	The first x-ray mammography device that provides 3-dimensional (3D) images of the breast has gained FDA approval. The agency said the Selenia Dimensions System, which uses the process of tomosynthesis, might help physicians more accurately detect and diagnose breast cancer. Currently, about 10% of women screened with conventional 2-dimensional (2D) mammography undergo further testing for abnormalities that prove to be benign, the FDA said. For further information, go to 

 NCCN 2011 Guidelines for Breast Cancer Continue to Recommend Avastin

	The NCCN’s 2011 Guidelines for Breast Cancer recommend Avastin (bevacizumab) in metastatic breast cancer, despite the FDA’s move toward revoking the indication. The NCCN continues to back Avastin based on the PFS benefit demonstrated in several trials. The same trials failed to show an overall survival benefit with Avastin, and an FDA panel concluded Avastin’s side effect risks outweigh its PFS benefit. The FDA granted Avastin manufacturer Genentech a hearing to plead its case against revocation on June 28 and 29.

	The FDA has authorized pharmaceutical company Hospira Inc to market generic docetaxel. It is the first generic version of Taxotere sold in the United States. Taxotere’s patent expired in November 2010, but the FDA had requested that Hospira make alterations to its generic drug’s label before distribution. Docetaxel is FDA-approved for the treatment of breast, non— small cell lung, prostate, gastric, and head and neck cancers.

Articles

Updates

3D mammogram system approved, NCCN 2011 Avastin breast cancer guidelines, and the approval of generic docetaxel.

OncLive Nursing FDA Updates From April 2011

	The American Society of Clinical Oncology (ASCO) has developed a new set of recommendations for using bone-modifying agents for patients with metastatic breast cancer amid growing therapeutic options and fresh concerns about serious skeletal-related events.

	The ASCO panel said only patients with evidence of bone metastases should be treated with the therapy, and that there is insufficient evidence to demonstrate greater efficacy of 1 bone-modifying agent over another.

	The options are: denosumab 120 mg subcutaneously every 4 weeks; intravenous pamidronate 90 mg over no fewer than 2 hours; or zoledronic acid 4 mg over no fewer than 15 minutes every 3 to 4 weeks. Serum creatinine should be monitored before each dose, and patients should receive dental care before and during therapy.

ASCO releases new recommendations amid growing therapeutic options and fresh concerns about serious skeletal-related events.

ASCO Updates Guidelines on Bone-Modifying Drugs in Breast Cancer

Adoption of research findings in clinical practice tends to evolve over time and can be highly variable. Contrary to this traditionally slow pace, the American College of Surgeons Oncology Group’s Z0011 trial has seemingly changed practice overnight.

	The Z0011 study examined the survival impact of axillary lymph node dissection in breast cancer patients with sentinel lymph node metastasis. Axillary lymph node dissection has long been the standard of care for women with breast cancer who have a positive sentinel lymph node biopsy. In the Z0011 trial, women with 1 or 2 positive sentinel lymph node biopsies had the same outcome with or without axillary lymph node dissection. This means that women who are diagnosed with stage T1 or T2 invasive breast cancer no longer need to have their axillary lymph nodes removed.

	The phase III trial followed 891 women who underwent lumpectomy, whole-breast radiation, and sentinel lymph node dissection that confirmed metastasis. Patient accrual took place between 1999 and 2004, and trials were conducted at 115 centers across the United States. Trial enrollment was halted early in 2004 when it was determined that accrual of more women in the study would not alter the survival findings, and final follow-up for data analysis was completed in 2010. The results were presented in June 2010 at the American Society of Clinical Oncology Annual Meeting in Chicago, Illinois, and were published this past February in the 

Journal of the American Medical Association

	Want to share your thoughts on the impact of the Z0011 trial on clinical practice?

	Responses may be published in an upcoming issue.

	The study randomized women to either axillary lymph node dissection (n = 445) or sentinel lymph node dissection alone (n = 446), with adjuvant chemotherapy being administered at the discretion of the treating physician. Patients in the axillary lymph node dissection cohort had a median of 17 lymph nodes removed compared with 2 for women randomized to sentinel lymph node dissection alone.

	The results were nearly identical for the 2 cohorts, with 5-year overall survival rates of 91.8% for the women who had axillary lymph node dissection and 92.5% for the women who had sentinel lymph node dissection alone. Five-year disease-free survival rates also showed no significant difference. Patients were followed for a median of 6.3 years.

"The Z0011 trial appears to be changing breast cancer treatment overnight."

	The researchers noted that forgoing the standard practice of axillary lymph node dissection when sentinel nodes are positive for metastasis constitutes a practice change that could potentially improve the clinical outcomes in thousands of women each year by reducing the complications associated with axillary lymph node dissection. As oncology nurses, we’re familiar with those potential complications—infection, sensory changes, and lymphedema. And even if a complication does not occur, women who have had axillary lymph node dissection need to avoid having their blood pressures taken and IVs started in the arm on the side of the dissection. I would also think that not needing axillary lymph node dissection would allow women to preserve the veins in both of their arms, which may reduce the need for central line catheter or implanted port insertion for chemotherapy.

