Podcasts about wisconsin carbone cancer center

Dr. Beth Weaver is a Professor in the Department of Cell and Regenerative Biology and the Department of Oncology/McArdle Laboratory for Cancer Research at the University of Wisconsin-Madison School of Medicine and Public Health. She is co-Leader of the Developmental Therapeutics Program at the University of Wisconsin Carbone Cancer Center. Beth studies a group of commonly used chemotherapy agents to better understand how they work, who will respond to these treatments, and how to make resistant tumors more sensitive to these drugs. Outside of work, Beth enjoys spending time with her family. She, her husband, and their two children enjoy making fun group Halloween costumes, and she also brings this creativity into entertaining and hosting themed parties. Beth received her B.S. in biochemistry from Brown University and her Ph.D. in biomedical sciences from the University of California, San Diego. Afterwards, Beth conducted postdoctoral research at the Ludwig Institute for Cancer Research before joining the faculty at the University of Wisconsin-Madison. She has received various awards and honors during her career. These have included receipt of the Bothwell Prize and the Women's Health Research Mentorship Award from UW-Madison. In addition, she has been named an American Cancer Society Research Scholar, a Romnes Faculty Fellow by the Wisconsin Alumni Research Foundation, and a University of Wisconsin Carbone Cancer Center Ride Scholar. In this interview, she shares more about her life and science.

Dr. Christian Capitini is an associate professor and the Jean R. Finley Professor of Pediatric Hematology and Oncology. He serves as co-leader of the Developmental Therapeutics Program at the University of Wisconsin Carbone Cancer Center and director of clinical innovation at the Forward BIO Institute. He has received many awards for his clinical and research contributions, including the Department of Pediatrics Gerard B. Odell Research Award, the Outstanding New Member Science Award from the Society for Pediatric Research (SPR), and the Janet Rowley Award from the Jonas Center Cellular Therapy Symposium at the University of Chicago. Nationally, Dr. Capitini is an active member of the Society for Immunotherapy of Cancer (SITC) and serves as at-large director. Additionally, he serves on the executive board for the Pediatric Real World chimeric antigen receptor (CAR) T Consortium. Dr. Capitini leads an NIH-supported laboratory focusing on development of cell-based immunotherapies, including natural killer (NK) cells and CAR T cells, for the treatment of pediatric solid tumors. The Capitini Lab also develops alternatively activated macrophages for complications of bone marrow transplant, including graft-versus-host-disease (GVHD) and acute radiation syndrome. Dr. Capitini was one of the site principal investigators (PI) for the first multicenter CD19 CAR T cell trial, which led to the FDA approval of tisagenlecleucel-T (Kymriah) for relapsed/refractory B cell leukemia. Currently, he is site PI for a Kymriah trial related to the upfront treatment of high-risk B cell leukemia and for a multicenter GD2 CAR T cell trial for neuroblastoma and osteosarcoma through the Pediatric NCI-Cancer Immunotherapy Trials Network (CITN). He is also a sponsor and PI for a University of Wisconsin clinical trial expanding gamma delta T cells in vivo using zoledronate after alpha beta T cell depleted stem cell transplant. --- What We Do at MIB Agents: PROGRAMS: End-of-Life MISSIONS Gamer Agents Agent Writers Prayer Agents Healing Hearts - Bereaved Parent and Sibling Support Ambassador Agents - Peer Support Warrior Mail Young Adult Survivorship Support Group EDUCATION for physicians, researchers and families: OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma MIB Book: Osteosarcoma: From our Families to Yours RESEARCH: Annual MIB FACTOR Research Conference Funding multiple $100,000 and $50,000 grants annually for OS research MIB Testing & Research Directory The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter. https://www.mibagents.org​ Help support MIB Agents, Donate here https://give-usa.keela.co/embed/YAipuSaWxHPJP7RCJ SUBSCRIBE for all the Osteosarcoma Intel

In this episode, Ko Un “Clara” Park, MD, FACS, Member of the SSO Breast DSWG and Assistant Professor of Surgery at The Ohio State University Wexner Medical Center reviews wire-free alternatives for localization of non-palpable breast lesions for surgery. Panelists and alternatives reviewed include: Dr. Michael Alvarado, Professor of Surgery and member of the breast care and melanoma programs at the UCSF Helen Diller Family Comprehensive Cancer Center, discusses the use of radioactive seed. Dr. Susan Hoover, Professor of Surgery at the Moffitt Cancer Center in Tampa, Florida, reviews other ‘seed-like' localizers such as Savi Scout, Magseed, and the Faxitron localizer. Dr. Lee G. Wilke, the Hendricks endowed chair in Breast Cancer Research; a tenured Professor of Surgery and the Associate Director for Clinical Research for the University of Wisconsin Carbone Cancer Center as well as the Director of the UW Health Breast Center in Madison, WI, discusses an innovative intraoperative navigation platform for tumor identification, a Smart Clip technology which can be inserted at time of the biopsy.

Dr Natalie Callander from the University of Wisconsin Carbone Cancer Center discusses key presentations on multiple myeloma, Waldenström macroglobulinemia and amyloidosis from the 2020 ASH Annual Meeting. CME information and select publications here (http://www.researchtopractice.com/OncologyTodayPostASHMM21).

