Cancer Care magazine, Spring 2019

care

CANCER

for anyone touched by cancer Baffled by a pathology report? page 7

Careers guided by love page 8

Reconstructing a face page 12

Seniors with breast cancer can live longer page 15

Surprising risk factors page 18 Summer camps page 22

A nurse becomes a patient page 4 Brought to you by the

Spring 2019

YOUR G UI DE

Ask her for help Librarian enjoys finding answers for patients, the public Some people have questions about a diagnosis or treatment. Others are researching drug interactions. And others seek healthy recipes. Librarian Sarah Lawler strives to help everyone through the “Librarian on Call” service.

She is stationed in the Family Resource Center on the first floor of the Upstate Cancer Center for hours on Tuesdays, Wednesdays and Thursdays. She also responds to email at lawlersa@upstate.edu and phone calls at 315-464-7192.

“I am able to provide information on many types of health questions, not just questions related to cancer,” she says. The service is meant to help patients and visitors locate trustworthy, current, evidence-based health information. A similar service is offered in the Upstate Golisano Children’s Hospital Family Resource Center.

Lawler is a senior assistant librarian in Upstate Medical University’s Health Sciences Library, which supports the academic, research and clinical activities of the university.

Librarian Sarah Lawler with free books that are available at the Upstate Cancer Center. The Family Resource Center has computers so that Lawler can assist staff, patients and family members with online searches.

PHOTO BY RICHARD WHELSKY

Upstate Cancer Center librarian’s hours:

Tuesdays, 10 a.m. to noon Wednesdays, 1 to 3 p.m.

Thursdays, 2 to 4 p.m.

EXPERTS FOR KIDS Upstate is the only children’s hospital for 700,000 families from Pennsylvania to Canada and the only nationally veri ed pediatric trauma center in New York state.

SYRACUSE, NY 1 800 464 8668 WWW.UPSTATE.EDU/GCH

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SPECIALTY SERVICES JUST FOR KIDS

PEDIATRIC EMERGENCY & URGENT CARE

• Ear, Nose & Throat • Gastrointestinal Services • Center for Development, Behavior & Genetics • Joslin Center’s Pediatric Endocrinology & Diabetes • Margaret L. Williams Developmental Evaluation Center • Orthopedics • Pietrafesa Center for Children’s Surgery • Sleep Center • Urology • Waters Center for Children’s Cancer & Blood Disorders

Pediatric Emergency Department Downtown Campus 750 E. Adams St., Syracuse Open 24/7 Upstate Golisano After Hours Care Community Campus 4900 Broad Road, Syracuse Hours: Mon. through Fri: 4 to 10 p.m.; Sat. and Sun: Noon to 10 p.m.

...and more

care C O N T E N T S CANCER

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. It is located at 750 E. Adams St., Syracuse, NY 13210.

ON THE COVER

Upstate’s chief nursing officer, Nancy Page, was treated for breast cancer.

Marine battles thyroid cancer

CARING FOR PATIENTS

Surgery + radiation = breast cancer treatment page 4

Are you baffled by your pathology report? page 7

SHARING EXPERTISE

A way for seniors with breast cancer to live longer page 15

CANCER CARE

WRITERS DESIGNER

Amber Smith 315-464-4822 or smithamb@upstate.edu

Jim Howe Darryl Geddes Charles McChesney Amber Smith

LIVING WITH CANCER

6 surprising risk factors page 18 Easy summer lasagna

page 19

Advice from a mom on parenting a child with cancer page 20 Investigating how cancer spreads page 16

PHOTO BY SUSAN KAHN

MANAGING EDITOR

Seeking to prevent fractures back cover

page 6

MAKING A DIFFERENCE

See story, page 4.

EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications

Spring 2019

How a surgeon reconstructs a face

A 5-year-old gives back

Overnight camps for kids touched by cancer

page 21 page 22

page 12

Susan Keeter

UPSTATE CANCER CENTER DIRECTOR (INTERIM)

Jeffrey Bogart, MD

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 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 315-4644836. Cancer Care offices are located at 250 Harrison St., Syracuse, NY 13202.

Drawn to careers in cancer care by personal experiences page 8

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CARING FOR PATIENTS

New combination treatment How surgeons and radiation oncologists are treating breast cancer together – and how a vigilant nurse became a patient aer an abnormal mammogram

BY AMBER SMITH

I

Chief nursing officer Nancy Page says, “I always think about, for myself and my family, where is the best care?”

When she was diagnosed with breast cancer, her answer was Upstate.

n her role as chief nursing officer at Upstate

University Hospital, Nancy Page is part of the

leadership team that reviews major hospital

purchases. In 2017, they gave the go-ahead for

intra operative radiation therapy equipment, which

would allow a surgeon and a radiation oncologist to simultaneously treat breast cancer.

“When we vetted the equipment, I could see that this would allow a woman with a particular type of breast cancer to have her surgery and radiation all in one day, so she would not be returning for 15 successive treatments,” Page recalls. She could see where offering it at Upstate would boost patient quality of life. “It just seemed like a very wise investment.”

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PHOTO BY SUSAN KAHN

She had no way of knowing that several months later, she would need the treatment. Page, 59, was diagnosed with early-stage breast cancer after a routine mammogram in July 2018.

Mammograms matter

Page dutifully went for her annual mammogram since she was 40. She had no lumps or drainage.

She was not at high risk for breast cancer. Some older relatives had different cancers, but Page did not have what doctors would consider a family history of breast cancer.

So when she got a phone call asking her to return for a biopsy, her mind raced.

Continued on page 5

CARI NG FOR PATI ENTS

BREAST CANCER TEAM OF DOCTORS: The doctors who cared for Nancy Page during her breast cancer care, from left: Katherine Willer, DO, is the radiologist who performed the biopsy. Lisa Lai, MD, is the breast surgeon. Anna Shapiro, MD, is the radiation oncologist. Abi Siva, MD, is the medical oncologist. Gloria Morris, MD, PhD, is the genetic counselor. “Knowing that my treatment team understood the possible cosmetic effects of surgery was hugely comforting,” Page says.

Combining treatment

continued from page 4

Her case “really underscores the importance of preventive health care,” she says.

Page’s diagnosis was “ductal carcinoma in situ,” which was cancer in the milk ducts that has not spread. Her nursing background is helpful for understanding medical terms and procedures and making sense of medical journal articles. But it can also provide a lengthy list of worst-case scenarios and things that could go wrong.

