August 2010 Archives

By Lana Maciel, MD Anderson Staff Writer

For cancer patients undergoing treatment for their disease, doctors are offering a new kind of prescription -- exercise.

Despite beliefs that patients should rest as much as possible during therapy, a new set of guidelines from the American College of Sports Medicine (ACSM) indicates that exercise is actually beneficial for patients and survivors.

The ACSM's message to avoid inactivity stems from a recent review of published studies on the safety and effectiveness of exercise during and after cancer treatment.

Influence on health is beneficial

The new guidelines seem to contradict what many doctors have previously advised. But for the majority of cancer patients, exercise is an important part of the long-term healing process.

"Before, it was generally thought that patients needed to rest because they were sick, and that they shouldn't exert themselves too much," says Karen Basen-Engquist, Ph.D., professor in MD Anderson's Department of Behavioral Science. "There were always questions like, 'Is it safe?' or 'Is exercising right for me?' But it's important for patients to stay active. It helps improve their general quality of life."

Benefits of exercising while undergoing treatment include less fatigue, increased physical functioning and improved body image. For those who do not exercise during therapy, daily activities such as climbing stairs or walking distances can become difficult, even after the cancer treatment is complete.

Regimens should be tailored

A panel of 13 ACSM members created the guidelines, which recommend that cancer patients do about 30 minutes of moderate aerobic activity each day, five days a week.

The guidelines generally apply to patients of all cancer types, but the ACSM panel found exercise benefits to be strongest in those with breast, colon, gynecologic, prostate and hematologic (leukemia, lymphoma and myeloma) cancers.

In some cases, however, physical activity can affect safety, and patients should seek professional supervision.

"With some conditions, such as known heart problems or cancer that has metastasized to the bone, patients and survivors should consult with a physician before beginning an exercise," Basen-Engquist says. "Such conditions will often require a modification of the exercise recommendation. But for the majority of cancer survivors, the quick summary of the guidelines is important to remember -- avoid inactivity."

MD Anderson resources:
Department of Behavioral Science at MD Anderson

Cancer Newsline - What Diet and Exercise mean the Cancer Patient (audio)

Additional resources:
Physical activity and cancer (National Cancer Institute)

American College of Sports Medicine

For the second year, MD Anderson has hosted graduate students from the University of Tokyo for two months of research. A lively, video-linked symposium marking the end of this year's visit was held Aug. 20. Participants included the students and MD Anderson faculty who hosted them, as well as faculty from the Schools of Engineering, Medicine and Pharmaceutical Sciences at Todai, short for Tokyo Daigaku as the University of Tokyo is also known. 

GAP_UTokyo2010.JPGThe program is run by the Center for Medical Systems Innovation (CMSI) at Todai. CMSI embodies a novel, cross-disciplinary approach to training and research on the boundary of medicine and engineering, with elements of social sciences and business rolled in.

I attended the CMSI Annual Meeting earlier this year and was impressed to see not only a wide range of innovative science and engineering projects, but also business plan presentations by the CMSI students. Equally creative, but thinking in a different way, the students identified needs and were proposing commercially viable solutions to them.

This year the students who visited us, and the research projects they worked on, were:

  • Yusuke Egashira, Mentor: Dr. Ritsuko Komaki, Radiation Oncology Treatment
    Experimental Evaluation of Dose Calculation Algorithms for Proton Therapy

  • Hitomi Hosoya, Mentor: Drs. Renata Pasqualini and Wadih Arap, Genitourinary Med Oncology-Research 
    Multi-platform, Ligand-Directed Delivery of Doxorubicin for Cancer Therapy
  • Mariko Ikuo, Mentor: Dr. George Calin, Experimental Therapeutics
    Plasma microRNA of Chronic lymphocytic leukemia patients

  • Hiroki Akiba, Mentor: Dr. Juri Gelovani, Experimental Diagnostic Imaging
    Construction of Reporter System for Monitoring HIF-1 Dimerization

  • Minghui Bai, Mentor: Dr. Oliver Bogler, Neurosurgery and Neuro-Oncology
    Importin beta1 and CRM1 are involved in nuclear cytoplasmic shuttling of EGFRvIII
  • Shinya Hirota, Mentor: Dr. Joseph McCarty, Cancer Biology
    alphaVbeta8 integrin-mediated TGFbeta activation and signaling is essential for angiogenesis in the neonatal retina

For the first time this year, two MD Anderson students, from the Pasqualini/Arap lab, traveled to Tokyo for the summer: 

  • Julianna Edwards, Mentor: Dr. Tatsuro Irimura, University of Tokyo
    Characterizing the mechanism of action of a mitogenic, lectin-like, synthetic polymer

  • Lawrence Bronk, Mentor: Dr. Kazunori Kataoka, University of Tokyo 
    ICG Encapsulating Micelle for Photodynamic Therapy and Photodynamic Diagnosis

MD Anderson graduate students interested in participating next summer, by applying to visit Tokyo, are encouraged to contact Gloria Da Roza in Global Academic Programs. 

