Network-Winter 2013 by MD Anderson Cancer Center

The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center

network

Winter ’13

The ‘Healthy Bites’ challenge: Little

steps make a difference By Mary Brolley

Rob Yates laughs when asked how he came to join MD Anderson’s “Healthy Bites” initiative. He accepted one of the more difficult monthly challenges — drinking less alcohol for a month. “Somebody had to do it. You might say I was volunteered,” jokes the physician assistant and supervisor of mid-level providers in the Department of Pain Medicine. Like some people with demanding jobs, Yates had gotten into the habit of having an alcoholic drink or two after work to unwind. But he was open to making positive lifestyle changes and agreed to lessen his overall alcohol intake by taking this challenge.

Breaking behavior patterns Yates has special motivation to pay attention to his health. A decade ago, he was diagnosed with malignant melanoma. Ever since, he’s tried to stay active and make smarter food choices. To tackle the challenge, Yates started keeping a log of his alcohol consumption. His goal was to reduce his drinks by one serving a week. He also

paid attention to serving sizes and planned ahead for social engagements. “I’d forecast the week,” he says. “Once I started logging and measuring it, it was easy to cut down.” Adelina Espat, program manager in the Public Education Office, was part of a team that created the challenge in response to trends in obesity and its effects on health. She and her colleagues knew that nutrition was one of the most popular topics for subscribers to their monthly Focused on Health newsletter. “Obesity is a growing problem,” Espat says. “It’s a contributor to new cancer cases.” She imagined a challenge that would fulfill two goals: encourage the Focused on Health audience continued on page 2

The ‘Healthy Bites’ challenge continued from page 1 to make dietary changes to improve their health, and, by attracting new subscribers, increase the reach of this important health message.

Growing awareness of how diet affects cancer Making better food choices isn’t easy, Espat knows. To the many Americans who are overweight or obese, achieving and maintaining a healthy weight may seem daunting. To create the challenges, Espat worked closely with Mary Ellen Herndon, a dietitian in the Division of Human Resources’ Department of WorkLife and Wellness. They followed guidelines set by the American Institute for Cancer Research’s “Foods that fight cancer.” The 12 challenges spurred participants to make simple choices and maintain them for one month — long enough, perhaps, to form a new habit. January’s challenge was simple and straightforward: Eat breakfast every day. But it went beyond the cliché, offering workable and quick options for making the meal count.

Rob Yates says: “Tell someone you trust about your plan. Be patient and forgiving with yourself.” Other challenges were to eat less processed meat, more fruits and vegetables, whole grains, plant-based proteins, and to dine out less. Because consuming sugary drinks leads to weight gain, another challenge is to drink more water instead. To test the challenges before the public launch, they decided to reach out to MD Anderson’s more than 19,000 employees. “We’re a diverse population,” Herndon notes. “And it’s important to show that we practice what we preach.” “So we sent out an email asking for participants. We needed 12 volunteers. Within three hours, we had more than 250 responses,” Herndon says. “We had to shut the site down.”

Still time to join Network readers can take the challenge by signing up for the Focused on Health newsletter. Once they do, they’ll receive emails and links to supporting materials directly to their inboxes. They’ll also get new tools, recipes and tips to help them complete each month’s challenge. For more motivation, they

can read about and watch videos of those who’ve already taken one of the challenges. Yates is happy he accepted the challenge, and has maintained a reduction in his alcohol consumption. “Once a cancer patient, always a cancer patient,” he says. “I’ll do anything to lessen the chances of having a recurrence.” Grateful for the initiative’s success, Herndon and Espat are already planning the 2014 offerings, which may include an exercise component. “Making better food choices can seem overwhelming. Making huge changes overnight can seem impossible,” Herndon says. “That’s why the challenges are simple and achievable.”

“Little changes over time can have big effects.”

Go to www.mdanderson.org/healthybites to join the Healthy Bites challenge.

people profile The power of positivity By Erica Quiroz

Even after the removal of the left part of his jaw bone, a large section of his esophagus, part of his soft palate and a piece of his tongue, Ed Steger remains an optimist. Diagnosed in 2005 with stage III/IV head and neck cancer, he went through an intense rehabilitation program to improve his swallowing and speech capabilities. As a result, Steger speaks with a slower cadence and has dysphagia — difficulty in swallowing — and now “eats by gravity.” He started a blog (www.hncancer.blogspot.com) in 2007. “I have a bit of a speech impediment, and I found that writing about what I’ve gone through was cathartic for me,” Steger says. He also started working with the National Foundation of Swallowing Disorders — a nonprofit organization that raises awareness of how swallowing disorders affect a person’s quality of life. He became president of the organization in September. “I work with ear, nose and throat physicians and speech language pathologists to educate and support people with swallowing disorders,” Steger says. In his new role, Steger, who used to love to travel, does so when necessary. It takes considerably more effort now than before his cancer and treatment, but for the right cause, he’s up for an occasional trip.

