LEXINGTON, Ky. (Aug. 19, 2014) – A new web-based program developed by University of Kentucky Markey Cancer Center researchers will provide a simple, free way for healthcare providers to determine which brain tumor cases require testing for a genetic mutation.
Gliomas – a type of tumor that begins in the brain or spine – are the most common and deadly form of brain cancer in adults, making up about 80 percent of malignant brain cancer cases. In some of these cases, patients have a mutation in a specific gene, known as an IDH1 mutation – and patients who have this tend to survive years longer than those who do not carry the mutation.
Developed by UK researchers Li Chen, Eric Durbin, and Craig Horbinski in collaboration with software architect Isaac Hands of the UK Markey Cancer Center Cancer Research Informatics Shared Research Facility, the program uses a statistical model to accurately predict the likelihood that a patient carries the IDH1 mutation and requires screening.
Gliomas are often tested for IDH1 mutation following surgery to remove the tumor, but undergoing this type of testing often requires stringent insurance pre-approvals due to rising healthcare costs, Horbinski says.
"Currently, there are no universally accepted guidelines for when gliomas should be tested for this mutation," Horbinski said. "Obtaining insurance pre-approval for additional molecular testing is becoming more commonplace, and this program will assist healthcare providers with an evidence-based rationale for when IDH1 screening is necessary."
Additionally, Horbinski notes that the program will help conserve research dollars by helping brain cancer researchers narrow down which specific older gliomas in tumor banks – previously removed in a time before IDH1 testing was routine – should be tested as data for research projects.
Horbinski's research on the program was published in the May issue of Neuro-Oncology. The work was funded through a grant from the National Cancer Institute, the Peter and Carmen Lucia Buck Training Program in Translational Clinical Oncology, and the University of Kentucky College of Medicine Physician Scientist Program.
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LEXINGTON, Ky. (Aug. 13, 2014) – Becker’s Hospital Review magazine has listed the University of Kentucky Albert B. Chandler Hospital among the nation’s “100 Hospitals and Health Systems with Great Oncology Programs” in its recently released compilation of leading cancer care providers in the United States. The UK Markey Cancer Center, whose clinical programs are integrated with Chandler, received a National Cancer Institute cancer center designation in July 2013.
According to the health care industry trade publication, organizations included on the 2014 list are “leading the way in terms of quality of patient care, patient outcomes and research.” Becker’s noted Markey's recent NCI designation, its 29 percent patient growth over the past five years, and its status as a Blue Distinction Center for Complex and Rare Cancers for 10 cancer types.
The Becker's Hospital Review editorial team selected hospitals for inclusion based on rankings and awards they have received from a variety of reputable sources. The following awards were considered as part of the criteria for inclusion on the list: U.S. News & World Report cancer rankings, Truven Health Analytics, CareChex cancer care rankings, National Cancer Institute designations, the American College of Surgeons Commission on Cancer accreditations, American Nurses Credentialing Center designations, and awards and Blue Distinction Center recognition from the BlueCross BlueShield Association.
LEXINGTON, Ky. (July 30, 2014) – As part of a weeklong tour across the state, the Smoke-Free Kentucky Coalition will be making a stop at the University of Kentucky Markey Cancer Center today at 11 a.m. to promote better health for Kentuckians through smoke-free policies. The event at Markey is one of several stops across the state as it heads to western Kentucky for the annual Fancy Farm Picnic.
At each stop, the Smoke-Free Coalition is rallying supporters and reaching out to legislators, urging them to join 24 other states in passing a comprehensive, statewide smoke-free law that covers all indoor workplaces and public places, including bars and restaurants. The goal of the tour is to get all Kentuckians, around the state, active and engaged in supporting smoke-free policy as the campaign gears up for the 2015 legislative session.
Secondhand smoke contains more than 7,000 chemicals, almost 70 of which are known to cause cancer, and is proven to cause heart disease, lung cancer, respiratory illnesses and even premature death. In fact, studies indicate that secondhand smoke exposure causes about 1,000 deaths a year in Kentucky.
To find out more information about how smoke-free policies are good for health and businesses visit: www.smokefreekentucky.org
LEXINGTON, Ky. (July 30, 2014) — The phrase "we caught it early" is possibly the best news a patient can hear in the midst of a cancer diagnosis. Combating cancer in its earliest stages, when the disease is localized to a certain part of the body, gives patients the best chances of survival.
Screenings for breast, skin, colon, prostate and other forms of cancer are touted for saving lives through early detection. Many health care providers recommend cancer screenings as a precautionary measure, especially for high-risk patients. But in the case of lung cancer, the leading cause of cancer death in the United States, the patient's decision to undergo a screening process is more complex.
According to University of Kentucky psychologist Dr. Jamie Studts, lung cancer screening is an algorithm, not an event. Patients aren't always aware of the physical and psychological consequences of the lung cancer screening process, which can lead to false positive results, invasive biopsy procedures, harmful radiation exposure and anxiety caused by an ongoing process.
Studts, a researcher in the UK Department of Behavioral Science and the Cancer Prevention and Control Program of the Markey Cancer Center, is working to develop an online tool that will help individuals at high risk for lung cancer navigate the lung cancer screening decision-making process. He said the decision to undergo lung cancer screening should be well-informed and aligned with the patient's personal values. Studts is collaborating with Dr. Margaret Byrne, a health economist and medical decision-making researcher at the University of Miami, on this project, which is funded by a grant awarded from the National Cancer Institute.
"Screening is for asymptomatic, healthy people to find out there's something wrong," Studts said. "You are committing to a series of events that will lead to either learning you don’t have cancer, or detecting and treating it."
