2023 Cancer Center of Excellence Magazine

CANCE R C E N T ER OF EXC E LLE N CE MAGAZINE

Leading Quality Cancer Care and Research

Behind the Scenes Creating a Cancer Center of Excellence

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ollaboration between Gregg Fields, Ph.D, and Luis E. Raez, MD, FACP, had one main mission in mind: to certify the Memorial Cancer Institute Florida Atlantic University (MCIFAU) as a Florida Cancer Center of Excellence (FCCOE). Fields and Raez, co-directors of MCIFAU, met their goal in March 2021 and have since turned the certification into a powerhouse partnership that drives research and results.

“We have been able to create an important alliance to build cancer research in South Florida,” said Fields, interim vice president for Research and director of FAU’s Institute for Human Health and Disease Intervention (I-Health).

Consider this, the MCIFAU FCCOE has: • More than 110 members including physicians and scientists from MCI, FAU, The Herbert Wertheim UF Scripps Institute for Biomedical Innovation & Technology and Gift of Life.

•C linical research professor appointments in I-Health.

• A grant portfolio with funding from the National Cancer Institute (NCI), Florida Department of Health, Community Foundation of Broward, the pharmaceutical industry and philanthropy.

• A H. Lee Moffit Cancer Center partnership, with more than 25 Moffit physicians and Advanced Practice Providers working at Memorial Hospital West, allowing delivery of the best cellular therapy for patients with hematology malignancies including more than 450 procedures (CAR-T cell therapy, allogeneic and autologous marrow transplantations).

• Opened more than 65 clinical trials that provide access to patients with new agents that are not yet approved by the Food and Drug Administration (FDA), as well as being the first cancer center in Florida to enroll patients in two clinical trials with the agent LOXO-292, an oral tyrosine kinase inhibitor developed for patients that carry tumors with the RET translocations.

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Gregg Fields, Ph.D. Luis E. Raez, MD, FACP

“We were able to benefit a dozen patients that came from other cities in Florida and other countries like Peru, Brazil and Colombia after they failed standard therapy for lung, thyroid and colorectal cancers, two years before the FDA approval,” said Raez, chief scientific officer and medical director of MCI. “Our research portfolio has been increasing mainly around Phase I studies with new agents and basket and umbrella studies (multi-tumoral) that expedite the approval of more agents for cancer therapy.”

The MCIFAU FCCOE has also earned numerous accolades including being one of the main members of the NCI Alliance of Clinical Trials, being a cancer center of excellence for lung, breast and hematology malignant tumors and being the first certified Oncology Medical Home in Florida by the American Society of Clinical Oncology.

The MCIFAU FCCOE also benefits from graduate medical education, with 15 hematology/oncology fellows, it is one of the largest programs in the state of Florida, providing oncology education to internal medicine residents and medical students from training programs.

“We have many exciting new programs and projects that benefit our patients, such as the incidental pulmonary program, where we use artificial intelligence to help improve lung cancer detection, the creation of a biorepository for minority cancer patients (tumor bank), and the implementation of social determinants of health dashboards in the electronic medical records to help us eliminate disparities in cancer care,” Fields said.

“We firmly believe that this is only the beginning of our journey to become a destination for cancer patients in the Southeast United States and Latin America and we are working hard to achieve this goal.”

CANCE R CE NT ER OF EXCELLENCE

Managing Editor Cammi Clark, Ph.D. Contributing Writers Andres Alvarez, MD, Ph.D., Bethany Augliere, Alejandra Ergle, MD, Brian Gotkin, MD, Delia Guaqueta, MD, Jennifer Logue, MD, Maray Salina, Jose Sandoval-Sus, MD, Andrea Searle, RN, Carlos Silva, MD Photography Paige Russo, Katarzyna Bytnar, Alex Dolce, Jultmartin Eugene, iStock.com, Courtney Miller, Ph.D. Design and Graphics Craig Korn

Notice: Reasonable requests should be sent to the Division of Research at least 20 days in advance via dorcommunications@fau.edu.