The students who join this competitive CMSI program represent some of the best of the upcoming generation of scientists and innovators, and it is an honor for MD Anderson to be part of the CMSI exchange program. We hope that many of the CMSI-graduates will join us in our mission to fight cancer.


By Laura Nathan-Garner and Lora Shea, MD Anderson Staff

Is a prostate-specific antigen (PSA) test the best way to screen for prostate cancer? And if my doctor finds prostate cancer, how aggressively should it be treated, if at all?

If you've read recent headlines, you may be asking these questions. It's understandable. After all, about 217,730 men will be diagnosed with prostate cancer in 2010, according to the American Cancer Society. So it's smart to arm yourself with knowledge about prostate cancer detection, prevention and treatment.

We recently chatted with John W. Davis, M.D., assistant professor, Department of Urology at MD Anderson and organizer of Prostate Health Conference 2010. Check out the slide-show and podcast below.

Still have questions? Post them below or on our Facebook page. We'll try to get them answered by Dr. Davis and other MD Anderson experts at Prostate Health Conference 2010 on Saturday, Sept. 11. 

We also invite you to join us at this free event. Among the topics we'll be discussing are what men at high risk for prostate cancer need to know, when to seek treatment, PIN and prostate cancer risk, and Finasteride. To learn more about Prostate Health Conference 2010, visit

After a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband Tom was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective.
Read more posts in this series

By Judy Overton

overton_helicopter.jpgMy sister Jackie reminded me last weekend that Sunday, Aug. 22, would've been Tom's and my 29th wedding anniversary. We always favored the day we met, May 5, 1977, so it's not a surprise that I needed a reminder. However, as I reflect on our wedding day, I'm reminded of one line in the vows:

        ... in sickness and in health ...

We had just finished dinner on Labor Day six years ago. It had been a quiet weekend. Tom had studied for a class he was taking toward his master's degree and had made some marvelous ribs. I was on the phone with a friend around seven that evening when he entered the kitchen, doubled over in pain. "I need to go to the emergency room," he said, with a lot of effort. I got off the phone and we drove to the hospital about a mile from the house.

We should have called an ambulance.

We reported Tom's symptoms to the receptionist, and were directed to chairs in the busy waiting area. Our wait dragged on for 2-3 hours, during which I made several trips to speak with the receptionist to see when Tom would get into the inner sanctum. She said, "We see the people brought in by ambulance first, and then the most serious cases after that." Isn't urinating blood and having excruciating pain pretty serious, I thought to myself.

After one of these frustrating exchanges, another woman approached the desk and was given a similar line. She walked up to me and said, "Do you know they haven't even offered my husband any ice for his ankle?" The man had been sitting in a wheelchair when we first sat down in the lobby. His ankle was extremely swollen. "What's wrong with your husband?" she asked.

"He's urinating blood," I replied.

"And that's not serious?" she responded.

Tom eventually made it to an emergency room with the temperature of a meat locker. He was not only in great pain, but extremely cold. No one seemed to be tending to him. I know he produced a urine sample after they requested one, but other than a nurse getting his vitals, that was the extent of the check-up.

My timing may be off a bit since six years have passed, but I recall a nurse asking Tom to again give her a urine sample. "I did," he responded curtly. When she saw that it was filled with blood, she looked startled and got into action. "I need to order an MRI," she said. It was around 4 a.m., and Tom would be taken to the MRI room. Since I couldn't settle down in the straight-backed chair, I told him I was going to go home and get some sleep. "Please call me as soon as you know something," I pleaded.

About two hours later, the ringing of the phone awakened me. It was Tom. "They found a large mass, and are transporting me to Hermann Hospital," he said calmly.

 "I'll be right there," I replied. After collecting myself and quickly getting cleaned up, I drove back to the hospital for a short wait. I followed the ambulance to Hermann Hospital, where I'd been many times before as a news photographer awaiting the arrival of a shooting victim or a patient being brought in by the LifeFlight helicopter.

