Fred Hutchinson Cancer Research Center announced today that it has named an expert in cancer genetics and precision medicine. D. Gary Gilliland, M.D., Ph.D., a physician-scientist with a background in academic medicine and the pharmaceutical industry, as its new president and director. Gilliland will take the helm as Fred Hutch’s new leader on Jan. 2.
Leasing a new building will in Spokane will “help UW expand its medical school program in Spokane. The school’s plans to grow have been a point of contention over the last year as Washington State University also announced plans to start the state’s second publicly-funded medical school in Spokane.
Q: What brought about the decision to split up?
A: It was the view of the UW that in order to continue our participation in the WWAMI program we had to be “100 percent in,” and that was the term that was used by UW. And by that they meant we could not continue in the WWAMI program while pursuing aspirations to have a second medical school in the state.
UW officials say the study wildly over-estimated the cost per student to attend medical school at UW.
They also claim a new medical school would suck resources from the existing medical program known as WWAMI, which is named for the five states it operates in: Washington, Wyoming, Alaska, Montana and Idaho. Washington State University is part of the program.
UW Medicine and PeaceHealth have agreed to create a “strategic affiliation,” with details to be spelled out by the end of September, Seattle Times health write Carol Ostrom reports.
PeaceHealth, a not-for-profit system based in Clark County and founded by the Sisters of St. Joseph of Peace, operates nine hospitals and physician groups in Alaska, Washington and Oregon, and a Medicaid health plan.
The two organizations said they will remain legally separate and independent, but critics of such affiliations noted that after Swedish Medical Center used such language in an affiliation with Providence Health & Services last year, it stopped doing elective abortions and closed its hospice service.
The U.S. Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services restrict such services as abortion, birth control, sterilization and patients’ rights regarding end-of-life treatment.
Seattle Times staff columnist Danny Westneat questions the growing role of the Catholic church in healthcare in Washington state.
By the end of this year, half of our state’s medical system will be Catholic-run, as measured by number of hospital beds. That’s the highest share in the nation, and rising fast — up from about 30 percent just last year. Somehow our godless state has become Ground Zero for faith-based medicine.
We’d never turn our education system over to one church to run. Why are we doing it with health care?
To learn more:
- Read Ostrom’s article: UW Medicine, Catholic health system to have ‘strategic affiliation’
- Read Westneat’s column: Is Catholic Church taking over health care in Washington?
By Jim Malewitz
Stateline Staff Writer
Marian Alicea, an engineering student who is slated to graduate from college this spring, needs a doctorate degree to achieve her lofty career goal of becoming a White House environmental adviser with scientific expertise.
But the budget battle in Washington is complicating her plans for getting there.
In normal times Alicea, who attends Southern Polytechnic State University in Marietta, Ga., would likely be a shoo-in for a full research stipend. She is an honors student who has snagged several prestigious internships. And as a Latina she belongs to a minority group that is underrepresented among engineers.
But because of the sequester—the automatic federal budget cuts that went into effect March 1—some of the schools that want Alicea can’t offer her the financial aid she needs.
Federal agencies pour billions each year into university research, largely through grants that allow student researchers to pay their bills as they work.
With less federal money to spend, some Ph.D. programs are delaying admissions decisions, while others have already cut positions amid the uncertainty.
In 2011, federal money accounted for more than $40 billion of the $65 billion universities spent on research. At several large research universities, including Johns Hopkins, the University of Washington, the University of Pennsylvania and Harvard, federal dollars comprised 80 percent of research spending.
Like most other federal agencies, the National Institutes of Health must cut 5 percent of its budget to comply with sequestration. Because NIH funnels about 85 percent of its budget to researchers, it is already scaling back some grants, according to director Francis Collins.
Meanwhile, the National Science Foundation, facing similar cuts, estimates it will give out about 1,000 fewer research grants and awards this year, affecting as many as 3,000 researchers.
Researchers and university officials worry the lost funding will slow or halt research on everything from cancer treatments to contaminated soil and water.
They also fear it will dissuade young scholars from pursuing scientific careers.
“It will be profoundly devastating for this generation of students,” said Michael Reid, head of the physiology department at the University of Kentucky’s College of Medicine.
Alicea was accepted into four of the dozen programs she applied to, but only two —Virginia Tech and Auburn — offered her financial help.
The other universities, Maryland and Illinois, said they could not guarantee her money because the sequester had muddled their budgets.
Enrollment in graduate schools was already lagging amid growing concerns about student debt. Between 2010 and 2011, first-time U.S. enrollment across programs fell by 1.7 percent, following a decade of gains, according to a survey by the Council of Graduate Schools.
“This financial stress on institutions comes at a really tough time,” said Debra Stewart, the council’s president. “It has a chilling effect on what was already a chilly situation.”
For all university students, sequestration will mean higher fees on Stafford Loans and reduced payments from some grants, including federal work study.
Some educators worry that the prospect of amassing higher debt will scare students away, particularly as institutions hike tuition amid eroding state funding.
But the economic forecaster Moody’s expects universities as a whole to face only “minimal” immediate effects from sequestration as they turn to other revenues.
For graduate students in the sciences, the impact will be more dramatic. A lack of federal money prompted the University of Kentucky’s College of Medicine to admit about a third fewer students to its Ph.D. program in physiology, according to department head Reid.
“There were a number of qualified candidates we had to turn away,” he said.
