care
CANCER
for anyone touched by cancer SUMMER 2017
Daughter, mother beat the odds page 8
Positive, but realistic page 4
Are you at risk to inherit cancer? page 11
How to improve blood draws page 10
A ‘truck’ that delivers drugs to tumors page 12
Brought to you by the
No more excuses
YOUR GUIDE
Free program improves access to mammograms What would it take for you to get screened for breast cancer? e Upstate Cancer Center has someone who will: l
schedule the mammogram appointment for you,
l
explain what to expect during the exam,
l
navigate any insurance requirements,
l
help arrange child or elder care,
l
set up transportation and
l
provide assistance with any follow-ups aer the initial appointment.
Her name is Liz Fuertes-Binder. She’s the screening navigator, and her services are offered without charge. “Mammograms save lives,” she said. “It is important that women get screened regularly, because breast cancer diagnosed early is most treatable.” e American College of Radiology says that since 1990 mammography has helped reduce breast cancer mortality by 40 percent. Upstate’s free community patient navigator program is paid for by the National Accreditation Program for Breast Centers’ Patient Navigator Project, which seeks to increase breast cancer screenings by 10 percent over the next five years. Reach Fuertes-Binder by calling 315-464-5267 or emailing fuertese@upstate.edu Liz Fuertes-Binder
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CANCER CARE
upstate.edu/cancer l summer 2017
INSIDE
4
6
15
12
11
Inside this issue CARING FOR PATIENTS
SEARCHING FOR CURES
Connecting women with mammograms page 2
A scientist keeps on “trucking”
A bladder cancer so rare only a handful of cases are reported each year page 4
LIVING WITH CANCER
A child with ALL rallies
page 6
Daughter, then mother develop lung cancer in the same spot
page 8
page 10
How to help blood draws go smoothly
page 10
Are you at risk for a hereditary cancer?
page 11
care
CANCER
for anyone touched by cancer
SUMMER 2017
CANCER CARE
UPSTATE CANCER CENTER
EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications
DIRECTOR (INTERIM) Jeffrey Bogart, MD
MANAGING EDITOR
Amber Smith 315-464-4822 or smithamb@upstate.edu
WRITERS DESIGNER
Jim Howe, Susan Keeter, Amber Smith 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 2017 l upstate.edu/cancer
How to hire a caregiver
page 14
Recipe: Broccoli, Garlic and Lemon Penne
page 14
MAKING A DIFFERENCE
SHARING EXPERTISE Smoking endangers more than lungs
page 12
DEPUTY DIRECTOR (INTERIM) Gennady Bratslavsky, MD ASSOCIATE DIRECTOR FOR CLINICAL AFFAIRS Ajeet Gajra, 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
Video project helps patients share life
page 15
Three-time survivor gives back
page 15
.
On the cover: Daughter-mother lung cancer survivors Amy Scullion and Darlene Barbato. See story, page 8. PHOTO BY SUSAN KAHN
care
CANC ER
for anyone
touched
by cancer
SUMMER
2017
Daughter, mother beat the odds page 8
Positiv but realist e, ic page 4
Are you
at risk to inherit cancer ? page 11
How to improv blood drawse page 10
A ‘truck’ that deliver s drugs to tumor s page 12
Videos Brought
share lives page 15
to you by
the
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. The Cancer Center is located at 750 E. Adams St., Syracuse, NY 13210.
ASSOCIATE ADMINISTRATOR Richard J. Kilburg, MBA
CANCER CARE
3
CARING FOR PATIENTS
First chemo... then vacation Margit Foti, who is being treated for bladder cancer, on the last day of her 24-week chemotherapy regime. PHOTO BY SUSAN KAHN
BY SUSAN KEETER
“I AM SO SORRY you have to give me this bad news,” Margit Foti, 71, remembers telling her urologist, Elizabeth Ferry, MD, on the day Foti learned that she had a rare bladder cancer with a poor prognosis. “I could see the upset in her face,” explains Foti. Her symptoms began late last summer, when Foti was traveling on a dream-come-true vacation in Hungary, her childhood home. During the trip, she developed pelvic discomfort that she suspected was caused by a urinary tract infection. When Foti returned home in September, her primary care physician prescribed an antibiotic to treat what they agreed was likely an infection.
