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& COVID-19 HOW THE PANDEMIC IS AFFECTING SCREENINGS AND TREATMENT
10: NCI OUTSTANDING INVESTIGATOR AWARD 11: Q&A WITH DANIEL POLLYEA, MD, MS 12: ALEX TREBEK AND PANCREATIC CANCER 14: CANCER DISPARITIES AND RACE 18: CLINICAL TRIAL PROVIDES HOPE 22: GIVING BEYOND THE NORM
N WS CU Cancer Center Team Goes Over the Edge for Research In September, 12 members of CU Cancer Center came together to help raise money for cancer research while going Over the Edge with Cancer League of Colorado. The team rappelled down 36 stories of a building on the corner of 16th Street and Broadway in downtown Denver. Thanks to donors, the CU Cancer Center team raised more than $18,000. Altogether, the event raised more than $300,000 for Colorado-based cancer research.
CU Researchers Come Together to Better Understand Ovarian Cancer Tumors and Treatment Outcomes After nearly four years of work, a group of researchers and clinicians from the University of Colorado School of Medicine are sharing findings from research that looks at how the composition of ovarian cancer tumors changes during chemotherapy and contributes to therapeutic response. While the standard of care consisting of surgery and chemotherapy for ovarian cancer patients is usually effective, disease recurrence and resistance are common. However, a small percentage of patients will never recur or will remain in remission beyond five years. The group set out in November 2016 to look at ways to be able to better predict a patient’s response to chemotherapy. This information could change maintenance and surveillance and will take a step toward a precision medical approach for each patient. “Our ultimate goal is that someone who is diagnosed with ovarian cancer would be able
to come in and we would be able to take the primary tumor and use the two major technologies described in the research study—transcriptomics using NanoString and multi-spectral immunohistochemistry— to get an idea about what is being expressed and what the tumor microenvironment looks like,” says Benjamin Bitler, PhD, CU Cancer Center member.
BENJ AMI N BI TLER, PHD
Between these two technologies, the team can characterize the important players that might be involved in promoting the tumor progression or response to therapy. In the present study, the research group examined ovarian cancer tumors before and after chemotherapy, with the goal of describing how chemotherapy remodels the tumor composition.
Building on this research, the long-term objective of the ovarian cancer research group is to leverage their understanding of the effects of chemotherapy on the tumor to predict response and disease recurrence.
I MAGES REPRESENT THE TU MO R MI CRO ENVI RO NMENT.
Get more CU Cancer Center news on our blog: n e w s . c u a n s c h u t z . e d u / c a n c e r- c e nte r
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SAYING
GOODBYE In Honor of Dennis Ahnen, MD It is with great sadness that we inform you that Dennis Ahnen, MD, former CU Cancer Center member, died on Aug. 16, 2020. He was diagnosed with advancedstage appendix cancer a year before his death. Ahnen completed his medical school training at Wayne State University and completed a medical residency and chief residency at Hutzel Women’s Hospital in Michigan before attending the University of Colorado as a fellow in gastroenterology in 1977. D E N N IS A H N EN , M D After completing his fellowship, he completed a membrane pathobiology research fellowship at Stanford University, then returned to join the faculty of the University of Colorado School of Medicine. In 2014, he retired from his longstanding faculty position of 32 years at the Department of Veterans Affairs Eastern Colorado Health Care System, and in 2016 he retired from the University of Colorado School of Medicine faculty as professor of medicine.
In 2017, he was appointed professor emeritus at the University of Colorado School of Medicine. After his retirement, he joined the staff of Gastroenterology of the Rockies in Colorado part time to run the clinic’s genetics program.
Hesselberth Presented NIH Director’s Tr ansformative Research Award Jay Hesselberth, PhD, CU Cancer Center member and associate professor of biochemistry and molecular genetics, has received a Director’s Transformative Research Award from the National Institutes of Health. Hesselberth’s group developed a new breakthrough method to directly measure enzymatic activities in thousands to millions of single cells. To date, researchers in the field have relied on methods that measure differences in gene expression, chromatin accessibility and protein levels across thousands to millions of cells to understand developmental trajectories of tissues, tumors and whole organisms. From those measurements, investigators infer functional status. Hesselberth’s group has developed functional assays that enable investigators to directly quantify enzymatic activities in single cells.
J AY HESSELBERTH, PHD
The National Institutes of Health granted only 85 awards through its High-Risk, High-Reward Research program to fund highly innovative and unusually impactful biomedical or behavioral research.
R amachandr an Named School of Medicine Pew-Stewart Scholar CU researcher Srinivas Ramachandran, PhD, was named one of the five 2020 Pew-Stewart Scholars. These researchers are selected to spearhead innovations in cancer research. Ramachandran, mentored member of CU Cancer Center and assistant professor of biochemistry and molecular genetics, is exploring how to improve methods for early cancer detection. His does this by examining unique signatures from cell-free DNA—which is shed by tumors—to help identify abnormal gene patterns associated with certain stages or types of cancers. “We know that if there is a tumor in the body, you will usually see the tumor DNA in plasma. Now the question is how to identify the tumor DNA in plasma, especially as the tumors evolve and mutate,” says Ramachandran. Ramachandran’s lab has two main goals for the next four years. The first is to identify the origin of cancer found in the liquid biopsy, and the second area of focus is to see how early the liquid biopsy can detect cancer.
S R I NI VAS RAMACHANDRAN, PHD
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Cancer & COVID-19 HOW THE PANDEMIC IS AFFECTING SCREENINGS AND TREATMENT
By Jessica Cordova and Greg Glasgow
COVID-19 was the most-talked-about health concern in 2020, but for many, it was not the deadliest disease. CU Cancer Center leadership is bringing attention to the fact that more people died from cancer than COVID last year. “Cancer is still the number one cause of death in Colorado,” says Cathy Bradley, PhD, deputy director of the CU Cancer Center and Colorado School of Public Health’s associate dean for research. “COVID might be a bigger concern for those over the age of 80 or with compromising health conditions, given the immediate risks that it presents. But for younger age groups, cancer is still an important concern and can be deadlier than COVID.” According to the American Cancer Society, there were an estimated 606,520 deaths due to cancer in the United States in 2020. As of January 1, the Johns Hopkins University tracking website shows that more than 354,000 people have died of COVID-19 in the United States. In Colorado, an estimated 8,220 people died from cancer in 2020 and so far, more than 5,000 have died from COVID-19. “Both are terrible, devastating diseases that cause a lot of death. They impact the ability to make a living, and they cause a lot of pain and suffering,” says Richard Schulick, MD, MBA, director of the CU Cancer Center and chair of the CU Department of Surgery. “I am glad that there is now a vaccine for COVID and COVID will eventually be taken off the table. But I think we have a lot more work to do with cancer. I am hopeful that one day in the not-too-distant future, we will actually be able to conquer a lot of the cancers that Americans and Coloradans suffer from.”