This flight would be for the life of my love -- my very best friend.

Contact Judy Overton at

By: François Pouliot, Ph.D., M.D., assistant professor and clinical ethicist, Department of Critical Care

Five interns had the chance to discover clinical, research and/or organizational ethics during the summer and to contribute to activities and projects of the Section of Integrated Ethics at MD Anderson Cancer CenterOne of them, Thomas Hoang, tells us more about his experience in Clinical Ethics.


Tell us more about yourself

I attend The University of Texas at Austin. I am pursuing a degree in biology and a minor in Spanish. After receiving my undergraduate degree, I plan to embark on a career in medicine, and plan on applying to medical schools shortly after I graduate. Health care has always been an interest of mine since I was young, and it continues to be because I admire the profession of a physician. Helping others and living a life of selflessness are two virtues that I've come to believe will satisfy me in this lifetime, and both are intertwined within the career of a doctor.


Why did you apply to a clinical internship?

Before I was appointed to this intern position, I had a background in the hard sciences more than I did the philosophical and ethical. We all know that health care is heavily science-based, but there is that other dimension of ethics that is also very important to patient care. My previous experiences in a clinical setting were administrative and more focused on hospitality toward the families of the patient. I applied to this internship to gain more exposure  to patients, to see other aspects of the clinical setting and to understand that health care is not just science, but that there are many other spectrums of patient care that are just as important as the surgeries, lab techniques, DNA assessments and epi tubes.


What is an average day like in this internship?

I have done a wide array of things in the duration of this summer internship. My daily schedule for this past summer consisted of researching and reading in an effort to gain a better understanding of ethics, I attended rounds in the ICU, attended various lectures that address many different aspects of health care, took a survey course in clinical ethics, and researched for the design of a protocol to create an efficient screening tool. The experience I've gained from doing these things has been extremely beneficial to me.

One event I remember very clearly was the bus rounds hosted by Dr. Eduardo Bruera and his colleagues. This was quite intriguing to me because it gave me exposure to terminal patients, which was quite difficult to deal with at first. Overall, the kind of exposures to patients I had this summer further developed my interests in seeking a profession in health care.


What are the most important things you learned during this experience?

Aside from the clinical experiences and research experiences, this internship let me dive into the daily work life of the health profession. It allowed me to work with a diverse group of professionals and colleagues that I have learned so much from. Learning about the organizational structure of a large medical institution like the well-renowned MD Anderson Cancer Center was a great experience.  It defined for me all of the types of people involved in health care. I also had great exposure to research creation and protocol review. The most interesting was being able to attend an Institutional Review Board (IRB) session and to see how they review protocols, as well as being involved in creating one to potentially be submitted through the IRB.


What comes next?

I will continue to pursue acceptance into a medical school. This experience has been a privilege and will be very beneficial to me as I continue with my education. I have a year left of undergraduate study and, hopefully, this experience will make me a more competent medical school candidate. I have learned during my tenure here at MD Anderson that many health professionals are not aware of clinical ethics and its importance especially to the patient. If my goals are achieved, I will practice medicine with the utmost respect for patient autonomy, beneficence, non-maleficence and justice.

After a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband Tom was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective. Write to her at

The Caregiver Chronicles, Part 1
By Judy Overton

Each time I visit my husband's grave, I can't help but zero in on the date of his birth - November 2, 1953. Tom died a little more than three years ago at the age of 53. My eyes then pan to my name and date of birth: February 23, 1955.

I'm 55 years old. My next thought is, "What would I do if I knew this would be my last year on earth?"

For one, I've always wanted to share Tom's and my cancer experience with others by writing a book. In fact, the title I've given this blog is the one I planned to use for it.

I often talk to my closest colleagues about my husband and our experiences during our more than 30 years together. Of course, sometime when I share moments of his diagnosis and treatment, my pent-up emotions can't help but surface. Recently, after such a conversation, a colleague suggested that I contribute to the Cancerwise blog in order to share my experiences with other caregivers.

Caregivers, my heart goes out to you. 

A family member once corrected my use of the term, insisting it should be "caretakers." My immediate thought was, "Doesn't she know! Caretakers don't take anything, but we give everything we've got."

It just seems appropriate that I'm writing this just a few days before the beginning of Caregivers Week here at MD Anderson.

