More than Miles

**This blog post was written by Kimmel Cancer Center development specialist Allison Rich.

For Te(5A)m, the Ride to Conquer Cancer is about far more than the miles. The team was founded by the oncology nurses from Unit 5A of the Kimmel Cancer Center in Baltimore – but the team members’ stories are far more diverse than their namesake would suggest. While each teammate’s reason for riding is unique, what brings Te(5A)m together is their cohesive goal – to move us one step closer towards eradicating cancer entirely.

For team member Kathie Garben, an oncology nurse herself, this goal strikes very close to home. Having beat cancer not once, but twice, her own experiences are what inspired her to go back to school to study nursing. Working with research and clinical trials throughout her nursing career, Kathie has seen firsthand the huge advances that researchers have made in the past several years alone. Beyond the research taking place at the laboratory bench, she has also seen the bravery of those patients who know there is not a cure for them, yet willingly participate in research trials in the hope of helping someone else down the road.

This is the lynchpin of why Kathie is gearing up to ride this September – to make others aware of the critical research that is taking place at the Johns Hopkins Kimmel Cancer Center, Sibley Memorial, and Suburban Hospitals, and to raise funds to support it. After first getting into cycling as a hobby, and then successfully taking on challenges such as the Five Borough Tour in NYC (twice!), the Ride to Conquer Cancer offered the perfect opportunity for Kathie to combine her desire to pay it forward with a sport that she loves.

For Ryan Close, the drive to participate in the Ride to Conquer Cancer is as deeply rooted as Kathie’s. Having battled cancer three times, Ryan first came to Johns Hopkins for treatment back in 2011. Having planned to get into cycling once he was well, Ryan received a bike from a close friend in celebration of conquering his disease. Since then, he has immersed himself fully into what is now his favorite activity – cycling – and has successfully completed a few centuries (100 mile rides), as well as a triathlon.

As Ryan describes it, the Ride to Conquer Cancer is a great way to pay tribute to the physicians and nurses who helped him beat his disease: “It’s a great way to give back – if it weren’t for them, I wouldn’t be around and wouldn’t be able to enjoy cycling as much as I do now.”

Long after the Ride has ended, the funds raised by Ryan, Kathie, and their teammates from Te(5A)m will continue to help accelerate discoveries that will make a difference in the lives of patients and their families. With only a few short weeks left before the opening ceremonies on September 13th, the team has a few more fundraisers planned to help them make it to the starting line.

To help riders and community members reach their fitness goals, the Maryland Athletic Club (MAC) has offered a “25 days for $25” deal, available to all first time MAC members, with proceeds going towards cancer research at Johns Hopkins.  Additionally, on Wednesday, September 3rd, Te(5A)m will be hosting a spin class at the MAC in Harbor East. The hour long class will start at 7:15 PM, and a $25 donation covers the class as well as all-evening access to the MAC’s numerous amenities, such as the pool and hot tub. The class will also be followed by a free cool-down yoga class taught by the team’s own yogi, Halley Friedeman!

With the Ride to Conquer Cancer just around the corner, now is the time to come together to support all of our riders, patients, and families as we prepare to ride to victory this September. As Te(5A)m demonstrates, no matter why we choose to ride, we cannot do it without each other.

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Hope Matters

**This blog post was written by Elisabeth Carrino-Tamasi. Elisabeth is a Clinical Social Worker at the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital and the proud daughter of Dominic Carrino

You have cancer.  Those three words turn the world upside down and leave patients, family members, and loved ones reeling from the news – and seeking sources of hope.  For each of us, hope comes in different forms.  Understanding and recognizing these individual distinctions and personal nuances is an essential component of optimizing oncology care at the Kimmel Cancer Center.  Because hope matters.

photoIn 2012, the Kimmel Cancer Center unveiled The Hope Project.  The program is designed to incorporate each patient’s definition of hope into their treatment plan, while establishing a community of support that complements these hopes. This requires faculty, staff, caregivers, and patients to be fluent in the language of hope and its individual interpretations.

