Up close: A peek at laboratory analysis

Roy Philpot, chemistry coordinator, pathology, Upstate Cancer Center (photos by William Mueller)

Roy Philpot, chemistry coordinator in the pathology department at the Upstate Cancer Center (photos by William Mueller)

BY CHARLES McCHESNEY

Pneumatic tubes whisk blood samples to the new Core Laboratory on the fifth floor of the Upstate Cancer Center, where two Roche cobas 8000 analyzers stand, whirring quietly. The machines test hundreds of blood samples each day for signs of illness and disorders.

One of the machines that analyzes blood at the Core Laboratory

One of the machines that analyzes blood at the Core Laboratory

Small samples of blood — as little as a single drop — are decanted to small containers called cuvettes and glide automatically to the correct module of the yards-long machines, where an automated arm drops down to add a reagent — a chemical that will coax a test result.

The swiftness of the machines allows caregivers to quickly assess situations. Sped from the operating room to the lab, a sample from a patient undergoing surgery for cancer of the parathyroid can be collected and delivered, and within 20 minutes — while the patient remains on the operating table — the analyzer can show whether all the cancer was successfully removed.

Cancer Care magazine winter 2019 coverHealthLink on Air logoThis article appears in the winter 2019 issue of Cancer Care magazine. Click here for a “HealthLink on Air” podcast/radio interview with pathologist Matthew Elkins, MD, PhD, about the lab and its relocation to the cancer center. 

Posted in health care, HealthLink on Air, pathology, technology

Recipe: Gingerbread is a comforting winter treat

gingerbread

Serve this gingerbread warm, topped with fresh fruit or your favorite sauce, for a comforting cold-weather treat.

Nutrition experts, chefs and “foodies” collaborated on recipes —including this gingerbread — for “The New American Plate Cookbook,” published by the American Institute for Cancer Research.

This recipe uses whole-wheat pastry flour instead of white flour, which adds fiber, vitamins and phytochemicals and makes for a lighter version of traditional gingerbread. It’s moist and flavorful, thanks to naturally sweet molasses and aromatic spices, and it goes well with fresh fruit or a cup of tea.

Prep time is an hour, and baking time is 35 minutes. This makes 9 servings.

Ingredients

Canola oil spray

1¾ cups whole-wheat pastry flour

¼ cup packed light brown sugar

1½ tablespoons ground ginger

¼ teaspoon ground cinnamon

¼ teaspoon ground nutmeg

¼ teaspoon ground cloves

1½ teaspoons baking soda

½ teaspoon salt

½ cup dark unsulfured molasses

½ cup unsweetened applesauce

6 tablespoons canola oil

1 large egg

½ cup boiling water

Preparation

Preheat oven to 350 degrees. Lightly coat 9-inch square pan with canola oil spray. In medium bowl, sift together flour, sugar, spices, baking soda and salt.

In separate, large bowl, whisk together molasses, applesauce, canola oil and egg until well blended. Add dry ingredients and stir until well combined. Whisk in boiling water and pour batter into prepared baking pan.

Bake for about 35 minutes, until the cake begins to pull away from the pan and a wooden toothpick inserted near the center comes out clean. Cool in pan on wire rack for 30 minutes. Invert cake onto platter and cool for about 15 minutes before serving.

Cut into 9 squares and serve warm. For storage, wrap tightly in foil and keep in refrigerator for up to 3 days.

Nutritional information

per serving:

245 calories

10 grams total fat (1 gram saturated)

37 grams carbohydrate

3 grams fiber

357 milligrams sodium

4 grams protein

Source: AICR.org/health-e-recipes

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

Posted in health care, recipe | Tagged

‘Look Now’: Breast cancer survivors share their stories for artistic project

Tula Goenka, center, with her daughter, Ranya Shannon, who was 9 when Goenka was diagnosed with breast cancer, standing next to Cindy Bell’s portrait of Goenka at the “Look Now” exhibition. (This and the following photos taken at the opening of the exhibit are by Susan Kahn; the Look Now" exhibition portraits shown are by Cindy Bell)

Tula Goenka, center, with her daughter, Ranya Shannon, who was 9 when Goenka was diagnosed with breast cancer, standing next to Cindy Bell’s portrait of Goenka at the “Look Now” exhibition. (This and the following photos taken at the opening of the exhibit are by Susan Kahn; the Look Now” exhibition portraits shown are by Cindy Bell)

BY SUSAN KEETER

Breast cancer led Tula Goenka to re-evaluate her life.

“I realized I could use my experience, and my body, to say something about breast cancer. All of us can use our experiences to advocate for others,” she explains.