In truth, my husband was an ideal patient who so appreciated my efforts. Toward the end of his life, Tom would often say, "You're an angel." But I never could accept it, and would flinch at the thought, because I knew how imperfect I was. My curt answer would be, "No, I'm not!"

I felt I was falling short in so many ways.

The "Birth" Date

empty trackTom's diagnosis occurred six years ago, in 2004, during the Labor Day weekend. He casually told me on that Sunday morning that his urine was mainly blood. I was a little stunned, but since he wasn't experiencing pain, we agreed he would make an appointment with a physician on Tuesday after the holiday passed.

Still in shock, I consulted a medical diagnosis book. Under "urinating blood," I was led to information about prostate and renal cancer.

Cancer? Could it really be that? We were enjoying our first full year of having an empty nest. Our younger son, Matt, was now a sophomore at the university where Tom worked, and his older brother Nathan had been in college for about three years.

Things were running so smoothly, and we were now connecting at a much deeper level than ever before.

After my consultation with the medical books and sharing the unsettling news with Tom, I went for a walk at the high school track.

(We both would walk at the track on weekends, but we always went in separate cars. Tom liked to cruise the small town where we lived before he began his walk. I preferred to get right to the heart of the matter. In fact, people didn't know we were married, because we wouldn't walk together.)

During the walk, I remember thinking, "I could be a widow before I'm 50."

I shed a few tears, then decided I really ought to wait for a professional diagnosis before burying him!

And as I looked across the field to where Tom was strolling, I wondered what was going on in his head, too.

Two studies led by scientists at MD Anderson open new areas of research that could potentially improve ovarian cancer treatment.

The discoveries published today in the journal Cancer Cell are preclinical - they employ laboratory experiments to better understand the molecular processes that drive formation and growth of cancer.  Both studies found previously unknown roles for two proteins, singling them out for further research and possible drug development.  

In the August edition's featured article, Robert C. Bast Jr., M.D., vice president for translational research and professor of experimental therapeutics, and colleagues show that the protein SIK2 plays a vital role in mitosis, or cell division.  The team  demonstrated in a mouse model that inhibiting SIK2 makes ovarian cancer more susceptible to the chemotherapy drug paclitaxel, one of a group of drugs that attack cancer cells by blocking their division.   

Overabundance of the protein occurs in 30 percent of human ovarian cancer cases and is associated with advanced disease.  

Another article by Anil Sood, M.D., professor in the departments of Cancer Biology and Gynecologic Oncology, and colleagues reports that the protein EZH2 fuels the formation of blood vessels that feed ovarian cancer by shutting down genes that block the birth of new blood vessels -- angioigenesis. Depleting EZH2 in the tumor and in blood vessel cells with an engineered nanoparticle steeply reduced the size of tumors in a mouse model of the disease.

An analysis of 180 ovarian cancer tumors showed that patients with the protein overexpressed in either their tumor or its associated blood vessels survived about one third as long as those without abundant EZH2.

Both teams are following up on their initial findings.

Novel Role: EZH2 Boosts Creation of Ovarian Cancer Blood Vessels

Researchers Identify Potential New Target for Ovarian Cancer

By: DJ Fomby, Andrea Skoglund, and Stephen Collazo, MD Anderson Social Work Counselors

"There was a narrowing of my vision; nothing mattered except helping him survive."
Caregiver 4 Caregiver Group Participant

The acute nature of a patient's illness and the need for swift treatment often means that the patient's needs supersede all other considerations as the family focuses on the patient's survival. Caregivers experience tunnel vision, or as one caregiver explained, "There was a narrowing of my vision; nothing mattered except helping him survive." This contracted outlook often means that caregivers, especially spouses, neglect their own needs.

Another common feeling caregivers experience is a sense of loneliness. Typically, the caregiver has primary, if not sole, responsibility for the patient's care. This can mean a support role as extensive as around-the-clock oversight of the patient's condition by that caregiver. Hobbies, friendships and even the caregiver's career may be put on hold so that the obligation to care for the patient can be fulfilled.

While friends and family may try to offer assistance and support, a feeling of "you don't know what it's like for me" is both common and reasonable. These feelings of isolation, along with a singular focus on meeting the needs of a loved one, can lead to caregiver burnout. Symptoms of burnout include enduring fatigue, feeling overwhelmed or trapped, anger, guilt and depression.