To further etch The Hope Project into the daily culture of the Kimmel Cancer Center, a sunflower was chosen to symbolize the program.  Bold and bright and always turning to face its source of nourishment, the sunflower is the perfect embodiment of what hope means and why it matters to each of us.  For example, pins featuring the sunflower have been widely distributed amongst the Kimmel Cancer Center community, frequently from provider to patient, as a means of initiating dialogue and increasing fluency in the language of hope.

Last fall, my dad – Dominic Carrino – passed away after a battle with melanoma.  To anyone who knew him, Dominic was larger than life and full of hopeful optimism.  Sitting at my desk one day, I looked down at a plaque he gave me that reads, "HOPE – choose to see through optimistic eyes.”  From there, an idea came to life. My family decided to support The Hope Project, and establish a lasting memory of Dominic through the creation of a work of art modeled on the project’s sunflower logo.

Thus, at this year’s Cancer Survivor’s Day, 200 patients wrote their hopes on the petals of a sunflower that was then assembled by two local artists and blessed by Rhonda Cooper, the Kimmel Cancer Center chaplain. The completed project now hangs in the Weinberg Ceremonial Lobby, and will serve to both honor the eternal optimism of Dominic and help educate the Kimmel Cancer Center community about hope and the vital role it plays in the face of cancer. Most importantly, the Carrino Sunflower will be a lasting reminder to all of us that hope is a reservoir of strength, a sustaining force, a guide, a positive state of mind, a peace-giver – and a lifeline.

Dr. Evan Lipson, Dominic’s oncologist, remarked that “Mr. Carrino was a warm and genuine man whose sense of hope brought joy and fulfillment to him and his loved ones.  A hopeful inner strength exists in every one of us; as an oncologist, one of my jobs is to help patients access their hope, to empower patients and families confronting a cancer diagnosis.”

As part of The Hope Project, the Carrino Sunflower will also be featured on posters which will hang in each exam room, displaying information about the Project that patients may use to help initiate conversations about hope with their physicians. Online teaching modules, and a video compiling interview clips surrounding the role of hope in patient-physician interactions, will further spread the language of hope throughout the Cancer Center and the community. A befitting tribute to Dominic, our eternal optimist, as well as to the battles being fought by each patient who walks through the Cancer Center, the Carrino Sunflower will continue to represent the optimism and hope that supports patients and families throughout their entire cancer journey.

 

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Whether you have just been diagnosed with cancer, are currently undergoing treatment, or are in remission…. YOU are a cancer survivor!  This survivorship experience is unique for each cancer survivor and their caregivers.  Some are challenged by changes in appearance or physical abilities, by changes in priorities, or by changes in daily routines.  Others are challenged by increased levels of anxiety and worry, finding new interests,  or by trying to find their new “normal”.

To help address survivorship challenges,  the “Surviving Survivorship: Living with Cancer” free educational event is being offered to cancer survivors and their caregivers.  Workshops are led by experts and are designed to address a variety of needs and interests.

WHEN:   Saturday, October 11, 2014
12 noon - 4 pm

Workshops include:
Tools for Taming Worry and Anxiety (led by Lacy Fetting, LCSW-C)
The Challenge of Caregiving: A Conversation for Caregivers (led by Terry Langbaum, MAS)
The Art of Thriving, the Grace of Living (led by Cinder Hypki, MS)
Survivorship from a Physician’s Point of View (led by Katherine Thornton, MD)
Yoga for Cancer Survivors and Caregivers (led by Kymberly Sevilla, ACSM)
The Needs of the Spirit: Is There Meaning in Cancer? (led by Rev. Christopher Brown, MDiv)
Beauty Inside and Out! (led by Marianne Kelly)

A complimentary, seated lunch is offered to all attendees.  This conference is conveniently located to provide easy access from Baltimore City and from Baltimore, Howard, Anne Arundel, and Montgomery counties.