stones, they controlled her pain, alerted Foti’s primary care physician and referred her to Ferry in urology. Within a week, Foti’s condition had deteriorated to the point that she needed diapers. Ferry scheduled a CT scan of Foti’s abdomen and pelvis. en, Ferry performed a cystoscopy, a procedure in which a lighted tube is inserted into the urethra to examine the inside of the bladder. e cystoscopy revealed a large tumor, and Foti was taken to surgery for removal. Surgical pathology identified signet ring cell adenocarcinoma, a type of bladder cancer so rare that just a handful of cases are reported each year, worldwide.
Two days aer that appointment, Foti was plagued by a constant need to urinate and was in such pain that she could not sit or lie down. Her son-in-law, a nurse, insisted that she go to the emergency department at Upstate’s Community campus.
Upstate’s urology team met to discuss Foti’s case. e urologists sought opinions from colleagues nationwide. Because the condition is so uncommon, there is no protocol for treatment.
rough imaging, doctors saw swelling in Foti’s kidneys and increased thickness in her bladder. Suspecting kidney
Urologist Oleg Shapiro, MD, assisted by Ferry, performed surgery on Foti. e plan was to remove the cancer from continued on page 5
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CARING FOR PATIENTS
WHAT IS SIGNET RING CELL ADENOCARCINOMA?
Margit Foti’s team includes (top row from left) medical oncologists Muhammad Naqvi, MD, and Sam Benjamin, MD; urologists Elizabeth Ferry, MD, Oleg Shapiro, MD, and (second row from left) Gennady Bratslavsky, MD; interventional radiologists Katsuhiro Kobayashi, MD, and Mitchell Karmel, MD; and Kaushal Nanavati, MD, medical director of integrative therapy.
First chemo
continued from page 4
the bladder, but they found it had spread outside Foti’s bladder and into her abdomen, prohibiting removal.
Signet ring cells are glandular cells found in the tissue that lines certain internal organs and makes and releases mucus, digestive juices or other fluids. Adenocarcinoma is a cancer that begins in those glandular cells. Signet ring cell carcinomas are found most oen in the stomach lining, but also develop in the bladder and other organs. e cancerous cells are called “signet ring” because their shape is similar to monogrammed rings of the same name. SOURCE: NATIONAL CANCER INSTITUTE, CANCER RESEARCH UK
e next day, interventional radiologists implanted tubing through Foti’s skin into her kidneys to remove urine. Cancer was blocking drainage into her bladder. Upstate’s genitourinary multidisciplinary team — including medical oncologist Muhammad Naqvi, MD — recommended six months of chemotherapy with daylong treatments every two weeks. Foti responded well to the chemotherapy and was relieved that the treatments could be done on an outpatient basis. Aer three months, the chemotherapy had shrunk the cancer enough that the tubes in her kidneys could be removed, and Foti’s bladder function gradually returned to normal. roughout diagnosis and treatment, Foti has stayed busy, learning everything she can about her disease and looking forward to the possibility that new treatments may be available any day. She exercises regularly and attends a cancer survivors program at the YMCA that Foti describes as “a support group with giggles.” She follows a “clean” diet, as recommended by Kaushal Nanavati, MD. at is, she eats mostly unprocessed, whole foods, including vegetables, fruit, whole grains and lean meats with no artificial ingredients or preservatives. rough her research, Foti connected with a Long Island police officer and a woman living in England who had the same type of cancer but who have since died. Foti accepts that her future is somewhat beyond her control but firmly believes that she and her medical team are doing everything possible to battle her cancer. “I especially like Dr. Naqvi. His eyes smile when he talks,” Foti explains. “He is very positive but realistic. He makes no promises but never gives up. ere is always something he is ready to try to help me with.” What’s in her immediate future? With chemotherapy treatments finished, and the cautious assumption that the cancer is in remission for now, Foti is making plans. With her doctors’ OK, she took a trip to New York City to visit friends, then packed her bags for a vacation with her two daughters and four grandchildren. “Someday, my daughters will scatter my ashes over Jones Beach on Long Island,” Foti winks. “But first, we’re enjoying Myrtle Beach together!” ●
summer 2017 l upstate.edu/cancer
Margit Foti with oncologist Muhammad Naqvi, MD, at the Upstate Cancer Center. PHOTO BY SUSAN KAHN
Margi Foti shared her story with the Upstate Foundation. To share your story, email FND@upstate.edu To donate to the Friends of Upstate Cancer Center, visit upstatefoundation.org or call 315-464-4416.
