Podcasts about md anderson cancer center

  • 247PODCASTS
  • 528EPISODES
  • 28mAVG DURATION
  • 5WEEKLY NEW EPISODES
  • Nov 5, 2022LATEST

POPULARITY

20152016201720182019202020212022


Best podcasts about md anderson cancer center

Latest podcast episodes about md anderson cancer center

The BoatCast...  this is your TRiBe
Texafied Day 2 - Breakfast with the BoatCast

The BoatCast... this is your TRiBe

Play Episode Listen Later Nov 5, 2022 42:50


Day 2 Texafied JamFest 2022Friday of Texafied was a whirlwind - literally. The Boys of The BoatCast are joined by special guests Jon Tyler Wiley, Ali Novitsky, and Brett Newski to recap highlights of the day. Jon Tyler Wiley joined BoatCast to talk music, Texafied (especially the fantastic job the Connors have done hosting), and just reliving the family of music around here. The BoatCast also gives an important shoutout to Clee and Chris of Simplified who couldn't make it due to health reasons. Ali Novitsky then joins us to give listeners her Texafied experience thus far. Last but not least, Brett Newski joins us just before his Saturday show to kick off Day 2 of Texafied. Unfortunately he will have to leave us to perform a show in Houston if anyone is in that area tonight, check it out because he rocks!!Proceeds go to funding Pediatric Cancer at MD Anderson Cancer Center.Texafied JamFest can be found at:Facebook: http://www.facebook.com/texafiedjamfestInstagram: https://www.instagram.com/texafied_jamfest_/Spotify: https://open.spotify.com/playlist/3HGn5yjsDISISSHbDLtzoa?si=860867debc8146e3Special Thanks to Alice Hsieh Photography for allowing us to use the photo of Leah and Tod for the podcast episode!We atThe BoatCast are proud to be named “Official Podcast of Texafied”. We would also like to thank our sponsor, lifecoachingforwomenphysicians.com, for supporting us in promoting Rock Boat Artists. If you want to get the word out about these artists and are interested in sponsoring The Boatcast, please email Chris at: ChristopherRhoad@gmail.com.

The BoatCast...  this is your TRiBe
Texafied Day 1 - Breakfast with the BoatCast

The BoatCast... this is your TRiBe

Play Episode Listen Later Nov 4, 2022 43:04


The first night of Texafied exceeded all expectations!!! The night kicked off with JD Eicher covering Petty's “Learning To Fly” and ended late into the morning wit a collaboration of The Boss' “I'm on Fire”Texafied JamFest 2022Join Christopher Rhoad and BoatCast Mark for breakfast with impromptu interviews of several artists, including Meaghan Farrell, Green Light Morning, Todd Carey.Proceeds go to funding Pediatric Cancer at MD Anderson Cancer Center.Texafied JamFest can be found at:Facebook: http://www.facebook.com/texafiedjamfestInstagram: https://www.instagram.com/texafied_jamfest_/Spotify: https://open.spotify.com/playlist/3HGn5yjsDISISSHbDLtzoa?si=860867debc8146e3Special Thanks to Alice Hsieh Photography for allowing us to use the photo of Leah and Tod for the podcast episode!We atThe BoatCast are proud to be named “Official Podcast of Texafied”. We would also like to thank our sponsor, lifecoachingforwomenphysicians.com, for supporting us in promoting Rock Boat Artists. If you want to get the word out about these artists and are interested in sponsoring The Boatcast, please email Chris at: ChristopherRhoad@gmail.com.

ASCO Daily News
Novel Therapies Targeting KRAS in Lung Cancer & RAS-altered Tumors

ASCO Daily News

Play Episode Listen Later Nov 3, 2022 28:33


Dr. Vamsi Velcheti and Dr. Benjamin Neel, of the NYU Langone Perlmutter Cancer Center, and Dr. John Heymach, of MD Anderson Cancer Center, discuss new therapeutic approaches for KRAS-mutant lung cancers and therapy options for RAS-altered tumors.   TRANSCRIPT Dr. Vamsidhar Velcheti: Hello, I'm Dr. Vamsidhar Velcheti, your guest host for the ASCO Daily News podcast today. I'm the medical director of the Thoracic Oncology Program at Perlmutter Cancer Center at NYU Langone Health. I'm delighted to welcome two internationally renowned physician-scientists, Dr. John Heymach, the chair of Thoracic-Head & Neck Medical Oncology at the MD Anderson Cancer Center, and my colleague, Dr. Benjamin Neel, the director of the Perlmutter Cancer Center at NYU Langone Health, and professor of Medicine at NYU Grossman School of Medicine. So, we'll be discussing new therapeutic approaches today for KRAS-mutant lung cancers, and we will talk about emerging new targeted therapy options for RAS-altered tumors. Our full disclosures are available in the show notes, and the disclosures of all the guests of the podcast can be found on our transcript at: asco.org/podcast. Dr. Heymach and Dr. Neel, it's such a great pleasure to have you here for the podcast today. Dr. John Heymach: My pleasure to be here. Dr. Benjamin Neel: Same here. Dr. Vamsidhar Velcheti: Dr. Neel, let's start off with you. As you know, RAS oncogenes were first discovered nearly four decades ago. Why is RAS such a challenging therapeutic target? Why has it taken so long to develop therapeutic options for these patients? Dr. Benjamin Neel: Well, I think a good analogy is the difference between kinase inhibitors and RAS inhibitors. So, kinase inhibitors basically took advantage of an ATP-binding pocket that's present in all kinases, but is different from kinase to kinase, and can be accessed by small molecule inhibitors. So, the standard approach that one would've thought of taking, would be to go after the GTP-binding pocket. The only problem is that the affinity for binding GTP by KRAS is three to four orders of magnitude higher. So, actually getting inhibitors that are GTP-binding inhibitors is pretty much very difficult. And then, until recently, it was felt that RAS was a very flat molecule and there weren't any surfaces that you could stick a small molecule inhibitor in. So, from a variety of biochemical and medicinal-pharmacological reasons, RAS was thought to be impervious to small molecule development. But as is often the case, a singular and seminal insight from a scientist, Kevan Shokat, really broke the field open, and now there's a whole host of new approaches to trying to drug RAS. Dr. Vamsidhar Velcheti: So, Dr. Neel, can you describe those recent advances in drug design that have enabled these noble new treatments for KRAS-targeted therapies? Dr. Benjamin Neel: So, it starts actually with the recognition that for many years, people were going after the wrong RAS. And by the wrong RAS, the overwhelming majority of the earlier studies on the structure, and for that matter, the function of RAS centered on HRAS or Harvey RAS. We just mutated in some cancers, most prominently, bladder cancer, and head & neck cancer, but not on KRAS, which is the really major player in terms of oncogenes in human cancer. So, first of all, we were studying the wrong RAS. The second thing is that we were sort of thinking that all RAS mutants were the same. And even from the earliest days, back in the late eighties, it was pretty clear that there were different biochemical properties in all different RAS mutants. But this sort of got lost in the cause and in the intervening time, and as a result, people thought all RASes were the same and they were just studying mainly G12V and G12D, which are more difficult to drug. And then, the third and most fundamental insight was the idea of trying to take advantage of a particular mutation in KRAS, which is present in a large fraction of lung cancer patients, which is, KRAS G12C. So, that's a mutation of glycine 12 to cysteine and Kevan's really seminal study was to use a library of covalently adducting drugs, and try to find ways to tether a small molecule in close enough so that it could hit the cysteine. And what was really surprising was when they actually found the earliest hits with this strategy, which was actually based on some early work by Jim Wells at Sunesis in the early part of this century, they found that it was actually occupying the G12C state or the inactive state of RAS. And this actually hearkens back to what I said earlier about all RASes being the same. And in fact, what's been recently re-appreciated is that some RAS mutants, most notably, G12C, although they're impervious to the gap which converts the active form into the inactive form, they still have a certain amount of intrinsic ability to convert from the inactive form. And so, they always cycle into the inactive form at some slow rate, and that allows them to be accessed by these small molecules in the so-called Switch-II Pocket, and that enables them to position a warhead close enough to the cysteine residue to make a covalent adduct and inactivate the protein irreversibly. Scientists at a large number of pharmaceutical companies and also academic labs began to understand how to access various other pockets in RAS, and also even new strategies, taking advantage of presenting molecules to RAS on a chaperone protein. So, there's now a whole host of strategies; you have a sort of an embarrassment of riches from an impoverished environment that we started with prior to 2012. Dr. Vamsidhar Velcheti: Thank you, Dr. Neel. So, Dr. Heymach, lung cancer has been a poster child for personalized therapy, and we've had like a lot of FDA-approved agents for several molecularly-defined subsets of lung cancer. How clinically impactful is a recent approval of Sotoracib for patients with metastatic lung cancer? Dr. John Heymach: Yeah. Well, I don't think it's an exaggeration to say this is the biggest advance for targeted therapies for lung cancer since the initial discovery of EGFR inhibitors. And let me talk about that in a little more detail. You know, the way that lung cancer therapy, like a lot of other cancer therapies, has advanced is by targeting specific driver oncogenes. And as Dr. Neel mentioned before, tyrosine kinases are a large percentage of those oncogenes and we've gotten very good at targeting tyrosine kinases developing inhibitors. They all sort of fit into the same ATP pocket, or at least the vast majority of them now. There are some variations on that idea now like allosteric inhibitors. And so, the field has just got better and better. And so, for lung cancer, the field evolved from EGFR to ALK, to ROS1 RET fusions, MEK, and so forth. What they all have in common is, they're all tyrosine kinases. But the biggest oncogene, and it's about twice as big as EGFR mutation, are KRAS mutations. And as you mentioned, this isn't a tyrosine kinase. We never had an inhibitor. And the first one to show that it's targetable, to have the first drug that does this, is really such an important breakthrough. Because once the big breakthrough and the concept is there, the pharmaceutical companies in the field can be really good at improving and modulating that. And that's exactly what we see. So, from that original insight that led to the design of the first G12C inhibitors, now there's dozens, literally dozens of G12C inhibitors and all these other inhibitors based on similar concepts. So, the first one now to go into the clinic and be FDA-approved is Sotoracib. So, this again, as you've heard, is inhibitor G12C, and it's what we call an irreversible inhibitor. So, it fits into this pocket, and it covalently links with G12C. So, when it's linked, it's linked, it's not coming off. Now, the study that led to its FDA approval was called the CodeBreak 100 study. And this was led in part, by my colleague Ferdinandos Skoulidis, and was published in The New England Journal in the past year. And, you know, there they studied 126 patients, and I'll keep just a brief summary, these were all refractory lung cancer patients. They either had first-line therapy, most had both chemo and immunotherapy. The primary endpoint was objective response rate. And for the study, the objective response rate was 37%, the progression-free survival was 6.8 months, the overall survival was 12.5 months. Now you might say, well, 37%, that's not as good as an EGFR inhibitor or the others. Well, this is a much harder thing to inhibit. And you have to remember in this setting, the standard of care was docetaxel chemotherapy. And docetaxel usually has a response rate of about 10 to 13%, progression-free survival of about 3 months. So, to more than double that with a targeted drug and have a longer PFS really is a major advance. But it's clear, we've got to improve on this and I think combinations are going to be incredibly important now. There's a huge number of combination regimens now in testing. Dr. Vamsidhar Velcheti: Thank you, Dr. Heymach. So, Dr. Neel, just following up on that, unlike other targeted therapies in lung cancer, like EGFR, ALK, ROS, and RET, the G12C inhibitors appear to have somewhat modest, I mean, though, certainly better than docetaxel that Dr. Heymach was just talking about; why is it so hard to have more effective inhibitor of KRAS here? Is it due to the complex nature of RAS-mutant tumors? Or is it our approach for targeting RAS? Is it a drug-related problem, or is it the disease? Dr. Benjamin Neel: Well, the short answer is I think that's a theoretical discussion at this point and there isn't really good data to tell you, but I suspect it's a combination of those things. We'll see with the new RAS(ON) inhibitors, which seem to have deeper responses, even in animal models, if those actually work better in the clinic, then we'll know at least part of it was that we weren't hitting RAS hard enough, at least with the single agents. But I also think that it's highly likely that since KRAS-mutant tumors are enriched in smokers, and smokers have lots of mutations, that they are much more complex tumours, and therefore there's many more ways for them to escape. Dr. Vamsidhar Velcheti: Dr. Heymach, you want to weigh in on that? Dr. John Heymach: Yeah, I think that's right. I guess a couple of different ways to view it is the problem that the current inhibitors are not inhibiting the target well enough, you know, in which case we say we get better and better inhibitors will inhibit it more effectively, or maybe we're inhibiting it, but we're not shutting down all the downstream pathways or the feedback pathways that get turned on in response, in which case the path forward is going to be better combinations. Right now, I think the jury is still out, but I think the data supports that we can do better with better inhibitors, there's room to grow. But it is also going to be really important hitting these compensatory pathways that get turned on. I think it's going to be both, and it seems like KRAS may turn on more compensatory pathways earlier than things like EGFR or ALK2, you know, and I think it's going to be a great scientific question to figure out why that is. Dr. Vamsidhar Velcheti: Right. And just following up on that, Dr. Heymach, so, what do we know so far about primary and acquired resistance to KRAS G12C inhibitors? Dr. John Heymach: Yeah. Well, it's a great question, and we're still very early in understanding this. And here, if we decide to call it primary resistance - meaning you never respond in the first place, and acquired - meaning you respond and then become resistant, we're not sure why some tumors do respond and don't respond initially. Now, it's been known for a long time, tumors differ in what we call their KRAS-dependence. And in cell lines and in mouse models, when you study this in the lab, there are some models where if you block KRAS, those cells will die immediately. They are fully dependent. And there's other ones that become sort of independent and they don't really seem to care if you turn down KRAS, they've sort of moved on to other things they're dependent on. One way this can happen is with undergoing EMT where the cell sort of changes its dependencies. And EMT is probably a reason some of these tumors are resistant, to start with. It may also matter what else is mutated along with KRAS, what we call the co-mutations, the additional mutations that occur along with it. For example, it seems like if this gene KEAP1 is mutated, tumors don't respond as well, to begin with. Now, acquired resistance is something we are gaining some experience with. I can say in the beginning, we all knew there'd be resistance, we were all waiting to see it, and what we were really hoping for was the case like with first-generation inhibitors with EGFR, where there was one dominant mechanism. In the first-generation EGFR, we had one mutation; T790M, that was more than half the resistance. And then we could develop drugs for that. But unfortunately, that's not the case. It looks like the resistance mechanisms are very diverse, and lots of different pathways can get turned on. So, for acquired resistance, you can have additional KRAS mutations, like you can have a KRAS G12D or V, or some other allele, or G13, I didn't even realize were commonly mutated, like H95 or Y96 can get mutated as well. So, we might be able to inhibit with better inhibitors. But the more pressing problem is what we call bypass; when these other pathways get turned on. And for bypass, we know that the tumor can turn on MET with MET amplification, NRAS, BRAF, MAP kinase, and we just see a wide variety. So, it's clear to us there isn't going to be a single easy to target solution like there was for EGFR. This is going to be a long-term problem, and we're going to have to work on a lot of different solutions and get smarter about what we're doing. Dr. Vamsidhar Velcheti: Yeah. Thank you very much, Dr. Heymach. And Dr. Neel, just following up on that, so, what do you think our strategies should be or should look like while targeting KRAS-mutant tumors? Like, do we focus on better ways to inhibit RAS, or do we focus on personalized combination approaches based on various alterations or other biomarkers? Dr. Benjamin Neel: Yeah. Well, I'd like to step back a second and be provocative, and say that we've been doing targeted therapies, so to speak, for a long time, and it's absolutely clear that targeted therapies never cure. And so, I think we should ask the bigger question, "Why is it that targeted therapies never cure?" And I would start to conceive of an answer to that question by asking which therapies do cure. And the therapies that we know do cure are immune therapies, or it's therapies that generate durable immune response against the tumor. And the other therapies that we know that are therapies in some cases against some tumors, and radiation therapy in some cases against some tumors. Probably the only way that those actually converge on the first mechanism I said that cures tumors, which is generating a durable immune response. And so, the only way, in my view, it is to durably cure an evolving disease, like a cancer, is to have an army that can fight an evolving disease. And the only army I know of is the immune system. So, I think ultimately, what we need to do is understand in detail, how all of these different mutations that lead to cancer affect immune response and create targetable lesions in the immune response, and then how the drugs we'd give affect that. So, in the big picture, the 50,000-foot picture, that what we really need to spend more attention on, is understanding how the drugs we give and the mutations that are there in the first place affect immune response against the tumor, and ultimately try to develop strategies that somehow pick up an immune response against the tumor. Now in the short run, I think there's also lots of combination strategies that we can think of, John, you know, alluded to some of them earlier. I mean one way for the G12C inhibitors, getting better occupancy of the drug, and also blocking this so-called phenomenon of adaptive resistance, where you derepress the expression of receptor tyrosine kinases, and their ligands, and therefore bypass through normal RAS or upregulate G12C into the GTP state more, that can be attacked by combining, for example, with the SHIP2 inhibitor or a SOS inhibitor. Again, the issue there will be therapeutic index. Can we achieve that with a reasonable therapeutic index? Also in some cases, like not so much in lung cancer, but in colon cancer, it appears as if a single dominant receptor tyrosine kinase pathway, the EGF receptor pathway, is often the mechanism of adaptive resistance to RAS inhibitors, and so, combining a RAS inhibitor with an EGF receptor inhibitor is a reasonable strategy. And then of course, some of the strategies they're already getting at, what I just mentioned before, which is to try to combine RAS inhibitors with checkpoint inhibitors. I think that's an expected and understandable approach, but I think we need to get a lot more sophisticated about the tumor microenvironment, and how that's affecting the immune response. And it's not just going to be, you know, in most cases combining with a checkpoint inhibitor. I think we ought to stop using the term immunotherapy to refer to checkpoint inhibitors. Checkpoint inhibitors are one type of immunotherapy. We don't refer to antibiotics when we mean penicillin. Dr. Vamsidhar Velcheti: Dr. Heymach, as you know, like, there's a lot of discussion about the role of KRAS G12C inhibitors in the frontline setting. Do you envision these drugs are going to be positioning themselves in the frontline setting as a combination, or like as a single agent? Are there like a subset of patients perhaps where you would consider like a single agent up front? Dr. John Heymach: So, I think there's no question G12C inhibitors are moving to the first-line question. And the question is just how you get there. Now, the simplest and most straightforward approach is to say, “Well, we'll take our standard and one standard might be immunotherapy alone, a PD-1 inhibitor alone, or chemo with the PD-1 inhibitor, and just take the G12C inhibitor and put it right on top.” And that's a classic strategy that's followed. That may not be that simple. It's not obvious that these drugs will always work well together or will be tolerated together. So, I think that's still being worked out. Now, an alternative strategy is you could say, “Well, let's get a foot in a door in the first-line setting by finding where chemotherapy and immunotherapy don't work well, and pick that little subgroup.” There are some studies there using STK11-mutant tumors, and they don't respond well to immunotherapy and chemotherapy and say, “Well, let's pick that first.” And that's another strategy, but that's not to get it for everybody in the first-line setting. That's just to pick a little subgroup. Or we may develop KRAS G12C inhibitor combinations by themselves that are so effective they can beat the standard. So, what I think is going to happen is a couple things; I think they'll first be some little niches where it gets in there first. I think eventually, we'll figure out how to combine them with chemotherapy and immunotherapy so it goes on top. And then I think over time, we'll eventually develop just more effective, targeted combos where we can phase out the chemo, where the chemo goes to the back of the line, and this goes to the front of the line. Dr. Vamsidhar Velcheti: And Dr. Heymach, any thoughts on the perioperative setting and the adjuvant/neoadjuvant setting, do you think there's any role for these inhibitors in the future? Dr. John Heymach: Yeah, this is a really exciting space right now. And so that makes this a really challenging question because of how quickly things are moving. I'll just briefly recap for everybody. Until recently, adjuvant therapy was just chemotherapy after you resected a lung cancer. That was it. And it provided about a 5% benefit in terms of five-year disease-free survival. Well, then we had adjuvant immunotherapy, like atezolizumab, approved, then we had neoadjuvant chemo plus immunotherapy approved; that's a CheckMate 816. And just recently, the AEGEAN study, which I'm involved with, was announced to be a positive study. That's neoadjuvant plus adjuvant chemo plus immunotherapy. So now, if you say, well, how are you going to bring a G12C inhibitor in there? Well, you can envision a few different ways; if you can combine with chemo and immunotherapy, you could bring it up front and bring it afterwards, or you could just tack it in on the back, either with immunotherapy or by itself, if you gave neoadjuvant chemo plus immunotherapy first, what we call the CheckMate 816 regimen. So, it could fit in a variety of ways. I'll just say neoadjuvant is more appealing because you can measure the response and see how well it's working, and we in fact have a neoadjuvant study going. But the long-term benefit may really come from keeping the drug going afterwards to suppress microscopic metastatic disease. And that's what I believe is going to happen. I think you're going to need to stay on these drugs for a long while to keep that microscopic disease down. Dr. Vamsidhar Velcheti: Dr. Neel, any thoughts on novel agents in development beyond KRAS G12C inhibitors? Are there any agents or combinations that you'd be excited about? Dr. Benjamin Neel: Well, I think that the YAP/TAZ pathway inhibitors, the TEAD inhibitors in particular, are potentially promising. I mean, it seems as if the MAP kinase pathway and the GAPT pathway act in parallel. There's been multiple phases which suggest that YAP/TAZ reactivation can be a mechanism of sort of state-switching resistance. And so, I think those inhibitors are different than the standard PI3 kinase pathway inhibitor, PI3 kinase mTOR inhibitor, rapamycin. I also think as we've alluded to a couple of times, the jury's still out in the clinic, of course, but it'll be very exciting to see how this new set of RAS inhibitors works. The sort of Pan-RAS inhibitors, especially the ones that hit the GTP ON state. So, the G12C inhibitors and the initial preclinical G12D inhibitors that have been recorded, they all work by targeting the inactive state of RAS, the RAS-GDP state. And so, they can only work on mutants that cycle, at least somewhat, and they also don't seem to be as potent as targeting the GTP or active state of RAS. And so, at least the Rev meds compounds, which basically use cyclophilin, they basically adapt the mechanism that cyclosporine uses to inhibit calcineurin. They basically use the same kind of a strategy and build new drugs then that bind cyclophilin and present the drug in a way that can inhibit multiple forms of RAS. So, it'll be interesting to see if they are much more efficacious in a clinic as they appear to be in the lab, whether they can be tolerated. So, I think those are things to look out for. Dr. Vamsidhar Velcheti: Dr. Heymach? Dr. John Heymach: Yeah, I agree with that. I'm excited to see that set of compounds coming along. One of the interesting observations is that when you inhibit one KRAS allele like G12C, you get these other KRAS alleles commonly popping up. And it's a little -- I just want to pause for a second to comment on this, because this is a little different than EGFR. If you inhibit a classic mutation, you don't get multiple other separate EGFR alleles popping up. You may get a secondary mutation in cyst on the same protein, but you don't get other alleles. So, this is a little different biology, but I think the frequency that we're seeing all these other KRAS alleles pop up tells us, I think we're going to need some pan-KRAS type strategy as a partner for targeting the primary driver. So for example, a G12C inhibitor plus a pan-KRAS strategy to head off these other alleles that can be popping up. So, I think that's going to be probably a minimum building block that you start putting other things around. And by partnering an allele-specific inhibitor where you might be able to inhibit it a little more potently and irreversibly with a pan-KRAS, you may solve some of these problems at the therapeutic window. You can imagine KRAS is so important for so many different cells in your body that if you potently inhibit all KRAS in your body, bad things are likely to happen somewhere. But if you can potently inhibit the mutant allele and then dampen the other KRAS signaling that's popping up, it's more hopeful. Dr. Benjamin Neel: There is a mouse model study from Mariano Barbacid's lab, which suggests that postnatal, KRAS at least, complete inhibition is doable. So, you could take out KRAS postnatally and the mice are okay. Whether that translates to human of course, is not at all clear. And you still have the other RAS alleles, the HRAS, the NRAS that you'd still have to contend with. Dr. John Heymach: Yeah, it's an interesting lesson. We've shied away from a lot of targets we thought weren't feasible. I did a lot of my training with Judah Folkman who pioneered targeting angiogenesis. And I remember hearing this idea of blocking new blood vessels. I said, "Well, everyone is just going to have a heart attack and die." And it turns out you can do it. You have to do it carefully, and in the right way but you can separate malignant or oncogenic signaling from normal signaling in an adult, pretty reasonably in a lot of cases where you don't think you could. Dr. Vamsidhar Velcheti: All right. So, Dr. Neel, and Dr. Heymach, any final closing comments on the field of RAS-targeted therapies, you know, what can we hope for? What can patients hope for, let's say five years from now, what are we looking at? Dr. John Heymach: Well, I'll give my thoughts I guess first, from a clinical perspective, I think we're already seeing the outlines of an absolute explosion in targeting KRAS over the next five years. And I think there's a really good likelihood that this is going to be the major place where we see progress, at least in lung cancer, over these next five years. It's an example of a problem that just seemed insolvable for so long, and here I really want to acknowledge the sustained support for clinical research and laboratory research focused around RAS. You know, the NCI had specific RAS initiatives and we've had big team grants for KRAS, and it shows you it's worth these large-scale efforts because you never know when that breakthrough is going to happen. But sometimes it just takes, you know, opening that door a little bit and everybody can start rushing through. Well, I think for KRAS, the door has been opened and everybody is rushing through at a frantic rate right now. So, it's really exciting, and stay tuned. I think the landscape of RAS-targeting is going to look completely different five years from now. Dr. Benjamin Neel: So, I agree that the landscape will definitely look different five years from now, because it's reflective of stuff that's been in process for the last five years. And it takes about that long to come through. I want to make two comments; one of which is to slightly disagree with my friend, John, about these big initiatives. And I would point out that this RAS breakthrough did not come from a big initiative, it came from one scientist thinking about a problem uniquely in a different way. We need a basic science breakthrough, it almost always comes from a single lab person, thinking about a problem, often in isolation, in his own group. What big initiatives can help with is engineering problems. Once you've opened the door, and you want to know what the best way is to get around the house, then maybe big initiatives help. But I do think that there's been too much focus on the big team initiative and not enough on the individual scientists who often promote the breakthrough. And then in terms of where I see the field going, what I'd really like to see, and I think in some pharmaceutical companies and biotechs, you're seeing this now, and also in academia, but maybe not enough, is that sort of breaking down of the silos between immunotherapy and targeting therapy. Because I agree with what John said, is that targeted therapy, is just sophisticated debulking. If we want to really make progress-- and on the other hand, immunotherapy people don't seem to, you know, often recognize that these oncogenic mutations in the tumor actually affect the immune system. So, I think what we need is a unification of these two semi-disparate areas of therapeutics in a more fulsome haul and that will advance things much quicker. Dr. Vamsidhar Velcheti: Thank you both, Dr. Neel and Dr. Heymach, for sharing all your valuable insights with us today on the ASCO Daily News podcast. We really appreciate it. Thank you so much. Dr. John Heymach: Thanks for asking us. Dr. Benjamin Neel: It's been great having us. Dr. Vamsidhar Velcheti: And thank you all to our listeners, and thanks for joining us today. If you value our insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review and subscribe. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Vamsi Velcheti @VamsiVelcheti Dr. Benjamin Neel @DrBenNeel Dr. John Heymach Want more related content? Listen to our podcast on novel therapies in lung cancer.    Advances in Lung Cancer at ASCO 2022 Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Vamsi Velcheti: Honoraria: Honoraria Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline Dr. Benjamin Neel: None disclosed Dr. John Heymach: None disclosed    