Location: BWI Airport Marriott, 1743 West Nursery Rd, Linthicum, MD
RSVP Required:  Seating is limited, please register by October 1!
By Phone:  Barry Miller, 410-955-8934

Please join us on October 11 for this 2nd annual conference!

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“Don’t be shy. It is not a sign of weakness to want a person of faith by your side at a time like this,” says Rhonda Cooper, an oncology chaplain at the Hopkins Kimmel Cancer Center in Baltimore.  If you are struggling to understand why you have cancer, are feeling a range of emotions from guilt to anger, or feel isolated from your faith community, our experts in spiritual and pastoral care can help you as well as your family members in a non-denominational setting. As you progress on your cancer journey, our chaplains can:

  • Make sure your religious traditions and practices are observed as fully as possible.  For example, Communion and Anointing of the Sick can be provided during your hospital stay.
  • Offer you comfort in times of spiritual distress and anxiety.  Listening to your concerns is at the heart of the Chaplain’s practice.
  • Pray with you during your treatment.  You may want to pray with a Chaplain, as a source of comfort and support during your treatment
  • Support your family and friends. Chaplains also are available to support your personal support team. You also can ask a chaplain to participate in physician-family conferences.
  • Talk with you about end-of-life decisions. Chaplains can assist you in completing advance directives, including a selection of a health care agent, treatment preferences (living will), and decisions about organ donation.

Your doctor, nurse or social worker can contact a chaplain for you. Chaplains for the cancer center are located in the Weinberg Building, Suite 1210, or by calling 410-502-1500. Here’s a video consultation with Chaplain Cooper to get you started:

 

Find out more about the full range of spiritual support services at the Johns Hopkins Kimmel Cancer Center, and look for other useful resources in our Patient and Family Education pages.

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Theodore DeWeese on Mount Everest

Photo at Left: Dr. Ted DeWeese at the summit of Mt. Kala Pattar. It is 18,600 feet above Everest Base Camp and is considered the best place in the world to view Everest.

The name is even more recognizable than our own Johns Hopkins and mispronounced with far less frequency. The country of Nepal’s Mount Everest—for nearly a century, mountaineers, sportsman and adventurers have sought to climb planet Earth’s highest mountain. It’s peak among the Himalayan Mountains sits 29,000 feet above sea level. (For context, it would take 20 Empire State Buildings or nearly 30 Eiffel Towers stacked one atop the other to reach the peak of Everest.)

To climb Everest requires incredible mental and physical stamina. From altitude sickness, subfreezing temperatures, avalanches, dangerous crevasses, and large pieces of falling ice, Everest can subject even the most skilled of its would-be ascenders to a variety of challenges. Its rocky and frozen face is the setting for great accomplishments and incredible tragedies. Dr. Theodore DeWeese, Director of Radiation Oncology and Molecular Radiation Sciences, witnessed a little of both during his recent trek to the Base Camp of Mt. Everest and the scaling of several mountains around it.

Dr. DeWeese trained for more than a year to get ready for his Everest trip. Part of his regimen included daily stair climbs with a weighted backpack from the basement to the roof of Johns Hopkins’ tallest building, the Zayed Tower.

He was well prepared, and although the elements were not always kind, including 50 mph winds and temperatures in the twenties, his trip was everything he had hoped. The grandeur of the mountain is difficult to describe, he says. “Photos, even those done by professional photographers, do not do it justice, and words cannot adequately describe the beauty and size of the mountain,” says Dr. DeWeese. “It is a place that causes a person to become quite conscious of his connection to the world.”

At about 14,000 feet on his trek to the mountain, he and his fellow climbers serendipitously came upon the funeral for one of the local mountain guides from the community called the Sherpa who was killed in a recent avalanche. They were invited into the Tibetan Buddhist monastery where it was being held. The Sherpa was one of 16 killed in the April 2014 disaster that resulted in the largest loss of life ever in a single day on Everest. The event was both a reminder of the unpredictability of the mountain and of its beauty. “It was an honor to observe this 800-year-old culture. It was an amazing experience, and one that could not have been witnessed anywhere else in the world,” says Dr. DeWeese.

