Cancerwise | Cancer blog from M. D. Anderson Cancer Center

Max - imize Yourself ...

2009-11-06T22:50:27Z

Renowned artist Peter Max will donate a custom portrait to benefit the Children's Art Project at M. D. Anderson Cancer Center

Peter Max, who capitalized on the psychedelic 60s and is still painting today, loves to combine his passions for painting and astronomy. In November, he will jet his way to the Off the Wall Gallery in the Houston Galleria where a special selection of his recent works, "Colors of a Better World," will be on display.

Max, who was born in Germany, still finds himself fascinated by his original interest in the universe and astronomy. He explains that the comparison of the size of a person to the size of the earth is an incredible thought. "I'm just amazed at this universe and still wonder how it happened," he said.

However, a chance invitation to attend art school got in the way of his desire to be an astronomer. "I went to art school and got the bug," Max explains. However, his artwork is filled with suns and moons and stars, all astronomical images.

Based in New York City, Max says that he can't wait to get to work each morning and always hates to leave. Fortunately, he lives near to his studio where he comes in daily to paint.

Along the way, Max also discovered his philanthropic side. To that end, he is donating the painting of a custom portrait to a lucky bidder in a silent auction at the Off the Wall Gallery. Bids may be placed at the Houston gallery beginning Saturday, Nov. 7 and continuing through Saturday, Nov. 14 at 8 p.m.

The winner of the portrait will be notified at the event or by phone on Monday, Nov. 16, 2009. All proceeds from this auction will go directly to the Children's Art Project at M. D. Anderson Cancer Center to help make life better for children with cancer. Through worldwide sales of young cancer patients' original artwork featured on seasonal note cards and gifts as well as through generous donations, the project has funded offerings from the Children's Cancer Hospital such as educational programs, college scholarships, summer camps, ski trips, the Child Life program and other exciting activities that benefit cancer patients and their families.

Don't miss this chance to see the recent work of Peter Max. Previews of the art begin Nov. 7 at the Off the Wall Gallery in the Houston Galleria. Max himself will be at the gallery on Saturday, Nov. 14 from 6-9 p.m. and Sunday, Nov. 15 from 1-4 p.m. The gallery would appreciate an RSVP, 713-871-0940, if you plan to come by.

Clinical Trial Key to This Patient's Success

2009-11-06T20:07:38Z

The New York Times article by Gina Kolata -- Forty Years' War, A Place Where Cancer Is the Norm -- made my heart swell with pride to be part of the M. D. Anderson team and my eyes well with tears for those whose struggles she wrote about.

I think about the thousands of patients I have had the honor to care for over the last 30 years. I wish Kolata could have met my patient Dorothy.

Flashback to 1979, I was a new oncology nurse at M. D. Anderson when I met this 38-year-old, petite and strikingly beautiful brunette who had advanced cervical cancer. Her doctors at home told her that she had only one year to live.

Dorothy came to M. D. Anderson searching for treatment that would allow her to live to see her 10-year-old daughter graduate from high school. She entered a clinical trial receiving intra-arterial chemotherapy using a then-new drug named Cisplatin. Dorothy received this drug for four months. It wasn't for the weak of heart. She lost her hair, vomited and was exhausted for two weeks after the chemotherapy was completed. Just as she began to feel "normal," it was time for the next round of therapy. Then the treatment regimen was complete.

For the next five years or so, I saw Dorothy when she returned for her doctor's visits. We'd share stories about our families while she anxiously awaited her test results. After her doctor would give her the results of yet another "clean" CT scan, she would give us a hug and huge sigh of relief.

Dorothy beat her cancer with what I think Kolata would call "unconventional treatment." For Dorothy, this was a clinical trial.

T Helper Cell Directs an Immune System Strike against Cancer

2009-11-05T16:04:28Z

Cancer eludes, suppresses or subverts the body's immune system to survive and grow.
Scientists at M. D. Anderson have found that the helper T cell Th17 awakens the immune system to attack and destroy tumors with custom-made killer T cells. Professor of Immunology Chen Dong, Ph.D., and colleagues report their findings online today at the journal Immunity.

