Blood pressure demonstration with Mayor Rawlings-Blake

Baltimore's Mayor Stephanie Rawlings-Blake undergoes a blood pressure screening by Dina Lansey, clinical trials outreach coordinator for the Johns Hopkins Kimmel Cancer Center

Today, a historic market near the Johns Hopkins East Baltimore Medical Campus re-opened after extensive building renovations. Funded, in part, by Johns Hopkins, Northeast Market vendors also renewed their offerings with expanded produce choices and cooking with healthier ingredients. The Kimmel Cancer Center offers educational materials and health screenings at the Market.

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We’re starting a series on frequently asked questions about Kimmel Cancer Center clinical trials. This first question is the most basic: What is a clinical trial?

A clinical trial is research study that involves people to test new ways of preventing, diagnosing or treating cancer.  While many patients think that all clinical trials test experimental therapies, there are several kinds of clinical trials in which patients may be able to enroll, says Dina George Lansey, a nurse and clinical research recruitment specialist for the Kimmel Cancer Center.  “Treatment trials may include new drugs, vaccines or techniques for surgery or radiation. They may involve current standard treatments being used  in a new way or combine new and current standard treatments,” Lansey says. Even if cancer patients are not part of a treatment trial, “ patients they may be asked to participate in  other types of trials during treatment for their cancer. These might include research studies that seek to study ways to prevent cancer or learn more about side effects of cancer treatment, quality of life studies,” she explains.

It’s important to note that treatment trials “are done in a series of steps called phases. These steps help researchers figure out whether new treatments are safe, what side effects it causes,  if it is effective and if it is better than the current standard treatment.  It's a safety mechanism,” Lansey says. “At each phase, the results of the study are evaluated to determine whether it's safe to proceed to the next clinical trial phase.  This process is monitored very closely by those conducting the trials as well as the Food and Drug Administration (FDA). When all of the phases are completed, the FDA decides if the drug may be approved and marketed to the public.   “Clinical trials are opportunities for us to learn from cancer patients and for patients to contribute to the future care of others with cancer,” Lansey says.

Caregiver and blogger Dena Battle shared her thoughts about clinical trials on her blog, The Kidney Cancer Chronicles. I think you'll find that Dena's analogy of shoes and clinical trials makes a lot of sense, especially for those of us with a shoe fetish. Dena and her husband honed a very important skill of searching for clinical trials and asking questions of their medical team. We hope this blog series will help you learn more about clinical trials, and to help find the right size clinical trial for you, learn more about Kimmel Cancer Center research and search a database of ongoing trials.

Part 2: How is my safety as a patient protected?

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Ride to Conquer CancerAfter a few days of food indulgence and giving thanks for our great bounty, I start thinking about refocusing my goals and aiming high for a new set of aspirations. My sister just completed a half-marathon and is training for an "aquathlon." (I watched her swim an impressive mile this summer.) My husband completed a week-long bike ride across Iowa...twice...when he was 9 and 10, on a single-speed bike. It's inspiration like this that will help me settle on the new year's goal, and there's already a challenge to consider.

The Ride to Conquer Cancer is set for September 13-14, 2014. A two-day bike ride of more than 150-miles through Washington, D.C., Virginia and Maryland. The Ride benefits the Johns Hopkins Kimmel Cancer Center, Sibley Memorial and Suburban Hospital. Registered participants get support in training and raising the $2,500 in donations to participate. Now is the time to prepare and commit to new goals. For a cause like cancer, I can aim high.

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**A continuation of our series on breast cancer and nutrition.

Research studies show that organic foods do not contain any more nutrients than non-organic foods, says Hopkins Kimmel Cancer Center nutritionist Mary Eve Brown. But you may want to choose organic foods for other reasons, such as avoiding antibiotics, hormones or pesticide residues in your food.

If you are concerned about these residues, she does advise that you choose organic foods when looking for meat, poultry, eggs or dairy products, due to their exposure to hormones and antibiotics.

Again, if you have concerns, she also suggests looking for organic options when buying fruits or vegetables in the so-called “dirty dozen” – foods that are more likely to retain pesticide residues and so are best to buy organic. They include peaches, apples, sweet bell peppers, celery, nectarines, strawberries, cherries, pears, imported grapes, spinach, lettuce and potatoes. Fruits and vegetables with a thick skin do a better job repelling pesticide residues, so you can stretch your food dollar by focusing your organic purchases on thin-skinned produce.

You can find out more about nutrition and your breast cancer journey in Brown’s recent free webinar, What’s Food Got to Do With It? Eating Well Before, During and After Treatment.

