurrence and aspirin use. However, it has stimulated a lot of discussion about the role of inflammation and anti-inflammatory drugs, like aspirin, on cancer.

 

Inflammation can open window

Inflammation is the body's response to an assault, such as an injury or infection. The body retorts by producing chemicals that signal immune cells to rise up, attack and kill the invading germs. Unfortunately, in the process they also can damage surrounding tissue, leading to pain and redness, and in some cases of chronic inflammation, open a window for uncontrolled cell growth -- which is cancer.

 

Certain drugs known as NSAIDs (non-steroidal anti-inflammatory drugs), including aspirin, ibuprofen and other over-the-counter and prescription medicines, have been known to reduce inflammation. Since the 1970s, we have known that these drugs work by inhibiting the production of prostaglandins, body chemicals that are necessary for blood clotting and that also sensitize nerve endings to pain.

 

NSAIDs can block two different cyclooxygenase (COX) enzymes, COX-1 and COX-2, which are produced by the body at sites of inflammation and also are produced by some precancerous tissues. COX-1 and COX-2 are key players in the conversion of certain fatty acids into prostaglandins, which in turn are associated with inflammation.

 

Aspirin and other aspirin-like drugs (called NSAIDs) can block both COX enzymes. However, they also can cause medical problems, such as stomach bleeding, when taken regularly for long periods of time. To try to circumvent these side effects while still providing relief against inflammation, in the early 1990s pharmaceutical companies began developing NSAIDs that inhibit only COX-2 enzymes (sometimes called COXIBs) and were marketed as Celebrex.

 

NSAID-cancer prevention connection

The connection between NSAID use and cancer prevention has been studied for a few decades. Scientists conducted a series of animal experiments to see if NSAIDs might inhibit the occurrence or growth of colorectal cancers. They found that, in fact, the colorectal tumors regressed in animals given NSAIDs. Later, randomized clinical human trials established that two NSAIDs (sulindac and celecoxib) suppressed adenomatous polyps and caused existing polyps to regress in patients with familial adenomatous polyposis (FAP, a rare hereditary condition).

 

The next step was to see how these medicines might affect people who didn't have FAP but might still be at risk for colon cancer. During the 1980s, epidemiologists began collecting evidence from population studies showing that people who reported regular NSAID use had a lower incidence of adenomatous polyps and lower colorectal cancer death rates. These results indicated a possible protective effect against colon cancer from NSAIDs for the general population.

 

In my laboratory in the early 1990s, we began investigating why NSAIDs might convey this protective effect. My research team and I discovered that some intestinal epithelial cells made significant amounts of the COX-2 enzyme in response to growth factors or tumor initiators. This led us down a path of discovery that connected the two and helped explain, in part, how selective COX-2 inhibitors can reduce the risk of some cancers in people.

 

Scientists moved forward to test this theory in human patients. Two randomized clinical trials conducted in the 1990s and early 2000s confirmed that aspirin suppresses the recurrence of adenomatous polyps in people with a previous colon polyp. What's more, other limited epidemiologic data has shown that NSAID use may be associated with a lower incidence of or death from cancers at other sites, including the esophagus, stomach, breast, lung, prostate, urinary bladder and ovary.

 

Unfortunately, patients at high risk for cardiovascular disease have more serious cardiovascular events when taking NSAIDs and selective COX-2 inhibitors at high dosages for prolonged periods of time. On the other hand, some patients can tolerate these medications without cardiovascular complications quite well, especially at lower dosages when given once daily.

 

Further NSAID study needed

Scientists and clinicians are now working to determine how NSAIDs might protect against various cancers, possible effects of the long-term use of these drugs, optimum dosages and contraindications. They also are studying the benefits and risks of NSAID treatment across a broad range of treatment regimens, outcomes and patient populations.

 

Evidence from the nurses' study suggesting that aspirin use may be associated with a reduction in the recurrence of breast cancer may provide one more piece to this complicated puzzle. It certainly will launch the field further into this line of investigation.

  Isaiah Fidler, D.V.M, Ph.D. Isaiah J. Fidler, D.V.M, Ph.D., a pioneer in understanding how cancer spreads to other organs and then taps its new environment to thrive and grow, will receive the Lifetime Achievement Award from Nature Publishing at the 2010 Miami Winter Symposium - Targeting Cancer Invasion and Metastasis.

Fidler, a professor in M. D. Anderson's Department of Cancer Biology and director of the Cancer Metastasis Research Center, will be honored tonight and will deliver an award lecture on the biology and therapy of metastasis . 