The BoatCast...  this is your TRiBe
"Who are Leah and Tod Conner? (of Texafied)" part II

The BoatCast... this is your TRiBe

Play Episode Listen Later Oct 31, 2022 24:36


November 3rd is almost here!!!Texafied JamFest 2022Rock Boaters Leah and Tod Conner share their excitement about their upcoming music festival, Texafied Jamfest. The event will include around twenty bands. It kicks off with a Thursday meal and subsequent artist collaborations the rest of the evening. On Friday and Saturday, festivities kick off at noon and go well into the night (Simplified goes on stage at 1:30 in the morning!!!). The guys of The BoatCast share their excitement and announceLive Music Interviews Every morning, The BoatCast will be doing several live interviews with artists and are excited to collect audio/video/photos for all of those unable to join in person. Support this amazing cause and get your Texafied JamFest tickets here!!!Proceeds go to funding Pediatric Cancer at MD Anderson Cancer Center.Texafied JamFest can be found at:Facebook: http://www.facebook.com/texafiedjamfestInstagram: https://www.instagram.com/texafied_jamfest_/Spotify: https://open.spotify.com/playlist/3HGn5yjsDISISSHbDLtzoa?si=860867debc8146e3Special Thanks to Alice Hsieh Photography for allowing us to use the photo of Leah and Tod for the podcast episode!We atThe BoatCast are proud to be named “Official Podcast of Texafied”. We would also like to thank our sponsor, lifecoachingforwomenphysicians.com, for supporting us in promoting Rock Boat Artists. If you want to get the word out about these artists and are interested in sponsoring The Boatcast, please email Chris at: ChristopherRhoad@gmail.com.

Health Analytic Insights Podcast
Interview on A Short Primer on Why Cancer Still Sucks!

Health Analytic Insights Podcast

Play Episode Listen Later Oct 30, 2022 26:57


In this episode, I am excited to interview Dr. David Stewart about his book titled: “A Short Primer on Why Cancer Still Sucks”. This book covers several topics, including why cancer is so common, how cancer causes symptoms, different therapies, the future of cancer care, etc. The book also discusses “systems” issues: why it takes too long to develop new drugs, why therapies cost so much, and changes needed to permit much faster, cheaper access to effective new drugs. It also compares the American and Canadian healthcare systems. Dr. Stewart trained in medical oncology in the Department of Developmental Therapeutics at MD Anderson Cancer Center in Houston Texas, 1976-1978. He was on staff at MD Anderson from 1978 to 1980, and then in Ottawa, Ontario, Canada from 1980 to 2003. He moved back to MD Anderson in 2003 but returned again to the University of Ottawa in 2011 as Professor of Medicine and Head of the Division of Medical Oncology. Since completing his term as division head in 2019, he has continued to teach and to practice oncology in Ottawa. Where can I purchase the book? https://whycancerstillsucks.com/ Amazon Books Looking to secure your first role in health informatics? Get the step-by-step guide to help you through the process: eBook: https://hlthanalyticinsights.gumroad.com/l/healthinformatics Sign up to the newsletter and get your FREE guide to starting your career in health informatics here: https://mailchi.mp/e4cd52ccaaf5/health-analytic-insights. Welcome to the Health Analytic Insights Podcast. This podcast is ALL about creating a community of like-minded individuals who are passionate about the field of health informatics. I hope to share information and advice in topics such as health analytics, digital health, biomedical engineering and data visualization in healthcare and in exchange I would love to hear from you DEAR listener about your experience and interest in this field, you can drop me a line at healthanalyticinsights@gmail.com. Sign up to the newsletter and get your FREE guide to starting your career in health informatics here. DISCLAIMER: The views expressed on this podcast are my own and do not reflect those of people, organizations or institutions that I might be associated with in a professional capacity, unless explicitly stated. The views expressed by the guests on this show are their own and may or may not reflect those of people, organizations or institutions that I might be associated with in a professional capacity, unless explicitly stated.

Houston Matters
New partnership targets cancer in women (Oct. 21, 2022)

Houston Matters

Play Episode Listen Later Oct 21, 2022 45:39


  On Friday's show: The University of Texas MD Anderson Cancer Center and the World Health Organization are partnering to fight women's cancer worldwide. MD Anderson's Dr. Welela Tereffe joins us to discuss what the collaboration could mean. Also this hour: From plans to replicate the surfaces of the moon and Mars at Space Center Houston, to the Astros forcing the cancellation of Elton John's final concert in Houston, we discuss The Good, The Bad, and The Ugly of the week. And a chamber opera from renowned composer Philip Glass at the University of Houston combines a fully staged performance featuring instruments and singers with a screening of a 1946 French film version of Beauty and the Beast.

Health Care Rounds
#153: Overcoming the Costly Roadblocks to Developing Novel Cancer Therapies, with Dr. David Stewart

Health Care Rounds

Play Episode Listen Later Oct 21, 2022 27:48


David Stewart, MD; Head, Division of Medical Oncology, University of Ottawa; Author, A Short Primer on Why Cancer Still SucksDr. Stewart received his MD degree from Queen's University, Kingston, followed by training in internal medicine at McGill University and in medical oncology in the Department of Developmental Therapeutics at the UT MD Anderson Cancer Center. He first moved from MD Anderson to the University of Ottawa in 1980, and served as Chief of Medical Oncology at the Ottawa Civic Hospital from 1989 to 1999. He returned to the Department of Thoracic/Head and Neck Medical Oncology at MD Anderson Cancer Center from 2003 to 2011 where he served as Chief of the Section of Experimental Therapeutics (2003-2005), Chair Ad Interim (2005), Deputy Chair (2006-2009), and Director of Translational Research (2009-2011). He was also the Principle Investigator of MD Anderson' phase II N01 contract with the National Cancer Institute, and was the clinical leader of a number of other federally-funded translational research projects. In 2011, Dr. Stewart returned to Ottawa from the University of Texas MD Anderson Cancer Center (Houston, TX) in 2011 to assume the position of Head of the Division of Medical Oncology at The Ottawa Hospital and the University of Ottawa. John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow. About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

SurgOnc Today
The Case of the Missing Clipped Axillary Lymph Node

SurgOnc Today

Play Episode Listen Later Oct 20, 2022 16:55


In this episode of SurgOnc Today®,  Judy Boughey, MD, from the Mayo Clinic in Rochester, MN, and Vice Chair of the SSO Breast Disease Site Work Group, discusses with her colleagues how they manage a missing clipped axillary lymph node. She is joined by Puneet Singh, MD, from MD Anderson Cancer Center and Firas Eladoumikdachi, MD, from Rutgers Cancer Institute of New Jersey. Their discussion is focused on patients with node positive breast cancer who were treated with neoadjuvant chemotherapy.

Project Purple Podcast
Episode 222 - “Why Cancer Still Sucks” With David J. Stewart, MD, FRCPC

Project Purple Podcast

Play Episode Listen Later Oct 7, 2022 58:05


This week, we're joined by David J. Stewart, MD to discuss “Why Cancer Still Sucks” which also happens to be the title of his book. In this episode, Dr. Stewart goes into detail about the things that set cancer research and treatment back despite all of the progress we have made. Dr. Stewart also asserts that although improvement in the treatment of metastatic cancers seems to be slow, we are never more than one or two discoveries away from a major breakthrough. Dr. David Stewart trained in medical oncology in the Department of Developmental Therapeutics at MD Anderson Cancer Center in Houston Texas, 1976-1978. He was on staff at MD Anderson from 1978 to 1980, and then in Ottawa, Ontario, Canada from 1980 to 2003. He moved back to MD Anderson in 2003 but returned again to the University of Ottawa in 2011 as Professor of Medicine and Head of the Division of Medical Oncology. Since completing his term as division head in 2019, he has continued to teach and to practice oncology in Ottawa. His areas of research interest have included (among others) resistance mechanisms to anticancer agents, pharmacology of anticancer agents, new drug development, the negative impact of dysfunctional regulation and clinical trial designs on the rate of clinical research progress, and the huge costs of this clinical research dysfunction in terms of increased health care costs and lives prematurely lost. He has more than 340 peer-reviewed publications. In April 2022 he published a book intended for patients entitled “A Short Primer on Why Cancer Still Sucks”, available through Amazon books or his website https://whycancerstillsucks.com/. This book covers several topics, including why cancer is so common, how cancer causes symptoms, different therapies, the future of cancer care, etc. The book also discusses “systems” issues: why it takes too long to develop new drugs, why therapies cost so much, and changes needed to permit much faster, cheaper access to effective new drugs. It also compares the American and Canadian healthcare systems. To learn more about Project Purple, visit https://www.projectpurple.org/ or follow us on social media at these links: https://www.facebook.com/Run4ProjectPurple https://www.instagram.com/projectpurple/ https://twitter.com/Run4Purple https://www.youtube.com/channel/UCgA8nVhUY6_MLj5z3rnDQZQ

The Visible Voices
Kedar Mate and Ian Sinnett: Medical Malls Design and Refurbished Spaces

The Visible Voices

Play Episode Listen Later Oct 7, 2022 32:23


In 2010  Ellen Dunham Jones gave a TedTalk on retrofitting the suburbs and repurposing malls. In 2021, Kedar Mate et al authored a piece in Harvard Business Review Why Health Care Systems Should Invest in Medical Malls Kedar Mate, MD, is the President and Chief Executive Officer at the Institute for Healthcare Improvement (IHI), President of the Lucian Leape Institute, and a member of the faculty at Weill Cornell Medical College. Dr. Mate's scholarly work has focused on health system design, health care quality, strategies for achieving large-scale change, and approaches to improving value. Previously Dr. Mate worked at Partners In Health, the World Health Organization, Brigham and Women's Hospital, and served as IHI's Chief Innovation and Education Officer.  Dr. Mate has published numerous peer-reviewed articles, book chapters and white papers and has received multiple honors including serving as a Soros Fellow, Fulbright Specialist, Zetema Panelist, and an Aspen Institute Health Innovators Fellow. He graduated from Brown University with a degree in American History and from Harvard Medical School with a medical degree.  You can follow him on twitter at @KedarMate Ian Sinnett, AIA, ACHA, is a Principal and board-certified healthcare architect who co-leads the Dallas Health Practice for Perkins&Will. His expertise is concentrated on the strategic, pre-design, programming, and planning phases of projects furthered by a continued level of intensity and project engagement through completion and first-patient. Ian has worked with a range of for-profit, developer, rural, academic, and not-for-profit clients including MD Anderson Cancer Center, HCA, UT Southwestern, Children's Health, Penn Medicine, Legacy Community Health, and RedBird Dallas. Notable recent projects include critical access hospitals in Uvalde, TX and Pecos, TX, a complete reconfiguration and expansion of the Lancaster General Health ED (15th busiest in the US), and acting as the Principal in Charge of the RedBird Mall Sears Dark Store revitalization with UT Southwestern and Children's Health in Southern Dallas. Outside of his professional life, Ian travels the world with his wife, is a volunteer and advocate for Big Brothers Big Sisters, and is building his dream get-a-away in the high deserts of West Texas.