In today's podcast, Dr. Noelle LoConte discusses the relationship between alcohol and cancer. According to the American Cancer Society, alcohol use is one of the most preventable risk factors for cancer. They further state that alcohol use accounts for about 6% of all cancers and 4% of all cancer deaths.  For many cancers, the more alcohol you drink, the higher your cancer risk. But for some types of cancers, in particular breast cancer, consuming even small amounts of alcohol can increase the risk. Furthermore, BreastCancer.org warns women that as little as three alcoholic drinks per week give you a 15% higher risk of breast cancer compared to non-drinkers. Most people don't realize that tipping back a beer, wine, or a cocktail could increase their cancer risk. Noelle LoConte, M.D., specializes in the relationship between alcohol and cancer. She is the first author on the American Society of Clinical Oncology policy statement on alcohol and cancer and has served on the ASCO prevention Committee. Dr. LoConte is an Associate Professor of Medicine at the University of Wisconsin Carbone Cancer Center in Madison, Wisconsin. She completed medical school at the University of Illinois at Chicago, did her internal medicine  internship at UW, and completed her internal medicine residency at Oregon Health Sciences University in Portland, Oregon.  Her clinical interests are in medical oncology, and she maintains a practice in gastrointestinal cancers.  Her research and outreach interests are in cancer control across the cancer continuum, and she is the principal investigator (PI) for the Wisconsin Comprehensive Cancer Control Program.  Through this work, she chairs the action plan on alcohol for Wisconsin. Today's podcast will encourage us to take an honest look at the connection between alcohol and cancer along with: Pema Chödrön quote from - "When Things Fall Apart: Heart Advice For Difficult Times" How much alcohol increases the risk of cancer What kinds of cancer are connected to alcohol How alcohol causes cancer The relationship of alcohol and breast cancer How alcohol increases levels of estrogen Head, neck, and esophageal cancer Alcohol and cancer treatment Alcohol and mortality "The Undying" A book by poet Anne Boyer about her battle with breast cancer Cancer and Covid 19 The four main rules of practicing oncology Thank you for joining me today. For recipes and inspiration, please follow me on Instagram and Facebook. You can purchase my vegan, organic line of CBD products on my website. The National Institutes of Health released a study that "revealed very high rates of clinically significant insomnia along with more stress, anxiety, and depression since the COVID-19 pandemic."    All-natural CBD from hemp can enhance the serotonin receptors. Low serotonin levels are commonly associated with people who have depression and anxiety. Anxiety is a key factor behind insomnia. I hope my CBD can help you get a good night's sleep. Additionally, you can find my cookbook "The Easy 5 Ingredient Vegan Cookbook" HERE I would also like to thank Forager for sponsoring this podcast. Don't forget to go to Foragerproject.com/cultivatehealth  for your FREE cup of yogurt. Please stay safe and stay well.  

Dr. Narjust Duma is a faculty member in the Division of Hematology, Medical Oncology and Palliative Care at the University of Wisconsin School of Medicine and Public Health. She is a medical oncologist at the University of Wisconsin Carbone Cancer Center with clinical and research focus on thoracic malignancies. Her clinical interests include the care of women with lung cancer including their unique aspects of cancer survivorship. She is also a champion for empowering gender and racial equity in medicine. Dr. Duma is a co-founder of Latinas in Medicine, Inc., a nonprofit inspiring, supporting, and empowering Latinas who choose careers in medicine.

Stories are powerful. They help us connect, energize, and heal. As a Clinical Social Worker at the University of Wisconsin Carbone Cancer Center trained in Dignity Therapy, Jean Ligocki uses the power of storytelling as medicine for patients with terminal illness. In this episode, Jean shares some amazing encounters she has had with patients and their families undergoing Dignity Therapy as part of end-of-life care.

Dr. Ruth O'Regan is the Division Head of Hematology and Oncology in the Department of Medicine at the University of Wisconsin School of Medicine and is an associate director of the University of Wisconsin Carbone Cancer Center. Dr. O'Regan specializes as a breast cancer physician and researcher. She is ranked by Newsweek/Castle Connolly Medical as one of the top oncologists in the nation. She received her MD from University College in Dublin, Ireland. She completed her internal medicine residency at Northwestern University and the Medical College of Wisconsin. She completed fellowships in Oncology from Mater Hospital in Dublin and Northwestern University. Dr. O'Regan is the Chief Scientific Officer of the Big Ten Cancer Research Consortium. She is the Vice-Chair of the Wisconsin Association of Hematology and Oncology, and is on the Executive Committee for the National Comprehensive Cancer Network. Prior to the University of Wisconsin, Dr. O'Regan was the chair and medical director of breast cancer research at Emory University, and the director of breast cancer research at the Winship Cancer Institute. Tune in to hear about breast cancer: causes, symptoms, treatments, and much more.

In the latest episode of Lung Cancer Considered, three experts in thoracic oncology from around the world discuss and share their stories and experience about diversity and equity in medicine. This episode features a conversation between Dr. Narjust Duma, assistant professor of medicine - thoracic oncology at the University of Wisconsin Carbone Cancer Center; Dr. Jhanelle Gray, chair of the department of thoracic oncology and program co-leader for chemical biology and molecular medicine at the Moffitt Cancer Center; and Dr. Clarissa Mathias, Brazilian Society of Medical Oncology president, IASLC Board Member, Chair of the ASCO International Committee and Medical Oncologist at Grupo Oncoclinicas.

Dr. Toby Campbell, a thoracic oncologist and chief of the Palliative Care program at the University of Wisconsin Carbone Cancer Center, reveals how the COVID-19 pandemic is impacting his work with seriously ill patients, and tackles the challenges of communicating with families forced to distance themselves from their loved ones.  Dr. Campbell also discusses the promise of telehealth palliative care as a way to get clinicians connecting with more patients and families in this health crisis and beyond. 