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“I am hopeful that one day in the not-too-distant future, we will actually be able to conquer a lot of the cancers that Americans and Coloradans suffer from.”
RI CHARD SC H U L IC K, M D , M B A
Of more immediate concern is the fact that, because of the pandemic’s interruption to the health care system, more people may die from preventable cancers because they are putting off vital screening, diagnostics and treatments.
“Nationwide, we saw a steep decrease in screening mammograms in March,” says Jennifer Diamond, MD, CU Cancer Center member and associate professor in the CU School of Medicine Medical Oncology Division. “We had some rebound later in the year, but levels of screening have not returned back to where they were before the COVID pandemic. In my practice, I’m seeing more patients that put off diagnosis of a clinically evident breast cancer because of the pandemic—not just a screening mammogram, but patients who have actually noticed a lump in the breast but didn’t bring it to clinical attention because of COVID and concern about exposure to the virus if they did go to the doctor to get it evaluated.” Tom, a patient of CU Cancer Center member Martin McCarter, MD, says he had some concerns about COVID19 when he first discovered he was at risk for colon cancer, but his fear
of the disease prompted him to get screened anyway. Tom found out he was at risk when an at-home colon cancer test showed the possible presence of a tumor. His doctor insisted on a colonoscopy, and the cancer was caught early. That’s when he was referred to the CU Cancer Center and the CU Department of Surgery for an operation to remove the tumor. Tom says he knew COVID-19 was a factor during both the testing for and treatment of his cancer, but “all the safe distancing and security measures as far as mask-wearing and all that kind of stuff had been introduced” in both instances, he says. “In my mind, everything was very well adhered to and taken care of as far as mitigating any risks from COVID.” Tom says he’s happy that any worries he had around COVID-19 didn’t prevent him from getting the care he needed in a timely fashion. Any delay could have made things worse. “The hospitals, doctors and staff all seem to know how to deal with it,” he says. “A lot of the risk has been removed. Temperature checks, masks, distancing, all that stuff was well-handled. There was never a point where I thought, ‘I’m being exposed to sick people that are putting me further at risk.’” But not every patient is like Tom. There are two large concerns for oncologists and cancer researchers when looking at the long-term impacts COVID-19 has on cancer: a reduction in the number of preventative cancer screenings and changes in treatment.
Reduction in cancer screenings Whether mammograms, colonoscopies or pap smears, regular screenings are important to help stop cancer in its tracks. Early-stage cancer is much easier to treat than later-stage cancers, many of which can spread to other parts of the body. “It is important to continue to do what you can to stay healthy. Part of being healthy is getting cancer screenings,” Bradley says. “Like wearing masks and social distancing to protect ourselves from COVID, we also need to continue to protect ourselves from cancer through regular screenings and reducing risks through a healthy lifestyle.” Norman “Ned” Sharpless, director of the National Cancer Institute, published an article in the journal Science that estimated the COVID-19 pandemic will cause at least 10,000 excess deaths from breast cancer and colorectal cancer over the next 10 years in the United States. These numbers are due to people not getting mammograms and colonoscopies since the start of the pandemic. This is a 1% increase in deaths, but Sharpless noted that these are conservative numbers because they do not include the effects of treatment delays and treatment interruptions caused by the pandemic. Nor do they include the results of a decrease in preventive procedures such as the HPV vaccine. According to EPIC, a popular electronic health record system, there was a drop of between 86% and 94% in preventive cancer screenings in 2020 for cervical,
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“Routine screening for cancer is extremely important. We would prefer to prevent it than to treat it.” colon and breast cancer across the United States, presumably due to access disruptions caused by COVID-19. These numbers looked at averages each week in 2020 and compared them to equivalent weeks from 2017–19. The CU Cancer Center has seen a similar decrease in the number of screenings. “Routine screening for cancer is extremely important. We would prefer to prevent it than to treat it,” Bradley says. “In the case of colorectal cancer, with screening we can remove premalignant tumors so that it never progresses. With an HPV vaccine, we prevent the cancer from occurring altogether.”
CATHY BRADLEY, PH D
If the trend of reduced cancer screenings and absence of vaccines continues, the data suggest that many cancer cases could go undiagnosed or be diagnosed at a later stage with a poorer prognosis.
Treatment changes In addition to putting off testing, some patients also are forgoing treatment or altering their treatment schedule in order to avoid possible exposure to COVID in hospitals and clinics. “In patients with metastatic disease, we’ll typically do scans every two to four months to make sure that things are stable, but for some patients now, we’ve said, ‘If you’re doing well, if the bloodwork looks good, you feel good, let’s spread that out to five or six months,’” Diamond says. “We’ve really tried to individualize the treatment for patients to try to minimize COVID exposure but at the same time keep them on their treatment.” Diamond is part of a new research study in which cancer-fighting drugs typically administered by infusions in a clinic are instead given as an injection in a patient’s home. “They’ll set up a visiting nurse that will actually go out and administer the injection to the patient at home and draw any labs that are needed, and then the patient can just do a telehealth visit,” she says. “I think that’s something that is really innovative—a way that we are adapting our practice to make it safe for patients as far as minimizing COVID risk but also keeping them on their curative therapies.” While there is no data out yet on the impact of delaying or reducing treatment, experts say it will have an impact. “We were very fortunate in Colorado that our cancer center was able to continue infusions in March and April,” Bradley says. “Very few cancer centers across the country were able to keep up infusions. Only over the summer were they starting to ramp up again.”
