CONQUEST SUMMER 2009
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VOL 23
ISSUE
4
SUSPICION OF CANCER PROGRAM
askMDANDERSON
UNDIAGNOSED BREAST CLINIC
G at e way s to C a r e International Cancer Assessment Center
SATELLITE CENTERS
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   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: Specialized diagnostic and assessment clinics now provide additional gateways to expert and prompt care.
Visit the Conquest Internet site at www.mdanderson.org/conquest
Features
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CONTENTS C O N Q U E S T
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SUMM E R 2 0 0 9
Departments D e p artment s 2 FRONTLINE Joint efforts critical to finding new therapies:
4 Gateways to care
centers as entry points to M. D. Anderson, there is an
News from the 100th annual meeting of the AACR —
Discovering the tricks of brain metastasis
Blueprint for targeting bladder cancer
Uncovering more secrets in ovarian cancer Finding the missing link
In addition to the extensive number of disease-specific expanding range of specialized diagnostic and assessment clinics and services that open the doors to cancer care or surveillance.
10 Patient advises, ‘Run, don’t walk’
Lymphedema affects the quality of life of many women who have breast cancer surgery with lymph node involvement.
14 Cancer briefings
A patient shares her experience of a new surgical procedure
Video games go to war against smoking and stress
that is alleviating this debilitating side effect.
Focusing on cancer’s most lethal aspect Addressing the pre-surgery jitters
12 Presidential magnitude
Making a difference in everyday lives
The George and Barbara Bush Endowment for Innovative Cancer Research celebrates its 10th anniversary this year with important discoveries that are moving to the clinic. A melanoma patient tells how one of the therapies is extending her life.
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Where are they now?
Five survivors share the power of hope
Five survivors, whose early cancer journeys were described in previous Conquest stories, share where they are now and their positive philosophies about life as they celebrate more than 75 cumulative years since they were diagnosed with different types of cancer.
CONQUEST | SUMMER 2009
FRONTLINE
Isaiah J. Fidler, D.V.M., Ph.D.
Joint efforts critical to finding new therapies News from the 100th annual meeting of the AACR The first symposium involving the nation’s two
of this approach,” says Raymond DuBois, M.D., Ph.D.,
premier cancer research organizations took place
immediate past president of AACR and provost and
this April at the American Association for Cancer
executive vice president of M. D. Anderson.
Research’s 100th annual meeting. With a focus on the inflammatory protein, COX-
2
Other important M. D. Anderson findings presented at AACR this spring included:
2, which is implicated in a variety of cancers, this
• Discovering the tricks of brain metastasis: Cancer
meeting brought to fruition the efforts of past and
that spreads to other organs finds a particularly
current presidents of the American Association for
inviting hideout in the brain, where it is usually
Cancer Research (AACR) and the American Society
far harder to treat than in other locations. Two
of Clinical Oncology (ASCO).
speakers discussing new approaches to dealing
COX-2 is best known as a target for preventing
with chemotherapy-resistant brain metastases
dangerous polyps that lead to colorectal cancer, but
were Isaiah J. Fidler, D.V.M., Ph.D., profes-
it also is advancing as a target for treatment of many
sor in the Department of Cancer Biology, and
solid tumors.
Raymond Sawaya, M.D., professor and chair of
“In prevention, inhibiting this enzyme reduced the
the Department of Neurosurgery. “Astrocytes are
number of high-risk precancerous colon polyps by 66
spider-like cells that normally play the important
percent. The time is ripe to combine basic science and
role of providing oxygen and nutrients to neurons,
clinical expertise to advance the therapeutic potential
and protecting neurons from naturally occur-
[ frontline ]
ring toxins,” Fidler says. “We show that brain
• Uncovering more secrets of ovarian cancer:
metastases subvert astrocytes, tricking them
Discovery of genetic variations in the micro-
into protecting the tumors and that this is the
RNA (mi-RNA) processing pathway genes and
important factor in resistance to chemotherapy.”
miRNA binding sites predict a woman’s risk
• B l u e p r i n t f o r t a r g e t i n g b l a d d e r c a n c e r :
for developing ovarian cancer. They also have
Researchers have discovered genetic variations in the inflammation pathway that reduce the likelihood of recurrence and increase survival of patients with non-muscle invasive bladder cancer (NMIBC) treated with mainstream therapy. Patients with these risk-reducing genotypes were 84 percent less likely to have their disease recur after treatment with Bacillus Calmette-Guerin, the prevailing immunotherapy
the potential clinical application of indicating a patient’s prognosis by showing who will respond to different therapies through analysis of a single blood sample, according to senior author Xifeng Wu, M.D., Ph.D., professor in the Department of Epidemiology. She and her colleagues will combine this genetic information with epidemiological findings to build a comprehensive model that predicts susceptibility to ovarian cancer.
to prevent high-risk NMIBC patients from recurrence. The recurrence-free median survival time among these patients was 96.7 months compared with 47 months among those with the more typical genotype.
Finding the missing link Researchers have discovered how the gene Rak can stabilize the PTEN protein to prevent breast cancer development, according to Shiaw-Yih Lin, Ph.D., assistant professor in the Department of Systems Biology. This discovery is important in several other types of cancer. PTEN frequently is mutated or inactivated in glioblastoma, melanoma and cancers of the prostate and endometrium. Reported in the April edition of Cancer Cell.