This podcast reviews the results of KEYNOTE 164 investigating the use of pembrolizumab for mismatch repair deficient metastatic colorectal cancer, the place of this agent in the current clinical paradigm, and future directions to identify which patients are most likely to benefit from this treatment strategy. TRANSCRIPT This JCO Podcast provides observations and commentary on the JCO article 'A Phase II, Open-Label Study of Pembrolizumab in Treatment-Refractory, Microsatellite Instability-High/Mismatch Repair-Deficient Metastatic Colorectal Cancer: KEYNOTE-164' by Le et al. My name is Dustin Deming, and I am an associate professor at the University of Wisconsin Carbone Cancer Center in Madison, Wisconsin. My oncologic specialty is gastrointestinal oncology. Microsatellite instability high status or mismatch repair deficiency is found in approximately 15% of early stage colorectal cancers, but only 3-4% of metastatic colorectal cancer. The mechanisms by which these cancers acquire their DNA repair aberrations can vary, including germline mutations, somatic mutations and promoter methylation, which is often observed in the setting of the hypermethylation phenotype associated with BRAF mutations. This distinct colorectal cancer subtype is of particular interest for immunotherapy strategies as the lack of adequate mismatch repair can lead to 1000s of mutations and also fusions leading to the potential for expression of more neoantigens.   This world-wide phase 2, open-label study enrolled 124 patients with microsatellite instability high or metastatic mismatch repair deficient colorectal cancer following 2 or more lines of standard therapy in cohort A and following 1 or more lines of therapy in cohort B. Patients received pembrolizumab 200 mg every 3 weeks, up to 2 years, until progression, unacceptable toxicity, or withdrawal. The primary endpoint was objective response rate by Response Evaluation Criteria in Solid Tumors version 1.1 by independent central review and secondary endpoints included duration of response progression-free survival, overall survival, safety and tolerability.   At the time of this report the median follow-up for cohort A was 31.3 months and 24.2 months for cohort B. The objective response rate was 33% for both cohorts. This includes 7 patients who achieved a complete response. The median PFS was 2.3 months for cohort A and 4.1 months for cohort B. For those patients that developed an objective response the duration of response was quite prolonged with the median duration of response not reached in either cohort. The median overall survival was 31.4 months for cohort A and not reached in cohort B. This treatment was well-tolerated in this population with the most common toxicities being fatigue, pancreatitis, and increased alanine aminotransferase or lipase.   Overall pembrolizumab is an exciting addition to the treatment strategy for patients with metastatic mismatch repair deficient cancers. Based on these results, in part, this agent is now FDA approved for patients with previously treated microsatellite instability high or mismatch repair deficient metastatic colon cancers after fluoropyrimidine, oxaliplatin, and irinotecan, and for patients also for non-colorectal solid tumors following at least one prior therapy, regardless of tumor type or origin. This was the first FDA approval of a tumor histology agnostic anticancer therapy.   Long-term follow-up from this, and similar cohorts, is required to further define the duration of response for these patients, as there is hope that some of these patients could even be cured. Unfortunately, it is only a minority of patients that seem to benefit from this approach as demonstrated by the short median progression free survival in both cohorts. A better understanding of which patients are likely to benefit from immunotherapy approaches are clearly needed.    The presence of Lynch syndrome was not captured in this study to evaluate for differential response in this setting. The BRAF mutation status was collected and across both cohorts 14 patients had BRAF mutant cancers. The response rate for these patients was 43%. A similar benefit was also observed in KRAS or NRAS mutant and wild-type cancers. This study was limited in its ability to further assess those factors that could influence pembrolizumab response given the relatively small sample size and limited biospecimen collection.   Further clinical trials are investigating the use of anti-PD1 therapies for these patients in the first-line and adjuvant settings, in combination with chemotherapy and with other immune checkpoint agents, such as CTLA4 and LAG3, among others. This includes Checkmate 142, which is a phase II study that is examining nivolumab and ipilimumab in a cohort of 46 patients with microsatellite instability high or mismatch repair deficient colorectal cancer in the first-line setting. Preliminary results were presented at the 2018 European Society of Medical Oncology meeting demonstrating a 60% objective response rate and a 12 month progression free survival of 77%. These early results are promising, but further investigation is needed.   As we look forward to which factors could be leading to a lack of clinical benefit from these agents it is important to consider those factors that are intrinsic to the cancer cells, tumor microenvironment, and patient specific factors. Tumor cell intrinsic factors include important cell attributes for the immune response such as the tumor mutation burden, MHC class I expression, including beta-2-microglobulin expression, the mutation profile, including alterations in WNT signaling shown to be important for immunotherapy resistance in metastatic melanoma, and tumor heterogeneity. There is also a growing understanding of factors that are important within the tumor microenvironment for tumors to be permissive to immune cell infiltration. These factors include differences in the immune and fibroblast cell subtypes present and also the presence of certain matrix proteins. This includes a matrix proteoglycan called versican that my laboratory and others have demonstrated has immunosuppressive properties, but can be cleaved by ADAMTS proteases to an immunostimulatory fragment. Additionally, patient specific factors need to be considered such as the microbiome, immunosuppression and adverse event management.   In summary, the results of KEYNOTE 164 are a significant advance for patients with microsatellite instability-high and mismatch repair deficient cancers. Long-term follow-up from this study and further studies into the most efficacious clinical setting to use these agents will continue to advance the clinical use of immunotherapy options for these patients.   This concludes this JCO Podcast. Thank you for listening.

