The James Cancer-Free World Podcast

There has been a lot of news and some confusion in recent months about the connection between alcohol consumption and cancer risk. In this episode, Dionisia Quiroga, DO, PhD, a James breast cancer specialist, explains the recent findings of the U.S. Surgeon General, what they mean and what people need to know to reduce their cancer risk. “One of the data findings was that most Americans don't know alcohol is a risk factor for cancer development,” Dr. Quiroga said. “It's important people know so they are empowered to make the right decisions for themselves.” Previous research indicated one alcoholic drink per day for women and two for men was a safe level of consumption. “When we look at the new data, it shows that any alcohol consumption can increase the risk,” Dr. Quiroga said. One of the theories about why alcohol consumption increases the cancer risk is that “alcohol in the system breaks down into substances that can cause DNA damage” that leads to cancer. “And alcohol can alter the hormones in the body and most cases of breast cancer are linked to some sort of hormone issue,” Dr. Quiroga said, adding this could also be a factor in prostate cancer risk. “Alcohol use is also tied to other types of cancer where alcohol passes through the body and is processed, such as head and neck cancer, colon cancer, and liver cancer since the liver breaks down alcohol.”

“Ten years ago, there were relatively few treatment options [for bladder cancer] compared to what we have today which is a relative wealth of options,” said Debasish Sundi, MD, a James urologist and bladder cancer specialist. In this episode, Dr. Sundi explained the function of the bladder (storing urine), the different types of bladder cancer (contained within the bladder and metastatic), how new immunotherapies have led to better options and outcomes, and his research which focuses on identifying the biomarkers in a patient's bladder cancer by analyzing their urine, instead of a more invasive procedure using a scope. There are about 80,000 new cases of bladder cancer diagnosed ever year in the United States and “about 75 to 80 percent are in males,” Dr. Sundi said, adding “the number one cause is exposure to tobacco smoke and tobacco products.” The primary symptom is blood in the urine. “If you see blood in your urine, even if it's just pink, it is worthwhile to talk to your primary care doctor or see a urologist.” Clinical trials have led to the development and approval of several new immunotherapy treatments. “The challenge is we do not have any good biomarkers to tell us how our patients will respond,” Dr. Sundi said. “My lab is developing an assay [test] to non-invasively make an assessment. We've learned that if we look at the immune cells in the urine of someone with bladder cancer, they are similar to the immune cells in their tumor … And this could lead to significantly improving the therapeutic options and helping doctors pick the best medicine for their patients from the start.” Dr. Sundi said his research is motivated by his patients. “When I started in this field the experiences of patients with bladder cancer was something we could and should improve,” he said. “Working toward this is the fuel that is self-sustaining and there is so much excitement in terms of the innovation happening in the bladder-cancer field.”

Cancer impacts the entire family of a patient, including the children. To help parents help their children through these difficult time periods, the James has created a team of certified child life specialists (CCLS). “We help parents navigate these situations and conversations,” said Sami Rundo, CCLS. The help comes in many forms, Rundo explained. “It starts with understanding the medical situation [of the patient] … And then we prepare the family to navigate discussions and conversations. What does that conversation look like? And do they want our child life services to have these discussions with their children or provide the resources they can use in these conversations.” Rundo explained how these discussions can trigger emotions and that parents can “embrace the fact there will probably be some tears and the need for breaks and walks.” She also detailed why it can be important to explain the medical procedures that will take place, such as surgery and radiation treatments, and how their parent's treatment could impact a child's daily routine. The team has a doll they utilize to visually show children different medical procedures and what a port that delivers chemotherapy looks like. “We also talk about the ways in which the children can be helpers, caregivers,” Rundo said. “And what's appropriate for that child. Can I get you a blanket if you're cold, but maybe not taking care of their other siblings.” The James certified child life specialists can let parents know about cancer-themed children's book they might want to utilize in their discussion with their children, and “we can create customized books for a family,” Rundo said. The James certified child life services team is relatively new and growing. “Over time [with a family] we develop trust and an openness of communications,” Rundo said. “I've learned so much about families and to see them grow and become stronger during these difficult times is really profound.”

Because there are no symptoms in the early stages of pancreatic cancer “about 75 to 80 percent of patients are diagnosed in the later stages of the disease,” said Somashekar Krishna, MD, a James physician scientist who specializes in the early detection and screening of pancreatic cancer. Krishna and the team of pancreatic cancer experts at the James are using enhanced screening and artificial intelligence (AI) to better identify pre-cancerous cysts and cancerous tumors in the pancreas; and are the first in the world to use high-tech ablation techniques to attack and kill pancreatic cysts and tumors in a new clinical trial. Most pancreatic cancer tumors begin as pre-cancerous cysts and are most commonly found in people 60 and older. “For people in their 50s there is about a 10-percent prevalence, this doubles in people 60 to 70 to 20 percent and is 25 to 30 percent in people 70 to 80,” Krishna said, adding, “most are small and never grow and become cancerous.” Endoscopy procedures are used to better “see” these cysts and cancerous tumors, and the use of artificial intelligence is another tool to identify and determine the risk factor of pre-cancerous cysts. “The tip of the endoscopy probe can see even the tiniest structures in a very detailed manner, and we can pass a needle through the scope and do a biopsy and establish the risk,” Krishna said. Surgery is one option, but the procedure is quite invasive and not easily tolerated by older patient with other medical issues. “A new option is ablation, using heat, in a very precise and careful manner,” Krishna said. “We are the only ones doing this in the United States and have done this with nearly 30 patients in a clinical trial.” Krishna is determined to improve screening and treatment for pancreatic cancer and reduce the mortality rate. “Early in my career, 80 percent of patients diagnosed with pancreatic cancer did not make it more than a year,” he said. “We want to change these outcomes to intervene early and with better and better treatment options.”

“Primary care physicians are your first line of defense against cancer,” said Matthew Farrell, M.D., an Ohio State Wexner Medical Center primary care physician and a clinical associate professor of family and community medicine. Prevention, screenings and early detection are crucial and begins with a patient's family history with cancer and other medical issues. “We are thorough and ask about their first-degree relatives, their parents, siblings and children, and their secondary relatives, such as grandparents and aunts and uncles,” Farrell said. “If I see a pattern, a certain number of relatives with the same cancer, especially at an early age, there could be a genetic factor.” A patient with an inherited genetic mutation will then be screened at an earlier age and more often. Dr. Farrell also talked about the importance of children receiving the Human Papillomavirus (HPV) vaccine that prevents certain types of cancer. He examines patients to detect skin cancer and melanoma in the early stages. “Skin cancer is the most common form of cancer and it's personal for me; my mother was diagnosed with melanoma three times … and she's doing fine.” Breast cancer and prostate cancer are two of the most common forms of cancer. Dr. Farrell discussed when women should begin getting yearly mammograms, and why and when men should begin to undergo regular Prostate-Specific Antigen (PSA) tests. Men and women without a family history of colorectal cancer should get their first colonoscopy at 45. “My brother-in-law was 52 when he had his first colonoscopy,” Dr. Farrell said. “They found a large tumor in his colon; it was removed, and he's been cancer free for 20 years now.” Lung cancer screenings are relatively new and recommended for long-time smokers. They are vital because “if you wait until there are symptoms it's very hard to treat and cure,” Dr. Farrell said, adding “I'm fortunate to be part of the Ohio State system and the James where we have experts and specialists for every type of cancer and medical issue my patients have.”

Screenings for colorectal cancer are very effective and save lives. “Since we started doing colonoscopy screenings in the mid-1990s the overall incidences for colorectal cancer have been coming down and down and down, and the number of deaths has been going down and down and down,” said Peter Stanich, MD, a James clinical associate professor of internal medicine and colorectal cancer specialist. In this episode, Stanich describes how lifestyle choices such as diet, exercise and obesity can impact the chances of being diagnosed with colorectal cancer. Inherited genetic mutations are another risk factor. “The risk for the average person with no family history [of colorectal cancer] is about 4 percent, but for someone with an inherited genetic mutation, such as Lynch Syndrome, that greatly increases the risk, to as much as 40 to 80 percent,” he said. For people with no family history of colorectal cancer, colonoscopy screenings are recommended to start at the age of 45. “For patients with Lynch syndrome we start screenings at around 20 or 25.” Colonoscopies can detect and remove pre-cancerous polys in the large intestine before they become cancerous. “We have tools that go through the scope, a snare, that can slice off the polyps, or forceps that can cut them off,” said Stanich, who does these procedures regularly. “It's very rewarding, that feeling of helping of helping multiple people every day from ever getting cancer.” Stanich also talked about screenings people can do at home, the increase in colorectal cancer diagnoses for younger patients and his research. It focuses on when to do follow-up screenings for patients detected with multiple polyps in their initial colonoscopy. “Only about 60 percent of people are up to date with their colorectal cancer screenings,” Stanich said. “If we could get another 20 to 30 percent of people up to date that would have a huge impact in reducing colorectal cancer.”