CANCER CARE
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CARING FOR PATIENTS
Care that evolves
Youngster with ALL graduates to monthly checkups BY AMBER SMITH
DURING THE ENTIRE TIME from when their toddler was diagnosed with acute lymphoblastic leukemia, to his stay at the Upstate Golisano Children’s Hospital, and through his nine months of chemotherapy, Christina and omas Trottier never used the word “cancer.” So three years later, their son surprised his parents when he greeted a new baby sitter. “I had cancer,” Greyson Trottier announced. “He understands way more than he lets on,” says his mother, Christina Trottier of Watertown. Greyson, now 5, was diagnosed in January 2014, when he was 21 months old. He had fallen at day care, leaving a bruise on his head. In examining him that aernoon, Greyson’s pediatrician noticed additional bruises on his legs. Blood test results came back about 5:30 p.m. Suddenly the Trottiers were scrambling to find people to watch Greyson’s twin, Jameson, and older brother, McKennon. Four hours later, Christina and omas Trottier
checked Greyson into the children’s hospital in Syracuse. “e doctor who checked us in kept saying he didn’t look like a cancer kid. He was going like the Energizer bunny,” Christina Trottier recalls. “He didn’t have a lack of appetite, or coughing or fevers. He didn’t have any of the symptoms.” But the next day, a bone marrow biopsy confirmed the blood test results. Greyson was hospitalized for a week, receiving the first of his chemotherapy treatments. “It was pretty intense,” Trottier says, recalling the infections, the seizures and the spinal taps that happened during the months he was on chemotherapy. Greyson saw neurologists, cardiologists and oncologists at Upstate, plus eye doctors and dentists closer to his Watertown home. He bonded most tightly with nurse Yvonne Dolce. She has twin daughters. continued on page 7
Greyson Trottier proudly wears his cancer survivor’s T-shirt. PHOTO BY WILLIAM MUELLER
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CANCER CARE
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CARING FOR PATIENTS
UPSTATE’S
HealthLink on Air Radio Show Podcast On Demand
89.9 & 90.3 FM WRVO.ORG Above: Nurse Yvonne Dolce pricks Greyson’s finger to get a blood sample while he is absorbed in an electronic game, thanks to child life specialist, Sarah Buck. Below right: Pediatric oncologist Andrea Dvorak, MD, checks Greyson’s heart rate and lung function during the same checkup in May. PHOTOS BY WILLIAM MUELLER
Intense treatment continued from page 6
Trottier calls her a saint. “She is a constant calm in the storm. We would be lost without her.” Greyson completed chemotherapy in March. A few months later, he finished pre-kindergarten. e specter of cancer remains. Anytime he gets a bruise, his mother worries. ese months aer cancer treatment are nerve-wracking for the family. Greyson sees Dolce and pediatric oncologist Andrea Dvorak, MD, every month for a checkup. “ey love him,” Trottier says, “and he loves them.” ●
Produced by Upstate Medical University, HealthLink on Air explores health and medical issues of interest to Central New Yorkers.
Now airing on Sundays on WRVO at 6 a.m. & 9 p.m.
ABOUT ACUTE LYMPHOBLASTIC LEUKEMIA
Acute lymphoblastic leukemia (also known as ALL or acute lymphocytic leukemia) is a type of cancer in which the bone marrow makes too many immature lymphocytes, a type of white blood cell. ● Signs of ALL include fever and bruising. ● Tests that examine the blood and bone marrow are used to diagnose ALL. ● Red blood cells, white blood cells and platelets may be affected. ● ALL typically gets worse quickly if it is not treated.