A number of factors, including the Affordable Care Act's provision of accessibility to cancer screening services and results from a 2011 National Lung Screening Trial conducted by the National Cancer Institute, have reinvigorated the public's interest in lung cancer screening. The National Lung Screening Trial reported a 20 percent relative reduction in mortality for high-risk individuals who received a low-dose computed tomography (CT) scans. But the report also identified substantial risks and limitations to lung cancer screenings, which included overdiagnosis and relatively high false positive rates. The rate of false positive occurrence in the study of a high-risk population was 39 percent. With high rates of false positive scans and ongoing follow-up treatment, Studts said widespread lung cancer screening could be a costly burden for government-funded health care but could also prevent very expensive treatments for late stage lung cancer.
Studts and his fellow researchers have proposed a decision-making aid that is designed to accomplish three objectives: disperse knowledge, empower the patient and clarify individual's values. The aid will present accurate information about the screening process and calculate feedback that's tailored to the individual. The tool will also empower the individual to discuss the decision with their health care provider by providing a prompt list of potential questions. Finally, the values clarification component of the tool will explore the patient's personal preferences regarding the lung cancer screening process. For instance, if a patient is ultimately unwilling to undergo surgery for a lung biopsy, the tool can determine that they will likely experience minimal benefit from a screening.
"The goal is to help people interpret what they learn in the context of what’s important to them regarding their goals in health," Studts said. "They will learn about lung cancer screening options, benefits, harms and uncertainties associated with the modality.”
To develop the provider education program, Studts has collaborated with a team of University of Kentucky experts, including Dr. Eric Bendsadoun, a pulmonologist and director of the lung cancer screening program; Dr. Susanne Arnold, a medical oncologist who is part of the multidisciplinary lung cancer screening program; Dr. Michael Brooks, a cardiothoracic radiologist; Dr. Mark Dignan, a cancer prevention and control researcher; Dr. Eric Durbin, a cancer research informatics expert; and Dr. Brent Shelton, a cancer biostatistician.
The next step in their research will be conducting a clinical trial to test the decision-making aid among high-risk individuals, or high pack-year smokers, in Florida and Kentucky. Recently, Studts, along with Dr. Tim Mullet, a cardiothoracic surgeon at UK, received funding from the Kentucky Lung Cancer Research Program to develop an online continuing education program geared toward educating health care providers about lung cancer screening and how to discuss the lung cancer screening question with their patients. Eventually, he envisions dispersing a comprehensive educational toolkit on lung cancer screening to clinics and hospitals.
Studts said the current research suggests that lung cancer screening has minimal benefits for individuals younger than 55. Still, many Americans with a history of high pack-year smoking will face the decision of whether to be screened for cancer in their lifetime. Studts believes it will be helpful to implement an online tool that will help guide members of the high-risk population through a decision-making process.
"We’re interested in delivering high quality patient centered care – helping people be engaged in their health care choices and helping health care providers engage in these choices too."
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LEXINGTON, Ky. (Aug. 6, 2014) – The Louisville Ironman – a triathlon consisting of a 2.4-mile swim in the Ohio River, a 112-mile bike ride, and a 26.2-mile run – is a competition that would test even the toughest of wills.
But for University of Kentucky radiation oncologist Dr. Jonathan Feddock, the competition is about more than achieving a personal goal – Feddock, an accomplished triathlete, is using his athletic talents to help provide better care for the cancer patients he treats. When he competes in the Aug. 24 Ironman, he'll be doing so to raise money to pay for renovations and updates to the brachytherapy program at the UK Markey Cancer Center.
Brachytherapy is a specific form of radiation treatment where radiation sources are placed inside or close to the area requiring treatment.
”The main benefit to using brachytherapy for the treatment of cancer is that this is the only method of radiation treatment where we can make radiation appear exactly where we want to," said Feddock. "If your goal is to treat a tumor with curative doses of radiation and not treat the normal parts of the body immediately next to it, then brachytherapy is the best option.”
The total estimated cost for the brachytherapy project is approximately $1.2 million dollars, and Feddock has a specific goal to reach – he is trying to raise $200,000, with the remaining $1 million to be matched through the University, independent philanthropists, and department funds. The proposed changes would consolidate all areas involving brachytherapy, including moving the implant procedure room and the radiation treatment room into a combined space, and upgrading the current brachytherapy equipment.
Brachytherapy treatment is commonly used to treat most gynecologic cancers, as well as malignancies of the breast, prostate, and skin. Under Feddock’s leadership, the radiation medicine department has developed a niche practice that uses brachytherapy for recurrent tumors in patients who have previously received radiation. As a result, UK sees patients from all over the country.
Unfortunately, Kentucky holds the distinction of having some of the highest cancer rates in the country – including being No. 8 in the U.S. for cervical cancer incidence. The availability of brachytherapy in the state is limited, and as a result, Markey provides brachytherapy services for essentially all patients coming from central, eastern and southern Kentucky.
Currently, Markey patients receive their brachytherapy implants in the Ben F. Roach Building, but have to be transported down a long hallway to the radiation treatment room in the UK Albert B. Chandler Hospital. Because the radiation therapy treatment and recovery rooms require a shielded vault, consolidation is not an easy process.
However, Feddock points out, the renovations will improve staff efficiency and the overall patient experience, in addition to allowing his team to see even more patients per day.
"Currently, the setup and logistics of brachytherapy treatment limit me to no more than two cases a day," Feddock said. "As our patient population grows, there's a real need to streamline the process so we can see more patients. I believe the proposed changes would allow me to treat three to four patients a day."
Feddock is determined to reach his goal, and he's even implemented a clever strategy to bring in donations. After speaking with members of the World Triathlon Corporation, he has been given special permission to begin the Ironman in Louisville this year in last place – and he's encouraging donors to "bet against him" by pledging a small amount for every single person he passes in the race. With close to 3,000 competitors ahead of him, that's a lot of potential donations.
The plan becomes more impressive when you look at his track record: in 2011, Feddock finished 30th in the Ironman; in 2013, he finished 17th.
