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July 2010 Archives

By Mary Brolley, MD Anderson Staff Writer

gail smith_uniform.jpg

Born in tiny Lennon, Mich. -- "just a spot on the road, population 400" -- Adeline "Gail" Smith always wanted to travel the world.

So, straight out of high school, she joined the Women's Army Corps (WAC) and served five years, including a stint in Germany. Then she married, had two sons and worked in administrative office jobs before retiring to Naples, Fla., several years ago.

Having shown such spunk all her life, it was no surprise that when faced with a rare form of bladder cancer in 2008, Smith wasn't willing to take the first medical advice she got without question.

And, ultimately, the minimally invasive surgery she chose allowed her to return to her active life quickly and painlessly.

Second opinion reflects multidisciplinary approach
Diagnosed in October 2008 with a stage III urothelial carcinoma, her primary care physician advised immediate surgery to remove one of her kidneys and the affected ureter, the tube that connects the kidney to the urethra.

Smith decided to take some time to explore her options. And her sons, one of whom lives in Texas, wanted her to get a second opinion at MD Anderson. There, her medical team agreed that surgery was necessary -- but not yet.

Led by Arlene Siefker-Radtke, M.D., the MD Anderson team advised Smith to begin with chemotherapy to shrink the tumor and reduce the chances of its spreading. They suggested she consider enrolling in a clinical trial.

"They explained it to me honestly," Smith says. "Their opinion was that it would help me."
The chemotherapy regimen, which lasted eight weeks, was arduous but effective. The tumor shrank considerably.

"I was floored," Smith says. "They showed me exactly how it had shrunk. They were all pleased, but not as pleased as I was."

How best to treat this rare cancer?
Urothelial carcinoma, also known as transitional cell carcinoma, is the most common type of cancer in the bladder. But in about 4% of cases, including Smith's, it occurs in the ureter or renal pelvis (the inner part of the kidney where urine collects).

This called for a specialized approach, says Smith's surgeon, Surena Matin, M.D., associate professor in the Department of Urology and medical director of the MINTOS (Minimally Invasive and New Technology in Oncologic Surgery) Collaborative Group at MD Anderson.

 "The surgery not only requires removal of the kidney, but also the entire ureter down to the bladder including a little portion of bladder that surrounds the ureter," he says. "The old-fashioned approach to this (open surgery) required one very long incision or two separate incisions."

But with the minimally invasive technique suggested by Matin, Smith would likely have less pain, blood loss and scarring. She'd need less postoperative pain medication. 
Best of all, she'd go home sooner.

In the last decade, MD Anderson has increasingly embraced minimally invasive surgical techniques -- endoscopy, image-guided surgeries, robotic surgeries and those using real-time MRIs -- because of such benefits to patients. (For more information, see link to Q&A at the end of this story, in which Matin answers questions about this type of surgery.)

"What's more important though," Matin says, "is the rational integration of these techniques into the spectrum of cancer care. In this case we not only did the standard surgery after chemotherapy, but also did a fairly extensive lymph node dissection. Most gratifying was the fact that she had a complete response, something that was rarely ever seen before the multidisciplinary approach."

"Our minimally invasive cases have quadrupled since 2001," Matin says. The majority of radical prostatectomies at MD Anderson are done with minimally invasive techniques. Other procedures that lend themselves to these techniques are radical and partial nephrectomies (complete or partial surgical removal of a kidney) and robotic cystectomies (surgical removal of the bladder).

Matin, who got his start at the Cleveland Clinic in the 1990s when these techniques were being explored and developed, believes that the use of minimally invasive techniques will only grow. 

"Of course, there will always be a role for open surgery, because many patients come to us with more advanced disease or need complex reconstruction," he says.

Treatment over, back to 'gallivanting'
gail smith_now.jpg

Over the six months of her treatment, Smith developed a strong admiration for her medical team. "They treat you like a person -- a human being. They respect you," she says.

She recalls Matin's willingness to collaborate to determine the best treatment for her. "Because my cancer was rare, especially in women, he discussed my case with experts to see what was the best thing to do," she says.

Within a day or so of surgery, Smith was up and walking, and her recovery went smoothly. Nearly 18 months later, she's back to her favorite pastimes: walking, reading, shopping and "gallivanting around" with her sister.

She marvels at the small incision that's the only souvenir of her lifesaving surgery. "It amazes me how he got that kidney out. It blows your mind," she laughs.

Related story:

Q&A: Minimally Invasive Surgery
Surena Matin, M.D., associate professor in the Department of Urology and medical director of the MINTOS (Minimally Invasive and New Technology in Oncologic Surgery) Collaborative Group at MD Anderson, answers questions about minimally invasive surgery. Read More


MD Anderson resources:

MD Anderson Bladder Cancer Support Message Board

Minimally Invasive Surgery

Bladder cancer treatment (audio podcast)

MD Anderson Genitourinary Center

Additional resources:
American Cancer Society overview on bladder cancer


roboticsurgery.jpgJust a few years ago, most surgeries were "open," or invasive, procedures in which a surgeon made a large incision while the surgery went on. Surena Matin, M.D., associate professor in the Department of Urology and medical director of the MINTOS (Minimally Invasive and New Technology in Oncologic Surgery) Collaborative Group, discusses newer, minimally invasive techniques and how they've changed the standard of care for certain types of surgery at MD Anderson.

