Pathways to Discovery - Summer 2020 - University of Chicago Medicine Comprehensive Cancer Center

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

Special COVID-19 Edition FEATURE STORIES 1 I NNOVATIVE SOLUTIONS FOR CANCER CARE CHALLENGES DURING THE PANDEMIC 4 C ANCER CLINICIANS AND SCIENTISTS TRANSITION THEIR TALENTS TO TACKLE THE COVID-19 PANDEMIC 8 A DDRESSING COMMUNITY NEEDS IN THE CONTEXT OF CORONAVIRUS 11 O NCOLOGISTS ANSWER QUESTIONS ABOUT CORONAVIRUS SUMMER 2020

Pathways TO DISCOVERY

AT THE FOR E FRONT OF CANCER CARE AND DISCOVERY

Summer 2020 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

Michelle Le Beau, PhD Kathleen Goss, PhD DESIGN

Pivot Design, Inc.

COV E R D E S C R I P T I O N

The cover shows a group of researchers looking at the binding of the surface spike glycoprotein of the SARS-CoV-2 virus to an angiotensin-converting enzyme 2 receptor on a human type II alveolar cell.

Isabel Romero Calvo, MS, PhD, is a biomedical illustrator and the creative director of Morphology LLC (morphologyvisuals.com).

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 .

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© 2020 The University of Chicago Medicine Comprehensive Cancer Center.

All rights reserved.

From the Director For the first several months of 2020, the COVID-19 pandemic has spread at an alarming rate, forcing the entire world to respond to the deadly outbreak— changing life as we knew it in the process.

With no cure or vaccine developed, social distancing has become particularly important for protecting individuals undergoing cancer treatments, who may be immunocompromised.

At this watershed moment in history, we are faced with many challenges presented by COVID-19. In addition to addressing the needs of the general population to combat COVID-19, we have faced the challenge of continuing to provide exceptional care to patients at risk of developing cancer and those undergoing treatment.

Overall, the constant threat of coronavirus has changed the way we care for cancer patients, conduct cancer research and engage with the community. In this issue, you’ll read about how our expert physicians and scientists are responding quickly— and compassionately—to address the problems brought about by the virus. Some are collaborating with investigators from other disciplines to research potential vaccines. Others have initiated clinical trials to test new treatments. And some are helping cancer patients affected by the COVID crisis by seeing them virtually, providing masks or delivering food and disinfectant supplies to their homes.

These stories show that although social distancing has kept us apart, many people are still finding meaningful ways to show we are all in this together.

As always, thank you for your support.

Michelle M. Le Beau, PhD Director, The University of Chicago Medicine Comprehensive Cancer Center; Arthur and Marian Edelstein Professor of Medicine

SOLUTIONS

INNOVATIVE

FOR CANCER CARE CHALLENGES DURING THE PANDEMIC

BY MOL LY WOUL F E

The COVID-19 pandemic marks a tipping point for cancer care at the University of Chicago Medicine A SYSTEM-WIDE CHALLENGE Comprehensive Cancer Center.

While the COVID-19 statistics continue to emerge, Virtual visits, curbside labwork and other pilot programs implemented to protect immune-compromised patients may be the new norm.

Medical oncologist Murtuza Rampurwala, MD, MPH, worried for months over his patients’ well-being.

“Elderly patients especially are at the highest risk of developing infections and complications,” said Rampurwala, of UChicago Medicine Orland Park.

One challenge: To integrate new, “touchless” safeguards with hands-on treatments like chemotherapy and radiation therapies.

“Care continuity became more of an issue as time went by, and we realized the pandemic wasn’t going to end in a week or month,” Rampurwala said.

But cancer care is transforming. Amid an epidemic of hospital closures, UChicago Medicine is leveraging the talents and resources of its large, multisite network. For example, to improve safety and reduce risk, healthcare workers are traveling to the homes of patients to draw blood and collect samples for testing. This Hyde Park initiative has been adopted by UChicago Medicine Comprehensive Cancer Center at Silver Cross Hospital-New Lenox and is under consideration at UChicago Medicine Ingalls Memorial.

the pandemic compelled UChicago Medicine to mitigate operational risks and share new methodologies to provide customized cancer care to patients. The key to success has been collective problem-solving.