The reach of the James Cancer Hospital extends far beyond Central Ohio. As part of Ohio State's Global One Health Initiative (GOHi), Robert Baiocchi, MD, PhD, is leading the research, vaccination and treatment efforts in Ethiopia for patients with lymphoma. “Lymphoma, a cancer of the white blood cells, is far more common in Sub-Saharan Africa, and afflicts people at a younger age” said Baiocchi, a James medical oncologist who specializes in treating patients with blood cancers. The prevalence of malaria and the Epstein-Barr virus (EBV) has led to the increased number of lymphoma diagnoses. “Starting in 2015 we opened a lab in Addis Ababa [the capital of Ethiopia] to study these viruses and how they cause cancers,” Baiocchi said, adding the initial research was to determine why the lymphoma rate was so high. “We're zeroing in on a couple of interesting findings; children who get malaria and EBV, that seems to be the perfect storm [for lymphoma].” Differences in the genetic makeup of people in Sub-Sharan Africa could be another factor in the increased lymphoma rates. Baiocchi and his team, and their partners in Ethiopia, are working on vaccines for malaria and EBV. “Studies tell us the virus here [in the United States] is different from the viruses in Ethipia and the vaccines we use here won't work there,” he said. “It's important to understand the genetic makeup of EBV in order to develop a vaccine that will be effective in that region.” The standard of care at the James for lymphoma patients includes a combination of chemotherapy drugs – and has proven to be very effective. “The resources for this aren't available in Ethiopia,” Baiocchi said, adding the James is developing a less-expensive, targeted therapy that shows promise. There are also plans to create a facility in Addis Ababa where lymphoma patients will be treated with cell therapy.

David Cohn, MD, described one of his goals for patients of the James. “When a patient and a family say we didn't want to be diagnosed with cancer and we didn't want to be at the James Cancer Hospital, but after this experience there's nowhere else we'd rather be and that is the end result of empathetic care and compassion in the delivery of that care,” said Cohn, the interim chief executive officer and the medical director of the James. In this episode, Cohn and John Schaffner, MBA, the director of coaching at Ohio State's Fisher College of Business, described a new coaching program for James physicians that's part of the Physician Wellness Program. This coaching focuses on compassion and helps physicians better understand their careers and goals and utilize compassion when working with their colleagues and patients. “It's not that our physicians had problems, they're exceptional, it was rather, how can we support our people so they can flourish,” Cohn said, adding this type of leadership initiative was welcomed by his team. Schaffner, who leads the James coaching program, explained his definition of empathy. “There's cognitive empathy, that's noticing someone else's emotions; there's empathetic concern, which is an emotional reaction to someone else; and this empathy plus action equals compassion.” There are currently 15 certified coaches who work with the 240 attending physicians of the James. “I love working with physicians,” Schattner said. “They're smart and ambitious, understand the idea of flourishing and they do the work.” Some of these physicians, he added, are new to leadership positions and coaching can help them communicate better and build comradery. The coaching program is new and funded through a philanthropic donation to the James. Cohn said the program is designed to help each physician be the best version of themselves they can be with the overreaching goal of delivering the best-possible care to James patients. “Everything we do is driven by the delivery of care to our patients and this is another process to help us get there,” he said.

“We're so fortunate to have so many individuals come to us and want to share their time and help our patients and families,” said Kathleen Kiene of the 300 James Cancer Hospital volunteers. Kiene is the Administrative Associate Director of System-Wide Volunteer Services, and she recruits, trains and mentors her small army of volunteers, who include a large number of former James patients … such as Laura Schoettmer. “I just want to make people feel hopeful, because there is so much hope here,” said Schoettmer, who was diagnosed with lymphoma several years ago and is now in remission. Kiene described all the different ways in which volunteers contribute to patient care, which includes: wayfinding and escorting, interacting and helping patients while they receive chemotherapy, in the surgical visitor's lounge, as waiting room ambassadors, in the James's outpatient facilities. “In our Restful Nights program volunteers are there from 5:15 to 7:15 p.m. and they man carts and visit patients and offer amenities,” Kiene explained. “Conversations start and there are bonding moments between the patients and our volunteers. One volunteer watched Jeopardy with a patient and another patient played the guitar and our volunteers were there to listen and be part of that.” Schoettmer began volunteering in 2015, three years before she was diagnosed with cancer. She lost a cousin to breast cancer “and I was very angry and wanted to do something.” Some volunteers may initially be concerned interacting with cancer patients can be difficult emotionally. “It's so fulfilling and so rewarding and every Thursday morning when I walk into the James [to volunteer] I feel exhilarated,” said Schoettmer, who volunteers in the chemotherapy clinic. For more information of becoming a James volunteer: https://cancer.osu.edu/for-donors-and-volunteers/volunteering/volunteer-opportunities

The James Cancer Hospital is a leader is helping cancer patients deal with the pain that can be associated with treatment. “Our inpatient oncology rehabilitation service is the first in Ohio, the second in the United States and the third in the world to be accredited,” said Whitney Luke, MD, medical director of oncology rehabilitation at Ohio State. “We now have an inpatient and an outpatient oncology rehabilitation program, and I could not have developed these programs if I wasn't at a comprehensive cancer center like this,” added Luke, who led the creation of these programs and is a pioneer in the field of pain management for cancer patients. “I'm so fortunate to be at a hospital where I could grow these programs and where we have so many experts in so many different fields.” Luke described how some cancer treatments can lead to varying levels of pain for patients, and why it is important to work with each patient to develop a plan to reduce their pain. “Our team includes oncologists and physicians, physical, occupational and speech therapists, social workers, psychologist; the goal is to improve functional outcomes for patients so they will better tolerate treatments and get them home doing the things they normally do.” Some of the many medical options for treating pain include: injecting joints with a combination of steroids and anesthesia; implanting a device in the spine that provides electrical stimulation at regular intervals; an internal pain pump that releases medication directly to the points of pain; and the use of ablations (heat) to clock nerves. “When I have a patient who was in severe pain come back and tell me they were able to go to their daughter's wedding and feel normal, that opportunity to help patients during their cancer journey, that's what motivates me,” Luke said.

Scientists have known for many years that smoking tobacco products greatly enhances the lung cancer risk and is the number-one cause of this deadly disease But what about vaping and electronic cigarettes? “Vaping is so new, and it takes years and years for lung cancer to develop so we don't yet know the effects,” said Marisa Bittoni, PhD, MS, BS, an Ohio State scientist whose research focuses on how lifestyle choices such as diet, exercise and smoking/vaping can impact and increase the risk of lung cancer. Bittoni and her colleagues at the James are pioneers in researching the cancer-related effects of e-cigarettes. She led a new study that has shown the combination of smoking and vaping greatly increases the lung cancer risk. The study looked at Ohio State patients already diagnosed with lung cancer and a control group of people who had not been diagnosed with this disease.“Compared to non-smokers, smokers have about a 10 times higher risk of lung cancer,” Bittoni said. “And people who smoke and vape have about a 40 times higher risk than non-smokers.” Bittoni said that further, follow-up research is needed to confirm these initial findings and find out even more. “We're at the start of a new wave of research [on the effects of vaping],” she said. “The tobacco industry wants to promote vaping as a safer alternative to smoking, but we don't really know if that's true yet.” This new research is another step forward for Bittoni. “My whole career has been looking at risk factors and survival,” she said. “By improving your diet and exercising and not smoking you can reduce your cancer risk, and, even after diagnosis and treatment improvements in diet and exercise can help people live longer. There are estimates that 30- to 40percent of all cancers could be avoided by better lifestyle choices.”

The OSUCCC -James is a leader in the treatment of pancreatic cancer, with the utilization of robotic Whipple surgery, the use of chemotherapy and radiation before surgery, multiple clinical trials designed to find even better ways to treat patients and a large multidisciplinary pancreatic cancer clinic.“We're always thinking about what's the next step and about the patient of tomorrow, that's a huge driver,” said Susan Tsai, MD, MHS, a surgical oncologist who specializes in pancreatic cancer and is Director of the OSUCCC – James Division of Surgical Oncology. “The pancreas helps regulate blood sugars and also helps you digest food,” Tsai explained, adding that it's hard to diagnose, which means patients often come to her with later-stage cancer. “In 70 to 80 percent of the patients we see, they will have recurrent disease somewhere else in their body,” Tsai said, adding this statistic has led to a new way to treat patients. “In the old days we'd often rush patients to surgery to remove the cancer as quickly as possible, but because the recurrence rates were so high maybe that isn't the best way to treat patients. Now, we utilize systematic therapy [chemotherapy and radiation] upfront, before surgery and we're seeing better results.” The development of robotic Whipple surgery to perform the complex and invasive pancreatic cancer surgery is another innovation. Using previous surgical techniques “there was about a 30 percent mortality rate,” Tsai said, adding the advances of the less-invasive and more precise Whipple surgery “practiced at a high-volume comprehensive cancer center such as the James have reduced that to less than 3 percent.” To date, pancreatic cancer has not been a good target for immunotherapy. “Now, we have been able to target a genetic mutation, called KRAS, a gene that drives many different types of cancer,” Tsai said, adding clinical trial are now testing drugs that appear to be able to target KRAS and enable the immune system to recognize and attack them. In another, soon-to-open clinical trial in which Tsai helps lead, the molecular profile of a biopsy of a patient's pancreatic cancer is analyzed to determine which chemotherapy drug to utilize. “This could be a great resource for patients,” Tsai said.

