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A Publication of the University of MIchigan Comprehensive Cancer Center | SPRING 2013

Heritage and Healing Education and support for the next generation


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The Rehabilitation Remedy

Make Your Life Matter

The U-M Comprehensive Cancer Center prepares you for your life during and after cancer.

Simple lifestyle changes that can help you prevent cancer.

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06 Relax and Distract Borrow an Apple iPad tablet from the Patient Education Resource Center during your day at the Cancer Center.

One Native American patient strives to make heritage part of her healing process.

15 Research Round-Up

08 Detecting Distress Patients find resources and relief through a new screening tool based on national guidelines.

On the cover: Patient Shoshana Phillips started a non-profit organization to help other Native American cancer patients and their children cope with the diagnosis.

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Life Traditions

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Learn about the latest in research at the U-M Comprehensive Cancer Center.

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SPRING 2013 CONTENTS

Published quarterly by the University of Michigan Comprehensive Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5944. If you do not wish to receive future issues of Thrive, please call Martha Towas at 734-936-0434. Max S. Wicha, M.D., director Marcy B. Waldinger, M.H.S.A., chief administrative officer Karen Hammelef, R.N., M.S., director of Patient and Family Support Services Nicole Fawcett, manager of cancer communications Beth Johnson, editor and senior writer Karen Moeller, art director; Chas Moeller, project manager, Karen Moeller Design Edda Pacifico, photographer, Edda Photography Executive Officers of the University of Michigan Health System: Ora Hirsch Pescovitz, M.D., Executive Vice President for Medical Affairs; James O. Woolliscroft, M.D., Dean, U-M Medical School; Douglas Strong, Chief Executive Officer, U-M Hospitals and Health Centers; Kathleen Potempa, Dean, School of Nursing. The Regents of the University of Michigan: Mark J. Bernstein, Julia Donovan Darlow, Laurence B. Deitch, Shauna Ryder Diggs, Denise Ilitch, Andrea Fischer Newman, Andrew C. Richner, Katherine E. White, Mary Sue Coleman, ex officio. The University of Michigan is an equal opportunity/ affirmative action employer. Š 2013 The Regents of the University of Michigan. For more information about the stories in Thrive or any other cancer-related information, please call the Cancer AnswerLine at 800-865-1125.


NEWS | QR Codes 101

QR Codes 101 Unlocking the mysterious black squares

HERE’S WHAT INFORMATION YOU WILL FIND:

QR CODE? What are those squiggly black squares you keep seeing in magazines, on advertisements and now, even in the U-M Comprehensive Cancer Center? They’re called QR codes, which stands for Quick Response and, even though they originated in the world of industry, have become a common way for companies—and even hospitals— to get information to customers. A QR code is like a website address except that instead of typing a URL into a web browser, you scan it with your smart phone or tablet to be directed to information on the web. All you’ll need to read the code is an application like QR Reader for iPhone, Android or whatever kind of smart phone or tablet you use. Just search QR code reader in your app store and you’ll find free options to download.

Patient Education Resource Center

WHAT INFORMATION?

Patient and Family Support Services

With your QR code application installed and ready, be prepared to unlock the secrets behind all those squiggly black squares. Just point and scan one of the five QR codes we’ve created to help answer your questions and give you access to more resources and support throughout the Cancer Center. You’ll find the codes at displays throughout the Cancer Center. Don’t worry, we’re not trying to sell you anything. We’re only trying to make your experience as easy as possible.

Learn more about our educational topic of the month.

Voices Art Gallery As you view the artwork on display, check out past shows and find out how you can submit your own art.

Learn about services that can help you cope with the distress of cancer.

Med Inn Directions Follow our step-by-step directions from the Med Inn back to the Cancer Center.

Practical Assistance Center Find resources related to billing, financial assistance and the community.

Look for the tear-out insert in this issue to keep the QR codes nearby. SPRING 2013

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FORUM | Carr ying On With Cancer

Carrying On With Cancer Making rehabilitation a part of cancer care and survivorship

HERE’S A POP QUIZ: What does rehabilitation mean in the context of cancer treatment? A. Physical therapy after surgery or an injury B. An exercise program to get back into shape after being inactive C. Physical, emotional and practical help throughout cancer treatment Answer: C.

In a nutshell, it means helping each patient live life to the fullest before, during and after cancer treatment.