	If you’ve been in practice for a long time, you probably remember the days of caring for women who had radical mastectomies. Then there was a period of time when modified radical mastectomies became the standard of care, and now, breast-conserving lumpectomies are the standard of care. Axillary lymph node dissection has been around a long time, and it is astounding to learn that it may no longer be needed in women with stage T1 and T2 invasive breast cancer. The National Comprehensive Cancer Network’s updated 2011 Guidelines in Breast Cancer now even reference the results of the Z0011 study in a footnote to an invasive breast cancer treatment algorithm. T he Z0011 trial appears to be changing breast cancer treatment virtually overnight.

Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. 

Nurse's Notes

Contrary to the traditionally slow pace of research adoption, the American College of Surgeons Oncology Group's Z0011 trial has seemingly changed practice overnight

New Study Findings Change the Standard of Care for Women With Breast Cancer

Marcia Donziger, founder of the MyLifeLine.org Cancer Foundation.

 Cancer Foundation believes a strong support community is critical for cancer patients. Every day we provide free, personal websites to cancer patients and caregivers to easily connect with family and friends, because no patient should ever feel alone.

	At the age of 27, Marcia Donziger, the founder, was diagnosed with stage III ovarian cancer. During the treatment process, she really struggled with communicating effectively with friends and family. She couldn’t call people back in time when she was sick and found it depressing to repeat the same information over and over.

	In 2003, Marcia met Lori, who was diagnosed with brain cancer at age 33. Lori’s friends owned a Web company and created a beautiful website so that her family could easily communicate during the treatment process. Marcia knew this was a tool that would have been incredibly helpful during her recovery stage.

	Sadly, Lori passed away at age 35. Marcia kept thinking about Lori and the incredible support she received. Lori’s mom called the website their family’s “lifeline.” MyLifeLine.org was founded in 2007 as a nonprofit organization—in Lori’s memory&mdash;so every cancer patient would be surrounded by the best support network possible.

	Today, people are overwhelmed with emails, phone calls, text messages, and more. MyLifeLine. org is the only personal website service that consolidates all caregiving needs in one place while focusing 100% on cancer and the tools necessary to navigate the treatment process.

	Since 2007, MyLifeLine.org has grown to support over 30,000 people, including patients, caregivers, friends, and family. The website gets over a quarter million visits per month from 93 countries and 6,330 cities. In 2010, the growth rate of members exceeded 50%.

	Research proves that when a patient has a strong support community, treatment compliance and healing outcomes improve while mortality rates decrease.

	Collaborating with strategic partners is a key initiative. MyLifeLine.org offers cancer centers and nonprofit partners the option to provide co-branded patient websites in exchange for outreach benefits, such as placement on the partner’s home page and other marketing vehicles. Through these strategic partnerships, MyLifeLine.org will reach more people and improve patient outcomes.

	Program innovation is another key initiative. MyLifeLine.org is currently working on the creation of a mobile version and iPhone and Droid applications with unique features important to cancer patients. Other future innovations include a healthcare gift registry, prescription assistance tool through partnerships, survivorship and memorial guidance tools, and more.

	MyLifeLine.org's personal websites are offered to patients and caregivers at no cost. Here are some of the features.

 is the place to add chemotherapy and radiation schedules. Here patients can ask for help like a friend to accompany them to these appointments so they won’t feel alone. This can alleviate many duties from the main caregiver.

 page enables patients to share information on their specific cancer type.

 page is the place to smile. Every day, a new joke is shared to lift people’s spirits.

 page is the place where patients can set up a personal fundraiser to raise money needed for medical costs not covered by insurance.

 feature is the place to share health updates. Sharing in one central place relieves the patient or caregiver’s burden of repeating the news multiple times.

 page is where friends and family can inspire patients through messages of love and encouragement.

"MyLifeLine was the best thing to help me recover. I never felt alone. Thank you for such a great service."

	Don and Rebekah were a couple in their 50s living in Colorado. Rebekah struggled with pancreatic cancer since her diagnosis in February 2009. At first, she was against having a website to communicate with loved ones. But Don pressed her to let him create one on MyLifeLine.org.

	Once they started, the support was overwhelming. Over 100 friends waited weekly for her updates. Because of the website’s Helping Calendar, they had drivers for all of Rebekah’s chemo and radiation treatments. They also had a steady stream of meals coming weekly. MyLifeLine.org allowed Don to continue to work without giving up vacation days.

"This could not have happened without your website. It has made our lives easier in spite of the tremendous stress we are under."

	Sadly, Rebekah passed away in June 2010. Don expressed his gratitude to MyLifeLine.org for providing a tool that made the end of Rebekah’s life special and meaningful.

Advocacy Spotlight

MyLifeLine.org Cancer Foundation believes a strong support community is critical for cancer patients.

Advocacy Spotlight: MyLifeLine.org

	A breast cancer diagnosis is a highly distressing, life-changing experience. A small study presented at the Oncology Nursing Society 11th National Conference on Cancer Nursing showed that just being at a higher risk for the disease can also alter a woman’s life.