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This was due to many cities and states considering cancer treatment as elective. In Colorado, Governor Polis left all cancer treatments as necessary procedures during early shutdowns. “You would not want to be the person in the middle of your treatment or starting treatment and having to have it delayed by several weeks or months,” Bradley says. At CU Cancer Center, infusions stayed at about 98% of pre-COVID levels, while cancer-related surgeries dropped in the second quarter of the year to about 60% of pre-COVID levels. Surgeries later rose to about 110% of pre-COVID levels to make up for the patients who did not come in or delayed their care. At other facilities around the country, not only was treatment delayed, but many changed their standards of care as well. “One of the interesting things going on around the country is that some of the doses of chemotherapy and other infusion therapies have been reduced to decrease the chances of side effects, so that a patient would not be as susceptible to an infection or getting
sick,” Bradley says. “We do not know what that does to treatment effectiveness. Now there are some discussions around if we needed to give that much chemotherapy or treatment to begin with, or if instead, treatment is being given at inefficacious doses. We don’t know.” Diamond says that while COVID-19-related protocols are necessary to keep patients safe, they are having secondary effects on doctor-patient communication. “There are barriers in communication with patients because we have to wear masks and face shields, and now the patients are wearing masks, so it makes some of these difficult conversations with patients more challenging because you can’t really see those nonverbal cues,” she says. “It’s also difficult because there have been intermittent restrictions on visitors coming to the clinic. That’s to keep people safe, but that makes it really challenging, especially at times when patients haven’t been able to bring a support person into the clinic. It just makes it really hard in the communication process when there’s not another set of eyes and ears to be present for those discussions.”
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Safe to get screening or treatment Though patients understandably have concerns about exposure to COVID19 when they go to a hospital or clinic, experts say medical facilities still are very safe due to the strict procedures they follow. “The in-hospital infection rate is extremely low. At this point, clinics have become savvier at reducing the risk of infections,” Bradley says. “If patients are doing their part with wearing masks, washing their hands and social distancing, the actual clinic environment is relatively safe.” For those who have already missed their screening, Bradley recommends they work with their doctor to weigh their own risks—especially looking at items like family history—and strongly consider getting the screenings they need. “Most providers would tell you that their clinic environments are safe, and that the risk of cancer is greater,” she says. Diamond advises her patients to watch for ebbs and flows in the number of
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COVID-19 cases reported locally, and to schedule their screenings when cases are lower. “I’ve been encouraging people to let the clinics help them in understanding when the risk might be lowest, and also focusing on all the measures that we’re doing in health care facilities now that we understand how the virus spreads and how we can protect people,” she says. “Things like masking and health screens and separating symptomatic patients from well patients—there’s a high awareness in staff of health screenings and people not coming to work if they’re sick. We’re doing all of these things to keep patients safe.” Diamond also lets patients know that telehealth is an option if they want to talk about their specific circumstances— especially if they feel a lump that causes concerns. “You might not be able to get a biopsy or the diagnostic procedures, but you could at least talk to your doctor about how urgent is it that I get this evaluated now, versus waiting six months,” she says. “That’s a great resource.”
Impacts on underrepresented groups The Office of Community Outreach and Engagement at CU Cancer Center has many community partnerships and programs in place to identify and address barriers to cancer health equity and improve outcomes in underserved areas of Colorado, including urban and rural areas across the state. But many of those programs and their associated research studies have been put on hold longer than any other research area because they are in the least controlled environments. “Health disparities are only going to be exacerbated during this pandemic, and the risk of cancer continues to rise,” Bradley says. “It is unfortunate that these types of research are set back, because it is all about prevention, treatment and getting people the care that they need. This will have an immediate negative impact on these communities.” Bradley, along with other members of CU Cancer Center, has received supplemental funding from the National
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DEC Cancer Institute to look at the excess in incidents and upstaging that occurring in rural Colorado.
On the positive side The COVID-19 pandemic is not all bad news. It is leading to new research that will have impacts on other diseases, including cancer, and innovations like telehealth will last even after the pandemic has passed. “In times of crisis, we do tend to see incredible medical advancements,” Bradley says. “A lot of cancer treatments have been repurposed to see their effectiveness with the treatment of COVID. This may lead to us getting better in some areas of cancer treatment and have a chance for new discoveries. Discoveries in treating and preventing COVID may apply to cancer. Advancements in telehealth will unquestionably benefit cancer patients. Challenges often accelerate and bring about our most creative thinking and willingness to work together.”
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“If we can expand access to expert opinions in rural communities, I think that will improve cancer care moving forward.”
DING CANCER
Common Cancer Screenings Mammogram Screens for:
Breast cancer Who should get one?
Women ages 40-85 How often?
Every two years
Pap Smear Screens for:
Cervical cancer Who should get one?
Women ages 25-65 How often?
Every three years
Colonoscopy Screens for:
Colon cancer Who should get one?
Men and women ages 45-75 How often?
Every 10 years
Low-dose Computed Tomography (LDCT)
Screens for:
J E N N I F ER D I A M O N D , M D
Diamond says the advances in telehealth resulting from the pandemic are a good thing for some out-of-state patients who will no longer have to drive to Denver for a checkup or second opinion. They also will result in better outcomes for rural patients who don’t have easy access to cancer specialists. “If we can expand access to expert opinions in rural communities, I think that will improve cancer care moving forward,” she says. “People who live in Wyoming or even rural Colorado, where they may have an oncologist but not really a subspecialized oncologist, it’s great that they’ll be able to get a second opinion from an expert at the University through telehealth.”
Lung cancer Who should get one?
Men and women ages 55-80 with a history of heavy smoking, who smoke now, or who have quit within the past 15 years How often?
Yearly
According to the Centers for Disease Control, screening for ovarian, pancreatic, prostate, testicular and thyroid cancers has not been shown to reduce deaths from those cancers. The U.S. Preventive Services Task Force has found insufficient evidence to assess the balance of benefits and harms of screening for bladder cancer and oral cancer in adults without symptoms, and of visual skin examination by a doctor to screen for skin cancer in adults.
