30928_UNC.qxp 5/2/2008 1:04 PM Page 2 UNC Linebcancererger Comprehensive Cancer Center LinesThe Cancer Program of UNC-Chapel Hill & UNC Health Care Spring 2008 Cancer Survivorship: From Clinics N.C. CANCER HOSPITAL to Communities, UNC is There LINEBERGER COMPREHENSIVE CANCER CENTER For many cancer patients, the end of active treatment creates address the needs of the growing number of cancer survivors. a lot of uncertainty. After long periods of regular treatments There are now about 12 million cancer survivors in the U.S.; and doctor visits, the routine changes. But concerns, about 300,000 North Carolinians are survivors. challenges and potential "In the past the focus health problems remain. has almost entirely "Some have described been on treatment it as being 'dropped off a and 'beating' the cliff,' " says Elizabeth cancer," explains Marci Sherwood, coordinator of Campbell, the Center's cancer survivorship principal investigator programs. "Their cancer and professor of may be treated, but the nutrition at UNC's cancer is still part of their School of Public Health. Profile: life. As healthcare "Our cancer survivors Nancy Raab-TTraub professionals, we can need programs and 4 facilitate this transition services to help them from active treatment to deal with long-term surveillance by attending health issues including to the concerns of the possible late effects of patient and managing their cancer. They some of the ongoing are concerned about physical issues related to wellness issues such as cancer and cancer Dr. Paul Godley (left) and Elizabeth Sherwood (right) meet with patient Nathan Ladd healthy eating, exercise, treatment." during his visit to the survivorship clinic. weight control and Cancer survivors in quitting smoking in Nutrition Luncheon North Carolina will now receive this kind of wide-ranging order to prevent other chronic diseases. They also need post-treatment care. Earlier this year, the Lance Armstrong psycho-social support and may have issues and concerns 6 Foundation (LAF) invited the UNC Lineberger about employment, insurance, etc." Comprehensive Cancer Center to join the LIVESTRONG The LIVESTRONG Survivorship Center of Excellence at Survivorship Center of Excellence Network. UNC Lineberger UNC Lineberger was formed with a five-year $1.5 million is now one of only eight centers in the nation designed to continued on page 3 Radiologists Bet on Simulations

Ironically, a technology originally used to develop nuclear Harriet Farb weapons is now being used by radiation oncologists at UNC to deliver more accurate doses of radiation therapy. 7 Physicists working on the Manhattan project developed an algorithm relying on random sampling to calculate the chain The upper image shows the reaction in nuclear weapons. They called it a Monte Carlo Monte Carlo predictions of simulation, and it is now used to calculate how radiation radiation dose deposited in the deposits in human tissue. lung tumor and surrounding tissue. The color map indicates the "It's nice that it can now be used to heal the sick and cure expected accuracy of the cancer," says Dr. David Morris, assistant professor of radiation calculation, with the blue region oncology and director of the UNC CyberKnife® program. "It over the tumor indicating a makes it easier for us to know what dose we are actually calculation accuracy of 99% delivering, and it will likely make it easier for us to understand or better. Leaving A Legacy: and determine the risk for tumor control and treatment 7 The Wards complications." continued on page 5 the inside line up ... 30928_UNC.qxp 5/2/2008 1:04 PM Page 3

strategy projects, training opportunities and technologic advancements between our two institutions. This partnership will N.C. CANCER HOSPITAL director’s strengthen cancer research and care and LINEBERGER COMPREHENSIVE will help both universities and our CANCER CENTER Message patients. UNC Lineberger is designated a UCRF funds were leveraged by a Comprehensive Cancer Center by $9 million gift from Fred Eshelman to the the National Cancer Institute. In today's world When cancer patients and their UNC School of Pharmacy's programs in we are exposed to physicians are working together on drug discovery, nanotechnology and Cancer Lines is a tri-annual huge amounts of getting the best treatment, information is individualized therapy. This gift will publication of the UNC Lineberger information. How on center stage. But once the routine of accelerate discoveries that can be Comprehensive Cancer Center, does information seeing doctors and nurses is in the past, translated into effective therapies for The University of North Carolina shape medical how survivors get information is less cancer patients. School of Medicine at Chapel Hill. decision-making? clear. UNC's new survivorship clinic is The first wave of UCRF innovation Dr. H. Shelton Earp, III, Director Our researchers addressing this issue for patients at UNC grants in laboratory and clinical sciences Dr. Richard M. Goldberg, Associate are looking at and in communities across the state. have been awarded. These projects range Director questions about Having more information can help from unraveling the cause of nicotine Dr. Joseph S. Pagano, Director Emeritus how the amount, clinicians plan treatment more effectively. dependency to developing a new Dr. H. Shelton Earp, III Debbie Dibbert, Director of delivery method The Monte Carlo system, profiled in technology for assessing genetic change External Affairs and type of information people receive these pages, uses information from in breast cancer. Dianne G. Shaw, Director of impacts their care. What information supercomputers to improve the accuracy The goal of the UCRF is to expand our Communications/Executive Editor helps patients to make better medical of radiation doses, especially for patients information and advance our Margot Carmichael Lester, Writer decisions? Or clinicians to offer better with tumors near the lung. understanding of cancer. In its first year, Alyson Newman, Design & Layout therapies? Or survivors to know what Information is also helping UNC we have made progress toward that goal. tests and follow-up care they need? shape priorities and programs of the We thank the NC Legislature for their „ Please remove me from your Patients are asked to make critical University Cancer Research Fund vision in creating this fund and the mailing list decisions while under the enormous (UCRF). Through listening sessions in communities we have visited for their stress of a cancer diagnosis. This stress Greenville, Asheville, Wilmington and insights. We are mindful each day of can affect how well they absorb and Greensboro, we have received thoughtful North Carolina's enormous confidence Name process information. Cancer Lines reports and useful insights from patients, and trust in what we are doing. We are „ Please add the following to the on efforts by physicians and scientists at survivors, health care professionals and grateful for this opportunity to save lives Cancer Center’s mailing list. the UNC Decision Support Lab. These citizens about the cancer priorities in and reduce suffering from cancer, in Lineberger members work at the Sheps their communities. One more session in North Carolina and beyond. Center for Health Services Research and Charlotte is scheduled for May 20. • Name develop strategies and methods to help Regionally, UNC is joining forces with Address people make decisions about their cancer East Carolina University to increase the risk, screening and treatment. flow of ideas, clinical trials, prevention City, State, Zip

