Livestrong Cancer Institutes Inaugural Annual Report (2021)

Lailea Noel

Gail Eckhardt

Jessica Cisneros

Todd Triplett

Bill Matsui

Dell Medical School at The University of Texas at Austin INAUGURAL ANNUAL REPORT: SUMMER 2021

LIVESTRONG CANCER INSTITUTES

Welcome From the Chair The Livestrong Cancer Institutes at Dell Medical School are advancing care and improving health outcomes through a patient-centered strategy developed in partnership with the Central Texas cancer care community. The approach is in practice at UT Health Austin, where renowned oncologists, researchers, clinicians and patient advisers provide compassionate, state-of-the-art cancer care — the CaLM Model of Whole-Person Cancer Care.

Created through a founding gift from the Livestrong Foundation in 2014, the Livestrong Cancer Institutes are involving patients to redesign the complete range of cancer care, from prevention to diagnosis, treatment, survivorship and end-of-life care — all with a focus on patients’ needs, values and preferences.

Beyond the clinical environment, the Livestrong Cancer Institutes work with community partners to design and implement a cancer education pipeline to introduce learners of all ages to various aspects of oncology, including care and research.

In early March of 2020, the first presumptive case of COVID19 was identified in the state of Texas. In order to protect our patients, clinicians, faculty, staff and students, the Livestrong Cancer Institutes transitioned to a remote work environment.

From April to December 2020, 70% of appointments with UT Health Austin transitioned to telemedicine, allowing patients to continue their care while maintaining social distancing.

Telehealth visits and remote work continued throughout 2020.

On December 11, 2020, the U.S. Food and Drug Administration issued the first emergency use authorization for the first vaccine for the prevention of COVID-19, and UT Health Austin became one of the first institutions to receive the vaccine for distribution. Members of the LCI supported UT Health Austin’s efforts to distribute COVID-19 vaccines to physicians, front-line health workers, first responders and importantly, our cancer patients.

Health Discovery Building

LIVESTRONG CANCER INSTITUTES LEADERSHIP

Our team welcomes opportunities to collaborate in shaping the future of cancer medicine, research and education. Feel free to contact us at livestrongcancerinstitutes@dellmed.utexas.edu.

DELL MEDICAL SCHOOL

Revolutionizing How People Get & Stay Healthy Dell Medical School at The University of Texas at Austin is rethinking the role of academic medicine in improving health — and is doing so with a unique focus on our community.

Created in unprecedented partnership with local taxpayers who voted to support the vision of improving health and making Austin a model healthy city, Dell Med is focused on harnessing the power of innovation, technology and partnerships to modernize academic medicine, create new clinical care delivery models and foster a thriving research environment.

Dell Med works to make health care better and more accessible. To tackle the health problems physicians alone cannot. And to build a better system to support innovation, economic development and opportunity for all.

TABLE OF CONTENTS

Sincerely, S. Gail Eckhardt, M.D., FASCO Director

William Matsui, M.D. Deputy Director

Laura Q.M. Chow, M.D., FRCPC

Associate Director of Clinical Research

John DiGiovanni, Ph.D.

Associate Director of Basic Research

R. Declan Fleming, M.D., FACS

2 Clinical Care

Associate Director of Surgical Services

Barbara Jones, Ph.D., MSW

Associate Director of Social Sciences and Community Based Research

Jeanne Kowalski-Muegge, Ph.D. Associate Director of Cancer Clinical Genomics

Rebekkah Schear, MIA Associate Director of Patient Experience

Nick Smith-Stanley, MBA

Associate Director of Finance and Administration

S. Gail Eckhardt, M.D., FASCO Director, Livestrong Cancer Institutes Chair, Department of Oncology, Professor and Associate Dean of Cancer Programs CPRIT Scholar Dell Medical School The University of Texas at Austin

8 Research 22 Education 30 Community Engagement & Philanthropy 36 Looking Ahead

EXTENDING CALM TO MORE PEOPLE WITH CANCER It is a time of significant growth for the Livestrong Cancer Institutes clinics at UT Health Austin. Guided by the CaLM (Cancer Life reiMagined) Model of Whole-Person Care, our clinical team serves patients with gastrointestinal and gynecologic cancers, hematological malignancies, lung, head/ neck, and breast cancers and surgical oncology.

Alex B. Haynes, M.D., MPH, FACS

Patients at the Livestrong Cancer Institutes’ clinic at UT Health Austin have access to world-class clinical care, as well as a strong team of other experts to address their unique needs such as a dietitian, a genetic counselor, an onco-psychiatrist, a clinical social worker and supportive care specialists, all intended to address the needs of the whole person, not just their disease.

Dell Medical School

CLINICAL CARE

Medical Director, Oncology Integrated Practice Unit, UT Health Austin Associate Chair for Discovery and Investigation, Department of Surgery and Perioperative Care Associate Professor of Surgery and Perioperative Care, Division of Surgical Oncology Director, Research Distinction; MS3 Innovation, Leadership, and Discovery

Anne Courtney, ACNP, AOCNP, DNP Assistant Director, Oncology Integrated Practice Unit Oncology/Acute Care Nurse Practitioner UT Health Austin Left: R. Declan Fleming, M.D., FACS

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CLINICAL CARE

PATIENT ADVISOR PIONEERS NEW CANCER MODEL The CaLM Model of Whole-Person Cancer Care was designed by and for cancer survivors.

In February 2021, the Livestrong Cancer Institutes lost a patient, friend, and one of the co-founders of its CaLM Model of Whole-Person Cancer Care.

As a young adult patient with chronic metastatic colorectal cancer for the past six years, Christina Bain was a cancer patient pioneer, co-founding a new model of interdisciplinary, personalized whole-person cancer care providing psychosocial, palliative and supportive care from the point of diagnosis. She began volunteering her precious time with the Livestrong Cancer Institutes for more than a year before opening an outpatient oncology clinic at UT Health Austin in December 2018.

After opening the clinic, Bain became one of the first patients, transitioning her care to a brandnew clinic that she helped to build and oversee as a patient adviser.

Bain’s experience was not uncommon — her previous providers did not seem to communicate with one another, requiring her to retell her symptoms and medical history multiple times. Her appointments focused only on her disease, and she often felt more like a number than a person. Although she received top medical care, Bain’s emotional, social and practical concerns were all on her to address.

When she did receive a referral for supportive services, the burden was on her and her family to coordinate the appointment, and the care provided was not considered or factored into her medical care.

Despite having chronic, metastatic cancer, being on active treatment for more than six years, and being 4 | ANNUAL REPORT 2020-21

a wife and amazing mom to a young daughter, Bain showed up to virtually every meeting, speaking engagement and volunteer opportunity that we offered. In 2017, she participated in a patient experience group, sharing amazing insights on her cancer experience and how it could be improved.

She helped to interview the care team for the new clinic, emphasizing the need for empathic providers at all levels. She volunteered to speak at provider trainings, to facilitate med school classes, and to talk with middle and high school students about cancer. The Livestrong Cancer Institutes wanted to embed patient voices in the design and delivery of care from the very beginning, and Bain provided a strong, compassionate and dedicated voice.

“

I want to keep using my voice to tell people about my life and my experience. It makes me feel strong, and I hope it can help someone else — be it getting tested themselves or just learning how to better support a friend going through it.”

experience. There is no “average patient.” Every cancer experience is unique. Bain recognized her own privilege of living in Central Texas with access to top specialists, with insurance, flexible employment and a loving support system, and as a married white woman with a steady income.

