Conquest Magazine - Fall 2009 by MD Anderson Cancer Center

CONQUEST FALL 2009

â&#x20AC;˘

VOL 24

ISSUE

First Best Hope Teamwork, innovation and efficiency in the operating room

MISSION The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.

VISION We shall be the premier cancer center in the world, based on the excellence of our people, ®

our research-driven patient care and our science. We are Making Cancer History .

C O R E VA L U E S

Caring By our words and actions, we create a caring environment for everyone.

Integrity We work together to merit the trust of our colleagues and those we serve.

Discovery We embrace creativity and seek new knowledge.

On the cover: Ann Gillenwater, M.D., professor in the Department of Head and Neck Surgery, and David Clark, M.D., a resident in the department, perform a delicate surgery that involves a team of health care professionals, including a plastic surgeon and a dental surgeon, to rebuild a patient’s jaw.

Visit the Conquest Internet site at www.mdanderson.org/conquest

Features

CONTENTS C O N Q U E S T

FALL 2 0 0 9

Departments D e p artment s 2 FRONTLINE

First best hope Variously described as a village, a city and an anthill,

Vaccine: a personalized cocktail

the 31 gleaming operating rooms at M. D. Anderson

New drug, new combination, new hope for children

showcase the skills of hundreds of surgeons,

Weighing BMI’s impact on pancreatic cancer

anesthesiologists and care team members using

Dramatic increase in survival for metastatic colon cancer

the latest techniques and equipment.

Putting the body’s defense system to work Common drug, new direction for chemoprevention

Five genes raise risk for brain tumors

Management practices help health care executive deal with cancer Fifteen months into discussions with M. D. Anderson about joining together to create a cancer center in the Phoenix area, Peter Fine was diagnosed with cancer

22 Cancer briefings

at the base of his tongue.

M. D. Anderson tops national cancer rankings, again Growth in cancer diagnoses among U.S. elderly, minorities

A family affair An epidemiologic study is gathering significant data from

“Yacker Tracker” hushes hospital

Mexican-Americans, who are both underserved and understudied, in an effort to help identify their potential health risks living in Houston.

24 Moving forward

Richard Garriott Removal of unusual liver tumor puts him in space

Bank on it New sources of state, federal and philanthropic funding for cancer research provide fresh opportunities for M. D. Anderson faculty.

Back to hamburgers and roping steers Watching Daniel Porras interact with his family, one wouldn’t know that he is battling a rare and highly aggressive cancer. A new type of surgery with few side effects has offered him hope.

CONQUEST | FALL 2009

FRONTLINE New drug, new combination, new hope for children A common treatment for severe acne combined with a novel drug may significantly hinder tumor growth in pediatric patients with neuroblastoma, a type of brain cancer, according to Peter Zage, M.D., Ph.D., assistant professor with the Children’s Cancer Hospital at M. D. Anderson. The clinical trial is the first in the world Larry W. Kwak, M.D., Ph.D., professor and chair of the Department of Lymphoma and Myeloma, continues his work on a lymphoma vaccine that is an important step toward personalized therapy for patients.

to test vandetanib, a multi-kinase inhibitor, in children. The acne treatment is 13-cisretinoic acid (CRA).

Vaccine: a personalized cocktail In a Phase III multicenter clinical trial, a lymphoma vaccine — custommade for each patient — extended the time the disease remained in

vessel formation around neuroblastoma

remission.

tumors in mice. When combined with CRA,

“This is the first vaccine in lymphoma that’s shown a positive result, improving time to relapse,” says Sattva Neelapu, M.D., assistant professor in the Department of Lymphoma and Myeloma and principal investigator at M. D. Anderson. A likely key to success is that only patients in complete remission or with minimal residual disease after chemotherapy were vaccinated, according to Neelapu. “With lymphoma, you can get patients to a minimal disease state with chemotherapy and then bring in the vaccine to mop up remaining cancer cells. That’s the strategy, and it should work for other cancers,” says Larry W. Kwak, M.D., Ph.D., who invented the vaccine while at the National Cancer Institute and is now chair of M. D. Anderson’s Department of Lymphoma and Myeloma. “Even if two patients have the same type of lymphoma, their tumors will still have different proteins,” Kwak continues. “It’s the ultimate in personalized therapy.” Reported at the 2009 annual meeting of the American Society of Clinical Oncology (ASCO) in May. Hear more about this study in Conquest online at www.mdanderson.org/conquest Sattva Neelapu, M.D.

“By itself, vandetanib inhibited tumor growth by two-thirds and decreased blood

the impact was even greater on tumor growth,” says Zage, who received this year’s Young Investigator Award from the American Society of Pediatric Hematology/ Oncology and was selected to present his research in a special platform session in April. According to the American Cancer Society, approximately 650 children in the United States, mainly under the age of 5, are diagnosed with neuroblastoma each year. Reported at the 22nd annual meeting of the American Society of Pediatric Hematology/ Oncology (ASPHO) in April.

[ frontline ]

Weighing BMI’s impact on pancreatic cancer In reviewing the weight history of pancreatic cancer patients across their life spans, researchers at M. D. Anderson have determined that high body mass index in early adulthood may play a

Dramatic increase in survival for metastatic colon cancer Better surgical interventions and new drugs

significant role in someone’s developing the disease at an earlier age.

have increased the five-year survival of patients

“This is the first study to explore at which ages excess body

with metastatic colon cancer from 8 percent to 30

weight may predispose a person to pancreatic cancer,” says Donghui Li, Ph.D., professor in M. D. Anderson’s Department of Gastrointestinal Medical Oncology and the study’s corresponding author. “With our epidemiological research, we aimed to demonstrate the relationship between BMI and risk of pancreatic cancer across a patient’s life span and determine if there was a time period that specifically predisposes an individual to the disease, as well as the link between BMI and cancer occurrence and overall survival of the disease.” In the United States, obesity in adults has increased by 60 percent in the last 20 years and is considered an epidemic by the U.S. Centers for Disease Control and Prevention. “As we see obesity dangerously on the rise in the country, this study has true public health implications. Like smoking, obesity is a modifiable risk factor,” says James Abbruzzese, M.D., professor and chair of the Department of Gastrointestinal Medical Oncology and senior author on the study. “Our study suggests that weight control at a younger age should be the primary preventive strategy to reduce the risk of pancreatic cancer.” Reported in the June 24 issue of the Journal of the American Medical Association.

percent, according to recent research. Results from this study, the first in the past 20 years to examine this population, showed that median overall survival is now more than 30 months, compared to eight months for patients diagnosed before 1990. Recently, researchers have made great strides in identifying active agents for the disease, resulting in approval by the U.S. Food and Drug Administration of numerous chemotherapies, explains Scott Kopetz, M.D., assistant professor in M. D. Anderson’s Department of Gastrointestinal Medical Oncology. In addition, over the past decade, the concept that specific metastatic liver lesions can be surgically removed has become more widely accepted as practice. Therefore, more emphasis is now placed on identifying candidates for liver surgery. “In the study, we found not only a significant improvement in overall survival for metastatic colorectal cancer patients, but we also demonstrated that the degree and rapidity of the improvement is of a magnitude that is rarely seen in metastatic cancers,” Kopetz says. “Many of these patients are not necessarily disease-free, but living with their cancer with a high quality of life.