Prostate cancer is the second most common cancer in men, behind only skin cancer. In recent years, advances in screening, surgery and radiation treatment have improved outcomes and led to an increase in what is known as active surveillance after the initial diagnosis of prostate cancer. “The goal of active surveillance is to maximize the quality of life for patients while at the same time preserving the quantity of life,” said Akshay Sood, MD, a James urologic oncologist who specializes in treating prostate and bladder cancer. Dr. Sood explained the importance of screening, the prostate-specific antigen (PSA) test and what it means, the Gleason score and how these numbers help oncologists determine when to treat patients. He also discussed what's involved in prostate-cancer surgery and radiation treatments, and advances in both of these areas. Dr. Sood is also one of the leaders of the James Multidisciplinary Prostate Cancer Clinic and he described the benefits to patients of this all-in-one clinic that includes a large team of prostate cancer experts. “Unfortunately, there are no symptoms, which is why screening is so important,” Dr. Sood said of prostate cancer. PSA screening should begin at the age of 45 for most men. African American men (who have a higher rate of prostate cancer) and those with a family history of prostate and other types of cancers should begin their yearly PSA screenings at 40. “A PSA level below 4 is considered normal, while a score above 4 is abnormal,” Dr. Sood said. A high score will often lead to a biopsy to determine of the patient has cancer and, if they do, where it ranks on the Gleason scale and the genetic mutation causing the cancer.

Liquid biopsies and circulating tumor DNA are changing and improving the way cancer is detected and treated. In this episode, Sameek Roychowdhury, PhD, MD, explains the basics of circulating tumor DNA, how it's being used at the James, his lab's clinical trials, and the promising future. “When a normal cell and a cancer die they sheds fragments of their DNA,” he said. “Cancer can be detected in the blood by looking for these fragments and this is becoming an important research tool and treatment tool for the care of cancer patients.” For example, about 50 percent of cancer patients who have a tumor surgically removed will have a recurrence. And it's very difficult to determine which patients will have the recurrence. Minimally invasive liquid biopsies after surgery “helps us stratify and determine patients with a lesser recurrence risk who won't need chemotherapy or immunotherapy treatment versus those patients who need even more treatment than we've normally given them in the past.” Monitoring circulating tumor DNA “also becomes part of the surveillance program and we'll do a precise test every three months that measures fragments in the blood,” Roychowdhury said, adding that finding a recurrence of cancer from these fragments, months before it would appear on more traditional scans “allows us to make a diagnosis about the molecular drivers of the cancer and we can begin treatment earlier and better understand which treatment options will work best.”

The James Center for Tobacco Research “is truly one of the largest, if not the largest centers in the country and we clearly have the greatest breadth and depth of tobacco research in the country,” said Ted Wagener, PhD, director of the Center. Since the adoption of the 2009 Tobacco Control Act, the U.S. Food and Drug Administration has regulated the tobacco industry. Wagener compared this to “whack-a-mole,” explaining that “the tobacco industry is always looking for loopholes.” These loopholes include the use of menthol, synthetic cooling agents, electronic cigarettes and flavored products for electronic cigarette use that are more attractive to teenagers. The tobacco industry is also developing a synthetic nicotine product that might not be considered a tobacco product in order to avoid regulation by the FDA. “We can, as researchers, affect legislation through our research … and we're trying to stay one step ahead of the [tobacco-producing companies],” Wagener said. “And that's tough to do because they're the ones creating the products.” For example, Wagener explained, tobacco companies use menthol to make their products less harsh and more palatable. “Menthol has a cooling sensation that makes it easier for young people to inhale.” He adds that research has shown that the tobacco industry targets younger users through these types of “starter programs,” hoping to create lifelong users. Initial research indicates electronic cigarettes are a nicotine delivery system that “delivers less carcinogens and toxicants than cigarettes,” Wagener said. “But still there are some carcinogens and toxicants and so, it seems to me, the cigarette companies are trying to come up with ways to negate the bad effects and still deliver nicotine. So far they haven't been able to. In the meantime, they're going to sell whatever they can and try to get away with whatever they can.” For example, while flavors for electronic cigarettes are banned, they are still readily available. While the number of smokers in the United States is dropping “we still have 500,000 people a year dying of tobacco-related diseases,” Wagener said.

“I see myself as an educator first and foremost,” said Bridget Oppong, MD, an OSUCCC-James surgical oncologist who specializes in breast cancer surgery at the Stefanie Spielman Comprehensive Breast Center and is also the deputy director of the James Center for Cancer Health Equity. In this episode, Oppong shares her wealth of knowledge about the importance of self-examinations and breast cancer screenings; advances in surgery, chemotherapy and immunotherapy; radiation; and outreach programs to underserved communities in Columbus and throughout Ohio. “Early detection is saving lives,” she said. “The five-year survival rate for early-stage breast cancer is over 90 percent … [and for women diagnosed with later-stage breast cancer that has metastasized] we can manage their breast cancer and they can still live a long life.” Self-examinations and annual mammogram screenings are the key to early detection. “I always advocate for self-examinations,” said Oppong, who described how often and what to look for during a self exam. “And if you notice anything different, bring it to medical attention immediately, to your primary-care physician or oncologist.” The recommended age for women to begin annual mammograms is 40. “But if you have a family history of breast cancers or any cancers at an early age, I recommend starting mammograms five to 10 years earlier,” Oppong said. “For example, if your sister was diagnosed with breast cancer at 35, I want you to get started at 30 at the latest.” The average age for diagnosis of breast cancer is about 60, but Oppong said more younger women are being diagnosed in recent years. She also explained the significance of the BRCA1 and BRCA2 (the breast cancer inherited mutations) and how having this mutation increases the breast-cancer risk and means starting mammograms earlier and adding MRIs for some patients. She also described how breast feeding can reduce a women's risk of developing breast cancer. As for treatment, “we have seen awesome advances in all three modalities: surgery, medical (such as chemotherapy and immunotherapy) and radiation,” Oppong said. She described some of the advances in surgery, including the nipple-sparing surgery she performs and how she works with plastic surgeons. Oppong is passionate about and determined to reach out to underserved communities. “The advancements are real and are amazing and our focus is to make sure that all women and men have equitable access to all levels of cancer care from screenings all the way through to survivorship.”

“Cell division is fundamental to the growth of every living thing and when it goes wrong and is out of control this is the basis for all cancers and understanding this process is important,” explained Sir Paul Nurse. When it comes to understanding the fundamentals of cell division and the cancer connection, Sir Paul is a world-renowned expert and pioneer. He was awarded the Nobel Prize in Physiology or Medicine in 2001. In this podcast, he explained the ideas that sparked his ground-breaking research and how his findings gave scientists around the world the insight and tools they needed to develop advanced cancer therapeutics such as immunotherapy. Sir Paul is adept at explaining his work and the complexities of science in easy-to-understand language, combined with his keen intellect, modesty and a warm sense of humor. He's someone you will enjoy spending time with. As a young scientist, Sir Paul said he knew there would be a lot of ups and downs, and he was determined “to study something important and what is more fundamental than the process that is the basis of all growth … I didn't do this to cure cancer, but to understand the principles behind dividing cells and I thought by understanding this it would have implications for cancer and other diseases.” Sir Paul, director and chief executive of the Francis Crick Institute in London, was recently in Columbus as the recipient of the 26th Annual Herbert and Maxime Block Memorial Lectureship Award for Distinguished Achievement in Cancer. In addition to delivering a lecture, the Block Lectureship includes a mentor/mentee collaboration between Sir Paul and Li-Chun Tu, PhD, an Ohio State and OSUCCC-James assistant professor in the Department of Biological Chemistry and Pharmacology. Dr. Tu joined the second half of this podcast, and described her work in genetics. Sir Paul and Dr. Tu look forward to working together. “I truly believe he will give me such good advice,” Dr. Tu said.

Skin cancer is the most common form of cancer, and melanomas are the most serious form of this disease. “And we project an increase every year of 20 to 30 percent more cases,” said Merve Hasanov, MD, a James skin cancer and melanoma expert whose research focuses on how melanomas metastasize and spread to the brain. In this episode, Hasanov describes how exposure to ultraviolet light from the sun is the leading cause of all the different types of skin cancer, and that family history is another indicator. “Sun exposure creates a cumulative risk over a lifetime and some people, with a fair complexion, are at higher risk,” she said. Precautions that reduce risk “are decreasing your exposure to the sun, using sun block and reapplying every 50 to 90 minutes and avoiding tanning beds, which use UV rays,” Hasanov said. “Wear a hat or long sleeves, and, even when it's cloudy or during the winter the UV rays are coming from the sun.” Advances in treatment have led to better outcomes for patients, especially when melanomas are detected in the earlier stages, before they have metastasized and spread to other parts of the body. Because of this, “it's now recommended that you should, once a year, get a thorough dermatological exam,” Hasanov said, and she also explained the A-B-C-D-E method of detecting skin cancer: asymmetry, border, color, diameter and evolving. Immunotherapy has been a big breakthrough for the treatment of melanomas. “Melanomas have a lot of molecular and genetic changes that can be recognized by the immune system,” she explained. “But cancer cells are smart and can shut down the immune system. But immune checkpoint inhibitors [in immunotherapy drugs] take the brakes off the immune system so the T cells better recognize and kill cancer cells.” Hasanov said that the melanomas in 10 to 12 percent of patients diagnosed in the early stages of their disease will eventually metastasize and travel to the brain. “My research focuses on detecting this earlier when we have better treatment options and survival rates,” she said. Hasanov and her lab have developed a scoring system to determine which early-stage melanoma patients are most likely to develop brain metastasizes. These patients can then be screened on a regular basis. “We're hoping that this information will lead to better guidelines and trying to spread this information to more physicians and oncologists.”