Shiaw-Yih Lin, Ph.D.
See more about this discovery in Conquest online at www.mdanderson.org/conquest.
— Scott Merville and Sandi Stromberg contributed to Frontline
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CONQUEST | SUMMER 2009
Gateways to Care by Julie Penne
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[ GATEWAY Clinics, Services ]
In addition to the extensive number of disease-specific care centers as
When one door closes, another one opens. While this adage often is used to express life’s everyday ups and downs, it’s especially applicable for those who are faced with a diagnosis of cancer and choose to come to M. D. Anderson for confirmation of their diagnosis, a second opinion or treatment.
entry points to M. D. Anderson, there is an expanding range of specialized diagnostic and assessment clinics now available that can provide additional gateways to appropriate and prompt care. They are clinics and services that review existing pathology and films, order additional diagnostics, do physical assessments and then steer patients to the right place for care or monitoring, a vital step when cancer is first suspected or confirmed. “We see a change in diagnosis in 5 percent to 15 percent of the cases that come to M. D. Anderson for a second opinion or a confirmation or restaging of their diagnosis,” says Thomas Burke, M.D., executive vice president and physician-in-chief. “These clinics, which are primarily diagnostic, do great work using leading technology, developing a plan and sending patients in the right direction for followup. As we look to improve effectiveness and efficiency in health care nationally and certainly at M. D. Anderson, these various access points are especially helpful to patients and give them what they want and need: a clear-cut plan for action.” Burke adds that many of the diagnostic clinics — especially the Beth Sanders Moore Undiagnosed Breast Clinic, the Children’s Cancer Hospital’s Suspicion of Cancer Program (see sidebars) and other programs such as the Suspicion of Cancer Clinic for adults and the Thyroid Nodule Clinic — see patients at the earliest stage of disease and can have a significant impact on their outcomes. “There’s nothing better than a care team telling patients that they don’t have cancer and then sending them back home,” Burke says. “When the team has to tell patients that their diagnosis is confirmed or staged more precisely, they can get them quick access to the most appropriate care that is so vital, no matter how early or advanced, rare or common the cancer.”
Medical criteria eliminated, capacity expanded The many and diverse entry points for M. D. Anderson have opened new resources for patients who want to come for care but who may have encountered obstacles in the past. In April, M. D. Anderson opened its doors even wider to patients when it eliminated medical acceptance criteria and worked to expand capacity in clinics. About six weeks after the launch of the initiative, the wait time for new patient appointments was cut in half, from an average of 15 working days to an average of 7.5 days. Financial clearance also has become more efficient, contributing to patients getting in the door faster for appointments. Burke says that some clinics have been able to offer patients an appointment the day that they call. “It’s very reassuring for patients to hear that they can have an appointment at M. D. Anderson within a week, if not sooner,” says Gerard Colman, senior vice president and chief of clinical operations.
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CONQUEST | SUMMER 2009
SUSPICION OF CANCER PROGRAM
Immediate help from pediatric cancer experts
A young teenager visits his doctor when a nagging pain in his arm turns worse after a sports injury. His doctor decides to take some X-rays to pinpoint the cause and finds a suspicious mass on the film. He doesn’t want to alarm the patient or family about what this mass could be, especially since cancer is rare in teenagers. Before discussing a potential diagnosis with the family, the doctor picks up the phone. It’s a situation like this that inspired the Children’s Cancer Hospital at M. D. Anderson to create the Suspicion of Cancer Program. For physicians who rarely see a case of childhood cancer, this program provides a way for them to consult with
experienced pediatric oncologists about their patients. They just have to dial a dedicated phone line that provides access 24 hours a day, seven days a week. “The questions vary from very general to very specific,” says Bill Walker, director of administration and operations at the Children’s Cancer Hospital. “For example, a physician might want to discuss a patient’s symptoms, get help in deciding which diagnostic test is appropriate, or inquire about findings on previous tests. Whatever the concern, the physician does not have to wait until the next day or for the call to be returned — he or she will have an answer right away.” A child may be seen either the same day or the next day for diagnostic consultation and help with treatment planning if desired. “We consider this program a partnership through which we not only contribute to a patient’s early diagnosis and make relevant treatment recommendations, but we also share our knowledge about cancer with community-based physicians,” says Eugenie Kleinerman, M.D., professor and head of the Children’s Cancer Hospital. For information on the Children’s Cancer Hospital’s Suspicion of Cancer Program, call 1-888-KIDCHEK (1-888-543-2435). — Sara Farris
“Being able to talk with a specialist before I give a family a cancer diagnosis is a great resource that hasn’t been readily available in the past,” says Houston pediatrician Kamini Muzumdar, M.D. “I think it’s great to have a program that gives me direct access to pediatric cancer specialists and allows me to get my patient in for a consultation quickly.” The Hoglund PediDome at the Children’s Cancer Hospital 6
[ GATEWAY Clinics, Services ]
International Cancer Assessment Center
Removing barriers for international, domestic patients
When the International Cancer Assessment Center opened more than two years ago, its role was clear — complete cancer staging evaluations for patients who come to M. D. Anderson from other countries and refer them to the appropriate disease-site center for treatment. “Recognizing that international patients face, and pose, unique challenges compared with domestic patients, our goal was to minimize or remove barriers for these patients so that we could provide the level of care for which M. D. Anderson is renowned,” says Daniel Epner, M.D., associate professor in the Department of General Oncology, who provides care in the ICAC. In 2008, 176 new international patients were seen in the ICAC, which is located on Floor 8 of Mays Clinic. The medical team emphasizes open communication with patients and family members — calling on Language Assistance and other resources from M. D. Anderson’s International Center — as goals of care and treatment plans are discussed. While the ICAC continues to assist international patients, its role has evolved this year to also help selected domestic patients who are routed from one of M. D. Anderson’s care centers or via a community physician referral. “For domestic patients that we are asked to see, we handle the medical and diagnostic work-up, particularly in cases where the diagnosis is unknown, inconclusive or requires additional study prior to treatment,” explains Martha Coleman, nurse manager and supervisor of patient access for the ICAC. “We partner with some centers to evaluate selected patients who have a possible cancer diagnosis that needs to be evaluated fully prior to being referred to the appropriate multidisciplinary care center,” Coleman says. “An example is a patient with a history of breast cancer who now has an abdominal lesion that may or may not be related to her original diagnosis.”
