broadening the conversation

about cancerForwardFOX CHASE CANCER CENTER I FALL/WINTER 2014

MAKINGSENSE

OF IT ALLThe Evolution of

Patient Decision-Making in an Age of

Information [Overload]

Cancer Hits Home for Fox Chase Faculty

One Patient’s Unusual Path to Conquering Cancer

A Day in the Life of a Nurse Navigator

10

16

20

As an organization thatfocuses exclusively oncancer, we are well awareof the physical and emotional challenges that

often accompany a cancer diagnosis.We understand the anxiety that can surround patients and their families—the urgency to have questions answered and begin treatment as quickly as possible.

For this reason, I launched an initiative at Fox Chase in March to offer every new patient anappointment within 24 hours—including those without a definitivediagnosis. I knew it could present alogistical challenge, but our facultyand staff stepped up and made it areality; thus far every new patient hasbeen offered a next-day appointment.

In this issue, you’ll read aboutother ways Fox Chase is working toease our patients’ experience, to provide that “something extra”beyond expert cancer treatment.

On page 20, take a glimpse intothe daily life of a Fox Chase nursenavigator—often the first person togreet patients upon their arrival, or

the first voice they hear overthe phone. These speciallytrained nurses are equippednot only to answer clinicalquestions, but to guidepatients through the fullgamut of issues that mayarise, whether logistical,financial, or emotional.Nurse navigators bring thefull complement of Fox Chaseresources to ensure our patients benefit from all we have to offer.

We know that the volume ofresources and information available topatients today can be overwhelming,both within the clinic and outside ofit. In the cover story on page 6, wereport on how Fox Chase researchersand physicians are helping patientsnegotiate the information overloadand tease out useful information—empowering them to make moreinformed decisions about their care.

And in our coverage of “WhenCancer is Personal” on page 10,three Fox Chase doctors explain howcancer hit close to home, and howtheir experiences drive their passionfor oncology and inform how they

understand and address the needsand concerns of patients.

One such patient is WarrenChambers, who discovered he had a rare, metastatic gastrointestinalcancer despite having no symptoms.Today, having regained his health,Chambers is using his experience toprovide encouragement to fellowpatients (see page 16).

While we seek to make the cancerjourney smoother for our patients,they give something back to us: theymake our work rewarding.

Richard I. Fisher, MDPresident and CEO

forward thinkingP R E S I D E N T ’ S M E S S A G E

That Something Extra

EDITORIAL ADVISORY BOARD

Dr. J. Robert BeckChief Academic and Administrative Officer

Michael J. BurtonChief Development Officer

Dr. Carolyn Y. FangCo-leader, Cancer Prevention and Control

Dr. Erica A. GolemisDeputy Chief Scientific Officer

Anne JadwinChief Nursing Officer

Dr. Michael H. LevyVice Chair, Medical Oncology

Dr. Ranee MehraAttending Physician, Medical Oncology

Dr. Glenn F. RallAssociate Chief Academic Officer

Dr. John A. RidgeVice Chair, Surgical Oncology

FORWARD magazine is published twice a year for friends ofFox Chase Cancer Center by the communications departmentof Fox Chase. One of the leading cancer research and treatmentcenters in the United States, Fox Chase was founded in 1904 as one of the nation’s first cancer hospitals, and was amongthe first institutions to be designated a National CancerInstitute Comprehensive Cancer Center in 1974. Fox Chasejoined Temple University Health System in 2012.

Temple Health refers to the health, education and researchactivities carried out by the affiliates of Temple University HealthSystem (TUHS) and by Temple University School of Medicine.TUHS neither provides nor controls the provision of health care.All health care is provided by its member organizations orindependent health care providers affiliated with TUHS memberorganizations. Each TUHS member organization is owned andoperated pursuant to its governing documents.

EDITOR

Madeline Weber

CREATIVE SERVICES

SteegeThomson Communications

Design byKarlyn Rosen Aires

Cover by AcquireVisual.com

Inquiries:editor@fccc.edu

LEADERSHIP

Dr. Richard I. FisherPresident and Chief Executive Officer

Dr. J. Robert BeckChief Academic and Administrative Officer

Dr. Jonathan ChernoffChief Scientific Officer

Judith L. BachmanChief Operating Officer

Anne JadwinChief Nursing Officer

Lisa BaileyInterim Director of Communications

333 Cottman Avenue, Philadelphia, PA 19111-2497foxchase.org • 1-888-FOX-CHASE

FALL/WINTER 2014

ED CUNICELLI

FALL/WINTER 2014 1

20 FOCUS: A Day in the LifeNurse navigators are becoming more common athealthcare facilities all over the country, but whatexactly do they offer patients? We spend a day withhead and neck navigator Joanne Stein to find out.

22 REVIEW: News of NoteFox Chase and its doctors rank high | A milestone for pain and palliative care | Inaugural wine auctionraises funds

24 REWIND: Moments in Fox Chase HistoryResearchers studying protein death found the key tocreating life-saving cancer drugs—a discovery that ledto the Nobel Prize.

ON THE COVER:Making Sense of It All A click of the mouse can reveal a near-endless collectionof data points, diagnoses, and treatment options totoday’s cancer patients. To empower patients to makeinformed decisions about their care, healthcareprofessionals at Fox Chase and beyond are helpingpatients sort through the information overload.

Story on page 6

FA L L / W I N T E R 2 0 1 4

F OX CHASE CANC E R C E NT E R

menu

FOX CHASE CONTINUES TO STAND AT THE FOREFRONT OF NURSE NAVIGATION

See page 20

12 ADVANCE: Research HighlightsWhy mothers are less likely to develop breast cancer | Surgical relief for patients with lymphedema | New options for drug-resistant cancers

10 When Cancer Is PersonalFox Chase staff members treat and research cancer every day, but what happens when the disease hits close to home? A researcher and two physicians reflect on how their personal experiences have changed how theyapproach their work.

14 CONVERSATIONS: Rising StarsA veteran scientist sits down with four youngresearchers to find out what drew them to the lab and what keeps them motivated in their quest to make the next big discovery.

16 CLOSE-UP: A Power Play on CancerAfter overcoming a rare, metastatic cancer, Warren Chambers uses positivity—and one other unusual ingredient—to stay healthy and bring hope to other survivors.

18 MAKING A DIFFERENCE: Welcome HomeAt Boo’s Boutique, Fox Chasepatients find what they need to feel whole again—without evenleaving the building.

JOE HURLEY

BRYAN LATHRO

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2 FALL/WINTER 2014

Taking a detailed look atwomen’s DNA and RNA,Fox Chase researchers areunearthing new clues onthe relationship between

pregnancy and breast cancer. “We are trying to understand

how the natural process of givingbirth helps prevent cancer,” says Julia Santucci-Pereira, who has beenstudying the topic. Santucci-Pereirais a molecular biologist in FoxChase’s Breast Cancer Research Laboratory; in 2013 it was named in honor of Irma H. Russo, who co-founded the lab with herhusband Jose Russo in 1975.

In two recent studies, Santucci-Pereira and her colleagues usedsophisticated nucleic acid sequencingtechnology to compare geneticactivity in cancer-free breast tissuesamples from more than 100women—mothers and non-mothers.They found that tissues from thetwo groups appeared to showdifferences in the process duringwhich developing cells becomespecialized types. In addition, theynoticed that the influence of genes

on the development of breastanatomy was different between thetwo groups. One possible driver ofthese changes may be humanchorionic gonado tropin, a hormoneproduced during pregnancy. JoseRusso, director of the Breast CancerResearch Laboratory, is investigatingthe hormone’s effects on cancer.

A third study compared sectionsof genes in women who had and hadnot given birth to see how “non-

coding” genetic material—whichdoes not contain instructions formaking protein—interacts withother parts of the genome, for cluesregarding how it may impact cancer.They found 42 different non-coding segments that showed a distinctionbetween mothers and non-mothers.

“Our goal,” says Russo, “is tosomeday replicate these changes andreduce the risk of cancer for womenwho have not been pregnant.”

advanceR E S E A R C H H I G H L I G H T S

NEW CLUES ON HOW GIVING BIRTH PROTECTSAGAINST BREAST CANCER

“Our goal is to someday replicate thesechanges and reduce the risk of cancer forwomen who have notbeen pregnant.”

—JOSE RUSSO, Irma H. Russo Breast Cancer Research Laboratory

JOSE RUSSO & JULIA SANTUCCI-PEREIRA

BRYAN LATHRO

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Lymphedema, a painfulcondition of fluid build-upand swelling in soft tissues,is common among patientswho have had lymph nodes

removed during cancer treatment.Until recently, there were few optionsfor relief. Two innovative surgicalprocedures being offered at FoxChase are changing that.