Videos from Mary Eve Brown:
Colon Cancer and Nutrition

Pancreatic Cancer and Nutrition

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Katie Couric quoteThis quote from Katie Couric's keynote speech at A Woman's Journey sums up the hard work of cancer scientists, clinicians, patients, families and friends.

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Katie Couric

When TV host Katie Couric underwent a colonoscopy procedure on-air during the Today Show, she changed the way health and medicine is covered in the news today. Couric continues her mission of education and advocacy by compelling all of us to support cancer research. On Saturday, Couric was the keynote speaker at A Woman's Journey in Baltimore, which is coordinated by Johns Hopkins. Health education was the theme of this weekend's event, and we've seen how Couric has been able to transform public knowledge. Let's take Couric's advice and encourage friends and family to get educated about cancer and support research to cure and prevent it. Read more in the Baltimore Sun's story about the event.

 

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**A continuation of our series on breast cancer and nutrition.

Many breast cancer patients assume they will need to take supplements to boost their nutrition during treatment, says Hopkins Kimmel Cancer Center nutritionist Mary Eve Brown, and many people think that adding nutritional supplements to their diet will reduce their chances of getting cancer. However, no supplement has been proven to prevent cancer. But in most cases, a balanced diet that includes a variety of foods is the best way to ensure you’re getting the right nutrition, she says.

It’s important to note that supplements are not always safe when taken in combination with other drugs, and that they have side effects of their own that may put you at risk. Brown urges you to share everything you are taking with your health care team, whether supplements, prescriptions or over-the-counter drugs to find out whether they all fit into your treatment program.

Two important nutrients to check on in your diet are calcium and Vitamin D. Brown reccomends getting 3 servings of high calcium foods daily, such as milk, yogurt, cheese or leafy greens. For men who are between ages 19 and 70, that comes to 1000mg per day, increasing to 1200 mg per day for men over 71. For women age 19 to 50, your three servings should include 1000mg per day, increasing to 1200 mg earlier, at age 51 and older. If you’re not getting the recommended amount, you may want to talk to your health care team about taking a supplement. Calcium citrate is very easily digested, Brown notes.

Your physician can check the level of Vitamin D in your blood. Brown notes that, even with adequate Vitamin D in your diet, you still may benefit from a supplement if the test shows that you are deficient. Certain cancers are linked to Vitamin D deficiency, so this is an important issue to discuss with your doctor.

You can find out more about nutrition and your breast cancer journey in Brown’s recent free webinar, What’s Food Got to Do With It? Eating Well Before, During and After Treatment.

Videos from Mary Eve Brown:
Colon Cancer and Nutrition

Pancreatic Cancer and Nutrition

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**A continuation of our series on breast cancer and nutrition.

Creating a prevention diet is an important part of your transition from breast cancer treatment to an after-therapy life, says Hopkins Kimmel Cancer Center nutritionist Mary Eve Brown.  She notes five hallmarks of a smart prevention diet: 

  • Unprocessed, plant-based foods
  • High-fiber foods with whole grains, like brown rice and quinoa
  • Foods low in saturated fat, since saturated fat can be a trigger for some tumors
  • Plenty of vegetables, in an array of colors, aiming for 2 cups per day
  • Mindful amounts and sources of animal protein, using the leanest cuts possible with the fat trimmed, and avoiding processed meats. Prefer white meat poultry or fish to red meat, and make sure your portion looks about the size of a deck of cards.

What does that look like on a plate? Brown suggests these menu items for your meals throughout a typical day:

  • At breakfast, reach for steel-cut oatmeal for fiber, with dried cranberries for fruit and fiber, walnuts for a healthy fat, and skim milk for a low-fat start to the day.
  • At lunch, fortify yourself with lean protein, like a tuna fish salad on a 100% whole wheat roll, accompanied by fruits and vegetables like lettuce, tomato, and fresh strawberries. Finish with a non-fat yogurt, and have some water to stay hydrated.
  • At dinner, try a plant-based protein like bean chili, accompanied by cornbread for fiber, a spinach salad loaded with colorful vegetables with homemade vinaigrette, and hot green tea. You’ll get more phytochemicals if you brew loose green tea rather than the kind that comes in tea bags. Having some vegetarian meals during the week helps to cut down on the amount of animal protein you’re consuming.

You can find out more about nutrition and your breast cancer journey in Brown’s recent free webinar, What’s Food Got to Do With It? Eating Well Before, During and After Treatment.