For three years, Bain worked side by side with oncologists, palliative care and supportive care experts, social workers, health care administrators and others affected by cancer to design and implement the CaLM Model of Whole-Person Cancer Care. Through this model, the Cancer Institutes aims to dissipate the chaos of a cancer diagnosis, helping patients to achieve calm by addressing not just their disease, but also the needs of the mind, body and spirit. CaLM also references work of Elizabeth Teisberg, Ph.D., emphasizing the need to focus on what matters to patients, examining how they define capability, comfort and calm. Pushing our brand-new cancer clinic to develop and offer a Young Adult Oncology program is a great example of the collaborative work that she led. Bain worked with leadership and staff to create a patient and family advisory board dedicated to the young adult cancer experience, and to offer services specific to young adults.

Christina Bain, her work on developing and implementing the CaLM Model of Whole-Person Cancer Care, and the two patient and family advisory

boards have not only influenced the way in which cancer care is delivered but also the ways in which care can be patient-centered. In no way are patients and loved ones a “rubber stamp” for the Livestrong Cancer Institutes. Patients and loved ones co-design and co-create all programs, services and materials in our outpatient oncology clinic. Rather than giving the advisory boards things to react to, Bain pushed for them to lead the way and have the care team, administrators and marketing team react to what patients created. And patients and loved ones are involved far beyond their monthly meetings — they are included in meetings, events, interviews, publications and searches to find new providers.

In Memoriam Christina Bain died from complications from colon cancer on Feb. 8, 2021. She is survived by her husband, Wesley Bain; her daughter, Marlowe Bain; her father, Jan de Roos; her mother, Marie de Roos; and her sisters, Alex and Adriana de Roos.

Her friends at the Livestrong Cancer Institutes are grateful for her insight, candor and vulnerability, which has helped providers, students and people facing their own health struggles. She will be missed, and her story will continue to be told.

(LEFT) Christina Bain (RIGHT) From left: S. Gail Eckhardt; Christina Bain; Elizabeth Kvale, M.D., MSPH; and Elizabeth Teisberg at the South

by Southwest Festival panel discussion “Reimagining Life with Cancer” in 2019.

CHRISTINA BAIN Livestrong Cancer Institutes Patient

Bain always said that oncologists may be experts in treating cancer, but they are not experts on having cancer. She was frank when she talked about her cancer experience but was always quick to remind us that her experience was not everyone’s

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CLINICAL CARE

CALM MODEL OF WHOLE-PERSON CANCER CARE The CaLM Model of Whole-Person Cancer Care offers the most advanced cancer treatment available along with tailored support services, empowering patients and their families to live their lives fully even during the experience of cancer care. Oncologists and providers from various disciplines all work on a single team that collectively coordinates every aspect of the patient’s care, ensuring that the focus is not just on treating cancer, but on creating a life well lived for the whole person.

Clinicians discuss a patient’s case at the weekly Gastrointestinal Cancers Multidisciplinary Case Conference in spring 2019.

MULTIDISCIPLINARY CONFERENCE The Livestrong Cancer Institutes host seven Multidisciplinary Case Conferences focused on Gastrointestinal Cancer, Hepatobiliary Cancer, Hematologic Malignancies, Hereditary Cancers, Cutaneous Oncology and Head and Neck Cancers.

In addition, the Research Molecular Tumor Board called the Total Molecular Profiles with Actionable Yields (TOMWAY) analyzes key genomic findings and variants of unknown significance to facilitate selection of clinical trials.

Patient input at every stage: Before the clinic doors even opened, the Livestrong Cancer Institutes began working to measure what matters to cancer patients, survivors and caregivers, looking specifically at what helps them achieve capability, comfort and calm.

Understanding whole-person needs: To address the needs of a patient’s mind, body and spirit, the 6 | ANNUAL REPORT 2020-21

CaLM care team talks with patients over several visits to assess their needs, wants and preferences, and offer tailored, wraparound support — both on-site and through warm, well-coordinated handoffs to community-based experts.

Interdisciplinary collaboration: CaLM is made of an interdisciplinary care team working together to develop and execute a treatment plan tailored uniquely for each patient.

2021 will see the launch of the Genitourinary Cancer and Breast Cancer multidisciplinary case conferences. There is also continued collaboration with Ascension Seton, Austin Cancer Center and St. David’s HealthCare to bring specialists together from across institutions in order to offer patients the best care possible.

Multidisciplinary Case Conferences are beneficial for patients, clinicians and students. They provide patients with highly individualized, intentional and person-centered care. They enable clinicians to stay up to date on recent advances in best practices for cancer treatment; Continuing Medical Education credits are provided for each conference. Finally, they are an educational opportunity for current medical students, residents and other clinicians in training to learn more about treatment planning for complex cases.

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RESEARCH REVOLUTIONIZING PATIENT-CENTERED CARE Embedded within The University of Texas at Austin, a top-tier research institution, the Livestrong Cancer Institutes are positioned to become a renowned center for technologies and models that strengthen the fight against cancer.

In order to achieve the Cancer Institutes’ goals of improving both access to care and patient quality of life, the institutes’ research programs expand, enhance and connect university efforts focused on cancer research; translate basic science research into tools and treatments that improve patient outcomes; offer high-quality clinical trials; and focus on precision-based medicine. We are committed to exploring new partnerships and opportunities to improve all aspects of basic, translational, prevention and clinical research, with the overall goal of revolutionizing patient-centered care.

William Matsui, M.D. Deputy Director, Livestrong Cancer Institutes Professor, Departments of Oncology and Medicine Associate Chair of Research, Department of Oncology Dell Medical School

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RESEARCH

FROM BENCH TO BEDSIDE: WHEN CANCER RESEARCH BECOMES CANCER TREATMENT The ability to build collaborations and leverage these relationships is the most crucial step in creating new ways to research and treat cancer. Through the Livestrong Cancer Institutes, Hyun Jung Kim, Ph.D., has experienced this firsthand. Kim, an assistant professor in UT Austin’s Department of Biomedical Engineering in the Cockrell School of Engineering, has explored new technologies to mimic the microstructure and physiological function of our human organs and tissues. In his research laboratory, Kim developed a memory stick-size human “gut-on-a-chip” microchip that can grow both human gut cells and bacteria together for a period of days to weeks, allowing the opportunity to study the important relationship between gut bacteria and gut health and disease. Kim has developed a collaboration with the Livestrong Cancer Institutes, Dell Medical School, UT Health Austin and Ascension Seton gastrointestinal clinicians and surgeons who routinely meet with patients to obtain patient samples.

Since initiating the collaborations in fall 2018, samples have been collected on 29 patients in the Austin area. By obtaining patients’ tissues, bacteria and immune cells, Kim is researching how to build a new model that can act as a patient avatar that will specifically mimic a patient’s physiological and pathological outcome. “In collaboration with clinicians, we aim to build a patient-specific ‘avatar’ model to recapitulate someone’s genetic background, disease history or microbial signature germane to the patient’s disease,” said Kim. “If we have a patient’s avatar model, we will use that device to test the toxicity or efficacy of the new therapeutics.” This new model system will allow 10 | ANNUAL REPORT 2020-21

local and diverse population in studies such as Kim’s. Research and collaborations such as those that Kim and the Livestrong Cancer Institutes have spearheaded will allow informed and targeted research to

translate into the clinic, which means better treatment and better outcomes for Central Texas patients.

In 2020, this work was published in two scientific journals, iScience and Micromachines.

for truly patient-specific therapies for GI diseases including colorectal cancer. By using the gut-ona-chip to study tissue directly from a patient’s tumor, different drugs can be tested to determine what the most effective course of treatment will be for the patient before starting treatment. This could decrease the time and number of therapies a patient may need before seeing an effect on the cancer.

“

In collaboration with clinicians, we aim to build a patient-specific “avatar” model to recapitulate someone’s genetic background, disease history or microbial signature germane to the patient’s disease. If we have a patient’s avatar model, we will use that device to test the toxicity or efficacy of the new therapeutics.”

