Up Close: A device to connect veins

The device that is used to connect two veins is shown in close-up. (photos by William Mueller)

The device that is used to connect two veins is shown above in close-up and below. (photos by William Mueller)

Microvascular surgery involves transplanting tissue from one part of the body to another, which requires tiny blood vessels to be reconnected.

The device that is used to connect two veins. (photos by William Mueller)Surgeons such as Jesse Ryan, MD, an assistant professor in the Upstate department of otolaryngology – head and neck surgery — need to make sure the blood vessels are connected properly and flowing after an operation.

Jesse Ryan, MD

Jesse Ryan, MD

A flow coupler (made by Synovis MCA) is a tiny implant that can be used to reconnect small veins during microvascular surgery. The implant both connects two veins together and monitors blood flow through the vein using a tiny ultrasonic Doppler probe. A small box that sits at the patient’s bedside alerts nurses if a problem develops with blood flow in the small vein during recovery. This may allow a problem, such as a blood clot, to be detected quickly so that the surgery can be salvaged. The Doppler wire is removed after a few days of close monitoring.

Ryan says “the flow coupler is an innovative technology that has helped us take better care of our patients by giving us a tool to monitor the transplanted tissue more closely following a large cancer surgery.”

Cover of spring 2020 issue of Cancer Care magazine

This article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, ear, nose and throat/otolaryngology, health care, surgery, technology

Recipe: Fusilli With Broccoli and Deconstructed Pesto

Fresh pasta with broccoli, pesto and pine nuts, selective focus

This recipe uses the ingredients found in pesto sauce in a fresh, less muddled way. Instead of blending herbs, nuts and cheese into a paste, here they are left in their individual states, so the flavors sing.

Cooking the garlic mellows it, and adding a little chicken broth replaces some of the oil traditionally used to make pesto.

Serves 4.

Ingredients

8 ounces fusilli or other shaped pasta

12 ounces small broccoli florets

2 tablespoons olive oil

5 garlic cloves, minced

½ cup reduced-sodium chicken or vegetable broth

¾ cup chopped fresh basil

½ cup chopped fresh Italian parsley

2 tablespoons extra-virgin olive oil

¼ cup freshly grated Parmesan cheese

2 tablespoons pine nuts, toasted

Salt and freshly ground black pepper

Preparation

Prepare the fusilli according to the package directions for al dente (firm, not mushy). About 2 minutes before the pasta is ready, add the broccoli. Reserve ¼ cup of the pasta water before draining.

Meanwhile, in a large skillet over medium heat, add the olive oil. Sauté the garlic for 1 minute. Add the broth and bring to a boil for 3 to 5 minutes, or until reduced by half, stirring frequently. Reduce the heat, add the pasta and broccoli, and stir until coated with sauce. Add the basil and parsley and stir to combine.

Transfer to a bowl and drizzle with the extra-virgin olive oil (if too dry, add a tablespoon or so of reserved cooking liquid). Top with the cheese and pine nuts. Season with salt and pepper.

Source: American Cancer Society

Nutritional Information

per serving

400 calories

170 calories from fat

18 grams total fat

3 grams saturated fat

zero grams trans fat

4 grams polyunsaturated fat

11 grams monounsaturated fat

48 grams carbohydrates

12 grams protein

5 grams dietary fiber

130 milligrams sodium

4 grams sugar

Less than 5 milligrams cholesterol

Cover of spring 2020 issue of Cancer Care magazineThis article is from the spring 2020 issue of Cancer Care magazine.

Posted in health care, recipe

A peek inside the Upstate Golisano Children’s Hospital

Nine-month-old Maryangeliz Rodriguez, of Syracuse met Snow White and Cinderella during her brother Michael’s appointment at Upstate’s Waters Center for Children’s Cancer and Blood Disorders. The Disney princesses are from the Moment of Magic Foundation. Michael went home with a free book after his appointment. (photo by William Mueller)

Nine-month-old Maryangeliz Rodriguez, of Syracuse met Snow White and Cinderella during her brother Michael’s appointment at Upstate’s Waters Center for Children’s Cancer and Blood Disorders. The Disney princesses are from the Moment of Magic Foundation. Michael went home with a free book after his appointment. (photo by William Mueller)