What is minimally invasive surgery?
In general, minimally invasive surgery means any technique that aims to minimize the trauma of traditional surgery. Practically speaking, we're usually referring to endoscopic, laparoscopic or robotic techniques.

Endoscopic techniques generally refer to any type of procedure that allows the surgeon to view the inside of a body cavity or organ through an existing opening -- for example, diagnostic procedures like colonoscopies.

Laparoscopic also called band-aid or keyhole, surgery refers to operations in the abdomen performed through small  (0.5-1.5 cm) incisions. A laparoscope (essentially a miniature camera) is used to guide the surgeon, and a light helps illuminate the area.

Fairly new, robotic surgery uses a sophisticated robotic system to perform laparoscopic surgery. The surgeon, seated at a console across the room, wields instruments as he or she watches a video monitor of the surgical area.

The technology actually allows the surgeon to even be miles away, a concept called "telesurgery". This has been tested and shown to be possible with simple operations but is not yet routinely done as there are many technical, legal, financial and ethical considerations that have not yet been addressed.

What skills does a surgeon need to perform these techniques?
Surgeons performing minimally invasive procedures need expert hand-eye coordination and the ability to work in a small area with a limited view and without tactile clues. The biggest challenges with laparoscopy include working in a three-dimensional field while having only a two-dimensional view (the TV monitor) and the lack of dexterity with typical straight laparoscopic instruments. Robotic technology addressed both those constraints by providing a 3-D view and instruments with dexterity.




How long have these techniques been around?
It's been more than two decades since the first gallbladder was removed and two decades since the first kidney was removed laparoscopically. Robotic techniques have been performed for fewer than 10 years, and as a routine practice in most centers, less than five to seven years.

What are the benefits, in general, of minimally invasive techniques?
Generally there is less pain, less bleeding, less scarring, a shorter hospital stay and recovery time. But, this really depends on the type of operation and the disease being managed, and just as important, on the surgeon and his or her experience. In some cases, minimally invasive techniques offer no clear benefit.

For patient Adeline "Gail" Smith, minimally invasive surgery was the best answer. The kidney and entire ureter down to the bladder, including a portion of the bladder that surrounds the ureter, needed to be removed. The old-fashioned approach required one very long incision or two separate incisions. With minimally invasive surgery, she experienced less scarring, pain and loss of blood, plus she could go home sooner.

What are the risks of this surgery?
We have to remind patients that even though the incisions are small, the surgery is no less risky. In fact, in inexperienced hands or with more complex cases the risks may even be higher than traditional surgery. So the typical risks of major surgery are still present. Punctures, perforations or injury to nearby organs, infections and anesthesia complications are a few of the risks. And patients who've had previous surgeries might be at higher risk for complications.  

We work very hard at minimizing risk. The fact is, however, that we cannot eliminate risk.  Also, what most people don't realize is that health care efforts are only part of the equation. Patients play a big role in minimizing risk by quitting smoking, improving their exercise capacity, losing weight and other "modifiable risks."

Which procedures lend themselves to this technique?
In urologic cancer surgery, feasibility and safety has been shown for:
•    Kidney cancer

o    Laparoscopic radical nephrectomy, removal of a kidney
o    Nephroureterectomy, removal of a kidney and its ureter
o    Robotic partial nephrectomy, removal of part of the kidney
•    Prostate cancer
o    Robotic prostatectomy, removal of the prostate
•    Bladder cancer
o    Robotic cystectomy, removal of all or part of the bladder and lymph nodes

In each of these cases, we are also doing aggressive lymph node removal when necessary. With penile cancer, we are evaluating the role of endoscopic inguinal lymph node removal. This technique removes the possibly involved lymph nodes -- the nodes that lymphatic fluid moves to first -- to see whether cancerous cells are present. The hope with this procedure is to minimize the incision size, which has clearly been associated with high wound complications so that the patient is spared complications.

In orthopedic surgery, arthroscopic techniques, which address problems inside of a joint like the knee, shoulder, etc., have been used for a number of years. Minimally invasive techniques are also well established or gaining ground in gynecological, thoracic and cardiac surgeries. There are very promising developments in head and neck surgery and endocrine surgery. Even our plastic surgeons are doing complicated reconstructions after major resection of head and neck cancers.

How has the use of these techniques grown at MD Anderson?
Based on 2009 data, we've quadrupled our minimally invasive procedures since 2001 and tripled them since 2004. We now do over 3,200 a year, if you look at all kinds of minimally invasive procedures. Since 2004, when we first started tracking this more carefully, and until the end of fiscal year 2009, we had done 13,275 procedures.

This growth is mostly seen in urologic oncology and gynecologic oncology, but as mentioned above many other specialties are learning from one another and applying these techniques to their fields. It's a growing trend as cancers are detected earlier, as minimally invasive surgery lends itself to treatment of early-stage disease. The techniques are also sometimes used for diagnostic purposes.

Is minimally invasive surgery preferable for the procedures listed above?
Sometimes minimally invasive procedures are not better than the open counterpart in every respect. There are trade-offs, just as in everything we do, including when we decide not to operate.  

One procedure may be associated with a shorter recovery time, but it may come at the cost of a slightly higher risk of a particular complication. Sometimes the cancer is not perfectly suited for a minimally invasive procedure, but minimally invasive is what the patient really wants; we need to make sure those patient expectations are realistic and based on facts, not hopeful wishes. In these cases when there are choices and resulting trade-offs, patients play an important role -- with the surgeon as guide -- in determining what's important to them and what their priorities are.  

