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Cancer, Health and Fitness, Stanford News, Women's Health

Ironman of Stanford Women’s Cancer Center

Ironman of Stanford Women’s Cancer Center

ironmanOliver Dorigo, MD, PhD, loves training. The associate professor of obstetrics and gynecology has trained in medicine, surgery, gene therapy, molecular biology, laboratory research and clinical trials management. And that’s just for his day job(s), directing Stanford’s Division of Gynecologic Oncology and the gynecologic oncology program at the Stanford Women’s Cancer Center.

In his spare time Dorigo’s training has included enough running, biking and swimming to compete in 19 Ironman distance triathlons, the most recent being the 2013 Ironman World Championship, held in Kona, Hawaii in October. (For those keeping score, “Ironman distance” means a 2.4-mile swim, a 112-mile bicycle ride and a 26.2-mile run.)

Dorigo says the physical and psychological rigors of triathlon training have helped him professionally to overcome challenges and find solutions for success in difficult situations. And they are lessons he imparts to his patients. As he told me:

In every race, there is a moment when making another step forward seems almost impossible. However, with persistence and the right attitude, this step and all others necessary to reach the finish line will eventually happen. There’s just no giving up. And that’s exactly the attitude I convey to my cancer patients. Don’t give up; keep fighting! Otherwise, how does one ever know whether one could have reached the finish line?

Dorigo and his primary medical passion – ovarian cancer – are discussed in the latest edition (.pdf) of the Stanford Cancer Institute News.

Michael Claeys is the senior communications manager for the Stanford Cancer Institute.

Previously: Frontiers in the fight against ovarian cancer and Ovarian cancer biomarkers may enable personalized treatment, say Stanford scientists
Photo by Grayskullduggery

Cancer, Stanford News, Videos, Women's Health

Stanford Women’s Cancer Center: Peace of mind and advanced care under one umbrella

Stanford Women's Cancer Center: Peace of mind and advanced care under one umbrella

Flamingo-pink carpet lined the path to the Sharon Heights Golf and Country Club in Palo Alto, Calif. – the location of the fifth annual Under One Umbrella benefit for the Stanford Women’s Cancer Center. As I walked into the reception hall, I thought of the phone call that was my introduction to the center several months before.

In March, I tested positive for the HPV virus that can cause cervical cancer and I was scared. Cervical cancer claimed the life of my best friend, and the memory of the day she mentioned that she needed “some testing” is etched in my mind. My phone call to the Stanford Women’s Cancer Center gave me the information and courage I needed to schedule additional testing. “We hope you never need our services,” the receptionist said, “but if you do, we’re here if you need us.”

I ultimately didn’t need the services of the center, but many of the nearly 340 guests in the fundraiser’s reception hall did. For these people, and for many others, the center is a source of medical treatment and hope.

Yet, the center is more than a cancer care facility, as Nicole Kidman, Academy Award-winning actress and honorary chair of the Under One Umbrella committee, explains in the short film above. The center unites medical treatment with cancer research and prevention.

The Under One Umbrella committee supports the cancer center’s efforts, and the annual benefit is a big part of that support. “It brings together an amazing group of people who are interested in furthering research of women’s cancer,” Lloyd Minor, MD, dean of the Stanford medical school told me. “It highlights the talents of Stanford researchers and the wonderful job that Jonathan Berek, MD, [the center's director] has done with the center. It also gives us the opportunity to rededicate our commitment to the cause.”

A crucial step of this commitment and care begins when a patient first learns she has cancer. As social worker Jordan Chavez explains in the film, “When patients come in and have a diagnosis of cancer there’s pandemonium, either internal or external. I think a lot of what I do is to provide, hopefully, some stability and some calm amidst a lot of chaos and to normalize what is a very scary experience for patients and for families, and to help them understand that they will not be alone.”

This sense of camaraderie pervaded all aspects of the benefit. As the fundraiser came to a close, the guest of honor, country music star Keith Urban, gave an (outstanding) unplugged, solo concert. As he sang, the cancer survivors, their family members and friends, and the center’s medical experts forgot themselves. They were simply a crowd of fast friends.

