care
CANCER
for anyone touched by cancer SUMMER 2018
IN THIS ISSUE
Will immunotherapy work for you? page 9 Chemotherapy might not be necessary for breast cancer page 10 Caring for your colon page 12
4 ways to love cruciferous vegetables page 15 Advice from a dad page 17
Brought to you by the
YOUR guide
Lobby of the newly opened fourth floor in the Upstate Cancer Center. PHOTOS BY RICHARD WHELSKY
Expansion makes way for more patients, infusion rooms WHEN THE UPSTATE CANCER CENTER OPENED its doors in July 2014, only the first three floors of the five-story building were completed and occupied. e fourth and fih floors, each about 20,000 square feet, were constructed but le empty, anticipating future Upstate needs. ree years later, those needs became obvious as more and more adult cancer patients have been seeking treatment at Upstate, said Dick Kilburg, associate administrator of the Cancer Center. Aer about a year of designing, planning and construction, the new fourth floor opened in early June. It comprises patient exam rooms, upping the number from 14 to 35. Moving exam rooms from the second to the fourth floor allows for additional infusion rooms to be added to the second floor, increasing that number from 27 to 44. e fih floor is scheduled to open this fall and will house
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Upstate’s Clinical Pathology Lab. “Patients may never see the lab, but getting lab results to physicians quickly, so that they may initiate appropriate therapy sooner, is key to quality patient care and patient satisfaction,” said Sophia Lustrinelli, department manager of clinical pathology. Kilburg said the fourth floor was constructed with the same patient-focused design qualities as the rest of the cancer center. Huge, floor-to-ceiling photo murals of lush garden landscapes adorn the pillars in the reception/waiting area, and wherever you look there is art — from a huge hanging sculpture near the front to vibrant abstracts lining the hallways. “We’ve had a lot of comments from patients and family members who said they feel like they are going to a museum rather than going for care,” Kilburg said. “We’re trying to take their mind off why they’re here.” ●
upstate.edu/cancer l summer 2018
inside
4
9
17
14
10
Inside this issue Caring for patients The Cancer Center expands
page 2
Giving hope to youth affected by cancer
page 4
Photographer chronicles Lola
page 6
Immunotherapy success
page 8
page 12
Important words to know
page 13
Learning to thrive
page 14
What’s a circulating tumor cell?
back cover
Living with CanCer
sharing expertise What you need to know about immunotherapy
Caring for your colon
Recipes: 4 ways with cruciferous vegetables
page 15
Advice from a Dad
page 17
page 9
Making a differenCe
You may not need chemotherapy for breast cancer
page 10
Combining surgery and radiation for breast cancer treatment
page 11
Teens on a team
page 18
.
On the cover: Abi Siva, MD, who cares for a patient whose immune system is successfully fighting cancer. See story, page 4.
care
CANC ER
PHOTO BY SUSAN KAHN
care
for anyone
Brought
to you by
the
for anyone touched by cancer
SUMMER 2018
CANCER CARE
UPSTATE CANCER CENTER
EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications
DIRECTOR (INTERIM) Jeffrey Bogart, MD
Amber Smith 315-464-4822 or smithamb@upstate.edu
WRITERS
Jim Howe Susan Keeter Amber Smith
DESIGNER
Susan Keeter
The Upstate Cancer Center provides the quarterly magazine Cancer Care for anyone touched by cancer. Send subscription requests and suggestions to magazine@upstate.edu and request additional copies by calling 315-464-4836. Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202.
summer 2018 l upstate.edu/cancer
SUMMER
by cancer
Caring for your colon page 12 4 ways to love crucife rous vegeta bles page 15 Advice from a dad page 17
CANCER
MANAGING EDITOR
touched
2018
IN THIS ISSUE Will immun othera py work for you? page 9 Chemo therap might not y be necess ary for breast cancer page 10
Cancer Care magazine received a national 2018 Clarion Award from the Association for Women in Communications. e publication was named best overall external magazine with a circulation below 100,000. Cancer Care launched in the summer 2014. Subscriptions are free by emailing your address to magazine@upstate.edu with “Cancer Care subscribe” in the subject line. e AWC is a professional organization, begun in 1909 by seven female journalists, that champions the advancement of women across all communications disciplines.
DEPUTY DIRECTOR (INTERIM) Gennady Bratslavsky, MD ASSOCIATE DIRECTOR FOR CLINICAL RESEARCH Stephen Graziano, MD ASSOCIATE DIRECTOR FOR BASIC AND TRANSLATIONAL RESEARCH Leszek Kotula, MD, PhD ASSOCIATE DIRECTOR FOR COMMUNITY OUTREACH Leslie J. Kohman, MD ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA
The Upstate Cancer Center is part of Upstate Medical University in Syracuse, N.Y., one of 64 institutions that make up the State University of New York, the largest comprehensive university system in the United States. Upstate Medical University is an academic medical center with four colleges, a robust biomedical research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s downtown and Community campuses, the Upstate Golisano Children’s Hospital and many outpatient facilities throughout Central New York — in addition to the Upstate Cancer Center, which is located at 750 E. Adams St., Syracuse, NY 13210.
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CARING FOR patients
p Giving ho e
to youth affected by cancer
BY SUSAN KEETER
CHARLIE POOLE, 16, WENT HIKING in Highland Forest last spring. It was an accomplishment for a young man who, 26 months earlier, was diagnosed with a brain tumor that le him with weakness in the right side of his body, vision problems and a host of other challenges.