Ambulatory Operations Director Bobby Lester summed up the mindset. “Cancer leadership and ambulatory leadership work in tandem to put virtual visits into place while also safely delivering in-person visits,” he said.

About 8,500 cancer patients are treated annually in Hyde Park and off-site clinics. The majority of their care is delivered at outpatient settings at the Duchossois Center for Advanced Medicine (DCAM) and suburban locations.

The latter includes the UChicago Medicine Comprehensive Cancer Center at Silver Cross Hospital-New Lenox and UChicago Medicine Orland Park. The Center for Care and Discovery (CCD) in Hyde Park and the 478-bed facility at Ingalls Memorial provide inpatient care.

When the COVID-19 pandemic spread to the United States in January, the medical center activated its Hospital Incident Command System (HICS) to address the threat. Chief Compliance Officer Krista Curell, JD, RN, serves as commander.

Under the leadership of Curell, who also serves as Vice President of Risk Management and Patient

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Virtual visits by video are now offered to keep cancer patients safe during the pandemic.

temporary payments to clinicians providing the services to Medicare recipients. Illinois Governor J.B. Pritzker followed up on March 19, relaxing state restrictions to make telehealth billable and reimbursable by insurers until further notice.

Safety, the multidisciplinary team assessed operations organization-wide. Triage and separate clinical units were set up for COVID-19 patients at the CCD and Ingalls Memorial. New protocols included universal masking, limited points of entry and social distancing.

As for oncology services, overseen by Sonali M. Smith, MD, interim Section Chief of Hematology and Oncology, and Mitchell Posner, MD, Chief of Surgical Oncology and Physician-in-Chief of the UChicago Medicine Comprehensive Cancer Center, delayable surgeries and treatments were postponed. Entry of new patients onto clinical trials was paused.

User-friendly features include an online tutorial on virtual visits, how to book appointments and how to access MyChart data (see here).

POSITIVE BUZZ

Yet cancer keeps its own timetable. In late March, telehealth was launched as a real-time bridge and alternative to in-person care.

Preliminary reports show that most patients are highly satisfied with their virtual visits on Zoom and other online communications platforms. Satisfaction scores are continuing to improve. Patients appreciate convenience factors such as not having to drive, pay for parking or wait in waiting rooms.

PILOTS TAKE OFF

Oncology patients are especially relieved.

Among the first users were members of the hematology/oncology teams on the main campus, many of whom remained on-site to coordinate and facilitate virtual visits with patients.

The hematology/oncology outpatient clinic, which logged nearly 6,000 clinic visits in February, saw in-person appointments dip to 4,440 (-24%) visits in March. April visits declined to 1,400 (-68%).

Meanwhile, telemedicine gained ground. Laptop and smartphone conferences, nonexistent in March, accounted for almost 1,900 interactions (1,290 videoconferences, 570 phone calls) between May 1 and May 20.

“Now, about 60 percent of our current volume is done via video,” Lester said. “We see patients on campus when they come for radiation therapy, and when appointments align with other scheduled treatments, such as chemotherapy.”

Under the Coronavirus Aid, Relief and Economic Security Act, also known as the CARES Act, the Centers for Medicare and Medicaid Services (CMS) backed telemedicine on March 17, authorizing 2

An interdepartmental collaboration helped patients get up to speed. Ambulatory Services, Marketing and Communications, Information Technology and the Call Center developed a telemedicine page for UChicago Medicine websites.

PATHWAYS TO DISCOVERY SUMMER 2020

“The last place they want to be is near a hospital that might have COVID-19 patients,” said radiation oncologist Azhar Awan, MD.

TOTAL CANCER ENCOUNTERS 10K 8K 6K 4K 2K 0 FEB

MAR In-Person

APR Video

MAY Telephone

For the clinicians, there were predictable initial tech glitches such as finding “unmute” buttons.