The Fountain in Alkek Hospital
Call 713-745-0450 to refer a patient to the International Center or to speak with Martha Coleman about the International Cancer Assessment Center. — David Berkowitz
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CONQUEST | SUMMER 2009
askMDAnderson
A team armed and ready to answer
Tucked away on the fifth floor of an office building a few blocks from M. D. Anderson’s main campus is the “front door” to the institution for many new patients. Armed with telephones, computer databases and a wealth of knowledge about cancer and services available at M. D. Anderson are health information specialists who make up the askMDAnderson team. Since it was established in 1995, askMDAnderson has handled more than 736,000 phone calls and e-mails that help prospective patients: • Learn how to make an appointment • Understand treatment options • Learn about research studies • Navigate M. D. Anderson’s Internet site • Learn about and use patient amenities, such as travel and support resources • Access prevention and screening services • Find accurate cancer information • Locate community cancer resources “We’re the first point of contact for people who have any type of question about M. D. Anderson,” says Jennifer KennedyStovall, associate director in the Public Education Office and head of the askMDAnderson service. There are three main ways for someone to begin the appointment process: • Call askMDAnderson at 1-877-MDA-6789 • Refer yourself online at www.mdanderson.org/contact_us • Have your personal physician refer you online at my.mdanderson.org Based on the person’s cancer type, stage and treatment history, all calls and e-mails to askMDAnderson about becoming a patient are sent to a Patient Access Services representative in the appropriate disease site center. Center staff then help with medical and financial clearance details needed for someone to schedule an appointment. In Fiscal Year 2008, nearly 27,000 new patient appointments were initiated by phone or online. Through the first six months of Fiscal Year 2009, 17,000 phone and online inquiries turned into new patient appointments. — David Berkowitz
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When something doesn’t feel right
UNDIAGNOSED BREAST CLINIC
Denna Baskin followed her intuition. Although a yearly screening mammogram and subsequent biopsy deemed a questionable spot in her breast most likely benign, the private school owner wasn’t satisfied and scheduled an appointment in the Beth Sanders Moore Undiagnosed Breast Clinic. The clinic is part of M. D. Anderson’s Cancer Prevention Center. Its staff and clinicians see patients who may have had an abnormal mammogram, inconclusive biopsy or have found a lump through self-exam but haven’t received a definitive diagnosis. “I decided to come where I had the most faith and comfort, and where I knew I would receive the best care,” Baskin says. She brought with her five years of breast imaging records and the results of her most recent biopsy, which aided in the scheduling of her appointments and decreased the time it took to learn her diagnosis. Within 24 hours she had her answer: She did, indeed, have breast cancer. Fortunately, it was caught early, and she’s begun radiation treatments at the M. D. Anderson Radiation Treatment Center in The Woodlands in suburban Houston. “The mammography technician was magnificent and so caring. She went beyond the call of duty and was the epitome of kindness. I would strongly encourage any woman with a breast problem to visit the clinic,” Baskin says. The Undiagnosed Breast Clinic is on Floor 5 of the Mays Clinic. To make an appointment, e-mail undiagnosedbreast@mdanderson.org, or call 713-745-8040 and choose option four. Supplying previous breast imaging and pathology information is not necessary to become a patient. — Robin Davidson
[ GATEWAY Clinics, Services ]
SATELLITE CENTERS
Receiving treatment closer to home an easy choice
Doug Rathe knows the importance of doing his homework. Over the course of 38 years as an engineer for Shell Oil, his inquisitive nature and research skills were put to the test every day. When diagnosed with prostate cancer in September 2008, Rathe used those attributes to decide what treatment course to follow. He studied information on M. D. Anderson’s Internet site. He asked his doctors lots of questions. He discussed his options with friends. In the end, he selected radiation therapy over surgery. And when given the choice of receiving therapy at M. D. Anderson’s Radiation Treatment Center in The Woodlands or at the institution’s main campus in the Texas Medical Center, it was an easy choice. “Choosing a 20-mile roundtrip over a 40-mile roundtrip and not having to face that heavy Houston traffic made it an easy decision,” says the 65-year-old retiree who lives near Tomball, Texas, with his wife. “My experience at The Woodlands facility was excellent. I know I made the right choice.” Rathe recently completed 38 treatments at The Woodlands RTC, one of six Houston-area satellite locations that deliver M. D. Anderson’s standard of care closer to where many patients live.
