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SUMMER 2020

08 COVID-19 +

CANCER FAQ

12 SOCIAL MEDIA +

THE WAR ON CANCER

20 THE HOPE

NETWORK

THE RIDE OF

HER LIFE


CONTENTS

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HEADLINES

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COVID-19 + CANCER FAQ

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COMMUNITY

12 FOCUS

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PARTNERS

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MEET A TEAM MEMBER

Director, UF Health Cancer Center JONATHAN D. LICHT, M.D. Chief Communications Officer, UF Health MELANIE FRIDL ROSS, M.S.J., E.L.S. Assistant Communications Director MARILEE GRIFFIN Communications Support KACEY FINCH Designer J&S DESIGN

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WELCOME. Thank you for picking up this issue of UF Health Cancer Center Cares, the patient newsletter for the UF Health Cancer Center — an organization Greetings dedicated to from the serving the Director residents of Florida through the provision of state-of-the-art cancer treatment, prevention, control and education. Our cancer experts work to ensure coordinated care is available to each patient through diagnosis, treatment and recovery. Our goal is to enhance the tools that help to prevent, detect and ultimately treat cancer.

Jonathan Licht, M.D.

For more information about the care and services offered at the UF Health Cancer Center, please call 352-273-8689.


HEADLINES

CALL IT QUITS UF Health researchers find medication most effective quitting method for cancer survivors who smoke

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or years, evidence has shown the negative effects that smoking cigarettes has on cancer patients’ health outcomes, but sometimes quitting is easier said than done. Now University of Florida researchers have found that medications that help people quit smoking are the most effective method used by cancer survivors to stop tobacco use. Using data from a year-long national survey of smokers in the United States conducted by the National Institutes of Health and the U.S. Food and Drug Administration, the researchers focused on the cessation methods used by 565 adult cancer survivors who were past-year smokers and the success of those methods.

location and is outside of controlled environments, like a clinical trial,” said Ramzi Salloum, Ph.D., lead author and an assistant professor in the UF College of Medicine’s department of health outcomes and biomedical informatics. “This is real-world information about cancer survivors who smoke and their attempts to quit smoking.” The researchers found that medications that help people quit smoking — also called smoking cessation medications — were effective in cancer survivors’ attempts to quit smoking when used alone and in combination with other methods, such as behavioral therapy, unassisted attempts and e-cigarettes. Using these

RESEARCHERS FOUND THAT MEDICATIONS THAT HELP PEOPLE QUIT SMOKING — ALSO CALLED SMOKING CESSATION MEDICATIONS — WERE EFFECTIVE IN CANCER SURVIVORS’ ATTEMPTS TO QUIT SMOKING ...

“To our knowledge, this is the first population-based study that’s looking at a sample that represents the entire U.S. population instead of a single

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HEADLINES

The study also highlights the importance of quitting smoking after receiving a cancer diagnosis, Salloum said. Some patients may think it is too late to quit smoking after already being diagnosed with cancer, but cessation has been proven to have “This is important because the health and financial step of offering benefits for these smoking cessation SMOKING patients, such as medication may CESSATION IS increased treatment be overlooked effectiveness, during the course MORE CRUCIAL risk of cancer of a patient’s overall THAN EVER FOR reduced recurrence and lower cancer treatment,” CANCER PATIENTS treatment costs. said Salloum, also a UF Health WHO ARE NOW “The period around Cancer Center FACING THE ADDED a cancer diagnosis member. “This RISK OF THE NOVEL may be a stressful study highlights time for a cancer the importance CORONAVIRUS, patient,” Salloum said. of including COVID-19. “The decision to quit smoking cessation smoking is something medication as a part that patients actually of the treatment for can have control over, whereas they cancer patients who smoke.” medications, which are recommended by the FDA and by clinical practice guidelines for smoking cessation, 28.5% of the smokers successfully quit smoking.

may feel that they have less control over other aspects of their life.” Currently, the National Cancer Institute is leading an initiative to support implementation of smoking cessation programs at cancer centers across the country, because although oncologists recognize the importance of cancer patients quitting smoking, tobacco cessation has not been consistently addressed as a part of routine oncology practice. “This study could inform that initiative in terms of highlighting the importance of medication use,” Salloum said. “Cessation medications are potentially lower cost and may be easier to implement compared with other cessation methods.” Smoking cessation is more crucial than ever for cancer patients who are now facing the added risk of the novel coronavirus, COVID-19. While the exact impact of COVID-19 on smokers and cancer patients who smoke is still being studied, it is known that COVID-19 is a respiratory disease and smoking is particularly harmful to the respiratory system. “Smoking cessation can only benefit patients when it comes to the potential threat of COVID-19,” Salloum said. “It’s definitely an opportune time to consider smoking cessation if a cancer patient is currently smoking.” The study, “Smoking-Cessation Methods and Outcomes Among Cancer Survivors,” was published online in May by the American Journal of Preventive Medicine. It was co-authored by fellow UF Health Cancer Center members Ji-Hyun Lee, Dr.PH., and Chengguo Xing, Ph.D., and was funded in part by the Cancer Center.

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IN THE NEWS

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Researchers find new details of immune system’s molecular “switch”

UF researchers discover breakthrough anticancer drug Researchers have discovered a safer and more effective anticancer drug to target leukemia, lymphoma, and breast and lung cancers. Known Daohong Zhou, M.D. as DT2216, the drug acts on a protein called B-cell lymphomaextra-large, or BCL-XL, which fuels the growth of malignant cells Guangrong Zheng, and strengthens their resistance Ph.D. to therapy. The researchers demonstrated in mathematical and mouse models that DT2216 suppressed the growth of several tumors on its own and in combination with other drugs.

