Conquest Magazine - Spring 2009 by MD Anderson Cancer Center

CONQUEST SPRING 2009

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VOL 23

ISSUE

There’s no PlaCe like hoMe outpatient surgery aims to get Patients home Within 24 Hours

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, ÂŽ

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

C O R E â&#x20AC;&#x2C6; 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: Certified Registered Nurse Anesthetist Nancy Almon prepares a patient for a pain-relieving, paravertebral block before outpatient surgery.

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

Features

CONTENTS C O N Q U E S T

S P R ING 2 0 0 9

5 D ep p artment a r t m e n t ss De 2 FRONTLINE Two plus two may equal better treatment Dicer and Drosha run interference Novel biomarker forces cells to eat themselves The power of a single gene Supplements don’t hold the answers

5 Putting a face to the disease The patient advocate research team is an essential and required component of each Specialized Programs of Research Excellence (SPORE) grant from the National Cancer Institute. Three patients share their advocacy experiences. 8

22 Cancer briefings A sweet addition for Sugar Land Talk of the town Long-time survivors ‘RENEWed’

Who says you can’t go home? More than 4,000 patients pass through Mays Clinic’s outpatient operating room each year. By streamlining scheduling and procedures, and addressing issues of pain early, physicians can allow most patients to return home within 24 hours.

13 increasingly treatable advances in multiple myeloma

24 Moving Forward

Researchers are developing new drugs, including immunotherapies, trying new combinations and exploring ways to improve transplants as they push to make myeloma a chronic disease and develop potential cures.

Ify Ezeobele

Lymphoma patient turns ‘devastation’ into achievement with doctorate degree 18

Tough decisions for young women Prophylactic Mastectomies

A new study helps identify women with cancer in one breast who are at high risk of developing cancer in the other breast. A patient shares the story of why she chose contralateral prophylactic mastectomy. 20

The cancer crusade M. D. Anderson’s journey through the eyes of a historian

James Olson, Ph.D., took eight years to sift through nearly seven decades of documents and weave together the history of M. D. Anderson and his own cancer journey in a book published this spring by the Johns Hopkins University Press.

CONQUEST | SPRING 2009

FRONTLINE Two plus two may equal better treatment

Edward Kim, M.D., assistant professor in M. D. Anderson’s Department of Thoracic/ Head and Neck Medical Oncology, visits with Jerry Stutts, a patient taking part in Kim’s innovative clinical trial.

The combination of two standard therapies and two

safety. Our next priority will be to analyze the tissue from

targeted therapies proves to be safe and may improve

this study to help find appropriate biomarkers for the

survival for patients with advanced lung cancer, accord-

disease to best understand who might benefit from this

ing to results of a Southwest Oncology Group Phase II

drug regimen.”

study led by Edward Kim, M.D., assistant professor in

SWOG is one of the largest of the National Cancer

M. D. Anderson’s Department of Thoracic/Head and

Institute-supported, cancer clinical trials cooperative

Neck Medical Oncology.

groups with more than 550 institutions, including 18 of

Until now, the SWOG standard regimen for lung

NCI’s 63 designated cancer centers, conducting research

cancer has been a combination of two chemotherapies,

that is shared with more than 5,000 physicians across

carboplatin and paclitaxel, with the targeted therapy,

the United States.

cetuximab (Erbitux®). In this study, researchers added a

Presented Nov. 13, 2008, at the press program of the Chicago Multidisciplinary Symposium in Thoracic Oncology.

second targeted therapy, bevacizumab (Avastin®), to see if they could increase the efficacy of the drugs without compromising safety. “Our findings were certainly compelling and are the best results ever for a SWOG-based study for advanced lung cancer,” Kim says. “While early, this four-drug combination seems to show promising, yet modest improvement in efficacy without compromising patients’

[ fRontlinE ] DICER AND DROsHA RUN INTERFERENCE The level of two proteins vital to a cell’s gene-silencing

Anil Sood, M.D., professor in the departments of Gynecologic

machinery in a woman’s ovarian cancer are strongly associ-

Oncology and Cancer Biology. “Very consistently, we found that

ated with her likelihood of survival, according to researchers at

low levels of Dicer in particular are predictive of poor outcomes.”

M. D. Anderson. Women with a high level of these proteins, called

Molecular details of the raised risk for patients remain to be

Dicer and Drosha, had a median survival of 11 years. Those with

discovered, but it is likely that low levels of Dicer and Drosha permit

low levels of both had a median survival of 2.66 years.

some genes to continue functioning when they should be silenced.

Researchers also analyzed gene expression data in groups of

“RNA interference has only been known for about a decade.

lung and breast cancer patients and found similar associations

The components of the machinery, what it does in cancer, and how

with patient survival.

it affects outcomes and therapy are not fully known,” Sood says.

“Dicer and Drosha are crucial for two types of RNA interference, which cells use to shut down genes,” says senior author

Reported in the Dec. 18, 2008, issue of the New England Journal of Medicine.

anil sood, M.D., professor in the departments of gynecologic oncology and Cancer biology, has identified two proteins shown to be associated with survival.

NOvEL BIOMARkER FORCEs CELLs TO EAT THEMsELvEs A research team has discovered that a protein known to inhibit the growth of ovarian cancer works in part by forcing cancer cells to eat themselves until they die. The group also found that expression of the protein, known as PEA-15, is an independent indicator of a woman’s prospects for surviving ovarian cancer, says senior author Naoto Ueno, M.D., Ph.D., associate professor in M. D. Anderson’s Department of Breast Medical Oncology. An analysis of ovarian cancer tumors from 395 women showed that those with high expression of PEA-15 had a median survival time of 50.2 months, compared with 33.5 months for women with low levels of the protein in their tumors. “These findings provide a foundation for developing a PEA-15 targeted approach for ovarian cancer and for clarifying whether this protein is a novel biomarker that can predict patient outcomes,” Ueno says.

PEa-15 Protein PEa

Reported in the Nov. 15, 2008, issue of Cancer Research.

CONQUEST | SPRING 2009

FRONTLINE The power of a single gene Variations in a common gene pathway may affect the risk of esophageal cancer, a dangerous and rapidly increasing type of cancer that now ranks sixth in cancerrelated deaths worldwide. Results of the study, which is the first to look at the association between variations in genes related to microRNAs (miRNAs) and esophageal cancer, found seven genotypes that were significantly associated with esophageal cancer risk and four more that showed at least borderline significance. “Previous research has shown miRNAs control approximately one-third of human genes and may play a part in cancer risk,” says the study’s lead author, Xifeng Wu, M.D., Ph.D., professor in M. D. Anderson’s Department of Epidemiology. “But whether genetic variants of miRNArelated genes influence esophageal cancer has largely remained unknown.” “This research showed not only that a single gene contributes to the risk of esophageal cancer, but more important, that the joint effect of several genetic elements also can increase risk,” says the study’s first author, Yuanqing Ye, Ph.D., an instructor in M. D. Anderson’s Department of Epidemiology. Reported in the November 2008 issue of Cancer Prevention Research, a journal of the American Association of Cancer Research.