Reid, who oversees a lab studying how chronic disease, such as cancer, speeds up muscle deterioration, said one of his lead doctoral students will lose his grant if sequestration continues, threatening to halt his education and dramatically slowing down the line of work.
If the politicians in Washington can craft a budget deal that replaces the sequester, Reid’s lab could immediately resume some of its stalled research, he said. But when it comes to genetically engineering mice, a process that can take years, it would likely have to start from scratch. When that type of research is halted, Reid said, “That’s it. You’re toast.”
A “grim fate”
Alicea has no qualms about taking the offer from Virginia Tech, but she is frustrated by her constricted choices and troubled by what it says about lawmakers’ support for the sciences.
Experts consider investment in those areas to be essential for the country’s economic competitiveness and ability to improve health and technology.
Consider Lucas Arzola, founder and head of Inserogen, a biotechnology startup that uses tobacco leaves to speed up the development of human and animal vaccines. He originally developed the technology as a Ph.D. student at the University of California-Davis, largely supported by federal grants.
If Congress doesn’t act, “how many graduate students will no longer have the support to make that next critical discovery?” Arzola said in a video testimony shortly before sequestration took effect.
Major drug, energy and engineering companies are increasingly relying on universities to build on their research and develop new products, said Robert Duncan, vice chancellor for research at the University of Missouri.
Duncan says sequestration “is terrible for U.S. competitiveness,” pointing to a 2010 National Academies of Sciences studythat showed the U.S. has begun to lag behind other countries in math and the sciences.
“In spite of the efforts of both those in government and the private sector, the outlook for America to compete for quality jobs has further deteriorated,” the authors concluded. They called for more spending on research and education.
Furthermore, many economists argue it is misguided to curb research spending to address the nation’s budget crisis, because several studies have shown such spending spurs economic activity far greater than what is invested.
Last fall, an analysis by the Information Technology and Innovation Foundation, a non-partisan think tank in Washington, estimated cuts to research and development funding under sequestration would reduce GDP by as much as $860 billion over nine years.
“If we want to see our still somewhat lagging economy pick up again, (investing in research) is one of the major ways to achieve it,” said Collins, the NIH head.
At NIH, the cuts follow a decade in which funding stayed static despite inflation, and could result in the elimination of as many as 20,500 U.S. research jobs, according to an analysis by United for Research, a coalition of research institutes and patient advocates.
“It is a paradoxical thing that we are both at a time of remarkable and almost unprecedented scientific opportunity,” Collins said, “and we‘re also at a time in the United States of unprecedented threat to the momentum of scientific progress.”
Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.
From MedlinePlus magazine
What is Lung Cancer
Lung cancer forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
- Small cell: The cells of small cell lung cancer look small under a microscope. About 1 of every 8 people with lung cancer has small cell lung cancer.
- Non-small cell: The cells of non-small cell lung cancer are larger than the cells of small cell lung cancer. Most (about 7 of every 8) people diagnosed with lung cancer have non-small cell lung cancer. It doesn’t grow and spread as fast as small cell lung cancer, and it’s treated differently.
Lung cancer is the leading cause of cancer death in both men and women. Lung cancer is the second most common cancer in the United States, after skin cancer. The number of new cases and deaths from lung cancer is highest in black men.
The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer. If a person has stopped smoking, the risk becomes lower as the years pass.
When smoking is combined with other risk factors—such as secondhand smoke, asbestos and arsenic exposure, and air pollution—the risk of lung cancer is increased. A family history of cancer can also be a risk factor for lung cancer.
In 2005, Dusty Donaldson experienced tenderness and pain in her neck that didn’t go away over several months. When her doctor couldn’t detect any physical cause, and the pain continued, Donaldson decided more had to be done. “The pain was persistent, and so was I.”
Today, she’s thankful for her persistence. Ultrasound and CT scans found something suspicious in her right lung. That turned out to be a five-centimeter cancerous tumor between the upper and middle lobes of her lungs. It was an early-stage cancer and had not spread to other parts of her lungs or her body.
Donaldson, who had quit smoking 26 years before her diagnosis, had not even considered that she might have lung cancer.
“I was really surprised at the time to find out that lung cancer is the number one cause of cancer deaths in men and women. More people die from lung cancer than from all the others combined,” Donaldson says. “Lung cancer death rates are the equivalent of a 747 jumbo jet crashing to the ground every single day.”
Surgeons removed almost two-thirds of her lung and treated her with chemotherapy for three months. Today, she remains cancer free and has made a commitment to help others understand lung cancer and the need for early detection.
“I’m compelled to find others and share with them information regarding screening,” she says. “Early detection is key to survivorship,” she adds. “There’s not a single soul on this earth who doesn’t need to know about lung cancer. People who don’t know they are at risk, need to know that there are other risk factors—genetics, radon, and other things that can cause lung cancer.”
“If I could tell the world one thing about lung cancer, it’s that anyone can get it and no one deserves it.”
—Dusty Donaldson, 58, High Point, NC.
“Now thanks to the National Lung Screening Trial, we know screening can be more effective than anything else,” says Donaldson. “People who are at great risk don’t have to consider themselves doomed to lung cancer. They can have early detection, get treated early, and hopefully live a long and healthy life.”
X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
Possible signs of non-small cell lung cancer include a cough that doesn’t go away and shortness of breath. Check with your doctor or other health professional if you have any of the following problems:
- Chest discomfort or pain.
- A cough that doesn’t go away or gets worse over time.
- Trouble breathing.
- Blood in sputum (mucus coughed up from the lungs).