Working with a mouse model of metastatic human melanoma tumors, the researchers show that the absence of Th17 led to virulent growth of melanoma in the lungs, while injecting Th17 cells prevented melanoma development and destroyed existing tumors. Th17 secretes the inflammatory protein interleukin-17 (Il-17), which launches the immune system response.

"While there is much work to be done, these preclinical findings imply the possibility of taking a patient's Th17 cells, expanding them in the lab, and then re-infusing them as treatment," Dong said. Development of a vaccine to stimulate Th17 cells would be another possible application.

Dong is co-discoverer of Th17, one of only four known types of T helper cells that guide adaptive immune system response. His team also established that Th17 produces interleukin-17 and further showed that overexpression of IL-17 causes both autoimmune and inflammatory diseases.

Th17's involvement in autoimmune disease is probably why it is able to recognize and attack cancer, which is also self tissue. "So a key to developing therapy will be to use Th17 cells that only recognize tumor antigens but do not react to normal tissue," Dong said.

Read the full News Release
AAI Honors Chen Dong for Breakthrough T Lymphocyte Research

A Place Where Hope is the Norm

2009-11-04T14:59:09Z

It's a matter of time. I have no doubt about it. The human will, determination and intellect that invented electricity, the phone, the radio, airplanes, the polio vaccine and penicillin, and that put a man on the moon, will definitely find the cure for cancer. Yet, I agree with most, including those who expressed their frustration in the recent New York Times article, that the war on cancer is taking too long to win. It's a war that we have to win.

According to the American Cancer Society (ACS), 1,479,350 people in the United States will be diagnosed with cancer this year, and it's expected that 562,340 will die from it. In fact, cancer is the second most common cause of death in the U.S., accounting for 23% of all deaths. This means that one of four people living in the U.S. will eventually die of cancer.

These numbers are even more dreadful when you consider the global impact. The World Health Organization predicts that the number of people worldwide living with cancer will rise from about 28 million today to about 75 million in 2030. The challenge is so big, and those of us on the front lines have no illusion of what we're facing. The New York Times article clearly articulated this challenge.

But to balance these dismal statistics, one has to keep in mind that more and more people survive cancer every year. In 2005, the ACS estimated that more than 11 million cancer survivors were in the United States, and this number continues to increase.

In my own subspecialty, there are many success stories. For example, over the past decade, the expected survival of patients with indolent lymphoma has increased from an average of eight years to 15 years. For mantle cell lymphoma, it increased from 1.5 years to more than five years, and for Hodgkin's lymphoma the cure rate improved from 30% in 1960 to almost 80% today.

More broadly, after almost three decades of a stalemate, cancer mortality is starting to slowly decrease. Furthermore, our knowledge of the basic molecular and genetic structure of cancer cells has exploded, identifying new therapeutic targets. A decade ago, only a few drugs were in development for cancer. Today, there are more than 800 drugs, with more coming. So I'm confident that we're on the right track, and it's only a matter of time until we find the cure.

So how do we speed up the process? In my opinion, one of our biggest challenges is the inadequate participation of patients in innovative clinical trials. The public is rightly expressing frustration on the slow progress. But to demand and expect speedy development, they also have to actively participate in clinical trials. With an average of less than 10% of cancer patients participating in clinical trials in the U.S., one shouldn't be surprised that the field is moving forward at a slow pace.

When I read the New York Times article, I was concerned that, despite the challenges that we all face in the war on cancer, a message of hope may have been unintentionally missed. So I posted the article on my Facebook page and asked my followers, many of whom are patients and cancer survivors, to comment.

To lead the discussion I stated, "While I agree that there is so much work to be done, the article should have provided a more balanced picture of the many patients who are cured of cancer and are living a normal life with their loved ones. I also think that we need to move away from the currently available harsh treatments that are debilitating. We need to develop more gentle targeted therapy that are effective but maintain a good quality of life ..." And here are some of the comments that were posted:

"I can see and understand your point of view, Dr. Younes. At the same time, I'm also glad that the author expressed the gravity of the cancer battle. Too often these days, I think, people who haven't been touched by the disease assume that modern science has evolved to the point that cancer is uniformly curable with one shot. That belittles the gravity of the malady and the fight patients wage each and every day. If this article informs that viewpoint, I'm grateful. That said, I do agree with you that there is great hope, and that's what we must focus on to advance treatment and management of cancer. Thank you, speaking from my heart and as a survivor, for your efforts on that front!"