UNC Lineberger Earp Receives UNC’s Thomas Jefferson Award Comprehensive Cancer Center Dr. Shelley Earp, UNC Lineberger director, faculty committee chooses the recipient. mentor and leader, citizen and colleague... CB# 7295 has been honored by his peers with the Chancellor James Moeser presented the true blue Tar Heel," Rimer said. School of Medicine 2008 Thomas Jefferson Award. The annual award at a meeting of the Faculty Council "Dr. Earp has strengthened this University of North Carolina award recognizes a UNC faculty member on April 25. Barbara K. Rimer, dean of the university not only through his own at Chapel Hill Chapel Hill, NC 27599-7295 who, through personal influence and School of Public Health and Alumni accomplishments, but by nurturing a (919) 966-5905 performance of duty in teaching, writing Distinguished Professor, wrote the citation culture of collaboration. Because of Dr. www.unclineberger.org and scholarship, has best exemplified the honoring Earp. Earp's efforts, there is better treatment today ideals and objectives of Thomas Jefferson. "A man of Jeffersonian breadth and for patients in North Carolina, and there

UNC faculty members nominate candidates depth, Dr. Earp is an exemplary scientist will be much better prevention and Printed on Recycled Paper for the honor, which carries a cash prize; a and humanitarian, educator and healer, treatment tomorrow."• UNC-Chapel Hill, ECU Team Up pledge $9 million to support cancer research at on Cancer Care, Research the UNC School of Pharmacy if a matching gift The University of North Carolina's two medical could be found. schools and their cancer centers have signed a The board of North Carolina's University memorandum of understanding that creates a Cancer Research Fund accepted the challenge partnership to advance cancer research and bring and matched the gift, generating a total leading-edge treatment to North Carolinians. investment of $18 million over five years. The Officials at East Carolina University's Brody conduct collaborative research that benefits our funds will support the work of the UNC School School of Medicine and its Leo W. Jenkins Cancer citizens," said UNC President Erskine Bowles. of Pharmacy and UNC Lineberger Center, the University of North Carolina at Chapel "Working together, medical faculty and scientists Comprehensive Cancer Center researchers whose Hill's School of Medicine and its Lineberger at ECU and UNC at Chapel Hill can accomplish work focuses on genetics, individualized cancer Comprehensive Cancer Center and the UNC far more than they could individually. This is therapy, drug discovery and drug delivery. system signed a memorandum of understanding truly a case where two plus two can equal five." "This gift is a wonderful example of a private outlining basic aspects of an arrangement where In the past few months, 12 ECU faculty have gift leveraging cancer fund money through they will work together to improve cancer care for become members of UNC Lineberger's research partnerships among cancer center faculty across North Carolinians and further research into the programs. UNC,” said Robert Blouin, dean of the UNC state's leading cause of death. School of Pharmacy. "Working together we will "Service to North Carolina is a key part of the UCRF Spurs Large Gift accelerate discoveries that can be translated into University's mission, and this new partnership for Cancer Research more effective therapies for cancer patients. Fred involving our two highly respected medical Fred Eshelman, chief executive officer and Eshelman's gift will speed the fight against cancer schools will help us advance and expand how we founder of Wilmington-based PPD Inc., had a in North Carolina and beyond," said Dr. Shelley care for cancer patients, train physicians and vision to improve his alma mater. He would Earp, UNC Lineberger director.