Episode 171: Advances at the Pelotonia Institute for Immunology-Oncology, with Zihai Li by Steve Wartenberg

Two James physicians are part of an international clinical trial that utilizes an artificial intelligence (AI) algo rhythm to better determine the risk factor of a patient's colon cancer and whether or not chemotherapy is necessary after surgery. “The algo rhythm determines if a patient is high, medium or low risk category,” said Eric Miller, MD. Miller is a radiation oncologist who specializes in treating patients with gastro-intestinal cancers such as colon cancer. He has teamed with Vidya Arole, MD, MBBS, an assistant professor in the Department of pathology and an expert in the pathology of colon cancer. The clinical trial began after Arole met a team in Norway. “They had a tool, an algo rhythm, for stage 2 and 3 colon cancer patients and we decided to collaborate,” she explained. “They basically trained their algo rhythm from thousands of patients in Europe already treated for colon cancer to predict the outcomes,” Miller added. “The next step, here at Ohio State, was to use the algo rhythm on patients we had already treated, in which we knew the outcomes, and to see if the algo rhythm could accurately predict the outcomes … and it did a pretty good job.” Understanding and predicting the severity of a patient's colon cancer and whether or not chemotherapy is needed after surgery has traditionally been the role of pathologists, in consultation with a patient's oncologist. “We are the doctors who give a diagnosis by looking at the cells under a microscope traditionally [and now with digitized pathology],” Arole said. The James is a world leader in adopting and utilizing digital pathology. AI is the next step forward. “It's like having a second set of eyes,” Arole said. The work is in the clinical trails stage and has great potential. “The first goal was to validate the findings from Norway here in the United States,” Miller said. “The next goal is to increase the patient numbers and make sure the results still stand.” Miller is optimistic the AI algo rhythm will continue to “learn” and help him and his James colleagues better understand which patients need the additional chemotherapy and which ones don't.

The mission of Chyke Doubeni, MD, MPH, is clear. “I believe everyone deserves the right and opportunity to get the best care possible and I believe people who have socioeconomic and other barriers need not be prevented from getting that care,” said the Wexner Medical Center's Chief Health Equity Officer and the OSUCCC- James Associate Director for Diversity, Equity and Inclusion. “All of us at the Wexner and James are very motivated by our mission to insure that everyone in Ohio has the best healthcare possible.” Dr. Doubeni is a family doctor and his research focuses on the effectiveness of screenings, such as colonoscopies, lung cancer and breast cancer screenings and recognizing and overcoming the social determinants of health. “These social factors are major contributors to poor health outcomes for underserved communities and understanding and addressing these barriers is crucial and my role is to create the processes to allow us to do this with better fidelity,” he said. His goal for the James is to provide better educational, screening, testing and treatment options to underserved populations in Columbus and in rural areas of Ohio, such as Appalachia. One of the ways to do this, Doubeni explained, “is to go to people where they are … with our mobile lung cancer van, our mobile breast cancer van and a free colonoscopy program run by the staff of the Wexner and James who volunteer their time.” Colon cancer screenings are another important area. The James is in the midst of what Dr. Doubeni called a pilot program in which people are given a fecal immunochemical test (FIT) that that is not invasive and that they can take at home to detect this all-too common type of cancer. “Our hope is to reach even more people who wouldn't otherwise be screened,” he said. The James is also leading the way in using circulating tumor DNA to detect cancer in its early stages. “We have found ways to use a liquid biopsy, a blood sample, to detect cancer in the blood,” Dr. Doubeni said. This type of screening is still in the early stages, shows great promise and could be effective in reaching underserved populations.

The OSUCCC-James has one of the largest and most comprehensive blood and bone marrow transplant (BMT) and cellular therapy programs in the country, led by Marco de Lima, MD. “You want to cure everyone, period and we work toward that,” de Lima said, as he explained what drives him to find better treatment options for patients. “That's the motivation and the only currency that matters, and that's helping people.” Dr. de Lima described three new programs designed to help patients in Ohio and beyond: providing bone and blood marrow transplants (BMTs) and chimeric antigen receptor (CAR) T-cell therapy on an outpatient basis; engineering the genetic modifications of the cells used in CAR T-cell therapy inhouse; and a partnership to expand cellular therapy programs in Brazil. In the CAR T-cell process, T cells (the cells that fight cancer) are removed from a patient and reengineered in a lab to make them more efficient in recognizing and killing cancer cells. They are then put back into the patient to do their job. In the past, patients were admitted to the James during BMT and CAR T-cell treatments “and their stay was three to five weeks, in relative isolation,” de Lima explained, adding that “our ability to prevent infections, safer chemotherapies have set the stage where we don't have to admit some patients … We will continue to offer inpatient options but will expand the option of coming here daily instead of being admitted to the hospital.” About 20 patients have undergone CAR T-cell treatment on an outpatient basis already. “Of these, 40 percent never needed admission to the hospital and the other 60 percent had their admission times dramatically reduced,” de Lima said. “We want to increase the percentage who will never see the inside of a hospital.” In the past, it took up to two months to send and receive back a patient's re-engineered T cells from labs located throughout the country. “That's too long,” de Lima said and then explained that the OSUCCC – James can now re-engineer the T cells inhouse. “We've currently treated 14 patients in a clinical trial and it's taken us seven days from collecting the cells to giving them back to the patient,” he said. Dr. de Lima also described a partnership with Caring Cross (an organization devoted to providing medical services to underserved populations around the world) and Brazilian health officials. Members of de Lima's team at the James will provide the technical expertise and training to create mobile clean rooms in Brazil that will re-engineer cells for CAR T-cell treatment. “This is a very ambitious program to provide CAR T-cell for free within the Brazilian healthcare system,” de Lima said.

The James has one of the largest head and neck cancer departments in the country, featuring experts in robotic and reconstructive surgery, proton radiation, chemotherapy and immunotherapy treatments, as well as cutting-edge clinical trials. “The key is you need a huge support network [of nurses, therapists and other specialists] to get patients through surgery, radiation, chemotherapy and immunotherapy … we have a team of more than 200,” said Matthew Old, MD, director of the James Department of Otolaryngology – Head and Neck Surgery. Any cancer above the clavicle, except for brain tumors, are head and neck cancers. The number of head and neck cancer cases is on the rise, Old said, adding the reason is the prevalence of the human papillomavirus in adults. “We'll see an increased rate for the next 10 to 15 years because the HPV vaccine wasn't available a few decades ago … HPV is the cause of about half the head and neck cancers we see.” James surgeons perform about 350 transplants a year for their head and neck cancer patients. “We are all cross trained in reconstructive surgery,” Old said. “We can take tissue and bone from a patient's body and use it to reconstruct their tongue, mouth, jaw, any type of defect.” Old said that between 50 and 60 head and neck cancer patients receive radiation therapy daily at the James. The James is one of the few cancer hospitals offering proton radiation and it's “more precise and we think it minimizes the long-term consequences to the patient,” Old said. There are about 20 head and neck cancer clinical trials at the James. In one trial initiated by James physicians and scientists, patients receive immunotherapy before surgery. “This is done to prime the immune system to recognize the cancer cells as foreign,” Old said. “Then after surgery, the patient receives a year of immunotherapy.” In another clinical trial, James doctors utilize circulating tumor DNA to determine the effectiveness of treatment for their patients. “We can watch their response to treatment and tailor the treatment accordingly,” Old said.

Breast screenings saves lives, and the James Cancer Hospital's Stefanie Spielman Comprehensive Breast Center is a world leader in providing screenings, such as mammograms. “I really care about each and every patient and I want to make sure every woman has access to good health care and knows that we're here to help then through this,” said Amy Kerger, DO, a diagnostic radiologist and mammogram expert. In this episode, Kerger explains the history of breast screening, which dates back more than 100 years and began with X-rays. Low-dose radiation mammogram machines were introduced in the 1960s “and the United States started screenings programs in the 1990s when the (Food and Drug Administration) enacted standards,” Kerger said. Every woman should begin getting yearly mammograms at the age of 40, and those considered high risk, due to family history and other factors, should start at an earlier age in consultation with their doctors. “There are still 20 to 30 percent of women who don't come for yearly screenings,” Kerger said. “If you wait until it's palpable or other symptoms, the treatments are harder and it's harder to save that woman's life.” The Spielman offers breast screenings in several locations throughout central Ohio. All James mammograms are done with the latest 3D technology, which is known as breast tomosynthesis. “Ultrasound is often used for women with dense breast tissue,” Kerger explained. “Women with dense breast tissue have a small, increased risk of breast cancer and it's easier to see through the dense tissue with ultrasound.” Overall, 8 percent of women will get breast cancer during their lives, Kerger said. Spielman experts discuss family history and several other factors, such as having a child at a later age or getting periods at a younger age, and determine each patient's risk of breast cancer. Those who score a 20-percent risk are considered high risk and are referred to the Spielman's High-Risk Breast Cancer Program. “At the Spielman we are all specialists in breast cancer,” Kerger says. “I only read breast imaging. Our surgeons and radiologists only specialize in breast cancer. I feel that we know what patients are going through and we're there to help you get through that.