HYUN JUNG KIM, PH.D. Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin

With cancer the No. 1 cause of death in Travis County, it is extremely important to include the

THE SHINE AWARDS FOR EXCELLENCE IN RESEARCH & RESEARCH MENTORSHIP Members of the Livestrong Cancer Institutes received two of the three inaugural Shine Awards for Excellence in Research and Research Mentorship, a celebration of investigation and inquiry at Dell Medical School made possible through the generosity of Ken Shine, M.D. Research is an essential and integral component of academic medicine, and the Shine Awards seek to recognize distinction in both the achievements of trainees and mentorship by Dell Medical School faculty.

S. Stephen Yi, Ph.D., director of bioinformatics and an assistant professor of oncology, was awarded the Shine Award for Excellence in Research Mentorship by Faculty in recognition of his excellent mentorship. Yi has received many honors/awards, including NIH Outstanding Investigator Award, Komen Scholar Award, and NIH Career Development Award. Under Yi’s mentorship, undergraduate, graduate and medical students have learned the crucial role bioinformatics and statistics play in developing therapeutics for cancer care.

Kiera Rycaj, Ph.D., a research scientist, received the Shine Award for Excellence in Research by Trainees for her work examining the role of protein production in the pathogenesis of multiple myeloma. Rycaj, who joined Dell Medical School in 2019, has been a crucial member of the Livestrong Cancer Institutes. Since joining the Developmental Therapeutics Lab under the mentorship of William Matsui, M.D., Rycaj has been active in basic and translational research as well as education.

STEPHEN YI

KIERA RYCAJ

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RESEARCH

COLLABORATING TO DEVELOP NOVEL TREATMENTS THAT STARVE CANCER CELLS OF KEY COMPONENTS A team of researchers at the Livestrong Cancer Institutes is working to develop novel treatments for several cancers. This collaborative project involves researchers from the Division of Pharmacology and Toxicology in the College of Pharmacy, the McKetta Department of Chemical Engineering in the Cockrell School of Engineering, and the Department of Molecular Biosciences in the College of Natural Sciences. This multidisciplinary approach is an excellent example of collaborative science that is the key to success in the war against cancer.

Many cancers require higher than normal amounts of amino acids such as L-cysteine (L-Cys) and L-methionine (L-met) to keep up with cell growth and in some cases to prevent the buildup of toxic byproducts of metabolism. George Georgiou, Ph.D., a professor in chemical engineering; and Everett Stone, Ph.D., a research assistant professor in molecular biosciences, engineered a human enzyme to degrade L-Cys, a nonessential amino that is made by most cells in the body and, thus does not have to be absorbed through the diet. This key amino plays a central role in defending against damage to important cellular components that can occur due to the increased cell growth and metabolism seen in cancer cells.

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Together with Division of Pharmacology and Toxicology researchers John DiGiovanni, Ph.D., Achinto Saha, Ph.D., and Dawit Kidane, Ph.D., the team has shown that cancer cells were selectively killed by depleting L-Cys outside the cell using the engineered enzyme, called Cyst(e)inase, while sparing normal cells. This cancer-selective depletion provides a novel way to specifically target cancer cells, and the researchers have shown this effect in the lab using the engineered enzyme in cancer cells of the prostate, pancreas and breast as well as for a type of leukemia.

or in combination with other cancer treatments.

Several combinations of agents with Cyst(e)inase have been explored to date that look extremely promising. The longer-term goal of the research is to work toward clinical evaluation of Cyst(e)inase and possibly other amino acid degrading enzymes being developed in human clinical trials.

“

I think the reason our team at Livestrong Cancer Institutes has been so successful in therapeutic discovery and pre-clinical development is of course due in part to the deep multidisciplinary expertise our long-term collaboration brings to the table, but perhaps just as importantly … it’s because we are like family. We help each other out. We all hunker down over grueling grant deadlines. We have fabulous brainstorming sessions. We celebrate our wins … basically … we are just better, together.”

“I think the reason our team at Livestrong Cancer Institutes has been so successful in therapeutic discovery and pre-clinical development is of course due in part to the deep multidisciplinary expertise our long-term collaboration brings to the table, but perhaps just as importantly … it’s because we are like family,” added Stone. “We help each other out. We all hunker down over grueling grant deadlines. We have fabulous brainstorming sessions. We celebrate our wins … basically … we are just better, together.”

The potential for translation to human clinical application is supported by the fact that another amino acid degrading enzyme (asparaginase) derived from bacteria has been used clinically for the treatment of childhood leukemia since it was approved in 1978. The short-term goal of this research effort is to further develop engineered compounds for cancer treatment, either alone

EVERETT STONE, PH.D. Member, Developmental Therapeutics Research Program, Livestrong Cancer Institutes Research Assistant Professor, Molecular Biosciences, College of Natural Sciences Assistant Professor of Oncology, Department of Oncology, Dell Medical School The University of Texas at Austin

TEXAS EXPERIMENTAL CANCER THERAPEUTICS NETWORK: Collaborating Across Texas to Advance the Development of Novel Therapeutics The Livestrong Cancer Institutes received funding from the National Cancer Institute (NCI) to become part of the NCI’s Experimental Therapeutics Clinical Trials Network (ET-CTN). The network in Texas is called the Texas Experimental Cancer Therapeutics Network (TEX-CTN) and is composed of the University of Texas MD Anderson Cancer Center (lead), UT Health San Antonio Mays Cancer Center, the Livestrong Cancer Institutes and University of Texas Medical Branch at Galveston. The intent of this network is to advance the development of novel therapeutics using precision oncology approaches and rationally designed clinical trials. The collaboration will give the Livestrong Cancer Institutes access to Phase I clinical trials at each partnering site, funding to develop new therapies, and the ability to build collaborations that utilize the expertise of these world-class institutions.

The TEX-CTN will unite four University of Texas institutions to facilitate access to novel therapies and biomarker-driven trials across the network, for patients with rare and common tumors, as well as patients from underserved minority populations. The team consists of internationally recognized leaders of Phase I and II trials, multidisciplinary disease experts, interventional radiologists, translational pathologists and diagnostic radiologists. TEX-CTN is well poised to attain a new paradigm for early experimental therapeutic clinical trials for cancer patients in Texas and beyond.

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RESEARCH

CANCER CLINICAL GENOMICS: A BRIDGE TO INTEGRATING GENOMICS IN MEDICINE Cancer Clinical Genomics takes inventory of an external view of a vast, complicated, dynamic process of cancer and tries to make sense of it by turning the vast amounts of data collected into information that may be evaluated and applied in the clinic for improved cancer clinical decision making. At the Livestrong Cancer Institutes, this effort is led by Jeanne Kowalski-Muegge, Ph.D., professor in the Department of Oncology, associate director of cancer clinical genomics and co-lead of quantitative oncology for the Livestrong Cancer Institutes.

Advances in the ability to sequence tumors have enabled the generation of data at unprecedented speed and levels of throughput. Consequentially, researchers are in a better position to study biological systems at the level of whole genomes and whole transcriptomes. Importantly, this technology not only affects research, but also how oncology medical care is provided; hospitals have already started to generate sequence data for patients in an effort to customize diagnosis and treatment for that patient. However, the biggest challenge for using the power of such data remains limited by our ability to obtain quick and reliable insights from it. This is where cancer clinical genomics plays a crucial role as a bridge between big data and patients that, with a car packed full of discoveries and fueled by several quantitative results, enables travel back and forth to visit places on each end, some leading to unfortunate dead ends and some to new routes never before traveled.

Cancer clinical genomics is an emerging, blended discipline borne out of the need to translate and connect big data into clinically informed results.

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The overall goal of cancer clinical genomics is to leverage the breadth and depth of big data and tools for their use in cancer care, including: 1) individualized patient decision-making using complex molecular features (precision medicine), 2) the use of bulk and single cell technologies to study treatment resistance across therapeutic paradigms (pharmacogenomics) and 3) harmonization of data from large contextualized research and clinical patient cohorts for computational dissection and discovery (real-world data for real-world evidence).