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Survivorship continued from page 1 action is the worst thing you could do." Read more about Ladd at nccancerstories.org grant and is charged with developing survivorship programs and services through the Expanded Services N. C. Cancer Hospital and partnering sites around The LAF designation allows UNC Lineberger the state. The Center benefits from the advice and to build on its clinical and investigative expertise of a large Community Advisory Board experience to become a nexus for survivor made up of cancer survivors and advocates from and family support, service, research and around the State. This group meets quarterly with advocacy in North Carolina. "We will the UNC team to plan upcoming activities, advise collaborate with our partners at the state level on issues of concern to the survivor community, to ensure that programs and services reach and provide feedback on progress. cancer patients and families as well as to enhance education for health providers caring Not A New Idea for cancer survivors in their communities," Campbell says. The focus on survivors isn't new to UNC Marci Campbell, LIVESTRONG Survivorship Center of Lineberger. The pediatric oncology practice has run The team also will work with Walter Shepherd, director of the State of North Carolina Excellence principal investigator, and Mindy Gellin, a survivorship clinic for about 15 years. A similar outreach coordinator, discuss program plans. clinic for testicular cancer patients who have Comprehensive Cancer Program in Raleigh, to completed treatment was recently established. expand the reach of survivorship programs and with community partners to deliver health "Through this clinic, we are piloting the use of a education to every region of the state. services," Godley says. "Another emerging idea of survivorship care plan, a treatment summary, and a Shepherd also is the executive director ours is to develop a survivorship cohort that can be transition plan to assist patients in their transition of the North Carolina Advisory utilized to answer important questions about the back to their primary care physician and life Committee on Cancer Coordination long-term health-related challenges faced by cancer after cancer treatment," explains Dr. and Control in the State Division of survivors." Paul Godley, associate professor Public Health. A cohort is a group of people who are tracked of medicine and the In addition, the Center of over an extended period of time to enable long-term Center's co-principal Excellence will share its clinical studies. Godley hopes to collaborate with other investigator. "The and outreach programs with LIVESTRONG Survivorship Centers of Excellence clinic services have colleagues at East Carolina on this new study concept. received high praise University in Greenville, from patients, and plans and Rex Hospital in Strengthened Commitment for additional survivorship Raleigh. Plans to The addition of the Center of Excellence showcases clinics for breast cancer expand to other UNC Lineberger's role as a leader in the patients, bone marrow transplant interested sites are comprehensive care of cancer patients. patients, and adult survivors being developed. The Center also represents a commitment by of childhood cancers are in "A statewide network of UNC Lineberger, UNC Hospitals and the University development." information for patients, families, and to support cancer patients throughout their cancer Researchers and clinicians will develop caregivers as well as health care professionals journey, not just while they are undergoing clinical survivorship programs for specific will be established and made accessible," notes treatment. "We are dedicated to helping them cancers at the N.C. Cancer Hospital, as well as Mindy Gellin, LAF outreach coordinator. through the transition to life after treatment," education and outreach programs at UNC and its Additionally, a peer counseling program will be built, Godley says. community based centers in Greensboro, Newton matching survivors with trained peers to provide "Becoming a LIVESTRONG Survivorship Center Grove and Wilmington. support and information primarily via telephone. of Excellence is an extraordinary honor," adds Nathan Ladd, a testicular cancer survivor from Dr. Shelley Earp, UNC Lineberger's director. "The Kill Devil Hills, N.C., finds value in the clinics. A Collaborative Effort collaboration among UNC's Schools of Medicine "Attending the survivorship clinic is the right thing The Center for Excellence Network also enables and Public Health, in partnership with North to do for me. I beat the cancer, so I want to stay on members to collaborate and learn from each other. Carolina communities, will help us understand how top of it," he says. "This clinic is the way to do that. Working together, Network members will be able to best to address the needs of survivors across the I am monitored and tested and followed for any establish best practices for survivor care. "One of the population." possible late effects from treatment. Not taking innovations we hope to bring is experience working •