See more about this study in Conquest online at www.mdanderson.org/conquest

For some patients, our goal of making metastatic colorectal cancer a chronic condition is closer to becoming a reality.” Reported in the May issue of the Journal of Clinical Oncology. Hear more about this study in Conquest online at www.mdanderson.org/conquest

CONQUEST | FALL 2009

Putting the body’s defense system to work A vaccine for advanced melanoma, one of the most lethal cancers, showed improved response rates and progression-free survival for patients when combined with the immunotherapy drug, interleukin-2. The findings mark the first vaccine study in this disease — and one of the first in cancer overall — to show benefit in a randomized Phase III multicenter clinical trial. The peptide vaccine, known as gp 100:209217 (200M), works by stimulating patients’ T cells, which are known for controlling immune responses. “Obviously, this is a disease, in its advanced setting, in need of better therapies for our patients,” says Patrick Hwu, M.D., professor and chair of the Department of Melanoma Medical Oncology and co-investigator on the study. “While more follow-up is needed, this study served as a proof-of-principle for vaccines’ role in melanoma and in cancer therapy overall. If we can use the body’s own defense system to attack tumor cells, we provide a mechanism for ridding the body of cancer without destroying healthy tissue.” Reported in May at the 2009 annual meeting of the American Society of Clinical Oncology (ASCO). Hear more about this study in Conquest online at www.mdanderson.org/conquest

Patrick Hwu, M.D., professor and chair of the Department of Melanoma Medical Oncology, is discovering how the body’s defense system can work better to fight cancer.

[ frontline ]

Common drug, new direction for chemoprevention Taking the most commonly prescribed anti-diabetic drug, metformin, reduces a person’s risk of developing pancreatic cancer by 62 percent, according to M. D. Anderson researchers. “This is the first epidemiologic study of metformin in the cancer population, and it offers an exciting direction for future research for a disease greatly in need of treatment and prevention strategies,” says Donghui Li, Ph.D., professor in M. D. Anderson’s Department of Gastrointestinal Medical Oncology. An oral medication, metformin is the most commonly prescribed drug for type 2 diabetes. According to Li, more than 35 million prescriptions for the drug are filled annually, and it’s most often given to type 2 diabetic patients who are obese and/or have insulin resistance. For the study, diabetics were categorized by their use of four common classes of antidiabetic therapies — insulin or drugs that

Collaboration between Melissa Bondy, Ph.D., professor in the Department of Epidemiology, and Ching Lau, M.D., Ph.D., director of the Cancer Genomics Laboratory at Texas Children’s Hospital, has led to new discoveries about brain tumors.

Five genes raise risk for brain tumors

stimulate insulin production, metformin,

Common genetic variations spread across five genes raise a person’s

thaizolidinediones, and/or other common anti-

risk of developing the most frequent type of brain tumor. Conducted by

diabetic therapies — and the duration of use.

an international research team, the study is the first to identify glioma

Diabetics who had taken insulin or insulin stim-

risk factors of any type.

ulators had a 4.99- and 2.52-fold increased risk

“This is a ground-breaking study because it’s the first time we’ve had

for pancreatic cancer, respectively, compared

a large enough sample to understand the genetic risk factors related to

with those who had never used it.

glioma, which opens the door to understanding a possible cause of these

Li notes the study has limitations, including the relatively small size of its diabetic popula-

brain tumors,” says co-senior author Melissa Bondy, Ph.D., professor in M. D. Anderson’s Department of Epidemiology.

tion. She hopes the research will be replicated

The top variations in each of the five genes individually raise a person’s

in a larger sample size. Still, the findings

glioma risk by 18, 24, 27, 28 and 36 percent over someone without the

present the immediate opportunity to explore

variations. The team found that the effects are independent of one another,

metformin as a chemopreventive agent.

so risk escalates with the number of genes involved.

Reported in the Aug. 1 issue of Gastroenterology.

Reported in the August issue of Nature Genetics.

See more about this study in Conquest online at www.mdanderson.org/conquest

— Sara Farris, Scott Merville, Sandi Stromberg and Laura Sussman contributed to Frontline

CONQUEST | FALL 2009

First best hope

by Mary Brolley

Teamwork, innovation and efficiency in the operating room

Linda Ferrante’s job in the OR command center is rarely dull. As coordinator of clinical care in M. D. Anderson’s Main Building operating rooms, she might be compared to an orchestra conductor.

Her charge is to assemble and schedule the teams that fill the 31 surgical suites and are responsible for nearly 11,000 procedures a year. These are complex surgeries, often requiring more than one team of surgeons, plus anesthesiologists, nurses, mid-level providers and technicians. “It’s a challenge,” Ferrante says. “You have to know what’s going on everywhere. It’s a puzzle that — when all the pieces fit — is very satisfying.” After an orientation class 20 years ago, she was instantly “hooked” on surgical nursing. Even in her administrative role, she has a soft spot for fellow surgical nurses, who must quickly become familiar with an ever-evolving slate of technology and equipment. “With all of the equipment to set up, you’re almost an engineer,” she says. When she trains new nurses, “I ease them in there. I want them to come back the next day,” she says with a laugh. “Our nurses are wonderful — we have some of the best. The doctors really depend on them.”

[ the operating room ]

Passion, teamwork and technology Variously described as a village, a city and an anthill, the 31 gleaming operating rooms showcase the skills of hundreds of surgeons and care team members using the latest techniques and equipment. Despite incredible growth in the importance of chemotherapy and radiation therapy, effective surgery is still of paramount importance, says Raphael Pollock, M.D., Ph.D., head of the Division of Surgery. “For solid tumors, there’s usually no curability without surgical intervention.” Even so, Pollock champions collaboration among surgeons, radiation oncologists and medical oncologists at the institution. “Our shared mission allows us to act together for patients. The biggest ego in the room is the tumor.” In Pollock’s view, the Division of Surgery is successful because of a confluence of factors, beginning with surgeons who are “students of the disease,” passionate about learning

how best to treat individual patients. Other factors are the use of the latest equipment and techniques in superb facilities and a reliance on collaboration between surgeons in all specialties. One “student of the disease” is Jean-Nicolas Vauthey, M.D., professor in the Department of Surgical Oncology. His 15 years of training include a residency in general surgery, a fellowship in surgical oncology and a specialization in the hepatobiliary (liver, gallbladder and bile ducts) system. His extensive knowledge has led him to discoveries in technology, technique and research. He has developed and uses a protective “sling” to hold the liver during surgery, increasing accuracy and reducing the chances of damage to the vena cava (the vein that carries blood to the heart’s right atrium) or rupture of the tumor. Vauthey also has worked with medical oncology colleagues to track which chemotherapy drugs may do more damage to the liver, reducing a surgery’s success.

