C3: Winter 2021 by University of Colorado Cancer Center

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WINTER 2021

REACHING NEW HEIGHTS IN CANCER TREATMENT A CRITICAL MIX OF TALENT AND TECHNOLOGY MAKE THE CU CANCER CENTER A NATIONAL LEADER IN CAR T-CELL THERAPY 10: CREATING AN INTEREST IN CANCER RESEARCH WITH A NEW GENERATION 11: Q&A WITH JAMIE STUDTS, PHD 12: BIG CHANGES IN COLORECTAL CANCER SCREENING 14: TRIATHLETE BATTLES AML 18: HOW METABOLISM AFFECTS CANCER 20: BFITBWELL PROVIDES EXERCISE TRAINING FOR SURVIVORS

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N WS CU Cancer Center earns distinguished title from National Pancreas Foundation For its excellence in prevention, education, care, research, and outcomes, the CU Cancer Center has been recognized by the National Pancreas Foundation as a National Pancreas Foundation Academic Center of Excellence for pancreatic cancer. It is the only such center in the Rocky Mountain region that includes Idaho, Montana, Utah, Nevada, New Mexico, Arizona, and the Dakotas. Among the factors that led to the designation are the CU Cancer Center’s multidisciplinary clinics, in which 25 to 30 experts discuss a patient’s case and work together on treatment options; the center’s focus on

early detection of pancreatic cancer; and the CU Cancer Center’s range of clinical trials that allow pancreatic cancer patients to access promising treatments years earlier than they are widely available elsewhere. “We have one of the highest volumes of taking care of pancreatic cancer patients in the country,” says Richard Schulick, MD, MBA, director of the CU Cancer Center and chair of the Department of Surgery at the CU School of Medicine. “This has allowed us to develop specific expertise in the management of the disease.”

CU Cancer Center Receives Highly Competitive SPORE Gr ant for Head and Neck Cancer Research and treatment of head and neck cancers at the CU Cancer Center reached a new level in June with a highly competitive Specialized Programs of Research Excellence (SPORE) grant from the National Cancer Institute. The SPORE is led by CU Cancer Center member XJ Wang, MD, PhD, and CU Cancer Center Developmental Therapeutics Program co-leader Antonio Jimeno, MD, PhD, who says that head and neck cancer has seen a 70% increase in the U.S. over the past decade. “In 2005 there were 39,000 cases, in 2015 around 66,000 cases, and in 2020, the estimates are 72,000 cases,” Jimeno says. “The NCI recognizes this is very important because there are a lot more patients than there used to be, and many of them are younger than ever.” SPOREs are designed to enable the rapid and efficient movement of basic scientific findings into clinical settings, as well as to determine the biological basis for observations made in individuals with cancer or in populations at risk for cancer. Currently, there are three other head and neck cancer SPOREs in the U.S. This will be the only SPORE at the CU Cancer Center; however, the center is hoping to expand designation into other SPOREs in the upcoming years.

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Director of Animal Imaging Shared Resource honored for contributions to the field Natalie Serkova, PhD, director of the Animal Imaging Shared Resource at the CU Cancer Center, in May received a 2021 Senior Fellow Award from the International Society of Magnetic Resonance in Medicine. The award recognizes her leadership in pre-clinical MRI and significant contributions to functional and molecular MRI in cancer. Overseeing an array of state-of-the-art equipment dedicated to MRI, optical imaging, CT and PET, metabolomics, irradiation, and more, Serkova has, over the past 19 years, turned the CU resource into one of the most advanced animal imaging centers in the Rocky Mountain region. She collaborates with many researchers on the CU Anschutz Medical Campus.

NATALI E SERKO VA, PHD

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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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New leadership for Prevention & Control Linda Cook, PhD, joins CU Cancer Center as associate director of population sciences Bringing more than two decades of experience in population health and cancer prevention and control, Linda Cook, PhD, joined the CU Cancer Center in July as associate director of population sciences. Cook joins the leadership team overseeing the CU Cancer Center’s Cancer Prevention & Control Program, L IN D A C O O K , P H D which applies the expertise of behavioral, basic, and clinician scientists to conduct innovative and impactful cancer research to reduce Colorado’s cancer burden. Its goals include discovering and evaluating novel approaches to cancer prevention and early detection; conducting population-based cancer control interventions; and identifying and diminishing cancer disparities through health services and policy research. “If you can synergize with other researchers across schools and across the cancer center, then you can do some really amazing things,” Cook says. “There is so much talent, so much excellence at the University of Colorado Cancer Center — I see getting teams together to further advance cancer prevention and control research for the state of Colorado. New initiatives are always coming down the pike from the National Cancer Institute and the NIH, and to be able to capitalize on that and grow in a way that benefits the people of Colorado, that would be fantastic.” Cook comes to the University of Colorado School of Medicine from the University of New Mexico, where she most recently served as interim division chief in the Division of Epidemiology, Biostatistics, and Preventive Medicine and co-leader of the Cancer Control Research Program at the UNM Comprehensive Cancer Center. She is motivated by the opportunity to overcome health disparities and get people the screenings and treatments they need to prevent cancer from forming or spreading.

CU Cancer Members Recognized for Contributions to Immunother apy in Pediatric Cancer Three members of the CU Cancer Center and a longstanding supporter of the CU Anschutz Medical Campus are part of a group of more than 200 researchers nationwide who were recognized in April with the Team Science Award from the American Association for Cancer Research. The CU researchers — Terry Fry, MD, Lia Gore, MD, and Amanda Winters, MD, PhD, all of whom practice at Children’s Hospital Colorado, along with patient advocate Kevin Reidy — are part of the St. Baldrick’s Foundation Stand Up To Cancer Pediatric Cancer Dream Team, a group of some 200 researchers across 10 leading children’s hospitals and childhood cancer-focused research programs who are helping to develop new immunotherapy approaches for high-risk childhood cancers.

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TERRY FRY, MD

AMANDA W I NTERS, MD, PHD

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Reaching new heights in cancer treatment

A critical mix of talent and technology make the CU Cancer Center a national leader in CAR T-cell therapy. By Greg Glasgow “When you lose hope, you lose everything,” says Ron Randolph. “It’s like you’re in the bottom of a hole and you see this light at the top of the hole. It’s a very small light, but there’s no way to escape.” Randolph was at the bottom of the hole. After being diagnosed with the blood cancer multiple myeloma in 2018, he underwent several chemotherapy treatments — some of which had side effects so severe that they sent him to the hospital — as well as a bone marrow transplant. But still the cancer kept creeping back. The light at the top of the hole shone brighter for Randolph in March 2021, when the U.S. Food and Drug Administration approved a new type of treatment for multiple myeloma: chimeric antigen receptor cell therapy (CAR T-cell), other forms of which already had been approved for blood cancers including acute lymphoblastic leukemia and non-Hodgkin’s lymphoma. With the revolutionary new cancer treatment, doctors draw a patient’s blood and send it to a lab, where immune cells are extracted and reengineered to become cancer fighters before being reinfused into the patient’s body. “When they’re placed back in your body, they act like hunter-killers,” says Randolph, 65, who lives in Greeley, Colorado. “They only attack my myeloma cancer cells. They do not attack normal cells like chemotherapy does. I was blessed to get the CAR T-cell treatment. Without that, my only other option was another bone marrow transplant.”

