October 2010 Archives

By Lana Maciel, MD Anderson Staff Writer

Lanie_Prejean.jpgAt age 51, Elaine Prejean finally understands the importance of breast cancer awareness and the dangers of neglect. Since no one in her family had a history of breast cancer, the disease was never a topic of discussion. Therefore, getting a mammogram was not a priority on her health list.

But a breast cancer diagnosis in 2008 was a wake-up call for her on just how important it is to take the necessary precautions when it comes to cancer screenings. And now, she's spreading the message to other women in her community.

Prejean successfully completed radiation and chemotherapy treatment in April 2010, but two months later, an alarming and unusual discharge in her breast sent her to the emergency room. Doctors initially treated her condition as an infection, but after draining a significant amount of discharge, they proceeded with further testing. The results proved worse than just an infection; the cells were malignant, and Prejean's cancer had returned.

Recurrence calls for more change
This time, it will take much more than standard radiation and chemotherapy to fight the cancer. But, prepared for the battle of her lifetime, Prejean faces another change from her mastectomy in October.

She realizes how much of an impact the procedure now has on her life, but she also knows that she has an entire 15,000-member congregation supporting her at Windsor Village United Methodist Church in Houston, where Prejean is a member. Through the L.I.F.E. Ministry program, a group for cancer survivors and caregivers, she is able to get information, encouragement and support from fellow congregation members affected by cancer.

"I'm very thankful to be involved in a ministry like this," Prejean says. "It's a great support group. There is another young lady who is a four-time cancer survivor, and I talked with her a lot during my second diagnosis. She prayed with me and shared her personal experience. I feel very blessed to have all those people pulling for me. The power of prayer is strong."

Promoting awareness
In addition to her involvement with L.I.F.E. Ministry, Prejean participates in Project CHURCH (Create a Higher Understanding of Cancer Research and Community Health), a research study conducted by MD Anderson's Department of Health Disparities Research, to help spread the message of cancer awareness.

Prejean joined Project CHURCH shortly after her first cancer diagnosis, and she continues to encourage friends and family members to participate in the study -- a series of questions designed to investigate the factors that contribute to cancer-related health disparities between population groups. She is a big proponent of the research not only because she has battled cancer twice, but also because of her personal experience in neglecting health exams.

"It's a great thing to have, just getting more people aware of their health," Prejean says of the study. "Just because no one in your family has had cancer, it doesn't mean you can ignore it."

The power of pink
Prejean also spreads her message of prevention, awareness and hope through what she wears, not just what she says. Every day, she wears on her clothing a symbol of her fight against cancer -- an angel pin with a pink ribbon and an inscription of the word "Hope." The pin, she says, speaks volumes to those who see it.

"I'm taking a college speech class right now, and my teacher noticed the pin I was wearing and asked me about it," she says. "I told her what it meant to me as a breast cancer survivor, and she said it has gotten her to become more aware of cancer and its effects."

Even Prejean's wardrobe palette is reflecting the ideas in which she so firmly believes.

"I've started to wear a lot of pink, and it's turned into a conversational piece with other people," she says. "They'll often say, 'Oh, pink must be your favorite color,' and I say to them, 'Well, I like to wear pink as a statement for breast cancer awareness.' And that helps me spread the message about it."

Related story:
Q&A :Community Involvement Promotes Cancer Awareness
Project CHURCH is designed to discover, develop and educate the African-American community -- which has the highest cancer death rate of any ethnic group -- on cancer prevention interventions and lifestyle adjustments. Read more about Project CHURCH

MD Anderson resources:
Breast cancer
Nellie B. Connolly Breast Center at MD Anderson
Department of Health Disparities Research

Additional resources:

Project CHURCH (Windsor Village United Methodist Church)

Of all the populations in the country, African-Americans have the highest cancer death rate and the shortest survival rate from the time of diagnosis of any ethnic group. This research statistic makes cancer awareness and prevention programs of utmost importance within this population.

To help address these health disparities and investigate the reasons why this population is more at risk, the Department of Health Disparities Research at MD Anderson established Project CHURCH to "Create a Higher Understanding of Cancer Research and Community Health." Project CHURCH began in December 2008 as a three-year study to investigate behavioral, social and environmental risk factors that contribute to cancer-related health disparities between population groups.

The study recruited 1,500 participants from Windsor Village United Methodist Church, one of Houston's largest African-American churches. Participants receive prevention services, referrals, educational materials and navigation assistance to health services and resources.

While data is still being analyzed, Lorna Haughton McNeill, Ph.D., assistant professor in the Department of Health Disparities Research and principal investigator on Project CHURCH, explains how the study is designed to discover, develop and educate the community on cancer prevention interventions and lifestyle adjustments. McNeill is also co-director of the Center for Community, Implementation and Dissemination Research funded by the Duncan Family Institute.

Why did you decide to develop the Project CHURCH study, and what were your initial goals?

African-Americans bear a disproportionate burden of cancer-related disparities. They experience higher rates of many types of cancer than other Americans for reasons that often remain unknown. One issue is that, because minorities are under-represented in many cancer prevention studies, we have limited knowledge about the applicability of many research findings to African-Americans. Further investigation is needed to explore why cancer-related disparities exist and what can be done to reduce and eliminate them. To be successful, this will require innovative partnerships between communities and researchers to coordinate research and promote activities that will reduce disparities.

Why are community-based cohort studies so important?

Cohort studies, such as Project CHURCH, analyze a large group of individuals with a common quality and update the information regularly for many years. Community-based cohort studies can help answer important questions regarding cancer risk by examining a host of factors that might explain cancer-related health disparities. In this study, we are examining lifestyle and behavioral factors such as diet, physical activity and tobacco use. We're also looking at elements rarely examined, such as neighborhood factors, occupational exposure and racial discrimination, to name a few.