CONQUEST | FALL 2009

Ann Gillenwater’s Operating Room 6, Wednesday morning: It takes a coordinated team of surgeons, anesthesiologists, nurses and technicians to perform an intricate head and neck surgery.

Teamwork pays off for patients As a head and neck surgeon, Ann Gillenwater, M.D., can’t imagine not working as part of a team. Nearly every time she operates, she navigates a narrow, concentrated space with an anesthesiologist, a plastic surgeon and a dentist. A professor in the Department of Head and Neck Surgery, she recalls a recent example.

100 80

Liver resection

60 40

Landmark

Overall Survival (%)

If liver surgery, or hepatectomy, is possible, he says, “it offers a chance of long-term remission to patients who might otherwise be guaranteed a poor outcome.” Since he came to M. D. Anderson, liver surgeries have quadrupled. And a retrospective review published in May 2009 in the Journal of Clinical Oncology showed that liver resection to treat metastatic colorectal cancer has had a dramatic impact on five-year survival rates (see graph and Frontline article, “Dramatic increase in survival for metastatic colon cancer,” on page 3).

No liver resection

Time (months) A study, conducted by M. D. Anderson and Mayo Clinic and published in the Journal of Clinical Oncology, showed that among the nearly 50,000 patients treated for metastatic colorectal disease between 1998 and 2006, there was a significant increase in the five-year survival of those who underwent surgical liver resection compared to those who did not.

[ the operating room ]

‘Perioperative’ defined The term “perioperative,” meaning that which occurs around surgery, refers to the assessment and medical optimization of patients before — as well as the intensive care during and immediately after — surgery. The surgical procedures performed at the institution are among the most complex in the world.

“I was sharing a patient’s airway with the anesthesiologist. Dr. Matthew Hanasono (plastic surgeon) was working on the leg to prepare the fibula bone to mold into the jaw. Dr. Jack Martin (dentist) was coming in to bend the reconstruction plate to attach the bone segments. It’s great collaboration,” she says. “It’s like a dance.” There are 30,000 cases of oral cancer in the United States every year, and 8,000 people die from it. Worldwide, it is one of the 10 most common types of cancer. Gillenwater’s willingness to collaborate and contribute to research extends beyond the institution. She is working with Rebecca Richards-Kortum, Ph.D., professor of bioengineering at Rice University, and her students to develop an optical device that can detect and diagnose oral cancer at premalignant and early stages. Once the optical device is perfected, patients could be screened for these deadly cancers by their own dentists during regular checkups.

Facilitating the shift to more comprehensive perioperative care is Vijaya Gottumukkala, M.D., associate professor and chair ad interim of the Department of Anesthesia and Perioperative Medicine. He is proud of the department’s 60 anesthesiologists and 60 certified registered nurse anesthetists, who, along with nurses, physician assistants and supporting staff, provide superb perioperative care for patients. Anesthesiology and perioperative medicine are exploring new frontiers, he says. “Our techniques and practice can have lasting beneficial effects on cancer survival and patient outcomes,” he says. “And we are aided immeasurably by our research section, headed by Dr. Hui-Lin Pan.” Gottumukkala looks forward to a continued focus on evidence-based practice to improve patient care and to working closely with other cancer institutions in the country to advance cancer anesthesia. — Mary Brolley

CONQUEST | FALL 2009

Raphael Pollock, M.D., Ph. D. (left), professor and head of the Division of Surgery, confers with Garrett Walsh, M.D., professor in the Department of Thoracic and Cardiovascular Surgery, who also heads M. D. Anderson’s Perioperative Enterprise to ensure teamwork, innovation and efficiency in the operating room.

“If we can catch these oral cancer lesions earlier, treatment is likely to be less disfiguring, less debilitating and more successful,” Gillenwater says.

Plastic surgery ‘remarkably extends what we can do’ If surgery is the cornerstone of cancer treatment, plastic surgery has become an ever-increasing part of the equation. Many multi-team surgeries in the Main Building OR involve a team of plastic surgeons, Pollock says. “They remarkably extend what we can do.” “Plastic surgery allows the oncologic surgeon to be aggressive — not concerned about the extent of the operation — to achieve negative margins,” says Geoffrey Robb, M.D., professor and chair of the Department of Plastic Surgery. “We work to restore the physical body contours and to maintain or restore functional elements, such as the restoration of a disfigured or abnormal body part. Often we will need to address loss of function caused by the cancer and treatment.” Plastic surgeons are experts in microsurgery, using a surgical microscope to aid in the careful removal and reapplication of a patient’s own vascular tissue to help restore normal contours and function. Robb is proud of his 16 plastic surgeons, the largest and most productive team devoted to cancer in the world. Team members have pioneered a post-mastectomy approach that uses tissue expanders to develop and maintain natural breast contours before and after a patient undergoes radiation therapy. They also have developed the integration of digital 3-D imaging

to construct surgical models of the mid- and lower face that have revolutionized reconstructive strategies. And they have changed the standard of care in the surgical management of esophageal cancer, using leg tissue for throat replacement. “Function is not a separate but rather an intrinsic goal,” Robb says. “We’ve helped develop a multidisciplinary process that augments the effects of oncologic surgery and allows better overall quality-of-life outcomes for patients.”

‘Combining our brainpower’ The institution has increasingly embraced minimally invasive surgical techniques because of the benefits to patients. With these techniques, which include endoscopy, imageguided surgeries, robotic surgeries and those using real-time MRIs, patients have decreased blood loss, shorter hospital stays, decreased pain and need for postoperative pain medications, and quicker recoveries and returns to normalcy. “We’ve quadrupled our minimally invasive cases since 2001,” says Surena Matin, M.D., associate professor in the Department of Urology, who leads MINTOS, or Minimally Invasive and New Technology in Oncologic Surgery, program at M. D. Anderson. “It’s a growing trend as cancers are detected earlier. The techniques also are used for diagnostic purposes.” He says that the majority of radical prostatectomies are done with minimally invasive techniques. Other procedures that lend themselves to these techniques are partial nephrectomies (surgical removal of a kidney) and robotic cystectomies (surgical removal of the bladder).

[ the operating room ]

“Of course, there will always be a role for open surgeries because many patients come to us with more advanced disease,” Matin says. He relishes the chance to work with experts in other specialties and recalls a recent surgery when he asked for assistance from colleague Pedro Ramirez, M.D., associate professor in the Department of Gynecologic Oncology. “There’s an acknowledgement that it’s hard to keep up, even within your specialty. Working together — combining our brainpower — gives us the chance to interact outside of our silos.”