A quintessential application of cancer clinical genomics using the current infrastructure in place can be seen through the first of its kind Research Molecular Tumor Board, termed TOMWAY (Total Molecular Profiles With Actionable Yields). In

alignment with the Livestrong Cancer Institutes’ focus on total patient care as evidenced through the novel CaLM model, TOMWAY focuses on total molecular profiles and their effect, if any, on treatment recommendations. Unlike most other molecular tumor boards focused on treatment recommendations based on key molecular findings, researchers evaluate the entire, clinically sequenced molecular profile from the perspective of quantitative analyses, familial associations, and medical oncologist. TOMWAY has already resulted in an ASCO abstract submission and a grant application for measuring real-world evidence from real-world data in the form of clinical sequencing reports of patient tumors, with a paper underway describing this new type of molecular tumor board.

LIVESTRONG CANCER INSTITUTES DEVELOPMENTAL THERAPEUTICS LABORATORY: An Innovative Program to Foster Collaboration

Clinically, cancer clinical genomics is the study of molecularly guided strategies for cancer diagnosis, prognosis and treatment. Quantitatively, cancer clinical genomics is defined by a blend of several disciplines that includes biostatistics and bioinformatics. Computationally, cancer clinical genomics requires the creation and implementation of newly created workflows and novel adaptations of existing ones to translate data into results.

Scientists in the Developmental Therapeutics Lab believe the greatest successes for improving health care will come from environments where the complementary natures of different disciplines are exploited and where biomedical scientists closely collaborate with physicians to foster innovative research ideas. The Developmental Therapeutics Laboratory at the Livestrong Cancer Institutes is a multi-Principal Investigator lab maximizing a team science approach and working in collaboration with physicians and researchers across Dell Medical School and The University of Texas at Austin.

Led by co-directors S. Gail Eckhardt, M.D., and Carla Van Den Berg, Pharm.D., the lab brings together a strong faculty of physicians and scientists with

diverse backgrounds and broad expertise in a comprehensive, integrated program dedicated to improving health care and for advancing knowledge in the biological sciences. Our scientists are focused on bringing novel therapeutic options from the laboratory to patients as quickly and safely as possible and are dedicated to training the next generation of researchers to meet the highest standards of drug therapeutics development, including students, residents, and junior faculty.

We are committed to improving health by educating leaders, developing new models of care, advancing innovation from health products to health care delivery and building models that scale for increasing impact to enable better health for all.

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RESEARCH

TACKLING THE LEADING CAUSE OF CANCER DEATH IN TRAVIS COUNTY In Travis County, lung cancer accounted for 20% of cancer deaths in 2017. Those in Travis County’s safety net care system are particularly at risk.

Many patients in the CommUnityCare system are eligible for smoking cessation interventions and/ or lung cancer screening. However, due to the intensive nature of smoking cessation counseling and shared decision-making related to lung cancer screening, these services have not been widely available. It is this gap in access to care that Michael Pignone, M.D., MPH, hopes to reach with his recently awarded grant that will centralize outreach to promote smoking cessation and lung cancer screening.

“Our goal is to fill a significant gap in cancer prevention across Central Texas, especially among people facing financial and access barriers to these critical preventive services,” said Pignone.

The project, funded by the Cancer Prevention and Research Institute of Texas (CPRIT), aims to increase access to low-dose CT scans for patients at CommUnityCare who meet certain eligibility criteria, based on age and smoking history.

Patients who are eligible will complete a shared decision-making process that provides more information about lung cancer and screening, while encouraging active patient involvement in their own health care decisions. The project will also provide comprehensive, evidence-based intensive cessation services to patients who are interested in quitting smoking, including counseling support and pharmacological intervention. To increase the number of patients offered and receiving screening, Dell Medical School will collaborate with others at

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The University of Texas at Austin, CommUnityCare and the Community Care Collaborative.

50% of patients ages 55-77 smoke or formerly smoked

3,000 patients currently smoke

more than

1,000 patients smoked heavily in the past

Over the course of three years, the project team will assess the appropriateness of screening and cessation services through centralized outreach and clinic in-reach of about 7,500 age-eligible

patients who have a documented current or former smoking status. The anticipated number of patients thought to be eligible for the CT screening is approximately 2,000-2,500.

Through the support of CPRIT and in collaboration with community health partners, this innovative project will provide a template of an effective, efficient and scalable system for others who wish to implement low-dose CT screening and intensive tobacco cessation intervention to reduce lung cancer incidence and mortality in vulnerable, often uninsured or underinsured safety net clinic populations.

“

Our goal is to fill a significant gap in cancer prevention across Central Texas, especially among people facing financial and access barriers to these critical preventive services.”

MICHAEL PIGNONE, M.D. Co-program Leader, Cancer Prevention and Control, Livestrong Cancer Institutes Chair, Department of Internal Medicine Dell Medical School The University of Texas at Austin

KICKING OFF CLINICAL TRIALS Phase I Clinical Trials are the initial step in the four-step clinical trial process. At this early stage, researchers aim to determine the safety, side effects and proper dosage of novel treatments.

Phase I clinical trials build upon extensive laboratory testing, which has developed new treatments with great potential that are given to patients for the first time. The Livestrong Cancer Institutes have taken several steps toward building a robust oncological Phase I program with the goal of offering more comprehensive opportunities for Austin-area cancer patients.

A critical component to enrolling patients in clinical trials is to educate and empower the patient to make an informed decision to participate in the study. To ensure patients feel capable and comfortable enough to make informed decisions, designing a comprehensive patient education initiative has been an integral part of developing the Phase I program. An outcome of this initiative is a comprehensive new pamphlet that has been developed with input from a panel consisting of nonmedical patient advocates, caregivers and current/previous cancer patients.

Beyond serving local cancer patients, the Phase I clinical trial program will move the needle forward in the Livestrong Cancer Institutes’ mission to improve treatment for all those living with cancer by identifying and advancing drugs that may eventually turn cancer into a livable disease for 100% of those who are affected.

“We’re trying to rethink everything. We are dedicated to making something that is easier to understand so that as physicians and as a team, we are able to really reach out to the patient and provide the information they need to participate in an early-phase clinical trial,” said Anna Capasso, M.D., Ph.D., assistant professor in the Department of Oncology and principal investiga17 tor on two of the active trials.

RESEARCH

Transportation Housing: Rent/Mortgage/Hotel

Food

Tele-Medicine

Parking

ENGAGING COMMUNITY-ACADEMIC PARTNERSHIPS: THE INFLUENCE OF HEALTH DISPARITIES ON EQUITABLE TRANSITIONS OF CANCER CARE

Education Medication

Gas Card

Members of the Patient and Family Advisory Committee participate in a group modeling session on April 18, 2019.

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Although increased attention has been paid to cancer disparities and their influence on patient outcomes, interventions to eliminate disparities are limited in reach and sustainability. As a result, more community-academic partnerships have emerged during the past decade to improve local health concerns and reduce health disparities. It is becoming clear that these partnerships and coalitions are necessary for developing lasting health promotion and wellness across communities.

Resource Map Guide

Patient to Patient

Mental Health Primary Care Services

Internet Access

Computer/wifi during hospital stay

Wigs etc.

Specialist

Funding

Adaptive Aids

Caregiver Navigation

Patient Navigator

Quality of Life

Employment

Insurance

Spiritual Support

End of Life Care

Palliative Care

Financial Services Veterans: Years in Service and Active Reserve Duty

Family

Interpreters

Children

Referral Services

Peers

Emotional Support Language Barrier

Communication

Through collaborative work with the Livestrong Cancer Institutes, the Steve Hicks School of Social Work and community partners, Lailea Noel, Ph.D., investigated the social conditions that contribute to lower cancer treatment utilization and higher mortality rates in marginalized communities, particularly communities of color and communities within residentially segregated rural and urban neighborhoods in Central Texas. Noel’s research emphasizes a shift in perspective from pursuing only interventions that address the influence of genetics and individual risks on health outcomes to include interventions that address the impact of policies, systems and environments on individual risk factors, leading to an increase in inequity. This research explores services and resources needed to connect marginalized communities with care along with the identification of environmental changes required to improve trust, care coordination and timely access to care, medications and supportive services.