What makes the Project CHURCH cohort unique is its relationship with Windsor Village United Methodist Church. We have been able to provide an example of a successful partnership that resulted in strong minority participation.

Why was Windsor Village United Methodist Church chosen as the source for gathering participants for the study?

Windsor Village and MD Anderson have a long history of collaboration on cancer prevention and research. Kirbyjon Caldwell, senior pastor at Windsor Village, is on the Board of Visitors of the cancer center, and several MD Anderson faculty members have provided important cancer prevention resources, such as PSA testing for prostate cancer and mammography screening, to the congregation. Also, Windsor Village is actively involved in ministering to the health of the community, as well as to that of its congregation. This makes Windsor Village a leading venue for community-based health promotion efforts.

The response at the Methodist church was overwhelming in such a short time span. Did you expect such a response?

We definitely did not expect the tremendous, positive response that we received from the church. More than 500 members signed up for the study in one day. Our initial recruitment goal was 1,200. Based on this response, we increased our enrollment to 1,501. We had also set a recruitment timeline for 12 months, hoping we would be able to enroll 1,501 in one year. We were able to meet our goal within six months.

Typically, research shows that African-Americans are less likely than other ethnic or racial groups to participate in research studies. But the enthusiastic response we received shows how the members of Windsor Village have embraced MD Anderson and indicates how African-Americans are committed to reducing cancer disparities.

Elaine Prejean joined Project CHURCH shortly after her first cancer diagnosis and she continues to encourage friends and family members to participate in the study. (Read more of her story at the link below.

What is next for Project CHURCH as it enters its third year?

We are now in the process of discussing Project CHURCH's future as we approach our third year of the study. Most important, we want to make sure we've fulfilled everything that was promised to the church. We are on track to fulfill those goals. Then, it will be important for the church to let us know whether it is interested in continuing. And of course, we will need to identify future funding.

Related story:
Breast Cancer Survivor Shares Danger of Neglect
At age 51, Elaine Prejean learned the importance of breast cancer awareness and the dangers of neglecting to have mammograms. Read Elaine's Story

Department of Health Disparities Research at MD Anderson

Project CHURCH (Windsor Village)

SCR2010-2.jpgThe Symposium on Cancer Research held recently at MD Anderson brought together internationally recognized scientists from academic, industry and regulatory agencies to describe and discuss state-of-the-art approaches to personalized cancer therapy and prevention. Symposium chairs were Waun Ki Hong, M.D., Stanley Hamilton, M.D., and Lajos Pusztai, M.D., D.Phil. 

More than 300 participants attended presentations and poster sessions, at which 12 awards were given. In a very dynamic set of lectures that engendered active discussion, the speakers covered systems approaches to discovering the best markers to guide therapy and emphasized new technologies that will revolutionize how we assess patient health and disease. 

Several cutting-edge examples of how personalized medicine is being brought to specific diseases, including breast and lung cancer, were presented in depth. The integration of this approach in MD Anderson's Phase I program was showcased, and new lab-based insights focusing on models and signal pathways also were discussed.

Important cautionary tales on the appropriate use of bioinformatics and conforming to regulatory requirements were included to help the audience understand the larger context in which these exciting developments are moving to the clinic.

Keynote lectures were given by Joe Gray, Ph.D. and Waun Ki Hong, MD. The Bertner Memorial Lecture was delivered by Carlo Croce, M.D., and the Heath Memorial Award by Leroy Hood, M.D., Ph.D. Michael Davies, M.D., Ph.D., won the Wilson Stone Award.

For more information on the program and awards, and to view the presentations, please visit The series also is available to watch or download on iTunesU

By Lana Maciel, MD Anderson Staff Writer

FishOil.jpgDoctors have often recommended that patients take fish oil supplements to reduce the risk of heart disease. But a recent study indicates that taking this supplement, which has strong anti-inflammatory properties, may also combat the risk for breast cancer.

The Vitamins and Lifestyle (VITAL) study surveyed 35,016 post-menopausal women, from 50 to 76 years old, who had no history of breast cancer. After six years, those who reported taking fish oil supplements regularly had a 32% reduced risk for developing invasive ductal breast cancer, the most common type of breast cancer, compared with those who did not take supplements.

"This study is one of the largest studies that have come out showing that there may be a role for fish oil in the prevention of cancer, specifically breast cancer," says Lorenzo Cohen, Ph.D., professor in the departments of Behavioral Science and General Oncology and director of the Integrative Medicine Program at MD Anderson. "We know fish oil is useful in relation to cardiovascular health, and the jury is still out on whether it helps in the prevention of breast cancer, but if used appropriately, it should not be harmful."

Studying the fish oil connection
Researchers are still unsure of the direct connection between fish oil and breast cancer risk. Although some studies have not found a link between breast cancer and eating more fatty fish, it is possible that fish oil supplements have a much higher amount of omega-3 fatty acids than what is typically found in the fish itself.

Still, research on how the supplement affects various cancers continues. Peiying Yang, Ph.D., assistant professor in MD Anderson's Integrative Medicine Program, recently received a grant from the National Cancer Institute to study the effects of fish oil supplements on lung cancer risk.

"Fish oil, in general, is a very good anti-inflammatory agent, and inflammation plays an important role in cancer development," Yang says.

Although previous studies indicate there is a positive link between fish oil and reduced cancer incidence, researchers note that there is not sufficient evidence to make a public health recommendation.

"I would not recommend that people start taking fish oil specifically to prevent breast cancer because the data is just not there yet," says Bette Caan, Dr.P.H., senior research scientist at the Kaiser Permanente Northern California Division of Research. "But if they are taking it for other reasons, they should continue."

MD Anderson resources
Integrative Medicine Program at MD Anderson

Essential Fatty Acids: The Good, the Bad and the Balancing Act (Cancerwise)

Additional resources
Omega-3 fatty acids, effects on cancer

Omega-3 fatty acids (American Cancer Society)

By Lorenzo Cohen, Ph.D., and Richard Lee, M.D.