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A group led by a UF Health researcher found out how one molecular “switch” influences the immune system — a finding they say has major Dorina Avram, implications Ph.D. for future treatments for immune system diseases and cancer. The absence of a specific gene — known as Bcl11b — in regulatory T cells triggers fatal systemic inflammation in mice. When the Bcl11b gene is absent, T cells are unable to function normally to control multiorgan inflammation in the lungs, liver, skin and kidneys.

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Researchers find link between demographics and liver cancer A study by UF Health researchers found that Hispanics, as well as the elderly and people with diabetes, have a higher risk of developing liver cancer. The findings showed alcoholic and nonalcoholic fatty liver disease, which are distinguished by the patient’s alcohol consumption, share the same cancer risk factors, suggesting demographic differences may be what puts some patients more at risk of developing liver cancer. Those over the age of 60 are almost four Ali Zarrinpar, times more at M.D., Ph.D. risk, whereas Hispanics and diabetics are nearly two times at risk.

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Researchers identify nine noncancer drugs with potential to improve cancer survival UF Health researchers sifting through millions of electronic health records found Yonghui Wu, Ph.D. evidence that nine drugs already being used to treat other health conditions may also have the potential to improve cancer survival. The researchers, led by Yonghui Wu, Ph.D., hope that with additional study, some of these drugs — currently used to treat noncancerous health conditions such as high cholesterol, acid reflux, hypertension and diabetes — could be repurposed as effective cancer treatments.

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HEADLINES

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Researcher finds link between common food poison toxin and colorectal cancer

New hepatitis C therapy effective, costs less for patients and payers, UF researchers find

UF researchers led by Christian Jobin, Ph.D., have found a link between colorectal cancer in mice and the most commonly Christian Jobin, Ph.D. reported bacterial cause of food poisoning in the United States. One of the key findings of the current cancer study is that using inflammatory inhibitors in a mouse model prevented inflammation and cancer, suggesting the capability to manipulate cancer-causing activity of C. jejuni. It’s possible that carrying C. jejuni might also put humans at higher risk of cancer.

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UF researchers examined the clinical and economic outcomes of directacting antiviral therapy, which cures hepatitis C in nearly 95% of patients. When left untreated, hepatitis C can cause liver cancer; cirrhosis, or liver scarring; and other serious liver problems. In a finding the researchers called “disturbing,” 70% of David Nelson, M.D. hepatitis C patients in the nationwide health insurance database analyzed in the study had not received treatment, reflecting expensive drug costs and prior authorization policies. Haesuk Park, Ph.D.

Study provides guidance to avoid unnecessary thyroid biopsy A group led by UF Health researcher Naykky Singh Ospina, M.D., authored an analysis of the medical literature to give physicians a handy reference on strategies for the diagnosis, treatment and monitoring of thyroid nodules. Naykky Singh It’s critically Ospina, M.D. important to have a discussion with the patient about the best approach given their situation, clinical presentation and their estimated risk of thyroid cancer. The researchers hope physicians discuss the clinical evidence and collaborate with patients when making the decision on whether to do a biopsy or monitor with ultrasound.

CORONAVIRUS NEWS Certain compounds may block coronavirus from cells, UF Health researcher finds Computer simulations run by a UF Health researcher have shown that three compounds appear to have the potential to block cells from being infected by the novel coronavirus COVID-19. The next step involves validation of the findings by David A. Ostrov, Ph.D., the Targeted Therapeutics Program leader at the UF Health Cancer Center. The simulations were run at the request of the Global Virus Network, an international group of scientists who are working together to combat viral disease.

Developing a next-generation coronavirus test for home use Piyush Jain, Ph.D., was headed home from another late night in his University of Florida lab when he got the word from his grad student — the rapid test they had been trying to develop for the novel coronavirus worked. While not yet approved for commercial use, the test uses a strip comparable to a pregnancy test to give a quick visual indicator of the presence of the coronavirus in the body. Although it has not yet been tested in humans, the goal is a test that can be done in minutes, eliminating the need for a trip to a health care facility.

L E AR N MOR E : TO STAY CUR R ENT WITH O UR L ATEST N EWS, PLE A SE VI SIT C ANCER . UFL . ED U.

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PREVENTION Tobacco Impact in the Our Area

2019 WAS A BIG YEAR for the UF Health Cancer Center’s Office of Community Outreach and Engagement in terms of impact on disseminating leading edge tobacco research and implementing broad policy change. While cigarette smoking continues to decline in Florida, rates in our catchment area remain some of the highest in the state, and lung cancer is the No. 1 diagnosed cancer in our 22-county catchment area. With these statistics in mind, the COE office set its sights on a multi-level strategy to address tobacco use guided by the efforts of our partners — Tobacco Free Alachua and Suwannee River Area Health Education Center. In January 2019, “Tobacco 21,” a county wide policy that raises the legal age of tobacco sales from 18 to 21 and creates a 1,000-foot buffer for tobacco sales around schools, was passed unanimously by the Alachua County Board of County Commissioners. This decision was a historic win, as Alachua became the first county in Florida to implement this important policy change and came after years of work by Tobacco Free Alachua, a dedicated group that works to achieve “A Tobacco Free Life for All Floridians.” Sarah M. Szurek, Ph.D., Community Outreach and Engagement’s program director, and other UF faculty and staff went on official record at the County Commission hearing to present data on the catchment area’s tobacco use and lung cancer burden. The work of Tobacco 21 continues, as well as our partnership with Tobacco Free Alachua to oversee policy implementation by disseminating

Tobacco Free Alachua team

OFFICE OF COMMUNITY OUTREACH AND ENGAGEMENT

the regulations to local businesses and sharing strategies within and beyond our catchment area. In May 2019, Suwannee River Area Health Education Center held its Annual Rural Tobacco Summit. The Community Outreach and Engagement office facilitated this outreach event by supporting the travel of two UF researchers, Ramzi Salloum, Ph.D., and Jaclyn Hall, Ph.D. Dr. Salloum presented his research on how informational inserts in tobacco packages have been successful in other countries. Dr. Hall talked about correlations between dollar stores selling tobacco and tobacco use in rural communities. The summit presenters also discussed ongoing and broad systems change, as Area Health Education Center Program Offices and Centers work extensively with health care systems to integrate strategies that ensure tobacco use is assessed and treated at every patient encounter. The summit successfully engaged tobacco control advocates, hospital administrators, researchers and clinicians to identify solutions to impact tobacco use disparities in rural communities.