Griffin’s Guardians raised more than $1,500 to provide “Joyride Therapy” for youngsters in treatment at the Upstate Golisano Children’s Hospital. The program puts pediatric patients in the driver’s seat of a shiny red car, so they can cruise to their treatment while maintaining a sense of independence, control and freedom. Victor Gloo, 3, of Baldwinsville, was one of the first patients to drive the car. His parents, Aaron and Veronica Gloo, stand back while nurse Sarah Holzhauer shows him how to work the car. (photo by Emily Kulkus)

Griffin’s Guardians raised more than $1,500 to provide “Joyride Therapy” for youngsters in treatment at the Upstate Golisano Children’s Hospital. The program puts pediatric patients in the driver’s seat of a shiny red car, so they can cruise to their treatment while maintaining a sense of independence, control and freedom. Victor Gloo, 3, of Baldwinsville, was one of the first patients to drive the car. His parents, Aaron and Veronica Gloo, stand back while nurse Sarah Holzhauer shows him how to work the car. (photo by Emily Kulkus)

Cover of spring 2020 issue of Cancer Care magazineThis article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, health care, Upstate Golisano Children's Hospital/pediatrics, volunteers

Helping families cope with a child’s grave illness

Mark MacDougall, Kara Fund president, is shown with Arianha Williams at the “Thriving Together: Starring Kids With Sickle Cell Family Event,” which included informational and fun activities and was held at Upstate in late 2019. The fund provided a photo booth as well as volunteers and other support. (photo by Robert Mescavage)

Mark MacDougall, Kara Fund president, is shown with Arianha Williams at the “Thriving Together: Starring Kids With Sickle Cell Family Event,” which included informational and fun activities and was held at Upstate in late 2019. The fund provided a photo booth as well as volunteers and other support. (photo by Robert Mescavage)

BY JIM HOWE

Families with a seriously ill child face all sorts of needs and stresses. A local nonprofit group is working to provide those families with a measure of both material and emotional support.

The Kara Fund was started in memory of Kara MacDougall, a senior at East Syracuse Minoa High School who died in 2010. She was diagnosed with liver cancer while an exchange student in Australia and returned home for treatment — from both the pediatric oncology team at the newly opened Upstate Golisano Children’s Hospital and from CHOICES, the pediatric palliative care service directed by Upstate’s Irene Cherrick, MD.

Kara MacDougall, who died of cancer in 2010, inspired the fund. (provided photo)

Kara MacDougall, who died of cancer in 2010, inspired the fund. (provided photo)

Kara did not live to see her class graduate.

The Kara Fund, incorporated in 2012, works to show families facing a child’s life-threatening illness — including cancer and other diseases — that their community cares about them. The aim is to follow in the spirit of Kara, whom family and friends describe as passionate about giving back to her community, as well as bright, energetic and athletic.

“We’re not looking to supplant any charity, but to augment services or to help a group that is not being helped,” said Mark MacDougall, Kara’s father and the director and president of the Kara Fund.

The fund channels its help in three principal directions:

— Comfort care: For children in a hospital setting. The fund works with the Upstate Golisano Children’s Hospital, the Neonatal Intensive Care Unit at Crouse Hospital and CHOICES.

— Home care: For children making the switch from a hospital back to their home. The fund works with Nascentia Health, an agency offering long-term care at home.

— Family care: Direct support to families in crisis.

Specific programs

Kara MacDougall's painting of a flower represents the positive spirit of the charity named in her memory.

Kara MacDougall’s painting of a flower represents the positive spirit of the charity named in her memory.

Here are a few of the ways that families receive Kara Fund support:

— Family photo sessions when the child’s life expectancy is short, such as when an unborn child is not expected to survive. This can help with bonding and closure and provide a keepsake and is done through CHOICES.

Also through CHOICES, books and comfort items tailored to the individual relatives of a seriously ill child, including siblings and grandparents. Called the Pillar Project, it is designed to help everyone in the family cope with the child’s illness and death and the grief that follows.

Oral health care bags, with toothbrushes and other items, that are distributed by dentist Racquel Vlassis, DDS, when she instructs young cancer patients about the need for keeping up dental care, which is important to help decrease their risk of infection.