“One-fifth of them are now either chairs of departments of surgery or heads of surgical oncology sections at major medical centers all over the United States and abroad,” he says. “Between 1984 and 2009, we’ve changed the landscape of American surgery.”

To have the safest operating rooms in the world Over the last three years, M. D. Anderson has begun a comprehensive process to identify best practices in scheduling staff, purchasing and maintaining essential equipment, all while keeping an eye on costs in its operating rooms. “It’s a focus on the processes necessary to ensure the best outcome for our patients — which instruments we use for a particular procedure, how rooms are prepared,” says Garrett Walsh, M.D., head of Perioperative Enterprise and professor in the Department of Thoracic and Cardiovascular Surgery. A crusader for efficiency, Walsh instituted a multidisciplinary value analysis team that reviews and assesses all products for safety and compatibility. They carefully consider input from all members of the surgical staff, then evaluate products in a systematic way. To streamline procedures and eliminate waste and duplication, the team has reviewed and made suggestions about which instruments are to be used for certain surgeries. “Though an individual surgeon may prefer a certain instrument, the committee has the final decision — and ultimate responsibility — for the outcomes,” he says. In addition to his administrative and teaching roles, Walsh continues to enjoy his practice as a thoracic surgeon. “Besides giving me an understanding of the frontline issues, it’s the most relaxing time of my week,” he says. “The only time that things are completely under my control.”

Changing the landscape The legacy of surgery at the institution is not only within its operating rooms. M. D. Anderson-trained fellows and residents have gone on to lead surgical programs in hospitals and medical centers around the country, Pollock says. In the 27 years he has been here, he says, “we have evolved from being the surgical department of a state cancer hospital to one of the best surgical oncology units in the world — all by working as a team.” Pollock, himself a former fellow at M. D. Anderson, gestures proudly at a list of 154 M. D. Anderson-trained surgeons who’ve made their mark in the field after leaving the institution.

SmartSponge technology tested in operating rooms M. D. Anderson is one of the first hospitals in the nation to try using new technology to improve patient safety by reducing the risk that a foreign object might remain in the patient following surgery. As part of the Clinical Safety and Effectiveness educational program, a team of surgeons, nurses and performance improvement experts is testing the impact and cost-effectiveness of the ClearCount SmartSponge System that electronically identifies and counts surgical sponges. Currently, operating room nurses and technicians manually count these items before each case, followed by a recount after the case to make sure the numbers match. With SmartSponge, each item has a radiofrequency tag sewn in that uniquely identifies it. When a case is completed, all of the items are dropped in an attached bucket. If something is missing, the system knows exactly how many and what the items are. The SmartSponge pilot is being led by Miguel Rodriguez-Bigas, M.D., professor in the Department of Surgical Oncology, and Pamela Soliman, M.D., assistant professor in the Department of Gynecologic Oncology. “The beauty of the technology is that it forces you to locate each sponge before closing up the patient. It makes you accountable for every item, which is ideal from the patient safety perspective,” Soliman says. “We recognize the potential benefit, but before committing to the technology, more information will need to be collected by the Clinical Safety and Effectiveness team.”

— Erika Hargrove

CONQUEST | FALL 2009

Management practices help health care executive deal with cancer

by Bill Byron

[ banner health ]

That morning in mid-July of 2008 was of no particular significance to Peter Fine. He got up, got ready for work and made it into his office at Banner Health, headquartered in Phoenix, at his customary time. Of course, there was that little matter of a small lump that he felt near his throat when he was shaving. It nagged at him until later that day when he talked to his doctor about it. Fine’s doctor told him that “just to be sure,” he should have a CT scan. The scan revealed diseased tissue; two biopsies followed. Within a week the diagnosis came back — cancer. Specifically, it was a squamous cell carcinoma primarily located at the base of his tongue. Fortunately, it was in the early stages. “People who know me know that I am very decisive, which is why I didn’t wait to talk to my doctor,” he says. “What I felt was abnormal. I wanted it checked out immediately, and I’m glad that I did.” Fine contacted M. D. Anderson. Coincidentally, the health system for which he serves as president and chief executive officer, Banner Health, was deep into nearly 15 months of discussions with M. D. Anderson about joining together to create a cancer center in the Phoenix area. “I had a pretty good understanding about the capabilities at M. D. Anderson, but, until I started my treatment, I had no idea how amazing this institution really was,” Fine states. “I’m extremely proud and pleased, as well, that M. D. Anderson chose to join with Banner Health to build the M. D. Anderson Banner Cancer Center in the Phoenix area.”

The ‘select’ club With the support of his local physicians, he began a treatment regimen at M. D. Anderson that spanned a five-month period, from late July to mid-December of 2008. The first part of his treatment was aggressive chemotherapy followed by six weeks of highly targeted radiation therapy. “There’s a lot of emphasis and priority in the health care industry on the patient experience, and, with 32 years of experience in health care, I know a great patient experience when I see it,” he says. “At M. D. Anderson, from the receptionists at desks, to nurses, to technicians, to physicians — they all treat patients with the utmost

respect and dignity. They’re outstanding and are dedicated to delivering the best experience to patients.” Fine joined the select club of people who understand the challenges of cancer treatment from a deeply personal perspective. Supporting him through his treatments was his family, especially his wife Rebecca, and a concerned network of friends and colleagues. He also had another important and effective ally — more than 30 years of management success that he put to good use.

An artist’s rendering shows the new M. D. Anderson Banner Cancer Center, slated to open in 2011.

Visibility, credibility, trust “During my treatment I heavily relied on three management practices that were taught to me by mentors I have had in the course of my career,” Fine reveals. Early in his career, he worked as an assistant administrator in an Indiana hospital where the CEO understood the phrase “visibility breeds credibility, credibility breeds trust, so if you want to be trusted you have to be visible.” This phrase, which was a daily and successful practice of that CEO and now Fine, led him (Fine) to reveal his cancer diagnosis and regularly update his progress to Banner Health’s more than 35,000 employees. In Fine’s monthly column he used a photo that displayed a newfound baldness that was the result of his cancer treatments.

CONQUEST | FALL 2009

“I was amazed at the feedback I received,” he recalls. “Through e-mails, cards and letters, many employees revealed their own experiences with cancer, and all of them expressed their support of my situation. Often, these communications helped me through some difficult days.”