Goenka, a professor at Syracuse University, organized a photography and video exhibition showcasing breast cancer survivors this past fall at the Point of Contact Gallery in Syracuse.  Prints made by photographer and breast cancer survivor Cindy Bell featured 42 women and two men, 25 of whom were shown in clothed portraits accompanied by photos of their bare breasts altered by surgery. The remaining 19 chose anonymity, posing only for photos of their chests.

Inspiration for the project came from a poster Goenka saw at SU’s Newhouse School in 2009, three years after she was diagnosed with breast cancer. The poster advertised a talk by Playboy’s former CEO Christie Hefner, who spoke about transforming the domestic publishing-based business into a global multimedia and lifestyle company. Goenka wondered whether the magazine known for photos of naked women would ever put on its pages a woman after breast cancer surgery.

Goenka, whose treatment included two lumpectomies, chemotherapy, a double mastectomy and reconstructive surgery, thought it was time for a project championing breast cancer survivors. She met with colleagues and cancer survivors to discuss cultural ideals of beauty, breasts as sources of nourishment and symbols of femininity, and the significance of breasts bearing the battle scars of cancer treatment. The result was a project that included not just the photography exhibit and documentary video, but a website (looknowproject.org) and theater performance, now in process. It’s called “Look Now: Facing Breast Cancer.”

Here are stories from five participants.

The long view

Lois Schaffer, diagnosed in 1972

Lois Shaffer

Lois Shaffer

“It was the 1970s, and a paternalistic environment,” explains Lois Schaffer, who had lymph nodes removed along with her mastectomy.  “I was annoyed with male surgeons who just didn’t get what breast cancer patients were going through.”

Then Schaffer met Patricia Numann, MD, surgeon and founder of Upstate’s Breast Care Center, which is named in her honor. “Dr. Numann helped me put what I was feeling into words.  I adore her.”

Through Numann, Schaffer got involved with Reach to Recovery and Cancersurmount, programs in which survivors provide support to others with cancer. Schaffer remained Numann’s patient for many years.

Schaffer has nothing but praise for two male physicians she encountered in the 1970s: radiologist Robert Sagerman, MD, who insisted she have radiation treatments, and Howard Weinberger, MD, who ran a program in which Schaffer and other survivors taught Upstate medical students about their experiences with cancer.

Looking back 45 years, how did breast cancer affect Schaffer? “I became active in the women’s movement. I got a master’s degree in adult education. I ran a program for displaced homemakers,” says Schaffer. ”I wouldn’t wish cancer on anyone, but it gave me strength.”

Angels and a little pink bag

Patti Muller, diagnosed in 2007

Patti Muller

Patti Muller

Patti Muller had just moved to Central New York when she was diagnosed with breast cancer shortly after Thanksgiving. Alone in a new area with a new job and two young children, Muller was introduced to Carol and Beth Baldwin, founders of the breast cancer research fund that bears their name.  “Carol and Beth stayed with me throughout my surgery and first chemotherapy treatment,” remembers Muller. “Beth was by my side dozens of times throughout treatment.”

Under the direction of oncologist Sheila Lemke, MD, Muller had surgery, chemotherapy and radiation treatments at Upstate. And — as a woman of Ashkenazi Jewish descent, which is a risk factor — Muller had genetic testing at Upstate to see if she carries a breast cancer gene. She does not.

How does Muller look back at breast cancer? “I was given a pink gift bag at my first appointment. I was busy thinking, ‘I don’t want to be part of the breast cancer club,’ so I never looked in the bag until much later,” she remembers. “It was filled with useful information and health care products that I needed. I could have saved myself a lot of work if I’d just opened the bag.”

Here for her daughters

Stephanie Fay, diagnosed in 2014

Stephanie Fay

Stephanie Fay

Stephanie Fay, 47, describes her breast cancer as “sneaky.”

Three years ago, after a day teaching preschoolers, Fay was unconcerned as she drove to her annual mammogram appointment. A 3-D mammogram looked clean.  But because Fay’s breast tissue is dense, doctors ordered a follow-up ultrasound. It identified something.

Upstate surgeon Mary Ellen Greco, MD, performed three biopsies. Fay soon learned that she had invasive lobular carcinoma in her right breast and several lymph nodes.

Upstate oncologist Mijung Lee, MD, recommended chemotherapy before surgery.

Fay describes the first 12 weeks of chemotherapy as the toughest part of treatment. She lost her hair, had little energy and felt sick much of the time. She had to take a leave from teaching because chemotherapy depressed her immune system, and close contact with children and childhood diseases would have been dangerous.