“I like walking in the woods and just listening to the birds,” Poole explained during a H.O.P.E. social event held in May at the Baldwinsville YMCA. H.O.P.E. (Helping Oncology Patients and Families Engage) represents another accomplishment for Poole. He championed the idea of organized social activities for children and teenagers treated at the Upstate Cancer Center, “so we can get to know other people who understand the whole cancer situation.” Poole talked with Upstate social worker Stephanie Barry, nurse manager Molly Napier and nurse navigator Kristen omas about his idea. Other patients and families shared Poole’s interest, and H.O.P.E. was created. e first event, held in January 2018, featured a group discussion and practice of stress management techniques led by Kaushal Nanavati, MD, medical director of integrative therapy at the Upstate Cancer Center.
e second event was all fun and treats. Mothers painted landscapes together, families had portraits taken, and children played board games. e young cancer patients “shopped” for Mother’s Day gis from a treasure trove of donated gis. Poole chose a handmade bracelet for his mother. Pet therapy dogs snuggled, licked and played ball. Everyone enjoyed pizza and gourmet cupcakes.
roughout the evening, Poole watched his idea come to life and reflected on how it came to be. Poole was a member of the track team at FayettevilleManlius High School. “I started leaning to one side when I ran,” he recalled. “When one of my teammates gave me a friendly shove, I fell to the ground and couldn’t get up. I got nauseated when I laid on my back. “My pediatrician saw that my pupils were different sizes and sent me to the emergency department at Upstate,” he continued. It was Feb. 2, 2016. Emergency doctors ordered a magnetic resonance imaging scan. Because metal would interfere, Poole’s braces had to be removed. e results of the scan arrived with a flood of specialty doctors. Poole had diffuse intrinsic pontine glioma, known as DIPG. It’s a lethal brain-stem tumor. Unlike continued on page 5 Charlie Poole at the H.O.P.E. event with, from left, his mother, Lynda Poole, and Upstate Cancer Center nurse Kristen Thomas and social worker Stephanie Barry. In a Facebook post the day Charlie died, his mother said he would want nothing more than for the rest of us to appreciate the life we have, “to stop, look around and feel the wonder surrounding us.” PHOTOS BY ROBERT MESCAVAGE
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CARING FOR patients
Giving hope to youth
continued from page 4
most pediatric cancers, which have an overall survival rate around 83 percent, only about 10 percent of people diagnosed with DIPG survive for two years aer diagnosis. Poole died Aug. 6, two and a half years aer his diagnosis. When Poole was diagnosed, he learned that surgery was impossible because of the location and type of tumor. Treatment — to improve his quality of life, not cure the cancer — was radiation, which could be done on an outpatient basis. Poole and his parents, Keith and Lynda, went home to absorb the news. With his doctors’ permission, they took a weeklong family vacation before their son started treatment in 2016. Six weeks of five-day-a-week radiation took the hair off the back of Poole’s head and affected his sense of smell. His wavy, ash-blond hair returned, but Poole’s sense of smell and taste were still affected. His parents spent hours online, connecting with other families affected by DIPG and searching for options. With support from his oncologist, Irene Cherrick, MD, Poole enrolled in a 14-month clinical trial at the Cincinnati Children’s Hospital, testing the effects of chemotherapy drugs on DIPG.
Alayah Green, 4, kisses her mom, Katie Green, while she and other mothers of cancer patients paint landscapes at the H.O.P.E. art session led by Ally Walker.
“My tumor stayed stable,” noted Poole. “But I’m not sure it helped.” In June 2017, near his 16th birthday, Poole learned that his tumor was growing again. Aer careful consideration, Poole was given 10 more radiation treatments. Because of the gravity of his condition, his family chose to try an experimental treatment in Mexico, which involved traveling back and forth for four months. In October, Poole had a setback at home and was unable to return to Mexico for treatment. Cherrick later prescribed two new chemotherapy medications, one of which required permission from the manufacturer and the U.S. Food and Drug Administration. Poole’s follow-up imaging scans showed that his tumor had changed shape.
H.O.P.E.
events are open to any pediatric cancer patient and his or her family. Contact nurse Kristen Thomas for details: 315-464-7227. Funding for the H.O.P.E. event was provided by the Upstate Foundation (Paige’s Butterfly Run and Ozzie’s Army funds) and by On My Team16. That new non-profit was inspired by Jack Sheridan, a student-athlete at LeMoyne College and a cancer survivor who was treated by Irene Cherrick, MD, at the Upstate Golisano Children’s Hospital. See his story on page 18.
Raising DIPG awareness, page 6.
“Being told that I am going to die has changed me for the better,” Poole said in May. “I am more caring and compassionate.” One reminder of his compassion: the H.O.P.E. events, which connect strangers with one another. ● Levi Haddad, 4, plays with a puppy from Pet Partners of CNY at the H.O.P.E. event at the Baldwinsville YMCA. Levi and Alayah (above) are both being treated for acute lymphoblastic leukemia at the Upstate Cancer Center and Upstate Golisano Children’s Hospital. They became friends at the May event.
summer 2018 l upstate.edu/cancer
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CARING FOR patients
national media featuring Lola Muñoz raise attention for deadly brain cancer Lola Muñoz hoped the treatment she received in a clinical trial would help other cancer patients. PHOTOS BY MORIAH RATNER
BY AMBER SMITH
PHOTOGRAPHS OF A 12-YEAR-OLD PATIENT of Melanie Comito, MD, accompanied recent stories in the Washington Post and National Geographic magazine. Lola Muñoz lived for 19 months aer her diagnosis with a deadly brain cancer called DIPG, diffuse intrinsic pontine glioma. She died in April. Lola chose to participate in a clinical trial of a new combination of chemotherapy drugs to treat DIPG, even though the treatments would make her sick. “I wasn’t doing it for me. I was doing it for all the other kids who suffered,” she told photographer Moriah Ratner, who recently graduated from Syracuse University’s S.I. Newhouse School of Public Communications. Ratner spent almost 18 months taking pictures of Lola and her family, including parents Melissa and Agustin Muñoz.