His trip included a two-week Sherpa-guided climb up the mountain to 18,600 feet, and a one-week trip back down. (Hikers can climb to 21,000 feet without oxygen.) On the last day of the trip down the mountain, Dr. DeWeese passed a young man and woman sitting to the side of the trail. Sensing something was wrong, he returned to check on them. The man was ill with food-poisoning-like symptoms. It was the first day of the couple’s trip up the mountain, and despite his ill health, the man was determined to continue their planned hike for the day. The young American couple, who seemed to be in their mid to late twenties, appeared very fit, but they were attempting their climb without a guide. Each was carrying backpacks weighing about 70 pounds, and they still had had four hours of steep climbing ahead of them. Dr. DeWeese had medical supplies in his gear, and he gave the man an antibiotic and hydration packets. Dr. DeWeese’s guide suggested a small lodge nearby where the couple could go to rest and allow the antibiotic to go to work.

Dr. DeWeese returned to his group, but the young couple remained on his mind, so he and two of his hiking mates walked back. Just 30 minutes had passed since he had left the couple, but the man was now laying in the dirt. He was pale, shaking, and sweating profusely. Dr. DeWeese recognized that the man had a systemic and potentially life-threatening infection, which he later learned was caused by an ill-advised chicken burrito he ate in Katmandu, Nepal the day before.

Dr. DeWeese and another climber carried the sick climber to the small lodge the Sherpa had mentioned earlier. Had they not been on the side of a mountain, Dr. DeWeese says the man was sick enough that he would have been hospitalized. Once there, Dr. DeWeese learned he had not yet taken the antibiotic, so he got him into one of beds in the tiny six-foot by six-foot space and went to work administering antibiotics and fluids. Up until this point, the young man was trying to convince himself that his illness was not that serious, but now he was scared and compliant.

During the of course their conversations, Dr. DeWeese was surprised to learn that the woman had just graduated from medical school and was about to begin training in radiation oncology. The couple did not have cell phones or radios, and without medical attention, the young man could have died on the mountain. Yet, there in the one of the remotest areas of the world, they came upon each other—this young, up and coming radiation oncologist and one of the world’s leading and most seasoned radiation oncologists, and fortunately for the young couple, Dr. DeWeese was well prepared. He left the woman with all of his medical supplies, instructions for caring for her friend, and a few words of sage advice.

“Remember, this is a vacation,” Dr. DeWeese told them. “I know you have a goal, but you can always come back another time.”

A few weeks after he returned from his trip, Dr. DeWeese received an email from the young woman thanking him for his help and letting him know that her friend had recovered and they were able to safely complete their climb to Everest Base Camp.

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**This blog post was written by Kimmel Cancer Center development specialist Allison Rich.

Michael Iati

With August just around the corner, it is crucial that we pause and take stock of our progress towards the goals we hope to reach before the starting line on September 13th. For Michael Iati, the Senior Director of Architecture and Planning for the Johns Hopkins Health System, watching several close family members battle cancer – and witnessing the amazing work that happens each day at the Kimmel Cancer Center – provided the impetus he needed to not just reach, but remarkably exceed, his own fundraising goals.

Currently the top individual fundraiser for this year’s inaugural Ride to Conquer Cancer, Michael has raised over $18,600 towards his current $20,000 goal. Having initially set a goal of $5,000, which is double the required individual fundraising minimum, Michael equates his fundraising success to starting a machine that, once running, is nearly impossible to stop. For Michael and his wife Dominique, who is also riding, this machine took the form of email requests sent out to friends and colleagues explaining what they were hoping to accomplish and requesting donations of whatever amount may be feasible. Using this fundraising approach familiar to many of us, Michael shared his top advice for fellow riders who hope to reach – and exceed – their fundraising goals before September:

  • The rate of response for each email blast will only be about 30%. Don’t be disappointed if not everyone comes through – find another 10 people to send it to, and cast as wide a net as you can.
  • Don’t forget about people like your mechanic or your accountant. Cancer touches everyone, and they may have a compelling reason to want to give.
  • Always send out thank you notes right away, regardless of how much the person gave.
  • Don’t be afraid to send a second follow up email – especially to family!
  • Send an email update once a month to keep donors posted. The email can include fun facts such as training milestones and the number of flat tires that month, which will help keep donors engaged and spreading the word about your goals.
  • Don’t forget about the opportunity for friends and family to double their impact through matching corporate contributions, should their employer provide such a program.
  • Remember to personalize your fundraising page! Telling your story, or even making your own personal contribution, can make a huge difference to people who might be on the fence about giving.
  • Set your initial goal at an amount that is low and attainable – and when you meet it, raise it. Never let people see your goal at 100% or more!
  • Set your own deadlines for fundraising, letting email recipients know that you are hoping to raise X amount by a certain date. This small change can make all the difference to those people who might otherwise forget or put off giving.

Most importantly, for those who have already met their goals, consider helping to pay it forward by directing donors to the pages of riders who have not yet achieved their fundraising minimum. After exceeding his own goals, Michael read the stories of other riders, selected 13 people whose stories inspired him, and included a link to each of their pages on his own. By beseeching friends to help these riders, five of them have been able to reach their minimum goals in time for this epic event.

To learn more about Michael’s story, please visit his fundraising page. If you have any fundraising tips and tricks of your own, please share them in the comments section below.

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Te(5A)m shirt design**This blog post was written by Kimmel Cancer Center development specialist Allison Rich.

There are as many reasons to gear up and join the Ride to Conquer Cancer as there are riders. Whether you are riding for the physical challenge, or are a cancer survivor yourself, each reason for riding paints a compelling picture of the unique journeys that will coalesce into one epic impact this September 13th and 14th. However, while our motivations may differ, we all share in common some challenges that stand between us and ultimately conquering this disease. From physical training to fundraising, these challenges begin to seem far less imposing when we take them on together.

For Te(5A)m, supporting each other during the Ride – and on the unit – is what makes the journey to September so feasible. Aptly named after its founding members, the Kimmel Cancer Center oncology nurses from the 5A unit of Weinberg, Te(5A)m is 17 riders strong – and even includes one very dedicated rider from Australia! Sharing an infectious enthusiasm for the impact that the Ride can make in the lives of their patients, families, and friends, the team has overcome the challenges of fundraising by working together long before the starting line.

Approaching fundraising as a steady climb, much like the 150-mile ride itself, Te(5A)m has spent the past several months raising funds through a variety of approaches which run the gamut from events at restaurants like The Green Turtle and Slainte’s Pub, where a portion of the proceeds are donated to the team, to simply cycling around Baltimore with donation buckets at the ready. Overall, the team has successfully raised over $17,000, and a series of upcoming efforts are sure to bring them even closer to their final goal.

Te(5A)m’s latest fundraising approaches involve a specially designed t-shirt, available for sale until July 21st, and a raffle for a huge gift basket featuring gift cards and gear from an assortment of local businesses such as Looney’s Pub, Dog Watch Tavern, Pitango Gelato, and Ten Thousand Villages. The t-shirt is available in several colors with either long or short sleeves (priced at $10 and $15, respectively), and features a white ribbon, indicative of the hope to conquer all cancers. The raffle tickets are priced at $1 each, or six for $5, and a winner will be drawn on August 1st.

Te(5A)m blog photoTo show your support for Te(5A)m by purchasing a shirt or a raffle ticket, please email Kathie Garben at kgarben1@jhmi.edu. As September swiftly approaches, we can all draw inspiration from the work of Te(5A)m, realizing that the difference we can make when we come together is far more powerful than that which we can achieve on our own.