Luis E. Raez, MD, FACP Chief Scientific Officer and Medical Director Memorial Cancer Institute/Memorial Healthcare System Co-Director MCIFAU Florida Department of Health Cancer Center of Excellence Research Professor Florida Atlantic University Clinical Professor of Medicine Florida International University 954-265-4325 lraez@mhs.net Gregg Fields, Ph.D. Interim Vice President, Research, Florida Atlantic University, Executive Director, FAU Institute for Human Health and Disease Intervention (I-Health) Co-Director, MCIFAU Florida Department of Health, Cancer Center of Excellence Professor, Department of Chemistry and Biochemistry 561-799-8577 fieldsg@fau.edu

2023

CONTENTS 4 Partnering for the Cure 6 Connecting Cancer and Epigenetics 8 Early Path to Prevention 10 Harnessing the Immune System 12 Fighting Back 14 Deep Ocean Drug Discovery 16 Screening to Save Lives 18 Addressing Racial Deficits 20 Road to Cancer Survivorship

URMA 2017 Survey

Member of the University Research Magazine Association

C AN C E R C E N T E R OF E XC E L L E N C E 3

Partnering for the

Cure

Collaboration Leads to Better Cancer Treatment for All

By Andres Alvarez, MD, Ph.D., Delia Guaqueta, MD, and Alejandra Ergle, MD

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o expedite finding new treatments for breast cancer and other solid tumors, Memorial Cancer Institute and Florida Atlantic University (MCIFAU), a Florida Cancer Center of Excellence, created a partnership focused on the development of clinical trial exploring the molecular biology of the tumors and the potential impact race/ethnicity can have on cancer behavior.

MCIFAU has one of the five largest breast cancer programs in the state of Florida with more than 900 new patients annually. Members are working to develop and advance breast cancer research on all fronts, including participating in several clinical trials with new FDA approved agents for breast cancer since 2004.

One of the biggest challenges of treating cancer is when it spreads, particularly to the brain. So, in addition to advancing treatment when cancer is caught early, MCIFAU scientists are searching for methods to tackle metastasized cancer. To do this research, they are using cutting-edge medical treatments like immunotherapy, radiosurgery, and targeted therapies, as well as clinical trials that incorporate CAR-T cell therapy for solid tumors, which uses the patient’s immune system as a tool to target cancer.

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Many MCIFAU clinical trials also address disparities, given the impact in outcome that has been noted when looking at survival based on a patient’s race and ethnicity. For example, according to the Breast Cancer Research Foundation, Black women have a 40% higher death rate from breast cancer compared to white women.

While some of these disparities are caused by the presence of social determinants of health, there is also a genetic component that is being explored.

MCIFAU oncologists, radiologists, pathologists, surgeons and scientists are collaborating on several projects that address these issues.

MCIFAU is also building a biorepository (tumor bank) which will help evaluate health outcomes in breast cancer patients. Scientists are using this biorepository to analyze biological and genetic factors to better understand the behavior of breast cancer, its causality, and how race impacts breast cancer outcomes.

“We hope to advance personalized medicine,” said Luis E. Raez, MD, medical director for MCI. “Together, we can make a significant contribution to the battle on cancer, reduce disparities in cancer outcomes, and ultimately improve the quality of life for cancer patients and their families.”

From left: Andres Alvarez, MD, Ph.D, director of clinical research, and Alejandra Ergle, MD, breast medical oncologist, Memorial Healthcare System

“… We hope to advance personalized medicine.

Together, we can make a significant contribution to the battle on cancer…”

– Luis E. Raez, MD

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Patrick Grant, Ph.D.

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Connecting Cancer

and Epigenetics Investigating Childhood Cancer Treatment Resistance

By Bethany Augliere

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he number of cases of childhood acute lymphoblastic leukemia (ALL) — a type of blood cancer — has steadily grown by about 0.7% annually since 1999. And for 10% of those cases, the cancer is resistant to treatment, such as chemotherapy, according to Patrick Grant, Ph.D., professor, Charles E. Schmidt College of Medicine and member of the Memorial Cancer Institute/Florida Atlantic University (MCIFAU) Florida Cancer Center of Excellence.

“The patients have very aggressive treatmentresistant leukemias and the thing is, we don’t fully understand what drives that,” Grant said. That’s where his epigenetics research comes into play, for which he recently earned a grant from the Florida Department of Health Live Like Bella Pediatric Cancer Research Initiative to learn more about how resistance works, in an effort to increase the fiveyear survival rate for high-risk patients. In ALL, 90% of patients survive past five years. But for 10%, they don’t survive five years and they are called very high-risk patients, Grant said.