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MD
CLINICAL
CARE
CU Cancer Center Leukemia Researcher Receives NCI Outstanding Investigator Award Craig Jordan, PhD, received the award for his work on leukemia stem cells by greg glasgow Craig Jordan, PhD, has spent more than 20 years developing better treatments for acute myeloid leukemia (AML), a rapidly progressing cancer of the blood and bone marrow that can spread to other parts of the body, including the lymph nodes, liver, spleen and central nervous system. In October, Jordan—CU Cancer Center member and chief of the hematology division in the CU School of Medicine— was awarded a 2020 National Cancer Institute Outstanding Investigator Award, a seven-year grant that supports investigators with outstanding records of productivity in cancer research to embark upon new projects of unusual potential in cancer research and provides more than $5.9 million in research funding. Jordan and his team will use the funds to continue their research into the role of leukemia stem cells in AML and its treatment. For Jordan, it’s a journey that began more than 20 years ago when he was a new assistant professor at the University of Kentucky. “I started out my career working on normal blood formation, but my office happened to be right next door to a young investigator who was also a new assistant professor and a leukemia doctor,” Jordan says. “Between my scientific background and her clinical work, we became good friends and collaborated on projects early on. That switched me over from studying the growth of normal blood cells to the leukemia world.” Targeting stem cells When he came to the CU School of Medicine in 2013, Jordan was deep into his work on leukemia stem cells, which he likens to the root of a weed growing in your backyard. If you pull the weed but don’t get all of the root out, the weed will grow back. The same goes for stem cells in leukemia, and he had a good idea of how to eradicate them. “When I got into the leukemia field in the late ’90s, the main drugs that were used for AML, even at that point, were already pretty old,” he says. “Standard chemotherapy started in the early ’70s,
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so we had 25 years or so of the same drug regimen that didn’t work very well, but it was all we had.” Taking the job at CU was an amazing opportunity to advance the hematology division’s research program, Jordan says. “With support from the Department of Medicine and the CU Cancer Center, we built a world class team of investigators. Treating any kind of cancer is a complex problem, so it really takes a village. Our team of physicians, leukemia biologists, drug experts and clinical trials investigators is the best I’ve ever seen.” Jordan’s research team quickly found that the existing drugs weren’t much help against leukemia stem cells, so they started comparing regular stem cells and leukemia stem cells to look for differences they could specifically target. They eventually discovered that a protein called Bcl-2 was key to the way in which leukemia stem cells create energy. “All cells, cancer or normal, have a basic need to make energy for growth and survival,” he says. “We discovered that leukemia cells use Bcl-2 to control energy output from mitochondria. Normal cells make energy in ways that do not require Bcl-2. Imagine running a car engine on ethanol vs. diesel fuel. In both cases the engine is providing power to turn the wheels, but the fuels are different. It’s not a bad analogy for leukemia vs. normal stem cells. They both need the mitochondria to make energy, but the way they run the engine, so to speak, is a little different.”
cause leukemia stem cells to die due to lack of energy. In 2014, Jordan began working with one such drug, venetoclax, which—thanks in large part to his research—was recently approved by the FDA for treatment of AML in older patients who are unfit for intensive chemotherapy. Jordan stresses that venetoclax is no magic bullet, as most patients who take it eventually relapse, but for those older patients, it can make a huge difference. “Venetoclax is much less toxic than conventional chemotherapy,” Jordan says. “One of the big problems with chemotherapy is it kills tumor cells, but it kills normal cells too.” Patients can get really sick from standard chemotherapy, he says, and patients who are older or have other health conditions often can’t tolerate it. “The great thing about venetoclax is it’s much more specific,” he says. “It kills most tumor cells and very few normal cells, so it’s tolerated much better. It puts about 70% of patients into remission, but the catch is that most of them don’t stay in remission. In other words, we haven’t completely killed all the leukemia root.
Finding the right drug Because Bcl-2 also prevents the biological process called programmed cell death, it already was of interest to drug manufacturers. They understood that if they could create a drug that targets Bcl-2, it would cause cancer cells to die more quickly. But Jordan knew that such a drug would also be helpful in treating AML, as it would
CRAI G J O RDAN, PHD
But if you’re an older patient and can go into remission for a few years with a drug that doesn’t make you horribly sick, that’s a big step forward. It’s also a great starting point for building more sophisticated approaches to leukemia treatment.” The research continues Armed with the NIH award, Jordan and his research team plan to spend the next few years figuring out how to make venetoclax
even more effective, experimenting with secondary drugs that can be administered with venetoclax to make it better at killing leukemia stem cells. “If you look at the history of most cancer treatments, it’s rare that progress is made overnight from fatal to cured,” he says. “It’s almost always gradual. You do a little better and a little better, so it’s incremental progress that you make. AML has been stalled for decades where 20% or less of people would survive because previous
drugs failed to kill the root of disease, the leukemia stem cells. Now we’ve made an important improvement with venetoclax, as this drug more effectively targets leukemia stem cells, thereby increasing the length of remission. Our ultimate goal is to create therapies that are so effective that the leukemia stem cells are completely destroyed.”
A CONVERSATION WITH DANIEL POLLYEA, MD, MS The associate professor of hematology was among the CU investigators who did early work on venetoclax. BY GREG GLASGOW
leukemia stem cells. Of 33 patients given venetoclax in a 2018 clinical trial at the CU School of Medicine, 20 experienced a complete response (aka complete remission) and eight experienced a complete response but with continued low blood counts. Of the three patients who did not respond to treatment, two discontinued the study before the first week due to personal reasons unrelated to treatment or side effects.
DA N IE L POL LY E A , M D , M S
Thanks in large part to early work by investigators at the CU Cancer Center, patients with acute myeloid leukemia (AML) have a new treatment option that has fewer side effects and has been shown to increase longevity. On October 16, 2020, the Food and Drug Administration granted regular approval to the drug venetoclax (Venclexta), in combination with a low-dose chemotherapy treatment, for the treatment of AML in older adults who are unfit for intensive chemotherapy. The drug works by targeting and inhibiting the Bcl-2 protein, a key component of
The FDA granted the drug preliminary approval based on those clinical trials, which were conducted by CU Cancer Center researchers Craig Jordan, PhD, and Daniel Pollyea, MD, MS. Though they weren’t involved with the phase 3 trial that led to the full FDA approval in October, the two still are researching the drug and now are hopeful that venetoclax will eventually be approved for all AML patients. The CU Cancer Center sat down with Pollyea to talk about the drug and his and Jordan’s role in the FDA approval.
C3: You presented your original research on venetoclax in late 2018 —what was the path from there to the drug being used elsewhere, and ultimately to the full FDA approval? Pollyea: That’s part of the amazing story about this. The uptake of this by the leukemia community has been so
incredibly rapid—this is now the standard of care, and it is so widely accepted by the community. So many patients now diagnosed with AML get venetoclax as some point in their treatment journey. It really has touched the entirety of this disease in a way that we haven’t seen in the decades that people have been working on this disease. It’s been almost an immediate overnight improvement in what we can do for patients.
C3: What was it like to work with patients in the clinical trial, and to see the drug’s effect on them? Pollyea: It’s incredible. The patients who volunteered to be on the clinical trial, who were the pioneers that led the way, are amazing people to be able to have that kind of altruism to volunteer their bodies and their lives for a hope—that things will be better for them, but a certainty that we would learn from their experiences and the field would improve. That’s an incredible feeling, and as soon as the drug got approved, prescribing it for the first time, that was an amazing thing, too. To see that because of the work that we had done, it translated into the ability just to write a prescription, and to know that that was the same thing that any oncologist in the country could do because of this work, that’s an amazing feeling.