Dr. Noelle LoConte, associate professor of medicine at the University of Wisconsin, presents two patient cases regarding cancer prevention. TRANSCRIPT Hello. My name is Noelle LoConte. I am a physician and associate professor at the University of Wisconsin Carbone Cancer Center in Madison. I am a GI medical oncologist in my clinical practice, and also the principal investigator of my state's Comprehensive Cancer Control program, and an implementation science researcher in cancer prevention and screening.  Today, we will compare two patient cases that relate to cancer prevention. These two cases have similarities yet the recommended treatments may be different. Let's look at our cases.  Patient case number one is Harold. Harold is a 55-year-old man with a history of head and neck cancer treated with curative intent with chemotherapy and radiation, which was completed about six months ago. He is seeing you for a follow-up surveillance visit. He reports he is currently drinking three to four beers per day, most days of the week. He had quit smoking at diagnosis, but prior to diagnosis had a 45 pack-year history. He recently reports that he started vaping or using e-cigarettes.  Our second patient case is Susan. Susan is a 44-year-old woman with node-negative, ER-positive, PR-positive, HER2 neu-negative breast cancer. She has also been treated with curative intent with surgery, chemotherapy, and radiation, and has completed her treatments about six months ago. She is seeing you for a routine follow-up visit and reports no new symptoms. She tells you she is drinking two glasses of wine per day, and she denies any history of smoking.  As you can see, both cases are very similar, but there are some differences. How would you counsel each patient about their use of alcohol? And in the case of Harold, about his use of e-cigarettes? Do either of these affect the risk of recurrence for the patient? And what are the alcohol-associated cancers?  For background, the cancer burden attributable to alcohol is significant. In 2012, an estimated 5.6 percent of worldwide cancer deaths were attributable to alcohol-associated cancers. In the United States, alcohol accounted for about 3.5 percent of cancer deaths in 2009. Both of these numbers are increasing over time as alcohol use is becoming more common both in the US and globally.  Upper airway and squamous cell esophageal cancers accounted for the majority of alcohol-attributable deaths among men. Breast cancer accounted for the majority among women. Additional cancers causally linked to alcohol include hepatocellular carcinoma and colorectal cancer. Cancer risk correlates with increasing alcohol consumption for cancers in which alcohol is implicated.  E-cigarettes are currently approved for adults as a way to decrease the harms from combustible tobacco products, but much about their risk remains unknown, particularly for cancer survivors. Although the risk appears to be lessened with e-cigarette use, they are not proven to be safe and can often serve as a gateway product for youth and nonsmokers to more traditional combustible smoking products.  In both cases, each patient has an alcohol-associated cancer. However, it is unclear for all but head and neck cancers and esophageal squamous cell carcinoma if cutting down on alcohol intake after cancer diagnosis reduces the risk of recurrence. E-cigarette use among cancer survivors is an emerging issue for clinicians, who often do not know how to counsel their patients about these products.  For Harold, with his head and neck cancer, there is clear data that supports that patients with that diagnosis who continue to drink do have higher rates of recurrence and also secondary head and neck cancers. Thus, the oncologists should counsel him to stop, or at least cut down on his alcohol drinking.  The current guidelines recommend no more than two servings of alcohol a day for men and no more than one per day for women. As a reminder, a serving of alcohol varies dependent on the product being consumed. It is roughly one 12 ounce bottle of regular beer, five ounces of wine, or 1 1/2 ounces of distilled spirits.  For Susan, who has an estrogen and progesterone receptor-positive breast cancer, the data is less clear. There is a suggestion in some studies that ongoing alcohol use for hormone receptor-positive patients may increase the recurrence rates. However, the data is not definitive. It would be prudent for all health risks related to alcohol to counsel her to stick to the recommended amounts of alcohol use, however. So for her, this would be one drink per day for women.  For e-cigarette use, a 2015 ASCO and AACR statement on ENDS, or electronic nicotine delivery systems, concludes that oncologists should not recommend e-cigarettes to their patients as first-line treatment for quitting smoking. Oncologists should also be aware that more and more cancer survivors are using e-cigarettes and similar products, and they should ask about use at each visit. The unclear health risks of e-cigarettes should be discussed with patients.  Thank you for listening to this week's episode of the ASCO eLearning weekly podcast. For more information on cancer prevention, including additional patient cases and opportunities for self-evaluation, visit the comprehensive eLearning center at elearning.asco.org.  [MUSIC PLAYING]  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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. 