Zamboni Joins UNC School of translational drug development. He also will from childhood to adult. The projects should Pharmacy and UNC Lineberger establish a Good Laboratory Practice Analytical demonstrate significant potential for advances William Zamboni, PharmD, PhD, an expert in Facility at UNC. and break new ground at UNC. translational studies of anticancer agents, has "Dr. Zamboni is one of the first scientists Competition was fierce with 123 applications joined the UNC School of Pharmacy and the recruited with help from the University Cancer requesting $18.3 million in support. UNC Lineberger Comprehensive Cancer Center. Research Fund and is a true investment in clinical Applications came from faculty representing Zamboni, who came to UNC from the research excellence," said Dr. Claire Dees, nearly 30 departments in the College of Arts and University of Pittsburgh, is an associate professor associate professor of medicine and head of the Sciences and in the Schools of Dentistry, in the School's Division of Pharmacotherapy and Lineberger Clinical Research Protocol Office. "He Medicine, Pharmacy and Public Health. Experimental Therapeutics. He is also a member is not only a terrific scientist, but also brings The first Innovation Award winners were of the School's Institute for Pharmacogenomics analytical capabilities to our Early Phase Clinical announced in February. 18 faculty members and Individualized Therapy (IPIT) and a UNC Trials Program that will place UNC in the top received Innovation Awards totaling $2.26 Lineberger member. rank of cancer centers." million in funding. In addition, 8 faculty "Dr. Zamboni brings an international members received Clinical Innovation Awards reputation in cancer clinical pharmacology and UCRF Completes First Round of totaling $500,000. Dr. Rudy Juliano chaired the will make a big impact on the development of Competitive Awards Program Innovation Award Review Committee while Dr. new therapies for the patients of North Carolina," One initiative of the University Cancer Research Richard Goldberg chaired the Clinical Innovation says Howard McLeod, the director of IPIT. Fund is the establishment of a new competitive Award Review Committee. For a detailed He will direct a drug development and clinical cancer award program open to UNC faculty to description of each of these grants, visit: pharmacology lab focusing on the translational support novel collaborative science across the www.unclineberger.org/ucrf/grant/ development of drugs, anticancer agents, and broad continua of cancer - from fundamental • nanoparticles. The lab will have the capacity to laboratory science to community intervention, support all pharmacologic studies required in from disease prevention to palliative care, and cancerLines Spring 2008 3 30928_UNC.qxp 5/2/2008 1:05 PM Page 5

Even though EBV- disease and cancer, and to teach students how to ask associated cancers rarely occur and answer important questions." faculty in the U.S., about half of And, to show them how spellbinding it can be to Hodgkins lymphoma cases, search for a cure for cancer. which occur mainly in young Nancy was one of the original group of faculty Profile adults, are EBV-associated. recruited for Lineberger. She has risen to national "As most people are prominence and has steadfastly refused to accept There are no tricks to studying the intricacies and infected with the virus, it is offers for leadership positions elsewhere. Her two complications of cancer, but for Nancy Raab-Traub important to determine why cancer develops in children, Emily, 27, a UNC graduate, and Donald, there is a lot of magic. some infected people and not others," she says. Lab 24, an Appalachian State graduate, were born in The professor of virology, who loved reading work done by Raab-Traub and her team focuses on Chapel Hill and raised in the early 20th century fantasies as a child, knew early on that her favorite identifying the viral genes expressed in these Raleigh house that Nancy lovingly restored. pastime would probably not lead to a career in cancers to determine how the genes force the • sorcery. But her chosen path would be just as infected cells to grow and become cancer. bewitching. In the eighth grade Raab-Traub visited the Conjuring Up A Career World's Fair in Seattle and saw a picture of a virus Raab-Traub started her work in Chapel Hill as a that could infect bacteria. It was the beginning of a post-doctoral fellow with Joseph Pagano, Lineberger fascination with molecular biology that would lead director emeritus and one of the first researchers to to her delving into the unknowns of the Epstein- study the cancer, nasopharyngeal carcinoma. She Barr virus (EBV). had just completed her PhD at the University of Chicago. Demystifying EBV "I was interested in how EBV caused cancer and EBV is one of eight human herpesviruses that I wanted to work with him and apply the new remain in the body after infection. More than 95 molecular skills that I had learned and helped to percent of the world has the EBV, but for people develop at the University of Chicago," she recalls. with impaired immune systems or certain Raab-Traub's research interests were piqued by a populations (like those in China, the Mediterranean job in a virology lab as an undergraduate at the and Africa), it can cause cancer. University of Michigan. "I loved the laboratory work "EBV causes all of the lymphomas that develop and was thrilled with learning how to find out in patients after organ or bone marrow important things about human disease," she says. transplantation and many of the lymphomas that That love continues today. "My major goal is to develop in patients with AIDS," Raab-Traub, UNC contribute to our understanding of the causes of Lineberger Virology Program leader, explains. Nancy Raab-Traub