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Alex Trebek’s Death Raising Awareness and Questions About
PANCREATIC CANCER The ‘Jeopardy!’ host died in November after his battle with the disease. By Greg Glasgow Longtime “Jeopardy!” host Alex Trebek announced it to the world on March 6, 2019: Like 50,000 other Americans each year, he had been diagnosed with stage 4 pancreatic cancer. “Normally, the prognosis for this is not very encouraging, but I’m going to fight this, and I’m going to keep working,” Trebek said at the time in a video message to fans. “And with the love and support of my family and friends, and with the help of your prayers also, I plan to beat the low survival rate statistics for this disease.” Thanks to new and innovative treatments, Trebek did live longer than many people who are diagnosed with pancreatic cancer at stage 4, but he succumbed to the disease on November 8, dying at his home at the age of 80. Twenty months elapsed between his diagnosis and his death. “Pancreatic cancer is not one of the most common cancers, but it still is currently the third-highest cause of cancerrelated death in the United States,” says Marco Del Chiaro, MD, division chief of surgical oncology at the CU Department of Surgery and CU Cancer Center member. “Its incidence and mortality rates are almost the same, meaning almost everyone who gets it dies from it. A study published a few years ago says by 2030, pancreatic cancer will be the number-two cause of cancer-related deaths around the world. The trend is in the wrong MARCO DEL CH IA R O, M D direction.” One of the reasons pancreatic cancer is so deadly is that it is difficult to detect. The pancreas is deep inside the body and can’t be routinely examined, and there is no approved screening test, like a colonoscopy, to identify pre-cancerous lesions or cancer in its early stages. By the time many people show symptoms, the cancer is often very advanced. Newer treatments like the immunotherapy drugs Trebek was on can help, but pancreatic cancer still has a very low survival rate—9% of patients diagnosed will live five years or longer. Most die within a year.
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“The treatment that we have right now is extremely better than the one we had 10 years ago, but we are still not able to fully control the disease in the majority of patients,” Del Chiaro says. “We improved a lot in the last decade, but there is still a long way in front of us. With a disease like colorectal cancer—when I was a young surgeon, even when I was a resident, you saw a patient with colonic cancer and liver mass, it was a very terrible diagnosis. Today, there is very long survival in many of those patients. Maybe one day we will be there with pancreatic cancer, but we have a long way to go.”
Inspiring others with pancreatic cancer Trebek was very open about his fight with the disease, sharing the ups and downs of his treatment and symptoms. Alexis Leal, MD, CU Cancer Center member and assistant professor in the division of medical oncology, says that made him an inspiration to other pancreatic cancer patients around the world, who suddenly felt less alone in their struggles.
ALEXI S LEAL, MD
“Patients that I have had with pancreas cancer have really looked to Alex and what he was going through. He’s really been a source of hope for them because he continued to work and he remained in the public eye,” she says of Trebek, who taped his final “Jeopardy!” episodes in the weeks before his death. “I think a lot of patients saw that as very hopeful as they were going through their own journey. It’s great that he had a job that he loved and he was able to continue to work and was very public with his journey.” Leal says Trebek’s openness about his treatment also has made patients more aware of—and open to—clinical trials like the ones he was part of during his battle with the disease. There are many such trials going on for pancreatic cancer patients at the CU Cancer Center, including studies on medicines to better treat the disease.
Del Chiaro notes another advance in recent years is the discovery that cysts in the pancreas can progress to cancer. By tracking people in whom the cysts have not yet turned cancerous, researchers may get more clues to the ways in which the cancer develops. Currently, doctors consider those with a family history of the disease or those with certain genetic mutations—including the BRCA mutation that also causes breast and ovarian cancer—to be at risk for pancreatic cancer. Those patients are often given scans, but they can be costly and are not considered part of a general preventive screening. “Pancreatic cystic lesions are very common in the general population and generally incidentally discovered,” Del Chiaro says. “Considering the low risk of progression, a populationbased screening for these lesions is not cost-effective, but once the diagnosis is made, for some of them, a surveillance is recommended and can help in preventing pancreatic cancer in these patients.”
Highest level of care at CU Cancer Center At CU Cancer Center, patients with pancreatic cancer, as are patients with all cancers, are treated in a diseasespecific multidisciplinary clinic that puts up to 50 doctors— surgeons, surgical oncologists, medical oncologists, radiation oncologists, pathologists, dieticians, genetic counselors and more—to work on a patient’s case. Del Chiaro says that kind of specialization and collaboration can be key to successful treatment. “It’s not only important to take out a tumor of the pancreas, but it is important to understand the timing and who benefits from surgery and who doesn’t,” he says. “It is important to
understand which kind of treatment is better for this patient compared to another patient. It is important to offer the best clinical trial available, even when the normal treatments are not applicable to this type of patient. “It happens more and more often that we see a patient in our multidisciplinary conference who has been told by another doctor, ‘There is nothing we can do for you.’ They come here and they get the treatment,” he says. “That’s not because we are better surgeons, because we are better oncologists, because we are better radiologists, but because the team working on that is working specifically on the pancreas.” November, coincidentally, is Pancreatic Cancer Awareness Month, and last fall, Trebek taped a publicservice announcement to air during that time, calling attention to the warning signs of the disease. “I wish I had known sooner that the persistent stomach pain I experienced prior to my diagnosis was a symptom of pancreatic cancer,” he noted in the one-minute video. “Other common symptoms can include mid-back pain, unexplained weight loss, new-onset diabetes and the yellowing of the skin or eyes.” Del Chiaro says people with any of these symptoms should see their doctor immediately, even in the midst of a pandemic. Trebek’s death, he says, is “another reminder that cancer happens even in a pandemic. If people have symptoms, if people are not feeling OK, I don’t think they should wait because they are worried about going to the hospital. Of course, COVID puts limitations on the capacity of hospitals and the availability of diagnostic equipment, but people can die from something else than COVID. I think that is a very important message.”
