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Cancer, In the News, Palliative Care

Popular author writes about the “the circle of caring for a dying person”

Dying roseThanksgiving is a time of gratitude, obviously. But for many, it’s also a time to remember loved ones conspicuously missing from the dinner table. Death and dying are tough topics, but worth talking about even during a holiday weekend.

Last week, one of my favorite bloggers and authors, Catherine Newman, wrote a powerfully moving piece for the New York Times about caring for a lifelong friend as she was dying. I’ve been a fan of Catherine’s since before her second child, Birdy, was born – faithfully reading her thoughts about motherhood and the weird blend of elation, terror, sadness and longing that accompanying the experience of raising babies into children into teenagers. We’re the same age, and our children have grown up together, in a way. I’ve given her book, Waiting for Birdy, to many friends and colleagues, and I consider her a friend I’ve just never happened to meet yet. So when she mentioned on her blog that she’d written about her friend for the Times, I clicked through instantly. And then started to cry.

The article, “Mothering my Dying Friend“, is powerful and sad and unbelievably beautiful. As Catherine writes:

In a Venn diagram of tending helpless people at the extremes of life, the circle of caring for a dying person overlaps almost completely with the one for caring for a baby. Both are repetitive, intimate, often gross, sometimes funny, weirdly frantic even as they’re crushingly tedious, and a total act of devotion. […]  And for all of your endless patience there is nothing at the end. Just death, and your only job is a kind of mothering right up to the lip of the abyss.

I know it sounds grim, but I promise you won’t regret reading. Once again Catherine reminds me that we’re all in this together. I’m no longer of an age where my friends are getting married and having babies. Instead we’re caring for dying parents, getting divorced or watching, gobsmacked, as our formerly helpless infants waltz off with the car keys and a promise to not be late. I hope I can weather these and other changes with the same grace and beauty with which Catherine cared for her friend during her last days.

Previously: Author-physician Atul Gawande on dying and end-of-life care Desire for quality end-of-life care crosses ethnic groups  and Stanford doctor on a mission to empower patients to talk about end-of-life issues 
Photo by Ben Rea

Big data, Cancer, Genetics, NIH, Precision health, Research, Stanford News

“Housekeeping” RNAs have important, and unsuspected, role in cancer prevention, study shows

"Housekeeping" RNAs have important, and unsuspected, role in cancer prevention, study shows

BroomsNot every character in a novel is a princess, a knight or a king. It’s the same for our cellular cast of characters. Most molecules spend their time completing the thousands of mundane tasks necessary to keep our cells humming smoothly. Many of these are referred to as “housekeeping” genes or proteins, and biologists tend to focus their attentions on other, more flashy players.

Now dermatologists Paul Khavari, MD, PhD, and Zurab Siprashvili, PhD, have found that a pair of housekeeping RNA molecules play an important role in cancer prevention. They published their findings yesterday in Nature Genetics.

As I explain in our release:

[The researchers] compared 5,473 tumor genomes with the genomes obtained from surrounding normal tissue in 21 different types of cancer. In many ways, cancer cells represent biology’s wild west. These cells divide rampantly in the absence of normal biological checkpoints, and, as a result, they mutate or even lose genes at much higher rate than normal. As errors accumulate in the genome, things go ever more haywire.

The researchers found that a pair of snoRNAs called SNORD50A/B had been deleted in 10 to 40 percent of tumors in 12 common human cancers, including skin, breast, ovarian, liver and lung. They also noted that breast cancer patients whose tumors had deleted SNORD50A/B, and skin cancer patients whose tumors made lower levels of the RNAs than normal tissue, were less likely than other similar patients to survive their disease.

The researchers used data from the National Institutes of Health’s The Cancer Genome Atlas to find that the RNAs are frequently deleted in tumor tissue. They further went on to show that the RNAs bind an important cancer-associated protein called KRAS and keep it from associating with an activating molecule.

“This is really last thing we would have expected,” said Khavari. “It was particularly surprising because my lab has been studying KRAS intensively for more than a decade, so it was quite a coincidence.”

The researchers believe that understanding more about how the RNAs inhibit KRAS activation could point to possible new therapies for many types of human cancers.