Doug Rathe rings the bell, an M. D. Anderson tradition that celebrates the end of radiation treatments.
During his Monday-through-Friday treatment routine, Rathe’s inquisitive nature was evident. His radiation oncologist, Pamela Schlembach, M.D., and other care team members patiently answered his questions about the equipment and procedures being used to deliver his treatments. Rathe was on a first-name basis with many of the staff members, including a nurse who is a NASCAR fan. A NASCAR enthusiast himself, Rathe and a group of 11 former Shell coworkers have a 15-year tradition of driving to the Talladega (Ala.) 500. This year’s race conflicted with his treatment schedule, but that didn’t stop him from finding a solution. “I asked Dr. Schlembach if there was any way we could change the timing of my last treatment so I could attend the race with my friends, and she was able to adjust my schedule,” Rathe says. “My friends met me at the center on that final day. I put on my No. 29 hat (representing driver Kevin Harvick of the Shell-Pennzoil racing team), rang the bell to signify a successful completion to my treatment, and said ‘I’m off to Talladega.’ Then everyone wished me good luck. It was pretty special.” Patients may speak with their physicians about treatment at one of six M. D. Anderson’s satellite locations. Learn more online at www.mdanderson.org/satellites.
The Clinical Care Center in the Bay Area (Nassau Bay, Texas), one of six Houston-area satellites
— David Berkowitz
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[ LYMPHEDEMA]
Patient advises, ‘Run, don’t walk’ by Laura Sussman
At heart, Susan Buck is an educator. An English teacher and librarian for nearly 30 years, she left the classroom five years ago to lead H o u sto n M u s e u m o f N at u ra l Science’s field trip efforts. In the beginning a department of one, she now heads a team of 11 who develop curriculum and arrange class visits from schools in the more than 50 school districts in the Houston area. Under her tutelage, more than 400,000 students visited the acclaimed museum in 2008.
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CONQUEST | SUMMER 2009
Buck also became the learner when she was diagnosed with stage II breast cancer in July 2005.
to microscopic vessels — approximately .3 to .8 millimeters in diameter — promoting drainage. The minimally invasive procedure is usually completed in less than four hours under general anesthesia, allowing patients to return home within 24 hours.
After undergoing a second surgery because of lymph node involvement, she experienced a painful and all-too-common side effect of her surgery, lymphedema. According to the National Cancer Institute, 25 percent to 30 percent of women who have breast cancer surgery with lymph node removal and radiation therapy develop lymphedema. The condition results when lymph nodes are removed or blocked due to treatment and lymph fluid accumulates, causing chronic swelling in the upper arm. Currently, there’s no cure or preventive measure, and it’s difficult to manage. Compression bandages, massage and other forms of therapy are commonly recommended options for patients.
Researchers evaluated 20 M. D. Anderson breast cancer patients with stage II and III treatment-related lymphedema who underwent the bypass from December 2005 to September 2008. Prior to surgery, the patients’ affected arm averaged 34 percent larger than the unaffected arm. Of the women, 19 reported initial significant clinical improvement. In patients with postoperative analysis measurements, the average volume reduction at one month was 29 percent; at three months, 33 percent; at six months, 39 percent; and at one year, 25 percent. Long-term follow-up with patients is necessary to determine if drainage continues after one year. Chang believes that fluid volume will keep decreasing over time. He also notes that while the surgery is most effective when completed in earlier stages before the affected arm is fibrotic, almost any breast cancer patient with the condition is a candidate. “Working toward a definitive technique to cure this encumbering side effect and improve a patient’s quality of life is our priority,” he says. “As we begin to refine our technique, we have the potential to impact a large number of people. In the future, the surgery could possibly be used as a preventive measure for lymphedema.” Two years post-surgery, Buck couldn’t be happier with her results. Her right arm is now just 7 percent larger than her left, in the normal range. Even more, the decreased swelling allows her the freedom and range of motion she had before breast cancer. And when it comes to sharing word of the surgery, Buck admits to doing a little more than educating. “I approach total strangers I see wearing compression bandages,” she says. “I tell them to run, not walk, to Dr. Chang. It may not work as well on them as it did on me, but how will they know if they don’t take the chance?”