Nurse Kristen Thomas draws Lola’s blood for tests at Upstate after six weeks of radiation.
DIPG is a tumor of the nervous system that forms in the glial tissue of the brain and spinal continued on page 7
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upstate.edu/cancer l summer 2018
CARING FOR patients
national media showcase Lola Muñoz
continued from page 6
cord. It typically grows rapidly, spreading through the brain stem, making treatment difficult. Surgery is usually not an option because of the precarious location of the tumor. Radiation can shrink the tumor, but it usually grows back within the year. Comito, chief of pediatric hematology and oncology at Upstate, was one of Lola’s doctors. For 20 years she has not been able to offer much in the way of treatment for children with this type of brain cancer. She recently attended a medical symposium and felt the excitement in the room as researchers discussed the potential of a new targeted therapy they want to try. One of the reasons research focuses on DIPG is because of families like the Muñozes, who share their story to raise awareness, Comito says. “She was a very special person,” she says of Lola, “and I think Moriah captured that in her photos.” ● Upstate pediatric cancer chief Melanie Comito, MD, gives Lola a goodbye hug.
Fighting cancer — as a patient, parent and philanthropist Teen with DIPG launched H.O.P.E., page 4.
GARY WEEKS KNOWS the challenges and consequences of cancer from several perspectives. As a patient, he had been fighting bladder cancer intermittently for three years before he was referred to Upstate urologist Oleg Shapiro, MD. “I came to the Upstate Cancer Center,” he explains, “because I understand the importance of a team working together to find answers for the specific needs of each patient. I was impressed with the extended consultation time I received from Dr. Shapiro and the nurses. My urology team helped me find clinical trials, not once but twice, which led to an effective treatment that has worked for me.” As a parent, Gary suffered the anguish of losing his daughter Heather to colon cancer. Along with his wife Frieda, they initiated Hope for Heather, an organization dedicated to research, awareness and local support for ovarian cancer, which was their daughter’s special interest. For more than a decade, Gary and Frieda have been raising money in memory of their daughter. e Weekses established a fund at the Upstate Foundation that assists Upstate’s ovarian cancer patients with a variety of needs to help ease the financial burden of their cancer journeys. e Weekses find their relationship with Upstate fulfilling, as both a grateful patient of Shapiro and a longstanding partner with the Upstate Foundation, as they continue fighting cancer. ● summer 2018 l upstate.edu/cancer
In their role in the Hope for Heather organization, Gary and Frieda Weeks attend events to raise awareness and support for ovarian cancer, a cause supported by their late daughter. They also created a fund at the Upstate Foundation to provide support to ovarian cancer patients treated at the Upstate Cancer Center.
to donate to friends of upstate Cancer Center, visit www.upstatefoundation.org or contact the upstate foundation at 315-464-4416.
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CARING FOR patients
Harnessing his immune system to fight cancer BY AMBER SMITH
THE TUMORS NEAR EUGENE YOUNG’S liver turned up by chance. At the age of 67, he was dealing with symptoms of acid reflux. inking he may have a problem with his gallbladder, Young’s doctor sent him for an ultrasound. “at’s the first I knew I had a problem,” Young says of the imaging test he underwent in February. It showed tumors in his liver, spleen, adrenal glands and bones. Weeks later, he had a biopsy — and a cancer diagnosis. What he needed was a cancer doctor. He chose Abi Siva, MD, a medical oncologist at Upstate who thought Young would be a good candidate for immunotherapy, a medication that works with the body’s immune system to fight cancer cells.
Eugene Young talks with his oncologist, Abi Siva, MD, about encouraging results of immunotherapy medication.
“She did some genetic testing,” Young recalls, “and found that I had the genes necessary for a good reaction to Opdivo.” at’s a new medication also known as nivolumab. Young’s treatment included intravenous infusions of the drug every couple weeks. Aer four doses, he developed some unusual side effects. His vision became blurry, he lost some hearing, and he developed some dizziness. Steroid treatments have helped improve his vision and hearing, he says. Before he started taking the medication, he had an imaging test called a positron-emission tomography scan that reveals metabolic processes. Aer four doses, he underwent another PET scan.
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PHOTO BY RICHARD WHELSKY
“I was hoping that maybe it would show some slight decrease,” Young says. “It was like a miracle. It showed that there were no active cancer cells. We don’t know what that means: Are they dead? Are they gone? Am I cured?” Siva was impressed with the effect of the medication. “e scans are negative. at’s a great sign. ere is no active cancer, but there could still be dormant cells.” e oncologist says Young’s follow-up will include periodic scans, and she’s optimistic about his health. “We know that when people have a complete response like he has, they may keep this response going for years.” Young was able to go ahead with his wedding early this summer. He is resuming his law practice and has returned to his role as a councilman for the town of Clay. ●
upstate.edu/cancer l summer 2018
SHARING expertise
Will immunotherapy work for you? BY AMBER SMITH
OUR IMMUNE SYSTEM FIGHTS off colds. Why not cancer? “Cancers develop mechanisms to get around the immune system,” explains Stephen Graziano, MD, chief of hematology/oncology at Upstate. “ey express a protein on their surface which basically paralyzes the T-cells, which are the part of the immune system that’s active in the immune response.” Immunotherapy drugs such as Keytruda and Opdivo are designed to be antibodies to that protein, “so they basically release the tumor from the immune cells, allowing them to do their job.” It’s a concept that is more than a Stephen Graziano, MD century old. In the last 30 or 40 years, scientists have been able to harness the body’s immune system to fight cancer, “and we’re starting to see advances that translate to patients,” Graziano says. “It’s almost dizzying as an oncologist to keep up with the advances.” Various immunotherapy medications are already in use for cancers of the lung, stomach, bladder, head and neck, and also for Hodgkin’s disease. In addition, Graziano says Upstate has clinical research underway that uses immunotherapy to treat patients with three stages of lung cancer, melanoma, sarcoma, cancers of the kidney, colon and head and neck.