Listen anytime: HEALTHLiNKONAir.OrG or iTunes (search podcasts for “HealthLink”)
● Treatment options and prognosis depend on several factors, including age at diagnosis. SOURCE: NATIONAL CANCER INSTITUTE
summer 2017 l upstate.edu/cancer
CANCER CARE
7
Daughter, then mother, survive lung cancer
CARING FOR PATIENTS
BY AMBER SMITH
BOTH MOTHER AND DAUGHTER were diagnosed with lung nodules that turned out to be cancerous, almost by accident. ey underwent the same types of tests, and then the same type of surgery followed by chemotherapy. Darlene Barbato of North Syracuse was there for her daughter, Amy Scullion, when she was sick. And then Scullion, who lives in Clay, was there for her six years later when she went through the same health crisis. Both daughter and mother faced lung cancer, in the same lung, at the same stage of advancement.
Scullion was diagnosed in September 2008, when she was 36. She had just started her master’s program to become a nurse practitioner through Upstate Medical University’s College of Nursing. She remembers having a bad day. When she got home, she noticed a red streak on her leg. She went to an urgent care center and was diagnosed with phlebitis, an inflammation of a vein. While she was there, she was asked if she was having chest pain. Scullion answered “yes, and you would too if you had the day that I did.” at affirmative answer is why she was sent for a chest X-ray and to follow up with her primary care provider. continued on page 9
Amy Scullion, a graduate of Upstate’s College of Nursing, shares a laugh with her mother, Darlene Barbato. Both are longtime lung cancer survivors. PHOTO BY SUSAN KAHN
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CARING FOR PATIENTS
Daughter, then mother
continued from page 8
Even though she felt better, Scullion kept that appointment with her primary care doctor. It’s good that she did. When the X-ray results arrived, she and the doctor were both surprised. A nodule was in the le lobe of her lung. It appeared small. Scullion went for more imaging tests, including computerized tomography and positron emission tomography (CT and PETscans). She chose a lung surgeon at Upstate, Elizabeth Dexter, MD, who offered video-assisted thoracotomy. Instead of cutting open Scullion’s chest, Dexter would make four 1-inch incisions and remove the upper le lobe, containing the nodule, through one of the holes. Pathology tests showed that the tumor was more advanced than Scullion had hoped. It was stage 3a, meaning the cancer had spread, in her case into the aortic pulmonary lymph node. She had to undergo chemotherapy, which was four treatments spread over three months, “the hardest three months of my life.” Darlene Barbato, a hair stylist, had problems with her neck. In April 2014, at age 58, she had a neurostimulator implanted. A week later, she began wheezing. So her doctor sent her for a chest X-ray. Just like with Scullion, the X-ray revealed a nodule in the upper le lobe of her lung. “It was kind of hard to wrap your head around,” she says. Scullion said reading her mother’s medical records was like reading hers: Both had non-small cell adenocarcinoma, the most common type of lung cancer. It was the end of July 2014 when Barbato had her upper le lobe removed. She traveled to Rochester, where the surgeon, Dexter, had since relocated. Her cancer was also a stage 3a, so she had chemotherapy aerward, just as Scullion had. So far, both daughter and mother have recovered well. Says Scullion, “We both had God’s hand taking care of us.” Scullion continued with her studies throughout her cancer treatment. When she could not be in class, a classmate would video conference her into the lectures, so she would not fall behind. Today she is a nurse practitioner working in geriatrics. She says the cancer experience has made her a better health care provider. She believes she’s more compassionate, especially when it comes to sharing news that isn’t good.
summer 2017 l upstate.edu/cancer
“It’s a different level of empathy I have now, from knowing what it’s like to be on the other side.” One lesson she likes to share from her experience: If you have a test done, make sure to get the results. It sounds simplistic, but Scullion realizes that the results of her X-ray could have fallen through the cracks. She could have canceled that follow-up appointment, but she kept it. Her doctor could have focused only on the phlebitis, but she noticed in the urgent care notes about the X-ray. Instead, they both waited for the X-ray report to be retrieved. And because of that, Scullion’s lung cancer was treated before symptoms became apparent. ●
BEATING THE ODDS Lung cancer is the leading cause of cancer death, killing more people each year than colorectal, breast and prostate cancers combined. e incidence of Amy Scullion and Darlene Barbato’s diagnoses are unusual in a couple of ways: 1. ey were young. Scullion was 36 and Barbato 58 when they were diagnosed. Lung cancer is most frequently diagnosed among people aged 65 to 74. 2. ey have survived. Scullion was diagnosed in 2008 and Barbato in 2014. Fewer than 20 percent of lung cancer patients live five years or more, according to the American Cancer Society. “Because survival statistics are based on large groups of people, they cannot be used to predict exactly what will happen to an individual patient. No two patients are entirely alike, and treatment and responses to treatment can vary greatly,” the society says on its website.