“Choosing to have a bilateral mastectomy was easy,” Fay explains. “I wanted to do whatever I needed to get better.”

The second round of chemotherapy was much easier, and Fay was able to return to teaching part time.

Now, she has appointments with Greco and Lee twice a year and is back teaching full time.

How has breast cancer affected Fay? “Cancer reminds me to be grateful. Because of all the care I got, I’ll see my daughters, Evelyn and Julia, graduate from high school,” says Fay. “I’m watching them develop into powerful women. I’m so glad to be here.”

Fay was one of the 19 participants who chose to have only an unidentified photo of her bare chest in the exhibition.

Appreciative of a new life

Anju Varshney, diagnosed in 2006

Anju Varshney with her husband, Pramod Varshney

Anju Varshney with her husband, Pramod Varshney

Anju Varshney had just had a mammogram that was “fine” when she woke up and found a quarter-sized lump in her left breast. She shrieked and called her husband, Pramod.

Varshney met with surgeon Mary Ellen Greco, MD, on a Thursday and had a lumpectomy the following day. On Tuesday, Varshney learned the tumor was malignant and aggressive. The next day she met with Upstate oncologist Sheila Lemke, MD, who started chemotherapy immediately. Greco performed a bilateral mastectomy and removed lymph nodes, some of which proved cancerous. Varshney continues to have annual appointments with Greco at Upstate’s Community campus.

“I trusted the people right here,” says Varshney. “Staying in Syracuse for treatment was the best decision I could have made.”

What does Varshney remember about breast cancer? “Tula (Goenka, creator of “Look Now”) and I went through treatment together. We sat near each other and chatted while we had chemotherapy infusions at Upstate.”

How has breast cancer changed Varshney? “Cancer has given me a new life. I have faith in the doctors, in the people around me, and in God. My motto is, ‘Life happens. Keep smiling.’”

Surprised by pink ribbons

Jeanine Capone, diagnosed in 2002

Jeanine Capone

Jeanine Capone

Jeanine Capone was 38 when she stood in front of a mirror and saw that her left nipple looked strange.

A mammogram didn’t show anything worrisome, but a sonogram found a lump that was thought to be a cyst. A needle biopsy was inconclusive. It took a core biopsy to identify cancer. Capone had the lump removed surgically, and she had to find an oncologist.

She remembers walking into Upstate’s outpatient oncology center (which today is the Upstate Cancer Center.) “I’ve got breast cancer, and I don’t know what to do,” she remembers saying to a nurse. The nurse showed her around and talked with her at length.

Capone worried about what to say to her sons, who were 8 and 9 at the time. “You tell them the truth,” she remembers the nurse telling her, “and you answer their questions.”

Two days later, Capone received a gift from that Upstate nurse: two books on how to talk with children about cancer. Capone was referred to Upstate oncologist Jonathan Wright, MD, and together they planned her post-surgery treatment:  chemotherapy and radiation, followed by 10 years of estrogen-suppressant medication.

Growing up, Capone’s sons, Bradley and Bryan, did multiple school projects on breast cancer. In high school, they surprised her by asking to see her surgical scars. When they turned 18, Bradley and Bryan got pink ribbon tattoos on their chests, in the same location as their mother’s scars from breast cancer surgery. Photos of their tattoos are part of the “Look Now” exhibition at looknowproject.org.

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

 

 

Posted in cancer, health care, patient story, women's health/gynecology | Tagged , ,

He chose radiation treatment for his prostate cancer

Jan Roberts, left, with radiation oncologist Jeffrey Bogart, MD. Roberts wears a cap that honors those, like him, who served in Vietnam, especially those who didn’t come back. (photo by Richard Whelsky)

Jan Roberts, left, with radiation oncologist Jeffrey Bogart, MD. Roberts wears a cap that honors those, like him, who served in Vietnam, especially those who didn’t come back. (photo by Richard Whelsky)

BY JIM HOWE

Jan Roberts wasn’t sure what to expect when he received radiation treatments for prostate cancer at the Upstate Cancer Center.

A disabled Vietnam veteran, he receives primary care at the Syracuse VA Medical Center, where he was diagnosed after an elevated test result for his PSA, or prostate-specific antigen. It would have been a lengthy drive from his home in Cazenovia to Albany, the nearest VA offering treatment. The Veterans Choice Program, however, allowed him to receive treatment at Upstate.

Offered the choice of surgical removal of the prostate or radiation treatment, Roberts chose a non-invasive approach with focused radiotherapy. He became a patient of Jeffrey Bogart, MD, the head of radiation oncology and the interim director of the cancer center..