For many people, joining a support group helps them to address their situation and cope with burnout. By definition, support groups bring together individuals experiencing similar life challenges to reduce feelings they may be experiencing. In most support groups, professional facilitators are there to encourage participants to share their personal experiences and encourage group members to offer anecdotal support and guidance in response to one another's challenges.

At MD Anderson the Department of Social Work hosts a support group exclusively for the caregivers of our patients. Care 4 Caregivers is held each Tuesday, 12:30-1:30 p.m., in the Patient/Guest Relations area of the Rotary House International hotel. Participants are encouraged to share feelings and challenges they face in their role as caregivers, while offering strategies for coping and support to each other. By sharing their experiences with one another, participants realize they are not alone in their caregiving struggles. As a result, members begin to develop the knowledge, resources and strength to meet their caregiving challenges.  

We ask that only caregivers attend this group so that they can speak freely about any caregiving issues they may be facing. If individuals with cancer wish to attend a group, there are several groups designed specifically for people living with cancer that would be more appropriate for their needs.

For more information about the Care 4 Caregivers support group, please contact DJ Fomby, 713-792-6824, or Andrea Skoglund, 713-563-2397.

If you are not able to attend this particular group but still have an interest in attending any support group, please talk with the social worker in your clinic about other groups that might be available at MD Anderson or in your own community.

By Laura Nathan-Garner, MD Anderson Staff Writer

FOH_yogawoman.jpgWork. The economy. Your health. Relationships. There's a lot to be stressed about, isn't there?

But as I learned from chatting with friends from around the Web, and Focused on Health's Facebook and Twitter followers, there are plenty of ways to unwind.
Here are just a few ways people told me they unwind:

  • I can't believe I'm saying this, but clean house. -- Lynda H.

  • I watch short segments of Mama Mia. It's impossible to stay stressed out listening to "Dancing Queen" or "If You Change Your Mind." The music is infectious.  -- Christy M.

  • I have a small office with no windows. To reduce stress at work, I have taken pictures of the great outdoors and the ocean, and put them all over my tiny office space walls. -- Michael C.

  • Take a bubble bath and watch a funny show -- there's no better medicine than a nice bath and some laughter after a stressful day. -- Connie R.

Why all this talk about reducing stress? Because making time to relax, recharge and connect with others helps your body fight off diseases like cancer.

Find out more in this month's issue of Focused on Health.

You'll get stress-reduction advice from an MD Anderson expert and find out other ways real people unwind. You'll also learn how healthy relationships boost your health and find out whether you should take supplements to prevent cancer.

How do you de-stress? Share your strategies below, or join the conversation on our Focused on Health Facebook page.

By: Shubhra Ghosh MD, CCRP, Project Manager, Global Academic Programs

A research retreat was held in Houston July 29-30 in which participants from Banner Health and MD Anderson discussed developing a research program at the Banner MD Anderson Cancer Center, due to open in Phoenix next year.

The visitors from Banner had the opportunity to meet experts from MD Anderson who introduced them to different aspects of cancer research. Raymond DuBois, M.D., Ph.D., provost and executive vice president, talked about MD Anderson's mission to eliminate cancer within Texas and beyond by a seamless integration of research with clinical care and prevention. He mentioned that MD Anderson is using advanced educational and training programs and developing new technologies to enhance the level of cancer care.


GAP_Banner2010.JPGEric Reiman, M.D., chief scientific officer, Banner Research Institute, expressed great interest in developing a clinical research program at Banner MD Anderson Cancer Center that would offer the best treatment options to patients coming to the new center. He wanted to know how MD Anderson works with its partners in this regard. Oliver Bogler, Ph.D., vice president for Global Academic Programs, presented an overview of the global network of MD Anderson partners that collaborate on research projects to make breakthroughs in the understanding of cancer and explore novel ways to treat it.


The significance of research-driven cancer care was highlighted in the presentations on various types of cancers. All speakers stated that the vast majority of clinicians in their departments were actively involved in research. Hagop Kantarjian, M.D., associate vice president for Global Academic Programs, Clinical Research, summed up the group's sentiment by stating that "in cancer, research-based care is the best care."


Bill Camp, chief executive officer for the Banner Research Institute, presented Banner's current research infrastructure and stated the importance of developing a fiscally viable research program at the new cancer center. The group discussed the challenges and investment required to set up the infrastructure in terms of personnel, policies and procedures, information technology, quality assurance and quality control, and oversight.