In a procedure called vascularizedlymph node transfer, surgical oncol-ogists Sameer Patel and Eric Chang,who specialize in plastic and recon-structive surgery, are transferringlymph nodes from other parts of apatient’s body to the area affected by lymphedema. They reestablishblood flow to the transplantednodes, which are then able to helpdrain excess lymphatic fluid fromthe affected extremity into the veins,where it circulates normallythroughout the body.

“Lymphedema can cause asignificant decrease in patients’quality of life and serves as aconstant reminder of their battleagainst cancer,” Patel says.

Fox Chase is one of only twoinstitutions in the region to offervascularized lymph node transfer,which is available at a handful ofcenters nationwide. The Center willalso soon be the only facility inPhiladelphia to offer lymphovenousbypass, another option for treatinglymphedema. The procedure, whichfeatures a shorter operative time andhospital admission, connects thelymphatic vessels directly to smallblood vessels in order to allow fluidto drain.

FALL/WINTER 2014 3

INNOVATIVE SURGICAL PROCEDURES PROVIDE RELIEF FOR PATIENTS WITH LYMPHEDEMA

Lymphedema affectsup to about 50 percentof breast cancerpatients and up toabout 30 percent of gynecologic cancerand prostate cancerpatients.

SAMEER PATEL

LYMPH NODE TRANSFER

• Innovative surgical procedure

is used to transplant healthy

lymph nodes into area affected

by lymphedema

• Lymphatic fluid collecting in

the affected extremity drains

into the veins, reducing swelling

DAVID DEBALKO

JESSICA HUI

LYMPHEDEMAIN THE ARM

HEALTHY LYMPH NODES TRANSPLANTED IN AFFECTED UNDERARM

HEALTHY HARVESTED PELVICLYMPH NODES

4 FALL/WINTER 2014

advance

BRYAN LATHRO

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Two recent studies led byFox Chase medical oncol-ogist Ranee Mehra aremaking promising stridesin the development of new

treatments for previously drug-resistant cancers.

The first study examinesadvanced squamous cell carcinomaof the head and neck, which isgenerally treated with radiation anda chemotherapy drug calledcisplatin, an inorganic platinumcompound that inhibits cellgrowth. Many patients do notrespond well to this therapy, butoncologists are unable to prescribealternative agents because theydon’t know which patients willrespond to platinum therapy andwhich won’t. However, Mehra’steam found that the level in apatient’s tumor of the ERCC1enzyme, which helps repairtreatment-related DNA damage,helps predict a patient’s chance of survival. The findings mighteventually help guide treatmentselection for patients with squa-mous cell carcinoma of the headand neck.

“The results of this study openavenues to testing other agents thatcould be more effective in specificpatients and have a better side-effects profile,” Mehra says.

A more recent study investigatedan alternative therapy for patientswith a rare type of non-small cell lungcancer, termed advanced anaplasticlymphoma kinase-positive, or ALK+,who are likely to develop resistance tothe standard treatment. Results froma clinical trial conducted by Mehra,published in the New England Journalof Medicine, showed a favorable

response to the new therapy, a drugcalled ceritinib. Known commerciallyas Zykadia, ceritinib receivedapproval from the Food and Drug

Administration in April, addressingthe needs of patients with this type oflung cancer who have progressed onprior therapy.

STUDIES FIND PROMISING NEW OPTIONS FOR DRUG-RESISTANT CANCERS

“The results of this study open avenues to testing other agents that could be more effective in specific patients.”

—RANEE MEHRA, medical oncologist

RANEE MEHRA

FALL/WINTER 2014 5

By inhibiting a protein thatguides other proteins tofold into stable shapes, Fox Chase researchershave found a way to slow

the growth of ovarian tumors.Molecular biologists Erica Golemisand Denise Connolly, together withmedical oncologist Lainie Martinand colleagues, discovered thatinhibiting heat shock protein 90(HSP90) significantly depressedtumor growth and caused tumorcell death while showing noevidence of detrimental side effects.It also made cancerous cells moresensitive to standard chemotherapyagents such as cisplatin andpaclitaxel.

“Ovarian cancer disseminateswidely throughout the abdominalcavity and adheres to the colon andother vital organs. That’s what reallycauses mortality,” says Connolly.

“Being able to identify therapeutictargets that actively inhibit theprocess of metastasis should be beneficial to these patients.”

The work that led to thediscovery at Fox Chase was part ofthe National Cancer Institute’sSpecialized Programs of ResearchExcellence in ovarian cancer. APhase I/II clinical trial at Fox Chaseis now testing the safety and efficacyof the HSP90 inhibitor ganetespibin combination with paclitaxel.

A different team of researchers,led by Golemis, found a potentialbenefit for treating anothercondition—autosomal dominantpolycystic kidney disease (ADPKD).Their research showed thatinhibiting HSP90 slowed the onsetof cyst formation and improvedkidney function in mice primed todevelop a disease comparable to thehuman form of ADPKD.

A Leading Kidney CancerTrial Finds a Home at Fox Chase

Offered through the Society of UrologicOncology, the ADAPT

clinical trial is testing a newtherapy that harnesses theimmune system to fightadvanced kidney cancer. Fox Chase is currently the only site in the Philadelphiaarea enrolling patients in thisPhase III clinical trial. The study seeks to determinewhether there is an overall survival benefit for patientstreated with an experimentaltherapy, AGS-003, incombination with standardtreatment, compared topatients who only receivestandard treatment. AGS-003revs up a patient’s immunesystem by using cancer cells to create new immune cells, which in turn teach the immune system to attack tumors.

ERICA GOLEMIS

INHIBITING “HEAT SHOCK” PROTEINS SHOWS PROMISE FORSLOWING TUMOR GROWTH

BRYAN LATHRO

P

ADAPT is one ofnearly 200 clinicaltrials underway at Fox

Chase. To learn more about

open trials and the innovative

clinical research happening

right now, visit foxchase.org/

cancer/clinicaltrials.

6

Ayear afterhis full nephrectomy surgery for papillarykidney cancer, Mark Kabulski thought he had beatenthe disease. But at his one year check-up, the Mt.

Holly, New Jersey, resident faced a recurrence in his lymphnodes and the prospect of a complex operation.

Kabulski and his wife Barbara sorted through their optionswith his doctor. Then, as millions of Americans do, he lookedonline for a surgeon who could perform the procedure andprovide follow-up care locally. His search led to Robert G. Uzzo,chair of surgical oncology at Fox Chase.

“When I asked him if he thought he could remove the lymphnodes successfully, [Dr. Uzzo] looked right at me and said, ‘Yes, Ican get those out, no problem,’ and I knew he would. He gave ustotal confidence that surgery was the best option.”

How do cancer patients reach decisions?Unfortunately, not all searches are as simple or successful.

An Internet search can place thousands of providers,opinions, data points, potential diagnoses, and prognoses at thefingertips of today’s cancer patients. The volume of informationcan do as much harm as good. While a searcher can findinformation about any type of cancer on the web,

MAK I N GSENSEO F I T A L L

˛

The Evolution of Patient

Decision-Making in an Age of Information[Overload]

By Togo Travalia

FALL/WINTER 2014 7

out-of-context or unmonitored information can yield outdatedor unfounded recommendations, create confusion, and promptunnecessary anxiety. Newly diagnosed patients are particularlyvulnerable as they cope with emotional and physical challengesand a plethora of questions about their disease.

Yet the Internet is often a third party in the most intimatediscussions between doctors and patients. Its role as informationsource is the backdrop for the work of Suzanne M. Miller,director of Fox Chase’s psychosocial and biobehavioral medicineprogram. Miller has made a career of studying how cancerpatients process information and reach decisions.

She divides patients’ information-gathering styles into twobasic groups—“monitors” and “blunters.” Monitors spend hoursporing over information on the Internet and discussing it withtheir providers. In the other camp are blunters, content to knowwhat they need to know and more willing to trust and acceptinformation from their physicians. Some patients, like MarkKabulski, fall between the two extremes. He used the Internet toidentify his surgeon and research treatment options, then reliedon Uzzo to choose the best treatment path.

“Blunters also use the Internet but usually to validate whatthey’ve heard from the care provider,” says Miller. “Monitors, onthe other hand, are more likely to be online all the time, alwaysseeking new options. Monitors may print out what they’vefound and bring it in to question their physicians. They’rethinking, ‘Can this be right?’”