CANCER FREE AND ENJOYING LIFE Just one month after his CAR T-cell infusion at UCHealth University of Colorado Hospital (UCH), Randolph was declared cancer-free. Multiple myeloma is a terminal cancer that almost always comes back eventually, but for now, Randolph is enjoying life cancer-free in what his doctors say will be the longest remission he has had since he began waging his battle against multiple myeloma nearly four years ago.

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THE CAR-T REVOLUTION Though newly approved for treatment of multiple myeloma, CAR T-cell therapy has, over the past few years, created new hope for patients with blood cancers. Researchers are now reviewing its effectiveness in treating solid tumors and brain tumors as well. Armed with the expertise and equipment to conduct numerous clinical trials involving CAR T-cells, the CU Cancer Center is one of the institutions on the leading edge of a revolution in cancer treatment. “We’ve known for some time that cancers have many devious ways of turning off the immune system against the cancer,” says CU Cancer Center member Clay Smith, MD, director of the Blood Disorders and Cell Therapies Center at UCH. “Only in the past few years have we learned “He’s gotten into a really deep

how to overcome that and reverse

remission. It’s the best response

that. One of the ways is to take a

he’s had to any of his treatments,”

person’s immune cells out of their

says CU Cancer Center member

body and genetically reengineer them

Peter Forsberg, MD, who has treated Randolph since 2018. “We anticipate all multiple myeloma patients are likely to have some recurrence of their disease down the road, but the hope is that this will create a pretty stable, relatively long-lasting remission where he won’t need other therapies. It’s great peace of mind for him, and it’s a really nice relief to be able to spend some time away from that continuous treatment approach that we’re so often stuck with in myeloma.” In patients with other types of cancers, CAR T-cell therapy has gone beyond initial remissions to more long-term remissions that look like complete cures. It marks a huge advance in cancer treatment, says CU Cancer Center member Michael Verneris, MD, one of the primary CAR T-cell researchers at the University of Colorado School of Medicine.

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so they’re now primed and ready to go back in and attack cancer cells.”

That reengineering happens via an unlikely source: the HIV virus, a part of which is used to introduce a new piece of DNA called a chimeric antigen receptor (CAR) into the immune cell called a T-cell. The newly formed CAR T-cells are programmed to seek out and destroy cancer cells once they are put back into the patient’s body in a one-time infusion. “You can genetically engineer out all the bad parts of the HIV virus and put in all the cancerfighting parts,” Smith says. “We do that because the HIV virus is very efficient at infecting the T-cells to turn them into CAR T-cells. Having

“This is an exciting time and an important time in medical

grown up at the time when HIV was first

history,” he says. “In the future, when we draw a timeline of all

discovered and was a tragic epidemic, it’s been

of the advances in medicine — anesthesia, antibiotics — this

amazing to watch how they can take something

will be one of the things on that map. This is how important this

that devastating and turn it into something not

will turn out to be. I’m convinced of it.”

only harmless, but actually beneficial to people with cancer.”

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For patients like Randolph, the CAR T-cell therapy process

at least respond — and sometimes you see the cancer

begins with a simple in-clinic blood draw. The blood is then

go away really quickly — it’s incredibly exciting and

frozen and sent to a lab, where the CAR is added to the T-cells.

satisfying as a physician.”

A few weeks later, the patient checks into the hospital and

BUILDING THE INFRASTRUCTURE

receives some mild chemotherapy to neutralize immune cells that might attack the CAR T-cells. The reengineered blood is then infused back into the patient over several hours, and doctors watch closely for side effects including cytokine release syndrome, an inflammatory response from the immunotherapy that can cause inflammation in the brain. The treatment currently is approved only for patients who have failed other forms of chemotherapy and immunotherapy, but researchers are hopeful it will eventually become a more frontline standard of care. CAR T-cells not only have the advantage of destroying only cancer cells, leaving normal growth cells alone, but they are “living drugs” that proliferate in the bloodstream and persist for months to years after the infusion, potentially providing long-term surveillance against cancer recurrence. Smith, who works with patients who have undergone CAR T-cell therapy — helping them manage side effects and hopefully seeing them get better — has seen how effective the new therapy can be.

At the CU Cancer Center, the road to the CAR T-cell revolution began in 2006, with the opening of the Gates Center for Regenerative Medicine on the University of Colorado Anschutz Medical Campus. Established with a generous gift in memory of Denver industrialist and philanthropist Charles Gates, the Gates Center accelerates collaboration among medical researchers and clinicians in the areas of regenerative medicine and gene therapy. Focused originally on stem cell therapy, the center has since become a leader in CAR T-cell therapy as well. In 2015, the Gates Center and its partners built the Gates Biomanufacturing Facility to help on- and off-campus investigators translate innovative research discoveries into safe and effective new cell therapy and protein products for use in clinical trials. That means CU Cancer Center researchers performing clinical trials on CAR T-cells and

“It’s really remarkable. There are patients for whom all

other gene therapies no longer have to send a patient’s

chemotherapy has failed, and if we didn’t have this treatment,

blood to California or New Jersey to be reengineered;

likely we wouldn’t have anything for them,” he says. “To see them

they can simply send it across campus to the Gates

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Biomanufacturing Facility for processing. Staff at the facility offer researchers support and technical expertise for their projects as well. “Researchers have long noted the ‘valley of death’ that lies between having a good idea and actually getting it into a phase I clinical trial,” says Matthew Seefeldt, PhD, executive director of the Gates Biomanufacturing Facility. “It’s complicated. The academic has this idea, then they must suddenly learn FDA regulations they’ve never had to deal with before. They have to go out and raise a bunch of money, and they have to get the science right. To have us around to help with that, so we can get their project developed so it can become a fundable technology, is really important. There are otherwise a lot of technologies that would die on the vine. “The fact that we have this capability on campus allows patients to have access to a therapy they might not normally have access to, and at the same time demonstrates that the infrastructure is now in place for us to handle these CAR T-cells in all aspects on campus,” Seefeldt continues. “We can develop them, we can

expertise in CAR T-cell therapy led to an explosion of research on campus. In addition to Verneris, CU Cancer Center members including Eduardo Davila, PhD; Terry Fry, MD; Breelyn Wilky, MD; and Eric Kohler, MD, PhD, are involved in clinical trials studying the effectiveness of new forms of CAR T-cell therapy on different types of cancers in children and adults.

manufacture them, we can then carry them over to the

“We’re all doing slightly different things, but the goal is

hospitals and administer them. Being able to build that

to create the next generation of therapy,” says Verneris,

entire system is unique. It doesn’t happen everywhere in

who is working to develop a CAR T-cell that targets more

the country. It really differentiates UCHealth University of

than one biomarker on a cancer cell in order to double its

Colorado Hospital and Children’s Hospital Colorado from

effectiveness.

other institutions in the country.”