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COVID-19 + CANCER FAQ Cancer doesn’t stop — not even for COVID-19 The unknowns surrounding the novel coronavirus are leaving people concerned, especially patients who suffer from weakened immune systems as a result of cancer treatment. Stay-at-home restrictions are beginning to lift in several areas across the United States, but immunosuppressed cancer patients are still at high risk of falling seriously ill from COVID-19. In a series of webinars co-hosted by the UF Health Cancer Center’s Community Outreach and Engagement office, Christopher Cogle, M.D., a UF professor of medicine; Amar Kelkar, M.D., a UF hematology and oncology fellow; Merry-Jennifer Markham, M.D., FACP, FASCO, associate director for medical affairs at the Cancer Center, provided information for cancer patients, survivors, caregivers and providers on how to best navigate cancer treatment and survivorship during the coronavirus pandemic. Here are some of their answers to COVID-19 questions cancer patients may have:

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What is COVID-19? How can I contract it? How can I prevent it? Coronaviruses are a family of viruses that typically cause respiratory illness. COVID-19 is caused by a novel coronavirus originating from an outbreak in Wuhan, China. COVID-19 spreads from person to person through droplets released into the air by infected individuals. These droplets can also live on surfaces for several hours to days. Other people contract the disease by breathing in the droplets or touching infected surfaces and then touching their

eyes, nose or mouth. Symptoms of this coronavirus include cough, fever, shortness of breath, muscle aches, sore throat and loss of taste or smell. Currently, there is no vaccine for COVID-19, so prevention includes washing hands frequently, staying home and wearing a mask to prevent touching your face. To learn more about COVID-19, check out the Centers for Disease Control and Prevention’s fact sheet.

Is it safe to delay my cancer screening test or risk-reducing surgery if I have a hereditary cancer syndrome? How long is it safe to delay? For patients with an increased risk of cancer due to a hereditary syndrome, the safety of delaying a cancer screening or a risk-reducing surgery depends on the individual patient and their medical history. Patients and their doctors must weigh the risks associated with not delaying — the risk of becoming very ill with COVID-19 if exposed

during a health care visit versus the risk of cancer being diagnosed through a screening test. It is unknown how long is it safe to delay preventive cancer surgery. However, it is important to note that your doctor will only suggest delaying screening or surgery if it is safe for you to do so.


Am I at higher risk of becoming critically ill? According to the American Cancer Society, cancer patients fall in the high-risk category due to weakened immune systems caused by cancer and its treatments. Being high risk means cancer patients are more likely to become seriously ill from COVID-19, which could include pneumonia and multi-organ system failure. Cancer survivors will likely have a recovered, normal immune system but current and past cancer patients should consult their doctor regarding COVID-19. The type of treatment a patient receives factors into their immunosuppression. So, what treatments suppress the immune system? • Chemotherapy does. Immunosuppression can be measured by the white blood cell count. However, the immune system is sometimes weakened even if the white blood cell count isn’t lowered. There is no definite answer on how long immunosuppression

from chemotherapy can last. It often depends on the type of chemotherapy and the type of cancer. • Immunotherapy doesn’t. In some cases, this treatment option can actually strengthen the immune system. However, doctors are not sure what impact it has on COVID-19 infections or symptoms. • Biologic agents may or may not. Many times, they don’t affect the immune system but this may vary by medication. It is important to discuss your risk with your doctor. • Radiation does. Radiation is known to cause immunosuppression for some period of time. • Surgery does. Immunosuppression from surgery may last for about a month, but it also depends on the type of surgery. For example, a splenectomy (surgery to remove the spleen) may result in chronic immunosuppression to some degree since the spleen plays a large part in the body’s normal immune function.

When should I… Call my doctor? You should call your oncologist as soon as you show symptoms, including fever, cough, fatigue, diarrhea, dehydration or worsening cancer symptoms, or if someone in your home tests positive for COVID-19. Get tested? Seek a COVID-19 test when you present with fever or cough. The COVID-19 Call Center is available 24/7 at 866-779-6121 or COVID-19@flhealth.gov. You can get tested at county health departments or drive-thru test sites (with a referral from your doctor). Go to the hospital? Try to avoid the hospital unless you begin to experience shortness of breath, a low white blood cell count or fever with a medical history of a transplant. Why is or isn’t my doctor delaying my cancer treatment during this time? If you are currently undergoing treatment for cancer, you may notice some of your appointments or treatment plans being delayed, even if you aren’t COVID-19-positive.

If your doctor is delaying your treatment, they must have good reason to do so. Some may include: • You have COVID-19. •  Your postsurgical treatment can be delayed with low risk. •  Your long-term treatment can be delayed with low risk. •  Your treatment puts you at high risk of a weakened immune system. •  There is an alternative oral treatment available. If your doctor is not delaying your treatment, it’s because doing so would negatively affect your treatment outcomes. Some reasons may include: •  You have a disease with high risk of progress. •  You may die without therapy in the next 2-4 weeks. •  There are no alternative treatments available. •  Your surgery is time-sensitive. •  Your symptoms cannot be controlled by oral medications. •  You have life-threatening complications from the disease.