Their examination clearly receiving screening tests that can detect cancer revealed the cellulose was in early, when it is treatable." the form of microfibers as According to the survey, fewer women got the small as five nanometers in recommended screening test (Papanicolaou - or research diameter, as well as Pap - tests) as body mass index increased. The composite ropes and mats. studies showed a stronger trend among white DNA also was observed, but women than black women. The studies also Briefs in much lesser amounts than showed lower rates of mammograms - which cellulose. The study was screen for breast cancer - among obese white Looking for Signs of Life supported in part by grants women compared to healthy weight women. Jack D. Griffith, Kenan Distinguished Professor from the National Institute of Environmental The study results were published online by the of microbiology and immunology at the UNC Health Sciences and the National Institute of American Cancer Society. School of Medicine and a UNC Lineberger General Medical Sciences. In addition to Cohen, the review was written by member, found ancient cellulose microfibers in The cellulose appears highly stable and more Andrew Olshan, chair of the UNC epidemiology samples taken from pristine ancient salt deposits resistant to ionizing radiation than DNA. "If it is department, adjunct research professor in the deep beneath the New Mexico high desert. relatively resistant to harsh conditions such as UNC School of Medicine's department of How ancient? Until now, the oldest evidence those found in space," Griffith says, "it may otolaryngology/head and neck surgery, and of biological material was some protein provide the ideal 'paper trail' in the search for life program leader for cancer epidemiology in the fragments dated at 68 million years. "The age of on other planets." UNC Lineberger Comprehensive Cancer Center; the cellulose microfibers we describe in the Rachel Palmieri, Sarah Nyante, Daniel Koralek, study is estimated to be 253 million years old," Obesity May Keep Some Women Sangmi Kim, and Patrick Bradshaw. The review Griffith said. "These are the oldest native from Getting Cancer Screenings was supported in part by grants from the National macromolecules to date to have been directly A review of cancer screening studies shows that Cancer Institute. isolated, visualized and examined bio- white women who are obese are less likely than chemically." His report was the cover story for healthy weight women to get the recommended Most Lethal Melanomas the April issue of the journal Astrobiology. screenings for breast and cervical cancer. The are on Scalp and Neck The samples are from the Department of trend was not seen as consistently among black People with scalp or neck melanomas die at Energy's Waste Isolation Pilot Plant (WIPP), the women, though there were fewer high-quality nearly twice the rate of people with melanoma world's first underground repository licensed to studies that examined black women separately. elsewhere on the body, including the face or ears, safely and permanently dispose of radioactive "Obesity is increasing, and so is the evidence UNC researchers have found. waste left over from nuclear weapons research that obesity increases the risk of certain cancers The analysis of 51,704 melanoma cases in the and production. Griffith studies the samples in like colorectal cancer and post-menopausal U.S. confirms that survival rates differ depending his transmission electron microscopy lab at the breast cancer," says Sarah Cohen, an on where skin cancer first appears. Those with Cancer Center. In examining the content of fluid epidemiology researcher at the School of Public scalp or neck melanomas die at a rate 1.84 times "inclusions," or microscopic bubbles, in the salt Health. "It's a disturbing trend, then, to see that higher than those with melanomas on the and in solid halite crystals, he and his team women who are at increased risk of cancer extremities, after controlling for the possible found abundant cellulose microfibers that were because of their body size are less likely to be influences of age, gender, tumor thickness and "remarkably intact." ulceration.

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Simulations conjunction with the CyberKnife® Robotic continued from page 1 Radiosurgery System. UNC is one of those places. Faculty Appointments This is a huge boon to UNC Lineberger radiation Chair of Radiation Oncology Several years ago, Lineberger partnered with Dell oncologists and the cancer patients they treat Dr. Lawrence Marks has been and Microsoft to speed processing/computing time because the combination allows technicians to appointed chair of the department for Monte Carlo simulations in radiation oncology to direct radiological treatment more precisely. "No of radiation oncology at the UNC deliver more accurate dose calculations. The project one likes measuring with a 'crooked ruler,’" Morris at Chapel Hill School of Medicine. has since expanded to include new supercomputers quips. "Until now, that is the best we have had Regarded as one of the country's to increase the efficiency of Monte Carlo simulation available. Monte Carlo simulation is the most top breast cancer specialists, Marks as well as other applications for radiation oncology accurate and precise dose calculation around." comes to UNC from Duke such as better imaging and targeting of tumors. This By running these simulations, UNC Lineberger University, where he had been a member of the new capacity will allow the simulations to be used in specialists can get an accurate picture of what radiation oncology faculty since 1989. the clinic, not just in the lab. radiation dose the patient will actually receive from "This is an exciting time to be at UNC," Marks Only a handful of medical centers worldwide a given course of treatment. The result is a more said. "The new facility is a wonderful opportunity have begun to use Monte Carlo simulations in targeted treatment that optimizes patient outcomes. to provide patient-friendly, state-of-the-art cancer "For example, a conventional care. And with the state's deep commitment to treatment planning calculation might the University Cancer Research Fund, there is a indicate that a certain beam arrangement mandate here to expand UNC's already excellent produces a uniform dose across the entire cancer research program." tumor," explains Eric Schreiber, chief physicist for the UNC CyberKnife® Pediatric Division Chief Center and a research assistant professor Dr. Stuart Gold, professor of of radiation oncology. "But a subsequent pediatrics, has been named Monte Carlo calculation could more division chief of pediatric accurately reveal that a portion of the hematology and oncology at the tumor might be receiving 10 percent less UNC School of Medicine. Gold dose than intended. It's important that the joined the UNC faculty in 1989. physician know this, because less dose As division chief, Gold is can result in less effective tumor control. responsible for developing the division's clinical Having this information allows the care programs, translational research, and physician to adjust the plan to ensure that training of residents and fellows. He will continue the entire tumor is treated to the running a monthly outreach clinic at New appropriate dose." Hanover Regional Medical Center in Wilmington, Eric Schreiber and Dr. David Morris with the CyberKnife® system at UNC. • NC.•