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he U-M Comprehensive Cancer Center has spent nearly a decade developing programs and services to help patients with rehabilitation. We sat down with Patty Clark, M.S.N., R.N., director of the Cancer Center’s Adult Survivorship Program, to talk about the broad scope of rehabilitation and how it should be a routine part of your care.

 Can you help Thrive readers understand what we mean by “rehabilitation?”

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With rehabilitation, we try to help people with cancer function at their optimum levels in life based on any limits that may have resulted from their cancer diagnosis or treatment. Cancer rehabilitation addresses physical, social, emotional and work-related changes and helps each person set achievable goals to maximize his or her ability to carry on with life.

 Why has rehabilitation become a major issue in cancer care?

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Cancer rehabilitation has been an objective of cancer care since the National Cancer Act in 1971. I think we are seeing more about it in the media because more and more people are living with cancer. Cancer survivors want to live like anyone else. They want to be active in their families, at work, at church and in the pursuit of their interests, just like they did before their diagnosis. However, successful cancer treatment may result in some changes, limitations perhaps, and people with cancer need help overcoming these as much as possible.


WEB EXCLUSIVE Visit mCancer.org/thrive to see what the National Institutes of Health is saying about cancer rehabilitation.

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 Does rehabilitation mean the same thing as survivorship?

Survivorship is a phase of your cancer care that begins after treatment. Rehabilitation is an ongoing aspect of cancer care. Rehabilitation can begin at diagnosis with something like, for example, quitting smoking before surgery. Restorative rehabilitation that usually takes place after treatment might include range of motion exercises after breast surgery or an exercise prescription to fight cancer-related fatigue. Supportive rehabilitation also takes place after treatment and can include physical rehabilitation like strengthening exercises after a long period of inactivity or learning to use a prosthetic limb after amputation, as well as psychological rehabilitation, which might include participating in a support group or one-on-one counseling. Palliative rehabilitation can take place throughout the cancer experience and involves treating symptoms related to cancer and its treatment.

 Can you tell Thrive readers about your desire to build a survivorship model at the Cancer Center that crosses all diagnoses? The Cancer Center has expert doctors and nurses who provide excellent survivorship care to our patients and have done so for many years in multi-disciplinary clinics and select specialty clinics. We have three main goals for expanding our survivorship model to all areas: 1) First, we want to create treatment summaries and care plans for patients and their primary care providers. These will give patients a summary of their treatment and a plan for followup going forward. Patients will understand what is expected after treatment and who they should contact for various issues. 2) Secondly, we want to monitor each patient’s quality of life and symptoms between visits with the goal to prevent a symptom that “isn’t quite right” from becoming “urgent.” We are building a system that will reach out to cancer survivors and ask them to tell us how they are doing using a variety of methods, from low-tech phone calls to high-tech applications on smart phones and mobile tablets.

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3) Our third goal is to improve communication between the various health care providers a patient sees during care, specifically between oncology and primary care teams. Treatment summaries and care plans are not only for patients; they also help primary care doctors and other providers involved with the care of a cancer patient know exactly what treatment has been given and the plan of “who does what” for both patients and clinicians.

 Why is the topic of rehabilitation important to you?

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Our population is aging, but is generally an active population and we should do our best to keep it that way. We want to help people with cancer be healthy and as active as possible. Cancer rehabilitation is one way to make that a reality.

 What would you say to a Cancer Center patient struggling with issues during or after cancer treatment? I would encourage any Cancer Center patient who is struggling with issues during or after cancer treatment NOT to try to do it on their own. First, tell your doctor and your cancer care team. They are very engaged and eager to help in any way that they can. There are many services here at the U-M Comprehensive Cancer Center that provide a wealth of assistance for practical matters like prescription coverage issues, symptom management and psychosocial care. We also partner with others in the community who offer support groups for survivors. The first step is to talk with your treatment team and let them know what you are experiencing. They can help you find the help you need.

Not sure where to start with questions about rehabilitation? Speak to your oncologist or call the Cancer AnswerLine at 800-865-1125.