Organizers of the annual scholarly meeting select an important topic as a theme, invite experts in the field to present the program, and honor a select few influential scientists. Metastasis -- the spreading of cancer from its original site to other organs -- causes 90% of all cancer deaths.

"This honor is fitting recognition of Dr. Fidler's crucial contributions to our understanding of the origins and mechanisms of cancer metastasis," says Raymond DuBois, M.D., Ph.D, executive vice president and provost of M. D. Anderson. "His insights into how the metastatic cell subverts routine biological processes to support its growth in a new organ underpin today's routine study of the tumor microenvironment."

Fidler's major findings include:

  • 99.99% of cancer cells that depart a primary tumor die, with metastases originating from less than .01% of cells, even from a single cell.
  • Metastatic cells exist in the genetic diversity of the original tumor and are uniquely suited to spread and grow. Like a "decathlon athlete," they must overcome at least 10 separate biological hurdles to escape the main tumor, run a gauntlet of hazards, and then settle in their new home. 
  • The destination of a metastatic cell is not governed by a random process or physical proximity. Rather the metastatic "seeds" of a given cancer only take root and grow in certain organs with a welcoming microenvironment, or "soil." For example, prostate cancer metastasizes mainly to bones. By demonstrating this, Fidler revived the "seed-and-soil" hypothesis of metastasis, an insight by 19th century British physician Stephen Paget that had been neglected for nearly 100 years. 

Successful cancer therapy must target both the seed and the soil. Fidler's research currently focuses on brain metastasis, which afflicts more than 200,000 people annually in the United States. Fidler and colleagues have shown that lethal metastases from primary cancers, such as lung or breast, resist therapy because they trick astrocytes -- brain cells that nourish neurons -- into supporting them.

The Winter Symposium is a 42-year-old series of annual sessions focusing on major biological questions. It's organized by the Nature Publishing Group, the Department of Biochemistry and Molecular Biology and the Sylvester Comprehensive Cancer Center, both  at the University of Miami Miller School of Medicine.  

February is American Heart Month and cardiologists at M. D. Anderson are taking the opportunity to emphasize the importance of maintaining a healthy heart before, during and after cancer treatment.

When cancer and heart disease - the leading cause of death in men and women worldwide - are combined, managing both conditions can be challenging for both patients and doctors.

There's a spectrum of heart disease that's associated with cancer care, including high blood pressure, weakening of the heart muscle and congestive heart failure, according to Guilherme H. Oliveira, M.D., assistant professor in the Department of Cardiology at M. D. Anderson. "The role of cardiac care in cancer treatment is becoming more important than ever," Oliveira says.

"While newer cancer treatments offer patients a better chance of survival, many also have a direct impact on the cardiac system." For example, Oliveira explains that newer targeted therapies zero in on and destroy the molecules that are essential for the survival of cancer cells. But these are the same molecules that are vital for optimal functioning of heart cells.



Who's at risk
While cardiotoxicity can occur in any patient, Oliveira points out that only about 20% of cancer patients will develop treatment-related heart complications. Because many cancer patients are over the age of 50, the chances are fairly high that they have pre-existing heart disease when diagnosed with cancer. Even those without a prior cardiac condition may develop heart problems as a result of the drugs they're taking for cancer treatment. Certain therapies are known to bring a higher risk of cardiac complications, including drugs in the anthracycline family (including doxorubicin, epirubicin, idarubicin and daunorubicin) and tyrosine kinase inhibitors, like trastuzumab (Herceptin).

What to look for
Symptoms of heart failure - such as fatigue, shortness of breath, tightness in the chest and swelling in the lower extremities - are very similar to those of cancer and other diseases like diabetes, obesity and cirrhosis, and often go unrecognized. "Patients need to be aware that not all side effects experienced are caused by the cancer treatment itself and that feeling ill while taking a certain medication may signal insidious onset of heart failure," Oliveira says.

There's always hope
Considering potential cardiac complications that can result from cancer treatment is daunting for any patient, but should not preclude cancer treatment because side effects can often be managed or even prevented if addressed early.

"There are therapies that can prevent or reverse damage to a weakened heart and so there is always hope in the things that we can do and the ways we can help patients navigate and balance cardiac care and cancer treatment," Oliveira says.

According to Oliveira, multidisciplinary management of cancer treatment with close communication among the oncologist and cardiologist is key to protecting the heart.

