New guidelines recommend against pelvic exams for women. But wait …

July 2, 2014 | by   

New pelvic exam recommendations or not, women shouldn’t give up those routine gynecological appointments. The revised guidelines from the American College of Physicians exempt most women from pelvic examinations, but a cancer specialist at City of Hope says women should still plan on regular visits with their gynecologist for cancer screening.

gynecologist exam

New guidelines say that most women do not need a regular pelvic exam. However, physicians say, they should still plan on their regular Pap test to screen for cervical cancer. Some experts fear the impact of this change.

The guidelines were published July 1 in the Annals of Internal Medicine, and call for routine pelvic exams to be skipped for women who are asymptomatic, of average risk for problems and not pregnant. No one is disputing the need, however, for regular Pap tests and cervical exams.

The study on which the recommendations are based found that routine pelvic exams were not beneficial to asymptomatic, average risk women who are not pregnant, as the exams rarely detect important disease and don’t reduce mortality, said Linda Humphrey, M.D., co-author of the guideline, in a news release.

The key to communicating this new guideline is making sure women understand that they should still receive Pap smear screening to detect cervical cancer. The incidence and death rates for cervical cancer have plummeted in the last 60 years, and continued to drop in the last decade, largely due to good screening, said Robert Morgan, M.D., co-director of the Gynecological Oncology/Peritoneal Malignancy Program at City of Hope. » Continue Reading

Meditopes: Hitching cancer drugs to antibodies (w/VIDEO)

July 1, 2014 | by   

Scientists have long searched for ways to bolster the immune system to fight diseases that seem to evade it, including cancer.

City of Hope scientists discovered what they call a meditope, an opening in the center of an antibody and a peptide that fits neatly into it, creating the perfect "hitch" that allows medicines to be attached to the antibodies for delivery to tumor sites.

City of Hope scientists discovered what they call a meditope, an opening in the center of an antibody and a peptide that fits neatly into it, creating the perfect “hitch” that allows medicines to be attached to the antibodies for delivery to tumor sites.

Many have focused on monoclonal antibodies, trying to use them as trucks to drop off payloads of drugs right at the site of an infection or tumor. The problem, however, has been welding the payload to the truck. While analyzing the structure of these antibodies, City of Hope scientists discovered a “hitch” – a hole in the center of the antibody’s structure, and a peptide that fits cleanly and easily into it.

This universal “hitch” – named a meditope by John C. Williams, Ph.D., and his research team that discovered it – has the potential to arm the immune system against cancer as well as other diseases.

Williams says his team is still exploring the applications but that the discovery has the potential to dramatically change oncology, radiology and other disciplines. Because the peptide can easily link to therapeutic molecules and hitch them to antibodies, the use for meditopes goes beyond cancer. Some of the diseases Williams and his team have considered so far include rheumatoid arthritis, Crohn’s disease and macular degeneration.

This video explains how Williams and his team discovered the meditope.

Children with cancer, Part 2: How parents can help their kids

June 30, 2014 | by   

John Cloer was three months shy of his third birthday in 2004 when he was diagnosed with acute lymphoblastic leukemia. For the next three and a half years, he received chemotherapy at City of Hope, finally obtaining long-term remission.

John Cloer

Now 13, John Cloer, right with younger brother Steve, was only 3 when he was diagnosed with acute lymphoblastic leukemia. His parents learned the hard way how to cope with a new array of parenting challenges. Shown here: John (right) with his brother, Steve.

His parents Bill and Gina, along with John and his younger brother Steve, recently sat down to reflect on that experience, sharing tips for family members and friends of children with cancer and now, their advice for parents facing a similar challenge.

In this second of a three-part series, they answer the question:

How can parents help their children with cancer? 


1. Numb the pain. Perhaps because he still remembers caregivers frantically trying to start an IV in him the day he was diagnosed, John still dreads IVs and injections. The Cloers now ask nurses to use lidocaine to numb a site before the needle goes in. (They pay for this off-protocol request, but find it worth the costs.)

In the early days of John’s illness, the tense toddler used to “rub the rubber right off his pacifier,” said Bill. “I wish we had had a better tool set to manage his anxiety,” he added. Gina regrets they didn’t get John into the habit of meditating before procedures, “a coping skill I wish he’d have now.” » Continue Reading

Musicians On Call brings healing power of music to patients

June 27, 2014 | by   
Singer Gavin DeGraw meets patient Robert Hughes at the launch of the Musicians On Call Jason Pollack Bedside Performance Program. Photo credit: Andy Featherston

Musician Gavin DeGraw meets patient Robert Hughes at the launch of the Musicians On Call Jason Pollack Bedside Performance Program. Photo credit: Andy Featherston

Music makes a difference – in patient mood and in patient healing. To that end, patient care at City of Hope now has a special new program called the Musicians On Call Jason Pollack Bedside Performance Program, which brings live, in-room performances to patients undergoing treatment or unable to leave their hospital beds.

