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Cancer

Cancer, Health Costs, In the News, Stanford News, Videos

An initiative to deliver more compassionate and affordable advanced cancer care

This 9-minute video report from Al Jazeera America’s “America Tonight” offers an intimate glimpse into the lives of veterans suffering from advanced cancer, as they discuss end-of-life issues with their care providers at the Veterans Affairs Palo Alto Health Care System.

More than 200 late-stage cancer patients are participating in this Stanford-designed pilot study. Its goal is to improve the quality of life of these patients, while simultaneously reducing the costs of 11th-hour treatments that might not offer life-extending or life-enhancing benefits.

The driving force behind this study is Manali Patel, MD, a young Stanford oncologist who designed the plan with three others during her fellowship year at the Stanford Clinical Excellence Research Center, called CERC. The Center’s mission includes tests of its innovative care concepts at diverse U.S. health-care sites, in order evaluate and refine them prior to advocating widespread adoption.

The video focuses on one of three major components of the new CERC-designed approach to cancer care. The first is earlier patient counseling and shared decision-making about treatment options, well before a patient is on the brink of death, when emotions overwhelm the decision-making skills of patients, families and clinicians.

These difficult discussions don’t happen as often as they should, as I wrote in a 2012 Stanford Medicine magazine article on topic:

According to a recent study, end-of-life discussions typically take place only 33 days before death. With Patel’s proposed cancer care model, patients would be thoroughly briefed on the survival odds and side effects before being rushed off to surgery or chemotherapy. Many months before the family is gathered around a loved one’s deathbed, a person’s final wishes – resuscitation, feeding tubes, assisted breathing and whether a person wants to die at home – would be well-informed and documented.

Other pilot sites tests are in the process of implementing various components of the new approach. Last week Patel provided an update on these new cancer-care pilots:

And finally, an update on the cancer patients featured in the video: former Army police officer Rafael Arias, who chose to skip a final round of chemotherapy, recently passed away peacefully at his home. Timothy Blumberg is still in remission.

Previously: Uncommon hero: A young oncologist fights for more humane cancer careTV spot features a more humane approach to late-stage cancer care, “Stop skipping dessert:” A Stanford neurosurgeon and cancer patient discusses facing terminal illness
Video courtesy of Al Jazzera America

Cancer, Health Disparities, Patient Care, Research, Stanford News

Study shows evidence-based care eliminates racial disparity in colon-cancer survival rates

Study shows evidence-based care eliminates racial disparity in colon-cancer survival rates

For the past two decades, the National Cancer Institute has documented that African-American patients have consistently had lower survival rates in colon cancer when compared with white patients. In a study published today in the Journal of Clinical Oncology, lead author Kim Rhoads, MD, PhD, and colleagues from Stanford show that receiving high quality, evidence-based treatment can eliminate this racial disparity. As Rhoads explains in our press release:

Historically, we’ve taken less than a critical eye on our own health-care system in terms of how we can take the lead in addressing disparities. The big take away in this paper is that it’s treatment, not necessarily patient factors, but following evidence-based guidelines that gives all patients the best chance for survival. Our work also suggests a real opportunity to equalize these racial differences.

The evidence-based guidelines were created by the National Comprehension Cancer Network, which used clinical trials and medical research to create step-by-step, evidence-based treatments for most cancers. However, adherence to those guidelines depends on the facility and research shows that minority patients tend to receive care from hospitals that have low adherence rates.

The study found that integrated health-care organizations, which provide all of a patient’s health-care services, hospital care and insurance, delivered evidence-based care for colon cancer at a higher rate than non-integrated health-care organizations. In these facilities, all patients had higher survival rates and racial disparity for colon cancer survival disappeared.

“In integrated systems, there’s already a big push to thinking about following evidence-based guidelines, so everyone within that system is in the same mindset,” said co-author Manali Patel, MD, MPH. “It’s easier to do the right thing when you have the system-level support to do so.”

Integrated health-care systems are well suited for coordinating care among several specialists, which is another advantage for colon-cancer patients, because the treatment of colon cancer requires different types of treatments and different types of specialists, the study pointed out.

The results support the development of integrated health care models as envisioned by Affordable Care Act.

“With health-care reform, millions more patients are coming into the system, and we’re going to need to become more integrated in order to meet the demand. We’re going to need to work more closely together, decrease variations in care and standardize what we do,” Rhoads told me. “In this paper, we have a model that shows that when you do this, you get better colon cancer outcomes for everyone.”

