William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

“The best approach is to have a significant conversation with your physician about the risks and benefits of screening. It's shared decision making,” says William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “People have different attitudes about what they’d like to do with their health. If someone had a brother who had prostate cancer and became very sick, that person may be very concerned about prostate cancer and may want to take maximum advantage of screening in an effort to reduce the chance that his life might be threatened by prostate cancer. If, on the other hand, a person knows two or three other men who have had bad side effects from treatment, they might not want to pursue screening. Still others are concerned about overtreatment for prostate cancer.”

Watch an AACR Webinar about cancer screening.

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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 Johns 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. Here’s a video 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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At the annual Research Matters conference yesterday, top scientists from the Johns Hopkins Kimmel Cancer Center and University of Maryland Greenebaum Cancer Center discussed research using advanced imaging methods to develop better ways pinpoint and track cancer cells — down to the microscopic level — and precisely target each cell with anti-cancer drugs. Experts also delivered presentations on advances in four types of cancer affecting Marylanders: pancreatic, lung, liver and mesothelioma, a cancer of the lining of the chest and abdomen.

Flip through following slideshow of tweets during the conference:

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William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

Prostate-specific antigen (PSA)-based screening for prostate cancer has received mixed reviews from different organizations, says William G. Nelson, M.D., Ph.D., director of the Johns Hopkins Kimmel Cancer Center. Today, the United States Preventive Services Task Force has posted draft recommendations for prostate screening that encourage men ages 55 - 69 to make individual decisions about screening after talking with their doctors about potential harms and benefits.

Other organizations recommend that PSA-based screening should be offered to all men beginning at age 50-55; that PSA-based screening should be considered before age 50 for African-American men and for men with a strong family history of prostate cancer; and that all men at risk for prostate cancer should participate in shared decision-making with physicians to ensure that the benefits and harms of screening are well understood before pursuing PSA testing.

“Prostate cancer screening has become somewhat controversial in our society even though it works,” says Nelson. “The controversy stems from the belief that the reduction in prostate cancer deaths due to screening, although real, is small. Some also worry that the harms associated with the diagnosis and treatment of the cancers being detected are common, persistent and may actually be a hazard. They worry that the more men they screen, the harms will increase and the benefits won’t be as fully realized. So they conclude that the benefits don’t outweigh the harms."

“There are screening recommendations from many organizations. Almost all of them come down to the notion that screening can be effective, but there should be serious consideration of the risks and benefits for each individual through a discussion with their doctor and shared decision making to ensure that all the benefits and harms of screening are well understood before pursuing PSA testing or a screening strategy.”

"The increasing use of active surveillance, where many men with low- or very low-risk prostate cancers can avoid treatment and its side effects altogether, may reduce the potential harms of prostate cancer screening at a population scale.”

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*This blog post was written by the Kimmel Cancer Center's development specialist, Allison Rich.

Anyone who has ever heard the words “you have cancer” knows that no part of their life remains unaffected by the reality of this diagnosis. Yet even though we know this to be true, the traditional approach to cancer medicine has not always incorporated these multifaceted and all-encompassing impacts into the plan of care. Here at Johns Hopkins, Claire Snyder, Ph.D., is seeking to transform this traditional paradigm, ensuring that every aspect of functioning and well-being is taken into account throughout the course of a patient’s cancer treatment and beyond.

Dr. Snyder’s background in healthcare outcomes and quality of life began when she was an undergraduate. Upon returning to Duke University from a health policy internship on Capitol Hill, she took a course on value in healthcare. This course showed her that medicine as a whole was largely lacking an evidence-based approach to understanding how what we do and how we do it impacts the day-to-day lives of patients and families. The awareness she gained in this course deeply resonated with her, and she knew that this was something that she wanted to spend the rest of her life doing.

This revelation has in fact shaped the course of her entire career, and is what drove Dr. Snyder to go on to receive her Master of Health Science in Health Policy, and then her Ph.D. in Health Policy & Management, from the Johns Hopkins Bloomberg School of Public Health. Johns Hopkins is still her professional home today, where she holds appointments in Medicine, Oncology, and Health Policy & Management. Her work centers on two principle areas: improving communication between cancer care providers and primary care providers across the treatment continuum and into survivorship, and developing tools to help cancer care providers better monitor patient well-being during active treatment. Broadly speaking, Dr. Snyder describes her work as assessing “how we can we use the patient’s own voice to improve the quality of life they experience and the quality of care they receive.”

