Cancer Center News by Upstate Medical University

UPSTATE CANCER CENTER

NEWS SUMMER

2012

New Cancer Center takes shape The next phase of construction for the $70 million Upstate Cancer Center is under way as more than 550 tons of steel began arriving on the Upstate campus at the end of June. The building has been taking shape over the summer. “Seeing steel go up on the site is a significant milestone for this community,” said Paul Seale, chief operating officer of Upstate University Hospital, which is building the cancer center. The center is being built in an environmentally and socially responsible fashion, enabling Upstate to pursue a Silver Rating under the United States Green Building Council’s Leadership in Energy and Environmental Design (LEED) rating system. Part of the project is paid for through bonds. Upstate is also conducting a capital campaign that has raised $13.1 million since 2010 toward the campaign goal of $15 million. The five-story facility will encompass more than 90,000 square feet dedicated to cancer care for children and adults, featuring private infusion rooms, a four-season rooftop garden, a meditation room and a family resource center.■

Above: Steel workers from Raulli and Sons, Inc. work in 90 degree heat to install metal decking at the Upstate Cancer Center, scheduled to open in 2013. Upper left corner: Architect’s rendering of the Upstate Cancer Center.

Pathology chair leads the way into digitization A cancer diagnosis today starts with a pathologist peering through a microscope at a blood or tissue sample on a slide. Soon, he or she will look at computer screens rather than directly through microscopes. In laboratories today a staining technique helps pathologists identify proteins and other substances that characterize certain disease entities. Soon, computers will zero in on even the most subjective of substances. Pathologists today count the number of cancer cells that divide, known as mitosis. But soon, computers will track cellular mitosis. Today pathologists count the number of receptors visible

on cancer cells to determine if chemotherapy drugs will work. Soon, computers will locate and count the receptors. Not only that: Computers will determine which aspects of a digital image Robert Corona DO the pathologist has looked at, or overlooked. The transformation to what is known as “e pathology” means precision and accuracy in laboratory diagnostics like never before. Coupling molecular pathology, genomics and other “omics” with new computing and communications technologies in a field called bioinformatics will significantly impact

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New lung cancer screening may reduce mortality The Upstate Cancer Center and the Upstate Department of Radiology are beginning a new comprehensive lung cancer screening program. A recent landmark study known as the National Lung Cancer Screening Trial published in the New England Journal of Medicine showed that screening using a low dose CT scan of the lungs can detect tumors early and can reduce lung cancer mortality by up to 20 percent for high-risk smokers and ex-smokers. Although not yet indicated for everyone, benefit existed in this high risk population.

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Syracuse New York

Welcome From the Medical Director choose (verb): to select from a number of possibilities; pick by preference wisely (adverb): prudently, judiciously, discretely, and with wisdom When you visit a doctor, do you expect to be told what to do? Maybe you expect the doctor to tell you all the possibilities and ask for your decision. Or, do you want to hear about the possible tests and treatments, discuss the pros and cons, and — with the doctor’s input — make an informed decision about your best course of action? Most of us would prefer the third option. Barriers to wise choices include physician time constraints and preferences, general lack of medical evidence, and patients’ lack of sufficient knowledge and education to be able to choose what is best. We certainly want the best for ourselves and our loved ones when it comes to making choices about health

care, especially when it involves a lifethreatening condition such as cancer. Often, it is hard to determine what is “best,” and “best” is different for every patient and every family situation. Sometimes we misperceive that more is better and that cost is no consideration when it comes to health care. We are now learning that more is often worse for patients, and that high costs do not guarantee better outcomes. Physicians have been accused of poor stewardship of finite health care dollars. In response to this, the American Board of Internal Medicine and nine specialty organizations (with eight additional in late 2012) joined together to choose five common practices in each specialty which are commonly used but do not

provide value to Leslie J. Kohman MD patients. Numerous consumer organizations, such as the American Association of Retired Persons (AARP) have joined the effort, and the recommendations are being published in Consumer Reports magazine. The American Society of Clinical Oncology (ASCO), a professional oncology society committed to conquering cancer through research, education, prevention and delivery of high-quality patient care, is one of the first to publish its recommendations. Almost all medical oncologists are members of the group, which every year hosts the largest cancer conference in the world.

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From the Associate Administrator June 18, 2012 marked an important day for the Upstate Cancer Center as the first piece of steel to outline the new building was put into place. After a year of work underground, it is time to move upward in the construction of this much-needed facility. The next significant day will be the placement of the last piece of steel, which is expected in January 2013. The planned opening of the Upstate Cancer Center is late fall 2013. While construction continues, so does program development. We at Upstate Medical University realize that the cancer center building is only as good as the programs and people who work in it. Therefore, we are preparing and readying many of the support services and programs that will function in the cancer center to include breast, lung, thyroid, head and neck, prostate,

hepatobiliary, and gynecology multidisciplinary programs, as well as new and enhanced support services Richard J. Kilburg MBA such as nutrition, psychosocial, navigation, palliation, integrative therapies, survivorship and various others. The Upstate Medical University family is very excited and very much looking forward to the opening of the Upstate Cancer Center and the opportunity to offer the latest in cancer care technologies and treatments to our patients and their families in Upstate New York. “Our family taking care of your family.” Richard J. Kilburg MBA Associate Administrator Upstate Cancer Center

At the Upstate Cancer Center construction site: Burt Thomas and Tom Pelis of Facilities Planning; Bob Marzella of Hospital Administration, Dick Kilburg of the Upstate Cancer Center, Paul Seale of Hospital Administration, and Leslie Kohman MD of the Upstate Cancer Center.

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Summer 2012

Welcome F R O M T H E M E D I C A L D I R E C T O R – Continued from page 2 ASCO chose five categories of tests, procedures and/or treatments whose common use and clinical value are not supported by available evidence. These tests and treatment options should not be administered unless the physician and patient have carefully considered if their use is appropriate in the individual case.

The five recommendations of ASCO are as follows:

Don’t use cancer-directed therapy for certain solid tumor patients. This includes patients who are confined to a bed or chair for more than half of their waking hours, patients who saw no benefit from previous chemotherapy and patients who are not eligible for a clinical trial. Studies show that cancer directed treatments are likely to be ineffective for these types of patients, who instead need continued attention from their care team regarding appropriate palliative and supportive care.