Work the plan, tune out the static Another practice that Fine learned through a mentor, while serving as a senior vice president for operations at an academic medical center in Chicago, was the discipline of planning and implementing: “plan the work and work the plan.” With the help of his wife, Fine created and then meticulously followed a plan. “It really helped us navigate through each day — no matter what the day held,” he says. Fine is well known among his colleagues for his ability to focus, another lesson from a mentor while he was serving as the chief operating officer of a large multi-hospital system in Milwaukee. The trick is “to tune out the static.” “People with cancer have to deal with a lot during treatments, and it can be easy to lose focus on what it takes to get through treatments successfully,” Fine says. “Thanks to what I was taught by one of my mentors, I can focus on a goal each day and not be distracted by other things going on around me — the static.” To these three, Fine has added one more management philosophy: The notion that misery is optional. “Misery really is a choice,” Fine says. “Once you recognize that, dealing with cancer is about having the right attitude and thinking positively about your future.”

Employees of Arizona’s leading health care provider gather to mark the announcement of the collaboration with M. D. Anderson.

Bill Byron, senior director of Public Relations and Online Services for Banner Health, contributed this piece to Conquest.

Shared values, shared goals: M. D. Anderson joins with Banner Health Southeast of Phoenix, the town of Gilbert, Ariz., is get-

“In Banner, we believe we’ve found the right team, in

ting ready to welcome a new and very important resident

the right city to truly make a difference in the lives of many

to the community. Once known as the “Hay Capital of the

who will face cancer,” says Thomas Burke, M.D., physician-

World,” Gilbert will aspire to a new designation — leader

in-chief and executive vice president at M. D. Anderson.

in cancer treatment.

“To continue to increase our impact on the national and

Based on the collaboration between Arizona-based

global cancer epidemic, we must collaborate. Banner shares

Banner Health and M. D. Anderson, plans are under way

our values and belief in multidisciplinary care and has a

to break ground on the M. D. Anderson Banner Cancer

strong desire to expand cancer services to the people of

Center in early 2010.

this fast-growing city and state. Together, we will help many

The decision to embark on creating a new 120,000 -

patients in Arizona.”

square-foot outpatient treatment center supported by 76

M. D. Anderson will have clinical oversight for all aspects

patient beds at the existing Banner Gateway facility was

of care delivery at the center, which has a targeted opening

not taken lightly. To deliver the kind of world-class oncology

in late 2011, and will offer medical oncology, radiation oncol-

and patient care that are fundamental to both institutions,

ogy, surgical oncology, pathology, laboratory and diagnostic

leadership knew they needed to have more in common

imaging as well as other supportive clinical services. The

than just a high tolerance for long summers and triple-digit

facility is modeled after M. D. Anderson’s outpatient clinics

heat indexes.

in Houston that feature individual areas for specific cancers.

— Wendy Gottsegen

[ mexican-american study ]

A family affair

Cohort puts the health of Mexican-Americans first by Katrina Burton

“Before joining Mano-a-Mano, I was not taking care of my health; not taking tests like mammograms. Now I take care of myself and my family.”

— Ana Hernandez

ating the right foods, exercising, minimizing stress and making time in our busy schedules for health-related screenings is not always easy. Ana Hernandez, the mother of seven children and M. D. Anderson Mexican-American Cohort participant, would have to agree. “But since joining the cohort, taking care of my health, as well as the health of my children, has become really important to me.” The Hernandez family is one of many families who have joined the cohort — an epidemiologic health study that follows individuals over time. Initiated eight years ago, the goal of the study has been to gather significant data that will help identify potential health risks for Mexican-Americans living in Houston.

“This population is not only underserved but understudied,” says Margaret Spitz, M.D., former chair of the Department of Epidemiology at M. D. Anderson. Under the leadership of Melissa Bondy, Ph.D., professor in the Department of Epidemiology, director of the Childhood Cancer Epidemiology and Prevention Center and principal investigator on the Mexican-American Cohort, the Mano-a-Mano health study has recruited more than 19,000 families to follow. With the help of coinvestigator Michele Forman, Ph.D., also a professor in the Department of Epidemiology, and a league of researchers and coordinators, this resource will help researchers estimate — and ascertain causes related to — disease incidence and mortality in the Mexican-American population.

CONQUEST | FALL 2009

Members of the extended Hernandez family gather on the front porch of their East Houston home. Clockwise: Kimberly Castillo (far left), who initiated the process of entering the family into the Mexican-American cohort, Genevieve, Ana, Gwendolyn, granddaughter Clarissa and Jesus (far right).

[ mexican-american study ]

Participants agree to be followed throughout the study, during which detailed epidemiologic information, biologic samples and information on family health is collected and analyzed. “The data collected will allow us to identify behavioral and genetic risk factors that will help us disseminate specific cancer prevention strategies for that population,” Bondy says. Mano-a-Mano is currently the largest long-term health study of Mexican-Americans in the United States. With such a large number of participants, it has paved the way for other funded studies.

“For the Mexican-American community, the family provides an important setting through which people interpret and share health information and formulate strategies to engage in health-promoting behaviors,” says Laura Koehly, Ph.D., investigator at the National Institutes of Health and principal investigator on the RAMA study. Not only does RAMA investigate how families communicate about their risk for common and complex diseases, but it also provides an opportunity to study how different types of feedback might motivate participants to address their risks for the diseases studied.

Building a smoke-free future One of the first studies implemented under the cohort was the “Mexican-American Tobacco Use in Children” (MATCh) study conducted by M. D. Anderson researchers. Funded by a grant from the National Cancer Institute, the study explored experimentation with cigarette smoking in children of Mexican origin, who were 11 to 13 years old when the study began. “We wanted to collect longitudinal data on children to determine the role of acculturation in smoking initiation. We were also interested in evaluating how psychosocial factors, socioeconomic status, peer influences and genetic make-up contributed to adolescent smoking,” says Spitz, principal investigator on the MATCh study. Results published in the Journal of Adolescent Health indicate that certain adolescents may view behaviors such as smoking as a way to achieve higher status and thereby increase their peer social standing. Through research and multiple publications in scientific journals, MATCh is providing the scientific community with invaluable opportunities to conduct further research on other specific lifestyle behaviors of young adolescents in the Mexican-American community, including alcohol use, diet and level of physical activity.

A look in the mirror The Risk Assessment for Mexican-Americans (RAMA) project, funded by the National Human Genome Research Institute and completed under the umbrella of the Mexican-American Cohort, is a family-based intervention that examines the effectiveness of taking a family-centered approach to communicating disease risk information.

With an ultimate aim toward prevention of ill health, researchers on the Mexican-American Cohort seek to understand the effects of the Houston environment on local inhabitants, such as members of the Hernandez family who live near an oil refinery.

“In this study we want to see if providing risk assessment information coupled with behavioral change messages motivates people to change their behavior more than simply providing information about their risks alone,” says Anna Wilkinson, Ph.D., assistant professor in the Department of Epidemiology and M. D. Anderson’s principal investigator on the study. Through the generosity of the Duncan Family Institute, M. D. Anderson will expand recruitment efforts to Mexican-Americans living in other areas of Harris County and add the collection of dietary habit information. The institute’s support to strengthen the cohort ensures that new questions about cancer-risk factors in this population can be asked and answered with the ultimate goal of helping people like Ana Hernandez take care of their health.