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In this month's cancer news review podcast, Dr. William Nelson, director of the Johns Hopkins Kimmel Cancer Center, discusses top cancer stories on a new bladder cancer center announced at Johns Hopkins, liver cancer on the rise, cancer cells in tumors and more.

First, Dr. Nelson speaks on the announcement of a new bladder cancer institute at Johns Hopkins Kimmel Cancer Center.  He explains the significance of bladder cancer and the need to bring together experts in different disciplines to collaborate on patient care and research.

Next, Nelson discusses a few cancers that seem to be on the rise. One of those being liver cancer. He believes liver cancer is one of the more common cancers and the common causes of cancer death throughout the world. Some of the liver cancer causes is due to diet, obesity and fatty liver.

Finally, based on a study published in the scientific journal, Science, Nelson reviews the idea of harvesting T cells in someone's tumor in the laboratory to control metastatic disease. Scientists are able to research what the T cells are recognizing in the cancer and why  some treatments work in some people's cancer and not in others.

Listen to the full podcast to hear all of the latest cancer news this month.

Program notes:

0:19 New bladder cancer center at Johns Hopkins
1:20 Cancer data worldwide
2:20 Liver cancer on the rise
3:20 Fatty liver
4:10 Modified measles vaccine to treat cancer
5:11 Can also change cell processes
6:09 Harvesting T cells
7:10 Cells in tumor
8:10 Disease stabilization
9:10 Scale up techniques
10:15 End

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Healthy living was the theme of June 18th’s Day at the Market event held at Northeast Market on Monument Street in East Baltimore.

Cooking presentation by Chef Gayle Owens

The bimonthly event brings together Johns Hopkins nurses and other clinicians, safety experts, and others to interact and to share information with Baltimore citizens on simple things they can do to prevent cancer and other diseases.  Today’s event featured a cooking presentation by Chef Gayle Owens, who showed visitors to the market how to make a healthy meal (see the recipe) for under $3!  The event also featured the unveiling of a new video screen that provides easy-to-follow tips for living a healthy lifestyle.

Johns Hopkins Kimmel Cancer Center Director, Dr. Bill Nelson, attended the event and praised Maryland and Baltimore City elected officials for their dedication to the health of its citizens.  He reminded visitors of a dark day in 1990, when Maryland made national news as the state with the highest cancer death rates in the nation.  The dismal report led to the Maryland Council on Cancer Control and the Maryland Cigarette Restitution Fund, which helps fund the Day at the Market Program.  As a result of these dedicated efforts, which includes funding for Johns Hopkins Kimmel Cancer Center and Bloomberg School of Public Health cancer researchers, Maryland now ranks 30th in the nation for cancer deaths, and these rates continue to go down.   Dr. Nelson said this Maryland success story is the model for managing—and one day eradicating—cancer.

Baltimore City Council President Jack Young and Councilman Carl Stokes also attended the event.

Healthy Living was the theme of Northeast Market Day.

 

 

 

 

 

 

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**Note: This blog was written by Elissa Bantug of the Kimmel Cancer Center's Breast Cancer Program.

On March 7-8, 2013, over two hundred physicians, nurses, and other healthcare providers from around the region attended the Seventh Bi-Annual Johns Hopkins Breast Cancer Conference to discuss the latest trends in research and clinical care.  Due to improved therapies, better screening processes, and enhanced multi-modality approaches, breast cancer survivors have seen a reduction in morbidity and mortality.  Conference speakers are world-renowned experts in the fields of surgical oncology, reconstructive surgery, pathology, radiology, medical oncology, radiation oncology, genetics, immunology, palliative care, social media, healthcare quality, and survivorship.  This multidisciplinary approach highlighted some of the many ways breast cancer care is improving in the U.S.  Below is some of what was discussed:

1)     Neoadjuvant Care.  Medical oncologist Dr. Karen Smith presented research indicating that neoadjuvant chemotherapy (chemotherapy before surgery) may improve surgical outcomes in patients who have certain kinds of tumors, such as those that are locally advanced and/or poorly differentiated.  Factors that may determine whether a patient is a good candidate for neoadjuvant treatment include age, grade, stage, t-score, and tumor subtype (e.g. triple negative disease).  Although long-term outcomes seem to be similar whether chemotherapy is given before or after surgery, neoadjuvant treatment may also provide clues about how certain populations respond to specific drugs or drug combinations.