Related story:

Former WAC Takes Bladder Cancer in Stride
Having shown spunk all her life, it was no surprise that when faced with a rare form of bladder cancer in 2008, Gail Smith wasn't willing to take the first medical advice she got without question. And, ultimately, the minimally invasive surgery she chose allowed her to return to her active life quickly and painlessly. Read More

MD Anderson resources:

Minimally Invasive Surgery

Minimally Invasive Surgery for lung and prostate cancer (audio podcast)

Bladder cancer treatment (audio podcast)

Genitourinary Center


Additional resources:
American Cancer Society overview on bladder cancer



By Lana Maciel, MD Anderson Staff Writer

Thirty years ago, the five-year survival rate among men diagnosed with prostate cancer hovered at around 69%. Thanks to medical advances and treatment options, survival rates today are notably high, at nearly 100% after five years.

The 15-year rate is just as impressive at 76%. It's a promising sign that doctors and researchers are gaining an even stronger upper hand on the most common cancer among men.

Prostate cancer
develops from an overproduction of cells in the prostate, the gland in the male reproductive system below the bladder and in front of the rectum. This cell growth damages surrounding tissue and inhibits normal function of the gland.

More than two million men live with the disease today, and in 2009, more than 192,000 were diagnosed with it. An estimated one in six men will develop the disease during their lifetimes, which is why screening tests are critical. When detected early, prostate cancer is nearly 100% curable.

Are you at risk?
Though prostate cancer is the most common cancer in men, age is the strongest risk factor, and the disease typically does not appear until after age 50.

Other risk factors include:

  • Family history -- Men with a father or brother who has had prostate cancer are likely to inherit these same DNA changes.

  • Race -- Prostate cancer is more common among African-American men, who have nearly twice the incidence compared to Caucasian men. It is less common in Asian or Hispanic/Latino men. Researchers are still unclear as to why these racial differences exist.

  • Diet -- High-fat diets and frequent consumption of red meats have been linked to prostate cancer risk. Incorporating more fruits and vegetables into your diet is believed to decrease risk.

  • Weight changes -- Some studies have found that obese or overweight men have a higher risk of developing the disease. In one study funded by the National Cancer Institute, researchers at MD Anderson found that a man's weight at the time of diagnosis and his history of weight gain play key roles in how aggressive the cancer may become.

Treatment and survival
Early detection as well as modern treatments for prostate cancer have helped decrease the disease's mortality rate over the past three decades. In addition to chemotherapy, hormone therapy and the traditional prostatectomy, in which the prostate is removed through open surgery, advanced technologies have allowed for more minimally invasive procedures and different types of radiation.

These include:

  • Robotic laparoscopic radical prostatectomy (LRP) -- A tiny camera is attached to a thin tube and inserted through an incision in the abdomen. While viewing the camera footage on a monitor, surgeons remotely control robotic arms that use small instruments to perform the surgery and remove the prostate. Robotic LRP procedures are more precise and have fewer side effects and faster recovery times.

  • Radiation -- Radiation therapy is offered both internally and externally. External options include proton therapy, intensity modulated radiation therapy (IMRT) or the more common external beam radiation. Brachytherapy is a one-time procedure done internally by implanting tiny radioactive metallic seeds into the prostate.

Navigating the roadmap
These are just a few of a patient's options for prostate cancer treatment. But with so many different avenues of therapy, patients may feel that they need the equivalent of a roadmap to help guide them through the experience and select the best treatment option.

MD Anderson's Multidisciplinary Prostate Cancer Clinic serves just that purpose. There, a team of specialists from various disciplines comes together to assess a patient's condition from their own medical vantage points and collaborates on finding the best individual treatment.

In other words, a visit to the clinic is much like having a panel of experts confer about their separate evaluations of a patient's condition and return with their best advice.

For patients living with prostate cancer, the clinic tends to make the journey a little easier. And it's one more arm in the fight to keep prostate cancer survival rates near the 100% mark.

Related stories and Multimedia:
When specialists confer, patients benefit (Network, Winter 2010)

Enlightened choices: Individualized options for prostate cancer patients (Conquest, Spring 2010)

Choosing the Right Treatment For Prostate Cancer (Cancerwise)

Making Cancer History: Focus on prostate cancer (video)

Multidisciplinary Prostate Cancer Clinic (audio)



MD Anderson resources:
Prostate cancer

Multidisciplinary Prostate Cancer Clinic

GAP_Clinica_Alemana.jpgBy Karen V. Francis, Project Director, Global Academic Programs

Specialists from MD Anderson recently participated in a Uro-Oncology Update, which was jointly organized by our faculty and their colleagues at Clinica Alemana in Santiago, Chile.

Clinica Alemana is one of our three sister institutions located in South America. Since 2003 when our agreement was signed, Clinica Alemana faculty have continued to collaborate with their MD Anderson colleagues in the departments of Urology, Genitourinary Medical Oncology and Radiation Oncology regarding novel treatments and technologies used in the fields of prostate, renal, bladder and testicular cancers.

MD Anderson faculty who participated in the symposium were Colin Dinney, M.D., Christopher Wood, M.D., John Davis, M.D., Ashish Kamat, M.D., Randall Millikan, M.D., Ph.D., and Deborah Kuban, M.D. George Thalmann, M.D., chair of Urology at the University Hospital of Bern in Switzerland, also participated.

