Pathways TO DISCOVERY
AT T H E FO R E F R O NT O F C A N CE R CARE AND DIS COVE RY
In Pursuit of Health Equity FEATURE STORIES 1 CANCER AND COVID-19: THE IMPACT OF MISSED SCREENINGS IN VULNERABLE COMMUNITIES 4 ADDRESSING HEALTH EQUITY IN CANCER GENOMICS 7 EDUCATION ROUNDUP FALL 2021
Pathways TO DISCOVERY
AT THE FORE FR ON T OF CANCER CARE AND DISCOVERY
FALL 2021 E X E C U T I V E E D I TO R
Jane Kollmer SENIOR SCIENCE WRITER
Tiha M. Long, PhD E D I TO R I A L A DV I S O R S
Kunle Odunsi, MD, PhD DESIGN
Pivot Design, Inc. PRINTING
G Thomas Partners LLC
Pathways to Discovery is a publication of the University of Chicago Medicine Comprehensive Cancer Center. T H E U N I V E R S I T Y O F C H I C AG O M E D I C I N E CO M P R E H E N S I V E C A N C E R C E N T E R 5 8 41 S . M A RY L A N D AV E . MC1140, H212 C H I C AG O , I L 6 0 6 3 7 P H O N E 1 -7 7 3 -70 2- 6 1 8 0 FA X 1 -7 7 3 -70 2- 9 3 1 1 F E E D B AC K@ B S D . U C H I C AG O . E D U
© 2021 The University of Chicago Medicine Comprehensive Cancer Center. All rights reserved.
From the Director Cancer is a major public health concern that can affect anyone. However, in the United States, certain population groups suffer more from cancer and its effects. These are known as cancer disparities, and they impact people according to their race/ethnicity, sex, age and socioeconomic status. In this issue, we explore the ways in which our researchers are working to improve outcomes for groups disproportionately affected by cancer. Their research efforts range in scope from designing and implementing culturally appropriate health interventions, to improving access to care and clinical trials, to examining genetic factors that may explain differences in rates of aggressive cancers. Another area we can make a great impact is by ensuring that the next generation of cancer researchers reflects the full diversity of our community. You’ll read about how our pathway education programs are mentoring and inspiring youth from different backgrounds to pursue careers in cancer research. Because many different factors can influence cancer disparities, addressing them is not always simple or straightforward. But by understanding why certain groups are at increased risk of developing or dying from particular cancers and addressing the factors that influence those disparities, we can make healthcare more equitable and improve outcomes for those who are most vulnerable to cancer’s devastating effects. Enjoy the issue,
Kunle Odunsi, MD, PhD AbbVie Foundation Director, University of Chicago Medicine Comprehensive Cancer Center
Cancer and COVID-19: the impact of missed screenings in vulnerable communities By Sobhika Agarwala, PhD
The COVID-19 pandemic has led to steep declines in cancer screenings, particularly in underserved communities, which have led to decreased diagnoses and could result in thousands of deaths, worsening cancer disparities. It has been over a year since the COVID-19 pandemic created an unprecedented public health crisis throughout the world. Although the immediate threat of COVID-19 has decreased due to vaccination efforts, its devastating effects will be felt for years to come. Especially concerning is the drop in cancer screening rates, with the most dramatic reduction in screening occurring in medically underserved communities. This has led to decreases in diagnosis and treatment and is expected to result in thousands of preventable deaths. According to the Centers for Disease Control and Prevention, the screening rates for breast and cervical cancers fell by more than 80%, with the most severe declines occurring in populations of low-income women of color.
The threat of worsening cancer outcomes has been recognized by the international cancer research community as a leading priority. In a June 2020 editorial, Norman E. Sharpless, MD, director of the National Cancer Institute, expressed concerns about the mortality related to breast and colorectal cancer in particular. Early projections showed that if these trends continue, mortality for these cancer types is expected to increase by nearly 10,000 in the next 10 years in the U.S. alone as a result of missed cancer screenings and treatment, assuming a disruption of 6 months. However, the pandemic has lasted far longer than anyone anticipated, so the effects could be greater.
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It is not surprising that the underserved com munities comprising Black and Hispanic people are disproportionately affected, according to Nita Lee, MD, MPH, associate professor of obstetrics and gynecology, and Blase Polite, MD, professor of medicine, at the University of Chicago Medicine Comprehensive Cancer Center, who have been working in the field of cancer disparities for decades. Polite said, “Even before the pandemic, healthcare disparities such as lower screening rates and higher mortality rates for some cancers were apparent in medically underserved communities due to the lack of access to quality care.” He added, “Loss of income and health insurance during the pandemic has exposed a fragmented health system that has failed to provide a safety net to these communities,” said Polite. According to Lee, “If people had health issues or COVID-19 or if their loved ones are suffering from COVID-19, cancer screening might not be a priority for them over other necessities,” she said. “People in vulnerable populations already have to make tough decisions about the use of inadequate resources. For instance, many people may lack easy access to transportation, or not be able to take time off from work or from caring for family members, and these difficulties have only been worsened by the pandemic.” Lee said addressing these problems will need creative solutions. She added that the community- based and public health avenues that have been emergently activated for creating awareness about COVID-19 should also be used to spread awareness about cancer screening and detection to minimize preventable cancer-related deaths. A key part of the Comprehensive Cancer Center’s mission is to promote cancer health equity among all populations and communities, especially among groups where there are known cancer disparities based on decrease in cancer screenings for low-income race, ethnicity, lanwomen of color during guage and geographic COVID-19 location. The team of experts specializes in cancer control, prevention