Previously: Listening in on the Ras pathway identifies new target for cancer therapySmoking gun or hit-and-run? How oncogenes make good cells go bad  and Linking cancer gene expression with survival rates, Stanford researchers bring “big data” into the clinic 
Photo by Rob Shenk

Cancer, Complementary Medicine, In the News, Research

“We need a breakthrough”: Cancer researchers call for more effective, lower cost therapies

"We need a breakthrough": Cancer researchers call for more effective, lower cost therapies

1024px-Tripterygium_regelii_1Cancer is wily. Although drug developers are continually crafting hard-hitting drugs, a variety of factors, such as a tumor’s genetic heterogeneity, mean that cancer usually comes out on top.

Something else is needed.

And that something, writes a panel of 180 researchers in a special issue of Seminars in Cancer Biology, is an array of treatments that bombard a series of targets. These treatments can be based on substances found in nature that are lower in cost and toxicity than many current treatments, the researchers write. Some of these compounds stem from plants, such as the Chinese herb Tripterygium wilfordii (although that herb, like many treatments is not without a downside: it also suppresses the immune system).

The team identified 74 molecular targets deserving of investigation and set up a framework for researchers to pitch in. And the time is now, researchers Anupam Bishayee, PhD, and Keith Block, MD, write in the introductory paper: “We have a long way to go before oncology can offer true comfort to most patients.”

Stanford oncologist Dean Felsher, MD, PhD, was part of the project. “This is an area that merits considerable attention and where interdisciplinary and international collaboration is needed,” he said in a statement.  “Our approaches to therapy are improving, but we need a breakthrough that can helps us address the problem of relapse.”

Previously: Researchers develop molecular target for brain cancer, Kidney cancer secrets revealed by Stanford researchers and Tool to identify the origin of certain types of cancer could be a “boon to doctors prescribing therapies”
Photo by Qwert1234

Cancer, Pediatrics, Research, Stanford News

A cure is not enough for young cancer survivors

flower-887443_1920I survived Hodgkin’s lymphoma as a young adult about twenty years ago, thanks to the chemotherapy and radiotherapy that I received at Stanford Hospital as part of a clinical trial.

Even back then, the focus of the research was on fine-tuning my cancer treatment to maintain an excellent likelihood of survival, while minimizing the long-term health problems due to therapy. I knew Hodgkin’s was unlikely to kill me, so I had to worry instead about future health issues caused by my radiation and chemotherapy.

People that survive cancer at a young age are expected to live many decades after diagnosis and treatment, so they are the most vulnerable population to long-term damaging effects from cancer therapy. Stanford’s Karen Effinger, MD, MS, and Michael Link, MD, explore this issue in an editorial published today in JAMA Oncology.

The editorial explains that it is critical to directly study the late effects in young adult cancer survivors, rather than the common practice of extrapolating from studies of children and middle-aged adults.

In particular, they discuss a new study by Katherine Rugbjerg, PhD, and Jorgen Olsen, MD, DMSc, from the Danish Cancer Society Research Center, which used the national Danish registries to compare the long-term risk of hospitalization in almost 34,000 5-year survivors of adolescent and young adult cancers with that of more than 228,000 age- and sex-matched population controls. Reported in the latest issue of JAMA Oncology, Rugbjerg and Olsen found that adolescent and young adult cancer survivors had significant health issues due to their treatment; however, these treatment effects were different than survivors of childhood cancers.

The editorial also discusses the late effects of pediatric cancer treatment on survivors’ neurocognitive development, which impacts education, employment and quality of life. Effinger and Link specifically describe a new study reported in JAMA Oncology by Kevin Krull, PhD, and colleagues from the St. Jude Children’s Research Hospital, which compared the neurocognitive outcomes in 80 adult 25-year survivors of a pediatric cancer with 39 controls. Krull concluded that the risk of neurocognitive impairment from cancer treatment was related to the development of chronic health conditions — rather than directly from exposure to high-doses of chemotherapy, as expected — but longitudinal studies are needed to sort out possible modifying factors.

The editorial authors conclude:

Going forward, we must apply our knowledge of late effects to improve monitoring and interventions for patients. While the progress made in the management of cancer in children and young adults has been gratifying, we must remember the words of Giulio D’Angio, who reminds us that “cure is not enough.”

Jennifer Huber, PhD, is a science writer with extensive technical communications experience as an academic research scientist, freelance science journalist, and writing instructor.