Improving the patient-physician relationshipCopyrighted by Fox Chase, Miller’s system for classifyingpatients’ decision-making behavior has been translated intohundreds of languages, giving oncologists around the world new insights about how to best support patients and familymembers, who are also information seekers.

Her work contributed to the development of an AmericanCollege of Surgeons standard calling for all newly diagnosedcancer patients to take “distress assessments” by 2015, whichmeasure their need for attention to the stress surrounding diagnosis or treatment. The results, which will be listed onpatients’ electronic medical records, will help prepare the wholecare team for more productive interactions with their patients.

“You have to remember that patients’ time with physicians is limited,” Miller points out. “Knowing how a patient mightprocess information helps physicians be more attuned topatients and in control of situations.”

To help patients, Miller and fellow Fox Chase behavioralresearcher Kuang-Yi Wen developed a series of web-based

modules that will walk cancer patients through a customizabledecision-making process. It is replete with resources: a virtualphysician and health educator, video stories from survivors, a questionnaire, and a virtual “room” where the patient can list,and weigh, the pros and cons to reach a high-quality, informeddecision about treatment options. The first modules, forprostate and breast cancer patients, are in final testing beforepatients begin using them next year.

What does good information look like?Another important venue for patient information-gathering isFox Chase’s Resource and Education Center (REC), a patientand family multimedia learning center that forms the hub of theCenter’s health education program.

On any given day, you can see patients at computers in theREC, accessing information, with a professional health educatornearby to assist with questions. When the REC opened in 2000,

AN INTERNET SEARCH CAN PLACE THOUSANDS OF PROVIDERS, OPINIONS, DATA POINTS, POTENTIAL DIAGNOSES, ANDPROGNOSES AT THE FINGERTIPS OF TODAY’S CANCER PATIENTS.

“HEALING CHOICES” AND “PATHWAYS TO RECOVERY,”web-based programs developed by Fox Chase behavioralresearchers, help breast and prostate cancer patientsweigh treatment options and navigate survivorship.

8 FALL/WINTER 2014

it was one of the nation’s first staffed resource centers for cancerpatients and their families. Today, the model still has few peersand recently passed the landmark of serving 40,000 patients.

“One-on-one interaction between patients and healtheducators is the key,” says Stephanie Raivitch, director of healthcommunication programs. “Many other facilities provide self-serve resource areas. Our patients and families receive personalattention and can be assured that the information they areprovided is evidence-based and communicated in plain language.”

All the resources at the REC are carefully selected to meetthese standards. Patients and families find a variety of options,including publications, fact sheets, periodicals, and websites, tomeet their learning needs. They can also review a list of approvedwebsites, which the REC vets through a sophisticated websiteevaluation tool. More extensive than any other in use today, thetool ensures that websites are accurate and current. Staff membersactively maintain and update all resources in the REC.

As a complement, Fox Chase’s Patient EducationDepartment provides printed and online educational materialsto staff and patients in clinics, on display racks, and on bulletinboards throughout Fox Chase. The department’s PatientEducation Committee, composed of patients and familymembers as well as nurses, social workers, and a range of otherhealthcare professionals, carefully reviews these materials forcredibility, accuracy, and readability.

And in an effort to make information portable, healtheducators from the REC have uploaded educational appsand e-books onto iPads and shared them with patients in the chemotherapy infusion room. “It’s an important way toreach even more patients. We can now go to those who can’tcome to us,” says Raivitch.

This comprehensive approach to getting goodinformation into patients’ hands is one of the qualitiessought by the National Cancer Institute when designatingComprehensive Cancer Centers—a distinction Fox Chaseshares with only 40 other centers nationwide.

“Just like the patient care we perform and thebiomedical research we conduct, our public education andoutreach are held to an extremely high standard,” says J.Robert Beck, chief academic and administrative officer.

Harnessing technology to engage patients The patient’s online search for health information is here tostay, and the ability to navigate cyberspace will only grow inimportance. In a June 9 article in The Wall Street Journal,reporter Laura Landro described patient engagement as the“last mile in the race to fix health care” and hailed new onlinetools as the key to making it happen. While a 2012 Institute of Medicine report cited patient engagement as the key to aneffective healthcare system, the Center for Advancing Health in 2010 showed it is still an uphill climb: more than half ofMedicare patients don’t bring a list of questions to doctorappointments, and 61percent of Americans don’t maintain theirown medical records, whether paper or electronic.

Health systems are responding by giving patients access totheir health records online. Patients can check lab results or adoctor’s notes; the tech-savvy can plug personal information intonew health apps and generate a personalized fitness regimen thattakes into account their weight or an injury. Of course, not allpatients are equally facile with online tools, so providers arestarting to meet them halfway.

Fox Chase urologic oncologist Alexander Kutikov is amongphysicians who have integrated technology into the clinicalexperience to boost patient engagement and understanding.

ONE-ON-ONE INTERACTIONBETWEEN PATIENTS AND HEALTH EDUCATORS IS THE KEY.

Health educator Kelly Lopez advises a patient visiting Fox Chase’s Resource and

Education Center.

MAKING SENSE OF IT ALL

JESS HUI

“ “

“I’ve witnessed a general shift in the approach to care sincemedical school. Patients are becoming true, active partners inmedical decisions,” says Kutikov. “But engaging patients asparticipants means showing them information about optionsand outcomes, and then enabling them to overlay their valuesystems onto a particular decision. Technology can now helpfacilitate this process.”

With more than a half-million downloads, drawMD, a suite of iPad apps that Kutikov co-developed with Harvard MedicalSchool classmate Todd Morgan and technology expert JohnCox, is used nationally and internationally, including at FoxChase. The app offers a dozen anatomical palettes on whichphysicians can visually explain surgical procedures by creatingpatient-specific images.

“Dr. Kutikov spent time with me, showing me what mysurgery would involve, drawing on a hand-held device,” saysMarie Fiss, who needed removal of her right adrenal gland dueto a rare tumor growth known as pheochromocytoma. On anelectronic tablet, Kutikov showed her how just a few smallincisions would allow him to operate laparoscopically. “I leftfeeling informed and encouraged and knowing I was in the best of hands,” Fiss says.

Kutikov describes the app as “a dynamic piece of paper. It supports decision-making because the best surgical optionmay not be the latest procedure. Our group in urology pridesitself on being trained in all modalities, including traditionalopen surgery, laparoscopy, and robotics. With drawMD, we canhelp a patient see the trade-offs among various surgical optionsand facilitate a time-sensitive decision.”

Kutikov notes that no single electronic tool can providecomplete information. He also uses MedlinePlus.com, acomprehensive online reference library developed by theNational Library of Medicine and National Institutes of Health,and CancerNomograms.com, a Fox Chase tool that generatespoint-of-care predictive models of outcomes and survival ratesfor bladder, kidney, penile, prostate, and testicular cancer.

Fellow NCI-designated Comprehensive Cancer Centers havealso begun designing tablet-ready resources. Dana-Farber/Harvard Cancer Center created Ask the Nutritionist: Recipesfor Fighting Cancer, an app to help patients find an optimal dietfor their particular type of cancer. An MD Anderson CancerCenter app connects patients through social media accounts tothe center itself, fellow patients, and caregivers. And the About

Herbs app, developed by Memorial Sloan Kettering CancerCenter, lists more than 200 monographs describing thepurported uses, adverse effects, and drug interactions of various herbs, supplements, and complementary therapies.

Even as technology plays an increasingly significant role incancer patient education and decision-making, Kutikovacknowledges that it only goes so far.

“Nothing is ever going to replace the sincere and well-explained conversation with a patient about their options andthe uncertainties about their outcomes,” he says. “Some patientsneed to feel empowered. It’s the physician’s responsibility to letthat happen after gauging how much control of the process apatient wants and needs.”

FALL/WINTER 2014 9

PATIENTS AREBECOMING TRUE, ACTIVEPARTNERS IN MEDICALDECISIONS.

“ “

Top: The drawMD app, developed by Fox Chase urologic oncologist AlexanderKutikov, can demonstrate trade-offs between surgical options. Bottom: Kutikovuses an iPad to illustrate a surgical procedure to patient Marie Fiss.

LISA BAILEY / TOMMY LEONARDI

VICKI WAS A qUIET GIRL withshort, sandy blonde hair, who lived in Klingerstown,Pennsylvania, 40 miles north of Harrisburg. When she

was diagnosed with leukemia in 1970, the announcement madea big impression on her second-grade classmates.