While DNA of genes carry the genetic information in an individual, epigenetics is a process of how those genes turn on and off.

Behaviors and environment can cause changes and impact how genes work. For instance, consider identical twins. While they share the same DNA, their unique experiences in life will cause some genes and not others to express themselves. This is why identical twins may eventually look and behave differently.

Epigenetic mechanisms work by making chemical or physical changes to the cells. In one case, it’s by changing the proteins in cells, specifically histone proteins. Histone proteins bind to DNA and contribute to genes being turned on and off, which has implications for cancer cells and how they multiply or develop resistance to chemotherapies.

“What we believe is happening in treatment resistant patients is that they have activation of some of these epigenetic pathways that allow the cancer to escape treatment,” Grant said.

By understanding those pathways, Grant and other MCIFAU scientists could target them to restore that drug’s sensitivity in the cancer patient.

To examine those pathways, Grant and his research team begin by studying the chemical modification of histone proteins in cells and use genetically engineered histone proteins that can no longer be modified. Then, they test the cells for whether they’ve suddenly become sensitive to chemotherapies when they normally wouldn’t, he said. “That points us towards pathways of this histone modification that mediate resistance, and then further investigate these pathways in leukemia cells from children with cancer.”

“We’re missing something in our ability to help everybody, and it’s critical to find new targets for therapy, particularly for high-risk patients,” Grant said. “And the highest risk patients are the ones who are resistant to treatment.”

C AN C E R C E N T E R OF E XC E L L E N C E 7

Early Path

to Prevention

Guiding Young Breast Cancer Survivors

By Bethany Augliere

W

hen it comes to surviving breast cancer, a person’s age at diagnosis, genetics, racial and ethnic background, as well as socioeconomic status, all matter, according to Tarsha Jones, Ph.D., assistant professor, FAU’s Christine E. Lynn College of Nursing and member of the Memorial Cancer Institute/Florida Atlantic University (MCIFAU) Florida Cancer Center of Excellence.

Breast cancer kills nearly 44,000 people in the U.S. each year and 685,000 worldwide.

Addressing breast cancer is an urgent public health issue, Jones said. Each year, in the state of Florida, MCIFAU follows around 900 new patients with breast cancer from diagnosis to therapy to survivorship programs.

Young breast cancer survivors diagnosed prior to age 40 are a rapidly growing population in the U.S., with more than 12,000 young women diagnosed annually with breast cancer. Young women have profoundly different experiences compared to older women and face many challenges as they transition from active treatment into the survivorship period. For example, younger women experience:

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• Diagnosis strongly associated with mutations in breast cancer genes, such as the BRCA1/2 mutation • Delay in diagnosis • Larger tumors, advanced stage breast cancer, with node involvement, and biologically aggressive tumors such as triple negative breast cancer • Higher rates of recurrence • Development of contralateral breast cancer in the opposite breast • Higher mortality rate from breast cancer compared to older women with breast cancer Black and Hispanic/Latina young breast cancer survivors are particularly vulnerable. These women suffer greater cancer-related health disparities, with breast cancer being the leading cause of cancer-related deaths for both groups.

Black women in general have a 40% higher mortality rate from breast cancer compared to white women and Hispanic/Latina women are diagnosed with advanced stage cancer and have barriers to timely care, especially for those who are Spanish-speaking.

Jones said she seeks to understand the experiences of young racially and ethnically

diverse breast cancer survivors, particularly in South Florida, to improve survival and health outcomes for this population.

“Historically, research studies including my own previous work, have shown that there is an underutilization of genetic testing among young breast cancer survivors,” Jones said. “Genetic counseling followed by multigene panel testing is an absolute priority for these young women, regardless of race/ethnicity in order for them to understand their hereditary cancer risk.”

In addition, young women with positive genetic test results need decision support and resources for cancer risk management, she said.

Family risk communication and subsequent cascade genetic testing of at-risk relatives can potentially reduce disparities and ultimately save lives from breast cancer. However, genetic testing among unaffected high-risk family members remains low, Jones added.

