There is good news today for lung cancer patients. The FDA has announced that it has approved expansion of the immunotherapy drug nivolumab (Opdivo) for certain lung cancer patients.
Julie Brahmer, M.D., oncologist at the Johns Hopkins Kimmel Cancer Center and director of its Thoracic Oncology Program, is one of the leaders of the initial, first-in-human trial of nivolumab and ongoing clinical trials that the FDA reviewed in its decision today to approve nivolumab for advanced squamous cell lung cancer. She says, "This is an exciting development for lung cancer patients today. We're entering a new era of treatment, notably, the first time immunotherapy has shown improved survival outcomes compared to chemotherapy and the first time any type of immunotherapy for lung cancer has been approved. We hope it's the first step to more immune-targeted treatments for lung cancer patients."
The latest issue of the Kimmel Cancer Center’s magazine Promise & Progress marks the 10th anniversary of the Department of Radiation Oncology and Molecular Radiation Sciences. Knifeless radiosurgery, proton beams, radiation sensitizing drugs, immune-stimulating therapies, informatics systems, efficiencies models, and inventions that move research forward and make treatments safer are a sampling of the exciting new cancer science and medicine detailed in this issue.
The issue also includes information on the latest research making headlines, new clinicians and scientists, honors and awards, and the generous donations that are helping us fight cancer.
Find Promise & Progresson the Kimmel Cancer Website and also search for it in “Newsstand” on the iPad. Print copies can be requested by email at firstname.lastname@example.org.
What better way to begin 2015 than with a nod to our scientists who, according to the American Society of Clinical Oncology (ASCO), have led some of the past year's major achievements in clinical cancer research and care.
The research, in the immunotherapy and prostate cancer fields and led by Johns Hopkins Kimmel Cancer Center and Brady Urological Institute scientists, was selected by the ASCO for inclusion in Clinical Cancer Advances 2015, the Society’s annual review of progress against cancer and emerging trends in the field.
Kimmel Cancer Center oncologist Julie Brahmer led research that was presented at the ASCO annual meeting and published in the Journal of Clinical Oncology regarding a clinical trial of an anti-PD-L1 antibody for patients with lung cancer, adding to continued progress in the field of immunotherapy. In other news on the immunotherapy front, Kimmel scientist Drew Pardoll forecasts developments in immunotherapy in the American Association for Cancer Research blog, Catalyst.
According to results of a study led by Kimmel Cancer Center oncologist Emmanuel Antonarakis and Brady Urological Institute scientist Jun Luo, prostate cancer patients whose tumors contain a shortened receptor called AR-V7 are less likely to respond to two widely used drugs for metastatic prostate cancer. If large-scale studies validate the findings, the investigators say men with detectable blood levels of AR-V7 should avoid these two drugs and instead take other medicines to treat their prostate cancer. A report on the work was described online Sept. 3 in the New England Journal of Medicine and presented at the ASCO annual meeting.
To learn more, read ASCO's report at www.cancerprogress.net/CCA.
One strand of brightly colored lights instantly uplifted the spirits of 17-year-old Matsie and cheered up her hospital room. Matsie, like many others young and old with cancer, would be spending the holidays in the hospital. Her father’s thought to buy her a small strand of lights transformed her stark white hospital room into a colorful display. It brought her so much joy that she decided all patients in the Johns Hopkins Children’s Center this Christmas should receive lights to decorate their rooms. Matsie and her family began calling local businesses and members of the community, asking if they would be able to donate 100 strands of Christmas lights to Johns Hopkins. Matsie’s goal was to receive 20 strands of lights, but to her surprise, within just two days, they were able to get 100 donations.
Matsie didn’t stop at strings of lights. She and her friends hand-decorated 100 gift bags, each with a handwritten note. She also included a special winter craft for patients to make.
Matsie worked with Jenny Seilier, a Kimmel Cancer Center child life specialist, who had the holiday bags delivered to patient rooms throughout the pediatric oncology unit and the entire Johns Hopkins Children’s Center.
Patients have been so grateful for their special bags that it inspired them to start a social media community using #matsieslightsoflove, where they share photos of their brightly decorated hospital rooms. Matsie has created her own social media pages for her “lights of love,” including Facebook Instagram and Twitter, where patients and family members can share photos. She also has set up a giving fund, with all proceeds going toward future supplies for gift bags. The fund already has received more than $1,000.