Don’t perform radiologic scans of newly diagnosed prostate cancer patients whose cancer has likely not spread. No evidence suggests that positron emission tomography, PET, computerized tomography, CT, or radionuclide bone scans improve the detection of metastatic disease or survival in the staging of low-grade cancer of the prostate. Instead, unnecessary imaging can lead to harm through unnecessary invasive procedures, overtreatment, unnecessary radiation exposure and misdiagnosis. To determine whether the cancer is low-grade, doctors consider the level of a man’s prostate-specific antigen, a protein produced by cells of the prostate gland. The Gleason score, assigned to cells examined through a biopsy, is also considered. A higher score means the cancer is likely to spread. Men with scores of 6 or

below, with a PSA below 10 are considered to have low-grade disease.

for this complication due to age, medical history or disease characteristics.

Don’t perform radiologic scans of newly diagnosed breast cancer patients whose cancer has likely not spread.

None of these recommendations should replace a medical professional’s independent judgment in consultation with the patient. They are provided to help educate patients and families so they may understand medical decisions recommended to them, and question practices that may be suggested without evidence of their value in the clinical situation. Also, patients on clinical trials may be exceptions to these rules.

As with prostate cancer, no evidence demonstrates a benefit for the use of PET, CT or radionuclide bone scans in women or men who do not have symptoms of an early stage breast cancer or ductal carcinoma in situ, DCIS.

Don’t test biomarkers or perform imaging for breast cancer patients without symptoms who have undergone treatment meant to cure their disease. There is no benefit from routine imaging or serial measurement of serum tumor markers in patients without symptoms. False-positive tests can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.

Don’t use white cell stimulating factors to prevent fever and a drop in white blood cell count in patients who do not have a big risk of this complication. Drugs that are used in some chemotherapy patients to prevent febrile neutropenia should only be used when there is at least a 20 percent chance of such a complication occurring, or if the patient is at high risk

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The Upstate Cancer Center strives to provide the best in evidence-based practice for its patients. We adhere to best practice recommendations of the American College of Surgeons’ Commission on Cancer, and our Quality Improvement Committee continually evaluates and advises on ways to provide better care with fewer complications. Informed patients and their loved ones are our best allies in this endeavor. We want every cancer patient to learn as much as he or she wants to about testing and treatment options, and to understand that even when elaborate tests or intense therapy have no advantage, our teams will work with you to provide the best quality and length of life possible. Leslie J. Kohman MD Medical Director Upstate Cancer Center

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C ancer News Report: Counties with high rates of lung cancer have high rates of smoking, poverty

Prostate cancer is the state’s most common cancer, but lung cancer remains the single largest cancer killer, with about 25 percent of cancer deaths caused by lung cancer. “Lung cancer has a higher mortality rate than the other common malignancies and has been less amenable to therapeutic advances,” the report said. “Prostate cancer and breast cancer patients have much greater chances of surviving their diseases.” The counties with the highest rate of lung cancer among men include the Upstate and Central New York counties of Cayuga, Chemung, Clinton, Cortland, Franklin, Greene, Jefferson, Niagara, Oswego, Rensselaer, St. Lawrence, Schuyler, Steuben and Washington. The highest lung cancer rates among women are found in the counties of Chemung, Clinton, Fulton, Greene, Jefferson, Madison, Niagara, Oneida, Onondaga, Oswego, Putnam, Rensselaer, St. Lawrence, Seneca, Sullivan, Warren and Washington.

– Continued from page 1 The Upstate Cancer Center and the Upstate Radiology department have developed a lung cancer screening program for current and former smokers who are between 55 and 74 years of age, have a smoking history of at least 30 pack years, and are either current cigarette smokers or former smokers who quit within the past 15 years.

High rates of cigarette smoking in Central New York are likely to blame for higher-than-average rates of lung cancer, according to a study by the American Cancer Society. The study showed that cancer of the lung, prostate, breast and colon/rectum represent more than half (52 percent) of all new cancer cases in New York State and nearly half (46 percent) of the state’s cancer deaths. Cancer is the second most common cause of death, after heart disease. An estimated 107,000 New Yorkers were diagnosed with cancer in 2011, and more than 34,000 died from the disease. That means each week about 2,000 New Yorkers learn they have the disease, and 660 people die from it.

LU N G C A N C E R T E ST S

30 pack years is defined as one pack a day for 30 years or two packs a day for 15 years. Participants in the comprehensive lung cancer screening program will receive: • A low dose CT scan that can be scheduled after normal business hours

The counties with high lung cancer rates correlate with those where the smoking rate is higher than average. These rural areas of the state also have the lowest household incomes and highest rates of poverty, the report said. “The City of New York and some of its suburban neighbors has a long history of aggressively implementing policies to curb tobacco use,” the report said. “New York City has instituted its own tobacco tax, led the state in prohibiting smoking in business and public settings, and focused on strong enforcement of laws that curb children’s access to tobacco products. “All of these efforts have helped dramatically reduce the smoking rate in the city and helped reduce lung cancer incidence rates and deaths.” Though smoking is known for causing lung cancer, it also causes cancer of the oropharynx, larynx, esophagus, pancreas, bladder and kidney. The report suggested ways to help reduce the incidence of cancer, including to restrict the sale of flavored tobacco products to minors and to ban minors from using indoor tanning facilities. ■

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• A professional reading and interpretation of the findings by an experienced chest radiology physician • A CD with the images for the participant’s personal records • A letter to his/her personal physician • Free smoking cessation counseling by a certified smoking cessation counselor • Referrals to other medical professionals as well as access to Upstate’s Multidisciplinary Thoracic Oncology Program if anything worrisome is noticed on the scan. Insurance does not yet cover the cost of the scan. We estimate that the charge will be approximately $235 for which the participant will be responsible. The scans will be done on Mondays at 550 Harrison Center. Free parking is available. If you would like to be part of the lung cancer screening program and you meet the criteria above or have questions, call or email Linda Veit, the Upstate Cancer Center Project Manager at (315) 464-6303 or VeitL@upstate.edu ■

Summer 2012

award-winning care

Dr. Bratslavsky with Mr. Churakov on YNN

Russian man travels to Syracuse for care from “highly skilled people” Two Upstate department chairs were featured on the local news station, YNN, for taking care of a man who travels to Syracuse from Russia for cancer treatment.