Lymphedema compromises quality of life “I had total confidence that I would survive my cancer, but the lymphedema was another story. Despite wearing compression bandages and doing physical therapy, I just couldn’t find relief — my right arm was 17 percent larger than my left. At some point, I felt like my fingers were going to explode,” Buck remembers. When months of physical therapy didn’t relieve her symptoms, Buck turned to David Chang, M.D., professor in M. D. Anderson’s Department of Plastic Surgery and director of the Plastic Surgery Center. Chang is one of only a few physicians in the country to offer a technically complex, super-microsurgical technique known as lymphaticovenular bypass. “Lymphedema is like a massive traffic jam with no exit,” Chang says. “This procedure helps relieve the condition by giving the fluid a way out. Until now, surgical techniques, in particular, have been limited, making it important to determine which new techniques promise to bring real benefits to patients.” In the surgery, Chang uses tiny microsurgical tools and makes two to three small incisions measuring an inch or less in the patient’s arm. He then redirects lymphatic fluid
Surgery makes a difference
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[ BUSH endowment ]
Presidential magnitude Making a difference in everyday lives by DeDe DeStefano
A summer cold might have saved 23-year-old Audi Hill’s life. In May 2007, as a student at Fort Hays State University in her hometown of Hays, Kan., she visited the student health center with cold symptoms. During the routine exam, a student training to become a doctor found a suspiciouslooking mole on the side of Hill’s neck. She suggested Hill see a dermatologist, which she then did. The dermatologist removed the mole and determined that it was melanoma. Hill traveled to Kansas City, four hours away, where clinicians performed a neck dissection, removing lymph nodes and surrounding tissue to see if the melanoma had spread. It had. With at least one sentinel node positive, Hill underwent interferon treatment in Kansas City for a year. The cancer continued to spread. By June 2008, a tumor the size of a cantaloupe had developed in her abdomen and wrapped around one of her ovaries. While physicians removed the tumor and one of her ovaries and continued to suggest
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further surgeries, Hill’s father was reading about the promise of T-cell therapy. After doctors found that the cancer had spread to her ribs, adrenal glands, duodenum, pelvis and two spots on her back, her father suggested she make a trip to M. D. Anderson.
The trip and the treatment Traveling to M. D. Anderson required a five-hour drive to Denver and a 2 ½-hour flight to Houston. “When we arrived, I was overwhelmed at first. I come from a town of about 1,000 people. M. D. Anderson is huge,” she said. Her oncologist, Nicholas Papadopoulos, M.D., professor in the Department of Melanoma Medical Oncology, soon put her at ease. Hill learned that she qualified for a study called “lymphodepletion plus adoptive cell transfer.” By harvesting her own immune system’s T cells, growing them in mass quantity and then re-infusing them into her body, Papadopoulos hoped to have Hill’s own immune system fight the cancer cells itself. Exactly what her father had read.
CONQUEST | SUMMER 2009
The tumor from Hill’s pelvis was removed in October 2008, and the T cells were grown from it. While the cells were being grown, she underwent additional chemotherapy. By November, her T cells had grown to 115 billion, more than enough for infusion. She was ready to begin treatment. Almost immediately, her tumors began to shrink. After six trips to Houston, during which she received one infusion of T cells, followed by 13 infusions of high-dose interleukin-2, she has seen dramatic changes. Both tumors on her back, one the size of a fist, are completely gone. Only a few small tumors remain, and they too are shrinking.
Bush Endowment: unleashing creativity The George and Barbara Bush Endowment for Innovative Cancer Research was established in 1999 during an event celebrating former President George H.W. and Barbara Bush’s 75th and 74th birthdays, respectively.
Even better news — giving thanks
Designed to honor the couple’s commitment
Hill was able to finish college during her treatment, and she continues to come back to M. D. Anderson for scans every two to three months. When asked how she feels now, Hill says, “I feel awesome. And, to top it off, I am almost four months pregnant.” Hill and her husband, Matt, found out they were expecting a baby after she finished her treatment. The Hill baby is due to arrive on Thanksgiving Day.
to M. D. Anderson through their years of service to the institution, the Bush Endowment provides scientists and physicians the freedom to unleash their creativity and pursue new pathways of discovery. Through friends and supporters, the Bushes have celebrated raising more than $55 million in endowed funds for M. D. Anderson.
Science at work In 2005, Patrick Hwu, M.D., professor and chair of the Department of Melanoma Medical Oncology, received funding from the George and Barbara Bush Endowment for Innovative Cancer Research for studies in the area of immunotherapy. With support from the Bush Endowment, Hwu, Papadopoulos and others are developing ways to stimulate the body’s immune system against cancer. Private gifts helped them identify T cells with the ability to specifically recognize melanoma antigens and grow these tumor-reactive T-cells to large numbers in the lab. And that has led to the development of protocols for patients like Audi Hill.
Patrick Hwu, M.D. (left), and Nicholas Papadopoulos, M.D.
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CONQUEST | SUMMER 2009
CANCER BRIEFINGS Videogames go to war against smoking and stress Promoting the health of women and men serving in the armed forces is an important focus of the U.S. Department of Defense (DoD), which recently awarded $3.7 million to Alexander Prokhorov, M.D., Ph.D., to develop an interactive videogame geared to smoking cessation and stress management. A professor in M. D. Anderson’s Department of Behavioral Science, Prokhorov has already designed and pilot-tested a similar videogame, “Escape With Your Life,” for troubled and economically disadvantaged youth. “The DoD site visitors who reviewed this program suggested we apply for a larger DoD grant to design a similar educational product specifically for the U.S. Army, and we are honored to be selected again,” says Prokhorov, who is principal investigator on the grant, a partnership with the U.S. Army in Fort Hood, Texas. Tobacco use among members of the U.S. Army is alarmingly high. Thirty-eight percent smoke cigarettes and 15 percent use smokeless tobacco.