"I could not agree more Dr. Younes - the article really focuses on the most difficult cases ... but that is why the people with difficult cases come to MD Anderson - b/c MDA will stop at nothing and will always give you hope ..."

"My time at MDA was the best medical experience I've ever had. Ironic, given it was related to the worst diagnosis I've ever had. Thanks for sharing!"

Having worked at M. D. Anderson for the past 16 years, I know that the message of hope prevails on everyone's face and is implanted in everyone's soul. I see it on the faces of everyone who works here, from the president to the cleaning crews. After all, it's this spirit of optimism, dedication and hope that will help us eliminate cancer in Texas, the nation and the world.

Love and Support Help Gulf Coast Resident Cope With Brain Cancer

2009-11-03T21:16:07Z

By Tomise Martin, Staff Writer

When Patrick Williams was diagnosed with an aggressive form of brain cancer called glioblastoma multiforme, the three constants he'd always cherished -- family, laughter and colleagues -- helped him cope.

A 27-year veteran of the fire department in Ocean Spring, Miss., he recalls feeling lightheaded and unable to find his balance one day after a staff meeting.

"I couldn't focus, and I needed to brace against a wall for support," Williams recalls. "All I wanted was to go home and take a nap."

Luckily a friend and colleague, trained as a registered nurse, noticed Williams' difficulty and quickly reacted.

"Initially, he and I joked about me slowing everyone down," Williams says. "The banter turned to concern once he heard my symptoms."

As the colleague was taking him to a local hospital, Williams had a seizure. Tests showed he had a brain tumor and would need surgery. It was unknown whether the tumor was cancerous or non-cancerous.

"When anyone mentions cancer, my family thinks of M. D. Anderson," Williams says. "There was no question about my next step."

His first appointment
Days later, surrounded by a group of friends and family, Williams arrived for his first M. D. Anderson appointment.

His surgeon, Sujit Prabhu, M.D., associate professor in the Department of Neurosurgery, told him the tumor was stage IV glioblastoma multiforme, the most common form of brain cancer, and was located in his right parietal lobe. Prabhu explained that the side effects from surgery could include blurry vision, impaired spatial orientation and headaches.

Three days later, Williams emerged from surgery unable to see images to the far left.

"If a board read 'nurse manager,' I would only see 'n rs m nager,'" Williams says.

Although Prabhu described the possible side effects very clearly, Williams felt unprepared for the outcome. He still considers the experience unreal.

Multidisciplinary care
With a team of brain cancer experts, including a neurosurgeon, neuro-oncologist and a radiation oncologist, Williams benefited from M. D. Anderson's multidisciplinary approach to cancer care.

After surgery, he met with Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology. She checked his neurological functions and discussed the remaining treatment options -- chemotherapy, radiation and clinical trials.

"With chemotherapy and radiation still available, I had no desire to try the third option," Williams says.

Loghin prescribed Temodar® (temozolomide), an oral therapy found to be effective for some patients with glioblastoma multiforme, and referred Williams to Anita Mahajan, M.D., associate professor in the Department of Radiation Oncoloy, for radiation therapy.

To complete his radiation treatments, Williams moved to Houston. While the side effects of treatment were hair loss and nausea, his spirits stayed high with frequent family outings and dining at his favorite restaurants.

Try, try again
During a follow-up appointment with Loghin about six weeks later, Williams learned that the brain cancer had not responded to chemotherapy. As a result, he chose to join a Phase II clinical trial studying the effectiveness of XL184, an investigational drug, on glioblastoma multiforme.

In January 2009, he received the good news that some tumors had disappeared or stopped growing.

Life as a brain cancer survivor
Life has changed. Williams has retired as fire chief of the Ocean Springs fire department and his energy level has dropped. But his vision has cleared enough so he's able to drive again on a limited basis.

"I plan activities with their needed recovery time," Williams says. "One day of fishing is followed by two days of rest."

But he doesn't let these new details hamper life. He's usually cracking jokes or surrounded by his friends and family. A brother-in-law always accompanies him to follow-up appointments, which are every four weeks.