Fassil B. Mesfin MD, PhD

Yuri Churakov’s son, Alexei, told reporter Kat De Maria they chose Upstate after researching the best methods and places to treat his father’s kidney tumors, which have spread to his lungs and brain. “We are in the hands of highly skilled people, and we trust them,” he said. Gennady Bratslavsky MD, chair, Urology, explained that Churakov’s care requires a multidisciplinary approach. The Churakovs were in Syracuse in early June for the first step, using the gamma knife to eliminate his brain tumor.

Welcome to new spine surgeon Dr. Bogart

“The goal is to kill off the tumor with very intense radiotherapy,” said Jeffrey Bogart MD, chair, Radiation Oncology. The Churakovs are expected to return to Syracuse for additional care. ■

Fassil B. Mesfin MD, PhD, a new assistant professor of neurosurgery, has been appointed Director of Complex Spine and Spine Oncology. Mesfin’s medical degree and doctorate in molecular biology are from Albany Medical College. For his doctoral thesis he studied anti-cancer drug design and development, and he holds four patents. After his residency at Albany Medical Center Hospital, Mesfin completed his fellowship in neurosurgical spine oncology, including complex spine and stereotactic radiosurgery training, at the University of Texas MD Anderson Cancer Center.

The Gamma Knife

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Mesfin has published research throughout his training in journals including the Proceedings of the National Academy of Sciences, Journal of Neurosurgery, and Neurosurgery. ■

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Award-winning C are D I G I T I Z AT I O N – Continued from page 1 the future of both diagnostic and therapeutic medicine. And Upstate Medical University will play an important role in shaping how some of these new digital technologies are used.

He expects to have some studies underway by fall, though it is too soon to share specifics. For now, he says the FDA permits the use of digital tools for education and some consultations.

“We are on the cusp of a new way of doing things, not just here at Upstate but throughout medicine. Indeed, pathologists will be able to consult with their medical peers across the globe,” said Robert Corona DO, MBA, the new chair of the Department of Pathology and Laboratory Medicine.

Patients are likely to appreciate the upgrades in clinical pathology because their images will be easily shared among health professionals. A pathologist will be able to view images and confer about particular patients, in real time, with the radiologist, surgeon, oncologist and, if necessary, other pathologists.

“We’ll be testing some of the newer systems,” he said, explaining that the computational analytics programs that will facilitate the move of pathology into the digital age require approval from the Food and Drug Administration.

Looking further into the future, Corona says the experts at Upstate will be able to analyze blood and tissue samples from patients from anywhere in Central New York, without requiring patients to travel or samples to be shipped to Syracuse. Indeed, pathologists will be able to consult with their medical peers across the globe.

That means research conducted at Upstate will essentially compare a human pathologist using a microscope with a human pathologist using a computer and digital images. Corona said it is important to remember that the computer does not replace the pathologist. “Rather, it is a decision support tool.”

This all makes for an exciting time to be a pathologist. Corona, who founded Upstate’s Telemedicine Program in 1995 and then was Chief Medical Officer and Vice Pres-

ident of Medical and Scientific Affairs at Welch Allyn Inc., returned to Upstate May 1 to lead the Department of Pathology. He is the John B. Henry Professor of Pathology and Laboratory Medicine. He is a neuropathologist and leader in bioinformatics who has lectured widely on issues related to the interface of technology and advances in medicine. Earlier in his career at Upstate, Corona received Best Teacher of the Year honors and the President’s Award for Excellence in Teaching. His doctor of osteopathic medicine degree is from the New York College of Osteopathic Medicine. He performed an internship at Southeastern Medical Center in Miami and then trained at Upstate in neurology, anatomic pathology and neuropathology under George Collins MD. Corona completed additional fellowships in neuropathology at the Armed Forces Institute of Pathology. Corona is board certified in anatomic pathology, neuropathology and medical management and has been certified as a physician executive by the American College of Physician Executives. ■

Patients appreciate symptom booklets Cancer caregivers at Upstate created a series of patient booklets about managing symptoms related to cancer treatment, in direct response to patient feedback about a need for symptom management information.

95 90 85 80 75 70

“It appeared that patients were overwhelmed with the volume and varied types of information they were given,” said Bonnie Chapman, director of quality at the Upstate Cancer Center. Now, instead of receiving numerous handouts, patients receive an overview pamphlet during their first visit. At subsequent visits they receive only the booklets that pertain to their symptoms.

AV E R A G E S Y M P T O M MANAGEMENT SCORE

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2012

Booklets exist for chemotherapy side effects on the brain, constipation, diarrhea, fatigue, fever, mouth sores, nausea, neuropathy, nutrition, pain, sexuality and skin care. Another set of booklets is being created for side effects of radiation therapy.

the second half of 2011, scores pertaining to patient education for symptom management hit an all-time low of about 80 percent. So a multi-disciplinary team was assembled and developed the booklets.

Patients are randomly selected to complete a survey about their experiences after visiting Upstate for cancer care. During

As a result of the booklets and continued efforts by the staff, Chapman says, survey scores on symptom management have increased to above 90 percent. ■

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summer 2012

Award-Winning C are Integrative medicine will be part of cancer care By Kaushal B. Nanavati MD Imagine an environment where a patient meets with his oncologist while another patient sits with an integrative health care provider, reviewing her health condition and the provider’s perspective on wellness of mind, body and spirit. At the same time, a third patient meets with a nutrition counselor, and a fourth receives manual therapy/ acupuncture/energy therapy. In the same building a group of patients may be working with a trainer who guides them on physical exercise while another group engages in mindfulness training and spiritual support. Sound fascinating, but unlikely to happen in your lifetime? Well, as the Upstate Cancer Center is being built, we are envisioning this exact environment. Our goal is to create a place where our expert oncologists can provide the best of conventional cancer therapeutics alongside integrative evidence-based care to support and boost the patient’s ability to fight disease and maintain health. We will provide care and education and conduct research on novel therapies such as Reiki, mindfulness, and other approaches to wellness. Our goal is to offer services that have been proven beneficial, that are grounded in sound evidence. We also want to study treatments and approaches in which patients express interest but which may not have been