A total of 166 attendees participated in the two-day course, with the majority being physicians. Other attendees were residents, fellows, interns, nurses and pharmacists. Most were from the metropolitan area of Santiago, with representation from almost all of the public and private hospitals and teaching universities. 

Dinney emphasized the multidisciplinary care of these cancers, which involves coordinating with urologists, medical oncologists and radiation oncologists. He commented that "MD Anderson has a trusting and cultivated relationship with Clinica Alemana, which provides the opportunity for us to extend our expertise and discoveries in genitourinary oncology to benefit those living in Chile, and by doing so, extends our influence well beyond the boundaries of Texas and the United States."
 
More than 1,600 Chileans die each year from prostate cancer. Recent studies have shown that with an annual exam, that number can be reduced by 20% to 50%.


Mario Fernandez, M.D., a urologist at Clinica Alemana and director of the symposium, noted that courses like this are very helpful and practical from the clinical perspective, and that we must continue to recognize the importance of quality, evidence-based science in daily practice.


He added that it's equally relevant to coordinate a multidisciplinary team. In the end, the great benefit is realized by the patient.

Just over a year ago, I had successful surgery to remove a lemon-size brain tumor. But, after all the steps forward I have taken, lately I've been taking a few steps back. Just when I thought all was well, I began feeling funny. There was nothing I could call and describe to my doctor -- I just knew that I didn't feel quite right.

However, it didn't take long for me to discover the problem. One night I felt something burning on my stomach. When I felt the spot where it was burning, I felt some bumps that I quickly examined. I knew immediately -- and the Internet confirmed my diagnosis. I had shingles.

Gail Goodwin Seattle.jpg
I guess I was the perfect storm for the disease. Being over the age of 60, having a little stress in my life, being immune-compromised, having cancer, taking chemo -- these are all risk factors for the disease. 

I stayed home from work the day after I discovered the problem to find out what to do next. Was I contagious? Could I go to work? Was there medicine for this? And, most importantly, could I still go on the vacation I had scheduled for the next week?

The answers were promising. I found out that I couldn't infect others so long as they did not come in direct contact with the ever-growing rash around my middle, and, yes, there was medicine for me to take. Work was no problem, but I was restricted from going to the main hospital and I couldn't be around the pediatric patients in the Children's Cancer Hospital. The best news was that I was cleared to continue with my vacation plans.

The burning, stinging, itchy rash came along with me on a long train ride from Houston to Seattle. I enjoyed the views with only minor discomfort, and managed a long, but wonderful, weekend in Seattle with my son and his new bride, my daughter and her husband and their new baby, and my major support system, husband Clif.

My plan was that this would be over by the time I got back to Houston, but now I'm on to plan B. I'm beginning the second month of this misery. Actually, the shingles are gone; it's just the pain that lingers. 

At the last visit to my oncologist, we spent more time discussing shingles than we did talking about my brain (luckily, it's doing just fine). My pain meds have been upped and I'm working on putting all of this behind me. 

However, you should heed my warning, there's a vaccine you can get for shingles. You have to be a certain age to get it, but when you can take it, do. 

It may be that more than a year has passed, but right now I would say that dealing with this discomfort makes recovering from brain surgery look pretty easy.

By Victor Scott, MD Anderson Staff Writer

Ever wonder if the $25 you donate to a cause can really make a difference? At MD Anderson, the answer is definitely "yes." And there are so many ways to give. One way is through what we call "third-party events."

Third-party events are defined as fundraising events sponsored by individuals or organizations that are not directly under the supervision of MD Anderson. These events have long been an important part of MD Anderson's fundraising success, supporting the institution's mission of Making Cancer History®.

From North Dakota to Texas, New York to California, dozens of third-party events are held every year across the United States to support MD Anderson. The individuals sponsoring these events often devise some very unique ways to raise money.

Here are a few examples:

  • Teacher and Burro.jpgIn appreciation for the treatment her husband received at MD Anderson, a teacher at Buist Academy in Charleston, S.C., came up with "Kiss the Burro." She promised students that if they each raised $50 for MD Anderson, their teacher would have to kiss a donkey. It was a challenge the students met with extreme enthusiasm. They raised the money and the entire staff, including the principal, kissed the donkey.
  • "Beating Cancer with a Stick" is an annual lacrosse tournament held at The Kinkaid School in Houston. High school and college teams from across the country travel to Kincaid to play in the tournament and raise money for the MD Anderson Children's Cancer Hospital. During the inaugural tournament this year, the school presented MD Anderson with a check for $10,000.
  • "Polo on the Prairie" was started almost a quarter century ago by Midland, Texas, natives Melinda and Henry Musselman, and Melinda's mother, Mary Anne McCloud. During the first weekend in May, the Musselmans turn the pasture at their Lazy 3 Ranch into a polo field where players from around the world come to play polo and raise money for MD Anderson. Polo on the Prairie raised more than $226,000 this year. 
Polo on Prairie.jpg
Every Gift Matters
It's not uncommon to see a news story these days about a multi-million dollar philanthropic donation to a charitable organization. MD Anderson has been fortunate over the years to receive gifts of that magnitude. But gifts that large are rare. The majority of donations MD Anderson receives don't attract headlines. But regardless of the dollar amount, every gift received from a third-party event is important in the fight against cancer.