Lung Cancer Considered
Pathology with Dara Aisner And Ignacio Wistuba

Lung Cancer Considered

Play Episode Listen Later Oct 4, 2022 45:43


The role of the pathologist in lung cancer treatment has dramatically evolved as our understanding of lung cancer biology has advanced. Lung Cancer Considered host Dr. Stephen Liu discusses that evolution with renowned lung cancer pathologists Dr. Dara Aisner from the University of Colorado and Dr. Ignacio Wistuba from MD Anderson Cancer Center. Dr. Wistuba is a Professor in the Department of Thoracic and Head and Neck Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston. He is the Head of the Division of Pathology and Lab Medicine and an expert in translational pathology. Dr. Aisner is an Associate Professor in the Department of Pathology at the University of Colorado in Aurora, CO. She has expertise in Anatomic as well as Molecular Genetic Pathology and is the Medical Director of the Colorado Molecular Correlates Laboratory.

The Oncology Nursing Podcast
Episode 226: Patient Education for Next-Generation Sequencing to Guide Cancer Therapy

The Oncology Nursing Podcast

Play Episode Listen Later Sep 23, 2022 47:01 Very Popular


“Nurses can bridge the information gap and help patients better understand that the information received from next-generation sequencing (NGS) can really help to determine which treatment they will respond best to, if there are therapies that won't be effective, or if there are clinical trials that are open to them based on the results,” Danielle Fournier, RN, MSN, APRN, AGPCNP-BC, AOCNP®, CORLN, advanced practice RN in the department of thoracic surgery at MD Anderson Cancer Center in Houston, TX, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. Fournier discussed the advancements being made in NGS technology and how it can be used to care for patients with cancer. This episode was produced by ONS and sponsored by Foundation Medicine. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes NCPD contact hours are not available for this episode. ONS Next-Generation Sequencing Toolkit, Sample Report, and Discussion Tool ONS Biomarker Database Oncology Nursing Podcast episodes: Episode 169: How Biomarker Testing Drives the Use of Targeted Therapies Episode 172: Address Knowledge Gaps in Evidence-Based Precision Medicine Care Episode 180: Learn How Nurse Practitioners Use Biomarker Testing in Cancer Care ONS Voice articles: Oncology Nurses' Role in Translating Biomarker Testing Results Advocate for Equal Access for Next Generation Sequencing and Clinical Trials Help Patients Understand Genomic Variants of Unknown Significance How DNA Sequencing Technologies Are Used in Cancer Care, Now and in the Future ONS clinical practice resources: Biomarker Testing Quick Guide Biomarker Testing for Genomics Variants: What to Know From the Laboratory Performing the Test Paired Somatic and Germline Testing Resource The Oncology Nurse's Role in Somatic Biomarker Testing Biomarker Testing Nursing Process Understanding Genetic Variants Discussion Tool ONS Genomics Taxonomy ONS Genomics and Precision Oncology Learning Library International Society of Nurses in Genetics Position statement on informed consent National Comprehensive Cancer Network Guidelines National Comprehensive Cancer Network Biomarkers Compendium Information on Sanger sequencing Information on the Genetic Information Nondiscrimination Act Video series: Seq It Out To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “With next-generation sequencing (NGS), multiple biomarkers can be evaluated using one test. So, in cancer care, we're learning that any given tumor may harbor a variety of variants. So, if we're considering using in situ hybridization (ISH) or fluorescence in situ hybridization (FISH) to identify biomarkers, multiple assays may be needed and may need to be performed in order to test for multiple variants.” Timestamp (TS) 10:21 “There are multiple testing strategies that can be used with NGS technology, which is kind of what makes it so versatile. What type of testing is most appropriate really depends on the patient's risk factors, their diagnosis, their cancer stage, what testing has previously been completed, and what tissue is available for analysis.” TS 12:00 “Within oncology care, there is a role for NGS in the identification and management of both solid tumors and hematologic cancers, and this role is likely just going to continue to expand. So, really there's been an increased focus on genomic pharmacotherapy and targeted therapy, and this is playing an ever-greater role in the treatment of cancer. So, NGS will really continue to serve as a means to take a closer look at a patient's cancer at the molecular level and hopefully match patients with treatments that will be most effective at treating their cancer.” TS 20:54 “In reality, there's an expanding role for NGS testing in the diagnosis of many complex diseases. So, I think more than likely what we're going to see is that the indications and utility of NGS is only going to continue to grow in both the oncology setting as well as the non-oncology setting.” TS 23:08 “The oncology nurse really plays a key role in several important steps along the way. The first place they may be involved is in the informed consent process. Many—but not all—hospitals require patients to sign consent for genetic and genomic testing and this is just acknowledging that the patient is making an informed and autonomous decision related to their health care. Nurses may also play a role in the collection of a tissue sample or blood sample. And once testing has been completed, nurses may play a role in discussing the NGS results with patients.” TS 24:03 “Nurses really can help to somewhat bridge this information gap and help patients better understand that the information received from NGS can really help to determine which treatment they will respond best to, if there are therapies that won't be effective, or if there are clinical trials that are open to them based on the results. And these are all really important considerations for cancer treatment.” TS 36:21

Treating Blood Cancers
What's New in the Treatment of BPDCN?

Treating Blood Cancers

Play Episode Listen Later Sep 20, 2022 35:24


Naveen Pemmaraju, MD, The University of Texas MD Anderson Cancer Center, Houston, TX Recorded on September 6, 2022 Join us as Dr. Naveen Pemmaraju from MD Anderson Cancer Center, returns to discuss blastic plasmacytoid dendritic cell neoplasms (BPDCN)! In this episode, Dr. Pemmaraju provides an overview of BPDCN, including major updates in the treatment of the disease since our last episode on this topic in 2019. What is BPDCN? How is it treated? Is it curable? What resources are available for patients living with this rare disease? Join the conversation and learn more today!   This podcast episode is supported by Stemline Therapeutics, Inc.

ASCO Guidelines Podcast Series
Integrative Medicine for Pain Management in Oncology: SIO-ASCO Guideline

ASCO Guidelines Podcast Series

Play Episode Listen Later Sep 19, 2022 18:26


An interview with Dr. Jun Mao from Memorial Sloan Kettering Cancer Center in New York, NY, lead author on "Integrative Medicine for Pain Management in Oncology: SIO-ASCO Guideline." Dr. Mao reviews the recommendations on integrative approaches, such as acupuncture, yoga, reflexology, massage, guided imagery with progressive muscle relaxation, hypnosis, and music therapy for managing pain in patients with cancer, and the evidence behind these recommendations. He also addresses the implications for clinicians and patients as well as outstanding questions about the use of integrative approaches for pain management. Read the full guideline at www.asco.org/survivorship-guidelines.   TRANSCRIPT Brittany Harvey: Hello, and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcast. My name is Brittany Harvey, and today I'm interviewing Dr. Jun Mao from Memorial Sloan Kettering Cancer Center in New York, New York, lead author on ‘Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology and American Society of Clinical Oncology Guideline'. Thank you for being here, Dr. Mao. Dr. Jun Mao: Thank you, Brittany. It's great to be here. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available in line with the publication of the guideline in the Journal of Clinical Oncology. Dr. Mao, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Jun Mao: No, I don't. Brittany Harvey: Great. Then I'd like to get into the content of this guideline. So what is the purpose and scope of this joint SIO-ASCO guideline? Dr. Jun Mao: So Brittany, about one in two cancer patients or survivors experience pain that often are not adequately controlled by conventional medications. So often individuals seek out complementary and alternative medicine, more recently known as integrative medicine, for the relief of pain, but there's a very little synthesized information for oncologists to help guide the patients in choosing evidence-based integrative therapy approach. Therefore, we decided to really do a systematic review and come up with a system of guidelines that can help oncologists and patients make informed decisions about choosing the right type of integrative medicine approaches to manage pain. The Society for Integrative Oncology and the American Society of Clinical Oncology joined forces that really convene a group of panelists, that represent many fields in conventional oncology in support of integrative medicine. And after reviewing over 200 articles from clinical trials to systematic review have come up with very thoughtful recommendations to help patients and physicians to provide the best evidence-based care on how to manage pain for patients with cancer. Brittany Harvey: Excellent. And yes, it's great to have SIO and ASCO join forces on this guideline. So then next, I'd like to review those key evidence-based recommendations of this guideline that you just mentioned. The recommendations are provided in the guideline by pain type. So I'd like to review each category for our listeners, starting with: what is recommended for patients experiencing aromatase inhibitor related joint pain? Dr. Jun Mao: So we recommend acupuncture should be offered to patients experiencing aromatase inhibitors related joint pain in breast cancer. And this is really evidence-based, benefits outweigh the harms. And with intermediate quality of evidence and moderate strength of recommendation. As many of our audience would know, aromatase inhibitors cause very severe types of joint pain that not only affect quality of life and functions, but make many women stop taking these life saving drugs. So the panelists want to recommend this therapy based on large randomized control trial that hope this can be part of a pain management strategy along with exercise and duloxetine so give people the options so that women can not only have better quality of life, but also hopefully they can stay on aromatase inhibitor to prevent the recurrence of breast cancer. And we also found some weak evidence for yoga to improve joint pain related to AIs. However, the evidence is weak, although the benefit outweighs the harm. So clearly, more studies are needed to make yoga as a part of therapies for cancer patients. Brittany Harvey: Understood. And thank you for reviewing the level of evidence behind those two interventions for patients experiencing aromatase inhibitor related joint pain. So following those recommendations, what is recommended for patients experiencing general cancer pain or musculoskeletal pain? Dr. Jun Mao: So in terms of general cancer pain or musculoskeletal pain, there are three therapies that we consider that may be offered to patients experiencing this type of pain: acupuncture, reflexology or acupressure, or massage. So reflexology and acupressure use the same kind of principles like acupuncture, but instead of using needles, by using hands. So that's kind of in between acupuncture and  massage. So these are evidence based recommendations with benefits outweigh harms, and the quality of evidence is intermediate with moderate level of evidence and recommendations. So clearly, for cancer patients or survivors that experience this type of general cancer pain or musculoskeletal pain, I think these approaches may be appropriately integrated along with conventional pharmacotherapy or physical therapy. Brittany Harvey: Definitely. It's great to have options to go along with conventional pharmacologic therapy. So then following those recommendations you just mentioned, what is recommended for patients with chemotherapy-induced peripheral neuropathy? Dr. Jun Mao: So chemotherapy-induced peripheral neuropathy, also known as CIPN, is a very bothersome symptom resulting from certain types of chemotherapy that can be very functional limiting, and resulting in falls and that also can cut the dosage of chemotherapy. So this is a quite bothersome to patients and also can be really challenging in the practice of oncology. So based on the current evidence, we recommend either acupuncture or reflexology or acupressure may be offered to patients who experience CIPM. So, unfortunately, the evidence base here is weaker. So although it's evidence-based, benefits outweigh harms, but the quality of evidence is low. Therefore, the level recommendation is weak. So basically, there are a number of smaller trials that really provide some good signals that this type of therapies can be beneficial. But we really need more large and definitive trials to establish the strength of the evidence Brittany Harvey: Understood. It's important to know in which patient populations we have more evidence and where we still need confirmatory results. So following those recommendations, what is recommended for patients who experience procedural or surgical pain? Dr. Jun Mao: Many surgery procedures or surgery itself can cause acute short-term pain that if not adequately treated, can then become chronic. So in this setting, there is actually a pretty reasonably robust base for hypnosis. So the evidence base really is intermediate with moderate level recommendation. We consider that hypnosis may be offered to patients experiencing procedural pain in cancer treatment or diagnostic workups. However, for other type of therapies like acupuncture or acupressure or music therapy, although there are some smaller trials to show that it could be beneficial, the current evidence base is very low and the strength of recommendation is weak. So clearly, we need more high-quality trials to establish the evidence base for those therapies for surgery or procedure-related pain Brittany Harvey: Understood, and we'll get into some of those outstanding questions or where there's insufficient evidence a little bit later in the episode. So then the last category of recommendations that the panel made: what is recommended for patients who have pain during palliative and hospice care? Dr. Jun Mao: So for patients with advanced cancer near the end of life, there is some good evidence that massage may be offered for patients experiencing pain during palliative and hospice care. So we recommend massage should be used with an intermediate level of evidence and moderate level of recommendation. And I do think the caveat is we still don't know the long-term effects for massage. Therefore, many of the trials, the follow up are reasonably short. But the evidence showing that acupuncture in the population of palliative care hospice patients can produce immediate pain relief as well as to enhance coping. Therefore, we suggest massage may be offered to patients experiencing pain during hospice or palliative care settings. Brittany Harvey: Understood. Well, thank you for reviewing all those recommendations, the level of evidence behind them and the strength of those recommendations. But you've also mentioned that in several areas, there's low evidence or insufficient evidence. So are there interventions that the panel reviewed but found insufficient or inconclusive evidence to make recommendations? Dr. Jun Mao: Brittany, I feel like the field of integrative medicines research is still in its infancy or adolescence. So there's clearly a lot of gaps, particularly in the area of mindfulness-based interventions. There are studies showing outside oncology settings, it can be very helpful for managing pain and pain coping, but that literature in oncology is very, very limited to make any reasonable recommendation. So I think research is needed. Another area is in the area of herbal medicine or supplements. A lot of cancer patients have a lot of interest in using supplements or herbs to manage symptoms, improve their sense of well-being. But the trials unfortunately in this setting are just too sparse and the quality is too poor to make any recommendation. Last but not least, is for children that experience pain. This guideline was sought out to develop recommendations for both adults and children. Unfortunately, the trials in the pediatric populations are just too few and some of the quality are just too poor. Therefore, there's inconclusive evidence in that population to recommend any specific therapy to be used to manage pain. So I do think these represent really important gaps in research that we really need to be developing and designing and conducting rigorous clinical trials to build an evidence base so we can bring integrative medicine into conventional oncology care to help patients with a variety of truths. Brittany Harvey: Yes, well, we certainly appreciate the panel reviewing this mountain of evidence across several different integrative oncology approaches, even if we ended up not making recommendations for certain interventions because of inconclusive or insufficient evidence because it still demonstrates the need for high-quality trials in those areas. In your view, Dr. Mao, what is the importance of this guideline? And how will it change clinical practice? Dr. Jun Mao: Brittany, I think this guideline is both important and timely. With the opiate epidemic experienced in the United States, managing pain for cancer patients and survivors is incredibly challenging. This is the first SIO and ASCO joint guideline for integrative medicine for pain. And for the first time, we have solid recommendations for specific integrative medicine modalities to care for patients and survivors with pain. I do think the implementation process will take time. First of all, we need to find ways to educate oncology providers as well as patients about the evidence base of this treatment so they can talk to their patients about this type of therapies. Second of all, some of the therapies are not uniformly covered by insurance. So we do need better insurance coverage for integrative therapies such as acupuncture, massage, or reflexology for managed pain for cancer patients. So people from across socioeconomic areas can access it. I think last but not least, as we know, there are disparities in healthcare infrastructures. In large hospitals like Memorial Sloan Kettering Cancer Center, Dana-Farber, or MD Anderson Cancer Center, we do have acupuncture services developed to help cancer patients. But then in smaller community hospitals, especially in those who serve predominantly black and brown populations, those services may not be in existence. So we need to partner with our community partners to develop the necessary resources to overcome those structural barriers for these therapies to be incorporated as part of standard oncology care. Brittany Harvey: Definitely. Those are key points on the implementation of this guideline and the availability and accessibility of integrative medicine modalities across different hospitals and patients. So then, this leads into my next question, how will these guideline recommendations impact patients? Dr. Jun Mao: It is my hope this will really help improve patient care, and also patients here in such  conventional oncological treatments,  whether they're chemo therapies or hormonal treatments. I do think patients in general have a lot of preferences for using therapies that are a little bit more natural or therapies are in addition to drugs to manage their pain or symptoms. So these guidelines clearly provided recommendations based on prior research. And I do think as we engage patients in shared decision making, we need to really acknowledge patients' beliefs, preferences, as well as availability of treatments in their care settings. So hopefully we can provide both evidence-based and patient-centered care to manage pain. Brittany Harvey: It's great to have more options beyond conventional treatments to offer patients to help with pain management because it occurs across cancer patients. Finally, Dr. Mao, you've already talked about some interventions where we lacked data such as mindfulness-based interventions, herbal medicines and supplements, and interventions in the pediatric population. But what are the outstanding questions for the use of integrative approaches and managing pain in patients with cancer? Dr. Jun Mao: Brittany, as a researcher, I'm always thinking about the future questions. I do think with clinical trials in the last 10 years, there's definitely larger and well done trials to demonstrate both efficacy and effectiveness of specific integrative medicine therapies for improving pain. We need to do more of that in the next 10, 20 years. In addition, I think two particular areas of research I hope to see more research as part of these guidelines being implemented, one is what I consider precision pain management. But just because acupuncture works for some patients, it doesn't work for everyone. We need to figure out what type of molecular biomarkers, so psychological attributes can help to predict who may respond to acupuncture or not so we can make sure the right person gets the right care for best pain management and at the least amount of cost to him or herself or to the society. The second issue I really think we've got to do better is I feel like there's wide acknowledgement of health disparity in pain management, particularly in cancer patients. I'd love to see more research designed for and in populations of historically underserved populations, so we can really implement this approaches to narrow the health disparity issues in cancer care. Brittany Harvey: Absolutely. Those are key points about providing equitable care for pain management in oncology. So I want to thank you for all of your work on these guidelines, Dr. Mao, and thank you for taking the time to speak with me today. Dr. Jun Mao: Brittany, it's such a pleasure. Thank you so much. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/survivorship-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available on iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Ori Spotlight
Jason Bock – CEO, Cell Therapy Manufacturing Center (CTMC)

Ori Spotlight

Play Episode Listen Later Sep 14, 2022 68:30


In episode 20 of the Ori Spotlight Podcast, Jason C. Foster is joined by Jason Bock, CEO at CTMC (a joint venture between Resilience and MD Anderson Cancer Center) as they discuss bringing advanced therapies to patients at scale. Jason has also recently joined Ori as a member of our SAB - we're honored to have Jason's expertise and insights support us in achieving our mission. Jason Bock has substantial experience in biopharmaceutical development, where he has previously held senior positions at Teva Pharmaceuticals and MD Anderson. He now leads CTMC (Cell Therapy Manufacturing Center) - a joint venture between Resilience and MD Anderson Cancer Center, that was created to better enable innovation from academia and biotech, and accelerate the impact of cell therapy for patients. Together, they both share their insights into the digitalization of CGT manufacturing, how we can overcome challenges within the CGT industry and how we can support the industrialization of novel advanced therapies. Learn more about Jason Bock

The BoatCast...  this is your TRiBe
"Who are Leah and Tod Conner? (of Texafied JamFest)"

The BoatCast... this is your TRiBe

Play Episode Listen Later Sep 10, 2022 59:59


Texafied JamFestOn November 3-5th, 2022 TRB Veterans and music enthusiasts Leah and Tod Conner will be putting on TEXAFIED - a music festival that has been likened to “Rock Boat on Land”. 20 bands.3+ Days of Music Incredible food at Mama's PlaceA “Family” Reunion (with intimate access to meet your next favorite artist). Proceeds go to funding Pediatric Cancer at MD Anderson Cancer Center.Like our very own BoatCast Chris, Tod is a cancer survivor. Dr. Tod Conner pays it forward every day working as a pediatrician, helping children and their families. Proceeds from the sale of Texafied Cookbooks and merch will continue to do that for years to come.SPOILER ALERT!!! This episode features a Boat-O-Bomb from another key individual involved in Texafied. Support this amazing cause and get your Texafied JamFest tickets here!!!Texafied JamFest can be found at:Facebook: http://www.facebook.com/texafiedjamfestInstagram: https://www.instagram.com/texafied_jamfest_/Spotify: https://open.spotify.com/playlist/3HGn5yjsDISISSHbDLtzoa?si=860867debc8146e3Special Thanks to Alice Hsieh Photography for allowing us to use the photo of Leah and Tod for the podcast episode!We atThe BoatCast are proud to be named “Official Podcast of Texafied”. We would also like to thank our sponsor, lifecoachingforwomenphysicians.com, for supporting us in promoting Rock Boat Artists. If you want to get the word out about these artists and are interested in sponsoring The Boatcast, please email Chris at: ChristopherRhoad@gmail.com.