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Reducing Cancer Disparities in Colorado CU Cancer Center sponsors research to help vulnerable populations By Jessica Cordova CU Cancer Center has launched five studies focused on addressing disparities in care and outcomes for Black and Hispanic communities in Colorado. According to the American Cancer Society, Black Americans have shorter survival rates and higher death rates among all racial groups in the United States. Hispanics in Colorado are more likely to be diagnosed with late-stage cancer and often have limited access to proper treatments. To address these disparities, CU Cancer Center’s Office of Community Outreach and Engagement is leading efforts to promote a better understanding of the causes and to improve access to timely care. “The vision of CU Cancer Center is to prevent and conquer cancer together,” says Richard Schulick, MD, MBA, director of CU Cancer Center and chair of the Department of Surgery. “Our physicians and researchers are working together to enhance the ability of all Coloradans to have access to the best cancer care.”
CU Cancer Center’s Office of Community Outreach and Engagement, which was started in 2019, is leading these efforts. This program adds to the Cancer Center’s longstanding history of commitment to advocacy, education, outreach and engagement throughout the state of Colorado. The office’s goal is to engage people closer to their homes and help them prevent and detect cancer early enough that there is still a chance for treatment to extend their life. These five studies, each of which received a $100,000 grant, demonstrate CU Cancer Center’s commitment to Colorado communities. “I hope to see CU Cancer Center become the catalyst of change through breakthrough research and state-of-theart treatments that decrease the unequal burden of cancer in Colorado,” says Evelinn Borrayo, PhD, associate director of the Community Outreach and Engagement office in CU Cancer Center and professor at the Colorado School of Public Health.
“I hope to see CU Cancer Center become the catalyst of change through breakthrough research and state-of-the-art treatments that decrease the unequal burden of cancer in Colorado.”
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Head and neck cancer clinical trials Jessica McDermott, MD, assistant professor in the Department of Medicine, aims to increase the representation of underserved populations in head and neck cancer clinical trials. Because expert care for head and neck cancer is not widely available in community clinics, J E SSIC A M C D ER M O TT, M D McDermott plans to identify historic patterns and locations of care for Spanish-speaking head and neck cancer patients. This study will compile data about when and where patients are receiving health care. Using census and CU Cancer Center data, McDermott wants to establish longitudinal partnerships with community providers and patients. The initiative will also reach and engage key community partners to join in efforts to educate and advocate for sustained preclinical and clinical research involvement of Hispanic patients. A pilot clinic with Spanish-speaking doctors, nurses, and staff will open within a year. “This pilot clinic will focus on patients with head and neck cancer, but our ultimate goal is to broaden the scope to include all cancer types,” McDermott says. The head and neck cancer project aims to improve the quality of patient care while promoting research that uncovers racial and ethnic disease differences and treatment responses.
Lung cancer and personalized care The benefits of advanced lung cancer treatments, especially precision medicine that targets specific genetic mutations, have been limited in Colorado depending on the racial and socioeconomic status of some patients. Assistant Professor of Medicine Tejas Patil, MD, and his team are creating a database that gathers specific information about patients, including their sex, race, ethnicity, medical comorbidities, insurance status and use of palliative care.
Analyzing information from the database should help physicians understand how therapies and side effects vary in their patients based on their racial or socioeconomic status. Due to limited representation of patients from diverse backgrounds in clinical trials of lung cancer treatments, information about predictive biomarkers, negative side effects and effectiveness of the drugs is scarce. “These disparities can have an incredibly negative impact on those patients—for example, potentially losing years of life that they could have had with precision medicine,” Patil says.
Brain and central nervous system cancer Black and Hispanic children diagnosed with brain and central nervous system cancers have worse outcomes than white children do. With a grant from the Office of Community Outreach and Engagement, researchers at CU Cancer Center and Children’s Hospital Colorado are collaborating to better understand these disparities, as well as develop ways to reduce the burden of disease in these populations. Assistant Professor of Pediatrics Adam Green, MD, and his team will use clinical records of patient populations to add factors such as primary language and distance away from the hospital. They also will use molecular data collected from patients’ tumor samples to help determine whether there are biologic differences based on race and ethnicity.
ADAM GREEN, MD
“We will look at the effect of all these variables on how widespread patients’ tumors are when they’re diagnosed, their treatment, and their survival,” Green says. “We will analyze all these data to try to determine the source of demographic and socioeconomic disparities.” With the data, they plan to develop two pilot interventions. First, they will focus on educating primary care providers who are more likely to diagnose children from underserved, lowincome and rural populations. To do this, Green and his team will use an existing early diagnosis tool called HeadSmart that helps to identify pediatric brain tumor symptoms.
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Second, they will conduct qualitative interviews with patients and their families to determine the challenges involved with treatment and enrollment in clinical trials. With the help of multilevel community engagement, Green and his team hope to improve the outcomes of underserved patients diagnosed with central nervous system tumors in Colorado and to develop and refine interventions.
Leukemia treatments Newly diagnosed cases of leukemia depend on genetic and molecular testing. With this information, physicians can determine treatment options best
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suited for patients based on genetic mutations, fusions and other biologic features. While these tests are crucial for care, not all patients with leukemia have access to them because they are uninsured or underinsured. As a result, some patients do not have access to cutting-edge treatments.
This study focuses on creating a mechanism that allows for molecular testing in metro Denver, where many uninsured or underinsured patients are treated. The goal is to provide access to this highly sophisticated molecular evaluation by pilot testing the program with 25 patients this year. “If a patient’s leukemia has an identified abnormality that could be sensitive to a targeted therapy, recommendations for access to these therapies will be made,” says Lia Gore, MD, professor of pediatrics and co-director of CU Cancer Center’s Developmental Therapeutics Program. “Some patients may also be eligible for newer treatments like our on-campus chimeric antigen T-cell treatments, and this potential option would also be discussed.” Gore and her team hope to create an approach that can be exported to sites around the state and Rocky Mountain region with minimal modification. The testing also could be modified to provide care to patients with other cancers.
her team plan to overhaul the existing community outreach materials, which will be available online via social media, local programming and community centers. They will provide a “breast cancer tool box� to primary care and underserved care clinics across Colorado.
Finally, Borges and her team will expand the recruitment of breast cancer patients to the Oncology Research Information Exchange Network, a research partnership among top North American cancer centers. This effort will ensure diverse representation in translational breast cancer research.