“It’s critical that U.S. Army service members realize that tobacco use
The Army pilot program will feature animation, audio, video and interactive activities that provide facts about smoking and tobacco use, as well as a soldier-designed
may severely compromise physical
avatar that guides troops through the educational track.
and mental performance, and that
resisting peer pressure, coping with withdrawal symptoms
we provide ways to help them kick
Some of the modules will include educating participants on and preventing relapses. “Tobacco is typically regarded by young people as a
these addictions or resist them
dull subject. The videogame-based education program is
in the first place.”
and exciting experience,” Prokhorov says. “But what I like
— Alexander Prokhorov, M.D., Ph.D., professor in the Department of Behavioral Science
14
Alexander Prokhorov, M.D., Ph.D.
anything but boring. It provides a highly interactive, engaging most is the opportunity to raise the awareness of tobacco hazards among Army service members, motivate them to quit and give them the skills necessary for adopting a tobacco-free lifestyle.”
[ cancer briefings ]
Addressing the pre-surgery jitters It is only natural that men facing a radical prostatectomy might experience stress and mood swings. Not only do they have to accept the possible personal consequences, which may include urinary incontinence and erectile dysfunction, but they may worry about
Focusing on cancer’s most lethal aspect
whether or not the surgery will cure their cancer. To address this situation, researchers at M. D. Anderson initiated
Cancer Metastasis Research: Bench to
the first study to examine the benefits of psychosocial intervention
Bedside is a one-of-a-kind graduate program
for prostate cancer patients prior to surgery. It found that men who
that will begin this fall at The University
participated in brief stress management sessions prior to and imme-
of Texas Graduate School of Biomedical
diately after surgery experienced less short-term mood disturbance
Sciences at Houston, a combined program of
and better long-term quality of life, compared to patients who had
M. D. Anderson and The University of Texas
the procedure but did not have any behavioral intervention.
Health Science Center at Houston.
“From other areas of research, we know that going into surgery
“Metastasis is far and away the major killer
overly stressed may increase a patient’s recovery time. With this
of cancer patients, and this doctoral program
study, we wanted to intervene in the pre- and post-surgical setting
is the first to treat the study of metastasis as a
and try to relieve stress and minimize mood disturbance, such as
separate discipline,” says program organizer
depression, anxiety and distress, both in the short- and long-term,”
Gary Gallick, Ph.D., professor and director of
says Lorenzo Cohen, Ph.D., the study’s senior author, professor in
education in M. D. Anderson’s Department of
the departments of Behavioral Science and General Oncology, and
Genitourinary Medical Oncology and a member
director of the Integrative Medicine Program.
of the GSBS faculty. The metastasis program integrates a traditional hypothesis-driven, basic-science research approach with M. D. Anderson’s strong emphasis on cultivating close collaborations among physicians and scientists. Funded over the next three years by a $485,250 grant from UT System, the program was one of only seven recipients in a Systemwide competition called the Graduate Program Institute. The UT System Board of Regents allocated $5 million for the initiative to cultivate innovative programs that will attract high-quality graduate students to UT System institutions. “It’s crucial that we improve our basic understanding of the underlying mechanisms for the spread of cancer to distant sites,” says M. D. Anderson Provost and Executive Vice President Raymond DuBois, M.D., Ph.D. “The program will enhance the training of future scientists who will advance metastasis research.” Lorenzo Cohen, Ph.D.
— Katrina Burton, Scott Merville, Sandi Stromberg and Laura Sussman contributed to Cancer Briefings
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[ FIVE SURVIVORS ]
Where are they now? Five survivors share the power of hope
by Mary Jane Schier
They never met as teenagers being treated at M. D. Anderson in the early 1990s. Now Kurt Weiss, M.D., and Amir Steinberg, M.D., are physicians who often think about the cancer center where they were inspired to pursue careers in oncology. Both emphasize that they learned the power of hope from M. D. Anderson caregivers, who were role models for effectively communicating with patients and their loved ones. Today, Weiss, 35, and Steinberg, 34, are among more than 12 million Americans counted as cancer survivors. Other M. D. Anderson “alumni” enjoying long-time survival include Laurine Schuler, 79, a frequent swimming cham-
pion; Richard Johnson, 46, a tax accountant who danced on TV; and Sara Strom, Ph.D., 54, an accomplished scientist and mentor. Their experiences taught these five survivors — whose cancer journeys were described in previous Conquest stories — to cherish every day. All have shared their positive philosophy with numerous patients during their more than 75 cumulative years since they were diagnosed with different types of cancer.