While going through cancer treatment, people often ask, "What can I do to help?" The answer is to adopt a healthy lifestyle. A healthy lifestyle might help people feel stronger and fitter. It also may help support the cancer treatments so that they work better. We encourage all patients to do all they can to strengthen their body's natural defenses to improve health, well-being and clinical outcomes.

Eat Well
Diet plays an important role during and after cancer treatment. A healthy diet can help manage treatment side effects, improve outcomes and lower cancer risk. Use the tips below to eat well.

Choose to Eat Mostly Plants

  • Eat at least five servings of fruits and vegetables daily. Choose a variety of colors and preparation/cooking methods.
  • Eat fiber-rich foods, such as beans, peas, lentils, nuts and seeds. Whole fruits and vegetables have more fiber and less sugar than juices or canned foods.
  • Limit red meat and limit meat portions to less than 4 ounces per meal (size of a deck of cards). Avoid high-fat and highly processed meats such as hot dogs, bologna, bacon and salami.

Choose Healthy Fats That Help the Body Prevent Disease

  • Increase omega-3 and monounsaturated fats in your diet. Good sources are olive and canola oils, olives, nuts, avocado and cold water fish, such as salmon, sardines, trout and tuna.
  • Limit saturated fats and large amounts of omega-6 fatty acids. These are found in fatty meats; high-fat dairy products, such as whole milk, cheese and butter; and fried foods.
  • Avoid trans fats typically found in packaged snack foods, fried foods and shortening. Do not buy foods with "hydrogenated" or "partially hydrogenated" listed on the food label.

Change Unhealthy Eating Habits

  • Learn to recognize when you feel hungry and when you feel full.
  • Eat fewer high-calorie, low-nutrient foods like sodas, fruit flavored drinks, candy and processed sweets or other foods. If you want something sweet, eat a small portion of a high-quality, homemade dessert. Or, eat a small piece of dark chocolate.
  • Limit alcohol to no more than two drinks per day for men and one drink per day for women.

Exercise Often

Physical activity includes all movement, and it is important for good health. Exercise helps us maintain weight, lower disease risk, fight fatigue and improve overall health. While exercise may be tough at first, it will get easier over time.

Aim for 30 to 60 minutes of moderate to hard physical activity every day. Judge the level of an activity by how easy it is to talk. While doing moderate activity, you should be able to talk, but not sing. With harder activities, you should only be able to talk in short phrases. Always talk with your doctor before starting an exercise program.

It is important to choose activities that fit your lifestyle and will motivate you. A few examples include the following:

  • Walking or jogging
  • Gardening or housework
  • Swimming
  • Weight lifting
  • Dancing
  • Golf (without a cart)

Be as lean as possible within the range of your normal body weight. A healthy diet and physical activity are the keys to weight loss for people who are overweight or obese.

Manage Stress

Stress occurs when a demand is placed upon your body and mind that exceeds your ability to cope. A demand can range from actual physical danger to the excitement of buying a home to a family disagreement. Long-term stress may increase cancer risk, promote tumor growth and interfere with treatment.

It is healthy to practice stress management for at least 10 minutes every day. This is good for your body and mind. Listed are a few tips to manage stress:

  • Use relaxation techniques, such as guided imagery, meditation and yoga
  • Have quiet time (prayer, reading, listening to music)
  • Exercise often
  • Find a hobby
  • Add humor and laughter to your life

Accept Help and Support From Others
Having a network of friends, family, neighbors and others in your life to help and comfort you is important for good health. During your cancer treatment, you might feel afraid, alone or confused. Having people around who care about you can help you feel better. Several studies have found that cancer patients with the most social support had better quality of life and lived longer than those with the least amount of social support.

Use your support system:

  • Ask for help or for a listening ear.
  • Join a support group that meets your needs.
  • Be support for others.

For more information about making the most of your cancer care, visit the Department of Integrative Medicine at MD Anderson.

MahajanandChild.jpgThe 42nd Congress of the International Society of Pediatric Oncology (SIOP) is in full swing as close to 2,000 pediatric oncology experts have traveled from 92 countries to learn and share the latest research and experiences in the field.

Anita Mahajan, M.D., professor in MD Anderson's Department of Radiation Oncology, shared insights at the annual meeting from her experience treating pediatric patients at MD Anderson's Proton Therapy Center. She sat down with me after her talk to answer some questions.

Some quick facts:

  • Approximately 100 pediatric patients a year receive proton therapy at MD Anderson, making it one of the largest centers for pediatric proton treatment in the nation.

  • One-third of its pediatric patients are younger than 5 years old.

  • About 43% travel to MD Anderson from outside of Texas for proton therapy.

  • MD Anderson is one of only five proton centers in the United States that treats pediatric patients.

How do you decide which pediatric patients get proton therapy versus traditional radiation?

We use our medical judgment to evaluate whether proton therapy will be significantly more beneficial for the patient. For instance, if a patient has leukemia and needs total cranial radiation, then we wouldn't use proton therapy because the entire brain would be irradiated. However, for a young child with a brain tumor, we would most often use proton therapy to help spare the healthy tissue and areas essential to cognitive growth. Also, we believe proton is more beneficial for patients needing large doses of radiation because preliminary data shows that it can help reduce late effects. The potential benefits of proton therapy are greatest in younger children

What are MD Anderson's foremost strengths when it comes to treating pediatric patients with proton therapy?

MD Anderson is known for its excellent multidisciplinary support. Regardless of where patients come from, they not only benefit from our resources at the proton center, but they also have access to the specialists at the Children's Cancer Hospital. Within our team, we are sub-specialized. I focus primarily on pediatrics, someone else focuses primarily on lung tumors and so on. Because of that and the amount of patients we see, there are a huge number of resources I can access when planning a patient's course of treatment. Overall, I think our resources and the experience of our specialists, plus our emphasis on pediatrics at MD Anderson, are what set us apart.