Most importantly, a healthy heart is much more tolerant of aggressive cancer therapies than a diseased heart. So, a healthy lifestyle including regular exercise, proper nutrition and not smoking will help improve a patient's treatment outcomes on both the cancer and cardiac fronts.

Questions will be answered live on Feb. 25

Do you have more questions about how to take care of your heart during cancer treatment? Guilherme H. Oliveira, M.D, will be available live on Twitter Thursday, Feb. 25, to answer your questions. Follow @Cancerwise on Twitter and the hashtag #CancerandHeart, or join us on tweetchat.

The Birth of 'Patient Power'

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By Guest Blogger, Andrew Schorr

AndrewSchorr.jpgOne evening in August 2000 - on the night of the finale episode of the first season of "Survivor" - I began my participation in a clinical trial for chronic lymphocytic leukemia (CLL) at M. D. Anderson. Watching the TV show helped pass the time and the great nursing I received gave me confidence.

Some terrific things came out of that. First, the trial "worked" and I have had no sign of the disease since 2001. And second, while in Houston I began a dialogue with M. D. Anderson staff about creating a new support channel for patients and family members where I would host webcasts featuring M. D. Anderson faculty and inspiring patients.

Those discussions by day, while I was undergoing therapy at night, led to the birth of "M. D. Anderson Presents Patient Power." A light bulb in my head had popped on for me, while receiving chemo and experimental medicine, that my experience as a reporter and now as a patient could be used in a new way to help others and this great institution. I will forever be indebted to M. D. Anderson for its lifesaving research and care and in supporting these programs.

The concept of our programs is simple: I, as an M. D. Anderson cancer survivor, bring my experience and perspective as a patient to radio talk show-style interviews that are posted online. The guests are leading M. D. Anderson doctors, researchers, nurses, counselors and nutritionists. But that's not all. The Patient Power programs typically feature the real-life story of a patient who has faced a cancer diagnosis and received care at M. D. Anderson.

I have found after interviewing these folks that - as I often say - they are my new "best friend." The patients touch your heart with their stories and the medical team members touch you with their dedication to saving lives, making the lives of cancer patients better, and - if at all possible - Making Cancer History®. That comes through on each program.


Now something like 200,000 people have listened to our vast library of cancer discussions. I am so honored to be part of it. It's so satisfying to know that we can reach people on the Internet around the world with potentially life-changing information - specific information that, unfortunately, might never be available in depth in your local newspaper or on radio or TV. It's also been very gratifying to hear from people who have benefited from these programs. There are many. It just makes me want to do more.

Of course, my closest connection to someone at M. D. Anderson remains my own doctor, Michael Keating, a world-renowned specialist in CLL, and now my everlasting friend. I first met him in 1996 soon after I was diagnosed. I thought I "wasn't long for this world." He brought me back to reality, told me he'd soon have a suitable clinical trial to offer - the one I later chose. And he gave my wife, Esther, and me the confidence to have a third child, Eitan, now a star 12-year-old basketball player!

Dr. Keating has now been on several of our programs, just like his peers at M. D. Anderson, leaders in other fields of cancer care and research.

I urge you to listen to the program(s) that are most relevant for you and please tell others about Patient Power. I am convinced there is no resource like this anywhere to help you get oriented about a cancer concern with leading-edge, highly credible information you can use. This information - the perspective of experts and patients who have preceded you -- can truly arm you as a "powerful patient."

Wishing you success in your cancer journey as I have had in mine - thanks to M. D. Anderson.

Listen to Patient Power Podcasts
 

My Valentine's Wish for 2010

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My birthday is on the 11th, my mom's is on the 12th, my brother's is on the 13th and my father's is on the 14th -- all in different months. Since my dad's birthday is in February, my Valentine's Day reflections are for him.

At M. D. Anderson we're always focused on doing the very best for our patients. Ingrained in this notion of providing the "best" possible care is feeling unsatisfied when our treatment doesn't routinely produce the outcome we strive for -- cure of disease with outstanding quality of life and function in survivorship.



Because we're unsatisfied, we strive for better care through research and by rapidly and skillfully applying new advances in cancer medicine to the care of our patients. How do we sort out the most important new advances in cancer care from those that are less important or more uncertain? Here are some categories that come to mind:

Category A -- advances where some new, proof-of-principle in science is demonstrated. A breakthrough in scientific terms.

Category B -- advances that have major impact on lives or patterns of care, either due to the large number of affected patients or the large magnitude of change in the outcome or pattern of care.