Currently, Dr. Snyder’s work in improving communication between cancer providers and primary care providers focuses on how to help cancer patients transition to survivorship when their initial treatment is complete. Her research and that of her colleagues has shown that many cancer survivors don’t receive the care that they should be getting – or, in some cases, even receive care that they don’t actually need. To remedy this issue, the National Academy of Medicine recommends that patients receive a “survivorship care plan,” or SCP, when they complete treatment. This document summarizes the therapies received and outlines the follow-up care needed, and is intended to be a tool for both survivors and primary care providers. Dr. Snyder is co-Principal Investigator of a randomized, controlled trial to investigate the best approaches for delivering SCPs in the most effective and efficient manner possible, with the goal of ensuring that survivors and their primary care providers are both on precisely the same page, without placing a burden on either the survivor or their oncology care team. As these plans are now required for accreditation by the American College of Surgeons Commission on Cancer, Dr. Snyder’s work is exceptionally relevant to creating a model which will ensure that patients and providers have access to this important document both here at Hopkins and at other cancer centers across the region.

For patients who have not yet concluded their treatment process, Dr. Snyder has also spearheaded efforts to, as she describes, “make quality of life assessment as routine a part of cancer care as laboratory values and imaging studies, so that when a patient is being seen by their cancer clinician, the clinician has in front of him or her the lab values, the imaging studies, and the patient’s own report of their feelings, functioning, and well-being.” Dr. Snyder and her colleagues hope that this effort will not only help clinicians identify issues that may have otherwise gone unnoticed, but will also give patients an open line of communication to discuss topics that are sometimes difficult to raise, such as sexual function. Since Dr. Snyder implemented this approach through an online portal called PatientViewpoint, patients and providers alike have expressed how beneficial it is to have the opportunity to readily discuss these issues. While clinicians reported that the portal allowed them to gain insight into elements of their patients’ health that may not have come up during a standard office visit, such as increased feelings of depression or life events conflicting with treatment schedules, patients revealed that the process made them feel that their oncology team truly cared about them not only as patients but as people, allowing them to voice concerns about topics such as body image that may otherwise have been forgotten between visits or pushed to the wayside in light of other medical concerns. For Dr. Snyder, comments such as these underscore the value of what she calls “putting the ‘care’ in cancer care.”

In addition to focusing on making sure the patient’s voice is heard across the entire cancer care spectrum, and providing a mechanism for this data to be included in the medical record in a systematic and routine way, Dr. Snyder also established a platform for Johns Hopkins faculty who are passionate about these same issues to come together and establish a research community, called the BLOCS program. BLOCS, which stands for Building Lifestyle, Outcomes, and Care Services Research in Cancer, created a home for researchers and clinicians who, like Dr. Snyder, believe strongly in finding ways to improve quality of life and care delivery for patients and their families. Currently, BLOCS has 30 members, including clinicians and researchers from multiple disciplines, and facilitates additional research advances through communication, collaboration, and connections that would be far more difficult to make were it not for BLOCS.

Since she first discovered its incredible importance as an undergraduate, Dr. Snyder has dedicated her career to learning how to best serve patients and families, whether they have just received a cancer diagnosis or are well on the road of survivorship. Whether the prognosis is fantastic or difficult, she and her colleagues, including the members of the BLOCS program, believe that honing the tools necessary to improve the quality of how we provide cancer care at Johns Hopkins is of paramount importance, allowing patients to feel that their personhood is never taken out of the equation, and that their entire care team is united in the effort to provide them with the best possible quality of life for as long as is feasible.

 If you are interested in learning more about Dr. Snyder’s work and opportunities for support, please contact Ashlyn Sowell at asowell2@jhmi.edu.



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Sabrina Wang

Sabrina Wang discusses her poster presentation at the AACR 2017 Annual Meeting.