Nutrition

Child Care

Pet Care

Plan of Care

Caregiver Support

Diversity in Staff

Legal Services

Resulting model of a system of cancer care service delivery by people affected by cancer.

Cancer centers are encouraged to initiate conversations with community organizations to nurture trust, convey respect and create community-defined prioritization of goals. Research methods utilizing community engagement, a cooperative relationship between academics and community members, allow cancer centers to receive critical feedback from individuals representing different constituent groups across their community and aid in evaluating ongoing initiatives (Noel et al., 2019).

This community-based research agenda in Central Texas during the past two years has yielded such results, allowing Livestrong Cancer Institutes and their community partners the opportunity to identify critical areas within the community that has the potential to generate a sustainable impact on health inequities in service delivery.

Noel conducted a separate group modeling session with three stakeholder groups: (1) people affected by cancer, (2) nonprofits in Central Texas that provide services to cancer survivors, (3) academic and hospital leadership who influence service delivery. A second group modeling session was held

with groups (1) and (2) to report back the resulting system model created by the group for the purpose of validating the information. The final three separate stakeholder models were then combined, representing a global view of the (ideal) system of cancer care for Central Texans.

Key themes of these systematic conversations with stakeholders revealed a renewed interest in understanding the factors influencing provider trust and respect and patient trust and respect from the patient, medical care provider and community-based service delivery perspectives.

Both community service providers and patients and caregivers mentioned a more diverse provider workforce, more focus on cultural sensitivity, decreased distance to clinics, increased provider availability, and more community-academic partnerships. These conversations with stakeholders also highlighted the difficulty of coordinating care in an environment that includes an ever-changing cancer landscape coupled with residential instability and displacement of communities most affected by disparities.

IT IS BECOMING CLEAR THAT THESE PARTNERSHIPS AND COALITIONS ARE NECESSARY FOR DEVELOPING LASTING HEALTH PROMOTION AND WELLNESS ACROSS COMMUNITIES. 19

RESEARCH

FEATURED PUBLICATIONS Developmental Therapeutics Cancer Prevention and Control Molecular Oncology Supportive Care and Survivorship Quantitative Oncology Tumor Immunology and Microenvironment

Head and Neck Cancer. Chow LQM. New England Journal of Medicine. 2020 Jan 2;382(1):60-72.

Most head and neck cancers (73% in the United States) are now related to human papillomavirus infection rather than tobacco and alcohol. Primary cancers are largely squamous-cell cancers, but combined treatment is resulting in long-term survival for most patients.

Machine Learning and the Cancer-Diagnosis Problem - No Gold Standard. Adamson AS, Welch HG. New England Journal of Medicine. 2019 Dec 12;381(24):2285-2287.

Machine learning has the potential to be extremely useful in medicine, particularly in the interpretation of medical images. But it also has inherent limitations, especially when it comes to diagnosing earlystage cancer.

Development of an Adrenocortical Cancer Humanized Mouse Model to Characterize Anti-PD1 Effects on Tumor Microenvironment.

Lang J, Capasso A, Jordan KR, French JD, Kar A, Bagby SM, Barbee J, Yacob BW, Head LS, Tompkins KD, Freed BM, Somerset H, Clark TJ, Pitts TM, Messersmith WA, Eckhardt SG, Wierman ME, Leong S, Kiseljak-Vassiliades K. Journal of Clinical Endocrinology & Metabolism. 2020 Jan 1;105(1):dgz014.

This study explores the effect of anti-PD1 20 | ANNUAL REPORT 2020-21

immunotherapy on the alteration of the immune milieu in adrenocortical carcinoma (ACC) and reports the first humanized ACC patient-derived xenograft mouse model to ultimately provide more personalized care for patients with ACC. Current methods in translational cancer research. Lee MW, Miljanic M, Triplett T, Ramirez C, Aung KL, Eckhardt SG, Capasso A. Cancer Metastasis Reviews. 2020 Sep 14.

This review assesses the predictive utility of both well-established and emerging pre-clinical methods in terms of their suitability as a screening platform for treatment response and their ability to represent pharmacodynamic and pharmacokinetic drug properties, and it debates the translational limitations and benefits of these models.

Mailed fecal immunochemical test outreach for colorectal cancer screening: Summary of a Centers for Disease Control and Preventionsponsored Summit. Gupta S, Coronado GD, Argenbright K, Brenner AT, Castañeda SF, Dominitz JA, Green B, Issaka RB, Levin TR, Reuland DS, Richardson LC, Robertson DJ, Singal AG, Pignone M. CA: A Cancer Journal for Clinicians. 2020 Jul;70(4):283-298.

In 2019, the Centers for Disease Control and Prevention convened a meeting of experts who concluded that mailed fecal immunochemical testing (FIT) is an effective and efficient strategy with great potential for increasing colorectal cancer screening in diverse health care settings if more widely implemented.

Outcomes That Matter Most to Young Adults Diagnosed with Cancer: A Qualitative Study.

Guzik P, McKinney JA, Ulack C, Suarez J, Davis V,

Teisberg E, Wallace S, Eckhardt SG, Capasso A. Journal of Adolescent and Young Adult Oncology.

2020 Nov 25.

The purpose of this study is to provide insight for improvement in care for young adults diagnosed with cancer (YADC) by identifying underemphasized outcomes that strongly matter to YADC and the gaps in care that may limit achieving these outcomes for this unique and vulnerable population.

Distinct DNA repair pathways cause genomic instability at alternative DNA structures.

McKinney JA, Wang G, Mukherjee A, Christensen L, Subramanian SHS, Zhao J, Vasquez KM. Nature Communications. 2020 Jan 13;11(1):236.

Here, we discover that Z-DNA is mutagenic in yeast as well as in human cells, and that the nucleotide excision repair complex, Rad10-Rad1(ERCC1-XPF), and the mismatch repair complex, Msh2-Msh3, are required for Z-DNA-induced genetic instability in yeast and human cells.

Integrated Genomic Characterization of the Human Immunome in Cancer. Li Y, Burgman B, McGrail DJ, Sun M, Qi D, Shukla SA, Wu E, Capasso A, Lin SY, Wu CJ, Eckhardt SG, Mills GB, Li B, Sahni N, Yi SS. Cancer Research. 2020 Nov 1;80(21):4854-4867.

A comprehensive understanding of how cancer mutations rewire immune signaling networks and functional output across cancer types is instrumental to realize the full potential of immunotherapy.

Our systems-level analysis results help interpret the heterogeneous immune responses among patients and serve as a resource for future functional studies and targeted therapeutics.

Cortical Brain Age from Pre-treatment to Postchemotherapy in Patients with Breast Cancer.

Henneghan A, Rao V, Harrison RA, Karuturi M,

Blayney DW, Palesh O, Kesler SR. Neurotoxicity Research. 2020 Apr;37(4):788-799.

This study demonstrated evidence of increased cortical brain aging in middle-aged patients with breast cancer after chemotherapy treatment that was associated with decreased verbal memory performance.

C o m m u n i c a t i n g O n c o l o g i c Pr o g n o s i s With Empathy: A Pilot Study of a Novel Communication Guide. Lippe M, Phillips F, CurrinMcCulloch J, Stanley A, Jones B, Goodgame B. American Journal of Hospice and Palliative Care.