"I'm fortunate to have the love and support of my family," Williams says. "Life is what you make of it. I choose to live mine filled with laughter and surrounded by my loved ones."

Related article:
Q&A: Coping With a Brain Cancer Diagnosis and Treatment

M. D. Anderson resource:

Brain and Spine Center

Additional resources:
Brain Tumors (American Cancer Society)

Brain Tumor (NCI)

Q&A: Coping With a Brain Cancer Diagnosis and Treatment

2009-11-03T14:05:28Z

A cancer diagnosis can be a shock. But a brain cancer diagnosis is even more challenging. A malignant brain tumor can impact patients' thoughts, speech and communication, and motor skills, and perhaps their ability to financially support themselves or their families.

Brain cancer is a rare disease that originates in the brain, spinal cord or nerves. According to the American Cancer Society, more than 22,000 people will be diagnosed and nearly 13,000 will die from brain cancer in 2009.

Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology at M. D. Anderson, answers questions on how to deal with a diagnosis and cope with the side effects of both the cancer and its treatment.

What can I expect during my first appointment?
During the first appointment, I always discuss the patient's diagnosis and treatment options. Many patients, however, feel overwhelmed during this appointment and may choose not to discuss details about treatment. In this case, I advise them to take it one step at a time and only gather information that they're able to cope with during their first visit. I suggest having a loved one present during appointments. They can provide emotional support through this process and be an extra pair of ears.

Here are some key questions to ask at a first appointment:
•   Is this a definitive diagnosis?
•   What type of tumor do I have?
•   What are my treatment options?
•   What support services are available to assist during my treatment?

What are the treatment options?
Depending on your diagnosis and type of cancer, a combination of the following treatments could be available:
•   Surgery
•   Radiation
•   Chemotherapy

Each treatment and the associated side effects are discussed with the specialist managing a patient's care.

As a neuro-oncologist, I manage the patient's chemotherapy. We discuss the side effects and concerns the patient or caregivers may have regarding therapy.

The selection of chemotherapy is based on the type of tumor and functional status of the individual diagnosed with the disease. If a patient is physically or mentally impaired, I choose a therapy with low toxicity. In addition, monitoring the individual's health during treatment is very important. When discussing treatment options with the patient, I share my reasons for choosing the chemotherapy, the side effects and any support M. D. Anderson offers.

What are the side effects of chemotherapy?
The usual side effects of therapy are:
•   Nausea
•   Constipation
•   Vomiting

How will treatment impact daily life?
Because chemotherapy impacts each patient differently, it's challenging to anticipate how each one will respond to treatment.

For some patients, chemotherapy may not impact their lives. They can continue working full time and maintain their full neurological functions. This isn't always the case, however. Those receiving treatment may be unable to continue working, which could impact their ability to financially support their families.

My goal is to help patients and family members cope with potential changes in their lives. I explain that treatment can leave patients unable to complete tasks that were once easy for them. They may not be able to think as quickly as before. When psychological effects like these arise, I involve our psychiatry team. The psychiatry team can help those diagnosed and their family members cope with these changes.

At M. D. Anderson, we have an education clinical pharmacologist on staff help monitor each person's care. Every eight weeks, I evaluate patients' responses to treatment and the impact on their health. These evaluations allow me to make any necessary changes to the treatment schedule. If patients are responding to treatment, we discuss whether or not they can return to work -- or do so on a part-time basis.

What services can patients and caregivers seek to help them adjust and cope?
•   Look for social workers in your community. They can assist with transportation, parking or support at home. If patients exhibit neurological deficits, social workers can evaluate patients' at-home needs through home health support.
•   Sometimes a therapist can help patients and caregivers cope with a cancer diagnosis and the emotional side effects from treatment.
•   Many communities have support groups available to patients and their caregivers. These groups offer support and guidance from others who are facing or have overcome similar challenges.

Related article:
Love and Support Help Gulf Coast Resident Cope With Brain Cancer (November Cancerwise FA1)

M. D. Anderson resources:

Monica Loghin, M.D.

