Recently by Sarah Todd Thomas

On March 16, faculty and staff of MD Anderson and Instituto Nacional de Enfermedades Neoplásicas (INEN), as well as representatives of the government of Peru, met in Lima to formally sign a sister institution (SI) agreement.

Administered by MD Anderson's Global Academic Programs (GAP), SI agreements are a concrete expression of MD Anderson's belief that an institution is a valuable partner in the fight against cancer, as well as a willingness to engage collaboratively to further the aims of helping patients and eradicating cancer. In INEN's case, the development of this partnership has been nearly four decades in the making.

INEN-Dubois-and-Vallejos-252x260 (2).JPG

When talking to major players in cancer care, especially leukemia, there is a name routinely referenced. For baseball fans it would be akin to speaking of Mantle, Ruth or DiMaggio, or to the physics crowd similar to discussing Planck, Feynman or Einstein. 

It takes a few discussions with prominent researchers before one realizes there are certain individuals who have had a comparable impact on the world of oncology. An impact, which throughout the remaining story of man will silently ripple, often imperceptible to those who would learn or benefit from it.

What brings together 100 graduate students, head of the Science and Technology Section for the European Union, science attachés from embassies including the United States', speakers from Massachusetts General Hospital and the École Polytechnique Fédérale de Lausanne, and senior industry leaders from Nestlé and MSD Pharmaceuticals to discuss research, cultural exchange and nascent business plans in biomedical science? The annual symposium of the University of Tokyo's Global Center of Excellence (COE) Center for Medical Systems Innovation (CMSI), that's what.

Global COEs are five-year programs awarded to top Japanese universities by the Japanese Ministry of Education, Culture, Sports, Science and Technology. Similar to U.S. Program Project Grants (PO1s) and Specialized Programs of Research Excellence (SPOREs), the COEs bring together cross-disciplinary research teams to tackle important problems in public health.

Kendra Woods, Ph.D., is not your typical researcher. She refers to herself as a researcher/educator, unable to separate the two labels and perceiving one as vital to the other. Her personal goal throughout her career has been to contribute to the education of those who work to understand and better treat cancer.

It should come as no surprise to discover Woods has championed the development of the recently launched MD Anderson Professional Oncology Education classes, available to anyone with a computer and an Internet browser.

MD Anderson and Woods recognized by providing enduring foundational training to international partners, future fellows and trainees, and anyone else interested in better understanding cancer care prior to physically visiting MD Anderson, each subsequent interaction would be more productive. Not to mention, MD Anderson faculty could provide the same information to a multitude of audiences without ever having to make travel arrangements.

Watching the high-quality films will be important preparation for observers and visitors to MD Anderson, who will arrive with a core of information, thereby enhancing every minute spent on the Houston campus.

The first step in developing the courses was to figure out what defined foundational. 

What did health care professionals need and want to know that would underlie both clinical and research focused professionals? To answer this question, Woods and others at MD Anderson surveyed hundreds of researchers regarding possible topics. 

The MD Anderson group concluded the areas with the broadest appeal that would provide the greatest foundational information were:

  • Introduction to Clinical Oncology
  • Survivorship
  • Breast Cancer
  • Inflammatory Breast Cancer
  • Cancer Pathology
  • Cancer Biology

The Survivorship I course, Breast Cancer course and Inflammatory Breast Cancer course are all available online. Upcoming courses include Survivorship II and Introduction to Clinical Oncology, with the remaining categories to follow over the next year.

Another ideal group of lectures, according to Woods, would be the "Core Curriculum" Lecture Series given to incoming fellows in many departments. Woods' hope for the educational future of MD Anderson is that these courses will become part of a broader, integrated effort to disseminate cancer care information to a larger portion of oncology professionals across the globe.

She envisions the training leading to second tier education in the form of:

  • streaming media
  • webinars
  • off-site conferences
  • Internet case studies
  • onsite conferences
  • textbooks
  • collaborative user groups

"I really see this as educating the next generation of educators and researchers," Woods says. "Sharing this information does not decrease our influence, but increases our ability to further MD Anderson's mission of eradicating cancer. This will accelerate everyone's rate of discovery."

Lois Ramondetta's connections to the Middle East are personal and professional. With a husband from the region, she travels frequently to the area and has grown to know and love the people and culture. 

As a result of her personal attachment, she has started to focus on developing collaborative research and knowledge-sharing relationships with her oncologist peers in the Middle East.

Dr Ramondetta and Nuhad.JPGThis fondness for the area and history of interaction made Ramondetta a natural fit for the scientific committee coordinating the Women's Cancer Conference held in late January in Beirut, Lebanon.

Although physician-scientists from several countries attended, including The Kingdom of Saudi Arabia, Iraq and Syria, the event was jointly organized by The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center (AUB), King Hussein Cancer Center (KHCC) in Amman, Jordan and The University of Texas MD Anderson Cancer Center

For Ramondetta, the engagement was preceded by months of video conference calls and e-mail, but was well worth the effort.