“The best part about this has been seeing and hearing how much the strands mean to the patients,” says Matsie. “I have received some really amazing cards and feedback on social media. It makes me happy that this really is impacting patients more than I ever imagined. It also has been wonderful seeing how much people have been willing to help. The entire experience has been overwhelmingly positive for everyone involved.”
Through a grant from The Women's Board of The Johns Hopkins Hospital, selected Kimmel Cancer Center patients are receiving ChemoCozy jackets this winter. The fleece jackets, stylishly and thoughtfully designed by cancer survivor Greg Hamilton and his wife, provide easy access to peripherally and centrally-inserted intravenous lines, implanted devices and pockets for surgical drains. “We are always so excited when we know patients will get a little comfort during their treatments,” says Greg. Nurses in the Infusion Center and Inpatient/Outpatient Program are distributing the jackets to patients receiving chemotherapy who could most benefit from them.
"The Cancer Center is very grateful to The Women’s Board for making these jackets available to our patients, and to the Hamilton's," says Sharon Krumm, R.N., Administrator/Director of nursing at the Kimmel Cancer Center.
(Photo at left: The Hamilton's at the Kimmel Cancer Center presenting ChemoCozy's to Sharon Krumm, R.N.)
The Johns Hopkins Kimmel Cancer Center offers many resources to patients and families including spiritual and pastoral care. Our staff members offer sensitive, spiritual support for patients, family members, caregivers and hospital staff from a wide variety of religious denominations.
Chaplain Rhonda Cooper shared her calling to work with cancer patients in a recent article for Johns Hopkins Dome. "God brings me into the lives of people here for a reason. Though I wish I knew what these patients were like before the became sick, I accept that I know them now and want to be there for them in the present," she said.
Read the article about Rhonda and how she is finding peace for patients.
In November 2012, the Obama administration issued a proclamation that recognizes the challenges faced by the approximately 65 million Americans who care for their sick, elderly, and disabled relatives and friends. President Obama said:
“National Family Caregivers Month is a time to reflect on the compassion and dedication that family caregivers embody every day. As we offer our appreciation and admiration for their difficult work, let us also extend our own offers of support to them and their loved ones…Family caregivers have an immeasurable impact on the lives of those they assist, but their hours are long and their work is hard. Many put their own lives on hold to lift up someone close to them.”
In a MetLife Study of Working Caregivers and Employer Health Costs, it has been reported that six in ten family caregivers are employed. 73% of family caregivers who care for someone over the age of 18 either work or have worked while providing care; 66% have had to make some adjustments to their work life, from reporting late to work to giving up work entirely; and 1 in 5 family caregivers have had to take a leave of absence. While caregiving for a loved one while working poses many challenges for the employee the results of a quality of life study done by the American Cancer Society in 2005 show that some caregivers benefited from being employed and better emotional adjustment. The report also states that one quarter of all employees are acting as caregivers. The reasons the employed caregivers did better emotionally are not outlined but might be attributed to support from their employer and co-workers that helped to reduce the distress of cancer caregivers to make their caregiving experience manageable and more meaningful. For many of us, our workplace is another supportive environment.
I asked Terry Langbaum, Chief Administrative Officer, Kimmel Cancer Center at Johns Hopkins, to weigh in. “It is important to recognize that caregiving is hard work – emotionally and physically. At times, it requires the employee to give up preferred activities to provide care, reassurance or transportation to the sick family member. It can be disruptive to the employee’s routine, and cause him/her to lose time from work that would otherwise be vacation or sick time. It can cause employees considerably anxiety and stress, which can impact their ability to function well on the job.
A supportive work environment will provide a family caregiver with encouragement, recognize the time and effort they are spending to benefit their loved one, and support the employee during this time of concern about their loved one. Work also provides a diversion from that worry, and can be distracting and satisfying to the caregiver.
Many caregivers will feel torn between obligations at work, and obligations for their loved one. Managers and supervisors need to treat everyone fairly and follow the human resources policies, but they can be an extension of the support system for a family under stress due to medical conditions.
So if you are a caregiver or know of someone who is acting as a caregiver let’s recognize the personal sacrifice it takes. Some of us are caregiver to multiple people at once or over a period of time. This month is dedicated to recognizing these unsung heroes. We may all be there one day caregiving or receiving care.
*This post was written by Marie Borsellino, B.S.N., R.N., O.C.N., oncology nurse navigator for the Managing Cancer at Work Program.