Supplements don’t hold the answers Results from the Selenium and Vitamin E Cancer Prevention Trial (SELECT) have shown that neither of these supplements taken alone or in combination for an average of 5 1/2 years prevents prostate cancer. Begun in August 2001, the study set out to determine whether selenium, vitamin E or both could prevent prostate cancer and other diseases in relatively healthy men. Funded by the National Cancer Institute, with additional contributions from the National Center for Complementary and Alternative Medicine, the Phase III trial followed 35,533 participants from 427 sites in the United States, Canada and Puerto Rico. The randomized, placebo-controlled and double-blind trial divided the participants into four intervention groups: selenium, vitamin E, both selenium and vitamin E, and placebos. While the study found no evidence of benefit in any of these categories, the data showed two statistically non-significant findings of concern: slightly increased risk of prostate cancer in the vitamin E group and type 2 diabetes mellitus in the selenium group. Both trends may be due to chance and were not observed in the group taking the two supplements together. “SELECT presented a unique opportunity to improve the lives of men from every social and ethnic background through chemoprevention,” says Scott Lippman, M.D., professor and chair of M. D. Anderson’s Department of Thoracic/Head and Neck Medical Oncology, who led the Southwest Oncology Group study along with Eric Klein, M.D., of the Cleveland Clinic Lerner College of Medicine. “Although supplementation has been discontinued, we will continue to follow these men and monitor their health for approximately three more years, conducting regular prostate screening tests and questioning them about diabetes and other health issues,” Lippman says. “Doing so is critical not only to determine any possible long-term effects of the selenium and vitamin E, but also to gain a better understanding of prostate and other cancers and age-related disease.” Reported in the Dec. 9, 2008, issue of the Journal of the American Medical Association.

Xifeng Wu, M.D., Ph.D. (right), professor in the Department of Epidemiology, works closely with Di Zhang, coordinator in the research laboratory.

[ spore PATIENT ADVOCATE PROGRAM ]

As SPORE advocates, Tom Touzel and Jane Dinney bring a unique perspective to research that helps bladder cancer patients and those dedicated to preventing and treating this disease communicate.

Putting a face to the disease Tom Touzel got his first taste of patient advocacy when he was diagnosed with bladder cancer in 2005. As he searched for the best treatment options, he admits to having been “pushy and a bit proactive” before he chose M. D. Anderson. But the minute he walked through the door, he knew he’d made the right decision. In fact, the Canadian native exchanged his winter residence in Florida for a condominium in Houston, where he can monitor his health without the expense of traveling to and from the cancer center. And for the last three years — with three surgeries and a history of smoking behind him — he has spent five days a week at M. D. Anderson advocating for bladder cancer patients through a Specialized Programs of Research Excellence (SPORE) grant.

by Sandi Stromberg

Established by the National Cancer Institute in 1992, SPOREs are multi-project, multidisciplinary, “translational research” grants, meaning research done at the “bench” (laboratory), then progressing to the clinic for the benefit of patients. Translational research can be bi-directional in that clinicians often make observations that stimulate basic research. The patient advocate research team is an essential and required component of SPOREs. “Every five years investigators have to reearn their SPORE,” says Robert Bast Jr., M.D., vice president for translational research at M. D. Anderson. “It’s highly competitive and demands there be results. It always asks, ‘Did you accomplish something beneficial for patients?’ ”

CONQUEST | Spring 2009

Becoming conduits Currently, M. D. Anderson is the recipient of 11 of these prestigious, multimillion dollar grants — in leukemia, melanoma, and cancers of the bladder, brain, breast, head and neck, lung, ovary, pancreas, prostate and uterus. Eleven SPOREs are the most granted to any U.S. institution. Twenty-nine patient advocates volunteer their time to provide principal investigators with patient perspectives. Though their roles differ, depending on the disease site, patient advocates generally participate in research discussions and strategy meetings, review clinical trial protocols, identify barriers and gaps in the research system, talk to patients, and ask results-oriented questions that help focus on moving discoveries to the clinic. In 2006, Touzel accepted an invitation to become a patient advocate from Colin P.N. Dinney, M.D., professor and chair of the Department of Urology and principal investigator on the genitourinary (bladder) SPORE. “Advocacy allows patients to feel empowered,” Touzel says. “When I grew up and went to the doctor, you didn’t question anything. Doctors were omnipotent. Today patients get more involved in their treatment, and advocates act as conduits to aid that process.” “Besides increasing public awareness about bladder cancer,” Dinney says, “these advocates help the patient and family achieve more control over their disease and reduce the feelings of helplessness and hopelessness that often accompany

diagnosis. They also bring the patient voice and experience into research. Their ‘why’ questions help us focus our research, identify translational gaps and find solutions. In essence, they put a face to the disease, which helps us as physicians keep our perspective as we work toward understanding the disease and finding better treatments.”

Building relationships For Dorothy Paterson, a patient advocate on the breast cancer SPORE, her role has been “about building relationships.” “If the only thing I do is be a face of a patient — to remind doctors of the urgency of translating their findings in the laboratory as fast as reasonably possible to the clinic — I’ve done my job,” she says. When she was diagnosed with stage III ductal carcinoma in 1998, she was married with two children, 9 and 11 years old, and worked as a full-time geologist. “It was a difficult 18 months of treatment,” she says. “But I had strong support from my family and friends, as well as my company and colleagues. About the time I was ready to give back, a new program was being launched at M. D. Anderson — the Pink Ribbon Volunteers. Being a founding member of it in 2001 was the beginning of my advocacy.” In July 2006, Gabriel Hortobagyi, M.D., professor and chair of the Department of Breast Medical Oncology and principal investigator on the breast cancer SPORE, asked her to serve as part of his patient advocate research team. Along with Touzel and others, Paterson traveled to Baltimore to attend the 2006 SPORE conference. “They actually sent us a notebook on genomics ahead of time. We were to work through it and then attend a separate class at the conference so we could understand what a huge impact the genome mapping project has had on cancer research. “For the first time, we were in the room with people from all over the United States representing all different disease sites. It was then that we saw what we could do as advocates and how we could have an impact on research. We also realized that advocates at M. D. Anderson needed to have joint meetings.”

Energizing each other

Susan Massman talks about her role as a patient advocate on the leukemia SPORE with Claudine James (right) and Kenneth Woo (middle), cancer survivors and members of Anderson Network, a program of the Department of Volunteer Services.