The Doctor's Art
Facing the Rarest of Cancers (with Katie Coleman)

The Doctor's Art

Play Episode Listen Later Sep 6, 2022 48:56 Transcription Available


On New Year's Eve of 2020, at the age of 29, Katie Coleman was diagnosed with metastatic renal oncocytoma, a type of kidney cancer so rare that she is the only known case in the United States and one of only a handful around the world. The sheer uniqueness of her situation resulted in a prolonged course of prognostic and therapeutic uncertainty. Thanks to the work of oncologists at the National Cancer Institute and MD Anderson Cancer Center, Katie is now in remission. Today, she is a patient advocate who passionately supports other patients through their cancer journeys. In this episode, Katie joins us to share her incredible story, her experiences with grief, uncertainty, and hope, and her lessons learned on finding joy and meaning in life.In this episode, you will hear about:Katie's backstory and the events leading up to her diagnosis - 1:50The experience of being diagnosed with one of the rarest cancers in the world - 3:58How Katie's oncologists discussed this unusual diagnosis with her - 10:42The experience of receiving treatment with the goal of prolonging life, rather than curing the disease - 13:06How co-host Dr. Tyler Johnson communicates issues of serious illness with his patients - 15:38How the uncertainty around a terminal cancer prognosis impacts the way patients approach living their lives - 22:21How Katie's changing prognoses have altered her life plans - 28:53The wisdom on living well one gains from facing a life-limiting illness - 34:32Lessons on hope in the face of uncertainty - 39:55The various ways clinicians can open up and connect with their patients on a human level - 44:14Katie's story has been profiled by the National Cancer Institute, NBC News, and the Today Show.You can follow Katie on Twitter @KayDAustinKatie is also an active content creator and patient advocate on Youtube, TikTok, and Instagram.Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor's Art Podcast 2022

ASTRO Journals
Radiation Therapy for Glioma: An ASTRO Clinical Practice Guideline

ASTRO Journals

Play Episode Listen Later Aug 31, 2022 13:06


Practical Radiation Oncology associate section editor Debra Nana Yeboa, MD, of MD Anderson Cancer Center, hosts a conversation on ASTRO clinical practice guideline on radiation therapy for IDH-Mutant Grade 2 and Grade 3 Diffuse Glioma. Two of the guideline authors, Lia M. Halasz, MD, of University of Washington and Helen A. Shih, MD, MS, MPH, of Massachusetts General Hospital discuss the development process of the guideline and the evidence for the recommendations.

Mindfully Integrative Show
Bonus Episode Mindful CHat With Terry Tucker Motivational ​INSPIRING PEOPLE TO LEAD UNCOMMON AND EXTRAORDINARY LIVES

Mindfully Integrative Show

Play Episode Listen Later Aug 17, 2022 33:01


Terry Tucker  The Motivational Check I have reinvented myself frequently over my professional career. After I graduated from college at The Citadel (where I played NCAA Division I basketball), I was employed in the Marketing Department at the corporate headquarters of Wendy's International in Dublin, Ohio. From there, I worked in hospital administration for Riverside Methodist Hospital in Columbus, Ohio. After getting married and moving to California, I became the Customer Service Manager for an academic publishing company in Santa Barbara. When our daughter was born and we moved to Cincinnati, Ohio, I became a police officer with the Cincinnati Police Department, where I was a SWAT Hostage Negotiator. In 2004, I obtained my Masters's degree from Boston University. Following a family relocation to Texas, I started a school security consulting business and coached high school girls basketball. Each time I took on a new job, I had to develop new skills and faced different challenges.  But my greatest challenge began in 2012 when I was diagnosed with a rare form of cancer called Acral Lentiginous Melanoma, which presented on the bottom of my foot. By the time the cancer was detected, it had metastasized to a lymph node in my groin. Because my disease is extremely rare I was treated at the world-renowned MD Anderson Cancer Center. I had two surgeries to remove the tumors, and after I healed, I was put on a weekly injection of the drug, Interferon, to help keep the disease from returning.  I took those weekly injections for almost five years before the Interferon became so toxic to my body that I ended up in the Intensive Care Unit with a body temperature of 108 degrees. Fortunately, expert medical care saved my life. The Interferon gave me severe flu-like symptoms for two to three days after each injection. I lost fifty pounds during my therapy, was constantly nauseous, fatigued, and chilled, my ability to taste food significantly diminished, and my body constantly ached. This misery went on for over 1,660 days! One thing I learned during all my pain and discomfort is that you have two choices. You can succumb to the debilitating distress and misery, or you can learn to embrace it and use it to make you a stronger and better human being. I chose the latter. Make no mistake, there were times I felt so poorly and was in so much agony that I prayed to die. Each day was a struggle to use my mind to override my body's apathy and distress. I realize pain and discomfort can beat you to your knees and keep you there if you let it. But I also came to appreciate that I could use my hurting and anguish to make me stronger and more resolute. I was no better at dealing with pain and discomfort than the next person. But every day, I found a way to survive, with the knowledge that I would need to do it again the following morning. I wrote my book, Sustainable Excellence, Ten Principles to Leading Your Uncommon and Extraordinary Life to help people find and live their uncommon and extraordinary purpose. The ten principles outlined in the book will provide the bedrock necessary to form the foundation of unshakable beliefs and dedicated behaviors to reinforce your attitude, no matter how much pain you must endure or how many obstacles you must overcome. Sustainable Excellence is available on Amazon (https://www.amazon.com/dp/B08GLGVTVS), Barnes & Noble.com, (https://www.barnesandnoble.com/w/sustainable-excellence-terry-tucker/1137534840), or anywhere you can get a book online. ​ Support the show

Freshstart Podcast with Author D.L. Henning
Terry Tucker, Cancer Survivor,Author of Sustainable Excellence Is Back

Freshstart Podcast with Author D.L. Henning

Play Episode Listen Later Jul 13, 2022 39:25


Terry is the author of Sustainable Excellence, Ten Principles to Leading Your Uncommon and Extraordinary Life to help people find and live their uncommon and extraordinary life. Join the community: SustainableExcellenceMembership.com Watch on YouTube “What are your 4 Truths and how did you come up with them?” 1. Control your mind or your mind is going to control you. 2. Embrace the pain and difficulty that we all experience in life and use that pain and difficulty to make us stronger and more resilient individuals 3. What you leave behind is what you weave into the hearts of other people. 4. As long as you don't quit, you can never be defeated. The three F's of Terry Tucker's life: Faith, Family and Friends He has reinvented himself frequently over his professional career. "After I graduated from college at The Citadel, where I played NCAA Division One basketball against Michael Jordan and James Worthy at University of North Carolina in 1982, the year they won the championship, and played against Jim Valvano, coach of 1983 N.C. State National Champions. Right out of college, I was employed in the Marketing Department at the corporate headquarters of Wendy's International in Dublin, Ohio. From there, I worked in hospital administration for Riverside Methodist Hospital in Columbus, Ohio. After getting married and moving to California, I became the Customer Service Manager for an academic publishing company in Santa Barbara. We then moved to Cincinnati, Ohio, I became a police officer with the Cincinnati Police Department, where I was a SWAT Hostage Negotiator. Following a family relocation to Texas, I started a school security consulting business and coached high school girls basketball in Houston. "But my greatest challenge began in early 2012 when I was diagnosed with a rare form of cancer called Acral Lentiginous Melanoma, which presented on the bottom of my foot. By the time the melanoma was detected, it had metastasized to a lymph node in my groin. I was treated at the world-renowned MD Anderson Cancer Center. After two surgeries to remove the tumors, I was put on a weekly injection of the drug, Interferon, to help keep the disease from coming back. "I took those weekly injections for four years and seven months before the Interferon became so toxic to my body that I ended up in the Intensive Care Unit with a fever of 108 degrees. "The Interferon gave me severe flu-like symptoms for two to three days after each injection. I lost fifty pounds during my therapy, was constantly nauseous, fatigued, and chilled, my ability to taste food significantly diminished, and my body constantly ached. There were times I felt so poorly and was in so much agony that I prayed to die. Each day was a struggle to use my mind to override my body's apathy and distress.I was no better at dealing with pain and discomfort than the next person. But every day, I found a way to survive. Join the community: SustainableExcellenceMembership.com

The Accelerators Podcast
“LeBron Wasn't Created in a Day”: Inclusion With Julianne Pollard-Larkin

The Accelerators Podcast

Play Episode Listen Later Jun 24, 2022 63:42


Fill your cup with this inspiring episode of The Accelerators Podcast! Dr. Matt Spraker is joined by Dr. Julianne Pollard-Larkin, medical physicist, service chief of the thoracic physics group at MD Anderson Cancer Center, and chair of the EDI Committee of the AAPM. We discuss topics and strategies for creating an inclusive workplace for all of #RadOnc, especially now when we need it the most. We begin with a discussion of how to be a great leader and it starts self-care. Star athletes don't do it alone, get yourself a coach! The discussion then moves to our personal experiences with COVID, the importance of leading with a physical presence, and how MD Anderson Radiation Oncology is screening for burnout. We close with a more traditional discussion of DEI and Julie's important work with AAPM creating affinity groups.Some other things mentioned in the show:Black Men in White Coats Dr. Kamran et al. analysis of diversity of US medical academic faculty over time and associated tweetorial

ASCO eLearning Weekly Podcasts
Advanced Practice Providers - APPs 101: What and Who Are Advanced Practice Providers (APPs)?