Another unique aspect of third-party events is that these donations are often used as "seed money" for research on less common, but equally devastating types of cancer. Securing federal funding for research on these cancers is often a challenge, but when researchers receive gifts that give them the resources to prove their ideas work, they often are then successful in obtaining substantial national research grants.

Osteosarcoma is one type of cancer that fits in this category. Eugenie Kleinerman, M.D., head of MD Anderson's Division of Pediatrics, leads a team of researchers focused on this less common type of cancer. She knows firsthand how critical funding from third-party events can be.

"Federal funding can be very difficult to obtain for research on certain cancers and almost impossible to obtain without proven data," Kleinerman says. "These fundraising events provide the seed money so that we can generate the preliminary data to help secure an NCI grant to support critical research. We are very grateful for the people who take the time to put together an event to raise money for cancer research. They are truly making a difference in the lives of our patients."

Endless Possibilities
From kissing a donkey to playing lacrosse to competing in a polo match, each third-party event generates support in its own unique way. And while the motivation for creating a fundraising event varies, the hope of a world without cancer is easily seen on the faces of those who support these causes year after year. These inspired individuals offer a future of endless possibilities in the fight against cancer.

So, if you're feeling inspired and want to create your own third-party event, then contact the MD Anderson Development Office at 713-745-6215. The Development Office coordinates fundraising efforts for MD Anderson and can offer excellent advice on making your event a success. 
               

Physicians are learning to pay more attention to patient concerns such as symptoms and quality of life, in addition to tumor shrinkage and other treatment issues.


Michael Fisch, M.D., professor and chair of the Department of General Oncology at MD Anderson, took that message to a recent video with The Wall Street Journal's Market Watch.


Asking patients closed-ended questions that set them up for a "yes" or "no" answer doesn't encourage them to open up about their concerns, Fisch notes. The likely response will be, "I'm doing just fine, doctor, keep my treatment going."


Communicating Care

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By Will Fitzgerald, MD Anderson Staff Writer

ICARE screen shot"What we have here is a failure to communicate." A well-known phrase and one that two MD Anderson doctors are on a mission to ensure never occurs, especially when it regards medicine.


Starting just three years ago, the Interpersonal Communication and Relationship Enhancement program, or I*CARE, is an online education tool that seeks to improve interactions between cancer patients, their families and clinicians.

Developed by MD Anderson's Walter Baile, M.D., and Robert Buckman, M.D., Ph.D., the program offers physicians, nurses and other health care professionals the opportunity to gauge and improve their own communication skills through a series of engaging online content, including video modules, podcasts and expert interviews.

"I*CARE started as a program to promote effective communication skills in oncology," Baile says. "Although some people are born with good interpersonal skills, it's quite different when you need to know how to give bad news to patients or talk to families about end-of-life decisions. Our mission was to provide expert knowledge and a set of best practices."

The Resources
For those interested in obtaining free CME credits, I*CARE contains a growing list of video courses that cover a wide range, from essential communication skills, to more advanced scenarios, such as telling patients they have cancer. Little things, such as the importance of having Kleenex available so it will let the patient know that it's OK to cry, are reviewed.

"Seeing is believing," Baile says. "You can do things with video that you can't do on paper or even verbally."

In addition, taped lectures on topics such as using humor as a coping strategy are available for free download on iTunes, providing users with a portal learning environment.

Winning Awards
People are taking notice. I*CARE was recently awarded three Telly Awards, which honor high-quality commercials and video production, placing MD Anderson in a distinguished group that includes past winners like NBC Universal, ESPN and Harpo Studios. I*CARE won in the education category and training category, and received the highest Silver Award for a video module, "Crossroads," which depicts interactions between physicians and patients regarding emotions in response to hearing bad news.

Cathy Kirkwood, I*CARE project director, and Baile credit MD Anderson's experts, including UT Television, along with an institution-wide collaboration for making the program such a success.

"I'm so grateful that at MD Anderson we have the talent and resources to bear," Baile says. "I don't think there's any other medical institution in the world that could put together a site to bring content to people in such an exciting way."

To view videos and other education modules that provide free CME credit, visit the website at www.mdanderson.org/icare

The South American business magazine America Economia rated Latin American hospitals and clinics for the first time in their November 2009 issue, and two of our Sister Institutions were at the top:  Hospital Israelita Albert Einstein, Sao Paulo, Brazil was #1 and Clinica Alemana, Santiago, Chile was #2 (Rankings - America Economia)

GAP_AERankings.JPGWith the help of the ministries of health of 10 countries, the magazine invited 180 clinics and hospitals from Argentina, Brazil, Columbia, Costa Rica, Chile, Uruguay and Venezuela to submit information for the rating. The top 20 are presented in the article. Each entity was evaluated in a range of categories, including hospital safety and control of patient risk, hospital-based infections, information transparency, patient satisfaction, availability of specialties, access to physicians, and activity of ethics committees.

In contrast to MD Anderson's model, many of the doctors are not full time employees of their clinic or hospital, but have privileges there. Interestingly, 91.4% of the doctors reported having a specialty, and about a third had a subspecialty. Many have had some training abroad. Overall, larger institutions did better in the rankings, offering a more complete range of services with a more consistent, high-standard of quality, and better ratios of medical staff to patients.

Dr. Claus Krebs, Medical Director of Clinica Alemana, was featured on the cover of the Chile edition. In an accompanying interview he emphasized that doctors have had to become aware of the limitations of modern health care economics. He said that almost $300 million had been invested in Clinica Alemana helping it focus on many of the important areas that this survey assessed, such as patient safety. When asked what he saw as key to running an exceptional clinic, he said that it was knowing what was central to the patient, being able to offer them the best options and collaborating with them in selecting the right choices.