What can we learn from other proton therapy centers?

We always strive to improve our techniques and can learn from other centers what works best for them and what experiences they have had. By exchanging information with other centers, we can all help minimize side effects from treatment and know what is normal versus something that needs additional attention. We're all in this together and want to keep improving the experience and outcomes for our patients.

What are some of the key messages you presented at SIOP?

We shared some preliminary results from our studies that indicate proton may have the benefits we have expected. It's still early, though, and we have to be careful and follow our patients in the long-term and collaborate with others to keep track of them. We need sufficient data to illustrate to insurance companies how the benefits of proton therapy most often will outweigh the costs in the long run. We also shared some results from a study that showed the potential to use lower dosages of proton therapy than with other forms of radiation, but we haven't started applying this in our treatment plans yet.

What does the future of proton therapy look like?

There's a strong momentum right now for proton therapy. It's largely accepted among physicians and the technology continues to improve, such as with the advancement of pencil beam or spot scanning proton therapy.

It's exciting and our program is really developing. Proton therapy isn't magic and can't help everyone, but it's very promising and there's a huge emphasis on pediatrics in Houston.

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 cover aspects of the cancer experience from the caregiver's perspective.
Read more posts in this series

winding_road.jpgThe Dreamsicle-colored sun rose slowly as I entered my fourth mile at the high school track. I've just completed the first week of an 18-week training for the 2011 Chevron Houston Marathon, my second attempt at the 26.2-mile run.

My first and only marathon was in 1995, a month before my 40th birthday.

As I round the 13th lap, I recall encountering my small fan base -- my husband Tom and our sons Nathan and Matt -- on that beautiful winter day 16 years ago. I remember the photograph Tom took of me waving as I rounded the curve from Main Street onto University Boulevard.

They were waiting for me again at the halfway point on Weslayan Boulevard.

Then, further down the path, under the arches along Post Oak Lane, Tom and Matt greeted me. "Nathan stayed in the car," Tom said.

The next time I saw Tom, he had only his camera in tow. This was on Memorial Drive, near the park where I'd prepared for this personal feat.

"Where are the boys?" I asked.

"They wanted to stay in the car," he said.

My loyal companion

Tom and I joked early on in our relationship that we had an imaginary "silly old sheep dog." We were like that for one another, loyal to a fault.

But for a while after Tom's surgery to remove the cancerous tumor and his left kidney, I felt abandoned and alone. He had other things to deal with, and they seemed to be more important than me.

In the days leading up to his operation, Tom knew he was facing mortality. This was between him and God. But once he was back home recovering, Tom conducted phone conversations with colleagues and others in a "business as usual" manner, and gave me the proverbial silent treatment.

I was perplexed and hurt. Could it be just my imagination?

The final straw came one Saturday afternoon while I worked in a flowerbed on the far end of the yard. Tom returned from an errand, got out of his car, and made a slow, deliberate approach to the door. Our yard is large, so he wasn't that close, but at least within distance to wave to me.

"Why isn't he looking this way?" I wondered.

Not acknowledging me may not seem like a big deal to most people, but it struck a harsh chord with me. In the past, Tom would always either look up, smile and wave, or even walk over and catch me up on things.

To get over this impasse, I gave him a creatively-framed scripture verse from Psalms 91:11: "For He shall give His angels charge over thee, to keep thee in all thy ways."

After that, he let down his guard a bit, but I still felt I needed to confront the issue. I can't recall the full conversation, but I do remember saying, "I'm still here" -- hoping he would once again include me in his thoughts and feelings. That may sound a little selfish considering what he was facing, but I wanted to emphasize that we were both alive and should be available to each other.

From then on, it became our journey, not just his.

Seventeen years later, as I train for and eventually run the marathon next January, I know that Tom's spirit will be present, not only at strategic points along the course, but every step of the way.

By Katrina R. Burton, Staff Writer, MD Anderson

As tropical depressions form in vulnerable coastal waters, hurricanes hurtle towards thriving businesses and homes, residents scramble to safer places and "diehards" prepare for impact, Gulf Coast residents are reminded of past and present disasters closer to home.

Hurricanes Katrina and Ike, and the BP oil spill, are just a few of the disasters that have wreaked havoc on the Gulf Coast community's economic stability and even more important -- the community's health and well-being.

Helping communities prepare and recover more quickly from disasters such as these -- natural or man-made -- is the primary focus of a recent alliance between seven leading medical centers, universities and public health institutions including MD Anderson Cancer Center. Supported by funds from the American Recovery and Reinvestment Act, the SECURE (Science, Education, Community United to Respond to Emergencies) consortium has plans under way.
"Our goal is for recovery centers such as SECURE to help health disparity communities plan, prepare and establish their capacity to respond to disasters of all kinds," says John Ruffin, Ph.D., director of the National Center on Minority Health and Health Disparities of the National Institutes of Health, which allocated $4 million to fund this initiative.

Members of the consortium are combining their services and systems that are already in place to develop a systematic blueprint that will aid researchers and health care providers in addressing the many health concerns vulnerable communities face during and after a disaster.

"Currently, there is no unified system in place along the Gulf Coast that will enable vulnerable communities to keep moving forward and obtain the necessary health care needed when disasters occur," says  Lovell Jones, Ph.D., director of the Center for Research on Minority Health and lead principal investigator of SECURE. "This is an ongoing problem that contributes to health disparities."

Leading the efforts of the consortium, the Center for Research on Minority Health in the Department of Health Disparities Research at MD Anderson has developed a disaster preparedness education program designed to engage local youth through training modules, workshops and activities that focus on human health and the environment with an emphasis on disaster preparedness.