Now that stay-at-home restrictions have been lifted, what should I do? Coronavirus is still circulating in our communities — some more than others. Just because the stay-at-home restrictions will begin to lift soon does not mean that the risk of contracting COVID-19 has gone away. It is likely that we will

see another wave of COVID-19 cases and deaths when nonessential businesses reopen. Continue to stay at home and avoid public places as much as possible, especially if you are at high-risk and/ or immunosuppressed.

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COMMUNITY

YOU MAKE IT HAPPEN

It takes a village to move cancer care and research forward, and it’s a community we are proud to be a part of.

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Pancreatic Cancer Awareness – Volleyball

The UF Health Cancer Center raised awareness for pancreatic cancer at the Gators volleyball game in November. Steven Hughes, M.D., chief of surgical oncology at UF Health, served the game ball.

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Making Strides

In 2019, friends and family from UF Health participated in Making Strides Against Breast Cancer, a national awareness walk hosted by the American Cancer Society. Teams from UF Health raised more than $40,000.

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Cheers to the New Year

In January, UF Health Cancer Center faculty and staff gathered in the UF Cancer and Genetics Research Complex atrium to celebrate the center’s myriad achievements in 2019 and to toast to the opportunities and successes of the coming year.

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Ocala Royal Dames – Tiara Ball

The Tiara Ball is the signature annual event of the Ocala Royal Dames for Cancer Research – a charitable organization composed of more than 200 women focused on supporting cancer research and education. A portion of the proceeds from the last event went to support UF Health research in several areas.

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Danny’s Dream

The second annual Danny’s Dream event was hosted in March 2019. It was established in honor of Danny DiNatale, who lost his battle to Ewing’s sarcoma in 2016. The event has raised over $245,000 for Ewing’s sarcoma research at the UF Health Cancer Center since its inception.

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Hyundai Hope on Wheels

Hyundai Hope on Wheels presented UF Health Shands Children’s Hospital with a $300,000 Hyundai Young Investigator Grant in September. The grant fund supports the research of pediatric oncologist Elias Sayour, M.D., Ph.D.

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Link to Pink

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Ante Up Against Cancer – Poker Tourney

The Gators gymnastics team hosted the UF Health Cancer Center during its annual Link to Pink meet at the Stephen C. O’Connell Center. 01

In March, the fourth annual Ante Up Against Cancer poker tournament at the card room at Oxford Downs in Summerfield featured live music, food and drinks. The event benefited the UF Health Cancer Center.

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Rick Croton Memorial Golf Tournament

The second annual Rick Croton Memorial Golf Tournament for Prostate Cancer Research was held at the Country Club of Ocala last May, with over 100 participants honoring Rick’s fight against prostate cancer. Sponsored by the UF Health Cancer Center, the event also served to raise awareness of prostate cancer screening and advances in prostate cancer diagnosis.

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Women’s Wellness Cancer Symposium

Last March, the Women’s Wellness Cancer Symposium featured three presentations by UF Health providers about women’s cancer prevention, treatment and research.

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Chomp Melanoma

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Climb for Cancer

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Chomp Melanoma, a group composed of UF medical and undergraduate students, hosted a free skin cancer screening open to the public at UF HealthStreet.

In September, the Climb for Cancer Foundation held the Barbara Padilla Concert at the Santa Fe College Fine Arts Hall featuring renowned soprano, America’s Got Talent season four runnerup and cancer survivor Barbara Padilla. In March, the group held the 7th annual Hogtown 5K Beer Run at Haile Plantation. All proceeds benefited the foundation, which supports UF Health cancer patients and their families.

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FOCUS

TAKING THE WAR ON CANCER TO

THE WEB There’s a new weapon in the war against cancer: social media.

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ancer researchers, physicians, patients, caregivers and survivors have turned to social media as a resource for research, networking, patient care and support. University of Florida Cancer Center researchers and clinicians have engaged with colleagues on Twitter, recommended online support groups to patients and opened up new doors for social media cancer research.

A cancer patient’s backstage pass to cancer information, research and support Social media is like an all-access pass — people have access to more information than ever before. For cancer patients, social media offers access to cancer information, research and communities. Merry-Jennifer Markham, M.D., FACP, FASCO, associate director for medical affairs at the UF Health Cancer Center and social media editor for the American Society of Clinical Oncology’s by Journal of Clinical Oncology, sees social media as a resource for patients and physicians. “Social media has accelerated information to patients and to clinicians in a way that is probably mind-boggling to both,” Markham said. While it’s true that you can’t believe everything you read online, Markham thinks social media is a great way to find information from trustworthy sources and to spark important conversations with her patients. “I love when patients bring to me things they’ve read on social media,” Markham said. “It’s a great way to start a conversation and can be a good segue into a conversation that you didn’t know you needed to have. It’s also a great opportunity to correct incorrect or misleading information that can be found on social media as well.”