Once acquainted with the new technology, though, they found it easy to transfer their “bedside manners” screenside.

Tech-savvy young patients tend to be the most receptive, while some baby boomers and seniors can be resistant. One woman balked at videoconferencing because “she wasn’t dressed up well enough for a video visit and didn’t want to spend an hour and a half to do her hair,” Rampurwala said.

Awan makes do with phone visits. An expert on leading-edge radiation treatments, he is based at Ingalls in suburban Harvey, an underserved community with high rates of unemployment.

Most of his patients lack access to tablets and smartphones, so phone calls are the rule. “We’re on a learning curve as we improve our understanding of patient needs,” Awan said.

Both he and Rampurwala agree that in-person visits will remain vital. First, physical exams are more thorough. Second, personal empathy is inherent to physician-patient relationships.

“When delivering bad news or sharing a prognosis that is critical and life-changing, you want to be holding their hand,” Rampurwala said.

SMALLER VENUES, BIG IDEAS Promising off-site innovations may be destined for widespread implementation.

Credit the UChicago Medicine Comprehensive Cancer Center at Silver Cross Hospital-New Lenox for inviting staff and patients alike to suggest ways to enhance care.

After learning last year that Hyde Park was testing mobile blood-draw services, the New Lenox team contracted the same firm. Specimens are delivered to New Lenox’s in-house lab for processing.

“The patients love the convenience,” said practice administrator Liz Zavala, RN. So does the staff, now able to expedite lab services beyond their on-site lab. This initiative preceded the pandemic, reinforcing social distancing protocols months in advance in both Hyde Park and New Lenox.

Drive-up testing and curbside labwork protects immunecompromised patients from being exposed to the coronavirus.

At a staffer’s suggestion, New Lenox followed up with remote check-ins. When patients arrive for their appointments, they park, phone the staff and check in. After nurses ensure the lobby is clear, each patient receives the go-ahead. He/she enters the cancer center, is screened and directed straight to an exam room.

The enterprising Orland Park cancer center team resumed near-full operations in April after outlining ways to minimize exposure to COVID-19 and to maximize social distancing. “We banded together with Ambulatory leadership to keep Orland open and staffed for our patients,” practice manager Alicia Fagan said.

Oncology patients are now directed to enter via a separate entrance, take a designated elevator to the oncology floor and meet with their physicians in select exam rooms.

Another Orland Park brainstorm: a curbside lab.

Patients drive up at prescheduled times, are escorted to a “clean” tent or remain in their vehicles for blood draws, then leave. “We bring the inside lab outside,” Fagan said.

For Rampurwala, the innovative thinking that has kept the staff on call—and providing essential care to patients during the pandemic—is a remarkable outcome in itself.

“A few of my oncologist colleagues at other institutions feel paralyzed—really limited—because their resources were diverted to COVID-19,” Rampurwala said. “We struck a balance, caring for our COVID-19 patients while also attending to our cancer patients.”

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VISUAL BY MORPHOLOGY LLC

The surface of a spike glycoprotein of the SARSCoV-2 virus binds to an angiotensin-converting enzyme 2 receptor on a human cell.

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PATHWAYS TO DISCOVERY SUMMER 2020

Cancer clinicians and scientists transition their talents to tackle the COVID-19 pandemic

BY TIHA M. LONG, PhD

The spread of COVID-19 has challenged physicians and scientists across the globe to come together and use their expertise to tackle the pandemic. The physician-scientists of the University of Chicago Medicine Comprehensive Cancer Center are leading large-scale efforts to diagnose and treat this disease, not only to protect cancer patients, but to efficiently monitor the spread of COVID-19, characterize responses and develop treatments to minimize the need for intensive care and prevent death in all patients. Comprehensive Cancer Center basic and translational researchers are stepping in to unravel the mechanisms of SARS-CoV-2 infection and COVID-19 pathology.