”While I'm approaching some corporate sponsors and individual philanthropists about making larger donations, I think crowdfunding is the key here," Feddock said. "Every single dollar helps, and if a lot of different people contribute just a small amount, it will add up. By pledging even a small donation, you'll be making a huge impact on cancer care for women and men across Kentucky."
Dr. Marcus Randall, chair of the Department of Radiation Medicine, says his team fully supports Feddock's undertaking.
“Dr. Feddock’s commitment to his patients and to UK HealthCare is inspirational to us all," Randall said. "The department is strongly supporting Dr. Feddock, which shows that we truly have 'skin in the game' when it comes to giving our patients the best treatment possible.”
To support Feddock's mission and improve patient care at the UK Markey Cancer Center, visit his personal fundraising page, Ironcology.net for details on how to donate. All donations are processed through the Markey Cancer Foundation.
LEXINGTON, Ky. (July 24, 2014) – Eastern Kentucky faces some of the highest rates of cancer incidence and mortality in the nation, but two hospitals in the Appalachian Regional Healthcare (ARH) system are stepping up the fight against cancer. Williamson ARH Hospital in South Williamson, Ky. and Harlan ARH Hospital have announced a new affiliation with the University of Kentucky Markey Cancer Center, the state's first and only National Cancer Institute-designated cancer center.
"ARH is consistently working to build a new level of health care for the people we serve in eastern Kentucky and southern West Virginia by providing our communities local access to some of the most advanced health care services," said ARH President and CEO Joe Grossman. "This affiliation with the UK Markey Cancer Center will further enhance the services provided in Williamson and Harlan and will help us ensure our residents receive only the best oncology care right here at home in conjunction with a team of nationally recognized medical professionals."
"We are so pleased to announce our affiliation with the Markey Cancer Center, and we believe this new relationship will allow us to provide better care for our patients," said Dr. Walid Baz, medical director of hematology and oncology services for Williamson ARH Hospital. "Most cancer patients require multimodal therapy including surgery, chemotherapy, radiation and psychosocial therapy. Working together will enable the medical staff to leverage their collective experience, and that experience combined with Markey's specialized treatment, technology and clinical trial opportunities will help us take cancer care to the next level. This is great news for cancer patients and their families in our community."
The UK Markey Cancer Center Affiliate Network was created to provide high-quality cancer care closer to home for patients across the region, and to minimize the effects of cancer through prevention and education programs, exceptional clinical care, and access to research.
The ARH hospital system is the largest provider of health care in southeastern Kentucky. By joining the UK Markey Cancer Center Affiliate Network, Williamson ARH Hospital and Harlan ARH Hospital will be able to offer their patients access to additional specialty and subspecialty physicians and care, including clinical trials and advanced technology, while allowing them to stay in southeastern Kentucky for most treatments. The Markey Cancer Center Affiliate Network supports UK HealthCare's overall mission of ensuring no Kentuckian will have to leave the state to get access to top-of-the-line health care.
"UK HealthCare doesn't just serve Lexington and Central Kentucky – our mission is to provide all Kentuckians with the best possible care right here in the state," said Dr. Michael Karpf, UK executive vice president for health affairs. "The Markey Cancer Center Affiliate Network allows us to collaborate with community hospitals to provide top-notch cancer care much closer to home -- saving both travel expenses and time for the patients, in addition to keeping them close to their personal support system."
Markey is one of only 68 medical centers in the country to earn an NCI cancer center designation. Because of the designation, Markey patients have access to new drugs, treatment options and clinical trials offered only at NCI centers.
Moving forward, the Markey Cancer Center is working toward the next tier of designation – an NCI-designated Comprehensive Cancer Center. Currently, 41 of the 68 NCI-designated cancer centers in the country hold a comprehensive cancer center status. The Markey Cancer Center Affiliate Network will play a large role in bringing that next level of cancer funding to Kentucky. Maintaining and increasing focus on cancer prevention, care, and research in Appalachian Kentucky will remain a top priority for the cancer center.
"The burden of cancer in Kentucky is huge, particularly in Eastern Kentucky," said Dr. Mark Evers, director of the UK Markey Cancer Center. "That's why I am thrilled to have Williamson and Harlan join the Markey Affiliate Network. By working together, we have the potential to make a serious impact on cancer care in the part of the state that needs it the most."
The UK Markey Cancer Center Affiliate Network began in 2006 and includes 11 hospitals across the state of Kentucky:
Evaluations are under way for four other hospitals, including two more outside the state of Kentucky, extending Markey's reach and establishing it as the destination cancer center for the region.
LEXINGTON, Ky. (July 23, 2014) — Good nutrition is critical during cancer treatment, but side effects of chemotherapy and radiation can often cause patients to lose their appetites at a time when they need sustenance the most.
As a registered dietitian at the University of Kentucky Markey Cancer Center, Rachel Miller does all she can to help patients get the nutrition and calories they need.
"A lot of patients have trouble with weight loss and decreased appetite while they're going through various treatments," Miller said. "One of the things that's hardest to do when you don't feel like eating is getting that nutrition you need."
Much of Miller's time at Markey involves one-on-one counseling. She sees patients throughout the process of their treatment, provides them with nutrition education, and in some cases, assists patients with setting up their tube feeding.
In addition to the individual consults, Miller also tries to provide a more tangible example of healthy eating during cancer treatment. On the fourth Wednesday of each month, she hosts a smoothie demonstration in the Whitney-Hendrickson Building. The demonstrations are open to everyone at Markey, including patients, families and medical providers.
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Smoothies are an ideal way to boost nutritional value in a small volume of food, Miller said. Adding in healthy fats (for example, coconut milk) serves to improve the taste of the drink as well as pack in much-needed extra calories.
"Sometimes it's difficult to eat a full meal," Miller said. "So trying to fortify what you're eating, although it's a small amount, is one of the things I think is helpful to teach patients to do at home."