Previously: Study highlights childhood cancer survivors’ increased risk of future health problems, Questioning whether physicians are equipped to care for childhood cancer survivors and A cancer survivor discusses the importance of considering fertility preservation prior to treatment
Photo by klimkin

Cancer, In the News, Pediatrics, Stanford News

“Earth angel” brings smiles to sick kids in hospital

"Earth angel" brings smiles to sick kids in hospital

6552156879_1cd906fbab_zHere’s a tale that will tug on your heart strings: It begins in a small town in Pennsylvania, in 1926, at the birth of Joe Manfrey, the fifth child in a family that would eventually grow to nine.

Like many his age, Manfrey served in World War II; his ship was part of the battle of Iwo Jima.

But unlike many of his peers, Manfrey, now 89, is still volunteering twice a week in the cancer unit in the Lucile Packard Children’s Hospital Stanford where he spreads good cheer, hope and sock monkeys. Manfrey was featured in a recent story in the San Jose Mercury News:

“Joe embodies the great values of the Greatest Generation,” said Leslie Griffith, a nurse in the Bass Center for Childhood Cancer and Blood Diseases. “He is funny, engaging and soothing to parents, who can be crying or overwhelmed by a surreal sadness. But just when they feel lost, someone kind and upbeat like Joe arrives — an Earth angel, a beautiful spirit.”

But there’s a twist to Manfrey’s story.

His own son, now 47, survived acute lymphoblastic leukemia as a child, at a time when its survival rates were much lower than they are now. He shows patients a photo of his son as a bald, 5-year-old, and then one as a healthy adult.

“By showing them the pictures together, it lets them know that I personally know what they are going through. It also gives them hope because they can see that Rob grew up to be healthy and strong,” Manfrey said in the article.

“This is not about me,” he emphasized in the story. “I do this for the kids and the parents, in order to take their minds off the difficulties they are going through. I try to make them feel a little more comfortable.”

Previously: California collaboration focuses on analyzing pediatric cancers, A look at the dramatic improvement in pediatric cancer survival rates and Children’s hospital volunteers snuggle infants to soothe tiny patients and reassure their parents
Photo by Clyde Robinson

Cancer, Imaging, Research

Researchers develop molecular target for brain cancer

Researchers develop molecular target for brain cancer

cai CD146 cancer detection_labels_560x270

About 23,000 new cases of brain and central nervous system tumors are diagnosed annually, and more than 15,000 patients are expected to die of brain cancer this year in the United States, according to the American Cancer Society. Glioblastoma multiforme is the most common brain malignancy, but it remains incurable with only 5 percent of patients surviving at least 5 years after diagnosis. This bleak scenario has motivated the search for a better molecular target for glioblastoma multiforme diagnosis and therapy.

Weibo Cai, PhD, an associate professor of radiology and medical physics, and his research team at the University of Wisconsin-Madison searched the Cancer Genome Atlas database and identified an effective biomarker for the deadly glioblastoma multiforme: the CD146 gene, which is highly active in glioblastoma.

CD146 genes place unique CD146 proteins on the surface of cells. Cai’s team developed an antibody that selectively latches onto the CD146 proteins concentrated on the glioblastoma tumors. They also tagged the antibody with a radioactive copper isotope, so the tumors could be easily identified and localized with a positron emission tomograph (PET), an imaging scanner commonly used to detect cancer.

Cai tested their antibody by implanting animal models with human glioblastoma tumors, injecting them with the antibody and imaging them with a small animal PET scanner. The copper-labeled antibody preferentially accumulated in the tumors, allowing PET imaging to accurately identify tumors as small as 2 mm. Their study results were recently reported in the Proceedings of the National Academy of Sciences.

As Cai explained in a university news release:

We’ve created a tag that – at least in our mouse model – is highly specific for this aggressive brain cancer. If the technique proves out in further tests, it could be used to diagnose some strains of aggressive glioblastoma, and also to evaluate treatment progress or even to test potential drugs.

The researchers also found high activity of CD146 in ovarian, liver, and lung tumors so their antibody could have a wide range of applications. However, there is a lot of research to be done before the technique could be used in the clinic. Cai said in the news release, “This targets tumors with the worst survival, but I want to emphasize that human trials are some years in the future.”