2020 Dec;37(12):1029-1036.

An interprofessional team explored extant literature and developed a communication guide that serves as a promising mechanism to enhance patient-centered communication about prognosis for patients with incurable cancer.

Reply to Appropriate considerations of “rural” in National Cancer Data Base analyses. Virostko J, Capasso A, Yankeelov TE, Goodgame B. Cancer.

2020 Apr 1;126(7):1586-1587.

Urban and rural populations exhibit differences in the proportion of colorectal cancer cases diagnosed prior to age 50, with higher rates of young diagnosis in urban counties.

Views From Patients With Cancer in the Setting of Unplanned Acute Care: Informing Approaches to Reduce Health Care Utilization. Kaufmann TL, Rendle KA, Aakhus E, Nimgaonkar V, Shah A, Bilger A, Gabriel PE, Trotta R, Braun J, Shulman LN, Bekelman JE, Barg FK. JCO Oncology Practice. 2020 Nov;16(11):e1291-e1303.

Patient-centered care models should focus on early delivery of supportive interventions that help patients and caregivers navigate the unexpected issues that come with cancer treatment.

21

INITIATIVES As a developing cancer center, the Livestrong Cancer Institutes is invested in creating educational programs for the local and national community. The Livestrong Cancer Institutes OnTrack Cancer Research and Career Enhancement Pipeline creates educational opportunities to introduce a new generation of learners to cancer and research.

Through keystone programs such as Livestrong at School, the Summer Healthcare Experience (SHE) and the Summer Undergraduate Research Fellowship (SURF), the Cancer Institutes address the disparities and lack of representation of certain groups in oncology and research.

Laura Q.M. Chow, M.D., FRCPC Professor, Department of Oncology Associate Chair of Education, Department of Oncology Director of the Lung, Head and Neck and Clinical Immunotherapy Programs Associate Director for Clinical Research, Livestrong Cancer Institutes Dell Medical School

EDUCATION 22 | ANNUAL REPORT 2020-21

23

EDUCATION

BUILDING AN INCLUSIVE AND DIVERSE EDUCATIONAL LANDSCAPE IN CANCER RESEARCH Building an innovative and interactive cancer research and career enhancement educational pipeline for students interested in cancer as a career is the goal of most cancer centers. The Livestrong Cancer Institutes have created multiple programs for students as young as those in middle school that offer age-appropriate lessons on how to deal with the impacts of cancer, how they as students and members of the community can contribute to the fight against cancer, and the

various options they have to work in oncology as a career.

By specifically recruiting students from underrepresented backgrounds, the Livestrong Cancer Institutes are addressing the disparities in health care, as well as in cancer-related careers. Through these pipeline programs, students have an opportunity to see firsthand the incredible and impactful work that is being done in the research labs, clinics and in the community.

OnTrack Cancer Research and Career Enhancement Pipeline Total Trainees 2019: >1400 2021: >1700* Career Stage

Programs and Opportunities

2019: 1200 2021: 1500* K-12 • Explore UT • Livestrong at Schools • Summer Healthcare Experience in Oncology

2019: 30 2021: 30*

2019: 180 2021: 200*

Undergraduate Students

Graduate Students

• Summer Undergraduate Research Fellowship (SURF) • Advocates for Cancer Awareness • Observational Learning

• Rotating students from UT Austin • Curriculum (MS1-3) • MS3 Projects and Research • Cancer Interest Group (CIG) • SURF 2.0

Postdocs, Residents, Fellows

2019: 6 2021: 7* Junior Faculty

• Mentor and • Fellowship Support Mentoring Committees • Collaborative Research Projects • Grant and • ACGME Fellowship Proposal Review (2022) Committee • Monthly cancer • Monthly cancer seminars seminars

Cancer Uncovered: An Educational and Empowerment Podcast * projected Participation numbers for the OnTrack Cancer Research and Career Enhancement Pipeline in 2019-2021.

24 | ANNUAL REPORT 2020-21

Students identifying malignant tissue in a radiological scan at the Livestrong Cancer Institutes middle school symposium on March 2, 2020.

LIVESTRONG AT SCHOOL On an unseasonably chilly fall morning, 40 health science students at Juan Navarro High School in Austin, Texas, gathered in small groups with physicians, administrators and cancer survivors to discuss the impact cancer has had on their lives and how they became advocates working in oncology. Some of the students already had strong ideas about where they wanted their academic and professional careers to take them. Others were not as clear.

“I definitely want to be a pharmacy tech,” one student said. Another added, “I don’t know for sure, but I definitely want to work in pediatrics.”

These conversations were part of the Livestrong at School Program. During the program, which begun as a partnership between the Livestrong Foundation and Scholastic, high school students are introduced to lesson plans featuring various ways they can make an impact on cancer. Starting in 2018, the Livestrong Cancer Institutes deployed the curriculum to local schools and created the “Cancer Warriors” panels. The panels allowed

Kristen Wynn, educational program coordinator, welcoming students to the middle school symposium on March 2, 2020.

students to interact with physicians, students, researchers and survivors to discuss the various career paths they could take. The students also developed detailed community action plans on how they could act in their neighborhoods and families.

As the needs of the community grow, the Livestrong at School program will expand to include middle and high school symposiums on the campus of Dell Medical School. During the symposiums, students will identify creative solutions to the unique needs cancer patients and their families face during their battle with cancer.

25

EDUCATION University of Chicago Cancer Center and University of Pennsylvania Medical School have formed a partnership to deploy SHE to engage high school students with the goal of affecting the lack of women in cancer, research and academic leadership.

“

The inaugural SHE group with S. Gail Eckhardt, M.D., M. Yvette Williams-Brown, M.D., MMSc, and staff on July 26, 2019

ADDRESSING THE DISPARITY OF WOMEN IN CANCER AND RESEARCH The Summer Healthcare Experience (SHE) in Oncology aims to encourage young women to pursue careers in cancer and research. The first of its kind, the SHE program introduces high school students to oncology and research through the lens of the challenges women face in academics. During the summer of 2019, local high school students attended a weeklong pilot of SHE at Dell Medical School. The innovative curriculum, presented by Dell Med faculty members, staffers and students, as well as cancer survivors and community organizations, introduced the participants to cancer biology, cancer care through the CaLM Model, cancer research and survivorship and support. The students were also involved in leadership exercises and trainings to start each day. A highlight of the week was when eight cancer support organizations 26 | ANNUAL REPORT 2020-21

in Austin hosted a “World Café” networking session, which highlighted the care outside the clinic offered to people with cancer and their families in Austin.

“Talking to the students individually and hearing their project presentations gave me great confidence in the process of education, exposure and mentoring in helping to grow the next generation of leaders,” said S. Gail Eckhardt, M.D. SHE has generated excitement and enthusiasm nationwide. In 2021, thanks to funding from the American Cancer Society’s ResearcHERS program, the Livestrong Cancer Institutes will collaborate with medical schools and cancer centers throughout the midwest region to expand SHE to additional student populations. Livestrong Cancer Institutes, the University of Michigan’s Rogel Cancer Center, University of Kentucky’s Markey Cancer Center,

Talking to the students individually and hearing their project presentations gave me great confidence in the process of education, exposure and mentoring in helping to grow the next generation of leaders.”

CANCER INTEREST GROUP For students who eventually attend medical school, options are available to further explore oncology. At Dell Medical School, medical students have formed the Cancer Interest Group. Made up of 67 medical students, the Cancer Interest Group meets monthly to discuss various cancer-related topics, including research and care. Students are also paired with research mentors with whom they will collaborate on a cancer-related research project. A select number of Cancer Interest Group students are chosen to present their work at the annual conference of the American Society of Clinical Oncology.

S. GAIL ECKHARDT, M.D. Director, Livestrong Cancer Institutes Chair, Department of Oncology Dell Medical School The University of Texas at Austin

The first Cancer Interest Group in 2017 with Carla Van Den Berg, Pharm.D.