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 world’s leading professional organization for doctors who care for people with cancer. 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. 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 the data described here may change as research progresses. Many people are aware that quitting smoking or other tobacco use will reduce the risk that someone will develop cancer. In today’s podcast, Dr. Noelle LoConte, Dr. Jeffrey Gershenwald, and Dr. Cynthia Thomson will discuss their article from the 2018 ASCO Educational Book, “Lifestyle Modifications and Policy Implications for Primary and Secondary Cancer Prevention: Diet, Exercise, Sun Safety, and Alcohol Reduction,” and share tips for other changes people can make to reduce their cancer risk. Dr. LoConte is a medical oncologist at the University of Wisconsin Carbone Cancer Center and an Associate Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. Dr. Gershenwald is Professor in the Department of Surgical Oncology at The University of Texas, MD Anderson Cancer Center. Dr. Thomson is a Professor and Director of the Canyon Ranch Center for Prevention and Health Promotion in the Mel and Enid Zuckerman College of Public Health at the University of Arizona. Published annually, the Educational Book is a collection of articles written by ASCO Annual Meeting speakers and oncology experts. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology. ASCO would like to thank Dr. LoConte, Dr. Gershenwald, and Dr. Thomson for discussing this topic. Dr. LoConte: Hello, my name is Dr. Noelle LoConte from the Carbone Cancer Center. I’m joined today by Dr. Jeffrey Gershenwald, from The University of Texas MD Anderson Cancer Center, and Dr. Cynthia Thomson from the University of Arizona Cancer Center. In this podcast, we will be sharing some key points from our 2018 ASCO Educational Book article titled, “Lifestyle Modifications and Policy Implications for Primary and Secondary Cancer Prevention: Diet, Exercise, Sun Safety, and Alcohol Reduction.” Lifestyle behaviors and their impact on a person’s cancer risk have been widely studied by cancer researchers. Experts have found that modifiable behaviors, like diet and exercise, account for between 30 to 50 percent of cancers. And, many reports have found that if Americans followed the cancer prevention recommendations issued by the American Cancer Society, that cancer rates could be reduced by about 17% overall and by up to 60% for some cancers in high-risk groups. One major driver of cancer risk is obesity. Dr. Thomson, you’ve done quite a bit of work studying obesity and cancer risk. Can you tell us about what you’ve learned? Dr. Thompson: I’d be happy to, Dr. LoConte. Over the past several decades, rates of obesity have risen to epidemic proportions in the United States, and it is likely that this factor has contributed to higher rates of several cancers in America. Experts estimate that obesity increases cancer risk as much as 20% overall and 50% for people under the age of 65. These findings mean that we need to promote life-long weight management as a way to reduce the rates of cancer. For those who are overweight or obese, losing even a small amount of weight has been shown to have health benefits. Dr. LoConte: What foods should be avoided to reduce cancer risk and maintain a healthy weight? Dr. Thompson: Avoiding sugary drinks, processed meats like those we find in the deli, red meat, and refined grain products like white bread, can promote weight control and thus help some people to reduce the risk of cancer. We should try to eat more of a variety of vegetables, fruits, whole grains, and legumes. Ideally, a person would eat at least 2 and half cups of vegetables every day.  And of course, alcohol consumption should be reduced or eliminated. Dr. Gershenwald: What are some other ways people can manage their weight? Dr. Thompson: Controlling the amount of food you eat is the most important step toward weight loss and weight control. But physical activity is another great way to maintain a healthy weight, Dr. Gershenwald. Adults should engage in at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity each week. Children and adolescents should engage in at least 1 hour of moderate or vigorous intensity activity each day, with vigorous intensity activity at least 3 times per week. A good way to tell what level of activity you’re engaging in is the talk test. During a moderate-intensity activity, you should be able to carry on a conversation, but not sing. During a vigorous activity, you should be breathing heavily. In general, we need to try to limit the amount of time we’re sitting, lying down, watching television, or playing on our phones. These sedentary activities can negatively impact our weight and our health. Dr. LoConte: Dr. Thomson, you mentioned earlier that alcohol consumption should be reduced or eliminated to help with weight loss, and I wanted to talk a little more about that. We know that alcohol negatively affects a person’s weight, but we are now learning more and more about how alcohol and cancer are related. Head and neck cancer, breast cancer, squamous cell esophageal cancer, liver cancer, and colorectal cancer have all been linked to alcohol. Dr. Thomson: Is the cancer risk for alcohol consumption dependent on how many drinks a person has per day? Dr. LoConte: Although risks are highest with moderate and heavy drinking, there is increased cancer risk even among light drinkers. Studies have shown that if someone only has 1 drink per day, they may be putting themselves at an elevated risk for some types of cancer, like breast cancer. For cancer prevention, it’s best not to drink alcohol. The take home point is that the more you drink, and for the longer the period of time, the higher your risk of cancer. As an oncologist, it’s important for me to be honest with my patients about the role of alcohol and cancer. This is really hard because we live in a culture where alcohol use is widely accepted as a norm. Dr. Gershenwald: What kinds of alcohol are associated with cancer risk? Dr. LoConte: All kinds, Dr. Gershenwald. Wine, beer, and liquor. In any form, alcohol plays a role in carcinogenesis—meaning it helps cancer grow. A drink is considered to be 5 ounces of wine, 1.5 ounces of distilled spirits, or 12 ounces of 5% beer. Dr. Thomson: Another behavior that is tough to change, but is critical for cancer prevention, is overexposure to ultraviolet, or UV, radiation. Dr. Gershenwald, this happens to be your area of expertise. Can you tell us more about how UV radiation exposure impacts our risk for cancer? Dr. Gershenwald: I’d be happy to, Dr. Thomson. UV radiation exposure is a major contributor to risk for and cause of most skin cancers, including melanoma, the most lethal. It is somewhat alarming to hear that nearly 95% of all melanomas arising on the skin, as well as deaths from melanoma in the United States, are attributable to UV radiation. When melanoma is caught in its early stages, it is very treatable and most patients have favorable outcomes. But when melanoma is diagnosed at later stages, it can be highly aggressive and difficult treat. Dr. LoConte: If such a significant fraction of melanomas are related to UV, is there anything people can do to reduce their risk of cancer due by reducing UV radiation exposure? Dr. Gershenwald: Absolutely. Using broad-spectrum sunscreen with an SPF of at least 30 and wearing protective clothing–including wide-brimmed hats, long-sleeved shirts, and sunglasses as some examples–can help reduce the harmful effects of ultraviolet radiation when you’re outside. Try not to be outside between 10 AM and 2 PM when the sun’s rays are the strongest, and if you are, try to seek shade. Sun-protection practices are important for people of all ages, but are especially important for children and teens. Having 5 or more blistering sunburns while young has been estimated to increase a person’s risk of melanoma by about 80%.  Facilitating the use of sunscreens in our schools is also a great way to promote sun safe behavior at a young age. Dr. LoConte: What about tanning beds? Are they a safe alternative to the sun? Dr. Gershenwald: No, they are not safe, Dr. LoConte. Tanning beds emit the same kind of UV radiation as the sun. Avoiding tanning beds is important to reduce the risk of skin cancer. Starting indoor tanning before age 18 increases melanoma risk by 85%, and starting between age 18 and 24 increases melanoma risk by about 90%. Dr. LoConte: Thank you, Dr. Gershenwald. To summarize what we’ve discussed today, there are many known behaviors that can help reduce a person’s risk of cancer, including maintaining a healthy weight, avoiding alcohol consumption, and protecting against ultraviolet radiation. Healthy lifestyle choices promote a cancer-suppressing environment in our organs, tissues, and even at the DNA level, thus increasing the potential together to reduce cancer risk. I hope you’ve enjoyed our podcast. To learn more, please view our article online at ASCO.org/edbook. Thank you. ASCO: Thank you Dr. LoConte, Dr. Gershenwald, and Dr. Thomson. Please visit ASCO.org/edbook to read the full article. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. Cancer.Net is supported by ASCO’s Conquer Cancer Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/support.

September is Gynecologic Cancer Awareness Month, which seemed like a great opportunity to learn more about BRCA. When present, BRCA mutations can increase our risk of certain types of cancer, including breast and ovarian cancer.  In this episode of the Women's Healthcast, Dr. Lisa Barroilhet talks about how BRCA mutations work, the risks and benefits of genetic testing, and what a positive BRCA test means for cancer treatment and prevention. Dr. Barroilhet is a gynecologic oncologist and ovarian cancer expert in the UW-Madison Department of Obstetrics and Gynecology. If you’re in the Madison area and would like to support gynecologic cancer research happening at the University of Wisconsin Carbone Cancer Center, please join us on September 29 for our annual Sparkle of Hope Gala. Meet the researchers and providers working to improve gynecologic cancer care and celebrate with survivors and families. More information and tickets are available at sparkleofhopemadison.org.