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and population research while implementing new approaches to screening and prevention. But because of COVID-19, now more than ever, it is critical that they encourage local residents to adopt a healthy lifestyle that includes cancer screenings. Through the Office of Community Engagement and Cancer Health Equity (OCECHE), the Comprehensive Cancer Center has ramped up its activities that inform and empower community members to take charge of evidence-based cancer prevention strategies. The group meets monthly with its Community Advisory Board (CAB) to address concerns and actively partner to address issues of concern for community cancer needs. This year, much focus has been on addressing questions related to the COVID-19 crisis, the COVID-19 vaccine and resources for cancer patients. CAB members include active community partners — including leaders of federally qualified health centers, nonprofit cancer advocacy organizations, cancer survivors and advocates, local cancer support centers, and religious and cultural organizations with a focus on the needs of cancer patients throughout the cancer care trajectory. “With our strong ties to community organizations, we can identify what residents need to stay safe and healthy so that we can help connect them with the appropriate resources and support during this extremely challenging time,” said Karen Kim, MD, vice provost for research and associate director for community outreach and engagement for the Comprehensive Cancer Center. Although face-to-face meetings are still the best way to communicate, the OCECHE team has adapted an all-digital approach to community engagement and health education. For example, community health worker trainings are an integral part of the OCECHE community cancer education offerings. In response to the COVID-19 crisis, OCECHE partnered with Comprehensive Cancer Center member Marcia Tan, PhD, assistant professor of public health sciences, and City Colleges of Chicago to deliver a virtual tobacco cessation module for the 20-hour Community Health Worker (CHW) certificate program at Malcolm X College on the Near West Side. Tan discussed her research and strategies to help patients quit tobacco. One-hundred percent of participants reported knowledge gains and are interested in more virtual education opportunities
“ If people had health issues or COVID-19 or if their loved ones are suffering from COVID-19, cancer screening might not be a priority for them over other necessities.” —Nita Lee, MD, MPH with the Comprehensive Cancer Center. Additional modules are being planned for the CHW certificate programs at Malcolm X and Olive Harvey College. OCECHE is the recipient of a National Cancer Institute Community Health Educators (CHE) grant, which allows the department to host in-person education sessions on colorectal cancer screening, HPV vaccine for cancer prevention and cancer clinical trials. With the COVID-19 crisis preventing live education, OCECHE has moved its entire CHE program to virtual platforms to remain engaged with the community and provide critical cancer education.
OCECHE also developed a series of faculty-led webinar presentations and discussions for cancer patients, survivors and caregivers, offering suggestions for staying safe and managing the additional stress of dealing with cancer during a pandemic. The topics included breast cancer, presented by Olufunmilayo Olopade, MD, and Sheila Rajagopal, MD; gynecologic cancers, presented by Lee; colorectal cancer, presented by Polite; and lung cancer, presented by Jessica Donington, MD, among others. The webinars for cancer education for both employees and community members are ongoing. Moving forward, whether efforts are done in-person or virtually, Lee and Polite emphasize that medically underserved populations face an urgent need for solutions to the cancer care challenges exacerbated by the COVID-19 pandemic, and that the medical community must prioritize the reduction of cancer health disparities.
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ADDRESSING H E A LT H E Q U I T Y I N C AN C ER GENOMIC S A N I N T E R V I E W W I T H L O R E N S A U L S B E R R Y, P H D B Y LY N D R A VA S S A R
While studies have confirmed that certain racial and ethnic groups are at greater risk for developing cancer and experiencing adverse health outcomes, progress is underway in cancer genomics to help eradicate well-documented disparities. Loren Saulsberry, PhD, a faculty member within the University of Chicago Medicine Comprehensive Cancer Center and assistant professor in health policy and health services research in the Department of Public Health Sciences, recently received a career development (K) award from the National Institutes of Health (NIH) to develop new research programs that prioritize health equity and serve the needs of underrepresented groups in genomic medicine and pharmacogenomics research.
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C A N YO U S H A R E A B I T A B O U T W H O YO U A R E , YO U R P E R S O N A L BAC KG RO U N D A N D H OW IT ’ S S H A P E D Y O U R PA S S I O N F O R H E A LT H E Q U I T Y I N C A N C E R G EN O M I C S A N D PH A R M ACO GENOMICS RESEARCH?
I come from a very mixed family background, with people of all shades and levels of education, combined with lots of Southern culture. Growing up in Texas, I was exposed to lots of different languages and cultures. Despite living in what many people may consider the traditionally segregated South, I grew up experiencing more cultural mixing than some might imagine, so when I started pursuing research — particularly in health policy and health equity — bringing that diverse lens to my work was really important to me. I knew I wanted to focus on topics relevant to translational medicine and care delivery that would improve patient experiences and outcomes despite their personal background. Integrating health
equity into areas of rapid technological advancement for treating the chronic conditions that disproportionately affect underserved and underrepresented communities is particularly significant to me.
C U R R E N T LY T H E R E ’ S A M A J O R D E B AT E I N C A N C E R G E N O M I C S A N D PH A R M ACO G EN O M I C S A B O U T I N C O R P O R AT I N G R A C E / E T H N I C I T Y A N D / O R G E N E T I C A N C E S T R Y D ATA I N T O R E S E A R C H S T U D I E S . W H AT ARE THE COMMON ARGUMENTS YO U ’ V E H E A R D S U R R O U N D I N G THEIR USE IN THESE FIELDS — WHY ARE SOME PEOPLE FOR OR AGAI N ST IT ?
It’s essential to acknowledge that there are valid concerns on both sides. Whenever we think about this debate, it’s important to remember that we’re not conducting research involving diverse populations in a vacuum. This kind of research comes with a lengthy history of discrimination within health systems and egregious policy decisions that have negatively impacted underserved and underrepresented populations. People often cite Tuskegee as the main example, but Tuskegee is not by far the only breach of bioethics. So, the reason there is such a debate surrounding this is that everyone is trying to pursue cancer genomics with the most ethical approach. On one side, you have some who believe that considering race/ethnicity or genetic ancestry in cancer genomics is backsliding in a sense. They fear that racial categories, which are completely socialized and political constructs, will be inaccurately tied to biology and that we may do more harm to populations by reinstituting, perhaps in really new pernicious ways, deleterious narratives around differences between racial populations.