CANCER CARE
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You know smoking causes lung cancer.
How patients can improve blood draws
SHARING EXPERTISE
Do you know what other diseases tobacco causes? IF YOU OR SOMEONE YOU LOVE SMOKES, lung cancer is not your only health concern. Regular tobacco and electronic cigarette smokers increase their risk of heart and vascular diseases, including stroke, and lung diseases, including emphysema — plus a variety of cancers. “Smoking has an effect on all the organ systems in the body,” explains Leslie Kohman, MD, professor of surgery and director of outreach for the Upstate Cancer Center. “Smoke that’s inhaled through the lungs is delivered to the bloodstream.” Even people who use smokeless tobacco expose their bodies to nicotine and at least 30 additional chemicals that are known to cause various cancers, including these 12: l Mouth and throat l Pancreas l Voice box, or larynx
l Liver
l Esophagus
l Urinary bladder
l Lung, bronchus
l Uterine cervix
(bronchial tube) and trachea l Stomach l Kidney
l Colon and rectum l Acute myeloid leukemia,
a cancer that starts in bone marrow
FOR HELP QUITTING SMOKING:
Call the New York State Smokers Quitline at 866-697-8487 for cessation counseling and nicotine replacement. Consider free smoking cessation classes from Upstate’s Quit and Stay Quit Cessation Program at 315-464-8668.
NURSES AND PHLEBOTOMISTS — the people who draw blood and start intravenous lines — perform multiple “venipunctures” each day, inserting needles through skin and into veins to draw blood, or start intravenous lines. Patients typically feel a slight sting when the needle is inserted.
Nurse Cecelia Jones prepares to draw blood. PHOTO BY SUSAN KAHN
Relaxing may be more easily advised than accomplished, but patients can do a few things to help the procedure go smoothly. Some advice: 1. Your blood will flow better if you are well hydrated, so drink plenty of water starting a couple of days before your procedure. 2. Eating well the day before can help improve blood flow. If you are told to fast before your blood work, do not eat or drink anything in the eight hours leading up to your test. Also, no strenuous exercise and no tobacco products during that time. Patients should check with their health care provider about all prescription and nonprescription medications. 3. Taking a walk before you go for your procedure can raise your blood pressure, making your veins more prominent. is is not advised if you are fasting. 4. Moisturizing the skin from your hand to your elbow at least four times a day in the days leading up to your procedure can help lessen the pain from the puncture. If you remain sensitive to the pain, ask if a numbing cream can be used. 5. Body warmth increases your blood circulation, making it easier for the phlebotomist to find a vein. So while you are waiting, keep your coat or sweater on. Warming your hands under a heating pad may help, if your blood is difficult to draw. 6. Bring music or something to read to help distract yourself if you feel anxious. Look away if you can’t bear the sight of blood. 7. If you think you might faint, ask the phlebotomist if you can lie down while he or she draws your blood. 8. If you will require frequent blood draws, and you have veins that pose a challenge for phlebotomists, inquire whether a catheter or port is a possibility. ● SOURCE: UPSTATE CLINICAL PATHOLOGY DEPARTMENT
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SHARING EXPERTISE
What you need to know about hereditary cancers UP TO 10 PERCENT of cancers result from a genetic mutation that is inherited from a parent. Since half of our genes come from our mother and half from our father, the cancer history from each side of our families is equally important. Gloria Morris, MD, PhD, explains that while some chromosomal conditions appear only in children who receive two copies from both parents, “the genetic components of cancer mutations can be so strong that it only takes one copy from one parent to actually raise the risk of cancer in an adult child.” Morris is an Upstate cancer doctor who specializes in genetics. She can tell whether someone is at an increased risk for developing certain types of cancers, based on his or her personal and family history of cancer (see “7 red flags” at right) and a blood or saliva test. SHOULD YOU SEEK ANSWERS?