During the monthly demonstration, Miller tries to incorporate a variety of foods into the smoothies, testing out different tastes and textures. A common side effect of chemotherapy is a change in taste — many patients report a "metallic" taste in the mouth — so using strong flavors can be helpful in making the meal more appealing. As she prepares the drink, Miller talks her audience through the process, explaining the health and taste benefits of each ingredient.
Though she has regular medical staff who attend, her audience is often filled with families and friends of patients who are waiting for their loved one to complete an appointment or treatment. In addition to giving them information that will help them provide for their loved ones at home, Miller hopes the demonstrations also add a little levity to their day.
"I think the demonstrations have been very helpful," Miller said. "People have a lot of questions. It's easier to see and watch someone else do it, and then be able to implement that in your own home. I think it's also convenient, because a lot of patients have long days here so it can be a fun little break while you're waiting."
Smoothie demonstrations are offered on the fourth Wednesday of every month at 1 p.m. in the Psych-Oncology Services office, third floor, Whitney-Hendrickson Building. Miller also periodically partners with local chefs to host food demonstrations for patients and families.
For more information on good nutrition during cancer treatment, visit Miller's blog: the Markey Menu.
LEXINGTON, Ky. (July 15, 2014) — A new study by University of Kentucky researchers shows how a genetic defect in a specific hormonal pathway may make people more susceptible to developing melanoma, the deadliest type of skin cancer.
Fair-skinned people who tend to burn (rather than tan) from sun exposure have a much higher risk for melanoma than darker-skinned people. On the surface, it appears that the amount of melanin, the natural substance in the skin that determines pigment and acts as the skin's "natural sunscreen," would be the only determinant of melanoma risk. However, the truth is more complicated.
Published in Molecular Cell, the study looked at the role of the melanocortin1 receptor (MC1R), the receptor on melanocytes in the skin that gets called into action following ultraviolet exposure to help the skin lay down more UV-blocking melanin to protect itself. Fair-skinned people are more likely to inherit a defect in this receptor, and as a result, cannot make enough melanin to fully protect themselves from UV damage.
Since UV from sunlight or tanning beds is a major cause of melanoma, inherited problems in the MC1R means that the skin lacks natural protection by melanin, which acts as a biologic sunblock. This leads to more UV light chronically getting through to the sensitive layers of the epidermis, where it can contribute to cancer.
However, the UK study showed that MC1R defects contribute to melanoma development in ways other than melanin production. Besides regulating the amount of melanin that gets made in the skin, MC1R also controls how well melanocytes can repair their DNA from UV damage. Having defects in MC1R signaling delays the body's ability to clear out existing DNA damage in the skin – leading to an increased potential for cancerous mutations.
“Knowing whether people have a specific genetic predisposition for melanoma could potentially save many lives”, says Dr. John D'Orazio, Associate Professor and the Drury Pediatric Research Endowed Chair at UK’s Markey Cancer Center. “If you happen to be born with a problem in this MC1R hormonal pathway, then you need to be extra careful with respect to UV safety.”
A good indication of a person’s MC1R status is what happens to the skin after sun exposure.
“If you tan well, then your MC1R probably works well,” D'Orazio said. “If you tend to burn, then you may have inherited a problem with your MC1R, and you probably should avoid purposeful UV exposure like tanning bed use or unprotected sun exposure."
D’Orazio and his research team found an important molecular link between MC1R signaling and DNA repair in their study. The team hopes to use this information to develop new melanoma-preventive treatments, like additives that can be included in sunblocks to ramp up the skin’s ability to deal with UV damage.
Melanoma incidence has increased steadily over the past few decades – in the 1930s, an estimated one in every 1,500 Americans developed the diseases. Today, the odds are about one in every 60. Having a problem with the MC1R pathway raises a person’s lifetime risk of melanoma about four-fold.
LEXINGTON, Ky. (July 11, 2014) — A year ago, a crowd of hundreds gathered in Pavilion A of the University of Kentucky Chandler Hospital to celebrate a long-awaited special announcement – the unveiling of the UK Markey Cancer Center as the state's first and only National Cancer Institute-designated cancer center.
The designation was the culmination of years of tireless work by the faculty and staff of Markey and its supporting service lines and colleges – all guided by Director Dr. Mark Evers, who came to UK in 2009 with the vision of propelling Markey to NCI designation.
"Even before earning the NCI designation, we'd already taken extraordinary steps in the past few years in terms of combating cancer incidence and mortality through preventative measures, treatments and research," Evers said. "But having the support and approval of the NCI has already made a huge impact in terms of both research and our clinical care."
Patient Care at Markey
As the word spread about Markey's NCI designation, clinicians and staff experienced an increase in the patient population in almost every clinical area. In 2014, Markey saw nearly 150 more new patients over the previous year, with total patient visits increasing from roughly 75,000 last year to more than 85,000 this year – which also marks a 29 percent increase in patient visits compared to just five years ago.
In particular, Markey's outpatient clinics are growing -- the Comprehensive Breast Care Center, the Multi-Disciplinary Clinic, and the Gynecology-Oncology Clinic saw unique patient growth of 29 percent, 10 percent, and 5 percent, respectively, over the past year.
With such an increase in patient volume – and variety – Evers and his team have also stepped up recruitment, seeking out the best cancer specialists in their fields to join the Markey Cancer Center. Markey's already vast team of specialists now includes a bevy of new team members added in the past year, including four medical oncologists; three hematology and blood and marrow transplantation specialists; three surgical oncologists; two genitourinary cancer surgeons; two oral and maxillofacial surgeons; and a specialist in oncofertility, a new program starting up at the cancer center.
Recruiting strong researchers is a major aspect of earning and maintaining an NCI designation, and this year Markey landed a major established research team in metabolomics. Rick Higashi, Hunter Moseley, Teresa Fan, and Andrew Lane joined Markey last fall, bringing with them more than $18 million dollars in funding. One of the major focuses of the team's work is to develop early diagnostic approaches for lung cancer based on metabolism markers, which is especially important in Kentucky, where we own the distinction of having the worst rates of lung cancer incidence and death in the country.