“We are also focusing on some solid tumors in children

THE TALENT EXPLOSION

and adults,” says Verneris, director of bone marrow

The Gates Biomanufacturing Facility put the University

transplantation and cellular therapy at Children’s Hospital

of Colorado School of Medicine on the map for cell and

Colorado. “For a lot of these tumors, therapy hasn’t changed

gene therapies, including CAR T-cells, and the School

from the 1970s until now. It’s not for a lack of trying, but

of Medicine began recruiting faculty members whose

nothing has worked. We’re targeting these tumors now with

“The fact that we have this capability on campus allows patients to have access to a therapy they might not normally have access to, and at the same time demonstrates that the infrastructure is now in place for us to handle these CAR T-cells in all aspects.”

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CAR T-cells, and at least in mice, it’s

“We don’t know how to use this

working really great.”

therapy perfectly yet. There’s a lot to

Verneris and other CU Cancer Center researchers also are working on clinical trials in support of a new type of CAR T-cell he says is almost like something out of science fiction. In an “allogeneic” CAR T-cell, instead of taking a patient’s RON RAND OL PH

concept to the bedside, allows you to really learn and treat this in an iterative way and to do the very best for these patients.” For Randolph, the patient who

cell, a single donor would donate their

received CAR T-cell therapy in June

blood to create an off-the-shelf CAR

for his multiple myeloma, “hope”

T-cell that could be infused into any

is a word that has re-entered his

number of patients. Doctors could order

vocabulary. “It was like a cakewalk compared to

“If you’re a young, healthy person, we

my bone marrow transplant,” he says

could get blood cells from you,” Verneris

of the CAR T-cell procedure. “I had no

says. “Then we could make CAR T-cells,

major side effects. I came home and

and also make them so that another

felt great. For people out there with

person’s immune system doesn’t see

multiple myeloma, there is now hope

them as foreign. It’s even more genetic

for living longer.”

engineering, and it sounds like science fiction, but those clinical trials are just getting underway, and the results are pretty cool.

Randolph now works out every day and has more time to spend with his family instead of in a hospital room. He retired from his longtime hobby of

“I anticipate one day having a medical

car racing a couple of years back, but

student seeing a child with leukemia,

he’s found another high-speed pursuit:

and taking that medical student aside

skydiving. He has gone twice so far

and saying, ‘I remember when we

and plans to go again soon.

used to give those children three years of chemotherapy.’ And now just one cell infusion will cure him. That’s how transformative this is,” Verneris adds.

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mass of people, all the way from the

own blood to create the cancer-fighting

it like any other treatment.

be learned,” he says. “Having a critical

“It was on my bucket list,” he says with a laugh. “I like the rush. I am definitely an adrenaline junkie.” Randolph is thankful he was “in the

A BRIGHTER FUTURE FOR MORE PATIENTS

right place at the right time” to receive

As time goes by and more patients

the CAR T-cell treatment, and he’s

receive the treatment, Verneris says,

thankful to Forsberg for helping him

physicians will become better at

get the therapy. The future, he says,

administering it and finding ways to

looks a lot brighter than it used to.

minimize side effects. CU Cancer Center

“Every day is a gift from God,” he

doctors recently treated their 100th adult

says. “I check the obituaries to make

CAR T-cell patient, but that’s just the

sure I’m not in them, and if I’m not in

beginning.

them — man, it’s a good day.”

DEC

DING CANCER

CAR T-Cell Therapy CAR T-Cell Therapy 2 2

Make CAR T-cells in the lab Make CAR T-cells in the lab

CAR protein

Insert gene for CAR Insert gene for CAR

CAR protein

CAR T-cell CAR T-cell

3 3

Grow millions of CAR T-cells Grow millions of CAR T-cells

T-cell T-cell

1 1

Remove blood from patient to Remove get T-cells blood from patient to get T-cells CAR T-cell

Cancer Cell Cancer Cell

5 5

4 4

CAR T-cells bind to cancer cellsT-cells and kill CAR them bind to cancer cells and kill them

Infuse CAR T-cells into patient Infuse CAR T-cells into patient

Antigen

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CLINICAL

CARE

Educational Pipelines Ensure Future Interest in Cancer Research

Eduardo Davila, PhD, and Adela Cota-Gomez, PhD, discuss the importance of creating interest in cancer-related careers. By Valerie Gleaton When you ask a classroom full of middle schoolers what they want to be when they grow up, you’re likely to get a range of answers, from pro athletes and astronauts to musicians and movie stars. Leaders at the CU Cancer Center’s Cancer Research Training and Education Coordination (CRTEC) program hopes to add “cancer researcher” to that list. Led by associate director Eduardo Davila, PhD, a professor of medicine in the Division of Medical Oncology, and assistant director Adela Cota-Gomez, PhD, CRTEC aims to educate and train the next generation of cancer clinical researchers and scientists. But first, they must find them. Davila and Cota-Gomez have been busy establishing new initiatives — and supporting existing programs — to reach future cancercare professionals, starting as young as middle schoolers and ranging up to junior faculty members. “My interest has always been to provide opportunities for people to see all the options out there in terms of medical careers, especially academic medical careers,” CotaGomez says. “When young people say, ‘I’m going to be a doctor,’ they’re usually only thinking about being in an office or hospital treating patients. I was one of those kids, and it wasn’t until I got to college that I realized there were so many research options. There’s an entire world of possibilities within medicine.”

Creating childhood interest in cancer research

For middle and high school students, CRTEC often partners with state and local schools to introduce students to cancer research as a future career option. In 2020, scientists at the CU Anschutz Medical Campus began partnering with science educators at the nearby Aurora Science & Tech Middle School. The program is supported by a federal grant funded by the National Cancer Institute. “What’s novel about this program is that we’re bringing in the teachers to develop

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new curricula for their students so they can introduce them to cancer research in the classroom,” Davila says. “Then, during the summer, we bring both the students and the teachers onto our campus and provide them with a hands-on, immersive research experience.” Another event, called Learn About Cancer Day, occurs each February and is aimed at local high school students. The daylong event includes short lectures on multiple aspects of cancer care and research, along with tours of CU Cancer Center research labs and Q&A sessions with technicians, graduate students, and faculty members.

A D EL A C O TA - GO MEZ, PHD

Fostering future scientists CRTEC also offers programs for undergraduate and graduate students interested in entering the field of cancer research. One of the biggest is the Cancer Research Experience for Undergraduates (CREU). Every summer, 30 undergraduate students are given the opportunity to spend 10 weeks in cancer research laboratories.

