This month, Kimmel Cancer Center director William Nelson reviewed four major cancer research stories ranging from pets that sniff out cancer to a reminder of the dangers of cigarette smoking.

The first story is one that has been reported for several years.  A variety of reports have shown that dogs can detect cancer in people by sniffing their breath, in the case of lung cancer, and urine, for genitourinary cancers.  The question, says Nelson, is what cancer-related molecule(s) are the dogs detecting?  If we can determine the specific marker the dogs are identifying, we can study these markers for broader use, he says. As for using Fido now as a detection tool, Nelson says these studies are small and have not been compared in studies to any other detection tool, so stick with the proven methods.

Nelson also discussed, what he calls, "extremely exciting" news for metastic melanoma.   The drug, vemurafenib, marketed by the name Zelboraf, was recently approved by the FDA for metastatic melaoma.  It works by interfering with a growth signal in cells that gets turned on by the BRAF gene. When the gene is defective, the signal becomes stuck in a chronic "on" state and leads to uncontrollable growth of cells, resulting in cancer.  Vemurafenib interferes with this growth signal.  In studies of the drug, half or more of patients had "tremendous shrinage of tumors," according to Nelson, who says the approval is a "giant first step." He says the drug may have potential as a treatment for earlier stage melanoma and possibly in combination with immune-stimulating drugs currently being studied. 

In a recent study evaluating whether inherited genes affected the course of cancer, researchers identified five variant genes that seem to be associated with aggressive prostate cancer.  Nelson says that understanding how these genes contribute to cancer could help define why some cancers are more deadly than others and help tailor aggressive therapies to patients at higher risk for it.

Finally, cigarette smoking remains one of the largest factors that drives cancer, according to Nelson, and the relationship between lung cancer and smoking has been well known, but it is also known that smoking increases the risk for other cancers, including bladder cancer in men.  A recent study reveals that smoking-related risk for bladder cancer may be even higher than previously thought.  The study also shows that people who quit smoking reduce their risk of bladder cancer significantly. Nelson says, as the number of women who smoke has risen throughout the years, the number of smoking-related bladder cancers in women also has increased.  Study authors point out that changes in the contents of cigarettes may have contributed to the rise in bladder cancer risk.

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Elissa Bantug

Elissa Bantug

Everyone has their own reason.  For some, they feel grateful for how far they have come or to remember those they have lost.   For others, they want to inspire hope and galvanize progress toward ending this disease.  Others may want to participate in the event as a way to fight back at a disease that attacked them or loved ones. 

Team member Jessie Bernstein said she does it for, “the friendships, the strangers, and the stories.”  She will continue to get blisters until walking is no longer needed. “It’s the perfect reason, so no one forgets our mission,” Jessie said.  This year was Jessie’s eighth walk—she’s done six in D.C.; one in New York City; and one in Long Beach, California. Along with two other walkers, Jessie formed a team called the Pink Pixies, after her best friend’s mom was diagnosed with breast cancer.  Her electrifying personality is hard to miss.  She made this cause her mission, saying: “The participants in these walks are my family from coast to coast, and I am honored to be part of the unity. It's not for me I walk, but for the women I have never met, for the future, for the now.”

Like so many walkers, I obsessed about being able to complete the nearly 40 mile walk.  For my first Avon Walk last year, I had reconstructive breast surgery 10 days before the event and had a newborn infant at home.  That particular weekend, D.C. was breaking records for unseasonably hot and humid weather.  Jessie reminded us that the most difficult part of the walk is not fundraising, nor the 40 mile walk itself, but rather accepting that completing the route is the least important part of this mission.  Instead, we must stay focused on raising awareness and funds to combat breast cancer every day.  It was Jessie’s words that made me realize that walking is just one part of this event.  Sharing experiences, making new friends, seeing old friends, remembering those whom we have lost, pushing one’s body to extreme limits, and watching people do what seems almost impossible, is so much more important than the total number of miles walked throughout the weekend.

It takes months of planning, training, coordinating, and fundraising.  And I take great pride that have I survived breast cancer twice and am still able to walk 40 miles in two days.  More importantly, though, I walk because I believe that the more we talk, raise money, guest bartend, write letters, and walk for breast cancer, the closer we come to a cure.

Within a week after the Walk, the fatigue was gone, the blisters had started to heal, and I registered for the next year’s event.  I felt satisfied in a way, even vindicated.  On the first day of this year’s walk, I saw a poster declaring: “[I’m] walking so one day my daughter won’t have to.”  I have two daughters now, and this is a powerful sentiment: to imagine a world free of the fear, pain, and heartache of this disease.  It whispers me onward and urges me forward day after day, mile after mile.

Previously...
Part 1: Why We Walk
Part 2: Walk the Talk
Part 3: Bonds that Bring Us Closer

More on Breast Cancer Survivorship

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Evan Lipson

Evan Lipson, M.D.

There's something about exercising that helps cancer survivors take back some control of their bodies. Kevin Stenstrom was a marathon runner and a Naval Flight Officer who, during a routine physical, was diagnosed with melanoma. After several surgeries and months of cancer therapy, Kevin founded team Miles 4 Melanoma, a program that provides runners with coaching and individual training plans, all the while raising money to support the Melanoma Research Foundation.

