Dr. Rachel Ceballos, a public health scientist at Fred Hutchinson Cancer Research Center, recently returned from the American Public Health Association conference in Denver, where she was presented with the 2016 Aetna Award for Excellence in Research on Older Women and Public Health.
The award, presented to Ceballos and her co-investigators, was for her work with the Staying on Track After Recovery Study — also known as the STAR Study — a collaborative project designed to better understand the experience of African-American breast cancer patients after they leave active treatment.
“We are definitely very excited,” said Ceballos, who presented the results in two posters and a talk entitled “Providing Emotional Support during Transition to Survivorship: Perceptions of Oncology Professionals and African-American Breast Cancer Survivors.” “There were three main pieces that we honed in on. The one that got the award was focused on documenting the emotional experience after treatment ends.”
For many, she said, this period is an emotional mixed bag, both celebratory and scary.
“[Survivors] are finally faced with all of the emotions that could not be addressed during treatment,” she said. “There’s a sense of isolation. There’s fear of recurrence. One doctor quoted one of his patients, saying, ‘They felt like they went through a meat grinder and got dropped in a bowl at the other end.’”
Ceballos began the project by engaging with a handful of African-American community consultants, building trust over the course of a year before even designing the study. The consultants helped the researchers develop and shape interview questions, facilitated outreach, then conducted one-on-one interviews and led focus groups with 45 cancer survivors and 27 oncology professionals.
Poster co-authors and collaborators included patient advocates Bridgette Hempstead, founder of the African-American cancer support group Cierra Sisters; Jacci Thompson-Dodd, founder of the cancer and wellness support group LiveThrivorship.com; nurse practitioner Shauna Weatherby; and Fred Hutch project managers Rachel Malen, Sarah Hohl and Dr. Yamile Molina (now at the University of Illinois at Chicago). The award was presented during the annual American Public Health Association, or APHA, conference. APHA is a 140-year-old institution dedicated to improving the health of the public and achieving equity in health status.
Several key findings came out of the STAR Study.
“We found that the emotional impact comes as a shock to some women,” Ceballos said. “It’s almost like being in an emergency: You take care of what needs to be done then when it’s over, you actually process the emotional impact of it. We also identified fragmentation of the system, meaning the lack of communication and continuity of care related to emotional needs — if they’re even identified in the first place.”
Many participants, she said, acknowledged the tradition of being “strong black women.” One participant put it this way: “As African-American women … we have to be strong and do it all, and we won’t admit to even having a problem.”
Ceballos echoed the sentiment: ”Many African-American women may not easily reveal emotional and other vulnerabilities due to pride, a history of being denied services and fear of rejection. This is concerning, as there is often no standard procedure for assessing emotional well-being.”
According to Ceballos, “Some oncology professionals stated, ‘I just know when my patients need help’ or ‘I ask them if they need help,’ but that in no way means the people are going to reveal their concerns.”
Doctor-patient trust and issues of equity also came up during the conversations.
“A lot of patients said, ‘I just want to have some eye contact, so they know I’m human,’” she said. “These issues are particularly important when you’re talking about African-Americans who [may already be] coming in with concerns because of historical injustices.”
According to Ceballos, most of the patients interviewed felt they’d been treated equally at their cancer centers but “micro-aggressions” were observed when they came into a larger hospital setting.
“Some were followed by security or weren’t helped in the same way others were helped,” she said.
Ceballos hopes the study will eventually lead to policy change, new methods for patient self-advocacy and better training for oncology professionals.
“We’re hoping to make oncology professionals more aware of the patient perspective as well as give them recommendations for little things like making eye contact [and] encouraging them to show compassion,” she said. “We still have a long way to go as far as making sure we provide and meet the emotional needs of survivors, particularly within vulnerable communities like African-Americans.”
A grant from the Fred Hutch/University of Washington Cancer Consortium Support Group provided funding for the pilot project.
— Diane Mapes / Fred Hutch News Service
Three Fred Hutch scientists have won grants from the American Cancer Society totaling nearly $1.3 million to investigate immunotherapy and an important aspect of cell division.