A positive impact Steger says he’s always been involved in things that make him feel good, and enjoys making a positive impact on people. To continue that goal, he volunteered as a patient research advocate for the SPORE (Specialized Programs of Research Excellence) grant in head and neck cancer during his treatment at MD Anderson. “At the time, I was the only patient sitting in with management, physicians and researchers in the head and neck area representing the patient perspective,” Steger says. “Once

a month, I would sit and listen to presentations about new developments in research studies, activities and special projects.” The most rewarding part of his duties was providing feedback to researchers during the biopsy selection process. “The feedback I gave allowed the researchers to become more aware of how they presented what they were trying to accomplish,” Steger says. “The patient perspective enabled them to recruit more patients to their studies, which was a key goal.” In remission since 2009, Steger lives in Virginia with his family. Steger says staying positive and having friends and family who understand his disorder has helped him through the tough times. “Cancer changes your life, but with it comes opportunity,” Steger says. “Some flexibility is required, and if you’re open to change, there are still ways to get fulfillment from life. I’m an optimist.”

Ed Steger is a member of Anderson Network. To learn more, call 713-792-2553 or 800-345-6324 or click on www.mdanderson.org/andersonnetwork. 3

doctor, doctor

Focus on the dangers of sepsis We asked Imrana Malik, M.D., assistant professor in the Department of Critical Care, about MD Anderson’s initiative to raise awareness about the common but littleknown disorder called sepsis.

Imrana Malik, M.D.

How can it be prevented?

What is sepsis and how common is it? Sepsis occurs when the body attempts to fight an ongoing infection. Initially, this can be an appropriate and necessary response to infection; however, sometimes sepsis causes the body’s immune system to go into overdrive and damage its own tissues and organs. This can lead to shock, which is the failure of multiple bodily organs, as well as death. Sepsis is common. Throughout the world, someone dies of the disorder every 3-4 seconds. Yet it’s not very well known.

Why should cancer patients and their caregivers be concerned about it? Worldwide, sepsis causes more deaths each year than prostate cancer, breast cancer and HIV/AIDS combined. Cancer patients have a particularly high risk for it because they may have frequent hospital stays, increasing their risk of acquiring an infection.

There’s no single agent or strategy to treat sepsis. That’s why it’s so dangerous. We have to not only fight the infection directly with antibiotics, but also support any failing organs resulting from it (with dialysis and life support, for example). Using these strategies, we buy time for the body to heal and recover.

Sepsis can happen to anyone. It requires only an infection and a delay in identification or treatment.

What are the symptoms?

In patients with depressed immune systems, such as some cancer patients, sepsis can happen even if there’s no delay in identification or treatment, because the immune system cannot respond to infection.

Why are health care providers so determined to raise awareness of, and prevent, sepsis?

Sepsis can present in many different ways, but some of the most common signs are:

Once it’s begun, what are the ways to treat it?

It’s been called an “equal-opportunity” threat. Why is this?

They may also have depressed immune systems because of cancer treatments, and may have additional weakness due to poor nutrition, illness or frailty, all of which increase the risk of developing an infection.

• Fever and shaking chills • Reduced mental alertness, sometimes with confusion • Nausea and vomiting • Diarrhea • Increased heart rate, greater than 90 beats per minute • Increased respiratory rate, greater than 30 breaths per minute • High or low white blood cell count • Low blood pressure • Altered kidney or liver function

Awareness of the problem and a high degree of suspicion are key tools in prevention and early treatment. Prevention includes good hygiene and hand-washing techniques, as well as close attention to signs of the disorder. Once the signs of sepsis are present, getting prompt and appropriate medical attention improves patient outcomes.

Our goal is to keep our patients safe from the threat of sepsis, which can be especially dangerous if the immune system is depressed. Cancer patients deserve a fair shake at fighting cancer without losing the battle to sepsis along the way.

As we raise awareness about sepsis, we will collaborate with all health care workers and the general public to find ways to prevent it — which is the best way to fight it.