After her biopsy, she and her husband prepared for what they knew would be a three- or four-hour appointment at the Upstate Cancer Center. “We were able to talk to the breast surgeon, the radiation oncologist, the medical oncologist, and then we also spoke with a geneticist.

“In one visit we were able to go from one to the other to the other. The entire team had talked about my case before each of them came in, which I thought was really beneficial. They already had discussed the possible approaches.”

Choosing the best option Page had three options:

1.Surgery to remove the lump, recovery, and three weeks of daily radiation treatments.

2.Intra operative radiation therapy (IORT). A surgeon removes the lump and a radiation oncologist administers a focused dose of radiation in the space where the cancer had been.

3.Participation in a clinical trial. Half of the women in the trial are treated with surgery or radiation or both, plus an annual mammogram; and the other half opt for close monitoring and mammograms twice a year.

“What they don’t know about this type of breast cancer is: If they just let it sit, does it just sit?” Page explains. “Does it not grow? Does it not become invasive? Do women not need surgery? Do they need surgery, but do they not need radiation?”

Patient Advice Chief nursing officer Nancy Page’s advice for someone facing a breast cancer diagnosis:

Resist the urge to act immediately.

Seek trustworthy information.

Prepare questions to ask the doctors.

Get your care where you feel comfortable.

She considered the trial, “but I just couldn’t do it,” she says. “All I could think is, what if I’m the woman whose cancer isn’t going to chill out?”

Having the surgery and radiation in one procedure made the most sense for Page.

One day surgery/radiation

The IORT procedure is straightforward.

Page registered early that morning, receiving a name bracelet just like any other patient at the Community Campus of Upstate University Hospital.

A nurse started an intravenous line, and then Page went to Upstate’s Wellspring Breast Care Center, the same place where she had her mammogram several weeks before. A radiologist placed a wire into her breast “to really point the surgeon to where, exactly, that cancerous lesion is.”

Page went to the operating room. Surgeon Lisa Lai, MD, removed the lump. With the tissue gone, she placed a balloon in the empty space, and radiation oncologist Anna Shapiro, MD, administered a targeted dose of radiation. Then the balloon was removed, the surgery was completed, and “I was home by 1 o’clock that day,” she remembers.

Treatment continues for her, in the form of a daily hormone-lowering pill shown to help prevent breast cancer recurrence. CC

Information at upstate.edu/iort upstate.edu/cancer l spring 2019 l C A N C E R C A R E

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CARING FOR PATIENTS

Battling cancer rough 3 surgeries and 6 weeks of radiation, this determined Marine keeps his chin up

BY DARRYL GEDDES

When radiation therapy was recommended to target any rogue cancer cells after his surgery, Howard “Mac” Waterman, 73, of Boonville was able to travel to Oneida (instead of Syracuse) for six weeks of treatment last fall. The Upstate Cancer Center staffs a radiation oncology office in Oneida, which cut Waterman’s drive time almost in half.

PHOTO BY ROBERT MESCAVAGE

oward “Mac” Waterman, 73, of Boonville is

H

a Vietnam War veteran who saw combat as

a Marine, but his biggest fight has been a

recent bout with medullary thyroid and neck can-

cer. He appears to be outmaneuvering the enemy.

In 2015, a suspicious lump on the left side of his neck brought Waterman to the Donald J. Mitchell VA Clinic in Rome, NY where his primary physician set in motion testing that ultimately revealed the growth to be cancerous.

An endocrinologist at the Syracuse VA Medical Center arranged for Waterman to see Mark Marzouk, MD, a specialty surgeon at Upstate University Hospital.

Within a few weeks, Waterman underwent extensive surgery to remove the cancerous thyroid and dozens of neck lymph nodes. In spite of eight of the more than 30 lymph nodes testing positive for cancer, his recovery was remarkable.

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Unfortunately, 18 months later, Waterman required a second but comparatively easier operation for a recurrence of neck cancer. Again, his recovery was noteworthy, and a postponed hip replacement surgery soon followed, with a timely return to normal activity.

C A N C E R C A R E l spring 2019 l upstate.edu/cancer

A third neck surgery took place less than a year ago to remove a tumor hidden below his left shoulder. All three cancer surgeries were performed by Marzouk; Waterman credits the skill of his surgeon and the care received at Upstate for his health today.

Some of that care took place in Oneida, at a radiation oncology practice staffed by Upstate. Waterman underwent six weeks of radiation therapy during the fall of 2018, to target any rogue cancer cells.

“The initial cancer diagnosis was devastating, but the care and support from the VA and the Upstate team has been excellent this entire journey,” Waterman says.

The determined Marine credits the strength and support of his wife, family, friends and fellow Marines with helping him stay upbeat, and he says he is only looking forward. CC

CARING FOR PATIENTS

Baffled? is pathologist helps you make sense of your pathology report

BY AMBER SMITH

L

ike many women who are diagnosed with breast cancer, Amanda

Gilmore of Phoenix struggled with the new knowledge that her body

contained cancerous cells that she could neither see nor feel.

She read her pathology reports, but she couldn’t understand them.

She and her mother used the Internet for help with vocabulary, but it was still hard to put random words into context to know what they meant for her situation.

Then Gilmore’s surgeon, Kristine Keeney, MD, offered to bring Gilmore behind the scenes to meet with her pathologist.

A medical pathologist is a doctor who specializes in diagnosing and studying diseases using laboratory methods. He or she may supervise tests on blood and other body fluids and tissue, such as the breast tissue removed during Gilmore’s biopsy.

Pathologist Rohin Mehta, MD, says pathologists are the doctor’s doctors. Typically their work is in the background, with little if any direct patient contact. That’s changing in some areas of the country.

Lowell General Hospital in Massachusetts launched a pathologistpatient consultation program last year called Cancer Pathology 101.

At Upstate, Mehta has begun a more modest undertaking. He offers to meet one-on-one with breast cancer patients who want help understanding the pathology of their cancer.

“I can see how scared they are, and this can give them some solace,” he says.

For Gilmore, 38, seeing images of what the cancer cells looked like in comparison to her healthy cells, with Mehta’s explanation, made her realize her situation was not so dire.

“He definitely reassured us,” she recalls. “Dr. Mehta was personable and very easy to talk to. After I met with him, I felt much better about all of it.

“It made me feel like breast cancer was no longer a foreign concept.”

Gilmore was diagnosed after a biopsy in October. Keeney operated to remove the mass in her breast in November. Then Gilmore went through radiation therapy. She finished in January and because “my cancer showed it was reactive to estrogen,” she takes a medication to block the estrogen.

Mehta enjoys the patient interaction.