Brain and Spine Center at M. D. Anderson

Additional resources:

Brain Tumors (American Cancer Society)

Brain Tumor

Neuropathy: It's More Than a Feeling

2009-11-02T14:37:01Z

By Bayan Raji, Staff Writer

For some cancer patients, reactions to certain medications and treatments create tingling sensations -- similar to when you sit on your foot too long -- that don't go away.

This tingling, known as neuropathy, typically begins on the palms of the hands or the soles of the feet. Eventually, it may become painful and debilitating.

About half of cancer patients who receive chemotherapy drugs experience neuropathy. In about one-eighth of patients, the pain may become chronic.

Drugs may play a role

Neuropathy can be caused by radiation, surgery or chemotherapy drugs, including taxanes, platinum, Oncovin® (vincristine) and Thalomid® (thalidomide). It often is irreversible and even may worsen over time.

Common symptoms of neuropathy include:
•   Numbness
•   Tingling
•   Prickling
•   Burning, shooting or pinching pain
•   Cramping

Patrick Dougherty, Ph.D., professor in the Department of Anesthesia and Pain Medicine at M. D. Anderson, says patients should bring these symptoms to the attention of their doctors.

Cause may be elusive

Some doctors believe neuropathy is caused when the interaction between nerve endings and the surrounding tissue is affected during chemotherapy. However, no concrete evidence exists to explain the origins of the neuropathy some cancer patients experience.

"The cause may be difficult to determine because these drugs are very different from one another, and they work differently to kill the cancer cells," Dougherty says.

Trial and error may be necessary

Allen Burton, M.D., chair of the Department of Pain Medicine, says doctors may try several methods to reduce neuropathy symptoms.

"When the symptoms are acute, and the patient is receiving, or has recently finished, chemotherapy, the oncologist may lower the dose or extend the time between doses of the drug that are suspected of causing neuropathy," Burton says. "Often, the problem drug is a component of a combination chemotherapy regimen."

Drugs used to treat severe or chronic neuropathy cases include:
•   Opioids (pain medications)
•   Anticonvulsants such as Neurontin® (gabapentin) and Lyrica® (pregabalin)
•   Antidepressants such as Cymbalta® (duloxetine) or Elavil (amitriptyline)

These medications, in conjunction with physical therapy, often help reduce pain and restore the patient's ability to function, Burton says. Occupational therapy may be useful if the patient's hands are affected by neuropathy.

Alternative therapies may help

In addition to medication, doctors may advise patients to try integrative medicine approaches. These may include:

•   Physical therapy
•   Acupuncture
•   Aromatherapy
•   Heat therapy

Dougherty recommends patients work down the list to find therapies that work for them. The most helpful place to access information to these and other alternative therapies is a multidisciplinary pain center, he says.

"It's important to note that certain methods may work really well for some patients but make the pain worse for others," Dougherty says.

Risk isn't clear

Doctors aren't able to determine fully who is at risk for neuropathy. Dougherty says his general impression is that younger patients are more likely to experience it than older patients, but no real explanation exists.

Clinicians at M. D. Anderson are working to develop a pain level chart to better categorize the sensations of neuropathy.

In addition, researchers are conducting several clinical trials for patients with or at risk for neuropathy. Contact askMDAnderson at 1-877-MDA-6789 for information.

Related articles:

Bridging the Divide (Conquest)

Cancer and Neuropathy (Patient Power webcast)

M. D. Anderson resources:
Peripheral Neuropathy

Department of Pain Medicine

Additional resource:
Peripheral Neuropathy Caused by Chemotherapy (American Cancer Society)

Cancer Newsline... This Month in Cancer News - November 2009

2009-10-31T13:42:15Z

Toad Venom May Help Treat Cancer

Huachansu, a Chinese medicine that comes from venom secreted by the skin glands of toads, may slow the growth of cancer in some patients and do so without significant side effects.

Researchers at M. D. Anderson and Fudan University Cancer Hospital in Shanghai, China, reported their Phase I clinical trial findings Aug. 21 in the online Early View feature of the journal Cancer.

Stereotactic Radiosurgery Preferred for Brain Metastases

Cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) to treat 1-3 metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone.

Findings from a Phase III randomized study led by M. D. Anderson researchers were published in the Oct. 5 online edition of The Lancet Oncology.

