Karen Reckamp, M.D., M.S., has an office next to my own, and we often see patients at the same time. As such, I’ve gotten to know her quite well over the years, and I’ve also gotten a glimpse of many of her patients.
She specializes in lung cancer, and most of her patients have tumors that have spread widely to the bones, brain and other sites (termed “advanced,” or “metastatic,” disease). When I first started in the field about a decade ago, her patients had a characteristic appearance – weak and debilitated by chemotherapy, and dejected by a grim prognosis.
Now, things have changed.
Reckamp, co-director of the Lung Cancer and Thoracic Oncology Program, has been at the forefront of a number of lung cancer clinical trials that have had a marked impact on survival, meaning her patients have benefited from new therapies before they’ve become available to the general patient community. These clinical trials frequently involve drugs that more selectively target cancer tissue and spare normal tissue, enhancing effectiveness while limiting toxic side effects. This has had a palpable effect on what I observe in her clinic – her patients appear to be enjoying a far better quality of life than in years past. » Continue Reading
Today is National Doctors Day, the official day to recognize, thank and celebrate the tremendous work physicians do each and every day.
Launched in 1991 via a presidential proclamation from then-President George Bush, the observance offers a chance to reflect on the qualities that define truly great medical care. Compassion and expertise are vital, of course, as is the intuitive understanding that each patient must be treated as a person, not his or her disease. But research is vital as well.
As the proclamation states: “The day-to-day work of healing conducted by physicians throughout the United States has been shaped, in large part, by great pioneers in medical research.”
Here, we acknowledge a few of the City of Hope physicians working to improve care and treatment of patients everywhere by maximizing the most leading-edge research from around the world – and by conducting it themselves at City of Hope.
Karen S. Aboody, M.D.: Pushing the frontiers of brain cancer therapy
Although the mass of a glioblastoma, the most aggressive and common type of primary brain tumor in adults, can be removed surgically, removal of all the tumor cells is virtually impossible – meaning recurrence is common. Karen S. Aboody, M.D., professor in the Department of Neurosciences and Division of Neurosurgery at City of Hope, believes the answer could lie in special cells called neural stem cells. Neural stem cells are known for their ability to become any type of cell in the nervous system. These cells not only are attracted to cancer cells, they have the ability to deliver drugs directly to the tumor sites, sparing healthy tissues and minimizing side effects. City of Hope is currently conducting a phase I clinical trial of neural stem cells to treat glioblastoma. » Continue Reading
When considering cancer risk, categories like “women’s cancers” and “men’s cancers” may not matter. A complete medical history, especially of first-degree relatives, must be considered when evaluating risk.
A new study drives home that fact. Published in the journal Cancer, the study found a link between a family history of prostate cancer and an increased risk of breast cancer in women. The study, one of the largest efforts to examine the link between these cancers, found that women with a father, brother or son with prostate cancer may have a 14 percent higher risk of breast cancer than women without that family history. Women with a family history of both prostate and breast cancer appear to have a 78 percent greater risk of developing breast cancer, according to the study.
The researchers, from the Barbara Ann Karmanos Cancer Institute at Wayne State University in Detroit, cautioned that their study found a connection, not a cause-and-effect relationship. Nonetheless, it gives food for thought to how women should think comprehensively when assessing individual cancer risk.
Precision medicine holds promise – on that doctors, especially cancer specialists, can agree. But this sophisticated approach to treatment, which incorporates knowledge about a person’s genetic profile, environment and lifestyle, isn’t yet standard for all cancers. It can’t be. Researchers and scientists are still amassing as much information as possible, in order to better understand the best avenues of research and the resulting treatment options.
The National Institutes of Health (NIH) sums up the status of precision medicine in this way: “While significant advances in precision medicine have been made for select cancers, the practice is not currently in use for most diseases. Many efforts are underway to help make precision medicine the norm rather than the exception.”
Steven T. Rosen, M.D., provost and chief scientific officer at City of Hope, is an expert on precision medicine, understanding the potential that comes with increased knowledge of diseases such as cancer and what it will take to help the field evolve.
Here he answers questions about the current, and future, state of precision medicine at City of Hope: » Continue Reading
The physical side effects of cancer can damage anyone’s self-confidence, but especially that of women who, rightly or wrongly, are more likely to find their appearance (or their own perception of their appearance) directly connected to their ability to face the world with something resembling aplomb.
Further, although many people may think they’re prepared for such side effects, the reality is often different.
City of Hope understands this.
- The Positive Image CenterSM routinely sponsors complimentary events and beauty classes for patients going through treatment.
- It hosts monthly Look Good . . . Feel Better sessions, part of a free, national program sponsored by the American Cancer Society for women currently undergoing radiation or chemotherapy. The classes are taught by specially trained, licensed cosmetologists on skin care techniques, alternatives for hair loss and much more.