ASCO eLearning Weekly Podcasts

Play Episode Listen Later Jun 21, 2022 37:14


Partners in cancer care – who are advanced practice providers? In the first episode of ASCO Education's podcast series on Advanced Practice Providers (APPs), co-hosts Todd Pickard (MD Anderson Cancer Center) and Dr. Stephanie Williams (Northwestern University Feinberg School of Medicine), along with guest speaker, Wendy Vogel (Harborside/APSHO), discuss who advanced practice providers are, share an overview of what they do, and why they are important to oncology care teams. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org   TRANSCRIPT Todd Pickard: Hello everyone, and welcome to the ASCO Education Podcast, episode number one of the 'Advanced Practice Providers' series, 'APPs 101: What and Who Are Advanced Practice Providers?' I'd like to introduce my co-host for this series, Dr. Stephanie Williams. My name is Todd Pickard. I'm an advanced practice provider, I'm a PA, and I work at MD Anderson Cancer Center in Houston, Texas. I'm also the Executive Director of Advanced Practice and my clinical practice is in urology. Dr. Williams, how about you introduce yourself? Dr. Stephanie Williams: Thanks, Todd, and thanks for this opportunity to present this incredibly important topic. I am currently retired from clinical practice. I had been in practice for over 35 years both in an academic setting, a private practice, and more recently in a large institutional, multi-specialty institutional type of practice. My primary clinical care has been in stem cell transplants and cellular therapy. And we have used APPs, both PAs and NPs for a couple of decades in our particular area. Todd Pickard: Great, thanks for that. I'd also like to introduce you to our guest panelist today, Wendy Vogel from Harborside, who is a certified oncology nurse practitioner with over 20 years of clinical experience and expertise. We're excited to be chatting with Wendy today about the basics of advanced practice providers and who they are. This will be an introduction for the rest of the upcoming episodes of APP Podcasts. Wendy, why don't you tell us a little bit about yourself and your practice. Wendy Vogel: Thanks, Todd. It is a pleasure to be here. I appreciate you asking me to talk. I am an oncology nurse practitioner as you said. I do a high-risk cancer clinic and do that a couple of days a month. And I am also the executive director of APSHO, the Advanced Practitioner Society for Hematology and Oncology. Todd Pickard: Great! We're looking forward to a robust and informative discussion today between the three of us. So, I'd like to get started with some basics. Wendy, do you want to always start with a definition of advanced practice registered nurse? Wendy Vogel: Okay, great question! So, APRNs or advanced practice registered nurse include nurse practitioners. It can include clinical nurse specialists, nurse anesthetists, and nurse midwives. And generally, APRNs hold at least a master's degree in addition to some initial nursing education as a registered nurse. Some APRNs have doctorates like the DNP or Doctorate of Nursing Practice. But licensure for APRNs generally falls under the State Board of Nursing.   So, we're also required to have a board certification, usually as some sort of generalist as in family medicine, pediatrics, geriatrics, women or acute care. But in oncology, many APRNs also carry oncology certification. Todd Pickard: Excellent! Thanks for that. I'll go ahead and add to the conversation by defining physician assistant. So, physician assistants are individuals who are trained in the medical model and are licensed to practice medicine in team-based settings with physicians. Very much like advanced practice registered nurses, we come from a variety of backgrounds, and our education model is really focused on thinking about the patient the same way that our physician colleagues do. We're trained in really taking a very broad look at patient care, and our education as a generalist model. PAs are certified by the National Commission on Certification of Physician Assistants, which is one national certification that includes all of the content areas in which we will practice. Dr. Stephanie Williams: For those out there who don't know, what are the differences between a physician assistant and an APRN? Or are there differences in practical terms, in terms of how we practice our field? Wendy Vogel: That is a great question, Stephanie, thanks for asking that. We function very much the same. The main difference is just in our educational background, where nurse practitioners come from a nursing background and the nursing model of care, and I'll let Todd speak to where PAs come from, but basically, our functions are very much the same. Todd Pickard: I very much agree. If you are in a clinical setting, and for some reason, Wendy or myself failed to identify who we are, you wouldn't really detect a distinction between the care either of us provide, because we are there in that provider setting and we're really there to assess the conditions you have like appropriate history in physical examination, think through differential diagnosis or a workup, create a diagnosis and then a therapeutic plan and also to educate you as the patient or to make an appropriate referral. So, really, when APPs, PAs, and NPs work side by side, there's really not a lot of difference in what people detect in what we're doing and how we're doing things. But there are some educational differences, which are pretty minimal. So, for example, one small difference is that PAs include surgical assisting as part of our core fundamental training, and our APRN colleagues generally don't. So, in my institution, we do have nurse practitioners that go to the OR and do assisting, but in order to get there, they did a Registered Nursing First Assist Program, it's a certification. So, they learn those fundamentals of sterile technique and surgical technique. So, in essence, there's really not a whole lot of difference. Dr. Stephanie Williams: I think what I was struck with about the difference was the history and the fact that PAs came out of the Mobile Army Surgical Hospitals. To me, that was just fascinating. I think Duke was the first graduating class. Wendy Vogel: You know, the role of the APRN has really changed drastically. It began in the 1960s, because there were not enough primary care providers, particularly for children in the urban and rural areas of the US, and the first nurse practitioner program was in 1965, at the University of Colorado. So, gosh! Have we come a long way since then, both the PA role or the NP role. When was the first PA role, Todd, when was that? Todd Pickard: We were born at the same time in 1965, we just happened to be at Duke University and y'all were in Colorado. You know, I think that the most important thing about working with advanced practice providers is that you look to work with somebody who has the competencies, the skills, interpersonal communication, and the pertinent experiences because honestly, I know fantastic APRNs, I know fantastic PAs, and I know some of either profession that really just don't quite fit a particular role. And so, there is some kind of mythology around PAs and APRNs, and who should work where, like PAs should be more procedural and more in surgery, and nurse practitioners should be more in medicine in the hospital. And really, there's nothing in our training that defines that per se, I think it's just a natural progression of we're over 50 now, so our professions are middle-aged. And we're starting to really have our feet underneath us. And I think people who've worked with PAs or NPs really understand, it's about the individuals and what they bring to the table. It's not really about the initials behind our names, because honestly, that's not what makes me do good work. It's not that I have the PA or NP behind my name. It's my commitment and dedication to my patients and supporting the rest of my team. Wendy Vogel: I think Stephanie, that's why we use the term advanced practitioner, advanced practitioner provider because it doesn't single out either one of us because we are functioning in the same manner. It's easier to say than say, PAs and NPs, so we just say, APPs. Todd Pickard: Yeah. And it doesn't mean that we don't identify as individual professions, because we do. I mean, I'm a PA, but I am part of a larger group. And part of that larger group is identifying as advanced practice provider because, at my institution, there are over 1000 of us, and we are a community of providers, and that's the way that we sense how we function within the team and within the institution. And so, it's really about that kind of joint interprofessional work. And speaking of work, Wendy, tell us a little bit about what are typical things that advanced practice providers do? Wendy Vogel: It might be easier to say what we don't do. I've got a list. Do you want to hear my list? Todd Pickard: Yeah, lay it on us. Wendy Vogel: Okay, here you go. Staff and peer education, survivorship care, palliative care, hospice care, pain management, acute care clinics, case management, research, cancer patient navigator, genetic services, lung nodule clinics, quality improvement. We're writers, we're authors, we're speakers, we mentor, and we do all kinds of public education. We can have clinical roles with faculty and professional organizations. We do procedures like bone marrows, paracentesis and suturing, and all that kind of stuff. We do a lot with all the other things like diagnosing, all the things you said earlier, diagnosing, ordering lab tests, ordering chemotherapy, etc. Todd Pickard: I think what's amazing about advanced practice providers is the flexibility we have to fill in gaps on teams or in service lines, no matter what that is. You know, I like to say and I'm sure everybody thinks that they originated this, but I feel that advanced practice providers are the stem cells of the team because we differentiate into whatever is necessary. At my institution, we recently had a gap in how our peer-to-peers were handled. Many times, you order an MRI or a PET scan, and the payer will, the day of or the day before, say, ‘Oh, I need to talk to somebody.' How that gets to the clinical team and when the clinical team has time to do that, it's really hard to coordinate. So, we created a team of advanced practice providers who spend one day a week doing the regular clinical roles, but then the rest of the time, they are dedicated to facilitating these peer-to-peer conversations. They have over a 95% success rate. And the payers, the medical directors, have actually gotten to know them. And so, they'll say, ‘Hey, I want to talk to so and so because she's fantastic and knows our program, and it's really easy to have these conversations.' And so, patients are taken care of and these business needs are taken care of, and then our clinical teams can really focus on what they're there for, which is to see those patients in and out every day. So, that's the power of advanced practice, its flexibility, filling in gaps; we can bend and morph to whatever we need to do because one of the things that's in our DNA is part of PA and advanced practice RN, we're here to serve, we're problem solvers or doers, too. When we see something, we pick it up and take care of it. That's just in our nature. Stephanie, tell us a little bit about your experience working with an advanced practice provider, is what Wendy and I are saying ringing true, or what's your experience? Dr. Stephanie Williams: Oh, absolutely! As I look back on my career, I'm not certain that I could have accomplished much of what I did, without my team members and advanced practice providers, both PAs and NPs. We also use them in an inpatient setting. And I can't remember Wendy mentioned that to take care of our stem cell transplant patients, because of residency, our requirements were removed from our services, and they became the go-to's to taking care of the patients. It actually improved the continuity of care that the patients received because they would see the same person throughout their 4 to 6-week course in the hospital, they also helped run our graft versus host clinics. I hate that term physician extender because they're really part of our health care team. We are all healthcare professionals working together, as Todd beautifully mentioned, for a common goal to help that patient who's right there in front of us. And not only that, from a kind of selfish viewpoint, they help with a lot of the work, doing the notes, so that we could all split up the work and all get out on time and all have at least some work-life balance. And I think that's a very important part of any team is that we can each find our own work-life balance within the team. So, I feel that they're a very important part of the oncology healthcare team. And I would recommend that everyone who wants to take care of patients, incorporate them into their team. Wendy Vogel: Can I say something right here that you mentioned that I'm so glad you did, which was physician extender. That is a dirty, dirty word in the AP world now because we don't know what part we're extending, that is not what we do. And also, we don't want to be called mid-level providers because – you can't see but I'm pointing from my chest to my belly - I don't treat just the mid-level, nor do I treat in mid-level care. I give superior care. I just give different care. And I give care on a team. And the last one is a non-physician provider. That is also a no-no because I wouldn't describe a teacher as a non-fireman, nor would I describe you, Stephanie, as a non-nurse practitioner. So, I don't want to be a non-physician provider either. Todd Pickard: It is an interesting phenomenon that even after 50 years, so many different places, whether it's the Joint Commission, or the Centers for Medicaid and Medicare Services, whether it's a state legislator, an individual state, an individual institution like Memorial Sloan Kettering or an MD Anderson or a Moffitt, everybody comes up with these different terms. And it's so interesting to me. Physicians are either physicians, doctor, sometimes they're called providers. But as a PA, who's an advanced practice provider, those are the two things that resonate with me: either call me PA or call me advanced practice provider. All these other names seem to just be, it's an alphabet soup, and it really doesn't carry any meaning because some places just come up with these strange terms. And I agree, physician extenders has been the one that always has amused me the most because it reminds me of hamburger helper. Am I some noodles that you add to the main meal so that you can extend that meal out and serve more people? I think what Wendy and I are really trying to get at, I know this has been with a little bit tongue in cheek, but we are part of the team. We work with physicians in a collaborative team-based setting, just like we all work with social workers and schedulers and business people and pharmacists and physical therapists. I think the main message here is that oncology care and taking care of patients with cancer is a team effort because it is a ginormous lift. It's a ginormous responsibility and our patients deserve a full team that works collaboratively and works well and has them in our focus like a laser, and I know that's what APPs do. Dr. Stephanie Williams: I think that's well said, Todd. What I enjoyed in the clinic in particular, was sitting down and discussing patient issues and problems with my APPs. And we worked together to try to figure out how to resolve issues that would come up. But we also learned from each other, you're never too old to learn something from people. I just felt the interaction, the interpersonal interaction was also very satisfying as well. Wendy Vogel: I think that the job satisfaction that comes from being a team player and working together is so much higher and that we're going to experience so much less burnout when we're working together each to the fullest scope of our practice. Todd Pickard: So, Wendy, one of the things that people ask a lot about when they work with advanced practice providers is, ‘Well, gosh! How do I know that they have this training or this experience or this competency?' And then the question arises about certification. So, let's talk a little bit about certification and what that means and what it doesn't mean. So, tell me, are advanced practice providers certified? And are they required to get a variety of certifications throughout their career? Let's talk a little bit about that. Why don't you open up the dialog. Wendy Vogel: Okay, happy to! So, to be able to practice in the United States, I have to have a board certification. And it can vary from state to state, but generally, it has to be either a family nurse practitioner certification, acute care nurse practitioner, geriatrics, women's health, pediatrics, there are about five. So, you are generally certified as one of those. There are a few oncology certifications across the US, board certifications to be able to practice at the state level, but not all states recognize those. So, most of us are educated in a more generalist area, have that certification as a generalist, and then can go on to get an additional certification. So, many nurse practitioners in oncology will also get an advanced oncology nurse practitioner certification. So, that's a little bit different. It's not required to practice. But it does give people a sense that, ‘Hey, she really knows what she's doing in oncology.' Todd Pickard: The PA profession has one national certification, and it is a generalist certification. It's probably similar to USMLE, where you really are thinking about medicine in its entirety. So, whether that be cardiology, orthopedics, family medicine, internal medicine, geriatric, psychiatry, or ophthalmology. I mean it's everything – and oncology is included as well. And that certification really is the entree into getting licensure within the states. It's basically that last examination that you take before you can get that license just to make sure that you have the basic knowledge and fundamentals to practice. And so, I always respond to this kind of question about certification, I say, ‘Well, is it really the experience and the onboarding and the training that one gets on the job and the mentoring and the coaching that one gets from our physician colleagues and other advanced practice providers that brings them the most value? Or is it going through an examination, where basically you're responding to a certain amount of information, and you either pass it or you don't, and you can get a certification? I'm not saying there's not value in that, but I'm also making the argument that if you are working with your APPs well, and they have good mentors, and they have good resources, they're going to be excellent clinicians. And having an additional certification may or may not make some huge difference. Many times I see people use it as a differentiator for privileges or something. It's really an external kind of a pressure or a desire, it doesn't really have anything to do with patient care. I mean, Wendy what has your experience been around that need for additional certification? Wendy Vogel: I've seen it used in practices to merit bonuses, which isn't really fair when a PA does not have that opportunity to have a specialty certification per se. So, I've seen it used negatively. I'm a great believer that any additional education that you can get is beneficial. However, I will say just like you said, if you are getting your mentoring, you have good practice, you're doing continuing education, then it's essentially the same thing. To be able to have an oncology certification, I had to practice for a year and I had to take a test that really measured what I should know after one year. And that's what a certification was for that. Is it beneficial, do I want it? Yeah, I want it. Do I have to have it to practice? No. Todd Pickard: I think that is a great way to segue to having a brief conversation about how you bring APPs in? I mean, just at a very high level, should people expect for an APP to come in right out of school and just hit the ground running without any additional investment? And I could ask the same question about a resident or a fellow who completes an oncology training program. Do you just put those people to work? Maybe that's an older model, and now really mentorship and that additional facilitated work is, I think, critical. So, I'll start with Stephanie, tell us a little bit about what's your experience been with advanced practice providers, or even young physicians as they enter the workforce? What's the role of onboarding or mentoring program? Dr. Stephanie Williams: So, it's important. We had a set process for bringing on our new APPs and it pretty much followed the guidelines from the American Society of Cellular Transplantation in terms of the knowledge base that they would need to know. So, it was a checklist. And we would also have them do modules from ASCO's oncology modules, as well looking at primarily hematologic malignancies, so they could get a background there. And then we would slowly bring them on board. Usually, they would start taking care of autologous patients, a certain subset of patients, and then move on to the more complicated patients. We did the same clinic, whether they were clinic or inpatient APPs. So, it took us about three to four months to onboard our APPs. In terms of a fellow becoming an attending physician, I'd like to say that there's specific onboarding there. Unfortunately, sometimes they're just, ‘Okay, these are your clinic days, this is when you start.' I mean, you're right Todd, we really need to work more on onboarding people. So, that one, they like their jobs, they're not frustrated, and they want to stay and continue to work in this field. I see many times after two or three years, if they're not onboarded properly, they just get frustrated and want to move on to a different area. Wendy Vogel: We know that most of the advanced practitioners who come into oncology don't have an oncology background, PA or NP.  They just don't, and we don't get a lot of that in school. So, it takes months, it would probably, I dare say, take 12 months of full-time practice to feel comfortable in the role. But how many practices particularly in the area that I've practiced in you get this AP, and you throw them in there, and in four weeks, you're supposed to be seeing patients. How can you make those decisions when you haven't been properly mentored? So, absolutely important to have a long onboarding time till that APP feels comfortable. Todd Pickard: Yeah, I think that it is critically important that we set up all of our team members for success, whether they be physicians, or PAs, or nurse practitioners or nurses, or pharmacists, and I think that is the role of onboarding and mentoring, having people who will invest time and energy in what you're trying to accomplish. You know, Wendy is spot on. Advanced practice providers have specific types of training within their educational program. As a PA, my focus in oncology was to screen for and detect it. So, to understand when a patient presents with a mass or some symptoms that may make you think that, oh gosh, maybe they've got acute leukemia or something else and looking at those white counts and, and understanding. But that transition from identifying and screening and diagnosing cancers is very different than how do you care for specific types of tumors and specific disciplines, whether it be radiation oncology, surgical oncology, medical oncology, cancer prevention. There's a lot that folks need to be brought up to speed about the standards of what do we do in this practice and how do we care for these types of cancers? And that really is the role for the onboarding and mentoring. You know, you may be lucky, you might get an advanced practice provider who used to work at a big academic cancer center in the same field, whether it be breast medical oncology or GI, and yeah, that's a much easier task. That person probably really needs mentoring about the local culture, how we get things done, what are the resources, and which hospitals do we refer to. But for the most part, working with an advanced practice provider means that you've got a PA or an NP, who has a strong foundation in medical practice. They know how to care for patients, they know how to diagnose, they know how to do assessments, they know how to critically think, they know how to find resources, and they know how to educate. But they may not know how long does a robotic radical prostatectomy patient going to be in the hospital? And how long does it take to recover and what are some of the things you need to be considering in  their discharge and their postoperative period? That is very detailed information about the practice and the local resources. Every advanced practice provider is going to need to have that kind of details shared with them through mentorship, and a lot of it is just how do we team with each other? What are the roles and responsibilities? Who does what? How do we have backup behaviors to cover folks? So, a lot of this really is just deciding, ‘Okay, we've got a team. Who's doing what? How do they work together and how do we back each other up?' Because at the end of the day, it's all about the team supporting each other and that's what I love about advanced practice. Wendy Vogel: Very well said, yes. I had an AP student yesterday in clinic, who told me - I was asking about her education in oncology and what she got - and she said, ‘Well, so for lymphoma, we treat with R-CHOP. So, a student, of course, raised their hand and said, ‘What's R-CHOP? She's like, ‘Well, the letters don't really line up with what the names of the drugs are, so, just remember R-CHOP for the boards.' So there you go. That's kind of what a lot of our education was like specific to oncology. And again, I'm a little tongue in cheek there also. But Todd, are you going to tell everybody about the ASCO Onboarding tool that's now available? Todd Pickard: Absolutely! ASCO has done a really great job of trying to explore what advanced practice is, and how teams work together. All of us are part of the ASCO Advanced Practice Task Force. One of the things we did was really to look at what are some best practices around onboarding, orientation, scope of practice, and team-based cancer care, and we created a resource that is available on the ASCO website, and I think that it is a great place to start, particularly for practices, physicians, or other hospital systems that don't have a lot of experience with advanced practice. It's a  great reference, it talks about the difference between orientation and onboarding. It gives you examples of what those look like. It talks about what are the competencies and competency-based examinations. So, how you assess people as they're going through the onboarding period. It has tons of references, because ASCO has done a lot of great research in this field, around collaborative practice and how patients experience it, and how folks work on teams, and what do those outcomes look like. So, I highly recommend it. Wendy, thank you for bringing that up. It's almost like you knew to suggest that. Well, this has been a really, really good conversation. I'm wondering, what are some of those pearls of wisdom that we could all provide to the folks listening? So, Stephanie, what are some of your observations that, you know, maybe we haven't just thought about, in your experience working as a physician with advanced practice providers? Dr. Stephanie Williams: One, it's important to integrate them into the team, and, as Wendy mentioned, to mentor them – mentor anybody correctly, in order for them to feel that they're contributing the most that they can to the care of the patient. I think there are other issues that we'll get into later and in different podcasts that come up that make physicians hesitant to have nurse practitioners or physician assistants. Some of those are financial, and I think we'll discuss those at a later time. But really, that shouldn't keep you from employing these particular individuals for your team. It really is a very rewarding type of practice to have. You're not alone. You're collaborating with other providers. I think it's just one of the great things that we do in oncology. Todd Pickard: I wanted to share a moment as a PA, advanced practice provider, when I most felt grateful for the opportunity to work as an advanced practice provider. My clinical practice has been in urology for the past 24 years for the main part. I've had a few little other experiences, but mainly urology, and I'll never forget a patient who was a middle-aged lady who had been working with transitional cell bladder cancer. It was superficial. So, the treatment for that is BCG and repeat cystoscopies and surveillance. And I walked into the room and I was going to give her BCG installation, and she was so angry. I wanted to know what was going on. I thought, gosh, should I make her wait too long or something else? So, I asked her, I said, ‘How are you doing today? You seem to be not feeling well.' And she said, ‘Well, I'm just so tired of this. I don't understand why y'all don't just fix me. Why don't y'all just get this right? Why do I have to keep coming back?' And as I looked at the medical record, this patient had had superficial bladder cancer for years. And I thought, ‘Has nobody ever really kind of sat down and mapped this out for her?' So, I asked her to get off the examining table, and I pulled the little paper forward, so I had someplace to draw. And I drew a big square and I said, ‘This is a field, just think of any big field anywhere near you. And it's full of weeds.' And I drew some weeds on there. And I said, ‘You know we can pull them out and we can pluck them, and we can put some weed killer in that field,' I said,  ‘do you think that if you come back in three months and there will be any weeds on that field?' She said, ‘Of course, there will be. There are always weeds because they always come back. It's very hard to get rid of.' And I said, ‘Well, this field is your bladder. And the type of cancer you have are like these weeds, and we have to constantly look for them, remove them, and then put this treatment down, that's why you come.' And she started crying. And I thought, ‘Well, I've blown it.' Because this was in the first couple of years of working as a PA in urology. And I said, ‘I'm so sorry. I really apologize.' She said, ‘Don't you dare apologize to me.' I said, ‘Man, I've really blown it now.' She said, ‘Todd, I've had this disease now for this many years. This is the first time I've ever fully understood what's happening to me. I am so grateful to you.' I will never forget this patient. I will never forget this experience. And I'm extraordinarily proud. It's not because I'm the smartest person in the world. I just happened to investigate, take the time, and I drew it out. I explained it in the simplest of terms because I wanted her to understand. And then whenever she came back, she always wanted to see me. So, it was great. I really developed a really lovely relationship with this patient. It was very rewarding. Wendy, can you think of a story that you have about an advanced practice provider that makes you particularly happy or where some big lesson was learned? Wendy Vogel: Yeah. I love your analogy. That's a great analogy. I think that part of what I love to do is similar to you, Todd, in that I like to make things understandable because I consider myself an East Tennessee southern simple person, I want to understand things in the language that I understand. So, I like using a language that a patient understands. I think if I was to say about some of the proudest things, or what makes me so excited about oncology is what we've seen in our lifetime. So, Todd, you and I practice probably about the same number of years and we could say we remember when Zofran came out, and how that revolutionized chemotherapy nausea and vomiting – Stephanie's nodding here, too. We all know that. And then wow! When we found out that we could maybe cure CML, that we're having patients live normal lives in our lifetime, that we've seen non-small cell lung cancer patients living past a year that are metastatic – Oh my gosh! This is such an exciting field and we learn something every day. There's new drugs, there's new treatments, there's new hope, every single day, and that's what makes me proud to be a part of that. Todd Pickard: Yeah, I think that oncology and the work that we get to do as a team is so incredibly rewarding. It's challenging, and we have losses, but we also have wins, and those wins are amazing, and transformative, not only for us but for our patients. So, some final pearls of wisdom. I'll share and then Wendy, I'll turn it over to you. One thing that I really want to convey to folks is to know about the state that you work in and what are the practice acts for advanced practice providers. Because, unlike our physician colleagues who have a very standard scope of practice across the country, advanced practice can drastically change from state to state and place to place even from institution to institution. So, be aware of that, so that you can build your team-based practice around what are the constraints, what is the scope of practice, and you can comply with that. It just takes a little bit of pre-work at the beginning. It's not daunting. These things are written in English. We're all smart folks. We can understand them and we can build our teams in the right way. So, just keep that in the back of their mind. It is not an obstacle. It's the instruction manual of how to build your team. That's all it is if you just think about it simplistically like that. So, Wendy, what's one or two things that you would say you really want our listeners to understand about advanced practice? Wendy Vogel: I loved what you said, Todd, both of our PA Associations and our Nurse Practitioner Associations have that information online, so it's very easy to find. But I think I would say, don't be afraid to stand up for yourself as an advanced practitioner or as a physician who wants an advanced practitioner. Don't be afraid to stand up for yourself and your scope of practice, know what you can do, know what you can't do, know and demand the respect that you deserve. I would always say that just don't forget that ‘no' is the first step to a ‘yes,' and keep on trying. Todd Pickard: I think we can all appreciate that sentiment, whether we be a PA an NP or a physician. Many times, we're advocating for our patients within our systems or our practices or with our payers or insurance providers. And yeah, sometimes you start from a place of ‘no' and then you work until you get to that ‘yes', or at least a compromise, if you can get to a 'maybe,' that's a good place too. Stephanie, any particular last words of wisdom or wrap us up with our conclusion? Dr. Stephanie Williams: Thanks, Todd and Wendy, for sharing your insights today. It's always a pleasure chatting with you both. Stay tuned for upcoming episodes where we plan to dig deeper into the various types of APPs, how they are trained, what a day in the life looks like for an oncology APP, their scope of practice, and the importance of team-based care, especially in oncology. Thank you to the listeners as well. Until next time. Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org.   The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product , service, organization, activity or therapy should not be construed as an ASCO endorsement.  