As I left the event, I wondered how I could explain the importance of the women’s cancer center to someone who wasn’t a woman with cancer. The answer came to me in the form of an umbrella I carry with me rain or shine.

I know that I won’t need an umbrella most days, but it’s comforting to know that if I do, it will be there to shelter me from the storm.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Garth Brooks and Trisha Yearwood help fundraising effort for Women’s Cancer Center at StanfordStanford expert weighs in on ovarian-cancer screening recommendationWhat’s 1,454 feet tall, glows pink and sounds like country music?Stanford Women’s Cancer Center opens Monday and Wellness after cancer: Stanford opens clinic to address survivors’ needs
Video, Embracing the Challenge, from Friday’s Films


Hope and faith are powerful medicine

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; the latest comes from North Carolina father Buddy Ruck.

“We have treatments that can help you survive for about two years.”

I remember those mind-numbing words spoken by my pulmonologist on February 18, 2011. I knew the doctor had a reputation for being one of the best pulmonologists in the area – but come on, how could he throw this news at me and make me feel like I was going to die and that was it? I remember thinking to myself that there had to be someone on this earth who survived this disease.

It had all started earlier that month when I called out of work thinking I had the flu. I went to my PCP to get treated. After a chest X-ray, CT scan, MRI and bronchoscopy/biopsy, I was told that I had small cell lung cancer.

How could this be happening? No! I have a wife and four young children at home. They need me! I was deeply depressed and couldn’t eat or talk about it. I pulled away from everyone because that’s all everyone could think and talk about and I wanted no part of it. I was told I was going to die and no one seemed to understand how I was feeling. Between not eating and loss of water weight through my tears, I quickly lost 20 pounds. So many thoughts went racing through my mind. Just a few weeks earlier I had a great life – a great family, career, friends and health. And now it was all gone in a matter of a few weeks? How could God let this happen? Why me? What did I do to deserve this? I was so angry that I actually told God that I hated him. I knew it was the wrong thing to do but I couldn’t stop myself from feeling this way.

Like many, I decided I wanted to educate myself on what I was up against. I remember trying to search for any longterm survivors of SCLC. I found one forum where there was a man who was a four-year survivor but he hadn’t posted anything new in more than three years. This is the only story I could find on the Internet showing some length of survival. I don’t know why it made me feel better, but it did. I guess it gave me some hope to hold onto.

While sitting with my wife in the waiting room before my PET scan, we cried together. I was so scared and had many questions. Had it spread all over my body? Will they tell me I only had months or weeks to live? When I met with my oncologist to get the results a few days later, I said to her, before she could say a word, “Doc, do I have any chance of beating this? My pulmonologist told me I may live up to two years with treatment.” I closely watched her body language. I knew I had put her in a difficult position, but what else could I do? I needed to know. She told me I was staged with limited SCLC because the disease was confined to my right upper lobe with no lymph node involvement. She replied with confidence, “Yes, you can beat this. We are treating to cure!”

I can’t describe how much weight was lifted off of my shoulders with just those two sentences. That was the turning point for me. It restored all hope, all faith. I can’t explain it, but at that moment I just knew I was going to beat this beast. Soon after being diagnosed, friends and their church members brought us meals and comforting words. These acts of kindness meant more to us than they will ever know. I knew God was there watching over me and my family.

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Cancer, Global Health, Research

News of a celebrity’s cancer may prompt people to quit smoking

ash2Celebrities draw attention to fashion and beauty trends, charitable causes and fitness crazes, among other things. Now, a study has found that media attention given to a celebrity’s cancer diagnosis may be a powerful motivator to help more people quit smoking.

Scientists from San Diego State University, the Santa Fe Institute, the University of North Carolina and the Johns Hopkins Bloomberg School of Public Health examined Internet news searches and found that more people seek information on smoking cessation after a celebrity has publicly struggled with cancer than on New Year’s Day or World No Tobacco Day, both popular quitting times.