Cancer Newsline Podcast Series

New Breast Cancer Screening Guidelines
Therese B. Bevers, M.D., Professor in the Department of Clinical Cancer Prevention explains the newly released breast cancer screening guidelines. Dr. Bevers discusses how the new guidelines address women at higher risk of being diagnosed with breast cancer and when and how often they should be tested by mammogram or breast MRI.

Why Legs Get Restless, What to Do

2009-10-29T16:28:22Z

By Dawn Dorsey, Staff Writer

Getting a good night's sleep when you have cancer can be a challenge. In addition to treatment side effects and anxiety, a condition known as restless leg syndrome (RLS) gives some sleepers fits.

As many as one-tenth of adults are affected by RLS, according to the American Academy of Sleep Medicine. It's likely that figure is even higher among cancer patients.

What is RLS?

RLS, which happens most frequently at night when a person is at rest, causes a strong, undeniable urge to move the legs. Many people with RLS also have paresthesia, uncomfortable feelings deep in the legs that often are described as burning, tingling or prickling.

Many people with RLS also have periodic limb movements, in which muscles tighten, twitch or flex when they are resting. These movements may wake them or another person sleeping nearby.

RLS and its accompanying conditions are roadblocks to sleep quality and quantity, which is so important to the health of cancer patients. Among other dangers, sleep disruption may affect the immune system and endocrine (hormonal) function, since hormones are produced during certain levels of sleep.

Triggers are varied

RLS causes may include:

•   Iron deficiency
•   Medications including:
•   Nonprescription allergy and cold medicine like Benadryl®
•   Antidepressants like Elavil® and Prozac®
•   Major tranquilizers like Haldol®, Mellaril®, Thorazine®
•   Family history of RLS

Solutions depend on severity

For mild cases of RLS, try:

•   Establishing a regular daytime exercise program
•   Taking hot baths
•   Getting leg massages
•   Using a heating pad
•   Avoiding alcohol
•   Doing stretching exercises like yoga or Pilates late in the day

If your iron levels are low, talk to your doctor about oral or intravenous iron treatments.
More severe RLS may be treated with drugs including:

•   Requip® (ropinirole) or other dopaminergic agents
•   Benzodiazepines, such as Valium® or Xanax®
•   Opiates, such as Vicodin®

If you experience RLS symptoms, tell your doctor or health care provider.

Related article:

Cancer Patients Need to Treat Sleep Disorders

More Older Women Receiving Lumpectomies, Yet Disparities in Treatment Still Remain

2009-10-28T16:37:25Z

By Laura Sussman, Staff Writer

While older women with early invasive breast cancer are increasingly undergoing breast conserving surgery (BCS), commonly known as lumpectomy, significant socioeconomic and geographic disparities still preclude some from receiving the therapy, according to a study published in the Journal of the American College of Surgeons.

Led by Grace Li Smith, M.D., Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Radiation Oncology, the study compares the use of lumpectomy to that of the other surgical option available to women with early invasive disease, mastectomy.

Combined with radiation, lumpectomy has proven to be as effective as a mastectomy for the treatment of early invasive breast cancer, yet previous studies have reported that less than half of all patients eligible receive this option, said Smith.

"Treatment of nonmetastatic invasive breast cancer has improved significantly over the past several decades, but we continue to fall short of the goal to treat every woman with the highest quality of care," said Smith. "Our study suggests that barriers exist that may prevent may women with breast cancer - especially those in poorer areas, areas with low education levels, rural communities and counties with few radiation oncologists - from being offered every treatment that should be available to them."

For the retrospective study, Smith and her M. D. Anderson colleagues used Medicare claims to examine the treatment history of women 65 and older who were surgically treated for invasive breast cancer in 2003.

Of the 56,725 women identified, 59 percent underwent a lumpectomy, compared to 41 percent who received mastectomy. BCS was used most frequently in women younger than 70 and had no lymph node involvement. In contrast to mastectomy, the study also found BCS more prevalent in areas with low poverty, high education, a high population of treating radiation oncologists and/or in larger metropolitan areas. Looking at geographic regions, the researchers found that women in the Northeast and Pacific West were most likely to receive the procedure, while the South and parts of the Midwest were the least likely.