Jennifer Huber, PhD, is a science writer with extensive technical communications experience as an academic research scientist, freelance science journalist, and writing instructor.

Previously: You know it when you see it: a precision health approach to diagnosing brain cancerA Stanford neurosurgeon discusses advances in treating brain tumors, and A century of brain imaging
Images by Weibo Cai/Department of Radiology, University of Wisconsin-Madison. On the left, the antibody is linked to a label that shows up in a PET scanner, and the aggressive cancer shines brightly. On the right, a similar cancer without the molecular marker is less obvious.

Cancer, Pediatrics, Research, Stanford News

A family’s story changes the science of a rare tumor

A family's story changes the science of a rare tumor

Super-DylanWhen Danah Jewett’s 5-year-old son, Dylan, was dying from a brain tumor in 2008, she wanted to know if there was anything her family could do to help other children who might someday face the same terrible diagnosis. Yes, said Dylan’s doctor, Michelle Monje, MD, PhD: Would you be willing to donate his tumor for cancer research after his death?

Danah and Dylan’s dad, John, didn’t hesitate. If it will help, they said, we’ll do it.

Monje explained that scientists needed a way to study Dylan’s rare tumor, diffuse intrinsic pontine glioma, in the lab. The tumor grows tangled into a part of the brain stem that is risky to biopsy in living patients, and decades of chemotherapy trials had not budged the disease’s five-year fatality rate of 99 percent. But having DIPG tumor cells in a dish would open a new world of research options for understanding the biology of the tumor and – Monje hoped – developing new treatments.

After Dylan’s death in early 2009, Monje’s team succeeded in transforming his tumor cells into the world’s first DIPG tissue culture. A few months later, I wrote a feature story for Stanford Medicine magazine about the Jewetts’ donation and its impact. In the intervening years, as I’ve continued to report on Monje’s DIPG research, she has also kept me abreast of the effect of Dylan’s story. It’s pretty remarkable: So far, 21 other families have donated DIPG tissue from their deceased children, many after reading the Stanford Medicine story. And DIPG families have also raised more than $1 million to help fund Monje’s work. Their generosity is enabling new understanding of how the tumor functions, and has helped Monje’s team identify an existing drug that slows DIPG in mice.

I recently interviewed Danah for a short follow-up piece for Stanford Medicine about the impact of Dylan’s story. I asked her to reflect on why she felt able to share the story, given that many families wouldn’t want to open a window for the world into such a heartbreaking part of their lives.

“It’s a hard one,” Danah told me. “I do know a lot of families stay private, but it didn’t dawn on me at the time. I knew then that I just didn’t want to let his memory die. By sharing the story, it helped Dylan to be living on – in my heart and other people’s.”

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Bioengineering, Cancer, Imaging, Public Safety, Research, Stanford News, Technology

A new way to scan for plastic explosives could someday detect cancerous tumors

A new way to scan for plastic explosives could someday detect cancerous tumors

14591799636_128fbe50ee_zSci-fi shows and superhero films are full of gadgets and beings that have the power to remotely scan their environment for hidden things. For us mere mortals this superability may sound unachievable, but now Stanford engineers are working to develop a safe and portable way to detect concealed objects by scanning with microwaves and ultrasound.

As this Stanford Report story explains, the idea began with a challenge posed by the Defense Advanced Research Projects Agency: Design a way to detect buried plastic explosives from a safe distance without touching the surface of the ground.

A team of electrical engineers led by assistant professor Amin Arbabian, PhD, and research professor Pierre Khuri-Yakub, PhD, took up the challenge, paying homage to the scanning device made popular by sci-fi show Star Trek in the process. They created a tricorder-like device that senses the ultrasonic waves created by objects as they expand and contract when warmed by electromagnetic energy (e.g., light and microwaves).

Here’s the really interesting part: Because everything expands and contracts when heated — but not at identical rates — this scanning tool could have medical applications as well. For example, blood vessels that sprout from cancerous tumors absorb heat differently than surrounding tissue. So, blood vessels radiating from tumors could appear as “ultrasound hotspots” when scanned with the tricorder device.

The team is working to make this device ready to detect the presence of tumors and other health anomalies sometime within the next decade or so.