Markham steers her patients toward resources she has personally vetted and can trust. Her recommendations are: n American Cancer Society n Cancer.net n National Cancer Institute “My No. 1 recommendation for patients is to actually talk to their physician about the information they want to be able to find or how they would like to use social media,” Markham said. “Their physician or someone within the clinic, perhaps a social worker, might be able to point them to some good online resources for both information and for support.” Social media offers patients supportive communities to feel less alone. Markham said social media networking is especially important in areas where in-person support groups may be limited. “Social media is Merry-Jennifer Cancer patients can helping to change Markham, M.D. find support groups the way in which searching their we conduct type of cancer on Facebook or research because Clinical through hashtags of its availability, research reaps on Twitter, such widespread use and as #BCSM (breast the benefits of inexpensiveness.” cancer social media), social media #gyncsm (gynecologic While social media is cancers), #LCSM (lung undoubtedly making its mark cancer) and more. on patient care as a whole, one of its greatest impacts on the cancer Other online support resources Markham community has been making clinical recommends are: trials easier to access than ever before. n Blog.stupidcancer.org Greater access to cancer clinical trials n Bcsm.org (Breast Cancer Social Media) — highly structured and scientifically n Lcsmchat.com (Lung Cancer Social rigorous experiments to test new Media Chat) treatments, improvements in care and n Gynsm.blogspot.com (Gynecologic scientific advancements — gives more Social Media) patients the opportunity to receive novel treatments and allows researchers the “Social media has really opened up a opportunity to become one step closer world of potential for support for cancer to increasing the number of cures. patients,” Markham said. “They can find support within very focused groups “We’re already seeing places and ways in centered around one type of cancer, a type which social media is helping to change of cancer with a mutation or just general the way in which we conduct research cancer support. I think it’s a great thing for because of its availability, widespread patients to have.” UFHCC Cares | SUMMER 2020

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FOCUS use and inexpensiveness,” said Thomas George, M.D., FACP, associate director for clinical research at the UF Health Cancer Center. “I think it’s going to become more and more of a critical component of clinical research.” In current studies, the UF Health Cancer Center is partnering with the National Cancer Institute and NRG Oncology to investigate the best ways to use social media for clinical research through a social media and patient engagement program. The program takes the scientific information that normally goes onto a clinical trial’s web page and, with the help of patients, distills the information into what is most important for patients to know. This information is then used in a social media campaign that directs patients and their caregivers to a patientfriendly webpage. “The whole goal is to bring the clinical trial information, awareness and participation opportunities directly to the patients where they live, which is on social media,” George said. Aside from being a new way to recruit volunteers, social media also serves as a great messaging system, allowing researchers to push information and content to patients as a part of clinical research. Right now, because of privacy restrictions, the conversation is typically only one way, from researchers to patients, but George hopes that will change in the future. “I think ultimately the real potential is to have the conversation be bidirectional, so you can actually have back-and-forth engagement, communication, sharing of information and real-time adjustments of research,” George said. Social media does not eliminate the boundaries of privacy when it comes to a patient’s health information. To ensure patient health information is protected, the Institutional Review Board has strict social media engagement guidelines on aspects like how patients are approached, how a

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clinical trial is communicated, and what information can be shared. The entire process of patients providing their consent to enroll into a clinical trial through social media also has to be well-vetted and pre-approved by the IRB. Patient participation must be voluntary and privacy has to be protected. Although researchers must go through an approval process to use social media for clinical trial enrollment and participation, the benefits are worth the effort, George said. “If five times the number of patients can be reached, in half the time, and you’re engaging with patients that normally wouldn’t have any way to participate in your research, it’s totally worth the efforts,” he said. “Advances in cancer care through research can be significantly accelerated if more patients are able to participate.” Even in today’s highly connected world, cancer clinical trial researchers still have to overcome the difficulty of reaching underrepresented and underserved communities where internet is not as accessible. George hopes that over the next five years internet-service availability for these communities will be a national infrastructure priority and social media will be used even more.

“I think social media has really tremendous promise for making clinical research a lot more available to more people and making the results of clinical research more relevant to more people,” George said. “By having more patients involved and more diversity in the patients who are involved, the faster we can find better treatments and the more relevant the results will be to everyone suffering from this disease.”

A surprising ally in the fight against cancer: “mommy bloggers” It can be hard to find trustworthy online sources, especially when it comes to health information. A UF Health Cancer Center researcher has found a way to relay scientifically based breast cancer information to mothers through sources that women reportedly trust and relate to — “mommy bloggers.” Carla L. Fisher, Ph.D., a cancer behavior scientist, set out to find a way to disseminate evidence-informed breast cancer messages that would resonate with mothers and daughters, motivating them to talk about environmental breast cancer risk and lifestyle changes they could make together to reduce their risk. Fisher and her colleague Kevin Wright, Ph.D., of George Mason University, are scientists in the National Institute of


Environmental Health Sciences’ Breast Cancer and the Environment Research Program, or BCERP, a group of scientists and community partners created more than two decades ago to identify environmental breast cancer risk factors. Through an NIEHS-funded study, Fisher and Wright teamed to develop a social media intervention to communicate environmental breast cancer risk information to mothers and daughters. Fisher’s research shows that mothers and daughters are concerned about their risk but find talking about the topic challenging. Research demonstrates that online, third-party sources can help them navigate these conversations. Women who use the internet for health information and mothers often turn to “mommy bloggers,” women who make a living by blogging — online journaling — about motherhood and various aspects

of life, as a trusted source.

and on and on, because of the various connected platforms people use.”