The research awards were announced at the 12th annual ACS Legacy and Leadership Awards Ceremony, held Nov. 10 in Seattle. The event honored local volunteers and researchers, plus community and corporate partners “while highlighting the society’s accomplishments to end the pain and suffering of cancer in Western Washington and beyond,” the ACS program read.
Dr. Anna de Regt, a postdoctoral researcher, received an ACS fellowship for $163,500 that spans three years. The stipend will support de Regt’s work in the Fred Hutch lab of Dr. Sue Biggins in the Basic Sciences Division.
“I study the way cells accurately partition their chromosomes during cell division,” de Regt said. “Without the error-correction mechanism that I am studying, new cells would receive the incorrect number of chromosomes, which is a hallmark of many cancers.”
By seeking to explain that mechanism in healthy cells, de Regt said she hopes to “open doors to understand how this process goes awry during disease.”
“I think it's really great that the ACS recognizes that basic science research is a critical part of developing cancer therapies and was willing to enthusiastically support my basic science project,” de Regt said.
Dr. Stan Riddell, an immunotherapy researcher and oncologist at Fred Hutch, received the ACS Research Professor Award, worth $400,000. The support extends into 2021, with an option of renewal.
“The ACS Research Professor Award will be used to support my work developing effective immunotherapy for cancer by engaging T cells, both using adoptive T-cell transfer and therapeutic vaccination,” Riddell said.
“I am very humbled by the honor … which is the most prestigious award given by the society to recognize past and future accomplishments. I thank previous trainees and collaborators who have been instrumental in past discoveries and contribute to ongoing research in the lab,” said Riddell, a member of the Clinical Research Division.
Dr. Matthias Stephan, a researcher in Fred Hutch’s Program in Immunology, also was awarded a four-year Research Scholars Grant from the ACS to develop gene-containing nanoparticles that reprogram T cells to kill cancers. The $720,000 award was originally announced in mid-April.
— Bill Briggs / Fred Hutch News Service
Fred Hutch clinical researcher and hematology oncologist Dr. Anna Halpern recently received the Research Training Award for Senior Fellows from the American Society of Hematology, or ASH.
The $55,000 research grant came at the same time Halpern and colleagues from Fred Hutch and the University of Washington published a paper in JAMA Oncology on the “Association of Risk Factors, Mortality and Care Costs of Adults with Acute Myeloid Leukemia with Admission to the Intensive Care Unit.”
“The grant is really a great opportunity,” Halpern said. “One of the most challenging transitions a young oncologist faces is … from being a fellow to being a successful independent investigator. This award will allow me the time, mentorship and support to continue to do research and pursue an interesting and valuable question, not only for acute myeloid leukemia patients and their caregivers but to help health care systems deliver valuable, cost-effective health care. The research is valuable for lots of different parties.”
Halpern’s research and practice focus on patients with acute myeloid leukemia, or AML. Her recent paper, co-authored with Dr. Gary Lyman, co-director of the Hutchinson Institute for Cancer Outcomes Research, or HICOR, examined risk factors associated with admission to the intensive care unit after hospitalization as well as risk factors associated with patient deaths.
“Patients with AML have a high rate of admission to ICU during hospitalizations for treatment and treatment-related complications,” Lyman said. “But there hasn’t been a lot of study around what the risk factors are for subsequent admission to the ICU or with regard to their outcomes. We know the mortality rate for any type of cancer if a patient ends up in the ICU is higher because they’re sicker. But there are some factors that make that mortality extremely high, and there are others where they’re more likely to survive.”
Halpern’s study broke down hospitalization data from more than 43,000 AML patients admitted to more than 200 medical institutions in 43 states. Admission data spanned the years 2004 through 2012. The research team, which also included Fred Hutch researchers Drs. Eva Culakova and Roland Walter, found that 26 percent of the patients, or about 11,000 people, were admitted to the ICU. Out of those, 43 percent, or about 4,900, died.