	“It was surprising to me how very distressing the risk status itself is to both the women and their loved ones,” said Marlene Z. Cohen, PhD, RN, FAAN, from the University of Nebraska Medical Center, Omaha, in a press release. Cohen presented the research along with Janice Phillips, PhD, RN, FAAN, from the Nursing Research and Center for Clinical Cancer Genetics and Global Health, University of Chicago Medical Center, Illinois.

	The researchers interviewed 19 African-American women aged 22 to 40 years who were considered to be at a high risk for breast cancer. High risk was defi ned as having a personal or family history of breast cancer and/or carrying a gene mutation linked to breast cancer. Overall, in women aged <45 years, African-American women’s risk for breast cancer is higher than Caucasian women’s risk. Young African-American women also frequently present at late stage with few treatment options.

	A majority of study participants reported that the high-risk status had changed their life. They described how being at a higher cancer risk altered their relationships and interactions with their family and friends. “It was clear that education and support is needed for these women and their families, as well as for nurses who care for and counsel high-risk populations,” Phillips said in a press release.

Conference Highlights

A breast cancer diagnosis is a highly distressing, life-changing experience

The Meaning of Breast Cancer Risk and Surveillance Behaviors Among High-Risk African-American Women

	Negative attitudes toward smokers extend to patients with lung cancer, regardless of whether or not they have ever actually smoked. Data presented at the Oncology Nursing Society 11th National Conference on Cancer Nursing showed how "lung cancer stigma" causes depression and reduces overall quality of life in both smokers and nonsmokers with lung cancer.

	Janine K. Cataldo, PhD, RN, University of California, San Francisco, who presented the research, discussed lung cancer stigma in a press release. "Perceived lung cancer stigma can be described as the person’s awareness of their lung cancer as it relates to social disqualifi cation, limitations in opportunities, and negative changes in social identity," Cataldo said.

	Cataldo's study accrued 189 self-reported patients with lung cancer, ranging from aged 20 to 88 years (median age, 55 years). The majority of the patients were male (56%) and white (85%). Eighty percent of the participants were current or ex-smokers. Data were obtained through online questionnaires.

	Depression affected 55% of respondents, according to the criteria of the Center for Epidemiologic Studies Depression Scale (CES-D). Statistical analysis also revealed a strong negative correlation between lung cancer stigma and quality of life. Smoking status did not have a statistically signifi cant impact on the results. The study recommended intervening to prevent the negative effects of lung cancer stigma.

Negative attitudes toward smokers extend to patients with lung cancer, regardless of whether or not they have ever actually smoked

Lung Cancer Stigma, Smoking Status, Depression and Quality of Life

	As part of the Intellisphere Oncology Specialty Group’s new partnership with the John Theurer Cancer Center (JTCC), our online and print coverage will provide special insight from JTCC’s oncology healthcare professionals. This coverage will include interviews discussing cancer treatment and care, along with updates on developments at the JTCC. Many of the interviews will be filmed live at the JTCC and appear on 

, our new online video platform. This month, 

 discusses gastrointestinal cancer and general cancer-related topics with Advanced Practice Nurse Laura Metcalfe, MSN, RN, APN, C, AOCNS.

 What are the current recommendations concerning the age at which an individual should get a colonoscopy?

The guidelines say you [should] start at age 50, assuming you have no risk factors for colorectal cancer. Obesity, inactivity, the Western diet—high in red meat, high in fat, low in fiber and fruits and vegetables&mdash; those are the modifiable risk factors [for colorectal cancer. There are also] risk factors that aren’t modifiable&mdash;age, family history, or [a personal history of]…any inflammatory bowel disease.

	We’re seeing a lot of patients in their 70s and 80s who have never had a colonoscopy. And now, all of a sudden, some symptom develops—they get obstructed&mdash;and they wind up in the emergency room [having] surgery for colon cancer. Well, had they had a colonoscopy 20 years earlier, this might not have happened.

In October 2010, the FDA approved trastuzumab (Herceptin) for treatment of patients with gastric cancer. Is the treatment being used at the JTCC and, if so, what is your experience with trastuzumab?

	We see a lot of patients with gastric cancers or gastroesophageal junction, which is where the esophagus meets the stomach, so we sort of treat them the same way. We now routinely test all their tumors for HER2/neu, which is the marker that will be overexpressed. I think it’s a small percentage of the patients with gastric cancer who will be positive. But if they are, we will definitely add Herceptin into their regimen. And it’s only probably been within the last 6 months, maybe a year, that we’re adding—I think it’s a year&mdash;that we’re doing this. But it definitely, in studies, was shown to improve disease-free survival.

	[Trastuzumab] does have some potential side effects—some cardiac potential side effects&mdash;so we always check people’s heart function before we give it to them. And there may be a time you might have to stop the drug for a while if [the patient’s] heart function lessens. But other than that, because it’s not chemotherapy, per se, [trastuzumab] doesn’t cause nausea or hair loss or a lot of the other side effects associated with chemotherapy. So patients are usually kind of happy to get it, especially if it can help them without too many side effects, other than the cardiac issue.

"We have social workers [and] we really try to have them see every newly-diagnosed patient."

What are some of the emotional and psychological side effects your patients experience and how do you address them? Are there staff members available at the JTCC who can help patients with these issues?