CONQUEST | FALL 2009

Bank on it

New research funding opportunities abound New sources of state, federal and philanthropic funding for cancer research provide fresh opportunities for M. D. Anderson faculty. “Competing for grants from these new initiatives is a welcome challenge after years of stagnant or reduced funding for cancer research,” says Provost and Executive Vice President Raymond DuBois, M.D., Ph.D. “Our faculty have really stepped up with innovative research proposals aligned with these new programs.” The federal programs are under way, the Cancer Prevention and Research Institute of Texas is gearing up, and M. D. Anderson scientists have earned funding from the new philanthropy initiative, Stand Up to Cancer.

Stand Up to Cancer The best and the brightest, joining forces against a common foe — that’s the approach taken by the Entertainment Industry Foundation’s Stand Up to Cancer (SU2C) effort, which counts three M. D. Anderson faculty members among its Dream Team leadership. With a goal of making new cancer treatments available to patients more quickly, SU2C awarded grants totaling $73.6 mil-

by Scott Merville

lion to five Dream Teams comprising 200-plus researchers from 20 leading institutions. Gordon Mills, M.D., Ph.D., chair of M. D. Anderson’s Department of Systems Biology and director of the Kleberg Center for Molecular Markers, is a co-leader on one of those projects. Supported by a three-year, $15 million grant, the team hopes to accelerate development of drugs to attack a mutated molecular pathway that fuels endometrial, breast and ovarian cancers. “The pathway involved here, PI3K, is the most common abnormally activated pathway in all of cancer,” Mills says. “What we learn in women’s cancers will apply to many other types.” Another Stand Up to Cancer-funded Dream Team designed to advance epigenetic cancer therapy will draw on the expertise of Jean-Pierre Issa, M.D., professor in the Department of Leukemia. Epigenetics involves biochemical regulation of genes rather than actual damage to or mutation of DNA. Issa and colleagues were instrumental in the development of decitabine, one of the first epigenetic drugs, which turns on genes that have been chemically shut down. “We plan to find markers that can guide individualized epigenetic therapy by identifying patients most likely to respond,” Issa says. “We’ll start in leukemia, working primarily at M. D. Anderson.” Through a third Dream Team grant, Roy Herbst, M.D., Ph.D., professor in the Department of Thoracic/Head and Neck Medical Oncology, leads research through the department’s innovative BATTLE clinical trial. The team focuses on circulating tumor cells in the bloodstream to detect specific mutations in a variety of cancers and predict patients’ responses to treatment.

[ funding opportunities ]

“We hope circulating tumor cells will allow us to do the same thing without having to do a biopsy,” Herbst says. “We could conduct continuous sampling with this technology.”

Cancer Prevention and Research Institute of Texas Approved by Texas voters in 2007, CPRIT has received its first allocation from the Texas Legislature, $450 million for two years, and continues to build an outstanding leadership team, DuBois notes. Nobel Laureate Phillip Sharp, Ph.D., of the Massachusetts Institute of Technology, is the chair of CPRIT’s Scientific Review Council, which will set standards for reviewing and rewarding grant applications. Nobel Laureate Al Gilman, M.D., Ph.D., of The University of Texas Southwestern Medical Center in Dallas, is CPRIT’s scientific director, and former U.S. Centers for Disease Control and Prevention official William “Bill” Gimson is executive director. Grant application procedures are expected to be in place later this year so reviews can begin. Because CPRIT will require matching funds for each grant, M. D. Anderson will conduct an internal review to select projects for submission. Interested faculty members start by submitting letters of intent. “We received a remarkable 716 letters of intent for research projects from our faculty,” DuBois says.

American Recovery and Reinvestment Act of 2009 Sometimes generically referred to as stimulus funding, the ARRA opens a new grant initiative and expands the number of grants awarded under existing National Institutes of Health programs. The recovery act set aside $200 million for a new program of Challenge Grants designed to jump-start high-impact research that might quickly advance with a brief influx of funds. M. D. Anderson faculty submitted 206 Challenge Grant applications. It’s anticipated that about 200 of these two-year grants will be awarded in September out of the 20,000 applications received nationally. ARRA also provides sufficient NIH appropriations to routinely fund more high-scoring grant proposals. Applications to the NIH are rigorously reviewed and scored in a peer-review system. Tight funding in recent years meant that only the top

Scientists who work in the George and Cynthia Mitchell Basic Sciences Research Building and other research facilities on campus are exploring new avenues to fund their work.

12 percent were approved. A combination of regular budget increases and stimulus funds will allow approval for the top 25 percent of applications. “This is great news, because funding only the very highest-scoring projects leaves some terrific ideas on the table,” DuBois says. By the end of July, M. D. Anderson already had received 16 grants totaling $4.4 million under this program.

CONQUEST | FALL 2009

Back to hamburgers and roping steers New treatment gives teenager hope

by Sara Farris

It’s two days before surgery and Daniel Porras, 15, is joking with his family as he waits for an appointment with his oncologist. When asked if he is nervous about his pending 10-hour surgery, Daniel shrugs and says he just wants to make sure he gets a Chick-fil-A sandwich before he is admitted. Watching the teen interact with his family, one wouldn’t know that he is battling a rare and highly aggressive cancer called desmoplastic small round cell tumor (DSRCT). This soft tissue cancer primarily occurs as multiple tumors in the abdominal area and often resists standard chemotherapy and radiation. DSRCT treated with standard therapy has a poor long-term survival outcome according to Daniel’s surgeon, Andrea Hayes-Jordan, M.D., assistant professor in the departments of Surgical Oncology and Pediatrics at M. D. Anderson. Wanting to improve the chance of survival for these patients, Hayes-Jordan recently translated an adult surgical procedure called continuous hyperthermic peritoneal perfusion (CHPP) so that it could be performed in children. She is the first and only surgeon performing this novel procedure on children in North America. As part of the CHPP procedure, Hayes-Jordan surgically extracts as many tumors as possible before running heated chemotherapy agents through the abdominal area to kill remaining tumor cells. The heat and chemotherapy create a synergistic effect against the tumor.

Behind his dark brown eyes, smile and larger-than-life personality, Daniel Porras epitomizes a resilient spirit that keeps him getting back on the horse and fighting his disease.

[ Chpp surgery ]

“When regular surgery and chemotherapy are given, tumors of this kind usually return within four to five weeks,” Hayes-Jordan says. “However, with chemotherapy and the CHPP surgery, we are able to extend the disease-free time to several months. Patients receiving this surgery have more than a 70 percent chance of surviving for three years or more compared to the 20 percent survival rate of those who don’t receive the procedure.”

