“Lucky” is not usually a term used to describe someone diagnosed with cancer. But that’s how 34-year-old Alex Camargo’s doctor described him when he was diagnosed with thyroid cancer — the disease is one of the most treatable cancers at all stages.
That doctor was ultimately proved right, but not for the reasons he and Camargo initially thought.
Five-year survival outcomes for Stage 1 and 2 thyroid cancer are nearly 100 percent. Stage 3 has a 93 percent survival rate and Stage 4 has a 51 percent survival rate. “I was told that if I had to be diagnosed with cancer, this was the best cancer I could get, so I wasn’t scared,” Camargo said.
Then the Rialto, California, resident went to a cancer specialist to begin his treatment and discovered that his case wasn’t as simple as he had believed.
The cancer was starting to invade his trachea and larynx (more commonly known as the windpipe and voice box) and move into his lungs. In order to treat the cancer, his doctor told him, Camargo would need to undergo a total laryngectomy, which would leave him with a permanent breathing tube and no voice.
Geoff Berman, 61, starts his day with the motto: “The sun is up. I’m vertical. It’s a good day.”
Ever since he’s been in remission from lymphoma, Berman makes a special point of being grateful for each day, reminding himself that being alive is a gift. “I just enjoy living,” he said. “I give every ounce of positivity I can.”
This resolve followed Berman’s diagnosis for lymphoma in 2013, just days after purchasing a new home in Palm Desert, California, with his wife. They’d planned to live there peacefully and uneventfully with their two cats.
But what Berman first thought was a pulled groin turned out to be an abdominal mass the size of a grapefruit, and he was soon diagnosed with aggressive B cell non-Hodgkin lymphoma. Finally, after seven rounds of chemotherapy, Berman came to City of Hope for an autologous stem cell transplant.
Neural stem cells have a natural ability to seek out cancer cells in the brain. Recent research from the laboratories of Michael Barish, Ph.D., and Karen Aboody, M.D., may offer a new explanation for this attraction between stem cells and tumors.
Prior to joining City of Hope, Aboody, now a professor in the Department of Neurosciences and the Division of Neurosurgery, found that neural stem cells are able to home in on invasive brain tumors. Since then, she and her colleagues have harnessed this ability to target cancer cells in a clinical trial at City of Hope, delivering localized chemotherapy directly to the most lethal form of brain cancer, high-grade gliomas. However, the specific drivers behind the stem cells’ ability to find tumors remain elusive.
The latest study, led by Patrick Perrigue, a former graduate student mentored by Aboody and Barish, points to a protein called Jumonji, expressed in both normal and cancer cells, as a key factor.
The American Society of Clinical Oncology, a group that includes more than 40,000 cancer specialists around the country, recently issued a list of the five most profound cancer advances over the past five decades. Near the top of the list was the introduction of chemotherapy for testicular cancer. To many in the field, this comes as no surprise.
Prior to the advent of effective chemotherapy regimens, 90 percent of patients with advanced disease died. Now, the tables have turned entirely — more than 80 percent are survivors.
With April being Testicular Cancer Awareness Month, I think it’s entirely appropriate to celebrate these amazing statistics. After all, only a handful of cancers can be declared highly curable in 2015. As an oncologist, I can attest that treating testicular cancer can be highly rewarding. The disease tends to affect younger males, and a cure means they can return to the process of starting their careers and families.
However, it is important to draw a distinction between a disease that is highly curable and a disease that’s entirely curable — and testicular cancer is the former, not the latter. » Continue Reading
“The dying, as a group, have been horribly underserved.” So says Bonnie Freeman, R.N., D.N.P., A.N.P.-B.C., A.C.H.P.N., a nurse practitioner in the Department of Supportive Care Medicine at City of Hope.
After nearly 25 years, primarily in critical care nursing, Freeman saw that the needs of the dying were often not being met, so she developed an innovative tool – in the form of an easy-to-carry booklet – to offer nurses clear and practical information to help provide a compassionate, loving experience for patients nearing the end of life.
The CARES (short for Comfort, Airway, Restlessness, Emotional support and Self-care) tool is small enough to fold up and put in your pocket and holds simple, straight-forward steps to address the symptoms of a dying patient. It’s a “Here’s what you’ll see; here’s what you can do” approach to pain management, ethics, feeding, breathing, family, music, room temperature and even lighting.