The James provides a comprehensive survivorship program for patients and their families. “People are living longer with cancer and how do we make sure they have the best quality of life during their treatment and the years beyond,” said Denise Schimming, APRN-CNP, a certified nurse practitioner and survivorship specialist. Schimming and Julie DeBord, MSW, LISW-S, manager of JamesCare for Life, discussed the history, growth, the numerous and growing number of programs they offer and how they connect with patients and their families. “JamesCare for Life has been around for more than 20 years,” DeBord said. “We started with 10 programs and now we average more than 30 programs a month and we're continually looking at how can we meet the needs of our cancer patients and their families.” Some of the many programs JamesCare for Life offers include music and art therapy, nutrition classes and healthy cooking demonstrations, physical therapy, individual and group sessions from mental-health professionals, and presentations by James experts on a wide range of cancer-related topics, such as lymphedema. JamesCare for Life also provides equine therapy for families and the Garden of Hope is a large farm that provides patients and caregivers the opportunity to harvest and take home a wide variety of vegetables and herbs. “Cancer can be isolating and scary and we have educational classes to help with coping during times of uncertainty to manage stress, mindfulness programs for stress reduction and support groups and one-on-one care support,” DeBord said. Schimming and her team connect with patients while they undergo treatment, while DeBord and her JamesCare for Life team offer free programs for patients and their caregivers after treatment. Schimming and DeBord work together to meet the needs of patients and create new programs. An example is the recent addition of two certified child-life specialists. “We heard from patients that they didn't know how to tell their children and their grandchildren about their cancer,” Schimming said. “We hired two certified child-life specialists, one for inpatients and one for outpatients. They're experts in helping families cope with medical illness and we created a special playroom [in the James] for these interventions.”

The James Cancer and Aging Resiliency (CARE) clinic is a leader in treating older cancer patients. Patients have been treated with blood and bone marrow transplants (BMTs) for more than 40 years, but, initially, only younger patients were eligible. “There was a bar set as low as 40-years-old when this was a brand-new technology,” said Sarah Wall, MD, MPH, a James hematologist who specializes in treating patients with blood cancers. “Then it was 55 and 60 and 65 and now there is no official upper-age cutoff … it comes down to the individual patient.” In this episode, Wall explains the basics of BMTs. “There are two types, autologous, where a patient gets their own stem cells back, and allogeneic, in which we use donor cells,” she said. Improvements in the drugs used to treat graft-versus-host-disease (GVHD), which can occur in allogenic BMTs, have “really expanded the pool of donors for older adults who may only have siblings who are deceased or have had cancer themselves previously or some other disease that would make them ineligible,” Wall explained. “We have better drugs to prevent graft-versus-host-disease and to treat it when it does happen.” Several patients 70 and older have been treated with BMTs at the James. Wall said her oldest BMT patient is 80. “I have a [group] of the first three gentlemen 70 and older who I treated with a transplant all coming up to their five-year anniversary,” Wall said. “It's a testament to them and to their families and caregiver support that they got through this. We're the scaffolding they build this support on … and it's very rewarding to be part of this and especially to open doors for people who thought they were closed.”

Pelotonia has changed Joe Apgar's life. “I'll never forget how I felt in the moment someone told me I had cancer,” the CEO of Pelotonia said in this episode. “You feel completely lost and by yourself and you don't have answers to the questions running around through your head.” Apgar was diagnosed with testicular cancer while a student at Penn State. Pelotonia is the fundraising cycling event that has raised more than $285 million for cancer research at the James. Apgar first rode in 2011, soon after he moved to Columbus to work for Rockbridge Capital, a private equity firm that sponsors a Pelotonia team Apgar helped create. “I remember standing at my first opening ceremony [of Pelotonia] and how uplifted and excited and supported I felt … that's when I could flip the switch on it and feel empowered by my own story and experience,” Apgar said of the start of his first ride and crossing the finish line. Apgar talked about his cancer journey, how he connected with a James physician for his follow-up cancer care, his Pelotonia experiences as a rider and leader, and the future of the event. Apgar also talked about the importance of the Pelotonia “community” and how it has helped connect members of the James team with riders, volunteers and donors. “I think [the Pelotonia founders] hoped that some of this sense of community would happen, but I don't think anyone could have dreamed it would happen at the scale it has,” he said.

Because adrenal cancer is so rare, very few cancer hospitals have specialists equipped to treat patients and perform research and offer clinical trials for this type of cancer. “Very few physicians ever see a case in their lifetime and so there are a lot of physicians out there who don't really understand the disease process,” said Barbra Miller, MD, the co-director of the James Multidisciplinary Adrenal Clinic. “I want to make sure patients get good, consistent and comprehensive and safe care and as a surgeon I want to make sure every patient gets the best surgery.” In this episode, Miller and Priya Dedhia, MD, PhD, a James expert in adrenal surgery and research, discussed this rare form of cancer and the wide range of screening and treatment options at the James, and their cutting-edge research. There are currently no screening procedures, such as mammograms for breast cancer or colonoscopies for colon cancer. This means adrenal cancer is often first diagnosed in the later stages when it has metastasized and spread. “We don't know there's a tumor until it's quite large or has gone somewhere else, and another way we know is if [the cancerous adrenal gland] overproduces hormones,” Miller said. Some of the research at the James is focused on understanding how benign tumors in the adrenals can become cancerous. “We know colon cancer starts as a benign polyp,” Miller said. “We never thought this was true with adrenal cancer but now we're at the stage where we think we can prove this is true.” Surgery is the primary modality for treating adrenal cancer, often followed by chemotherapy or, in recent years, immunotherapy. “We're working to create new models for adrenal cancer treatment,” Dedhia said, adding that in her lab she has created “organoids” that “are like patient avatars and help us better understand and treat the cancer.” Organoids are masses of cells grown in the lab and can be used to test the effectiveness of new drug treatments, such as immunotherapy, prior to clinical trials in patients. “We've found two new pathways that kill these organoid cells and the next step we're hoping for is a clinical trial,” Dedhia said. “We believe we've found a way to improve the immune response [of new immunotherapy drugs] and we're very excited.”

A breast cancer diagnosis in 2011 changed the life and career path of Jessica Winter. “It was a really defining moment in my career,” said Winter, PhD, an Ohio State professor of engineering, and a member of the Ohio State Cancer Engineering Center. “I could have kept doing research and publishing papers … but now I really wanted to do translational work and take something from the lab to patients.” Winter is a leader in the growing field of utilizing nanotechnology for cancer science and treatment. “There are three areas where it can be applied – imaging, biosensing and drug delivery,” she said. Winter and her lab, and her collaborators at the James and the Ohio State Cancer Engineering Center are involved in all three of these areas. Nanotechnology has been used since the 1990s to deliver chemotherapy drugs. “Nanotechnology is defined as something between the size of one and 100 nanometers,” Winter said. “You can fit five million nanoparticles that are five nanometers in diameter inside a cell.” In her lab, Winter has developed what she calls “quantum dots” to improve the delivery of drugs to cancer patients. Another area of her research involves biosensing. “The COVID test is a biosensor and some of the earliest biosensors were home-pregnancy tests,” Winter explained. Winter and collaborators at the James are also working on a nanotechnology biosensing method to analyze solid tumors. “We came up with a method of erasable labelling,” she said of the method in which several different colors, or layers, of can be used to create a series of images. “We need better diagnostic tests to match the patient with the best therapy, this is personalized medicine,” Winter said. Her cancer diagnosis (she is in remission and doing well) continues to motivate Winter. “I love my job and what I do,” she said. “The idea that I can help people … and make real things for real people is very exciting.”

Knowing your family's medical history is important and can save lives. “When we think of family history in terms of cancer genetics [and inherited genetic mutations], we think about a broad spectrum of relatives, more than just your parents and siblings,” said Leigha Senter, MS, CGC, a James licensed genetic counselor. “We ask about grandparents and aunts and uncles and cousins and that can inform us about how likely you have a hereditary predisposition for cancer.” Ohio State and the James have one of the largest and most advanced genetic counseling programs in the country. “We have 12 genetic counselors on the faculty supporting the cancer program and we have genetic counselors who specialize in specific types of cancer,” Senter said. In this episode, Senter discusses the two most common types of inherited genetic mutations that increase the cancer risk: the Breast Cancer gene (BRCA1 and BRCA2) that increases the risk of breast cancer as well as ovarian, pancreas and prostate cancer; and Lynch Syndrome, which increases the risk of colorectal cancer as well as uterine cancer. “The average woman has a 12 percent chance over the course of their lifetime of developing breast cancer,” Senter said. “Those with [BRCA1 and BRCA2] have anywhere from a 50 to 80 percent chance.” Uncovering inherited genetic mutations leads to earlier and more frequent screenings that can detect cancer in its earliest and most treatable stages. In the case of patients with Lynch Syndrome, earlier and more frequent colonoscopies “can actually prevent a cancer from happening,” Senter said. Cascade testing is one of Senter's specialties. “Someone in every family is always the first to test positive for an inherited genetic mutation,” she said. “The next step is to help them share this information with as many family members as possible. This is cascade testing and is where are real potential to help people is.”