Previously: Beam me up! Detecting disease with non-invasive technology and Tiny size, big impact: Ultrasound powers miniature medical implant
Photo by Joe Haupt

Addiction, Cancer, Events, Health Policy, Medicine and Society, Public Health

The devil you know: Experts discuss the public-health consequences of e-cigarettes

The devil you know: Experts discuss the public-health consequences of e-cigarettes

e-cigarettesHow do we reduce health risk in the face of harm that can’t be eradicated completely? That’s the question that the medical school’s dean, Lloyd Minor, MD, presented to the audience at Monday’s Health Policy Forum on e-cigarettes — a topic about which he said “intelligent and reasonable people can disagree.”

E-cigarettes are a heavily contested subject in the public-health community. Panelists at this event debated whether the recently developed devices hold promise to help long-time smokers move away from combustible cigarettes, or whether they carry the worrisome potential to re-normalize smoking.

All panelists agreed that those under 21 shouldn’t be using any nicotine delivery devices, and they shared a goal of minimizing general use of harmful health products. They disagreed, however, on what the advent of e-cigarettes means to the accomplishment of those goals.

David Abrams, PhD, a Johns Hopkins clinical psychologist specializing in health psychology, addictions, and tobacco-use behavior, described himself as a harm reductionist. He argued that as an alternative mode of nicotine delivery, e-cigarettes pave the way for saving lives by helping addicted smokers not use traditional cigarettes.

“I do think the evidence is very solid that they are dramatically less harmful than cigarettes…because they absolutely have very low, almost undetectable levels or trace amounts of the top eight carcinogens that are found in cigarettes and they have no carbon monoxide,” he explained.

But a lack of extensive research makes Stanford’s Robert Jackler, MD, and Bonnie Halpern-Felsher, PhD, question whether vaping is actually safe — and a prevalence of candy-flavored e-liquids leaves them concerned for the potential for harm to youth.

“Let me point out that you can smoke [combustible cigarettes] for many years before you get chronic destructive lung disease,” said Jackler, who leads a Stanford research team studying the impact of tobacco advertising, marketing, and promotion. “So while I agree… that they are safer, the presumption that they are safe for teenagers to adopt as opposed to combustible tobacco, we won’t know that for decades.”

In the meantime, he worries that “we’re experimenting with the lungs of teens.”

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Cancer, Imaging, Public Health, Research

Tattoo ink may mimic cancer on PET-CT images, researchers warn

tatoo lady

The hit new crime thriller “Blindspot is about a mysterious woman, Jane Doe, who is covered in extensive full-body tattoos. If Jane Doe were a real woman who ever needed medical imaging, she might need to be concerned.

In a case report published recently in the journal Obstetrics & Gynecology, researchers found that extensive tattoos can mimic metastases on positron emission tomography (PET) fused with computed tomography (CT). PET-CT imaging is commonly used to detect cancer, determine whether the cancer has spread and guide treatment decisions. A false-positive finding can result in unnecessary or incorrect treatment.

Ramez N. Eskander, MD, an assistant professor of obstetrics and gynecology at UC Irvine, and his colleagues describe the case study of a 32-year-old woman with cervical cancer and extensive tattoos. The pre-operative PET-CT scan using fluorine-18-deoxyglucose confirmed that there was a large cervical cancer mass, but the scan also identified two ileac lymph nodes as suspicious for metastatic disease. However, final pathology showed extensive deposition of tattoo ink and no malignant cells in those ileac lymph nodes.

It’s believed that carbon particles in the tattoo pigment can migrate to the nearby lymph nodes through macrophages, using mechanisms similar to those seen in malignant melanoma. The researchers explain in their case report:

Our literature search yielded case reports describing the migration of tattoo ink to regional lymph nodes in patients with breast cancer, melanoma, testicular seminoma, and vulvar squamous cell carcinoma, making it difficult to differentiate grossly between the pigment and the metastatic disease, resulting in unnecessary treatment.

The authors warn other physicians to be aware of the possible effects of tattoo ink on PET-CT findings when formulating treatment plans, particularly for patients with extensive tattoos.

Jennifer Huber, PhD, is a science writer with extensive technical communications experience as an academic research scientist, freelance science journalist, and writing instructor. 

Previously: Stanford researcher discusses enhancing imaging methods with nanotechnology in NIH podcast and Stanford fellow addresses burden of cervical cancer in Mongolia
Photo by Paulo Guereta

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