As a comprehensive cancer center committed to treating the whole patient, City of Hope understands that music can lift the human spirit and enhance treatment programs. Studies have shown that live music soothes hospital patients by lowering blood pressure and reducing anxiety. For cancer patients in need of an emotional boost, soothing music or an upbeat singalong can be especially powerful. » Continue Reading

Could hepatitis B vaccine curb diabetes? New data suggests a link

June 26, 2014 | by   

Vaccinating people against hepatitis B could prevent diabetes from developing in some individuals, a new City of Hope study suggests.

New data suggest that vaccinating against the hepatitis B vaccine, shown here in a 3D model, could reduce the risk of diabetes.

New data suggest that vaccinating against hepatitis B, shown here in a 3D model, could reduce the risk of diabetes.

The study, an analysis of the National Health and Nutrition Examination Survey, indicated that people vaccinated for hepatitis B had a 50 percent reduction in risk for diabetes compared to those not vaccinated, even after adjusting the data for confounding factors.

The survey, called NHANES, is conducted by the Centers for Disease Control and Prevention to assess health and nutrition in U.S. adults and children. City of Hope researchers analyzed data on more than 7,000 participants with no prior diabetes history; about 1,400 of them had been vaccinated.

“The study showed people vaccinated with hepatitis B have a much lower risk for diabetes,” said Ken C. Chiu, M.D., from the Department of Clinical Diabetes, Endocrinology & Metabolism. “If we can vaccinate patients effectively, there’s a good chance for us to reduce the risk of diabetes by at least 50 percent.”

» Continue Reading

As kidney cancer treatments improve, oncologist’s optimism is growing

June 25, 2014 | by   

Treatments for kidney cancer have improved dramatically in recent years, with new therapies already in use and others on the near horizon. The need has never been greater: Incidence rates for kidney cancer are rising.

Cancer of the kidneys, shown here, is on the rise.

Kidney cancer is on the rise. Fortunately, so are treatment advances. City of Hope’s Sumanta Pal explains his optimism when it comes to treatment of kidney cancer.

This year, nearly 64,000 new cases of kidney cancer will be diagnosed in the United States, and approximately 13,860 people will die from the disease, according to the American Cancer Society.

Sumanta Kumar Pal, M.D., co-director of the Kidney Cancer Program at City of Hope, is confident that these new treatment advances will not only change kidney cancer statistics, but also improve the overall well-being of patients diagnosed with the disease.

City of Hope is at the forefront of this field. Its researchers are exploring an array of techniques and therapies to improve survival and quality of life for people with kidney cancer. Their investigations include the use of drugs (including PD-1 inhibitors, mentioned below, and S1PR1 inhibitors) to stimulate the body’s immune system, as well as the use of stem cell antibodies to target “bad” stem cells. » Continue Reading

‘I begin to consider what our patients experience at City of Hope…’

June 24, 2014 | by   

It is mid-afternoon on a Sunday at the cosmetics counter at Macy’s. A woman approaches with smiling eyes and dewy skin in a crisp white lab coat. I feel at ease as she offers me a seat.

With a soft touch she applies eye makeup and powder to my forehead and chin. She is charming, attentive and eager to please as she hands me a mirror. I look and see a new subtle glow on my cheeks. And now I feel delighted, refreshed.

The presentation and delivery of customer service is excellent. The experience matters to me.

quality of patient care

The quality of patient care can be, and is, measured in ways both large and small. But some of the most important aspects of the patient experience simply can’t be quantified. Patients at City of Hope know this. So do their doctors, nurses and everyone else who works to make City of Hope different.

I begin to consider what our patients experience at City of Hope. What is it like to navigate through a cancer diagnosis and treatment? As an anesthesiologist, I often wonder what it might be like if it were me on the gurney waiting to be wheeled into the operating room.

Medicine is science. It is procedures, algorithms and check boxes. But for our patients it is perceived differently.

The Centers for Medicare and Medicaid Services (CMS) have developed specific quality measures that are a fundamental part of medical care. These measures, or indicators, translate into cost of care and ultimately payment for both hospitals and individual physicians. CMS monitors this by way of the check box. This is a deliberate, substantive list of indicators that are used as a kind of measuring stick to be sure we have not omitted critical details in patient care and health care processes. » Continue Reading

Children with cancer, Part 1: How family members and friends can help

June 23, 2014 | by   

John Cloer became a teenager in May, an ordinary rite of passage made extraordinary because he is a cancer survivor – one of an estimated 370,000 pediatric cancer survivors in the U.S.