Both Hospital Israelita Albert Einstein and Clinica Alemana are active Sister Institutions affiliated via the Center for Global Oncology's Global Academic Programs.  In addition to annual medical conferences organized with MD Anderson faculty, several joint research projects are being pursued. We congratulate our Sister Institutions on their excellent rankings!

By Laura Nathan-Garner, Staff Writer

green livingFrom CT scans to toxic chemicals, there's been lots of talk lately about how the environment affects a person's cancer risks.

So last week, we polled fans of MD Anderson's Focused on Health Facebook page to see which environmental factors worry them most when it comes to cancer risk. Here's what we learned:

  • 20% are most worried about radiation from CT scans
  • 60% are most worried about pesticides on produce
  • 20% are most worried about BPA in plastic water bottles, and
  • 0% are worried about getting cancer from their cell phones

But are these the things you should be worried about? Find out in this month's issue of Focused on Health.

You'll discover small steps you can take to reduce your exposure to everyday toxins and possibly your cancer risk, learn how to reduce your carbon "food" print, and get the latest on effects of CT scans and cell phones. Plus, our video of David Servan-Schreiber, M.D., will change the way you look at your lifestyle, the environment and cancer prevention.

What's your biggest environmental worry when it comes to cancer risk? Share your thoughts below, or weigh in on our Facebook poll.

By Mary Brolley, Excerpted from Network Newsletter, Summer 2010

Anderson Network Support LineIn a preparatory meeting before surgery to insert his chemotherapy port, the middle-aged man had become agitated, then had burst into tears and said, "I'm going to die anyway. Why should I do this?"

Sarabia Cerda, a physician assistant in MD Anderson's Department of Surgery, remembered the Anderson Network Patient and Caregiver Telephone Support Line, which connects patients with survivors who share their diagnosis, and, if possible, treatment history.

She called Sam Short, senior administrative assistant for the Anderson Network, a patient and caregiver support organization. Short quickly searched the database of nearly 1,200 telephone support volunteers to find one with a similar diagnosis and treatment plan.

Within 15 minutes, Sarabia Cerda recalls, the patient's cell phone rang. On the other side of the line was a Tennessee man who had survived the same diagnosis, metastasis and surgery.

The men spoke for several minutes, then the reassured patient decided to go ahead with surgery. More than a year later, he is doing well.

"He was a tough guy, but he was frightened and desperate. We (health care professionals) are sympathetic, but we haven't walked in patients' shoes," Sarabia Cerda says. "It was great to be able to connect him with someone who understood exactly what he was feeling."



Bridging the gap to share expertise

The support line is among Anderson Network's most successful programs. Since 1986, it has linked more than 20,000 patients nationwide. Callers and volunteers are welcome, no matter where they received or are receiving treatment.

Its aim -- to connect those at different stages of the cancer journey so they can tap into each others' experiences -- bridges the gap between patients who might not otherwise meet. It's also available to caregivers who'd like to speak with another caregiver of a patient similar to their own loved one. There is also a separate database of and for pediatric caregivers.

To be connected with another caregiver or survivor, call 800-345-6324 or 713-792-2553, or visit the Anderson Network links in the Resources tab.

By: Sat-Siri Sumler and Lorenzo Cohen, Ph.D.

Massage_cohen_edit.jpgOncology massage is an approach to massage therapy based in both compassion and specialized massage treatments to help people manage their experience with cancer. 

Review of the scientific literature indicates oncology massage helps improve quality of life.  Benefits include improved relaxation, sleep, and immune function as well as relieving anxiety, pain, fatigue and nausea. 

Oncology massage therapists are trained to meet people where they are in their experience with cancer and apply a highly individualized massage treatment to comfort, nurture and support them in their process. 

The treatments are modified according to the full spectrum of cancer-related issues: the physical, psycho-social and emotional consequences of cancer.

The WIN Consortium is a new kind of organization - a network of research and medical institutes, universities and industry partners - coming together around personalized cancer therapy. It is a response to the need to make faster progress in fighting cancer, and the realization that we can only achieve this by working together.

On July 6, the partnering organizations (visit WINconsortium.org for a full list) gathered at the Palais de Congres in Paris and formally launched the WIN Consortium. MD Anderson President John Mendelsohn, M.D., was unanimously elected to chair the WIN Directorate, the executive group in the organization. 

Drs. Thomas Tursz and Vladimir Lazar from Institut Gustave Roussy were elected vice-chair and chief operating officer, respectively (see photo), with additional officers to follow. The newly elected chairs of the Scientific Advisory Board were this year's meeting organizers: Dr. Leroy Hood, head of the Systems Biology Institute, and Dr. Richard Schilsky, past president of ASCO.

GAP.WIN2010.jpgWIN's main goal is to address scientific questions about cancer in different populations across the globe. Founders participate with equal rights and duties, with the final shared aim of significantly improving the outcome for cancer patients.

The WIN objectives fall into the following areas:

1. To validate, harmonize and standardize tools allowing early diagnosis and individualized approaches for cancer treatment.

2. To initiate and conduct new types of clinical trials, based on assigning treatments that target the genetic and molecular abnormalities identified in an individual patient's cancer.