- Loss of appetite.
- Weight loss for no known reason.
- Feeling very tired.
- Trouble swallowing.
- Swelling in the face and/or veins in the neck.
Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer. Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time. Some of the following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.
- Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
- Chest X-ray: An X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through the body, making a picture of areas inside the body.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Lung biopsy. The patient lies on a table that slides through the computed tomography (CT) machine, which takes X-ray pictures of the inside of the body. The X-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.
- Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
- The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
- The type of lung cancer.
- Whether there are symptoms such as coughing or trouble breathing.
- The patient’s general health.
For patients with advanced non-small cell lung cancer, current treatments do not cure the cancer. The treatment that’s right for you depends mainly on the type and stage of lung cancer. You may receive more than one type of treatment.
Surgery may be an option for people with early-stage lung cancer. The surgeon usually removes only the part of the lung that contains cancer. Most people who have surgery for lung cancer will have the lobe of the lung that contains the cancer removed. This is a lobectomy. In some cases, the surgeon will remove the tumor along with less tissue than an entire lobe, or the surgeon will remove the entire lung. The surgeon also removes nearby lymph nodes.
Radiation therapy is an option for people with any stage of lung cancer:
- People with early lung cancer may choose radiation therapy instead of surgery.
- After surgery, radiation therapy can be used to destroy any cancer cells that may remain in the chest.
- In advanced lung cancer, radiation therapy may be used with chemotherapy.
The NCI booklet Radiation Therapy and You (www.cancer.gov/cancertopics/coping/radiation-therapy-and-you) has helpful ideas for coping with radiation therapy side effects.
Chemotherapy may be used alone, with radiation therapy, or after surgery.
Chemotherapy uses drugs to kill cancer cells. The drugs for lung cancer are usually given directly into a vein (intravenously) through a thin needle. Newer chemotherapy methods, called targeted treatments, are often given as a pill that is swallowed.
You’ll probably receive chemotherapy in a clinic or at the doctor’s office. People rarely need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
- When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired.
- Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
- Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your healthcare team can give you medicines and suggest other ways to help with these problems.
The NCI booklet Chemotherapy and You (www.cancer.gov/cancertopics/coping/chemotherapy-and-you) has helpful ideas for coping with chemotherapy side effects.
People with non-small cell lung cancer that has spread may receive a type of treatment called targeted therapy. Several kinds of targeted therapy are used for non-small cell lung cancer. One kind is used only if a lab test on the cancer tissue shows a certain gene change. Targeted therapies can block the growth and spread of lung cancer cells.
Depending on the kind of drug used, targeted therapies for lung cancer are given intravenously or by mouth.
Lung Cancer Research
- The large-scale National Lung Screening Trial, supported by the National Cancer Institute (NCI), has shown that screening current or former heavy smokers with low-dose helical computed tomography (CT) decreases the risk of dying from lung cancer. That finding was only for heavy smokers.
- Another recent study showed that low-dose nicotine does not enhance lung cancer development. This suggests that nicotine replacement therapy is safe for former smokers.
- Results of a 2011 research trial revealed that annual chest X-ray screening of people ages 55 to 74 years does not reduce lung cancer deaths compared with usual care.
- Researchers have identified genetic regions that predispose Asian women who’ve never smoked to lung cancer. The finding provides evidence that lung cancer between smokers and never-smokers can differ on a fundamental level.
- What type of lung cancer do I have?
- Has the cancer spread from the lung? If so, to where?
- May I have a copy of test results?
- What kind of surgery do you suggest for me?
- How will I feel after surgery?
- If I have pain, how can we control it?
- How long will I be in the hospital?
- Will I have any lasting side effects?
- When can I get back to my normal activities?
- When will treatment start? When will it end? How often will I have treatments?
- How will I feel during treatment? Will I be able to drive myself to and from treatment?
- What can I do to take care of myself before, during, and after treatment?
- How will we know the treatment is working?
- What side effects should I expect? What should I tell you about?
- Are there any lasting effects?
Chemotherapy or Targeted Therapy
- Which drug or drugs do you suggest for me? What will they do?
- What are the possible side effects? What can we do about them?
- When will treatment start? When will it end? How often will I have treatments?
- How will we know the treatment is working?
- Will there be lasting side effects?
To Find Out More
- MedlinePlus: www.medlineplus.gov Type “lung cancer” into Search box.
- Be Tobacco Free: www.BeTobaccoFree.gov brings together information on the health effects of tobacco, quitting smoking, and more.
- The What You Need To Know About Lung Cancer booklet (www.cancer.gov/cancertopics/wyntk/lung) provides information about lung cancer diagnosis, staging, treatment, and comfort care. Information specialists also can answer questions about cancer at 1-800-4-CANCER.
- The NCI Lung Cancer Home Page provides up-to-date information on lung cancer treatment, prevention, genetics, causes, screening, testing, and related topics. (www.cancer.gov/cancertopics/types/lung)
- Information on treatment options for non-small cell lung cancer and small cell lung cancer is available from PDQ, NCI’s comprehensive cancer database. (www.cancer.gov/cancertopics/pdq)
- Clinical trials for non-small cell lung cancer and small cell lung cancer can be found in NCI’s list of clinical trials. (www.cancer.gov/clinicaltrials)
Because most people who get lung cancer were smokers, you may feel that doctors and other people assume that you are or were a smoker (even if you aren’t or weren’t). Whether or not you were a smoker, it’s important for you to protect your body now from smoke. Avoid secondhand smoke from smokers near you.