“Our preliminary results show that the majority of young breast cancer survivors are completing genetic testing at the time of their diagnosis and are communicating their results to family members,” she said. “However, there remains a need to support survivors in which relatives disclose their results to and to encourage their

family members to get their own genetic tests and to make informed decisions for risk management.”

Tarsha Jones, Ph.D.

Jones’ research shows young survivors are reporting several unmet needs like ageappropriate information to manage breast cancer and to reduce their risk of recurrence and subsequent cancers. They also need peer-support from other young survivors, as young women feel overwhelmed with the multiple decisions that they face.

Jones recently received a National Institutes of Health Career Development Award, a fiveyear, $772,525 grant for a project to provide age-appropriate and culturally relevant information to diverse young survivors, addressing the need for multigene panel testing, promoting family communication, and providing women with decision support and actionable recommendations for riskreduction. Also, MCIFAU and leaders are taking steps to address cancer disparities in the state of Florida. For example, in 2021, the Florida Society of Clinical Oncology approved the organization of an annual national cancer disparities conference, currently entering a third year.

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Carlos Silva, MD, Moffitt Malignant Hematology and Cellular Therapy Program at Memorial Healthcare System 10 CA NCER CENTER OF E XCE LLE NCE

Harnessing the

Immune System Attacking Cancer with Precision

By Jose Sandoval-Sus, MD, Carlos Silva, MD, and Jennifer Logue, MD

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he immune system is the body’s army, comprised of white blood cells that fight foes like cancer. When cancer overcomes natural defenses and makes chemotherapy ineffective, scientists can harness the immune system to “waken” anti-cancer protection. These immunotherapies can cure cancer by targeting tumor proteins. Most recently, chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a tool to treat blood cancers.

CAR T-cells are “living drugs” made from T-cells, the “patrol and attack” cells of the immune system, re-engineered to “enhance” cancer killing. By adding the CAR protein to the T-cell surface, they recognize and kill tumors that carry a specific marker. Current CAR-T therapies approved by the Food and Drug Administration (FDA) target CD19, a marker of B-cells, or BCMA, a multiple myeloma (MM) marker.

Did you know?

Through the partnership with Moffit Cancer Center, more than 25 Moffit physicians and advanced practice providers work at Memorial Healthcare System, allowing delivery of the cellular therapy for patients with hematology malignancies including more than 450 procedures (CAR-T cell therapy, allogeneic and autologous marrow transplantations).

Since 2017, the FDA has approved four CAR-T therapies for B-cell acute lymphoblastic leukemia (B-ALL), large B-cell lymphoma (LBCL), follicular lymphoma (FL), and mantle cell lymphoma (MCL). With each indication, at least 40% of patients who previously had dismal outcomes are now surviving. Tisagenlecleucel (Kymriah) was the first approved CAR T-cell for children and young adults with relapsed/refractory (R/R) B-ALL, followed by axicabtagene ciloleucel (Yescarta) for adults with R/R

LBCL. Kymriah and lisocabtagene maraleucel (Breyanzi) are also approved to treat adult R/R LBCL. Yescarta and Kymriah were later approved for adult R/R FL. Brexucabtagene autoleucel (Tecartus) is available for adults with R/R B-ALL or MCL. Idecabtagene vicleucel (Abecma) was the first FDA-approved anti-BCMA CAR T-cell for adult MM patients with ≥ 4 prior lines of therapy, followed by ciltacabtagene autoleucel (Carvykti). Even in 2023, MM remains incurable and requires ongoing treatments; CAR-T allows patients to live one to two years off therapy without progression.

Distinctive CAR-T side effects are cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. The severity dictates management and may include corticosteroids and specialized antibodies.

Other CAR-T associated effects include infections and low blood counts.

In 2017, Moffitt Cancer Center and Memorial Healthcare System established a high-quality Malignant Hematology and Cellular Therapy program. The first CAR-T procedures in 2020 were via a clinical trial for MM, and in September 2021, the first patient was treated with Yescarta. The program has grown to 28 patients treated, six cellular therapy physicians, a dedicated multidisciplinary team, approved CAR-T therapy for ALL and lymphomas, and recent Foundation for the Accreditation of Cellular Therapy re-accreditation.

C AN C E R C E N T E R OF E XC E L L E N C E 11

Fighting

Back

Courtney Miller, Ph.D.