For more information about sepsis and efforts to fight it, go to www.sepsisalliance.org.

research briefs Cancer stem cells found among low-PSA cells

Protein feeds brain tumors’ sugar habit, new drug blocks it

Prostate cancer cells that defy treatment and display heightened tumor-generating capacity can be identified by levels of prostate specific antigen (PSA) expressed in the tumor cells. Using a new technique, researchers were able, for the first time, to separate low-PSA and high-PSA prostate cancer cells, leading to a discovery that the low-PSA population of cancer stem cells appears to be an important source of castration-resistant prostate cancer. Low-PSA cells were found to be both self-renewing and capable of differentiating into other prostate cancer cell types upon division. The findings demonstrate the need to develop new therapeutics that will target low-PSA prostate cancer cells that can be combined with hormone therapy to wipe out cancer cells and prevent recurrence. The study’s senior author is Dean Tang, Ph.D., professor in the Department of Molecular Carcinogenesis.

A protein that sneaks into the cell nucleus and sets off two separate cancer-promoting processes vital to the development of malignant brain tumors makes itself an enticing target for therapy.

New options for treatmentresistant CML and one type of ALL

Having exposed that dangerous behavior by pyruvate kinase M2 (PKM2) in a series of major publications, MD Anderson researcher Zhimin Lu, M.D., Ph.D., has uncovered a vulnerability he thinks could turn the metabolic protein into “an Achilles’ heel for cancer.” In a recent paper in Nature Cell Biology, Lu and colleagues identified a drug that inhibits the growth of brain tumors in mice by thwarting PKM2. Lu, an associate professor in the Department of NeuroOncology, and colleagues have discovered: • the cellular mechanism that overexpresses PKM2 in cancer cells; • the complex pathway that smuggles PKM2 into the cell nucleus; and • how, in the nucleus, PKM2 activates genes involved in cell division and in a glucose metabolism pathway that nourishes brain tumors and other types of cancer called the Warburg effect. “For tumors to form, PKM2 must get to the nucleus to activate genes involved in cell proliferation and the Warburg effect,” Lu said. “If we can keep it out of the nucleus, we can block both of those cancer-promoting pathways.”

Patients with chronic myeloid leukemia (CML) or acute lymphoblastic leukemia that carries the Philadelphia chromosome who can’t tolerate the targeted drugs that revolutionized care for these leukemias now have three new options. The U.S. Food and Drug Administration has approved ponatinib (Iclusig™), an effective drug for many patients with treatment-resistant disease. It joins bosutinib (Bosulif®) and omacetaxine (Synribo™), also recently approved. These drugs may be effective for the 30% to 40% of CML patients whose disease is resistant to imatinib (Gleevec®). Second-generation drugs nilotinib (Tasigna®) and dasatinib (Sprycel®) are effective for about half of those patients. The three new drugs work by thwarting treatment-resistant mutations (ponatinib and bosutinib) or by stifling creation of an aberrant protein (omacetaxine). “It’s important to have as many therapies against cancer as we can, because rarely does one drug or combination succeed for all patients,” said Jorge Cortes, M.D., professor in the Department of Leukemia, who led all clinical trials for the three new drugs.

To learn more about MD Anderson research, visit www.mdanderson.org/newsroom or the Cancer Frontline blog at www2.mdanderson. org/cancerfrontline.

‘A clinical instinct’: Hospitalists improve care for acutely ill inpatients By Mary Brolley

In an institution as large as MD Anderson, providing seamless care for patients throughout their cancer journey is a constant challenge. Those who go from outpatient to inpatient care — and back again — need an expert in both internal medicine and the insand-outs of the hospital environment. Enter the hospitalist. A specialty that’s exploded in popularity in the past three decades, hospital medicine recognizes that caring for acutely ill patients within the hospital setting requires physicians who are on site — embedded, in fact — in the hospital culture. Hospitalists are expert in providing treatment in a multidisciplinary setting, consulting with specialists as needed and managing comorbidities and the complications of the disease process and of therapy. They work cooperatively with the supervising oncologists and return the patient to their care when the acute issues are resolved.

Managed care spurs growth of specialty

A 1996 article in the New England Journal of Medicine predicted that hospitalists would be ever more in demand as a national shift to managed care forced improvements in efficiency in both inpatient and outpatient settings.