— Comfort/gift bags for children with sickle cell disease, including heating pads, thermometers, water bottles and other items to help manage pain. Fund volunteers also helped at an event at Upstate for families of children with sickle cell disease, passing out treats and hosting a photo booth.

— Gasoline cards, coffee cards and parking passes for Central New York parents whose baby is undergoing cardiac surgery at the Golisano Children’s Hospital in Rochester.

— Comfort/gift bags and various supplies — anything from a gift card to a toy or a blanket – for seriously ill children being cared for at home or in a hospital setting.

“We supply a lot of gift cards,” MacDougall said. The fund raises about a hundred thousand dollars a year, which pays for those cards and other supplies.

The group’s board contains people with a good mix of skills to help plan and carry out projects, says MacDougall. Some of the board members attended school and played soccer with Kara, such as Nicole Hurley and Allyson Rossi, who hope to keep the organization going well into the future.

“Reflecting on the difficulties the MacDougalls went through and continue to go through, I think we always want to know that others are around us and there for us,” said Hurley, the fund’s vice president. “It’s such an amazing feeling to be there for those in need; it’s priceless. Through the Kara Fund, we can assure families that, whatever the outcome of their child’s illness, they will always have another family here for them.”

Rossi, the fund’s treasurer, recalls that Kara was “very energetic, strong-willed and definitely was huge into giving back. We’re doing something she would be really proud of.” Both Hurley and Rossi noted that they and other board members are always trying to spread the word about the fund, in hopes they can find and help more people with unmet needs.

Learn more at The Kara Fund’s website.

Cover of spring 2020 issue of Cancer Care magazineThis article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, community, health care, Upstate Golisano Children's Hospital/pediatrics, volunteers

What’s the biology of your cancer?

Pathologist Jeffrey Ross, MD, who has expertise in genomic profiling, consults with other Upstate doctors and leads a monthly meeting in which he reviews and teaches about the ongoing care of individual patients at Upstate. He is shown with some laboratory samples. (photo by William Mueller)

Pathologist Jeffrey Ross, MD, who has expertise in genomic profiling, consults with other Upstate doctors and leads a monthly meeting in which he reviews and teaches about the ongoing care of individual patients at Upstate. He is shown with some laboratory samples. (photo by William Mueller)

Treatment is moving from ‘one size fits all’ into the modern era of personalization

BY AMBER SMITH

Among people who receive a cancer diagnosis, up to 8 percent won’t ever find out in which organ their cancer began. Because the cancer has metastasized, or spread, before it is discovered, it usually comes with a poor prognosis.

This type of cancer – known as CUP, or carcinoma of unknown primary – is among the most challenging types of advanced cancer to treat.

Some doctors will prescribe chemotherapy, with the goal of shrinking the tumor or improving symptoms.

A growing number of doctors will say, “We may not be able to know where your cancer started, but what’s the biology of your cancer?”

Up to a third of people diagnosed with CUP will have a genetic marker for which a new medication is available, says Jeffrey Ross, MD, an assistant professor of pathology and urology at Upstate and the medical director for Foundation Medicine in Cambridge, Mass. “But you won’t find it unless you sequence the tumor.”

Each person’s cancer has a unique combination of genetic changes, and tumor DNA sequencing is done to identify those changes. Some genetic alterations or mutations can help guide treatment plans, possibly pointing to medications that can prolong a person’s life by months or years.

This new generation of anti-cancer drugs is being developed together with diagnostic tests, which help predict which patients can be helped by a particular drug. For instance, some targeted therapies are effective for people only if their cancer cells have a specific mutation that causes the cancer cells to grow a certain way. Some immunotherapy medications will work only when there are a certain number and type of genetic alterations.

Ross says Medicare and most health insurers pay for at least one of the sequencing tests in use today. However, not all of the potential therapies are covered.

Tumor DNA sequencing is not meant for everyone who has cancer. And, it can’t help everyone with a CUP diagnosis.

Unfortunately, sequencing often reveals targets for which drugs do not yet exist, Ross explains. In the year 2020, about one-quarter to one third of those who undergo tumor DNA sequencing will learn of a potential treatment.

Ross says he expects one day about half of those tested will find new treatment options.

Currently, though, many people undergo batteries of tests, in hopes of identifying the primary tumor from which their cancer has spread. Without answers, they are diagnosed with CUP. Many doctors will recommend anti-cancer treatment or palliative care to relieve these patients’ symptoms. Only about one in 10 of these patients survives a year.