Last year, with support from the CU School of Medicine, Davila established a pilot program for recent graduates from traditionally underrepresented backgrounds called the Post-Baccalaureate Research Education Program (PREP). The one- to two-year mentored research program allows students to conduct full-time research in CU Cancer Center labs at the same time they’re beginning their applications for PhD or MD-PhD programs. Davila hopes to secure grant funding to expand the program and make it a permanent fixture of CRTEC. “The idea is to attempt to fill the very big void that exists when it comes to underrepresented people advancing into higher education programs, medical school, and PhD programs,” Davila says. Both he and Cota-Gomez emphasize that initiatives to increase diversity within cancer-related fields are essential. “We’re still very far from having our clinical teams be as diverse as the people we serve,” Cota-Gomez says. “And the same

ED U A R D O D AVI LA, PHD

is true for research. When I go into the community, people sometimes don’t believe I’m a researcher, because they’ve never met a Mexican, female scientist. But it’s a fact that diversity drives innovation and pushes research forward.”

Focusing on retention

Davila says his role isn’t just about creating pipelines to recruit future talent — it’s also about retaining the talent that already exists, both on campus and in the cancer-research field in general. One way CRTEC and the CU Cancer Center are doing that is by offering mentorship to junior faculty members. “The need for support doesn’t stop once someone gets their MD or PhD,” Cota-Gomez says. “I just talked with a postdoc who is considering faculty positions, but she’s scared because she doesn’t know the first thing about starting a lab. That training has never been formalized, but it’s the kind of thing you need to know to be successful and stay in the career long term. That’s the kind of support and training that we want to provide these mentored members.”

IMPROVING SURVIVORSHIP FOR INDIVIDUALS

DIAGNOSED WITH LUNG CANCER

BY GREG GLASGOW

There are two things most people believe about lung cancer, says Jamie Studts, PhD, co-leader of the Cancer Prevention & Control Program at the CU Cancer Center: Those who suffer from it most likely caused it by using tobacco, and the prognosis for surviving the disease is poor. While neither of those things is strictly true, the common perception of lung cancer means that those who survive it often do so alone, without the sense of community and togetherness that is the norm for many survivors of breast cancer, colorectal cancer, and other cancers. That’s why, when he served as professor of behavioral science at the University of Kentucky Markey Cancer Center, Studts led the development of an intervention to help support lung cancer survivors through their survivorship journey. Now on faculty at the University of Colorado School of Medicine, Studts — along with his colleague Jessica Burris, PhD, associate professor of psychology at the University of Kentucky — recently received a grant from the National Cancer Institute to further explore the intervention among lung cancer survivors in rural Kentucky. Working with collaborators from the James Graham Brown Cancer Center at the University of Louisville, the Markey Cancer Center at the University of Kentucky, and the GO2 Foundation for Lung Cancer, Studts, Burris, and their interdisciplinary team will measure the differences in outcomes between an intervention led by survivorship coordinators trained in the program he helped to create and a lesser-impact intervention in which lung cancer survivors have access to a workbook but no in-person counseling. The trial, slated to launch in spring or early summer 2022, will run for three years. Pending favorable results, Studts and his team hope the study will impact practice guidelines for lung cancer survivorship care. They also are planning further implementation and adaptation studies to examine how to facilitate implementation in diverse community settings. We talked to Studts about the intervention and the new study.

Stigma and shame can hinder the survivorship journey for lung cancer patients. An intervention co-created by CU Cancer Center member Jamie Studts, PhD, aims to make things better.

Q: Why is now a good time to launch an intervention like this? A: Over the past several years, there have been innovations in lung cancer care that have infused a great deal of optimism and improved prognosis substantially, whether those are new surgical approaches, new radiation approaches, immunotherapies, or targeted therapies. The next logical step is survivorship. Historically, we haven’t really focused on lung cancer survivorship that much because the prognosis was so poor. But now that there is a growing community of survivors, it helps expand an interest in quality of life, wellbeing, psychosocial outcomes, and behavior change to reduce the likelihood of having a recurrence.

Q: Why is survivorship more complicated for lung cancer survivors than for survivors of other cancers? A: If you consider the advocacy, development, and support that women with breast cancer receive, the contrast is fairly stark. The community does not rally around a lung cancer survivor in the same way they do with a breast cancer survivor. Lung cancer advocacy organizations are smaller, and individuals diagnosed with lung cancer don’t to the same degree affiliate with others who have also been diagnosed with lung cancer. And that is linked with a lot of the bias, stigma, and shame associated with what the public believes is a self-inflicted diagnosis.

Q: How does the survivorship intervention work? A: We ask our rural cancer care facilities to identify the individuals who are responsible for survivorship care at their institution, and we train those individuals with a treatment manual. Then we treat it like a restaurant of sorts. We give the survivors a menu so they can choose the supports they are most interested in and believe are the most relevant topics to improving their quality of life. There are 12 options on that menu, and they can choose one or they can choose all 12. They might say, “I’m really stressed; I want to work

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on managing my anxiety,” or, “ I don’t care about anything else; I just want to quit smoking.” They choose their adventure, and they can meet face-to-face or by computer or telephone with the survivorship care specialist over a period of weeks to work on those specific issues.

Q: How will the new randomized control study work? A: Once we determine they’re eligible, individuals in the intervention group receive the full intervention, which they can do on the phone or in person or on other platforms, and the control group gets what we call bibliotherapy. We created a treatment manual for survival care specialists and also a workbook. For the control condition, we give survivors the workbook. They get access to all the information, but they navigate it independently. With this randomized clinical trial, we hope to be able to test this strategy of reaching rural individuals who are facing lung cancer with an intervention that can improve their quality of life in areas including education, managing symptoms, psychosocial wellbeing, and addressing stigma and biases, as well as making any behavior changes they want to make. We’re really trying to test the efficacy of this intervention to make sure we can get it on the map as something that could be more readily adopted by any cancer program caring for individuals diagnosed with lung cancer.

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Recommended Colorectal Cancer Screening Age Lowered to 45 for People at Average Risk CU Cancer Center researchers say the move will save lives, particularly in medically underserved populations. By Greg Glasgow In a move that has the potential to save thousands of lives, the U.S. Preventive Services Task Force (USPSTF) in May lowered the recommended screening age for colorectal cancer from 50 to 45 for asymptomatic patients with no family history of colorectal cancer. Considered the leading source of medical guidance in the U.S., the USPSTF is an independent, volunteer organization made up of national experts in internal medicine, family medicine, pediatrics, OB/GYN, nursing, behavioral health, and more.

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“Since the 1970s, we have observed a steady increase in the incidence and mortality associated with colon cancer in patients under the age of 50,” says CU Cancer Center member Swati Patel, MD. “We don’t fully understand why this is happening, but if current trends continue — in part because we’re doing a great job of screening older individuals — by 2030 or so, up to 20% of all colon cancers and almost 30% of all rectal cancers will be diagnosed in patients under the age of 50.”

By lowering the recommended screening age, Patel says, the USPSTF is putting screening at top of mind for younger individuals, as well as ensuring that insurance companies will pay for the screening procedures for those 45 and older. “When you look at the increasing rates of colorectal cancer and how frequently it’s being diagnosed in the U.S., there’s this artificial jump in cases between 49 and 50,” she says. “That’s not because there is something biologically different between 49- and 50-year-olds; it’s because when patients are eligible for screening, there is a spike in diagnoses in people who had probably had colorectal cancer for several years and didn’t have symptoms. That really suggests to us that if we had the option to offer screening at age 45, that

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those patients could be diagnosed at earlier stages or the cancer could potentially even be prevented altogether.”