“I remember vividly. The teacher asked us to speak into atape recorder with a message for her, and shortly thereafter, shedied,” recalls David Wiest, Fox Chase’s deputy chief scientificofficer and co-leader of the Immune Cell Development andHost Defense research program.

Today, Wiest is an immunologist who studies how proteinscontrol the behavior of T cells, which coordinate the body’simmune response.

Lab research sparked his fascination with immunology whilehe was a college student at Penn State. How could the immunesystem be both a source of cancers and a tool for treating them?Despite a physician’s warning that he was a “starry-eyed optimist”for his choice of research, Wiest continued his studies of the

immune system in a PhD program at Duke University. Then,over a four-year fellowship at the National Cancer Institute,Wiest again came face to face with pediatric cancer. Entering theWarren Grant Magnuson Clinical Center, he frequentlyencountered bald children sitting in wheelchairs on the portico.

“Seeing the devastating effects of cancer on adults is difficultenough,” Wiest says. “When you see it in children, the impact is even greater. It set me on a trajectory. When it came time tolook for jobs, my mentor recommended I look at Fox Chase.Here I found real value placed on basic research coupled withthe ability to see if it mattered clinically.”

In 2007, Wiest proposed assembling a team to investigatethe clinical relevance of research in basic immune celldevelopment that his lab and other Fox Chase investigators were doing. “Our work fit with Dr. Stanley Reimann’sphilosophy,” Wiest notes, referring to the founder of Fox Chase’s scientific enterprise. “To understand cancer, you must first understand normal biology.”

Wiest found a gene that was required for the development of T cells. “Normally, 60 to 70 percent of kids with leukemiaare treated successfully, but we found that this gene wasinactivated in about 10 percent of patients, and those patientshad a significantly poorer prognosis,” Wiest says. “It led me on a path to determine how inactivation of the gene made cancermore aggressive and to devise strategies to treat those cases.”

10 FALL/WINTER 2014

WhenCANCER is

PERSONALCancer hits home for

Fox Chase faculty, influencing their drive

to care and cureBy Denise Portner

Photos by Bryan Lathrop

˛

In fall 2013, Wiest’s team received a Leukemia & LymphomaSociety grant to study the role of a molecule that regulatescellular stress responses, which can contribute to the origin anddevelopment of cancer. The team will look for a way to defeatcells that have a mutation that makes them more aggressive,developing therapeutics that block stress responses in patientswith acute lymphocytic leukemia.

Wiest is aware he is not the only researcherwhose work at the bench is motivated by peoplewho have wrestled with cancer.

“I would venture to say that every researcher atFox Chase has had a direct or indirect encounterwith cancer,” he says. “That exposure drives you.”

AN INSPIRED QUESTFOR A CUREA painting by Elena Gitelson called “Philadelphia:The City of Brotherly Love and The PhiladelphiaChromosome” hangs on the second floor of FoxChase’s Robert C. Young, MD, Pavilion. Thecolorful, Chagall-like work depicts a surrealPhiladelphia cityscape along a river at sunset.Overhead, a couple flies into the sky, as a flock ofbirds and chromosomes rise with them, all to meetat a distant point where the triumph of scienceand human spirit will intersect.

◊◊◊

Igor Astsaturov and Elena Gitelson met inMoscow while they were in a residency program atthe Russian Hematological Research Center. In2005, they moved to Philadelphia for fellowshipsat Fox Chase. Gitelson finished her residency andoncology fellowship at the Fox Chase/TempleUniversity Program, and in 2009 joined the faculty at Thomas Jefferson University as anoncologist focused on hematological malignancies.Astsaturov joined Fox Chase as a physician-scientist specializing in gastrointestinal cancers,including pancreatic, liver, and colorectal cancers.

The couple was living busy professional liveswhen, in 2012, experiencing unrelenting back

pain, Gitelson arranged for a CT scan. Reading her own imagesthe same day, she noticed an ominous looking mass in herpancreas and multiple lesions in her liver, which sheimmediately recognized as metastatic pancreatic cancer.

Gitelson was determined to fight the disease—as a patient,but also as a researcher. Knowing that tumor models are crucial

FALL/WINTER 2014 11

“I would venture to say that every researcher atFox Chase has had a direct or indirect encounterwith cancer. That exposure drives you.”

“Seeing the devastatingeffects of cancer on

adults is difficult enough. When you see it in

children, it has evengreater impact. It set me on a trajectory.”

—David Wiest

˛

12 FALL/WINTER 2014

for research, she had a sample of her tumor frozen and added to Fox Chase’s vast tissue sample repository. Astsaturov’s labgrafted the tumor sample in immunocompromised mice—atechnique they had just established in order to study thebehavior of patients’ tumors outside the human body. As thetumors grew in mice, Gitelson began chemotherapy.

Equipped with the new mouse model, Astsaturov assembleda team to study pancreatic cancer and find ways to suppress itsgrowth. Together with pharmaceutical companies; his formercolleague and mentor, medical oncologist Louis M. Weiner; and

multiple investigators at FoxChase, Astsaturov conducted amassive search for agents activeagainst pancreatic cancer. Sadly,answers didn’t come soon enoughfor Gitelson. She died in 2013.

“I was a gastrointestinalmedical oncologist involved intaking care of patients, but now it’ssomething very personal,” saysAstsaturov.

In the wake of Gitelson’spassing, Astsaturov has becomeactive in PANCAN, the Pancreatic

Cancer Action Network, a non-profit advocacy organization,running in 5K races and lobbying members of Congress forincreased funding. PANCAN was instrumental in securingpassage of the Recalcitrant Cancer Research Act of 2012,instructing the National Institutes of Health to fund research on

cancers with particularly poor outcomes,including lung and pancreatic cancer.

According to the National Cancer Institute,pancreatic cancer is the fourth leading cause ofcancer death in the United States and is ontrack to become the second by 2020, behindlung cancer. Overall, just six percent of patientssurvive five years after diagnosis. Yet only twopercent of the federal government’s five billiondollar budget for cancer research is devoted topancreatic cancer. Current hope for controllingthe disease lies in further identifying risk factorsand genetic changes, achieving greaterunderstanding of the metastatic process, anddeveloping better methods of early detectionand treatment.

Astsaturov’s lab, one of five in thetranslational pancreatic cancer research programat Fox Chase, remains devoted to understandingthe biology of the disease in order to developtreatments. Astsaturov says his wife’s passinghasn’t changed the way he practices medicine,

but it has made him acutely aware of the burden on caregivers.“I know firsthand what they are going through—not only thepatients but their family members. When you go home, youdon’t forget about them.”

Today, Gitelson’s memory lives on through Astsaturov’s workand that of her son, Sergei, 34. Formerly a software engineeringmanager at Amazon, he has taken a research position at theEuropean Molecular Biology Laboratory in Heidelberg,Germany, where he will be studying pancreatic cancer genomics.

At Fox Chase, Gitelson will be remembered through theElena Gitelson Chief Fellow honor, which is awarded eachsummer to a hematologic oncology fellow who embodies hercommitment to education and research.

“Elena’s disease and her death changed all of us,” Astsaturovsays. “She has been an inspiration for everyone around her.”

A NEW PERSPECTIVEON MEDICINE“I remember my dad saying, ‘This is going to make you a betterdoctor,’” says medical oncologist Crystal S. Denlinger of herfather Edgar’s journey with metastatic kidney cancer. From hisdiagnosis when she was in high school to his passing in 2008,the progress of his cancer shaped Denlinger’s development as an oncologist.

Denlinger’s frustration at the lack of therapies for kidneycancer available in the 1990s and early 2000s “drove me to whatI ultimately ended up doing as an oncologist—caring forpatients, developing new cancer treatments, and advocating for

Igor Astsaturov stands in front of his wife Elena Gitelson’s painting“Philadelphia: The City of Brotherly Loveand The Philadelphia Chromosome.”

When CANCER is PERSONAL

“Elena’s disease and her deathchanged all of us.She has been an inspiration for everyonearound her.”

˛

FALL/WINTER 2014 13

survivors,” she recounts. “I knew what it was like to face a cancer without a lot of treatment options, so I was drawn togastrointestinal cancers.” Treatment options and prognoses are typically poor for these cancers.

When Denlinger came to Fox Chase in 2004 for a medicaloncology fellowship, she had her father meet with Robert G.Uzzo, chair of surgical oncology, and Gary R. Hudes, a medicaloncologist. “Dr. Uzzo was confident he could treat the tumoron my dad’s remaining kidney,” she says. He removed threesmall tumors and saved her father’s only kidney withoutaffecting renal function.