Cigarette smoking is the most important risk factor in the development of lung cancer. It is estimated that as many as 90 percent of lung cancer diagnoses could be prevented if cigarette smoking were eliminated. Exposure to certain industrial substances such as arsenic, some organic chemicals, radon, asbestos, radiation exposure, air pollution, tuberculosis, and environmental tobacco smoke in non-smokers also increases a person’s risk of developing lung cancer.
What can I do? Be aware of new Screening Guidelines recommended by the U.S. Preventative Services Task Force outlined below:
• Yearly screening with a low-dose CT scan is recommended instead of screening with a chest x-ray or no screening for people age 55 to 74 who have smoked for 30 pack years or more or who have quit within the past 15 years. Medicare just recently made a proposal to reimburse these screenings for eligible patients.
• CT screening is not recommended for people who have smoked for less than 30 pack years, are younger than 55 or older than 74, have quit smoking more than 15 years ago, or have a serious condition that could affect cancer treatment or shorten a person's life.
• Talk with your health care provider about your personal risk especially if you have a family history, have had other cancers, or have smoked fewer years than the guideline had established.
• Make sure you have your screening done at a facility with experience in screening for and treating lung cancer.
• Visit a facility with established guidelines that are in line with the best established practices for screening for lung cancer.
• Most importantly, if you smoke stop smoking and seek help in quitting if you need to. Johns Hopkins employees have a smoking cessation program available.
Blending music and science may seem unusual, but Kimmel Cancer Center director Bill Nelson did just that when we created a video to explain how DNA changes because of epigenetics. It turns out that music hits just the right note when it comes to describing this scientific concept, thanks to our colleagues and musicians at the Peabody Conservatory.
*This post was written by Marie Borsellino, B.S.N., R.N., O.C.N., oncology nurse navigator for the Managing Cancer at Work Program
As we close international breast cancer awareness month, I would like to honor those women and finally the organizations that support those living with metastatic breast cancer. We know that in 2013, an estimated 232,340 new cases of invasive breast cancer were expected to be diagnosed among US women, as well as an estimated 64,640 additional cases of in situ breast cancer. Of those 6-10% of new breast cancer cases are Stage IV. Of all breast cancer cases diagnosed, 20-30% will become metastatic.
Of those living with metastatic disease, especially during October, there is a sense of isolation. They can actually be upset with the marketing strategies developed to promote awareness. When they attend support groups they can be accused of not being positive enough or even worse be perceived as a quitter. The reality, I am here to report could not be further from the truth. I have witnessed the strength, poise, and resilience of these men and women first hand. They are warriors like no other.
Years ago, when I was new in my role as a breast health navigator, during October, I attended a monthly support group. At the end of the meeting I was cornered by three women whom I knew all had metastatic disease. They pleaded for me to help them establish a group where they could freely talk about their issues. They eloquently laid out their case: Not one of them was looking to “give up” but their needs were plainly different. They were planning for a dignified farewell in case the new clinical trial or protocol being tried did not work. This group of women were determined to make the most of their time and needed a platform to vent about their issues. They didn’t want to “bum” out the other patients with the early stage treatable breast cancers that we, in this country, are so good at treating or perhaps if the critics are correct, over-treating. They wanted to talk about how to get affairs in order, talk to their kids, and grandkids, say good bye to their lover, their parents. These women know their loved ones don’t know how to deal with them. They were requesting a safe place to resolve feelings that they keep hidden from others but are right there always so close to the surface and finally, a place to freely discuss the physical and financial pressures that are a reality for most cancer patients.
I agreed to co-facilitate the group with one caveat; I needed to partner with an oncology social worker. Our group was attended by mostly stage IV advanced breast cancer patients, and we were fortunate to have some other breast cancer survivor/volunteers that were willing to provide transportation and maybe stop for a quick bite to eat if time allowed. The group was small but mighty in scope as we tackled so much in our time together. We did cry together when someone lost their battle, but I have to say, mostly smiled and laughed at the absurdities of life, and the power that comes from being embraced by a supportive environment. This collaboration lasted for almost five years until I moved here to Baltimore. I believe that working with this group was one of the best things professionally I have ever done. I learned so much from this group and saw how the effects of planned coordination, access to quality oncology care in a timely way, and the effects of plain, good old listening to each other can do wonders. Metastatic breast cancer patients deserve to be heard, and I would like to applaud all the wonderful groups out there that are heeding the call and providing these patients with education and support.
So here’s sending a special shout out to the following organizations:
Advanced BC.org - dedicated solely to the needs of people living with metastatic breast cancer