“What we see in the research is that mothers often Fisher and Wright developed identify with mommy partnerships with 75 bloggers,” Fisher said. “Mothers said that mommy bloggers to “They even, in a way, spread evidence-based when the information develop a sense information from is presented on of a relationship BCERP’s free online something like social and a community toolkit that was created media, it’s much within that social for mothers. With easier to talk to their media group.” their research team kids because it’s members, they created less personalized.” a shareable, un-editable The community infographic to incorporate of mommy bloggers into a blog post that provided presented Fisher and mothers and daughters four Wright an opportunity to action steps to take to reduce their distribute evidence-based information. risk. The researchers also provided the bloggers with an un-editable introduction “With social media, you can cast a wide paragraph to include to assure readers net, reaching more people,” Fisher said. that the information was coming from a “The dissemination can keep going on trusted source. Keeping with the theme of their blogs, the mommy bloggers were encouraged to write the blog in a way that would resonate with their readers. With blogs being shareable, the message made it onto several platforms, such as Facebook, Pinterest and Instagram. “We did see that there was an impact,” Fisher said. “It shows that this is an angle that we want to utilize more and a partnership that can bridge the social media community of mothers out there in society with the science community.” The blog posts reached more than 400 mothers, and the impact didn’t stop at getting the message to a wider net of people — the researchers also found that mothers exposed to the blogs were more satisfied with the breast cancer risk information, more motivated to engage in risk-reducing behavior, and more likely to share the breast cancer risk reduction tips with their daughters. “Mothers said that when the information is presented on something like social media, it’s much easier to talk to their kids because it’s less personalized,” Fisher said. “The information on social

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FOCUS media can facilitate a less emotionally charged conversation about cancer, particularly in a way where you’re not scaring and frightening your kids.”

The dark side of social media: e-cigarettes targeting young adults These days, electronic cigarettes are everywhere — even in the hands of young adults. But because e-cigarettes are such a new product, the long-term effects, including their cancer risk, are still unknown. There has also been a lot of discussion surrounding the potential implications that vaping could have on younger people and several restrictions, such as flavor bans, have been helpful in curbing their use. However, one area of the cigarette industry remains underregulated: social media. “There really is no regulation about what can be done in the social media environment, and this group of 18- to 24-year-olds pretty much live online,” said Jordan Alpert, Ph.D., an assistant professor in the UF College of Journalism and Communications’ department of advertising. “They’re being exposed to messages that are glamorizing and glorifying e-cigarettes every day.” Alpert set out to discover what impact the social media marketing of e-cigarettes has on young adults. He researched different brands and used documents from Phillip Morris International Inc., a cigarette and tobacco company, to study whether e-cigarette brands are using similar marketing strategies to target young adult consumers. Alpert found that e-cigarette brands often tried to target their younger audience by making their products look “cool” with flavors and pop culture references. “The big finding was that this kind of exposure to e-cigarettes really normalized

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them. They just became a typical, everyday thing that young adults see,” Alpert said. “It didn’t seem taboo or like anything was wrong with that. This constant exposure really normalized the activity for this age group.” Brands often focused on the appeal of an overall lifestyle without even mentioning their products. For example, Alpert said, one advertisement showed a person lounging by a luxurious swimming pool and holding an e-cigarette pen — never directly mentioning the product but instilling in consumers’ minds that this would be a “cool” lifestyle they could live. “The goal of this study was to bring more attention to the kind of marketing tactics that are going on and to try to have some discussion about any kind of regulations that could occur in the social media environment,” Alpert said.

Let’s Connect! Facebook helps researchers increase colorectal cancer screening rates Today, Facebook is used by billions of people to stay connected with friends and family — but what if the social media site can be used to access more than photos and updates? UF Health Cancer Center researchers Jiang Bian, Ph.D., and Yi Guo, Ph.D., turned to social media as a way to share information about cancer prevention. “We were thinking about whether we could use social media to do some outreach and get people to get cancer screenings,” Bian said. In 2016, the researchers conducted a study that aimed to use Facebook to educate about colorectal cancer and influence people over the age of 50 to seek cancer screenings, which are tests that detect cancer. Bian and Guo developed a web application based on the National Cancer Institute’s self-assessment tool, which

generates a patient’s five- to 10-year lifetime risk prediction based on their family history, medications, diet, exercise and more. “We used that mathematical model and developed a web app that allows you to calculate your cancer risk,” Bian said. “Then the application gives you tailored information to some of the free colorectal cancer screening resources within Florida.” If interested in the study, participants clicked on a link that would send a Facebook message to the user, leading them to the study’s web application, Guo said. To complete the risk assessment, study participants were able to log in using their Facebook credentials. “Most of the participants had gotten a cancer screening already,” Guo said. “But the intervention actually increased the screening rates in Florida.” Social media isn’t always the study itself, but it is a component of a larger research study, Guo said. Social media has the power to connect researchers with participants and allow for user feedback. “Social media is normally used as a supplement to other intervention delivery methods,” he said. While it is a tool to keep users engaged in research, social media has its limitations — the biggest being that researchers don’t have control of the platforms, Bian said. Bian hopes that researchers can work with social media companies to figure out ways to improve the platforms for the good of public health. “As a researcher, I think our job is to figure out better ways to create trusted sources for cancer information,” Bian said. “We want to do more research to figure out what the best ways to use social media are.”


PATIENT

THE RIDE OF

HER LIFE

Caption

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PATIENT

“If (being the first patient) affords other people the opportunity and the availability is here for them, then that’s great.”

Sandra Davis-Quinney and Jack Hsu, M.D.

S

andra Davis-Quinney has met bumps, curves and stops on her cancer journey. Even with the rough roads she’s traveled, Sandra tries to remain hopeful, resiliently staying on the ride. Her determination brought her to the UF Health Cancer Center’s Jack Hsu, M.D. After multiple rounds of chemotherapy from 2017 to 2019 were unsuccessful against

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her non-Hodgkin’s lymphoma, Sandra’s next option was a stem cell transplant. However, when her physicians were unable to collect enough stem cells for a transplant, that option was taken off the table. Heading home to Jacksonville to get back on medication and let her body “get itself together,” Sandra met with her UF Health Jacksonville oncologist, Joseph Mignone, M.D., and began looking into other available options.