Other members of the consortium, The University of Texas Medical Branch at Galveston, Baylor College of Medicine, Tulane University School of Public Health and Tropical Medicine, the University of Miami Leonard M. Miller School of Medicine, Meharry Medical College and the Houston Department of Health and Human Services, have tools in place to help strengthen communities and organized rescue groups with programs that educate Gulf Coast residents on how to prepare for and handle disasters, thus reducing health disparities during catastrophic times. 


I think that any statement about major advances in cancer care ought to be comprehensive and carefully considered. I find it particularly useful to reflect on what we mean when we call something an "advance." Here are some categories that I used to sort out different kinds of advances.

  • Category A: Advances where some new, proof-of-principle in science was 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 of the advances would be categorized, in my opinion. These are findings affecting fewer patients, influencing fewer life-years or producing generally less dramatic changes. Some of these advances are of greater interest to the lay population because of business implications or because they address topics of broad interest or shared experience.

Examples of Category A advances include the work with PARP inhibitors for selected patients with breast cancer in 2009, and the work with the new oral ALK inhibitor (crizotinib) for lung cancer patients in 2010 . These represent a new category of treatment for a subset of patients with common diseases. 

Previously, when the first breakthrough targeted therapy came along in the form of Imatinib (Gleevec), it was a story of major impact in rare diseases like chronic myelogenous leukemia (CML) or gastrointestinal stromal tumor (GIST).   In 2010, the new rare disease breakthroughs include vandetanib, an oral targeted agent for metastatic medullary thyroid cancer and everolimus, recently shown to dramatically improve progression free survival for pancreatic neuroendocrine tumors. When we're talking about a small subset of common diseases, it creates a new dilemma -- how do we screen all of these patients with common diseases to find the subsets of patients who would dramatically benefit from specific targeted therapy? It will take a lot of money, technology, and infrastructure change to accommodate the personalized cancer care approach. It is fascinating, exciting, and still daunting.

On the more positive side in Category B was the finding that the early integration of palliative care in patients with advanced lung cancer was associated with not only improved quality of life and decreased intensity of common symptoms, but also an increase in survival of 2.7 months.  This is the magnitude of survival benefit that is similar to that seen when chemotherapy was compared to not using chemotherapy. It was also demonstrated recently that physician-patient communication towards the end of life was associated with patient choices that lead to improved end-of-life care quality and value

Some of the Category B level "advances" represent disappointing, albeit important news. For example, the findings from the SELECT trial reported in December of 2008 demonstrated that vitamin E and selenium do not prevent prostate cancer. Similarly, we found 3 months later, in March of 2009,  that PSA screening does not effectively save lives in the way that we had hoped.

Finally, we learned in 2009 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.  Furthermore, in June of 2010 (also at the ASCO annual meeting) we found out that there is no benefit to adding cetuximab, a different monoclonal antibody therapy, with this same goal of preventing recurrent disease.  Ironically, the feelings about that news was somewhat mixed for oncologists. On one hand, oncologists always want to see positive findings about new therapies, but some oncologists also noted that the overall health care expense associated with a positive finding on these particular studies may have created some real dilemmas.

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, and that's where organizations like ASCO are perfectly on target with their recommendations.

The "engine" is the clinical research infrastructure, and it's an old and inefficient engine that needs to be fundamentally reformed according  to a report of the Institute of Medicine issued in April of this year. The "fuel" is the funding, and 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 fueling up a fixed engine is now upon us.

A research retreat was held Oct. 4-5 in Arizona. Teams from MD Anderson led by Oliver Bogler, Ph.D., vice president for Global Academic Programs, and Banner Health led by Bill Camp, chief executive officer, Banner Research Institute, participated in detailed discussions to formulate a research program for the new Banner MD Anderson Cancer Center, which is scheduled to open in fall 2011.

On the first day the team from MD Anderson, including Aman Buzdar, M.D., vice president ad interim of Clinical Research, and Paul Papagni, executive director of Clinical Research, provided an overview of the current research program at Banner MD Anderson. Mark Starling M.D., medical director, Banner Heart Hospital, presented an overview of the research program in Cardiology and the concept of a Physicians' Advisory Council that has been adopted by Banner Health for selecting clinical trials. Marwan Sabbagh, M.D., described Banner's clinical research program in Neuroscience. The group was also given a tour of Banner Sun Health Research Institute, including its unique Brain and Total Body Donation Program, led by Joe Rogers, Ph.D., and Tom Beach, M.D., Ph.D.

The second day was dedicated to discussions regarding the vision for the clinical research program at Banner MD Anderson Cancer Center. The group articulated our joint vision to bring a patient experience to the center that is closely modeled on what we do in Houston. Buzdar stressed the need for establishing a sound research infrastructure to ensure the development of a successful program that would offer high quality clinical trials. Hagop Kantarjian, M.D., associate vice president of Global Academic Programs, stated "once the infrastructure has been established and clinical investigators identified, research projects could be started in a relatively short time." The retreat ended with a tour of Banner Gateway Medical Center, which would provide the inpatient facility for Banner MD Anderson, and the new adjoining cancer center building that is under construction and will house the outpatient facilities.


Banner Under Construction.JPG

A candle symbolizes hope, but MD Anderson's Regional Care Center in The Woodlands will use soft pink light to raise awareness of breast cancer at a free, one-night-only event tonight at The Woodlands Market Street.

From 6 to 10 p.m., The Woodlands Market Street Central Park will be aglow in soft pink light while faculty and staff from the Regional Care Center in The Woodlands hand out breast cancer awareness materials and introduce the new team to the community.

MD Anderson Regional Care Center in The Woodlands recently expanded its services to include medical oncology, chemotherapy infusion and laboratory services and added another radiation oncologist to address the growing need for high-quality cancer care in the surging areas of north Houston and beyond. The center is located on the campus of St. Luke's The Woodlands Hospital.