3. To generate shared tumor specimens and databases including all available clinical, imaging and biological characteristics of patients enrolled in such trials.

4. To assist investigators in raising the necessary funding to conduct such trials, through either grant applications in various countries or direct collaborations with pharmaceutical companies.

5. To promote research and education in personalized cancer therapy, primarily through an annual meeting in Paris.

The second annual meeting was held July 7-10 and featured a long list of prominent speakers from many of the WIN member organizations, covering a large spectrum of issues surrounding personalized cancer therapy. The conference closed with a follow-up business meeting, as the WIN Consortium got down to managing the first details of forming and starting to work on the big challenges ahead.

In two small clinical trials, the experimental agent Olaparib has shown early promise in the treatment of inherited breast and ovarian cancers. The findings, recently published in Lancet, represent the first therapy to target the deleterious hereditary mutations BRCA1 and BRCA2.
 
Olaparib, is a PARP inhibitor, a class of drugs of growing interest in cancer research. The drug, an oral agent, specifically targets cancers caused by faulty BRCA1 or BRCA2 genes. Both parp enzymes and proteins produced by the BRCA genes are involved in the repair of DNA.
 
Approximately 5% to 10% of all cancers are inherited. About 10% of women with ovarian cancer and 5% of women with breast cancer have a BRCA1 or BRCA2 mutation. Those with the genetic predisposition have a far higher chance of developing cancer in their lifetime, and at an earlier age.
 
"Women with a BRCA mutation and their family members who may also be at risk have a unique set of medical needs. Currently, we are able to offer cancer risk management to healthy women with BRCA mutations -- ranging from screening to preventative surgeries -- so that they can make personal decisions, in terms of their individualized cancer risk," says Banu Arun, M.D., associate professor in the Department of Breast Medical Oncology at MD Anderson. "Yet, we now know that BRCA cancers might behave differently than those without the mutation. Given this understanding, our ultimate goal is to be able to provide personalized treatment strategies to women with a BRCA-related cancer."
   
MD Anderson enrolled patients in both of the international multi-center studies. The trials were similar in design -- both compared dosage levels of Olaparib in women previously treated for their disease. The results were impressive: the objective response rates in women taking the higher dose in the ovarian and breast cancer studies was 41% and 33%, respectively. The drug was well tolerated with women experiencing few side effects.

"These findings, while early, may represent a paradigm shift in how we approach breast and ovarian cancer patients with BRCA mutations," says Karen Lu, M.D, professor in the Department of Gynecologic Oncology. "In addition to offering counseling and screening that are of benefit to the sisters, daughters and other female members of the patient's family, one day we may be able offer women with BRCA positive breast and/or ovarian cancers a therapy specifically targeted at their mutation."
 
Follow-up clinical trials in both diseases are ongoing. In the lab, Arun is investigating the role of parp inhibition in hormone positive disease and in combination with other chemotherapy agents.


Resources

 

It's an annual national ranking that is much anticipated, but never taken for granted at MD Anderson.  

For the fourth year in a row, MD Anderson is the leading hospital in the nation for cancer care, according to the annual "Best Hospitals" survey published by U.S. News & World Report.
 
This is the seventh time in the last nine years that MD Anderson has ranked number one in the annual listing. Since the survey began in 1990, the institution has been ranked one of the top two cancer hospitals in the United States.

Five subspecialties at MD Anderson were singled out for high rankings, including ear, nose and throat (6); urology (10); gynecology (11); gastroenterology (19); and diabetes and endocrinology (21). MD Anderson's ranking in diabetes and endocrinology jumped 20 places this year, ranked number 41 in 2009 and unranked in 2008. Check out the complete survey results at http://health.usnews.com/best-hospitals

In May, in a separate survey of pediatric hospitals, also published by U.S. News & World Report, MD Anderson Children's Cancer Hospital was ranked 12th in the nation.

"We are proud to be ranked again as the top cancer center - an honor that reflects the expertise and accomplishments of our outstanding physicians, researchers, nurses, staff and volunteers, all focused on reducing the burdens of cancer for patients here and elsewhere," says John Mendelsohn, M.D., president. "The last decade of cancer research has yielded real benefit for patients worldwide, with declining death rates and improving five-year survival rates. To hasten our progress, the need for collaboration among the fine cancer programs recognized by U.S. News & World Report is greater than ever, and we must broaden our cooperation internationally and with government, industry and patients."



The annual U.S. News & World Report's "Best Hospitals" survey rankings are based on a reputation survey of board-certified physician specialists around the nation, nurse-to-patient ratios, nursing Magnet designation and technologies.

The faculty, staff and volunteers at MD Anderson share this recognition and pride with our patients, survivors, their families and caregivers.

marshall_family1.JPGWhen the Marshall family settled in New Orleans in 1999, they were there to stay. They didn't bargain on Hurricane Katrina uprooting their family only six years later.

Nor did they realize the hurricane would be a minor event compared to a personal storm that would strike the family just as they re-planted their roots in Texas.

Addison Marshall was 12 years old when he moved with his parents and older brother to Fulshear, Texas, outside of Houston, after the hurricane. He immediately got involved with the activities any youthful boy would -- football, Boy Scouts and hanging out with his buddies.

A mother knows when something is wrong


During spring football training in 2009, the tough-skinned 15-year-old started complaining about a pain in his side.

"Addison never complains so we immediately knew something wrong," recalls his mother, Valerie. "We thought maybe he had cracked a rib during football practice."