Over the past two years, Markey has increased its funding from the NCI by 27 percent and from other National Institutes of Health divisions by 16 percent. Overall, since the end of calendar year 2012, Markey's total research funding from both peer-reviewed and non-peer-reviewed sources has increased by $7.3 million.
Additionally, Markey researchers continue to push major findings out to their peers in academia – in 2014, Markey authors published 528 scientific articles, 49 more than the previous year.
Moving forward, Evers notes that his team will continue to seek out new clinician-scientists who have experience in clinical trials and early phase drug development, with the goal of significantly increasing the number of patients who participate in trials. Another emerging field of research for Markey is molecular epidemiology, the study of potential genetic and environmental risk factors for disease identified at the molecular level, which has the potential for great impact in Appalachia.
Markey's Reach Across the State
Though based in Lexington, Markey also strives to provide access to top-notch cancer care across the state and beyond through the Markey Cancer Center Affiliate Network. The Affiliate Network is a group of healthcare facilities that provide high-quality cancer services and programs in their communities with the support and guidance of the UK Markey Cancer Center, allowing patients to receive their care closer to home.
Currently, the network comprises nine hospitals across the state of Kentucky:
Since Markey earned the NCI designation, demand for new affiliations has grown. Two new ARH hospitals will be added this summer, moving Markey further into Eastern Kentucky, an underserved area known for some of the worst rates of cancer incidence and death in the country. Additionally, evaluations are under way for seven other hospitals, including two outside the state of Kentucky, extending Markey's reach further and establishing it as the destination cancer center for the region.
The Future of Cancer Care in Kentucky
Following last year's announcement of Markey's NCI designation, Evers joked with his staff that they had one day to celebrate – and the next day, they'd be back in full swing, ready to propel Markey to the next level of designation: an NCI-designated Comprehensive Cancer Center. Currently, 41 of the 68 total NCI-designated cancer centers in the country hold a comprehensive cancer center status.
To earn this top level of designation, cancer centers must show a depth and breadth of research in each of three major areas: laboratory, clinical, and population-based research, as well as substantial transdisciplinary research that bridges these scientific areas. Additionally, outreach is especially important, and comprehensive cancer centers must demonstrate professional and public education and outreach capabilities, including the dissemination of clinical and public health advances in the communities it serves.
NCI designations are renewable every five years, and Evers hopes that Markey's next application will be for comprehensive status. To reach that level, Markey has a long to-do list, including increasing cancer-related funding, accruing more patients into clinical trials (including pushing these trials out into the state via the affiliate network), and maintaining and increasing focus on Appalachian Kentucky.
"Our progress in the past year has been spectacular, but we can – and should – do more," Evers said. "As the only NCI-designated cancer center in Kentucky, it's our responsibility to be the leader in cancer care and to always seek out new ways to improve rates of cancer incidence and death in the state, and to make sure that we can also offer the best possible care for our patients right here in Kentucky. Earning a comprehensive cancer center designation from the NCI will be another big step in that direction."
LEXINGTON, Ky. (July 1, 2014) – UK HealthCare has been recognized by America’s Essential Hospitals for a patient safety initiative that has resulted in a significant decrease in mortality at the hospital compared with the general population.
America's Essential Hospitals, a national organization representing hospitals committed to high-quality care for all people, including the vulnerable, awarded UK HealthCare a 2014 Gage Award honorable mention for improving quality. The association made the award June 26, at its annual conference, in San Antonio.
“UK HealthCare’s patient safety initiative stands out among the innovative approaches our hospitals take to avoid harm and improve the quality of care,” said America’s Essential Hospitals President and CEO Dr. Bruce Siegel.
The Gage Awards, named after association founder Larry Gage, honor and share successful and creative programs that improve patient care and meet community needs. The Gage Award for improving quality recognizes activities that improve the quality of care delivered, or reduce or eliminate harmful events to individual patients or groups of patients.
"UK HealthCare is continuously working to improve, driven by our high standards and our commitment to serve the people of the Commonwealth and beyond and the Gage Award represents national recognition of this work," said UK HealthCare Chief Medical Officer Dr. Bernard Boulanger. "It is recognition of our team’s relentless, rigorous approach to improving patient care, in a manner that directly benefits our patients"
UK HealthCare received the award for the development of an internal process called SWARMING to help the hospital improve overall patient safety. A SWARM is initiated shortly after the occurrence of an adverse incident or undesirable event, and the people directly involved are empowered to "stop the line" when they observe a problem. Since instituting SWARMs in 2009, the hospital has experienced an overall reduction in the observed to expected mortality ratio from 1.5 to 0.7, as reported in December 2013.
"The SWARM process has been a remarkable and successful team effort throughout the UK HealthCare enterprise and everyone should be commended for their role in what has become one of our best tools in improving patient safety," said Dr. Michael Karpf, UK executive vice president for health affairs. "This award is another example of our commitment to excellence in patient care and patient safety and in keeping our promise to Kentuckians that they can get the very best care right here regardless of the complexity or care needed."
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LEXINGTON, Ky. (June 18, 2014) — Facing a cancer diagnosis is no easy feat. Patients at the University of Kentucky Markey Cancer Center have always inspired the community with their strength and courage, and Friday, June 6th was no exception, as Markey honored the experiences of those who have battled cancer with a day of recognition and celebration.
June is National Cancer Survivorship Month, and to mark the occasion, Markey held its inaugural Expressions of Courage event, an art exhibit showcasing original, artistic expressions connected in some way to an experience with a cancer diagnosis, or crafted by or in memory of a Markey patient whose battle has ended.
"We sent out over 6,000 letters," said Cindy Robinson, a nurse practitioner at Markey and one of the organizers behind the event. "And we asked people for any type of creative modality that they wanted to share with us, to share their cancer journey, whether it be positive or negative."