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FE ATU R E | Relax and Distract

Relax and Distract Borrow an Apple iPad tablet from the Patient Education Resource Center during your day at the Cancer Center

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om Basso loves to get out and ride his motorcycle, taking trips up to two weeks long in places as far away as Italy. It’s no surprise then when he comes to the Cancer Center for infusion once every two weeks, he and his significant other, Marcia, are often loaded down with motorcycle magazines as part of their day’s reading materials. “I’m usually here for a good five hours,” Basso says of his chemotherapy treatments. “We try to bring enough with us to fill the time.” During an infusion appointment, Basso noticed volunteers circling through the infusion area, offering laptop computers and other electronics for patients to sign out during their visit. He decided to use an Apple iPad tablet for the day. “It’s a great service,” Basso says. “I checked my email initially because I follow my friend’s online updates about his time spent in India. I also look at used motorcycles for sale. If you’re a motorcycle owner, you’re always in the market for a new one.” Apple iPads are the latest technology available to Cancer Center patients through the Sight and Sound Program, established in 2008 to provide relaxation and distraction to patients during treatments. Initially offering iPods loaded with music and podcasts, the program has added laptop computers and iPad tablets that allow patients to search the Internet or play games during their time at the Cancer Center. “We strategically selected the applications loaded on the devices, creating categories of applications diverse enough for everyone, whether someone wants to read a business journal, play a game or listen to music,” says Karen Hammelef, R.N., M.S., director of Patient and Family Support Services. The iPads come pre-loaded with apps, which are grouped in categories such as books, entertainment, games, health, music, news and sports. Patients can access the Internet through the web browser Safari, which lets you search for things like your personal email accounts, and in Basso’s case, restaurant menus and routes for future motorcycle tours. 6

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iPads are available to patients in two ways: • from the volunteer Tech Squad, made up of students who travel through patient areas with a cart full of devices to try • through the Patient Education Resource Center, or PERC, located on B1 near the infusion waiting room. In exchange for a valid picture ID and the patient’s registration number, the device can be borrowed for the day, until 4:30 p.m. Members of the Tech Squad and the PERC provide basic training on how to use the device, connect to the Internet and open applications. “The Tech Squad is great,” says Lori Boylan, information resource assistant at the PERC. “They’re students so they know how to use technology and can help even beginners get started. We want them to encourage patients to give it a try, especially if it helps their day go by faster.” Basso still brings his motorcycle magazines to his appointments, but uses the iPad as a back-up. “We check out an iPad when we run out of reading materials. Or, we’ll use it to check email or look up restaurant menus. It’s a good option to have,” he says. In his free time, Basso likes to build custom furniture, everything from kitchen tables to stools to bookshelves to bathroom vanities. He and Marcia are also planning a motorcycle tour out west this summer, heading toward Seattle. “We look forward to it,” he says. “It’s great to get out after being cooped up all winter. We might ride as much as 450 miles in a day. After all that planning and riding, you deserve a hot shower and a nice, comfy bed.”   t 

iPads are disinfected and resynced between each patient to remove personal information.


iPads were made available at the PERC through donations from: • Comfort Apps • Compassion, Let it Begin with Me Foundation • Other generous donors Visit mCancer.org/thrive to learn how you can help.

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COPING |  Detecting Distress

Detecting Distress A new tool provides relief and resources for concerned patients

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arry Opelt, 69, came to Adrian, Mich., from Ohio as a young man in pursuit of a career. After more than 35 years working for the city, he retired as director of finance, opting to serve on community boards as a volunteer and enjoy time with friends and family. Almost every morning at 8, Opelt still makes his way to the Tip Top Restaurant for breakfast with the other regulars. His plan to ease into retirement took a turn Christmas 2011 when a pancreatic cancer diagnosis slowed him down more than he’d expected. Getting through several months of powerful chemotherapy and radiation suddenly seemed like the easy part as acute pain overcame him last fall. “Because of the location of my tumor, I wasn’t a candidate for surgery,” Opelt says. “And the tumor is probably the source of the pain. It became unbearable and treating the pain with morphine wasn’t much better due to the side effects.” He recalls a defining moment last Thanksgiving as he drove his youngest of two daughters to the airport after a family celebration. At his next appointment with his oncologist, Opelt recalls filling out paperwork before he saw the doctor. “There was a thermometer and I had to check off how I was feeling. At that point, I was really down, feeling sad. That’s what I marked. I was sad and worried about my family. By the time I left that day, a social worker had come in to talk to me about it.”