S. Gail Eckhardt, M.D., with members of the Cancer Interest Group at the American Society of Clinical Oncology Annual Meeting in June 2019.

27

EDUCATION

SUMMER UNDERGRADUATE RESEARCH FELLOWSHIP As students transition to college, they have an opportunity to participate in the Livestrong Cancer Institutes Summer Undergraduate Research Fellowship (SURF). Over the course of 11 weeks during the summer, SURF hosts undergraduate students from across the United States to work in various basic, translational and clinical research labs at Dell Medical School and UT Austin. The fellows, whose fields of study range from biology to public health to history, attend biweekly lectures to learn about specific cancer types and research methodologies in addition to their research work with Livestrong Cancer institutes’ faculty. To close out the experience, the fellows participate in a

poster competition in which they have the opportunity to present the results of their independent research projects to faculty members, staffers and students. “The Livestrong Cancer Institutes SURF program solidified my goal to pursue an M.D./Ph.D,” said Srividya Kottapalli, a senior in biochemistry and history at The University of Texas at Austin.

The SURF Program, which recruits students from historically underrepresented racial and ethnic backgrounds, is a true reflection of the Livestrong Cancer Institutes’ educational mission to provide opportunities that value and recognize diversity by creating programs to support learners

Accepted 5% 29%

37%

19%

Gender

5%

10% 35%

47%

15%

30%

25%

Male Female

SURF participants at the poster session on Aug. 2, 2019.

SURF participants at the poster session on Aug. 2, 2019.

from all backgrounds. In addition to cancer- and research-specific lectures and trainings, students also participate in diversity, equity and inclusion training that features discussions and activities on how to contribute to a diverse and antiracist culture.

“

Race

25%

25%

24%

The Livestrong Cancer Institutes SURF program solidified my goal to pursue an M.D./Ph.D.” SRIVIDYA KOTTAPALLI, Senior, biochemistry and history major, The University of Texas at Austin

African American Asian Caucasian

71%

63%

33%

42%

14%

5% 2018 Gender

2018 Race

65%

2019 Gender

2019 Race

40%

70%

2020 Race

LatinX Other

25%

15% 2020 Gender

25%

2021 Gender

2021 Race

This shows the gender and racial identity of participants accepted into the SURF program in 2018-2021. The Livestrong Cancer Institutes strive to increase diversity in SURF as part of an overall effort to increase equity and excellence for all learners in the field of oncology.

28 | ANNUAL REPORT 2020-21

UNCOVERING CANCER The Livestrong Cancer Institutes launched a monthly podcast for learners with a desire to know more about cancer and careers in health care. “Cancer Uncovered: An Education and Empowerment Podcast” is a growing collection of interviews, talks and experiences that aims to empower and inspire. Topics covered in the podcasts include an honest discussion about race and racism with Dell Medical School students, health care disparities, nutrition in cancer care, and how the COVID-19 pandemic has affected cancer care.

29

INITIATIVES

COMMUNITY ENGAGEMENT & PHILANTHROPY

Dell Medical School exists because of our community, and it is only with continued community involvement that the Livestrong Cancer Institutes can rethink cancer care, from prevention to diagnosis, treatment and survivorship. We are here to serve our community, and we rely on community members to help us understand how we can best support people affected by cancer in Central Texas and beyond. Philanthropy—like the founding gift from the Livestrong Foundation that created the institutes — is just one way we work with our community to meet the needs of people affected by cancer.

Cancer disparities cannot be addressed until clinical care, education and research are informed by all of the communities that they serve. At the Livestrong Cancer Institutes, we work to engage the Central Texas community in all the work that we do, including operating a cancer clinic, hiring staff and faculty, and launching a clinical trials program. For example, the Cancer Institutes’ patient and family advisory boards—which are diverse in terms of race and ethnicity, cancer experience, age, ability, gender identity, orientation, socioeconomic background and geographic location—co-design and co-direct all of our clinical strategy and initiatives. Only in working together with our community can we rethink the future of cancer care.

Above: Anna Capasso, M.D., Ph.D., talking about colorectal health at the annual Explore UT K-12 community event in March 2019.

Left: Declan Fleming, M.D., FACS, demonstrating the DaVinci surgical robot to a visitor at Explore UT, March 2019.

30 | ANNUAL REPORT 2020-21

31

COMMUNITY ENGAGEMENT AND PHILANTHROPY

COLLABORATING TO MAKE AUSTIN A MODEL FOR CANCER CARE The Livestrong Cancer Institutes engages the voices of people affected by cancer in the design and deployment of cancer care, education and research.

The Livestrong Cancer Institutes work with two patient and family advisory boards that do not just approve ideas; they are charged with co-designing all clinical programs, services and materials.

Both advisory boards consist of a diverse group of in-treatment cancer patients, post-treatment survivors, and caregivers/loved ones.

Patient & Family Advisory Board: Members work directly with the Cancer Institutes’ physicians, clinical providers and staff to rethink cancer care.

This diverse group of individuals helps the Cancer Institutes improve the care provided to patients, the support it offers caregivers and loved ones, and the ways in which it communicates in the clinic.

The advisory board’s work also includes developing strategies to address disparities in cancer care in the community, offering clinical trials in Central Texas, helping patients find resources and speaking at events.

Young Adult Advisory Board: Young adult cancer patients aged 18-39 often do not fit into traditional pediatric or adult cancer care models. To develop a first-of-its-kind Young Adult Cancer Program, the Cancer Institutes convened this advisory board in 2018, working with it to pilot social and emotional support services, an opt-out oncology fertility program, practical supports, clinical staff training, age-appropriate information and resources, as well as educational and social events.

Members of the Livestrong Cancer Institutes’ Young Adult Advisory Board, who co-design clinical programs including a new Young Adult Cancer Program, in July 2019.

If you have been affected by cancer and are interested in serving on an advisory board, email CaLM@austin.utexas.edu.

32 | ANNUAL REPORT 2020-21

In 2020, the Livestrong Cancer Institutes and Dell Medical School joined Central Texas Addressing Cancer Together (CTX-ACT), a broad coalition of community groups committed to addressing cancer care for uninsured people in Central Texas.

This collaborative group selected breast health prevention and cancer care as the key areas of need in Central Texas for the coalition to address.

To address this need, the Cancer Prevention and Research Institute of Texas (CPRIT) awarded a grant to Dell Medical School in partnership with Lone Star Circle of Care (LSCC) to support the Big Pink Bus mobile mammography program. CTX-ACT community groups raised funds to purchase a 3D machine for the bus and support LSCC’s bus operations for the first three years. The Big Pink Bus will launch in spring 2021.

Uninsured women in Bastrop County will have better access to preventive cancer care thanks to The Pinky Promise, a breast cancer screening initiative lead by the nonprofit Bastrop County Cares and

the CTX-ACT. With a grant from the Shivers Cancer Foundation and support from local philanthropy, The Pinky Promise launched in fall 2020 and is working to provide no-cost screenings to uninsured women in Bastrop County.

In line with the coalition’s goal to expand to other cancers, Dell Medical School was awarded nearly $2 million by CPRIT to expand colorectal cancer prevention services among vulnerable populations in Central Texas, specifically adding new rural and medically underserved communities. It will expand services originally funded by CPRIT in 2018 and offered in partnership with CommUnityCare, that are focused on improving low screening rates through a mailed test-kit initiative. In addition, efforts are underway to tackle tobacco cessation and lung cancer prevention with CommUnityCare, as well as screening and treatment of unhealthy alcohol use as a means of cancer prevention with both CommUnityCare and Lone Star Circle of Care.

Both advisory boards are critical to the Livestrong Cancer Institutes’ work.

GET INVOLVED.

Members of the Livestrong Cancer Institutes’ Patient and Family Advisory Board meet with researcher Lailea Noel, Ph.D., on April 18, 2019.