If you smoke, talk with an expert about quitting. It’s never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.
To get help with quitting smoking…
- Call NCI’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
Sign up for the free mobile service SmokefreeTXT to get tips and encouragement to quit. To sign up, text the word QUIT to IQUIT (47848) from your mobile phone. Or, go to www.smokefree.gov/smokefreetxt/Signup.aspx.
Dollars for Docs: How to Evaluate Drug Payment Data
by Nicholas Kusnetz
Update: This story has been revised to reflect updated Dollars for Docs data on March 11, 2013.
Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But 15 companies have now made some of that information public.
ProPublica’s Dollars for Docs pulls their disclosures into a single database so patients can easily search for their doctor. We created Dollars for Docs database partly as an educational tool. How can patients use it? Here are some suggestions.
Q. My doctor is on this list. Should I care?
A. If your doctor is listed, it’s because he or she received money from one of the drug companies for promotional activities or consulting.
Payments are legal, so it doesn’t mean your doctor has done anything wrong. But research has shown that drug company marketing can influence what a doctor prescribes, and some experts say it is cause for concern.
Others say the information should carry less weight. They say the amount of money a doctor receives is less important than personal recommendations and the doctor’s training and experience.
One word of caution: Some doctors in our database have the same or similar names, so be sure to confirm with your doctor that he or she is actually the one on the list. Names and addresses on the data are as disclosed by the companies, and they sometimes use variations.
Q. My doctor is not on the list. What does that mean?
A. ProPublica included payments only from the drug companies that have made these relationships public so far. Many doctors do not do promotional work or consulting for drug companies.
Others may receive such payments from companies that haven’t yet disclosed them. So even if your doctor isn’t on the list, experts say it’s worth asking about the issue.
Q. What’s the best way to bring up the issue with my doctor?
A. Although it can feel awkward, some experts say it’s important to ask about potential conflicts of interest. Others say patients should trust their doctors to do what’s right for them.
If you do raise the issue, tell your doctor you want to feel confident the drugs he is prescribing for you are best for the job.
According to a 2010 national survey by Consumer Reports, conducted for this project, 70 percent of adults say doctors should tell their patients about payments they’ve taken from a drug company whose drugs they are about to prescribe.
Ask first if your doctor has any financial relationships with drug companies. If so, ask about what companies are involved, the nature of each relationship and the duration.
Most often, doctors are paid for promotional activities, such as speaking to other doctors about a drug, or for consulting or research.
It’s important to ask whether medications you are taking are made by the companies. If the answer is yes, it’s not necessarily a problem but is worth discussing further.
Q. How can I be sure my doctor is offering unbiased advice about a drug?
A. If your doctor has prescribed you medication made by a company he or she receives payments from, you should ask whether there are any cheaper generic alternatives. How does the drug compare to others in its class? What are the side effects? Are there alternatives with fewer side effects? And importantly, are there non-drug alternatives, such as diet, watchful waiting or physical therapy?
It may be that the drug you are on is the best option. But sometimes a drug company will market a new, more expensive version of an established drug even when the older one is cheaper and effective.
Asking these questions will show your doctor you’re aware of these issues.
Q. Where can I learn more about drugs my doctor prescribes?
A. Searching the Web will bring up a wealth of links and literature. One site that has comprehensive drug and supplement information is MedlinePlus.
To mark National Breast Cancer Awareness Month Seattle’s Fred Hutchinson Cancer Research Center and its clinical care partner, the Seattle Cancer Care Alliance have published a “baker’s dozen” of top beast health tips gleaned from four previously published tip sheets.
TOP TIPS FOR BREAST CANCER PREVENTION from Anne McTiernan, M.D., Ph.D., a member of the Center’s Public Health Sciences Division and author of “Breast Fitness” (St. Martin’s Press):
1) For all women: Follow a healthy lifestyle, including keeping your weight in normal range (body mass index under 25), being physically active (at least 30 minutes a day of moderate-intensity exercise), minimizing alcohol intake (one drink a day or less), and don’t smoke.
Overweight, inactivity and alcohol all increase risk for breast cancer, and smoking increases risk in some women.
2) For young women: Breast-feed your babies for as long as possible. Women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer.
3) For postmenopausal women: Avoid hormone replacement therapy.
Menopausal hormone therapy increases risk for breast cancer.
If you must take hormones to manage menopausal symptoms, avoid those that contain progesterone and limit their use to less than three years.
“Bioidentical” hormones and hormonal creams and gels are no safer than prescription hormones and should also be avoided.
4) For high-risk women: Consider taking an estrogen-blocking drug.
Women with a family history of breast cancer or who have had breast biopsies or are over 60 should talk to their doctor about the pros and cons of estrogen-blocking drugs such as tamoxifen, raloxifene, and aromatase inhibitors.
TOP TIPS FOR BREAST CANCER SCREENING AND EARLY DETECTION from Constance Lehman, M.D., Ph.D., director of Radiology at Seattle Cancer Care Alliance:
5) If you are over 40, get a mammogram. Early detection of breast cancer offers the best chance for a cure. SCCA supports the American Cancer Society’s recommendation that women begin annual mammography screening at age 40.
6) Know your risk. Tell your doctor if you have family members who have had breast cancer, especially a mother or sister, and if they had breast cancer before reaching menopause because your own risk of cancer may be higher than average.
Some women at high risk may be recommended for annual MRI in addition to a screening mammogram.