Kaushal B. Nanavati MD is director of integrative medicine for the Upstate Cancer Center and an assistant professor of family medicine at Upstate Medical University. substantiated through research. We want to educate the community on exactly what works, what doesn’t work, and what needs further study. We would also like to create an environment where we not only prevent disease but also promote wellness. There are several approaches to healing. One approach, such as with chemotherapy, is to attack the disease to eliminate it from the body. This can work well, but it can also weaken the

body. Another approach is that of strengthening the body — through proper nutrition, probiotics, exercise and stress management — so that it can fight the disease on its own. Both approaches have validity. When used together in a complementary manner, the approaches can strengthen the body while minimizing side effects. This is not a far-off fantasy. This is the environment patients will find within the Upstate Cancer Center. ■

Welcome to new staff Jessica Bygall, medical records assistant in Radiation Oncology Veronica Finnegan MD, resident in Radiation Oncology Rose Lisano Valentino, assistant director of nursing at the Upstate Cancer Center My Nguyen, medical assistant in the Regional Oncology Center Monica Zirath NP, nurse practitioner in the Regional Oncology Center Mandy Wendell, outpatient administrative specialist in the Breast Care Center Greer Williams, medical assistant in the Breast Care Center

Rendering of the healing garden at the Cancer Center

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Award-Winning C are Staff recognized in patient satisfaction surveys Eleanor Abel PA

Anett Marcarian

Jeffrey Bogart MD

Dena Martin

Robert Bowes

Peggy McPhillips RN

Pat Brady NP Jayne Charlamb MD Sue Chauvin RN

Recognition for the Breast Cancer Program The Breast Cancer Program achieved the highest patient satisfaction score for “sensitivity to patients’ needs” in the first quarter. Pictured with the trophy are, back: John McCabe MD, Haider Khadim MD, Anurag Singh MD, Sheila Lemke MD, Alicia Bair MD, Kara Kort MD, Anna Shapiro MD, Pat Brady NP, Rich Williams RN, Samuel Benjamin MD and Paul Seale; front: Katie Mooney, Shari Kelley NP, and Tina Evans.

Lisa Cico NP Jacqueline Connolly RN Lisa Donovan

“It’s way better than the valet parking that some of the other local hospitals offer. The staff that you employ are absolutely incredible, especially a gentleman named Bill. He is always there when my daughter pulls up to bring me for treatment with a wheelchair and a great big smile.” T H E R EG I O N A L O N CO LO GY C E N T E R :

“The staff have the perfect blend of knowledge, skills and genuine caring.” R A D I AT I O N O N C O L O G Y :

“I couldn’t have found a better facility and group of people anywhere else. It has enabled me to continue feeling positive throughout the process and about my future.” B O N E M A R ROW T R A N S P L A N T :

“Since my transplant in 2006, I have given birth to a healthy baby boy.” T H E T H O R AC I C O N CO LO GY P RO G R A M :

“I brought my daughter, and we both came in scared and weary, but the staff put us at ease and has followed through in a timely manner with everything to try to help my daughter.”

Paula Oxford Michael Poiesz MD Sue Rourke RN Robin Salvaterra RN

Tina Evans

Darlene SchickWaller RN

Simeon Garvin

Rahul Seth DO*

Doreen Heer RN

Anna Shapiro MD

Barbara Jakubowski

Lynn Siriswadi RN

What our patients are saying about… T H E A M BA S S A D O R P RO G R A M :

Roberto Carlos Montoya MD

Shari Kelley NP Haider Khadim MBBS* Laura Kilburg NP Mary Kilpatrick Ajeet Gajra MD Teresa Gentile MD Julie Grimsley RN

Dwaine Spence Sharon Sterriker RN Ibrahim Thabet NP Richard Wells MD Amy Williams Rich Williams RN Jonathan Wright MD

Kara Kort - Glowaki MD Stephen Graziano MD Seung Shin Hahn MD

* MBBS is a doctor of medicine degree from the United Kingdom, India and other Commonwealth countries; DO is a doctor of osteopathic medicine

Roseann Izquierdo RN Sheila Lemke MD

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summer 2012

Academic Difference CANCER RESEARCH INSTITUTE

Research focuses on elderly with cancer About 60 percent of all cancers and more than 70 percent of all cancer deaths occur in the elderly. Unfortunately, cancer care is hampered by a lack of data regarding the risks and benefits of cancer therapy in these older adults, said Ajeet Gajra MD, associate professor of medicine at Upstate and the fellowship director in hematology/ oncology. Older adults have been underrepresented in clinical trials, often because geriatric issues are not considered in cancer clinical trial design. Gajra said there is a great need for evidence-based recommendations for healthy and vulnerable older adults, as life expectancy increases and aging baby boomers are expected to double the United States population age 65 and older by 2030. Gajra represents Upstate as a member of a national coalition of researchers called the Cancer and Aging Research Group, whose members design clinical studies that address the needs of older adults with cancer. Members hail from various cancer centers across the country including California’s City of Hope, New York’s Memorial Sloan-Kettering, Case Western Reserve University in Cleveland, Wake Forest Baptist Medical Center in Winston-Salem, NC and the University of Rochester. The group has started to publish results from early studies, including one which established a way for oncologists to predict risk of toxicity before deciding to start chemotherapy in older patients,

and another that assessed the use of non-prescription complementary medicines, which are often overlooked but can interfere with chemotherapy. In addition, Gajra presented a study on behalf of the group at the American Society of Clinical Oncology’s national meeting, which evaluated how doctors make decisions about chemotherapy dosing in older adults — and the effect those doses have on outcomes. Additional recent research involving Gajra includes: In the journal, Blood, April: “Efficacy of vorinostat in a murine model of polycythemia vera,” by third-year graduate student Hajime Akada; technician Saeko Akada; Gajra; Stephen Graziano MD, professor of medicine; Robert Hutchison MD, medical director of clinical pathology; and Golam Mohi PhD, associate professor of pharmacology. In the Journal of Geriatric Oncology, April: “Geriatric thoracic oncology: Gaining momentum,” an invited editorial by Gajra. In Advances in Hematology, March: “Current status of new anticoagulants in the management of venous thromboembolism,” by Gajra and Roberto Carlos Montoya Barrazza MD, a fellow in hematology/oncology. In the journal, Cancer, February: “Use of complementary medications among older adults with cancer,” including Gajra as a co-author.