Previously: Stanford researchers examine disparities in use of quality cancer centers, Uncommon hero: A young oncologist fights for more humane cancer care and Report shows continuing health disparities for racial and ethnic minorities

Applied Biotechnology, Bioengineering, Biomed Bites, Cancer, Imaging, Technology, Videos

Beam me up! Detecting disease with non-invasive technology

Beam me up! Detecting disease with non-invasive technology

Here’s this week’s Biomed Bites, a feature appearing each Thursday that introduces readers to Stanford’s most innovative biomedical researchers.

Star Trek fans rejoice! Stanford radiologist Sam Gambhir, MD, PhD, hopes that someday he’ll be able to scan patients using a handheld device — similar to the one used by Bones in the popular sci-fi series — to check their health.

“Our long-term goals are to be able to figure out what’s going on in each and every one of you cells anywhere in your body by essentially scanning you,” Gambhir said in the video above. “We’ve been working on this area for well over three decades.”

This is useful because it will help doctors diagnose diseases such as cancer months or even years before the symptoms become apparent, Gambhir said.

And these advances aren’t light-years away. “Many of the things we’re doing have already started to move into the hospital setting and are being tested in patients. Many others will come in the years to follow,” he said.

Gambhir is chair of the Department of Radiology. He also directs the Molecular Imaging Program and the Canary Center for Cancer Early Detection.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Stanford partnering with Google [x] and Duke to better understand the human body, Nano-hitchhikers ride stem cells into heart, let researchers watch in real time and weeks later and Developing a new molecular imaging system and technique for early disease detection

Cancer, Complementary Medicine, Events, Patient Care

Knitting needles cancer while helping patients

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It may sound unusual, but knitting is one way to cope with difficult experiences, such as undergoing cancer treatment. Rhythmic and relaxing, knitting can sooth the mind and soak up the downtime that’s a big part of cancer treatment, according to Holly Gautier, RN, a nurse and director of the Cancer Supportive Care Program at Stanford.

“It’s the repetitive motion that you have with knitting… You’re focused on the stitching and your mind becomes somewhat blank – it really feels good to be making something new,” Gautier explained to me recently.

Although she administers a slew of programs – from yoga to art – Gautier said she’s particularly excited about a new knitting class, which meets weekly at the Stanford Cancer Center.  It’s free and open to all cancer patients and their families — not just those being treated at Stanford.

The class is led by a volunteer knitters, who provide supplies and teach the basic stitches. They can even accompany patients to treatment rooms to answer questions or undo an error, Gautier said. And they’re happy to put together “knitting-to-go” care packages for those who can’t stay.

While participants are welcome to work on other projects, such as scarves and hats, the class is currently making squares to create a quilt to raffle off at an upcoming benefit for the Cancer Survivorship Program. Gautier said the quilt project provides patients with an opportunity to give back – something that nearly all patients yearn to do.

Although the first session last Tuesday drew eight female patient-knitters, Gautier said she hopes other patients and caregivers, particularly men, stop by in coming weeks. More details on the Knitting with Friends program can be found here.

Previously: Knitting as ritual — with potential health benefits?, Image of the Week: Personalized brain activity scarves and A look at how helping others can be healing
Photo by meknits

Aging, Cancer, Research, Stanford News

Stanford researchers deliver double punch to blood cancer

Stanford researchers deliver double punch to blood cancer

Acute myeloid leukemia is an aggressive and deadly cancer affecting cells that turn into our blood. Now, a study published in Nature Medicine shows that a drug known to cause cell death might be effective for a particular subtype of this lethal disease.

To get an idea of just how aggressive and deadly acute myeloid leukemia is, consider the survival rates for the 13-14,000 American adults who are sickened each year. The overall survival rate is 30-40 percent, according to Stanford cancer researcher Ravindra Majeti, MD, PhD, but if patients are over 65 years old, the survival rate dips to just 5 percent. The majority of acute myeloid leukemia patients are elderly.

Apoptosis, or cell death, of tumors is the goal in cancer treatments. There are multiple pathways leading to cell death, and identifying ways to nudge cancer cells towards dying is the focus of much cancer research.

But sometimes the path to cell death is nonlinear and hard to find.

In this work, a team of Stanford cancer researchers led by Majeti and Steven Chan, MD, identified a two-pronged attack for acute myeloid leukemia cancer cells. The researchers first focused on mutated proteins called isocitrate dehydrogenase 1 and 2 (known as IDH1/2 for short). Cancer cells containing mutated IDH1/2 proteins often survive traditional chemotherapy treatments, contributing to relapse, and they exist in 15 percent of acute myeloid leukemia patients. The second focus of the Stanford researchers was the BCL-2 gene, which is known to enable cancerous growth by putting the brakes on cell death in acute myeloid leukemia and other cancer cells. Simply stopping BCL-2 activity in acute myeloid leukemia patients is not very effective, as indicated by low survival rates for the disease.