Researcher Develops Promising New Treatment for Brain Cancer

By Bethany Augliere

F

or people who develop glioblastoma, a type of aggressive and difficult-to-treat brain cancer, the five-year survival rate is 6.8%. By targeting a specific protein in the brain, Courtney Miller, Ph.D., a member of the Memorial Cancer Institute Florida Atlantic Cancer Center of Excellence, said she hopes to find better treatment options. “The current standard of care only extends lifespan by three to four months,” she said.

Miller, director of academic affairs and a professor at The Herbert Wertheim UF Scripps Institute for Biomedical Innovation & Technology in Jupiter, as well as the co-founder of Myosin Therapeutics, has developed a compound, called MT-125, to attack glioblastoma cancer cells in two ways.

It’s already showing promising results in mouse models, she said.

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With glioblastoma, there are two problems to address when it comes to treatment. The first is proliferation, where “the tumor cells just divide like crazy,” she said. There’s also invasion, where the tumor cells migrate and invade the healthy brain tissue. Invasion is particularly problematic because you cannot remove the tumor with surgery without causing too much damage to the brain.

“Most therapeutics in development target preventing growth, but they don’t address the issue of cancer cells migrating throughout the brain,” Miller said.

The compound Miller and her collaborators are developing targets a protein called myosin.

When MT-125 binds to myosin IIA, it prevents cancerous cells from altering their physical shape enabling them to spread to healthy tissue.

MT-125 also alters the structure

of myosin IIB, which prevents the tumor from growing by blocking cell division. This twopronged approach makes it different from other glioblastoma treatment options, Miller said.

It offers another benefit too. A common problem with treating cancer is developing resistance to treatment, whether it is chemotherapy or radiation. With Miller’s compound, it increases sensitivity to radiation.

Miller and colleagues are in the process of turning the compound into a drug. They’ve begun safety pharmacology studies, which examines the physiological impact of a substance in the therapeutic range and above.

So far, it’s well-tolerated in mice with no dangerous side effects. “We’re feeling really confident about moving it forward,” Miller said.

“Maybe early 2025 for a clinical trial.”

Coronal brain section label of active neurons in the brain

3D illustration tracing connections in the brain

High magnification of neurons Courtney Miller, Ph.D.

C AN C E R C E N T E R OF E XC E L L E N C E 13

Esther Guzmán, Ph.D.

Amy Wright, Ph.D. Marine organisms found in the deep sea off the coast of Florida, used to identify chemicals that can treat some of the most aggressive cancers, like pancreatic and triplenegative breast cancers.

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Deep Ocean

Drug Discovery Exploring the Sea for Cancer Cures

By Bethany Augliere

R

esearchers at the FAU Harbor Branch Oceanographic Institute Marine Biomedical and Biotechnology Research Program aim to use marine biotechnology to improve medicine and help save lives.

“Natural products are small organic molecules made by plants, animals and microorganisms, which are not essential to sustain life but provide advantages to the producing organisms,” said Amy Wright, Ph.D., research professor at FAU Harbor Branch and principal investigator of the natural products chemistry team. Natural products are used every day as medicines, she said. Since the oceans cover 70% of the planet and hold 50 to 80% of the biological diversity of the planet, it makes sense to expect that new medicines will come from marine sources, she said, including those to treat cancer.

“Cancer is not a single disease, but a collection of hundreds of diseases which share in common that cells in some part of the body are growing uncontrollably, or failing to die, and these cells contain damaged or mutated DNA,” said Esther Guzmán, Ph.D., research professor at the FAU Harbor Branch and principal investigator of the cancer cell biology team.

In one of their projects, the researchers grew triple negative breast cancer cells in 3D cell culture, called spheroids, to identify marine natural products that induce programmed cell death. This led to the identification of compounds that kill the cancer cells. In addition, they found that the compounds show synergy with paclitaxel, a drug used to treat triple negative breast cancer. This means that the combination of paclitaxel and the compounds works better than the simple addition of their individual activities, said Guzmán, which is of importance because patients can become resistant to paclitaxel. The compounds identified can help overcome this resistance. The work was done under a Florida Bankhead Coley Research Program grant. Researchers are in the process of securing more funding to do more work to move these compounds closer to the clinic.