	Well, everyone who comes in knows they have cancer—whether they were told the day before, or whether they were already aware of it for a couple of weeks. They’re still usually pretty much in a state of shock.

	We have social workers [and] we really try to have them see every newly-diagnosed patient, but certainly those who we can see are struggling. Sometimes the [patient’s] family needs help. One of our social workers—well she’s actually a psychiatric clinical nurse specialist&mdash;she has groups for children, because sometimes it’s hard for the children to see their mother losing hair or the physical changes that can accompany [cancer treatment].

	Sometimes that’s even harder than the diagnosis or the treatment—the physical changes that are almost like a beacon to the world that “I’m on chemotherapy.” I’ve had women tell me that actually losing a breast was less traumatic than losing their hair, because not everyone can see [that you’ve lost a breast]. Some people also lose their eyebrows and eyelashes, so it’s not even just a matter of putting a wig on.

	Skin color [can also] change. A lot of the pancreatic patients or gastric cancer patients wind up with a lot of jaundice and ascites…But, again, we do have social workers that will definitely hook up with them and try to help them learn to deal with [all of these symptoms] as best as possible.

Over the past several years, have you witnessed an increase in patient use of complementary therapies?

	I think [patients] have always used [these treatments], but I think they may be a little more upfront about it now, or maybe we even ask more about it now. There are some therapies that we would wholeheartedly endorse. We’ve sent patients for acupuncture for refractory nausea, different problems that don’t respond to traditional medicine.

	But some of these herbal supplements that patients want to take can actually interfere with the chemo or affect their liver. So we try to bring it up out of the gate. We ask patients what they are taking so that we can have our pharmacist take a look at everything and look at what chemo drugs they’re on.

	[For example,] the same enzymes in the liver metabolize St. Johns wort. That’s one that usually you can never take with chemo or CoQ10 and the chemo. You can’t take [them] because they could be inhibitors of the drug, make you have more drug in your system, or they could suppress it, and you could have less drug in your system.

	So the general rule we try to tell patients [is that something such as] a multivitamin is okay but none of these megadoses of vitamins. For example, everybody thinks antioxidants are good. Well, maybe they are for you or me, but no one has done this study. No one’s taken 100 patients, given 50 [of them] high-dose antioxidants along with chemotherapy and 50 [of them] no antioxidants along with chemotherapy to see if there is a problem. And no one is going to do that study, let’s be honest. But if the theory of antioxidants is that they protect cells from free radicals or damage, well, we certainly don’t want to protect cancer cells from the damage we’re trying to inflict with the chemotherapy. So it just seems counterintuitive for people to be taking high-dose antioxidants. [And yet] people come in with bags full [saying], “I take these 20 pills before breakfast, and this is good for my immune system, and this cleans my liver, and my neighbor had cancer and took 2 of these pills and it went away.” And [a lot of this stems from misinformation] on the Internet.

	I try to always caution my patients. Go on the Internet. I know you’re going to, that’s fine. I’m sure I would. Just know your source. If you’re looking up cancer information, go to Memorial Sloan Kettering. Go to the National Cancer Institute, MD Anderson, any big cancer center. Don't just believe what someone puts out there— some miracle story. It's the Acai berry [diet] this year. It was the Noni juice... last year. It's sad because it's a vulnerable population...So we try to keep the subject [of complementary therapy] out there so patients don’t feel like they have to hide it from us…Patients could be doing themselves more harm than good, so we try to keep it open.

“ We try to keep the subject [of complementary therapy] out there so patients don’t feel like they have to hide it from us.”

You brought up patient use of the Internet. Have e-Patients made your job more or less difficult?

	Probably a little bit of both. Some people get factual information. They’re well informed. They come in [and] they kind of already understand the process—they almost anticipate what treatment you’re going to tell them. Say FOLFOX is the standard of care. You say FOLFOX [and the patient says], “Oh, FOLFOX, okay.” And that’s good, and then they don’t doubt that they’re getting the best therapy.

	But [with] these other testimonials [available] from whatever quack is putting stuff out there, [patients]…come in with all this [and] it can be hard. Because I don’t want to say they don’t believe you, but I think there’s still that doubt, like, “Why are you not telling me about this juice that could cure me or this berry or plant.” And I don’t know what they [are doing] in their [own homes]. You can only tell them medically what’s advisable and if they use it, they use it.

How is the new John Theurer facility helpful for you and for your patients?

	Well, [in our previous facility] exam rooms…were very limited. So, for example, if the doctor saw the patient and then I needed to talk to them either before or after…to go over side effects of chemo or talk to their family, we had no place to do that because the doctor needed the patient out of the room for him to see the next patient. So it was always trying to find [someplace to talk with the patient that was] conducive to learning, to privacy.

	Now patients are saying [about the new facility], “It’s so big.” [The new building] has a lot of features for the patients. They have a meditation room. It’s just a beautiful building. I just think it’s a much more calming environment than our last facility was, only because we were so crowded. [If] you walk into a waiting room and see hundreds of people, already your stress level goes up just thinking, “How long is my wait going to be.” Before, 12 doctors were seeing…patients out of the same waiting room…Now we have doctors on [different] floors, so you don’t come into that mass wait like before. So I think the flow is better. And...we’re getting compliments from the patients.