When you come, bring a blanket or lawn chair to enjoy the music of Mark Towns who will be performing in the Central Park area or you can take in one of Market Street's many restaurants and shops.

A similar event will be held on Friday, Oct. 22, when MD Anderson's Regional Care Center in Sugar Land illuminates The Plaza at Sugar Land's Town Square in pink light. With great shops and fun restaurants, Town Square will host a free performance by the Fort Bend Symphony Orchestra while MD Anderson faculty and staff at the Regional Care Center in Sugar Land offer giveaways and answer questions. The booth will be open from 6 to 10 p.m.

Last night, millions of people around the world were glued to their TVs watching the successful rescue of the miners in Chile, who were trapped in a small chamber about 2,300 feet below the surface.

miners.jpgFor 17 days after the accident on Aug. 5, we didn't know their fate, and the whole world became skeptical that any of the miners would survive. But when we learned that they were still alive, all of us became hopeful that there was a chance to bring them back to the surface, alive.   

Although no one really knows these men, no one can recall their names and it is highly unlikely that we will ever meet them in person, last night we all cheered when the first man emerged from the small capsule back into the real world. We watched and cheered because this drama represented human triumph after months of unprecedented endurance.

The first thing that came to my mind as I watched is how many similarities this experience has with what cancer patients go through. Many patients and their families face a long period of uncertainty while getting their "rescue" version of anti-cancer therapy. We do not have precise measurements to predict who is going to be cured and who is not. Patients frequently have to wait until the end of therapy and many years later to learn whether they are cured.  
Similarly, the miners, their families and the entire world had numerous doubts about their final results. But the tremendous support from their families, friends and the public gave them a great sense of optimism, so they never lost hope. Recent studies showed that cancer patients who have social support also fare better.

Second, these men had to endure living underground in unprecedented conditions for more than two months before they were rescued. It took time, consultations, excellent planning, a team effort and patience to save their lives. There was no magic bullet.

What was amazing is that the miners and families understood that, and remained calm and collected throughout the lengthy ordeal. Taking shortcuts and reacting under pressure could have resulted in a different outcome.

But the last and most striking observation was how that these miners decided to surface back into our world.  They all shaved, took showers and put on clean clothes. They wanted to get back as soon as possible to their normal lives. Anyone would have understood, and perhaps would have been more sympathetic, if these men surfaced with shaggy long beards and dirty clothes. But after living that long with anxiety, uncertainty and fear, they elected to return to their normal lives rather than gain sympathy. That is a tremendous state of mind, and anyone should admire that. 

Younes.jpgOver the years, I have met and taken care of so many patients who came from different walks of life, different ages, tumor status and had various toxic treatments. I always admired those who took the time and made the effort, despite this most stressful period in their lives, to present themselves to their families, caregivers and the surrounding world in their best "normal" way, keeping a sense of optimism and courage. Somehow, I always felt that those patients did better. So did these miners.

By Laura Nathan-Garner, MD Anderson Staff Writer

"I like it on the bookcase."
"I like it on the kitchen table."
"I like it on the floor by the door."

By now, you've probably seen several status updates like these on Facebook. Maybe you've even posted your own.

Even though "it" refers to women's favorite places to put their purses, these status updates sound racy. And that's exactly the point. By piquing readers' curiosity, they're supposed to raise awareness about breast cancer.

It's a cute idea, especially since this is Breast Cancer Awareness Month.

Of course, when it comes to beating breast cancer, self-awareness is just as important as raising other people's awareness about the disease. Women can find tips to prevent breast cancer -- or find it early -- in this month's issue of Focused on Health, MD Anderson's online healthy living newsletter.

You'll learn what your breasts say about your cancer risk, what to expect at your first mammogram and whether breast MRI is right for you.

You'll also find out how health care reform will affect cancer prevention screenings and services as well as get our cheat-sheet for teasing out the facts when the next "big" study on how to avoid cancer makes headlines.

For more tips on how to prevent diseases like breast cancer, follow us on Twitter and join our conversations on Facebook

Boring? What's Boring?

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You should never say that things are getting boring because sure enough, they'll change on you.

For 18 months of treatment for brain cancer, I've had the same routine of bimonthly lab work and monthly chemo with an MRI and visit with my oncologist every other month. The report is generally the same: the scans look good, you should walk more and eat less. But, you always know there's a chance that there will be different news the next time.

Last month I went so far as to say that this brain cancer business was getting boring and guess what happened ... suddenly, it wasn't so boring any more. At my doctor's appointment, I knew right off the bat that something was amiss because my blood pressure was low -- so low that they took it again on the other arm. Then, the report came that my blood counts were low, too.

After 30 years of high blood pressure, all of a sudden here was a doctor advising me to eat salt and cheese and red meat. No one has ever said that to me. I celebrated with potato chips! I paid for it with very swollen feet and, once again, high blood pressure.

The doc kept an eye on me with frequent blood draws and reports that things were going even lower. Last week I got the news that even after a month of waiting and lots of vitamins, my bone marrow was sending me a message -- time to go off the chemo. I had managed to take 16 of the recommended 24 rounds. Now I was being put on a maintenance program of Accutane.

Yes, Accutane -- the same medicine that many teens take for acne. My oncologist assured me that I would be taking a much higher dose than those teens. But the good news would be that, after suffering through extremely dry skin, I would eventually have skin like porcelain, the kind that everyone would want to touch -- no matter that I kinda thought my skin looked OK already. And, being over 60, I wasn't too excited about having people touch it, either.

I asked how long I would be taking the Accutane and my oncologist replied that he had patients who had been on it for more than a decade. A decade? I was counting on being finished with all of this by next April.

So, things aren't boring any more. I'll be meeting face-to-face with my oncologist soon to receive more information. Maybe I'll even be able to recommend a great brand of skin lotion to everyone.