The number of younger patients diagnosed with colorectal cancer is on the rise. “We always used to say at age 50 get your first colorectal screening, and now we've dropped that to 45,” said Samuel Akinyeye, MD, an Ohio State gastroenterologist. “And the reason is we're seeing younger people being diagnosed with colorectal cancer … I'm seeing younger patients in my clinic.” In this episode, Akinyeye discusses several of the reasons for the increase, including the impact of unhealthy diets and sedentary lifestyles, and the role of family history and inherited genetic mutations that increase the risk of colorectal cancer. “We're eating more processed foods and greasy, fatty foods that are pro-inflammatory,” he said, adding obesity and inflammation increase the risk of cancer. He also talks about the importance of screenings, such as colonoscopies, and how they can reduce the number of colorectal cancer diagnoses and deaths. “Colonoscopies are the gold standard of screening,” Akinyeye said, adding they detect and pre-cancerous polyps that are then removed before they actually become cancerour and spread to other parts of the body. “Screenings save lives,” he said. Knowing your family history and discussing it with your primary care physician is vital. “We have a saying, that family secrets kill families,” Akinyeye said, adding people with a family history of colorectal cancer or even high-risk polyps should start screenings even earlier than 45. “People aren't getting screened as early as necessary because they're not aware of their family history.” Inherited genetic mutation, such as Lynch Syndrome, “greatly increase the chances of developing colorectal cancer and other types of cancer,” Akinyeye said.

To kick off Pelotonia 2024 Launch Week, this is a special re-release of episode 155, “The Next Leaps Forward in Cancer Treatment, with Guest Co-Host Raph Pollock.” The new version of this episode now includes an introduction and conclusion from Joe Apgar, Pelotonia CEO. Each of the James scientists and physicians featured in this episode has been funded by Pelotonia. Hearing directly from these individuals about the continued progress, groundbreaking research, and treatment advancements is inspiring as the Pelotonia movement kicks off its 16th year. Registration opens for Pelotonia's cycling events, Ride Weekend on August 3-4 and Gravel Day on September 28, 2024. Riders, Volunteers, and Challengers can sign up and commit to continue funding the work of James scientists and physicians like those you will hear from in this episode. Registration for Pelotonia 2024 opens on February 29 at Pelotonia.org/register.

Clinical trials are “the foundation of cancer research and lead to better treatment options and outcomes for patients,” said John Hays, MD, PhD, a James medical oncologist who treat patients with peritoneal cancers. He is also one of the leaders of the James clinical trials office and “at any given time we have between 500 to 600 clinical trial open and we put 1,000 patients a year on clinical trials, which is one of the largest numbers in the country.” In this episode, Hays explained the process of how an idea that begins in the lab (usually a new drug) goes through several different phases before it becomes approved for treatment. “Less than one percent of the Phase 1 clinical trials are ever approved,” he said, adding this is done to ensure patient safety and ensure the new treatment is an advancement over current options. “But, even if they're not successful, we can learn something we can apply to the next trial.” He also said there is a common misconception that clinical trials are the “last resort” for patients. “It can be at any phase during treatment, from a front-line treatment setting or a later stage,” he said. “In most cases it's adding something to the standard of care to make the standard of care work better … And, I never present to a patient that you have to do this trial. It's always their decision and my goal is to help them understand everything, answer their questions and allow them to make the best-informed decision for them.” A new national trend in clinical trials the James is helping to lead is decentralizing the location of the trials in order to reach more patients. “We're developing clinical trials by James people for patients all over the state and beyond,” Hays said. “We utilize tele-med and work with the patient's local oncologist. COVID opened our eyes about what we can do from a distance.” Advancing cancer science and bringing new treatment options to patients is what motivates Hays. “We want to be there for our patients and bring them the newest and best options,” he said. “The real joy for me is talking to a patient and giving them the option to participate in a clinical trial and maybe bring them a drug [or treatment option] that isn't available anywhere else.”

The foods we eat can reduce or increase the risk of developing cancer over the course of a lifetime, according to Fred Tabung, PhD, an assistant professor in the Department of Internal Medicine. “Think of food as medicine,” he said, adding that “what you eat should be enjoyable, but we should also eat in a healthy way to reduce the risk of cancer.” In this episode, Tabung joined with Candice Schreiber, RDN, LS, CSO, a James dietician, to discuss the importance of a healthy diet, including what it entails, how and why what we eat impacts the risk of cancer, and tasty ways to eat healthier. “A plant-focused diet is what I encourage people to eat,” Schreiber said. “It doesn't have to be vegan or vegetarian, the goal is to fill the majority of your plate with fruits and vegetables and whole grains.” In his James lab, Tabung studies “combinations of food and beverages that effect the metabolism, specifically inflammation and the insulin response,” he said, adding that too much inflammation and insulin can increase the risk of cancer. “High levels of insulin [from consuming too much sugar] can tell the cells to divide when they're not supposed to divide, and this can lead to cells becoming cancerous.” Red meat, processed meats, such as sausage and hot dogs, as well are highly processed foods chock full of preservatives and sugar increase the risk of cancer. “In these highly processed foods, the nutritious parts are removed … the cancer-fighting parts of the foods have been stripped away,” Tabung said. His lab is involved in a new clinical trial in which women with a high risk of developing breast cancer are placed on a diet designed to reduce the risk. “We're really excited about this,” he said. Tabung and Schreiber provided numerous tips and suggestions on how to eat healthier. For example, when it comes to beverages, unsweetened coffee and tea are metabolically active and provide healthy nutrients, while diet soda “is metabolically active, but not in a good way,” Tabung said. “My pet peeve is that people often think that healthy food doesn't taste good, but it absolutely does,” Schreiber said.

The new James mobile lung cancer screening unit is on the road, traveling around the state of Ohio. This is a big step forward because “lung cancer still accounts for more cancer deaths than breast cancer, colon cancer and prostate cancer combined,” said Michael Wert, MD, a James pulmonologist and director of the James lung cancer screening program. “I still see too many patients who haven't seen a doctor in a while, ignore symptoms and come in so sick that we'll do a CT scan and find they have really advanced lung cancer.” In this episode, Wert talks about the goals for the screening unit and why it is so vital. Smoking is the primary cause of lung cancer. “The new screening guidelines for lung cancer are that people aged 50 to 80 with a 20-pack-year history should be screened,” Wert said. “This means someone who has smoked a pack a day for 20 years, or two packs a day for 10 years.” Even people who have quit smoking years ago, but had a 20-pack-year history, need to be screened. “Too many people think what I don't know can't hurt me, but this isn't true, but this fear may prevent people from getting screened,” Wert said. Reaching out to underserved communities is vital in reducing cancer deaths. “Right, now, the major screening centers in Ohio are in the big cities,” Wert said. “And the highest risk patients for lung cancer often lives hours away from the nearest screening facility … We're one of only five or six mobile lung cancer screening units in the country and we're at the cutting edge of this. So, if you live in a remote area, don't be discouraged, our mobile lung cancer screening unit will be coming to you one day and don't let your fears or anxieties of finding an abnormality scare you away. My hope is we'll take our mobile screening unit to a town and hundreds of cars will be lined up waiting for us.”

Advances in cancer research and treatment are accelerating at a rapid pace. We asked several James scientists and physicians to tell us about an advancement that has them especially excited. Their answers were fascinating and filled with hope. This special episode was co-hosted by Raphael Pollock, MD, PhD, director of the Ohio State Comprehensive Cancer Center. “We've recruited more than 200 new members to the cancer center in the past four years, that's more that most cancer centers in the United States,” Pollock said, adding that collaboration is the key to breakthroughs and “this is the best collaborative environment for cancer research of any place I know of.” Roman Skoracki, medical director of the Stefanie Spielman Comprehensive Breast Center, said the development of advanced chemotherapy and immunotherapy drugs will reduce the need for breast-cancer surgery. “We're already seeing tremendous responses, to the point that there's so much shrinkage of the tumor that we're performing smaller surgical interventions,” he said. Advances in the techniques to genetically engineer a patient's immune cells to better detect and fight cancer is another big step forward. “One of the benefits of utilizing the immune system is we're seeing not only good responses, but responses that last a long time because your immune system has a good memory,” said Margaret Gatti-Mays, MD, MPH, a medical oncologist who specializes in immunotherapy. Advances in detecting cancer with sensors and blood draws that can identify the proteins on cancer cells “is coming and I think faster than people realize,” said James Rocco, MD, PhD, chair of the James Head and Neck Oncologic Surgery Division. Detecting new cancers earlier will save lives. Peter Shields, a lung cancer specialist, talked about how research into the use of psychedelics is in the very early stages and “has the potential for a huge impact” in reducing stress and anxiety for cancer patients and helping to improve their quality of life.