Feature Story

As part of the Intellisphere Oncology Specialty Group's new partnership with the John Theurer Cancer Center (JTCC), our online and print coverage will provide special insight from JTCC's oncology healthcare professionals

Nurse's Insight: An Interview With JTCC Advanced Practice Nurse Laura Metcalfe

Celebrity patients have been raising awareness and funding for various diseases, such as cancer, for over half a century. 

 discussed these high-profile patients with Barron H. Lerner, MD, PhD, author of 

When Illness Goes Public: Celebrity Patients and How We Look at Medicine

, and the Angelica Berrie-Gold Foundation associate professor of Medicine and Public Health at the Columbia University College of Physicians & Surgeons and the Mailman School of Public Health.

 What is it about the celebrity patient that draws your interest?

 I’m a historian in addition to being a doctor, so I noted that so many of the ways in which the public was being alerted to various medical issues and conditions seemed to be through famous cases. So you might expect the opposite, where it’s randomized controlled studies or sophisticated scientific information, but it was often a famous person’s story. So I got interested in trying to explore why that was the case and what these stories did and didn’t tell us.

Do most celebrities embrace the celebrity patient role?

	I wouldn’t say most embrace it. I would say many embrace it, and others go less willingly. But it’s become almost obligatory, and this is a real change. The first story I talked about in my book was Lou Gehrig. He was very, very reluctant. He didn’t want this at all. He wanted to be left alone, but he sort of got thrust into a spotlight.

	In the intervening 70 years, it’s become almost mandatory, just because there’s no privacy anymore and because other celebrities have done this in the past. Some I think really want to tell their stories and are comfortable talking about these sorts of things in public, and then there’s another big subset that just sort of rolls their eyes and says, “I guess I’m going to have to talk about this because people are going to be asking questions.”

What is it about our culture that draws us to celebrities and accordingly, celebrity patients?

	That’s chapter 1 in my book. I don’t get it, personally. But there’s something about celebrities that people really admire, which is, I think, their money, their fame, their abilities, and their wisdom. And why that is, deep down, I don’t know, but it’s just a fact. And so it really was a natural progression. If you’re interested in the lives of celebrities who are healthy and their marriages, and their divorces, and their movies, and what they’re wearing on the red carpet—when they become sick, why not be interested as well? And that’s exactly what gradually happened.

	And there’s a bit of a quid pro quo there. I think that if you are a celebrity and you have benefitted from the publicity surrounding your movies or surrounding other things you’re doing, it’s hard to [then] say “I used the media before, and now I’m not saying anything about my illness.” So there’s almost an obligatory aspect to when these guys get ill that they’ve got to talk then as well.

What role have celebrity patients played in creating the modern, more empowered patient? How have they changed the physician-patient relationship?

	I think that celebrities tend to be well connected. They tend to have a lot of money. And those factors, when you get sick, will enable you, if you’re interested, to be able to pursue a number of medical options. Celebrities can contact people who are on the cutting edge of technology, and they can access multiple doctors, and they can get advice from a lot of different people. That’s one of the appeals to ordinary patients—they see celebrities doing this, and they say, “If the celebrities do this, they must know what they’re doing. Why don’t I try to emulate that sort of thing, and why don’t I go into my doctor’s office with the following questions?”

	A couple of the best examples would be people like Michael J. Fox and Lance Armstrong. If you go to their websites, they’re very instructive about what you should say to your doctor…It’s very empowering. But one of the problems here is everyone’s disease is different. And people can run into problems if they say “I’m just going to do exactly what Michael J. Fox did,” because that may not be good advice.

Have there been any major scientific breakthroughs that have been facilitated by celebrity patients?

	There are more minor breakthroughs. Some people will say Brian Piccolo from the movie 

. He had a cancer that was actually not testicular cancer. It was another type of what’s called a gonadal cancer related to sex organs. But the money that was collected in his name from the NFL that got applied to research, a lot of it got applied to testicular cancer because the other cancer was so rare that fewer people were researching it. And some of the research that went into that really got a better handle on how to treat testicular cancer. It is said that Lance Armstrong, benefitted from that increased knowledge.

	That’s less of a straight line than you would tell in storybook fashion. It’s [usually] more complicated than that. But that’s an example where money was raised specifically as a result of a particular celebrity, and that helped to generate a particular research advance.

	The other stories are less direct. You can think about Betty Ford and breast cancer. That event propelled breast cancer into the spotlight. When Betty Ford talked about her breast cancer, a slew of money started going to breast cancer [research]. And then down the road, there were a bunch of very important [breast cancer] developments that, again, indirectly could be linked to that.

What negative impact have celebrity patients had?

	The celebrity cases can definitely give misinformation. So Steve McQueen is a quintessential example where he goes down to Mexico and starts getting this very complicated alternative treatment. There’s sort of this brief moment where he’s “cured,” but it turns out to not be true, but people think it’s true because enough people said it. And then people start going down to Mexico to get the same thing he did, which has never been shown to be of any value in a clinical trial.