When she learned at UF Health about the novel chimeric antigen receptor (CAR) T-cell therapy, a genetic therapy that modifies the patient’s own cells to attack their cancer, she knew her ride was just finally gaining momentum. Sandra was a candidate for the treatment, but she wasn’t just any candidate — she was the first CAR T-cell patient at UF Health. Hsu and his UF Health Bone Marrow Transplant Unit team spent two years


preparing to become certified as a CAR T-cell therapy site — developing policies and procedures, building relationships with those in other subspecialties and earning an accreditation for a stem cell lab. In October 2018, UF Health became a designated site for administering the therapy. “This is the first genetic therapy that was approved for the treatment of adult hematologic malignancies,” said Hsu, a clinical associate professor of medicine in the UF College of Medicine. “It provides another option for patients who have very-high-risk lymphoma.” Hsu was on-call 24/7 during DavisQuinney’s treatment. The reality of being the first CAR T-cell patient at UF Health didn’t sink in for Sandra until the process was set in motion, she said. She had heard about different clinical trials and new treatments, but now she was the star of the show in one of them. “Being the first patient is a big deal,” she said. “If it affords other people the opportunity and the availability is here for them, then that’s great.” The initial extraction of her cells wasn’t what she expected. She imagined it would be invasive and painful, but the procedure ended up being more like drawing blood. “You feel different in your body because they extract the blood, extract what they need from the blood, and put it back into your body,” Sandra said. “I was freezing cold, but it wasn’t painful.” Going through the actual CAR T-cell therapy was a different story. Because she had been through multiple rounds of chemo, Sandra said the therapy itself was bearable.

“It was not pleasant at times, but it wasn’t really bad until I went through the process of where I had to go to the intensive care unit,” she said. There are two possible major side effects to the treatment — cytokine release syndrome, which causes patients to develop swelling and their blood pressures to drop; and neurotoxicity, which causes changes to patients’ mental status, Hsu said. Sandra developed both. “Getting her through that, since we didn’t have practical experience before this, was very exciting because although we knew what to expect, actually seeing it was a different experience,” Hsu said.

“I’m happy to say that because we spent some time ironing out the details and trying to figure out potential points of failure, we didn’t really have much of a problem,” he said. The CAR T-cell therapy program at UF Health opens doors to new opportunities for patients, physicians and researchers. Now, UF Health can participate in CAR T-cell-specific trials and work with pharmaceutical companies to target other diseases. “Developing this program gives us the ability to participate in trials of this class of therapy because not all facilities are going to be able to do this,” Hsu said.

CAR T-cell therapy is in active investigation, not only for other blood cancers like multiple myeloma but also solid tumors like colon cancer. These treatments will become an important therapeutic option for patients like Sandra, “No pain, no especially as similar therapies gain. I just do are further what I need to designed and do and live life explored.

Because she developed neurotoxicity, Sandra doesn’t remember the week she spent in the intensive care unit. For days, she was coherent and talking, but there’s a gap where the memories of those days should be.

Although her body is still adjusting to life after CAR as a happy day T-cell therapy, an every day.” The accessibility evaluation three to novel treatments months after her like CAR T-cell therapy revealed the therapy is why news Hsu, Sandra and Sandra says she chose UF her family longed to hear — Health. While her cancer journey her lymphoma is in complete remission. hasn’t always been smooth, her determination to stay on the ride has “No pain, no gain,” Sandra said. “I just led her to the finish line. do what I need to do and live life as a happy day every day.” Hsu said treating the first CAR T-cell patient at UF Health was scary yet exciting. He was confident in the policies and procedures he and his team spent years perfecting.

“There are challenges. There’s days that I’m disappointed with what my counts are, but I don’t let it discourage me,” she said. “I keep praying, driving, putting fuel in my tank and propelling forward.”

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PARTNERS

THE HOPE NETWORK S

ome cancer treatments can harm a patient’s fertility. The University of Florida Health’s Helping Oncofertility Patients become Educated, or HOPE, Network is on a mission to help preserve it. “The goal of the HOPE Network is to try to help young, reproductive age or prepuberty oncology patients understand what their options

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would be to preserve their fertility,” said Alice RhotonVlasak, M.D., director of the HOPE Network. The program works toward that goal by offering novel fertility preservation options to UF Health patients. Currently, the HOPE Network is the only fertility program in Florida that is trained in and offering ovarian tissue freezing, which became a standard procedure with published guidelines in January.

The UF Health fertility program offers novel treatments for cancer patients


PARTNERS “Certain cancer treatments and surgeries can damage or destroy the ovaries and eggs, which leads to early menopause and infertility,” said Rhoton-Vlasak, a professor in the UF College of Medicine’s department of obstetrics and gynecology. “Ovarian tissue freezing is the newest option to preserve fertility.” The treatment involves removing a piece of or the whole ovary, freezing the extracted ovary in tiny strips containing the follicles with eggs, and transplanting the strips back into the area of the ovary post-cancer. The ovarian tissue can be frozen indefinitely, allowing women to choose to implant the tissue when they want to start a family. When the tissue is transplanted, hormones and menstrual cycles can come back, restoring fertility and allowing natural pregnancy to occur. “Those transplants don’t usually work forever,” Rhoton-Vlasak said. “They have a lifespan of about three to six years. You could potentially transplant back another piece of the woman’s own tissue so that she gets longer benefit from the hormones. Even if they don’t want more babies, those hormones are important for your bones and heart until the natural age of menopause.” When fertility preservation treatments need to happen quickly as a result of a patient’s cancer treatment, the HOPE Network team is available, working around the clock to see patients in their times of need. “It’s important that we can see people rapidly so that we don’t delay their cancer treatments,” she said. One way the program is able to see patients in a timely manner is with the help of the HOPE Network’s inpatient oncology patient navigator, Lauren Staley. “I would say the biggest difference between what we do at UF Health and