“Standard treatment for CUP has not changed in decades so, if we can change the outcome for the one in three patients with targetable mutations identified by DNA profiling, that could have an important impact on CUP therapy,” says Ross, one of the leaders of the molecular laboratory in the Central New York Biotech Accelerator at Upstate.

“CUP is a bit of a pariah because people don’t understand it and assume that nothing can be done,” he says. “We need to change that attitude and encourage clinicians to look for and treat the drivers of each patient’s disease as shown by DNA profiling.”

Ross reported on his research at the European Society of Medical Oncology last fall in Barcelona, a conference that attracted more than 28,000 attendees. Two other Upstate professors presented work there, including Gennady Bratslavsky, MD, on the genetic landscape of two specific types of cancerous tissue, and Jeffrey Bogart, MD, on radiation treatment plans for patients with small cell lung cancer.

Possible treatment: What’s the difference?

Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer. They differ from chemotherapy in that:

— they act as specific molecular targets associated with cancer; most standard chemotherapies act on all rapidly dividing normal and cancerous cells.

— they are designed to block tumors cell proliferation; many chemotherapies were identified because they kill cells.

— most are available as pills; some chemotherapy medication are pills, but most are infusions.

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. It’s delivered through an infusion. There are several types, including immune checkpoint inhibitors, t-cell transfer therapy, monoclonal antibodies, treatment vaccines, immune system modulators and others. Different immunotherapies are given intravenously, in pills or capsules, in creams that are rubbed onto the skin, or directly into the bladder.

Remember this:

Get yourself to an academic medical center where tumor DNA sequencing is an option if you have a cancer whose origin cannot be determined.

Up to one-third of people with CUP – the medical abbreviation for carcinoma of unknown primary – have an individual cancer characteristic that can be treated with an immunotherapy and/or targeted cancer therapy, but not until the biology of the tumor is known.

Approvals for new therapies are happening with such speed that keeping track of what’s available, its side effects and interactions requires expertise.

How is tumor DNA sequencing done?

A sample of your tumor and, in some cases, a sample of your healthy cells must be removed either during surgery or through a biopsy.

Your samples will be sent to a specialized lab — such as the one at Upstate Medical University — where researchers will isolate your DNA and then use a machine called a DNA sequencer to “read” it. They will then analyze the sequence of your DNA to determine if there are any genetic alterations that make your tumor susceptible to certain treatments. They may also examine the DNA sequence of your healthy cells to determine if you have any inherited mutations that can influence treatment decisions.

Based on your tumor’s unique genetic alterations, the specialized lab may generate a report that lists treatments to which your tumor is likely to respond.

Source: National Cancer Institute

Resources

Here are some places to learn more about the modern era of personalized cancer care:

— The American Society of Clinical Oncology website at ASCO.org. Click here, or under “research & guidelines,” look for “reports & studies,” and click on “Clinical Cancer Advances 2019.”

— The American Cancer Society website at cancer.org. Click here, or use the search bar to type in “carcinoma of unknown primary.”

— The National Cancer Institute website at cancer.gov. Click here, or type carcinoma of unknown primary” in the search field.

— Jeffrey Ross, MD, did a podcast for Upstate’s “HealthLink on Air.” Click here, or find it at Healthlinkonair.org by searching for “Jeffrey Ross” or “immunotherapy.”

This article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, genetics, health care

Lung cancer diagnosis offered many lessons to this research technician

Wanda Coombs works in a laboratory in Upstate’s Weiskotten Hall. (photo by Robert Mescavage)

Wanda Coombs works in a laboratory in Upstate’s Weiskotten Hall. (photo by Robert Mescavage)

BY AMBER SMITH

Wanda Coombs went for her annual medical exam in January 2016.

“I wasn’t even going to tell the doctor I had a cough, because in January everybody has a cough, but at the end of the appointment, she said, ‘Is there anything else that’s bothering you?’”

Two X-rays and a computerized tomography scan later, Coombs had a diagnosis of lung cancer and a date for surgery. Her surgeon removed one of the lobes of her left lung, and the tumor was found to be 4.5 centimeters, a little bigger than a walnut.