Multiple screening options While the colonoscopy is perhaps the best known screening option for colorectal cancer, Patel emphasizes that there are other tests available to screen for the disease. “There’s a whole menu of options that have been shown to be effective,” she says. “There are noninvasive tests such as stool-based tests, then also structural tests such as colonoscopy that can directly visualize the colon.” The advantage of the colonoscopy, Patel says, is that during the procedure doctors can find and remove precancerous polyps before they grow into cancer. The best test, she says, is “the test that gets done!”

Game-changer for medically underserved populations The change in recommended screening age is especially big news at the Colorado Cancer Screening Program (CCSP) at the CU Cancer Center, which exists to help patients in rural and medically underserved communities get screened for colorectal, lung, genetic, and hereditary cancers and also coordinates with the partnering breast and cervical cancer screening program. That’s not only because the change will result in more people getting screened at a younger age, but because Medicaid and other insurance providers now cover the procedures at no cost to patients, says CCSP director Andrea (Andi) Dwyer.

of early-onset colorectal cancer? How much of what we’re seeing is delayed care because of health care access? What resources are available in a community? Does a community have good primary care for younger individuals?”

ANDREA (AND I) D WY E R

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“Within our medically underserved community, particularly communities of color, this will be fantastic for us to have Medicaid and other types of private insurance being able to honor that USPSTF guideline,” she says. “Most of the people we see through the CCSP program and our partners are Medicaid patients, so this is really going to be a game-changer.” Chris Lieu, MD, associate director of clinical research at the CU Cancer Center, echoes that sentiment. Like many cancer doctors around the country, Lieu has seen an alarming increase in recent years of colorectal cancer cases in patients younger than 50. He is particularly concerned about the rise of colorectal cancer cases in patients from underrepresented populations — for instance, incidences among younger African Americans are nearly double the number in the young white population. In April, Lieu and two other researchers published an editorial in the journal Nature Reviews Cancer urging physicians to study the biological causes of early-onset colorectal cancer disparities while keeping in mind how social determinants of health — everything from health care access and systemic inequities to poverty and chronic stress — contribute to the problem. “There may be multiple things going on,” Lieu says. “We get so focused on the science that sometimes we forget about some of these other environmental and systemic and institutional topics. It’s a good reminder to be a little bit more holistic in the way we look at things.”

Multiple factors to consider At the individual level, while genetics plays a large role in earlyonset colorectal cancer, Lieu says, most cases are not caused by hereditary syndromes. More likely culprits, he says, are cellular mutations or even changes in gut bacteria. “As you move out from there, there are other individual factors that are outside of the body but just as important, if not more so,” he says. “How do race, gender, even insurance coverage, and general health impact the biology and development

Lieu and his co-authors know there is a lot of research going on around the world that addresses different pieces of the problem; in their paper they call for more collaboration and sharing of information to inform further studies and possible solutions. “It’s hard to answer all these questions in one system,” he says. “Even in the past year, there have been a lot of meetings put together over Zoom and efforts to put databases and information together. That’s the first step. Part of this is getting things together, whether it’s laboratory experiments or big databases of patient populations, but part of it is also using the expertise of multiple people to ask answerable questions. To really get down to why is this happening, and what are the things we can impact on an individual level and also a more macro level.”

Symptoms and family history still important While Patel is encouraged by the potential for lives saved by the lowered screening age, she stresses that the recommendation is for asymptomatic individuals with no family history of cancer. Those with a family cancer history or symptoms such as rectal bleeding, a change in bowel habits, or unexplained weight loss should not wait until age 45 to talk to their physicians, she says. “The most important time to talk to your doctor about colorectal cancer risk is when you first meet them, no matter how young or old you are,” she says. But for individuals at average risk, Patel says the USPSTF made the right move by lowering the recommended screening age to 45. “It’s not just that it prevents people from dying from colorectal cancer, but for somebody in their 40s or 50s, it has implications for the financial toxicity associated with a cancer diagnosis in an otherwise young, healthy, productive member of society,” she says. “These are individuals who are often caregivers; they’re often taking care of not only younger generations, but also caregivers for older generations, and they have decades of contribution remaining. Early detection of cancer at a curable stage is extremely important in this young population.”

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Acute Myeloid Leukemia Won’t Slow World Champion Triathlete Down Double clinical trials at the CU Cancer Center helped Siri Lindley go into remission after being diagnosed with cancer of the blood and bone marrow. By Jessica Cordova Siri Lindley couldn’t swim. She had never learned how. But when she became determined to complete her first triathlon, she knew she had to get in the water. “I couldn’t help but fall in love with triathlons,” Lindley says. “Something about it drew me in, and I knew I had to start training.” For eight years, Lindley dedicated her life to training for the sport she loved. In 1992, at age 23, she completed her first triathlon. Just four years later, in 1996, Lindley competed in the International Triathlon Union (ITU) World Cup Races. But competing was not enough. Lindley had a goal — she wanted to be number one in the world. Her dedication and passion for the sport reached its pinnacle in 2001, when Lindley won the title of ITU World Champion after winning six consecutive ITU World Cup Races. She retired from the sport on top and turned to coaching athletes competing in the Olympics and Ironman World Championships. “The thought of competing in a triathlon was an impossible dream at one point in my life,” Lindley says. “I was able to make the impossible possible.”

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Doing the impossible (again) Many tests later, Lindley’s world was turned upside down by the diagnosis of acute myeloid leukemia (AML), a cancer that starts in the bone marrow but quickly moves into the blood as well. “When I got diagnosed, my immediate thought was, ‘This is not my time to go. I am going to survive this. I am going to thrive through this,’” Lindley says. “Rather than focusing on the present situation, I focused on the final outcome.” Lindley knew she had to come up with the best treatment plan and work with the best doctors to get through her diagnosis. After receiving many recommendations, she landed at the University of Colorado Cancer Center under the care of Daniel Pollyea, MD, and Jonathan Gutman, MD.

Saved by the hip After years of training and competing, it was normal for Lindley to have some aches and pains occasionally. However, her hip had become so troublesome that she was no longer able to do her signature “silly dance” that she performed before every speech. “As fate would have it, I ended up as a speaker in multiple Tony Robbins events,” explains Lindley. “It started out as an interview in Hawaii after an event, which turned into participating in one of his podcasts, which eventually would lead to Tony Robbins asking me to speak at a leadership meeting. I had never done any public speaking before. Luckily, it came naturally and is now what I live for. But my sore hip was definitely taking away from my dance moves.” Lindley needed hip surgery. During her pre-operation appointment she had the standard tests, including a blood sample. Little did she know that these blood samples would ultimately save her life. “The doctors called me and said that they were very concerned about the results of my blood samples,” Lindley says. “They mentioned the word leukemia, and I thought, ‘There is no way.’ Looking back now, I am so thankful for my hip issues. I probably would not have caught it or caught it way too late had it not been for my sore hip.”