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Breast cancer care This year, approximately 4,500 women will be diagnosed with breast cancer in Colorado, according to the American Cancer Society. Among those diagnosed, Black and Hispanic women, younger women, postpartum mothers and women living in rural parts of the state will have higher mortality rates and worse outcomes. The breast cancer program at CU Cancer Center aims to develop tools for better community outreach and engagement for women of color, Spanish-speaking women and rural women. The effort, led by Virginia Borges, MD, professor of medicine, starts by using virtual focus groups to identify the unmet needs to breast cancer awareness and survivorship, including understanding the risks and options of lifestyle modifications to reduce the risk of breast cancer and breast cancer recurrence in underserved populations. Based on the information gathered from these groups, Borges and
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Melanoma Skin Cancer Clinical Trial Provided
HOPE When Options Looked Bleak Sam’s “life was saved” by an investigator-initiated trial at University of Colorado Cancer Center By Jessica Cordova As the 2018 holidays approached, Sam Worrell was given a present he did not want. He was diagnosed with stage 4 metastatic melanoma. “For Christmas, we took a family photo with all the grandkids,” says Sam’s wife, Janet. “The kids wanted to take this photo because they thought Sam would not be here next Christmas.” Melanoma is a dangerous type of skin cancer that is likely to grow and spread. When this happens, it is called metastatic cancer and for Sam it had spread to his lung. After two surgeries at the UCHealth Medical Center of the Rockies in Loveland, Colorado, to remove tumors, Sam’s oncologist, Dr. Douglas Kemme, knew Sam needed more than the standard treatment.
Transferring care to get on a clinical trial with CU Cancer Center Early in 2019, Dr. Kemme referred Sam to receive treatment at the University of Colorado Anschutz Medical Campus, where he met Dr. Karl Lewis. Sam learned about an investigator-initiated trial (IIT) taking place at CU Cancer Center for patients with metastatic melanoma and he fit the qualifications. “An IIT is a clinical trial developed specifically by researchers at the University of Colorado and only available here right now. The idea is that if an IIT is successful, it could be turned into a multi-center trial testing the overall survivor outcomes,” says Dr. Martin McCarter, the trial’s principal investigator.
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S A M A N D H I S FA M I LY AT C H R I S TMAS I N 2018.
“IITs really are the fundamental way that we discover new therapies and ultimately improve the way we care for patients.” “I was apprehensive at first when I was diagnosed with cancer, but then I felt a ray of hope from the clinical trial,” Sam says. “Dr. Kemme mentioned that the University of Colorado Cancer Center is known for the progress it has made in skin cancer research.” Due to Colorado’s altitude and outdoor lifestyle, the state has an especially high rate of melanoma and other skin cancers, making CU Cancer Center a hub of research and treatment. University of Colorado Cancer Center helped to test drugs that point the immune system at melanoma, and now Sam’s IIT hoped to take a next step.
“The rationale to pursue this clinical trial is that we know immunotherapy has been effective for many melanoma patients, but it doesn’t work with everybody. Sometimes the tumors suppress the immune system and prevent the immune reaction,” says Dr. McCarter. “We have been very interested in trying to overcome this immune suppression. Based on our early basic and translational research supported by the University of Colorado Cancer Center, we identified a particular cell population, called myeloid derived suppressor cells, that plays a role in melanoma induced immunosuppression.” Sam’s IIT would use two drugs: the common immunotherapy drug pembrolizumab (Keytruda), and along with this, a new drug combination
adding all-trans retinoic acid (ATRA), which targets the myeloid derived suppressor cells.
Tracking side effects As Sam’s was an early-phase clinical trial, an important part of the process was to explore any extra side effects of adding ATRA to the immunotherapy treatment. “Going into this study, I knew that headaches were a possible side effect,” says Sam, noting that he certainly had his share. Sam also lost function in his adrenal glands, but Dr. McCarter says that was not due to ATRA but rather to a known side effect from the immunotherapy. Meanwhile, Sam’s tumors were shrinking.
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“I feel very fortunate and blessed that this trial is working for me,” says Sam. “I could deal with the headaches for the extra time I am getting. I would encourage anyone to consider a clinical trial for their cancer treatment if it is available.”
“I feel very fortunate and blessed that this trial is working for me.” Like Sam’s trial, many CU Cancer Center clinical trials are built on the backbone of standard treatments, often adding a drug that has shown promise in laboratory and animal studies. Still, despite extensive testing before a drug is used with patients, it takes courage to be one of the first people to try a
new treatment. In Sam’s case, it also offered the opportunity to be one of the first patients to benefit. “I am very grateful for any patient that is willing to participate in a clinical trial,” says Dr. McCarter. “I like to point out to them that every single drug that is now FDA-approved and available to patients went through a similar process. Without people who are willing to participate in that process, we would not be where we are today.” Traveling for specialized care “We are really blessed that the CU Cancer Center is not far from our home,” says Sam, who lives in Longmont, Colorado. “It does not hit you until you go down to the Anschutz Campus a few times for treatment.
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I started noticing people with suitcases and realized that these people are coming from out of town to get their treatments. All I can think is how fortunate we are to just be able to drive for an hour.” CU Cancer Center is one of 51 National Cancer Institute-designated comprehensive cancer centers and one of only two in the Rocky Mountain Region. The ability to offer IITs like the one Sam is on, as well as the basic research taking place on the Anschutz Medical Campus
make CU Cancer Center a national and international leader in cancer research and care. “We were both really scared when we found out it was metastatic melanoma, because that is not a very good diagnosis,” Janet says. “They can’t do chemo or radiation and things were looking pretty bleak. This treatment option gave us hope.” Sam just wants to see his grandkids grow up. He has six grandchildren, all between the ages of 11 and 16.
Since starting Dr. McCarter’s IIT, Sam has four clear scans and continues on immunotherapy treatment. “I am very encouraged that cancer research will continue to grow. Four years ago there would have been no hope after my diagnosis,” says Sam. “Now these clinical trials can give people hope. This trial saved my life.”
New Melanoma Program Director Focused on Treatment Options By Jessica Cordova If you live in or have visited Colorado, you most likely have noticed that the state loves its outdoors. With 300 days of sunshine a year, many enjoy hiking, playing at a park or grabbing a craft brew on a patio. But with that love of sunshine comes an increased risk for skin cancer. “Denver is the Mile High City, and studies suggest that living at elevation, where there is less atmospheric protection from UV rays, can contribute to the development of melanoma,” says Camille Stewart, MD, assistant professor in the Division of Surgical Oncology and University of Colorado Cancer Center member. “It is a bigger problem for us in Denver and in Colorado than in other places.” Stewart, who was recently hired as director of the Melanoma Program within the Department of Surgery at the CU School of Medicine, is focusing efforts to reduce the risk of melanoma, catch it early and deliver effective treatments. “My goals for the program are to increase our local, national and international presence and to actively contribute to the body of knowledge of how to best treat patients with melanoma,” Stewart says.