“I went for radiation, and I was a little apprehensive, but once I got into the hospital, what  I thought was going to be an unpleasant scenario turned out to be a very good scenario, all things considered,” says Roberts, 73, who also deals with the effects of wartime wounds, exposure to the herbicide Agent Orange and post-traumatic stress disorder. He is retired from his family business of selling highway equipment, such as sanders and snowplows.

His treatments were given on the state-of-the-art Vero radiation system. Instead of traditional radiation treatments, which can take up to 45 daily sessions over nine weeks, the precision and accuracy of the image-guided radiation technology allowed treatment to be completed over 28 sessions in fewer than six weeks. He finished his treatments at the beginning of November 2018.

“I usually had the same staff every day. They made me feel wonderful, as though I was the only person in the hospital. They were all very kind, very good, and what could have been an unpleasant experience was pleasant,” Roberts says.

His routine involved stripping from the waist down, lying on a table with a custom body mold, his hands on two grips over his head. The machine, guided by daily integrated imaging of the precise location of the prostate, would revolve around him as it focused radiation on the cancer cells.

“It’s not a very long process. You’re in the room maybe 15 to 20 minutes.”

He didn’t feel anything during the procedure, but he would afterward.

“I got very fatigued as the treatment went on,” he says. He drove himself to the treatments every weekday, and he found himself sleeping more. He also had some bladder and bowel troubles that were cleared up with medication.

He noted the camaraderie that developed among fellow patients awaiting treatment. “We all talked about our different problems as we were being radiated,” he recalls.

After his course of radiation, he had a follow-up visit with Bogart, and his PSA levels will be monitored to see if they return to a lower number.

The fatigue is wearing off, and he pushes himself to keep busy each day. His activities include working with veterans at the Syracuse VA Medical Center as well as the group Combat Veterans Anonymous, where he helps fellow vets cope with the many aspects of PTSD.

“I have nothing but good things to say about Upstate, Fand not just the people radiating me,” Roberts says.

“As soon as I walked in the front door, they said, ‘Good morning,’ and they always had a smile, and I never had to wait for anything.

“You got the feeling that only person who counted was you, and they made everybody feel that way,” Roberts said.

Precision radiation through the Vero system can be delivered at unique angles, and the machine can move around the patient. 

Precision radiation through the Vero system can be delivered at unique angles, and the machine can move around the patient.

Vero offers latest in radiation technology

BY AMBER SMITH

When doctors recommend radiation therapy for a tumor in the lungs, the chest or another spot in the body, they must figure out how to target that tumor while minimizing damage to healthy tissue around it.

They also consider that even if the patient lies still during treatment, his or her digestion, heartbeats and breathing will cause the tumor to move.

One solution is a powerful stereotactic radiotherapy system called Vero, a 9-ton circular machine that was anchored into the ground floor of the Upstate Cancer Center when it opened.

Vero is designed to deliver concentrated and precise doses of high-power X-ray beams from almost any angle, and amid the normal anatomical movements of the body.

Vero has unique capabilities in being able to both image and treat complex tumors, unlike other radiotherapy technology. That is because Vero can move around the patient, using a first-of-its-kind robotic O-ring gantry pivot (see photo).

Vero “integrates several state-of-the-art capabilities and technologies into one machine,” explains Jeffrey Bogart, MD, who leads Upstate’s department of radiation oncology and is also the interim director of the cancer center.

“This includes the ability to deliver radiation treatment at unique angles that may better protect surrounding structures, such as minimizing radiation to the rectum and bladder in the case of prostate cancer. Vero also has a unique tracking feature that facilitates treatment of moving tumors, such as those in the lung, liver, and other tumors.”

The enhanced precision means patients may undergo more intense treatments in a fewer number of visits. Such customized care provides hope for greater cure rates — and fewer side effects.

Cancer Care magazine winter 2019 coverThe two articles above appear in the winter 2019 issue of Cancer Care magazine.

 

 

 

 

Posted in cancer, health care, medical imaging/radiology, patient story, technology, urology | Tagged , , , ,

For cancer patients: Advice on eating when you don’t feel hungry

illustration of fork, knife and spoonNutrition is an important part of staying healthy, especially during cancer treatment. But eating when you have no appetite or feel full all the time can present a challenge.