From a release:

Using the case of former Brazilian President Lula da Silva, who was diagnosed with laryngeal cancer in October 2011 and attributed his cancer to his long-held smoking habit, the researchers analyzed both media coverage of smoking cessation and the public’s online search activity surrounding the event.

By mining Google News archives, the team found Brazilian news coverage of quitting increased as much as 500 percent immediately after the diagnosis — and remained 163 percent higher for one week — before returning to typical levels. At the same time, Brazilian Google searches related to quitting smoking increased by 67 percent.

However, long after the media stopped covering Lula’s diagnosis, the public had not forgotten. Two weeks after the diagnosis, quitting-related Google searches remained 153 percent higher than expected, and remained 130 percent and 71 percent higher three and four weeks respectively after Lula’s announcement.

Study co-author Benjamin Althouse, PhD, an epidemiologist at the Santa Fe Institute, added, “In practical terms, we estimated there were about 1.1 million more quit-smoking queries in Brazil the month after Lula’s diagnosis than expected. Not only will quitting prevent throat cancer, but it can prevent nearly all cancers, including lung, stomach, breast, etc.”

The paper was published in the journal Preventive Medicine.

Previously: Quitting smoking for the baby you plan to have togetherCraving a cigarette but trying to quit? A supportive text message might help and Smoking rates increasing in the developing world
Photo by cogdogblog

Cancer, Public Health, Stanford News

Can repackaging aspirin get more people to take it daily for prevention?

Can repackaging aspirin get more people to take it daily for prevention?

aspirinNot many over-the-counter drugs can substantially improve your health. However, according to the U.S. Preventive Services Task Force, aspirin can reduce the risk of cardiovascular disease for some people. There is also building evidence that daily low-dose aspirin reduces risk of breast cancer, colon and other gastrointestinal cancers, and may even slow down dementia.

When a doctor agrees that the benefits of daily low-dose aspirin outweigh the potential side-effects, aspirin can be an effective, practical and inexpensive way to save lives and save billions in taxpayer-paid healthcare costs. Yet less than 50 percent of those thought eligible to take daily aspirin appear to be doing it. Why?

As a cancer prevention researcher I think a lot about people’s health-related behaviors – and how to change them. What if increasing people’s usage of daily aspirin were as simple as changing the packaging? Now, the only way to buy aspirin is in a bottle, making it hard to remember if you took one each day. What if we put it in a calendar blister pack? What if we made the pills in the shape of a heart to remind you why you are taking it? What if the packaging and marketing encouraged you to bring up aspirin at your next doctor’s visit?

I recently submitted these ideas as part of the Target Simplicity Challenge - a pioneering “crowdsourcing” effort led by Target to identify new ideas for simplifying healthcare. I found out about the challenge on Twitter (thanks, @seattlemamadoc!), typed it up and even shot some video on my iPhone. The judging panel of doctors, designers, marketing executives and other industry experts liked it enough to make it one of eight finalists in the competition. This week I’m off to Target headquarters in Minneapolis to talk more about the idea before the winners are announced later in the month. The grand prizes include the opportunity to work with Target on turning my idea into reality.

And the public got a say, too – as you can read about on Target’s site.

We need to stop and think about the easiest and simplest ways possible for people to take advantage of existing scientific evidence that will make them healthier. Doctors and medical researchers should work together with experts in design and marketing to identify more evidence-based opportunities to make prevention and healthcare simpler.

Aspirin is inexpensive and available widely over the counter, but still, we could make it easier to take for those people who could benefit. Short of legislating aspirin counseling (a good idea opined in the New York Times), we need fresh and exciting approaches. I really think better design will increase the appeal of daily aspirin for chronic disease prevention and hope I have the chance to find out.

Christina Clarke, PhD, MPH, is a research scientist at the Cancer Prevention Institute of California (CPIC) and a member of the Stanford Cancer Institute. Part of the Stanford Cancer Institute, the Cancer Prevention Institute of California conducts population-based research to prevent cancer and reduce its burden where it cannot yet be prevented.