Jean-Pierre Issa, M.D., professor in the Department of Leukemia and principal investigator on the leukemia SPORE, initiated the first meeting of M. D. Anderson patient advocates at the 2007 SPORE conference in Baltimore. To continue the synergy from that event and harness the collective talent, Nancy Hubener, project director in the Office of Translational Research, stepped in to facilitate these meetings, which now occur three to four times a year at M. D. Anderson. “This is a group of enthusiastic, motivated people who have a lot to offer to other patients and to researchers,” says

[ spore PATIENT ADVOCATE PROGRAM ]

Pam Jones, program manager in the Department of Breast Medical Oncology (left), welcomes patient advocates on the breast cancer SPORE, Dorothy Paterson (middle) and Jeannie Frazier, to a seminar on inflammatory breast cancer.

Hubener. “They have a unique perspective. Many didn’t know each other before we implemented these meetings, and now, I think, the group has formed a strong bond; they share their ideas and their experiences and inspire one another.” “It’s very energizing to see what others are doing and to share ideas,” Paterson says. “For example, Tom Touzel is helping accrue patients for clinical trials and that will be the next step for some of us on the breast SPORE. We can discuss how he’s approached it and what he’s learned so we don’t reinvent the wheel. We need more people to enroll in clinical trials, but we recognize there are barriers and we want to help remove them.” Paterson contends that a significant part of her emotional healing has been her involvement as an advocate. She reviews grant proposals, making sure they are written in lay terms when necessary, attends conferences and shares how M. D. Anderson leverages advocates to reach the next level of research. “We’re also willing to ask the ‘stupid’ questions,” she says. “In a multidisciplinary team there are different researchers present who might be reluctant to ask certain questions, but advocates can. We help them get it down to the basics.”

Sharing the journey As a patient advocate on the leukemia SPORE, Susan Massman combined her communications expertise with being

a survivor of three different cancers. In 1994, she was diagnosed with breast cancer, in 2003, with leukemia and, in 2005, with basal cell carcinoma. “I visit with cancer patients, one-on-one and in groups,” she says, “discuss the benefits of clinical trials and give them hope that recovery is possible. I believe I’m alive because I participated in a clinical trial testing taxol, which today is an approved cancer treatment used worldwide. And at the same time, I contributed to the healing of future cancer survivors.” Laura Sasse, grant program manager in the Department of Leukemia, helps incorporate patient advocates in various ways. “For the last three years, they have attended the annual American Society of Hematology meetings. We included their input in our application for the grant renewal in 2008, which was extended for five years. And our principal investigators feel that advocates help them maintain a continuous focus on translational research.” Over the last year, as the number of SPORE grants awarded to M. D. Anderson has grown, other patients have joined the advocacy teams. Along with Touzel, Paterson and Massman, they are helping build relationships as they become emissaries for clinical trials and empower themselves to ask the essential questions. As the face of the patient, they personify the humanistic side of medicine and intensify M. D. Anderson’s mission.

CONQUEST | SPRING 2009

Note: This is the first of a two-part series on surgical innovations at M. D. Anderson. To learn what is new on the surgical floor of the Main Building, watch for the second part in

Who says you can’t go home?

the fall 2009 issue of Conquest.

by Julie Penne

It’s 7 a.m. and the pre-op areas of the Mays Clinic and Main Building are beehives of activity. Though separated by Holcombe Boulevard, the pre-surgery areas on the north and south sides of the M. D. Anderson campus are virtually indistinguishable as teams of nurses, anesthesiologists, certified registered nurse anesthetists and nursing assistants hustle to prepare patients for the day’s surgeries and procedures. At 5 p.m., however, the scenes are quite different. In the 30 operating rooms of the Main Building, where some of the most complex cancer surgeries in the world are performed, multi-team operations may continue into the evening, and patients in the post-anesthesia recovery unit wait to be transferred to either a room in the hospital or the intensive care unit. In the Mays Clinic, all six operating rooms are empty, cleaned, stocked with supplies and ready for the next day, while a handful of patients in the 18-bed post-anesthesia care unit (PACU) wait to be given the green light to go home and recover in their own beds. Often referred to as day or outpatient surgery, the operating rooms at the Mays Clinic are used for procedures and surgeries that require less time, are less complex and typically let patients return home within 24 hours.

Patient satisfaction key measurement Taking the shorter procedures out of the Main Building and designating an outpatient surgical area streamlines surgery scheduling and allows surgical teams to develop their own rhythm for preparing and recovering patients, says Carla Willis, director of nursing for the Mays Clinic OR. “Teams in the two surgical areas work quite differently, setting and responding to the pace of the day’s schedule, the needs of patients and the fact that our ultimate goal is getting patients home within 24 hours,” she says.

[ outpatient surgery ]

Mays Clinic pre-op area 9

CONQUEST | SPRING 2009

Farzin Goravanchi, D.O. (left), associate professor, and Spencer Kee, M.D., assistant professor, both in the Department of Anesthesiology and Perioperative Medicine, confer in the PACU between surgical cases.

Since opening the outpatient surgical unit in 2005, shortly after the Mays Clinic began welcoming patients, an average of 4,000 procedures and surgeries per year have been performed. A maximum of 35 to 40 procedures are done daily with the average length about 90 minutes. “Early in my career as an anesthesiologist, surgical outcomes often were measured solely by the patient’s survival,” says Thomas Feeley, M.D., head of the Division of Anesthesiology and Critical Care and vice president for medical operations. “Today, anesthesia and surgery are much safer, and patient satisfaction is a key measurement. It means a great deal to patients to leave the hospital free from pain and discomfort, recover at home and get back to work quickly.” The most common procedures performed in the Mays Clinic include mastectomy and lumpectomy (without major reconstruction or lymph node removal), non-invasive ablation of tumors in the prostate, bladder procedures, implantation of pain devices and some reconstructive and plastic surgery, and other procedures where a long hospital stay is not necessary. The issue of sending patients home less than a day following surgery has been debated nationally for more than a decade, but Frederick Ames, M.D., clinical professor in the Department of Surgical Oncology and a breast surgeon at M. D. Anderson since 1977, has been an advocate for reduced stays since beginning his career here. Today, he operates almost exclusively at the Mays Clinic.

“The real payoff of the Mays OR is the great feedback you get from patients in follow-up visits. They want to have their surgeries, go home to their own beds and then quickly move on to their next chapters in life or treatment,” Ames says.

Research leads to less pain, fewer side effects Each week, only about 15 to 20 patients are kept overnight for observation by a nursing team in the Mays Post-Anesthesia Care Unit (PACU) until they are cleared to go home. Rarely are patients admitted to the hospital after their outpatient procedures, says John Frenzel, M.D., associate professor in the Department of Anesthesiology and Perioperative Medicine, who launched the unit and who now oversees a research program that is both collaborative, yet unique, to the patient population it serves. Frenzel and his colleagues admit that while anesthesiology is a vital service at M. D. Anderson and every hospital, it typically has not been a hotbed for research. However, the team of anesthesiologists — three of whom have been in the Mays Clinic OR since it was established — is driven by observations in their daily practice to make the patient experience even better through research. In the last three years, they have published and presented on three primary topics — the paravertebral block used to alleviate the surgical pain associated with mastectomy,

[ outpatient surgery ]

Patients are sedated when given the paravertebral block immediately prior to surgery. The block is administered by an anesthesiologist, assisted by a nurse and a certified registered nurse anesthetist.

reduction in post-operative nausea and vomiting, and patient identification through bar coding — and continue to work with colleagues to determine if new practices can be adapted to the Main Building OR.