7) Don’t put off screening because of discomfort or fear of the results: A mammogram should never be painful.
To reduce discomfort, try to schedule the exam after your monthly period, when breast tissue is less sensitive.
You may benefit by taking an over-the-counter anti-inflammatory such as ibuprofen or acetaminophen before your mammogram. Above all, tell the mammography technologist about any discomfort you may be experiencing.
Most abnormalities found after a mammogram are not cancer.
However, in some cases you may be called back for more tests, such as additional mammography or ultrasound screening, to confirm that the area on the screening mammogram is normal.
TOP TIPS FOR BREAST CANCER PATIENTS DURING TREATMENT from Julie Gralow, M.D., director of Breast Medical Oncology at Seattle Cancer Care Alliance and co-author of “Breast Fitness” (St. Martin’s Press):
8) Choose your doctor wisely. Breast cancer specialists who work at dedicated cancer centers offer specific expertise as well as access to the latest treatments that are part of clinical studies.
Such centers can provide other specialty services, usually under one roof, such as physical therapy, nutrition and social work.
9) Get specifics on your diagnosis and treatment. To maximize your time with your providers, bring your questions with you in writing to your appointments.
Ask for copies of your test results and keep a notebook of all these results. Keep a list of questions that arise between visits so you don’t forget, and take notes of the answers.
Above all, make informed decisions; learn as much as you can about your diagnosis and treatment.
10) Get good nutrition and bone up on bone health. Cancer treatment may influence taste and smell, and it may alter your digestion. Foods that you normally enjoy may not taste good during treatment while, paradoxically, foods that normally don’t appeal to you might taste better.
You may have more energy and less nausea if you eat smaller amounts of foods more frequently rather than eating three big meals per day.
Eat more vegetables, fruits, whole grains, nuts, seeds and legumes such as black beans and lentils.
Choose a rainbow of colorful whole foods (like deep greens of spinach, deep blues of blueberries, white for onions, and so on) to ensure that you get a variety of anti-cancer nutrients.
Alcohol is usually not preferred or recommended during treatment. Keeping your bones healthy throughout your life is important; however, if you’re a woman who’s been diagnosed with breast cancer, bone health is especially important.
Research shows that some breast cancer treatments can lead to bone loss. Plus, women are about twice as likely as men to develop osteoporosis after age 50.
Talk to your health care team about specific recommendations for keeping bones healthy, taking calcium and vitamin D, and appropriate weight-bearing exercises to help keep bones strong.
TOP TIPS FOR BREAST CANCER SURVIVORS from Karen Syrjala, Ph.D., director of Biobehavioral Sciences in the Hutchinson Center’s Clinical Research Division and co-director of the Hutchinson Center Survivorship Program
11) Get a summary of your treatments. Have a list of what surgery, radiation and chemotherapy doses you received so that you can communicate these to your primary care providers. This will help you plan for the next tip on the list.
12) Make a plan for monitoring the long-term effects of your cancer treatment. Talk to your doctor about the potential long-term effects of your cancer treatment and what to watch out for. For example, some cancer treatments can increase the risk of cardiovascular problems or second cancers; others can impact your bones.
13) Learn how to manage the fear of cancer coming back. First, find out your risk of recurrence from your health care provider. Second, remember that risk is an estimate based on averages and does not always apply to you as an individual. Third, consider counseling or other assistance to help you face your fears and move forward.
To learn more read the full tip sheets:
- Tips for breast cancer prevention.
- Tips for breast cancer screening and early detection.
- Tips for breast cancer treatment.
- Tips for breast cancer survivorship.
In this year’s list the magazine’s judges included more health-care leaders working outside the Seattle area, including Pullman, Walla Walla and Yakima.
- Lifetime Achievement Award: Rick Linneweh, CEO, Yakima Valley Memorial Hospital
- Outstanding Health Care Executive: Rick Cooper, CEO, The Everett Clinic
- Outstanding Health Care Professional: Margaret L. Hall, Northwest Hospital & Medical Center
- Innovation in Medical Devices: Physio-Control
- Innovation in Biopharmaceuticals: Seattle Genetics
- Global Health Organization: SightLife
- Community Outreach: Providence Senior and Community Services
- Wellness Program (Western Washington): Group Health Cooperative
- Wellness Program (Eastern Washington: Baker Boyer Bank
Seattle’s Marsha Rivikin Center will award over $1.2 million in grants this year to researchers studying ovarian cancer.
The largest grant will go to David Bowtell, PhD of the Peter MacCallum Cancer Center in Melbourne, Australia, who won the Center’s first Scientific Challenge Grant, a new award that seeks to encourage research into the origins of ovarian cancer with the goal of developing ways to diagnose the cancer early, when it is more treatable.
The two-year, $150,000 grant will fund Professor Bowtell’s to research to see whether ovarian cancers release enough of a form of DNA into the bloodstream that it might be possible to detect the cancer early with a simple blood test.
The Center also awarded one-year $75,000 Pilot Study Awards to 13 researchers conducting innovative research and three $60,000, one-year Scientific Scholar grants for promising young laboratory and clinical scientists pursuing careers in ovarian cancer research.
Among the recipients of the Pilot Study Awards is Lupe Salazar, MD of the University of Washington’s Tumor Vaccine Group, who studies how the immune system’s white cells can be induced to attack cancer cells. For a summary of her grant click here.