Dr. Jim Cleary talks with Dr. Pennell about this new resource-stratified guideline, which provides guidance to clinicians and policymakers on implementing palliative care in resource-constrained settings.   Welcome back, everyone, to the ASCO Journal of Oncology Practice podcast. This is Dr. Nate Pennell, medical oncologist at the Cleveland Clinic and consultant editor for the JOP. Now over the last decade or so, there has been a major change in our approach to the care of advanced cancer patients with the recognition of the importance of palliative care. There have been a number of trials now showing that integrating palliative care into cancer patients' care can make a major impact on their quality of life and possibly even their survival. And as a result, the involvement of palliative medicine has become part of treatment guidelines. However, much like cutting edge biomarker testing or expensive drugs, specialist-driven palliative care also takes a fair amount of resources that are not available everywhere. So joining me today to talk about this is Dr. Jim Cleary, who just moved from the University of Wisconsin Carbone Cancer Center, where he started the palliative care program in 1996 and for the last seven years, has led the Pain and Policy Studies Group, a WHO collaborating center for pain policy and palliative care. He's now been recruited to the Indiana University School of Medicine in Indianapolis, where he'll be the professor of medicine and Walther's senior chair in support of oncology and director of the supportive oncology program at the IU Simon Cancer Center. He's going to focus on building a program focusing on global supportive care and palliative care, which makes him the perfect person today for us to talk to about the recommendations of an expert panel that's going to be published this month in the JOP titled, Palliative Care in the Global Setting ASCO Resource-Stratified Practice Guideline Summary. Jim, thanks so much for joining us. Why, thank you very much for having me-- a real honor. So can you start out a little bit by telling us about the progression of the role of palliative care in oncology, and what has led to the impetus for forming the panel that you were a part of? So if we look back historically to the introduction of palliative care throughout medicine, it's actually been primarily in cancer care. If we go back to the original WHO guidelines in the 80s, it was all focused on cancer patients. And it's interesting if one looks at the very definition of palliative care from the word go, they said all the principles of palliative care can be applied upstream, earlier in the course of patients' illnesses from the-- even from the 80s. But as we look at it historically, and particularly in the US, with the introduction of the Hospice Benefit, palliative care really became brink of death care. So that you didn't get hospice or pallative care involved until someone was actively dying. So we were missing out on that very principle of-- let's address all the issues, the skills that palliative care provides early on. Let's address these earlier on in the course of people's illness, particularly when it comes to people with advanced disease. And it doesn't just have to be advanced disease to be including the skill set. So people who are getting chemotherapy, some may support it or call it supportive oncology, but really, it's the same principle-- supportive oncology, palliative care. It's total person care of patients with cancer and dealing with cancer. So as we look at those, the studies have been coming out saying it improves quality of life. You mentioned the survival benefit that's been suggested or hypothesized. And while that may be there, for me, that's not the primary reason for doing this. It's the right thing to be doing-- to be addressing quality of life. And even trying to get us to move beyond what seems to be that magic mark of survival-- length of survival or time of survival may not be the only important thing. Quality of life is becoming increasingly important as we address many of these issues. ASCO has recognized this, and in 2016, they actually published a paper-- again, a guideline-- the integration of palliative care into standard oncology care. And that was released in 2016, and it was based on what we would call research that was done in maximal resource institutions, largely in the high income countries. The United States, Canada, Western Europe, Australia-- those sorts of countries. What the situation is in the world is that probably 80% of the cancers are now being diagnosed in low and middle income countries. And in those countries, most people are actually being diagnosed with advanced disease. And this comes from the paucity of person power in terms of diagnosis, the lack of surgeons, the remoteness that these people-- where they live. They're really presenting in different ways. So as ASCO looked at this, and they've done this as well with cervical cancer, they said, let's get a guideline that is resource-stratified. So let's look at the issues that low and middle income countries face in getting this integration of palliative care and supportive oncology across the board. And that's what we aim to do in this setting. No, that sounds like a very important intervention. I have a soft spot in my heart for this topic. Because when I was a fellow at Mass General Hospital, that was when Jennifer Temel was running her initial trial of head of care that led to this possible survival benefit, which was just suggested retrospectively, or at least post hoc, in that analysis, but I remember when this was greeted with a lot of skepticism-- that palliative care was that important in cancer care. And of course, now people broadly accept how important it is. So I'm great to see that this is going to be extended outside of just academic centers in the United States. So one of the questions I have for you before we kind of delve into your paper, and this is a conversation I've had with Dr. Temel, as well. Most of the data is not just in maximized resource centers and countries, but also seems to focus on specialists trained in palliative medicine. Do we understand the aspects of palliative medicine, and what leads to quality of life benefits, enough to be able to extract those different pieces out and then extend them out beyond palliative care trained physicians? I don't think we do yet. And we need to do more research on this. And I know that Jennifer currently has a query study that is looking at the role of telemedicine. At about the same time that Jennifer was doing the study in Boston, we actually did a similar study out of the University of Wisconsin, which looked at an internet intervention through CHESS-- Comprehensive Health Enhancement Support System-- and the service was integrating palliative care information, internet support for both patient and caregiver. And we actually found a survival benefit that mirrored this-- the Temel effect-- for people who use the internet system. So I don't think we have a very good start understanding at all. I think Charles von Gunten has equally identified that there is this difference between primary, secondary, and tertiary palliative care. And primary palliative care is what all clinicians should be able to do. In Charles' papers that he's written on this, he's talked about oncologists should have a secondary level of palliative care knowledge and experience and be able to do this. And then really you need the tertiary level, or the specialty team, involved in palliative care for the difficult cases. I'm not convinced, still to this day, that I need to see every cancer patient with advanced disease. What we need to do in palliative care teams is actually fill in the holes when the current treating oncology team is not able to provide them. And if you have an oncologist who is excellently trained in symptom management, communication-- together with good nurses and social workers, pastoral care, spiritual care, who can come in and help with this-- the role of the palliative care physician may actually go on the palliative care team. Maybe a little moot in most settings, but really, it's filling in the holes and coming in and making sure that patients are getting the appropriate level of care. That appropriate level of care really does become tough in resource poor-- resource challenged settings. And that's probably true even in the United States, as well as in low and middle income countries. If the only health care center within 100 miles is actually with a primary health worker with