Not everyone wants to read their pathology report or see what their cancer looks like under a microscope. And many patients are satisfied with answers they can get from their primary doctor. For those with a lingering desire to know more, Mehta tries to oblige.

“I figure it’s the right thing to do,” he says. “This lets patients kind of envision what they’re fighting against.” CC

Rohin Mehta, MD

A few terms from a breast cancer pathology report: 1 o’clock excision—

refers to the geographic location of a tumor or tissue sample that was removed, if you envision the face of a clock on the breast; 1 o’clock would be above and slightly to the right of the nipple

gross description—

the pathologist’s overall description of the tissue; it may be a few words or a whole paragraph

mitotic rate—

tells how quickly the cancer cells are dividing

tumor focality—

the number of tumors; if there are many, it’s multifocal

macrometastasis and micrometastasis—

when cancer has spread to a lymph node, it will be called micro if it measures less than 2 millimeters and macro if it encompasses the whole lymph node

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CARING FOR PATIENTS

Guided by love 4 whose careers were inspired by family members who fought cancer

BY JIM HOWE

A

personal experience with cancer has led several people to careers in cancer care

at Upstate.

A mother who died of cancer inspired her

daughter, now a nurse practitioner, to care for

cancer patients. Other family members similarly

influenced the career paths of a radiation therapist,

a nurse and a medical student to work in the fields

of hematology and oncology, which deal with

blood disorders and cancer.

Here are their stories:

Her sister’s treatment showed her the value of nursing

Nurse Meghan Lewis is the clinical leader of the blood and bone marrow transplant program at Upstate University Hospital. Her job is both “bedside and leadership,” she says, describing it as being “the point person for how the floor is running.”

Generally, her patients are adults newly diagnosed with acute leukemia (also lymphoma and myeloma) who stay for several weeks and go home when their immune system is strong enough.

“It’s a very vulnerable time for them. I think nursing plays an important role in helping them process the diagnosis,” she says.

Patients with blood-related cancers like leukemia tend to stay in the hospital for a long time, so “you build relationships with not just patients but with the whole family. That part is very important to me.”

“I lost my sister (Laura) when I was 10. She had osteosarcoma, a bone cancer. She was 15 when she passed away, 27 years ago.

“I always wanted to be a nurse. My mom and both grandmas were nurses, but growing up and remembering the impact nurses had on not just her but on us as her siblings really left a lasting impression on me,” Lewis says.

Continued on page 9

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Nurse Meghan Lewis

CARI NG FOR PATI ENTS

Guided by love

continued from page 8

“I remember being confused — my aunt, instead of getting better, was getting worse. I couldn’t understand how medicine was failing her.

Laura was sick for 18 months and had to go out of town for some treatments, which were not done at Upstate at that time. This was years before the Upstate Cancer Center and the Upstate Golisano Children’s Hospital were built.

“I was upset because maybe the doctors weren’t doing what they needed to do. I was not understanding that cancer can’t always be cured, that medicine is not absolute, that there is room to explore more, understand more, a lot of unknowns about medicine.

Recalling her sister’s time in the hospital, Lewis said, “The nurses then treated us as though we were just as important as she was, which is hard to do when there’s a sick kid in the family. They always let us into playroom with her and let us spend time with her there.”

“Since then, I took an interest in science, and experimentation … to ask a complex question and find information about how to understand that question. This was my first insight into that.”

“My parents were great about it, too. We all had special days at home or with my mom and Laura. I didn’t have the feeling that she got all the attention. It was a very inclusive experience for all of us, a lot of it coming from my parents but also from nursing and physician involvement.”

Marcelus was the first person in her family to go to college, where she majored in biology and women’s studies. She says she realized her aunt faced racial and socioeconomic, as well as medical, issues, which affected what kind of health care she was able to get.

Her questions about cancer led Marcelus to do research in a Harvard professor’s laboratory through a mentorship program, where she looked at possible links between viruses and cancer and published her findings. This was her first exposure to oncology as medicine, she says. “I was on the other end of what I had seen as a kid going to the hospital with my aunt.”

“As a nurse, sometimes you want to take away that burden and be a bridge between the doctor and the patient. I feel that nursing has a crucial role in trying to make everything more manageable and being the patient’s strongest advocate.”

Her aunt’s disease led her to seek answers

Christina Marcelus, heading into her fourth year as a medical student, hopes to work in hematology and oncology as a physician, doing research and treating patients.

“When I was in middle school I had an aunt I was very close to who was diagnosed with breast cancer.

It was my first exposure to breast cancer. I didn’t know what it meant.

I thought you get sick, someone fixes it, and that’s the end of it.

Medical student Christina Marcelus

“What makes me excited about medical oncology is the personal care and being the person who orchestrates the care. And being the most important person at that time of the patients’ life is very important to me. As an oncologist you have a lifelong relationship with this person. Even if they are cured.”

She especially likes studying blood-related disorders, because it includes a range of non-cancerous but still potentially devasting

Continued on page 10

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CARING FOR PATIENTS

Guided by love

continued from page 9

niche. “I was so excited to talk with patients and have personal relationships with them. I’m a people person, so it fits in with my personality.”

illnesses, such as sickle cell disease.

She also hopes to address issues of health care access and affordability as a doctor.

Some in her family are surprised that she would want to make a career in cancer research and treatment because they find it “morbid and sad.” She, however, says, “It’s a world full of excitement. I don’t feel there is another field that is as broad, unexplored, unique, open to change, so dynamic — it changes all the time, in how we treat patients.”

“I was close to my grandmother growing up, and she died of lung cancer,” Gleason recalls. As a radiation therapy student, “I met a patient with lung cancer. She was very kind to all of us, and she was the spitting image of my grandmother.”

Gleason had to explain the treatment process and guide the woman through it. “It was so very special to me to have my first interaction be with her, also to be able to be with her on treatment. I could help her and wanted to help her because I couldn’t help my grandmother.”

She was interested because grandparents had cancer

Oncological radiation therapist Mary Gleason knew in high school that she wanted to work in a cancer-related field someday.

The patient “adopted” all of the students, brought them homemade baked goods and wrote a goodbye letter to all of them, thanking them for their care.

“Both my maternal grandparents and my paternal grandfather all had cancer, my dad had a scare that turned out not to be cancer, and I had friends through the years that have had cancer,” she says.

These days, Gleason works in the Hill Medical Center, a few blocks north of the hospital’s downtown campus. She sets up and administers radiation for patients, and although she likes the technical parts of her job, she especially enjoys giving people the best treatment possible. Her patients might come in for 10 or as many as 45 daily treatments, so she has a chance to get to know them.