Coombs, 56, of DeWitt has worked at Upstate as a microbiology research technician since 1986, soon after graduating from SUNY Binghamton with a degree in biology.

Before her diagnosis, she already knew a lot about cancer and science and medical care — yet her experience with lung cancer taught her some things:

1. Lung cancer is treatable, especially when caught early.

2. If you’re diagnosed with cancer, see an oncologist. Coombs felt fine after surgery, but she made an appointment with Upstate’s Stephen Graziano, MD, because she wanted an expert to follow her care.

3. Experts can disagree. Her surgeon does not recommend chemotherapy for tumors of less than 5 centimeters. Her oncologist recommends chemotherapy for tumors larger than 4 centimeters. Under a microscope, Coombs’ tumor looked like a squamous cell carcinoma, a slow-growing type of lung cancer that is almost always caused by smoking. Coombs was not a smoker. Graziano and colleagues examined her pathology and medical scans and determined her cancer to be a rare type influenced by the Epstein-Barr virus — for which chemotherapy was not recommended.

4. Listen to your body. Coombs was vigilant, and when back pain developed at the site of her surgical scar two years after her operation, Graziano sent her for medical images that revealed “three little spots” near her lung, Coombs recalls. That’s when Graziano prescribed chemotherapy and immune therapy.

5. Second opinions can be reassuring. Coombs went to Memorial Sloan Kettering Cancer Center in New York City and learned that doctors there recommended the same course of treatment she was receiving at Upstate.

To raise awareness of lung cancer, Coombs was asked to drop the puck at a Syracuse Crunch hockey game last fall. (photo courtesy of the Syracuse Crunch)

To raise awareness of lung cancer, Coombs was asked to drop the puck at a Syracuse Crunch hockey game last fall. (photo courtesy of the Syracuse Crunch)

6. Treatment recommendations evolve. The spots seemed to shrink at first, but when one grew a little bit, Graziano and Upstate radiation oncologist Jeffrey Bogart, MD, recommended radiation therapy.

7. Not all information is helpful. As she read about her disease, Coombs began to realize that much of what she found was more frightening than informative. Each patient is different. “Everybody is an individual, and how I respond to treatment is different than how anybody else will,” she says.

8. Therapy may have side effects. Her first round of chemotherapy did not affect her hair, but Coombs said she lost her hair when she was switched to another type. The immune therapy she was taking damaged her adrenal gland, so now she sees an endocrinologist. And, during her treatment she developed an allergy to the antibiotic amoxicillin.

9. Staying busy is beneficial. Coombs says that continuing to work full time helps her to feel normal and to manage the fear that the cancer might return.

10. Supportive loved ones help her stay positive. She admits there are days when she starts to feel sorry for herself, but Coombs says the support of her husband, Jeff, and daughter, Samantha, helps her maintain a good mood. She is grateful for every day.

Staying busy, including working full time, helps Coombs feel normal and manage her fears about cancer returning, she says. (photo by Robert Mescavage)

Staying busy, including working full time, helps Coombs feel normal and manage her fears about cancer returning, she says. (photo by Robert Mescavage)

This article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, chemotherapy, health care, lung/pulmonary

Global outreach: She volunteers to improve pediatric cancer care

Brooke Fraser with a cancer patient in Kenya. (provided photo)

Brooke Fraser with a cancer patient in Kenya. (provided photo)

BY AMBER SMITH

Leukemia is the most common childhood cancer all over the world.

Whether it’s diagnosed and how it’s treated help determine which children survive. Those in low- and middle-income countries such as Ethiopia and Kenya are four times more likely to die of the disease than children in high-income countries, such as the United States.

Upstate nurse practitioner Brooke Fraser works to improve that disparity.

She spends her vacation time volunteering with a global organization whose mission is to improve pediatric cancer care in developing countries.

“I love it,” she says. “It has made me who I am.”

Fraser, a nurse with 18 years of experience in pediatric hematology/oncology before becoming a nurse practitioner, has always believed in service work.

She was an emergency medical technician, and before she had children she volunteered as a Girl Scout leader. Once her children were older, she wanted to serve abroad. Fraser brought one of her sons, who was 15 at the time, on a trip to help operate a medical clinic in a rural area of El Salvador. That was in 2014.