Here are eight tricks to try, from Upstate Cancer Center registered dietitian nutritionist Maria Erdman:

Maria Erdman

Maria Erdman

  1. Small, frequent meals may be easier to stomach than three full sit-down meals.
  2. Plan to eat on a schedule, rather than just when you feel hungry. Set an alarm to go off every couple of hours and have a few bites of something.
  3. Choose foods high in calories and protein. (See list below.)
  4. Drink liquids 30 minutes before or after meals, and limit yourself to sips as needed while you are eating.
  5. Prevent becoming full too quickly by chewing slowly and thoroughly.
  6. Focus on foods that have enticing smells and look good. If certain food smells turn you off, try eating the food cold or at room temperature.
  7. Avoid foods that make you gassy or bloated; they can leave you feeling full.
  8. Exercise to help stimulate your appetite.

What sounds good?

Here are Erdman’s high protein/high calorie suggestions:

Eggs

Yogurt (Greek has more protein; plain with fresh fruit has less sugar; add granola or muesli with nuts, if tolerated.)

Milkshakes (made with Ensure or Carnation Instant Breakfast, with or without creamy peanut butter, cocoa powder and banana – use frozen chunks for thicker texture)

Milk or chocolate milk (add 2 tablespoons powdered milk to 1 cup milk to make it “fortified.”)

Cottage cheese with fruit and/or seeds (chia, sunflower or ground flaxseed), if tolerated

Hot cereal cooked in fortified milk

Macaroni and cheese cooked with fortified milk (stir in soft-cooked vegetables for nutrition boost)

Cheese or vegetable pizza

Baked turkey, chicken or fish

Mashed potatoes with fortified milk

Tuna/chicken/egg salad sandwich

Peanut butter and jelly sandwich, or peanut butter on crackers, or spread on toast with fruit

Cheese with crackers, melted on vegetables or grilled in a sandwich

Beans and lentils (dry or from can, rinsed to remove excess sodium)

Hummus with vegetables to dip (stir in olive oil for added calories)

Baked beans, refried beans or multi-bean salad with olive-oil-based dressing

Nuts – almonds, walnuts, pistachios, peanuts or pecans

Guacamole (avocado mashed with salsa, lime juice and plain Greek yogurt, as a dip or on top of scrambled eggs or beans)

Coconut milk (from a can, add 1 to 2 tablespoons to smoothies and cereals for added nondairy calories)

Tofu (add to smoothies, cook into stir-fry, or use to make chocolate pudding)

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

Posted in cancer, diet/nutrition, health care

5 reasons your child needs the HPV vaccine

Here are five reasons your child needs to get vaccinated for HPV, the human papillomavirus,  according to the American Cancer Society and the National Cancer Institute at the National Institutes of Health:

  1. Cancer screening tests will not protect your child from most cancers related to HPV.
  2. There is no treatment for HPV infection.
  3. More than 90 percent of HPV-related cancers are prevented by vaccination.
  4. The vaccine works better when given at the recommended ages of 11 to 12 years and before infection with the virus.
  5. The vaccine can safely be given with the tetanus and meningitis shots.

For educators, a curriculum that teaches about head and neck cancer

The Upstate Cancer Center offers a cancer prevention educational curriculum for people who teach secondary school students.

Physicians, researchers and caregivers created a self-guided education and advocacy program focused on head and neck cancer. The materials cover causes, prevention and how to minimize risk factors through smart lifestyle choices, including vaccination against HPV.

The curriculum includes a script paired with a digital presentation, HPV fact sheet, worksheets and an award-winning documentary, “beneath the surFACE.” The documentary focuses on an art project in which students in seven school districts transformed patients’ radiation therapy masks into art.

Patients with head and neck cancers are typically treated with a combination of radiation therapy, chemotherapy and surgery. To receive radiation therapy, patients are fitted with a polymer mesh mask that conforms to their head and neck during treatment. They can keep the masks after treatment is complete, but many patients decline.

Matt Capogreco, program and events coordinator at the cancer center, connected with high school art teachers who have their students decorate the leftover radiation masks as a school project.

Click here for more on the cancer prevention curriculum. Further  information is available from Capogreco at 315-464-3605.

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

Posted in cancer, ear, nose and throat/otolaryngology, education, health care, infectious disease | Tagged , ,

Treatment for canine cancer serves as model for humans  

Veterinary oncologists Kelly Hume, left, and Vincent Baldanza examine Sophie, a dog with lymphoma, at the Cornell University Hospital for Animals. Lymphoma in dogs is remarkably similar to lymphoma in humans, and researchers hope that studies of the canine cancer can help humans with the disease. Hume is a Cornell faculty member, and Baldanza, a resident veterinarian at the time, is now a veterinary oncologist in California (photo courtesy of Cornell University Hospital for Animals)

Veterinary oncologists Kelly Hume, left, and Vincent Baldanza examine Sophie, a dog with lymphoma, at the Cornell University Hospital for Animals. Lymphoma in dogs is remarkably similar to lymphoma in humans, and researchers hope that studies of the canine cancer can help humans with the disease. Hume is a Cornell faculty member, and Baldanza, a resident veterinarian at the time, is now a veterinary oncologist in California (photo courtesy of Cornell University Hospital for Animals)

BY JIM HOWE

Treating cancer in dogs aims for a twofold benefit, says a Cornell University scientist: Help the sick animal and possibly find new ways to treat cancer in people.