Paravertebral block

to those who are having lumpectomy, mastectomy (of one or two breasts) and some cases of lymph node dissection and reconstruction. M. D. Anderson is one of only a small number of cancer centers in the nation that routinely offers paravertebral block to patients, Goravanchi says. He estimates that about 2,100 M. D. Anderson patients have been given the block prior to their surgeries. “It’s great to offer this to patients, but it is not appropriate for everyone,” he says. “However, for the patients who get the paravertebral block, we see a dramatic reduction in the pain medication they take after surgery, thus eliminating the many side effects that come with that. Plus, patients are often less anxious going into surgery because they know they will wake up virtually pain-free and go home that way.” According to Goravanchi, early research suggests that paravertebral block also may inhibit recurrence in some breast cancer patients. The study, which was not done at M. D. Anderson, shows some “encouraging data” and warrants additional study about the blocking mechanisms and their effect on the cancer process, he says.

Brought to M. D. Anderson in 2005 by Farzin Goravanchi, D.O., associate professor in the Department of Anesthesiology and Perioperative Medicine, the paravertebral block is an injection of local anesthetic into a number of locations on the nerves of the spine to block the pain of some surgeries for up to three days. With pain as one of the primary reasons patients stay in the hospital, the option of the block is offered

Paravertebral block: ‘an added level of comfort’ by Bayan Raji JoAnna Burton was diagnosed with cancer in the right breast in October 2007. By November, she had decided to undergo a prophylactic bilateral mastectomy, the removal of both breasts. The method is generally a preventive measure for patients considered at high risk of developing cancer in the opposite breast. At-risk patients may have a family history of breast cancer or test positive for the cancer gene mutation, BRCA1 or BRCA2. When doctors recommended that Burton have the paravertebral block in addition to general anesthesia, she agreed and became one of a large number of women who have had the procedure at M. D. Anderson. The purpose of the block is to give patients relief from pain for days after the procedure, to cut down on their need for pain medication and avoid the side effects of narcotics.

For Burton, the PV block helped her recover from the trauma of surgery sooner. “I barely remember the doctor performing it,” she says. “There’s really nothing different to the patient, except an added level of comfort.” The block also allows patients to recuperate at home. Burton’s hospital stay was short and so was her recovery. While she experienced some soreness, she was back at the gym about four weeks later doing weight training.

CONQUEST | SPRING 2009

John Frenzel, M.D., associate professor in the Department of Anesthesiology and Perioperative Medicine, helped open the Mays OR in 2005 and is one of six anesthesiologists who care for patients there.

Post-surgery nausea and vomiting According to Frenzel, nausea and vomiting after surgery is the number one reason for keeping patients overnight following an outpatient surgery. However, giving the right mix and amounts of anti-nausea medications to the patient during the procedure can dramatically cut the number of patients suffering from this complication. It also is a common occurrence among patients having surgery in the Main Building, because of the nature and types of surgeries performed. Two studies have led to decreases in post-operative nausea and vomiting among M. D. Anderson patients who have surgery on either side of the street. In one study, researchers identified the top four risk factors for post-operative nausea and vomiting, characteristics that are discussed at each patient’s pre-operative assessment. Once high-risk patients are identified, they are given a combination of drugs at specific times during their surgery to decrease the chance of discomfort when they come out of their anesthesia. The study found that three established and less costly drugs were more effective than the same three combined with an expensive drug. Spencer Kee, M.D., assistant professor in the Department of Anesthesiology and Perioperative Medicine and a member of the research team, says, “We were very pleased to zero in on what we can do to make our patients more comfortable and get them home earlier. Plus, we shared this information with our colleagues in the Main Building OR so they could examine the problem as it pertains to their patients.” As a way of sharing the research and motivating their colleagues to assess and evaluate their practices, the research team developed an educational and communications program that measured instances of post-nausea and vomiting among patients.

The result of the collaboration and study findings is a decrease in post-operative nausea and vomiting. This is a quality improvement initiative in the Main Building OR and remains a high priority at Mays Clinic.

Bar coding to verify patient identification Launched and under way in the Mays Clinic OR and soon to arrive in the Main Building ORs, bar coding to verify patient information is a safety net to ensure that every member of the surgical team has timely access to vital and accurate patient information. Through an interface with M. D. Anderson’s patient records and anesthesiology’s database, the system provides an encyclopedia of patient information to decrease the possibility of error. Such information includes name and medical record number, but, more important, any allergies, the surgery that is scheduled for the day and specifics of the procedure. Both surgical areas now have multiple points at which the information is verified verbally. While that verbal identification will still be done, the bar coding and patient information system will take over after a patient is sedated or anesthetized. According to Joseph Ruiz, M.D., assistant professor in the Department of Anesthesiology and Perioperative Medicine, the new technology is a “tremendous boost to ensuring that our patients are in not only the best medical hands but also in the safest environment. “Medicine and surgery are becoming more and more sophisticated, but at the root of everything we do is patient safety. This tool will be a terrific addition to the processes we already have in place,” he says.

[ MULTIPLE MYELOMA ]

Seven years ago, when Alvaro Castro discovered that he had multiple myeloma, treatment options were few, survival prospects were brief, and there hadnâ&#x20AC;&#x2122;t been a new drug approved for the disease in decades.

All of that was about to change.

increasingly treatable Advances in multiple myeloma

by Scott Merville

[ MULTIPLE MYELOMA ]

Shown here with postdoctoral fellow Sally Hunsucker, Ph.D., Robert Orlowski, M.D., Ph.D., associate professor in the departments of Lymphoma and Myeloma and Experimental Therapeutics, developed the drug carfilzomib, a second-generation proteasome inhibitor that has advanced to Phase II clinical trials. So far the drug, which binds the proteasome more tightly than bortezomib, shows improved response rates and reduced neuropathy, debilitating nerve pain and numbness.