minimal training, how do you get appropriate oncology care, let alone an appropriate palliative care integrated into that? And I think one of the challenges that some of our panelists from low and middle income countries had was, well, how do you actually define good cancer care in our country? And that continues to be a country many people-- and I'll come back to remind listeners that hepatocellular cancer is actually one of the most common cancers in the world. And many of these people who have, and end up dying of, hepatocellular cancer never actually see an oncologist. Now I agree that that makes sense in so many places-- just even in our own country here, patients struggle to reach specialist oncology care. And so I think the idea of Jennifer's, of trying to be able to do palliative medicine consults with telemedicine, is certainly an interesting potential solution for that. So let's just dig into the panel's recommendations here, shall we? The guidelines are divided into different sections. And each section is very nicely broken down into what you term as basic, limited, enhanced, and maximal sections, depending on the available resources. So maybe we could go through them one at a time, and you can talk a little bit about them. So I think the first section is called, "Palliative Care Models." Can you talk a little bit about that? So what we were doing with the palliative care model with the [? gain, ?] if you think about some of these basic, limited, enhanced, and maximal, we were saying, hey, basic is the primary health care center which I mentioned. It may be a community health worker, or a clinical officer as they are commonly called. It may not be a physician. There may be a nurse, but they may not even be a nurse in some of those settings. So the recommendation is that we should be training and addressing these people to actually even start thinking about palliative care needs in this setting. So it's saying throughout the whole system, we need to be building in palliative care needs. Particularly in advanced cancer, one of the issues that comes up significantly, and is under Item 7, is ensuring that we have access to opioids for pain relief. And this becomes very difficult if you're talking about a rural community-- no one with a physician license or a nurse license. How do we actually get appropriate pain relief to these people, who may never see an oncologist, as they're dealing with advanced cancer needs? So we've gone through and actually looking at the strength of evidence saying, yes, this has to be integrated throughout the whole health care system. And there are evidence from different models as we look at places like Kenya and Malawi as they've introduced palliative care throughout these settings. It's quite possible. Uganda actually has nurses out in many of the districts in Uganda, who are now licensed because of their special training, to actually dispense morphine. And that's a real change. We go to other countries, which have a shortage of physicians interested in palliative care and doing this, and there are physician groups who actually say, there's no way nurses are ever going to be able to do that. Professional protectivism, if you want to look at it-- boundary protecting. No right answers, but I think these need to be considered. And we need to think outside the box with the models of care that we're providing to ensure the appropriate people are getting them. I visited a hospital in Zambia-- the Children's Hospital in Lusaka-- where each child with leukemia had a small bottle of morphine on the top of their locker, which the parents were administering to the children for appropriate pain relief because of their leukemia. Really quite incredible to watch this going on in a resource poor setting, and this was entrusted to the parents to do with appropriate education. Because they're the ones who are most concerned and available to do this sort of work. I've actually been to hospitals in other parts of Africa where the drug cupboard has actually been empty and the lock broken, and it takes 15 to 20 minutes to go to central pharmacy to actually get some morphine. So when someone is complaining of pain, that's not a good situation. So we need to make sure that all of these things actually fall into place and develop good care models. And that's really what recommendation number one does. Recommendation number two goes to look and talks about timing. And this comes up as a critical-- when should you get palliative care needs addressed? And as I said with the primary, secondary, and tertiary, really, they should be addressed from the point of diagnosis, if not even before diagnosis if you suspect someone has advanced disease. And so you're really saying, hey, let's consider this from the word go with everyone in the course of the illness-- a palliative care team, not just the needs of the patient. But a team, in the basic and limited settings, should probably get involved with overwhelming symptoms, particularly metastatic disease. And if a decision not to go for life prolonging therapy is made, that's when I think we need to be engaging teams at that stage. And really, it's coming in with the maximal. And if you've got the appropriate resources, it's saying everyone. And this comes from the 2016 guidelines as well. We should have this integration early in the diagnosis and ideally within eight weeks of diagnosis. The palliative care team should actually be involved at that stage. Oh, that makes perfect sense. I certainly remember when this idea of early palliative care started coming out. And it's so much easier for the patients when they are plugged in and connected with the palliative medicine team earlier in their disease, rather than trying to call them in late. And it's much more jarring and disturbing to them, and they don't get nearly as much of the benefit of the care, I think, at that point. And often pain control is a way I get involved early on. Other symptom management-- how can we help you through chemotherapy? Some of the issues go on. It does actually open up opportunities. Yes, I can maybe spend some more time there than the oncologist. Many nurse practitioners-- advanced practice nurses-- are actually doing this on their own. But it's coming in and helping the oncologist. It's building up that team. And as the disease transitions, that jarring nature of all this-- this guy who's now coming to meet you because I've run out of options. No, you're part of the team from the word go and will continue to stay involved. Yeah, absolutely. I think that has been my experience, that that makes the best sense. So the third section of the guideline addresses the workforce knowledge and skills. And how does that vary from the various resource levels. So this comes up, the resource levels and if you even go back to the WHO definitions of palliative care, we use the term interdisciplinary. It's very hard to be interdisciplinary when you're a single person. Although I often joke that Dame Cecily Saunders, who started the modern hospice movement, was trained as a nurse, a social worker, and a physician. So she could have a multidisciplinary team all by herself. So it's the basic level. If you're a single clinical officer, that may be very difficult. A single nurse-- that interdisciplinary team is really something that may be hard to come by. But having those basic skills is something that we need to teach. But as we move up into the limited or district level facilities, working on building teams together, and teams in some cultures-- and particularly with the nurse-physician relationship not being as strong as I think we see in most places in the United States, Europe, and Australia and New Zealand-- often these are real issues of hierarchy between the physicians and nurses. But we need to be ensuring that they do function as a team to maintain and provide the best level of care. So that's one of the things that we're looking at, recognizing that we are a team that does this. And that team continues to grow, particularly, we hope, with regional facilities or the enhanced level with the introduction of a counselor into that level. Again, if you look at the resource poor areas when you start talking counselors, one statistic I've heard is that there are three psychiatrists for the Horn of Africa, which is Ethiopia, Somalia, and those areas. And you think of only three. So the ability to train-- or having trained counselors around-- is something that is not common. So it's really integrating across the board, particularly as we move up to higher