Category C -- advances that are generally encouraging signs of progress. This is where most advances would be categorized, in my opinion. These are findings that affect fewer patients, influence fewer life-years or produce generally less dramatic changes. Some of this category's advances are of greater interest to the average non-physician because they address topics of broad interest or shared experience, or because there are business implications.

An example of a Category A advance, in my mind, is the work with PARP inhibitors (such as BSI-201) for selected patients with breast cancer. This represents a new category of treatment for a very difficult-to-treat subset of this common disease. This was a plenary session presentation at the 2010 annual meeting of the American Society of Clinical Oncology (ASCO), which reflects the scientific importance of this particular advance.

On the more positive side in Category B is the finding that testing tumors of patients with adenocarcinoma of the lung for specific mutations is likely to guide the best choice of treatment. It also was demonstrated this year that physician-patient communication near end of life is associated with patient choices that lead to improved end-of-life care quality and value.  

Some Category B level "advances" represent disappointing, albeit important news. For example, findings from the SELECT trial reported this year demonstrated that vitamin E and selenium do not prevent prostate cancer. We also learned that PSA screening does not effectively save lives in the way that we had hoped. Finally, we learned that the expensive monoclonal antibody bevacizumab -- while effective as part of the regimen treating advanced colon cancer -- is not actually useful as part of a strategy to prevent recurrence of colon cancer once it's been removed.

Ironically, feelings about that news was somewhat mixed for oncologists. On one hand, oncologists always want to see positive findings about new therapies. But importantly, we all want to know the truth about what really works and what does not. Many specialists also noted that overall health care expenses associated with a positive finding on this particular study may have created some real dilemmas.

With Valentine's Day approaching and so many loved ones (living and deceased) on my mind, I can't help but dream of new horizons. Like so many others, my heart has suffered losses attributable to cancer.

So what needs to be done to create a world in which more category A and B (high-impact) findings are produced, where the bulk of the advances are no longer stacked up in Category C (lower impact)? The cancer research world needs a better engine and more fuel.

The "engine" is the clinical research infrastructure, and that is an old and inefficient engine that needs to be fundamentally reformed. The "fuel" is the funding, and that fuel is necessary for any engine to run.

With expected large increases in the relative impact of cancer on the nation and its health and finances, the time for heartfelt focus on fueling up a fixed engine is now upon us.


Scientists at M. D. Anderson and Rice have proposed a solution to an imaging challenge that arises when a moving target is imaged using a combined PET/CT scanner. The CT portion of the scanner takes a quick, three-dimensional snapshot of the tumor's anatomical location. The PET scan takes a few minutes to acquire data to generate an image depicting the tumor's uptake of a slightly radioactive glucose-related compound, which provides a measure of the tumor's metabolic activity and thus its health.

conq-spring-07-017 web version.JPGIn lung cancer, for example, movement caused by a patient's breathing during data acquisition can blur the PET portion of this potent dual-imaging tool, explains Osama Mawlawi, Ph.D., associate professor in M. D. Anderson's Department of Imaging Physics and senior author of a recent paper in the Journal of Nuclear Medicine."PET provides powerful information by reporting the quantity of the injected tracer taken up by the tumor, because uptake is directly correlated to the malignancy of the tumor," Mawlawi says. A blurred image is less accurate and usually underestimates the amount of radioactive tracer in the tumor.

Scientists and physicians adjust for this problem in a number of ways now, including having patients hold their breath during repetitive short PET scans, which many with lung cancer, for example, cannot do. Working with Mawlawi and other scientists at the two institutions, Rice graduate student Guoping Chang designed the hardware, wrote the software and analyzed the data that provides the basis for an automated system to correct for this problem on existing PET/CT scanners. Their method allows the patient to breathe freely during the PET/CT scan while matching the tumor location that was captured during CT with that during PET. "This process is facilitated by automatically selecting PET data that only corresponds to the tumor location captured by CT," Mawlawi explains. This process, which adds 3-10 minutes to the scan, in effect freezes the respiratory motion at the same spot acquired during the CT. 

Patients are often nervous when undergoing a PET/CT scan, and it can take a few minutes for them to relax. Rather than taking the CT immediately after positioning the patient in the scanner, the team proposes conducting the PET scan first on all areas of the body except the area where the tumor lies. With the patient more settled, the CT image is taken followed by a PET scan over the tumor area. This process further ensures matching between the PET and CT scans. 