	Farrah Fawcett, similarly. I wrote a very carefully worded piece when she said, “I’m cured,” [that said that people should] take this with a grain of salt. Farrah Fawcett [followed] the same path that so many celebrities have, which is an obligatory period of optimism. Nobody wants to say anything bad, but the fact was, I could tell from being a doctor and how they were treating her, that her cancer was going to kill her. I knew it, assuming what I was reading was true. And I didn’t really want to come out and say that, but I just wanted to alert people that the story being told was a very contrived story. Ditto Patrick Swayze. You just knew the guy was not going to make it.

	It’s better than it used to be because now, in many cases, such as Michael Douglas, the journalists are actually asking better questions. They’ll ask, “What do you mean it’s Stage IV but he says he’s going to be cured?”

	The main theme of my book is how do you deal with these individual cases when they’re not necessarily representative. And that’s a point that I try to just talk about over and over in the book…It’s 

 famous case [and] what you can conclude from that is limited. You can learn from it, but you may not be able to draw relevant conclusions. So that’s the big caveat with any of these stories.

Do celebrity patients profit from going public?

	There was sort of a big stink—I think it was about 2000&mdash;when a bunch of celebrities were going on talk shows plugging various [products]. That’s the worst example of it and there was a backlash to that, and I think it’s happening less.

	But most people who really see themselves as advocates are very careful about that. Michael J. Fox and Lance Armstrong have been very careful not to take any money from anyone who has a very strong interest in a particular product. Now, they may say, ‘I’m taking this drug,’ but they aren’t taking any money from that company. Most of the celebrities have really genuinely tried to help people.

Controlling healthcare costs is a major issue. Obviously, celebrities can afford every possible treatment. Do you think this creates an unrealistic expectation for the general public?

	Maybe. Lance Armstrong is a good example here. He was able to go to multiple different medical centers and get multiple opinions and then pick one treatment. Many people can’t do that. [But] you can’t blame the celebrities for that. To some degree, it’s like anything else in America, there are the haves and the have-nots.

	Having said that, I think that even if you can’t access everything, you can still learn what questions to ask of your own doctors, even if you can’t fly around the country and get 20 opinions.

Celebrities all have greater access to public officials and legislative bodies. Is that a good thing?

	I think it’s good for the most part. The only people who really don’t like that are the people who don’t have a celebrity associated with their disease. So it does potentially create some inequality where if you’re more of an A-list celebrity, you can get more money for your disease, which seems like a crazy way to allot money for diseases, but that’s the way it is. So you hope that the Congress people are not simply wowed by a particular celebrity, but they’re listening to what the celebrity has to say. But I’m not sure that’s always the case.

	Look, if Michael J. Fox testifies in front of Congress, which he’s done many times, you can’t help but be moved by that. He’s really genuine. If I were a congressman, I’d open up the wallet if he came there and testified. But you really want to try to give money to the most logical research, the one that’s apt to help the most people.

OncLive Nursing discusses highprofile patients with Barron H. Lerner, MD, PhD, author of When Illness Goes Public: Celebrity Patients and How We Look at Medicine

A-List Advocacy: A Discussion of Celebrity Patients

March was National Kidney Month. Here are some myths and facts about kidney cancer.

Renal cell carcinoma is the only type of kidney cancer that can occur.

 The most common type of kidney cancer is renal cell carcinoma; however, less common types of kidney cancer include transitional cell carcinoma that affects the ureters but begins in the kidneys, and Wilms’ tumor of the kidney that can occur in children.

People with Von Hippel-Lindau syndrome are at higher risk for developing kidney cancer.

 Von Hippel-Lindau (VHL) syndrome, a rare familial disease caused by an abnormal VHL gene, increases a person’s risk of developing kidney cancer. The gene can also cause cysts or tumors to develop in the eyes, brain, and other body parts. Family members of patients with VHL who have kidney cancer can be tested to determine if they have the abnormal VHL gene, and if they do, can work with their healthcare providers to detect kidney cancer and VHL-related cysts/tumors before symptoms develop.

 Blood in the urine is a sure sign of kidney cancer.

: While blood-colored, rusty, or deep red urine is a symptom of kidney cancer, red-appearing urine may also be a sign of noncancerous disorders, such as a urinary tract infection. Red-tinged urine should never be ignored; it should be promptly evaluated by a healthcare provider. Other signs and symptoms of kidney cancer include persistent fl ank pain, lumps or masses in abdominal tissue, fatigue, fever, and weight loss.

March was National Kidney Month, so here is an opportunity to test your knowledge about kidney cancer.

Myths and Facts About Kidney Cancer

TMZ. Perez Hilton. Entertainment Tonight. People. InTouch Weekly.

 We intensely follow celebrities’ every move online, on TV, and in print. The media attention gives celebrities tremendous influence over our public discourse. Stars frequently use this outlet to speak out for various causes. This celebrity advocacy takes the form of both individual crusades and collaborative efforts, such as Stand Up To Cancer (SU2C).