On the other side of the argument, population markers based on race/ethnicity and/or genetic ancestry hold enormous potential to tailor cancer care and alleviate health disparities. Historically, new healthcare technologies are retroactively designed to serve diverse populations. There is a shift in thinking that promotes incorporating considerations of diversity at every phase of the biomedical enterprise so that all groups are poised to maximally benefit from technological breakthroughs all along. If we don’t include underrepresented or underserved populations in the science and clinical implementation of genomics research from the beginning, we could potentially be perpetuating inequities and/or exacerbating disparities.
A N D W H E R E D O Y O U S TA N D I N T H I S D E B AT E A N D I T S I M PA C T O N H E A LT H E Q U I T Y ?
Both sides of this debate deeply resonate with me. For me, I view my research through both lenses. What stands to be gained? What may be lost? To date, my interpretation of the evidence across the translational cycle from science to society suggests that both race/ ethnicity and genetic ancestry have important roles within genomic medicine. That means we have to be very clear about what we’re researching, the defined populations studied and the implications of the potential results. We have to ask, “Are we defining our study populations along the lines of race/ethnicity, genetic ancestry, or both?” And once we have an answer, we must be able to clearly justify the selection of those populations according to the research question and the methods selected to answer it. Finally, as a health policy and health disparities researcher, I carefully consider what the policy implications of the research may be and what levers might be pulled to improve health equity.
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that influence patient interactions with the health system. Although every study may not address all of these aspects at once, research conducted with a similar focus on equity helps to progress the field and, hopefully, ensure that new barriers aren’t being created along the way. Loren Saulsberry, PhD
W H AT A R E S O M E S O L U T I O N S T H AT C A N H E L P I M P R O V E H E A LT H EQUIT Y IN CANCER GENOMIC S AND PH A R M ACO G EN O M I C S R ES E A RC H ?
For health equity, there is no one solution. It’s going to take collaboration across multiple sectors, and no single researcher, clinician, public health practitioner or policymaker can address health equity alone. It will take all stakeholders within and beyond the health system lending their expertise and alternative perspectives to tackle health disparities. Collaborative science that clearly articulates its approach and methodology is an important place to start.
H OW D O YO U E N V I S I O N YO U R RESEARCH CONTRIBUTING TO S O LU T I O N S ?
As a part of the Cancer Center, my focus is on research that can have direct positive impact on patient lives. For example, tailoring genomic studies such that they incorporate the views and preferences of underserved and underrepresented populations. That means taking into account not only individual clinical factors but access, healthcare payment and reimbursement policy for genomic medicine, and the social determinants of health
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My current research focuses on health equity and pharmacogenomics, especially tailoring its clinical implementation to underserved and underrepresented patients. I’m excited to be building this research program at a place like UChicago, where there are opportunities to collaborate with the best in the field of translational genomics.
W H AT A R E S O M E P R A C T I C A L A P P ROAC H ES R ES E A RC H ER S C A N IMPLEMENT FROM THE GROUND L E V E L TO M A K E S U R E T H E Y ’ R E C O N S I D E R I N G P O P U L AT I O N S W H O A R E T R A D I T I O N A L LY U N D E R R E P RESENTED IN CLINICAL STUDIES?
Whether an intervention is within or outside of a clinical setting, when we think about health equity and what we aspire to achieve, equity doesn’t mean supplying the same exact type or level of resources to all patients, but more so supplying the resources that each individual patient needs based on their particular life situation and clinical factors. I’d encourage researchers to use an interdisciplinary team science approach to make sure this work is not done in a silo. In my experience, taking a team-based approach has illuminated aspects of the research that have ultimately augmented its impact to the real-world setting.
Education Roundup By Megan Mekinda, PhD
Scientists and trainees from diverse backgrounds and life experiences bring different perspectives, creativity and individual enterprise to address complex scientific problems. In spite of tremendous advancements in scientific research, not all information, educational and research opportunities are equally available to all. Several education programs at UChicago Medicine Comprehensive Cancer Center are working toward a diverse, inclusive and equitable cancer research community.
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(Left) Michelle M. Le Beau, PhD, and Sonia Hernandez, PhD, (right) with awardee Paula Viza Gomes (middle)
Paving a bright path forward Throughout her prestigious career in cancer research, Michelle M. Le Beau, PhD, has been an advocate, mentor and role model for young people eager to follow in her footsteps. Under her leadership, the University of Chicago Medicine Comprehensive Cancer Center established robust research training and career development opportunities for those as young as high school, empowering a new and diverse generation of scientists and clinicians. The Michelle Le Beau, PhD, Aspiring Scientists Fund continues this legacy, with a special commitment to women and others underrepresented in cancer research. Contributions to the fund directly support participants of the Comprehensive Cancer Center’s innovative cancer research training programs, which serve dozens of aspiring scientists from Chicagoland communities each year. “Before the program, I was a nervous 16-year-old from a low-income neighborhood who doubted herself,” said Crystal Mercado, an aspiring pediatric oncologist who participated in the Chicago Educators and Youth Enjoy Science (EYES) program. “The day I got accepted was the first time I actually believed I could pursue a career in STEM. The day I finished the program, I knew I was capable of accomplishing things I had never imagined.” Funds will also help facilitate ongoing mentorship and career development for program alumni, who are pursuing degrees in biochemistry, cellular and molecular biology, computer science, pharmacy, medicine and other scientific disciplines at top colleges and universities nationwide. The first-ever recipient of this award is Paula Viza Gomes, a recent alumna of the Chicago EYES on Cancer program (2019-2020) and a rising fourth-year at the University of Chicago (biology/ pre-med). She was also just accepted into the UChicago Research Honors in Biology program. She was awarded $2.5K through the fund to
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support her ongoing research and continued career development in the field of cancer research (the Research Honors in Biology program will contribute another $2.5K in summer funding). As part of Paula’s fellowship, she participated as a peer mentor for Chicago EYES on Cancer and researcHStart trainees this summer.
