MESSAGE FROM THE DIRECTOR
Stan Gerson, MD
Director, Case CCC
Food Safety for Cancer Patients
We all worry about food safety issues in cancer patients. Issues relate to proper advice about food preferences, treatment food interactions, and food restrictions in immunosuppressive patients. An additional topic of importance is how to counsel patients in the setting of food recalls, and the real potential that cancer patients are at special risk.
The USDA Office of Public Affairs and Consumer Education recently collaborated with the FDA to prepare a publication on Food Safety for Cancer Patients. The publication is free, and can be either downloaded from the FDA website or ordered via email from firstname.lastname@example.org.
PRESIDENT'S CANCER PANEL UPDATE
HPV Vaccination: A Significant Opportunity for Cancer Prevention
The following piece was written by Dr. Susan A. Flocke, Director of the Behavioral Measurement Core Facility and co-Leader of the Cancer Prevention, Control and Population Research Program of the Case Comprehensive Cancer Center. She is also Associate Professor of Family Medicine and Epidemiology & Biostatistics at CWRU.
The President's Cancer Panel monitors progress of the National Cancer Program, identifies topics of high importance to the nation, and recommends action to address identfied issues. Earlier this month, the Panel highlighted human papillomavirus (HPV) vaccines as an effective but under-used intervention to prevent cancers1.
Letters from the Panel were sent to multiple stakeholder organizations and to the President of the United States urging action to increase the uptake of HPV vaccination, especially in adolescents. The primary message of the calls to action is that HPV vaccination is cancer prevention and that the HPV vaccination is safe, effective, and especially important given the high prevalence of HPV.
In the United States, about 79 million people are currently infected with HPV and about 14 million become newly infected each year. More than 26,000 cancers each year are attributed to HPV, with cervical cancer in women accounting for most of these cases (10,300), followed by oropharyngeal cancer in men (6,700)2.
Currently, the Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for girls and boys at ages 11 and 12. For those who were not vaccinated at age 11-12, HPV vaccination is recommended for females ages 13 through 26 and males ages 13 through 21.
Cervarix and Gardasil are two HPV vaccines that are available for girls to protect against the HPV types that cause most cervical and anal cancers. Gardasil also protects against the HPV types that cause most genital warts; Gardasil is the only vaccine approved for boys. Both brands of HPV vaccine are given in three doses over six months.
Currently, only about 33% of US adolescent girls complete HPV vaccination3. Completion rates among boys is even lower at 7%. Unlike other types of vaccinations like Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis) and MenACWY (meningococcal conjugate) that have improved in coverage since 2006, HPV uptake has been poor with coverage rates dropping from 2011 to 20123.
Factors associated with lack of uptake include lack of provider recommendation4,5 and parental concerns about side effects or potential harm to the child from the vaccine4.
Specific suggestions from the President's Cancer Panel1 for accelerating HPV vaccine uptake include:
- Developing and implementing integrated and comprehensive communication strategies directed at parents and adolescents to raise awareness of the importance and addressing misconceptions about the vaccine
- Improving clinician preparedness to talk with parents about the vaccine and to make a strong recommendation
- Recommending HPV vaccination of age eligible individuals whenever other vaccines are administered
Clinicians can immediately act by providing a consistent and focused message about HPV vaccination to age-eligible patients and parents. The American Academy of Family Physicians recently summarized what clinicians can tell parents when they express concerns about the vaccine for their child:
- The vaccine is important. HPV vaccines prevent cancer. In girls it represents the single best defense against cervical cancer. It is a key tool in preventing anal and oropharyngeal cancers in both males and females.
- The vaccine is effective. Clinical trials have shown HPV vaccines to be extremely effective in both boys and girls. Studies in the United States and other countries where the vaccine is used demonstrate significant reductions in the incidence of infections caused by the HPV types targeted by the vaccine.
- The vaccine is safe. The vaccine has been carefully studied in both girls and boys and it has not been associated with any long-term side effects. If they do occur, most side effects are mild, consisting mainly of soreness or redness in the arm in which the vaccine is given.
- The vaccine consists of three doses in six months and it is important to get all three. The vaccine should be given to 11-12 year old girls and boys. As with other vaccines, it is critical that the child receive the vaccine well before he or she is likely to be exposed to HPV.
Increasing HPV vaccine uptake is a cancer prevention and public health priority. Action is required to change parental perception of the vaccine, increase its usage, prevent further spread of HPV.
1President's Cancer Panel, National Cancer Institute. (2014). President's Cancer Panel Annual Report 2012-2013.
2US Department of Health and Human Services, Centers for Disease Control and Prevention. (2013). Human papillomavirus (HPV)-associated cancers.
3US Department of Health and Human Services, Centers for Disease Control and Prevention. (2013). National and State Vaccination Coverage Among Adolescents Aged 13-17 Years –United States, 2012. Morbidity and Mortality Weekly Report62(34):685-693.
4Kester, LM, Zimet, GD, Fortenberry, JD, Kahn, JA, & Shew, ML. (2013). A National Study of HPV Vaccination of Adolescent Girls: Rates, Predictors, and Reasons for Non-Vaccination. Matern Child Health J, 17:879-885.