Among the three Scientific Scholar grantees is John Liao, MD, PhD, assistant professor of the UW Obstetrics & Gynecology Department, who is working on developing vaccines against ovarian cancer. For a summary of his grant click here.
Ovarian cancer is the ninth most common cancer among women, excluding non-melanoma skin cancers, according the American Cancer Society.
Each year in the U.S., about 21,990 women are diagnosed with ovarian cancer and about 15,460 die from the diseases.
Only about half of women diagnosed with ovarian cancer will be alive in five years, but if the cancer is found and treated before it has spread outside of the ovary, the five-year survival rate is 94 percent.
Early diagnosis is difficult, however, because early ovarian cancers often produce no or only subtle symptoms and no screening test has yet been proven to be effective, according to American Cancer Society.
As a result, only about one in five cases of ovarian cancer are diagnosed early.
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Pilot Study Awardees for 2011:
Karen Abbott, PhD
University of Georgia
Targeting Tumor-Specific Glycosylation: Discovery of Novel Membrane Receptors
Dr. Abbott’s work is focused on discovering new tumor-specific targets on the surface of cancer cells. Tumor-targeted therapy regimens will have less toxic side effects to normal tissues, and lead to a better quality of life for patients. This project is based on a recent discovery of a unique type of carbohydrate (glycan) found on proteins that cover the surface of ovarian tumor cells and not normal ovarian cells. The membrane receptors that help this glycan stick to the surface of tumor cells will be identified and subsequently used for the development of tumor-targeted therapeutics in the future.
Karen Cowden Dahl, PhD
The role of ARID3B isoforms in ovarian cancer and chemoresistance
Around 70% of women diagnosed with ovarian cancer have advanced disease and the prognosis is very poor. Treatment for ovarian cancer consists of surgery followed by chemotherapy. One of the contributing factors to the poor prognosis for advanced ovarian cancer is due to tumor cells becoming resistant to chemotherapy. This project aims to understand how a new overexpressed gene (ARID3B) is regulated in ovarian cancer and how different forms of this gene contribute to chemoresistance. These studies will further the understanding of genes that are involved in ovarian cancer and chemoresistance in order to better treat ovarian cancer patients.
Daniela Dinulescu, PhD
Brigham and Women’s Hospital
Experimental Models to Validate a Tubal Cell of Origin for Serous Ovarian Cancer
Too little is known about the genetic lesions responsible for ovarian cancer tumor initiation, and uncertainty remains over the specific cell or cells of origin. Data emerging from The Cancer Genome Atlas (TCGA) on the many genomic alterations in serous ovarian carcinoma has delivered a treasure trove of new candidates for investigation, but discerning which gene alterations are critical early events in cancer pathogenesis, how tumors evolve to their highly aggressive state, and which pathways represent the best therapeutic targets will require a large scale collaborative research effort. Animal models developed in Dr. Dinulescu’s lab, which accurately recapitulate the human disease, constitute great tools for defining the key roles that ovarian cancer cells in the ovarian surface epithelium and distal fallopian tube play in tumor initiation and resistance to chemotherapy. Furthermore, they provide us with unique, relevant in vivo systems in which to screen novel molecularly targeted therapies as they become available.
Thuy-Vy Do, PhD
University of Kansas Medical Center
Preclinical Evaluation of Aurora A Kinase and PARP Inhibitor Combination Therapy
Women carrying mutations in the breast-cancer associated 1 or 2 (BRCA1/2) genes are at higher risk for developing epithelial ovarian cancer. BRCA1/2 play critical roles in repairing DNA and helping genes avoid mutation. Interestingly, BRCA1/2 is not functioning optimally in cases of sporadic epithelial ovarian cancer, and BRCA2 and Aurora A interact in cells to regulate genomic stability. Dr. Do will test the hypothesis that Aurora A and BRCA1/2 interact to mediate DNA repair and cell growth. An Aurora A kinase inhibitor and a PARP inhibitor will be tested as therapies for ovarian cancer.
Alexander Nikitin, MD, PhD
Role of Stem Cells in Ovarian Cancer
Understanding of epithelial ovarian cancer development is critical for designing effective diagnostic and therapeutic approaches. During recent years it has become increasingly clear that cancers may arise from stem and progenitor cells. However, the location of the stem cell compartment of the ovarian surface epithelium that give rise to cancer cells remains unknown. Dr. Nikitin will explore a newly identified stem cell compartment in the ovary and determine properties of these stem cells and their contributions to epithelial ovarian cancer.
Daniel Powell, PhD
University of Pennsylvania
Preclinical Evaluation of Costimulated CIR Therapy for Ovarian Cancer
Adoptive immunotherapy is extremely effective for triggering tumor regression in patients with malignant melanoma. To develop adoptive T-cell therapy for epithelial ovarian cancer, we have created a chimeric immune receptor (CIR) that redirects the immune system against alpha-folate receptor, a protein on the surface of 90% of epithelial ovarian cancer cells. In designing this therapy, other strategies that will be taken into account including promoting growth and survival of the body’s own immune cells to fight ovarian cancer. The results of Dr. Powell’s work will provide preclinical data essential for clinical development.
Carrie Rinker-Schaeffer, PhD
University of Chicago
Milky Spot Macrophages: Co-Conspirators in Omental Metastasis Formation
No one knows what microenvironmental interactions control ovarian cancer metastasis. Getting this crucial information requires a fresh look from a new perspective. Recently Dr. Rinker-Schaeffer’s lab made a novel connection between ovarian cancer metastatic colonization and structures on the omentum (tissues in the abdomen) that contain immune cells and are called milky spots. It is suspected that cancer cells take advantage of milky spots to promote their own survival and growth. This project will identify interactions between omental immune cells and cancer cells that can be targeted in combination with current therapies in order to suppress metastatic growth, improve quality of life, and extend disease-free survival.