The Stanford scientists found that giving a drug that inhibits BCL-2 successfully lifted the blockade on cell death, but only in cells with mutated IDH1/2 proteins. Majeti said the drug that promotes cancer cell death by inhibiting BCL-2 is now in clinical trials.

Kimberlee D’Ardenne is a writing intern in the medical school’s Office of Communication and Public Affairs.

Previously: The latest on stem-cell therapies for leukemia, Blood cancers shown to arise from mutations that accumulate in stem cells and Leukemia prognosis and cancer stem cells

Biomed Bites, Cancer, Obesity, Research, Stanford News

Stanford researcher tackles tricky problem: How does a cell become a fat cell?

Stanford researcher tackles tricky problem: How does a cell become a fat cell?

Here’s this week’s Biomed Bites. Check each Thursday to meet more of Stanford’s most innovative biomedical researchers.

Mary Teruel had no intention of becoming a biology professor — after all, she was in a PhD program for aeronautical engineering. But the more she learned about cells, the more fascinated she became.

“I became very interested in the challenging problem of trying to understand the complex network in cells and trying to see if you could apply some of the principles from engineering to understand theses processes and make an insight into human disease,” Teruel says in the video above.

Teruel’s drive to investigate cells led her into her current role as an assistant professor of chemical and systems biology, where she’s striving to unravel a puzzle that underlies the obesity crisis in America: How do cells called pre-adipocytes (or pre-fat cells) become adipocytes (or adipocytes)?

By learning more about cell differentiation, Teruel’s research can also shed light on processes — and potential treatments — involved in cancer.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Secrets of fat cells discovered, Fed Up: A documentary looks for answers about childhood obesity and How physicians address obesity may affect patients’ success in losing weight

Cancer, Medical Apps, Stanford News, Technology

Using a smartphone and the Folding@home app to advance disease research

Using a smartphone and the Folding@home app to advance disease research

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Smartphones now have the power that personal computers had a few years ago, and more and more people have them. So researchers are developing ways to harness that computing power to solve pressing biomedical problems.

As described in a Stanford News piece, Stanford’s Vijay Pande, PhD, in partnership with Sony, recently developed a smartphone app that “folds” proteins while the phone’s owner sleeps. “There are a ton of people with really powerful phones, and if we can use them efficiently, it sets the stage for something really great,” said Pande, a Stanford chemistry professor.

This particular mobile app, called Folding@home, investigates the biology of diseases, including cancer, Alzheimer’s, and Parkinson’s disease. It’s an extension of the Folding@home distributed computing project started in 2007, and it’s now available on GooglePlay.

Disease biology is dependent on proteins, which are complex linear chains of molecules that become “folded up”, like snarled balls of yarn. The chain needs to be absolutely correct; any mutation that shifts a few molecules out of place will cause the protein to not work optimally, not work at all, or, worse, work in a way that does damage to the organism.

Understanding protein configurations is key to developing cures for disease. While real proteins take milliseconds to curl up, simulating this process with computers takes thousands of hours. But if 10,000 people download and use the Folding@home app, and it runs 8 hours a day while the phone is not otherwise in use, the team’s first research question could be solved in three months.

The app’s first focus is a kinase protein found in breast cancer. It seems that different people’s tumors respond differently to the several drugs available; currently, doctors use a guess-and-check method to choose a drug, but information derived from the proteins could enable doctors to choose correctly on the first try. In something as time-sensitive as cancer, this could save lives.

Next up for the app is a project related to Alzheimer’s disease. Eventually, if enough people enroll, the researchers could launch several projects simultaneously, allowing people to choose to take part in one that is personally meaningful.

Image of a protein Argonne National Laboratory

Cancer, Public Health, Research, Stanford News, Technology

Stanford researchers explore new ways of identifying colon cancer

Stanford researchers explore new ways of identifying colon cancer

B0006254 Human colon cancer cellsAfter my aunt died from colorectal cancer several years ago, my father was primed when his doctor suggested he get screened for colon cancer himself, and it’s a good thing he did. The doctor who performed the colonoscopy (a visual exam of the rectum and colon) found a large precancerous polyp.

If my father had skipped out on being screened, he would likely have been dead in five years. He was lucky that the polyp was easily visible during the exam, but not all lesions that turn out to be cancerous are. Some pre-cancerous areas are flat or depressed and much harder to see on colonoscopies or sigmoidoscopies.