Click below to hear his story.

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This web page was part of a research study to assess the effectiveness of online support, nurse practitioner Marian Grant, who answered questions on symptoms, treatments and support for pancreatic cancer patientsThis page is now closed to questions/comments, but for a list of previously answered questions by Marian Grant, go to the comments section below.

Marian Grant

Marian Grant

What is palliative care?
Palliative care is specialized medical care for people with serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness - whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work with a patient's other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.
What is a nurse practitioner?
A nurse practitioner is a registered nurse with advanced training or a master’s degree in a medical specialty. Nurse practitioners work as primary providers of health care. A nurse practitioner can offer information, education, and other support for people with serious illness and their families.
Palliative care nurse practitioner Marian Grant is certified in palliative care and has a Master’s degree in Nursing from Johns Hopkins University. She has practiced as a palliative care nurse practitioner in one of the Johns Hopkins hospitals. She also has a doctorate in nursing practice degree from the University of Maryland.
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Elissa Bantug

Elissa Bantug

My fellow team member Julie Thomas raised $13,760 this year alone, in her eleventh Avon Walk.  Julie’s been raising money for breast cancer for almost 20 years now, ever since losing a close friend to the disease.  She approaches the task with gusto, maintaining a donor list of 200 names, including family, friends, colleagues, and all of their friends. Each January through the end of April, she sends a monthly email to her list with a slightly different fundraising message.  After the Avon walk, Julie’s donors receive an email thank-you, a link to a photo album of the walk, and a reminder about the next event.  Julie has raised more than $64,000 for Avon.  It’s a feat that could inspire many, and Julie has created a network of people who feel like they’re an integral part of this mission.

Debby Stewart, our fearless team leader, participates in the Avon walk and says she’s grateful for her own blessings, and the Walk provides the inspiration she needs in her volunteer work with breast cancer patients.  This was Debby’s eighth walk, and she has created an amazing team of walkers and cheerleaders, who have become a noticeable presence in the D.C. Walk.  When I asked Debby why she does this year after year, she said, “I do it for every new patient I meet and for every study that brings us closer to better treatment or even a cure.  I also walk to remember all of the many faces we have lost to this terrible disease.” 

In February of this year, we lost a very dear friend and dedicated volunteer, Rosemary Carlson, who supported the Avon Walk for years and created cheers in previous years that inspired us throughout the two-day journey.  This year, our Johns Hopkins Cheering Squad, dressed in pink scrubs and strategically placed along the walk route, carried her message as they stood waiting for us, handing out snacks and wet wipes.  Ahh…the wet wipes.  They seem to come out of nowhere and are almost as important as the band aids.  Wet wipes enable walkers to temporarily remove the sweat, grim, and filth that seems to cover every inch of your body after walking through a city for 12 hours straight.   This is just one of many reasons that makes the volunteers invaluable! 

Debby is truly an inspiration to all of our team and brings together an amazing group of walkers and volunteers who support each other along this two-day journey.  Her motivation is to honor her friends, patients, and colleagues—to make meaning of their pain and their deaths in a way that may eventually mitigate others’ losses.

Next...
Part 4: Why I Walk

Previously...
Part 1: Why We Walk
Part 2: Walk the Talk

More on Breast Cancer Survivorship

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Michelle Potter

Michelle Potter

Fatigue during cancer treatment can be tough to manage.  While ranging from mild to extreme, for some there’s no tired like “chemo tired.”  Many patients describe it as feeling weak, weary, worn out, heavy or slow and it can be difficult for friends, family or co-workers to understand. No one wants to drag through the day, and for cancer patients, it’s particularly important to find strategies to help fight fatigue. Remember, talk to you doctor before starting any physical activity or changing your diet.

1. Surprisingly exercise will boost your energy levels. It’s important to get even a small amount of exercise in each day.  For example, walking up and down the steps in your house can give you a lift. Or, a brisk walk outside for 10 minutes will get your endorphins flowing -- the hormone that sends pleasure signals to the brain.

2. It’s important to spread activities throughout your day and take frequent rest breaks.

3. Eat high protein foods such as milk, eggs, cheese, meat and fish and talk to your doctor about seeing a dietician if you are having problems eating.

4. Set up regular bedtime and waking routines.

5. Try reducing your stress levels with slow breathing exercises and relaxation techniques

Check out our full list to manage fatigue

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Evan Lipson

Evan Lipson, M.D.

As oncologists, we encourage our patients to seek support wherever they can find it - family, friends, religious organizations, community groups... In the last decade or so, thanks to people like Amy Ohm, opportunities for support have begun to emerge on the Web.

Several years ago, after Amy was diagnosed with melanoma, she looked online to find information about her disease and to connect with other survivors. Finding little, she founded TreatmentDiaries.com, a social network for people living with or caring for someone with a chronic illness.

Click below to hear her story.