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Ajeet Gajra MD In Blood Coagulation & Fibrinolysis, an international journal in haemostasis and thrombosis, December: “Anticoagulantresistant thrombophilia in a patient with polycythemia vera: a case report,” by internal medicine residents Subhraleena Das, Hatim Karachiwala, Sujith Cherian and Amrinder Garcha; Sushama Jasti, a former oncology fellow; and Gajra. In the Journal of Clinical Oncology, September: “Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study,” including Gajra as a co-author. In Hospital Practice (Minneapolis), April 2011: “Treatment of advanced lung cancer in the elderly,” co-authored by Gajra. ■

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Academic Difference CANCER RESEARCH INSTITUTE

Can healthy tissue be protected during prostate cancer radiation therapy? Researchers at Upstate are studying a new system designed to reduce the amount of radiation a man’s healthy tissue is exposed to during radiation therapy to treat prostate cancer. Radiation therapy uses high-energy Xrays to kill cancer cells, but even though advanced techniques make the radiation more focused, there is still a risk of damaging normal tissue. The prostate gland sits like a donut in front of the rectum and beneath the bladder, with the urethra going through the gland. The new system, called SpaceOAR, uses an injectable gel to add space between the prostate and the rectum, to protect the normal healthy tissue of the rectum. When the gel is injected, three markers are placed into the prostate. The markers show up on X-ray, so even if the prostate moves, the radiation therapy can be targeted properly. Men

undergo 43 to 45 sessions, each lasting 10 to 15 minutes. Men involved in the study will get intensity modulated radiotherapy with image guidance and have the option of being treated with Helical Tomotherapy or Varian’s RapidArc technology. “Radiation to the prostate is very effective. There is a lot of information that shows even long term the likelihood of eliminating the cancer is quite similar for many patients whether they chose to have surgery or radiation therapy. That being said, there is some difference with the side effect profile, and our goal is to use the most advanced technology to further reduce the risk of side effects,”said Jeffrey Bogart MD, professor of radiation oncology and urology and chair of Upstate’s Department of Radiation Oncology, who directs the department’s prostate cancer program.

Jeffrey Bogart MD, radiation oncology The study is for men with early stage prostate cancer that is confined to the prostate gland, who are considering radiation therapy. To learn more about the study, call 315-464-5262 or email project coordinator Dena Martin at martind@upstate.edu Upstate is one of 20 hospitals in the United States participating in the SpaceOAR study. ■

Immunotherapy option for some men with prostate cancer A new method of treating prostate cancer using a patient’s own white blood cells is available at Upstate. Provenge® may extend a man’s life by several months.

Dendreon, a biotechnology company in New Jersey, where the patient’s personal dose is manufactured and shipped to Upstate, where the patient is infused.

“It’s a modest improvement in terms of survival for the patients,” said Bernard Poiesz MD, chief of Upstate’s Hematology and Oncology division and the Regional Oncology Center. Provenge does not shrink tumors or reduce levels of a man’s prostate-specific antigen, PSA. Rather, the immunotherapy is designed to harness the body’s immune cells to attack the prostate cancer cells.

Poiesz said the first step is obtaining approval by the patient’s insurance company. Because Provenge is FDA approved, most insurance plans cover it, but because it costs about $90,000 for three doses, patient copay amounts can be considerable. Then, Dendreon must agree that the patient is suitable for immunotherapy.

The Food and Drug Administration approved Provenge in 2010, but it was only available in a handful of hospitals. Now Upstate offers the therapy. Poiesz said the first patient is doing well. “The actual collection of the peripheral blood dendritic cells is done at the Red Cross,” he said. The cells are shipped to

Bernard Poiesz MD, oncology Patients who are likely to see the most benefit from Provenge are men whose prostate cancer has spread beyond the prostate gland but whose symptoms are minimal. Their immune system must be functioning. They have to be on hormone therapy, with rising PSA levels, and they cannot be taking narcotics for pain relief.

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Poiesz said this approach is promising and that future research will look at the value of giving Provenge to men soon after diagnosis, or pairing it with other immune system modulators. “This is fairly time-consuming research. It’s not easy to get quick answers,” he said. ■

Summer 2012

academic difference CANCER RESEARCH INSTITUTE

Egg freezing before cancer treatment can preserve fertility for women Sperm banks to help preserve a man’s ability to procreate have been in existence for decades. The ability to freeze a woman’s eggs is relatively new by comparison. Upstate offers several fertility preservation options to reproductive-age patients. Chemotherapy drugs can damage the eggs that are stored in a woman’s ovaries; depending on her age and the course of her therapy, her fertility may resume after treatment. Radiation can also damage eggs or cause early menopause, depending on its focus and dose. Bone marrow or stem cell transplants, which require high doses of chemotherapy, often permanently stop a woman from ovulating. That’s why it’s important, in the midst of all the other decisions that come with a cancer diagnosis, to also consider whether preserving fertility matters.

“The egg or oocyte is a unique cell. It is the largest cell in the human body. It contains a large amount of water. When you freeze a cell that contains a large amount of water, it causes the water to crystallize, and that can damage the genetic portion of the cell,” said Frederick Sengstacke MD, director of Upstate’s In vitro Fertilization program. “That can interfere with normal cell division, and the cell can die if you crystallize it. “Techniques have now evolved for freezing eggs. Pregnancies have resulted from oocyte cryopreservation, or freezing. It’s a technology that is now accepted as a fairly standard technology, but it’s not as routine as embryo (after the egg is fertilized) freezing. It requires much more technical savvy.” Sengstacke said egg freezing involves stimulating the ovary in advance of cancer therapy and then freezing the eggs.