“That was so life-changing,” she recalls.

HealthLink on Air logo(Hear Fraser talk about her overseas work in an interview with Upstate’s “HealthLink on Air.”)

Fraser applied in 2015 to become a consultant for the international nonprofit Aslan Project. She spends her vacation time and her own money for meals and ground transportation, but Aslan covers her transportation and lodging. Fraser traveled to different areas of Ethiopia in 2016 and 2017, and to Kenya in 2019.

She describes her role: “I work as a consultant, evaluating the current state of a program, and as a teacher, teaching nurses how to care for children with cancer.”

Cover of spring 2020 issue of Cancer Care magazineThis article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, health care, international health care, Upstate Golisano Children's Hospital/pediatrics

3 facts about endometrial cancer

diagram showing the endometriumHow to catch it early, be cured, reduce your risk

BY AMBER SMITH

Any vaginal bleeding after menopause — even if it’s only once, and even if it’s only a little bit — is abnormal.

It doesn’t always signal cancer, but “a woman can have a little bit of spotting for a couple of days and otherwise feel fine, and that’s the only sign that there’s a cancer developing,” explains Mary Cunningham, MD, the chief of gynecologic oncology at Upstate.

About one in 30 women will develop endometrial cancer in their lifetime, typically after menopause. It begins in the endometrium, the lining of the uterus where a baby grows.

She says it’s important to contact your health care provider for any bleeding after menopause and to realize there are other, non-cancer explanations for bleeding.

If you reach your mid- to late 50s without entering menopause, Cunningham says to discuss this with your health care provider. Also, women who are premenopausal can develop endometrial cancer. A sign can be irregular periods or very heavy bleeding.

The vast majority of women with endometrial cancer can be cured with surgery to remove the uterus.

Cunningham says other treatment options, including hormonal therapy and radiation therapy, may be used for young women who are planning to have children or for older women who cannot tolerate surgery.

It’s not common, but endometrial cancer can recur in other parts of the body after surgery. Cunningham explains: “Cancers come back not because of the cells that we have removed and sent to the lab. Cancers come back because there are individual cells that are too small for us to see that have escaped from the initial area where they were located.”

Anyone who had cancer is at greater risk for developing a second cancer, so she reminds women who have been treated for endometrial cancer to remain vigilant and be screened regularly for colon cancer and breast cancer.

If you are 30 pounds overweight, your risk for developing endometrial cancer is tripled.

That’s because “the hormones that are in your body are converted into estrogen in fat cells. So the more fat cells you have, the more estrogens your body is producing,” says Cunningham.

“Endometrial cancers are often related to the level of estrogen in the body.”

She says maintaining a healthy weight is the best way to reduce your risk.

However, not all women with endometrial cancer are overweight.

Another factor that increases risk is an inherited gene that may cause endometrial cancer or colon cancer. If you have biological relatives with either of these cancers, particularly at young ages, be aware of your increased risk.

HealthLink on Air logo(Hear Mary Cunningham, MD, discuss endometrial cancer in an interview with Upstate’s “HealthLink on Air.”)

Cover of spring 2020 issue of Cancer Care magazineThis article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, health care, women's health/gynecology

Softening the blow of chemotherapy

chemotherapy infusion illustrationBY AMBER SMITH

Some types of chemotherapy deplete bone marrow stem cells that are responsible for the body’s daily production of blood cells. That is debilitating for many patients, who may become so sick they require hospitalization. Their cancer treatment may be delayed or their medication dose lowered to a level that’s not effective — and that can have fatal consequences.

If scientists can come up with a way to help blood cells recover during chemotherapy, lives could be saved or improved and health care costs reduced.

Upstate’s William Kerr, PhD, thinks an enzyme in blood-forming stem cells could do the trick.

Kerr has spent much of his career studying the SHIP1 enzyme, which helps cells determine how to respond to signals that come from outside the cell. His initial work involved inhibiting this enzyme’s activity to enhance blood cell recovery after radiation exposure. A new study looks at inhibiting the activity of SHIP1 but after chemotherapy rather than radiation.

“If it works for radiation, we hypothesized that it would work for chemotherapy because chemotherapy and radiation are both essentially damaging the blood-forming stem cell capacity,” Kerr explains.