Alice Rhoton-Vlasak, director of the HOPE Network

what other fertility programs do is that we have an inpatient nurse navigator, so services are available in multiple settings,” Rhoton-Vlasak said. Staley saves patients a trip out of their hospital rooms by traveling to them, offering consultations and specimen collections in patients’ hospital rooms. Operated through the division of reproductive endocrinology and infertility in the UF College of Medicine’s department of obstetrics and gynecology, the HOPE Network consists of a diverse team of health care providers, including physicians, nurse coordinators, nurse navigators, psychologists, financial counselors, radiologists, surgeons and embryologists. Some fertility treatments are not covered by insurance, but patients have the opportunity to receive grant funding that is generously donated to the HOPE Network by the Climb for Cancer Foundation, Rhoton-Vlasak said. Over the past seven years, Diane and

Ron Farb, founders of Climb for Cancer, have donated thousands of dollars in grants to help build the program, covering resources such as patient education brochures, provider meetings and patient consultations. The HOPE Network offers a variety of fertility treatment options for men and women. Men have the option of sperm banking, while women may freeze eggs, freeze embryos or use a medicine that may protect the ovaries from chemotherapy. “Almost 100% of postpubertal male patients will bank sperm; it’s less expensive and causes no therapy delays,” Rhoton-Vlasak said. “For female patients, fertility preservation options are more complex and take more time, visits and money so less women do it, but probably an equal number of men and women get counseling at UF Health.” The HOPE Network lives up to its name — giving patients back the hope of having a family.

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MEET A TEAM MEMBER!

HELLO! MY NAME IS CARLA FISHER, PH.D.

Fisher is an associate professor in the UF College of Journalism and Communications, faculty affiliate in the UF Center for Arts in Medicine and member of the UF Health Cancer Center’s Cancer Population Sciences research program.

Q.

Q.

Q.

A.

A.

 Can you tell us about your research on communication and cancer?

A.

My research focuses on helping families who are coping with cancer or facing cancer risk learn to communicate in ways that are healthy. Communication can be challenging and I try to identify healthy communication families can engage in when coping, caregiving, discussing risk or adopting risk-reducing habits, navigating challenging conversations or topics, or talking with health care professionals. It’s also important that families know that our preferences for communicating can be different given our age, developmental maturity or the generation we grew up in. So what works for me, for instance, might not be perceived as very helpful to my mother or my grandmother. I focus a lot on mothers, daughters and breast cancer, including those with hereditary breast or ovarian cancer, or HBOC, and wrote the first evidence-based book on mothers, daughters and breast cancer. I provide

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mothers and daughters with communication strategies for coping together and also tailor this based on where they are in the lifespan (young adulthood, midlife, later adulthood).

Q.

How do you think communication across digital platforms can improve to positively impact cancer interventions and outcomes?

A.

It’s important for scientists to partner with online communities to ensure families and patients have access to credible information in a format that speaks to them and clinicians have online resources they trust that they can direct their patients and family members to. In my Family · Health · Lifespan Communication Lab we teamed with “mommy bloggers” and developed a successful social media intervention to get environmental breast cancer risk information to mothers with daughters and motivate them to adopt risk-reducing lifestyle changes together. To read more about this study see pages 13-14.

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Why did you choose interpersonal health communication as your life’s work?

The psychosocial side of cancer care can be as critical to wellbeing as the biomedical side. At the root of health is how we are communicating in our relational lives. Yet clinicians and researchers have acknowledged that families often enter the world of cancer without what’s been called a “psychosocial map” — understanding the emotional and social side of coping with cancer as a family. By providing a “psychosocial map,” you help families understand how cancer affects them emotionally or mentally, how it’s a disease that affects everyone in the family as well as their family dynamics, so that you can help them communicate in ways that promote family resilience. I hope to make cancer care more family-centered and contribute to that “psychosocial map” to enhance their disease coping.

What current or upcoming projects are you working on?

I’m working with my colleague Carma Bylund, Ph.D., and The Leukemia & Lymphoma Society on creating an intervention for adult child caregivers of parents diagnosed with a blood cancer on developing family communication skills at home and in the clinical setting. We are also developing an intervention for young-adult caregiving daughters of mothers diagnosed with breast cancer to enhance motherdaughter communication skills and communication skill when talking with health care providers. I’m also working with Marleah Dean Kruzel, Ph.D. (University of South Florida), Lisa Brown, GCG, and Karen Daily, D.O., on developing a decisionmaking tool for “previvors” (women who test positive for the BRCA1/2 genetic mutation) to help them manage chronic, distressful uncertainty about their HBOC risk and support their risk-reducing medical decisions.


Q.

What is the most rewarding part of your work?

A.

Narratives are a valuable tool to illustrate the importance of communication to our health and to teach us how to communicate in healthy ways. It is so rewarding when patients and family members are willing to be interviewed about their experiences. I feel privileged that they share their stories with me in order to help other families facing cancer, and it is very rewarding for me to elevate their voice in research as well as health care practice.

Q.

What challenges do you face in this area of research?

A.

I love working with community partners. Recruitment for studies can be very challenging. They are wonderful at connecting me with patients and families to recruit but also in ensuring that their needs are prioritized in research. Community groups are on the ground helping patients and their families every day. They see the need for more family-centered care — that “psychosocial map” — which takes a backseat to the biomedical side of care (another challenge). But when you work with community partners, your work is driven by the community and can reach those who can benefit from it.

“It is so rewarding when patients and family members are willing to be interviewed about their experiences.” Carla Fisher, Ph.D., enjoying time outdoors with her daughters, Isa and Sosi.

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UF Health Cancer Center | Cares | Summer 2020  

The biannual patient magazine of the UF Health Cancer Center.

UF Health Cancer Center | Cares | Summer 2020  

The biannual patient magazine of the UF Health Cancer Center.

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