Cancers that are most oen hereditary include some types of breast, ovarian, kidney and colon cancers. Having one of these particular cancers in your family may raise your risk for other types of cancers. “We want to make sure that the adult we are testing is really able to grasp the ramifications of what a positive result might mean for them,” she says. “e more that we’ve learned about these genes, the more we can appreciate how even a mutation in a certain location of a breast cancer gene might also have the potential to cause an increased risk of ovarian cancer or other cancers over one’s lifetime. “So we actually have to keep in mind the genetics of not only specific types of tumors but also where else they might overlap and show up in the family,” Morris says. ● SHOULD YOU SEEK GENETIC TESTING?
Maybe, if: l you have a personal or family history that suggests an
7 RED FLAGS Features of your personal or family medical history that, particularly in combination, may suggest a hereditary cancer syndrome include: l cancer diagnosed at an unusually young age
(under age 50.) l several close blood relatives that have the same
type of cancer; for example, a mother, daughter and sisters with breast cancer. l unusual cases of a specific cancer type,
such as breast cancer in a man. l several different types of cancer
that have occurred independently in the same person. l cancer that has developed in
both organs in a set of paired organs, such as both kidneys or both breasts. l the presence of certain
Gloria Morris, MD, PhD
birth defects known to be associated with inherited cancer syndromes. l being a member of certain
racial or ethnic groups known to have an increased risk of certain hereditary cancer syndromes. SOURCE: NATIONAL CANCER INSTITUTE
HOW TO MAKE AN APPOINTMENT People 21 and older can seek cancer risk assessment through the Upstate Cancer Center. Call 315-464-3510 for appointments.
inherited cancer risk, (see “7 red flags”), or if your maternal and/or paternal history is unknown, l the test results will be able to tell whether a specific
genetic change is present or absent, l the results will provide information that can help guide
your future medical care, and l you have spoken with a doctor, nurse, genetic counselor
or other professional trained in genetics, so you understand the risks, benefits and limitations of testing. You may learn that testing is not needed. SOURCE: NATIONAL CANCER INSTITUTE summer 2017 l upstate.edu/cancer
CANCER CARE
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Tandem treatment
SEARCHING FOR CURES
Polymer ‘truck’ penetrates tumor, kills ovarian cancer cells
ovary
ovary
fallopian tube
fallopian tube uterus
BY AMBER SMITH
Used separately, such high concentrations of doxorubicin are required in order to achieve the antitumor effects, which exposes the heart to toxic levels of the drug molecules. Doctors oen warn patients not to take vitamin B2 if they are taking doxorubicin because the vitamin can weaken the drug.
THE OVARIAN CANCER DRUG doxorubicin can be toxic to the heart. Giving a woman enough of the drug to be effective against her cancer may be too much to be safe for her heart. Scientists at Upstate Medical University are pairing doxorubicin with regular vitamin B2 in a new nanoformulation to treat ovarian cancer – with encouraging results that are gentle on the heart.
Juntao Luo, PhD
“We were able to demonstrate significantly inhibited tumor growth and prolonged survival,” Juntao Luo, PhD, says in describing his research in the journal Biomaterials. Luo is an assistant professor of pharmacology whose research focuses on the use of nanocarriers for drug delivery. A key piece of the success of the doxorubicin-vitamin B2 project is the creation of what is known in scientific terms as a “well-defined linear-dendritic telodendrimer nanoplatform.” It’s known colloquially as a truck — a teeny-tiny truck made of a polymer.