5Dorell, C, Yankey, D, & Strasser, S. (2011). Parent-reported reasons for nonreceipt of recommended adolescent vaccinations, National Immunization Survey–Teen, 2009. Clinical Pediatrics, 50(12), 1116-1124.
CASE CCC IN THE NEWS
Teen Optimistic Heading into Fight with Cancer
The Blade - Feb 24, 2014
What Kayleen heard on Feb. 3 was that she had lung cancer. Last week it was revealed it is an extremely rare cancer called an inflammatory myofibroblastic tumor, or IMT. Doctors at the Cleveland Clinic are planning for a surgery in early March to remove the tumor. It is curable, according toDr. Nathan Pennell, a staff physician in the department of solid tumor oncology at the Cleveland Clinic. He said lung cancer is "incredibly" rare for teenagers, and patients with lung cancer have an average age of 70. IMT shows up in less than one percent of lung cancers, but is more common for those under 40, like Kayleen.
Head & Neck Cancer Research Findings: Longer survival for HPV-positive cancers, the benefits of outpatient care
The Plain Dealer - Feb 20, 2014
Two chemoradiation regimens used to treat late-stage head and neck cancer had the same outcomes, but at very different price points, according to research conducted at the Cleveland Clinic...For several years Dr. John Greskovich Jr. a radiation oncologist at the Clinic's Taussig Cancer Institute, has been part of a Clinic committee that focuses on cost management. Once the clinical portion of the study had ended in late 2012, Greskovich led a team that conducted a cost analysis using information from the patients’ treatment start date to six months post-treatment.
Cleveland Clinic Part of Study Testing New Imaging Technology to Help Avoid Unneeded Breast Biopsy
The Plain Dealer - Feb 19, 2014
Cleveland Clinic is one of 16 sites across the country testing a new technology that someday could help cut down on the number of invasive biopsies of breast masses that end up being noncancerous...The Clinic is part of the PIONEER-01 trial, sponsored by a San Antonio-based medical imaging company that has developed an imaging device it hopes will lower the number of unnecessary biopsies. The trial is designed to gauge the effectiveness of Imagio, created by Seno Medical Instruments Inc., which combines ultrasound with opto-acoustics, an imaging technology based on sound and light..."Based on the type of imaging that's currently available, a lot of benign images look like malignant images," said surgeon Dr. Stephen Grobmyer, Section Head of the Breast Center at the Cleveland Clinic...Grobmyer is the principal investigator of the trial at the Clinic, which has analyzed information from the breast masses of 26 patients to date; nationally just over 1,000 women are participating. The goal is to collect data from more than 2,000 patients across the country.
FDA approves Imbruvica for CLL
Helio/HemOnc Today - Feb 12, 2014
The FDA today granted accelerated approval to ibrutinib for use in patients with previously treated chronic lymphocytic leukemia...Mitchell R. Smith, MD, PhD, Director of lymphoid malignancies at Cleveland Clinic Taussig Cancer Institute, offers his perspective.
Molecular Imaging Probes Detect Brain Tumors and Dispersed Cells
Reuters - Feb 7, 2014
Imaging probes that detect a protein segment found in brain and other cancers have successfully detected glioblastomas and 99% of the invasive cells these tumors disperse, in preclinical studies presented this week. The probes may be able to tag cancer cells for MRI and also for real-time fluorescent imaging to guide surgery, researchers say. "We can see tumor cells down to the single-cell level with the probes," lead investigator Dr. Susann Brady-Kalnay of Case Western Reserve University in Cleveland, Ohio told Reuters Health by phone.
SAVE THE DATE
Inaugural Case Comprehensive Cancer Center Academic Drug Development Seminar
The Inaugural Case Comprehensive Cancer Center Academic Drug Development Seminar, will be held on February 26 at 4pm in the Global Cardiovascular Innovation Center, 10000 Cedar Avenue. This first seminar will feature a presentation by Dr. Goutham Narla, Assistant Professor, Medicine and Transformative Molecular Medicine at CWRU/UH, on Drugging the Undruggable: Small Molecule Activators of Tumor Suppressor Genes.
As part of the Case CCC Developmental Therapeutics Program, this series will gather clinicians, scientists, medical chemists, computer-aided drug designers, screeners, and commercialization personnel in the same room as a stimulating presentation so that all attendees can learn and benefit from the sparked interaction.
Retreat: Engaging in Cultural Competence through Awareness, Knowledge and Action
Please mark your calendars for Thursday, March 13 from 2-5 pm to join the Case Comprehensive Cancer Center and the Case Center for Reducing Health Disparities as they explore issues related to cultural competence. Extend your knowledge and raise your awareness about the dynamic variety of people and communities the Case CCC serves. This retreat will feature a keynote address by Dr. Sonja Harris-Haywood, and will provide perspective on the growing need to be culturally competent and facilitate the impact of cultural beliefs within the health care setting, specifically in research.
The retreat is intended for investigators, research nurses, regulatory coordinators, outreach and training and education personnel. Pre-registration by Friday, March 7 is required. Please direct any questions to Katarzyna Karelus at 216.844.4176 or email@example.com.
Lung Cancer Research Foundation
The Lung Cancer Research Foundation is accepting applications for its funding program. The Foundation funds research it believes will make major contributions toward better treatments, screening, and prevention of lung cancer.
Deadline: June 16, 2014