But, mostly, my advice is to never get cocky and announce that your cancer treatment is boring. The fact is, it's necessary. If you're blessed with good reports, thank your lucky stars and the God who watches over you -- all while keeping your big mouth shut!

Read other post by Gail Goodwin

By Laura Nathan-Garner, MD Anderson Staff Writer

Ronnie DioWendy Dio's husband -- heavy metal singer/songwriter Ronnie James Dio of Rainbow, Black Sabbath, DIO and Heaven & Hell fame -- was a patient at MD Anderson until he died of stomach cancer in May. But that's not why I called Wendy recently.

In July, our team noticed a huge wave of people using MD Anderson's Cancer Risk Check. Most had found it through a link on The Official Ronnie James Dio Fan Page on Facebook.

Cancer Risk Check, as Dio fans discovered, calculates a person's chances of developing common cancers. It also makes personalized suggestions for lifestyle changes and cancer screening exams that may lower one's cancer risk.

Wendy's story
After finding that Facebook post, my co-workers and I wanted to thank Wendy for sharing Cancer Risk Check with Dio fans. We also wondered how she'd found it. After all, we hadn't sent out a press release or shared a link on our Facebook and Twitter pages yet.

I tracked Wendy down, and she shared her story with me.

It turned out her Los Angeles-based family doctor -- who sits on the board of the cancer foundation Wendy created after Ronnie died -- had found Cancer Risk Check. He'd sent her the link, and she'd shared it with the other board members.

Did they take Cancer Risk Check? "Oh, yes, we all took it," Wendy told me, "and we all discovered we're really bad at a lot of things." She rattled off a list: making healthy food choices, exercising, not smoking and not drinking alcohol -- all habits that reduce a person's risk of developing many cancers.

Ronnie hadn't been very good at these things either, she said. "He didn't eat right," Wendy told me. "Ronnie had a diet of meat, potatoes, pasta and rice. And alcohol, of course. He almost never ate fruits and vegetables."

Making changes
Taking Cancer Risk Check gave Wendy and the other board members a wake-up call -- one much stronger than I'd expected.

"One of our board members is very overweight, and now he's taking another look at his diet and exercise habits. He even plans to get tested for different cancers." Wendy paused, then added, "Actually, we've all arranged to see our doctors for cancer screening exams in the next few weeks."

Doing it for Ronnie
Wendy, as her post on Facebook hinted, wants everyone to use Cancer Risk Check, especially men, who are less likely to see a doctor. "It's important for people to be more aware of cancer risks and find out what tests they need," she told me.

This is exactly why MD Anderson's disease experts created Cancer Risk Check. "We created this online tool to be simple to use and to empower individuals to take actions for a healthier lifestyle," says Therese Bevers, M.D., medical director of MD Anderson's Cancer Prevention Center and Prevention Outreach Programs.

Before we hung up, I asked whether Ronnie might have gotten screened for cancer sooner if he'd used Cancer Risk Check.

"I think he would have," Wendy said. "If we'd known about different screening tests and things that can cause cancer, Ronnie may have been better about taking care of his health."

Take Cancer Risk Check at

Pediatric Ethics

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By Jessica A. Moore, D.H.C.E., Clinical Ethicist and Instructor, Section of Integrated Ethics in Cancer Care

Jessica_Moore_J.JPGPediatric ethics is a vital part of most clinical ethics services in the hospital setting. Devotion to study of and practical attention to issues unique to the field of pediatric medicine are essential for an ethics consultation service in hospitals with pediatric patient populations.

In many hospitals, pediatric ethics is a vibrant field of clinical practice in its own right. Throughout the year, there are numerous conferences that attend to the issues prevalent to pediatric ethics. As an ethicist who strives to excel in the competencies necessary for practice in both adult and pediatric ethics, I attended two important pediatric ethics conferences this year. Both conferences offered the opportunity to expand upon and strengthen my knowledge and experience in pediatric health care ethics issues, so that I might be a beneficial resource to the faculty, staff, patients and families at the MD Anderson Children's Cancer Hospital.

In April, Colleen Gallagher, Ph.D., chief and executive director of the Section of Integrated Ethics in Cancer Care, and I attended a conference hosted by the Cleveland Clinic. "Pediatric Ethics 2010: Advancing the Interests of Children" was sponsored by the network of children's hospitals in the Cleveland/Akron area including: The Children's Hospital of the Cleveland Clinic, Akron Children's Hospital, Hospice of the Western Reserve, MetroHealth Medical Center, University Hospitals Case Medical Center and Rainbow Babies & Children's Hospital.

Invited speakers came not only from the sponsoring institutions but from respected pediatric ethics programs around the country. The conference offered plenary and breakout sessions valuable to new and experienced pediatric health care professionals.

Topics included:

  • clinical ethics tools
  • health care policy matters
  • differences of opinion regarding care decisions
  • health care reform
  • maternal-fetal dyad
  • organ transplantation
  • institutional interests
  • palliative care
  • epidemiology
  • ong-term interests of families
  • legal cases
  • withholding and withdrawing life-sustaining interventions,
  • resource utilization
  • suffering and quality-of-life
  • child abuse
  • alternative medicine and
  • assent and dissent,
  • adolescent confidentiality

The most important message that I brought home from the very first plenary presentation of this conference was the lesson to carry multiple tools in my toolbox and use the appropriate one at the appropriate time. This is a reminder to remain open to multiple perspectives and alternate solutions.