HealthLInk on Air logo(Click here to listen to William Kerr, PhD, describe how his research aims to help lessen the blow of chemotherapy for patients.)

Kerr is a professor of microbiology and immunology, biochemistry and molecular biology and pediatrics at Upstate and a co-founder of Alterna Therapeutics, a private biotechnology company. Kerr, Alterna Therapeutics and a Syracuse University professor are the recent beneficiaries of a one-year, $225,000 grant from the National Institutes of Health to study how manipulating SHIP1 might help people better tolerate and recover from chemotherapy. Research supported by the grant will be conducted at the Central New York Biotech Accelerator at Upstate.

Alterna Therapeutics CEO Chris Meldrum notes that Kerr’s potential breakthrough could be especially helpful to patients who undergo chemotherapy or other treatments that severely deplete or suppress production of blood cells by the bone marrow. Such a discovery from Kerr’s lab may also have the potential to improve blood cell recovery following bone marrow transplant procedures.

This article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, chemotherapy, health care, research

He specializes in cancer care; now he’s got patient experience as well

Nurse practitioner — and cancer survivor — Ibrahim Thabet, right, with his Upstate oncologist and colleague, Stephen Graziano, MD. (photo by Susan Kahn)

Nurse practitioner — and cancer survivor — Ibrahim Thabet, right, with his Upstate oncologist and colleague, Stephen Graziano, MD. (photo by Susan Kahn)

BY AMBER SMITH

In the weeks before nurse practitioner Ibrahim Thabet turned 31, he took care of patients with cancer, as he has for more than eight years at Upstate.

In the weeks after his birthday, he became a cancer patient.

Thabet had a rare cancer with a poor prognosis. After months of treatment, he’s back at work. One of his patients says he’s got “street cred” now. This is his story.

A troubling cough

It was a mid-October weekend in 2018 when Thabet noticed a cough. “For some reason, I couldn’t complete a sentence without coughing.” He sometimes deals with a cough that comes from drippy sinuses, so he was ready to ride it out.

But he was also feeling a bit of pressure in his chest, and his mother was insisting he go to an urgent care clinic.

An X-ray showed dilated arteries in his lungs. The urgent care doctor suggested Thabet may have pulmonary artery hypertension, or high blood pressure in the lungs. The diagnosis was troubling to Thabet, who was otherwise healthy.

He decided to mention it at work Monday to his colleague Stephen Graziano, MD, Upstate’s chief of hematology and oncology. The two men had become friends, having worked together the past six or seven years. Graziano listened to Thabet’s story about his urgent care visit; he also didn’t like the sound of Thabet’s cough.

As it turned out, Graziano was headed to a meeting with Ernest Scalzetti, MD, the chief of thoracic imaging. He invited Thabet to come along and show Scalzetti the X-ray.

Scalzetti, a renowned radiologist who specializes in cardiopulmonary imaging, studied the image. “I think I see something,” he said.

Thabet would need an additional imaging scan using computerized tomography. Later that day, the CT revealed a mass in the front of Thabet’s chest, sitting on his heart and lungs. The tumor was 9.6 centimeters, just under 4 inches. That’s what was causing the pressure he felt and the cough.

Taking leave

“I have a very strong faith,” Thabet said.

While his medical colleagues went over the disease the mass might signal, he sat thinking “to God we belong, and to God we shall return,” a phrase Muslims recite in times of tragedy. Then he thought of his children: Dhuha, 10; Jenna, 7; Ismael, 6; and Aleena, 4 months.

Thabet finished seeing his patients that afternoon. Then he took leave.

At home, talking privately, his wife, Sara, began crying.

Thabet underwent several blood tests the next day, including one to measure his alpha-fetoprotein level. A normal level for an adult is less than 10 nanograms per milliliter. Thabet’s was 4,912 nanograms per milliliter. The results indicated cancer.

Among the additional tests he underwent was an echocardiogram, an ultrasound of his heart.

Graziano, the cancer doctor who works with Thabet, was at a conference in Chicago as all the test results came in. He and Thabet texted back and forth.

Thabet’s diagnosis was a rare cancer: He had an extragonadal mediastinal germ cell tumor. Those tumors develop from sperm or egg cells that stray from their intended location in the gonads. This happens during the time a fetus is developing in utero, when the gonads are starting to form.