2)     Tomosynthesis. Dr. Susan Harvey, Johns Hopkins Director of Breast Imaging, discussed tomosynthesis (often referred to as 3D mammography), a technology that combines the use of traditional digital mammography with 3D capabilities. Benefits of 3D mammography include a reduction in unnecessary repeat imaging, a 20-40 percent decrease in false positives and a 40 percent increase in the detection of invasive cancers.

3)     Genetic testing. Medical oncologist Dr. Deborah Armstrong provided an overview of genetic testing for breast cancer.  Approximately 10-20 percent of breast cancers are familial (running in the family) and 5-10 percent of all breast cancers are hereditary (associated with a known gene mutation such as BRCA 1 and BRCA 2).  Gene mutations can be passed down from either the mother’s or father’s side of the family, and may put affected women at a 50-85 percent lifetime risk of breast cancer and a 10-45 percent risk of ovarian cancer.  Factors that increase the likelihood of carrying one of these mutations include:

  • Multiple cases of breast cancer in a family
  • Early age of diagnosis (<50)
  • A family history of ovarian cancer
  • Breast and ovarian cancer in the same patient
  • Bilateral breast cancer
  • Ashkenazi Jewish descent
  • Male breast cancer

With the complexities of genetic testing, it is strongly advised that patients seek genetic counseling to understand result implications.  Expanded genetic testing is now becoming available however testing may yield results for which clinical significance and recommendations are currently unclear.

4)     Chemoprevention-Dr. Kala Visvanathan, medical oncologist and director of the Clinical Cancer Genetics & Prevention Service at the Sidney Kimmel Comprehensive Cancer Center, discussed breast cancer chemoprevention.  She advocated the use of currently underutilized prevention modalities and advised that providers discuss options with all patients who may be at high risk, including patients with a strong family history, atypical ductal hyperplasia (ADH), and lobular carcinoma in-situ.  It has been reported that taking chemoprevention drugs classified as selective estrogen receptor modulators (SERMs), such as tamoxifen and raloxifene, can strongly reduce the chances of estrogen-positive breast cancer in very high risk individuals.  More evidence is needed to better predict those most at risk for developing breast cancer and which may be good candidates for chemoprevention drugs.  Currently, there are very limited prevention options for women who may be at risk for estrogen-receptor negative disease.

5)     HER2 Guidelines-Medical oncologist Dr. Antonio Wolff discussed expanding systemic therapy options for HER2‐positive breast cancer. It is estimated that 15-20 percent of all breast cancers overexpress HER2.  These tumors tend to behave more aggressively.  Dr. Wolff acknowledged that beginning in the late 1980’s HER-2 positivity use to be perceived as a poor predictive marker.  In 1998, the drug trastuzumab was shown to improve overall survival in the metastatic setting.  By 2005, adjuvant trials began reporting very positive results.  Today with the use of targeted therapies, HER-2 positivity is often viewed with good predictive outcomes.  Targeted therapies can be very effective in treating patients with HER2-positive disease; however, not all patients with this overexpression respond to targeted therapy.  Data suggests that it is more likely for a patient to have a late recurrence with ER positive HER2-postive disease than with ER negative HER positive disease.  Historically, there was vast variability in HER2 testing, making the test unreliable in some circumstances. Now that HER2 testing quality has improved, heterogeneity has become a big concern. Research is underway to determine which patients have resistant disease and might require more therapy; if models can improve HER2 targeting strategies; and which patients have sensitive disease and require less therapy.