Death offers no second chances to get it right, not for the patient, the family or the caregiver. It’s a difficult experience for everyone, but Freeman has witnessed how every decision in end-of-life care has the power to make things better or make things worse.
“I once watched a mother try to touch her dying son through the gown and gloves they made her wear,” she said. But a call to the Infectious Diseases Department for new orders meant a mother’s last caresses didn’t include latex after all. It’s that individual approach that makes all the difference.
“Are we the only ones who feel this way?”
Courtney Bitz, L.C.S.W., a social worker in the Sheri & Les Biller Patient and Family Resource Center at City of Hope, often hears this question from couples trying to cope with a breast cancer diagnosis and still keep their relationship strong. The question isn’t surprising. Because cancer increases stress and impacts many aspects of life, it doesn’t affect only the person diagnosed. Rather, Bitz said, it affects their partner as well, sometimes leaving both feeling isolated.
No one understands that experience better than other cancer patients and their partners.
Knowing this, Bitz has started a support group for couples facing a breast cancer diagnosis, to help them better face the emotional and practical demands of a diagnosis and treatment regimen. Such a support group should be a role model for other institutions and other cancer programs.
“When facing the stressors of a cancer diagnosis, even the healthiest of couples can have a difficult time knowing what to say, what kind of comfort to provide and where to find help,” Bitz said. » Continue Reading
Diabetes investigators at City of Hope are studying the full trajectory of diabetes and metabolic disorders, as well as complications of the disease. One especially promising approach focuses on proteins known as growth factors.
Led by Fouad Kandeel, M.D., Ph.D., chair and professor of the Department of Clinical Diabetes, Endocrinology & Metabolism, researchers at City of Hope are exploring the use of growth factors to expand insulin-producing beta cells available for transplant in patients with type 1 diabetes. Once transplanted, these beta cells can restore insulin production and reverse diabetes.
Among the growth factors of interest is one called gastrin, which is a natural hormone found in the human body. Kandeel’s team has successfully used gastrin to expand human insulin-producing beta cells in the lab and in animals. The next step is to test gastrin’s ability to expand beta cells in humans.
Kandeel is currently planning this clinical trial, which he hopes will open early next year. » Continue Reading
Acute myeloid leukemia is the most common form of acute leukemia among adults, accounting for 18,000 diagnoses in 2014.
Two decades ago, in 1996, the National Comprehensive Cancer Network (NCCN) published its first guidelines for treatment of acute myeloid leukemia, or AML. Margaret O’Donnell, M.D., associate clinical director of the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, has chaired the guidelines panel since then. Those guidelines have undergone multiple revisions since that time, reflecting changing practice and increasing knowledge. They were recently revised yet again.
“Looking back on the very simple principles upon which the panel constructed the acute myeloid leukemia guidelines, it is interesting to see that, while much has changed, the principles still remain the same,” O’Donnell said. “We believed that it was our mandate to incorporate the best of current knowledge in the areas of prognostic indications, treatment and supportive care, but with a strong bias that we should not settle for the mediocre outcomes that were the norm at that time.”
While this form of leukemia remains the leading cause of leukemia deaths in the United States, key advances in treatment and diagnosis have made the disease more treatable and curable. One of the highlights has been the identification of a specific leukemia gene. The identification of that gene led to clinical trials in the U.S., China and Europe focused on new combination therapies. Using all-trans retinoid acid, or ATRA, and arsenic trioxide has proven to be especially potent: Preclinical studies yield up to 98 percent complete remission and survival of more than 90 percent at two years, according to a 2013 study in the New England Journal of Medicine.
Children diagnosed with cancer are more likely than ever before to survive the disease, but with a potential new set of health problems caused by the cancer treatment itself. Those problems can particularly affect the heart, and as doctors and other health care workers try to assess how best to care for this special population, City of Hope researchers are providing guidance.
Scientists from the Childhood Cancer Survivorship Clinic at City of Hope led an international effort to complete a comprehensive review of all available literature and make meaningful recommendations on how to protect the hearts of childhood cancer survivors. The recommendations are needed. Cardiovascular complications – coronary artery disease, stroke and congestive heart failure – have emerged as a leading cause of illness and death in adult survivors of childhood cancer.
“We’re ending a new era in survivorship care delivery,” said first author Saro Armenian, D.O., M.P.H., director of the Childhood Cancer Survivorship Program at City of Hope. “This collaboration allowed us to draw on international expertise for a critical review of the available data, identify research priorities and make some recommendations.” » Continue Reading
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