Frederick Sengstacke II MD, reproductive endocrinology and infertility “Then after she has completed her therapy, she now has frozen eggs that can be used for in vitro fertilization in the future.” Reach Sengstacke for referrals at 315-464-7249. ■

President’s Award goes to blood cancer researcher Golam Mohi PhD, an associate professor of pharmacology and member of the Upstate Cancer Research Institute, was selected to receive the President’s Award for Excellence in Basic Research by a Young Investigator. The award will be presented at the Fall Faculty Convocation, at 4 p.m. Sept. 19 in the Medical Alumni Auditorium in Weiskotten Hall. A reception will follow in the courtyard. Mohi has received national and international recognition for his research on cell signaling, hematopoietic stem cells and blood cancer and has participated on national review panels, study sections for the National Institutes of Health and as a reviewer of leading hematology/oncology journals. After obtaining bachelor’s and master’s of science degrees from the University of Dhaka, Bangladesh, he got his doctorate in molecular and cell biology

from the University of Tokyo in 2001. Then he completed a postdoctoral fellowship in cancer biology at Harvard Medical School in 2005. During that time he published several important papers on the mechanisms of leukemia development and new approaches for treatment of leukemia. Mohi joined Upstate’s Department of Pharmacology in 2006. During a short period of time, Mohi has developed and maintained a strong research program in a highly competitive field, attracting more than $3 million in research funding. His lab is studying the molecular pathogenesis and testing new therapies for a type of blood cancer called poycythemia vera. And, Mohi has published seven papers as an independent investigator in the last five years. “I was deeply impressed with his sharp, precise and objective comments,” one colleague said. In addition, Mohi and his group have published six studies in high

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Golam Mohi PhD, pharmacology impact, peer-reviewed journals in the last three years. Mohi received the prestigious American Society of Hematology Scholar Award and the José Carreras International Leukemia Fellowship from Germany, and also a Central New York Community Foundation Award. ■

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F o un d at ion f or Up s tat e Campaign closer to $15 million goal The Foundation has raised gifts and pledges totaling $13,113,670 (87 percent of our $15 million goal) from 2,833 individuals, corporations, foundations and organizations. The Upstate Family — Upstate Medical University Foundation, Upstate Council, faculty, medical staff, other employees, Advocates, volunteers and Upstate Foundation board members — has contributed more than $3.5 million toward the new cancer center. Generous Individual donors have contributed more than $4.2 million. Corporations and foundations have contributed more than $1.26 million, including these organizations with pledges of $30,000 or more: Advocates for Upstate Medical University, Bart-Rich, Carroll’s Corporation, CNY Infusion

Services, Eastern States Hyundai, Hancock & Estabrook, Harrison Center Associates, Hotel Skyler, Key Bank, M&T Bank, McLane Northeast Grocery Distributors PPC, Price Chopper Supermarkets, Sutton Real Estate Company, TOPS Markets and Upstate departments of Neurosurgery, Orthopedic Surgery, Pathology and Radiation Oncology. Gifts of $30,000 or more have come from organizations including the Carol M. Baldwin Breast Cancer Research Fund of CNY, Golub Foundation, Horwood C. & Alene S. Jones Foundation, Jewish Community Foundation of CNY, Kinney Drugs Foundation, Kiwanis Club Ontario Division, Lockheed Martin Employees Federated Fund, Lukie’s Soul Foundation, Miracle Motorcycle Ride, More Than a Game Foundation,

Paige’s Butterfly Run, Inc., Salt City Road Warriors, Syracuse University Sport Management Club, Upstate Medical University Foundation, and Walmart Foundation. The central New York community at large has contributed more than $2 million. These include 731 tribute gifts and 102 grateful patient gifts. Revenue has also come from golf tournaments, walks and runs, auctions, sporting events and bowling tournaments. You can join in this effort. Host an awareness reception, purchase or sell raffle tickets, or name a room in the new cancer center. For more information contact the foundation at 315-464-4416 or visit our website at www.foundationforupstate.org ■

Freemans host awareness reception Cyril and Ellie Freeman of Fayetteville opened their home to family and friends in June for an awareness reception in support of the Upstate Cancer Center campaign. The Freemans were gracious and charming, and their backyard gardens provided an idyllic setting. Nearly 60 guests attended, despite 90-degree heat. Upstate University Hospital Chief Executive Officer John McCabe MD and Leslie Kohman MD, medical director of the Upstate Cancer Center, spoke about the Cancer Center and the status of the campaign. Featured guest speaker Jayne Charlamb MD discussed the heightened role that cancer prevention services will have in the Cancer Center. ■

Consider a special occasion donation The Foundation for Upstate Medical University is creating special occasion place cards for the Upstate Cancer Center. These are small table cards that can be used at special occasions such as wedding showers, receptions or anniversary parties, indicating a donation has been made to the cancer center in lieu of a favor or flowers. A ribbon will intertwine at the card’s fold.

with gold or silver imprinting available. The Foundation is offering these cards as a service and has priced them so that production costs are covered with a minimum donation. For more information about the special occasion place cards, please contact Brenda Cannizzaro at cannizzb@upstate.edu or 315-464-4281. ■

The card can be displayed one-sided with the general donation information, or can be produced two-sided with customized information on the back. One-sided cards are laced with navy ribbon that is imprinted with the words “Upstate Cancer Center” in silver. Customized cards feature white ribbon

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Rick Gary, Karen Hartnett and John Hartnett announce the winner of the raffle at the Kitty Hoynes event.

