Director's Message: March 9, 2010
First, a public service announcement. As of yesterday, we had seven spots left for the March 19 UCCC Scientific Retreat. If you would like one of them, be sure to RSVP to Kaitlyn L’Archevesque today.
It’s stacking up to be a great meeting.
Dr. Thorburn
As you all know, UCCC is a NCI-designated comprehensive cancer center (NCI-CCC). Unfortunately, the three words in the last part of that title are sometimes used by other places that rather stretch their definition.
We often hear organizations describing themselves as “comprehensive” cancer centers, when in fact they participate in only a small part of the totality of activities that are expected of us (and the other 39 NCI-CCCs). They might provide clinical care that meets current standards—fine, as far as it goes, but it's a very limited definition of the word “comprehensive.”
So, what should “comprehensive” actually mean?
For us it means tackling the full gamut of areas that are important if we are to succeed in solving the cancer problem.
- For a truly comprehensive approach, we need to understand as much as possible about all aspects of cancer so that we can eventually prevent the approximately 50 percent or so of tumors that current data suggest could be prevented.
- We need to detect tumors early enough that they are easily dealt with.
- For those tumors that we can’t prevent or detect early, we need to develop better treatment strategies while delivering the highest quality of clinical care to our patients.
We don’t stop there. For us “comprehensive” extends to better understanding how to improve the lives of cancer survivors and their families and friends. It also means providing high-quality education at all levels from training the next generation of researchers, physicians and other health care providers to ensuring that the general public has accurate information about all aspects of cancer.
Last week, I wrote about our ability to determine molecular structures—research at the atomic level that is just about as basic as one can get. This week, in keeping with the idea that for UCCC, comprehensive means what it says, I thought we would consider the other end of the spectrum: cancer survivorship.
There are 12 million cancer survivors in the United States today
That fact is both a call for celebration and the reason why we need survivorship programs. People who just a few years ago might not have survived their disease are now being successfully treated. So, since we expect to continue to improve the numbers of people who survive cancer, we’d better work on improving how we deal with survivorship.
UCCC is well-known for its cancer survivorship work through our AMC Cancer Prevention and Control Program and for the leadership of program co-leader Dr. Al Marcus (SOM/Cancer Center), and UCCC deputy director and AD for Prevention and Control, Dr. Tim Byers (CSPH). One measure of this success: UCCC is one of just eight Lance Armstrong Foundation LIVESTRONG™ Centers of Survivorship Excellence. This grant supports our cancer survivorship clinics.
Clinics for cancer survivors
The TACTIC Clinic team
Dr. Brian Greffe (AMC Cancer Prevention & Control Program/SOM Pediatrics/The Children’s Hospital) developed one of the nation’s first clinic for childhood cancer survivors at Children’s in the late 1980s, called the HOPE Clinic. That clinic follows patients who are five years post-treatment with no recurrence for late effects.
Not long ago such survivors were depressingly rare. Now, the majority of children with cancer will be successfully treated—an obvious success, but it’s not the end of the story. We need continued research to better understand how to keep these survivors healthy for the decades ahead of them. However, Dr. Greffe and others think the pediatric oncology clinic is probably not the best place for a 60-year-old with heart problems to receive care, even if the heart problem is related to chemotherapy she received when she was 15.
To this end, we have the TACTIC clinic, a unique collaboration between UCCC, The Children’s Hospital and the University of Colorado Hospital. This clinic uses a consultative and referral model to help adult survivors of childhood cancer address the late effects of cancer and its treatment, their psychosocial and emotional concerns, as well as improve medical surveillance and coordination of care post-treatment with their primary care physicians.
TACTIC provides an opportunity to detect any issues that need to be dealt with by taking a collaborative multidisciplinary approach (as we commonly do in all aspects of our clinical care) to ensure that people receive the help they need as soon as they need it–with exactly the benefits that one might expect; improved lives for the patient and their loved ones. You can read more about the clinic in the Fall issue of C3, the UCCC magazine.
A similar multi-disciplinary clinic (THRIVE) addresses these same issues with survivors of adult cancers, starting with breast cancer patients who are transitioning from being cared for by their oncologists to their primary care physicians. I expect that we’ll see an expansion to other tumor types in the future.
Cancer Information and Counseling Line
1-800-525-3777
Another key cancer survivors resource available at UCCC is the national toll-free Cancer Information and Counseling Line (CICL), which provides cancer-related information and brief counseling by telephone (1-800-525-3777) as a national service to cancer patients, cancer survivors, their families and friends and the general public. It is the only service of its kind offered at a NCI-CCC.
Services that support research, and research that supports services is what comprehensive really means
All this work doesn’t just provide an important service. These clinics and CICL exemplify how such programs can generate raw data that can serve as the foundation for future research projects in cancer survivorship—multidisciplinary research involving physicians in oncology and primary care medicine, as well as researchers in behavioral and psychosocial oncology and cancer epidemiology.