Smith hopes that results from the study may prompt physicians and patients to work together to overcome some of the barriers to treatment.

"Physicians may be able to help women identify specific barriers to their care and be influential in helping patients overcome such obstacles," suggested Smith. "Or, if there are concerns or misconceptions about surgical options, patients themselves may play a role by becoming educated about the value of lumpectomy as an appropriate therapy, and helping to disseminate this information into their communities."

Bringing Ourselves Into Patient Care

2009-10-27T14:44:02Z

Sitting with the boys from Little League and their parents on Saturday night, a parent (and friend) surprised me when he said, "I know a lot about your Dad." He told me my Dad's name and he knew that his birthday was on Valentine's Day. It turns out that he had met the spouse of a former patient of mine, and she remembered me fondly and recalled this information that I had shared. I wondered ... what was the context for me sharing this about my Dad and was that appropriate?

The next morning, I read the front page article in the New York Times about M. D. Anderson Cancer Center. The question on my mind after reading this article is whether or not the story captured the essence of our top-ranked institution.

There are many perspectives on the story, depending on whether you talk to faculty and staff or patients familiar with M. D. Anderson, or other people who are mesmerized by the story but unfamiliar with our center. To me, of the images and various vignettes in the story, the most striking was that of a singular mission -- to eliminate cancer in Texas, the nation and the world -- and an ambitious and compassionate approach.

The nurse (Cindy Davis) and the physicians (Marty Raber and Patrick Hwu) featured were all intimately connected to their patients, striving to do everything in their power and professional scope to understand their patients in all possible dimensions, and most of all to help. The mission was personal to each of them, and this is how things go around here.

I wrote in an earlier post about the concept of buoyancy (the force that keeps us afloat) and some of the factors that this force has in each of us. To me, compassion is derived from the combination of our own buoyancy plus empathy (the process of understanding and being sensitive to the experience and feelings of another). As such, it's important to bring something of ourselves in order to be fully compassionate.

The idea of sharing something intimate, as a physician, can be humanizing and helpful to our patients. This was discussed in the New York Times wellness blog, and there was a strong acknowledgement that it can be an important and useful feature in caring for patients (as long as the intent and ultimate focus is squarely with the patient).

As I sit in my office and watch the storms approach here in Houston, I think I understand a bit better why I might have shared something intimate with a patient about my Dad.

The Nobel Prize in Medicine and Creative Minds

2009-10-26T21:35:42Z

Every October, scientists and the public from around the world eagerly await the announcement of the winners of the Nobel Prize in Medicine. This year, the prize was given to three U.S. scientists for the discovery and identification of telomeres and telomerase, a process that seals off the tips of chromosomes like the cap on the end of shoelaces, and is a key to understanding both aging and cancer.

Telomeres are essentially caps that protect the ends of chromosomes. The telomerase enzyme determines the length of the caps. The longer the caps, the more frequent the chromosomes can be copied, therefore, controlling how often the cell divides.

The potential impact of this discovery is obvious. Inhibiting the enzyme activity can reduce the cell capacity to divide, a hallmark of cancer. In aging cells, the caps, or telomeres, become shorter. Thus, maintaining telomerase activity may prevent aging.

The Nobel Committee cited the scientists' work that was published approximately 30 years ago (telomeres in 1978 and telomerase in 1985). This means that two of the recipients were in their 30s and one was in her 20s when they made these discoveries.

Intriguing selection process
The secretive nomination and selection process of the committee remains intriguing, and continuously generates rumors and fascinating stories. According to Alfred Nobel's instructions in his will, the committee members should always be selected from the Karolinska Institute faculty in Stockholm. In 1901, the committee included 19 members. Today, it includes 50. A total of 195 individuals have received the Nobel Prize in Medicine.

I visited Karolinska Institute in 1999, and had the opportunity to meet with its president, Dr. Hans Wigzell. At the time, Dr. Wigzell was the chairman of the Nobel Assembly that awards the prize in medicine. The following year I invited him to visit M. D. Anderson and to give a lecture on his scientific work in immunology. However, my hidden agenda was to get him to meet with our young medical oncology fellows, to discuss the award and to inspire them. He graciously accepted the invitation.