Johns Hopkins undergraduate student Sabrina Wang won first place in a competition among 125 students for her research on a lethal type of pediatric brain tumor called atypical teratoid/rhabdoid tumors (AT/RT), the most common brain tumor type in infants. The award was presented at the AACR 2017 annual meeting in Washington, D.C., on April 2. Wang found that a subset of AT/RT tumors expresses a gene called MYC. Research by Johns Hopkins Kimmel Cancer Center experts has shown that cancers cells expressing this gene can alter the way they process nutrients as an energy source. In cell culture studies, Wang used so-called glutamine-inhibiting drugs to block the metabolism processes of AT/RT cells. In mice, glutamine-inhibiting drugs doubled the survival of mice implanted with AT/RT brain tumors that express MYC compared to mice with similar tumors treated with a saline control. Wang works in the laboratory of Kimmel Cancer Center pediatric oncologist Eric Raabe.

"This exciting research opens a new avenue for AT/RT treatment," says Raabe. "Glutamine metabolic inhibitors have a good safety profile in children in phase 1 studies, and we believe they may add a new, less toxic modality to AT/RT therapy. Sabrina and her lab supervisor Dr. Jeffrey Rubens have worked with dedication to bring this research to this point. I applaud Sabrina for this well-deserved recognition."

Raabe also said that this award and the scientific research that underpins it confirms undergraduate students' valuable contributions to cancer research. "Undergraduates can bring a tremendous amount of energy and enthusiasm to the lab, and Sabrina is a prime example of this," Raabe says. "She is exemplary of undergraduate students who have made major contributions to our scientific efforts."

Alex's Lemonade Stand funded the research through its Pediatric Oncology Student Training program. "This program is essential for allowing us to capture the interest of talented undergraduates like Sabrina," says Raabe.

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Jiajia Zhang was a trained oncologist in China when she read news about former Vice President Joe Biden's visit to Johns Hopkins and the launch of the Bloomberg-Kimmel Institute. "I want to make more of an impact in patients' lives, and I believe immunotherapy is the future of cancer treatment," says Zhang.

Jiajia Zhang

Jiajia Zhang

She decided to focus the rest of her career on research, and she was accepted into a master of public health program in the Johns Hopkins Bloomberg School of Public Health.

It's been a transformative year for Zhang. She plans to work with Alex Baras, M.D., Ph.D., in the Bloomberg-Kimmel Institute for Cancer Immunotherapy, to develop databases that track biological cues in patients on immunotherapy drugs that may help physicians predict their response to the drugs.

Q&A with Zhang:

When did you first hear about the launch of the Bloomberg-Kimmel Institute for Cancer Immunotherapy?
I heard about the launch of the Bloomberg-Kimmel Institute for Cancer Immunotherapy last April, shortly after its announcement. At that time, I was deciding between MPH programs in the Johns Hopkins Bloomberg School of Public Health and Harvard T.H. Chan School of Public Health. The news of the Institute really swayed my decision towards Johns Hopkins because I believe this would be the place where my aspirations would be realized - combining biostatistics and epidemiological skillsets with cutting-edge cancer immunotherapy.

What aspect of the Institute caught your interest?
Cancer immunotherapy harnesses the body's own immune system to target cancer cells. It not only has major implications for established treatments, but will also impact cancer prevention in that infectious diseases vaccines have protected hundreds of millions from viruses and bacteria. At the Bloomberg-Kimmel Institute, leading scientists collaborate closely with clinical oncologists to innovate novel immunotherapy and screening strategies to fight cancer. Its solid foundation of translational research has led to the discovery of PD-1 inhibitory receptors, development of targeted antibodies and demonstration of their clinical activity in multiple cancer types.

What area of research will you focus on in the Institute?
I hope to use what I have learned in JHSPH to help create relational databases that would link all immune analyses of immunotherapy patients to their clinical outcomes. We aspire to create platforms that can link together the information from many institutions, not only in the US but internationally. I have been fortunate to have the opportunity to initiate a relationship between Dr. Jia-fu Ji, China's most prominent gastric cancer researcher in China and director of Peking University Cancer Hospital, and Dr. Drew Pardoll, BKI director. Dr Pardoll will visit Beijing this year to discuss a collaboration that will hopefully integrate experiences with the world's largest gastric cancer population and the immunotherapy expertise of the BKI.