“So, oncology was the route I was going to take, but I just couldn’t decide where in the world I wanted to be,” she says. She had hoped early on to combine her interest in cancer with documentary filmmaking, having pursued creative writing and cinematic studies in college, but that didn’t pan out.

She then shadowed a friend who works in radiation therapy, liked the emotional connection she saw between the patients and therapists and decided this could be her

Radiation therapist Mary Gleason

And she still thinks of that longago patient who reminded her of her grandmother. “She gave me recipes she developed,” Gleason recalls, noting she still has some of those recipes displayed on her refrigerator, and she still uses the recipe for buttercream frosting.

Continued on page 11

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CARI NG FOR PATI ENTS

Guided by love

continued from page 10

“A lot of it is explaining what to expect,” she notes. Soper watched her mother seek comfort in the nurses, in knowing the process and in knowing that she was, although dying, still living and still in control of how she dealt with her disease.

She tries to provide that comfort and hope for her patients; the same way her mother’s nurses did. CC

She now works with her mother’s oncologist Nurse practitioner Kristin Soper treats patients with solid tumors.

Before that she cared for cancer patients as a registered nurse.

“My mom was diagnosed with colorectal cancer when I was 15.

When she was here (at Upstate) getting treatment, I would see her with all the nurses, and she would say, ‘I feel safe here.’ I’d become friends with all the nurses; everybody knew our names. It was kind of like a home away from home for us and inspired me to want to create that for all the patients I take care of,” she says.

PHOTOS ON PAGES 8-11

BY ROBERT MESCAVAGE

Soper was 21 when her mother died, after fighting cancer for 6½ years.

“I knew I wanted to be a nurse as soon as I saw the impact that nurses made on the patients and the family. I felt that I could really touch a lot of lives by doing oncology. The impact is so great that you can make in patients’ lives. It’s an honor and a privilege to take care of people in that vulnerable state.”

Are you inspired?

Upstate Medical University offers training for a variety of health professions that provide care to people with cancer. Three options: NURSING – Earn a bachelor’s degree, or a master’s degree.

Upstate also offers a postmaster’s program and a doctor of nursing practice degree.

Soper works with oncologist Sheila Lemke, MD, who treated her mother. Soper’s mother told Lemke that her daughter wanted to be an oncology nurse. “Now it’s come full circle to work with her,” Soper says.

“The most important thing is to be with the patients and make the most impact, so, I try to spend as much time as possible with the patients and their families,” she says. “As providers, we come in and often give the patients difficult news, and we’re there so briefly that I always want to be more than that.

I strive to be the person who comes back to pick up the pieces and reinstall hope.”

RESPIRATORY THERAPY – A 21-month bachelor’s program is designed for those who want to help manage breathing problems caused by illness or injury.

Nurse practitioner Kristin Soper

MEDICAL IMAGING – Bachelor’s programs in medical imaging sciences are five or six semesters.

Additional training is available in computer tomography, magnetic resonance imaging and sonography.

Learn more at: upstate.edu/education

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SHARING EXPERTISE

Extensive operations Patients endure lengthy surgeries when cancer involves the face or jaw

BY AMBER SMITH

Michele Giblin had cancer behind her eye, and surgery involved reconstructing her upper jaw with bone from her leg.

I

n constant pain after two root canals and months of antibiotics that were no help,

Michele Giblin of Binghamton finally received

a diagnosis. She had a rare cancer called adenoid

cystic carcinoma. Her oral surgeon referred her to a specialized otolaryngologist at Upstate:

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Jesse Ryan, MD.

C A N C E R C A R E l spring 2019 l upstate.edu/cancer

PHOTO BY WILLIAM MUELLER.

Giblin liked him immediately.

“He was very sincere,” she says.

“I felt like I really matter to him.”

Treatment for cancer that is discovered in the jaw area may require an extensive operation that’s designed to both remove the cancer and reconstruct the area. Such surgeries require expertise and stamina from a team of surgeons, since they can take more than 20 hours.

Ryan estimates he’s involved in five to 10 such operations at

Continued on page 13

SHARING EXPERTISE

Extensive operations

continued from page 12

Computer model of Michele Giblin’s reconstructive surgery, courtesy Jesse Ryan, MD. The areas in shades of blue show what was rebuilt.

Upstate each year, on patients with cancer or traumatic injury requiring jaw reconstruction. “This is rare,” he says, “but this has been a major problem for this subset of the population for centuries. Initially, there was very little that could be done.”

If the front portion of the jaw is removed, its absence will impact a person’s ability to speak and swallow. Techniques evolved in the middle of the last century to use a titanium plate across the gap of missing bone, which would then be covered with skin or muscle in an attempt to preserve some of the structure, Ryan says. Infections and plate exposure over time meant this was not an ideal solution.

Advances in reconstructive surgery in the 1970s had surgeons transferring tissue from one part of a patient’s body to another, with assistance from engineers to shape the bone. Those developments shifted into jaw reconstructions, and today success rates are about 95 percent, Ryan says. The biggest challenge is establishing adequate blood flow to the transplanted area by connecting arteries and veins that are so tiny they require sutures that are smaller than a human hair.

Ryan’s education makes him a natural for this type of surgery.

His undergraduate degree is in mechanical and aerospace engineering from Princeton.

After graduating from Mount Sinai School of Medicine, he completed a residency in otolaryngology and head and neck surgery at the National Naval Medical Center and then a fellowship in head and neck oncology and microvascular reconstruction at the University of Michigan in Ann Arbor. He’s been at Upstate since 2015.

used to resurface both the inside of her nose and inside of her mouth.

Then a thin layer of skin was taken from her thigh to cover the area of her lower leg.

A leg bone that works in the jaw

Giblin spent seven days in intensive care. Then she spent several days on a regular hospital floor, recovering from the surgery. Later, she underwent radiation therapy.

Giblin spoke with Ryan before what would be a 19-hour operation in June 2017. “How do you feel about this?” she asked him.

“To be honest,” replied the surgeon, “I’m a little bit nervous.”

“Well, I’m not. I have faith in you.”

Giblin’s cancer started in a minor salivary gland in her left cheek sinus and involved her upper jaw and part of her nose. Removing it meant having to rebuild her upper jaw and palate. Replacement bone and skin came from her lower leg and was

Ryan explains that replacement bone typically comes from the fibula, a lengthy bone of the lower leg that most people don’t need.

Removing a piece of the bone may affect a marathon runner, but most people are able to walk normally afterward. “The leg bone fits pretty well in terms of the size and strength that’s needed to reconstruct the jaw,” he says.