And no, she doesn’t have a secret lab where she implants cancers into dogs, a question she is often asked.

“There is no colony of dogs with lymphoma. These are people’s pets that come into the vet school, and we are studying them in a very similar way to the way we study humans,” says Kristy Richards, PhD, MD, an associate professor in the department of biomedical sciences in the Cornell College of Veterinary Medicine in Ithaca and in the hematology/medical oncology division of Weill Cornell Medicine in New York City.

“The ‘comparative oncology’ strategy is still a bit of a foreign concept to most doctors, but veterinarians learn it from Day One,” she said in a talk at the Upstate Cancer Center, noting the idea of comparing animal and human diseases has been around since the 19th century.

Upstate Cancer Center Interim Director Jeffrey Bogart, MD, and Cornell University researcher Kristy Richards, PhD, MD. Richards spoke at the cancer center about lymphoma in dogs and its implications for lymphoma in humans. (photo by Jim Howe)

Upstate Cancer Center Interim Director Jeffrey Bogart, MD, and Cornell University researcher Kristy Richards, PhD, MD. Richards spoke at the cancer center about lymphoma in dogs and its implications for lymphoma in humans. (photo by Jim Howe)

Dogs can get lymphoma (see related story, below), and it is remarkably similar to the human variety, even under the microscope. Chemotherapy is the current standard of treatment for dogs, and Richards and her colleagues are hoping through drug trials to find alternatives to the harshness of chemo and, in the process, find better treatments for humans.

Of special interest is immunotherapy, or using the body’s immune system to fight cancer. Testing combinations of immunotherapy drugs in humans takes years because the drugs must be tested one at a time and must be proven in people who are not cured with chemotherapy before they can be tried with newly diagnosed patients.

With their lifespans of just 10 to 15 years, however, dogs can yield quicker results than humans, and there are fewer restrictions on combining drugs in trials. Richards hopes her work can help speed up the tremendous cost in time and money that it takes to bring a new drug from the idea stage to the market, which can easily reach 14 years and $2 billion, according to the National Institutes of Health.

“We set out to use the canine model in two ways,” said Richards:

— “One is to figure out what was molecularly similar and different between the human and canine lymphoma.

— “The other was to use the canine model in clinical trials to speed up that drug testing process in ways that are faster than human versions.”

She focuses on a subtype of non-Hodgkin lymphoma that is most common in both dogs and people: DLBCL, or diffuse large B-cell lymphoma.

In dogs, this lymphoma has only a 10 percent cure rate after the standard treatment of four-drug chemotherapy and a monoclonal antibody drug. The human cure rate tends to be much higher — around 60 to 70 percent, depending on when the disease is detected and other factors.

Among the drugs to be investigated in these canine trials will be an immunotherapy that was used in 2015 to halt the melanoma, a skin cancer, that had spread to former President Jimmy Carter’s brain. While the body can find and remove some cancer cells before they take hold, tumors can sometimes hide from this. The treatment used on Carter, called a PD1 inhibitor, blocks cancer’s ability to hide, but it is only about 20 percent effective. Richards will investigate whether combinations of PD1 inhibitors and other targeted therapies may increase the effectiveness of cancer treatment in dogs.

If your dog has lymphoma, it may be eligible for a clinical drug trial at Cornell University's Hospital for Animals. See below for details.

If your dog has lymphoma, it may be eligible for a clinical drug trial at Cornell University’s Hospital for Animals. See below for details.

Richards is also studying lymphoma using lab mice, but implanting cancer cells into an inbred mouse in a sterile laboratory lacks the real-world value of a pet dog whose owner brings it in for treatment. “We have a spontaneous tumor in its natural environment, not implanted or lab style.” The dogs are also readily available for the frequent biopsies the trials need.

Cornell is part of a consortium of several research universities taking part in developing canine drug trials. They hope to study a range of possible treatments, from immunotherapy drugs to natural products such as cranberry extract (to which some lymphoma cells are sensitive), as well as combinations of treatments.

Research trials on pet dogs, as well as cats, around the world include cancers of the brain, breast, lung and prostate, as well as for arthritis and seizures, according to the journal Science.  Researchers hope that drugs proven to work on household pets, rather than lab mice, will provide pharmaceutical companies with a better idea of where to put their resources for developing human cancer drugs.