What do you hope your research will accomplish?
We aim to design a pathway that links scientific research and patient-level data to accelerate scientific discovery, clinical application and public change in the field of cancer immunotherapy. There are many insights on how patients will benefit from specific immunotherapies that can only come from analysis of large relational databases capturing immunologic and clinical information from hundreds, even thousands of patients.

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--This blog post celebrates the one-year anniversary of the launch of the Bloomberg~Kimmel Institute for Cancer Immunotherapy.

When we launched the Bloomberg~Kimmel Institute for Cancer Immunotherapy last March, we committed to accelerate the progress of immunotherapies in a real and measurable way, taking advantage of its ability to produce unprecedented and durable cancer regressions. We also committed to developing “out-of-the-box” approaches that empower patients’ own immune systems to beat their cancer.

The success of immunotherapy in many cancer types now demonstrates that the immune system contains the power to vanquish virtually any cancer. The Bloomberg~Kimmel Institute has set itself apart, not just by advancing this concept through discovery but by moving beyond theory to translate these scientific discoveries into advances in the clinic and applying these advances to the treatment of patients. New technologies being developed in the Institute allow us to study immune responses in patients in ways that were unimaginable just five years ago.

It has meant the difference between life and death for a growing number of cancer patients, and it is the foundation of many new advances in cancer immunotherapy.

This progress and its impact are well-documented in publications in leading journals, such as the New England Journal of Medicine; FDA approvals of new immunotherapies; high impact collaborations and technology licensing agreements with biotech and pharmaceutical companies; and changes in the standards of cancer care. Bloomberg~Kimmel Institute clinicians and scientists have been recognized with the highest honors in the field, and the best and brightest young American and international physicians want to come here to continue their education and training.

The Bloomberg~Kimmel Institute stands out from other efforts because of its broad expertise and the foundational support that gives its experts the freedom to explore novel ideas and quickly move advances from the laboratory to the clinic. Progress flourishes in a collaborative environment that includes leading experts in essentially every field necessary to develop cancer immunotherapies and bring them to patients.

We are set up to take action, and this is evidenced in the headway made since the Institute was launched. Multiple initiatives have started that promise to bring major near-term and long-term payoffs. The energy is palpable. The number of clinical trials has exploded, side effects are now better understood and managed, research has revealed more ways cancer cells disrupt immune attacks, predictive markers of response to guide therapy have been identified, and immunology has been integrated into virtually every medical discipline, department and school at Johns Hopkins—even regenerative medicine.

Faculty members from all departments and schools at Johns Hopkins are collaborating with the Institute. Most importantly, lives are being saved.

I believe all cancer patients have an immune system capable of killing cancer cells. Our challenge is to make the immune system active against all cancers. Our experts continue to unravel the biology of the immune system and the cancer cell to make all cancers visible to the immune system and develop immunotherapies that destroy them.

Drew Pardoll, M.D., Ph.D.
Director, Bloomberg~Kimmel Institute for Cancer Immunotherapy at Johns Hopkins

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*The information in this blog post is based on the webinar, “Understanding Cancer-related Cognitive Impairment,” hosted by the Kimmel Cancer Center's Breast Cancer Program.

Q: What type of cognitive assessments can be done for cancer patients undergoing treatment or who have completed treatment who complain about ‘chemo brain’?

A: Tracy Vannorsdall, Ph.D., a neuropsychologist at JohnBrain_webs Hopkins in the Division of Medical Psychology, says her assessments usually require a three- to four-hour appointment. “I will review a patient’s medical records, and spend an hour taking a medical history while focusing on issues such as stress, sleep, mood, and in what kinds of situations the patient notices cognitive difficulties.” One of her technicians provides formal, one-on-one cognitive testing designed to look at different thinking skills, such as the ability to pay attention, to think quickly, to remember, to plan and to reason and problem-solve. Then patients fill out questionnaires that address mood, stress, sleep and fatigue.