When the team tested the approach in 13 lung cancer patients, they found that the maximum standardized uptake value increased by 27% and the mean standardized uptake value increased by 28%. Image contrast improved, making the tumor easier to visually inspect. "Now that the numbers are more accurate, we can see the tumor better and the tracer uptake number enables us to assess the tumor's stage more precisely as well as its response to therapy," Mawlawi says. 

While some PET/CT scanners can adjust the PET image based on the phase of the patient's respiratory cycle, none possess the technique honed by the research team, which relies on respiratory amplitude, a measure of the depth of respiration 

Anderson_Net_volunteer.jpgby Mary Donnelly Jackson, Volunteer Services

When I started volunteering at M. D. Anderson, I would often wonder at the end of a busy work day if I had enough energy to fight the Houston traffic and make my rounds visiting inpatients as a volunteer floor host. What I discovered was that I often left the hospital with more energy than when I had arrived. It was something about the patients that I met and their positive attitudes that gave me that energy. And it wasn't just me. Since I joined the M. D. Anderson Volunteer Services staff 10 years ago, I have often heard volunteers share the same sentiments.

I've heard perspective volunteers ask, "You have so many volunteers at M. D. Anderson, do you really need more?" And the answer is definitely "yes." Our Alkek Hospital will be expanding soon with several additional inpatient floors. With this expansion, we will need more volunteer floor hosts. Floor host volunteers are assigned a hospital floor and visit with patients and their families. Volunteers also may pick up and distribute patient mail, newspapers, TV guides and magazines. Depending on the patient's needs, each visit is different and may involve only an introduction to the hospital's services and amenities or may require a longer visitation.

Volunteers are also needed in our two Anderson Network Hospitality Centers, one in our Main Building and the other located in Mays Clinic. Volunteers staff the Hospitality Room, providing an informal and relaxed environment where patients and caregivers can rest and visit between appointments. The volunteers in this position provide hospitality, empathy and information about resources to patients and their family members.

To work in the Hospitality Center, you must have been a patient or caregiver to a patient at M. D. Anderson and must have good communication skills, and enjoy interacting with people.

If you, a friend or neighbor would like to volunteer at M. D. Anderson in the Hospitality Center or floor host positions, contact me, Mary Donnelly Jackson, at 713-792-3792, mdonnelly@mdanderson.org

 

Blackburn2_option2.jpgDr. Elizabeth Blackburn, 2009 Nobel Laureate, is the "real deal." She's an outstanding scientist, a role model for women in science, a wife, a mother, a fascinating person and the ultimate mentor.


She shares the Nobel Prize with Dr. Carol Greider, who was a graduate student in her lab in the mid 1980s. Now that is the ultimate mentor/mentee relationship.

Dr. Blackburn's recent Hogg Award lecture at M. D. Anderson showed us a woman who loves what she does and communicates that passion to her audience. She also is passionate about women in science, suggesting that not only is it good for science but it's critical to reshaping how science is done -- which could benefit both women and men.

Group.jpgHer message to young women in science: "Have a family, if that's what you want. You are not a failure as a scientist because you want to have a child."She does, and she received the Nobel Prize!

Let her be your role model. 











By Sara Farris, Staff WriterNoahandLeon_small.jpg

This week, patients from the Children's Cancer Hospital at M. D. Anderson Cancer Center kicked off the 2010 Valentine season with a special Valentine-making party in the Robin Bush Child and Adolescent Clinic. With glue, glitter and lots of paper, the kids made their own Valentines and signed Children's Art Project Valentine cards to give to adult patients at M. D. Anderson. The Valentines were later distributed to adult patients by the Department of Volunteer Services.
 
The Children's Art Project hosted the event, celebrating its 2010 Valentine collection while also meeting new Valentine designers. The designers are all undergoing treatment for cancer in the Children's Cancer Hospital at M. D. Anderson, and the artwork they create is often featured on the products produced and sold by the Children's Art Project. Since 1973, the art project has returned more than $27 million to the cancer center to support such programs as the education and child life programs, college scholarships, summer camps, pedi parties and other activities.


 
Children's Art Project Valentines are available for purchase at area grocery stores, retail locations, M. D. Anderson gift shops and the Children's Art Project Boutique in Uptown Park. They are also available online at www.childrensart.org or by calling (800) 231-1580.

From fish oil to acacia berries, the barrage of health trends offers an unending stream of promise. But do they really work?

Finding reliable health information is easy, if you know where to look. Jerah Thomas, a health education specialist with the Integrative Medicine Program at MD Anderson, recently shared with Houston-area seniors the best information resources for alternative, complementary and integrative medicines.