"We had a wonderful time and everyone got so much out of the event," she says. "Our hosts were amazing, the discussions were lively and the conference should lead to even more collaboration."

As an associate professor and gynecologic oncologist at MD Anderson, Ramondetta, M.D., has been actively involved in research regarding endometrial and cervical cancer, quality of life issues for cancer patients, and the effect of socio-cultural-economic factors on patients and their care. She brought those interests, as well as a desire to better understand how treatment differs in various regions, to the recent meeting.

"One of the most interesting discussions in the conference was the final session," Ramondetta says. "Members from AUB and KHCC debated the pros and cons of the use of the HPV vaccine in the region."

To Ramondetta, the discussion illustrated that although the Middle East is predominantly a traditional and conservative region, physicians recognize the probability of change.

Physicians in the session debated the recognition of traditional values with the need for medicine to be proactive, as it addresses the prevention of sexually transmitted diseases and the development of an HPV vaccine plan. Although the issue was in no way permanently decided, to Ramondetta, the fact that difficult items such as these were discussed was encouraging and beneficial. 

Also of interest to Ramondetta, and a regional difference that made planning the conference challenging, was the disparate way physicians in the Middle East and elsewhere treat gynecologic cancers. While gynecologic cancers are normally addressed by gynecologic oncologists throughout much of the Western world, in the Middle East, they are often initially treated by a general surgeon or benign gynecologist, followed by a medical oncologist. Ramondetta sees this as an area to encourage collaborative research and training.

"We know women who receive care from a gynecologic oncologist do better during and after treatment," she says. "It would be great to work together to train specialists in this area."

Ramondetta's future collaborative efforts include working with Geri LoBiondo-Wood, Ph.D., associate professor in the Department of Nursing at MD Anderson, and colleagues at KHCC to develop a cooperative research project studying quality of life for cancer patients and the effect of different cultures. 

LoBiondo-Wood, Ramondetta and members of nursing administration from KHCC hope to apply to MD Anderson's Global Academic Program's Sister Institution Network Fund for support and to continue to bolster their research efforts.

"The fact that both AUB and KHCC are sister institutions only increases our ability to work together," Ramondetta explains. "These relationships are going to lead to a lot of opportunities in the future."

In the photo
: Lois Ramondetta, M.D., and Ibrahim Nuhad, M.D., organizers of the Women's Cancer Conference.

These were Maha Kalaji's first words to a family friend physician the morning after she found a lump in her breast during a self-exam. A mammogram later, she was flying from her home in Amman, Jordan, to the United Kingdom, where she was raised, to consult with physicians. One of those physicians recommended The University of Texas MD Anderson Cancer Center for treatment.

With the help of two of her brothers who lived in Houston; she was at MD Anderson within a week. That was in 1993.

"I never associated having cancer with death," Kalaji explains. "I consider myself lucky. Cancer has changed my life, it's made me more realistic and more appreciative. Every day I wake up and am grateful for so many things."

Following chemotherapy, a lumpectomy and radiation therapy for her breast cancer, MD Anderson physicians found cancer in her liver in 1999. Since then, Kalaji has alternated between hormone therapy and chemotherapy to combat the liver cancer. That is until 2009, when surgeons removed 60% of her liver in the hope that it would eliminate the cancer. It did not, and within four months the cancer had returned.

Kalaji continues to visit MD Anderson every three months for check-ups and expects to continue her alternating hormone therapy and chemotherapy for the foreseeable future.

But cancer is only a small piece of Kalaji's story. She continues to reside in Amman, where she is the protocol officer for the United States Embassy.

Sharing her journey
In addition to her role with the embassy, Kalaji has taken on the mantle of educator, most notably through the recent release of her book, "Journey of Confrontation." Currently the book is available in Arabic, with an English version slated for release some time this summer. One of her main objectives with the book is informing patients in the Middle East about what it is like to have cancer.

"I met women who were receiving chemotherapy at King Hussein Cancer Center who did not know why they were there, because their families did not tell them," Kalaji recounts. "I think knowing what is going to happen to you ... what the side effects of chemotherapy are and how it is going to affect you, is important."

Kalaji's book is a sort of chronicle of what it's like to be a cancer patient, taking the reader step by step through procedures and stages of treatment. MD Anderson plays a role in the book and in how Kalaji approaches her cancer. As does the fact that MD Anderson and King Hussein Cancer Center in Amman, which acts as her second hospital, are sister institutions -- a result of initiatives by MD Anderson's Global Academic Programs in the Center for Global Oncology.

Working together
"It's such a wonderful thing that MD Anderson and KHCC are sister institutions. Both my doctors see eye to eye and they negotiate my treatment before it takes place." An additional partnership Kalaji highlights as important is the International Center and representatives like Eliane Sayeghe, who visited Jordan for Kalaji's book launch and has been her liaison at MD Anderson for many years.