Castro and his M. D. Anderson oncologist have since navigated a steady flow of novel drugs and new combination therapies that are extending survival for people with the still incurable, but increasingly treatable, cancer of the blood plasma cells. “I’ve always, always been on some type of chemo or other therapy,” Castro notes. Some worked for a while, others didn’t work at all, but there has always been another option to try. Three years ago, a clinical trial introduced him to a combination of new and old drugs that brought his disease under control. “I’m thankful and I’m pleased,” the 63-year-old retired program analyst says. He volunteers at his church and at M. D. Anderson, teaches English as a second language and recently took a Caribbean cruise with his wife. The clinical trial of a new drug and an old standby steroid was led by Castro’s physician, Donna Weber, M.D., associate professor in M. D. Anderson’s Department of Lymphoma and Myeloma. The combination of lenalidomide, known commercially as Revlimid®, with dexamethasone was approved by the U.S. Food and Drug Administration for second-line therapy. Lenalidomide and another new drug called bortezomib (Velcade®) have been instrumental in improving the prospects of myeloma patients. Each drug attacks the disease in a novel

way and in combinations also enhances the impact of older drugs, further multiplying treatment options. “Median survival now is about seven years. It used to be in the three-to-five-year range,” says Robert Orlowski, M.D., Ph.D., chief of the Myeloma Section and associate professor in the Department of Lymphoma and Myeloma. “There are many 10-year survivors now, which was incredibly rare not too long ago, and many patients can now enjoy long periods without ongoing treatment.” In the push to make myeloma a chronic disease and develop potential cures, M. D. Anderson researchers are: • Developing and evaluating new drugs, including immunotherapies, such as vaccines and antibodies, and new combinations. • Exploring ways to improve the impact of blood stem cell transplants, both from donors and with the patient’s own cells.

Alternatives to standard treatment emerge Multiple myeloma is caused by the proliferation of abnormal plasma cells, an infection-fighting white blood cell. These rapidly multiplying cells crowd out normal blood cells and form tumors in the bone marrow. About 19,000 new cases are diagnosed annually.

CONQUEST | SPRING 2009

Before new drugs arrived, the standard treatment was combination chemotherapy followed by an autologous blood stem cell transplant, in which eligible patients receive their own banked blood stem cells after high-dose chemotherapy destroys both their myeloma and their blood supply. Transplants were the only way to achieve a durable remission. Combinations that include lenalidimide or bortezomib as frontline therapy are achieving durable complete remissions in some patients, Orlowski notes, presenting a new option of delaying transplant. “We’ve presented data showing that complete remission is the most important goal and how you get there is less important. Whether by chemotherapy only or chemotherapy followed by transplant, the outcomes are similar,” Orlowski says. The question of when or whether to transplant will be sorted out by additional research. “Even with these novel drugs and our excitement about them, until we start curing people with drugs alone, transplant remains important in managing multiple myeloma,” he says. “It adds to survival and lengthens time to disease progression. Patients in remission after transplant can be off therapy entirely, which is an added bonus.”

Research brings new combinations to trials While at the University of North Carolina, Orlowski was instrumental in the preclinical and clinical development of the novel drug bortezomib, the first proteasome inhibitor of any kind. The proteasome destroys proteins that a cell no longer needs. When this useful destruction is blocked, cells die. “Our Phase I clinical trial showed the drug had some beneficial activity in all nine patients in the study, all of whom had either relapsed or refractory (treatment-resistant) myeloma. One patient had a complete remission, which was very unusual at the time,” Orlowski says. A series of clinical trials revealed a consistent advantage in response rates, time to disease progression and complete or partial remission, leading to FDA fast-track approval of the drug in 2003 for relapsed and resistant disease. Last year, the injectable drug marketed by Millenium Pharmaceuticals was approved for frontline therapy. Orlowski and colleagues also showed that bortezomib with pegylated liposomal doxorubicin, an antibiotic chemotherapy drug packaged for efficient delivery, improves time to progression and overall response rates over bortezomib alone. The FDA approved the combination for previously treated patients who have not had bortezomib. Thalidomide, a treatment for insomnia and morning sickness shown to cause birth defects in the 1960s, re-emerged in the late 1990s. It affects the immune system, and its precise mechanisms against multiple myeloma are not understood, but it attacks both the malignant cells directly and the environment that nurtures them. Marketed as Thalomid ® by Celgene Corp., the drug was thought to be the first truly new approach to multiple myeloma in 30 years. It was approved by the FDA as a frontline therapy in 2006. The company then developed lenalidimide, a thalidomide derivative designed to minimize the side effects of the original drug. An open question now is which combination of drugs to use in newly diagnosed patients. Orlowski says a combination of bortezomib, and either thalidomide or lenalidimide and dexamethasone appears to be emerging as the best treatment. Every patient in a recent clinical trial of bortezomib/ lenalidimide/ dexamethasone had either partial or complete responses to the combination, he notes. “We’re not yet curing disease, but certainly, getting a 100 percent response rate is moving in the right direction.”

Jeffrey Mallams, a multiple myeloma patient, realized his dream when he ran the Rock ‘N’ Roll San Antonio marathon in 3 hours, 25 minutes, 59 seconds.

[ MULTIPLE MYELOMA ]

Tandem transplants help patient As drug options proliferate, researchers also are exploring ways to optimize blood stem cell transplants. Research at M. D. Anderson has eliminated age as a risk factor for having a transplant. “It used to be common to have an upper age limit, 55, then 65 or 70 years old, for patients to receive an autologous transplant,” says Muzaffar Qazilbash, M.D., associate professor in the Department of Stem Cell Transplantation and Cellular Therapy. “Now, if you have adequate heart, lung, liver and kidney function and you’re reasonably active, you are eligible regardless of age,” he says. Patients into their 80s have received successful transplants at M. D. Anderson. For matched donor transplants, M. D. Anderson pioneered the reduced-intensity chemotherapy, or mini-transplant, regimen that employs a lower dose of chemotherapy, which does not entirely destroy a patient’s blood cells. The matched donor stem cells gradually replace the patient’s remaining blood cells, while the cells of the donor’s immune system help destroy lingering myeloma cells. Lighter chemotherapy has greatly reduced transplant-related mortality. At 34, Jerry Mallams is young for a multiple myeloma patient. He’s also in complete remission after receiving two consecutive transplants of his own blood stem cells in July and November 2006.

An avid runner, Mallams was feeling good enough in 2008 to ask Qazilbash whether he could train to run in a marathon, a longtime goal. “He said, ‘If you feel like you can, do it. Just listen to your body,’ ” Mallams says. On Nov. 15, he completed the San Antonio marathon in 3 hours, 23 minutes, which was good for 306th place out of 4,070 male runners and 343rd overall. “I ran cross-country in college and have always loved running,” Mallams says. “I found out about my multiple myeloma because I fractured a vertebra while I was running.” Painful fractures of the ribs and backbone are often the first symptoms of myeloma. After the fractures are repaired, targeted radiation destroys the tumors in the bone, and patients are put on medication to strengthen their bones. “This trial asks whether a second transplant within six months of the first will increase the complete remission rate, time to progression and overall survival,” Qazilbash says. “Preliminary data supports this approach. Results are expected in a year or so.” After the tandem transplant, patients were randomized to maintenance chemotherapy or observation. Mallams is delighted to be in the observation group. “Since I went off antibiotics in May 2007, I haven’t been on any drugs.”