Previously: Another big step toward building a better aspirin tablet and New research shows aspirin may cut melanoma risk
Photo by brxO

Cancer, Fertility, Research, Stanford News, Women's Health

An in-depth look at fertility and cancer survivorship

An in-depth look at fertility and cancer survivorship

Pregnant_woman2The physical and emotional after-effects of cancer treatment – things like fatigue, pain and depression – have been well-documented. And because some treatments cause havoc on parts of the body’s reproductive system, younger patients often must also contend with fertility issues.

In a paper recently published online in CA: A Cancer Journal for Clinicians, a group of Stanford researchers review the existing literature on fertility and cancer survivorship. The topic, they explain, is an increasingly important one, given that around 9 percent of patients diagnosed with cancer in the United States are younger than 45 years old and that infertility has been shown to negatively impact quality of life among cancer survivors. They write:

The distress resulting from the interruption of fulfilling one’s reproductive goals as a result of a cancer diagnosis and treatment  persists several years after the diagnosis, particularly for those who never conceive.

The goal of the review, which was led by Lynn Westphal, MD, associate professor of obstetrics and gynecology, was to aid in pre- and post-treatment fertility counseling for patients. In their lengthy article, Westphal and her colleagues summarize what is known about infertility and survivorship – and what we still need to study further. Among the information shared about patients’ reproductive health and the health of their offspring:

  • Since it varies with type of treatment and patient age, among other things, there isn’t an accurate estimate of women’s risk of infertility or primary ovarian insufficiency after cancer treatment. But, the researchers write, studies have shown the incidence of acute ovarian failure or premature menopause among childhood cancer survivors varies from 6 to 12 percent.
  • In the landmark Childhood Cancer Survivor Study, exposure of the ovaries to radiation was shown to be to be one of the highest risks for acute ovarian failure and premature menopause in women.
  • In several studies comparing pregnancies in cancer survivors with those in the general population, “the vast majority of pregnancies occurring in cancer survivors are routine  and uneventful.” But patients who have undergone abdominal or pelvic radiotherapy are known to face a higher risk of preterm birth, low birth-weight offspring, stillbirth and early neonatal death.
  • Testicular and hematologic malignancies are the most common cancers that are associated with impaired sperm production in men.
  • Recent estimates suggest that up to two-thirds of all pediatric cancer survivors will face male germ cell dysfunction.
  • For most cancer survivors, there is no increase in cancer or birth defects in their children. One study comparing more than 2,100 offspring of cancer survivors with more than 4,500 offspring of controls in the United States found no difference in birth defects between the two groups.

The authors discuss specific types of fertility preservation, including egg and embryo freezing, and note that techniques to help survivors have children have improved over the past decade. Yet, they write, only “a subset of oncologists discuss the gonadotoxic effects of cancer treatments with patients of reproductive age, and even fewer refer them for fertility preservation consultations.”

In light of research showing that treatment-related infertility is significantly associated with depressive symptoms among survivors, Westphal and her colleagues encourage clinicians to address these issues – and the options – with their patients.

“Discussion of the changes to a patient’s reproductive health after cancer treatment is essential to providing comprehensive quality care,” they conclude.

Previously: Study highlights fertility-related concerns of young cancer survivorsUnique challenges face young women with breast cancer and A need to provide infertility counseling to cancer patients
Photo by Canwest News Service

Cancer, Patient Care, Stanford News, Videos

A patient’s journey with lung cancer

A patient's journey with lung cancer

In this recent Stanford Hospital & Clinics video, Santwona Behera describes her medical and emotional journey with lung cancer. Her oncologist, Heather Wakelee, MD, discusses gene mutations that drive the cancer, and how knowing the gene mutation can change a patient’s course of treatment.

In the piece, Behera says Wakelee’s consideration of many treatment options gave her hope as well as brought her cancer under control. At Stanford, Behera says, “I feel that I am cared for.”