The proton radiation center began operations in the James Outpatient Center on December 13. While there are a handful of cancer hospitals in the world that offer proton radiation treatment, the James proton radiation facility is the “most advanced proton radiation therapy in the world,” said Arnab Chakravarti, MD, chair of the James Department of Radiation Oncology. In this episode, Chakravarti explains the advantages of proton radiation. “With conventional radiation there is an entry point and exit point and all the normal tissue in-between receives radiation,” he said. “With proton radiation, one of the great benefits, is it minimizes the amount of normal tissue that is irradiated and succumbs to acute and later side effects of radiation … The goal is to eradicate the tumor and minimize the side effects in patients.” Initial studies have shown that proton radiation can reduce the number of what Chakravarti calls “radiation-induced malignancies.” Over the next few years, Chakravarti and his radiation oncology team will develop new ways to better utilize proton radiation therapy, including FLASH proton therapy. “FLASH refers to an ultra-high dose of proton radiation that can be 10,000 fold more potent than conventional radiation,” Chakravarti said. “So, treatments that currently take six to eight weeks, with the patient being treated five days a week, can be shortened to a single treatment lasting less than a tenth of a second.” Pre-clinical tests will be developed to “prove the efficacy and safety” of FLASH proton therapy. Another advance is the development of image-guided proton radiation therapy. “Cancer cells have microscopic extensions beyond what we can see on scans,” Chakravarti said. “We're developing an image-guidance platform that will target cancer cells where they sequester; they can run but they can't hide from this technology.” Another advance being developed is utilizing artificial intelligence (AI) to better and more precisely deliver the proton radiation. The radiation treatment will be specific to each James patient and “will result in the tumor getting the maximum proton radiation dose and minimizing it on the surrounding tissue,” Chakravarti said.

It's been a year of growth and innovation at the Ohio State University Comprehensive Cancer Center and James Cancer Hospital. This special “Best of 2023” episode features highlights from several of the past year's episodes from the world-class scientists, physicians and leaders at the James. Another highlight comes from a patient enrolled in two James clinical trials. “I went in there [to see a James oncologist] feeling kind of hopeless and by the time my wife and I left we both felt very optimistic,” said Robert Bioni. “It will be six years from my diagnosis and I'm still here.” The thread that connected all these episodes was the passion of the guests, a passion that is directed toward developing new science, clinical trials and treatments to help patients. “People need and want and deserve a surgeon who is compassionate and caring and can listen and be there not only for the patient but for their families,” said Tim Pawlik, the James Surgeon-in-Chief. The clips in this episode highlight: Advances in minimally invasive surgery; advances in re-engineering a patient's immune cells to help them better recognize and attack cancer cells; the growth of several new multidisciplinary cancer clinics that specialize in treating one type of cancer; the opening of the new James Outpatient Care center; and how collaboration leads to better outcomes for patients.

Understanding the progression of a cancerous head and neck tumor, “how it started and how it evaded the immune system and got into the blood stream and spread provides a wealth of information we can utilize and gives us more treatment options,” said James Rocco, a head and neck cancer specialist and chair of the James Cancer Hospital's Head and Neck Surgery Department. In this episode, Rocco discusses how he and his collaborators have developed a computational data analytics program called PhylogicNDT. The program will evaluate the progression of head and neck cancer tumors caused by the human papillomavirus (HPV) and they believe “this approach can be applied to other types of cancers,” Rocco said. Diagnosing head and neck tumors in the early stages, when the tumor mutations are less complex and easier to treat, can be problematic. This is because the symptoms don't usually appear until the tumor has progressed significantly. However, “looking at the circulating DNA in someone's blood can detect head and neck cancer in the earliest stages,” Rocco said of this type of blood analysis. “We're not there yet with circulating DNA but we're getting close.”

Global warming, climate change and the increase in wildfires, weather events, emissions from fossil fuels and hotter temperatures will have a negative health impact, according to Lauren Koch, the Sustainability Program Manager for The Ohio State University Wexner Medical Center and Marium Husain, MD, a James medical oncologist who specializes in treating patients with soft tissue and bone sarcomas. In this episode, the two discuss how global warming and climate change could increase the cancer risk for people, but quickly add that scientific research into the specifics are in the early stages. The particles from wildfires and carbon emissions “break down into smaller particles, nanoparticles,” Kock explained. “A lot of data shows that when they are inhaled into the lungs it causes problems down the road.” Koch added that the increased number of wildfires, that are burning longer and hotter, and the continued reliance on fossil fuels are “a recipe for disaster” and will lead to more nanoparticles in the air. “We've already seen this in Beijing, the connection between increased particles and lung cancer,” Koch said, adding the number of skin cancer diagnoses could also increase. “As more of the sun's ultraviolet light is trapped in the atmosphere … that could lead to more exposure to ultraviolet light and that could lead to higher rates of skin cancer.” Despite the realities of global warming, Koch and Husain remain optimistic. “I find hope in the people who are here, like Lauren, and the investment we're making in these people,” Husain said.

The goal of the OSUCCC – James Center for Cancer Engineering is simple. “We're not trying to engineer cancer; we're using engineering processes and principles to better diagnose and cure cancer,” said Matthew Ringel, MD, co-director of the Center along with Jonathan Song, PhD. The Center is a collaborative effort between the James, the College of Engineering, College of Arts and Sciences and several other colleges across Ohio State. “We're taking advantage of the incredible people we have here at Ohio State,” said Ringel, a thyroid cancer specialist who also leads the James Department of Molecular Medicine and Therapeutics. “We have 56 members right now … and a core group is moving soon to the new Pelotonia Research Center (on Kenny Road).” There are numerous connections between cancer science and engineering. Developing the MRI technology used to diagnose cancer is a great example, Ringel said. The Center's areas of focus include imaging technology, creating and studying cancer tissue structures, using data analytics and artificial intelligence to better diagnose patients, and nanotechnology to deliver treatment more precisely and effectively. The Center's metastasis on a chip program is led by Aleksandar Skardal, PhD. Cancer cells are placed on “chips” and then researchers study how they metastasize and spread throughout the body. “This increases the discovery of the pathways that regulate the metastasis process as well as determining the drugs that may impact this,” Ringel explained. This process will ultimately be utilized for individual patients to better analyze and treat their specific cancer mutations “and is a great example of personalized care,” Ringel said. Another of the center's program's utilizes bio printing. “This is led by Dr. VanKoevering in our head and neck cancer department,” Ringel said. “For example, we can CT scan the jaw of a patient and then bio print an exact replica of [the portion of the jaw removed during surgery]. That bio-printed material then goes into the patient rather than a pre-made product that may not be the exact size.” Artificial intelligence programs can analyze groups of digital pathology images, or an individual patient's pathology “and assist our pathologists to help them better see patterns to give a better diagnosis and better predict outcomes,” Ringel said. Nanotechnology is being utilized to create microscopic structures that “can carry what we call cargo directly to the cancer cells,” Ringel said. “The goal is to better treat the cancer and minimize the side effects.”

“Inflammatory breast cancer is very aggressive and rare and a lot of times the diagnosis can be missed,” said Margaret Gatti-Mays, MD, MPH, a medical oncologist who specializes in breast cancer and is one of the leaders of the Stefanie Spielman Comprehensive Breast Center's Inflammatory Breast Cancer Program. In this episode, she explains that this rare form of breast cancer “accounts for less than 2 percent of all breast cancers, adding that “one-third of all inflammatory breast cancers will be metastatic [when first diagnosed] while only 5 percent of the more typical types of breast cancer we see are metastatic [when first diagnosed].” One of the reasons inflammatory breast cancer is initially misdiagnosed is that the symptoms “are non-specific,” Gatti-Mays said. “The onset is rapid and includes redness in the breast, or it can be pink, red or purple, and appear over one-third of the breast, as well as a rapid swelling of the breast; it feels full and swollen and the skin of the breast looks like an orange peel, with dimpling.” These symptoms can be misdiagnosed as mastitis or duct ectasia, which are more common and non-cancerous. Mastitis and duct ectasia are initially treated with anti-biotics. “If the symptoms don't improve, I encourage women to come to the Stefanie Spielman Comprehensive Breast Center,” Gatti-Mays said. “We have a diagnostic clinic and patients can self-refer and get imaging. Because of how aggressive inflammatory breast cancer is, there's a sense of urgency to get a biopsy, make a diagnosis and evaluate if it has spread.” The team that comprises the Spielman's Inflammatory Breast Cancer Program are experts in diagnosing and treating this type of cancer. “Breast cancer care has become more complicated and having a team at a comprehensive cancer center is important to identify patients who need to start treatment immediately.” Treatment options include surgery, radiation, chemotherapy, and immunotherapy. Soon after she arrived at the Spielman, Gatti-Mays treated a pregnant woman with inflammatory breast cancer. “That drove me to want to learn more and figure out how to better treat these patients,” she said. “I realized a lot of my Spielman colleagues shared this interest” and this led to the formation of the Inflammatory Breast Cancer Program. “As a physician-scientist, I can say with absolute certainty that the patients I see in my clinic gives me the fuel we need to push forward and do better and better.”

“We are constantly evolving,” said Roman Skoracki, MD, medical director of the Stefanie Spielman Comprehensive Breast Center. "There are so many exciting things go on." In this episode, Skoracki fills us in on some of these advances, including enhanced breast cancer screening technology; a program to reach out to women in underserved urban and rural areas to provide screening mammograms; a High-Risk Breast Cancer Program; innovative clinical trials, a new, Inflammatory Breast Cancer Program; and a comprehensive Survivorship Program to help improve the quality of life of Spielman patients. “We identified the hurdles some women have to overcome in order to be screened,” Skoracki said. “They can be socio-economic, language barriers, transportation issues … we want to reach out to these communities.” Under Skoracki's leadership, the Spielman will continue to evolve. “We have an emotional attachment with our patients and we want to continue to push the envelope and give our patients the very best,” he said.