WHAT IS DISTRESS? Karen Hammelef, R.N., M.S., director of Cancer Center Patient and Family Support Services, says screening patients for distress is as important as any other basic vital sign. It should be monitored at all points of care and should change Larry Opelt according to what’s happening in the lives of patients, their cancer and how they’re responding to treatment. Distress screening is endorsed by the American College of Surgeons as well as the Institute of Medicine. Distress is the response a person has to any symptoms caused by cancer or its treatments. It could be that a patient is concerned about finances, isn’t sure how to communicate with kids about what’s happening or has pain that’s become a problem. Anxiety or depression may keep a patient from adhering to a treatment regimen. 8

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Whatever the origin, unaddressed distress becomes a continuous cycle that builds upon itself. Opelt’s distress screening was a red flag for Cancer Center social worker Chris Henrickson, L.M.S.W., B.C.D., who was able to intervene, talk through the issues and help Opelt find resources. “In addition to worrying about their health, patients also worry about their families,” Henrickson says. “In Mr. Opelt’s case, he was concerned about how his family was coping. We talked through those issues and how they’re very normal concerns. We were able to direct the family to resources right in their local community.” Opelt has responded well to his chemotherapy treatment, which halted the growth of his tumor. A morphine pump was installed to manage his pain directly, without leaving him with all the side effects. He now has a six-week reprieve before his next scan, which has prompted him and his wife to plan a trip to South Carolina to visit one of their daughters and two granddaughters, who bring him incredible joy.

Speak to your oncologist, visit the Patient Education Resource Center on Level B-1 or call 734-647-8626 to find information about cancerrelated distress and Cancer Center services.


“We’re all doing much better than we were last fall,” he says. “It helped to talk through some things. Now I’m looking forward to playing with my granddaughters.”

SETTING THE BAR FOR THE NATION The distress thermometer screening tool Opelt filled out in the Multidisciplinary Pancreatic Cancer Clinic is the result of national clinical practice guidelines updated in 2012 by the National Comprehensive Cancer Network for distress management. Hammelef and Patient and Family Support Services are working with clinicians to roll out the use of the screening tool to cancer patients at the pancreas clinic, the Canton Health Center and, ultimately, the entire Cancer Center. Cancer-related distress describes a variety of experiences that affect up to 60 percent of cancer patients at some point during their care. Nearly 90 percent of cancer patients reported no problem filling out the screening form. Even more agreed they appreciated being asked about their emotional wellbeing. “If we didn’t ask the question, you’d continue to be distressed,” says Hammelef. “Unaddressed distress leads to increased emergency room visits, lower quality of life and failure to follow treatment plans. Evidence behind screening shows patients feel their care improves significantly from a form that takes less than one minute to complete.”   t 

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Extreme distress

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How to measure distress • Rate how much distress you’ve experienced in the last week • 0 is low, 10 is high • 5 categories of symptoms –– practical, family, emotional, spiritual/ religious, physical • A response of 4 or above results in action by your health care team to assist with your concerns. SPRING 2013

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EAT W ELL | Make Your Life Matter

WEB EXCLUSIVE Visit mCancer.org/thrive to learn about research on cancer and healthy amounts of sugar in your diet.

ADD MORE FRUITS AND

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KAREN PARKER MOELLER

VEGETABLES


Make Your Life Matter Simple lifestyle changes that can help you prevent cancer BY NANCY BURKE, R.D., DANIELLE KARSIES, M.S., R.D., AND MELISSA SHANNON-HAGEN, R.D., CSO U-M COMPREHENSIVE CANCER CENTER SYMPTOM MANAGEMENT AND SUPPORTIVE CARE PROGRAM

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n today’s age of fad diets and infomercials promoting the latest exercise craze, it’s easy to see that weight is a health concern. Besides making you feel more confident and look better, achieving a healthy weight can help reduce your cancer risk. Being overweight or obese has been associated with 14 types of cancer, including breast and pancreatic cancer. Simple changes to your lifestyle can help you reach a healthy weight and make a huge impact on your health.

WHAT IS A HEALTHY WEIGHT? A healthy weight is defined as a body mass index (BMI) between 18.5 and 25 kg/m2. Being too thin can be as unhealthy as being too heavy.

HOW CAN YOU ACHIEVE A HEALTHY WEIGHT? Make simple changes to your diet and a commitment to exercise. Exercise guidelines have been set at 150 minutes of moderate activity a week. This boils down to only 30 minutes of exercise, 5 days a week, which can be done in blocks of as little as 10 minutes. Remember, some activity is better than none so even if you don’t reach the weekly goal, keep moving. Dietary changes can be as simple as adding more fruits and vegetables and choosing whole grains over refined products. Following a vegetarian diet is not necessary, as long as your overall diet is high in fruits and vegetables. Strive to fill up the majority of your plate at each meal with these foods and think of meat and poultry as a side dish.