levels-- regional facilities and then to maximal, national cancer centers-- making sure that we have appropriately trained social workers and counselors available to join this team. So addressing all of the members of the team-- you know, the nursing roles, the spiritual care, the counseling-- and then just the recognition that in some places it may end up being the caregiver, or the physician, or whoever they are dealing with, that has to assume many of these roles, I think, is a nice recognition. Ideally, you'd love to have a large interdisciplinary team. But it's having the available resource, rather than who does it, that is important. Exactly right, and in many cases, it may actually be the nurse who is doing most of this work. And we even find that in our own situations here, it's often the nurses giving chemotherapy who may be doing a lot of the counseling with patients while they're administering the chemotherapy. I even make the comment to our own folks in in-patients, it may actually be the person who's working on housekeeping who is actually doing a lot of interaction and hearing of the needs of the patient, just because they feel comfortable talking to them, whereas they don't share that with others. So we don't exclude any member of this team across the board. That's really interesting. I don't know if you read Bloom County, the comic strip, but there is a storyline over the last couple of years of a sick child in the hospital. And it's the maintenance man who ends up providing most of the support to the child in this family and it's a really touching storyline. It reminds me of that a little bit. So I hope that's not because we weren't providing it, which is often something that can happen. But I think it reflects some of the comfort that people do have in dealing with like people. White coat syndrome, I think, applies as much to adults as it does to children. We need to look at those issues, that talking to that man-- that person in the white coat who stands at the end of the bed with 15 other people. That's not really a situation where you can share your inner thoughts and feelings. No, I think that's true. And then you touched on this a little bit earlier, but the seventh and certainly a very critical component of this, is the availability of opioids to help deal with pain. I guess it hadn't really occurred to me that this was a major problem, because drugs like morphine should be relatively inexpensive. But this is I'm guessing a major issue throughout the world. So 80% of the world's population lack access to appropriate pain control. And it's even made worse by the current dilemmas that we're facing, the unbalanced situation that we have in the United States with the current heroin and fentanyl crises. And I say that, because I think we've moved somewhat beyond most of the deaths being caused by prescription opioids. There's increasing evidence that people in the United States are getting first access through heroin and illicit fentanyl. So that these people are lacking access to the basic essential pain medicines, both postoperatively and as they deal with advanced cancer. And so we're even seeing some of that now reported in the United States, that people are actually being denied access to opioids, because of shortages in this country, as they deal with cancer. So it's a critical issue. We need to make sure these are all available. We saw even back in the 90s-- we saw some pharmaceutical companies in China saying, you guys don't need an immediate release morphine. Just use sustained release morphine. The reality is that immediate release morphine, even a morphine solution, together with injectable morphine, is something that should be available at the most basic settings for pain control of cancer patients. And then we can move up oral morphine together with sustained release, if you need to, in different forms. The costs can change. We see some countries in the world with fentanyl patches as the primary medicine used. But the cost of these is dramatically much greater than, in fact, it is for immediate release morphine. People say that levels are steadier, it's better pain control, and things with fentanyl patches, but the evidence doesn't necessarily support that overall. And so we will come back to the gold standard being very much based on oral morphine and making sure that's available in different formulations. And I will stress while this guideline was for adults, one of the advantages of a morphine solution does allow you to titrate and dilute the morphine appropriately for children across the board. You can't do that necessarily with tablets. So I think there are absolutely access to medicines-- and not just the opioids, but particularly the opioids-- is something that's being addressed with a number of levels and making sure that the current situation in the United States doesn't come back and not only rebound here for cancer patients, but really impact cancer patients around the world. Yeah, that's certainly a major topic in the United States, and I'm sure that's true elsewhere, as well. Well, so that brings me to my next question, which is-- while these recommendations make wonderful sense, and in many ways it's kind of reassuring. Because in some places when I talk about palliative care, and they say, well, you know, we don't really have access to specialist palliative care, a lot of this can be done just about anywhere as long as there are recognized the aspects of palliative medicine that are available and necessary. So what are the next steps to this? So the guideline is going to be published. How is ASCO going to work to try to make some of this more available? So I think it reflects the impact of ASCO around the world. ASCO is-- while it's the American Society of Clinical Oncology, it actually has very, very real impact. We're starting to see research take place. So the African Palliative Care Association is already beginning to use a palliative care outcomes scale, together with King's College in London to bring about this. So it's actually-- we're seeing a push. I think we're going to see some of the QOPI measures come out and be part of this international work. So for instance, as you mentioned, getting chemotherapy in the last two weeks of life is a negative QOPI indices. Getting people into hospice, we're seeing as a positive as we move forward. So I think that we're going to see this overall from ASCO coming out and saying, this is absolutely critical. ASCO is a player on the international scene. Works with a number of international organizations-- the NCI, Global Health Institute, the NCCN, and others are looking at the-- the Breast Health, Global Initiative. So this is all moving forward together with the World Health Organization, the Union for International Cancer Control, UICC. Many people are targeting this, and I think it's actually going to be the overall recognition of the importance of this. Many people have followed for years, saying we will do what ASCO does. ASCO is now saying, this is important. And I think we're going to see this change in low and middle income countries because of ASCO's leadership, and that's going to be critical. Well, I certainly hope that's the case. Because this really does sound like an incredibly important initiative. So Jim, do you have any take home points you'd like to give to our listeners as we wrap up the podcast? So take home points are to realize, within your own practice, that palliative care is important to integrate. But I think at this stage, it's an awareness of the importance of palliative care in cancer care around the world. We don't often think of that outside of our own settings. But it's absolutely important. Become involved in advocacy as you move forward. And promote this, both regionally within the United States, and for those listeners who are listening outside of the United States, work with your oncology organizations to say, what are we doing with palliative care and cancer care across the board? And I think it's those sorts of things where we're actually going to be seeing those changes as we move forward. Well, Jim, thank you so much for joining me today on this podcast. I'm sure our listeners are really going to appreciate this. Thank you very much, Nate. And I also want to thank the listeners who joined us for the podcast. The full text of the paper is available at ASCOpubs.org/journal/JOP published online in July of 2018. This is Dr. Nate Pennell for the Journal of Oncology Practice signing off.

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