Now, a team of Stanford researchers led by Matthew Bogyo, PhD, a professor of pathology and microbiology and immunology, are working on ways to make these less obviously cancerous regions on the colon more visible during screenings. They’re doing so by developing compounds that begin to fluoresce – or glow – when they attach themselves to enzymes called cysteine cathepsins. Present in nearly all cells of our bodies, cysteine cathepsins are abundant in and around cancerous tumor sites. “They’re regulators of inflammation,” Bogyo said when we spoke recently. “When a tumor starts to form, you get inflammation, and the tumor benefits from this inflammatory response. We take advantage of that inflammation, using these enzymes as markers.”

The researchers studied how well the compounds, called quenched fluorescent probes, identified lesions in two strains of mice – one, a specially bred strain of mice that produce a higher number of intestinal polyps and the other a wild-type mouse in which colon cancer is induced by a orally administered drug – as well as in human tissue samples. Their study was published today in the scientific journal Chemistry and Biology. A statistical analysis of the results showed that the probe was highly effective at identifying true cases of intestinal lesions and had a low rate of false positives. “Optical contrast agents allow us to see where lesions are and pick out problem areas,” Bogyo told me. “When they are ‘found’ by these enzymes, they turn bright.” Although it’s hard to compare a test like this to current methods of colorectal cancer screening, which do not involve the use of contrast agents, Bogyo is encouraged by the study’s results.

Bogyo noted that he was surprised that the probe worked just as well identifying lesions in mice intestines when it was applied topically to the inside surface of the intestines as when it was injected into the bloodstream. This opens up the possibility that – if approved for use in humans – it could simplify how the probe is used. A colonoscopist could simply spray the contrast agent out of the end of the endoscope to get a confirmation of potentially dangerous lesions.

Getting these kinds of probes into human use is still years away. Currently, no other targeted optical contrast agents are approved for human use, and the process of gaining approval from the Federal Drug Administration, much like developing a new drug, can be an expensive and arduous one. The probes would need to be tested for safety in animals and eventually humans before they could be approved for widespread use.

But the field is a promising one, and Bogyo is not the only researcher pursuing contrast agents as cancer-screening tools. He is optimistic and is currently exploring companies that may want to invest in developing cysteine cathepsin contrast agents for human use. Incorporating contrast agents into current practices “would move the field forward and make colonoscopy more accurate and rapid,” he said.

Previously: Researchers explore colonoscopy’s effect on the incidence of colorectal cancer, No day on the beach: A colon cancer survivor’s story, The cost-effectiveness of screening colon-cancer patients for Lynch disorder and Bacterial balance in gut tied to colon cancer risk
Photo of colon cancer cells by Wellcome Images

Cancer, Genetics, Stanford News, Videos, Women's Health

Stanford specialists discuss latest advancements in breast cancer screening and treatment

Stanford specialists discuss latest advancements in breast cancer screening and treatment

Invasive breast cancer will affect one in eight women in the United States during their lifetime. Many women, and men, may believe that if they don’t have a family history of breast cancer, then they’re not at risk of developing the disease. However, this is a common myth: About 90 percent of patients diagnosed with the disease have no family history of breast cancer.

But the good news is that breast cancer detected in the early stages can be very effectively treated. Additionally, breast-cancer death rates have been falling over the past 25 years as a result of increased awareness, improvements in treatments and earlier detection.

During a recent Stanford Health Library talk, captured in the above video, breast-cancer specialists discussed the latest advancements in genetic testing, diagnostic imaging, reconstructive surgery and treatments and adjunct therapies to surgery.

Previously: Don’t hide from breast cancer – facing it early is key, Despite genetic advances, detection still key in breast cancer and Ask Stanford Med: Radiologist responds to your questions about breast cancer screening

Cancer, Stanford News, Videos

Evidence-based tips and tools for helping cancer survivors manage fatigue

Evidence-based tips and tools for helping cancer survivors manage fatigue

There are an estimated 14.5 million cancer survivors in the United States, and this figure is expected to grow to almost 19 million in the next decade, according to the latest data (.pdf) from American Cancer Society.

At a recent Stanford Health Library talk, Kelly Bugos, a nurse practitioner and manager of the Stanford Cancer Survivorship Program, discussed managing fatigue, one of the most common side effects of cancer treatment. The above video offers an overview of the many cause of cancer-related fatigue, a discussion of how nutrition and exercise can help boost patients’ energy levels, and evidence-based tips and tools to help survivors feel more energetic and focused.

Previously: Practicing Qigong may help older prostate cancer survivors fight fatigue, pilot study finds, Dramatic increase in number of older cancer survivors expected and Stanford-developed fitness program helps improve cancer survivors’ quality of life

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