Not so eager at first Although CHPP has a low risk for side effects in children, Daniel originally refused to undergo the surgery in 2007. Having already had surgery, chemotherapy and an autologous stem cell transplant (harvested from his own stem cells) in Lubbock and Fort Worth, Texas, he was not eager to have another surgery and more rounds of chemotherapy when he arrived at M. D. Anderson. However, a physician friend in League City, Texas, convinced Daniel and his family to go through with the operation. “When your child is sick and you don’t have many options, you go with what you think is the best choice, and you give it your best shot,” Daniel’s mother, Laura, says. Daniel came through this CHPP surgery with flying colors. “I remember when I woke up from surgery that the first thing I wanted was a big hamburger. Unfortunately, they wouldn’t let me eat solid foods for a while,” Daniel says. “That burger was so good when I finally got to eat it.” In just a few days, Daniel was out of the hospital and set on returning to his normal routine. He went back to West Texas and continued to practice one of his favorite activities — team penning, a rodeo sport where he ropes steers on horseback with another roper. Daniel stayed in remission for 1½ years, but in February of 2009, he relapsed. After additional chemotherapy, Daniel underwent his second CHPP surgery in June. Within a week of his surgery, the teen was up and about and ready to head home. “Daniel is amazing,” says Holly Green, physician assistant at the Children’s Cancer Hospital at M. D. Anderson. “He has so much energy and personality. He rebounds quicker than most patients I know and continues to overcome his disease.” Although Daniel still has a tough battle ahead of him, he continues to beat the odds, more than four years after his original diagnosis.

Andrea Hayes-Jordan, M.D., assistant professor in the departments of Surgical Oncology and Pediatrics, is the first and only surgeon to perform on children the surgical procedure called continuous hyperthermic peritoneal perfusion.

Rare treatment for rare cancer Since Hayes-Jordan performed the first CHPP surgery in 2006, the number of cases she has treated for this rare disease has continued to grow. She has presented internationally on the novel surgery and is currently working with Memorial Sloan-Kettering Cancer Center in New York and the National Cancer Institute on a new study for DSRCT. The study will offer pediatric patients at the Children’s Cancer Hospital at M. D. Anderson and at Memorial Sloan-Kettering a new chemotherapy regimen followed by an initial surgery to remove the tumors. Then patients may choose between having the CHPP surgery, receiving an antibody therapy or receiving a T cell therapy. “DSRCT is a disease we haven’t found a cure for yet, but it is really encouraging to see how these new therapies are making a significant impact on the lives of our patients,” Hayes-Jordan says. “Patients like Daniel are the drivers that encourage these collaborations on rare diseases, so that one day we can find a cure.”

CONQUEST | fall 2009

CANCER BRIEFINGS

Growth in cancer diagnoses among U.S. elderly, minorities A recent M. D. Anderson study predicts dramatic growth in cancer diagnoses that will impact the current health care system over the next 20 years. “In 2030, 70 percent of all cancer will be diagnosed in the elderly and 28 percent in minorities,” according to Ben Smith, M.D., senior author on the study and adjunct assistant professor in M. D. Anderson’s Department of Radiation Oncology. “The number of older adults diagnosed with cancer will be the same as the total number of Americans diagnosed with cancer in 2010,” he says. “Also alarming is that a number of the types of cancers that are expected to increase, such as liver, stomach and pancreas, still have tremendously high mortality rates.”

M. D. Anderson tops national cancer rankings, again For the sixth time in the last eight years, M D. Anderson is the leading hospital in the nation for cancer care, according to the annual “Best Hospitals” survey published by U.S. News & World Report. Since the survey began in 1990, M. D. Anderson has been ranked as one of the United States’ top two cancer hospitals.

long-term cancer incidence projections. It predicts a 67 percent increase in the number of adults 65 years old or older diagnosed with cancer, from 1 million in 2010 to 1.6 million in 2030. In non-white individuals over the same 20-year span, the incidence is expected to increase by 100 percent, from 330,000 to 660,000. Smith and his team accessed the U.S. Census Bureau statistics, updated in 2008 to project population

In addition to the top ranking for cancer, the institution

growth through 2050, and the National Cancer Institute’s

received the most subspecialty rankings it has ever had with

Surveillance, Epidemiology and End Results (SEER)

top listings in ear, nose and throat (2), urology (9), gynecol-

registry, the premier population-based cancer registry,

ogy (12), digestive disorders (23) and diabetes and endocrine

representing 26 percent of the country’s population.

disorders (41).

Cancer incidence rates were calculated by multiplying

In a separate survey of pediatric hospitals published by U.S.

the age, sex, race and origin-specific population projec-

News & World Report in June, the Children’s Cancer Hospital at

tions by the age, sex, race and origin-specific cancer

M. D. Anderson was ranked 13th in the nation.

incidence rates.

“This national ranking is a great point of pride among our

“The fact that these two groups have been under-

employees and volunteers, one that we share with our patients,

represented in clinical research participation, yet their

survivors and their families,” says John Mendelsohn, M.D.,

incidence of cancer is growing so rapidly, reflects the need

president of M. D. Anderson. “This year, with the national eco-

for therapeutic trials to be more inclusive and address

nomic downturn and the impact of Hurricane Ike, the news is

issues that are particularly relevant to both populations,”

especially welcome as we redirect and recommit our resources

Smith says. “In addition, as we design clinical trials, we

to the many needs of those we serve.”

need to seek not only the treatment that will prolong

The U.S News & World Report “Best Hospitals” rankings

survival, but also prolong survival at a reasonable cost to

are based on a reputation survey of board-certified physician

patients. These are two issues that oncologists need to be

specialists around the nation, nurse-to-patient ratios, certain

much more concerned about and attuned to.”

technologies and services available to patients and the com-

Reported in the June 10 issue of the Journal of Clinical Oncology.

munity, and several other factors.

The study is the first to determine such specific

[ cancer briefings ]

‘Yacker Tracker’ hushes hospital Yvette Ong knew from experience that quiet time on an inpatient floor had positive benefits for patients. But a review of studies in this area supplied evidence-based research that substantiated her experience. An oncology nurse and associate director of nursing on M. D. Anderson’s melanoma and sarcoma floor, she discovered in her review that noise not only causes patients to lose sleep, but also that it stirs their anxiety, causes stress and cardiovascular stimulation, reduces pain tolerance, decreases wound healing, delays recovery and causes early readmissions. So she and her unit designated noon to 1 p.m. every day as “quiet time.” During this time the level of noise, light and activity are kept to a minimum. Patients’ doors are closed; overhead paging is reduced; lights are dimmed, ringer volumes lowered; the multidisciplinary team speaks in hushed tones; nurses respond to alarms quickly; and prolonged conversations are held in areas beyond the nursing station. While the nurses and ancillary staff police each other, two bold traffic stoplights known as “Yacker Trackers” bolted to the wall near the nurses’ station are a startling reminder to tone down the voices. The devices are preset to decibel levels, and when they pick up an overly enthusiastic conversation or clacking hard-soled shoes, they alert staff with a flashing red light. “The nursing staff on the unit takes quiet time seriously. They orient our incoming patients and their families about the designated time so we never lose sight of what we’re trying to accomplish,” Ong says. “The patients help us spread the word, too. They are as serious about getting their quiet times as we are.” Reported at the 34th annual Oncology Nursing Society Congress in May.