The plan made by the integrated team foresees starting with a focused deployment of clinical trials and research in selected specialties, to achieve early success, and then move aggressively to bring the new center up to speed with research closely tracking clinical development.

The retreat ended with an agreement to continue the dialogue. The next step is for MD Anderson to visit Banner.


Younes MD Aug 2010A year ago this month I launched this medical Facebook page.

It feels like yesterday.

This idea came four months after I started to use Twitter ( to share important information on medicine and cancer. Initially, the page allowed followers to be "friends." After consultation with colleagues, MD Anderson Communications Office staff and some of my followers, the site was changed to allow "fans" to follow me rather than friends. This allowed my followers, some of whom are patients of mine, to keep their privacy while giving them the opportunity to read and comment on my posts.

Since then, I have posted 633 links to important medical articles published in scientific and lay media outlets, an average of two posts every day. To date, this page has 617 followers, 81% of whom are women, and 51% are younger than age 45. Four hundred and eighty-nine of my followers are from the United States and 145 live in Houston.

Likewise, to date I have 1,511 followers on Twitter, and I tweet an average of seven links each day, mainly covering cancer (especially lymphoma) and other medical topics.

Thanks to support from the MD Anderson Communications Office, I have blogged 12 times here in Cancerwise, including blogging from the past two American Society of Clinical Oncology meetings In between, four short videos (,,, and two iTunes webcasts were also posted to promote clinical trials on lymphoma.

As I stated in previous blogs, this effort not only provides credible educational sources of information to the general public, but also has been a successful tool to promote participation in innovative clinical trials at our center. With time, I communicated with patients and their families, doctors, scientists and curious minds, most of whom I have never met in person.

Making myself available through social media and posting my e-mail address on my Facebook page allowed many people around the world to ask questions. In many cases, this resulted in referrals of patients who are interested in participating in clinical trials. Every week I get e-mails from patients and families around the world asking for help. This is a lot of work for me, but I consider it a good public service.

My goal is to reach out to every patient with lymphoma. Over the past year, 617 individuals followed my Facebook page and, of course, not all of them are lymphoma patients. This year, it is expected that 74,000 new patients will be diagnosed with lymphoma (both Hodgkin and non-Hodgkin) in the United States. That means I will have to reach out to 73,400 more individuals!

If you don't know me, I would like to assure you that I think this goal is achievable. I just have to keep working on it. But I would also like you to help me achieve this goal.

twitter_icon_15.jpgFollow Dr. Younes on Twitter

facebook_icon_15.jpgDr Younes on Facebook

Sgt. George Alderete has a strong core - physically and emotionally.

Alderete.jpgAn eight-year cancer survivor and 32-year veteran of the Houston Police Department, Alderete is a firm believer that family, faith and physical conditioning carried him through his cancer experience and today, those fundamentals are stronger than ever.

Alderete is one of more than 4,500 individuals at MD Anderson who have transitioned their annual follow-up visits and care to survivorship clinics. Though he no longer has a formal annual appointment with Christopher Wood, M.D., the surgeon who removed his kidney cancer, Alderete continues to return to the familiar surroundings of the Genitourinary Clinic and sees a team that monitors him for possible recurrence and late effects of treatment.  

Almost eight years ago, Alderete was experiencing fatigue and slowing times with his daily distance runs, symptoms and signs that were out of the ordinary for the active 43-year-old. An enthusiastic runner, athlete and softball coach in addition to being a devoted Catholic, family man and one of Houston's Finest, Alderete says the toughest part of his cancer diagnosis was telling his family.  

Confident in their support and love once sharing the news, Alderete forged ahead to prepare physically and emotionally for his surgery and recovery.  Already in great shape at the time of his diagnosis, Alderete added 300 sit-ups in the morning and 300 more in the evening to his exercise routine. He said he feels fortunate to have not needed chemotherapy or radiation.

"You don't know how much it means to hear yourself being called a 'survivor,'" says Alderete, who has an easy smile. "I know I was diagnosed with cancer for a reason, but I also know I survived for a reason. Every day, I try to live a life that reflects love, gratitude, hope and faith."

Today, the 51-year-old Alderete is special assistant to Houston Chief of Police Charles McClelland, who has been his close colleague for more than two decades. He also is husband to Frannie, who he calls his "best friend," and father to Stephanie and Jennifer, who are students at Texas A&M.   

Read more about Alderete's story and the survivorship program at MD Anderson
in the summer issue of Conquest magazine.  