CLASP_small.jpgThe presentation was part of a weekly series on a variety of topics, provided by the University of Houston at Clear Lake and the Clear Lake Association of Senior Programs (CLASP).

"As a League City (Texas) native, I'm happy to serve as an educator in my community," Thomas says. "At MD Anderson we work to improve the lives of our patients by integrating traditional and evidence-based complementary medicines. As health care providers, the more we learn and listen to the community, the better equipped we are to give people the quality care they need."

Thomas recommends approaching complementary medicines with a critical eye and plenty of research, but says that some such therapies complement traditional treatments well. "For example, we may recommend acupuncture for chemotherapy-related nausea," Thomas says.

Thomas notes that before starting any alternative/complementary treatment, it's important to speak with your physician about the medical supplements or therapy you're considering. Your doctor will then be able to recommend the best approach for your particular health needs.

Information on integrative therapies, as well as recommended resources for reliable information, can be found at www.MDAnderson.com/CIMER.

For the next available CLASP minicourse, visit www.uhcl.edu/clasp.

Each year on Feb. 4, the World Health Organization observes World Cancer Day in support of the International Union Against Cancer and its goal to promote ways to ease the global burden of cancer.

This year's theme, "Cancer can be prevented, too," focuses on simple measures to prevent cancer such as:

    * no tobacco use
    * a healthy diet and regular exercise
    * limited alcohol use
    * protection against cancer-causing infections

Up to two-thirds of all cancers may be preventable by avoiding tobacco and adopting other healthy lifestyle habits.

In the Cancer Prevention Center at M. D. Anderson we don't just explore better ways to treat cancer -- we want to understand how to prevent it, too. We believe that healthy lifestyle habits hold the key to cancer prevention, and conduct studies based on supporting those lifestyle and behavior changes. Our research then drives our commitment to educating the community at large about healthy lifestyle habits and their connection to cancer prevention.
 

Cancer Prevention Resources

Focused on Health

Focused on Health Podcasts & Videos

Cancer Prevention Center at M. D. Anderson

M. D. Anderson Prevention Research Studies


By Lori Baker, Staff Writer

You might be surprised to learn that some of the well-meaning words said to people with cancer are the things they want least to hear.

Why do so many people say the wrong things? Those who don't have cancer might not have the insights to offer the right words. Some speak before thinking. Others stumble due to anxiety.

"Some people feel uncomfortable talking to those with cancer because the disease taps into their own fears and misconceptions," says Walter Baile, M.D., professor in the Department of Behavioral Science and director of I*CARE, a program at M. D. Anderson to improve communications among cancer patients, their families and their providers. "As a result, they respond on an emotional level rather than considering what could be helpful to the other person."

The best advice on this topic comes directly from those who have, or have had, cancer.

Take it personally

As you probably suspect, there isn't a universally acceptable set of phrases and actions. Statements that one person found encouraging, didn't resonate with another. Actions viewed as supportive to one, weren't as welcomed by the next.

Therefore, one of the first tips is to recognize someone's individuality. Take into account what you know about that person and tailor your interactions accordingly. Is he or she an open book and more likely to welcome inquiries, or someone who's more private about his or her personal life?

"We all bring our personalities into cancer," says Sharon Parker, an eight-year cancer survivor who also is a caregiver for someone with cancer and an employee who interacts with patients as senior administrative assistant in Place ... of wellness. "So, think about that person's personality and factor it into deciding the best way to interact with him or her after a diagnosis."

If the person is a stranger, you still might be able to personalize your words. "I'm from Louisiana, so when I see someone wearing something reflecting my home state, I try to connect with them by telling them I'm a Baton Rouge boy," says Bill Baun, manager, Wellness Program, who is a three-year prostate cancer survivor.

Can't find a connection? General friendliness usually is well received. But, are knee-jerk pleasantries such as "Have a nice day" viewed as insensitive, since our patients are facing a serious disease that requires some not-so-pleasant treatments?

"As a patient, phrases like that don't bother me," says Martin Raber, M.D., clinical professor in the Department of Gastrointestinal Medical Oncology, who was diagnosed with cancer in 1995. "But I also say 'Good luck' or 'I hope things go well for you today' to patients in casual encounters."

The downside of upbeat

When cancer is part of the discussion, many people hope to encourage by making positive statements. Ironically, these can backfire and produce the opposite reaction.