“I pull it all together and look at the pattern of strengths and weaknesses in terms of cognition – where do we expect a patient to be based on his/her age and background, where the person is doing well and where he or she is experiencing difficulties,” Vannorsdall adds. “I like to craft a tailored, research-supported intervention using a person’s cognitive strengths to help counteract their cognitive weaknesses. Sometimes that involves keeping diaries to track cognitive errors and their context, sometimes I need to refer patients on to additional providers for treatment for depression and anxiety or sleep difficulties. I work with patients to address all of the potential modifiable factors to improve cognition and can help get them moving toward where they want to be. I can also help patients returning to work to make appropriate requests for accommodations. Employers often want to help employees be as successful as possible.”

Neuropsychological evaluations may be less frequently available in rural settings but there are psychologists, social workers, and other mental health providers who are knowledgeable about complex medical issues and the contributing factors to cognitive difficulties, Vannorsdall says. Quite often, the service is covered by insurance.

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T-cells attacking a tumor cell

A decade ago, Suzanne Topalian, M.D., led a team of researchers who made an astonishing contribution to how cancer is fought. Many cancers can “put the brakes” on the body’s immune cells — cells that would normally storm into a tumor and destroy it. Topalian, director of the Melanoma Program at the Johns Hopkins Kimmel Cancer Center and associate director of the Bloomberg~Kimmel Institute for Cancer Immunotherapy, and others developed a class of drugs called immune checkpoint blockers, which take the brakes off the immune system and give it a chance to fight back against cancer.

“Now, every oncologist is engaged in immunotherapy. These drugs are becoming a common denominator for cancer therapy,” Topalian says.

But as the drugs are approved for more types of cancer and used by more patients, oncologists still have questions they want to answer about cancer immunotherapy, says Topalian.

Which patients will respond best? Scientists are in the midst of a huge hunt for biomarkers — which can be anything from genetic mutations to proteins sampled from tissue or blood — that can help them determine which patients are most likely to benefit from immunotherapies, such as checkpoint blockers. There are some cancer treatments that target single genetic mutations, “but immunotherapy biomarkers are a bit more complex than that” and could involve a number of genes and proteins, Topalian says.

Johns Hopkins researchers have played leading roles in searching for these biomarkers, she says. For instance, in 2015, a team of Johns Hopkins oncologists found genetic biomarkers that identified a small group of colon cancer patients who responded well to a checkpoint blocker. “We need more sensitive and more specific markers like this to help us learn which patients are most likely to do well with these treatments,” says Topalian.

Can we combine immunotherapy with other treatments? “We know from lab studies that some of these checkpoint blocker therapies are potent, but they’re even more powerful when you combine them with other drugs,” Topalian notes.

Numerous clinical trials at Johns Hopkins and elsewhere are testing these combinations, whether adding a standard therapy, like radiation or chemotherapy, to a checkpoint blocker or combining an immunotherapy drug that lifts the brakes from the immune system with another drug that revs up the immune system. In some trials, Topalian says, both of the drugs could be still be experimental, “which is a new frontier for drug development.” The hope, she says, is that drug combinations that contain some kind of immunotherapy could extend the success of these drugs in difficult-to-treat cancers, like metastatic pancreatic, prostate, and head and neck cancers.

Can we improve how we deliver cancer immunotherapies? For the moment, checkpoint blockers are given to patients intravenously every two to three weeks during an hourlong treatment. But Topalian says scientists are studying whether this is really the best way to give these drugs, or if there might be a way to deliver them as a pill or in a form that requires less frequent clinic visits.

As more patients begin to benefit from these drugs, she notes, “We’re also doing active research to find out how long we can or should keep administering these drugs to patients, whether it’s months or years or indefinitely.”

What more can we tell patients about these treatments? “I think people are fairly well-informed about this, but it’s important to remember that this is a different kind of therapy because it doesn’t directly kill tumor cells,” Topalian explains. “This therapy treats the immune system, and then the immune system attacks cancer cells.”

Patients may worry about side effects from immunotherapy, especially whether the treatment will cause their immune systems to attack normal, healthy tissue. “Most of the side effects that we see are mild and managed fairly easily,” such as fatigue or rashes, says Topalian.

Topalian also wants patients to know that the work on immunotherapies — even ones that are already being used to treat cancer — never stops. “We study these drugs in patients and then in the lab and then back again to better understand how they are working,” she says. “For patients with cancer, I think there’s more reason than ever to be hopeful.”


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