CAN’T I JUST TAKE A PILL?

EXERCISE 30 MINUTES/DAY, 5 DAYS/WEEK

To make an appointment for nutritional counseling, call 877-907-0859.

The old adage of taking a daily multivitamin and mineral supplement as an insurance policy may be outdated. Recent data suggests a basic supplement provides no benefit and may increase risk of death among healthy individuals. It is now recommended, when possible, to obtain nutrients through food, mainly fruits and vegetables, as opposed to supplements. But, a general multivitamin and mineral supplement does still have its place, as some research suggests it has benefit in certain situations, such as men over 50 years of age with a history of cancer. To be on the safe side, only take dietary supplements if recommended by your physician.

TO DRINK OR NOT TO DRINK? Although alcohol has been shown to have some benefits for heart health, when it comes to cancer the question to drink or abstain remains unclear. Many cancers including breast and esophageal cancer have been linked to alcohol intake. Research also indicates that continuing to drink after being diagnosed with cancer can affect the risk of new primary cancers. The current recommendation is moderation: no more than 1 drink for women or 2 drinks for men per day (1 drink is equivalent to 12 ounces of beer, 5 ounces of wine or 1 1/2 ounces of liquor). Pick an area you can improve and make the change! Even making just one change can reduce your cancer risk.   t 

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LIFE

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COV ER STORY | Life Traditions

One Native American Gives Back

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hoshana Phillips has spent most of her 51 years engrained in Omaha Nation culture with the goal to educate and help her Native American tribe flourish. She traveled by car with her husband and two children to attend powwows—gatherings with music, food and dance—to help wherever needed: with environmental issues, religious freedom issues or even making beaded jewelry and powwow regalia for kids. It was only when she was diagnosed with multiple myeloma six years ago she realized the disparities among Native Americans with cancer, including children whose parents have cancer. “My diagnosis made me aware of a need to fill,” she says. “We realized cancer is something that affects the whole family, yet there are virtually no services for kids. A 20-year study showed that Native Americans were the only segment of the U.S. population where cancer deaths did not decrease over that time period.” For members of the Omaha Nation, Phillips says, there are four stages of life represented by four colors that coincide with the four directions on a compass. “East represents infancy, which is yellow,” she says. “South is for childhood and the color green. West direction is the time of adulthood and the color red. The north side is elderhood, represented by the color black.” Phillips’ daughter, Alethea, whose Omaha name means “girl with reddish brown hair” told her mom they should try to help Native American kids in a worse position than she was. Together they worked to form a non-profit organization intended to help children in need now and to educate young people to make healthy lifestyle choices to avoid obesity, diabetes and cancer in the future. Adult infusion nurse Colleen Dauw, R.N., says it’s not uncommon to see patients with cancer trying to give back. “Shoshana has been helping people in her tribe her whole life,” says Dauw. “It puts a very positive light on healing and working to become well. It doesn’t surprise me that her daughter is following in her footsteps to want to make a difference in the Native American community.” Still undergoing treatment for her cancer, Phillips recently secured an Ypsilanti house to be the home for her non-profit, Heritage of Healing. Her goal is to give her own family a safe and healthy living environment, as well as having dedicated space to take in Native Americans and their families when they’re in Ann Arbor for treatment. “On the reservations, there is no treatment for cancer. They have to send you somewhere else. We would like to be there in support of people being treated off the reservation. We’ll provide housing and work with Food Gatherers to offer meals. Eventually, we’d like to be able to provide rides to treatment and gift cards for things like gas and groceries.” SPRING 2013