Underrepresented undergrads explore exciting careers through the Diversity in Cancer Research program Through the Diversity in Cancer Research summer program, the UChicago Medicine Comprehensive Cancer Center welcomes undergraduates from underrepresented groups to explore exciting careers in cancer research. Participants work full-time in the laboratories of established cancer researchers, gaining hands-on experience in areas at the forefront of the field: cancer immunology, molecular mechanisms of cancer, clinical and experimental cancer therapeutics, computational cancer biology, cancer imaging, cancer engineering, cancer prevention and control, cancer disparities and more. The summer experience also includes career development and skill-building workshops, a cancer-based faculty lecture series, individualized mentoring and a culminating research symposium for family, friends and members of the scientific community. During the school year, participants complete monthly activities exposing them to key facets of the cancer field, from basic scientific concepts to patient care and advocacy.
2 Members of the Diversity in Cancer Research summer program
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Participants meet over Zoom.
SHE in Oncology empowers young women to pursue careers in cancer research and care Women face unique challenges throughout their training and careers in biomedicine. This is particularly true for those who identify as racial and ethnic minorities, economically disadvantaged or living with a disability. As a result, women remain underrepresented in senior faculty and other leadership positions in many scientific disciplines, including oncology. In July 2021, the Summer Healthcare Experience (SHE) in Oncology program addressed these trends by empowering high school students who identify as female to pursue career opportunities in cancer research and care. “The SHE in Oncology program provides a unique experience where young female-identifying leaders have the opportunity to be mentored by prominent women in the field and also work collaboratively and conduct research with students from other participating institutions,” said M. Eileen Dolan, PhD, professor of medicine and associate director for education at the UChicago Medicine Comprehensive Cancer Center. Piloted in 2019 by the Livestrong Cancer Institutes at the University of Texas at Austin, SHE expanded in summer 2021 to the cancer centers of the University of Chicago, the University of Kentucky, the University of Michigan and the University of Pennsylvania. Together, the five sites served nearly 80 young women, 19 of whom enrolled through UChicago.
communities throughout the country. Over the course of two weeks, they worked together to complete a cancer research project on genetics under the instruction of the eCLOSE Institute (ecloseinstitute.org); a fictional patient case study project; and daily skill-building and career development activities. The program was enriched by contributions from more than three dozen volunteers: faculty researchers, clinicians, graduate students, community outreach specialists, cancer survivors and others who served as lecturers, panelists, workshop facilitators, mentors and role models. SHE is funded by the American Cancer Society, in affiliation with the ResearcHERS campaign to support women in cancer research.
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Graduate student Juan Apiz-Saab (right) with Kunle Odunsi, MD, PhD, AbbVie Foundation Director of the UChicago Medicine Comprehensive Cancer Center
Award recognizes DEI efforts of graduate student Graduate student Juan Apiz-Saab is one of the awardees for the 2020-21 Annual Diversity, Equity and Inclusion (DEI) awards. Nominated by the UChicago Medicine Comprehensive Cancer Center, Apiz-Saab was recognized for his outstanding accomplishments during the past year. These awards highlight the breadth of DEI work done across campus and in the greater Chicago community, including community outreach, recruitment efforts, internal initiatives and other diversity, equity and inclusion endeavors.
SHE in Oncology was delivered virtually and jointly across sites, giving participants the unique opportunity to learn with peers from diverse
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Meet the Expert Nita K. Lee, MD, MPH ASSOCIATE PROFESSOR OF OBSTETRICS AND GYNECOLOGY
Nita Karnik Lee, MD, MPH, associate professor of obstetrics and gynecology, specializes in the diagnosis and treatment of patients with gynecologic malignancies. Her focus is on providing comprehensive and compassionate surgical, chemotherapy and survivorship care to those diagnosed with ovarian, uterine, cervical, vulvar or vaginal cancers. She is skilled in complex open and minimally invasive surgery, including robotic surgery for gynecologic cancers. As the assistant director for community outreach and engagement (COE) and the faculty director of the Comprehensive Cancer Center Office of Community Engagement and Cancer Health Equity (OCECHE), Lee demonstrates her commitment to supporting community collaboration in research and education to reduce cancer disparities. She is a passionate patient advocate and partners with organizations and survivors in their advocacy and education efforts. 10
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What is the impact of your research and community engagement? I hope that my work will continue to bring the patient and community voice to the center when we are thinking about research and improving cancer care outcomes. Some of my research focuses on better understanding individual patients’ needs, communication and decision making; yet community engagement work is critical to understanding the social context of our patients’ care.