Previously: Big data = big finds: Clinical trial for deadly lung cancer launched by Stanford studyCancer survivor: The disease isn’t a “one-off, one-shot deal”Weakness in lung cancer stem cells identified by Stanford scientists and When the journalist becomes the patient

Aging, Cancer, Dermatology, Patient Care, Research, Science, Stanford News

Dilute bleach solution may combat skin damage and aging, according to Stanford study

Dilute bleach solution may combat skin damage and aging, according to Stanford study

3350877893_9d1db3abf3_zIs it time to put away your fancy skin creams and moisturizers? A study published today in the Journal of Clinical Investigation by Stanford pediatric dermatologist Thomas Leung, MD, PhD, and developmental biologist Seung Kim, MD, PhD, suggests that a dilute solution of sodium hypochlorite (you’ll know it better as the bleach you use for cleaning and disinfecting), inhibits an inflammatory pathway involved in skin damage and aging.

The researchers conducted their studies in mice, but it’s been known for decades that dilute bleach baths (roughly 0.005 percent, or one-fourth to one-half cup bleach in a bathtub of water) are an effective and inexpensive way to combat moderate to severe forms of eczema in human patients.

According to our release:

Leung and his colleagues knew that many skin disorders, including eczema and radiation dermatitis, have an inflammatory component. When the skin is damaged, immune cells rush to the site of the injury to protect against infection. Because inflammation itself can be harmful if it spirals out of control, the researchers wondered if the bleach (sodium hypochlorite) solution somehow played a role in blocking this response.

The researchers found that the bleach solution blocks the activation of a molecule called NF-kappaB, or NF-kB, that is involved in inflammation and aging. They collaborated with radiation oncologist Susan Knox, MD, to investigate potential clinical applications. From our release:

Radiation dermatitis is a common side effect of radiation therapy for cancer. While radiation therapy is directed at cancer cells inside the body, the normal skin in the radiation therapy field is also affected. Radiation therapy often causes a sunburn-like skin reaction. In some cases, these reactions can be quite painful and can require interrupting the radiation therapy course to allow the skin to heal before resuming treatment. However, prolonged treatment interruptions are undesirable.

“An effective way to prevent and treat radiation dermatitis would be of tremendous benefit to many patients receiving radiation therapy,” said Susan Knox, MD, PhD, associate professor of radiation oncology and study co-author.

The researchers tested the effect of daily, 30-minute bleach baths on laboratory mice with radiation dermatitis, and on healthy, but older mice. They found that animals bathed in the bleach experienced less severe skin damage and better healing and hair regrowth after radiation,  and the fragile skin of older animals grew thicker than control animals bathed in water. But don’t ditch the contents of your medicine cabinet just yet– mice aren’t exactly tiny people, and more research needs to be done.

The researchers are now considering clinical trials in humans, and they are also looking at other diseases that could be treated by dilute-bleach baths. “It’s possible that, in addition to being beneficial to radiation dermatitis, it could also aid in healing wounds like diabetic ulcers,” Leung said. “This is exciting because there are so few side effects to dilute bleach. We may have identified other ways to use hypochlorite to really help patients. It could be easy, safe and inexpensive.”

Previously: Master regulator for skin development identified by Stanford researchers
Photo by Shawn Campbell

Cancer, Clinical Trials, Research, Stanford News

Guidance on improving Asian-American participation in cancer clinical trials

Guidance on improving Asian-American participation in cancer clinical trials

Much has been written about the need to involve more ethnic minorities in clinical trials. Now, the Stanford Cancer Institute is offering help to researchers in the form of a free online course called “Practical tips to improve Asian American participation in cancer clinical trials.” As described on the course website:

Racial and ethnic diversity is critical to the success of cancer clinical trials. Asian Americans, like other ethnic groups, have low recruitment, accrual and retention rates in cancer clinical trials. This represents a significant challenge on a national level for health advocates, healthcare institutions and the National Cancer Institute… This online course will educate healthcare providers and allied health professionals about cancer clinical trials and cultural humility skills as well as provide educational resources and tips for reinforcing change in practice to improve outcomes in Asian American clinical trial participation.