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COV ER STORY | Life Traditions Cancer incidences among American Indians vary by tribe, region and gender, but are often much higher than non-Hispanic whites. Many factors contribute, including a high burden of risk factors like tobacco and alcohol abuse, poor diets due to commodity items like white flour and white sugar, low awareness of cancer risks and screening options, high rates of poverty and poor access to health care due to low rates of health insurance. American Indian and Alaska Native populations have very high incidence rates for specific cancer sites and poor survival rates for most cancers. According to the American Indian Cancer Foundation, cancer has recently become the No. 1 cause of death for American Indians in many regions of the United States. In Phillips’ case, the doctors she initially saw were unable to piece together any of her symptoms, which included fatigue, a painful bump on her knee and unusual pain when her then-toddler son hit her in the back. Phillips pressed on with her family for four years before being misdiagnosed in Arizona with fibromyalgia, a chronic pain syndrome. When she came to the University of Michigan for a research study, she received her real diagnosis: multiple myeloma, a cancer of the plasma cells in bone marrow. Phillips ended up in a different research study altogether and had her first round of chemo while still admitted in the hospital from her emergency room visit. A clinical trial for the drug Velcade had just opened 10 additional spots for participants. Since then she has undergone two bone marrow transplants. “I’ve definitely beaten the odds for multiple myeloma, which has less than a 35 percent survival rate for more than five years,” says Phillips. “My diagnosis has definitely opened up a new path for me. I think all people have something they’re meant to do. The time I have now is more time to be with my kids, and to establish this legacy they can carry on in the future to help other Native Americans with cancer.” Now 13, Phillips’ daughter Alethea is living up to the color red through a very grown-up life of advocacy. She’s planned a summer camp for Native American kids and hopes to make it a reality this summer.   t 

Click: Visit mCancer.org/thrive to learn more about Heritage of Healing’s Walk for Health.

Patient Shoshana Phillips makes beaded jewelry at home and at her infusion treatments to pass the time. She sells the jewelry at Native American powwows.

TURNING IT AROUND For many, a cancer diagnosis is initially met with fear, shock and distress. But Alethia Battles, a social worker at the U-M Comprehensive Cancer Center, says she’s seen patients turn their diagnosis into something positive and meaningful. Here’s how: • Be creative Many patients turn to art as an outlet, not only for their own benefit, but to let others know things get better • Donate Give money to organizations that support cancer patients (including the U-M Cancer Center!) • Volunteer Some cancer survivors choose to volunteer at meetings or other community events for people dealing with a cancer diagnosis • Advocate Who better than cancer survivors to lobby for more treatment options, better patient care and more research funding • Contribute to change Represent patients by joining the Cancer Center’s Patient and Family Advisory Board

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NEW DRUG CUTS RISK OF GRAFT-VS.HOST DISEASE FOLLOWING BONE MARROW TRANSPLANT IN HALF A new class of drugs reduced the risk of patients contracting a serious and often deadly side effect of lifesaving bone marrow transplant treatments, according to a study from researchers at the University of Michigan Comprehensive Cancer Center. The study, the first to test this treatment in people, combined the drug vorinostat with standard medications given after transplant, resulting in 21 percent of patients developing graft-vs.-host disease compared to 42 percent of patients who typically develop this condition with standard medications alone. “Graft-vs.-host disease is the most serious complication from transplant that limits our ability to offer it more broadly. Current prevention strategies have remained mostly unchanged over the past 20 years. This study has us cautiously excited that there may be a potential new way to prevent this condition,” says lead study author Sung Choi, M.D., assistant professor of pediatrics at the U-M Medical School. Vorinostat is currently approved by the U.S. Food and Drug Administration to treat certain types of cancer. But U-M researchers, led by senior study author Pavan Reddy, M.D., found in laboratory studies that the drug had anti-inflammatory effects as well—which they hypothesized could be useful in preventing graft-vs.-host disease, a condition in which the new donor cells begin attacking other cells in the patient’s body. The first 47 participants were older adults who were undergoing a reduced-intensity bone marrow transplant with cells donated from a relative. Patients received standard medication used after a transplant to prevent graft-vs.-host disease. They also received vorinostat, which is given as a pill taken by mouth. The researchers found vorinostat was safe and tolerable to give to this vulnerable population, with manageable side effects. In addition, rates of patient death and cancer relapse among the study participants were similar to historical averages.

Sung Choi, M.D.

Pavan Reddy, M.D.

Weiqiang Chen

R ESEA RCH ROU ND-UP

CAPTURING CIRCULATING CANCER CELLS COULD PROVIDE INSIGHTS INTO HOW CANCER SPREADS

This false-color microscopic image shows cancer cells selectively adhering to patterned nanorough letters (UM) on a glass surface.