DETECTING AND DIAGNOSING COVID-19 Developing computer-aided imaging methods to outsmart COVID-19 Maryellen Giger, PhD, A.N. Pritzker Professor of Radiology, and an expert in computer-aided imaging of lung and breast cancers, is spearheading the development of artificial intelligence (AI) to detect, diagnose and guide treatment for COVID-19.

“Over the decades, my lab has been investigating and developing AI for cancer images with the goal of improving the detection, diagnosis and assessment of response to therapy,” Giger said.

“We are now applying that knowledge as we develop AI methods to help interpret lung images of COVID-19.”

Giger, with Samuel Armato, PhD, associate professor of radiology and chair of the committee on medical physics, and UChicago Medicine colleagues are collaborating with researchers UCHICAGOMEDICINE.ORG/CANCER

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from Argonne National Laboratory to develop AI to analyze x-rays and computed tomography (CT) scans from COVID-19 patients in order to identify, characterize stage of infection and guide treatment decisions.

This “computer vision” system for COVID-19 is developed by “training” the system with a pre-​ existing dataset of cases with various lung diseases, then building on that dataset through “transfer learning” with COVID-19 cases from UChicago Medicine. Giger’s innovative technology can apply models from other lung conditions, such as cancer, to characterize COVID-19 cases. In addition to helping individual patients, these algorithms may eventually be used to track current and previous infection, providing critical data for public health.

Optimizing molecular biology techniques to detect COVID-19 A molecular biology technique called PCR (polymerase chain reaction) has been widely used to detect the genetic material of the SARS-CoV-2 virus in order to determine if a patient is COVID-19positive. In general, this type of test is fairly quick and reliable, but sample collection by swabbing the nasal passages requires a healthcare professional, which is an extra hurdle. Also, the supplies needed for the test are expensive, limiting widespread use.

A team of Comprehensive Cancer Center researchers, led by Evgeny Izumchenko, PhD, assistant professor of medicine, with Jeremy Segal, MD, PhD, associate professor of pathology, Nishant Agrawal, MD, professor of surgery, and other UChicago collaborators, are comparing two different PCR tests: an optimized quantitative (q)PCR versus droplet digital (dd)PCR to see if they can reliably detect the COVID-19 virus in saliva as well as in nasal swabs. They will also optimize an automated high-throughput lab test to decrease the processing time and reduce the use of expensive reagents, or chemical ingredients, without losing accuracy.

Izumchenko commented, “the goal of this study is to develop a less invasive and more sensitive method and to reduce risk of exposure for healthcare workers.”

This work could lead to home testing for COVID-19 with only a saliva sample and without the need for expensive reagents, making testing much more affordable and convenient for widespread use.

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DIFFERENCES IN SEVERITY OF COVID-19 Why is the response to SARS-CoV-2 infection so varied?

Thomas Gajewski, MD, PhD, Abbvie Foundation Professor of Cancer Immunotherapy, is leading a study to track and characterize the immune response of patients enrolled in COVID-19 drug trials. Gajewski and colleagues are using samples collected from patients to examine their levels of cytokines—the molecules that trigger inflammation—and characterize their immune cells to see how these factors relate to a patient’s ability to fight the virus and respond to therapies.

“This translational research study is an outstanding example of the team science capabilities at UChicago Medicine, involving dozens of investigators,” Gajewski commented.

In addition to immune profiling of patients, this in-depth study will determine how other factors correlate with disease severity. The levels of virusattacking antibodies and T cells will be measured.

Gene expression analysis will be performed on patient immune cells to further characterize individual responses. Also, genetic tests will uncover differences in patient DNA that impact response.

Each of these components will provide insight as to why patients have widely variable susceptibility to the severity of COVID-19.

TREATING COVID-19: EXAMINING ALL APPROACHES Antibodies: keys to treatment and vaccine discovery Patrick Wilson, PhD, professor of medicine, is an expert in B cell biology and antibodies. Since early in the pandemic, he was analyzing blood samples from recovered patients provided by collaborators across the country. Wilson isolates B cells, immune cells which produce antibodies, from these samples, then sequences the DNA to use in the production of antibodies that may have anti-viral function. Antibodies created from this patient DNA are being tested against viral proteins to see which ones can bind.