Following pancreatic surgery to remove a metastasis from his kidney cancer in 2002, Edgar had quit his job as a PhD-levelresearch engineer because his physician thought the stress ofworking was contributing to his illness. “To not be working anddoing research was hard for him,” Denlinger recalls. “I jokedwith him that he got his MD the hard way. He knew moreabout kidney cancer than I did.”

By 2006, Edgar’s disease had metastasized to the point where it could no longer be removed surgically. He enrolled in a Phase I trial for kidney cancer but did not have good results.

Additional drugs now available for kidney cancer were notapproved quite soon enough to help him. He was hospitalizedfor much of the last year of his life, after the cancer had spread tohis brain, and he died in 2008. During that year, Denlinger splittime between being doctor and daughter, sleeping over somenights in the hospital, boosted by the support of her colleagues.“I’m eternally grateful to the entire clinical staff of Fox Chase,

both for the care they provided to my fatherand for their support during the hardest time in my life,” she says.

Nine months after her father’s passing,Denlinger’s mother, Cynthia, was diagnosedwith breast cancer. Treated at Fox Chase by medical oncologist Lori Goldstein and surgical oncologist Elin Sigurdson, she is now a five-year survivor.

“My experiences changed the way Ipractice,” Denlinger says. “I certainly knowwhat the family member sitting in the chair at the side of the exam room feels like, and Iidentify with the children of parents withadvanced cancer. I know what it’s like to getnews you may not want to hear. Now I walk in and give the CT results first, because I knowthat’s what I wanted to hear.”

“It’s also why I’m passionate about thesurvivorship program and the importance ofclinical research to develop new treatments,”adds Denlinger, who has led the charge toorganize and formalize the services that FoxChase offers to its survivors. She chairs theNational Comprehensive Cancer Network’sSurvivorship Guidelines panel, which developsstandards for survivorship care, and remainsactively involved in clinical research, serving asan investigator on a number of early-phaseclinical trials for gastrointestinal cancers.

“I am proud to be my parents’ daughter,”Denlinger says. “They are both my heroes foreverything they lived through and theirstrength.”

Crystal Denlinger and her mother Cynthia, a five-year breast cancer survivor.

“I remember my dad saying, ‘This isgoing to make you a better doctor.’”

GLENN RALL: Science hasbeen a lifelong interest ofmine. I was a little kid in1969 during the Apollo 11mission, which is when Iknew that was I going to bean astronaut. The fact that Iwas chubby and clumsy andgot easily nauseated didn’tseem to get in the way of mycapacity to have a truecareer in space. How aboutyou, James? Did you alwayswant to be a scientist?

JAMES DUNCAN: My entire family is chemical, electrical, andmechanical engineers. I’m the onlynon-engineer, a black sheep if youwill. My interest in science wassparked by a movie, “MedicineMan,” starring Sean Connery. I wasin grade school and was fascinatedwith his character’s ability to go offinto the jungle and find a drug. Ithought it was that simple. Now I realize that what I’m doing is asclose as it gets—my lab is devoted to drug discovery and finding newtherapeutic targets.

SERGEI GRIVENNIKOV: After second or third grade, I knew Iwanted to be a scientist. For a whileI wanted to be a chemist because Ithought all of the colorful stuff inchemistry was cool. Both of myparents are biochemists, so they usedto bring home reagents from theirlab for me to experiment with. Wehad a small summer house and Istarted doing chemical experimentsthere. Eventually my interests led mefrom chemistry to biology andmolecular biology, to immunology,and then finally to cancer research.

RALL: Steve, did you have anyrelatives in science or medicine?

STEPHEN SYKES: No, it wascompletely foreign to me. I’m likeJames in that it was a movie that first got me interested in research.Terribly, it was “The Rock” starringNicolas Cage as a biochemist. I sawthat when I was 17 and was blownaway. It’s on Alcatraz and he’s pullingout these beads with this neurotoxinand I was hooked after that.

RALL: That’s no surprise! I’ve heardthat a lot of kids are now interestedin virology because of movies like“Outbreak” and “Contagion.” Theysee how on-the-edge the field is,with things like hazmat suits and its many other precautions andinnovations. If it takes Hollywood tomove the field forward, then that’sokay. All of you eventually ended upin cancer research—what inparticular drew you to the field?

SYKES: I was intrigued by the effectthe word “cancer” can have onpeople. No one uses that wordlightly. Being able to see the way myparents reacted to it stuck with me.Several of my family members diedof cancer, so I decided I wanted tolearn more about it.

NEIL JOHNSON: The biology ofcancer is very interesting. It’s anextremely complex disease so there’salways more work to do.

RALL: It certainly is a vast field,which can be overwhelming. What doyou do to keep motivated? Whatsparks your creativity and new ideas?

GRIVENNIKOV: I look to colleaguesin neighboring fields of science forfresh perspectives and new ideas. In exchange, I help them with theirprojects and offer them new ways tolook at concepts.

JOHNSON: If I have severaldifferent ideas, my strategy is to getstarted on all of them at once and

14 FALL/WINTER 2014

conversationsW I T H F A C U L T Y

RISINGSTARS

Attracting rising stars is central to Fox Chase’s tradition ofleading cancer research. Forward gathered together four

young scientists who have recently joined the Center—JamesDuncan, Sergei Grivennikov, Neil Johnson, and Stephen Sykes.They talked with Glenn F. Rall, an immunologist who serves asthe Center’s associate chief academic officer, about what drewthem to a career in cancer research and what keeps themmotivated in their search for the next big discovery.

There’s only one reason why patients come to Fox Chase. If you think about the number of people that walk through thisdoor, it’s pure motivation.

—Stephen Sykes

‘‘ ‘‘

see what takes off the quickest. Themost promising idea will eventuallyreveal itself.

SYKES: I look to the potentialclinical relevance of my work withacute myeloid leukemia (AML) for inspiration. I start with the big-picture clinical problems withinAML, like its high mortality rate andresistance to current therapies, anddrill down from there. I think thebest creative ideas come from lookingat something two inches away fromyour face and then 20,000 feet away.

DUNCAN: My creativity is driven bythe desire to discover something newthat no one has ever observed, and tofigure out how those new conceptscan be used to help treat people with diseases such as cancer. Most of my ideas stem from unansweredquestions that exist in the scientificliterature. I very much like to tryunconventional approaches. That’swhen true discoveries are made.

RALL: One of the unique things aboutFox Chase is that scientists are rightdown the hall from the clinic—we allkind of share the same space. Has thishad any effect on you as you’ve begunyour career at Fox Chase?

SYKES: It really hits home with me when I’m walking around theCenter, or I stop down to get coffee,and see patients. The thing aboutbeing at a cancer center is thatthere’s only one reason why patientscome here. If you think about thenumber of people that walk throughthis door, it’s pure motivation.

GRIVENNIKOV: Seeing patientsalways reminds me of the importanceof translational research. We need tocome up with innovative approachesto making advanced cancers curablethat will become the standard of carein the next decade.

Photos by Bryan Lathrop

FALL/WINTER 2014 15

THE NEWCOMERSJames S. DuncanHOME COUNTRY: CanadaRESEARCH INTEREST: Alterations incellular proteins that lead to drugresistance

DISEASE IN FOCUS: Breast and ovariancancer

WOULD LOVE TO VISIT: Australia

Sergei GrivennikovHOME COUNTRY: RussiaRESEARCH INTEREST: Theconnection betweeninflammation and cancer

DISEASE IN FOCUS: Colon andliver cancer, autoimmunediseases

WOULD LOVE TO VISIT: FrenchPolynesia

Neil Johnson HOME COUNTRY: EnglandRESEARCH INTEREST: Howcancer cells repair or dealwith damaged DNA

DISEASE IN FOCUS: Hereditaryforms of breast and ovariancancer

WOULD LOVE TO VISIT: NovaScotia

Stephen M. SykesHOME COUNTRY: CanadaRESEARCH INTEREST:Molecularmechanisms that lead to tumordevelopment and drug resistance

DISEASE IN FOCUS: Acute myeloidleukemia

WOULD LOVE TO VISIT: London

My creativity is driven by thedesire to discover something new,that no one has ever observed. I liketo try unconventional approaches.That’s when true discoveries are made.