Raffle raised nearly $13,000 Five thousand tickets were distributed for sale to more than 25 locations including local Walmart stores, Kitty Hoynes, Syracuse University, Carousel Mall, Taste of Syracuse, Paige’s Butterfly Run and Syracuse University. The lucky winner, Mitch Burman was present when Rick Gary from radio station SUNNY102 pulled the winning ticket on June 15 at Kitty Hoynes. Karen Hartnett spearheaded this fundraiser, with help from community committee members, including Chris Arnold, Sharon Bauer, Jim Cifaratta, Jenny Doan, Didi Frechette, John Hartnett, Dee Petta, Anthony Richmond, Pam Ward, Rich Williams and Ellen Yeomans. ■

Summer 2012

Supporters Norm Swanson & the Genesee Grande Hotel For nearly a decade, Norm Swanson has opened both his wallet and the doors of the Genesee Grande Hotel and his new Hotel Skyler to the Foundation for Upstate Medical University. Beginning with his support of the Children’s Hospital campaign and continuing with his participation in the campaign for the Upstate Cancer Center, Norm has impressed the Foundation with his consistent generosity. As with the Upstate Golisano Children’s Hospital campaign, Norm’s gift to the Cancer Center campaign involves both cash and an in-kind contribution. Norm has pledged 50 percent of the total revenue from the signature Treehouse Suite at the Hotel Skyler for a 10-year period. As part of his gift, Norm also created a trade account at the Genesee Grande Hotel so that Foundation staff members can host small fundraising events in the hotel’s banquet facilities, and use the hotel’s warm and inviting 1060 Restaurant to host donors and special guests. Since the Genesee Grande Hotel is a neighbor of the Foundation — it is located only a couple of blocks away — it is a convenient and comfortable relationship. This is also a mutually beneficial relationship because the arrangement showcases Norm’s beautiful facility to newcomers who have never visited the hotel.

“Norm’s substantial financial and in-kind support is incredibly important to our fundraising efforts,” said Don Zorn, the Foundation’s cancer campaign manager. “The cash portion of his support is one of the largest single gifts to the campaign and directly supports the construction of the new Cancer Center. The in-kind portion of his gift is also strategically important Norm Swanson to the Foundation because it supports our efforts to cultivate and steward our major donors and prospective donors in a cost-effective manner.” Norm’s support of the Cancer Center campaign also generously includes his time. Norm is chair of the corporate phase of the campaign, and works with Foundation staff to raise money from Upstate vendors and companies within the community. ■

Paige’s Butterfly Run

Ride for Life

Paige’s Butterfly Run

Ride for Life

More than 2,600 runners and walkers turned out for the 16th annual Paige’s Butterfly Run, supporting pediatric cancer care at the William J. Waters Center for Children’s Cancer and Blood Disorders at Upstate. Among the record number of participants were more than 50 Upstate employees and family members. Money raised through the event helps pay for research into pediatric cancer at Upstate, and for a Family Assistance Fund and a Family Fun Fund that patients and families may use during their cancer care at Upstate. Last year, Paige’s Butterfly Run raised $190,000 and returned $168,000 to the Central New York community. This year’s event raised more than $200,000. ■

Bicycle enthusiasts raised more than $20,000 in a 25-day cycling challenge called Ride for Life. They logged as many miles as they could, anywhere they wanted between May 17 and June 10. Ride for Life differed from traditional one-day charity rides, but participants still approached friends and relatives to donate money for every mile they completed to help support the new Upstate Cancer Center. ■

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Supporters Recognition

ROC Stars

All patients who were hospitalized at Upstate University Hospital between July 2011 and January 2012 were invited to write tributes to their doctors or mid-level providers. These were compiled in the Upstate Foundation Office, and on Doctors’ Day, March 30, development officers hand-delivered certificates to the providers, including these 37 who are associated with the Upstate Cancer Center.

Upstate’s Regional Oncology Center Stars program was created to increase staff morale. These two individuals were recently recognized as ROC Stars for hard work and always putting Patients First:

Dilip Kittur MD, surgery Teresa Gentile MD, medicine Gennady Bratslavsky MD, urology Jiri Bem MD, surgery Ajeet Gajra MD, medicine Timothy Damron MD, orthopedic surgery Bernard Poiesz MD, medicine Jonathon Wright MD, medicine Kara Kort-Glowaki MD, surgery Oleg Shapiro MD, urology Stephen Graziano MD, medicine Walter Hall MD, neurosurgery Rahul Seth MD, medicine Jeffrey Bogart MD, radiation oncology Sheila Lemke MD, medicine Lawrence Chin MD, neurosurgery Thomas Coyle MD, medicine Jack Hsu MD, otolaryngology and communication sciences

Haider Khadim MD, medicine Toni Pacioles MD, medicine Anna Shapiro MD, radiation oncology Michael Curtis MD, surgery Steven Duffy MD, medicine David Duggan MD, medicine Gloria Kennedy MD, pediatrics Laura Kilburg NP, oncology/ medicine services Krit Kitisin MD, surgery Barbara Robinson MD, surgery Eleanor Abel PA, medicine Alicia Bair MD, medicine Anthony Cerminaro NP, medicine Irene Cherrick MD, pediatrics Vanessa Gibson MD, surgery Diana Gilligan MD, medicine Seung Shin Hahn MD, radiation oncology Dorothy Pan MD, medicine Trisha Tavares MD, pediatrics

The Upstate family lost a dear friend and colleague on April 18 with the passing of Maureen Knopp of Syracuse.

After 44 years at Upstate, Maureen retired in 2009 as the Chair’s Assistant in the Department of Radiation Oncology. She recently served as an active participant on the Patient and Family Advisory Group for the Upstate Cancer Center. Aside from the center being able to

Frank Johnson

From pilot to patient As a Medevac pilot, Frank Johnson has transported many trauma patients to the heliport at Upstate University Hospital in Syracuse. He knew this Level 1 Trauma Center very well, at least from the cockpit. But during a routine prostate exam in 2008, doctors discovered that Johnson had an elevated PSA, prostate-specific antigen. A biopsy found a small, localized tumor. “What a humbling experience to come into the hospital on the ground floor as a cancer patient,” he recalled.

In memory of Maureen

Maureen was the epitome of courage and strength as she battled eight different cancer diagnoses over 18 years. While she often remarked about the “phenomenal” care and emotional and moral support she received from her team of Upstate caregivers, it was Maureen’s steadfast bravery and determination that left her family and friends in awe.