By François Pouliot, Ph.D., M.D., assistant professor and clinical ethicist, Department of Critical Care

JNeumann.jpgJoyce Neumann, program director in the Department of Stem Cell Transplantation and Cellular Therapy at MD Anderson, recently was involved in a quality improvement project related to advance directives for patients awaiting a stem cell transplant. Here, she answers questions about this important topic. 

What's involved in a stem cell transplant?
Many malignancies of the blood (leukemia, myeloma and lymphoma) and some solid organs (ovarian, breast, testicular germ cell) can be cured or better controlled if cancer cells can be destroyed with very high-dose chemotherapy and/or radiation. For many patients, this is their last option for treatment because standard therapy has failed to effectively treat their disease. However, blood-forming (the hematopoietic) cells are also destroyed due to treatment, and we need to infuse stem cells from a person (collected from the patient previously or someone else) or from cord blood cells that have the potential to regenerate lost blood-forming cells. Although this treatment has become much safer over the last 30 years, it is a high-risk procedure because one can become very sick and sometimes die of complications like infections, graft vs. host disease (which happens in stem cell transplants from a different person) and relapse disease.

Why intervene in the process?

Many people have strong willpower to get through this kind of treatment. Our general approach is to use all available treatments, including artificial life support, if we think there is a realistic chance for recovery. In situations where recovery is not possible (which our experience tells us), heroic measures such as breathing machines, cardiac resuscitation or invasive procedures will not be used.

Because many patients are so hopeful and desperate for cure, they may not be mentally or emotionally prepared to think or talk about the possibility of life-threatening complications and poor outcomes such as death. We think that giving accurate information and the opportunity to formally express their wishes is important. Advance directives allow patients to express their wishes of medical treatment before care.

There are three kinds of advance directives in Texas:

  • The Medical Power of Attorney, by which you appoint someone you know and trust to be your agent. Your agent can make health care decisions for you if you are unable to make them for yourself.
  • The Living Will helps you communicate your wishes about your medical care. This Living Will takes effect only when you are in the terminal phase of illness or injury.
  • The Out-of-Hospital Do-Not-Resuscitate Order is an order signed by a doctor. This form allows the patient to refuse life-sustaining treatments when outside the hospital.

What was the goal of the intervention?

Our goal was to increase the number of advance directive documents and/or advance care planning conversations by 10% between March 1 and April 9 of this year.

Can you tell us more about the team members?

From a multidisciplinary institutional task force (Respecting Choices), a team was formed to look specifically at this. This team had diverse backgrounds and competencies. Lakshmi Naik (Social Work) was our team leader, Daniel Epner, M.D., (General Oncology), Colleen Gallagher, Ph.D., (Ethics) and myself made up the core team, and Ellen Siegel (Process Improvement) was our facilitator. I have been an advanced practice nurse and program director in Stem Cell Transplantation (SCT) for 18 years and an adjuvant ethicist in the Section of Integrated Ethics for six years, and increasing patient-practitioner (doctor, nurse, social worker) communication about this subject is something many of us have been striving to achieve for some time. We have had the support of our department chairman, Richard Champlin, M.D., and the wonderful nurses and faculty working in SCT. Our sponsors were Susan Gaeta, M.D. (Critical Care) and Margaret Meyer (Social Work).

How was the intervention done?

We used an existing 45-minute admission class taught by the SCT nurses to patients who were soon to be admitted for treatment, and added content and discussion about this topic with an advanced practice nurse or selected nurses. A previously written but not implemented document, "Advance Care Planning Before Your Stem Cell Transplantation," was presented to the patient and their caregivers. The topics addressed in this document included:

  • Stem cell transplant-related risks: relapse, graft failure, infection, graft vs. host disease, respiratory and multiple organ failure.
  • Encouragement to complete advance directives with discussion with family and the health care team.
  • Transition of goal of care.

Questions and concerns were welcomed in a group discussion.  

What were the results of the intervention?
We looked at 32 clinical records before intervention and 35 after intervention. We noticed an increase in the number of conversations regarding advance care planning (from 72% to 89%), the number of conversations addressing patient values and preferences (from 9% to 14%), and the number of advance directive documents found in medical records (from 37% to 40%). The intervention was deemed helpful.

What should be done in the coming months?
We recognize there were several limitations to this intervention, such as the short time-frame we used to see change, lack of documentation even if conversations occurred, and others.  We will continue classes, collect more data over six months, and modify or revamp the intervention if needed.


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