She has some trouble eating, and must sip drinks, but two years after her surgery, Giblin feels good about the results. She was afraid she would lose the side of her cheek, but friends say she looks as she did before. Today she takes care of people with developmental disabilities as a house director for New York state.

She has monthly appointments with Ryan, and she undergoes imaging scans every six months.

Continued on page 14

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SHARING EXPERTISE

Extensive operations

continued from page 13

Computer model of Paul Desimone’s reconstructive surgery, courtesy Jesse Ryan, MD

A skeptic who was impressed with his care

Paul Desimone, 52, of Sangerfield in Oneida County underwent a similar 20-hour surgery in October 2016. What he initially thought was a cold sore on his lip grew bigger, until he could not ignore it. Doctors in Utica confirmed the growth was cancerous and referred Desimone to Ryan.

When Ryan proposed surgery, Desimone says, “I was skeptical.

But I’m a skeptical guy. It had nothing to do with him. Trust me. I had not seen a doctor in 30 years.”

The sore on his lip was about 3 inches by 2 inches, and an affected lymph node had eroded through his lower jaw. DeSimone underwent two transplants in the same operation. First, Ryan used

tissue from the forearm to re-create a lower lip. Then, he used bone and skin from the lower leg to re-create the jaw and external cheek skin.

The surgeon used skin from Desimone’s hip to cover the forearm and lower leg.

Desimone went home from the hospital 16 days later. He wouldn’t undergo radiation or chemotherapy, and the cancer returned about a year later. At that time, he was willing to undergo radiation and chemotherapy, and he added two more doctors to his care team: oncologist Muhammad Naqvi, MD, and radiation oncologist Michael Lacombe, MD.

“What a pack of great guys.

They really know what they’re doing,” Desimone says. He is in remission now. CC

Ear, nose and throat specialist Jesse Ryan, MD, was interviewed about jaw reconstruction on Upstate’s “HealthLink On Air,” a podcast/radio show that airs on Sundays at 6 a.m. and 9 p.m. on WRVO radio. Hear his interview at healthlinkonair.org by searching for “Jesse Ryan.”

YOUR CONCUSSION

EXPERTS

Older adults are more likely to sustain injury from falls. The Upstate Concussion Center provides comprehensive evaluation and treatment services for concussion, including sports concussion.

315.464.8986 14

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WWW.UPSTATE.EDU/CONCUSSION

SHARING EXPERTISE

32 more months Research shows older women extend their lives by taking chemotherapy aer breast cancer surgery

The research team that explored survival rates of women older than 65 includes, from left, Shreya Sinha, MD, Lauren Panebianco, MD, Abi Siva, MD, Dongliang Wang, PhD, Danning Huang and medical student Xiancheng Wu.

Oncologists have long recognized the benefit of chemotherapy after a patient has surgery for early-stage breast cancer. Multiple studies have established that adding the drug regimen to the treatment plan can extend survival over the long term — but few of the patients in those studies were older than 65.

A team of researchers at Upstate tackled the question: If you’re older than 65, will chemotherapy help extend your life? Thier answer indicates yes.

Noting how many women diagnosed with breast cancer are seniors, “we believed it was important to study a large cohort of older patients to not only see if there was an improvement in overall survival with adjuvant chemotherapy, but also to figure out which factors led to the most benefit,” Shreya Sinha, MD, said in December at the San Antonio Breast Cancer Symposium, where the research was presented.

Sinha and colleagues worked with data from the National Cancer Database on 160,676 female patients 65 or older diagnosed with

stage I, II or III breast cancer from 2004 to 2015. That included 21,743 women who were older than 80.

The overall survival rates in the study Sinha presented were 144 months for the women who got chemotherapy after surgery and just 112 months for those who did not, regardless of age. That’s an average difference of 32 months, almost three years.

Whether a woman receives chemotherapy after surgery depends on many factors, including her age, whether her cancer is influenced by hormones, the stage of her disease, whether she had radiation therapy, the type of surgery she had and whether she’s able to tolerate the side effects.

The findings show chemotherapy can prolong the lives of women, even in their senior years. The most benefit is seen in women with the most advanced cancers.

Doctor and patient have to consider whether chemotherapy will be beneficial. Now they have the results of more research to consider. CC

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SHARING EXPERTISE

Mysterious ‘door’ guards cancer secrets Researchers work to halt a strange, deadly process in the spread of breast cancer

BY JIM HOWE

*

Here’s how breast cancer spreads: A tumor cell (green, No. 1), is in direct contact with a macrophage (blue, No. 2) and an endothelial cell (red, No. 3). The macrophage is a part of the immune system, and the endothelial cell is part of a blood vessel wall.

* 2

3

1

D

Other tumor cells (green, marked with *) then leave the tumor, pass through that opening into the bloodstream and travel to new parts of the body, where they can start new tumors. Collagen fibers are shown in purple.

ouble agents, secret doorways, infiltration … it sounds like a spy thriller, but it’s how some breast cancers can spread, and

eventually kill, a prominent researcher says.

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The tumor cell makes an invasive protrusion called an invadopodium (white arrow) that cuts a doorway into the blood vessel.

C A N C E R C A R E l spring 2019 l upstate.edu/cancer

IMAGE COURTESY OF PENG GUO THIS ILLUSTRATION IS BASED ON A MAMMARY TUMOR

Scientists hope that this medical drama, which plays out at a microscopic level, holds keys to better diagnosis and treatment of breast cancer.

While primary breast cancer tumors can often be treated

continued on page 17

SHARING EXPERTISE

Mysterious door effectively, comparatively little progress has been made in treating breast cancer after it has spread.

In most cases, death from breast cancer happens only after it spreads to places like the brain, lungs, bone marrow or liver.

Researchers can study cancer cells in a laboratory, but they learn much more by watching those cells inside a living body — how they sneak away from the tumor and what role the body’s immune system might play, says John Condeelis, PhD, a professor at Albert Einstein College of Medicine in New York City.

In the past several years, high-powered microscopes and special lasers have allowed his research team to peek inside a live mouse with breast cancer at a magnification not previously possible, says Condeelis.

He spoke of his findings in a lecture at Upstate sponsored by the Carol M. Baldwin Breast Cancer Research Fund of CNY. Doctors and scientists at academic medical centers such as Upstate have frequent opportunities to hear from leading researchers this way.

Condeelis’ team has learned that migrating cancer cells commandeer strands of nearby collagen tissue as miniature highways and head toward blood vessels.