Visiting the doctor, the Marshalls learned that Addison had three cracked ribs caused by an enlarged spleen. A blood test showed that his white blood count was abnormally high as well. Addison's grandfather battled leukemia as an adult, so the Marshalls feared what the high blood counts meant.

Transferring to MD Anderson Children's Cancer Hospital, their fears were realized as Addison was diagnosed with acute lymphocytic leukemia, the most common childhood cancer.

"After going through Hurricane Katrina together and then facing a cancer diagnosis, we've really learned what strength we have as a family," Val says.

Scientists have discovered the genetic underpinnings of a disease that causes baldness by launching an immune system attack on hair follicles.

Alopecia areata afflicts about 5.3 million people in the United States, causing baldness in patches that sometimes spread to cover the scalp or the entire body. It's the most common cause of baldness among women.

The disease is caused by an autoimmune reaction involving T cells and human leukocyte antigen (HLA) molecules, two immune system mainstays, but the genetic basis for alopecia areata has been largely unknown. By comparing the genomes of 1,054 people with the disease and 3,278 without it in a genome-wide association study, a team of scientists that included two members of the MD Anderson faculty linked a variety of genetic variations with the disease. Their results are reported this month in the prominent scientific journal Nature.

"The genes identified are related to immunity and two, CTLA4 and HLA, are autoimmune genes," says Christopher Amos, Ph.D., professor in the Department of Epidemiology in the Division of Cancer Prevention and Population Sciences.

"One of the more interesting genes is expressed in the hair follicle, so it's probably the target of the autoimmune responses." says Amos, whose group developed the database for the project's registry and performed much of the statistical analysis required to more precisely study genomic regions associated with the disease.

Madeleine Duvic, M.D., professor in MD Anderson's Department of Dermatology, has long studied the role of HLA in alopecia areata and considered it an autoimmune disease for many years. She is principal investigator on the project's tissue and data repository, the national Alopecia Areata Registry, which is funded by the National Institute of Arthritis, Musculoskeletal and Skin Diseases.

"This project has taken 10 years and we are thrilled with the results. Knowing the genes involved will help us to develop targeted therapy," Duvic says. "I work in understanding cutaneous T cell lymphoma (CTCL) which also has loss of hair mediated by T cells, similar HLA associations and abnormal T cell signaling pathways that are relevant to alopecia areata as well as CTCL."

More than 7,890 patients have registered and over 2,800 patients have donated blood samples used study. The website that Amos and his group designed allows patients to self-register at  www.alopeciaareataregistry.org. Patients who donated samples were examined at registry sites at MD Anderson, University of California, University of Colorado, University of Minnesota or Columbia University.

The research effort was headed by Angela Christiano, Ph.D., of Columbia University, corresponding author of the Nature paper.

One quirk about alopecia areata: it is thought to be behind the phenomenon of sudden whitening of hair during times of stress, grief or fear. The immune system attack targets pigmented hair, leaving only the white hair to grow.

By Tena Gardiner, Senior Social Work Counselor, MD Anderson

"OK, my nurse suggested that I attend a support group for cancer. She mentioned that I might find it helpful in dealing with my diagnosis, but I'm not really sure how."

In the Department of Social Work I hear questions like this from patients and family members all the time.

At MD Anderson we have a number of support groups dealing with various cancer-related issues, facilitated by our very own Social Work counselors and other medical professionals. Here are some common questions and answers about support groups at MD Anderson that will hopefully help you decide if a support group is the right fit for you.

Top Six Questions About Support Groups

1.  What is a support group?
A support group is simply a place for people to connect with others going through similar situations. Group members can give as well as receive both emotional and practical support. It's also a great place to exchange information.

2.  Why join a support group?

Well, there are many reasons, but the most important reason is: obtaining support while weathering the emotional storm that is sometimes associated with a cancer diagnosis.

3.  What types of support groups are available?
MD Anderson offers many different support groups for patients, families and caregivers. Some of the groups are specific to the type of cancer diagnosis, while others are more general in nature and open to any type of cancer diagnosis. Some of the groups have speakers with an educational/medical focus, while others devote more time to patients sharing their experiences.

4.  What do I need to look for in a support group?
Some questions you may want to ask yourself when considering which group is right for you are: Do I want to attend a group weekly or monthly? Do I want a group that is facilitated by a professional? Do I want to share my personal experiences with others or do I prefer a group with a focus on information?

Some support groups in the community are peer-led groups. All the support groups at MD Anderson are facilitated by professionally trained Social Work counselors or other medical professionals.

5.  What happens if I don't like my support group experience?
Each group experience can be different. So it's important to attend the session a couple of times to get a true sense of what the group is all about and whether it's a good fit for you. If the group doesn't feel right for you or doesn't match your needs, try a different group. There are so many support options available for cancer patients and caregivers at MD Anderson, we expect you will probably find some option that will fit your needs. If on-site groups do not meet your needs, we also offer a number of online support portals and a patient and caregiver phone support program through Anderson Network.

6.  How do I find a support group at MD Anderson?
We try our best to keep an up-to-date list of support group meetings on our website. If you need more help finding a group, call the Department of Social Work at 713-792-6195 and someone from our staff will be happy to assist you.

Support Resources :

MD Anderson Support Groups List
Message Boards and Online Support
Anderson Network Patient & Caregiver Support Line
All Patient and Family Support Resources

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