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Palliative care: It’s not what you think (or fear)

Stigma keeps many cancer patients from using a service that offers much-needed help to the sick as well as the dying

April 26, 2017 | By Diane Mapes / Fred Hutch News Service

Illustration by Kimberly Carney / Fred Hutch News Service

When Nancy Stordahl’s mother was hospitalized in 2008 for her rapidly progressing metastatic breast cancer, a palliative care team stopped by the room one day to talk about her mother’s needs. But Stordahl wasn’t interested in what they had to say. In fact, they were the last people she wanted to see.

“My mind immediately jumped to hospice care — this must be the end,” the writer and breast cancer survivor from Menomonie, Wisconsin, wrote in a 2014 blog post. “My next leap was, ‘Get out!’ What I actually did say to them I have no idea. But I do remember sitting there stewing.”

It’s a common misconception, according to experts at Fred Hutchinson Cancer Research Center. Palliative care may even be the most misunderstood phrase in cancer care. Half of patients don’t know what it is; the other half think it means they’re dying and anyone who mentions it has given up on them.

Sometimes referred to as comfort or supportive care, palliative care can definitely ease suffering in late-stage cancer patients entering hospice or approaching end of life. But it’s also a powerful tool for patients dealing with pain or treatment side effects anywhere along the cancer continuum, from early stagers grappling with chemo-induced nausea to metastatic patients learning to live with headaches, neuropathy and constant bone pain from their ongoing therapy.  

And research shows palliative care can do much more: it can cut back on emergency room visits; curb anxiety and depression; improve the ability to cope with disease for both patients and caregivers, and even help those who are in treatment to live longer.

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Dissolving implant could bring immunotherapy to solid tumors

A biopolymer sponge delivers cancer-shrinking T-cell therapy in preclinical study

April 24, 2017 | By Sabrina Richards / Fred Hutch News Service

Concentrating two waves of immune attack: Blue anti-cancer immune cells exit the dissolving implant at left, heading toward clusters of grey tumor cells. Green microspheres containing immune activators diffuse out to instigate a second wave of anti-tumor attack spearheaded by a patient's native immune cells (in yellow).

Image by Cognition Studio

Cellular immunotherapy is beginning to bring new hope to patients with certain blood cancers. Tumors that form solid masses, such as breast and pancreatic cancer, are the next frontier for the strategy — but scientists are still grappling with how to overcome the unique challenges large clusters of tumor cells present to engineered immune cells. In new work published Monday in the Journal of Clinical Investigation, researchers at Fred Hutchinson Cancer Research Center show that a dissolving biopolymer sponge packed with a trio of therapeutic ingredients can shrink tumors and extend survival in laboratory models of cancer.

Loaded with engineered immune cells, molecules that help stimulate those cells’ ability to eliminate cancer and a special ingredient that recruits a patient’s own immune cells for a second round of anti-cancer attacks, the spongey, lattice-like scaffold offers a new strategy for tackling genetically variable and crowded masses of tumor cells.

Current experimental cell-based immunotherapy strategies rely on immune cells that seek out a single target, but solid tumors may be able to slip past such a focused attack if certain cells in the tumor don’t possess that particular target but do have one of many other potential immune targets. The implant draws on the natural ability of the immune system to respond to a wide array of targets and deliver a multi-pronged attack.

“We address the main problem that solid tumors have,” said Fred Hutch’s Dr. Matthias Stephan, an immunobioengineer who led the study.

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Should prostate cancer screening be different for black men?

New study confirms prostate cancer is more common and more deadly in African-Americans

April 23, 2017 | By Linda Carroll for Fred Hutch News Service

Prostate cancer survivor Nate Battle

"Chills ran up and down my spine," said prostate cancer survivor Nate Battle. "If I had not gone in for that wellness screening, it would have been a completely different scenario."

Photo courtesy of Nate Battle

It was only by chance that doctors discovered Nate Battle’s fast-growing prostate cancer.

At age 49, the Del Ray Beach, Florida, businessman had agreed to a full physical to get a discount on his health insurance. Testing conducted for that physical led to the diagnosis of the aggressive cancer which, fortunately, was caught at an early stage.

“In my follow-up appointment, my GP said, ‘You had another six months before things would have gone really bad for you,’” said Battle, now 52. “Chills ran up and down my spine. If I had not gone in for that wellness screening, it would have been a completely different scenario.”

Battle’s experience falls in line with newly published research from Fred Hutchinson Cancer Research Center that shows black men may be at heightened risk not only of developing prostate cancer but also of having a more aggressive form at a younger age.  

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Good News at Fred Hutch

Celebrating faculty and staff achievements

April 20, 2017

Dr. Glenda Gray

Dr. Glenda Gray welcomes HIV Vaccine Trials Network members to an HVTN conference in Seattle in October 2014.