When doxorubicin and vitamin B2 are paired on the drug-carrying truck, however, they have what scientists call “synergy,” working more favorably to kill cancer cells together than either could alone.
rinki Agarwal, MD
e presence of vitamin B2 helps keep the doxorubicin molecules bound together on the polymer truck, minimizing the impact on the heart as it travels through the bloodstream en route to the tumor. Another form of doxorubicin used to treat ovarian cancer is Doxil, a medication that is incorporated into another style of truck, made of lipids. Doxil reduces heart toxicity, but its truck structure is too large to effectively penetrate the tumor, Luo describes. continued on page 13
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SEARCHING FOR CURES
OUR GRADS HAVE GREAT CAREERS… BUT FIRST THEY GET GREAT EDUCATIONS. in this hairpin binding model of VB2-DOX, doxorubicin is represented by spheres and vitamin B2 is indicated by interlocking sticks.
Tandem
FROM THE LAB OF JUNTAO LUO, PHD
continued from page 12
e blood vessel leading to the tumor has an opening that is comparatively wide. Luo’s truck is small enough to travel deep into the tumor, delivering the drug where it can be most effective. is allows more cancer cells to be killed than by Doxil or by plain doxorubicin without Luo’s polymer truck. Aer its work is done, the truck exits the body undetected through the urine. “e nanoparticle reaches the tumor site easier and releases the drug, with minimal effects on the heart,” Luo describes. “Our formation inhibits tumor growth much more efficiently.” is summer, Luo is working with gynecologic oncologist Rinki Agarwal, MD, to establish protocols for collecting samples of ovarian tumors from Central New York women. e samples would provide the next step toward testing this new treatment strategy. e scientists believe that testing this novel formulation directly on patientderived samples will bring them a lot closer to bringing it to clinical trials.●
Upstate students benefit from nationally recognized professors, excellent job placement and SUNY tuition. Open houses are held each fall and spring. DEGREE PROGRAMS Biomedical Sciences (MS, PhD) Cardiovascular Perfusion (MS) Medical Biotechnology (BS) Medical Imaging (BS, BPS) Medical Technology (BS, MS) Medicine (MD, MD/PhD, MD/MPH) Nursing (BS, MS, DNP, post-master’s certificate) Public Health (MPH) Physician Assistant (MS) Physical Therapy (DPT) Radiation Therapy (BS, BPS) Respiratory Therapy (BS)
l
l
Education Health Care Research
www.upstate.edu/students PHOTOS BY ROBERT MESCAVAGE
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CANCER CARE
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IMPROVING LIFE
So you’re looking to hire a caregiver
YOU’VE POSTED AN AD, received responses and invited your top candidates to interview for the position of caring for you at home. What should you ask of them? •
How long have you been doing this kind of work?
•
Why do you like this kind of work?
•
What do you like best about caregiving?
•
What do you like least about caregiving?
•
With whom have you worked? Can you describe your experiences?
•
May I contact your references? (Checking references is a must.)
•
What specific tasks have you performed/can you perform?
•
What tasks are you unwilling to do?
•
Do you have transportation to get to and from work and to take me to doctor appointments and/or therapy?
•
How would you cover your shi if you were ill?
•
What would you do in case of emergency?
“Remember, when you hire a caregiver, you’re inviting someone into your home to be with you many hours a day. You have to like that person and feel comfortable with him or her. Your personalities need to jibe. If you are quiet and don’t like to talk much, don’t hire a chatterbox. If you like to discuss the news, hire someone who is also engaged in current events. “Monitor your caregiver’s performance, and if you’re not satisfied, cut ties and hire someone else,” says Steven Z. Pantilat, MD, director of the Palliative Care Leadership Center at the University of California, San Francisco, in his book, “Life Aer the Diagnosis: Expert Advice on Living Well With Serious Illness for Patients and Caregivers.” ●
RECIPE
Broccoli, Garlic and Lemon Penne Ingredients 1/2 pound penne pasta 5 cups fresh broccoli florets or 1 12-ounce bag frozen broccoli florets 1/4 cup extra-virgin olive oil 10 garlic cloves, thinly sliced
Preparation
1/2 cup reduced-sodium chicken broth Grated zest of 1 lemon Salt and freshly ground black pepper 1/4 cup freshly grated Parmesan cheese