Wilson is collaborating with Argonne National Laboratory scientists to use the powerful x-ray

imager, Advanced Photon Source, to visualize the protein-antibody interactions to determine which antibodies best bind to viral particles and may be effective against the virus. Effective antibodies may be tested to directly treat patients and offer clues to develop effective vaccines. Also, it is possible to use this method to determine if people have immunity to the virus, which is important for modeling community spread.

Tocilizumab inhibits severe inflammatory responses High levels of the inflammatory cytokine interleukin (IL)-6, can trigger cytokine release syndrome (CRS), a deadly inflammatory response. The IL-6 receptor-targeting monoclonal antibody, tocilizumab, is an existing drug that successfully blocks IL-6 activity and is currently used to treat cancer patients with hyperinflammation following CAR T-cell therapy. It is a promising treatment of lung inflammation caused by COVID-19.

Mark Ratain, MD, Leon O. Jacobson Professor of Medicine, director of the Center for Personalized Therapeutics, and Gajewski, are coinvestigators on a clinical trial testing the efficacy of tocilizumab in COVID-19 patients. The trial is led by UChicago Medicine clinician Pankti Reid, MD, MPH, from the section of rheumatology. In addition to using tocilizumab to reduce COVID-19 symptoms, this trial will improve understanding of the role of IL-6 and the inflammatory response in COVID-19 disease.

Spotlight on basic science to understand and defeat SARS-CoV-2 UChicago BIG Ideas Generator Vision grants were awarded to several Comprehensive Cancer Center faculty to fund novel basic and translational research focused on SARS-CoV-2 infection and COVID-19 pathology, including: Targeting viral-host interactions to control SARS-CoV-2 is a collaboration between Marsha Rosner, PhD, Charles B. Huggins Professor of the Ben May Department of Cancer Research, Lev Becker, PhD, associate professor of the Ben May Department of Cancer Research, Shannon Elf, PhD, assistant professor of the Ben May Department of Cancer Research, Alex Muir, PhD, assistant professor of the Ben May Department of Cancer Research, Raymond Moellering, PhD, associate

professor of chemistry, Julian Solway, MD, Walter L. Palmer Distinguished Service Professor for Medicine and Pediatrics, Anne Sperling, PhD, professor of medicine, and additional UChicago colleagues.

Concerted chemistry effort to develop therapeutics that target SARS-CoV-2 is led by Bryan Dickinson, PhD, associate professor of chemistry, and Guangbin Dong, PhD, professor of chemistry, with colleagues from UChicago and Argonne National Lab. Jun Huang, PhD, assistant professor of the Pritzker School of Molecular Engineering, and colleagues were funded for Low-cost, rapid home testing of SARS-CoV-2 virus and antibodies.

Targeting pathologic cytokine signaling pathways in the inflamed lung to ameliorate acute respiratory distress syndrome in viral infection is led by Jeffrey Hubbell, PhD, Eugene Bell Professor in Tissue Engineering, and Patrick Wilson, PhD, professor of medicine.

CANCER CLINICIANS AND RESEARCHERS ARE CREATING SOLUTIONS Cancer clinicians and researchers are dedicated to maintaining and improving the health and wellbeing of their patients. Usually, this means screening, diagnosing, treating and developing new therapies to help patients beat cancer. In this time of the COVID-19 pandemic, these scientists leapt to the frontlines to fight this deadly virus to not only protect cancer patients, but to protect all patients.

“This translational research study is an outstanding example of the team science capabilities at UChicago Medicine, involving dozens of investigators.”

Thomas Gajewski, MD, PhD UCHICAGOMEDICINE.ORG/CANCER

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Addressing Community Needs in the Context of Coronavirus

By Jane Kollmer

During the public health crisis caused by COVID-19, local organizations that serve patients with cancer were faced with unanticipated challenges amid an extended shelter-in-place lockdown. In-person community events had to be cancelled or moved to a virtual setting, and normal activities were disrupted, leaving some underserved populations even more vulnerable than usual.