That’s when a strange thing happens. Bloblike immune cells called macrophages, which would normally engulf and kill invaders, do not destroy these traveling cancer cells.

Instead, when they are in a cancerous environment, the macrophages act as double agents, he says. Rather than trying to kill the cancer cells, the macrophages send messages that encourage cancer cells to migrate.

continued from page 16

Breast cancer quick facts: l The average American woman has about a 12 percent chance of developing breast cancer.

l Breast cancer is the second most common cancer in American women, after skin cancers, with about 250,000 new cases diagnosed annually.

l Breast cancer is the second leading cause of cancer death in women, after lung cancer. The chance that a woman will die from breast cancer is about 1 in 38, or 2.5 percent. l Overall breast cancer death rates dropped 39 percent between 1989 and 2015. l 81 percent of breast cancers are diagnosed among women ages 50 years and older, and 89 percent of breast cancer deaths occur in this age group. The median age at diagnosis for all women with breast cancer is 62.

SOURCES: AMERICAN CANCER SOCIETY, NATIONAL INSTITUTES OF HEALTH

What’s more, the macrophages and the cancer cells pair up, move to a nearby blood vessel and conspire with a blood vessel wall cell there to create a doorway into the vessel that will open and close at regular intervals. Condeelis and his fellow researchers describe this doorway as a “tumor microenvironment of metastasis,” or TMEM for short.

This doorway is what allows cancer cells to pass into the bloodstream

and travel all over the body.

These circulating cancer cells then form new tumors in distant spots and begin the process all over, creating additional doorways and more tumors.

“This is how metastases kill people,” Condeelis said. “It’s the perfect killing machine, an absolute catastrophe,” he says of the circulating cancer cells. “You have to stop tumor cells before they can get out of the tumors, wherever these tumors are in the body.”

He hopes that drugs can be developed to intercept that communication between macrophages and cancer cells, then “shut the doorway, block the highway and kill cancer cells.

“We think we have figured out how to close the door,” he says.

Using the drug Rebastinib as a doorway inhibitor, combined with chemotherapy, greatly increases survival rates by stopping the cancer’s progression, he says. The drug, still in development, is well tolerated in mice. In human trials, the vast majority of patients saw complete removal of circulating cancer cells, with no side effects, he says.

“Dissemination is the key to controlling metastasis,” he says.

“You’ve contained the disease, which buys time to kill the residual cancer cells with chemo or radiation.” CC

John Condeelis, PhD, is a professor, co-chair and holder of the Judith & Burton P. Resnick Chair in Translational Research at Albert Einstein College of Medicine, where he also co-directs the Biophotonics Center and Integrated Imaging Program.

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LIVING WITH CANC ER

6 surprising cancer risk factors

Y 1

ou know that cigarettes and radon and ultraviolet radiation can

all cause cancer. Here are six things you may not have realized

can increase your risk:

Alcohol

The American Society of Clinical Oncology cites evidence from 2017 that even light drinking can slightly raise a woman’s risk of breast cancer and increase a common type of esophageal cancer. Heavy drinkers are said to face much higher risks of mouth and throat cancer, cancer of the voice box, liver cancer and, to a lesser extent, colorectal cancers.

The lead author of the study, an associate professor at the University of Wisconsin-Madison, told the New York Times “The message is not ‘Don’t drink.’ It’s ‘If you want to reduce your cancer risk, drink less.’

And, ‘If you don’t drink, don’t start.’

It’s different than tobacco, where we say, ‘Never smoke. Don’t start.’

This is a little more subtle.”

2

Bacon

Science shows us that cells exposed to high levels of nitrates (such as found in bacon and smoked meats) are at greater risk for DNA modification. “The smoking process of meats is thought to introduce heterocyclic amine byproducts in the food, and the curing process involves nitrate salts that cause nitrosocompounds, which are thought to act as potential mutagens,” according to an article in the journal Nucleic Acids Research. Upstate neuroscientist Frank Middleton, PhD, explains that

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C A N C E R C A R E l spring 2019 l upstate.edu/cancer

our cells can respond to these mutations and repair them, but over a person’s lifetime, cells that are continually exposed to these types of mutagens will become less efficient at repair — and cancer may develop.

3

Oral sex

In the United States, the human papillomavirus is the most common sexually transmitted virus and is the leading cause of oropharyngeal (oral) cancers. Oral sex is one way HPV is transmitted.

More than 100 types of HPV exist, half causing warts and other skin infections, and half causing infections of the mucous membranes, says Upstate infectious disease specialist Joseph Domachowske, MD. “Most HPV infections are cleared spontaneously by our own immune system,” he says. But among those that infect the mucous membranes of the genital tract, more than 20 are known to cause cancer.

A vaccine for HPV is recommended for girls and boys before they become sexually active.

4

Body fat

Evidence consistently shows that excess body fat increases the risk for many common cancers including endometrial cancer, colorectal cancer, liver, kidney or pancreatic cancer, esophageal adenocarcinoma, cancer of the upper part of the stomach, multiple

myeloma or a slow-growing brain tumor called meningioma, according to the National Cancer Institute.

In related research, the group says physical activity may reduce the risk of several cancers through other mechanisms, independent of the effect on obesity, including colon cancer, breast cancer and endometrial cancer.

5

Immunosuppression

6

Working nights

Because of the medications people take after they have undergone an organ transplant, or if they have a disease such as lupus, their immune system is suppressed and less able to detect and destroy cancer cells or fight off infections that cause cancer. Infection with HIV also weakens the immune system and increases the risk of certain cancers, according to the National Cancer Institute.

Long-term night shift work increases the risk of breast cancer in women, according to a 2018 study in the journal Cancer Epidemiology, Biomarkers & Prevention. The study also found increased risks for cancers of the digestive system, skin cancer and lung cancer. Researchers suspect environmental factors of modern society play a role in cancer etiology and that circadian rhythm disruption and nocturnal melatonin suppression could be carcinogenic. CC

LIVING WITH C ANCER

EASY

Summer Lasagna

RECIPE

FROM THE AMERICAN INSTITUTE FOR CANCER RESEARCH

This hearty summer lasagna packs roasted eggplant, zucchini and lycopene-rich tomatoes. Whole-wheat noodles pack cancer-fighting fiber and natural plant compounds called phytochemicals, which protect cells from the type of damage that may lead to cancer. One batch serves 12, so make this recipe a part of your weekly meal prep.

Preparation

1.Preheat the oven to 450 degrees. Grease a 13-by-9-by-2-inch baking pan and set aside.