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What do you hope to accomplish during your career? On an individual level, I continue to hope that I can make a difference by providing compassionate and high-quality cancer care to each of my individual patients. I hope to continue to improve my own and teach others about a patient-centered and -driven approach to research and communication. From a public health perspective, eradication of cervical cancer is a critical goal within reach for our own local communities. How did you become interested in taking on cancer? I first became committed to a career in oncology, specifically gynecologic oncology, as a resident when I had the privilege of caring for women and their families at a particularly vulnerable time in their lives. I learned much about strength, grief and, ultimately, resilience from so many patients. I felt I was able to play a role in balancing the supportive care for patients with the exciting therapeutic and surgical innovation to better treat cancer. My personal connections to patients and their families and my background in public health led me to work in cancer prevention and education for gynecologic cancers and now more broadly in cancer disparities at the community level. Why are cancer disparities more pronounced in Chicago compared to the nation? Disparities due to access to care, bias, socio- economic factors and other health determinants are well established throughout the U.S., unfortunately. In Chicago, the gap in health outcomes is incredibly striking because it falls along geographic and racial boundaries. Cancer disparities in our catchment area include many common cancers, including lung, breast, colon, prostate and cervical cancer. The pronounced geographic differences, for example, among different ZIP codes are likely due to multiple factors, including longstanding racial and economic segregation, environmental differences and fragmented healthcare access to quality screening, care and treatment. What can people do to raise awareness of gynecologic cancers and get screened appropriately? Being aware of symptoms of gynecologic cancers and seeking care is critically important. As physicians or even as a friend or family member, we should not be afraid to talk about the “below the belt” cancers. Asking patients about symptoms
should be normalized. In addition, being aware about the importance of family history and genetic testing should be emphasized consistently. Cervical cancer is the only gynecologic cancer that we can screen for with pap and/or HPV tests. Cervical cancer and some vulvar cancers can also be prevented with HPV vaccines (male and female between the ages of 9 and 45). Like many cancers, increasing physical activity, maintaining a healthy weight, adopting a plantbased diet and decreasing tobacco use can reduce risks of many gynecologic cancers. There are nearly 17 million cancer survivors in the U.S. today. What should patients and caregivers know as they adapt to their “new normal” post-cancer diagnosis? Survivorship begins at the time of a cancer diagnosis and includes all patients living with cancer, those after treatment is completed and those on long-term treatment. Many survivors face longterm physical, emotional, psychological and financial effects related to their treatments that could include surgery, chemotherapy and/or radiation. Many patients will tell me “I am a different person.” I advise patients and caregivers to allow themselves time and space to adjust and to understand this is an expected process that is different for all. Patients and caregivers could reach out to their medical teams about advice and referral to supportive services at UChicago Medicine and through community organizations. How can policy and patient advocacy address cancer disparities? Documenting cancer disparities is only the first step in achieving cancer health equity. Policies at the local, state and national levels to support equitable efforts in care access, cancer risk reduction, screening, navigation and quality care are needed to actually create change. Survivors and caregivers who dedicate their time to advocacy in education and awareness, research advocacy and legislative advocacy are an incredibly powerful group that brings their lived experience and unique perspectives and solutions to any such efforts.
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Research Highlights Genetic variants impair arsenic metabolism and may impact susceptibility to arsenicassociated cancers
Tracking changes in weight could help better treat breast cancer patients.
Obesity may hide diagnosis of cancer-associated weight loss in breast cancer patients Obesity is associated with an increased risk for breast cancer diagnosis, but it has been unclear how weight gain or loss after diagnosis is associated with outcomes. This retrospective study led by Dezheng Huo, PhD, professor of public health sciences, and Olufunmilayo Olopade, MD, Walter L. Palmer Distinguished Service Professor of Medicine and Genetics, analyzed patient data from the Chicago Multiethnic Epidemiologic Breast Cancer Cohort (ChiMEC), to determine how weight loss and weight gain correlate with breast cancer survival and track differences in ethnic groups. The study showed that some patients had significant weight loss associated with advanced stage, comorbidities (the presence of other diseases) and chemotherapy, which correlated with decreased survival. The weight loss observed in many patients was consistent with cachexia — rapid, non-intentional weight loss >5% of body weight within 6 months, linked to loss of muscle tissue and cancer progression. Importantly, Black patients had the highest rates of weight loss, followed by Asian patients, with Hispanic and White patients having the lowest weight loss. Early diagnosis of cancer cachexia may help to initiate multifaceted health management plans for patients, including nutritional support, exercise, changes in cancer therapy regimen or palliative care. This study demonstrates the importance of tracking changes in weight to detect and treat cancer cachexia in breast cancer patients. Shang et al., Breast Cancer Research 23:1-18, 2021
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More than 200 million people worldwide are exposed to arsenic through drinking water and diet, increasing their risk for diseases, including skin, lung, bladder and kidney cancers. In most people, the enzyme AS3MT helps to metabolize arsenic and eliminate it from the body. Investigators Brandon Pierce, PhD, associate professor of public health sciences, and Habibul Ahsan, MD, Louis Block Distinguished Service Professor of Public Health Sciences, Medicine and Human Genetics, sought to determine the impact of rare protein-coding variations in AS3MT on arsenic metabolism across multiple populations. The cohorts included were the Health Effects of Arsenic Longitudinal Study (HEALS) from Bangladesh, the Strong Heart Study (SHS) of Native Americans and the New Hampshire Skin Cancer Study (NHSCS). They analyzed genetic sequences of AS3MT and arsenic-derived metabolites in the urine of all participants. Rare mutant alleles of AS3MT were discovered in all cohorts, and were associated with decreased levels of arsenic byproducts in the urine, indicating that these mutations impair arsenic metabolism. These variants likely result in increased retention of arsenic and associated health effects of arsenic toxicity. Delgado et al., Environmental Health Perspectives 129:1-12, 2021
Arsenic exposure increases risks for diseases, including cancer.
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Sociodemographic disparities in surgery for patients with advanced ovarian or colorectal cancer
Researchers are studying how to overcome barriers to colorectal cancer screening.