“Most of us have these cells, and they don’t become cancerous,” explained Graziano.

Extragonadal cells that go on to develop into tumors may grow anywhere in the body. Usually they begin in organs such as the pineal gland in the brain, the back wall of the abdomen, or in the mediastinum, the area between the lungs, according to the National Cancer Institute. That’s where Thabet’s tumor grew.

Finding hope

“People who have rare cancers, in general, tend to lack hope because there’s not that research or data out there to show the outcomes,” he said. Thabet relied on his faith.

Sam Benjamin, MD, became Thabet’s oncologist. He came up with a treatment plan. Before starting treatment, like many patients with the diagnosis of a rare cancer, Thabet sought a second opinion.

Graziano recommended Thabet travel to the Indiana University School of Medicine, where he knew of a particular doctor who treats more patients with Thabet’s diagnosis each year than most doctors treat their whole careers. Thabet would be one of about six patients with extragonadal germ cell tumors that Lawrence Einhorn, MD, would see in 2018. The doctor agreed to see Thabet three days later, on a Monday.

So one week after the X-ray at the urgent care center, Thabet and his family loaded into a car and drove to Indianapolis. Einhorn told him the cancer he had was considered high risk, and it had a poor prognosis. Thabet discourages patients from asking their survival odds, but Thabet couldn’t help himself. He wanted to know his chance of surviving. The doctor was straight with him: 30%.

After the consultation, Thabet drove back to Syracuse to begin chemotherapy at Upstate. Einhorn agreed with the plan Thabet’s oncologist had proposed.

He would be hospitalized for a week of infusions, then go home for two weeks. Then he’d return for another week of chemo, and go home for two more weeks. And so on, until mid-January. During his hospitalizations, because of his heightened risk of infection and how sick and weak he became, Thabet had to go without seeing his children.

Choosing Upstate

He chose Upstate for his care, among Benjamin and other caregivers who are colleagues, because “I trust the people here,” Thabet said. “I’ve seen them deal with patients, and I know the level of care and the state-of-the-art facility we have.”

Thabet was encouraged after his first round of chemo. That pressure in his chest went away. And, his alpha-fetoprotein level that had been 4,912 nanograms per milliliter dropped to 751. After the second round, it was down to 55. The third round brought it to 7; the fourth, 3. At the conclusion of the infusions, another CT scan of his heart revealed the mass had shrunk in half, to 4.5 centimeters.

Einhorn, the doctor in Indiana, had told Thabet three things needed to happen before moving forward with treatment:

— The tumor had to shrink.

— The tumor markers or blood work needed to normalize.

— And, he needed to tolerate chemo.

With all three accomplished, Thabet returned to Indiana in early February.

“Your tumor shrank, but…” the surgeon began. Thabet wasn’t discouraged about the “but.” He knew many patients didn’t make it through chemo, and their tumor markers didn’t respond. He was simply grateful to have made it this far.

Moving forward

The “but” referred to the delicate surgery Thabet would have to undergo to remove the remnants of the tumor. It was sitting on the phrenic nerve, which allows the diaphragm to expand and contract. If the nerve was cut, Thabet would be left unable to breathe normally.

The operation to remove what was left of the tumor lasted about an hour and a half. The phrenic nerve was undamaged. Thabet spent a week recovering in the hospital. On the third day, the pathologist’s report came back withencouraging news. The tissue removed by the surgeon was dead tissue. It appeared the cancer was out of Thabet’s body.

“We feel there’s a possibility you are cured,” the surgeon told him.

Thabet undergoes blood work and scans every couple of months. “Obviously there’s a chance it could come back,” he explains, “but I don’t let it dictate my life.”

He recovered enough to return to work at the Upstate Cancer Center in early April. Thabet brings with him a new understanding and ability to relate to patients. So many physical, mental and emotional aspects are similar among the various types of cancers. He says the experience has made him a better nurse practitioner. “You gain things that are not taught in a book.”

Before, he could describe how a port was installed. Now he can tell patients what it will feel like to have it done. Before, he believed he was cognizant of what patients were feeling. Now, as one patient said to him, “You’re one of us.”

This article is from the spring 2020 issue of Cancer Care magazine.

Posted in cancer, chemotherapy, health care, surgery