The American Cancer Society offers these insights: While it's good to be encouraging, it's also important not to show false optimism (such as, "I know you'll be all right"), or to tell the person to always have a positive attitude. Doing so might cause the person to feel you are discounting his or her fears, concerns or sad feelings.

Attempts to point out cancer's "silver lining" should be avoided.

While telling someone that he or she is brave or strong might seem like a compliment, it may actually make that person feel pressure to display these noble traits when they don't feel up to it. Statements of realistic empathy, such as "I'm sorry you're going through this," might be a better approach.

A gesture's worth a thousand words

If you feel tongue-tied when talking to someone with cancer, perhaps it's best to say nothing. "Eye contact, a compassionate smile or a reassuring hand squeeze are sometimes all the communication necessary," says Parker, who also emphasizes the importance of courtesy and small acts of kindness.

Another gesture that can be music to patients' ears is a genuine offer of help. "Instead of making a general statement, like 'Is there anything I can do for you?,' suggest a few essential activities that you can take off their plate," says Baile and several others. "Offer specific suggestions, such as going with them to an upcoming appointment, picking up some groceries or watching their children."

And continue offering periodically, as help declined at one point might be greatly appreciated later.

Avoid avoidance

Cancer can make a person feel isolated, and losing connections with people can add stress, according to Baile.

Make an extra effort to reach out. "It meant the world to me to know that people were concerned about me while I was in treatment and after," Parker says.

"We can do our best, but it's always possible that what we do or say will rub someone the wrong way. Just remember, if you do or say something 'wrong,' don't take it personally."

Excerpted from Messenger, M. D. Anderson's magazine for employees, retirees and families.

Resources
Tips on How to Talk With the Person With Cancer ( American Cancer Society)
*iCare Patient Communication Series (Patients & Families)


Vehbi Koc Foundation (VKF) American Hospital and M. D. Anderson recently announced that they are expanding cancer care services in Istanbul and Turkey through a new radiation treatment center located in the VKF American Hospital.


The new M. D. Anderson Radiation Treatment Center in Istanbul at American Hospital offers a full range of radiation therapies. It is the first M. D. Anderson radiation treatment facility outside of the United States that fully replicates M. D. Anderson standards of therapies, delivered by physicians trained in Houston.

Designed by M. D. Anderson radiation oncologists, physicists and consultants, this new center provides patients in Turkey with access to top experts and state-of-the-art technologies to assist them with their fight against cancer. The center has the capacity to serve approximately 400 patients annually and is the result of a $15 million capital investment by American Hospital.

M. D. Anderson has clinical oversight of all radiation treatment delivery, ensuring that patients receive therapy using the same guidelines, standards, process and procedures established for M. D. Anderson patients. Services at the M. D. Anderson Radiation Treatment Center in Istanbul at American Hospital will be delivered using a team approach. The physician leading the team will work with colleagues in the Division of Radiation Oncology at M. D. Anderson to determine therapy protocols.



M. D. Anderson and American Hospital are collaborating to meet a critical need in Turkey for expertise in radiation therapy that addresses the rising incidence of cancer, especially in lung and breast cancers. "Cancer is as devastating a health problem in Turkey as it is in the United States," says John Mendelsohn, M.D., president of M. D. Anderson. "We are proud to unite efforts with American Hospital to offer cancer patients in Turkey the best possible radiation treatment.


Read the news release American Hospital Brings Top-Ranked Cancer Services to Turkey With M. D. Anderson Collaboration

Feet-less But Not Defeated

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"Feet-less but not defeated" is an expression I learned last year from a pediatric double-amputee patient. It was an expression she used to get through her cancer treatment, and it was an expression that everyone embraced who attended the Children's Cancer Hospital rehabilitation ski trip.

For the second year in a row, I've had the privilege of attending the annual ski trip in Park City, Utah. I go to cover the trip from a communications standpoint, but I come back with inspiration and knowledge of what hope means for these patients and families.

The Children's Cancer Hospital at M. D. Anderson Cancer Center sponsored its first ski trip in 1982 when Norman Jaffe, M.D., was inspired by former patient, Teddy Kennedy, Jr., to take a group of amputees on a skiing adventure. Although the trip was initially for amputees, now it is open to other pediatric patients who have physical disabilities from their cancer treatment.

The week-long trip for patients and family members is funded by the Children's Art Project at M. D. Anderson. Besides learning how to ski through the National Ability Center in Park City, patients go snow shoeing, rock climbing and tubing. They also kick up their heels at a special dance and karaoke night held at the Park City Marriott and take over the hotel's lobby to play games each night. And, of course, no ski trip would be complete without a big snowball fight.