To address the crisis, the UChicago Medicine Comprehensive Cancer Center Office of Community Engagement and Cancer Health Equity (OCECHE) sprang into action. Their first order of business was to call an emergency meeting with members of its Community Advisory Board to address concerns and answer questions related to the COVID-19 crisis. Many participants are community partners—including leaders of Federally Qualified Health Centers (FQHCs), nonprofit advocacy organizations, support groups and religious and cultural organizations.

The community leaders shared feedback from their constituents and asked questions regarding coronavirus protocols and cancer treatment at UChicago Medicine. In response to the many questions from these community partners, OCECHE developed community-facing website content to disseminate both general and cancer-specific information on COVID-19 resources.

“We needed to find new and creative ways to continue our mission of reducing health disparities in the community, which have been greatly exacerbated by the COVID-19 crisis,” said Karen Kim, MD, vice provost for research and associate director for community outreach and engagement for the Comprehensive Cancer Center. “With our strong ties to community organizations, we can identify what residents need to stay safe and healthy so 8

PATHWAYS TO DISCOVERY SUMMER 2020

that we can help connect them with the appropriate resources and support during this extremely challenging time.”

In addition, cancer centers across the community came together to share knowledge and foster solution-oriented discussion around the issues brought up by coronavirus. The Chicago Academic Cancer Center Community Engagement Collaborative, spearheaded by UChicago Medicine in partnership with Northwestern and University of Illinois-Chicago, hosted a four-part COVID-19 webinar series addressing different community-related issues.

The webinar topics included “Cancer Care During COVID-19”; “COVID-19, Cancer, and Policy”; “Anxiety with Cancer During a Pandemic”; and “COVID-19 Cancer Survivorship & Care.” OCECHE’s faculty director, Nita Lee, MD, MPH, associate professor of obstetrics and gynecology and faculty director for OCECHE, joined physician experts from partner universities and the American Cancer Society Cancer Action Network as presenters for this series.

Lee also presented to cancer survivors in early June in honor of National Cancer Survivors Day. The virtual event was put on by community-based organization Peer Plus, with guidance from OCECHE education outreach specialist Alia Poulos, MA, MPP. The theme of the informational session

was “What’s Next? Testimony, Challenge and Hope: Cancer Survivors and COVID-19.”

“So many people are seeking out reliable information to help them come to terms with COVID-19’s impact on their lives,” Lee said. “No one has all the answers, but we can serve as a trusted resource based on what we’re learning about the virus through firsthand experience.”

In addition to providing easily accessible information to help local communities, OCECHE partnered with other UChicago and community organizations to address the community’s critical, day-to-day needs.

Safety Net for Low-Income Households The first and most pressing issue during the crisis has been to ensure residents have their basic human needs met. Numerous studies demonstrate that struggling with food insecurity, or lack of easy access to nutritious foods, can make recovering from health problems even more challenging for patients. This was a huge barrier for some UChicago Medicine patients and families touched by cancer, who would ordinarily obtain food from the Feed1st food pantry located at UChicago Medicine.

Food deliveries were made to adult and pediatric cancer patients and their families during the shelter-in-place order.

To make things easier, food pantry leader Ann Jackson, DPT, MPH, collaborated with oncology care teams to identify patients experiencing food insecurity, including pediatric and adult patients and their families. Jackson delivered food packages with shelf-stable items to their doors. Families also received non-perishable items such as fresh vegetables, fruits and meats.

“With this support, the patients have been able to shelter in place without fear of making themselves or other vulnerable family members ill,” Jackson said.

Another immediate need is protection from the virus, which is especially important for people who are immunocompromised, such as cancer patients who have gone through treatment. Stopping the spread of the virus requires washing hands frequently, wearing masks and using hand sanitizer and other cleaning disinfectants that kill germs

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and viruses. The OCECHE and local organization Sisters Working It Out coordinated with Bronzeville Pharmacy to procure medical-grade hand sanitizer. Members of the Comprehensive Cancer Center’s cancer education program donated disposable and reusable face masks of various sizes for several UChicago Medicine cancer patients and their family members.