A glass plate with a nanoscale roughness could be a simple way for scientists to capture and study the circulating tumor cells that carry cancer around the body through the bloodstream. Engineering and medical researchers at the University of Michigan have devised such a set-up, which they say takes advantage of cancer cells’ stronger drive to settle and bind compared with normal blood cells. Circulating tumor cells are believed to contribute to cancer metastasis, the process of the disease spreading from its original site to distant tissues. Blood tests that count these cells can help doctors predict how long a patient with widespread cancer will live. As important as the castaway cells are, scientists don’t know a lot about them. They’re rare, at about one per billion blood cells. And they are not all identical, even if they come from the same tumor. Existing tools for isolating them only catch certain types of cells—­those that express specific surface proteins or are larger than normal blood cells. “Our system can capture the majority of circulating tumor cells regardless of their surface proteins or their physical sizes, and this could include cancer progenitor or initiating cells,” said Jianping Fu, assistant professor of mechanical engineering and biomedical engineering and a senior author of a paper on the technique published online in ACS Nano. Fu and his engineering colleagues teamed up with U-M cancer researcher and breast cancer clinician Sofia Merajver, M.D., Ph.D., and her team. This multidisciplinary group believes that while the device could one day improve cancer diagnosis and prognosis, its first uses would be for researchers to isolate live circulating tumor cells from blood specimens and study their biological and physical properties. “Understanding the physical behavior and nature of these circulating tumor cells will certainly help us understand better one of the most difficult questions in cancer biology—the metastatic cascade, that is, how the disease spreads,” Fu said. “Our system could provide an efficient and powerful way to capture the live circulating tumor cells and use them as a surrogate to study the metastatic process.” This works was done in the laboratory. More research is needed before the technique can be offered to patients.

For information about clinical trials at U-M, call the Cancer AnswerLine at 800-865-1125 SPRING 2013

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PH A R M ACIST’S

Just a Phone Call Away

Corner

Art Therapy 877-907-0859

Do you have a question for the pharmacist? Email us at ThriveMagazine @med.umich.edu

Cancer AnswerLine 800-865-1125 Clinical Trials 800-865-1125 Fertility Counseling 877-907-0859

STAYING COOL DESPITE HOT FLASHES

Financial Counseling 734-647-5120

By Emily Mackler, Pharm.D., U-M Comprehensive Cancer Center Symptom Management and Supportive Care Program Both men and women may experience hot flashes and sweating from their cancer or cancer treatment. In people with cancer, hot flashes are most commonly associated with lower hormone levels from breast cancer or prostate cancer treatment. Other types of cancer that might also lead to hot flashes include carcinoid tumors, medullary thyroid cancer, pancreatic cancer and renal cell cancer. Some medications may be useful in controlling hot flashes. These include certain antidepressants, anticonvulsants, clonidine and a progesterone-like drug. But beware that some of these drugs might not be appropriate for your circumstances. Speak with your cancer provider before starting any medications for hot flashes, including herbal and dietary supplements. Estrogen replacement therapy for hot flash treatment should not be used if you have or had breast cancer. Certain supplements should be avoided in breast cancer and prostate cancer patients due to their hormone-like characteristics. Tips that may relieve sweats related to cancer or cancer treatment:

• Wear loose-fitting clothing made of cotton • Use fans and open windows to keep air moving • Practice relaxation and slow, deep breathing

Guided Imagery 877-326-9155 Make a Donation 734-998-6893 Music Therapy 877-907-0859 Nutrition Services 877-907-0859 Patient Education Resource Center 734-647-8626 Pharmacy 734-647-8911 Practical Assistance Center 877-907-0859 PsychOncology 877-907-0859 Social Work 800-888-9825 Skills Lab 877-907-0859

The Cancer Center’s Symptom Management and Supportive Care Clinic works with patients along with their oncologists to help manage the side effects of cancer treatments. To make an appointment, call 877-907-0859.

Smoking Cessation Counseling 734-998-6222 Symptom Management and Supportive Care 877-907-0859

THRIVE ONLINE

mCancer.org/thrive

Thrive doesn’t end here! Visit mCancer.org/thrive for more. Here’s what you’ll find: • Information on the potential benefits of an organic diet • Links to national studies about cancer treatment and distress • Details on the Voices Art Gallery and the healing power of art • More resources and articles about the ongoing process of rehabilitation during and after cancer • Links to statistics about disparities among Native Americans and other groups with cancer • Tips from the American Cancer Society on living a healthy lifestyle • More on the power of distraction through sights and sounds


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