All of the activities encourage patients to overcome their physical challenges and focus on their abilities. When I asked the patients what they liked best about the trip, they all seemed to have the same answer. They loved being around other amputees and sharing their experiences with peers who knew what they were going through.

The first-time trippers and current patients looked to the trip veterans and survivors as a source of hope. Family members were able to see firsthand what their children were capable of doing, despite their challenges. As one patient put it, "It's a confidence booster for everyone."

The ski trip really is a one-of-a-kind experience. Although the list of attendees may change from year to year, the spirit is the same as the patients tackle the slopes (like other challenges they may face) head on.

By Laura Prus, Staff Writer


TraceyFerrin_small.jpgWhen she was 18 years old, Tracey Ferrin had a husband, a 10-month-old daughter and was pregnant with her second child. She also had growing concerns about the unusual bump just above the knee on her femur.

What she didn't have, however, was insight into how the mysterious bump would change her life for the better.

Suspicions are confirmed

As she grew increasingly worried, she sought the advice of a friend who closely examined her leg and recommended that she pay a visit to M. D. Anderson. A biopsy confirmed her friend's suspicions; Ferrin had an aggressive case of osteosarcoma.

The most common type of cancer that develops in bone, osteosarcoma frequently occurs near the ends of long bones, especially around the knees and during adolescent periods of rapid growth.

Trying to understand

Due to her youth, Ferrin was unable to fully comprehend her diagnosis. "I didn't really have a reaction," she says. "The only thing I knew about cancer is that you were bald. I didn't really understand it."

She feared that her diagnosis meant losing her leg, but those around her tried to keep the atmosphere light. They often joked with her and eased her anxiety.

Doctors wanted her to start treatment immediately, but she was apprehensive about the effects chemotherapy would have on her pregnancy. "Most of my worries and concerns were for the baby, not me," Ferrin says.  She decided to wait a few weeks until she reached her third trimester before beginning treatment.

It's a girl

After two rounds of chemotherapy, Ferrin gave birth six weeks before her due date. She was elated to find that her treatments had not affected the baby. "I expected her to be bald, but she had so much hair, and she was screaming a lot," Ferrin says. Although the baby weighed only 3 pounds, 10 ounces, she was completely healthy.

"Notably, although Tracey was totally bald, her baby was born with a full head of hair," says Robert Benjamin, M.D., professor and chair of the Department of Sarcoma Medical Oncology. "It attests to the remarkable ability of the placenta to exclude harmful substances, and that permits us to safely administer chemotherapy to pregnant patients."
 
Ferrin then proceeded with her treatment. Only a month after her daughter's birth, she underwent a 13-hour surgery that spared her leg, followed by several more rounds of chemotherapy.

Ferrin family walking_small.jpgBack to normal

Ferrin is grateful for Benjamin and the medical staff who helped treat her.

"I had the most wonderful team," she says. "It's because of them and many other M. D. Anderson employees that today I'm a wife to the most amazing husband ever, a mother to four beautiful children, a sister to my three siblings, a daughter to parents who took care of me throughout this whole ordeal, a niece, a granddaughter and a friend."

Having cancer did not slowdown Ferrin either. "I'm not limited to what I can do from the surgery and chemotherapy. I do everything I did before. I'm able to walk, ride a bike, play sports, Rollerblade, exercise and play on the floor with my children," she says.


'I love my life'

However, other areas of Ferrin's life were deeply affected by her diagnosis. In fact, she says cancer changed her life completely. "To be honest, I was a bratty kid. I was not compassionate, and I was judgmental."

Having gone through a divorce during treatment, Ferrin found her life also changed in other ways. She has been happily married to her second husband for six years, and they now have four children. "I'm on a completely different path than the one I was headed down," she says.

Today, years after she won her battle, Ferrin exudes compassion and takes time to enjoy precious moments in her life. She also smiles a lot more.

When it comes to cancer, she didn't enjoy it at the time, but going through the process helped her grow as a person. It gave her a new outlook on life and brought out a different side of her personality. "I love my life," she says. "It's amazing."

Related article:

Q&A with Dr. Benjamin

M. D. Anderson resources:
Advances in the Treatment of Osteosarcoma (podcast)

Sarcoma Center

Bone cancer


Additional resources:
Osteosarcoma (National Cancer Institute)

All About Osteosarcoma

 

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