CENTRAL TEXAS ADDRESSING CANCER TOGETHER

BUILDING SUPPORT FROM THE CENTRAL TEXAS CANCER CARE COMMUNITY

information, affordable person-centered cancer support and integrative care throughout their cancer journeys.

The Austin Cancer Support Coalition, founded in 2017, convenes nearly 200 organizations who serve those in Central Texas affected by cancer at the Livestrong Cancer Institutes. The vision is for all cancer patients, survivors and caregivers across Central Texas to have access to reliable educational

Working with this coalition is critical to ensuring the Livestrong Cancer Institutes’ care team is up to date on resources available to those affected by cancer across the Central Texas. The Cancer Institutes work closely with other coalition members in developing new programs and services based on needs in the community.

33

COMMUNITY ENGAGEMENT AND PHILANTHROPY

ANTIRACISM, EQUITY, DIVERSITY AND INCLUSION

Livestrong at School panelists at an Austin ISD high school in 2018.

Racial inequities in the U.S. have persisted for centuries, but 2020 brought this issue to the forefront in ways that could not be ignored. A pandemic that exacerbated the already existing racial inequities in health and the taking away of Black lives at the hands of the police generated civil unrest and demonstrations calling for addressing structural racism. In response, the Livestrong Cancer Institutes are committed to identifying opportunities to create a diverse and inclusive ecosystem.

Through the creation of the Diversity and Inclusion Advisory Committee, we strive to provide opportunities to address disparities and underrepresentation in oncology, research and medical education.

Members of the Dell Medical School team at the annual Livestrong Challenge in October 2018.

TEXAS 4000

A GROUNDBREAKING PARTNERSHIP The Livestrong Cancer Institutes at Dell Medical School were established in 2014 with a $50 million commitment from the Livestrong Foundation to create a world-class destination for cancer care, research and physician training—one designed in partnership with cancer patients and survivors. Since 1997, the Livestrong Foundation has attracted national recognition for providing free cancer support services and advocating for policies that improve access to care and quality of life. The institutes and foundation share a passion for our Central Texas community and partner on various local initiatives, including the annual Livestrong Challenge.

High School students speaking with KK McCaslin, who oversees educational programs at the Livestrong Foundation, in 2019.

Greg Lee, president and CEO of the Livestrong Foundation, speaking with the first class of Summer Undergraduate Research Fellows in 2018.

34 | ANNUAL REPORT 2020-21

M. Yvette Williams-Brown, M.D., MMSc, speaking with members of the cancer care and support community at the Livestrong

One of the Livestrong Cancer Institutes’ key philanthropic partners in recent years has been Texas 4000 for Cancer, a nonprofit organization dedicated to cultivating the next generation of student leaders and engaging communities in the fight against cancer. Texas 4000 gets its name from an annual charity bike ride—more than 4,000 miles— from Austin to Anchorage, the organization’s cornerstone event. University of Texas student riders raise funds, educate communities along the route, and form a grant committee at the end of the ride that helps determine where funds go.

One of the cancer-related initiatives Texas 4000 has chosen to support is the Livestrong Cancer Institutes Adolescent and Young Adult Oncology Program, including fertility navigation and social work services. Texas 4000 has also supported Dell Medical School’s Texas Health Catalyst, a health product innovation accelerator. Thanks to Texas 4000, Texas Health Catalyst has been able to add cancer to its list of research priorities.

Cancer Institutes Launch event in 2017.

35

WHAT’S NEXT

LOOKING AHEAD GOALS FOR 2021-22

Survivorship program

The Livestrong Cancer Institutes have been delivering innovative cancer care, cutting-edge research and unique educational pipeline programs since 2018. Clinicians, researchers and administrators continue to work with patients, families and educational leaders on ways in which the Livestrong Cancer Institutes can add to and enhance program offerings.

Hematology and Medical Oncology Fellowship Starting in 2022, Dell Medical School will launch a Hematology and Medical Oncology Fellowship, approved by the Accreditation Council for Graduate Medical Ed u ca t i o n ( ACG M E ) . T h i s comprehensive three year program is designed to develop leaders in clinical medicine and research who will transform health care by making high-quality, person-centered, multidisciplinary care the standard for cancer patients. Recruiting will begin in the summer of 2021.

OnTrack Cancer Research and Career Enhancement Pipeline The Livestrong Cancer Institutes will work closely with our local

36 | ANNUAL REPORT 2020-21

and national partners to take a hard look at lessons learned from moving most programming online during the COVID-19 pandemic in 2020 and 2021 and make thoughtful decisions about how to expand and improve our education pipeline programs based on these experiences.

Although we believe that in-person programming is second to none, hybrid experiences may be the key to improving student and educator access and community outreach.

Research collaboration with MD Anderson Cancer Center on early onset colorectal cancer The Livestrong Cancer Institutes and MD Anderson Cancer Center have formed a disease-focused partnership centered on early

onset colorectal cancer. Early onset colorectal cancer is the most common cancer diagnosis for Texas men ages 20-49 and has an increased incidence and mortality, despite overall decreased incidence and mortality in the general population. Recognizing the increasing problem in Texas and the poor response to therapy, the two cancer centers have collaborated on a research working group, with plans to fund pilot projects around detection/prevention, epidemiology and genomics/ genetics.

Caregiver program Although loved ones go through the stress of a cancer journey with the patient, they often overlook their own health. In providing whole-person cancer care, the Livestrong Cancer Institutes also support those who care for patients.

Helping patients transition from in-treatment to post-treatment survivorship requires as much thought and planning as initial treatment planning, and this step in care can easily become overlooked. The Livestrong Cancer Institutes are working with advisory boards to better understand patient needs during this transition and develop flexible supports to address the wide-ranging preferences of post-treatment patients.

Clinical Research Program In 2020, despite the pandemic, the Livestrong Cancer Institutes clinical research team expanded, which will continue throughout 2021 as the clinical trial portfolio increases. The team also received approval for a master agreement with the National Cancer Institute (NCI) Central Institutional Review Board, which allows the Livestrong Cancer Institutes to more easily open trials with the NCI. This is related to our involvement in the NCI’s Experimental Therapeutics Clinical Trials Network consortium grant with MD Anderson Cancer Center, which provides access to trials, patients and funding.

HOW YOU CAN MAKE A DIFFERENCE THROUGH PHILANTHROPY The Livestrong Foundation’s gift created a solid foundation for the Livestrong Cancer Institutes, but our work isn’t done. Each new gift brings us closer to radically improving people’s cancer experience and quality of life, revolutionizing cancer treatment, and reinventing the way cancer patients receive care.

More than a partnership between the Livestrong Foundation and Dell Medical School, the exemplary work detailed in these pages is a collaborative effort of physicians, patients, partners, advocates — and, importantly, donors. As we continue to pursue breakthroughs in cancer research and care, we hope you’ll consider joining our family of supporters in a way that is meaningful to you. There are many ways to make a difference, and Dell Medical School’s development team members can help you craft your unique gift.

For more information, contact the development team at 512-495-5027 or dellmedgiving@austin.utexas.edu.

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LIVESTRONG CANCER INSTITUTES DELL MEDICAL SCHOOL AT THE UNIVERSITY OF AUSTIN Health Discovery Building 6.200 1601 Trinity St. Bldg. B Austin, Texas 78712 512-495-5400 livestrongcancerinstitutes@dellmed.utexas.edu dellmed.utexas.edu/units/livestrong-cancer-institutes @SGailEckhardt

CONTRIBUTORS S. Gail Eckhardt, M.D. Melissa Huddleston Nicole Kluz, MPH Jeanne Kowalski-Muegge, Ph.D. Jennifer McKinney, Ph.D. Lailea Noel, Ph.D. Laura Pavitt Robin N. Richardson, MA Nick Smith-Stanley, MBA