In July, I attended the annual conference of the Texas Pediatric Palliative Care Consortium, "PEDI-HOPE Conference 2010: Pediatric Hospice and Palliative Essentials." This conference was sponsored by the Texas Pediatric Society Foundation, Texas Academy of Palliative Medicine and Texas & New Mexico Hospice Organization. This conference was also an opportunity for new and seasoned professionals in pediatric health care to share their experiences and learn from each other. The focus of this conference was more specific to the needs of children with life-limiting conditions than the one discussed above. Topics included:

  • the concept of hope
  • spiritual needs of children and families
  • caregiver grief
  • family grief
  • pain and symptom management
  • ethical dilemmas
  • pediatric palliative care in the academic setting
  • communication skills
  • national guidelines
  • financial concerns
  • care of complex chronic condition

The first plenary session of the conference was an extremely important one for practical purposes. One of the student objectives of this presentation was to learn how to maintain honest communication with a patient and family and, at the same time, support enduring hope. This is a skill with which many of us struggle. The speaker provided many useful strategies aimed at improving this professional skill. I came home from this conference with a renewed focus on supporting the members of our multidisciplinary pediatric patient care team in their times of grief.

The Dream Horse Project

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By: Ian Cion, Artist in Residence, Children's Cancer Hospital, MD Anderson

Through the Arts in Medicine Program at MD Anderson Children's Cancer Hospital, my goal is to help make art a meaningful part of the lives of our young patients. When I meet with patients, I try to find out their interests so I can integrate art with their other passions. This not only helps build enthusiasm in the patient about making art, but it also serves to integrate a positive part of their personal world into their hospital experience.  

One great example of this process is the Dream Horse Project, created in collaboration with Maria Munoz, a talented young adult stem cell transplant patient who I began working with in May 2010.  

I had just finished working with a patient in The Park at MD Anderson when Maria introduced herself to me. She told me that she liked to draw but as her work obligations increased, she had less of a chance to do so. I offered to work with her while she was at MD Anderson for her stem cell transplant.

During our first art session, she told me about her love of horses and showed me a photograph of her horse. As her treatment prohibited her from coming in contact with her horse, she was feeling a real sense of loss and greatly missed both the companionship and the responsibilities. 

With this in mind, Maria and I began a series of drawings based on and inspired by the idea of eventually body-painting one of her horses. By setting a large-scale, long-term goal and establishing time each week to work towards this goal, the Arts in Medicine Program served as an integral part of making Maria's experience at MD Anderson a positive one. Over the course of the three-month project, even her doctors began to notice a difference in how she coped with her treatment.

One of the objectives of our program is to implement art projects that are grand in scale so that we can help expand patients' understanding of what is possible for them to accomplish, both as artists and as individuals. I have shown other patients photos and video footage of Maria's horse. When they see the scope of her project, it opens up the possibilities for what we can create in collaboration going forward.

Ian Cion Artists In Hospitals Blog

By: Rakhee Sharma, MD Anderson Staff

Tonya Edwards plants seeds and watches them grow into beautiful flowers. She's not a florist; she's a senior research nurse in the Department of General Oncology at MD Anderson, and her "growing season" is every day.

In 1995, MD Anderson started a small satellite general oncology clinic at Lyndon B. Johnson General Hospital. LBJ is a community hospital situated in an economically disadvantaged, underserved area of northwest Houston. Over the past 15 years, this clinic has developed into a program that provides research-driven oncology care to underserved and ethnically diverse cancer patients in the region. LBJ patients even have access to many of the clinical trials offered at MD Anderson's main campus in the Texas Medical Center.

Edwards spends three days a week at LBJ, where she sees all of her patients. As a nurse, her goal is to bring research from MD Anderson labs out into the community. She educates patients on the clinical trials available to them, enrolls them if they are eligible, and then monitors and tracks their progress. This is where Edwards tends to her proverbial garden.

Bringing MD Anderson into the community

"LBJ patients are offered the same chemotherapies and are also being offered more clinical trials to choose from," Edwards says. "Our faculty offer the latest treatments and make decisions based on what's best for the patients."

For clinical trials to ensure that the most people are benefiting from research advances, a more diverse patient population must participate.

Last year, 1,321 patients were seen in the medical oncology clinic at LBJ. Of those, 24% were enrolled in all protocols (including epidemiology and symptom research) and 2% were enrolled in therapeutic trials. Of the patients enrolled in all trials, 13% were white, 57% Hispanic, 27% black and 2% Asian or other races. These numbers are higher than the national average, and Edwards anticipates they will increase as the program grows. 

So far, MD Anderson's collaboration with LBJ has been a success in educating and enrolling more minority patients to clinical trials. But Edwards knows this is just the topsoil and there are many more buds waiting to bloom, so she keeps educating her patients.

"We thank each patient individually for participating in research clinical trials. Although the benefit may not come for that particular patient, the research will benefit someone else in the future. It's just a matter of time."

An MD Anderson physician-scientist who uses a mathematical program to pull lung function data from CT scans in hopes of improving treatment of lung cancer and other diseases has won an NIH Director's New Innovator Award from the National Institutes of Health.

The award provides $1.5 million over five years to Thomas Guerrero, M.D., Ph.D., associate professor in Radiation Oncology. Guerrero and colleagues have developed a mathematical program -- an algorithm -- designed to more accurately identify damaged areas of the lung.

"Our goal for lung cancer is to reduce toxicity caused when patients receive radiotherapy, and to characterize chronic obstructive pulmonary disease, or COPD. Our research methods produce images of the distribution of lung function, or lack of lung function, throughout the lung in these patients," Guerrero says. The grant will fund a lung cancer clinical trial and a study of lung function characterization in COPD.

"Dr. Guerrero's work represents a novel, noninvasive imaging method for better understanding of lung function, which will enable us to further personalize radiation treatment planning to provide the most effective and the safest treatment of lung cancer," says Thomas Buchholz, M.D., professor and chair of the Department of Radiation Oncology.  

The NIH announced 52 awards Thursday granted out of 2,200 applications.

"NIH is pleased to be supporting early-stage investigators from across the country who are taking considered risks in a wide range of areas in order to accelerate research," says Francis S. Collins, M.D., Ph.D., director of the National Institutes of Health. "We look forward to the results of their work."


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