Childhood cancer patient John Cloer

The parents of John Cloer, now a childhood cancer survivor, learned many lessons during his treatment for leukemia. Photo courtesy of the Cloer family.

He was three months shy of his third birthday in 2004 when what his parents Bill and Gina Cloer assumed was the flu was diagnosed as acute lymphoblastic leukemia. For the next three and a half years, John received chemotherapy – eventually leading to his long-term remission.

John finally became well enough to attend kindergarten and enjoy normal pursuits like T-ball. In fact, his perseverance (from staying late to practice, to reveling in teammates’ progress) earned the 6-year-old an invitation to play T-ball on the White House lawn and meet President George Bush. He has long raised awareness for City of Hope, from presenting an award to singer Miley Cyrus to riding on the hospital’s 2014 Tournament of Roses float as his sister Heather, a City of Hope nurse, walked alongside.

When John was embarking on cancer treatment, Bill and Gina were given well-tested roadmaps from oncologists adept at keeping children alive. On the comparatively uncharted path of cancer survivorship, they have longed for a similar roadmap. Along with regular follow-up visits with doctors such as Clarke Anderson, M.D., the Cloers are being helped in their survivorship journey by City of Hope’s Childhood Cancer Survivorship Program, led by Smita Bhatia, M.D., M.P.H., the Ruth Ziegler Chair in Populations Sciences, and nurse practitioner Karla Wilson, M.S.N., R.N.

In this program, John and his family receive a comprehensive medical summary of his diagnosis and treatment, as well as an individualized review of his potential late-effects from treatment.

Bill, Gina, John and his younger brother, Steve, recently sat down around their dining room table and offered some advice to parents of children with cancer, along with well-meaning family and friends.

In this first of a three-part series, they answer the question:

What can family/friends do to help parents whose children have cancer?

» Continue Reading

Meet our doctors: M. Houman Fekrazad on a potential chemotherapy patch

June 21, 2014 | by   

Chemotherapy is a major tool in the fight against cancer. This method of using drugs to destroy cancer cells has successfully treated many patients. Yet while chemotherapy has been proven to effectively attack cancer cells, it can cause serious side effects that can severely impact a patient’s quality of life.

Dr. Fekrazad says a chemo patch may help decrease side effects for patients.

Medical oncologist M. Houman Fekrazad is developing a chemotherapy patch that he believes will reduce side effects for cancer patients.

Here M. Houman Fekrazad, M.D., an associate clinical professor of medical oncology at City of Hope | Antelope Valley, discusses ongoing research, including a new chemotherapy patch he is currently developing. Such research has considerable promise not only to increase chemotherapy’s efficacy, but to reduce the toxic side effects that often accompany this form of treatment.

How does chemotherapy work? Chemotherapy works by stopping or slowing the growth of cancer cells. At the same time, it can damage normal healthy cells of the human body, such as those in the bone marrow, liver, kidney, nerves, hair or the lining of your mouth and intestines. Damage to healthy cells may cause side effects. Most are temporary while the patient is on treatment. However, long-term side effects of chemotherapy need to be discussed with patients prior to initiating therapy.

You own a patent on a patch that can deliver chemotherapy through the skin. Can you tell us more? Sure. By today’s standards, there has only been two ways to administer anti-cancer drugs – intravenously (IV) and orally. In this project (which is still in the planning stages), we aim to put chemotherapy into nanoparticles and then pass it through the skin. The chemotherapy will then be released in the bloodstream to target the cancer cells. There are several issues that can potentially be eliminated when chemotherapy is administered through the skin. For example: » Continue Reading

Cancer and DNA: Imbalance in genetic controller may be key to cancer

June 20, 2014 | by   

If DNA contains the code of life, epigenetics is the code on top of the code. It works through small molecular “control knobs” called methyl groups placed either directly on the DNA or on closely linked proteins. These methyl groups control the activity of genes, turning some on and others off.

DNA strands

City of Hope researchers recently pinpointed a key molecular change in cells that can inadvertently tip the genetic balance in favor of cancer. The findings may be the first to use human tissue samples to positively link an epigenetic code to the development and spread of colon cancer. Shown here: Illustration of DNA

Certain genes, however, fall into a special category. These “bivalent” genes can be both turned on and turned off depending on what part of them is methylated. So they find a balance, neither fully active nor completely shut down, but perfectly poised and controlled epigenetically.

Researchers led by City of Hope’s Gerd Pfeifer, Ph.D., the Lester M. and Irene C. Finkelstein Chair in Biology, recently pinpointed a key molecular change in cells that can inadvertently tip the genetic balance in favor of cancer. The findings may be the first to use human tissue samples to positively link an epigenetic code to the development and spread of colon cancer. » Continue Reading