Videos from Mary Eve Brown:
Colon Cancer and Nutrition

Pancreatic Cancer and Nutrition

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--This post is written by Kerri Kaplan, executive director of The Lustgarten Foundation

I’m often asked about new developments in the research landscape of pancreatic cancer, the nation’s most lethal cancer. As executive director of The Lustgarten Foundation, the nation’s largest non-profit foundation dedicated to funding pancreatic cancer research, I have seen tremendous progress made in the fight against this disease. The most encouraging transformation I have witnessed in my seven years at the Foundation is the rapid growth of collaboration among our highly motivated researchers and scientists, working together to find a cure.

When The Lustgarten Foundation was first formed in 1998, it was surprisingly difficult to attract researchers interested in studying pancreatic cancer since only a handful worked on studies related to the disease. A lack of funding and a lack of knowledge were also contributing factors. Thankfully that has changed, and today, there are more than 1,000 researchers who dedicate their careers to pancreatic cancer research. 

Collaboration has always been part of the Foundation’s mandate, and we work to ensure that these researchers no longer operate in ‘silos,’ separate and alone.  We recognize that in order to advance our understanding of pancreatic cancer, cooperating on research is essential.

Our partnerships with many leading organizations, foundations and institutions have helped to accelerate the rate of research discovery. In 2010, we established the Pancreatic Cancer Research Consortium, which comprises six world-renowned medical institutions (including Johns Hopkins University School of Medicine), and is designed to advance the most promising research initiatives aimed at ultimately finding a cure. Another consortium member is Cold Spring Harbor Laboratory (CSHL), with which we partnered again last year to establish The Lustgarten Foundation Pancreatic Cancer Research Laboratory. The laboratory focuses exclusively on pancreatic cancer research, with initial studies centered on early detection, drug development and drug delivery. The Consortium and dedicated pancreatic cancer research lab represent two significant steps forward in collaborative research.

We also are witnessing encouraging results through other collaborative efforts. For example, our long-term partnership with the National Cancer Institute and Johns Hopkins’s Cancer of the Pancreas Screening program [CAPS] led by Dr. Marcia Canto, resulted in important findings in the area of early detection. This multi-year collaboration of medical centers provided patients who have an inherited predisposition for pancreatic cancer with greater access to screenings. Many more researchers were able to tap into the data from this national study and they learned that monitoring in high-risk families using endoscopic ultrasound was one of the best options available to test for this disease and it could save lives. 

We also look forward to the results of our collaboration with the Cancer Research Institute, to co-sponsor a new clinical trial led by Dr. Carl June and Dr. Gregory Beatty at the Perelman School of Medicine at the University of Pennsylvania. The trial focuses on a new way to treat pancreatic cancer by altering and training a patient's immune system to target and eliminate cancer cells. A first in the pancreatic cancer research world, this trial would not have happened without shared funding and scientific expertise.

Similarly, we are now collaborating with Stand Up to Cancer, so its Pancreatic Cancer Dream Team can extend important research initiatives into clinical trials, which will include investigating a variety of drug combinations for pancreatic cancer patients to improve treatment options.

Research offers hope that, one day, early diagnosis of pancreatic cancer will require nothing more than a routine blood test, and that better treatments can be found, eventually leading to a cure. Working together, we move closer to realizing that goal every day.

Kerri Kaplan is executive director of The Lustgarten Foundation, the nation’s largest non-profit foundation dedicated to funding pancreatic cancer research. The Foundation has played a critical role in the evolution of pancreatic cancer research since its inception in 1998, contributing more than $65 million to more than 175 research projects at more than 50 medical and research centers worldwide. Every dollar donated to The Lustgarten Foundation goes directly to pancreatic cancer research because Cablevision, a leading media and telecommunications company, underwrites all of the Foundation’s administrative costs.  The Lustgarten Foundation and Cablevision are also partners in the curePC public awareness campaign. For more information, visit www.curePC.org

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***This blog post was written by Dena Battle.

My husband Chris was on a gurney in the hallway when I got to the emergency room at our local hospital.  Balking on drinking the contrast.  Sometimes a doctor or a nurse would drop by.  They’d ask him if his pain was managed.  He more or less nodded.  The pain was in his abdomen.  On the right side.  Had to be appendicitis.

But, the CT didn’t show appendicitis.  “It’s not your appendix.” said Dr. Brown.

Dr. Brown was as plain and non-descript as his name.  Balding.  If you asked me now how old he was, I couldn’t narrow it down to a decade.  He was nice, even friendly.  But, he didn’t mince words when he told us the results. 

“You have a large mass on your kidney.  We believe it’s renal cell carcinoma.”

He said some other things too, but I only remember hearing “carcinoma.”  Because “carcinoma” sounds like cancer.  Like something you get from smoking or being doused with agent orange.  Carcinogen has been burned into our brains with anti-smoking campaigns for long enough – I knew that carcinoma was bad like a pack of cigarettes.