More than 30 artists responded. Entries of visual arts included paintings, drawings, photography, sculpture, and quilting. The performing arts involved vocal music, instrumental music, and dancing, and poetry and short stories encompassed the literary arts.
The creations were on display all day in the Combs Research Building at Markey, with readings and performances starting in the afternoon and continuing into the early evening.
"The artwork is very moving and inspiring, and actually will bring tears to your eyes if you read some of the pieces," Robinson said. " We have some pieces here from patients that are no longer with us, and we personally know those people."
Expressions of Courage was made possible by gifts from the Markey Cancer Foundation and Biological Systems Consulting, Inc. With the help of Carla Repass, the assistant director for administration at Markey, and fellow Markey staff members Christie Daniels, Valeria Moore and Mincha Parker, Robinson said she felt they planned and pulled off the cancer center's first-of-its-kind celebration with flair.
"I think for our inaugural event, it's gone beautifully," Robinson said. "We have a lot of survivors here. They've shared their joy."
Shawna Cassidy Quan of Richmond, Ky., was one of the survivors in attendance, having been diagnosed with four different primary cancers over the course of fifteen years. Her expression of courage was an essay about her struggles with her multiple diagnoses.
"You figure out the answers to a lot of your problems even while you're sitting down writing," Quan said. "It's just been a wonderful, therapeutic thing for me."
Norton Cancer Center and Markey patient Phillip Meeks traveled nearly two hours from Jeffersonville, Indiana, to attend the event. Meeks' art piece, a drawing by his daughter, was inspired by the unlikely good fortune of his treatment. In 2012, he was diagnosed with acute myeloid leukemia, requiring a bone marrow transplant to survive.
As an African-American — a population which only makes up roughly 7 percent of the bone marrow registry — and an adoptee without biological siblings or parents to get tested, the odds of finding a match were against him.
The day he was admitted to the hospital, Meeks said, they found a token underneath his hospital bed: one side said "Believe in Miracles" while the other side said "Faith."
"To me, that was God's way of saying that I'm there with you, you know, don't be scared," Meeks said.
A donor match was found for him, and he received his life-saving transplant in January 2013. He notes that Expressions of Courage was not only a day to showcase talent, but a day that survivors could show their appreciation to the staff of Markey.
"I just want to give back," Meeks said. "That's my big thing. How can you thank so many people that are involved in saving your life? There's not a gift that you can give that's big enough. Hopefully this is my one little piece to say thank you for everything that everybody has done for me."
Many survivors and their families expressed their appreciation of the love and support of the UK and Markey community.
"You live life just as fully as you can, because you're not promised even another hour," Quan said. "I think we've done that today… I hope Markey does this again and keeps on doing it."
LEXINGTON, Ky. (June 5, 2014) -- The University of Kentucky Markey Cancer Center will host Expressions of Courage, a creative exhibit to honor those who have been affected by cancer on Friday, June 6.
Featuring the creative work of more than 30 participants, this inaugural event will take place in the atrium of Markey's Combs Research Building from 1 to 5 p.m. Cancer Center Director Dr. Mark Evers will give opening remarks and lead attendees in a moment of silence to begin the afternoon.
Exhibits include visual art, poetry readings, dance exhibitions, and vocal and instrumental performances by patients, survivors, and friends and family. Everyone Is encouraged to attend, enjoy the artwork and performances, and show their support. Light refreshments will be served.
Expressions of Courage was made possible by gifts from the Markey Cancer Foundation and Biological Systems Consulting, Inc.
LEXINGTON, Ky. (May 30, 2014) -- A multidisciplinary team of doctors, researchers, and informaticists at the University of Kentucky is working to improve identification of lung cancer patients who are eligible to participate in clinical trials for novel treatments.
Clinical trials are critical for advancing research into new and better treatments for patients, and the need for improved treatment of lung cancer is dire: Lung cancer is the leading cause of cancer death worldwide. Its burden is especially significant in the Commonwealth, where rates of lung cancer incidence and mortality are the highest in the country. In Appalachian Kentucky, the situation is even worse, with incidence rates nearly twice the national rate.
Despite high rates of lung cancer, less than 1 percent of lung cancer patients enroll in clinical trials. This is partly due to the difficult and tedious business of identifying and recruiting patients who are eligible for trials, a task currently conducted by research staff who manually reviews patient information for a multitude of (often complex) eligibility factors. The process is time consuming and inefficient, with studies showing that manual identification can overlook up to 60 percent of eligible patients. Furthermore, patient eligibility can vary by study and change over time.
And, unfortunately, the severity of the disease also contributes to the exceptionally low rates of lung cancer patient enrollment in clinical trials. Lung cancer is often diagnosed so late that the median survival time is only eight months, leaving little time for patients to explore treatment options or for doctors to identify patients who are eligible for novel therapeutic interventions offered through clinical trials.
The combination of the burden of lung cancer in Kentucky and the urgency of identifying patients who are eligible for clinical trials motivated Dr. Eric Durbin and his team to devise a more efficient method for screening patient eligibility. Durbin, an assistant professor in the division of biomedical informatics at the UK College of Public Health, is the director of the Cancer Research Informatics Shared Resource Facility at the UK Markey Cancer Center and director of cancer informatics at the Kentucky Cancer Registry.
With pilot funding from the Kentucky Lung Cancer Research Program (KLCRP), Durbin and his team are leveraging the rich and unique electronic data sources managed by the UK Center for Clinical and Translational Science (CCTS), the UK Institute for Pharmaceutical Outcomes and Policy (IPOP), the Markey Cancer Center, and the Kentucky Cancer Registry (KCR), which is housed at UK, to design, develop, pilot, and evaluate an innovative, electronic informatics system to automatically identify patients who are eligible for clinical trials. The outcomes of the automated identification system will then be compared to those of the manual identification methods. If successful, the automated system could dramatically increase the speed, completeness, and efficiency of identifying patients for lung cancer clinical trials.