Adoptive transfer of tumor specific Th1 cells derived from vaccine-primed patients achieved clinical benefits
Adoptive immunotherapy can induce cancer regression but rarely results in cure. We have infused HER2-specific Th1 cells in breast cancer patients, and 50% of patients had a partial or complete response to the treatment. Dr. Salazar hypothesizes that Th1/Th17 immune cells that can recognize tumor cells can have enhanced therapeutic efficacy. This project will determine the optimal conditions to grow these multifunctional immune cells in the lab in order to enhance their ability to identify and target cancer cells using IGFBP2. Results from this project will lead to a phase I study of adoptive immunotherapy in ovarian cancer after priming with an IGFBP2 vaccine.
Janet Sawicki, PhD
Lankenau Institute for Medical Research
Utilizing HuR to Combat Chemotherapeutic Resistance in Ovarian Cancer
The molecular basis underlying the range of ovarian cancer patient responses to chemotherapeutic agents is poorly understood. This project will address the urgent need to stratify ovarian cancer patients for therapy and enhance currently available treatment strategies. Recently, Dr. Sawicki’s lab discovered that the stress response protein, HuR, can mediate therapeutic efficacy of gemcitabine and a PARP inhibitor, two drugs currently used to treat ovarian cancer, by rapidly binding and regulating cancer-associated mRNA transcripts. Therefore, HuR may serve as both a potential predictive marker for drug efficacy and a promising target for therapeutic manipulation for the treatment of epithelial ovarian cancer.
Kavita Shah, PhD
Chemical genetic dissection of Aurora A Kinase in ovarian cancer
The function of kinases is to turn proteins on and off in cells. Aurora A kinase is one such kinase whose levels increase early in ovarian cancer and are associated with poor prognosis. By identifying the proteins that Aurora A kinase turns on and off in ovarian cancer cells that are not affected in normal cells, Dr. Shah can design drugs to inhibit Aurora A kinase from doing its job and reverse the cascade of proteins that are involved in progression of ovarian cancer. Safer drugs can be developed which target only ovarian cancer cells while avoiding normal cells.
Barbara Vanderhyden, PhD
Ottawa Hospital Research Institute
Role of PAX2 in the etiology of ovarian and fallopian tube cancers
The origins of ovarian cancer are poorly understood but most cancers seem to arise from the surface layer of cells on the ovary or the fallopian tube. Ovarian surface epithelial cells have the ability to develop into ovarian cancer subtypes that fall into two broad categories: low-grade and high-grade. Previous work shows that changes in a protein, PAX2, occur in the earliest cancerous structures in both ovaries and fallopian tubes. Dr. Vanderhyden’s lab has developed methods to isolate both ovarian and fallopian tube cells from mice and will determine how changes in PAX2 contribute to the early stages of ovarian cancer.
Christine Walsh, MD
Cedars-Sinai Medical Center
Genetic Modifiers of BRCA1-Associated Gynecologic Cancer Penetrance
Women who inherit a mutation in the BRCA1 gene have a 40% risk of developing ovarian, tubal, or peritoneal cancer. Dr. Walsh is seeking to shed light on genetic and molecular events that lead to tumor development in some women in this high-risk population but not in others. A significant difference in the genetic sequence of the PARK2 gene distinguishes BRCA1 mutation carriers that do develop cancer from those who do not develop cancer. This project will further investigate PARK2, which is mutated in other cancers and has a tumor suppressor function, by looking at its role in the biology of BRCA1-associated gynecologic cancer development.
Jian-Jun Wei, MD
MiR-182 overexpression in early tumorigenesis of high grade serous carcinoma
High grade papillary serous carcinoma may arise from serous tubal intraepithelial carcinoma in the fallopian tube. MiR-182 is a small RNA molecule that is significantly overexpressed in both types of carcinomas. Dr. Wei hypothesizes that miR-182 overexpression is a critical and early molecular change in papillary serous carcinoma. He will use normal fallopian tube secretory epithelial (FTSE) cell lines to investigate whether adding miR-182 in large amounts will result in tumors and whether miR-182 causes tumors via target genes BNC2 and MTSS1 known to be involved in papillary serous carcinoma. The results will provide a new marker in early detection and a potential therapeutic target for PSC.
Scientific Scholar Awardees:
Young Min Chung, PhD
Stanford University School of Medicine
Targeting Ovarian Cancer with Combination of Olaparib and Trifluoperazine
Dr. Chung is developing innovative therapeutic strategies by combining a clinically used small-molecule drug called trifluoperazine (TFP) and a chemical compound named Olaparib, which is an inhibitor of an enzyme called PARP, to suppress advanced ovarian cancer and to overcome PARP inhibitor-unresponsive ovarian cancer. In addition, novel biomarkers will be identified for monitoring therapeutic sensitivities in ovarian cancer. Ultimately, the results of this project will be used to design a clinical trial to treat patients with advanced ovarian cancer.