Journal of Clinical Oncology (JCO) Podcast
How to Confront Climate Change: A Framework for Change in the Operating Room and Hospital as a Whole. A Conversation with Dr. Anaeze Offodile and Dr. Elizabeth Yates.

Journal of Clinical Oncology (JCO) Podcast

Play Episode Listen Later Jun 17, 2022 27:51


Dr. Shannon Westin discusses the topic of climate change in the operating room with Dr. Anaeze Offodile and Dr. Elizabeth Yates.   TRANSCRIPT   The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hey everybody! Welcome back to JCO After Hours, a podcast where we get a little bit more intense, a little bit more specific about articles that are published in the Journal of Clinical Oncology. My name is Shannon Westin, and it is my honor to serve as the social media editor for the JCO. I'm an associate professor at the University of Texas MD Anderson Cancer Center and a gynecologic oncologist. Today, we are going to be discussing a really exciting paper which was published in the March online JCO. It's a Comments and Controversies piece called, “Prescriptions for Mitigating Climate Change-Related Externalities in Cancer Care: A Surgeon's Perspective.” I have several guests with me today, none of whom have any conflict of interest. The first is Dr. Anaeze Offodile, who is an assistant professor in the Department of Plastic Surgery, as well as in the Department of Health Services Research at the University of Texas, MD Anderson Cancer Center. He also serves as the Executive Director of Clinical Transformation at MD Anderson. He is the senior author on the paper, so he will have a lot to offer here. But we're also accompanied by Dr. Elizabeth Yates, who has the title of clinical fellow in surgery at the Brigham and Women's Hospital in Boston, but tells me she's a rising PGY 4 resident, which makes it even more impressive that she is already published on the role of the surgeon in climate change. And so, we're so honored to have her with us today to share her perspectives as well. Welcome both of you. Thank you for being here. Dr. Anaeze Offodile: Happy to be here. Dr. Elizabeth Yates: Thanks so much for having us. Dr. Shannon Westin: So, I'm definitely someone that has been interested in climate change for some time, and living in the state of Texas, does what I can to rally the political climate here. But I was really intrigued because I never really thought of it in terms of what we do in the operating room. So, I'd love for each of you to give just a little bit of background on your careers and how you kind of got involved with this idea of climate change and environmental sustainability here in the operating room and in medical care? Do you want to start, Anaeze? Dr. Anaeze Offodile: Liz can start first. Dr. Elizabeth Yates: Absolutely! So, I actually came at it from an interesting perspective, I have always been interested in issues of resource distribution and disparities. And when I was in medical school, I started to think about these issues pretty deeply, especially because my younger brother was at the University of Michigan at the same time as I was, studying Environmental Science for his undergraduate and kept nagging in my ear about this problem of climate change and why I wasn't thinking about it as a doctor. And with my kind of ongoing interest in disparities, I came to realize and become compassionate about the role that climate change will play in driving the existing disparities that we see both nationally and globally. And I realized that nobody was really talking about it yet, at least in the surgical field. It had started to permeate some of the medicine and subspecialties, but really, there wasn't a conversation in our world yet. It became all the more relevant to me because I did see this dual relationship where not only do the downstream factors of climate change, like heat waves and major storms, impact our patients' access to care and their outcomes, but on the flip side, we contribute to climate change, because the delivery of surgical care, particularly in high-income countries, is so energy intensive and so wasteful. And so, I felt like if any clinician has a role in this space to really lead and change the narrative, it would be us as surgeons. Dr. Anaeze Offodile: It's really interesting to listen to Liz's journey to this issue, which affects all of us. I came at it from the micro level, bottom-up level. So, when I was a fellow about four years ago, under the mentorship of Nancy Perrier, we launched and have since scaled, I don't know if you're aware of this, Shannon, so the 'Know Your Costs' program. For the audience, this is a project at MD Anderson where we really try to minimize cost variability and waste in the operating room by providing a feedback tool to surgeons that sort of made them more conscious about the spending directly attributable to disposable supplies, implants, devices in the OR. One direct outcome of the project that we found was that actually narrowing the variability in these disposable instruments, supplies implants surely had no impact on the outcome, but also got sort of the cost structure of what we do in the OR down. So, that's the value-based care proposition. And in doing this work as I dug more into literature, I learned as we so highlighted in the article, my co-authors and I, that actually the perioperative environment is a major driver of waste in the hospital setting. I think that recognition certainly led to this work, which we're very glad that JCO looked upon favorably to champion. Dr. Shannon Westin: Yeah, I love 'Know Your Cost'. My fellows make fun of me, because I always take the electrosurgery devices, they're the cheapest. And they're like, ‘Oh, you're using the Costco version!'. And I'm like, ‘You know what? We're reducing costs. So, just hold it a little bit longer there, and you're gonna be fine.' So, I was really struck by one of the first sentences out of the gate in your commentary that the healthcare industry accounts for roughly 8.5% of total GHG emissions in the United States, the most in the world in per-capita and absolute terms, I mean, to me, that was so eye-opening within the first few sentences. What are some of the other major takeaways that you hope that readers of the JCO get from this piece? Anaeze, I think we can start with you and then I'd be interested to hear your perspectives as well, Liz? Dr. Anaeze Offodile: So, I will say, a couple of high-level, and I can touch on the sort of specific prescription that we put forward, but I think the big takeaway is, one, is healthcare has a certain moral imperative to keep our contributions to sort of environmental sustainability, greenhouse gas emissions, to control that, there's a moral imperative to this work, right? One, climate change effects are differential. So, the vulnerable populations, like Liz said, tend to suffer the worst. So, when you think about communities and countries in the global south, they bear the brunt of this, not industrialized nations. And number two, our activity directly maps to greenhouse gas emissions. And as surgeons, the relationship is much more direct. So, carbon-intensive procedures like the robot, the perioperative environment, and the supplies, the waste, and the supply chain that sort of feeds into that. So, those are the things high-level that I want to call out. And many ways this paper is intended to start a conversation that will be ongoing amongst the community, the academy, and I'll say in both surgical and medical respect: to what extent do we take ownership of this problem and contribute to the meaningful solutions of the problems? And I can certainly talk about some of the recommendations we put forward, but I think that's the key takeaway. Dr. Elizabeth Yates: Yeah, as not an author, but a reader of this paper. I really thought it summarized the high-level ideas, and really did serve as a conversation starter in the best way. What I really liked, and I try to strive for in my own work at our hospital, and we implement sustainability initiatives, was the perspective that you took coming from more of a cost-saving perspective initially, because I think people have a misconception if they do ever think about sustainability and care delivery, that somehow quality has to be compromised for sustainability - to go green, you have to do less - and that's not necessarily true. And you really highlighted a lot of opportunities in the four domains you emphasize in this paper about how you can change the way your system works, or the choices you make, for the devices you use or the energy supply, without actually compromising outcomes for patients, that we can maintain a high level of quality that makes them smarter choices for our systems to also be more sustainable. And then a lot of the time there are cost savings. It could be a triple win but we just need to put more time and effort into the surgical world thinking about these issues. Dr. Anaeze Offodile: Liz, thank you so much. What we tried to articulate was, there is no trade-off between planetary health and value-based care and high-quality care. I think those two are actually synergistic, and certainly mutually reinforcing. So, that's the one thing we tried to do. I'm glad it came out to push forward. Dr. Shannon Westin: I was joking about our bipolar use and such, but that's really what I'm trying to teach our fellows is that you can do the right work with an instrument that doesn't cost as much. And in this case, the robot is perfect. I was reading that as a robotic surgeon who also does laparoscopy and I thought, ‘Gosh! When I'm making these decisions, this is such a trickle-down effect.' And so, I really do think that I'm interested in strategies to offset those things. Because sometimes, for us in gynecologic oncology, the robot is a superior tool as far as visualization and also surgeon back pain and such. But you really have to understand that trade-off or what else you're impacting. So, I guess, what can we do with the framework of this piece in mind, what can the clinical care providers really do across the country to meaningfully address climate change and improve overall healthcare sustainability? Dr. Anaeze Offodile: So, I will talk from the surgical perspective and maybe I'll point to Liz for a broader outlook on this, but we touched on four main buckets or domains of sub-activity. So, one is the OR environment, right? Thinking about the type of anesthetic gasses that we use, thinking about energy efficient lighting, thinking about the heating ventilation AC, HVAC, can we sort of bake in preventative maintenance on a scheduled time, and using things called setbacks. So, for instance, don't have it run overnight when no one is using the OR. For the most part, there are always emergency cases, but when there's low foot traffic, like nighttime, could we not have the HVAC running during that time period. So, some things like I'll say, low hanging fruit that we can do in respect to the OR environment. And as we think about building new ORs in new hospitals, let's bake in sort of an environmental impact assessment as you sort of commissioned these new environments. So, that's one. Number two, the supply chain and thinking about streamlining the disposables, the gowns, the implants that we use, and really thinking about the procurement and sourcing of these things, taking a climate change lens to picking vendors, picking partners, almost sort of requesting an audit for these vendors with respect to how they create these goods that are sort of being engineered for the environment. The third thing is actually waste. And thinking about sort of the amount of waste that comes from the cost of surgical care – Can we lean more towards reusable as opposed to disposables? Can we think about reprocessing devices sort of like, the world is a circular economy now? Can we think about those types of initiatives with respect to waste? And the last two are value-based care, specifically thinking about low-value surgical care, really that's another way of saying activity that doesn't track to meaningful clinical outcomes. So, that activity, if we're to reframe it , creates carbon that worsens our greenhouse gas emissions, but doesn't track to any meaningful benefit to patients' society. So, low-value care, de-escalating that, or de-implementing that certainly could help with our greenhouse gas profile. And lastly, COVID has been a major force in functioning telemedicine. Can we think about telemedicine in a way that optimizes traffic, and transportation, while keeping cost structure down and thinking about greenhouse gas emissions? So, those are the four or five main elements that we've sort of proposed in our paper. I'll say pieces of this can be contextualized in a medical context. Waste can be put in the medical oncology lens as is virtual care, and as is low-value practices. So, that's how we thought about it for this paper. Dr. Elizabeth Yates: It really nicely summed up the categories of areas for implementation. So, I think I'll keep my comments focused, one, on what does it mean to actually implement that kind of work, and then scale back and what can we do, as you highlighted more broadly as clinicians. But as someone who's really started this work, and we initiated what we call 'Watching Our Waste' program across our procedural spaces at our hospital, and working with my mentor, Dr. Winn who's a vascular surgeon has been really beneficial, because having a clinical voice start to push and champion these ideas, is really meaningful. And when it doesn't come from the administration or top down, it feels a lot more homegrown, and people accept it a lot more quickly on the clinical side, rather than an eco-green team being purely administrators and people who work behind desks. You know, having boots on the ground, saying that this is important, and champion ways to integrate it into our workflow without compromising efficiency or quality of care has been really meaningful. And for anyone who's starting these initiatives, I would say the gateway for anyone who wants to really tackle this, I would recommend a waste audit. Just start with your floor, your OR, whatever your clinical area practice is, your outpatient clinic, and see what kind of waste you make in a day. The efforts you put towards that in terms of meeting your environmental services people, meeting Environmental Affairs, going through the trash, understanding what your use of various supplies is, gives you so much information and such a strong foundation as an easy thing to do as a first step and you'll know where to go from there. It'll really guide your next steps. And as you scale out, and if you get more involved in this work, what I've come to find is the administrators are looking for a clinical voice. There's the policy being pushed at a national level, to start really looking at healthcare and its carbon emissions, and there isn't a lot of expertise, and making sure that this kind of effort and these policies and the implementation of more sustainable practices align with clinical care is a priority and a growing one at the hospital level. And they need clinical voices to actually understand how this is going to work and move this forward and in an effective way. So, if you're interested, I would just highlight that this is an opportune time to get involved. Dr. Anaeze Offodile: Can I make one somewhat controversial comment, I hope it's not that controversial. You know, Shannon, as you think about the demographic shifts in the next 15 years, millennials will be the dominant healthcare workforce and the dominant patient population, right? And as you think about awareness, I will say, as you go down in the age levels, I'll say anxiety, apprehension, and more optimism increase as you go down. So, as this population ages into the workforce and the patient mix, I will reckon that they'll begin to demand more of these initiatives from their health systems, both, like I mentioned, first of all, the moral imperative, but also, as most hospitals are the biggest employers in most towns in this country. So, I think there'll be a clarion call that gets louder and louder and louder and louder. So, in many ways, I think beginning to think about these issues now is probably the way to go. And in many ways feels inevitable to me. Dr. Elizabeth Yates: There's some great data to back that up. If anyone's interested, the Yale Center - I have no affiliation, this is a purely altruistic endorsement - but the Yale Center for Climate Change Communication has really impressive data that completely backs up everything that Anaeze has just said, he couldn't be more spot on. Dr. Shannon Westin: So, we need to be focusing on this. And I guess, balancing on that kind of thinking of the upcoming generation, clinicians, and patients, is there an opportunity to build a career that is a balance between climate change and clinical care? Dr. Elizabeth Yates: I sure hope so! Dr. Shannon Westin: Liz, this is your thing, right? Dr. Elizabeth Yates: There better be! Dr. Shannon Westin: But how do we operationalize this better? Is this something that should be part of the medical school curriculum? Where can we make an impact? Obviously, you all are doing this great work, but how can we get beyond our centers? Dr. Elizabeth Yates: I think one of the things I've learned in my two, kind of, research years during my residency, and really focusing deeply on this topic, is that there's a real dearth of data-driven work in this space both on quantifying the impacts of climate change downstream on our patient outcomes. And on the flip side, how to make surgical care or medical care more sustainable broadly. There are methods that are incredibly applicable to this space. One that many sustainability providers will know about is called lifecycle analysis, where you can actually quantify your impact on carbon emissions with different changes in which products you buy, and how you implement your systems. And being able to produce that kind of data for our clinical providers, whether it be in your outpatient clinic, or in the OR, so you can make more informed choices that align quality with sustainability is a really important next step. And understanding how to implement that kind of research needs a clinical voice. It can't just be these kinds of environmental practitioners who don't have a sense of how clinical care works on a real day-to-day basis. So, having an increasing number of providers who are interested in this overlap to inform that research, I think, I sure hope, is going to be a valuable contribution to the academic literature because I'm slowly building my career upon it, and it's quite the gamble. Dr. Anaeze Offodile: No, it's a pretty safe bet, Liz. I think as a clinician, academic or community-based, late early career at this point, so the way I think about moving forward will be one, Liz just talk about scholarship, right? Both empirical data-driven work, as in thought pieces, like the JCO paper that has a policy inclination, I think we need much, much more of it. And there's increasing activity in this space, but nowhere near commensurate with the gravity of the problem. So, that's number one. I think number two is actually just advocacy, right? In the same way that surgeons are very compelling and effective advocates for gun violence, for COVID, and related science for health equity. I do think there's a huge space for physicians, surgeons, medical oncologists, and primary care doctors in this space from an advocacy standpoint. I think some of the more productive arguments have touched on the fact that, typically in healthcare, the largest employers, I mean, healthcare is, paid on the year, almost 20% of our GDP, of our economic output, is a huge chunk of US healthcare, so, we have viable legitimacy to sort of have this bully pulpit on this issue. That's number two. And number three is about clinical practice. I think one thing about climate change is the ultimate tragedy of the commons, right? So, I'm like, how can one person make a difference? I think if everyone has a position, nothing's going to happen. I think the key thing is that we all begin to move in this direction, as I like to say, ‘Incremental change is not insignificant change.' There's certainly the proverbial 'burning platform' right now on this topic. I think as we begin to have our clinical practice, each of us individually be more aligned either from an adaptation standpoint or mitigation standpoint, where we're sort of reducing greenhouse gas emissions. I think that is a huge, huge benefit to us for future generations. So, let's hope with the three main ways practice, advocacy, and scholarship get built into our careers. Dr. Shannon Westin: Yeah, not to get into a total mentoring conversation here but Liz, there's a huge opportunity for policy and through our own home organization, ASCO, there's a policy fellowship, there are lots of opportunities that I think that you'll find your academic career could be supported by. So, just a little off note. Dr. Elizabeth Yates: I'll preview the recruitment. Dr. Shannon Westin: So, we'll talk about some inspiration as we close this conversation. You guys have kind of peppered this throughout, but maybe just summarize a little bit, what are you doing in your own practice, as well as in your lives, like out of hospital lives to contribute to these efforts? Dr. Elizabeth Yates: I try to live my life with a perspective of sustainability kind of in every aspect, but with an informed perspective because I really do believe that quality of life, just like the quality of care, does not need to be compromised in order to be green. And so, being really informed about what choices in your life and your actual career have a true impact, and an impact that can scale is really important. So, do I try to buy the least plastic that I can? Certainly. Do I kill myself to be completely waste-free? I do not. I try to amplify the need for these kinds of interventions across my own little local network, both socially and wider in my own career. And as I've started to pull this into my workplace, I was apprehensive about what the kind of reaction was going to be from pushing a sustainability perspective. I've been really pleasantly surprised and impressed with how many people in our workplace already, like me, are doing what they can at home, and just don't know how to start in the workplace, especially in a hospital. And so, being that champion, and having that voice to start, wherever you are, whether it be a small project or a big policy initiative, whatever you can take on, I would say is kind of the inspirational next step and as you see the reaction of your colleagues, I hope, like me, you will continue to be inspired to do more. Dr. Shannon Westin: Great! Anaeze? Dr. Anaeze Offodile: So, I'll lead off with a plug. I read this book called The Uninhabitable Earth by David Wallace-Wells. And I thought that book is the most compelling argument that we just think about climate change. It really created a sense of urgency within me. It came out about two and a half, maybe three years ago – compelling read. So, I'll just sort of start off with that. There are many sources that are available now, I think the National Academy of Medicine, they have a grand challenge and a national collaboration on decarbonizing the US healthcare sector, and they have a bunch of resources on their website. So, I'll certainly point many people to that. What I do in my day-to-day life and the way I've thought about this is what behaviors can I entrench in the long term. I think human beings, physicians, in particular, I'd say, we're high resistance pathways, old habits tend to come back to the surface. So, I've really focused in the last few years on embedding certain climate-sensitive practices in my life that I hope to continue moving forward. So, one of them is a) I drive less. Now, it's not super easy in Houston, Shannon, as you are aware, but I happen to live near the light rail. And for the last nine months, I've been taking the train in, every morning to work to and fro. That allows me to zone out. I put a podcast on, ASCO podcast, After Hours. Dr. Shannon Westin: Love it! Love it! Dr. Anaeze Offodile: So, that's one. Number two is just easy. My purchasing choices have a climate lens. So, in many ways, you could say what you buy reveals your preferences like nothing else. So, when I buy a new radio or a new TV, I look for the sticker that says EPA certified. It's a little thing but it's something that I'm able to maintain for the last 2-3 years now. So, I'll say, being informed, changing my commuting habits, I curtail my spending habits, also like the ways I'm just really embedding this into my daily life. Dr. Shannon Westin: That's great! I think there are so many great resources that you guys have mentioned, so, I hope our listeners will check it out. I will put a plug in. I love to compost. It's super easy to do, and you can use it to grow food and beautiful flowers. And so, that is something that my husband and I have been doing for years now. So, another simple little thing. I mean, you can get everything online. It's magical. So, alright guys. Well, this has been incredible. I have so enjoyed getting to chat with both of you and I hope our listeners have the same feeling. Just as a reminder, this article can be found online in the March version of the JCO, “Prescriptions for Mitigating Climate Change-Related Externalities in Cancer Care: A Surgeon's Perspective.” Many thanks to my guests, and you all have a great day. I hope to see you next time. Dr. Anaeze Offodile: I'm happy to be here. Thank you so much for having us. Dr. Elizabeth Yates: Thank you so much!   The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