“We’re going to get you into a room and get you comfortable.  Then we’ll get an x-ray, do a brain scan.  I’ll talk to the surgeon – we need to get that kidney out.” 

We didn’t ask questions, we just nodded in agreement.  The next few days were a blur.

Chris had been home from the hospital recovering from surgery for about a week when he called me at work.  “I need a fax number – the doctor has my pathology report.”

What happened next was what I would call a panic attack.  One of my friends though is always quick to point out that he thinks it’s probably a normal reaction to a spouse being diagnosed with cancer.  I started to sweat profusely and my speech was sort of garbled.

“You want to fax it here?  I don’t know if I really have a fax.  Who uses faxes anymore?”  My heart was pounding out of my chest.  I had been worried about what the pathology report would say and now I was going to have it, delivered to me, alone at my office. 

“Dena?  I really need the fax number.”

Not aware that I was melting into my chair, Chris was becoming slightly impatient – not angry, but sort of frustrated at my inability to give him a number.  I finally relented.

I was on the floor beneath my desk when Chris called me to discuss the results.

The pathology report wasn’t good.  I had tried to avoid reading what I could about Chris’s cancer, but I’m a researcher by nature and I knew enough to know that it was bad.  The tumor was big – 11 cm.  The designation for a stage 2 tumor is 7 cm.  Chris’s was almost double.

The Fuhrman grade tells you how aggressive the cancer is.  On a scale of 1 to 4, 1 is the least aggressive and 4 is the most aggressive.  Chris’s tumor was a grade 3 out of 4. 

Chris was methodical.  Analyzing each detail.  I was a babbling mess.  He talked through the results, I cried.

“This isn’t great – it’s grade 3. I really was hoping it was grade 1.”  Like he’d gotten a B+ instead of an A on an exam.

“I’m sure that if it was really bad, the doctor would have called us, right?”  But, I knew in my heart that it wasn’t right.  I knew that our doctor wasn’t the expert we needed.  I wanted so badly for everything he said to be true. 

“You’re cured!” Those were his words after the surgery.  He was so confident.  “I got it all!” 

Over the next few weeks, we processed differently.  Chris poured through medical journals, looking at survival algorithms, studying necrosis and hemorrhaging of tumor tissue. 

I cried.  I went through our refrigerator and threw away everything that had been bought before cancer.  I cried some more.

After a few weeks of this, Chris sat down with me and showed me a chart he had made.  “We’re smart people, Dena.  We both have good research skills.  I’ve divided up areas that each of us will focus on.”  And he had.  There were two columns – his and mine.  I was assigned treatment analysis, he was going to research lifestyle changes.

The day before Easter, I sat down at the computer to begin my research.  After a few searches, I found a group called SmartPatients.  Suddenly, I was “meeting” patients from all over the world who were dealing with kidney cancer.

Everyone said the same thing: “A chest x-ray isn’t sufficient, you need a CT scan – with contrast.  You need a different doctor.  You need an oncologist, preferably a specialist in kidney cancer.”  They also said things like this: “You will survive. You’re strong.  Chris will fight.  We will help you.”

The doctor who had performed Chris’s surgery was recommending that Chris come back for an x-ray in six months.  He didn’t want to do any other testing and he was mostly focused on Chris’s remaining kidney.

Four doctors later, we finally found an oncologist who would perform a CT scan with contrast.  The results showed that Chris had metastatic disease in both lungs. 

My heart dropped when I heard the words.  The numbness that I’d felt at the original diagnosis crept back in.  But, then the doctor said something else, “We need to get you set up on chemotherapy.”

That numbness faded and anger seared behind my eyes.  This was our fourth doctor – the one who finally had given us the scan that we needed.  And one thing I knew for certain was that kidney cancer did not respond to chemotherapy.  Armed with new information, I was no longer a frightened caregiver, one that would simply nod at a doctor’s suggestions. 

I didn’t even look at Chris.  I just said, “No. I don’t think so.  This cancer doesn’t respond to chemotherapy.”

We left the office in the same way we had left the offices of the doctors who only wanted to do an x-ray.  We just walked out, washing our hands of bad advice.  My eyes were red and swollen and I had a headache.  But, I wasn’t panicked and I didn’t crawl under my desk this time.

That day, I told Chris a theory that I had – kidney cancer is just common enough that every doctor thinks he knows how to treat it and just rare enough that only a specialist does. That day we began a quest for a doctor and a place that would fight this battle with us – not for us.  That’s the search that led us to Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Chris Battle ultimately lost his fight with kidney cancer.  However, his wife Dena maintains the blog they founded together and still advocates for other kidney cancer patients.  For more on their journey go to: http://kidneycancerchronicles.com/ 

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