Richard Johnson: Continues to dance Before hearing he had acute lymphocytic leukemia in 1996, Houston tax accountant Richard Oluwole Johnson thought he was “dancing through life.” But his preferred jazz music ceased as he coped with multiple courses of chemotherapy and struggled to recover from a transplant of matching blood stem cells donated by younger brother Charles. Severe complications kept him hospitalized in isolation at M. D. Anderson or homebound for many weeks, during which he was “limp as a dishrag.” Just when he began to feel better, Johnson received shocking news that his brother Charles had been killed in a car accident. “I was devastated. He had given me a priceless gift and saved my life. For a long time, I wondered why Charles had died and not me. I went through a terrible period emotionally,” Johnson remembers, “but with the support of my family, friends and my church, I rededicated myself to helping others as a tribute to Charles.” Another turning point occurred when he participated in the Making Cancer History® advertising campaign to raise awareness of M. D. Anderson as the foremost center for cancer care. “I had been inspired when I saw similar TV ads while I was very sick, and I was excited to offer hope to others since I
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know you can beat cancer,” Johnson says. “Plus I loved being photographed dancing.” Johnson and his wife Vivian enjoy church and school activities with daughters Kemi, 15, and Dorina, 10, and traveling to see extended family and friends. He is active in a community organization that provides education about cancer and treatment options.
Richard Johnson
CONQUEST | SUMMER 2009
Kurt Weiss, M.D. (right), spent time in 1999 working with Eugenie Kleinermann, M.D., on strengthening the protocol that saved his life.
Kurt Weiss: Knows the value of clinical trials Weiss will never forget receiving the last rites in the M. D. Anderson chapel during the summer of 1990. Then 15, he had undergone surgery and chemotherapy for osteosarcoma, a primary cancer of the bone, but the prognosis was dismal after his doctors in Pittsburgh discovered lung metastases for the third time. Fortunately, his family found that a first-in-humans study was under way at M. D. Anderson, where Eugenie Kleinerman, M.D., was applying a novel technique developed in her laboratory. The immune-based method was designed to destroy drug-resistant bone tumor cells that had spread to the lungs. “M. D. Anderson was our last hope,” recalls Weiss, the 18th patient enrolled in the experimental study. Kleinerman, now head of the Division of Pediatrics, has pioneered clinical research to improve long-term survival of osteosarcoma patients for 25 years. After leading two early clinical trials of MEPACT (mifamurtide or L-MTP-PE), her technique was expanded by a national cooperative group. Recently, the European Commission approved the therapy for patients with primary bone cancer that has not metastasized. In the United States, only relapsed pediatric osteosarcoma patients are able to receive MEPACT, but Kleinerman remains
optimistic that the U.S. Food and Drug Administration will approve it for newly diagnosed patients, as well. The summer of 1999 was a milestone for Weiss, who spent eight weeks in Kleinerman’s laboratory through M. D. Anderson’s Summer Research Program for Medical Students. “It was an emotional experience but very exhilarating,” Weiss says about working with the research team to strengthen the therapy that had saved his life. After earning his medical degree in 2003 from Jefferson Medical College, he conducted basic research on metastatic bone tumors in the National Institutes of Health Howard Hughes Research Scholars Program. He recently completed his residency in orthopedic surgery at the University of Pittsburgh Medical Center and began a fellowship at the University of Toronto. “I’m focusing on musculoskeletal tumors that occur in adults and children,” Weiss notes, adding that one of his most meaningful moments was making his first research presentation four years ago at the Musculoskeletal Tumor Society. Some of his happiest times involve wife Laura and their children, Connor and Annaliese, particularly “making pancakes for them on Sunday mornings. We are richly blessed.”
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[ FIVE SURVIVORS ]
Laurine Schuler: Stays in the swim of things Laurine Schuler was posing in a fashionable swimsuit when husband Regis observed, “I think she’s more beautiful now than when we got married 54 years ago.” The Schulers were relaxing at the Jesse H. Jones Rotary House International following checkups from their M. D. Anderson specialists. She is an 18-year breast cancer survivor while he is a 10-year prostate cancer survivor. Swimming had always been one of her favorite activities, but it wasn’t until she had a bilateral mastectomy and immediate breast reconstruction in 1991 that she began swimming competitively. Soon she was winning medals in Senior Olympic and Masters’ swim meets, often setting records for her age group. A decade later, Laurine’s smiling photo in a swimsuit — with medals around her neck — graced the cover of a Conquest magazine that featured several long-time survivors. More recent feats include winning five silver medals in a National Seniors competition in Pittsburgh.
Laurine Schuler
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“Since we’re both from Pennsylvania, it was great to see some family members and old friends,” she says. In addition to swimming three or four times a week, Laurine delivers meals to the elderly and frequently counsels newly diagnosed cancer patients. She is a long-time member of the Anderson Network and an American Cancer Society volunteer. “My cancer experience taught me the importance of going to the best place to be treated by the best doctors as a first resort,” she states. “For us that was M. D. Anderson.” The Schulers enjoy traveling, especially to see three sons, one daughter and eight grandchildren. After their checkups in April, they stayed with two granddaughters while the girls’ parents took a vacation. Whether at home in Tulsa or elsewhere, they strive to keep Friday night “dinner dates.” Regis, an engineer who works part-time, confides, “We have a lot of fun and are both so thankful for our good health.”
CONQUEST | SUMMER 2009
Sara Strom, Ph.D., appreciates the opportunity to visit with Paul Mansfield, M.D., the surgeon who removed the tumor in her stomach.