Cancer.Net Podcasts
Molecular Testing for Early-Stage Non-Small Cell Lung Cancer, with Ryan Gentzler, MD; Xiuning Le, MD, PhD; Brendan Stiles, MD; and Vamsidhar Velcheti, MD, FACP, FCCP

Cancer.Net Podcasts

Play Episode Listen Later Jun 15, 2022 17:27


ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, members of the Cancer.Net Editorial Board discuss new research in molecular testing, also known as biomarker testing or tumor marker testing, to help guide treatment for people with early-stage non-small cell lung cancer. This podcast is led by Dr. Ryan Gentzler, Dr. Xiuning Le, Dr. Brendan Stiles, and Dr. Vamsidhar Velcheti. Dr. Gentzler is the director of the Thoracic Oncology Clinical Research Program at the University of Virginia (UVA) and chairs the UVA Cancer Center's Lung Cancer Translational Research Team.  Dr. Le is an assistant professor in the Department of Thoracic/Head and Neck Medical Oncology in the Division of Internal Medicine at The University of Texas MD Anderson Cancer Center. Dr. Stiles is chief of thoracic surgery and surgical oncology at Montefiore and Albert Einstein College of Medicine. Dr. Velcheti is the director of thoracic medical oncology at New York University Langone's Perlmutter Cancer Center. View disclosures for Dr. Gentzler, Dr. Le, Dr. Stiles, and Dr. Velcheti on Cancer.Net. Dr. Gentzler: Thank you, everyone, for joining us. We've got a great group here today, and we're really going to focus on talking about molecular testing in lung cancer. This is a very hot topic. My name is Ryan Gentzler from the University of Virginia. I'm a thoracic medical oncologist. We have Drs. Le, Stiles, and Velcheti with us today. I'd like them to go ahead and introduce themselves, starting with Dr. Le. Dr. Le: My name is Xiuning Le. I'm an assistant professor. I'm at the MD Anderson Cancer Center here in Houston, Texas. I'm also a medical oncologist. Thank you, Ryan, for inviting us today. Dr. Stiles: Hey, everybody. I'm Brendan Stiles. I'm a thoracic surgeon. I'm chief of thoracic surgery at Albert Einstein College of Medicine in Montefiore Health System here in the Bronx in New York. Dr. Gentzler: All right, thanks for joining us. And Dr. Velcheti. Dr. Velcheti: Thank you, Ryan. I'm Vamsidhar Velcheti. I'm the director of the thoracic oncology program at NYU. Dr. Gentzler: All right, great. We hear a lot of terms thrown around about molecular testing, genomic testing, biomarkers, oncogenic drivers, and I thought it would be good to just define what exactly is molecular testing, so all of our listeners are aware of what we're talking about. Dr. Le, do you want to take this question? Dr. Le: Yeah. So we have many terms, as you described. In my eyes, there are 2 sets of testing, and then some of them also classify into actionable versus not actionable. So for clinical use, we usually ask the tumor to be tested for both the mutations as well as the immune marker. Usually, the panel of mutational testing is more than a field. Usually, it's depending on the platform we're using, oftentimes in the hundreds of things. And then the immune markers, usually, we refer to PD-L1 and the tumor mutational burden. Those are the 2 commonly used markers now in the clinic. Some of those markers, especially the hundreds in gene testing, not all of them can lead to a clinical decision because we're still in the phase of understanding the interactions of different genes. However, there is a subgroup of those mutations. Nowadays, we have targeted therapy for, we call those actionable mutations. So in the clinic, we push for testing for a panel of mutations as well as immune markers, hoping to look at the tumor comprehensively so that we can recommend a good treatment regimen precise to that particular tumor, precise to that particular patient. Dr. Gentzler: Yeah. Wonderful. This has also been termed precision medicine, where we really match a therapy to a specific genomic abnormality identified on these tests and maybe, Dr. Velcheti, if you could maybe elaborate on some of the different ways that these tests are performed and how we're using these in clinic today? Dr. Velcheti: Yeah, definitely. I think our understanding of the biology of lung cancer has evolved quite dramatically over the past several years and obviously it's led to a lot of advancements in terms of treatment opportunities for patients. Broadly, the way I look at biomarkers in lung cancer or, for that matter, any cancer, it's like you have biomarkers that actually kind of give us very deep insights into the biology of the cancer and giving us insights into how aggressive somebody's cancer is. Those are called prognostic biomarkers, kind of predicting outcome. And there are predictive biomarkers where there are certain biomarkers. If you do have some of these biomarkers in the tumor, then you could potentially use certain treatments that might work better for patients who have those biomarkers. So now we have a lot of different approaches in terms of how we kind of test for these biomarkers. Especially in lung cancer, now we have a lot of new therapeutics for certain genomically categorized types of lung cancer. And the challenge now is that we have so many different mutations we absolutely need that information to decide on treatment. So how do we test that? Until a few years ago, we've been doing a single gene testing. The problem with those approaches is that we have so many different genes we need to test and we kind of do sequential gene testing, a single gene testing, we won't get all the information we need to make the right decision for our patients. So the standard approach in most oncology practices, especially larger cancer centers and academic medical centers, is do comprehensive genomic profiling, and that's being widely accepted as a standard approach right now. Dr. Gentzler: Wonderful. And this has really been something that has fallen on the laps of thoracic medical oncologists as we've treated patients with advanced stage or stage 4 disease. And this is starting to become more and more important and relevant for surgeons. And Dr. Stiles, I just wanted to bring you into the conversation and see if this is something that, prior to some of the more recent data, which we'll discuss in a minute, is this something that as a surgeon, you've kept up with and think it's important in a surgical practice? Dr. Stiles: Yeah, definitely, Ryan. And I think now is probably the most exciting time for that, right? We used to just be sort of in the prognostic side, like Vamsi said, but now we really are in the predictive side in the early-stage disease. And I think that's why everybody is so excited. But that's why there's now this pressure about the timing of biomarker testing. What do you get? Do you get a whole panel? As we'll talk about some of the trials that have made their way into earlier stage disease, but it becomes inherent upon surgeons to really think about this and understand this, from the first time that they meet the patient I think, as we increasingly get better therapies in earlier stage disease. Dr. Gentzler: So as this has moved into earlier stage disease, a lot of this has been driven by some new data from clinical trials, and Dr. Velcheti, I thought maybe you could comment on the IMpower010 trial and its relevance and why molecular testing is important in the context of that trial. Dr. Velcheti: Yes, absolutely. I think the IMpower010 Trial is certainly a new shift in our approach to treating stage I, II curable non-small cell lung cancers. So we haven't had an approval in the adjuvant setting in a while. I mean, of course, we had approval with the osimertinib result of the ADAURA trial, but that's only for EGFR patients. Now we have approval for using immunotherapy in the postoperative adjuvant setting for patients with any level of PD-L1 expression. So this is a large randomized study looking at the role of adjuvant atezolizumab, which is a PD-L1 inhibitor in patients who have PD-L1 expression greater than 1%. Patients were randomized getting platinum doublet alone, which is a standard-of-care adjuvant assistant therapy for patients at stage I, II lung cancer. It is atezolizumab at a dose of 1,200 milligrams given every 3 weeks. Patients who received atezolizumab had significantly improved outcomes in disease-free survival. And the benefit was actually really striking for patients who had high PD-L1, patients with PD-L1 testing TPS score of greater than 50%. They had a really remarkable increase in terms of disease-free survival for those patients. So this is certainly very encouraging. And of course, we know it's now approved. We are still awaiting some overall survival results to mature. But given the extent of the benefits we're seeing with the disease-free survival, I think it's a very promising approach. Dr. Gentzler: Yeah, so obviously, immune therapy has had a tremendous benefit in the adjuvant setting from this trial and still some longer-term follow-up that's needed. But I think the important point here is that molecular testing may identify certain mutations that may make patients less likely to benefit or respond, or perhaps there's more appropriate treatments than immunotherapy within this group. And that brings us to the next trial that I think really shifted this discussion stage with the ADAURA trial. Maybe Dr. Le, if you could summarize this trial and give us your thoughts on why molecular testing is so important in the era of ADAURA. Dr. Le: Yeah. So ADAURA trial is also an adjuvant trial, meaning that the patient received additional treatment after the completion of surgery. So ADAURA trial looked at patients who have EGFR mutations. So it's a different biomarker. It's a gene biomarker, not the immune biomarker. So this is a large international trial, enrolled almost 700 patients and then randomized the patients after surgery, after standard chemo, the patient can go on to either receive 3 years of osimertinib, which is the standard-of-care therapy for EGFR mutant patients for metastatic setting, or the control group if the patient just received standard of care, which is to continue the monitoring. The trial actually showed that for people who had osimertinib before that prolonged time of 3 years, the risk of the disease coming back is almost 5 times lower than the patient who did not receive therapy. So based on that really striking benefit of after surgery, after chemotherapy, continue osimertinib in EGFR patients, FDA approved after the surgical resection and all the standard care patient can go on for osimertinib for a prolonged time, which we think currently the data is saying the disease is more likely not to come back. And hopefully, in the future, that result will translate into overall survival benefit. Dr. Gentzler: Okay, wonderful. And I think both of these trials, both the ADAURA and the IMpower010, are adjuvant trials. So these are trials that allow us adequate time to do molecular testing on a large surgical specimen, formulate our plans, and implement those plans up to a month or longer after surgery. Obviously, there's some new data that we've seen in a press release from the CheckMate 816 trial. This is a neoadjuvant trial of chemotherapy plus nivolumab. We've seen previous data from this trial showing some results, but this moves the conversation into the neoadjuvant space, and Dr. Stiles, I wonder if you could give us a summary of your thoughts on the CheckMate 816 and the relevance for molecular testing in that context of neoadjuvant therapy. Dr. Stiles: Yeah. Thanks, Ryan. I think, first of all, those are incredibly important adjuvant trials. I saw 2 patients each this week on adjuvant osimertinib and adjuvant atezo [atezolizumab], so it's real-life practice. Every day, it's going to benefit patients. But I think that's easy, like you said, these are big specimens that are taken out. You've got time to decide while the patient gets better. Now, we have to shift all this even earlier because CheckMate 816 really has some pretty impressive results. We, unfortunately, don't have the paper yet. I'm told it's going to be coming out soon, but the primary endpoint pathologic complete response 24% versus 2.2%. That's with chemo-nivo versus chemo alone. Obviously, people are questioning, does pathologic complete response correlate with outcomes? Certainly, we got a signal on a press release that the event-free survival is going to be the hazard ratio is 0.63, so it sounds like it does, and I think we'll see more data on that in the next couple of months. A difference in median event-free survival of 32 months versus 21 months in the report. So everybody is excited to see this. And I think it has some advantages over the adjuvant strategy. First of all, more patients are able to tolerate it. It's just 3 cycles, and so it's not given indeterminately for a year. And it worked across different subgroups. And we can talk about some of the nuances, but as where atezo [atezolizumab] was only looking good in the PD-L1-high. This sort of worked across different groups. The caveat to that is we don't really know what happens with these EGFR patients who are eligible and sort of, how do we then move that test? And all of a sudden, we've got to make a decision on neoadjuvant therapy. Now we need to know. It helps to know the PD-L1 maybe preoperatively, with the high PD-L1, maybe you could wait until adjuvant therapy, with the low to sort of medium PD-L1, maybe you want to give them their shot in the neoadjuvant space. But if they have an EGFR mutation, it's probably not the right thing. We don't really know the data on that and CheckMate 816 yet, but certainly, I'd be sort of hesitant to give them neoadjuvant chemoimmunotherapy. So then you have to teach surgeons all this too, and teach them to think about this and teach them to hold their horses on taking patients to the operating room while they wait for molecular testing. But that probably means we need to speed up the process somewhat either with sort of more rapid turnaround test, with consideration of liquid tests in some instances. It's just an incredibly fast-changing place that here we are speaking about a trial that hasn't even been published yet, so that tells you how fast things are happening. Dr. Gentzler: One last question. How can the results of these tests guide therapy after surgery? Do we incorporate a full NGS [next-generation sequencing] panel at the time of surgery? And we don't have data on adjuvant therapy for ALK or ROS1, or RET. Do we factor that into how we think about adjuvant chemotherapy, adjuvant immunotherapy, do we employ targeted therapies for some of these mutations? Any thoughts on that? Dr. Le: Ryan, I think you bring an important point in that EGFR is 1 of the 8 actionable mutations we have nowadays based on FDA and NCCN. The tumor biology between EGFR and ALK-fusion oncogenesis and potential response and benefits probably share some similarities. So we look forward to seeing trials reporting out the adjuvant setting with ALK inhibitors with ROS1. And the smaller target might require a multi-institutional or co-op group effort to really achieve the sample size for us to see. But as of now, we don't have the approval. We try to enroll patients to the oncogene trials, but I think currently we're practicing based on EGFR and PD-L1. Dr. Stiles: Yes, and I agree. I'm excited to see what comes out of some of those trials. They're slow to grow, but we'll eventually get some readouts. I think an interesting question sometimes is PD-L1. And we had an example recently where in the pre-op biopsy, the patient had a low PD-L1, and so not particularly enthusiastic. And the question sometimes arises, do you test that whole tumor to consider them as kind of an adjuvant to atezo [atezolizumab]and then the fully resected tumor, the PD-L1 was greater than 50%. And so I would sort of sound a caution that the small biopsy sample, they're incredibly helpful for many things, incredibly helpful for moleculars. It may not always be totally representative of the PD-L1 staining. Dr. Gentzler: And I think that's a good point. Even for molecular testing, sometimes if you have smaller biopsies, you may get a result that's negative, but it could be low levels of DNA and not sufficient to complete the full panel with high quality. So you really have to pay attention to the report and make sure that there's some confidence in the amount of DNA in some of these results. Well, I think that's all the time we have here, so I appreciate everyone's participation, and hopefully we're able to learn a little bit about genomic testing today. ASCO: Thank you, Dr. Gentzler, Dr. Le, Dr. Stiles, and Dr. Velcheti. Learn more about treating lung cancer at www.cancer.net/lung.  Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

FIA Speaks
A conversation with Dr. Mara Antonoff - Practical ways to boost inclusive recruitment

FIA Speaks

Play Episode Listen Later Jun 14, 2022 36:15


Dr. Mara Antonoff, Associate Professor of Thoracic and Cardiovascular Surgery at MD Anderson Cancer Center, talks to FIA Board Member Jamila Piracci about her practical approach to inclusive recruitment that can be put into practice regardless of industry or sector. Speaking about recruitment themes very similar to those in the financial services industry, Dr. Antonoff explains how her recruitment process overcomes blind spots and implicit biases, resulting in an increased number of bright, accomplished and talented trainees from distinct backgrounds and experiences that better represent the diversity of patients they serve. “This is the start, but our work does not stop the moment someone gets their foot in the door,” Dr. Antonoff says, adding that “Conversations like this are important - we can learn from different fields, and we can share transferable experiences.”