Bridging the Digital Divide

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.

With the abrupt shift to all-virtual engagement, many community organizations and community members have had to make fast adjustments to move their programs online. To help ease this transition, the OCECHE compiled a digital resource guide, which includes step-by-step instructions for the video-conferencing tool Zoom, and a list of free or low-cost options for community organizations to remain connected with their constituents, such as a texting service that allows for internet-free communication.

This summer, OCECHE is coordinating a COVID-19 forum specifically for community-based organizations. This online event will provide space for community-based organizations to connect and share ideas, advice and concerns about the future of their work during the COVID-19 pandemic.

Additionally, OCECHE Director Gina Curry, MPH, MBA, and partners within the Comprehensive Cancer Center administrative team identified households without adequate devices and delivered loaner laptops to help bridge “the digital divide.”

The forum is part of an overarching goal of OCECHE to gather insight from community-based organizations on how COVID-19 has impacted their service delivery and identify areas for Comprehensive Cancer Center support.

“Not all people have the same access to internet service and technology to stay connected during the lockdown,” Curry said. “We can’t ignore the fact that, at a time when most interactions take place in a virtual environment, some people— especially low-income seniors—may be missing out on vital information.”

The OCECHE also started 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 Blase Polite, MD; and lung cancer, presented by Jessica Donington, MD.

Getting the Message Out Although face-to-face meetings are still the best way to communicate, to protect the community, the OCECHE has embraced 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

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sciences, and City Colleges of Chicago to deliver a virtual tobacco cessation module for the 20-hour Community Health Worker 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 with the Comprehensive Cancer Center.

PATHWAYS TO DISCOVERY SUMMER 2020

These are just some examples of the ongoing work that the OCECHE is doing to keep cancer patients and their families safe, healthy and informed as the entire community faces the COVID-19 pandemic.

“If there’s anything that’s certain during these uncertain times, it’s that the Chicago community is strongest when we all work together,” said Curry.

Research News

Ask the Experts

Oncologists Answer Questions About Coronavirus

University of Chicago Medicine medical oncologist and Interim Section Chief of Hematology and Oncology, Sonali M. Smith, MD, and gynecologic oncologist Nita Karnik Lee, MD, MPH, answer common questions about coronavirus for cancer patients, cancer survivors and their loved ones.

As a patient with cancer, how much higher is my risk of severe consequences with COVID-19?

Cancer patients are among those at high risk of serious illness from an infection because their immune systems are often weakened by cancer and its treatments. Cancer patients who finished treatment a few years ago or longer have immune systems that have most likely recovered, but each person is different. It’s important that all cancer patients and survivors, whether currently in treatment or not, talk with a doctor who understands their situation and medical history.

Drs. Smith and Lee provide information for cancer patients about COVID-19 through a video.

Should I delay my treatment, surgery or radiation therapy at UChicago Medicine?

Right now, this is a very personalized plan. Each of the providers and all of the oncology, gynecologic oncology, radiation oncology and surgical teams are making decisions on a “case-by-case” basis.

We are continuing with chemotherapy. We are looking at all of our patients to see what’s going to be the most appropriate course for care. Our patients are getting personal calls from our nursing teams or their physicians to help us make those decisions. We want to do what’s safest and best.

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Research

Ask the Experts (continued) Should I be tested for COVID-19 because I have cancer?

Even though cancer patients may be at slightly higher risk, we do not think that there is any recommendation for COVID-19 testing in that circumstance unless patients have symptoms of the disease, which include fever, flu-like illness, cough, some gastrointestinal symptoms, some cluster that makes it indicated. If you’re not having any symptoms, there is no reason to leave your house and come to get tested.

If you are having symptoms, we recommend that you call your provider. Let them know so they can best help you decide whether COVID-19 testing is appropriate for you.

What should I do if I develop symptoms of a respiratory infection?