“In most AML cases in patients under 60, it is traditionally diagnosed after a person goes from being very healthy to being incredibly sick in a matter of weeks. Without treatment, it is a rapidly lethal disease,” explains Gutman.

DANI EL PO LLYEA, MD

In most cases, it is not caught in a screening like Lindley’s. But Gutman strongly believes that in weeks to months she would have started to show AML symptoms. “Historically speaking, and at virtually any other cancer center in the country right now, if a 51-year-old extremely healthy person walked in the door with Siri’s specific type of AML, they would get induction chemotherapy, then probably a stem cell transplant,” says Gutman.

J O NATHAN GUTMAN, MD

Induction therapy, or seven-plus-three chemotherapy, will wipe out a patient’s blood counts to nothing, and then they will spend a month in the hospital, letting the blood cell count recover and hopefully go into remission. “It is a very challenging thing to go through. People often become very sick, and it doesn’t always work,” says Gutman.

New AML treatment for a new population Fortunately for Lindley, Pollyea was conducting a clinical trial for patients like her. “While there is no one healthier than Siri Lindley in the universe, that shouldn’t automatically mean she should get induction chemotherapy,” Pollyea says. “Just because she’s likely to survive, it shouldn’t mean she

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“My doctors are my absolute heroes. I have no doubt they saved my life.” should get it. In Siri’s case, her disease features suggested she would have only around a 40% chance of responding to this treatment. We need to do better for these patients.” Instead, he offered Lindley the clinical trial, in the hope that it would be a better treatment option. This trial involved a drug called venetoclax, which Pollyea’s team has been working on since 2015 and was FDA approved in 2018 for elderly AML patients who are deemed unfit for intensive chemotherapy. “This has been a revolutionary treatment for AML. In the process of treating now upward of 200 patients with venetoclax-based regimens, we noticed that the typical risk features for a poor response to chemotherapy aren’t relevant in people who get venetoclax,” Pollyea says. “Knowing that venetoclax carries up to a 70% response rate, and does well in patients who have bad risk factors for traditional chemotherapy, we developed a clinical trial to use it in younger, fitter patients, who might survive chemotherapy but are unlikely to respond because of their underlying disease features,” he says. Lindley did respond to the new clinical trial treatment option. She had minimal side effects, and did not have to stay in a hospital for a month with intensive chemotherapy. “Siri is the poster child for somebody fit for the old-fashioned chemotherapy, but the important thing with Siri is that even though she’s fit for it, it wasn’t the right thing to do. We understand this disease better now, and we can do better. With more patients like Siri volunteering to participate in this trial, we hope to be able to prove to the world that this should be the preferred strategy in these situations,” Pollyea says. This is one example of how the hematology division at the CU School of Medicine is leading a shift in the approach to the treatment of this disease, and showing that these treatments can be less toxic, equally effective, and much more manageable.

Starting her second clinical trial for a bone marrow transplant “As soon as I went into remission, I immediately went in for my stem cell transplant,” Lindley says. “It was the hardest experience I had ever gone through, but I was determined to come out stronger than before.” Her stem cell transplant was part of another clinical trial taking place at the CU Cancer Center that she hopes will cure her.

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Gutman is the principal investigator on this clinical study, which uses matched donor cells in combination with umbilical cord blood. The trial is designed to result in more rapid recovery of blood cell counts after transplant than after a traditional cord blood transplant. The goal is to get patients through the acute transplant process more easily and shorten time in the hospital. “My doctors are my absolute heroes,” Lindley says. “I have no doubt they saved my life.” Lindley used vision boards that motivated her through her hospital experience. Pictures of her running her favorite trail, enjoying life with her wife, Rebekah, and spending time with her beloved horses kept her going. Once again, Lindley has defied the odds and done the impossible. She is more than one year out from her transplant and cancer free.

Finding the good Although finding good from a cancer diagnosis can be difficult, Lindley knows the experience came with a lot of positive outcomes.

“The diagnosis brought my family back together. We had grown apart, but they all gathered around me in such an incredible way,” Lindley explains. “My mom, my wife, and the doctors were all superheroes.” Lindley’s mom slept at the hospital every day for a month. “I also got to spend more time with my horses, which is so therapeutic and healing.” Lindley and her wife run a horse rescue in Longmont called Believe Ranch and Rescue. “In the last three years we have saved 117 beautiful horses,” Lindley says. “It has been the most beautiful experience saving these horses and giving them a loving life. For me, the horses gave me a sense of safety and calm while I was going through treatments.” Today, Lindley is back to doing what she loves most — public speaking and coaching a world-class group of triathletes. She has already participated in multiple online events, with more planned later this year. She also has a new appreciation for life that probably would not have happened without a cancer diagnosis. “I get to live!” Lindley says. “It is a miracle. I will make the most out of this life. I will love; I will share — every single moment of life is a gift. I am just so grateful.”

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METABOLISM IS A KEY RESEARCH AREA FOR THE CU CANCER CENTER A crosscutting initiative aims to develop multidisciplinary projects around everything from molecular research to diet and exercise. By Greg Glasgow All cells use the process of metabolism to turn nutrients into energy — including cancer cells. Metabolism is a fundamental function whose role in cancer is being explored by researchers across the CU Cancer Center. “We define metabolism pretty broadly,” says CU Cancer Center member Paul MacLean, PhD, who helps oversee metabolism-related research. “It ranges from cell metabolism and targeting molecules in cancer cells to what you eat at the dinner table and how that changes your body. We go from molecules all the way up to nutrition and exercise, and that really allowed a lot of different programs in the cancer center to come together.” The role of metabolism in cancer became clear in the 1920s, when German scientist Otto Heinrich Warburg discovered that cancer cells metabolize differently than normal cells, allowing them to grow and progress more quickly. “Over the years we’ve realized that cancer cells are just very adaptable,” MacLean says. “The more aggressive cancers can be very adaptable with their metabolism and can use different types of fuels.”

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Variety in research Along with the aging process, metabolism is one of two crosscutting themes for researchers at the CU Cancer Center. In fall 2020, the center funded four different research projects on the theme, including one on regulating mitochondrial metabolism to improve CAR T-cell immunotherapy, and another focused on the effects of cardiorespiratory fitness, physical activity, and sedentary behavior on insulin resistance in breast cancer survivors. “We are interested in exploring how different facets of exercise might impact diabetes risk for women who are being treated with endocrine therapies for their breast cancer,” says CU Cancer Center member Heather Leach, PhD, who is conducting the latter study with Rebecca Scalzo, PhD. “Women who have a hormonepositive tumor typically receive therapy that lowers their estrogen levels, and that has implications for increased disease risk, particularly diabetes. We’re looking at how fitness, as well as activity patterns, are associated with insulin resistance and glucose tolerance.” Leach, associate professor of health and exercise science at Colorado State University and director of

the Physical Activity for Treatment and Prevention Lab, hopes the study yields more information about the importance of exercise and activity patterns in preventing and recovering from cancer. “From my perspective, it’s really about the impact on prevention and control,” she says. “We know that one of the leading risk factors — not only for developing cancer, but cancer-related mortality — is obesity. The other side of that coin is diet and exercise. Those have a lot of implications for metabolism, from trying to figure out how can we get people to engage in these behaviors that we know are going to help them, and why they are so important.”