Sara Strom: Carries on her cancer research A lingering acid taste in her mouth prompted Sara Strom, Ph.D., to see her doctor in 2000. She expected to get a prescription to relieve the problem, but an endoscopy revealed early-stage stomach cancer. “I was very fortunate because stomach cancer usually is discovered after it has metastasized,” explains Strom, associate professor in M. D. Anderson’s Department of Epidemiology. Looking back, Strom believes her healthy lifestyle and positive attitude were plus factors during chemotherapy, radiation, surgery and recovery. Having access to the best specialists and other caregivers coupled with “wonderful family support” helped her resume her research and teaching routines quite rapidly. “By nature, I’m a positive person. I always expected to get well and return to my normal schedule … and, for me, normal was — and still is — my research, my exercise and all my family activities,” she says.
Today, she is busier than before confronting cancer. Her research focuses on molecular, clinical and epidemiological risk factors associated with the development and progression primarily of prostate cancer and leukemia. “Because of my outcomes research, I’ve had a lot of interaction with cancer patients and survivors. I thought I knew what they considered relevant,” Strom says, “but it was only after I survived that I could understand what is really important,” That insight led to improving the way she and her team talk with patients and compile data. They “strive to be more sensitive to the patients as individuals” and not as statistics for a research project. Strom’s experiences prompted her to propose and now chair the Cancer in the Workplace Employee Network, which started in 2008 for faculty and employees who have survived cancer as well as coworkers, caregivers and others interested in cancer-related issues.
Visit the Making Cancer History® Internet site at www.makingcancerhistory.com for more stories about cancer survivors.
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[ FIVE SURVIVORS ]
Amir Steinberg, M.D.
Amir Steinberg: Exchanges invincibility for hope The power of hope was instilled in Amir Steinberg, M.D., from the day he arrived at M. D. Anderson shortly before Thanksgiving 1992. Then 17 and a senior at Bellaire (Texas) High School, Steinberg had thought he was “invincible” until diagnosed with Hodgkin’s disease, a type of lymphoma that attacks the body’s lymphatic system. That attitude changed during months of chemotherapy and radiation. Throughout his treatments, Steinberg adopted the advice of Fredrick Hagemeister, M.D., now professor in the Department of Lymphoma and Myeloma, who coordinated his care and continues to follow his progress. “He told me to always have hope, never feel sorry for myself, to continue pursuing my dreams and not let cancer get in the way of living normally,” recalls Steinberg, who now dispenses similar counsel to his patients. Today, Steinberg is a hematologist/oncologist in the Blood and Marrow Transplant Program and the Outpatient Cancer Center of the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles. He and his wife, Courtney, were “thrilled” when daughter Sophie was born last October. “Thanks to Dr. Hagemeister, I think I learned how to be a good doctor. I spend a lot of time with my patients and really listen to them,” Steinberg says. “Because I’ve been there, I understand how they feel. None of us knows what will happen tomorrow, so I tell each one to enjoy every day to the fullest.”
He also is grateful for the Children’s Art Project scholarships that helped him graduate magna cum laude from The University of Texas at Austin and while earning his medical degree at Texas Tech University School of Medicine. His interest in the field of transplantation was solidified while working in a laboratory one summer with Steven Kornblau, M.D., associate professor in the Department of Stem Cell Transplantation and Cellular Therapy. During a fellowship in hematology/oncology at Lenox Hill Hospital in New York City, Steinberg took time to describe what hope has meant to him in a poem that was published by Oncology Times in 2005. “Everyone deserves hope,” he says.
Hope
by Amir Steinberg, M.D. ... So whether what they have Is an early or advanced stage Give them hope regardless As I learned once from a sage And the next time you see A new patient with cancer When they ask if there is hope Now you know the answer
The full text of Amir Steinberg’s poem as it appeared in Oncology Times is online at www.mdanderson.org/conquest. 20
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
affiliations
M. D. Anderson Cancer Center Orlando, Orlando, Fla. M. D. Anderson Banner Cancer Center, Phoenix, Ariz. Centro Oncológico M. D. Anderson International España, Madrid, Spain M. D. Anderson Clinical Care Center in the Bay Area, Nassau Bay, Texas M. D. Anderson Radiation Treatment Centers in Bellaire, Fort Bend, Katy and The Woodlands, Texas; and Albuquerque, N.M. Christus Spohn Stem Cell Program affiliated with M. D. Anderson Cancer Center Outreach, Corpus Christi, Texas
R. Steven “Steve” Hicks, Austin Janiece M. Longoria, Houston Wm. Eugene “Gene” Powell, San Antonio Robert L. Stillwell, Dallas Benjamin L. Dower, Dallas Student regent
Francie A. Frederick General counsel
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Francisco G. Cigarroa, M.D. Chancellor
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.
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, Katrina Burton, Robin Davidson, DeDe DeStefano, Sara Farris, Scott Merville, Julie Penne, Mary Jane Schier, Sandi Stromberg, Laura Sussman Designer: Michael Clarke Photographers: Eli Gukich (cover, pages 7, 12, 13 ), Gini Reed (cover, pages 4, 6, 8, 10, 11), Wyatt McSpadden (pages 9, 14), John Smallwood (page 3), F. Carter Smith (pages 16, 18, 19, 20), Beryl Striewski (page 17)
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Raymond N. DuBois, M.D., Ph.D. Provost and executive vice president
Leon J. Leach
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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
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Ali A. Saberioon
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