Melanoma is the most serious form of skin cancer but is less common than basal cell carcinoma or squamous cell carcinoma, which together are known as non-melanoma skin cancers. According to the American Cancer Society, it is estimated that there will be close to 2,000 new cases of melanoma of the skin in Colorado this year, around .02% of the population. In the past there were not many effective treatments for melanoma. This left surgery, sometimes radical surgery, as the primary treatment option.
Details about Camille Stewart, MD
Dr. Stewart will be seeing patients at Anschutz Medical Campus, Highlands Ranch UCHealth Cancer Center and Cherry Creek UCHealth Cancer Care and Hematology Dr. Stewart was trained in general surgery at the University of Colorado, and in Complex General Surgical Oncology at City of Hope in Duarte, California. She is director of the melanoma program and also sees patients with sarcoma and gastrointestinal cancers.
“There have been major advances in research and treatment for melanoma, making this an exciting field to be in right now,” Stewart says. Right now, there are more than 50 clinical trials around the treatment and detection of melanoma taking place at the Anschutz Medical Campus. On top of providing patient-centered care in the clinic, Stewart wants to keep a component of her work in research, learning more about new treatment options.
C A M I LLE STEWART, MD
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Giving Beyond the Norm Arnette Schouten is dedicated to funding research on rare conditions. By Greg Glasgow
Like most people, Arnette Schouten has been touched personally by cancer. One of her cousins is in hospice following a battle with melanoma; her sister-in-law had a long fight with breast cancer; and Arnette herself had early symptoms of ovarian cancer that were caught in time for effective treatment. But her reasons for donating to the University of Colorado Cancer Center have less to do with her personal history and more to do with the wide range of ages cancer affects and the many rare forms of the disease. “It’s such an awful thing,” she says of cancer. “And it doesn’t affect just old people, but you see the babies and the young kids fighting it. I think it would be so awesome if that was one thing we could just get rid of.” Arnette has a long history of giving on the Anschutz Medical Campus. Her first gift was to the UCHealth Burn and Frostbite Center, which helped her husband, Jerry, after he was badly burned in a race car crash. He later died from his injuries. Part of Arnette’s gift allowed UCHealth to purchase computers that let patients communicate via eye-tracking technology. Jerry, who loved conversing with his wife, spent his last days on a breathing tube, unable to speak. Arnette wanted to help future intubated patients better communicate with their loved ones.
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At the CU Cancer Center, Arnette’s generosity has helped fund research into solid tumors and rare melanomas, as well as investigatorinitiated trials (IITs), which advance “homegrown” ideas from researchers and investigators who are active in lab and clinical settings. Unlike trials that are initiated by sponsors such as pharmaceutical companies, IITs start in research sites such as the Cancer Center. Donations to melanoma research Richard Schulick, MD, MBA, director of CU Cancer Center and recipient of the Aragón/Gonzalez-Gíustí Chair, says he is thankful for Arnette’s support, especially when it comes to her gift supporting research into rare melanomas. “We’re one of the top rare melanoma centers in the country,” he says. “A lot of people come to us, we have clinical trials, and for a lot of these rare melanomas we’re not quite sure
what to do. We’re investigating and doing clinical trials and trying the new immunotherapy agents and seeing whether they work. We’ve had a huge push in immunotherapy over the past couple of years, and there are some really promising therapies that we’re setting up.”
Helping with solid tumor research In another of the areas Arnette supports, tumor research, Schulick says enormous progress has been made in recent years as medical researchers discovered how to use genetic information to more accurately treat cancer. “The thinking used to be that, for instance, pancreas cancer is one disease, and everyone who has it should be treated the same way,” he says. “And it didn’t get great results. When the ability to actually read the genes in humans and in cancers came about, we started finding out
that whether it’s pancreas cancer or melanoma—there are a thousand different diseases. The trend now is studying the genes of each cancer, categorizing them by whatever the genetic changes are, and if they have these genetic changes, they should receive this therapy. It doesn’t matter if it’s melanoma or pancreatic or gastric or ovarian—if they have these genetic changes, they should get this treatment.” Arnette says it’s important to her to focus her giving on rarer diseases that have a high funding need. “There’s a lot of money and attention going to things like breast cancer, but we need to look at other stuff,” she says. “The rarer it is, the harder it is to figure out. That’s where we need to start in order to bring these diseases to light and to figure them out. See what the genetics are for something that we don’t know. Let’s do some more research and see where that can go.”
Get more CU Cancer Center news on our blog: news.cuanschutz.edu/cancer-center
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Our commitment to dismantling racism T H E
M E S S A G E
The CU Cancer Center will address biases and disparities in the health system The past year has illuminated the need for change.
On June 5, doctors at the CU Cancer Center and
In addition to the toll it has taken on lives, health
around the Anschutz Medical Campus joined
and livelihood, COVID-19 has shed light on health
doctors across the country in the White Coats
disparities and inequities facing our communities
for Black Lives Kneel for Justice event, kneeling
of color. The inexcusable killings of George Floyd,
outside for 8 minutes and 45 seconds in memory
Ahmaud Arbery and too many others should make
of George Floyd and to raise awareness of racial
us understand our history of violence, as well as
justice and health equity.
complacency toward the lives of Black people and
FROM THE DIRECTOR RICHARD SCHULICK, MD, MBA DIRECTOR, UNIVERSITY OF COLORADO CANCER CENTER CHAIR OF SURGERY, UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
other communities of color. These disparities and
As Dr. Martin Luther King Jr. said, “There comes
discrimination are uncomfortable truths we must
a time when silence is betrayal. Our lives begin to
face. To remain silent would make us complicit.
end the day we become silent about things that
matter. In the end, we will remember not the words
In terms of anti-racism, the CU Cancer Center must
of our enemies, but the silence of our friends. Only
be upstanders and not bystanders. As a group, we
in the darkness can you see the stars.”
have developed our vision statement, “Prevent and Concur Cancer. Together,” and our core values, which call us to be collaborative, compassionate, exemplary, inclusive, scholarly and transformative. Together we are committed to the work of dismantling racism that impacts our profession, our patients and our society. We all have biases, and we are committed to addressing them. There is no shortcut to this work and we may stumble on our journey, but we will push ahead, because the end justifies the means.
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