"Scalp and neck melanoma patients have a Kramer Honored higher rate of death than patients with melanoma anywhere else on the body," said Nancy Thomas, Mark Kramer is the 2008 Dr. Shelton Earp, UNC Lineberger director, and M.D., Ph.D., associate professor of dermatology recipient of the W. Scott Dr. Michael O'Malley, UNC Lineberger associate in the UNC School of Medicine, a member of the Blackwood Excellence in director. In their nomination letter they praised UNC Lineberger Comprehensive Cancer Center Research Administration Kramer for his excellence, dedication, and the study's senior author. Anne Lachiewicz, Award. Kramer is UNC commitment and service to the University. "For a medical student in the UNC School of Lineberger’s assistant director for research the past 23 years, he has worked tirelessly for the Medicine, is the lead author of the study. administration. Cancer Center and UNC. He has always looked for Thomas recommends that physicians pay The Award recognizes a University employee new ways to improve our systems and faculty. special attention to the scalp when examining for meritorious and distinguished accomp- Mark’s legendary 70 hour work weeks help make patients for signs of skin cancer. "Only six percent lishments in research administration at UNC at UNC Lineberger what it is.” of melanoma patients present with the disease on Chapel Hill. Kramer was nominated by • the scalp or neck, but those patients account for 10 percent of melanoma deaths. That's why we need to take extra time to look at the scalp during full- skin examinations," she said. Dole Announces Nearly $4 Million The study helps address a controversy among cancer researchers: whether scalp and neck skin for UNC Health Research cancer is more lethal primarily because it’s U.S. Senator Elizabeth Dole visited UNC on January 18 to announce that she helped secure nearly $4 diagnosed later than other melanomas. “That was million for three major health research initiatives at UNC. In a visit to the UNC Lineberger Comprehensive the thinking of a lot of people in the field,” Cancer Center, Dole said that the federal budget for fiscal year 2008 includes $2.4 million for the North Thomas said. But the analysis indicates that the Carolina Cancer and Genomics presence of the melanoma on the scalp or neck, Research Center, $560,310 for the in itself, is an indicator of a poorer prognosis. Program in Racial Disparities and “We think there’s something different about Cardiovascular Disease, and $984,000 scalp and neck melanomas,” Thomas said. “This for the Collaborative Initiative in gives us directions for research to look at tumor Biomedical Imaging. Dr. Terry Van cell types in those areas at the molecular level Dyke, Sarah Graham Kenan Professor and to see if there are differences. I’m interested of Genetics in the UNC School of in identifying the mutations that drive Medicine and UNC Lineberger faculty malignancy.” member, is principal investigator of The results appear in the April 2008 issue of the North Carolina Cancer and the journal Archives of Dermatology. Study co- Genomics Research Center. authors are from the University of New Mexico. • Funding was provided by the National Cancer Institute and a Holderness Medical Foundation Senator Elizabeth Dole visits with Dr. Terry Fellowship to Lachiewicz. Van Dyke and Shari Sweeney (far right), • a research technician in the Van Dyke lab.

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Helping Doctors and Patients Make Better Decisions