—James Duncan

‘‘‘‘

16 FALL/WINTER 2014

c lose-upA P A T I E N T ’ S P E R S P E C T I V E

A Power Play on Cancer By Katie Derickson

“I had difficulty swallowing,” saysChambers. “I knew I had a busy fewdays ahead and just didn’t want to goto the hospital. I was up all night andeventually made peace with the factthat I needed to go to the doctor.”

At the emergency room, Cham-bers was diagnosed with a late-stagemetastatic gastrointestinal stromaltumor (GIST), a rare cancer thathad possibly spread to his liver.

Doctors described the tumor as “the size of a large cantaloupe.”

“Out of nowhere this big Ccrept up on me,” says Chambers.“When the doctor gave me theresults, I was shocked. He askedabout the mass in my stomach andI said, ‘What mass? I ran five milesyesterday.’” Chambers had exhibitedno symptoms prior to his suddeninability to swallow.

Chambers researched cancertreatment centers and, with advicefrom friends and colleagues in themedical field, decided on Fox Chasefor his care. Initial consultationswith Margaret von Mehren, a medical oncologist, and James C.Watson, a surgical oncologist,turned up some good news—Chamber’s biopsy specimen hadpositive reactions to the oralchemotherapy Gleevec. After sixmonths of chemotherapy, his tumorhad shrunk to the size of a golf ball,and Dr. Watson was able to removeit surgically.

Warren Chambers started the day like he didmany others—a five-mile run, a shower, then off to a lunch meeting. It was at lunch that he realizedsomething was wrong.

BALANCING CANCER AND CAREER

Before his diagnosis, Chambers had started a line of personal careproducts inspired by an unusualingredient—magnesium sulfate, alsoknown as Epsom salts. “When I waslittle, I remember my grandmotherwalking around with an apronpocket full of bath salts,” saysChambers. “Both she and mymother instilled in me that makingproducts from these salts wouldbring me joy.”

During his freshman year atMemphis State University, Cham-

bers worked as a technician in theUniversity of Tennessee College ofMedicine’s oncology laboratory,where he learned some fundamentalsof the science of human skin andconnective tissues. This knowledge,combined with an interest inalternative medicine, led Chambersto partner withArthur Sumrall, a dermatologistand founder ofthe LongevityInstitute ofIndiana, anddevelop a line ofsalt soaks, creams,and sprays madewith magnesiumsulfate, whichhelps reduce inflammation andrelieve joint pain and musclesoreness.

What started as a casual interestsoon grew into a successful businessas professional football, basketball,and hockey teams began using theproducts. In Philadelphia, Ed Snider,then owner of the Flyers and 76ers,brought the products to his teams.But when Chambers was diagnosedwith GIST, the company was justbeginning to thrive. “I owe so muchto the Flyers and 76ers,” Chamberssays. “When I was at my sickest,they were loyal customers. Theyhelped me keep my business afloatwhen I was battling.”

GROWING A COMMUNITY OF SUPPORT

After his initial treatment andsurgery in 2007 and 2008, Chambersbounced back to his routine of run-ning and exercise. A relapse in 2011,requiring Dr. Watson to remove a

second tumor as well as part of hiscolon, left Chambers with a far moredifficult struggle to regain hisphysical health and strength.

“From surgery, my blood pressurewas elevated, my kidneys were notfunctioning normally, and I wasexperiencing inflammation and painthrough my entire body,” explainsChambers. “I started thinking about my research and what mygrandmother had taught me about

magnesium. I asked the nurses—with myphysicians’ approval—to apply the magnesiumcream and spray on mylegs.”

Chambers realized he might also be able to provide relief to other cancer patients.Through speakingengagements, media

stories, editorials in health maga-zines, and his testimonial on the Fox Chase website, Chambers hasbeen connecting with cancerpatients and survivors. It hasbecome an important part of hispersonal healing process.

“Being diagnosed with cancer isone thing, but surviving is another,”says Chambers. “To have a rarecancer and be able to share my story,or just to offer a simple kind word of encouragement to other patientswho are in need of support, meansthe world to me.”

Chambers still uses magnesiumsulfate to help counter kidney issueshe experienced from an increase inhis chemotherapy dosage. It washard not to laugh, he says, when avisit to a nephrologist ended with a recommendation to reduce hisinflammation and protect hiskidneys using Epsom salt soaks. “I told him I was already on thecase.”

FALL/WINTER 2014 17

“I owe so much to theFlyers and 76ers. When I was at my sickest, they were

loyal customers. Theyhelped me keep my

business afloat when I was battling.”

“To have a rare cancerand be able to share mystory, or just to offer asimple kind word ofencouragement to otherpatients who are in needof support, means the world to me.”

NEAL SANTOS

Warren Chambers (left) and JimMcCrossin (right), the Flyers’ athletictrainer and strength and conditioningcoach, at the team’s practice facility inVoorhees, New Jersey.

18 FALL/WINTER 2014

making a differenceB O O ’ S B O U T I Q U E

Welcome HomeBOO’S BOUTIQUE SUPPORTS A HOLISTIC APPROACH TO TREATMENT AND RECOVERY

Boo’s Boutique, nestled within the Women’s Cancer Center at Fox Chase,opened in 2012 and offers fashionable, specialized products and personal

services for women undergoing cancer treatment and in recovery. Located in theYoung Pavilion corridor near the gift shop, the boutique partners with Jay AnnIntimates, whose specially trained team fits women for post-surgical bras andprostheses while renewing hope that “the new you” will remain beautiful.Visitors can also register for Reiki treatments offered at no charge for patientsand families. By providing these services in-house, the Boutique helps Fox Chaseachieve its mission to treat the whole woman, and not just her disease.

Boo’s Boutique was made possible thanks to generous gifts from the Binswanger family, the Friends of the Hospital of Fox Chase Cancer Center, the Joan HaradGoodis Fund, and Jane Villon in memory of Joyce Clapper, mother of Fox Chaseresearcher Margie Clapper.

“Surviving cancer mattersto us, but quality of life matters to us too. We wanted to provide a space internally for cancer survivors so theycould leave Fox Chasewith all their needs taken care of.” —BONNIE MILLER,

administrative director, Women’s Cancer Center

The family-owned Jay Ann Intimates is run by Farrell Friedenberg (left) and Randi Denmark, both certifiedmastectomy fitters. Friedenberg also operates a Jay Ann location in nearby Huntingdon Valley.

The boutique is named for LouiseBinswanger. A longtime Fox Chasefriend and patient, she was knownas “Boo” by her grandchildren, whopainted the tiles in her memory.

Photos by Neal Santos

FALL/WINTER 2014 19

“Randi came looking for me after my surgery. With her help, I look symmetrical and feel balanced. Oh, and the selections!The colors, the designs! So many pretty things! I learned thateven after the surgery, I can still be a woman and be pretty.”

—TIJUANA TANCEMORE, breast cancer survivor, pictured with Randi Denmark

“Boo's Boutique is a way for us to give back to patients—a little place that’s welcoming and makes them comfortablewithin their Fox Chase home.”

—LINDA HAMMELL, director of community cancer screening and president ofthe Friends of the Hospital of Fox Chase Cancer Center

“I always take visitors by Boo’s Boutique. I’m proud that I work at a place that considersa patient as a person, not just their cancer. Thisfeels like such a holistic and healthy approach.” —GLENN RALL, immunologist and associate chief academic officer

“I’ve been breast cancer-freefor 14 years, but until I camein for a recent six-monthcheckup, I had no idea these products existed. I feel so much better now.”

—DOLORES WOLFF, breast cancersurvivor

Kathryn Dollard (left), co-manager of Boo’s Boutique and vicepresident of ways and means of the Friends of the Hospital ofFox Chase Cancer Center, and Linda Hammell (right).

20 FALL/WINTER 2014

focusO N N U R S I N G

A D A Y I N T H E L I F E : NURSE NAV IGAT ION AT F OX C HA S E

gynecologic oncology navigatorCarol Cherry and breast navigatorsTracey Newhall and Jessie Schol—toattend a reception in which Dr. JillBiden, an educator and wife of U.S.Vice President Joe Biden, spokeabout the positive impact ofnavigation on healthcare.

Fox Chase has been at the forefront of the nurse navigationmovement, launching its formal program four years ago. Today,twelve navigators specialize in a rangeof cancer types, including breast,gynecologic, thoracic, genitourinary,gastrointestinal, hematologic, andhead and neck cancers, along withmelanoma and sarcoma.