Targeting ‘deranged’ molecules by Scott Merville While M. D. Anderson researchers pursue a cure for multiple myeloma, a major new initiative focuses on relieving the debilitating symptoms caused by both the disease and its treatments. Deep and persistent fatigue, relentless pain, loss of appetite and sleep disorders might all be rooted in a handful of deranged inflammatory signaling molecules that are themselves vulnerable to attack. “We’re trying to understand the root causes of such symptoms, so that rather than throw an analgesic at someone to relieve their pain, or give a stimulant to somebody who is fatigued, we can treat or prevent symptoms by targeting the underlying cause,” says Charles Cleeland, Ph.D., professor and chair of M. D. Anderson’s Department of Symptom Research.

Xin Shelley Wang, M.D., associate professor in the Department of Symptom Research, is project leader on one part of the NCI program project grant looking for the root causes of both cancer- and treatment-related symptoms. 16

CONQUEST | SPRING 2009

Qazilbash and Sergio Giralt, M.D., professor in the Department of Stem Cell Transplantation and Cellular Therapy, work with colleagues in myeloma to improve transplants by exploring new pre-transplant chemotherapy regimens and combinations to use when the disease returns. A myeloma vaccine developed by Larry W. Kwak, M.D., Ph.D., professor and chair of the Department of Lymphoma and Myeloma, is in a clinical trial to improve donor transplants. The vaccine is given to donors to stimulate their immune system T cells against multiple myeloma. Patients then receive the enhanced immune response from the donated stem cells. Ten patients have been enrolled in the Phase I trial led by Giralt.

Moving from chronic to cured A major, multi-institutional clinical trial will soon be launched by the Blood and Marrow Transplant Clinical Trials Network, a federally funded alliance that plans and carries out the country’s transplant research agenda. Giralt is chair-elect of the network and will begin a twoyear term as chair in January 2010. The network advances promising results from single-institution trials to multipleinstitution trials to enroll enough patients to conduct timely studies.

“We’re looking for a cure,” Giralt says. “Right now we’re really trying to make multiple myeloma a chronic disease. We’ve made progress, but we aren’t there yet.” Greater molecular understanding of the disease is a key to progress. “We now know multiple myeloma is seven or eight different diseases based on chromosomal analysis,” Orlowski says. As research progresses, more targeted approaches will develop. If the time comes to change treatment, Alvaro Castro will consult Weber. “She’s willing to work with you, suggests different possibilities, informs you of clinical trials, and reviews the possible outcome of any option,” he says. Castro spends his active retirement enjoying his family and continuing to learn. “I study French. I read the Gospel. Time flies.”

Cleeland is principal investigator on an $8 million National Cancer Institute program project grant aimed at multiple myeloma’s symptom burden. The prime suspects are inflammatory cytokines, signaling molecules that serve a useful purpose in response to injury or illness but “go crazy and become toxic” when distorted by cancer or cancer therapy, Cleeland explains. Cytokines play a major role in development of multiple myeloma and can be aggravated by aggressive cancer therapies. The project studies will draw on preclinical research, clinical trials and a longitudinal study of patients’ symptoms and their correlation to circulating levels of three cytokines (IL-1, IL-6 and TNFα). NF-κB, a precursor protein capable of activating all three cytokines, also will be targeted.

The grooved pegboard is used by symptom researchers to test a patient’s upper extremity fine motor dexterity.

Separate clinical trials will examine the effect of cytokineinhibiting drugs on symptoms of patients undergoing either combination chemotherapy or autologous stem cell transplantation. Another project focuses on curcumin, a component of a common spice known to have an inhibitory effect on NF-κB, including assessment of its effect on symptoms for patients undergoing combination chemotherapy.

CONQUEST | SPRING 2009

Tough decisions for young women Prophylactic mastectomies

or graphic artist Jill Butler, there was a different kind of calm before the big storm. Just two days before Hurricane Ike made landfall in September 2008, Butler underwent a surgery that gave her peace of mind — a mastectomy to remove both her cancerous left breast, as well as her non-affected right breast, in hopes of reducing her chances of having the disease return. “The hurricane did add a little levity to the situation. Imagine coming off anesthesia, changing bandages and reading prescription bottles in the dark,” she says. Diagnosed at age 38 with early stage disease, Butler first underwent a lumpectomy. But when her pathology came back with unclear margins, she knew she had decisions to make. Catapulted by her young age, pathology results and strong family history of breast cancer — her mother died at 47, her maternal grandmother’s sister also had the disease and her maternal grandmother died from ovarian cancer, which is often genetically linked to breast cancer risk — Butler sought the care of Kelly Hunt, M.D., professor in the Department of Surgical Oncology at M. D. Anderson. Together, they reviewed Butler’s risk factors and discussed risk-reducing options.

What’s in a word? “For me, the word mastectomy was loaded, perhaps because of my mother’s diagnosis. However, once I came to terms with my decision to have a mastectomy, deciding to remove both breasts was easy. I needed to feel like I was doing everything possible to minimize my risk of the disease returning,” Butler says. Until recently, clinicians had few tools to determine for whom risk reduction surgery would be most appropriate. Now, researchers at M. D. Anderson have found that the preventive procedure to remove the unaffected breast in patients with disease in one breast, contralateral prophylactic mastectomy, may only be necessary in patients with specific high-risk features. Their findings, published in Cancer, may one day not only help physicians predict the likelihood of patients developing breast cancer in the opposite breast, but also stratify risk and counsel patients on their treatment options. Currently, it’s very difficult to identify those patients at highest risk who may benefit from this aggressive and irreversible procedure, Hunt explains. Women often consider contralateral prophylactic mastectomies not because of medical recommendation, but because they fear having their breast cancer return.

by Laura Sussman

“We’ve always known contralateral breast cancer risk is not the same for all women, and it is unnecessary to perform preventive mastectomies routinely,” says Hunt, the study’s lead author. “As we begin to clarify the specific risk factors, the number of women undergoing the surgery may decrease, and those with a low-to-moderate risk may be more open to less extreme options for risk reduction, such as hormonal therapy and newer agents for breast cancer prevention.”