When we're not feeling well, we're often scared and "While this present study will be too small to anxious. "Our ability to bring in new information answer that question, I hope it will provide may not be as good as it usually is," explains adequate preliminary data to allow us to plan, and Michael Pignone, associate professor of medicine. receive funding, for a larger study." And that can impact our treatment and outcomes. "Given the right means of presentation, doctors can Prostate Cancer provide both individualized and population-based To help men decide whether to undergo prostate recommendations to patients, who can then cancer screening, Stacey Sheridan, assistant incorporate their preferences and values into professor of medicine, developed an intervention. making decisions about their care." "This will help men make better decisions because That's why researchers and clinicians at UNC it provides evidence-based information to help Lineberger are focusing on helping patients and them clarify their values and encourage their doctors make better decisions when it comes participation in decision-making with their to healthcare. "We're doing research to figure out doctors," she explains. how we can better help patients and doctors work Jennifer M. Griffith, Decision Support Lab director The intervention includes a video that provides together to make better decisions," he says. "We're (standing), works with a study participant. an overview of the kinds of prostate cancer and the giving information in advance, like decision aids, to process of learning and deciding about screening. help people have grist for the mill. We're also There also is a coaching session for patients in looking at helping patients learn to get their Colorectal Cancer which they begin to define their values, understand questions and concerns across to their doctors and Decision-making among colorectal cancer patients their decision-making process, and prepare for a make sure those things are being implemented." who are neither exceptionally fit nor exceptionally discussion of screening with their doctors. Finally, frail is the focus of Hanna Sanoff, assistant professor the intervention also includes training for healthcare Breast Cancer of hematology and oncology. "In situations where providers, helping them convey the importance of "Our beliefs about risk inform our medical choices," there is no 'right' answer or where substantial risk screening and highlight the value of shared asserts Noel Brewer, assistant professor of health comes both with treatment and without, it is of the decision-making. behavior and health education. "The chances of utmost importance that each patient's individual Pignone, Brewer, Sanoff, and Sheridan are cancer coming back, the chances of being cancer preference be taken into account when deciding members of a multi-disciplinary group of free, the chances of side effects." about whether to proceed with chemotherapy," she investigators called the Working Group on Risk, In his research, Brewer discovered that breast explains. "Yet patients are largely unable to Communication, and Shared Decision Making cancer patients are very interested in new genomic communicate their preferences to their physician if whose members are affiliated with UNC Lineberger tests that identify the risk of cancer recurrence with they are not provided with enough information to and the Sheps Center for Health Services Research. greater accuracy. "Although these tests are not yet understand the nature of the decisions, and the "We work together to perform basic and applied developed for all types of breast cancer, they can consequences of each possible choice." research into clinical decision making for a range of help many patients with early stage breast cancer Sanoff has undertaken a project to assess the cancer related decisions, including those related to make better decisions about whether to have adequacy of the decision-making process and the prevention, treatment and survivorship," Pignone chemotherapy. Potentially, some of these women information exchange in colon cancer patients faced explains. "We've developed the UNC Decision could safely forgo this treatment because the with the choice of receiving chemotherapy for stage Support Lab where we seek new solutions to many genomic test suggests that they are at low risk and II or III cancer. Results of the survey are expected of the vexing cancer care problems, such as the there would be little benefit." soon. "My long-term goal is to compare the persistence of ethnic disparities in health outcomes adequacy of information exchange and decision- and the inconsistent application of effective health making in younger to older patients," she says. services."• Outstanding First Annual Service Nutrition Luncheon Recognized In recognition of National Nutrition Anne Wilson of Month, March 2008, the Patient and Morganton, NC, received Family Resource Center sponsored the 2008 Outstanding weekly nutritional programs related to Service Award from the symptom management in the Lineberger Board of chemotherapy and radiation therapy Visitors. Wilson was waiting areas. Aimee Shea, MPH, RD, cited for her "inspiring LDN, the outpatient oncology dietitian, advocacy for lung cancer research at the state and shared tips, recipes, and food samples national level" by Center director Dr. Shelley Earp. with patients and family members. As "Anne speaks with eloquence about the urgent need part of the insightful session, the for increased research into the causes and new presenters gave food tips for therapies for lung cancer," he said. "She is a strong participants who have difficulty and effective advocate for this important cause." swallowing or are dealing with GI side Anne and John Wilson's 28-year-old daughter, Pictured (left to right): Pam Baker, Resource Center Staff; Stephanie Lu, UNC graduate student; and Aimee Shea, UNC oncology dietitian welcome program effects, and handling a loss of appetite Katherine, died of lung cancer in 2005. Since participants. during cancer treatment. Katherine's death, the Wilson family has supported A highlight of the month was marked a scholarship in Katherine's memory at the UNC by UNC's First Annual National School of Nursing as well as the Patient and Family Registered Dietitians Day Luncheon in memory of Zeny Datiles. Shea presented the 2007 American Institute Resource Center at UNC Lineberger. for Cancer Research (AICR) guidelines on cancer prevention and nutrition to a "standing room only" crowd. In 2006, she won an international photography Special lunches of healthy comfort food were also served to patients in the chemotherapy infusion area who contest for her picture titled "This is not a Dress were unable to attend the luncheon. Rehearsal" of Katherine and her father John, both Heartfelt thanks to the family of Zeny Datiles. "Zeny's Garden," the Oncology Nutrition Library of the hairless due to Katherine's chemo and a sympathetic Patient and Family Resource Center, was established in memory of Zeny Datiles and in recognition of the shave by John.• work that Zeny began more than 25 years ago as a dietitian at UNC.• 6 cancerLines Spring 2008 30928_UNC.qxp 5/2/2008 1:05 PM Page 4