Evidence-based interventions to improve colorectal cancer screening Improving rates of colorectal cancer screening is critical for cancer prevention. Evidence-based interventions have the potential to improve approaches that result in meaningful patient outcomes, but these interventions do not always translate into improvements, particularly in safetynet health systems, such as federally qualified health centers (FQHCs) that provide care to patients from low-income, uninsured and minority populations. Karen Kim, MD, professor of medicine, and Blase Polite, MD, professor of medicine, sought to identify facilitators and barriers that affect interventions to improve colorectal cancer screening in an urban FQHC that could offer actionable recommendations for improving implementation efforts. They found that barriers include problems with electronic health record reminders, challenges to serving a diverse patient population, lack of awareness and education for patients and poor communication about screening goals. Positive facilitators of interventions included provision of assessments and feedback, integration with workflows, pressure from funding requirements, peer pressure, a culture of teamwork and a patient-centered mentality. Identification of these determinants will help to move interventions into daily practice and ultimately improve screening rates for colorectal cancer among diverse populations. Lam et al., Implementation Science Communications 2:57:1-16, 2021
In a retrospective study using data from the National Cancer Database, Oliver Eng, MD, assistant professor of surgery, and colleagues, investigated sociodemographic disparities in surgery in patients with advanced ovarian and colorectal cancers. This study focused on the complex surgery that removes tumor tissue from the abdomen in patients with metastatic cancers. This beneficial surgery is an established treatment for ovarian cancer and is becoming more acceptable for colorectal cancer. The researchers found that the surgery in patients with metastatic ovarian cancer was associated with higher income, having private insurance and was more common for White versus Black patients. In patients with metastatic colorectal cancer, surgery was associated with treatment at academic research facilities, which tend to treat higher-income patients. Overall, lowerincome, nonprivate insurance and Black compared to White patients were less likely to receive this surgery. The authors conclude that inequities in the accessibility of high-quality treatments are a barrier to improving health outcomes. The effects of systemic racism and economic accessibility to quality healthcare must be addressed. Goldberg et al., Ann Surg Oncol Online ahead of print, 2021
A study examined which groups of people were more likely to get surgery for advanced ovarian and colorectal cancer.
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Clinical Trials Through the African American Experience BY JANE KOLLMER Clinical trials are studies that test new ways to prevent, find and treat disease. They also help to make sure that new medicines and treatments are safe and effective. As important as they are, fewer than 1 in 20 adults with cancer enroll in clinical trials. Of that small number, the majority of volunteers are Non-Hispanic White. “Minority participation in clinical trials is lower than it should be. The communities that may benefit from them aren’t represented,” said Nita Lee, MD, MPH, faculty director of the University of Chicago Medicine Comprehensive Cancer Center Office of Community Engagement and Cancer Health Equity (OCECHE). “We are interested in exploring the barriers of minority recruitment to clinical trials and what we can do better in approaching this issue.” A history of medical mistreatment and structural/ systemic racism has made it hard for communities of color to trust the medical profession administering vaccines and conducting clinical trials. Yet it’s important to evaluate new therapies in a diverse population of cancer patients to determine whether, and ensure that, all racial and ethnic groups benefit from the therapy. OCECHE is spreading awareness of the need for more diverse participation in cancer clinical trials to pave the way for precision medicine. In recognition of Black History Month this past February, OCECHE hosted a panel on Clinical Trials Through the African American Experience. Black cancer survivors served on a panel to share their stories about their clinical trial experiences, what motivated them to join a clinical trial and their recommendations for others to join clinical trials. Jazz pianist Billy Foster credits clinical trials for keeping him alive. Foster’s rare metastatic kidney cancer had spread to his brain, liver and lungs. The standard treatment options at the time were 14
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ineffective. By participating in several clinical trials testing experimental new medications, Foster was able to find a treatment that worked for him in reducing the size of the tumors and keeping them from growing. He takes the medication to this day. Similarly, Janice Sing, a uterine cancer survivor, benefited from a clinical trial. “What made me decide to go ahead was the opportunity to help other people, which is very important because my cancer is rare,” she said. “So it wasn’t hard to make the decision.” One piece of advice Sing would share with others considering joining a clinical trial is to go into it with an open mind, listen to everything and ask plenty of questions so you are informed of all the benefits and risks. She said, “Remember that you’re not forced to stay in the program so if you try it and you don’t think it’s for you, you can always leave it.”
UChicago Medicine cancer experts are actively conducting clinical trials of new screening methods and treatments for cancer, including breakthrough approaches to harnessing the immune system to fight cancer. As a recognized leader in clinical trials, our physician-scientists are creating new cancer treatment methods that later become the standard of care elsewhere. Visit uchicagomedicine.org/ clinical-trials for more information.
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NCI-designated cancer centers call for urgent action to get HPV vaccination back on track Cancers caused by human papillomavirus (HPV) are a significant public health problem in the United States. But these cancers are preventable with HPV vaccination. The National Cancer Institute (NCI)-designated cancer centers fully endorse the goal of eliminating cancers caused by HPV through gender-neutral HPV vaccination and evidence-based cancer screening. The COVID-19 pandemic has profoundly interrupted delivery of key preventive services, resulting in many U.S. adolescents missing routine HPV vaccine doses. Even before the pandemic, HPV vaccination uptake in the U.S. lagged far behind several high-income countries and remains well below the Healthy People 2030 goal of vaccinating 80% of boys and girls ages 13-15. To protect adolescents from cancers caused by HPV, it is urgent to act now to get HPV vaccination back on track. NCI Cancer Centers strongly encourage parents to vaccinate their adolescents as soon as possible. The COVID-19 vaccination presents an opportunity for parents to protect their children by catching up on missed or routinely recommended vaccines that are due. The U.S. has recommended routine HPV vaccination for females since 2006 and for males since 2011. Current recommendations are for routine vaccination at ages 11 or 12 or starting at age 9. Catch-up HPV vaccination is recommended through age 26. The guidelines recommend that adults ages 27 to 45 talk with a healthcare provider
because some people who have not been vaccinated might benefit. According to the Centers for Disease Control and Prevention (CDC), 54% of boys and girls ages 13-17 completed the HPV vaccination series in 2019, compared to 42% in 2015, with variability by geographic region. The COVID-19 pandemic has jeopardized these modest but positive gains. In spite of more than 15 years of safety and monitoring data and strong evidence showing reduction of HPV vaccine-type infection and cancers, HPV vaccination uptake still isn’t meeting our national goal. The U.S. is facing a significant vaccination gap, especially for adolescents, due to the pandemic. Well-child visits are down. Usual “back to school” vaccination activity for adolescents has been limited by virtual and hybrid learning. Early in the pandemic, HPV vaccination rates among adolescents fell by 75%, resulting in large numbers of unvaccinated children. It is crucial that the nation gets back on track with adolescent vaccination to ensure protected children and safer communities. Now is the time to catch up on missed doses of HPV vaccine to prevent future cancers. Contact your local health department or healthcare provider to schedule an appointment for missed vaccinations today. More information on HPV is available from the CDC and National HPV Vaccination Roundtable.