Risk factors for requiring ICU care included age (being older than 80); being hospitalized in the South or in a low- or medium-volume hospital; having a comorbidity such congestive heart failure, lung disease, liver disease, diabetes or deep venous thrombosis; or contracting sepsis, an invasive fungal infection or pneumonia. Risk factors for dying in the ICU were age (being over 60); being nonwhite; being hospitalized on the West Coast; having a comorbidity; and contracting sepsis, an invasive fungal infection or pneumonia. The study also measured the cost associated with admission to the ICU, finding that it increased proportionally with each patient’s comorbidity burden.
“There are a lot of factors that put people at risk for morbidity, and some are modifiable and some are not,” Halpern said. “We can’t modify age or the region of the country, but comorbidities were highly predictive of ICU admission and mortality. So perhaps patients with lots of comorbidities will have special protocols — a higher nursing ratio or a different manner of intervention if they develop a fever. We can try to manage things differently.”
Both Halpern and Lyman referred to the study as a first step.
“This study is leading and guiding us,” Lyman said. “With future studies, we can hopefully quite substantially change the clinical practice and improve patient outcomes. We’ve seen advances in many different cancers and in chronic lymphocytic leukemia, but with AML we’re not much further along than we were three decades ago. Clearly, this is an area where we need further advances and this could move us closer to such progress. It’s not going to cure these patients, but it might enable and improve the quality and duration of survival.”
Lyman also praised Halpern for her dedication and hard work that resulted in the ASH grant.
“This study is the result of a very good research effort by a young investigator,” he said. “Anna is an excellent hematology-oncology fellow.”
Halpern said her next steps will be to create a risk-prediction model.
“Now that we’ve identified these factors, the next step, which has been funded by the grant, is to create a risk-prediction model that can be applied to any AML patient admitted to the hospital to predict their risk of ICU admission and subsequent mortality,” she said. “Once we’ve created these models and validated them, ideally we’ll use them to counsel patients and potentially design early interventions to prevent these poor outcomes and decrease mortality.”
— Diane Mapes / Fred Hutch News Service
Fred Hutch is maintaining a key role in the Cancer Moonshot as Dr. Amanda Paulovich facilitated a discussion on the national initiative during last week’s annual meeting of the Association of American Medical Colleges, or AAMC.
Paulovich, a Fred Hutch geneticist and oncologist, gave an overview on the current state of cancer research and care during a Moonshot breakout session at the AAMC’s signature learning and networking event held Nov. 13. About 4,000 members of the academic medicine community were estimated to have attended the Seattle meeting. The AAMC represents all 145 accredited U.S. medical schools and more than 400 teaching hospitals and health systems.
“The Cancer Moonshot really was born out of the optimism and enthusiasm that has grown from decades of very strong cancer research that has led to our much better understanding of the mechanisms that drive cancer and the ability to make targeted therapies. But there is still a whole lot of work yet to be done,” Paulovich said after the meeting, summing up her remarks to the group.
Paulovich participated on a three-person panel that included Dr. Doug Lowy, acting director of the National Cancer Institute, and Dr. Danielle Carnival, a representative of the Moonshot Cancer summit under Vice President Joe Biden’s Office.
Biden’s Cancer Moonshot Initiative seeks a decade of medical advances in five years through a $1 billion research infusion and tighter collaboration.
With Biden set to leave office in January, Carnival told the gathering that her colleagues in Washington, D.C., have been working with President-Elect Donald Trump’s transition staff to determine what can be accomplished on the Moonshot with the new administration. Carnival also reiterated that advancing cancer research remains Biden’s life’s work.
“What the Moonshot has accomplished is really to change the research atmosphere,” Paulovich said after the event. She studies the role of proteins in cancer. In June, Biden invited Paulovich to attend the National Moonshot Summit in Washington, D.C., where a new proteomics initiative was announced.
“The Moonshot got folks talking to each other who maybe weren’t talking to each other before,” Paulovich said. “It got them to think about ways they can accelerate progress.”
— Bill Briggs / Fred Hutch News Service