"The need for improvement was pretty obvious, and my colleagues and I thought it would be an ideal project for KLCRP pilot funding," said Durbin, who is the principal investigator on the project. "We're trying to leverage existing and new electronic data sources to improve the efficiency of the identification and recruitment process."
The pilot project will specifically focus on identification of eligible patients at the UK Markey Cancer Center. Due to its designation as National Cancer Institute, Markey offers unique clinical trials that are only available through NCI centers.
"Clinical trial recruitment is critically important to the Markey Cancer Center if we're going to get lifesaving therapeutics to our patients," said Dr. Susanne Arnold, associate professor in medical oncology and radiation medicine at the Markey Cancer Center and member of the project team. “It’s also how we make progress in cancer treatment.”
It is particularly important to identify and recruit clinical trial participants from the entire pool of eligible patients in order to remove any potential bias from the study results and to ensure that the findings are applicable to the general population. Additionally, under-recruitment in underserved populations, such as Kentucky's Appalachian residents, can be perceived as unequal access to the most cutting-edge treatments and technologies.
"We want to ensure that all patients have the opportunity to enroll in clinical trials," said Durbin.
The two-year project is currently in its seventh month, and the team is in the discovery phase of evaluating the multiple data sources and testing different query methods. In addition to using discrete data elements, such as lab values, the team is utilizing natural language processing methodology to incorporate more conceptual data, such as patient performance status, from the qualitative notes that doctors make in their medical records.
"We are combining discrete data elements with natural language processing approaches to extract complete information," said Durbin. "This is a very important area of informatics."
The objectives of the project align perfectly with the mission of the Kentucky Lung Cancer Research Program, who funded the project and whose mission is to reduce the burden of lung cancer in Kentucky.
"A critical component to reducing this burden is clinical research," said Dr. Nathan Vanderford, assistant director for research at the Markey Cancer Center and the center's liaison to the Kentucky Lung Cancer Research Program.
"The potential to greatly improve enrollment in studies will ultimately translate into improved lung cancer detection, diagnosis, and treatment in the future."
Vanderford recognizes the distinctive capacity of Durbin's team to capitalize on the robust data, expertise, and technology available at UK. In addition to the wealth of electronic health data at UK, the Kentucky Cancer Registry (KCR) is housed at the university by legislative mandate. The KCR operates a population-based electronic pathology reporting system that captures 90 percent of all histologically confirmed cancer cases in Kentucky within days of diagnosis.
"We are very uniquely situated in terms of the data sources and technology we have at UK. And this team is uniquely skilled to do this project. They have a significant number of years of experience and are very familiar with all the data sources. We're very cutting edge in being able to apply all these different data sources to achieve our objective in a much better way," he said.
While the pilot project focuses specifically on lung cancer patients at Markey Cancer Center, the automated identification system could be easily applied to a broad range of cancers and other disease conditions in the future.
"What's really exciting about Dr. Durbin's study is that it has the potential to greatly improve clinical research not only in lung cancer but in other cancers and disease conditions as well," said Vanderford.
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LEXINGTON, Ky. (May 23, 2014) – The future looks bright for cancer research in Kentucky – on May 22, the University of Kentucky Markey Cancer Center held its annual Markey Cancer Center Research Day, highlighting the work of UK students, postdoctoral fellows and faculty from the past year.
As the cancer center has grown, Markey’s research programs have become even more robust, helping propel the center into becoming the state’s first and only National Cancer Institute (NCI) designated cancer center.
“The NCI is pretty much all about research – it’s a huge part of what they’re looking for when they award the designation,” said Markey Cancer Center Director Dr. Mark Evers.
Research Day not only provides an opportunity for investigators to showcase their work, it also helps educate researchers about other ongoing projects at UK that they may not have known about before – and this often leads to new, fruitful collaborations for future research projects. Kathleen O’Connor, Markey’s associate director for cancer education, notes that providing opportunities for researchers to discuss their work with others is key for growth and improvement.
“If we don’t communicate the research that we do, then there’s no point in us doing it,” said O’Connor, who has been tasked with planning Markey Research Day for the past five years. “What we need to do is talk about our research, translate our research, and learn about opportunities to collaborate.”
Evers, who arrived at UK in 2009 with the goal of molding Markey into an NCI-designated cancer center within five years, agrees.
“It gives our students, fellows and faculty an opportunity to present their latest work, and it’s also turned out to be a great venue for collaboration,” Evers said. “Because even though we’re a very collaborative, collegial university, sometimes people working across the street don’t know about each other’s research. This gives them the opportunity to see what else is going on.”
This year’s event featured 141 posters; one student and two postdoctoral fellow oral presentations; and faculty oral presentations from Jon Thorson, Vivek Rangnekar, Mary Vore, and Mark Dignan, co-leaders of the four major research programs at Markey. Additionally, Evers presented his annual State of the Cancer Center Address and Dr. Harold Varmus, Nobel Laureate and director of the National Cancer Institute, gave the Susan B. Lester Memorial Lecture.
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The event finished with an award ceremony. Awards were presented in two different categories - basic science and clinical science - for both graduate and postdoctoral fellows. A Researcher's Choice Award was also presented, based on a popular vote by people who attended Research Day.
The winners are:
Graduate Basic Science
First place: Wei Zhang
Second place: Hedy Chawsheen
Postdoctoral Basic Science
First place: Jin Dai
Second place: Stuart Jarrett
Graduate Clinical Science
First place: Sally Ellingson
Second place: Shaoying Wang
Postdoctoral Clinical Science
First place: Rachel Stewart
Second place: Pallavi Sethi
Researcher's Choice Award
Winner: Emil Khisamutdinov
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LEXINGTON, Ky. (May 14, 2014) - Painful blisters and glowing red skin after a day outdoors are the short-term consequences of a child's overexposure to the sun. While sunburn heals with time, the long-term effects to the skin are irreversible. It's often years - even decades - later when the more dire consequences of sunburn can resurface in the form of malignant melanoma.