summer 2018 l upstate.edu/cancer
Patients are selected for those research studies, known as clinical trials, aer cells from their tumors are tested, so doctors know the likelihood the drug will work. Patients with serious autoimmune disease are not candidates for immunotherapy, since the medications could stimulate their autoimmune disease. Also, as with any treatment, immunotherapy has potential side effects. Patients may develop fatigue, rash, diarrhea, cough or other symptoms. In those instances, immunotherapy is halted while patients receive steroid treatment. “e nice thing about these immune therapies is they don’t have the side effects we usually associate with PHOTO BY ROBERT MESCAVAGE chemotherapy. ey don’t have the nausea and vomiting, the fatigue, the hair loss, the low blood counts. Most patients feel well aer they receive their treatment.” Graziano says that in his experience, about a third of patients receiving immune therapy see a remarkable prolonged remission, about a third experience a stabilization of their disease for a period of time, and a third may see no response. “We do have patients with advanced cancer who were on these drugs in early clinical trials for two years. And now, some patients have eight years of follow-up and are still in remission,” he says. “I think immunotherapy has great potential.”●
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Do you always need chemotherapy for breast cancer?
SHARING expertise
Oncologist explains research that informs, personalizes treatment options for women BY AMBER SMITH
RESULTS OF AN INTERNATIONAL STUDY — which includes some Central New York women who are patients at Upstate — are helping oncologists determine which breast cancer patients can skip chemotherapy. “ere is a subset of patients who will benefit from chemotherapy, but the majority of patients might not have to go that route,” explains Upstate oncologist Abi Siva, MD. She’s referring only to women with hormone-positive breast cancer that has not spread to the lymph nodes. e research does not apply to all women diagnosed with breast cancer. Women with hormone-positive breast cancer typically have surgery to remove their tumor. en a sample is sent to a specialized laboratory where the tumor cells are analyzed for specific genetic mutations in a test called Oncotype. e test predicts the likelihood of recurrence and whether chemotherapy would help. Women with a low score are considered low-risk and not recommended for chemotherapy. ose with a high score are recommended for chemotherapy. What about those in between? “It was challenging for physicians to make a decision about chemotherapy for these women because we really didn’t know what to do until this study came out,” Siva says. “Now we are more confident. “is is very personalized treatment for each patient, based on her score. We think now we are able to spare about 70 percent of the patients who fall into this category from chemotherapy.” For the study, led by a cancer researcher at Montefiore Medical Center in New York City, half of the women received chemotherapy and endocrine therapy. e other half received just endocrine therapy. Both groups fared well, with one exception — women under age 50, whose cancer is likely to be more aggressive, were found to derive benefit from chemotherapy. e study, which began in 2006 and has involved more than 10,000 women, was published in the New England Journal of Medicine and presented at the American Society of Clinical Oncology in Chicago this past spring. Paid for largely by the United States and Canadian governments and philanthropic groups, the research received some funding from Genomic Health, the company that makes the Oncotype tumor test, according to e New York Times. is is important information because chemotherapy —used to treat a variety of cancers — can take a toll. Side effects can include infections, alterations to kidney and liver function, nausea and vomiting, hair loss and neuropathy, or tingling in the hands and feet. Long-term effects may include difficulty with focused thinking, heart and/or lung problems, muscle weakness, bone and joint problems and secondary cancers or blood disorders. Aer surgery to remove the tumor, a woman with hormone-positive breast cancer may face chemotherapy or radiation, both or neither. Regardless, she will receive endocrine therapy, which is designed to suppress the effect of the hormone estrogen. “Even though we know the surgeon was able to remove the breast tumor, our concern is that there could be microscopic cells le behind in the breast or elsewhere in the body that could come back as a problem, five or 10 years down the road,” Siva explains. Hormone-positive breast cancers in young women are driven by the ovaries, where estrogen is made. Oen these patients receive the medication Tamoxifen, which works by blocking estrogen receptors in breast cancer cells. In post-menopausal women, cholesterol can be converted into androgens and then estrogens, so doctors oen use an aromatase inhibitor medication to block that conversion and decrease the amount of estrogen production. Abi Siva, MD PHOTO BY SUSAN KAHN
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Siva say studies are underway to determine how many years women should take aromatase inhibitors for the best protection against recurrence. ●
upstate.edu/cancer l summer 2018
SHARING expertise
New option combines surgery with radiation for breast cancer treatment
Radiation oncologist Anna Shapiro, MD, gives targeted radiation during surgery, eliminating the need for post-surgery radiation treatments for some cases of breast cancer.
PHOTOS BY SUSAN KAHN
SURGEONS AND RADIATION ONCOLOGISTS at Upstate are teaming up to provide intraoperative radiation therapy to women with early-stage breast cancer. is allows for an intensive dose of radiation to be applied during surgery in the space where the tumor is removed. e aim is to kill any microscopic disease that remains aer a tumor is removed, explains Anna Shapiro, MD, associate professor of radiation oncology. Instead of waiting for the patient to heal from surgery and then completing a three- to six-week course of radiation, this intraoperative option allows the radiation oncologist to precisely deliver radiation to the tumor bed at the end of the operation. Surgeon Lisa Lai, MD, says, “We’re able to complete both the surgery and the radiation in one day, so patients get back to their normal lives much quicker.” Women whose breast cancer has not spread may be candidates for this new procedure. Lai and Shapiro explain that every patient’s situation is reviewed by a team of specialists who make recommendations for her best treatment. ●
summer 2018 l upstate.edu/cancer
From left, breast surgeons Mary Ellen Greco, MD, Lisa Lai, MD, and Kristine Keeney, MD, and radiation oncologist Anna Shapiro, MD, in the operating room with the new intraoperative radiation therapy unit.