And while Richards says she hopes to alleviate the dogs’ suffering, her overarching goal will remain the same: “I am a human oncologist, so my main goal is to study human disease. If the dogs can help, it’s a win-win situation for both species.”

About canine lymphoma

— Lymphoma is a group of cancers that stem from lymphocytes, a type of white blood cell that helps the immune system fight infection. It affects the lymph, or lymphatic, system, which is part of the immune system, the body’s means of fighting infections and certain diseases.

— Lymphoma is one of the most common cancers in dogs. It is similar to non-Hodgkin lymphoma in people, with similar chemotherapy treatments for both dogs and people.

— In humans, non-Hodgkin lymphoma is the seventh most common cancer, representing about 4 percent of all cancers in the United States. Lymphoma is estimated to make up between 6 percent and 25 percent of all canine cancers.

— Dogs get cancer at about the same overall rate as humans, and close to half of dogs older than 10 will develop cancer.

— Canine lymphoma can affect any body organ but tends to be found in organs that play a role in the immune system, like the lymph nodes, spleen and bone marrow.

— Chemotherapy, which can be expensive, can slow the cancer’s progress in dogs but is unlikely to cure it. Remissions are possible, which means periods of time with no signs of the disease before it returns.

— Chemo rarely causes dogs to lose their hair, and it does not tend to make dogs as sick as it does people. The animals can suffer side effects, though, such as mild vomiting and diarrhea, decreased appetite and activity and increased drinking and urination.

— Dogs get chemo in much lower doses than humans, to avoid too much suppression of the immune system and vulnerability to infection; you can’t tell a dog to avoid germs by washing its paws.

Sources: American Veterinary Medical Association, Cornell University, American Kennel Club

If your dog has lymphoma

Owners of a dog with lymphoma can speak to their veterinarian, who should have information on the drug trials being offered by Cornell’s College of Veterinary Medicine in Ithaca, or call 607-253-3060. Several trials are planned to start within the next several months.

The cost of having a dog treated for lymphoma in a clinical trial at Cornell is usually just for the standard treatment, and Cornell pays for the additional biopsies and blood tests needed for the study.

If the dog is enrolled in a clinical trial, the pet will be seen by the oncology service at Cornell University Hospital for Animals. It will be seen by a board-certified veterinary oncologist, who will tell the owner about the trials available. The trials are often done with pills, which the owners can give the dog at home, so the owners just need to bring their dog back for rechecks every so often.

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine. 

Posted in cancer, drugs/medications/pharmacy, health care, research | Tagged , , ,

What cancer taught one mom: Keep things as normal as possible

Levi Haddad, 4, with his mother, Laurin Haddad. Adopted when he was 1 day old, Levi was diagnosed with leukemia on his fourth birthday. (photo by Robert Mescavage)

Levi Haddad, 4, with his mother, Laurin Haddad. Adopted when he was 1 day old, Levi was diagnosed with leukemia on his fourth birthday. (photo by Robert Mescavage)

BY SUSAN KEETER

Levi Haddad was about to turn 4 when he went with his mother to her doctor’s appointment in November 2017. The youngster was tugging on his ears. The doctor felt a line of bumps where Levi’s neck met his shoulders, prescribed antibiotics and scheduled a follow-up appointment in two weeks.

Laurin Haddad remembers that her son had been increasingly tired and congested, symptoms that mimicked allergies. Four days after the doctor’s appointment, Levi was so exhausted that he lay on the floor during his birthday party. At night, his snores turned into gasps for breath. The next morning, Haddad called the doctor to ask for blood tests and took Levi to an urgent care center.

After the blood work was done, mother and son tried to enjoy a pancake breakfast at The Gem Diner on Spencer Street in Syracuse. Before noon, their family doctor called with the results from the laboratory. She told them to immediately go to the emergency department at Upstate.

Philip Monteleone, MD

Philip Monteleone, MD

Levi was admitted to the Upstate Golisano Children’s Hospital. The next morning, he received his first treatment for T-cell acute lymphoblastic leukemia, under the care of pediatric hematologist/oncologist Philip Monteleone, MD, in Upstate’s Waters Center for Children’s Cancer and Blood Disorders.

For the first six months of treatment, Levi and his mother alternated between hospital stays and time at home, in relative isolation. Haddad wanted to protect her son from exposure to infections while his immune system was depressed by chemotherapy. She kept family and friends updated through a free website called CaringBridge.org.