If you develop any symptoms of a respiratory infection—such as fever, headache, body aches, cough or chills—it’s important for you to contact your healthcare provider and talk through these symptoms with them. If they are very severe, you should call 911. But in most cases, it’s important to talk to your provider first so they can advise you on whether or not you need to be tested for COVID-19.

If you need to be tested, you will be provided with a phone number along with the specific details on how to get tested.

What should people with cancer do to prepare for COVID-19?

The main thing we’re asking our patients to do is what we’re asking everyone to do, which is to maintain social distancing. As much as possible, avoid public spaces, group meetings and forums— even if that means gatherings you normally attend, such as church. Be sure to do thorough and frequent hand-washing or use alcohol-based hand sanitizer, especially if you have to go outside.

Those are all important elements to reducing the spread of coronavirus.

View a list of reputable resources to assist cancer patients, survivors and caregivers during the COVID-19 pandemic, including financial assistance programs, online support programs and up-to-date information from local and national organizations (see here).

Research Highlights Immunotherapy shows promise in treating aggressive high-risk breast cancer Some forms of breast cancer have a higher risk of spreading through the body and becoming fatal. A recent phase II clinical trial led by Rita Nanda, MD, associate professor of medicine and director of the breast oncology program, and conducted at the University of Chicago Medicine Comprehensive Cancer Center, shows that immunotherapy in combination with chemotherapy improves the response to treatment in women with high-risk, early-stage breast cancer. In this study, 250 women from 21 academic clinical sites were treated with the standard of care with or without the immunotherapeutic drug, pembrolizumab. The immunotherapy dramatically improved responses, and patients who achieved a pathological complete response had positive outcomes. This study paves the way for improving survival rates for all patients with high-risk breast cancer.

Nanda et al., JAMA Oncol 6:1-9, 2020

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Research

A newly characterized immune cell subset may be key to immunotherapy response Immunotherapies can be effective treatments but have shown a limited benefit in many types of cancer. Comprehensive Cancer Center cancer immunologist Peter Savage, PhD, associate professor of pathology, has characterized a subset of T cells that may play a key role in the response to immunotherapy. These immune cells, called memory-phenotype CD8+ T cells (CD8-MP cells), recognize non-mutated “self� ligands, differentiate prior to cancer development and are ready for mobilization into an immune response. Because cancer cells originate from normal cells, CD8-MP immune cells may be poised to battle against cancer cells. Savage’s team showed that CD8-MP cells are readily recruited into tumors in animal models, and express high amounts of the PD-1 molecule, a T-cell-expressed inhibitory receptor that is commonly targeted in immunotherapy.

Further investigations are expected to reveal the ability of these cells to respond to immunotherapy and attack cancer cells.

Miller et al., Nat Immunol 21:567-77, 2020

A new approach to fighting highrisk acute myeloid leukemia (AML) shows promising results Acute myeloid leukemia (AML) is a blood cancer characterized by excessive proliferation of immature white blood cells and disruption of the development of normal blood cells. AML can progress rapidly, so it is critical to start treatment as soon as possible after diagnosis. High-risk AML, which may occur in older adults, and may be chemotherapyor radiation therapy-related (t-AML), responds poorly to standard chemotherapy with poor outcomes. New approaches are needed to treat these patients to reduce recurrence and improve survival.

Comprehensive cancer center member Olatoyosi Odenike, MD, professor of medicine, and an expert in blood cancers, led a study with UChicago Medicine collaborators to test a novel combination approach to treat high-risk AML. Odenike treated patients with a low-intensity chemotherapy called azacitidine (AZA) to cause biochemical changes to a group of enzymes that regulate the expression of specific target genes, with a view to improving the response to standard chemotherapy. This clinical trial showed positive outcomes in the majority of patients and established an optimal dosage of AZA in combination with standard chemotherapy for further trials. Also, specific gene mutations linked to the likelihood of a positive outcome were identified, indicating the importance of a personalized medicine approach to tailor AML treatment.

Cahill et al., Blood Adv 4:599-606, 2020

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