Another project by the team focuses on cancers with mutations in Ras proteins, as these cancers are some of the most aggressive and include lung cancers, the leading cause of cancer death, pancreatic cancers, the fourth leading cause of cancer death, and breast cancers, the second leading cause of cancer death among women, Guzmán said. Mutations in Ras can lead to the activation of unusual pathways to obtain nutrients

that are beneficial to the cancer and bad for the patient. The researchers tested materials from FAU's marine natural products library to identify compounds that inhibit these pathways in pancreatic cancer cells. This data was used in a proposal for a newly awarded three-year grant from the Florida Bankhead Coley Research Program to continue the work. Compounds with the ability to inhibit these pathways have the potential to be used in the treatment of pancreatic cancer, as these cancer cells depend on these processes to grow.

Pancreatic cancer cells also express receptors such as FoxP3 and B7-H4 that help the cancer cells evade an immune response, Guzmán said. Researchers are also searching for marine natural compounds that can lower the expression of these receptors.

“Restoring an immune response may allow patients to see better clinical responses,” she said.

“Marine natural products have many activities that could help us fight aggressive cancers,” Guzmán said. “Our work aims to identify and investigate them with the intent of having some of them reach the clinic and help cancer patients.”

Note: Wright and Guzman are members of the Memorial Cancer Institute Florida Cancer Center of Excellence.

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Screening

to Save Lives Working Together to Promote Early Lung Cancer Detection

By Brian Gotkin, MD, and Andrea Searle, RN

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ung cancer is the leading cause of cancer-related deaths in the United States, according to the American Cancer Society. It accounts for more deaths annually than colon, breast and prostate cancer combined. Until recently, no screening tools existed for lung cancer.

That’s why the Memorial Cancer Institute/ Florida Atlantic University, (MCIFAU) as part of the Memorial Healthcare System is fighting back against lung cancer with the addition of a Lung Cancer Screening program and Incidental Lung Nodule program. These two programs consist of a multidisciplinary team including pulmonologists, thoracic surgeons, radiologists, nurse navigators and oncologists to detect lung cancer at an early stage.

of the chest. This scan is one way to find the cancer in its earliest stages while it is still treatable.

Criteria for lung cancer screening includes people between the ages of 50 and 80, who have smoked the equivalent of one pack a day for 20 years or more, and have either continued to smoke or have quit within 15 years. Ages 50 or older, who have a history of lung disease, family history of lung cancer, or known exposure to toxins, such as radon, are also eligible.

Most insurance companies cover the cost of screening. If insurance does not, MCI has a program that only charges $99 (self-pay rate).

The goal of lung cancer screening is to detect lung cancer at an early, treatable stage.

Lung Cancer Screening

Incidental Lung Nodule program

In 2011, the National Lung Cancer Screening Trial demonstrated a significant reduction in lung cancer mortality with low-dose CT scans

Lung nodules (spots, shadows and lesions) are common and can be an early sign of cancer or can be benign lesions. MCI has partnered

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with emergency room physicians to review all incidental lung nodules found on CT scans done through the emergency room. By reviewing these nodules, which could be either benign or cancerous, the goal is to diagnose cancer early — keeping people out of emergency rooms years later for metastatic lung cancer.

The addition of these programs will help MCIFAU save lives, according to Brian Gotkin, MD, leader of the pulmonary division. “We purchased a software program that will help create a dashboard to assist in the care coordination of high-risk patients throughout our health care system. Additionally, we are educating the community by sponsoring activities like educational roundtable discussion dinners with providers in the area,” Gotkin said. “For several years, we have been a certified Lung Cancer Center of Excellence for our screening efforts with these programs and other important achievements of our lung cancer program."

Did you know?

To prevent one cancer-related death, it takes

1,904

screenings for breast cancer

Only

1,250

320

screenings for colon cancer

screenings for lung cancer

Early detection of lung cancer reduces mortality.

The five-year survival rate of stage 1 lung cancer is Brian Gotkin, MD, medical director for adult pulmonology, Memorial Healthcare System

69 to 92%

as compared with only a

0-10%

“For several years, we have been a certified Lung Cancer Center of Excellence for our screening efforts with these programs and other important achievements of our lung cancer program."

– Brian Gotkin, MD

survival rate for stage 4 lung cancer.

The benefit of lung cancer screening increases survival in

20%,

which is larger than the benefit achieved with other screening tools (mammogram, pap smear, prostate-specific antigen test, colonoscopy).