Donna Destefano, Patient Access Sue Rourke, RN

Maureen Knopp speaking at the 2010 site dedication for the Upstate Cancer Center. provide the most advanced medical care, Maureen was enthusiastic about the opportunity for cancer patients to interact and share experiences in the new center. Maureen was an asset who will truly be missed. ■

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Radiation oncologist Jeffrey Bogart MD recommended that Johnson undergo a regimen of precision radiation using the hospital’s Calypso® system. “So far, no side effects. Incredible! And I know from others who have suffered from radiation burns — and my father who had a prostatectomy — just how bad the side effects can be,” Johnson said. Johnson’s confidence in Dr. Bogart and ‘Calypso’ has greatly increased his positive mental attitude. “The accuracy of this technology is right on target. “But,” he said, “I still prefer being in the cockpit.” ■

summer 2012

Supporters

Participants in the Tennis for the Cure Tournament at Gold’s Gym

Tennis Tournament for Cancer Care Patricia Plumley of Baldwinsville has organized an annual tennis tournament since 2010. “There are very few who can claim cancer has not impacted their lives. Whether it is a personal diagnosis or the diagnosis of a family member, a friend, co-worker or acquaintance, cancer is a very real, very sobering creature,” Plumley said at this year’s event in May, held at Gold’s Gym in DeWitt. “Hope, however, is also very real. And thanks to the Upstate Medical University initiative to build a cancer center in our community, we can be hopeful for better care and treatment to benefit all of us.” Proceeds from the tournament go toward a $20,000 cancer center pledge. ■ Newsletter Staff: Leslie Kohman MD, Medical Director Richard Kilburg MBA Associate Administrator Jeanmarie Glasser FACHE Assistant Director 315-464-5925, glasserj@upstate.edu Linda Veit, Project Manager 315-464-6303, veitl@upstate.edu Heidi Chapman, Staff Assistant 315-464-6065, chapmanh@upstate.edu Upstate Medical University Marketing and University Communications Design and Editorial Support 315-464-4836

Debbie Gregg (in the wheelchair, holding her sister’s baby) with her family at her 4th of July fundraiser in Cazenovia.

Patient raised money in honor of her doctor A patient appreciative of her doctor, Thomas E. Coyle MD, raised money for brain cancer research at Upstate. Debbie Gregg of Cazenovia raised more than $24,000 in honor of Coyle and his dedication to the field of neuro-oncology, and her family and friends plan to continue to raise money in her memory. Gregg was diagnosed with anaplastic astrocytoma, brain cancer in January 2008, and Coyle cared for her from diagnosis until her recent death. Coyle is a professor of medicine and neurology specializing in brain tumors and conducting research into the cellular mechanisms underlying the development and treatment of malignant brain tumors. “I had no symptoms. I never had headaches,” said Gregg last spring. “Just one day, thank God a friend of mine called as I was walking out the door to drive somewhere. As I was on the phone with her, all of a sudden I had a seizure.”

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Four and onehalf years after diagnosis, despite radiation therapy, chemotherapy and Coyle’s expertise, the lesions or tumors on Gregg’s brain continued to Thomas E. Coyle MD grow, and were inoperable. On Sunday, August 18, 2012, Gregg passed away peacefully at home, according to a friend. Donations in memory of Gregg, and in honor of Coyle, can be made to Debbie’s Brain Cancer Research Fund, at www.foundationforupstate.org/ teamdebbie. It was Gregg’s wish, and is her family’s goal, to have an infusion room in the new cancer center named after her, in addition to supporting brain cancer research at Upstate. ■

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Recent Events

National Cancer Survivors’ Day Upstate has been the local sponsor for 15 years of National Cancer Survivors’ Day, celebrated annually across the country on the first Sunday in June. This year more than 400 cancer survivors and their families participated in the Hooray for Hollywood-themed event at the Holiday Inn, Electronics Parkway in Liverpool. Live music, food, face painting and photographs made for a festive afternoon, providing support, information and fellowship to those touched by cancer.

Cancer Survivors’ Day

Upcoming Events

Helping families enjoy good times, despite diagnosis Gayle Withrow’s daughter, Shannon Froio was 6 ½ when she died in February 2007 from acute lymphoblastic leukemia.

Baldwin A Run for Their Life

Save the dates! Sept. 9 Carol M. Baldwin Ride for Research Motorcycle Ride Sept. 16 Carol M. Baldwin Breast Cancer Golf Tournament Sept. 21 Upstate Cancer Symposium * Sept. 22 Carol M. Baldwin Paddle for the Cure Sept. 30 The American Cancer Society Making Strides Against Breast Cancer Oct. 14 Carol M. Baldwin A Run for Their Life

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* Upstate Medical University sponsored events

The little girl was treated at Upstate from the age of two. Twice, she travelled to Memorial Sloan-Kettering Cancer Center for bone marrow transplants. When they discovered she had relapsed, doctors estimated she had a month to live. “We just wanted her to enjoy her life,” Withrow says. Every day that Shannon woke up and asked to go to Build-aBear, that’s where the family went. And that was just about every day. Shannon accumulated 25 stuffed animals. The spotted cat was her favorite. The last week of her life she was too sick to go to the store, so the store sent mascot, Bearamy, to her house to visit. After Shannon died, her parents started a foundation geared toward helping families have fun, even during times of medical treatment. They raised money for the Shannon Froio Endowment through golf tournaments. Now, twice a year the foundation invites families with children in the outpatient cancer center to visit Build-a-Bear for free. The visits are near Shannon’s birthday of May 26, and again in November. Withrow says some nurses are invited to make the trip with their children,

www.upstate.edu 750 East Adams Street l Syracuse, NY 13210

Shannon Froio, 2004 too. “It’s good for them to see each other in a different setting,” she says. Bearamy also makes an annual visit to the Center for Children’s Cancer and Blood Disorders at Upstate, bringing with him stuffed animals and various outfits. Do the foundation activities make Withrow sad about her daughter? “Just the opposite,” she says. Withrow was a medical technologist who stopped working when Shannon became ill. A couple months after Shannon died, Upstate had an opening for a clinical research associate in the center where Shannon received treatment. Withrow applied. Now she works in an office lined with notebooks, coordinating Upstate patients with clinical trials taking place all over the country. She is helping researchers find ways for children to have longer and better survivals from cancer. “This is a way to keep Shannon alive for me. It’s really very rewarding.” ■ SM

Knowing changes everything.