While the title of nurse navigatorhas become common nationally,those who hold it vary fromprofessionals with a social work focusto volunteers who help patients findtheir way to appointments. FoxChase follows a clinical navigator

model, meaning that every nursenavigator is a certified oncologynurse, able to address patients’ urgentclinical questions. Patients calling Fox Chase typically have manyclinical questions and having a nursenavigator available from the firstconnection has proven to beinvaluable for patients.

What other qualities make nursenavigators so valuable? What do theydo on a daily basis?

FOR THE ANSWERS, we followed a day in the life of JOANNE STEIN, a headand neck nurse navigator who has beenwith the program since its inception.

LAST NOVEMBER,the White House invited three ofFox Chase’s nurse navigators—

s

ABOVE: Fox Chase launched its nurse navigator program four years ago. Today it has twelve nurse navigators, each specializing in a specific cancer.

LEFT: At a White House reception commemorating breast cancer awarenessmonth, Dr. Jill Biden recognized three Fox Chase nurse navigators whenspeaking about the positive impact of nurse navigators on healthcare.

JOE HURLEY

OFFICIAL WHITE HOUSE PHOTO

BY DAVID LIENEM

ANN

5:00 A.M.: I’m up early, and have someoatmeal with my vitamins. On my way infrom Lawndale, 10 minutes away, I stop atthe Wawa and get a French vanilla coffee.

7:00 A.M.: I park in the East Garage. I liketo get in before clinic begins and thephone starts ringing.

7:15 A.M.: I head into the office that Ishare in the Women’s Cancer Center withnurse navigator Kate McFarland. I check myvoice mail, emails, and patient schedulesfor the day. I make sure the chemotherapyschedule is what it should be for the week,schedule radiology tests, and check thethree head-and-neck physicians’ schedules.I pull the new patient records and pathol-ogy reviews and bring them to clinic.

It’s our multidisciplinary day—medicaloncology, surgical oncology, and radiationoncology are running clinics at the sametime. A lot of the head and neck patientsneed to be seen by all three specialistsbecause they’ll require all three treatmentmodalities. It allows me to meet the newpatients. The ones receiving chemotherapyand radiation require a lot of support,and I follow them through the wholecontinuum of care.

9:00 A.M.: “Donna,” 36, married withthree kids, has been treated for tonguecancer with surgery, chemotherapy, andradiation. Two years post-treatment, sheis back to work at a bank, and her speechis excellent, despite the removal of partof her tongue. When she first came in,she was very distressed. She had gottenan opinion at a New York hospital; metwith a team of medical, surgical andradiation oncologists at Fox Chase on thesame day; and had another appointmentin Philadelphia. She called me back tosay she wanted to come to Fox Chasebecause it felt like home. It’s one of thereasons I like my job so much. I got toknow her really well, and now she says, “Igot through this because you were here.”

10:00 A.M.: “Rick,” 53, has a large neckmass with a stage 4 tumor, but it’scurable. He works as a manager for acommunications company, and isconcerned about how his disease willaffect his quality of life. I schedule him fora PET scan, make sure he has follow-up

appointments with the radiation andmedical oncologists, arrange for hischemotherapy port and teach him aboutit, and make sure he understands hischemotherapy schedule. Over the year, hehas a robotic tonsillectomy, chemotherapy,and radiation, and is disease-free threeyears later.

12:00 P.M.: Tuesdays are really busy, so Igrab a turkey sandwich that I’ve broughtfor lunch with potato chips, fruit, and asoda.

2:00 P.M.: I’m in the new patient clinicwith our surgeon, Dr. Ridge. If he gets areferral from a doctor, he asks the patientto contact me. If patients have financialquestions, I refer them to the financialcounselor. I explain where to park andhow to get here from the garage. On thephone before the visit, I ask the patientwhat’s going on, to gauge theirunderstanding of the disease. Most peopleare grateful that we’re reaching out.

3:00 P.M.: I take a call from “Sam,” 78,who has a voicebox tumor and multipleco-morbidities: diabetes, heart disease,and vascular disease. He’s hoarse anddifficult to understand, and isn’t sure hewants to be evaluated. I tell him he needsto come in and hear what the doctor hasto say, and it’ll be his decision whether ornot to receive treatment. The olderpopulation especially has preconceivednotions about how awful cancer treatmentcan be. He doesn’t have a family memberto bring him in, so he drives himself. Inotify the social worker. I meet him withDr. Ridge. He’s not a candidate for surgery,but has radiation and chemotherapy and a fairly good response.

Treatment for head and neck canceraffects swallowing, and the pain canbe intense. Patients need supportthroughout the process. I refer him to the case management departmentfor home health care.

6:00 P.M.: Clinic is over. On the wayhome, my mind is reeling. Did I doeverything I needed to do? Was everyonescheduled properly? Did I order thepatient’s pathology slides? I relax afterdinner, have a cup of coffee, read thepaper, watch a little TV.

WHAT I ENJOY MOST ABOUT BEING A NURSE NAVIGATOR is building relationships with the patients and theirfamilies. We care. Our patients are nottransferred to dozens of departments.They know there is one contact person,and we provide easy access to the physicians. I’m proud of my colleagues, some

of whom have shared their expertise atnational meetings. I enjoyed my ownspeaking engagement in New York Citywith survivors of oral and head and neckcancer. Our patients seem to bear out ourvalue: retention rates in the head andneck clinical program are between 85 and90 percent, and our patient satisfactionrate remains consistently at 99 percent or better.I understand that receiving a cancer

diagnosis can be frightening and over-whelming. As navigators, we work toreduce the anxiety of our patients andtheir loved ones and make sure the cancer journey is as easy to negotiate as possible. My days may be long, but I work hard so that my patients and their families don’t have to.

—Joanne Stein

A T U E S D A Y A T F O X C H A S E C A N C E R C E N T E R

JEFF BAXTER

21

PICTURED BELOW: Joanne Stein (left) with patient Loren Santamaria.

Fox Chase is among the top 20hospitals in the nation for cancercare, according to rankings releasedin July by U.S. News & WorldReport. Additionally, Fox Chasewas ranked as high performing inthe areas of nephrology, urology,and gynecology, as well as a newarea—ear, nose, and throat.

“Our remarkable standing in thisyear’s U.S. News & World Reportnational ranking reflects not only the hard work and mission-drivenmindset of everyone who works atFox Chase, but illustrates the greatstrides our Center is making in cancerscience and medicine,” says RichardI. Fisher, President and CEO.

The rankings take into account a number of factors, includingreputation among peers, facilitiesavailable, specific services offered,patient safety measures, Magnetnursing status, and selectedoutcomes metrics.

Locally, Philadelphia magazineranked 28 Fox Chase doctors asamong the best in the region in itsannual “Top Doctors” issue. The list highlights physicians who arenominated by peers, then screenedby physician-led research teamsbased on criteria such as educationand experience. See a list atfoxchase.org/topdocs.

22 FALL/WINTER 2014

reviewN E W S O F N O T E

For the fourth time in a row, FoxChase has been granted Magnetdesignation for excellence in nursingservices through the American NursesCredentialing Center’s MagnetRecognition Program®—making itthe first health care provider inPennsylvania, and one of only 13 inthe nation, to have achieved threesuccessful re-designations. Thenation’s highest form of recognitionfor nursing excellence, Magnetdesignation denotes superior nursingmanagement and practice standards,nursing leadership and support, andattention to cultural and ethnicdiversity, and is one of thebenchmarks used to measure thequality of patient care.

FOURTH CONSECUTIVE MAGNET DESIGNATION AWARDED TO FOX CHASE NURSES

JOE HURLEY

A MILESTONE FOR PAIN ANDPALLIATIVE CARE

Fox Chase Cancer Center’s pain and palliative care programreached an important milestone inApril when it received advancedcertification from The JointCommission. The recognition goes to inpatient programs that demonstrate exceptionalpatient- and family-centeredinterdisciplinary palliative care. Fox Chase is one of only fivefacilities in the region to receivethis certification.

The Commission’s certificationis the latest development in whathas been a decades-long quest to raise the profile of pain andpalliative care and to have thediscipline recognized as a distinctand integral component of medicalcare, explains Michael H. Levy,director of Fox Chase’s pain andpalliative care program and a leaderin developing palliative careguidelines and standards.

Fox Chase faculty and staff celebratedthe Center’s favorable ranking at aspecial celebration in July.