2.Slice the eggplant and zucchini in 1/2-inch slices. Layer them on two baking sheets and coat both sides of the vegetables with cooking spray.

Roast for about 40 minutes.

3.Reduce the oven temperature to 375 degrees.

4.Meanwhile, in a medium bowl, mix together the ricotta and/or cottage cheeses, eggs, Parmesan, nutmeg and garlic powder.

5.To assemble: spread a thin layer of sauce over the bottom of the prepared pan. Cover with a layer of pasta. Spread with one-third of the ricotta mixture. Sprinkle one-quarter of the mozzarella over the ricotta.

Spoon one-third of the roasted vegetables on top. Top with 1/2 cup of tomato sauce and continue the assembly as directed until you have four layers of pasta and three layers of filling. Spread the remaining sauce on top and sprinkle with the remaining mozzarella cheese.

Cover the pan with aluminum foil and bake for 30 minutes. Uncover and continue to bake until golden and bubbly, about 15 minutes more.

Let stand for 15 minutes before serving. CC

Ingredients

• 2 eggplants (about 3 pounds), quartered lengthwise

• 6 medium zucchini (about 3 pounds) • Canola oil cooking spray

• 15 ounces low fat ricotta or low fat cottage cheese (or a combination of both)

• 2 eggs

• 1/2 cup grated Parmesan cheese • 1/2 teaspoon ground nutmeg • 1/2 teaspoon garlic powder

• 4 cups low-sodium tomato sauce • 1 pound whole-wheat, no-boil lasagna noodles

• 3 cups low-fat mozzarella cheese

Nutritional Information Per Serving: 360 calories

11 grams total fat (5 grams saturated fat) 45 grams carbohydrate 23 grams protein

11 grams dietary fiber

310 milligrams sodium

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LIVING WITH CANC ER

Advice from a mom

H

er daughter was 10 when she was diagnosed with leukemia —

and Gwendolyn Webber-McLeod of Auburn began her education

in parenting a child with cancer.

Her daughter, Ashley McLeod, is 33 now, with a son of her own.

She’s been cancer-free for 23 years, but the impact of pediatric cancer followed her into adulthood. As she grew from pediatric cancer patient to survivor, she experienced residual effects such as learning disabilities, depression and anxiety — as do many survivors.

Today McLeod is a healthy, confident woman.

Webber-McLeod remains a support to her daughter. She recently spoke at a HOPE (Helping Oncology Patients and Parents Engage) event, sponsored by Upstate’s Waters Center for Children’s Cancer and Blood Disorders.

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Above, left: Gwendolyn Webber-McLeod, 2019 Above, right: Ashley McLeod, 1997 (at age 12).

At the time this photo was taken, she was getting weekly chemotherapy treatments.

C A N C E R C A R E l spring 2019 l upstate.edu/cancer

Webber-McLeod made these points:

UNDERSTAND. A child who seems rebellious may be trying to regain some control when his/her life feels out of control.

SUPPORT YOUR SPOUSE. It’s difficult for parents to stay strong during cancer, especially fathers. Encourage fathers to turn to other men for emotional support. Fathers often feel helpless because they can’t protect their children from cancer.

TEND YOUR RELATIONSHIP. The disease and the caregiving responsibilities will strain a marriage. Remind yourselves “we are in this together.” Schedule date nights even if you don’t feel like it.

FOCUS ON SIBLINGS. Cancer disrupts the childhood of all your children. Do what you can to make siblings feel important. Schedule special outings with the siblings who don’t have cancer. Encourage them to share feelings and concerns.

EMBRACE THE ‘NEW NORMAL.’ You may need to release the idea of what your family was before cancer, and learn to love, honor and respect what your family is now. There is still much to celebrate.

ASK FOR HELP. Look for relatives or friends who can talk to your child when she/he doesn’t want to talk with you. Engage nurses from the hospital who can connect with your child, too. You need a team of support to get through this.

GRIEVE. “Crying is the appropriate response to cancer,” Webber-McLeod says. “Give yourself permission to grieve, and grieve with an agenda. Be intentional about how you will bounce back. Our children need to believe we are OK and they will be too.” CC

MAKING A DIFFERENCE

Giving back A 5-year-old is old enough to begin caring and sharing

Aria Morris sells bracelets, T-shirts and candles to raise money for Upstate.

K

ids notice everything. So, Melissa Morris

wasn’t surprised — but was delighted —

when her 5-year-old daughter, Aria,

noticed the donor plaques on the walls of the

Upstate Golisano Children’s Hospital during one

of her treatments for leukemia.

“She asked me what the plaques meant,” says Morris, a nurse practitioner in the Upstate Cancer Center. “When I explained they were the names of people who donated money to help the hospital care for patients like her, Aria decided she wanted to have her name on the wall and help kids like her.”

Morris contacted the Upstate Foundation and learned that if Aria raised $5,000, her name could appear on a plaque. Undaunted, mother and daughter embarked on their fundraising campaign, and Aria continued cancer treatments.

Diagnosed with a form of cancer called Philadelphia chromosome-positive acute lymphoblastic leukemia, Aria spent two years under the care of a pediatric oncology medical team at the children’s hospital. Aria and her family grew especially fond of pediatric oncologist Andrea Dvorak, MD.

“The staff was amazing, both inpatient and outpatient, always working to ensure that Aria and my family had what we needed,” says Morris. “As a nurse, it was scary because I felt like I knew too much, but I was shown

PHOTO BY RICHARD WHELSKY

bright moments in our journey.”

Morris added, “Aria’s hair is growing back, and if you didn’t know it, you wouldn’t know she had cancer.”

Aria achieved her fundraising goal and her commemorative plaque in May 2018, the anniversary of her diagnosis. Having started her outreach with donated gift bags for her fellow patients in the outpatient clinic, Aria quickly decided to do more and launched a Gofundme page, followed by T-shirt, bracelet and candle sales.

“As a youngster who is clearly focused on goals, Aria is determined that future children with cancer will see — and take a measure of hope from — her name on a nearby wall,” observes Toni Gary of the Upstate Foundation. “She has clearly earned our admiration.” CC

To donate to the Upstate Cancer Center and Upstate Golisano Children’s Hospital, visit www.upstatefoundation.org or contact the Upstate Foundation at 315-464-4416.

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MAKING A DI FFERENC E

Taking a pause How summer camps let kids savor nature

BY AMBER SMITH

ummer camp means days full of swimming,

S

hiking and s’mores, but for kids affected

by cancer, it can provide more than fun

memories.