1. Prepare penne according to package directions for al dente (just firm). Two to three minutes before penne is ready, add broccoli. Finish cooking, drain and set aside. 2. Meanwhile, in a large skillet over medium-high heat, add oil. Sauté the garlic for 1 to 2 minutes, or until aromatic and beginning to color. 3. Add broth and bring to a boil for 3 to 5 minutes, or until reduced by half, stirring frequently. Add pasta, broccoli and lemon zest and cook until coated with sauce. Season generously with salt and pepper. Transfer to serving bowl and top with cheese. Serves 4. Tips: For quicker prep, buy bagged broccoli florets. For more cheese flavor and fewer calories, grate your own Parmesan cheese with a Microplane grater, a small-holed handheld grater. It produces a finer shred, so you get more coverage with less cheese. SOURCES: THE AMERICAN CANCER SOCIETY WEBSITE, CANCER.ORG, AND “THE GREAT AMERICAN EAT-RIGHT COOKBOOK”
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Nutritional information Serves 4. One serving contains: 395 calories 17 grams total fat 5 milligrams cholesterol 135 milligrams sodium 50 grams carbohydrates 5 grams dietary fiber 4 grams sugar 13 grams protein
upstate.edu/cancer l summer 2017
MAKING A DIFFERENCE
Palliative care patients leave lasting memories in ‘Sharing Life’ videos BY JIM HOWE
AFTER A PERSON IS GONE, it can be comforting for loved ones to hear their voice or see their face again. “It would be so awesome to capture that and to be able to leave messages for the future,” thought Chevelle JonesMoore, a social worker at the Upstate Cancer Center. is spring, that thought led her to begin making videos of patients on the center’s outpatient palliative care service. ese videos offer patients the chance to talk about their lives and leave messages for loved ones. e video can include a person’s photographs, trinkets and favorite music. Called “Sharing Life,” this service is offered free to patients when a cure is not an option and who are near the end of life.
e video is then given to the patient or patient’s family on a DVD. e patient must give written permission, and if he or she wishes to share the video for teaching or other purposes, a copy will be kept on file. e palliative care team also hopes to Chevelle Jones-Moore offer “Sharing Life” to people earlier in their illness, as an extra level of support, says Linda Troia, a nurse practitioner with the team. “e one thing that I’ve noticed so far in each one of our patients is that they are actually saying, ‘You know, I’m so glad I had this chance to do this video. ank you,’ ” Jones-Moore says.●
Three-time cancer survivor gratefully gives back
BY BETHANN KISTNER
MADELINE RUBENSTEIN made a gi to the Upstate Foundation in support of the Upstate Cancer Center. “I know firsthand how important up-to-date cancer research and treatments are. ese are the things that have saved me from three different cancers in 14 years.” Rubenstein first received the devastating cancer diagnosis in 2003. She had colon cancer surgery but cancer returned in 2009 — this time in the form of breast cancer. She became a patient of oncologist Sheila Lemke, MD. “I cannot say enough about Dr. Lemke and how good she was to me,” Rubenstein recalled. “She and her clinical care team gave me personalized attention.” Under Lemke’s care, Rubenstein emerged a breast cancer survivor. But the disease continued to follow Rubenstein and, in 2015, she was diagnosed with esophageal cancer. Aer her surgery, she was referred to the Upstate Cancer Center for follow-up chemotherapy and radiation treatments, administered under the direction of Ajeet Gajra, MD, and Jeffrey Bogart, MD, interim director of the Upstate Cancer Center. summer 2017 l upstate.edu/cancer
Rubenstein was delighted to discover that the new center, which opened in 2014, was welcoming and bright, and thrilled to find many of the clinical staff who had taken care of her previously were still on “her team.” “ey took such good care of me, just as they had before, Madeline rubenstein and with efficiency and kindness,” her husband she noted. Rubenstein added that her cancer doctors are highly regarded specialists and much in demand. “ey were kind and took time with me as a patient. at is very important. My cancer is under control now and I am on a six-month check-up schedule with them. I am very grateful for their care.” 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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Kaelem, 12, and Elodie, 5, Michel of Fayetteville played soothing classical music at the Upstate Cancer Center for the enjoyment of patients and families, including their grandfather (pictured). Musicians can apply to perform at the center by contacting Matthew Capogreco at capogrem@upstate.edu or 315-464-3605 for an application and guidelines. PHOTO BY SUSAN KAHN