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Addressing

Racial Deficits Collaboration to Make Cancer Research More Inclusive

By Bethany Augliere

A

t the Memorial Healthcare System’s Cancer Institute (MCI) 19% of patients are Black, and another 19% are Hispanic, reflecting the diversity of South Florida. But the studies that have fueled progress in cancer care have focused on white patients to the exclusion of others. A collaborative effort between the Florida Atlantic University and MCI is addressing this long-standing deficit.

“Cancer research, like the rest of medicine, faces a major challenge right now,” said Gregg Fields, Ph.D., interim vice president, FAU’s Division of Research, and executive director, Institute for Human Health and Disease Intervention (I-Health). “We know certain diseases, including cancer, hit some racial or ethnic groups harder than others and that some treatment strategies aren’t equally effective for everyone.”

Gregg Fields, Ph.D.

The partnership between MCI and FAU, which the state has designated as a Florida Department of Health Cancer Center of Excellence (CCE), leverages the two institutions’ combined research and medical expertise to move toward a solution. Together, they are gathering and storing samples and information from predominantly Black or Hispanic patients — contributions that will fuel studies to better understand and treat this devastating disease.

The researchers are establishing a biospecimen repository that covers a wide range of solid tumors.

Biospecimens are housed in FAU’s Clinical Research

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Unit on the Boca Raton campus and I-Health on the Jupiter campus. Teams are collecting specimens from several solid tumors, including breast, lung and pancreatic cancer.

Two grants totaling $500,000 from the Community Foundation of Broward Cancel Cancer and Mary N. Porter Cancer Research Fund of The Community Foundation of Broward, fund a team from MCI has recruited patients. Those who participate receive screening and treatment, and they have the option of contributing blood, and, if they have cancer, tumor tissue to the research effort.

Once samples are collected, researchers at FAU will step in to search for genetic differences in patient populations. For example, they are evaluating changes in a single letter of the DNA code, unique to Black and Hispanic women affected by breast cancer. By creating genetic profiles of patients and following how the women fare, researchers hope to better understand how genetic factors can play into disparities in treatment outcomes.

There’s still a lot to be done, but Fields, who is also co-director, CCE, said he is optimistic about what patient contributions today could mean for the future. “What we’ve learned is that using samples from patients gives us much more accurate information, especially when it comes to treatment strategies,” he said.

“What we’ve learned is that using samples from patients gives us much more accurate information, especially when it comes to treatment strategies.”

– Gregg Fields, Ph.D.

Steven Reinhardt, Ph.D., research coordinator of the FAU Clinical Research Unit, adds patient samples to the biorepository.

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Layla Silverman, clinical nutrition coordinator, Memorial Healthcare System

From left: Leonard McKhan, patient and family navigator; Carol Burgan, social worker; Donna Derby, social worker; Layla Silverman, clinical nutrition coordinator; Stephanie Roberts, patient advocate; Maray Salina, director of supportive care services, Memorial Cancer Institute (MCI); Alex Royes, Chaplain for MCI; Glorymar Dorta, patient and family navigator; Yesenia Rosario, patient and family navigator

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Road to

Cancer Survivorship A Team Approach to Guide Patients

By Maray Salina

C

ancer can completely overturn life for patients and their families. The Memorial Cancer Institute/Florida Atlantic University (MCIFAU) team wants patients and caregivers to know they are not alone in the survivorship journey, and there are several supporting programs like oncology support services and integrative medicine, at MCIFAU. The importance of survivorship is recognized from the time of diagnosis and throughout the continuum of care. It extends to the families and caregivers as a cancer diagnosis touches many aspects of patients’ lives. The definition of survivorship is personal and unique to everyone.

Important components of survivorship to keep in the forefront of patients’ health plans include a focus on prevention of other diseases not related to cancer (diabetes, hypertension and others), delivery and understanding of survivorship care plans with treatment summaries, linkage to primary care providers and other specialists, surveillance of recurrence or new cancers, as well as empowerment and spiritual growth.