- And twice a year, City of Hope welcomes the Beauty Bus, a mobile self-confidence boost that “delivers dignity, hope and respite to chronically ill men, women and children and their caregivers through beauty and grooming services and pampering products.”
This healing-on-wheels program brings complimentary salon services to patients directly, many of whom have compromised immune systems that prevent them from going to salons.
Amy Donner, L.C.S.W., in the Department of Supportive Care Medicine at City of Hope, offers the following tips for anyone, especially women, struggling with the physical changes of cancer. » Continue Reading
The promise of stem cell therapy has long been studied in laboratories. Now, as medicine enters an era in which this therapy will be increasingly available to patients, the nurses who help deliver it will be in the spotlight.
City of Hope, which has launched its Alpha Clinic for Cell Therapy and Innovation (ACT-I), is among the first to have a dedicated clinic for leading-edge stem cell therapy. The clinic’s nurses will bridge two disciplines that have long been separate: compassionate care, for which City of Hope is known worldwide, and protocol-heavy stem cell clinical trial research.
“In the Alpha Clinic, we will have staff who are seasoned in working with inpatient units for stem cell transplants, and we will combine that with excellent clinical research nursing support in a much more coordinated fashion than we’ve seen in any place else to date,” said Shirley Johnson, R.N., senior vice president, chief nursing and patient services officer at City of Hope. » Continue Reading
Just because you can treat a condition, such as high cholesterol, at the end of life — well, that doesn’t mean you should. That’s the basic lesson of a study to be published March 30 in JAMA Internal Medicine. The ramifications go far beyond that.
The research, in which City of Hope’s Betty Ferrell, Ph.D., R.N., participated, found that stopping the use of statins in patients with late-stage cancer and other terminal illnesses can actually improve quality of life, without doing harm to the patient. That’s no small finding. Statins are one of the most commonly prescribed medications in the United States, as the press release about the study points out, and many patients for whom cure is no longer an option will be affected if doctors take the lesson to heart.
To summarize: The study on end-of-life care involved 381 patients — with a mean age of 74.1 years — about half of whom continued their cholesterol medication and about half of whom stopped. More than a fifth were cognitively impaired, and almost half had cancer. The researchers found that the number of study participants who died within 60 days was about the same for both the statin-taking and statin-forgoing groups but, of special significance, the quality of life was better for those who stopped taking statins. » Continue Reading
The understanding of the relationship between genetics and cancer risk continues to grow, with more genetic testing than ever before available to patients.
However, the adage that a little knowledge is a dangerous thing is applicable: Without context for what a test result means, and without meaningful guidance from genetic counselors, genetic tests don’t do patients much good.
Case in point: In addition to those better-known mutations contributing to breast cancer, such as BRCA1 and BRCA2, researchers have identified about 20 other genes that may be implicated in causing cancer, many of them rare or having more discreet effects. People who carry those other mutations – and who test negative for the BRCA mutations – may face a higher risk than they realize.
The doctors and counselors who deal with patients every day need training in order to help as many people as possible benefit from such knowledge and from today’s scientific advances. Scientists, clinicians and genetic experts at City of Hope are committed to bridging the gap between the technology that’s available and the number of professionals who know how to use and interpret the results of that technology.
Led by Jeffrey Weitzel, M.D., director of the Division of Clinical Cancer Genetics, City of Hope recently hosted a cancer genetics and genomics conference, “From Evidence to Action: Next-Generation Approaches to Cancer Risk Assessment and Research.” Nearly 200 physicians and clinicians from across the nation and abroad attended the conference. » Continue Reading
Standard prostate biopsies haven’t changed significantly in the past 30 years – nor have the problems inherent with them. Regular biopsies have an expected error rate: Tumors may potentially be undersampled and, 30 percent of the time, men who undergo a radical prostatectomy are found to have more aggressive tumors than expected based on the initial biopsy.
Here, Jonathan Yamzon, M.D., assistant clinical professor in the Division of Urology and Urologic Oncology, explains some of the pitfalls of prostate biopsies, as well as the potential benefits of a magnetic resonance imaging (MRI)/ultrasound fusion biopsy.
What happens during a prostate biopsy?
In a standard prostate biopsy, an ultrasound probe is placed into the rectum to visualize the prostate. Local anesthesia is applied, and biopsy samples are taken systematically across the prostate, with the minimum standard being 12 cores.
A pathologist evaluates the tissue samples, assesses the aggressiveness of the cancer and gives the individual samples a Gleason score ranging from 3 to 5.
The sum of the Gleason scores is achieved by combining the two most prevalent scores seen in the tissue, ranging from 6 (least abnormal and aggressive) to 10 (most abnormal and aggressive). For example, if the reported Gleason is 3+4=7, a pathologist assigned a 3 to the most prevalent grade, followed by a 4, the second most-prevalent grade. The sum totals up to a Gleason score of 7.