	SU2C was started in 2008 as a program of the Entertainment Industry Foundation, the entertainment industry’s leading charity organization. SU2C’s 9 cofounders were each affected by cancer, either personally or through a loved one. They were dismayed at the lack of communication they witnessed between doctors and researchers in the oncology community. Despite breakthroughs in the science and technology of cancer, the lack of collaboration seemed to be obstructing real progress.

	Less competition, greater collaboration, and quicker results thus became the rallying points of SU2C. The cofounders collaborated with major cancer researchers to devise an entirely new funding model to emphasize these goals. They then began the process of raising the funds needed to implement the program.

	SU2C primarily generates funds through a biennial celebrity telethon. The organization also has a group of major donors, led by Major League Baseball.

	The first hour-long, commercial-free SU2C telethon was simulcast live on ABC, NBC, and CBS in September 2008. The broadcast reached 170 countries and included a bevy of major celebrities. Sherry Lansing, a cofounder of SU2C and former chair of the Motion Picture Group of Paramount Pictures, told 

 that when it comes to cancer, “Celebrities are no different than anybody else; everybody on the show has been touched by cancer in some way.” Shortly after the telethon, SU2C announced that it had raised over $100 million for cancer research since its launch.

		SU2C’s 5 Dream Teams are conducting translational research designed to quickly deliver results from the laboratory to the patient. For greater detail on the projects, go to 

Cutting off the Fuel Supply: A New Approach to the Treatment of Pancreatic Cancer

LEADERS: Craig B. Thompson, MD, director, Abramson Cancer Center, the University of Pennsylvania; Daniel D. Von Hoff, MD, senior investigator and physician-in-chief, Translational Genomics Research Institute

		The Pancreatic Dream Team is using advanced imaging techniques to determine which nutrients pancreatic cancer cells require for survival. Clinical trials will then be conducted to discover drug combinations that deprive pancreatic tumors of these nutrients.

Bioengineering and Clinical Applications of Circulating Tumor Cell Chip

 LEADER: Daniel A. Haber, MD, PhD, director, Massachusetts General Hospital Cancer Center

		The CTC Dream Team is optimizing the clinical application of the CTCChip, a microfluidic chip that can capture CTCs for scientific analysis. The researchers are examining the CTCChip’s value in early cancer detection and determining treatment efficacy.

Bringing Epigenetic Therapy to the Forefront of Cancer Management

LEADER: Stephen B. Baylin, MD, deputy director, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

		The Epigenetic Dream Team is creating biomarkers to assess the effectiveness of epigenetic treatments and conducting clinical trials designed to facilitate the integration of epigenetic treatment into clinical practice.

Targeting the PI3K Pathway in Women’s Cancers

LEADER: Lewis C. Cantley, PhD, director, Cancer Center at Beth Israel Deaconess Medical Center

		The focus of the PI3K Dream Team is to find molecular biomarkers for PI3K inhibitors in patients with breast, ovarian, and endometrial cancers. The researchers also hope to discover effective treatment combinations for patients with PI3K mutations.

An Integrated Approach to Targeting Breast Cancer Molecular Subtypes and Their ‘Resistance’ Phenotypes

 LEADERS: Joe W. Gray, PhD, Life Sciences Division director, Lawrence Berkeley National Laboratory; Dennis J. Slamon, MD, PhD, director of clinical/ translational research, UCLA’s Jonsson Comprehensive Cancer Center

		The Breast Cancer Dream Team is working to develop more effective treatments for estrogen receptor—positive, HER2-positive, and triple-negative breast cancers. A key element of the research involves examining how tumor cells become resistant to treatments that are initially effective.

	With the success of its initial broadcast, SU2C easily attracted major celebrity participation to its second telethon in September 2010. Some of the celebrity participants included Christina Applegate, George Clooney, Cindy Crawford, Michael Douglas, Sally Field, Michael C. Hall, Diane Lane, Jay Leno, Rob Lowe, Tobey McGuire, Gwyneth Paltrow, Seth Rogen, Adam Sandler, Ryan Seacrest, Will Smith, Denzel Washington, Reese Witherspoon, and Renée Zellweger.

	The hour-long program was broadcast live and commercial-free on ABC, CBS, FOX, NBC, and several other networks. Network news anchors Katie Couric (a founding member of SU2C), Diane Sawyer, and Brian Williams hosted the program, which was seen in 195 countries. The telethon raised >$80 million.

	The tremendous response to its fundraising efforts allowed SU2C to implement its innovative funding model. The model consists of 2 scientific grants, Dream Team Grants and Innovative Research Grants (IRGs), designed to facilitate greater collaboration and accelerated results in cancer research. The grants were created in collaboration with SU2C’s scientific partner, the American Association for Cancer Research (AACR).

	Dream Team Grants fund multidisciplinary, multi-institutional groups of scientists whose research can benefit patients in the near-term. IRGs support highrisk, high-reward projects with the potential to significantly impact cancer care.

	The grants are awarded and administered by the AACR’s Scientific Advisory Committee (SAC), which is chaired by Nobel Laureate Phillip A. Sharp, PhD, Institute Professor at the Massachusetts Institute of Technology and the David H. Koch Institute for Integrative Cancer Research. SAC vice chairpersons include Brian J. Druker, MD, director, Oregon Health & Science University Cancer Institute, Portland, and Arnold J. Levine, PhD, professor, Institute for Advanced Study and Cancer, Institute of New Jersey, Princeton. The remaining committee members comprise 15 prominent cancer researchers and physicians, along with 2 patient advocates.