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Protecting yourself from colorectal cancer
SHARING expertise
BY AMBER SMITH
signs and symptoms:
COLORECTAL CANCER kills some 50,000 men and women in America every year. e death rate could decrease by 90 percent, says Jiri Bem, MD, medical director of Upstate’s colorectal oncology program. “If everybody would be compliant with recommendations in terms of screening and surveillance, the number would drop to 5,000, which is clearly a striking difference,” he says.
“Many people who are diagnosed with colon cancer don’t have any symptoms, which is why the screening strategies are so important,” says gastroenterologist Sekou Rawlins, MD. “A lot of people felt perfectly normal, and then they had their cancer found.”
Jiri Bem, MD
• A change in bowel habits, such as diarrhea, constipation or narrowing of the stool that lasts for more than a few days.
Cancers of the colon and rectum are largely preventable. e majority of these cancers begin in polyps that can be removed — if they’re found before they’ve developed into cancer and spread. Most cancers found at screening are cureable.
• A feeling that you need to have a bowel movement that’s not relieved by having one.
screening recommendations:
• Rectal bleeding with bright red blood.
Bem recommends people at average risk of colorectal cancer start screening at age 50 and continue at least through age 79. ose at higher risk may need to begin screening earlier, and several gastroenterology societies say African Americans should start at age 45.
• Blood in the stool, which may make the stool look dark.
People at increased risk of colorectal cancer include those with a personal history of colorectal cancer or certain type of polyps, a family history of colorectal “cancer, a personal history of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), a confirmed or suspected hereditary cancer syndrome or a personal history of radiation to the abdomen or pelvis to treat a previous cancer. types of screening tests:
Stool tests can be used to detect blood or to examine genetic changes that may occur in colon cancer cells. Two options provide a look at the structure of the inside of the colon and rectum for abnormal areas that might be cancer or polyps. In a colonoscopy, the doctor inserts a flexible camera into the rectum to inspect the interior walls of the intestine. A virtual colonoscopy is an imaging scan. For both tests, the patient must empty his or her colon by consuming only liquids and a bowel preparation solution prior to the test.
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Sekou Rawlins, MD
Contact your doctor if you notice:
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• Cramping or belly pain. • Weakness or fatigue. • Unintended weight loss. prevention:
ese steps may help reduce your risk, but there’s no sure way to prevent colorectal cancer. • Maintain a healthy weight. • Participate in regular moderate physical activity. • Eat a diet high in vegetables, fruits and whole grains, and limit your intake of red meats and processed meats. • Avoid excessive alcohol use. • If you smoke, quit. do you need an appointment? For help scheduling a colonoscopy, contact the Upstate Cancer Center at 800-464-4673 or Upstate Gastroenterology at 315-464-1600.
upstate.edu/cancer l summer2018
LIVING WITH CanCer
1 5 WORDS FOR THE NEWLY DIAGNOSED Understanding this vocabulary may help you understand your disease Active surveillance – a treatment plan that involves closely watching a patient’s condition but not giving any treatment unless there are changes in test results that show the condition is getting worse.
Clinical trial – a research study that tests how well new medical approaches work in people.
Adjunct therapy – treatment used together with the primary treatment. Adjuvant therapy – additional treatment given to lower the risk that cancer will return.
Immunotherapy – treatment that stimulates or suppresses the immune system to help the body fight cancer, infection or other diseases. (See pages 8 and 9.)
Acute – symptoms that begin and worsen quickly; opposite of chronic.
Metastasize – to spread from one part of the body to another.
Biopsy – a procedure in which cells are removed from a suspicious area, so they can be looked at in a laboratory to see if cancer cells are present.
Oncology – the branch of medicine specializing in diagnosis and treatment of cancer.
Chemotherapy – treatment using drugs that stop the growth of cancer cells, either by killing the cells or stopping them from dividing. Depending on the type and stage of cancer, drugs may be given by mouth, injection, infusion, or absorbed through the skin.
Radiation therapy – killing cancer cells or shrinking tumors through the use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources.
Combination therapy – therapy that combines more than one method of treatment; also known as multimodality therapy.
Prognosis – likely outcome or course of a disease.
Stage – the extent of cancer in the body, usually based on tumor size and whether nearby lymph nodes contain cancer. Tumor – also known as neoplasms, tumors are abnormal masses of tissue that result when cells divide more than they should or do not die when they should. Some are benign (not cancerous), and others are malignant, (cancerous). ● SOURCE: NATIONAL CANCER INSTITUTE
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LIVING WITH CanCer
Mind-set to thrive optimizes quality of life Kaushal Nanavati, MD, leads meditation in the meditation room at the Upstate Cancer Center. Pictured, in the background, from left: medical students Megan Taggart and Alison Stedman; intern Amani Mike. PHOTO BY SUSAN KAHN
BY AMBER SMITH
A CANCER DIAGNOSIS can produce stress, no doubt. How a person responds to that stress impacts his or her quality of life.
have an impact and that being around people who exude positivity is beneficial — although neither have been proven scientifically.
Family medicine doctor Kaushal Nanavati, MD, is medical director of integrative therapy at Upstate. He reminds his patients who have cancer that no one is guaranteed to live another day, regardless of whether they have cancer.
What we do know is that people who are stressed or anxious trigger a stress response in their body that increases heart rate, blood pressure, respiration and muscle tension — conditions that can be detrimental if they become chronic.