Numbers on the rise According to the researchers, approximately 2.7 percent of women diagnosed with breast cancer choose to have the surgery. However, recent statistics have shown that these rates in women with stage I-III disease increased by 150 percent between 1998 and 2003. To classify risk factors, researchers reviewed the cases of 542 M. D. Anderson patients with breast cancer in one breast who had surgery to remove the second breast. Of these women, 435 patients had no abnormal pathology identified in the opposite breast, 25 had contralateral breast cancer identified at surgery and 82 had abnormal cells that indicate a moderate-to-high risk for breast cancer in the contralateral breast. Further analysis of patients with contralateral breast cancer revealed that strong predictors are a five-year Gail model risk of 1.67 percent or greater; an invasive lobular histology; and multiple tumors in the original breast. Patient race, estrogen receptor status and progesterone receptor status weren’t associated with increased risk. The Gail model, typically used for patients without breast cancer, evaluates factors such as age, age at first menstrual period, number and findings of previous breast biopsies, age at first live birth and number of first-degree relatives with breast cancer. “We went from having little information on the procedure’s benefit for individual patients to identifying three independent and significant risk factors,” Hunt said. “Each provides valuable insight into how likely a woman is to develop the disease in her other breast and enables physicians to make an educated recommendation if a patient will potentially benefit from surgery.” While Butler would have loved to have this tool available when she was making her decision, she has no regrets. “I’m really comfortable that the decision I made was the very best for me. Knowing that I had dramatically reduced my risk of cancer returning was the only way I could sleep at night. I plan to have a long, healthy life ahead of me — free of breast cancer.”

[ prophylactic mastectomy ]

Kelley Hunt, M.D. (left), and Jill Butler 19

[ M. D. Anderson History Book ]

The cancer crusade

M. D. Anderson’s journey through the eyes of a historian by Brenda Gunter and Bayan Raji

James Olson, Ph.D., works in the past, but he lives in the present. Originally diagnosed with epitheliod sarcoma in 1981, he came to M. D. Anderson for treatment. Nearly 30 years later, the institution has seen him through 10 recurrences, many rounds of radiation and chemotherapy, and the amputation of his left forearm. Olson doesn’t dwell on the past, but it’s his profession to explore it. He has taught history at Sam Houston State University in Huntsville, Texas, since 1972. As a historian with this personal experience of cancer, Olson brings a unique perspective to a new book that details the history of the institution that saved his life. “Disease and Discovery at The University of Texas M. D. Anderson Cancer Center: Making Cancer History,” which will be published this spring by the Johns Hopkins University Press, took him eight years to finish. Just as Olson’s own battle with cancer had high peaks and near-bottom lows, M. D. Anderson didn’t gain the U.S. News & World Report ranking as the nation’s No. 1 cancer center overnight. He hopes he’s shown that in the book. “The history of M. D. Anderson requires neither apology nor embellishment, and I intend the book to be more than

a psalm of grateful praise,” he says. “Triumphal history is boring, uncritical and dishonest, denying the vicissitudes of human nature with its hubris and heroism, its flashes of miserable failure and soaring success.”

Creating ‘new knowledge’ from old material Olson came up with the idea to write a history of the institution in 1986 but was told it wasn’t the right time. Then, in 1999, M. D. Anderson announced it was looking for historians interested in the subject. “Our national search for an appropriate author for the history had not yet turned up a candidate who seemed a match with the institution and its culture,” says Stephen Tomasovic, Ph.D., senior vice president for Academic Affairs. “However, when Steve Stuyck, vice president for Public Affairs, and I learned Dr. Olson once had expressed an interest in the project and then had the chance to meet him, we knew we had found not only a greatly qualified historian but also a perfect match to M. D. Anderson and its fascinating history.”

CONQUEST | Spring 2009

Olson began work right away Although he received nearly unlimited access to the institution, Olson was not allowed to view patient records. To keep the manuscript personal, he used much of his own narrative in the book. But the close ties also created a challenge for him. He didn’t want to write a book of glorification. He wanted it to be balanced. “Historians are supposed to take a big step back from the things we’re writing about and try to be dispassionate and objective, try to see what’s actually there,” Olson says. “The problem I had is I feel like M. D. Anderson has saved my life many times now.” To get around that issue, he waded through nearly half a million pages of documents, a number of personal interviews and countless stories to discover and record the history of an institution that has been working to cure cancer since the Texas Legislature approved its creation in 1941.

A history of his own Diagnosed with a type of brain cancer known as a glioma while he was working on the book, Olson battled bouts of depression and struggled to finish. It was his daughter who

gave him the piece of advice he originally gave her as a young girl at a track meet many years before. “It was hard for me to deal with brain cancer and read cancer documents all day long. Finally, I said, ‘What am I going to do?’ And then this 35-year-old woman says to me, ‘Dad just finish the race. Just finish it,’” he says. This inspired him to complete the project. Today, he is at the end of this chapter and happy to be here. Having a passion for the present as well as the past, Olson can’t wait to get to the next episode of his life.

CONQUEST | Spring 2009

CANCER BRIEFINGS

Talk of the town Since 1990, A Conversation With a Living Legend luncheons in Houston, Dallas and

A sweet addition for Sugar Land

Washington, D.C., have raised more than $8 million

M. D. Anderson and St. Luke’s Sugar Land Hospital are bringing innovative cancer care to southwest Houston by fall 2009. Occupying space in the medical office building attached to St.

for M. D. Anderson’s research, patient care and educational initiatives. Events held in Houston and Dallas in 2008 continued this popular tradition.

Luke’s Sugar Land Hospital, M. D. Anderson will operate a clinical

On Oct. 24, 2008, the 19th annual A

care center that includes radiation and medical oncology services,

Conversation With a Living Legend in Dallas featured

outpatient chemotherapy, laboratory services and a pharmacy.

oil and gas industry entrepreneur and longtime

A team of M. D. Anderson employees will staff the center, led by

philanthropist T. Boone Pickens in an interview

medical oncologists Amit Sarma, M.D., and Janet Tu, M.D., and

with Evan Smith, president and editor-in-chief of

radiation oncologist Isidora Arzu, M.D., Ph.D.

Texas Monthly.

“We’re delighted to join with St. Luke’s Sugar Land Hospital

As some 800 guests found their places,

to bring M. D. Anderson’s quality care and clinical trials pro-

the event’s fundraising tally topped $905,000,

gram to this rapidly growing area of Houston,” says Thomas

including a $100,000 contribution from the

Burke, M.D., executive vice president and physician-in-chief at

T. Boone Pickens Foundation. A surprise announce-

M. D. Anderson. “As our arc of outreach broadens and deepens,

ment from John Mendelsohn, M.D., president of

we can reach out not only to thriving suburban areas like Sugar

M. D. Anderson, revealed that Madeleine Pickens

Land but also to other rural areas that surround them.” This will be M. D. Anderson’s second satellite center that offers radiation treatment, medical oncology, chemotherapy infusion and related services. A clinical care center in the Bay Area (Nassau Bay, Texas) opened in 2007 with two medical oncologists and one radiation oncologist.