Clinical nurses Micah Vo (far left) and Valerie Thielemann hush passers-by next to the Yacker Tracker, along with the associate director of clinical nursing, Yvette Ong (right), who initiated quiet time on M. D. Anderson’s melanoma and sarcoma inpatient floor.

— Julie Penne, Sandi Stromberg and Laura Sussman contributed to Cancer Briefings

[ moving forward ]

Moving Forward: Richard Garriott by Gail Goodwin

Growing up in Houston with a NASA astronaut for a dad, Richard Garriott set his eyes on the sky. However, his hopes were initially dashed when a doctor told him his poor eyesight would prohibit him from becoming an astronaut. Determined to fly into outer space, Garriott resolved to find his own way. “All kids grow up with a fascination of flying into space,” Garriott says. “The difference here is that I lived in a neighborhood where some people actually did go into space.” During his college days, Garriott founded a start-up videogame company, Origin Systems, and later invested in and became vice chairman of Space Adventures, a company involved in space tourism. Eager to become a space tourist himself, he had a full medical work-up, a necessity to be cleared for space travel. The testing revealed a liver tumor called a giant hemangioma. Although the tumor was benign, it caused high internal pressure. Blood flowing from the feeding arteries accumulated without the proper venous outflow of normal organs. While Garriott didn’t feel the tumor and had no symptoms, he was at risk of its rupturing during a space landing. When it was determined that this surgery in an otherwise healthy patient needed specialized expertise, the physicianin-chief of NASA referred Garriott to Jean-Nicolas Vauthey, M.D., professor in the Department of Surgical Oncology at M. D. Anderson. Garriott arrived at M. D. Anderson in early January 2008 for this unusual surgery, during which Vauthey performed an enucleation of the hemangioma, a procedure that does not remove any liver tissue. Few surgeons in the world have the ability to perform this surgery, often called the two-surgeon technique and first described in a 2006 scientific report from M. D. Anderson. “My experience was unusual,” Garriott says. “I sat in M. D. Anderson waiting rooms with other people who were here for cancer treatment, but my case was optional — I just wanted to fly into outer space. The expertise of the doctors, nurses and staff and the positive attitudes of the patients are things I’ll always remember.”

By the end of January, less than a month after surgery, Garriott was at a Russian training center to prepare for his space flight. On Sunday, Oct. 12, 2008, with Garriott on board, the Soyuz TMA-13, a Russian space module, blasted off for 12 days in space and the International Space Station. As part of his flight, Garriott took part in several education and scientific outreach efforts. He is most proud of the experiment involving eyesight, which demonstrated that individuals with eyesight problems corrected by Lasik surgery would have no problem during space flights. As a result, NASA now allows people with photorefractive keratectomy to become astronauts. Though Garriott is retired, he says that the space industry will always be part of his life. He’s committed to making space travel more possible for the private citizen.

affiliations The University of Texas System Board of Regents

James R. Huffines, Austin Chair

Colleen McHugh, Corpus Christi Vice chair

Paul Foster, El Paso Vice chair

James D. Dannenbaum, Houston Printice L. Gary, Dallas R. Steven “Steve” Hicks, Austin Janiece M. Longoria, Houston Wm. Eugene “Gene” Powell, San Antonio Robert L. Stillwell, Dallas Karim A. Meijer, Katy Student regent

Francie A. Frederick General counsel

The University of Texas System Administration

Francisco G. Cigarroa, M.D. Chancellor

Kenneth I. Shine, M.D. Executive vice chancellor for Health Affairs The University of Texas M. D. Anderson Cancer Center EXECUTIVE COMMITTEE

John Mendelsohn, M.D. President

Thomas W. Burke, M.D.

Executive vice president and physician-in-chief

Raymond N. DuBois, M.D., Ph.D. Provost and executive vice president

Leon J. Leach

Executive vice president and chief business officer

The University Cancer Foundation Board of Visitors OFFICERS

Nancy B. Loeffler Chair

Ali A. Saberioon Chair-elect

Harry J. Longwell

M. D. Anderson Cancer Center Orlando, Orlando, Fla. Centro Oncológico M. D. Anderson International España, Madrid, Spain M. D. Anderson satellite facilities in Texas — the Bay Area (Nassau Bay), Bellaire, Fort Bend, Katy, Sugar Land and The Woodlands; and New Mexico — Albuquerque Christus Spohn Stem Cell Program affiliated with M. D. Anderson Cancer Center Outreach, Corpus Christi, Texas Stephen C. Stuyck, vice president, Public Affairs Sarah Newson, associate vice president, Communications Wendy Gottsegen, director, External Communications Executive Editor: David Berkowitz, associate director, External Communications Managing Editor: Sandi Stromberg, program manager, External Communications Writers: David Berkowitz, Mary Brolley, Katrina Burton, Bill Byron, DeDe DeStefano, Sara Farris, Gail Goodwin, Wendy Gottsegen, Erika Hargrove, Scott Merville, Julie Penne, Sandi Stromberg, Laura Sussman Designer: Michael Clarke Photographers: Gagarin Cosmonaut Training Center (page 24), Shawn Green (page 19), Eli Gukich (cover, pages 1, 6-7, 8-9, 10, 20), Karen Hensley (bottom of page 2), Wyatt McSpadden (top of page 2), Jerry Portelli Photography (page 12), Gini Reed (pages 1, 15, 16, 17, 23), John Smallwood (page 21), Barry G. Smith (page 4), F. Carter Smith (page 5) Conquest is published quarterly by The University Cancer Foundation Board of Visitors on behalf of The University of Texas M. D. Anderson Cancer Center. All correspondence should be addressed to the Division of Public Affairs-Unit 700, M. D. Anderson Cancer Center, 6900 Fannin St., Houston, Texas 77030-3800, 713-792-3457. E-mail: sfstromb@mdanderson.org. Articles and photos may be reprinted with permission. For information on supporting programs at M. D. Anderson Cancer Center, please contact Patrick B. Mulvey, vice president, Development, 713-792-3450, or log on to the How You Can Help Internet site at www.mdanderson.org/gifts.

Vice chair

Ernest H. Cockrell Immediate past chair

For information on patient services at M. D. Anderson, call askMDAnderson at 1-877-MDA-6789, or log on to www.mdanderson.org/ask.

V i s i t t h e C o n q u e s t I n t e r n e t s i t e a t w w w. m d a n d e r s o n . o r g /c o n q u e s t . Printed on recycled paper with soy-based ink.