Richard Wu, MD, PhD, is a medical oncologist who specializes in skin cancer and melanomas and the early development of new drugs. One of the new cancer treatments Wu is helping to develop is TIL – which stands for tumor infiltrating therapy. T cells in the immune system are programmed to locate and destroy cancer cells. “We take and isolate T cells from each patient's unique tumor and expand them to billions of T cells in the lab and then reinfuse them back into the patient,” Wu explained. Prior to reinfusing the T cell, patients “have received chemotherapy to deplete their immune system to make space for these new T cells. This is a very personalized form of immunotherapy.” The TIL procedure is currently being performed in clinical trials at the James and other leading cancer hospitals. Wu said that the Food and Drug Administration will soon approve a new drug that will make the procedure more effective. The process in the lab “will make the cells stronger and smarter and better able to differentiate between cancer cells and healthy cells … the amount of cells we put back into the patient is critical, we need billions,” Wu said. Currently, TIL is being used to treat patients with a very limited number of cancers, including metastatic melanomas. However, Wu is optimistic that the procedure will eventually be used to treat several other types of cancer. Initial clinical trials are testing the TIL approach for patients with head and neck cancer and triple-negative breast cancer. The early studies have indicated there's a potential efficacy, there are some really exciting signs,” Wu said.

The next chapter in the career of Peter Shields, MD, has begun. “Now I get to do what I started out doing … seeing patients and doing research,” he said. Shields recently stepped down as deputy director of The Ohio State University Comprehensive Cancer Center, a position he has held for more than a decade. Under his leadership, the Center continued to grow at a rapid rate and has become established as one of the leading cancer-research institutions in the world. But Shields, a lung-cancer specialist, is definitely not retiring. He will continue to see patients and do research. And, he is also in the midst of becoming licensed as a paramedic. “I had this passion as an undergraduate and in medical school for being an (emergency medical technician) and riding in ambulances, going to places where people really need help.” As deputy director of the Comprehensive Cancer Center, Shields recruited new physicians and scientists, helped pull together teams that collaborated to do research and apply for grants, and he helped created the Pelotonia Institute for Immuno-Oncology and the Center for Tobacco Research. “My job was to be a catalyst,” he explained. “It's not me doing the research, but it's understanding that this is the direction we need to go and fostering collaborations and providing our great people with the tools they need.”

CAR T cell therapy is revolutionizing the treatment of many leukemia and lymphoma patients. “For our relapsed leukemia and lymphoma patients we found some really impressive responses with these clinical trials,” said Samantha Jaglowski, MD, associate director for clinical operations and quality of the Blood and Marrow Transplant and Cellular Therapy Program. In this episode, Part 1 or a two-part series on the James Cellular Therapy Program, Jaglowski explains the basics of CAR T cell therapy. The white blood cells are removed from a patient and “re-engineered to become super charged fighters,” she said. “They are trained to recognize and respond [to cancer cells] and if these cancer cells pop up again these cells are already primed to recognize and fight it.” Now that CAR T cell therapy has been approved by the Food and Drug Administration to treat certain types of leukemia and lymphoma, Jaglowski and her James colleagues are exploring new ways to utilize this treatment option for other types of cancer. “We involved in studies to use cellular therapies for melanomas, cervical cancer, lung cancer … and we expect FDA approval; for treating melanoma [with CAR T cell therapy] in 2024.” She also discusses how the James is now re-engineering cells “in house,” which speeds up the treatment process; and new clinical trials to utilize donor cells in CAR T cell treatment. “The advantage is these cells have never been exposed to cancer and can be off-the-shelf and ready immediately.” The James will also begin treating some patients with CAR T cell on an outpatient basis. While the growth of CAR T cell therapy is a game changer, “we can never be satisfied,” Dr. Jaglowski said.

The team approach has helped Joel Mayerson, MD, build one of the nation's largest and best sarcoma cancer programs. Treating sarcoma patients “is a team sport,” said the director of the James Sarcoma Program. “And we use tri-modality care – medical oncologists for chemotherapy, radiation oncologists for soft-tissue sarcomas … and surgeons.” Mayerson has been at the James since 2001 and, under his leadership, the sarcoma team has grown significantly. The tri-modality model of patient care is the starting point for the sarcoma program. “We're very excited about our [growing] orthopedics plastic surgery program,” Mayerson said, adding plastic surgery is vital in patients in which large, cancerous masses are removed. “Plastic surgeons take muscles from other places [in the patient's body] and fill these spaces and can even return function by reconnecting the nerves,” he said. Mayerson and the James are also pioneers in targeted muscle reinnervation. This microsurgery technique reconnects nerves severed during an amputation so that “now they have something to fire into rather than into empty space,” Mayerson said. “This helps reduce pain and after surgery and also reduces phantom-limb pain.” Another advanced technique for patients requiring an amputation is inserting a metal stem into the “residual limb … so the patient can snap their artificial limb on and off instead of putting it into a socket,” Mayerson said. “Patients say this makes it feel more like their normal leg.” Mayerson has always been passionate about caring for his patients, but, “it became even more personal for me this past January,” he said. His mother was diagnosed with a late-stage soft-tissue sarcoma and passed away a few weeks later. “If it wasn't already personal enough, now it's family.”

Pelotonia is an emotional rollercoaster filled with special moments, connections, community and lots of memories. In this new episode, David Cohn, MD, joins Steve as co-host. Dave is the interim chief executive director of the James, has ridden in every Pelotonia, and has a lot of memories. “It's truly an emotional experience and I'm not hesitant to say I've cried at every Pelotonia at some point,” he said. We'll also hear from five other James physicians who participate in Pelotonia. Tim Pawlik came to Ohio State and the James a few weeks before a Pelotonia ride, and “I was blown away … the number of people riding and the number of people supporting the ride and the number of people along the side of the road.” Eric Singer is brand new at the James, recruited from a cancer hospital in New Jersey. However, the urologist knew about Pelotonia from one of his patients, a New Jersey man who rode ever year in Pelotonia. Joel Mayerson, an orthopedic oncologist, said his favorite memories are riding with patients. “It's an amazing feeling,” he said. Samantha Jaglowski was treated for a brain tumor and has some related physical issues that prevent her from riding. Instead, over the years, she has been a volunteer and a Challenger, raising money for Pelotonia. Mary Dillhoff has a rather unique way to cover the Pelotonia course: she runs. As much as 72 miles.

“We're taking a very patient-centered approach, we're putting the patient at the center of everything we do,” said David Cohn, MD, of the new James Outpatient Cancer Center that opened July 17. In this episode, Cohn, a gynecologic cancer surgeon and interim chief executive of the James Cancer Hospital, provides a detailed look at the new James Outpatient Cancer Center located on west campus in the new Carmenton District. The district also includes the Pelotonia Research Center and Energy Advancement and Innovation Center. The Outpatient Cancer Center will provide a long list of ambulatory (outpatient) treatments, including: clinical trials, screenings, digital pathology, infusions and cancer surgeries that do not require an overnight stay. “There are three goals: to create innovation, allow space for new programs and all for the expansion of our cancer program,” Cohn said. “The demand for cancer services is beyond what we've ever seen before, and we have to expand our footprint to accommodate the growing number of patients who need to be seen.” The Outpatient Cancer Center will focus on cancers that affect bone and soft tissue, blood, kidney, bladder and prostate, which are all cancers in which the treatment options have advanced to the point that outpatient care is now an option. The center will also be the location of the new proton radiation therapy facility created in partnership with Nationwide Children's Hospital. “This is really exciting, this is the next generation of cancer care,” Cohn said. “I couldn't be more proud of what will happen on July 17.”

“It's been a labor of love to get this project off the ground,” says Kristin Bixel, MD, of a new James clinical trial for a minimally invasive surgical technique for cervical cancer that she is leading. Minimally invasive surgery (also called robotic surgery) is being performed on a growing number of different types of cancer. These less invasive surgeries reduce complications and speed up the recovery process for patients. However, the first minimally invasive procedure and clinical trial for cervical cancer resulted in an increased rate of recurrence for patients – and was immediately abandoned. This spurred Bixel to think outside the box and develop a new, different technique in which the cancerous tumor in the cervix wasn't exposed to the peritoneal cavity. “My mind immediately went to the procedure itself,” Bixel said, adding she could picture the new surgical technique in her mind, as if looking through a scope, and began the long process of creating a clinical trial. The clinical trial began in February 2022 at the James, and several other leading cancer hospitals around the country have joined the trial. “If we can make this procedure safe for our patients that will be huge,” Bixel said. “One hundred percent of our patients want this type of small-incision surgery.”

The James Cancer Hospital is the first medical facility in central Ohio to offer radiofrequency ablation to treat and destroy benign and cancerous thyroid nodules. In this episode, Barbra Miller, MD, describes this high-tech, minimally invasive treatment technique and the advantages for patients. “It can be done in the office and most patients are in and out of the clinic within 30 minutes to an hour after the procedure,” she explained. Here's how radiofrequency ablation works: The surgeon insets a very small needle into the nodule; radiofrequency waves are used to heat the tip of the needle, and this ablates (destroys) the tissue in the nodule. “We use the moving-shot technique,” Miller said, adding this technique involves moving the end of the needle to different locations with the nodule to destroy it completely. Miller also describes microwave ablation, which is similar but uses microwaves to heat the end of the needle. This technique is in the early stages but could eventually be utilized as much or even more than radiofrequency ablation. “It's exciting to have this ability to offer our patients, something better and safer and that's always what we look to accomplish,” Miller said.