burden of worrying so we could pour all of our energy into Walter's recovery." Walter recalls that leaving a through interaction with these talented physicians they became aware of the Legacy importance of research. "Cancer takes a devastating Walter and Earlene Ward of Asheboro have always enjoyed a zest for life, toll on all family members. adventure and new discoveries. Their passion for diving began in 1980 when We want to be part of a primitive sign advertising dive trips caught their attention while driving finding a cure." down the Yucatan coast. Ever since, their travels have taken them to dive Following Walter's locales in remote corners of the world including Hawaii, Tahiti and the recovery, the Wards Caribbean. decided to create a That is until 1997 when Walter's diagnosis of non-Hodgkin's Lymphoma Earlene and Walter Ward $450,000 Charitable suddenly put their lives on hold. Earlene, who was previously treated for Remainder Trust (CRT) that rectal cancer, had already done her homework. At the time she sought several would provide a life income for them with the remainder to benefit UNC opinions including a consultation at Memorial Sloan-Kettering. Everyone Lineberger and upkeep of the cemetery of their country church. "It has been said the same thing: "the best place for cancer care is right here in your back a wise decision for us. We sold an inherited piece of property, and it made yard at UNC." Earlene added, "We knew from my cancer experience that no sense to pay half of the proceeds in taxes. The CRT was the perfect UNC would treat Walter's cancer proactively and aggressively. In Walter's financial tool for us to make an impact in areas we care deeply about." case there was no time to waste, he needed emergency treatment. Thank God Thanks to excellent care from UNC, the Wards were able to resume their UNC was there for us to act without delay." favorite hobby of diving. Just recently they spent a week in St. Kitts and Earlene reflects on the most challenging year of their lives: "Drs. Mitchell, Roatan exploring the wonders beneath the ocean's surface. What better way Tepper and Shea worked as a team on Walter's treatment plan. We are so to celebrate life and new discoveries! grateful for their wisdom and their profound sense of caring. They lifted the •

The Power of One visit www.celebrations.com/cure volunteer Spotlight Work with UNC Lineberger through its affiliation in the Cancer Research Alliance (CRA) - a newly formed collaboration of National Cancer Institute- The nurses in the oncology infusion floor call them "the dynamic duo" for their designated Comprehensive Cancer Centers - to help raise funds for cutting-edge energy and compassion. Since 1993, Jeanne Hagen has volunteered in the cancer research through national cause marketing business partnerships. clinical cancer center, helping patients to be more comfortable during their visits This Mother's Day through Father's Day, May 11 through June 15, support the and infusions and working with the nurses to make sure needed supplies are CRA by donating $1 to cancer research. The Cancer Research Alliance will give stocked and easily accessible. your $1 infinite power by adding it to all the other dollars we generate. This "We're here for the patients and the nurses," said Jeanne's husband, Armin, a money will then be used to speed progress on new treatments that are less volunteer since 1994. The couple distribute newspapers, offer juices and other invasive, more targeted and more powerful. nourishment and blankets and pillows, but most important, they offer support Please join our efforts to accelerate cancer research by visiting our sponsor and care to patients and www.celebrations.com/cure. Help us make this time of year from Mother's Day families. "Patients and families through Father's Day a time of infinite hope for families everywhere. So add your are here for hours," explained $1 and pass the word onto friends and family to do the same. Because change Jeanne, "so we want them to be starts right here and now with the infinite power of you. comfortable." • The four hours they spend at UNC are greatly appreciated by Cancer Survivor Climbs Mt. Kilimanjaro to Raise Funds the patients, families and Harriet Farb, an 18-year breast cancer nurses. "They have developed survivor, climbed Mt. Kilimanjaro in strong relationships with January and raised $15,000 for the patients and nurses," said Pat UNC Lineberger Patient and Family Decator, a longtime nurse in the Resource Center. While on active infusion area. "They're the therapy for a recurrence, she made the Jeanne and Armin Hagen offer juice constant presence on Fridays, trip with her brother, Ron Farb, and our patients and families co-founder of the non-profit to patient Margery Barton. look forward to seeing them. Climb for Cancer that sponsored the trip. They made it to 17,000 feet – They also help the nurses by keeping the storage closets stocked and orderly, 70 mile per hour winds prevented her critical since our clinic stays so busy." and others from making the summit. "It's payback time," the Hagens say. "We've had happy lives, so we're glad to Harriet said, “I have been blessed, help here." The Hagens moved to Fearrington Village in 1991, leaving Long and now is my chance to pay back Island to move to an area with "an academic medical center and a good for all the love and support I have environment for families." They both had retired from Sperry (now Unisys) received as a cancer patient.” when they decided to relocate to North Carolina. To read more about Harriet’s trip: In addition to her duties at the clinic, Jeanne also volunteered to participate www.unclineberger.org/gift/events/farb in two Breast Cancer Prevention Trials. Her mother died of breast cancer, and her sister had the disease, so Jeanne thought taking part in the trial was a positive step. "In fact," she said, "it saved my life." Because trial participants are so closely followed, when a small spot appeared on a mammogram, the follow-up care revealed a spot on her ovaries that was quickly removed while pre-cancerous. Both are active with the UNC Hospitals Volunteer Association and with various committees at Fearrington.• cancerLines Spring 2008 7 30928_UNC.qxp Havens with BlueShield Tammy prevention $155,000 this The 2 8 calendar 0 hplHill, Chapel Center, 23 22 Center, Smith 10 Mount, 4 O 12 S 14 J 20 M hplHill, Chapel 0 year 5th U CahDavis Coach 8 th E cancer A C B

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