Camp organizers say sleepover camps for youth with serious illnesses provide a break from a routine that is often filled with medical appointments, and a chance to regain confidence and independence.

Some camps are designed for kids with cancer and other serious illnesses, some involve siblings, some are for kids who have a parent with cancer. Several throughout New York state and nearby do not charge campers.

“The environment of camp creates such a safe space to talk about their parent’s cancer,” says Madeline Merwin, a senior at Syracuse University who volunteers at Camp Kesem. She was a camper at the age of 12, after her mom was diagnosed with cancer. At a camp in California where she lived, Merwin remembers an empowerment ceremony where a 6-year-old boy stood up and, without crying, explained how Camp Kesem was giving him the strength to return home and celebrate his mother’s life. “I think about him often, still,” she says.

The Children’s Oncology Camping Association International is a professional organization that connects summer camps that serve children and families touched by cancer across the globe.

“What’s most important for an oncology camp is to provide a normal experience, but in an environment where medical needs can be addressed if a child needs them,” Dave Smith says on the group’s website. He’s senior director of Camp Fantastic in Virginia.

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MAKING A DIFFERENCE

Eight special overnight camps to consider Camp Adventure kidsneedmore.org

1

ORIGINS: parents started the group, Kids Need MORE (which stands for Motivational Recovery Environments) in 1990 with the belief that fun heals

WHO CAN GO: for children ages 6 to 16 with cancer, and their siblings

WHEN: August 19-25; day camp is offered throughout July

WHERE: Camp Quinipet at 99 Shore Road, Shelter Island Heights (Suffolk County)

Camp Dost

rmhdanville.org

2

ORIGINS: sponsored by the Danville Ronald McDonald House, Camp Dost is designed to give pediatric cancer patients the chance to enjoy a summer camp experience without worrying about medical care

WHO CAN GO: children age 5 to 18 who have been diagnosed with cancer, plus a sibling; also a 24-hour camp option for 4- and 5-year-olds WHEN: July 6-12

WHERE: Camp Victory, a special-needs camping facility in Millville, Pa.

Camp Good Days and Special Times campgooddays.org

3

ORIGINS: celebrating its 40th year, the organization provides free programming to more than 1,500 children annually, thanks to community donations

WHO CAN GO: for children affected by cancer or sickle cell disease and their siblings; also offers adult retreats WHEN: various weeks starting in May WHERE: Keuka Lake in Branchport, N.Y. (Yates County)

Camp High Hopes camphighhopes.org

9 6 4

10

3

2

8

5 7 1

4

ORIGINS: because many camps do not accept children with bleeding disorders, which require specialized knowledge and care, Camp High Hopes launched a summer camp for boys with hemophilia in 1985

WHO CAN GO: boys age 7 to 17 with bleeding disorders such as hemophilia and von Willebrand disease WHEN: July 28-Aug. 3

WHERE: Camp Aldersgate, 7955 Brantingham Road, Greig, N.Y. (Lewis County)

LOCATION KEY: Camps are in New York, Pennsylvania and Maine

Camp Simcha

www.chailifeline.org

ORIGINS: started in 1987 by the international children’s health support network Chai Lifeline

WHO CAN GO: youth ages 6 to 20 battling cancer and blood disorders, in active treatment or post-treatment WHEN: Two-week camps for girls in June and July; for boys in July and August WHERE: 430 White Road, Glen Spey, N.Y. (Sullivan County)

Camp Sunshine campsunshine.org

Camp Kesem

campkesem.org/syracuse

8

9

ORIGINS: founded in 1984 as a retreat to provide respite, recreation and support

ORIGINS: founded in 2000 at Stanford University and now offered through several college campuses

WHO CAN GO: children with lifethreatening illnesses and their families

WHEN: June 30-July 6 (SUNY Stony Brook)

WHERE: 35 Acadia Road in Casco, Maine, on the shores of Sebago Lake

WHO CAN GO: for youth ages 6 to 18 who are impacted by a parent’s cancer

WHERE: Camp Herrlich, 101 Deacon Smith Hill Road, Patterson, N.Y. (Putnam County)

5

Double H Ranch

www.doublehranch.org

WHEN: Aug. 11-16 (Syracuse University)

6

WHEN: Aug. 18-23 (Cornell University)

7

WHERE: Camp Echo Lake, 177 Hudson St., Warrensburg, N.Y. (Warren County) WHERE: Camp Lakota, 56 Park Road, Wurtsboro, N.Y. (Sullivan County) WHEN: Aug. 25-30 (Columbia University)

WHEN: 25 sessions are offered, not just in summer

WHERE: Camp Lakota, 56 Park Road, Wurtsboro, N.Y. (Sullivan County)

10

ORIGINS: Philanthropist Charles R. Wood and actor Paul Newman started the Double H Ranch in 1993; it’s the second of a worldwide network of “Hole in the Wall Gang” camps for children with serious illness that Newman founded in 1988 WHO CAN GO: children and siblings between ages 6 and 16 who function at a cognitive age of at least 6 and who have a medical diagnoses of cancer, sickle cell disease or one of several other diagnoses

WHEN: individual weeks start in June and go through August WHERE: 97 Hidden Valley Road, Lake Luzerne, in the Adirondacks (southern Warren county) CC

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Non Profit Org. US Postage

PAID 750 East Adams Street l Syracuse, NY 13210

Permit No 110 Syracuse, NY

UPClose Timothy Damron, MD, and Kenneth Mann, PhD, are studying bone fracture risk in cancer patients after radiation treatment. While radiation therapy is an important and effective treatment for many cancers, bone exposed to radiation becomes brittle and has an increased risk of fragility fracture. Unlike traumatic fractures, fragility fractures occur during normal physical activities and are difficult to predict in patients.

The researchers want to develop ways to prevent and treat these fragility fractures in cancer survivors.

Bone density is not decreased after radiation therapy. Rather, changes in the bone material itself (for example, protein crosslinking, collagen and mineral organization) — as well as the activity of cells that make, maintain and renew bone — contribute to the brittleness of bone after radiation therapy.

Working as engineers and biologists, Damron and Mann are using translational models to understand how bone is altered by radiation therapy and test potential treatments. Their goal is to prevent post-radiotherapy bone fractures and thereby improve quality of life for cancer survivors.

19.049 0519 39.63mELsk

PHOTO BY WILLIAM MUELLER

19.017 0319 43.8M ELsk

Megan Oest, PhD, places a cylinder containing tiny pieces of bone into a CT scanner. Using software that takes precise measurements of the CT images, Oest creates 3-D images and identifies subtle changes in bone caused by radiation.