FOX CHASE AND ITS DOCTORSRANK HIGHLY IN NATION, REGION

LISA BAILEY

”In Vino Vita!” “In wine, life!”There was plenty of wine—andlife—in the grand ballroom of the Ritz-Carlton Philadelphia onMay 15 as Fox Chase hosted itsinaugural In Vino Vita wineauction and benefit in partnershipwith the Board of Associates.Nearly 250 people from across theregion enjoyed a festive evening to raise funds in support of theleading research and patient carehappening at Fox Chase. The eventraised a quarter of a million dollars,with a special pledge garneringmore than enough for the purchase

of 35 state-of-the-art recliners forthe infusion room.

The evening also included thepresentation of the 2014 Stanley P. Reimann Honor Award, FoxChase’s highest honor, to NobelLaureate Avram Hershko. Abiochemist who is currently onsabbatical at Fox Chase, Hershkoshared the 2004 Nobel Prize inChemistry with biologists Irwin A.Rose and Aaron Ciechanover fortheir co-discovery of ubiquitin-mediated protein degradation.

Read more about the discovery onpage 24.

FALL/WINTER 2014 23

MICHAEL H. LEVY, vice chair of medicaloncology and director of the pain and palliativecare program, has been selected by theAmerican Society of Clinical Oncology (ASCO)for its first ever Excellence in Teaching Award.The award, presented during ASCO’s 50thAnnual Meeting in Chicago in May, underscoresASCO’s belief that teaching is as important tothe future of cancer medicine as research, caredelivery, and clinical work.

ROBERT G. UZZO, chair of the department of surgery, was awarded the 2014 ResidentsCommittee Teaching Award by the AmericanUrological Association at its annual meeting in May. The award goes to an outstandingurology educator or program director who hasdedicated a portion of his or her career toteaching residents. This award also recognizesindividuals who encourage residents to pursuecareers in academic medicine.

SERGEI GRIVENNIKOV, a researcher in FoxChase’s cancer prevention and control program,was awarded the inaugural Landon Foundation-AACR INNOVATOR Award for Research in TumorMicroenvironment. The award, given by theAmerican Association for Cancer Research(AACR), recognizes outstanding achievement by a junior faculty-level scientist and reflects abelief that both the project and the researcherwill have significant impact. Grivennikovreceived the award for his project, “The role and mechanisms of tumor promoting, IL-17dependent inflammation.”

PAUL F. ENGSTROM, acting chair of medicaloncology and senior vice president ofextramural research programs, was honoredwith the National Comprehensive CancerNetwork’s (NCCN) prestigious Rodger WinnAward. The award recognizes Engstrom’s role in developing the organization’s widely usedclinical guidelines. NCCN's CEO, Robert W.Carlson, called Engstrom “the ‘father’ of theNCCN Clinical Practice Guidelines in Oncology,”noting his “demonstrated leadership anddedication to the welfare of patients” andactive membership in NCCN since its inception.

HORMOZ EHYA, chief of cytopathology at Fox Chase, received the 2014 L.C. Tao EducatorAward during the annual meeting of the United States and Canadian Academy ofPathology in March. The award, presented by the Papanicolaou Society of Cytopathology,cites Ehya’s exemplary contributions tocytopathology education.

HONORS & AWARDS

CERTIFICATION CONFIRMS BONE MARROWTRANSPLANT EXPERTISE

The Fox Chase-Temple bone marrow transplant program recently earnedreaccreditation for three years from the Foundation for the Accreditation of Cellular Therapy (FACT). This achievement affirms the expertise anddedication of the faculty and the high quality of care provided to patientsthrough the hematology program.

INAUGURAL BENEFIT AND WINE AUCTIONRAISES FUNDS FOR FOX CHASE

DANIEL BU

RKE

The In Vino Vita evening included a live wine auction. Proceeds went toward purchasing35 state-of-the-art recliners for the infusion room.

24 FALL/WINTER 2014

When Israeli biochemistAvram Hershko and histhen-graduate student

Aaron Ciechanover arrived at FoxChase in the summer of 1979, theinstitution was already regarded as atop place for cancer research.

“Fox Chase had five members ofthe National Academy of Sciences,including a Nobel Laureate, whichwas remarkable for a relatively smallresearch institution,” says Hershko,who found the talented roster ofresearchers inspiring. He andCiechanover joined the lab of Fox Chase investigatorIrwin A. “Ernie” Rose,where they examinedhow cells dispose ofdamaged proteins.Their work laid thefoundation for a newclass of effective cancer drugs andeventually added Hershko,Ciechanover, and Rose to the ranksof Nobel Prize winners.

During the late 1970s, many scientists were researching howproteins are made within cells.Hershko took a different approach.He began to study the other end ofthe protein’s life cycle—degradation,the process through which cells markproteins for destruction, thendestroy and dispose of them.

Hershko did not know of anyoneelse who shared this research interestuntil he met Rose at a scientificconference at the National Institutesof Health. Much to his surprise,Rose, an expert on enzymemechanisms, had also been lookinginto protein degradation. Hershkohad been scouting for an appropriatelocation to spend a sabbatical year,and it seemed he had found the

perfect match. He asked to joinRose’s lab, and Rose obliged.

Continuing his work on proteindegradation at Fox Chase, Hershko,together with Rose and his lab,uncovered the role of a moleculecalled ubiquitin, which cells use totag proteins that are defective or nolonger needed. Special enzymesattach ubiquitin to these obsoleteproteins, flagging them fordestruction by the proteasome, thecell’s protein garbage disposal. “Iremember the moment of greatexcitement when the results of the

experiment came outfrom the film-developingmachine showing thatubiquitin targets proteinsfor degradation,” saysHershko. Ubiquitinbecame known as the

molecular “kiss of death.” In decoding this process,

Hershko, Rose, Ciechanover, andtheir colleagues helped futureresearchers understand how cancersdevelop when the degradation cycleis disrupted. “The implications areenormous,” wrote Alfred Knudson Jr.in 1979 as then-director of theInstitute for Cancer Research, theearly name for Fox Chase’s scientificenterprise. “It is my opinion that thisis another of the ‘rare events’ in thehistory of ICR science.”

The implications of the discoveryweren’t fully realized until 2003,when a drug came to market thatharnessed the power of ubiquitin.Bortezomib, known commercially as Velcade, interferes with theproteasome to help destroy tumorsin multiple myeloma, a cancer ofthe bone marrow. It was the firstmedication based on the Fox Chase

team’s research to be approved bythe FDA.

In 2004, Hershko, Ciechanover,and Rose were awarded the NobelPrize in Chemistry for their work.“It does not mean that a miracledrug to beat cancer is on the way,”said Hershko in an interview withthe Associated Press in 2004. “But Ido believe there will be advances inthe treatment of cancer based on ourwork. This I truly believe in.” SinceVelcade, several cancer treatmentmedications based on this researchhave come to market.

Since the profound success of his first sabbatical at Fox Chase,Hershko has returned several timesover the following decades tocontinue his research on ubiquitin.Together with Fox Chase biochemistTimothy J. Yen, he is currentlystudying how ubiquitin works inmitosis, the process of cell division.“Someone who has uncontrolledmitosis will have tumors,” explainsYen. “Until we understand how acell regulates cell division correctly,we won’t understand how it does itincorrectly, as in the case of cancer.”

With 35 years and a Nobel Prizebehind him, Hershko, now 76,remains as dedicated to his researchas ever. “It takes a lot of hard work,determination, and patience to find the answer to the question,” he says. Yen seconds that, citingHershko’s earlier achievements.“Great discoveries don’t come bydesign. They come from asking good questions.”

rewindM O M E N T S I N F O X C H A S E H I S T O R Y

A PRIZE-WINNING QUESTION

The lab of former Fox Chase investigatorIrwin A. “Ernie” Rose (front center) inthe late 1970s. Avram Hershko stands inthe back row, third from left.

IN STUDYING PROTEIN DEATH, FOX CHASE RESEARCHERS

BREATHED NEW LIFE INTO CANCER DRUGS

By Katie Derickson

“It is my opinion that this is another of the ‘rare events’ in the history of ICR science.”

FOX CHASE ARC

HIVES; FACING PAGE: BRYAN LATHRO

P

“Great discoveries don’t come by design. They come from asking good questions.”

—TIM YEN

Avram Hershko (left) and Tim Yen

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“PHILADELPHIA: THE CITY OF BROTHERLY LOVE AND THE PHILADELPHIA CHROMOSOME”is the last work of Elena Gitelson, a Fox Chase-trainedmedical oncologist who died of pancreatic cancer in 2013. Today, her memory continues to drive her husband, Fox Chase physician-researcher Igor Astsaturov, in his quest to develop better treatments for patients. Read their story—and that of other Fox Chase faculty touched by cancer—on page 10.

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