Because 80 percent of lifetime sun exposure occurs before the age of 20, efforts to prevent melanoma, the deadliest form of skin cancer, must begin early in life. For a variety of reasons, melanoma incidence has increased steadily since the 1930s when only one out of 1,600 Americans were diagnosed with the disease.
Today, melanoma affects one in 60 Americans and is appearing more frequently in teenagers and young adults. In fact, melanoma is the most common cancer of young adults ages 25-29 and is the leading cause of cancer death in women ages 25-30. Because it can spread quickly through the body to places such as the brain and the liver, melanoma accounts for three-quarters of total deaths caused by skin cancer. Ironically, as much as melanoma is a growing public health concern, it is also largely preventable. Ultraviolet (UV) radiation from sunlight and tanning beds plays a major role in melanoma development.
Dr. John D'Orazio, a researcher at the Markey Cancer Center and a pediatric oncologist at Kentucky Children's Hospital, rarely sees skin cancer in children but says the pediatric years are a critical period for preventing melanoma later in life. Melanoma risk correlates especially with sunburns, and since the skin is more delicate in childhood, children are especially susceptible to sunburns. Having at least five sunburns increases the lifetime risk of melanoma, and blistering sunburns are particularly risky.
Know Your Child's Skin Type
According to D'Orazio, skin pigmentation and amount of exposure to UV rays are the predominant risk factors for developing melanoma. People who have dark pigmentation have high amounts of melanin pigment in their skin. Melanin acts like a natural sunblock and protects the skin very effectively against UV damage. Those who have fair skin and a lighter complexion are born with lower amounts of melanin in their skin and are much more vulnerable to UV penetrating deeply and altering skin cells. There is overwhelming evidence to show that skin cancers such as melanoma are caused by UV radiation that penetrates into the skin and causes mutations in skin cells.
Therefore, the more UV rays that penetrate into the skin without the protection of natural or artificial sunblocking agents, the higher the person's risk of developing melanoma. Children with fair complexions are most vulnerable to damaging effects of UV rays. It's important to notice whether a child is prone to sunburning or tanning. Knowing a child's skin profile will help parents determine level of protection that should be enforced during outdoor activities. Parents and caregivers must be vigilant about restricting sun and tanning bed exposure to ensure the long-term skin health of children and teens.
D'Orazio says to use common sense when it comes to sun safety and to avoid sunburns as much as possible. Avoiding or limiting outdoor activities during the time of day the sun is most intense, between 10 a.m. and 4 p.m., is a good strategy. If sunburn-susceptible children are outdoors during this time, seek a shady spot and wear UV-protected items, such as bathing suits, rash guards, sunglasses and hats to escape the sun. Apply sunscreen with a minimum SPF of 15 designed to block both UVB and UVA rays. Make sure all exposed areas of the body are coated, including the feet and the tops of ears. At a minimum, sunscreen should be applied every 90 minutes and immediately after sweating or swimming. Because their components break down over time, sunscreens should be replaced annually.
Get Teens Out of Tanning Beds
Despite having a strong link to melanoma, the use of tanning beds in adolescents and young adults continues to skyrocket. Sixty-seven percent of teens think they look better with a tan and 2.3 million American teens are estimated to visit tanning beds at least once a year. D'Orazio said research has shown a connection between frequent use of tanning beds and other addictive behaviors.
"The problem with the tanning bed is once you start, it’s hard to stop," D'Orazio said. "Many tanning bed patrons say they look and feel better with a tan… and there’s a good reason for this. When your skin tans, your body makes natural endorphins, which are morphine-like compounds."
One visit to the tanning bed under the age of 30 increases the chance of developing melanoma by 75 percent. In fact, the UV output of a tanning bed can be 10 times stronger than the sun. Currently there is no way to get a tan without the increased risk of melanoma and other skin cancers. In spite of those risks, in the greater Lexington area, tanning beds outnumber McDonald's restaurants and Starbucks combined.
Regulation of the tanning bed industry, including UV lamp output and restrictions on use by minors, is highly variable among states. Currently in Kentucky, there is no ban in place for indoor tanning by minors. Children under the age of 14 are allowed to use indoor tanning facilities if accompanied by a parent, and those ages 14-17 can come alone if they have signed parental consent. Sunless tanning products are healthier alternatives to tanning, but users should be aware such products don't provide much UV protection. Parents should strongly consider the risks when a teen expresses an interest in a tanning beds and other tanning products.
Fortunately, skin cancer in children is very rare, and D’Orazio has only seen a handful of children with melanoma. However, risk starts to rise in late adolescence and increases as people age. Death from this aggressive cancer is all too common in people in the prime of their lives. In his laboratory, D'Orazio is currently investigating ways to replicate the protective melanin mechanism for people who are especially vulnerable to sunburn and reverse the negative effects of UV exposure.
“By understanding what happens in the skin during sun tanning, we hope to develop new drugs to make tanning possible without the risk of cancer.”
For now, however, tanning remains a very risky business, especially for fair-skinned people who get sunburns. For these people, it is especially important to do regular skin surveys to get an early jump on problems. Early detection of melanoma can save lives. Since most melanomas develop in moles, guidelines focus on mole awareness. Be aware of the ABCDEs of moles to detect problematic or irregular patterns on the skin:
Skin surveys should start sometime in adolescence and be done at regular intervals, depending on melanoma risk. Since children and teens still associate beauty with tanning, a cultural change will be required for young people to fully embrace sun protection.
With the opening of pools, proms, graduations and warm-weather events, teens are focused on tanning in the spring and early summer seasons. Parents and pediatricians should look for “teachable moments” this time of year, such as discussions about tanning or sunscreen use, to share the dangers of sun exposure with children who are at high risk of sunburn.
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