Kim Rhoads, MD, MPH, is director of the course, which can be taken for Continuing Medical Education (CME) credit. Rhoads’ research focuses on racial disparities in cancer outcomes, a topic she addressed during a 1:2:1 podcast a few years back.

Previously: NPR explores the need for improving diversity in clinical trials, Survey confirms that small number of U.S. adults, children participate in research studies, Patients share clinical trial experiences at Stanford, What motivates people to participate in clinical trials?, Not enough cancer doctors refer patients to clinical trials

Cancer, Clinical Trials, Research, Stanford News, Women's Health

Common drug class targets breast cancer stem cells, may benefit more patients, says study

Common drug class targets breast cancer stem cells, may benefit more patients, says study

ab18038.jpg  Woman having a mammogramRecently there have been intriguing suggestions that breast cancer patients whose tumors appear insensitive to a class of drug known as anti-HER2 (the drug trastuzumab, marketed as Herceptin, is a well-known example) may somehow still benefit from treatment with the medication. Although there’s an ongoing clinical trial to determine if trastuzumab, given in combination with other treatments, really is beneficial to more patients than previously thought, the reason why it could be helpful is unknown.

Now research from the laboratory of Stanford radiation oncologist Max Diehn, MD, PhD, has started to answer some of these questions. The research was published recently in Cancer Research.

Typically, only tumors in which the cells express abnormally high levels of a receptor molecule on their surface called HER-2 — about 25 percent of all breast cancer cases — seem to shrink in the presence of the drugs, which bind to and inactivate the receptor. As a result, only these patients are given anti-HER2 agents. As Diehn explained in an e-mail:

Trials of anti-HER-2 agents like Herceptin in metastatic patients with HER-2 negative tumors haven’t shown tumor shrinkage or improved outcomes, which is why these drugs are only approved for use in HER-2 positive tumors. However, more recent clinical analyses have indicated that patients with microscopic disease remaining after treatment for earlier stage disease may see improved survival from anti-HER-2 agents regardless of their HER-2 status.

Diehn and Cleo Yi-Fang Lee, PhD, wondered why this could be. How could trastuzumab and other anti-HER-2 agents effectively fight tumors that didn’t overexpress HER-2? They hypothesized that perhaps the drugs were targeting only a few very important cells in the tumor: the cancer stem cells. Also called tumor initiating cells, or TICs, cancer stem cells are able both to renew themselves and to generate all the cells of the original tumor. Killing them is vital to ensure that a tumor does not recur after seemingly successful treatment with chemotherapy, radiation or surgery. Unfortunately, however, these cancer stem cells are uncommonly resistant to normal cancer therapies. According to Diehn:

Our hypothesis was that the clinical observations described above could be explained if the anti-HER2 drugs work against microscopic deposits of cancer stem cells in at least a subset of HER2-negative tumors. Patients with visible metastatic disease do not show responses since only a small proportion of cells in tumor deposits are cancer stem cells. However, if most of the tumor has been killed or removed through standard approaches, anti-HER-2 drugs may effectively target remaining cancer stem cells and possibly prevent recurrence.

To understand how this could occur, Diehn, Lee and their colleagues studied mouse and human breast cancer cells. They learned that, in a subset of HER-2-low tumors, the stem cells produce high levels of a molecule called neuregulin 1. Neuregulin 1 works by activating HER-2 in these cancer stem cells to promote their growth and self-renewal. Blocking HER-2 or another molecule in the pathway, EGFR, together or separately inhibited the growth of breast cancer cells grown in the laboratory and after transplantation into mice. It also made the stem cells more sensitive to the types of radiation used in cancer therapies.

The researchers hypothesize that a similar mechanism may exist in other types of cancers. Diehn said:

Anti-HER2 therapies are already being used for esophageal and gastric cancers and they have been explored for use in other cancers like those of the head and neck. It will be interesting to see if there is a similar dependence by cancer stem cells on HER2 signaling in the absence of HER2 amplification in some of these tumors.

Previously: Weakness in lung cancer stem cells identified by Stanford scientists and Red Sunshine: One doctor’s journey surviving stage 3 breast cancer
Photo by Tips Times

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