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Elissa Bantug

Elissa Bantug

It’s not every day that you commit to walking 40 miles in the heat and rain, but on April 30 of this year, I walked in my second D.C. Avon Walk for Breast Cancer as part of the Johns Hopkins Breast Center Team.  This quite a contrast from my humbling beginning 19 years ago with my first Susan G. Komen Race for the Cure 5k walk.

I have often been asked why I would take on such a daunting activity that takes months of planning, training, coordinating, and fundraising.  Part of it is definitely my own ego: not only have I survived breast cancer twice, but I’m still able to walk 40 miles in two days.  More than anything, though, I do it because I really believe that the more we talk, raise money, write letters, and walk for breast cancer, the closer we come to a cure.  

You can’t take walking 40 miles lightly, and the strategies to physically manage such a challenge are unique.  Imagine the possibility of walking in 100-degree heat or pouring rain; with painful blisters and sore feet, and you’ll begin to understand.

One of the medics last year told me that the number one reason why walkers are unable to finish the 40 miles is not exhaustion, but blisters.  We were warned many times—by walk organizers, past walkers, and other supporters--to take good care of our feet.  Blisters don’t only interfere with finishing the walk, but also make the experience miserable.  It is not uncommon to see walkers on the second day hobbling along in flip flops as they try to cross the finish line. 

There are many suggestions that are recommended to try to prevent blisters: trying to build up calluses on your feet in the weeks before the event; buying shoes a ½ size too big to accommodate feet swelling; wearing special socks to prevent moisture on your feet; changing shoes and socks throughout the two days to prevent rubbing; and/or covering your feet with something to prevent friction.  Last year, I heeded all of these suggestions (including covering and recovering my feet with Vaseline every few miles).  Luckily, my blisters were kept to a minimum.  A stroll past the medic tents at any of the rest stops will emphasize the importance of this as they insert needles into blisters to drain them.

 This year, a fellow walker and I were not going to take any chances and decided to take these warnings a step further.  We covered our feet with silicone-based lubricant.  After two days and forty miles, our feet had never felt so smooth—and we were the talk of the walk!! 

The Avon Walk requires participants to raise a minimum of $1,800 to take part in the event — it’s why most participants hesitate to sign on.  Last year, I agonized, fretted and stressed and barely made it.  This year, with a bit of experience and a competitive spirit, I tackled the challenge head-on: soliciting all my email contacts and Facebook friends; guest-bartending one evening; and helping to coordinate a silent auction.  Through my own resourcefulness, I learned an important lesson: raising my own personal minimum dollar amount is not only a preliminary step to the event, but rather an integral part of the Avon (and Komen) mission of raising funds for breast cancer.   I not only challenged my body to raise awareness for breast cancer by fighting illness with fitness, I challenged my intellect to raise more money for new research, screening, treatment, and survivorship programs.  My grand total this year was $2,110.

Next:
Part 3: Bonds That Bring Us Closer
Part 4: Why I Walk

Previously...
Part 1: Why We Walk, June 22

More on Breast Cancer Survivorship

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Vanessa Wasta

Vanessa Wasta

Recent news of the full results of the National Lung Screening Trial (NLST) published in the New England Journal of Medicine underscores the heavy toll that lung cancer takes on many lives.  It's still the deadliest of all cancers.  For Phyllis Curtis, who had enrolled in the trial at Johns Hopkins, the trial and screening she received made the difference in spotting her lung cancer and receiving prompt treatment.  Read the ABCNews.com story.  Earlier this year, evidence indicated that lung cancer death rates in women are on the decline, following a trend seen in men.  The hope is that a screening method can make further impact on death rates.

As for treating these cancers, Drs. Julie Brahmer and Susanna Ulahannan of Johns Hopkins, provided a brief review of available lung cancer treatments on EmpowHer.com.  They describe drugs, including ones that target cancer blood vessels, that are approved and in development for lung cancer.

Finally, Dr. Charles Rudin, in our educational video series, C-Answers, describes how many lung cancer patients are benefitting from personalized approaches to treating their disease by searching for biomarkers that indicate whether a particular drug may work for them.  Watch his video below.

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Valerie Mehl

Valerie Mehl

Recent news that the FDA will not approve the use of the drug Avastin for breast cancer has many patients who have benefitted questioning why.  Kimmel Cancer Center director William Nelson believes it is a perfect example of why personalized cancer medicine—getting the right drugs to the right patients—is so important.

“Often in trials, drugs do not look impressive, but that’s because we test them on everyone,” says Nelson.  “We need to start studying them in patients, based on the genetic profile of their cancers.  These are the patients where they are most likely to work.”

Avastin, he says is a timely example.  Does it work in breast cancer?  Despite the recent FDA decision, some women are benefitting.  The problem is that when the data for all breast cancer patients is analyzed, it appears to be largely ineffective.  Nelson believes researchers must look at the women it has helped, decipher the mechanism, and get it to those patients where it is most likely to make a difference.  “If we treat those our science shows it will benefit—and only them—the data immediately look better; we improve patient outcomes, and save money.  This is what personalized medicine is all about.”

More on personalized medicine

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