HPV CAN BE PREVENTED Pre-teens and teens who are vaccinated against HPV can be spared some of the deadliest, most disfiguring and hard-to-treat cancers — those of the cervix, vagina, vulva, penis, anus, mouth and throat. Over 90% of cancers caused by HPV can be prevented — 29,000 cases of cancer per year — with the HPV vaccine.
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COLORECTAL CANCER SCREENING NOW RECOMMENDED TO BEGIN AT AGE 45 Did you know the recommended age to begin screening for colorectal cancer has been lowered from 50 to 45? March was National Colorectal Cancer Awareness Month, and the UChicago Medicine Comprehensive Cancer Center Office of Community Engagement and Cancer Health Equity (OCECHE) led activities to spread awareness about the importance of screening. UChicago Medicine employees and community members were invited to participate in activities centered on colorectal cancer prevention, screening, treatment and disparities. If you are 45 or older and/or have a family history of cancer, talk with your doctor about what screening you need. A colonoscopy can save your life. Email communitycancer@uchicago. edu for more information.
EXAMINING RACIAL DISPARITIES OF CARE IN MULTIPLE MYELOMA The University of Chicago Medicine Comprehensive Cancer Center is collaborating with oncology data company COTA to investigate racial disparities of care in multiple myeloma. The venture is meant to better understand differences in the diagnosis, treatment patterns and outcomes of patients with multiple myeloma, which is expected to be the cause of over 12,400 deaths in the U.S. this year. Research has shown that the incidence rate of myeloma in Black Americans is two to three times higher than in other populations — and the death rates are higher as well. “Black individuals account for 20% of newly diagnosed multiple myeloma cases in the U.S., but they make up only 4.5% of patients enrolled on pivotal clinical trials in myeloma,” said Benjamin Derman, MD, assistant professor of medicine. “This has led to a strange dynamic where all of the trial data that is used to create risk prognostication scores in myeloma may not necessarily apply to Black patients.” Researchers at COTA and University of Chicago Medicine will use real-world data to examine potential disparities in clinical treatment pathways and outcomes. “Using real-world data, we hope to ideally create a more inclusive risk prognostication score that includes patients on the margins of clinical trials,” Derman added. “This partnership will also seek to understand racial differences in the treatment and outcomes of patients with myeloma to better guide how we can improve access to optimal care for all patients afflicted by myeloma.”
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New clinic provides expert care for aggressive, high-risk lymphomas Certain types of non-Hodgkin lymphoma grow quickly and are referred to as aggressive lymphomas. Aggressive lymphomas are considered high-risk and require prompt, focused care from a team of highly skilled lymphoma specialists. The UChicago Medicine Comprehensive Cancer Center created the High-Risk Lymphoma Clinic to meet the unique needs of patients with aggressive lymphomas. Because there are more than 70 variants of lymphoma, it’s crucial to get an accurate diagnosis. UChicago Medicine blood cancer pathologists are nationally recognized for their expertise in pinpointing even the rarest lymphoma subtypes. Patients also have access to advanced diagnostic techniques such as PET-CT imaging to aid in determining the exact extent of disease and to guide treatment options. The clinic provides care for patients with the following lymphoma subtypes: • Relapsed/refractory aggressive large B-cell lymphoma • Diffuse large B-cell lymphoma • High-grade B-cell lymphoma (i.e., double/triple-hit lymphoma) • Primary mediastinal B-cell lymphoma • Transformed indolent lymphomas • Richter’s syndrome (transformation of chronic lymphocytic leukemia (CLL) into an aggressive lymphoma)
• Relapsed/refractory mantle cell lymphoma • Peripheral T-cell lymphomas (either newly diagnosed or after prior therapy) Each patient’s case is reviewed by an interdisciplinary team of lymphoma specialists made up of physicians from medical oncology, radiation oncology, hematopathology and radiology. Lymphoma nurse navigators are key members of the treatment team, working closely with patients and their families throughout the cancer journey. Our lymphoma team meets weekly to discuss patient progress. The clinic offers the full spectrum of treatments for aggressive lymphoma, including advanced chemotherapies, radiation therapy, stem cell transplantation, immunotherapy, CAR T-cell therapy and clinical trials investigating promising new treatments. Call 1-855-702-8222 to request an appointment at the High-Risk Lymphoma Clinic.
SUMMIT FOSTERS COMMUNITY-FOCUSED RESEARCH IN GYNECOLOGIC CANCER In May 2021, the UChicago Medicine Comprehensive Cancer Center co-hosted the 2nd Annual Chicago Gynecologic Cancer Researcher-Survivor Summit virtually, along with the University of Illinois Cancer Center. The 77 participants included cancer survivors (over 50% of attendees), caregivers, researchers, clinicians and patient advocates from the Cancer Center’s catchment area and beyond. The event was designed to promote understanding of the patient and researcher experiences, share research topics, clinical trials and areas of new discovery and explore the role of patient advocacy in research and policy.
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News from the UChicago Medicine Comprehensive Cancer Center Office of Community Engagement and Cancer Health Equity (OCECHE)
OCECHE joins FDA Oncology Center of Excellence for Juneteenth National Black Family Cancer Awareness Week In June 2021, approximately 200 participants gathered at Friend Health Center, coordinated in partnership with OCECHE, for Juneteenth National Independence Day’s first celebration as a federal holiday that commemorates the emancipation of enslaved African Americans. The aim of the national event that used social media hashtag #BlackFamCan was to increase cancer awareness in one of the most vulnerable segments of the U.S. population, and to build knowledge surrounding cancer clinical trial participation and the need for minority population specimen donations to national genetic databases for cancer research. In addition to providing valuable cancer resources, OCECHE encouraged participants to get their COVID-19 vaccinations and invited Chicago institution Garrett Popcorn Shops to sweeten the deal with bags of their famous gourmet popcorn. OCECHE Community partner TZU Chi also generously provided 5K units of personal protective equipment to UChicago Medicine partners.