“If we distress about the fact that we might not have a tomorrow, we’re missing out on the today,” he says. “at sounds very simplistic, but when you live it, it shis your thinking, and it shis your biochemistry.” A recent study from the National Human Genome Research Institute showed that social interaction during cancer treatment can affect a patient’s response to treatment. at finding does not surprise Nanavati. He also believes a calm, nurturing treatment setting can 14
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Nanavati promotes a “core four” for wellness that consists of stress management, good nutrition, physical exercise and spiritual wellness. He’s liable to prescribe yoga, or meditation, along with conventional medical care. And he helps patients learn how to optimize their quality of life aer they receive a diagnosis of cancer. He helps them believe they can not only survive, but thrive.●
upstate.edu/cancer l summer 2018
LIVING WITH CanCer
one way to thrive:
Eat cruciferous vegetables. Kaushal Nanavati, MD, says research shows cruciferous vegetables can potentially reverse the buildup of plaque in arteries, helping to improve circulation. “We don’t have medications that can do that,” he says. “And yet, this food can be of benefit.” And not just for heart health.
ey’re also high in fiber. e National Cancer Institute explains that during food preparation, chewing and digestion, the glucosinolate in cruciferous vegetables break down into biologically active compounds that are being examined in research laboratories for their anticancer effects. So, here’s your shopping list: arugula, asparagus, bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kale, radishes, rutabaga, spinach, turnips, watercress and wasabi. *See below and page 16 for recipes using cruciferous vegetables.
4 recipes featuring cruciferous vegetables Cruciferous vegetables are rich in nutrients including carotenoids, vitamins C, E and K, folate and minerals.
1. easy Baked Broccoli tots preparation ingredients Preheat the oven to 350. Grease a nonstick baking sheet with cooking spray. Bring a large pot of water to a boil. Add the broccoli florets to the water and cook just until fork tender, about 5 minutes. oroughly drain the florets and transfer to a food processor. Pulse the broccoli for a few seconds just until the it breaks down into small pieces. (Do not overmix the broccoli or the mixture will be too wet to form into tots.) Measure out 3 packed cups of the broccoli and add it to a large bowl. Add the diced onion, bread crumbs, egg and Parmesan cheese and mix until thoroughly combined.
2 medium heads broccoli, cut into florets ¼ cup onion, finely diced ¼ cup finely ground bread crumbs or gluten-free pretzels 1 large egg ¼ cup grated Parmesan cheese Ranch dressing or ketchup, for dipping
nutritional information per 6 tots: 60 calories 2 grams total fat 25 milligrams cholesterol 120 milligrams sodium 8 grams carbohydrate 1 gram fiber 1 gram sugar 4 grams protein
SOURCE: JUSTATASTE.COM
Using your hands, portion out about 2 tablespoons of the mixture and mold it into a tater tot shape. Arrange the tots on the prepared baking sheet, spacing them about 1 inch apart. Bake the tots for about 20 minutes. en flip them once and bake them an additional 10 to 15 minutes until crisped. Remove the tots from the oven and serve them with ketchup, ranch dressing or hummus for dipping.
2. angie’s dad’s Best Cabbage Coleslaw preparation
ingredients
In a large bowl, combine cabbage, onion, carrots and celery. Sprinkle with 1 cup sugar and mix well. In small saucepan, combine vinegar, oil, salt, dry mustard and pepper. Bring to a boil. Pour hot dressing over cabbage mixture and mix well.
1 medium head cabbage, shredded 1 large red onion, diced 1 cup grated carrots 2 stalks celery, chopped 1 cup white sugar 1 cup white vinegar ¾ cup vegetable oil 1 tablespoon salt 1 tablespoon dry mustard Black pepper to taste
Cook’s note: Best if made ahead, from a day to two weeks. Just drain juice prior to serving. is makes 20 servings. SOURCE:ALLRECIPES.COM
summer 2018 l upstate.edu/cancer
nutritional information
per serving: 131 calories 8 grams total fat Zero cholesterol 364 milligrams sodium 14 grams total carbohydrate 1½ grams fiber 12 grams sugars 1 gram protein
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Recipes
continued from page 15
3. raw kale, grapefruit and toasted hazelnut salad
ingredients
preparation
2 pink grapefruit ½ small red onion, thinly sliced, divided ¼ cup fresh lemon juice ½ cup fat-free plain yogurt 2 tablespoons extra-virgin olive oil ½ teaspoon kosher salt ¼ teaspoon black pepper 8 ounces kale, very thinly sliced or baby kale leaves 1 ounce toasted hazelnuts, chopped (1/3 cup)
Peel and segment grapefruit, reserving 3 tablespoons juice in a large bowl. Mince 2 rings onion. Add to grapefruit juice, with lemon juice, yogurt, oil, salt and pepper. Whisk until well mixed. en, toss in kale. Top with remaining onion, grapefruit and hazelnuts. Makes four 1¾ cup servings. SOURCE:HEALTH.COM
4. Cauliflower risi e Bisi preparation
Heat oil in a large skillet over medium heat. Add scallions and garlic; cook, stirring for 30 seconds. Add cauliflower rice, peas, pepper and salt, and cook, stirring occasionally, for 3 minutes. Add water and continue cooking until the cauliflower is soened, 3 to 5 minutes more. Whisk milk and cornstarch in a small bowl and add to the cauliflower. Cook, stirring, until the sauce is creamy and thick, about 2 minutes. Remove from the heat and stir in Parmesan and parsley. Serve hot, topped with more parsley, if desired.