Living to 100 Club
Keeping Up with Technology as We Age

Living to 100 Club

Play Episode Listen Later Jun 13, 2022 39:31


Keeping Up with Technology as We Age On this Living to 100 Club Podcast, we have a conversation about the latest technological advances that make our homes smarter. Our guest is Dr. Wade Yarbrough, who is deeply interested in helping older adults solve problems by learning about home automation systems. We discuss smart speakers like Alexa, “smart plugs,” and programming emergency alerts. Also discussed is adding one of the leading “eco systems” from Google, Apple, or Amazon to our homes. Learn about setting up a program like Alexa to shut down appliances, and lock doors. Can we turn out the desired lights on a single command? Can this technology help older adults to live more independently, and possibly remain in their own homes longer? This is an educational conversation about being more receptive to technology that can help older adults live better. If you want to make the best use of products and programs to live smarter and safer, be sure to tune in. Mini Bio Dr. Yarbrough has a doctorate degree in psychology from West Virginia University. He also started working with computers in the 70s when you needed punched cards and the programming languages were FORTRAN and COBOL. For most of his career, he installed and supported health care information systems at facilities. These included the University of New Mexico Hospital, University of Pittsburgh Medical Center, and MD Anderson Cancer Center. One of Wade's passions was seeing the “lights come on” while training users on the software. He wanted to help them solve problems using the software. In 2014 he decided to shift his career, but not his passion. He found new ways to continue training people to be more productive and solve their problems. Now he teaches psychology at a local community college and trains seniors on technology for GetSetup. In his free time, Wade enjoys bicycle rides and walks in the park with his wife, Michelle, and their Bichon dog, Elsa Marie. One fun fact about Wade is that he plays the banjo. Items for Our Listeners Wade's Classes at Get Set Up Make Your Home a Smart Home Amazon Alexa - What It Is & Why You Might Want One How to Set Up Your Smart Home: A Beginner's Guide The best smart home devices of 2022

Integrative Cancer Solutions with Dr. Karlfeldt
A Different POV: Improve Your Cancer Treatment Plan by Understanding Oncologists' Perspectives with Dr. Stephen Iacoboni

Integrative Cancer Solutions with Dr. Karlfeldt

Play Episode Listen Later Jun 8, 2022 52:41


Our NEEDS are NOT always congruent with our WANTS.Here in the Karlfeldt Center, we highly encourage our patients' active participation in their respective treatment plans.However, problems arise when patients start suffering from “Tunnel Vision” …Opting only for one part of a combination therapy because that's the “least expensive” or “least painful”, among other personal considerations.You have to understand that there are many variables you need to consider in coming up with the BEST Possible Outcome in Cancer Care!And your team of medical professionals, especially your Oncologist, are responsible for helping you arrive at a highly-informed decision…If you let them!Stephen J. Iacoboni, MD, an Oncologist and author of The Undying Soul, served his fellowship at the prestigious MD Anderson Cancer Center in Houston Texas, receiving the Outstanding Researcher award and presenting his findings at the American Society of Clinical Oncology.Dr. Stephen has advised his fair share of patients battling cancer in his three-decade career. As part of his practice, he believes in letting his patients in on the perspective of oncologists.Patients don't know what they don't know!And so, providing them with the various perspectives (and possibilities) will allow patients to better respond to their bodies' needs.Your team of medical professionals serve as guides – lending you their experiences and knowledge of the technical aspects you need to understand about Cancer Care.How YOU leverage all these information, with respect to your knowledge of your body's needs, will determine the quality of your treatment plan!What are limitations legally imposed upon medical practitioners that affect their proposals for your treatment plans?How do ETHICS and STANDARD of CARE weigh in on these recommendations?Why do different generations of oncologists arrive at different perspectives (despite being in the same field)?Tune in to learn more about leveraging your Oncologist's expertise in order to design the BEST Cancer Treatment Plan you need!Integrative Cancer Solutions was created to instill hope and empowerment. Other people have been where you are right now and have already done the research for you. Listen to their stories and journeys and apply what they learned to achieve similar outcomes as they have, cancer remission and an even more fullness of life than before the diagnosis. Guests will discuss what therapies, supplements, and practitioners they relied on to beat cancer. Once diagnosed, time is of the essence. This podcast will dramatically reduce your learning curve as you search for your own solution to cancer. For more information about products and services discussed in this podcast, please visit www.integrativecancersolutions.com. To learn more about the cutting-edge integrative cancer therapies Dr. Karlfeldt offer at his center, please visit www.TheKarlfeldtCenter.com.

Trapped: Understanding Addiction
Episode 20: Addiction in Healthcare Professionals with Dr. Michael Sprintz

Trapped: Understanding Addiction

Play Episode Play 59 sec Highlight Listen Later Jun 1, 2022 59:15


Medical professionals bear an enormous responsibility taking care of patients and are often held to a higher standard than other members of society. However, they are human and are therefore also susceptible to the development of addiction, especially given the stresses they are placed under. In this episode, I speak with Dr. Michael Sprintz about substance use disorders in healthcare professionals. Dr. Sprintz is triple board-certified in anesthesiology, pain medicine, and addiction medicine and has struggled with addiction himself, giving him a unique understanding of this topic. He talks about why he first started using substances and how accepting who he was and being authentic was key to his long-term recovery.Dr. Michael Sprintz is a physician, entrepreneur, author, consultant, public speaker and a national expert on the intersection of chronic pain and addiction. He received training at top tier institutions including Johns Hopkins Hospital and MD Anderson Cancer Center. Dr. Sprintz founded the Sprintz Center for Pain and Recovery, located in Texas, in 2013 and at the same time started a software company, Cellarian, which automates medical documentation to give providers more quality time for their patients. Dr. Sprintz has consulted for organizations in the pharmacology, biotechnology, and medical device spaces. He is currently on an FDA advisory committee and is also active in local and national medical societies, working to create and support policies that help patients and providers become their own best advocates and re-engage and protect their healthcare relationships.Learn more about Dr. Sprintz at https://drsprintz.com/Learn about the Sprintz Center for Pain at https://www.sprintzcenter.com

Oncology Data Advisor
How to Build a Diverse Nursing Work Force With Maria Badillo and Diane Barber

Oncology Data Advisor

Play Episode Listen Later May 23, 2022 14:30


In honor of Oncology Nursing Month in May, Oncology Data Advisor is celebrating the stories of these essential members of the cancer care team. For this interview, editorial board member Maria Badillo, MSN, RN, OCN®, CCRP, speaks with Diane Barber, PhD, ANP-BC, AOCNP®, FAAN, Manager of Advanced Practice Providers at MD Anderson Cancer Center. Dr. Barber explains the importance of building a diverse nursing work force and shares ways to spread awareness about the opportunities that a career in nursing can offer.

Oncology Data Advisor
The Ever-Changing Opportunities of Research Nursing

Oncology Data Advisor

Play Episode Listen Later May 20, 2022 13:46


In honor of Oncology Nursing Month in May, Oncology Data Advisor is celebrating the stories of these essential members of the cancer care team. For this interview, editorial board member Maria Badillo, MSN, RN, OCN®, CCRP, speaks with Doyle Bosque, RN, Director of Nursing Research Programs at MD Anderson Cancer Center. Mr. Bosque explains the role that he plays in the oversight of clinical trials and shares the exciting opportunities that a career in research nursing can offer.

Behind The Knife: The Surgery Podcast
Clinical Challenges in Surgical Oncology: Surgical Management for Borderline Resectable/Locally Advanced Pancreatic Cancer

Behind The Knife: The Surgery Podcast

Play Episode Listen Later May 16, 2022 39:51 Very Popular


*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy. Learning Objectives:  In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

American Conservative University
A 'Disturbing Uptick' in Cancers and Viral Disorders.

American Conservative University

Play Episode Listen Later May 13, 2022 35:49


A 'Disturbing Uptick' in Cancers and Viral Disorders. https://www.theepochtimes.com/c-american-thought-leaders PART 1: Dr. Richard Urso: Alarming Post-Booster Trends and the Censorship of Treatments for COVID-19 “All of a sudden when the word COVID-19, coronavirus, came up, there was no treatment for inflammation, no treatment for respiratory compromise, no treatment for blood clotting. How is that possible? It's completely absurd.” PART 2: Dr. Richard Urso: Big Pharma Makes Billions by Rebranding Existing Drugs as ‘New' Products During the COVID-19 pandemic, standard protocols for finding treatments were thrown out of the window, says Dr. Richard Urso, a co-founder of the International Alliance of Physicians and Medical Scientists, which organizes Global Covid Summit events. “There is a way to mitigate damage in every disease, whether it's COVID, whether it's cancer … We look for the things that have the most evidence, the most biologic plausibility, and then we go from there,” says Urso. Urso is a drug design and treatment specialist, an ophthalmologist, and former chief of orbital oncology at MD Anderson Cancer Center. We discuss how science has been corrupted and we also take a look at many alarming trends he's seen primarily in individuals who have received their third or fourth vaccine booster shot. Here's the link to PART 2: Dr. Richard Urso: Big Pharma Makes Billions by Rebranding Existing Drugs as ‘New' Products.

The Hamilton Review
How Do We Clean the Air? New and Innovative Ways to Use Existing Technology with Dr. Linda Lee

The Hamilton Review

Play Episode Listen Later May 10, 2022 38:15


Join us for the latest episode of The Hamilton Review Podcast! In this conversation, Dr. Bob has an important and informative conversation with Dr. Linda Lee, Chief Medical Affairs and Science Officer at UV Angel. Dr. Lee shares her knowledge on how to clean the air that we breathe, specifically how to use UVC to treat resistant pathogens and treat the air safely. In the wake of a pandemic, this is a timely conversation and we thank you for listening! About Dr. Linda Lee, Chief Medical Affairs & Science Officer A sought-after health industry speaker and author, Dr. Lee has spent over 30 years working with organizations, ranging from CH2M Hill to the MD Anderson Cancer Center.A certified indoor air quality manager and certified in infection control with a focus on the relationship of opportunistic environmental pathogens, Dr. Lee brings more than three decades of experience to her role at UV Angel. In addition to positions at CH2M Hill, WM Healthcare Solutions, the University of Texas MD Anderson Cancer Center, and Stericycle, Dr. Lee has authored numerous peer-reviewed publications as well as three American Hospital Association-published books. After earning her Bachelor's in Environmental Health Science from Indiana State University, Dr. Lee earned a Master's in Operations Management from the University of Arkansas College of Engineering. She completed a Doctorate of Public Health in Occupational and Environmental Health from the University of Texas Health Science Center and has an MBA with an emphasis in Healthcare Management. Dr. Lee has been invited to present at SHEA, AIHce, IPAC-Canada, and the C Diff Foundation Conference and is a corresponding Member of ASHRAE Ultraviolet Air & Surface Treatment-T-TAC-TC02.09 & ASHRAE Roster Health Care Facilities-T-TAC-TC09.06. In her spare time, Dr. Lee enjoys spending time with her three grandchildren and rooting on her Houston Texans. How to contact Dr. Linda Lee: Dr. Linda Lee at UV Angel How to contact Dr. Bob: Dr. Bob on YouTube: https://www.youtube.com/channel/UChztMVtPCLJkiXvv7H5tpDQ Dr. Bob on Instagram: https://www.instagram.com/drroberthamilton/ Dr. Bob on Facebook: https://www.facebook.com/bob.hamilton.1656

The Oncology Nursing Podcast
Episode 206: Graft-Versus-Host Disease: Biomarkers and Beyond

The Oncology Nursing Podcast

Play Episode Listen Later May 6, 2022 45:00


“Biomarkers give us information not only to diagnose a patient, but also to see whether a patient is going to have GVHD in the near future, whether a patient is going to respond to the treatment we'll give, and what would be the overall outcome and survival.” ONS member Nilesh Kalariya, PhD, AGPCNP-BC, AOCNP®, research nurse practitioner at MD Anderson Cancer Center in Houston, TX, talks with Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, about managing acute and chronic graft-versus-host disease (GVHD) and biomarkers for the condition. You can earn free NCPD contact hours by completing the evaluation linked in the episode notes.    Music Credit: "Fireflies and Stardust" by Kevin MacLeod   Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by May 6, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Episode Notes  Check out these resources from today's episode:  Complete this evaluation for free NCPD.  Kalariya et al.'s Oncology Nursing Forum article: Diagnostic and Prognostic Biomarkers for Graft-Versus-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation  ONS course: Hematopoietic Stem Cell Transplantation ONS Huddle Card™: Hematopoietic Stem Cell Transplantation ONS Voice articles about GVHD National Institutes of Health's GVHD Working Group reports UpToDate results for GVHD research  To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

The Readout Loud
Episode 206: How cancer-killing cell therapies work, biotech's endless downturn, & an FDA conundrum

The Readout Loud

Play Episode Listen Later Apr 28, 2022 29:03


Can rewired cells cure some patients' cancer? Do biotech stocks ever go up? And why's it taking so long to get kids vaccinated for Covid-19? Immunologist Katy Rezvani of MD Anderson Cancer Center joins us to explain the massive potential of a new approach to treating wily tumors, one that repurposes human immune cells. We also discuss the latest news in the life sciences, including an interesting hire at Novartis, the pediatric Covid-19 vaccine saga, and another negative milestone for biotech.

American Thought Leaders
PART 2: Dr. Richard Urso: Big Pharma Makes Billions by Rebranding Existing Drugs as ‘New' Products

American Thought Leaders

Play Episode Listen Later Apr 26, 2022 53:02


“We have seen the ultimate demise of our health care system when it's in the hands of bureaucrats,” says Dr. Richard Urso, a co-founder of the International Alliance of Physicians and Medical Scientists. Previously, in part one of our interview, we discussed alarming post-booster trends he's seen and how usual protocols for identifying treatments were thrown out during the COVID-19 pandemic. Now in part two, we discuss how big pharmaceutical companies can make billions by essentially repackaging existing products. “Basically they took almost the exact same drug as Kaletra, dressed it up, they put a box around it, and they're selling it for what, [$]5 billion?” says Urso, referring to the Paxlovid COVID-19 pill. We also discuss Urso's work with other prominent doctors to create both a national telehealth system as well as an entirely new infrastructure of doctor-led medicine, where power is decentralized and less easily corrupted. “Once doctors became employees during this pandemic, it made them very reluctant to speak out,” Urso says. Urso is a drug design and treatment specialist, an ophthalmologist, and former chief of orbital oncology at MD Anderson Cancer Center. Follow EpochTV on social media: Facebook: https://www.facebook.com/EpochTVus Twitter: https://twitter.com/EpochTVus Rumble: https://rumble.com/c/EpochTV Gettr: https://gettr.com/user/epochtv Gab: https://gab.com/EpochTV Telegram: https://t.me/EpochTV

American Thought Leaders
PART 1: Dr. Richard Urso: Alarming Post-Booster Trends and the Censorship of Treatments for COVID-19

American Thought Leaders

Play Episode Listen Later Apr 23, 2022 37:00


Sponsor special: Up to $1,500 of free silver on your first order for all American Thought Leaders listeners - Call 855-862-3377 or text “AMERICAN” to 6-5-5-3-2 “All of a sudden when the word COVID-19, coronavirus, came up, there was no treatment for inflammation, no treatment for respiratory compromise, no treatment for blood clotting. How is that possible? It's completely absurd.” During the COVID-19 pandemic, standard protocols for finding treatments were thrown out of the window, says Dr. Richard Urso, a co-founder of the International Alliance of Physicians and Medical Scientists, which organizes Global Covid Summit events. “There is a way to mitigate damage in every disease, whether it's COVID, whether it's cancer … We look for the things that have the most evidence, the most biologic plausibility, and then we go from there,” says Urso. Urso is a drug design and treatment specialist, an ophthalmologist, and former chief of orbital oncology at MD Anderson Cancer Center. We discuss how science has been corrupted and we also take a look at many alarming trends he's seen primarily in individuals who have received their third or fourth vaccine booster shot. Follow EpochTV on social media: Facebook: https://www.facebook.com/EpochTVus Twitter: https://twitter.com/EpochTVus Rumble: https://rumble.com/c/EpochTV Gettr: https://gettr.com/user/epochtv Gab: https://gab.com/EpochTV Telegram: https://t.me/EpochTV

How Are You Helping?
16. Amber Barbach, Founder of the Glioblastoma Research Organization on Starting A Brain Cancer Research Non-Profit, Why Passion is Critical, the Importance of Funding Clinical Trials, and More

How Are You Helping?

Play Episode Listen Later Apr 18, 2022 41:30


Amber Barbach is the founder and director of the Glioblastoma Research Organization, a 501(c)(3) nonprofit organization raising awareness and funds for new global, cutting-edge research to find a cure for glioblastoma. Glioblastoma is an aggressive and treatment-resistant form of brain cancer that accounts for 48 percent of all primary malignant brain tumors. Amber is originally from Miami. She has extensive expertise in community development and brand management after nearly a decade of working in branding partnerships and event marketing for global brands such as VanDutch, David Stark, V2 Jets, and Ultra Music Festival. She earned a bachelor's degree in communications and business administration from Florida International University and is currently pursuing a master's degree in nutrition education from American University. In this episode, Amber explains the reason she was compelled to start this nonprofit, the importance of clinical trials and new research for brain cancer, tools and tips for nonprofit leaders who are early in their careers, and what some of her first encounters were like with major cancer centers that her nonprofit has provided funding for like the Cleveland Clinic, Lenox Hill Hospital and MD Anderson Cancer Center. Amber shares many lessons she has gathered first-hand which help nonprofit leaders be more effective at helping others, and she shares her personal why, habits, rituals and routines. Follow The Glioblastoma Research Organization at the link below: https://gbmresearch.org/ @glioblastomaresearch Follow How Are You Helping? @howareyouhelping Music by Robby Palmer, Megan Wofford, David Celeste, Ever So Blue, Airae, Frank Jonsson and Ran the Man

Management Muse
Organizational Culture: Values Unmasked With Welela Tereffe

Management Muse

Play Episode Listen Later Apr 5, 2022 48:19


In this episode of Management Muse, we're joined by Welela Tereffe, the Chief Medical Executive at the MD Anderson Cancer Center in Houston, Texas. Welela talks about strengthening culture in a large organization and what a healthy work culture looks like. Welela also shares how the pandemic taught her the importance of narrative in bringing together people and improving work culture. Finally, Welela shares how COVID caused people to reprioritize their life's goals and strengthen their gratitude practices. Welela explains that by openly and consistently communicating with employees in times of uncertainty, you build trust and strengthen an organization's culture. Episode Highlights: Systems and processes sometimes erect unnecessary obstacles for employees. In times of uncertainty, managerial support is more important than ever. There's immense cultural power in story and narrative. An intentional gratitude practice confers many benefits. Allow employees to correct from mistakes and well-intentioned errors. Timestamps: [1:41] How to impact the culture in a large organization. [2:20] The challenges to instilling a good culture in an organization. [5:05] The most surprising thing Welela learned about culture as a leader. [12:23] The benefits of verbalizing gratitude to one another in an organization. [14:42] The stigma around receiving mental health care, and how it could be overcome. [15:47] Anderson Cancer Center's 'Code Lavender' and 'Code Blue' for managing the mental health of teams. [23:30] Conflicts at MD Anderson Cancer Center, and how they deal with them even in a virtual setting. [28:41] What does it mean to go the extra mile for patients and employees? Welela talks about MD Anderson's initiatives for employees and patients during the pandemic. [33:16] MD Anderson's two-part wellness strategy: address all problems, make sure people feel cared for. [35:48] It takes more than four positive interactions to counteract a negative one—the impact of negativity bias. [39:18] Assume good intent; the vast majority of the people want to learn if they're missing the mark at work. [42:36] Welela explains why, after the COVID pandemic, MD Anderson's employee engagement scores shot up. [44:55] Ramping up employee care and well-being at MD Anderson Cancer Center. [46:18] Key points we've learned from Welela today. Episode Quote from Welela Tereffe: “I think the first thing is to recognize that culture drives everything else, so you have to be thinking about it, talking about it, and moving it forward. You've heard the saying that culture eats strategy for lunch. It eats everything else for breakfast: employee engagement in hospitals, and patient experience. And so much of how we feel about going to work every day is a reflection of our shared norms and behaviors and our sense of engagement on mission. And that's all about culture.” About Welela Tereffe: Welela Tereffe, M.D., is the Chief Medical Executive at M.D. Anderson Cancer Center in Houston, Texas. She's a graduate of Brown University, New York University Medical School, and Harvard University. Her medical specialization is in radiation oncology. Episode Resources: https://culsure.com/coaching/ https://ondemandleadership.com/strategic-planning/ Watch this podcast on YouTube https://managementmuse.com/