As planned, Dr. Wigzell met with our fellows in a small conference room over coffee and bagels. The informal meeting lasted 90 minutes, and the discussion spanned many interesting topics and anecdotes regarding the Nobel Prize. Although he couldn't reveal any secrets, he provided very important facts and insights.

The first fact was that nominations are kept very secretive and are not released to the public. You know that you got the prize when someone calls you from Stockholm early in the morning, shortly before the announcement is made public. So this is not like the Oscars. Although several investigators are nominated on a short list, the names remain secret and, therefore, there is no reward or even an acknowledgement for being nominated. Nothing to write about in your C.V.

The second fact was that no matter how important the discovery might be, the award is given only to a living scientist. No award is given after death.

The third, and most important observation that I recall from our meeting with Hans Wigzell, was that the majority of awards were given to scientists for discoveries that they made when they were young, mostly when they were in their 30s. A remarkable observation that strongly endorses the notion than many creative ideas come from young, unestablished investigators.

However, these discoveries have to be validated over time, and thus the awards are frequently given 20-30 years after their discoveries. This year's award was no exception.

Funding the young still critical
As research funds continue to decrease, a debate in the scientific community is focusing on who should get more research support: established senior investigators or new junior investigators. No one argues that established senior investigators should continue to receive research funding. However, a quick look at the history of the Nobel Prize and its laureates should convince everyone that funding young investigators is also critical for the continued progress through major discoveries that will have the greatest impact on humanity.

Health Care Debate Should Include Cancer Survivors' Voices

2009-10-22T17:13:35Z

You would have to be living on a deserted island these days not to hear about health care reform. Reforming the American health care system was a key aspect of President Obama's domestic agenda and Congress is moving this initiative forward.

But advocacy and industry groups, the public and elected officials, and even policy wonks have been talking about the need to make reforms to our nation's health care system for years. While one group's interest may be slightly different than the next, all are voicing their opinions on what's working and what's not working. One voice that needs to be heard is that of cancer survivors.

So as health care discussions continue this fall, be sure to let your family and friends know your perspective about what's important. Attend any health reform town hall sessions scheduled in your area and voice your opinion. Talk with or write to your elected officials and let them know to consider cancer survivors' needs as they set about reforming the system.

This is the story of one cancer survivor's effort to ensure her voice was heard. http://www.allbusiness.com/government/elections-politics-politics-political-parties/13000980-1.html

At a loss of what to say? Most of the time, our elected officials just need to hear our stories. But if you want to say more than that, an advocacy group for cancer survivors, the National Coalition for Cancer Survivors, has posted Lance Armstrong foundation posted its cancer policy platform. Also read the National Conference of State Legislatures Cancer Survivorship: State Policy Issues

M. D. Anderson Updates Screening Guidelines With a Focus on Risk

2009-10-20T16:17:40Z

Cancer screening examinations are medical tests performed when you're healthy and you don't have any symptoms. They help ensure that any existing cancers are identified at their earliest, most treatable stages.

M. D. Anderson has released updated guidelines for colorectal, cervical and breast cancers. The new recommendations are based on how likely you are to develop a certain kind of cancer. Therese Bevers, M.D., professor in the Department of Clinical Cancer Prevention, explains the basis for these important updates.

Visit our website to review the new cancer screening guidelines.

Do you get tests to check for cancer, such as a mammogram or colonoscopy? Did you know that you can make an appointment at the Cancer Prevention Center at M. D. Anderson for these and other preventative cancer screenings.

What do you think about the new screening guidelines?

Ovarian Cancer Drug Research = Improved Survival

2009-10-19T15:44:46Z

Maurie Markman, M.D., vice president for clinical research at M. D. Anderson, talks about a study in Japan with Paclitaxel and Carboplatin, a standard regimen for the treatment of ovarian cancer.

The study results, published in The Lancet on Sept. 20, indicate that dose-dense weekly Paclitaxel plus Carboplatin improved survival of women with epithelial ovarian cancer and may represent a new treatment option.

Markman says, "Here's an example of where we take an established drug and simply learn how to give it better, and we have an important impact on our patients' lives."

Related Articles

Read the article in The Lancet
New Chemo Regimen May Benefit Ovarian Cancer Patients (U.S. News & World Report)