Photo by Robert Hood / Fred Hutch News Service

Dr. Glenda Gray among Time magazine’s ‘100 most influential’

Dr. Glenda Gray, a leader of the Fred Hutch-based HIV Vaccine Trials Network and director of its Africa programs, is included in Time magazine’s annual list of the 100 most influential people in the world for her pioneering work on HIV prevention. The magazine announced the list today.

The South African-born Gray moved from being an anti-apartheid activist in the 1980s to fighting HIV, which took hold in her country in the 1990s, right around the time apartheid was ending. In those early days, she found herself doing battle on two fronts — against a deadly virus and the stigma that led so many others to refuse to acknowledge it.

Then a young pediatrician in training, she was particularly stricken to see babies dying of AIDS.

“Gray decided to fight the virus and the silence around it through research,” Time health editor Siobhan O’Connor wrote in a short essay on Gray that accompanied the announcement. “Thanks in part to her work on mother-to-child transmission, the number of babies born with HIV has dropped from 600,000 a year to 150,000.”

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Tiny tech reprograms immune cells to fight cancer

Nanoparticles turn immune cells into leukemia-fighting powerhouses while they’re still inside the body

April 17, 2017 | By Sabrina Richards / Fred Hutch News Service

Nanoparticle designed to carry CAR-programming genes to T cells

A cross-section of the nanoparticle designed by Dr. Matthias Stephan and his team, displaying the T cell–programming genes packaged inside. The yellow molecules coating the particle help it stick to T cells. The orange polymer helps bundle the genes and carry them to the nucleus.

Cognition Studio

Dr. Matthias Stephan has a bold vision. He imagines a future where patients with leukemia could be treated as early as the day they are diagnosed with cellular immunotherapy that’s available in their neighborhood clinic and is as simple to administer as today’s chemotherapy, but without the harsh side effects.

The key to that scientific leap? Nanoparticles, tiny technology that’s able to carry tumor-targeting genes directly to immune cells still within the body and program them to destroy cancer.

In a proof-of-principle study published Monday in Nature Nanotechnology, Stephan and other researchers at Fred Hutchinson Cancer Research Center showed that nanoparticle-programmed immune cells, known as T cells, can clear or slow the progression of leukemia in a preclinical model.

“Our technology is the first that we know of to quickly program tumor-recognizing capabilities into T cells without extracting them for laboratory manipulation,” said Stephan, the study’s senior author. Although his method for programming T cells is still several steps away from the clinic, Stephan envisions a future in which biodegradable nanoparticles could transform cell-based immunotherapies — whether for cancer or infectious disease — into an easily administered, off-the-shelf treatment that’s available anywhere.

Stephan imagines that in the future, nanoparticle-based immunotherapy could be “something that is available right away and can hopefully out-compete chemotherapies. That’s my excitement.”

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Mentors matter, but how do you find one?

Making the mentoring relationship — or better, relationships — work

April 14, 2017 | By Mary Engel / Fred Hutch News Service

Dr. Athea Vichas, left, and her mentor, Dr. Cecilia Moens

Dr. Athea Vichas, left, a postdoctoral fellow in developmental biology, found what she was looking for in mentor Dr. Cecilia Moens: mutual respect, open communication and a lot of freedom.

Photo by Robert Hood / Fred Hutch News Service

Dr. Athea Vichas knew what she wanted in a mentor when she set out to find the right spot to do her postdoctoral fellowship in developmental biology. High on her list was the Fred Hutchinson Cancer Research Center lab of Dr. Cecilia Moens.

Then a doctoral student at New York’s Cornell University, Vichas was intrigued by Moens’ research, which uses zebrafish embryos to model how human brains develop. Conversations with others in the field told her that the veteran Fred Hutch scientist was highly respected by her peers. And postdocs in Moens’ lab had gone on to successful academic research careers, which is Vichas’ goal as well.

What sealed her decision was attending a conference in Seattle, which gave her a chance to test-drive the relationship over an informal lunch and lab visit. Moens’ mentoring style — mutual respect, open communication and a lot of freedom — was exactly what the independent-minded Vichas was seeking.

“I wasn’t looking for someone to act like a manager, too hands-on,” Vichas said, a year and a half after starting a postdoc in Moens’ lab, where she focuses on the development of the cerebellum. “Her door is open, but she’s not always looking over your shoulder. Graduate students are needier, but as I’ve gotten farther on in my training, I’ve gotten more independent.”

Mentoring has almost a mystical status in biomedical research. Ideally, it’s a sustained relationship that helps junior colleagues acquire the knowledge, skills, behaviors and values needed to have a successful career and contribute to the field. The influence extends well beyond training. Many a rock-star researcher with a global reputation and pages of publications will start or end a scientific talk by saluting a mentor, still living or not.

But the relationship can also be so idealized that it all but invites dashed expectations. Not every mentor is as experienced as Moens, and not all mentees are as sure as Vichas about what they want from the relationship or how to go about getting it. 

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