ingredients 2 Tablespoons extra-virgin olive oil ½ cup sliced scallions 3 cloves garlic, minced 4 cups cauliflower rice, fresh or frozen 2 cups peas, fresh or frozen ½ teaspoon ground pepper ¼ teaspoon salt 2 tablespoons water 1 cup whole milk 2 teaspoons cornstarch ½ cup grated Parmesan cheese 2 tablespoons chopped fresh parsley, plus more for serving
nutritional information per serving: 184 calories 12 grams fat 1 milligram cholesterol 18 grams carbohydrate 3 grams fiber 179 milligrams sodium 5 grams protein
nutritional information per1-cup serving: 160 calories 8 grams fat 10 milligrams cholesterol 256 milligrams sodium 15 grams carbohydrates 4 grams fiber 6 grams sugars 7 grams protein
SOURCE: EATINGWELL.COM
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LIVING WITH CanCer
A Dad’s perspective
Theron Blair’s eldest son Trey, 7, has leukemia. In the two years since his son’s diagnosis, Blair has learned what it takes to be the parent of a kid with cancer. He shares his insights: l answer the phone when your wife calls
l invest in paper towels
My wife phoned from the grocery store and said she’d gotten a call to take Trey to the hospital. We’d taken him to the pediatrician because his legs hurt and his stomach was bothering him. A blood test showed Trey’s iron was low.
Everything needs to be extra clean, so you can avoid exposing your child to infection. Wash your hands. Use paper towels and disinfectant wipes. (Sponges and cloths spread germs.) Don’t be afraid to tell friends and neighbors, “You have a runny nose? Don’t visit!”
When we got to the Upstate Golisano Children’s Hospital, they sat us down and explained that he had acute lymphoblastic leukemia (see box, page 19.) Within 24 hours, Trey was in surgery having a port put in his chest for chemotherapy. It was April 23, 2015. l shave your head
Early on, when Trey had heavy chemo treatments, his hair started falling out. I’ll never forget him saying, “Dad, why is this happening to me?” as he looked in the mirror. at day, I shaved my head, so we’d be matching bald guys. Last April, his brother, Tyler, shaved his head to raise money for pediatric cancer research. l Learn to give shots
Everything is hard when your child has cancer, but giving chemotherapy injections at home is really difficult. Your child is going through a lot, and you have to put him through more. But you’ve got to learn to do it, and do it well, so he can get healthy.
l pay attention to both sons
“Doesn’t my brother like me any more?” was our younger son’s fear when Trey came home from the hospital. Tyler had welcomed Trey home with a punch which, in the past, would have led to wrestling, but Trey didn’t feel good. Children understand more than you think, so listen and talk with them about what’s happening. l Be understanding
Trey had times when he couldn’t control his anger because he was on steroids. He would say, “Mommy, I’m yelling at you, and I don’t like it.” Help your child understand that it’s the medication, and the condition, that are affecting his actions. Remind both children that they have good hearts. l eat healthy
Steroid treatments made Trey crave salt. Salty foods made his edema (swelling) so bad that he couldn’t walk. We knew we had to change our diets, so we set ground rules. Now our sons know, “We have to eat something healthy first.” Trey likes broccoli, and Tyler likes bell peppers. Once in a while, we have pizza and ice cream, but fresh vegetables are every day. l stay positive
Try to stay positive, even when things are rough. ●
Theron Blair of Baldwinsville with his sons Tyler, 5 (left), and Trey, 7 (right). Chemotherapy left Trey bald for a while, and now that his hair’s growing back, he’s not cutting it. Today, Trey has daily oral chemotherapy medication and sees pediatric oncologist Andrea Dvorak, MD, and nurse Yvonne Dolce monthly at the Upstate Cancer Center. PHOTO BY ROBERT MESCAVAGE
summer 2018 l upstate.edu/cancer
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Baseball-loving former patient, family pitch in to comfort kids with cancer
MAKING A differenCe IN THE KNOW
BY JIM HOWE
IN A BASEBALL MOVIE, Jack and Jordan Sheridan’s story might sound something like this:
and as teams, through sending notes to children or visiting the hospital.
Pitcher goes on injured list, recovers and, together with energetic manager and support staff, helps and inspires his teammates.
Jack, 19, went through three years of chemotherapy for acute lymphoblastic leukemia (see box). He was diagnosed during the 2014 baseball season, when he was a 15-yearold student at Christian Brothers Academy, where he pitched for the varsity team and wore the number 16.
e pitcher is Jack, the manager is his sister Jordan, the support staff is their family and friends, and the teammates are any kids hospitalized with cancer. But this is no sports movie; it’s the real story behind On My Team16, a charity founded in 2017 by Jordan Sheridan of Fayetteville, with the support of family and friends, to help comfort pediatric cancer patients at the Upstate Golisano Children’s Hospital. e charity has an optional bonus for sports fans: You can make donations as if it were a fantasy sports league. On My Team16 will take any sports statistic you can think of and keep track of it for you to pledge, say, $10 for every home run hit by your favorite pro or college player. And athletes are encouraged to help, which they have done individually
Headaches, fatigue and fever led to tests, then to Golisano, where he started weekly, later monthly, chemo treatments that would last until September 2017, when he was declared cancer free. His tests since then have all been good, and “as of right now, I feel as close to normal as possible,” he said recently. His illness delayed his CBA graduation from 2016 to 2017, and he returned to the pitcher’s mound in 2018 as a freshman at Le Moyne College. He will likely miss the 2019 season, though, aer a baseball-related arm injury. His sister Jordan, 23, who pitched for her CBA and St. Lawrence University soball teams and now works in social media for a local company, was a driving force in setting up the charity to carry out Jack’s wish to help other young cancer patients. “When I was in high school, I did a program called Strike Out Hunger,” Jordan said. “Whenever I got a strikeout, we donated a certain amount of money to the Samaritan Center (a Syracuse soup kitchen), so for my whole life I’ve been involved in fundraising. “But then, once he was diagnosed, I kind of changed who I wanted to help and focused on pediatric oncology patients, because of so many people, organizations and families that helped us when he was first battling cancer,” she said.