	SU2C announced the selection of the first 5 Dream Teams 

 in May 2009. The Teams comprise >300 total participants from >20 major cancer research institutions. Each Dream Team is conducting groundbreaking “translational” research designed to quickly move results from the “bench to the bedside.” The teams each received 3-year grants, and the total award amount was $73.6 million.

	The SAC selected the 5 Dream Teams from 237 total submissions. In an interview with 

, Sharp discussed some of the factors the SAC considered. “Teams had to be doing innovative and important cancer research. [They also] had to be either engaged in clinical programs—meaning they’re [currently reaching] patients&mdash;or very close to it.” The SAC also examined the likelihood of success, whether the projects addressed key research problems, and the various applicants’ collaborative potential. “We wanted people who…were committed to being a team,” Sharp said.

	The leader of the “Targeting PI3K in Women’s Cancers” (

) Dream Team, Lewis C. Cantley, PhD, director, Cancer Center, Beth Israel Deaconess Medical Center and professor of systems biology at Harvard Medical School, and chief of the division of signal transduction at Beth Israel Deaconess Medical Center, discussed his project with 

	The phosphatidylinositol 3-kinase (PI3K) pathway is involved with cell growth and survival. Mutations in genes that regulate the PI3K pathway promote the development and growth of tumors. Several targeted therapies that inhibit the PI3K pathway are being tested in ongoing clinical trials; however, molecular biomarkers are still needed to determine which patients should receive the PI3K inhibitors. Finding these predictors is the goal of Cantley’s Dream Team.

	Cantley and his Dream Team colleagues are the same researchers who discovered the PI3K pathway and its oncogenic properties. Their new research is focusing on breast, ovarian, and endometrial cancers, which have all been shown to have the PI3K mutation. After examining almost 2000 breast, ovarian, and endometrial cancers from 7 major cancer institutions, the team designed 10 phase II clinical trials, 2 of which are ongoing.

	The design of the 10 PI3K trials varies from the traditional clinical setup. Patients are usually placed into cohorts that receive the same treatment over the entire trial. In contrast, the PI3K Dream Team’s “adaptive” trial design will use biomarkers and ongoing tests to determine treatment decisions throughout the trial. The adaptive mechanism quickens the feedback on the efficacy of various biomarkers and treatment regimes.

	The trials are using both single-agent (PI3K inhibitors alone) and combination therapies. Cantley and colleagues are collaborating with pharmaceutical companies in their selection of investigational drugs for the trials. They hope to develop drug combinations that will strike multiple targets.

	Cantley said the specific endpoints vary among the trials. “Most of the trials will look for a clinical response—tumor shrinkage&mdash;as the primary endpoint, although it depends on the type of cancer. In most types of breast cancer that we’ll be working with, to look for survival as an outcome requires [too] many years…We’re looking for trials that will have endpoints that are more rapid than that. [However] with inoperable endometrial cancer, the survival is less than a year, typically. So, in those trials, survival will be an outcome.”

	Cantley attributes his project’s early success to the resources and collaborative process of SU2C’s funding model. “There really is no comparable NIH-funded or private-foundation- funded grant mechanism.”

SU2C Innovative Research Grants (IRGs) fund high-risk, high reward projects with the potential to revolutionize cancer research and treatment. Here are the first 13 IRGs, which were awarded in December 2009. To see the next set of 13 IRGs, which were awarded this month, go to 

An Emerging Tumor Suppressor Pathway in Human Cancer

						Fernando D. Camargo, PhD, principal member of the Harvard Stem Cell Institute; assistant professor at the Children’s Hospital Boston and the Stem Cell Regenerative Biology Department at Harvard University

Modeling Ewing Tumor Initiation in Human Neural Crest Stem Cells

						Elizabeth R. Lawlor, MD, PhD, assistant professor in the Departments of Pediatrics and Pathology at the University of Michigan

Cancer Cell Specific, Self- Delivering Pro-Drugs

						Matthew Levy, PhD, assistant professor of Biochemistry at Albert Einstein College of Medicine of Yeshiva University

Targeted Inhibition of BCL6 for Leukemia Stem Cell Eradication

						Markus Müschen, MD, director of the Leukemia Research Program at Children’s Hospital Los Angeles and the Leukemia and Lymphoma Program at the University of Southern California Norris Comprehensive Cancer Center; associate professor of Pediatrics, Biochemistry, and Molecular Biology at the University of Southern California, Keck School of Medicine

Identifying Solid Tumor Kinase Fusions via Exon Capture and 454 Sequencing

						William Pao, MD, PhD, associate professor of Medicine, Ingram associate professor of Cancer Research, and director of Personalized Cancer Medicine at the Vanderbilt-Ingram Cancer Center

Cover Story

Celebrity advocacy takes the form of both individual crusades and collaborative efforts, such as Stand Up To Cancer (SU2C)

April 2011