"I remember when I found out MD Anderson had an International Office. I remember thinking that I was in the right place," Kalaji recalls. "They just make life so easy for the patient. Whether I am having trouble with my schedule or contacting a nurse, they are available 24 hours a day to help."

Ultimately, Kalaji, who lost both parents to cancer, hopes her experience will help others understand cancer and the personal changes that occur with the disease. With her book already sold out in Jordan and a second printing ordered, she believes she is reaching people -- patients and non-patients alike. In the meantime, she remains an MD Anderson patient.

Audience at Maha book signing"MD Anderson gave me the confidence to write this book. The personal relationship I have with my doctor, the fact that MD Anderson encourages patients to participate in their treatment, that they are always presenting options, these things all gave me the confidence to write the book," Kalaji explains. "At MD Anderson, I don't feel like I am a number."

All proceeds from her book will benefit the King Hussein Cancer Center.

Appearing more like a United Nations expert group meeting than a typical stateside academic research gathering, the 2010 Global Academic Program Summit brought together representatives from 12 countries and 16 of GAP's 22 sister institutions (SIs).

The two-day event in mid-December was the first of its kind hosted by MD Anderson's Global Academic Programs. The summit was organized to launch the Sister Institution Network Fund (SINF) and the Collexis Research Profiles tool, both intended to accelerate and enable collaborative research between faculty at MD Anderson and the SIs.

SINF is a newly created seed fund that will provide $100,000 to faculty at MD Anderson who collaboratively engage with researchers at one or more of GAP's sister institutions. This is the first time MD Anderson is dedicating resources to spark work specifically with collaborating SIs. Sister Institutions would ideally match MD Anderson's investment by providing similar funding to their researchers. The most important consideration is that the resources to engage in the proposed work are present at all participating institutions.

Since MD Anderson and SI faculty may not yet be aware of all research partners with whom they could pursue projects and SINF funding, GAP has also deployed the Collexis Research Profiles tool. This database allows investigators to identify experts by research concepts and to see networks of collaborating scientists. In the near future, the tool will include information pertaining to researchers at the SIs.

Together, the two resources are the newest programs from the Center for Global Oncology and underline the dedication of MD Anderson to energize our network of collaborating institutions to reach beyond meetings, symposiums and conferences, which have been the historic bedrock of SI relationships.
SIs with lengthy affiliations attended the summit, as well as representatives from GAP's newest sister institutions -- Instituto Nacional de Enfermedades Neoplasicas (INEN) of Lima, Peru, and King Hussein Cancer Center of Amman, Jordan -- and possible future sister institution, Barretos Cancer Hospital of Barretos, Brazil.

To Mahmoud Sarhan, M.D., CEO and general director of the King Hussein Cancer Center (KHCC), the summit was an important opportunity to meet with members of MD Anderson and the sister institutions while gaining a better understanding of the changing emphasis of GAP toward one of active research collaboration.

"We (KHCC) have a wonderful cancer treatment program, but there are two areas we hope to improve by working with MD Anderson: our integrative medicine and personalized cancer care."  Sarhan adds, "We will definitely be applying to the Sister Institution Network Fund and already have the matching funds to begin research."

Carlos Vallejos, M.D., director of Peru's INEN, also expressed his enthusiasm for participating in the SI network and promised to bring his center's strength in clinical trials to the group. Vallejos went on to convey his desire to collaborate on research involving understudied U.S. cancers that are also important public health problems in Peru.

Many at the summit echoed similar objectives, although most recognized the infancy of the program and the inevitable unforeseen kinks to work through over the next year as the SINF assesses and supports its first research programs.

"We are planning on funding at least 10 research projects in the first year," explains Oliver Bogler, Ph.D., vice president for Global Academic Programs. "But if we receive additional high quality applications, we will try to fund more."

Each sister institution presented a 10-minute overview of their cancer research efforts, emphasizing opportunities for collaboration. These research briefs allowed newer SIs to gain a better understanding of the objectives and focus of their fellow sister institutions, as well as inform MD Anderson faculty of SI pursuits.

Perhaps the most productive portion of the summit occurred in the closing hour when John Mendelsohn, M.D., president of MD Anderson, and Raymond DuBois, M.D., Ph.D., provost and executive vice president, joined Bogler and the summit participants for wrap-up discussions focused on the big picture.

Productive suggestions included: development of cross-institutional workshops focused on specific disease sites; additional leadership provided by MD Anderson to enable communication and dissemination of information between developing research groups; and dedication to working toward cooperative design of clinical research studies.

Bogler is pleased with the results of the summit. "I think we were able to reach an agreement on how to move ahead together, and that our faculty and the faculty at our sister institutions are excited about the new fund and conducting collaborative research."



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