6)     Hormonal Therapy-Medical oncologist and co-director of the Johns Hopkins Breast Cancer Program, Dr. Vered Stearns, reviewed the current guidelines for hormonal therapy for patients with estrogen or progesterone- receptive breast cancers (ER+/PR+).  For premenopausal women with hormone positive disease, a daily oral medication called tamoxifen is prescribed for 5-10 years after the completion of initial therapy.  Although extended benefit has been demonstrated for 10 years of tamoxifen by multiple clinical trials, quality of life factors and individual risk musk be factored into this decision.  Data from the Oxford Overview indicates that five years of tamoxifen can reduce the risk of a recurrence by 40 percent.  Some very young premenopausal women with ER+ disease may also be advised to undergo ovarian suppression.  Research is underway to determine if ovarian suppression alone is as effective as chemotherapy in these young patients.

Data suggests that five years of an aromatase inhibitor (AI) may be better for postmenopausal women with ER+/PR+ disease. Sometimes, postmenopausal women with ER+/PR+ disease may be prescribed tamoxifen for a few years and then switched to an aromatase inhibitor to extend the total number of years of endocrine therapy.  Patients on AI’s often complain of significant side effects, and one study presented showed that 30-40 percent of patients discontinued AI use prematurely due to side effects.  Dr. Stearns recommends  NSAIDs, Vitamin D, antidepressants, yoga, exercise, and acupuncture to cope with some of these issues.

7)     Special Needs of Young Breast Cancer Patients.  Beth Thompson, nurse navigator/educator for the Johns Hopkins LiveWell Center for Young Women with Breast Cancer discussed the unique needs of the young breast cancer patient.  It is estimated that 12 percent of all breast cancers occur in women under 45, accounting for over 2,500 deaths annually in the United States.  Ms. Thompson presented research showing that these women have more aggressive breast cancers, have an increased risk of recurrence, and tend to have worse outcomes. They also show higher levels of emotional distress and due to their age, often balance newer careers, school, body image issues, sexual side-effects, fertility, and dating.  Specific age-appropriate resources are needed to tackle some of these complexities.

8)     Social media and oncology care.  Dr. Robert Miller, medical oncologist and the Johns Hopkins Kimmel Cancer Center’s Chief Information Officer, presented data on the use of social media.  He stated, “social media is user-generated content that is shared over the internet via technologies that promotes engagement, sharing, and collaboration.”  Dr. Miller offered three uses of social media for medical providers: to treat, teach, and learn.  Treating includes engaging with patients about their care.  Teaching allows providers to gain up-to-date and credible education.  Learning encourages professionals to share medical information and knowledge.  Although teaching and learning are preferable methods of social media, it is not recommended that providers use this technology to treat patients.  Dr. Miller offers the following advice when clinicians use social media:

  • Don’t be anonymous
  • Make thoughtful choices about what you are creating for the world to see
  • Everyone is watching
  • Developing trust in your online community takes time
  • Maintain a healthy skepticism

He proposes that medical professionals start by watching first (often called lurking).  This includes reading blogs, watching twitter feeds, listening to podcasts, and subscribing to RSS feeds for journals and news sites.  When joining twitter, Dr. Miller suggests you pick a short but descriptive twitter handle.  “Follow” people who share your similar interests and pay attention to twitter suggestions.  Finally, patience is required.  Allow time for you to gain comfortable and watch your social media contacts grow.

9)     Palliative Care-Dr. Tom Smith, medical oncologist and director of Palliative Care for Johns Hopkins Medicine discussed the importance of palliative care.  He presented research to indicate that palliative care has better patient satisfaction, higher quality of life, improved symptom control, and reduced depression and anxiety, all at a reduced cost when compared to usual care.  This is evidenced by more at-home hospice, fewer hospitalizations, fewer days in the intensive care unit, less chemotherapy/tests/imaging, and fewer treatment-related complications.  Dr. Smith advocated that almost all patients want honest information about prognosis, treatment options, and trajectory of disease progression.  Discussions about palliative care should be the standard of care and should occur before patients become too sick to make informed decisions.

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