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OCECHE ASSISTS WITH ILLINOIS CANCER CONTROL PLAN The Illinois Department of Public Health is finalizing the 2022-2027 Illinois Comprehensive Cancer Control Plan, referred to here as the Plan, after closing public edits and comments on May 19, 2021. The Plan provides a framework for action to reduce the burden of cancer in Illinois in three priority areas: Prevention; Screening and Early Detection; and Diagnosis, Treatment and Survivorship. The Plan is developed by the Illinois Cancer Partnership and its state cancer plan work group and sub work groups for each of the three priorities. OCECHE Director, Gina Curry, serves as Chair of the Illinois Cancer Plan and is working collaboratively with broad-based, multi-organizational partnerships across the state that work in collaboration with the Illinois Comprehensive Cancer Control Program ICCCP to develop, implement and monitor outcomes of the Plan. A multi-pronged statewide dissemination strategy is being developed for the Plan and is scheduled to begin this fall using in-person, virtual and hybrid platforms.
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RODRIGUEZ JOINS CANCER CENTER AS LATINX OUTREACH SPECIALIST
Romero to lead Cancer Center’s diversity, equity and inclusion
OCECHE has hired Erika Rodriguez for the newly created Latinx outreach specialist position. Rodriguez will assist OCECHE with the development and implementation of cancer-focused community outreach programs and serve as a liaison between Comprehensive Cancer Center investigators conducting research relevant to the Latinx community/ Hispanic cancer patients and community/advocacy organizations focused on this population.
Iris Romero, MD, MS, professor of obstetrics and gynecology and dean for diversity and inclusion, has been appointed as the University of Chicago Medicine Comprehensive Cancer Center associate director for diversity, equity and inclusion. In this new role, Romero will help the Comprehensive Cancer Center strengthen, grow and help create a more equitable and sustainable society through our research, education and outreach programs that serve local communities.
POULOS WINS APHA PUBLIC HEALTH EDUCATION AND HEALTH PROMOTION MATERIALS CONTEST As part of Breast Cancer Awareness Month programming, Alia Poulos, MA, MPP, education outreach specialist for OCECHE, created a nostalgia campaign to engage and encourage UChicago Medicine employees and community to obtain annual screening mammograms. The use of nostalgia in marketing campaigns is an established, evidence-based strategy for increasing engagement. Flyers were created using ideas pitched by members of the OCECHE Community Advisory Board. The flyers appealed to people from African American, Latinx and Chicagoland communities in the 40 to 60+ age group. Poulos’ campaign was chosen for oral presentation during the 2021 American Public Health Association Annual Conference in Denver, Colorado, and won first place in the Public Health Education and Health Promotion Materials Contest.
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Faculty Awards and Honors
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Susan Cohn, MD, professor of pediatrics, has been appointed as the University of Chicago Medicine Comprehensive Cancer Center Director for Faculty Development to support the growth and development of faculty, especially early-stage investigators.
Chin-Tu Chen, PhD, associate professor of radiology, has been appointed as a co-leader of the Comprehensive Cancer Center Clinical and Experimental Therapeutics Research Program.
Michelle Le Beau, PhD, the Arthur and Marian Edelstein Professor Emerita of Medicine, has been selected as recipient of the Medical & Biological Sciences Alumni Association’s 2021 Gold Key Award in recognition of her 40 years of service to the Department of Medicine, Biological Sciences Division and the University of Chicago as an outstanding scientist and leader.
Daniel Catenacci, MD, a physician-scientist and associate professor of medicine at UChicago Medicine, has received the National Cancer Institute 2021 Cancer Clinical Investigator Team Leadership Award.
Jing Chen, PhD, has been named the Janet Davison Rowley Distinguished Service Professor in the Department of Medicine.
Stacy Tessler Lindau, MD, MA, has been named the Catherine Lindsay Dobson Professor in the Department of Obstetrics and Gynecology.
Kunle Odunsi, MD, PhD, has been named the first AbbVie Foundation Distinguished Service Professor in the Department of Obstetrics and Gynecology.
Yu-Ying He, PhD, professor of medicine, has been named the new Associate Director for Shared Resources at the Comprehensive Cancer Center.
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Drew Memmott, MPhil, MA, joined the Comprehensive Cancer Center as Associate Director for Administration in August 2021. Memmott brings extensive cancer center administration experience, having served most recently as the senior vice president for cancer center administration and associate director for administration at the Dana-Farber Cancer Institute/Harvard Cancer Center since 2014.
Maryellen Giger, PhD, A.N. Pritzker Distinguished Service Professor of Radiology, Committee on Medical Physics, was honored with the 2021 SPIE Directors’ Award for her contributions to the field of optics and photonics, and for her volunteer work with The International Society for Optics and Photonics.
Olufunmilayo Olopade, MD, Walter L. Palmer Distinguished Service Professor of Medicine and Human Genetics, Department of Medicine, and director, Center for Clinical Genetics and Global Health, has been elected to the National Academy of Sciences. She will also receive the William L. McGuire Memorial Lecture Award at the 2021 San Antonio Breast Cancer Symposium in December 2021.
Sonali M. Smith, MD, Elwood V. Jensen Professor of Medicine, Section Chief of Hematology/ Oncology and Co-Leader of the Cancer Service Line, is the recipient of this year’s ASCO Excellence in Teaching Award, as well as the new chair of the Lymphoma Research Foundation’s scientific advisory board.
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Jeffrey Hubbell, PhD, the Eugene Bell Professor in Tissue Engineering in the Pritzker School of Molecular Engineering, has been elected to the American Academy of Arts and Sciences.
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