Survivorship care is complex, and a team approach is imperative to ensure successful outcomes. Dealing with short-term and long-

term side effects of cancer is also a relevant component of life after a cancer diagnosis. It is important to have an infrastructure to properly screen and address side effects of cancer diagnosis and treatment, which can range from simple to complex. Side effects can include physiological, socio-economical, spiritual and/or emotional conditions. Research has shown that patients who feel supported experience better health outcomes.

MCIFAU offers an array of comprehensive support services to complement the treatment plans from doctors and other health care providers within oncology.

These services include of nutrition counseling, support groups, chaplains and spiritual services, social workers, financial navigators, psychologists, exercise physiologists, patient advocate and more. (For a complete list, see the next page.)

Services and providers are part of the patient’s team, and they play a crucial role in the oncology care plan and delivery. Each specialty can play a significant role in cancer care and survivorship by decreasing fear and anxiety.

The Oncology Support Services (OSS) team also collaborates with community partners to leverage available resources and to advocate for grants to eliminate as many barriers to care as possible. The team has successfully secured numerous grants to aid patients with transportation, lodging and other social determinants of health needs. The team members take time to educate patients, answer questions and provide tools the patients will find helpful. Many of these services are complimentary to avoid further financial toxicity to patients. The education by the OSS team extends to caregivers, loved ones and the community as the team delivers informational presentations relevant to cancer care, challenges and how to overcome these. The Integrative Medicine (IM) team helps heal the body and soul with multiple interventions like acupuncture, massage therapy, sleep evaluations and the use of integrative medicines.

It is important not to wait until active treatment is completed to foresee and screen for potential side effects of a cancer diagnosis. Medical teams try to introduce patients to the OSS and IM programs early, helping patients better plan care and reinforce to patients that they are not alone.

C AN C E R C E N T E R OF E XC E L L E N C E 2 1

Cancer Support Services

Alex Royes, Chaplain for Memorial Cancer Institute

MCI offers a variety of services to provide comprehensive and compassionate care to patients, families and caregivers during and after treatment. The team strives to enhance quality of life and remove barriers to care.

Here’s a look:

A PATIENT NAVIGATOR is the main point of contact throughout a patient’s cancer journey. These specially trained health care providers guide patients, coordinate care and connect patients with other team members offering a wide array of cancer resources and services.

QUICK CARE CLINIC providers treat cancer symptoms and therapy side effects quickly and efficiently over the phone, via telehealth and in the clinic. With help from Quick Care, patients might avoid a trip to the emergency department.

NUTRITION COUNSELING from experienced registered dietitians helps ease nutrition issues from cancer and its treatment, including free healthy eating classes for patients and families.

PALLIATIVE CARE provides relief from cancer symptoms and stresses.

This type of specialized medical care is available at any time from diagnosis through survivorship.

INTEGRATIVE MEDICINE uses holistic practices such as acupuncture, massage, mindfulness, nutrition, yoga and exercise to help relieve cancer symptoms and the side effects of treatment.

CANCER REHABILITATION helps patients heal physically and emotionally after cancer treatment to achieve the highest possible function and quality of life.

EMOTIONAL SUPPORT from clinical psychologists helps patients and caregivers manage the mental health challenges that can come with a cancer diagnosis.

SPIRITUAL CARE from interfaith chaplains guides patients and families toward healing the spirit and soul during and after an illness.

SOCIAL SERVICES and resources from oncology social workers assist with the nonmedical aspects of cancer, such as employment and financial concerns.

Social workers are counselors who can help with emotional distress.

IMAGE RECOVERY CENTER helps patients regain a positive self-image with personalized consultations for wigs, specialized garments, spa services and care products.

Patients are also offered the option to meet with a patient advocate and financial navigator. *Most services are offered free of charge to patients and caregivers.

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SUPPORT GROUPS for patients and caregivers offer encouragement, community and hope during unfamiliar and uncertain times.

NEXT STEP classes for patients and caregivers.

One of only six Cancer Center of Excellence in Florida.

Memorial Healthcare System’s groundbreaking partnership with Florida Atlantic University has led to a Florida Cancer Center of Excellence designation for Memorial Cancer Institute and FAU. One of six cancer centers in the state to earn this designation, our partnership combines FAU research and Memorial cancer expertise, providing patients with greater access to clinical trials.

Memorial Cancer Institute and FAU — stronger together in providing advanced cancer care for our patients.

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LEADING QUALIT Y CANCER CARE AND RESEARCH