Constellation of satellites When the new Sugar Land center opens, M. D. Anderson will have seven satellite facilities — two clinical care centers and five radiation treatment centers: Clinical care centers • Bay Area (Nassau Bay, Texas) • Sugar Land, Texas Radiation treatment centers • Albuquerque, N.M. • Bellaire, Texas • Fort Bend (Richmond, Texas) • Katy, Texas • The Woodlands, Texas

[ cancer briefings ]

had moments before offered a donation bringing the total to $1 million. On Dec. 9, 2008, in Houston, the second annual A Conversation With a Living Legend, which raised more than $400,000, featured the dynamic presidential campaign duo Mary Matalin and James Carville. Veteran ABC News correspondent Sam Donaldson interviewed the couple, while former Houston television news anchor Shara Fryer led the program as mistress of ceremonies. Matalin and Carville co-authored The New York Times best-seller, “All’s Fair: Love, War and Running for President,” in 1994. Between them, they’ve worked for every U.S. president during the past 25 years.

The Oklahoma State University marching band greets T. Boone Pickens as he enters A Conversation With a Living Legend in Dallas.

Long-time survivors ‘RENEWed’ A home-based program to improve exercise and diet

seling sessions with a personal trainer and worked toward establishing several daily goals:

led to significant, clinically meaningful improvement in

•

Performing lower-body strength exercises

body weight and physical function among older long-term

•

Walking 30 minutes

•

Using portion-control plates, cups and bowls

•

Consuming fewer than 10 percent of calories from

cancer survivors. Preliminary findings from the RENEW (Reach-out to ENhancE Wellness) trial were presented by Wendy Demark-Wahnefried, Ph.D., at the seventh annual American Association for Cancer Research Frontiers in Cancer Prevention Conference.

saturated fat •

Eating more fruits and vegetables

At the end of the year, the group showed improvements

Trial participants were 65 or older; had been diagnosed

in their diet and exercise habits and improved physical

with breast, prostate or colorectal cancer at least five years

function scores. Most significant were notable strength

prior with no evidence of recurrence; were overweight or

improvements in the participants’ legs and lower body.

obese; and had no medical conditions prohibiting moderate exercise.

“These findings are significant as the survivors who participated in the program had much better ability to stand up,

The group was divided into 319 survivors who received

walk and function on their own, and enjoyed better quality of

an intervention and 322 who were placed on a waiting list.

life. These functions are critical in retaining independence,”

The intervention group participated in 15 telephone coun-

says Demark-Wahnefried, professor in M. D. Anderson’s Department of Behavioral Science. “We’re now following up with the participants to see if the effect is sustained and delivering the intervention to those in the wait-listed group.”

[ moving forward ]

Moving Forward: by Mary Jane Schier Ify Ezeobele

While she’s long been a role model for her nursing colleagues and students, Ify Ezeobele, Ph.D., is more enthusiastic about being a cancer survivor. “I am eager to share my cancer experiences and offer hope to others just beginning their cancer journeys,” says Ezeobele, senior nurse manager of three adult units at The University of Texas Harris County Psychiatric Center (HCPC) in Houston. When told she had stage III lymphoma in October 2002, Ezeobele says she “was devastated. Everything was going so well, both personally and professionally, and I couldn’t imagine having cancer.” At the time, she had just started working toward her Ph.D. in nursing science and had an article published in a nursing magazine. She thrived on providing extensive mental health services to patients at HCPC, teaching nursing students at Houston Community College and balancing those responsibilities with helping husband David raise son Kenny in their Houston area home. “I thought my life was about perfect,” Ezeobele recalls, “but I now think having cancer was a blessing because I appreciate every day even more.” Born in Nigeria, she was the fourth of six children whose parents encouraged each to get a good educa-

tion. With a diploma in nursing, she moved in 1979 to Houston, where over the next six years she met and married David, worked in two hospitals and received a bachelor’s degree in nursing and two master’s degrees, one in health education and another in nursing. “My goal was to get a Ph.D.,” explains Ezeobele, who was in the first semester at Texas Woman’s University College of Nursing-Houston Center when diagnosed. “I didn’t know a lot about lymphoma,” she says, “but I knew I wanted to come to M. D. Anderson.” During combination chemotherapy and radiation treatments, she had “some rough times,” including a serious side effect called “chemobrain” that affects concentration and memory. Ezeobele was determined not to drop out of classes. “Studying was therapeutic, even on the darkest days, and I had many supportive colleagues, a wonderful family and a strong faith to help me.” Although receiving her Ph.D. last December was “a dream realized,” she stresses that joining the ranks of cancer survivors was an “even better” achievement.

affiliaTions

The UniversiTy of Texas sysTeM boarD of regenTs

M. D. anderson Cancer Center orlando, orlando, fla.

James R. Huffines, Austin

Centro oncológico M. D. anderson international españa, Madrid, spain

Colleen McHugh, Corpus Christi

M. D. anderson Clinical Care Center in the bay area, nassau bay, Texas

Chair

Vice chair

M. D. anderson radiation Treatment Centers in bellaire, fort bend, katy and The Woodlands, Texas; and albuquerque, n.M.

Paul Foster, El Paso Vice chair

Christus spohn stem Cell Program affiliated with M. D. anderson Cancer Center outreach, Corpus Christi, Texas

James D. Dannenbaum, Houston Printice L. Gary, Dallas R. Steven “Steve” Hicks, Austin

stephen C. stuyck, vice president, Public Affairs

Janiece M. Longoria, Houston Wm. Eugene “Gene” Powell, San Antonio Robert L.Stillwell, Dallas

sarah newson, associate vice president, Communications Wendy gottssegen, director, External Communications

Benjamin L. Dower, Dallas

exeCUTive eDiTor: David berkowitz, associate director, External Communications

Francie A. Frederick

Managing eDiTor: sandi stromberg, program manager, External Communications

The UniversiTy of Texas sysTeM aDMinisTraTion

WriTers: David berkowitz, brenda gunter, scott Merville, Julie Penne, bayan raji, Mary Jane schier, sandi stromberg, laura sussman

Student regent

General counsel

Francisco G. Cigarroa, M.D. Chancellor

Designer: Michael Clarke

Kenneth I. Shine, M.D. Vice chancellor The UniversiTy of Texas M. D. anDerson CanCer CenTer exeCUTive CoMMiTTee

John Mendelsohn, M.D. President

Thomas W. Burke, M.D.

PhoTograPhers: dana driensky (page 23), John Everett (page 2), Eli gukich (pages 11, 13), Wyatt mcspadden (page 4), Jay olivier (cover, pages 5, 7, 9, 10, 11, 12, 14, 19), gini Reed (page 6), gus salinas (page 22), Barry smith (page 3), f. Carter smith (pages 16, 17, 20, 21, 24), www. asiphoto.com

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

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.

Ernest H. Cockrell Chair

Nancy B. Loeffler Chair-elect

Ali A. Saberioon Vice chair

Marc J. Shapiro Immediate past chair

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 development office internet site at www.mdanderson.org/gifts. for information on patient services at M. D. anderson, call askmdanderson at 1-877-mda-6789, or log on to www.mdanderson.org/ask.

Printed on recycled paper with soy-based ink.