Jack Sheridan, baseball pitcher and cancer survivor, who will be a sophomore at Le Moyne College this fall, is shown in his Christian Brothers Academy team colors. He is now a board member of On My Team16, a charity to help children hospitalized for cancer. PHOTOS BY ROBERT MESCAVAGE
“It’s nice to see what you can do as an athlete that’s more than just winning a game or performing. It’s nice to be able to give back,” she said. On My Team16 is a tax-exempt organization, and several friends and family members pitch in to help track finances, create spreadsheets to track the sports statistics, plan fundraisers and maintain the website. Jack and Jordan’s younger sister, Charlie, a soball pitcher at CBA, serves as the charity’s photographer and record keeper. e ambassador for the “patient care” side of things is Jack, “just because of the experience I’ve had. I can relate to the patients because it’s all stuff I’ve been through,” he said. continued on page 19
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MAKING A differenCe
Jack and his sister Jordan, the driving force behind setting up the charity he inspired. Their parents are Andy and Kim Sheridan of Fayetteville.
Baseball-loving Jack noted that he became friends with a pediatric cancer nurse at Golisano, Brian Langdon, during his treatment, and Langdon will sometimes help put him and Jordan in touch with a patient who could use a visit or pep talk, aer checking with the parents. Parents sometimes reach out directly to On My Team16 through its website, onmyteam16.com, or social media.
When Make-A-Wish Central New York asked Jack what he wished for, he wanted to give something back to his school. The result was this bullpen and batting cage, which debuted in 2016 at the CBA baseball field.
what kind of CanCer is that? continued from page 18
ALL is a fast-growing cancer that develops in lymphoblasts, which are immature forms of the white blood cells called lymphocytes found in the bone marrow. e cancerous cells can build up, crowding out normal cells, then spill into the bloodstream and spread to other parts of the body. If not treated, ALL would probably be fatal within a few months. Brian Langdon
“So that’s how most of the relationships start, and they just build from there,” Jack said. He told of one boy, now a young teenager, they followed through his whole cycle of treatment, who was presented a bat signed by his idol, former Yankee Derek Jeter, when he rang the bell signaling the successful end of his cancer treatment. Langdon, who has a grandson about Jack’s age, shared his love of baseball with Jack during his various hospital stays. “I saw him when he was very sick and when he laughed and things were good,” Langdon said. He praised On My Team16 for helping morale among the young patients and for getting athletes involved in their efforts. “Not all parents can stay there all day, so they are happy they (Jack and Jordan) can spend some time with their child,” he said. “ey’re wonderful, responsible young adults who are just trying to ease the burden of what goes on in a chronically ill child, Langdon said, and the patients are grateful for the gis. “ey’re totally mesmerized, they’re smiling from ear to ear, so happy … and the parents are also very happy because their child is having a good day.” Jack and Jordan are unsure of their career plans but said they would love to make a full-time job out of helping kids with cancer. ● summer 2018 l upstate.edu/cancer
Acute lymphoblastic leukemia, abbreviated as ALL and sometimes called acute lymphocytic leukemia, is the most common type of childhood leukemia.
e usual treatment is a varied course of chemotherapy that typically lasts two to three years. SOURCE: AMERICAN CANCER SOCIETY
LittLe gifts for LittLe patients
Examples of things offered by On My Team16 to young cancer patients: • a personal chat by Jack and/or Jordan with a newly diagnosed, and scared, child and family members. • a visit by a local or national On My Team16 wristbands sports figure, such as CiceroNorth Syracuse graduate Pat Corbin, now a pitcher for the Arizona Diamondbacks. • A pair of comfy, fuzzy socks for hospital wear, along with an inspirational message. • an iPad or a book. • little comforts like a ChapStick, a stress ball to squeeze or hand sanitizer. • tickets to a sporting event, which nurses distribute to the patients and their families. • a customized package, if they know a child’s sports team or other special interest. CANCER CARE
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750 East Adams Street l Syracuse, NY 13210
UPClose “YOU’VE GOT TO RESPECT the complexity of cancer,” Dario Marchetti, PhD, reminded researchers who gathered for his lecture at the Upstate Cancer Center recently. Marchetti is the director of the biomarker research program at the Institute for Academic Medicine at the Houston Methodist Research Institute. Upstate frequently hosts guest speakers.
18.2560818 39.67mcanfieldsk
Marchetti spoke about efforts to detect the presence of circulating tumor cells, known as CTCs. ese are cells that break off from a tumor and travel through the bloodstream. Most die in the blood, but some embed in tissues of distant organs, where they may form new tumors.
at’s what happens most oen in the case of brain cancer. Marchetti says just one in 10 cases arise from a tumor that originated in the brain. e rest are cancers that spread from other parts of the body. e Food and Drug Administration has approved one CTC test, CellSearch, which helps doctors monitor patients with metastatic breast, colorectal or prostate cancers by tracking the volume of CTCs in the blood. But it is not designed to find all CTCs. Other methods of isolating CTCs are in development. Researchers want to be able to analyze CTC DNA to identify tumor progression and potential drug targets. at would allow doctors to determine the most effective medications without subjecting the patient to a tissue biopsy. ●
Some scientists have said the search for CTCs is like looking for a needle in a haystack. One millimeter of blood contains a few million white blood cells, around a billion red blood cells, and – perhaps – one to 10 circulating tumor cells. ILLUSTRATION BY DAN CAMERON