Development of a polyepitope DNA vaccine for ovarian cancer immunotherapy
While ovarian cancer patients can respond to chemotherapy and achieve remission, the majority of advanced stage patients succumb to recurrent disease. Strategies harnessing the immune system have the potential to augment available therapies, prolong remissions, and prevent relapses. Vaccines generating immune responses against proteins in ovarian cancer cells could offer a possibility of selectively killing those cells. Dr. Liao has identified 6 proteins associated with poor prognosis. Vaccines targeting fragments of these 6 proteins will then be tested in a mouse model for ovarian cancer to evaluate safety and effectiveness in preparation for clinical trials.
Fiona Simpkins, MD
University of Miami
Characterization of subpopulations capable of self-renewal in ovarian cancers
Most ovarian cancer patients suffer disease recurrence, and most available chemotherapies are toxic and stop working. Cancer stem cells comprise a subpopulation of cells capable of self-renewal and are resistant to chemotherapy. By characterizing such subpopulations and determining which signaling pathways drive their growth, Dr. Simpkins would like to develop better strategies to target these subpopulations and overcome drug resistance. This project will characterize the self-renewal potential of cell populations expressing different surface markers suggestive of “stemness” in ovarian cancer, determine developmental and mitogenic signaling pathways unique to these populations, and determine how targeted treatments effect these subpopulations.
Money and medicine
KUOW looks at the salaries of Seattle’s top docs and charity care Washington non-profit hospitals give
John Ryan, a reporter for Seattle’s Public Radio affiliate KUOW, looked at how much Seattle-area hospitals, most of which enjoy the tax benefits of non-profit status, pay their top officials and how much charity care they provide.
Salaries, Ryan reports, often top $1 million a year:
KUOW has learned that 15 nonprofit hospital leaders in the Seattle area earned at least $1 million in 2007. This elite group includes the CEOs of Swedish, Providence, Virginia Mason, Group Health, Seattle Children’s and MultiCare in Tacoma. Another three dozen hospital officials in King, Pierce and Snohomish counties earned at least half a million that year.
Charity care, Ryan found, is often less than 2% of revenues:
Only three of the nonprofit hospitals in central Puget Sound give away more than 2 percent of their care to the poor: Providence Regional in Everett, Saint Clare in Lakewood, and Saint Francis in Federal Way.
To learn more:
- Visit KUOW’s Web page where you can either listen to or read the transcripts of Ryan’s reports.
Sotomayor’s nomination a milestone for people with diabetes, too
Two Seattle Times op-ed columnist point out that the nomination of Judge Sonia Sotomayor to the Supreme Court is sign of how we’ve come in the management of diabetes, a disease that not so long ago was considered a death sentence.
In the column, Irl B Hirsch, a professor of medicine at the University of Washington, and James S. Hirsch, author of “Cheating Destiny: Living with Diabetes” write:
But Judge Sotomayor’s nomination should be given its historic due. If a Latina would have never been considered for the highest court 40 years ago or even 20 years ago, neither would have a person with diabetes. Workplace discrimination was common; social stigmas flourished; misperceptions were the norm.
To learn more:
- Read the Seattle Times op-ed: Sotomayor’s nomination is historic also because she is living successfully with diabetes
Valley Medical Center Receives Achievement Award for Heart Treatment
The American Heart Association (AHA) has awarded Valley Medical Center a Silver Performance Achievement Award for its efforts to make sure the care the hospital provides to its heart failure patients meets the AHA’s treatment guidelines.
The award was given as part of the AHA’s “Get with the Guidelines” program, a national AHA initiative to encourage hospitals to provide heart failure care based on the best scientific evidence.
Under the guidelines, patients with heart failure patients are started on an aggressive therapeutic program while they are sill in the hospital to reduce their risk of recurrent heart failure and other complications.
For example, the guidelines recommend that, when appropriate, heart failure patients should be put on cholesterol-lowering, blood pressure, and anticoagulant therapies and that they be referred for cardiac rehabilitiation before they leave the hospital.
The AHA launched to Get With the Guidelines program after it was determined that many heart patients were not receiving the best evidence-based treatments that had been identified in AHA guidelines.
Valley Medical Center received the AHA award in recognition that it had achieved 85 percent compliance with the AHA heart failure guidelines for one year.
To learn more:
- Visit Valley Medical Center’s Web site
- Visit the American Heart Association’s Get With The Guidelines Web page.
AJC to honor Virginia Mason CEO Dr. Gary Kaplan
The Seattle chapter of the American Jewish Committee will give its Human Relations Award to Dr. Gary Kaplan, chairman and CEO of Virginia Mason Medical Center at an awards dinner June 4.
Dr. Kaplan is being recognized for his efforts to improve health care quality, safety and efficiency, his contribution to health care reform, and his work on both regional and national foundations and associations.
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Virginia Mason Opens Melanoma Specialty Program
Virginia Mason Medical Center has opened a specialty program for patients with melanoma.
The Center reports it has seen a 50-percent increase in the number of patients with melanoma over the past five years.
Melanoma, the most aggressive form of skin cancer, is diagnosed in nearly 60,000 Americans every year.
Melanoma causes 75 percent of deaths due to skin cancer.
However, with early detection and treatment melanoma can be cured.
Virginia Mason says the new program will provide:
- Multidisciplinary care to patients with localized and advanced melanoma.
- Dedicated dermatologists, oncologists, pathologists, radiologists, surgeons and nurses.
- An oncology clinical registered nurse coordinator who assists each patient through the treatment course, from referral to recovery.
- A detailed treatment summary sent to referring providers upon completion of treatment.
PHOTO CREDIT: Melanoma courtesy of the National Cancer Institute
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