Strengths in technology and collaboration Among the reasons for choosing metabolism as a crosscutting theme for the CU Cancer Center was the strengths the CU Anschutz Medical Campus already has in the area — within and outside of the center. “We have a lot of strengths in metabolism not directly related to cancer currently, but where we want to leverage those strengths,” says James DeGregori, PhD, deputy director of the CU Cancer Center. “One of them is the Nutrition Obesity Research Center, where they have done some studies linking obesity to cancer rates. We also have the CU Anschutz Health and Wellness Center, where there are studies ongoing to understand how exercise can impact not just cancer survival, but the well-being of cancer patients undergoing treatments.” MacLean, director of the Nutrition Obesity Research Center, says part of his research program over the past 15 years has been dedicated to building a bridge between his center and the CU Cancer Center and identifying

researchers interested in the intersections among cancer, nutrition, and obesity. “Under that umbrella are diabetes and metabolic disease, and asking questions about why are obesity and metabolic disease accelerating disease in so many different cancer types?” MacLean says. “How can nutrition — dietary interventions like weight loss or intermittent fasting — be used to counteract or eliminate this obesityassociated risk?”

J A MES DeG R EG O R I , PH D

The crosscutting theme also spans multiple campuses, including Colorado State University and the University of Colorado Boulder. It is also supported by improvements in technology, including the mass spectrometry and animal imaging shared resources. At a molecular level, DeGregori says, some cancers are more addicted to sugars, while others might more heavily rely on mitochondria, structures that produce energy within cells through metabolism. Research by CU Cancer Center members Craig Jordan, PhD, and Daniel Pollyea, MD, led to recent FDA approval of a drug called venetoclax in acute myeloid leukemia (AML); the drug works by targeting the metabolic abilities of mitochondria.

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“That’s a nice example of where a therapy was really shown to have a metabolic mechanism,” DeGregori says.

Working across disciplines

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“Our major goal is to stimulate crossdisciplinary research,” DeGregori says. “We want to find those people who are doing the fundamental work and connect them with the people doing exercise studies. Even a study that’s not a molecular study, like an exercise study, still has a basis in cells and tissues, and metabolic pathways. “We want to get these people from different disciplines talking to each other and collaborating, and at some point even forming projects where they get funding to work as a collaborative group.”

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Wellness Program Challenges Cancer Patients to Remain Active Graduates pay it forward by donating to program that helped them feel at home in their bodies again after cancer treatments. By Rachel Sauer Janice Woodward was already a member of the club nobody wants to join — the cancer club, membership involuntary — when she got an irregular mammogram result in May 2019. Ten years previously, in her mid-50s, Woodward had survived ovarian cancer and a surgical treatment that removed a 10-pound tumor from her lower abdomen. This time, though, she would need not only two surgeries, but radiation to treat the breast cancer with which she was diagnosed. It was before one of those radiation treatments that some wires got crossed regarding her appointment. But she got ready anyway, got into her gown, and wandered up to the clinic’s nursing station desk “because I just can’t be self-conscious about things like that anymore,” she recalls with a laugh. That’s where she made a discovery that helped her make some profound changes for the better: On the nursing station’s desk, she saw a flyer for the BfitBwell program in the University of Colorado Cancer Center. A three-month individualized fitness program for people who are currently receiving or recently completed treatment for cancer, BfitBwell provides evidence-based, cancerspecific exercise training with the goal of not only increasing functional capacity, but improving an individual’s overall quality of life.

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The program is based in the CU Anschutz Health and Wellness Center and operates in partnership with the CU Cancer Center. BfitBwell helped Woodward feel at home in her body again, especially after the unexpected exhaustion that steadily grew through her radiation treatments. Her experience in the program was so meaningful to her that after completing the three months in BfitBwell, she became a program benefactor. “I wanted to pay it forward,” she explains. “It was such a positive experience, and no one treats you like, ‘Oh, poor cancer patient.’ They treat you like a person who is working out. There’s no pity, none of that, and I think that everyone who receives a cancer diagnosis deserves to experience that.”

HELPING CANCER SURVIVORS GET THEIR LIVES BACK The desire to support people going through cancer treatment as they navigate changes in their bodies was the genesis for BfitBwell in 2013, says John Peters, PhD, who created the program with former CU Cancer Center member Tom Purcell, MD, MBA. It has now graduated more than 750 participants. “The notion was that there isn’t anything in terms of exercise for cancer patients like there is for cardiac patients — a program to support you getting back on your feet,” Peters says. “Cancer treatment can be pretty awful — it could be surgery, it could be radiation, chemotherapy. Those knock you down pretty hard, and then when you’re done you get a handshake and ‘good luck.’ “Our vision has always been that exercise is just as valuable for cancer survivors as it is for cardiac survivors — something to help them build back their strength and get their own life back.” A cancer survivor himself, Peters says a body of research shows that for people currently or recently going through cancer treatment, exercise can reduce fatigue, decrease depression, increase muscular strength and cardiovascular endurance,

promote healthy lifestyle choices, and improve overall quality of life. In designing BfitBwell, Peters and Purcell studied American College of Sports Medicine research that finds cancer survivors can benefit from participating in 30 minutes of moderate-intensity cardiovascular exercise three times per week and 30-minute strength training sessions two to three times per week. The program also is designed to contribute to the growing body of research relating to cancer treatment and exercise. Ryan Marker, DPT, PhD, assistant professor of physical medicine and rehabilitation in the CU Rehabilitation Sciences PhD program, leads assessments and research on the program’s measurable benefits and manages the registry of data for all participants. The BfitBwell program aims to balance scientific, evidence-based approaches to exercise and wellness with a human touch that helps people who have received a cancer diagnosis to navigate unfamiliar and often scary new paths. “So many patients are just thrown into the realm of cancer upon diagnosis,” says Nicole Gleason, CCES, CPT, BfitBwell program manager. “It’s bam bam bam,

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and they’re just given this treatment calendar. This is something they have control over; this is something they can say, ‘I want to do this for myself.’”