Additionally, UCCC investigators are running a myriad of research studies addressing diverse areas of survivorship, from how best to deal with insomnia to testing if interventions to promote weight loss affect risk of cancer recurrence.
So, as with every other aspect of our work, the philosophy of the UCCC shines through: Work together to across disciplines in innovative ways to help people directly while also generating new knowledge that will, in turn, help develop even better ways to help people in the future.
Applying the UCCC philosophy in all areas that impinge on cancer from the molecular to the behavioral and everything in between is what makes us special, and what the word “comprehensive” in our title really means.
Sincerely,
Andrew Thorburn, PhD
Interim Director, University of Colorado Cancer Center
Professor and Vice Chair, UC Denver Pharmacology
Grohne Chair in Basic Cancer Research
UCCC News
Lung SPORE opens lung nodule protocol to collect tissue from patients with lung nodules
Dr. Miller
More than a half-dozen groups of researchers at UCCC have promising tests for early diagnosis of lung cancer. In order to validate the developing tests—which include finding elevated levels of lung cancer markers in sputum, blood and exhaled breath—researchers require a broad collection of tissues as well as knowledge of the clinical outcomes of patients who donated them.
Now Dr. York Miller (UCCC Lung/Head & Neck Cancer Program/SOM Pulmonary & Critical Care Medicine/Denver VA) and Lung SPORE collaborators that include Dr. Stephen Malkoski, Dr. Rob Winn (UCCC Lung/Head & Neck Cancer Program/SOM Pulmonary & Critical Care Medicine), have opened a tissue banking protocol to collect specimens from patients at two Denver lung nodule clinics.
The Denver VA has had a dedicated lung nodule clinic for years, and UCH opened up a similar clinic in May 2009. (National Jewish Health also has a lung nodule clinic and may participate in the future.)
Both clinics are multidisciplinary, attended by pulmonologists and thoracic surgeons. And both clinics are key referral centers for primary care physicians and pulmonologists who want their patients to be worked up or followed carefully after finding a lung lesion via CT scan.
Dr. Miller says there’s a need to collect samples from patients at high-risk for developing lung cancer when the nodule is identified, so the nodule clinics are the perfect place for patient recruitment.
The lung nodule trial aims to enroll about 400 patients, collecting blood, sputum, urine and exhaled breath from patients over the course of a few years as they are biopsied and/or followed up with additional CT scans. The tissue will be collected in the UCCC Lung SPORE tissue bank and made available to researchers via the usual tissue bank mechanism.
$150,000 SPORE supplemental grant to study HIV and lung cancer
Dr. Merrick
Dr. Dan Merrick (UCCC Lung/Head & Neck Cancer Program/SOM Pathology/Denver VA) has a new $150,000 Lung Cancer SPORE supplemental grant to study the relationship between HIV infection and lung cancer.
People with HIV/AIDS are living longer thanks to anti-retroviral therapies. As survival increases, doctors are seeing increasing numbers of non-AIDS-related malignancies, including head and neck cancer, anal cancer, liver cancer, Hodgkin’s lymphoma and lung cancer, among this population. Recent studies have shown:
- HIV/AIDS patients are three to four times more likely to get lung cancer than HIV-negative people (double that if they smoke)
- They are prone to getting lung cancer 10 to 15 years earlier than HIV-negative people
- They seem to progress faster and do worse stage by stage than HIV-negative people
- Post-diagnosis survival for HIV/AIDS patients is half that of HIV-negative people—5 months vs. 10 months
Merrick’s grant is a collaboration with physicians in the infectious disease or HIV clinics at UCH, Denver VA , and the Medical University of South Carolina.
The project’s first aim is to identify HIV positive patients with a history of lung cancer to help build a national repository of lung cancer tissue with associated patient data. Merrick says this will provide invaluable material to characterize expression of biomarkers known to indicate high-risk of developing lung cancer and poor prognosis after diagnosis. The second aim is to understand the frequency and severity of premalignant lung lesions by recruiting about two dozen HIV-positive patients who are smokers to bronchoscopy.
Merrick, whose research focuses on both premalignant and malignant bronchial lesions, says the information will be helpful in developing adequate screening programs and identifying good chemoprevention strategies—the positive iloprost trial could be particularly helpful, for example—to decrease the amount of life lost to lung cancer in the HIV-positive population.
UPCOMING EVENTS
April 3, 2pm Colorado Rapids vs Chicago Fire, Dick Sporting Goods Park
A portion of ticket sales benefit UCCC. Buy $25 tickets online.
May 15, 8 am Gift of Life & Breath 5K, Anschutz Medical Campus
Join Team UCCC
June 26, 9 am Denver Undy 5000 5k & 1 Mile Fun Run, Denver City Park
Portion of proceeds benefit Colorado Colorectal Screening Program. More information at www.undy5000.org.