Levi received a variety of cancer medications, in liquid and pill form, and through intravenous lines. He submitted to lumbar punctures — needle sticks in his lower back — and had to take steroids.

Laurin Haddad acknowledges difficulty, especially when Levi’s “steroid monster” appears. That’s her description of the medication’s side effects: lethargy, salt cravings, physical pain and anger.

But many times Levi is still her kind-hearted son with the sweet smile. Haddad remembers one visit at the Upstate Cancer Center. Levi saw a little girl crying because she had to get a lumbar puncture. “It’ll be OK,” Levi told her as he put his arm around her. “It’s not that bad.”

In April 2018, with Monteleone’s approval, Levi returned to pre-kindergarten at the Jewish Community Center in Syracuse. His mother went back to her law practice, part time, and worked around Levi’s weekly chemotherapy treatments and hospitalizations. In August, the JCC hosted a blood drive and a bone marrow donor drive in Levi’s honor. At that time, his treatments followed a 10-day cycle: chemotherapy and an appointment at the Upstate Cancer Center, then home for 10 days.

Now, Levi is receiving maintenance chemotherapy. He has monthly intravenous treatments at Upstate and takes steroids for a week each month. Twice in three months, he has a lumbar puncture to inject chemotherapy into his spinal fluid. He takes a pill once a day, plus an additional pill once a week.  This treatment is scheduled to continue until April 2020.

Throughout it all, Levi has been busy at his pre-kindergarten class, working to make up for the six months of school he missed.

Haddad says she has learned a lot in the year since her son’s diagnosis.  “When your child has cancer, you see his life as more precious.

“You are terrified,” she admits. “But you can’t interfere with your child’s happiness. So you paint a smile on your face and figure out how to get your lives back to normal as much as possible.”

What is T-cell acute lymphoblastic leukemia?

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, found in approximately one-third of all newly diagnosed pediatric cancer patients.

ALL is a blood cancer in which too many lymphoblasts (immature white blood cells) are found in the bone marrow and blood. The T-cell type is fast-growing and found in 10 to 25 percent of pediatric ALL cases. Children with T-cell ALL typically receive more and higher doses of anticancer drugs than children with the more common early B-cell subtype.

Symptoms of ALL include fever; easy bruising or bleeding; loss of appetite; pale pallor; tiredness and weakness; bone or joint pain; pain or feeling of fullness below the ribs; painless lumps in the neck, underarms, stomach or groin; and petechiae, which are flat, pinpoint, dark red spots beneath the skin caused by bleeding.

Sources: National Cancer Institute and Atlas of Genetics and Cytogenetics in Oncology and Haemotology

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

Posted in cancer, chemotherapy, health care, Upstate Golisano Children's Hospital/pediatrics | Tagged , , ,

Care teams share workspace, improve efficiency at cancer center

Adham Jurdi, MD, explains that the reconfigured layout of the Upstate Cancer Center provides for a smoother, more efficient experience for patients and care providers. Jurdi is medical director of adult hematology/oncology at Upstate. (photo by Susan Kahn)

Adham Jurdi, MD, explains that the reconfigured layout of the Upstate Cancer Center provides for a smoother, more efficient experience for patients and care providers. Jurdi is medical director of adult hematology/oncology at Upstate. (photo by Susan Kahn)

Communication is easier, care is more efficient, and medical providers develop stronger bonds through the new layout at the Upstate Cancer Center. That’s because the members of a patients’ care team share the same work space.

Doctors, nurses, nurse practitioners, medical assistants and others including nutritionists, social workers or palliative care experts work in the same “pod,” situated near four or five rooms where patients are examined or receive treatment.

“Everyone that a patient will need to see during their visit is right there,” explains Adham Jurdi, MD, the medical director of adult hematology/oncology at Upstate. Such a design “gives the treating physicians the resources needed at our disposal to address the patients’ needs much faster.”

This style of team-based medical care has become common at cancer centers throughout the United States, so interior designs built around group work space have become popular ways to ease the way for patients who are fatigued and stressed.

The journal Healthcare Design described the trend in November 2017 this way: “What were once disjointed patient journeys that left many traversing from building to building for lab work, exams, procedures, specialist consultations, pharmacy pickups, and lab work again are being replaced with thoughtful solutions that put all of those stops under one roof.”

In 2018, when the cancer center expanded onto the fourth floor of its building, space devoted to outpatient care for adult cancer patients nearly doubled. Now there are 35 exam rooms and 44 infusion chairs for adults.

And, the fifth floor now houses Upstate’s clinical pathology lab. Jurdi says, “the goal is to have a more rapid turnaround time for certain lab work.”

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

Posted in cancer, health care