“THEY DIDN’T START ME OFF LIKE I CAN’T DO ANYTHING” For Pattie, a former BfitBwell participant who also became a program benefactor, the journey began with the discovery of a polyp after feeling that something just wasn’t quite right. “I’ve always been active, always been a runner, so I pay attention to how I’m feeling, and I knew that postmenopausal bleeding wasn’t normal,” she says, explaining why she made an appointment with her gynecologist. An ultrasound revealed the polyp, and a biopsy returned a diagnosis of endometrial cancer. “I was completely devastated,” Pattie recalls. “You never want to hear that.” She had a hysterectomy and received radiation treatments, and it was while working with radiation oncologist Christine Fisher, MD, a CU Cancer Center member, that she heard about BfitBwell. “I thought BfitBwell was for someone who maybe hasn’t exercised, but I called them anyway and said, ‘I don’t know if I even qualify for this,’ but they were so nice and said, ‘Absolutely, it’s for you, come in and we’ll do an assessment,’” Pattie recalls. “Honestly, I wasn’t sure what they could teach me. I’ve exercised my whole life. But boy was I wrong. I really needed them.” An aspect of the program she especially appreciated was that “they didn’t start me off like I can’t

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do anything,” she says. “They started me off right in the middle and pushed me much more than I was pushing myself. They talk to you, they support you where you are, they’re always there. They truly helped me.” The experience, Pattie says, was life-altering, which is why she decided to become a program benefactor and include the BfitBwell program in her estate plans. Being able to support a program from which she gained so much, she says, is an important way to ensure the program can continue for those who will benefit from it just as much.

INDIVIDUALIZED EXPERIENCES FOR EACH PARTICIPANT For each program participant, the journey through BfitBwell is individualized; no two experiences will be the same, Gleason says. Throughout the COVID-19 pandemic, the program adapted and added online components so participants can work out at home if that’s their preference. “We do an initial evaluation or assessment, which is pretty crucial

for us to understand where one’s starting point is,” Gleason explains. “A lot of individuals don’t even recognize where their start point is. Their mindset may be, ‘I used to do this, this, this, and don’t know how much might be too much.’ That initial assessment is so important and helps us have a safe starting point.” Participants then do individualized workouts with trainers who have specific training in working with people undergoing treatment for cancer. “All cancers are different, and the way the same type of cancer affects one person may affect another person completely differently,” Gleason says. “Plus, a person may have had surgery, may be having chemotherapy or radiation, they may be having completely different side effects or no side effects at all, so we look at that and a lot of other factors for each participant.” The program is for people currently going through treatment for cancer and those who are six months or fewer past the end of their treatment, Peters explains. The first month focuses on one-on-one training,

“Our vision has always been that exercise is just as valuable for cancer survivors as it is for cardiac survivors — something to help them build back their strength and get their own life back.” helping patients establish safe and effective movement patterns, and becoming familiar with exercise equipment. The second and third months focus on working through individualized programs in small-group settings, which helps participants build a sense of autonomy and familiarity with the equipment, exercises, and overall fitness environment. BfitBwell dedicates particular focus to resistance movements rather than aerobic exercise, Peters explains, “because we want to help participants understand how their bodies work and what are the most important muscles they’re going to need to live the life they want to live,” he says. “We want to have that understanding of how this exercise relates to what you’re going to do in real life — how do you lift up your grandchild without breaking your back? How do you squat to pick something up?” Some people going through treatment for cancer, or who have recently completed it, may feel hesitant to participate in BfitBwell because they didn’t exercise much before their diagnosis, Gleason says. Others may hesitate because they’re so sapped of energy from treatments, or because their prognosis isn’t good. “There’s a level of investment with our trainers, and they do a lot of deep listening with participants, focusing on the individual,” Peters says. “Ultimately, they’re coming from a place of working to help each person feel better, feel more in control of this aspect of their lives during a time when a lot of things feel out of their control.”

EVERYONE GETS STRONGER For Woodward, who has exercised her whole life, the loss of control manifested in the growing fatigue she felt as she progressed through her radiation treatments. There were times when she went for a walk in her neighborhood and worried she wouldn’t have the energy to get home. However, she says, the adaptability of the BfitBwell program and the personalized work she did with trainers meant that even on days when she started the workout depleted of energy, she somehow ended up gaining it. “What was reaffirming to me, and I think to everyone, is you do get stronger, no matter where you came in,” she says. “They take the time to get to know you, so they can push you in a way that’s motivating.” She says the educational component was especially helpful, learning the names of certain movements, how to do them, and how to create her own workouts. Perhaps just as important, though, was the camaraderie with other participants as well as with the trainers. Woodward says she benefitted as much from the emotional and social support, and from the friendships she made, as she did from learning how to correctly do challenging moves with progressively heavier weights. It’s why she decided to become a donor. “I just want more people to know about this program and to benefit it from it,” she says. “In BfitBwell you’ll never be treated like a poor cancer patient. You’ll be treated like an individual who is strong, you’ll be supported, you won’t be told all the things you can’t do, but all the things you can.”

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C3: Collaborating to Conquer Cancer Published twice a year by University of Colorado Cancer Center for friends, members and the community. (No research money has been used for this publication). Contact the communications team: Jessica Cordova | Jessica.2.Cordova@cuanschutz.edu Greg Glasgow | Gregory.Glasgow@cuanschutz.edu Design: Candice Peters | Design & Print Services University of Colorado The CU Cancer Center partners with: UNIVERSITIES

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A Leap Forward

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Going ‘Over the Edge’ for cancer research. In September, I joined 13 other members of the CU Cancer Center to take part in Over the Edge, an annual event organized by the Cancer League of Colorado (CLC) to raise money for Colorado-based cancer research. Participants rappelled down a 36-story building in downtown Denver, soliciting donations from family and friends to support their efforts.

FROM THE DIRECTOR RICHARD SCHULICK, MD, MBA DIRECTOR, UNIVERSITY OF COLORADO CANCER CENTER CHAIR OF SURGERY, UNIVERSITY OF COLORADO SCHOOL OF MEDICINE

It was my second year participating in Over the Edge. In addition to being part of an important fundraiser for the CLC — which is one of the primary funders of research at the CU Cancer Center — I have to say that it’s just a lot of fun to go down the side of a really tall building. For me, the fundraiser also has a symbolic meaning. Leaping over the edge requires a lot of trust, and I’m sure that when patients come to the CU Cancer Center for the first time, at some point they have to put their trust in us and decide to “take the leap” to entrust their care to us. That’s a responsibility I take very seriously. Rappelling down a building also takes a certain amount of boldness on our part, and I like to think we are equally bold in our fight to prevent and conquer cancer, whether that’s conducting research, leading clinical trials, or using the latest medications and technologies to give our patients the best quality of life possible. The CLC has given us close to $10 million in funding over the past 10 years, but we have many individual donors who help us as well. Some are new donors who want to help us make a

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difference, and some are people and families who support us year after year. Those people very often recruit other donors to help us, and they get the word out about all the terrific things that are going on at the CU Cancer Center. All of those donations are important because they help fund high-risk, high-reward projects and give us the leeway to generate pilot funding. With that pilot funding, we can then apply for grants from the National Institutes of Health, American Cancer Society, and other organizations. Some of our most meaningful donations come from former patients. It’s very gratifying to be involved in the care of a patient who has done extremely well — to see how grateful they are, and to see them wanting to do things that will enable the same results in other patients. No matter where they come from, we are so appreciative of all the donations we receive, as well as the donors who trust us enough to go “over the edge” with our research and patient care.