This has proven true at MD Anderson, as the number of hospitalists has doubled since the program’s launch in 2007. Then, Carmen Escalante, M.D., professor and chair of the Department of General Internal Medicine and colleagues began to recruit physicians dedicated to caring for cancer patients with medical problems requiring hospital treatment. One of the first hired was Maria-Claudia Campagna, M.D., who’d had the perfect preparation for such a career. In 2001, while practicing outpatient medicine following her internal medicine training, the leadership of the county hospital district asked her to assist their sole oncologist. She jumped at the chance. “I took care of all the hospitalized cancer patients under the direction of Dr. Debra Prow, who happened to be MD Anderson-trained,” she says. “It was intense and rewarding — like a first-year fellowship in general oncology.” Though all of MD Anderson’s hospitalists are generalists, able to handle problems of any oncology patient, some problems — high blood pressure, chemotherapy side effects or uncontrolled pain — occur frequently.

‘We know when something isn’t quite right’

Campagna is quick to give credit to the whole hospitalist team, which includes three advanced practice nurses and two pharmacists. “We know the system. With experience, we develop a sixth sense and pay attention to it. It’s often a clinical instinct — something isn’t quite right.” To centralize their efforts, the team, led by Josiah Halm, M.D., section chief ad interim and associate professor in the Department of General Internal Medicine, was recently assigned a permanent home on the newly opened Floor 19 in Alkek Hospital. The typical seven-day clinical rotation begins Monday and the hospitalists must quickly get to know every patient’s history, Campagna says. “First, we get a briefing about complex patient interactions and the day’s discharges. Then, after doing ‘computer rounds’ — looking over each patient’s charts and records — we see the new admissions and those being discharged,” she says. Hospitalists improve patient care and overall efficiency, says James Abbruzzese, M.D., chair of the Department of Gastrointestinal Medical Oncology. An early and enthusiastic supporter of hospital medicine, he and his colleagues often refer their acutely ill patients to the hospitalists.

‘Tremendous value’ for patients

“Our faculty has worked closely with the hospitalist service during the past five to six years,” Abbruzzese says. “This relationship not only provides excellent care for patients with GI cancers who require hospital admission, but working together has allowed our faculty to provide their expertise to more new patients coming to the GI Center.

Two of MD Anderson’s hospitalists: Maria-Claudia Campagna, M.D., and Josiah Halm, M.D.

“The arrangement offers tremendous value to our patients.” A 2010 survey by the National Association of Inpatient Physicians found that more than 7,000 hospitalists practice nationwide. The overwhelming majority practice general internal medicine, though some work in specialized areas like pediatrics or oncology. What kind of physician is drawn to this intense and demanding career? “It requires a longer-term commitment to acquire the subset of skills we need, in addition to general aptitude and abilities,” Campagna says. “And, of course, patients and their families are in crisis and need time and empathy. It’s very dynamic, and interpersonal

skills are important. You learn a lot about life’s realities they don’t teach at medical school.” And it doesn’t hurt to have energy to burn. “We usually don’t take lunch,” she admits. “We start, and we’re done when we’re done.”

Scan this QR code to hear a podcast on hospitalists.

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network The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center. Address changes should be sent to: Mary Brolley The University of Texas MD Anderson Cancer Center Communications Office – Unit 700 6900 Fannin St. Houston, TX 77030-3800 Phone: 713-792-0658 Fax: 713-563-9735 Email: mbrolley@mdanderson.org Articles and photos may be reprinted with permission. Susan French, Executive Director, Volunteer Services Debbie Schultz, Assistant Director, Volunteer Services/ Anderson Network Frank McCreary, Chair, Anderson Network Mary Brolley, Writer/Editor, Network Scott Merville, Erica Quiroz, Contributing Writers Gini Reed, Graphic Design © 2013 The University of Texas MD Anderson Cancer Center

Telephone Support Line needs your help Would you be willing to share your cancer experience with a newly diagnosed patient or caregiver? If so, call the Anderson Network at 713-792-2553 or 800-345-6324, and find out about becoming a member of our telephone support line that matches patients and caregivers dealing with similar diagnoses and treatment plans. • • • • • •

Especially needed are those who have experienced: adrenocortical carcinoma, advanced gynecologic cancer, bile duct cancer, gastric cancer, gallbladder cancer, and penile cancer

In addition, we’re looking for those who speak languages other than English, especially Spanish.

Your story and willingness to listen could make the difference in another person’s ability to cope with this potentially life-threatening illness. The Anderson Network motto is: “Sometimes the best help comes from someone who’s been there.”