Newsroom
Press Releases

Cancer Center’s Pam Alverson named UAB Employee of the Year

alverson stream

Pam Alverson, program director for the Office of Program Review and Monitoring Systems in UAB’s Comprehensive Cancer Center

Pam Alverson, program director for the Office of Program Review and Monitoring Systems in UAB’s Comprehensive Cancer Center, has been named UAB Employee of the Year. Alverson was chosen from the Employee of the Month award-winners selected during the 12-month period ending July 2017.

Alverson will be the guest of honor at an invitation-only ceremony and reception honoring her with the highest non-academic employee award in January.

“I am deeply honored and humbled to receive this recognition,” Alverson said. “To be awarded for a job you enjoy and working with people you love and respect is incredible. I am proud to work for UAB and be a part of the on-mission Comprehensive Cancer Center team.”

Alverson, who was selected December 2016’s Employee of the Month, was praised for her calm attitude that provides stability in an overwhelming system and for her dedication — she even sometimes plans vacations around important meetings — to her position.

In her role, Alverson oversees the administrative tasks of the scientific review process for cancer-related clinical trials, interacting with investigators, working groups and related committees and essentially moving clinical research protocols through the center’s process.

“She has incredible intention to detail working with scores of physicians and scientists performing clinical trials,” said Edward Partridge, M.D., then-director of the Cancer Center said in nominating her. “In spite of this challenge — akin to herding not cats, but tigers — I have never once seen her look frustrated or irritated, much less lose her temper. She is simply unbelievable.”

Alverson said that the biggest lesson she has learned in her 30 years at UAB is that everyone has a story, she said. “Everyone wants to be heard and respected; each person is important.”

For her, this was especially personified one spring, when she dressed as the Easter Bunny for the patients at Children’s Hospital. “I still clearly remember looking through the mesh eyes of the costume,” Alverson said, “and seeing sick children smile.”

Congratulations to the monthly award-winners

August: Kristen Dubose “embodies all that is genuinely good about working at UAB”

Each month, UAB recognizes an outstanding employee for their dedication, hard work and contributions to the university’s success. If you know of a great employee, you can learn how to nominate them for this recognition at uab.edu/humanresources.

September: Debby Frazer is “a champion of patients and their families”

October: Cynthia Helms “gets the job done” with a smile

November: Joy Lewis is a master of everything thrown at her

April: Will Callans brings enthusiasm and positivity to an oft-overwhelming field

May: Sharon Johnson “is a beacon of light” for Facilities division

June: Amie Traylor creates positive environment in nephrology lab

July: Rachel Schwartz “is always a team player” both with colleagues and patients

Pam Alverson, program director for the Office of Program Review and Monitoring Systems in UAB’s Comprehensive Cancer Center, has been named UAB Employee of the Year. Alverson was chosen from the Employee of the Month award-winners selected during the 12-month period ending July 2017.

Alverson will be the guest of honor at an invitation-only ceremony and reception honoring her with the highest non-academic employee award in January.

“I am deeply honored and humbled to receive this recognition,” Alverson said. “To be awarded for a job you enjoy and working with people you love and respect is incredible. I am proud to work for UAB and be a part of the on-mission Comprehensive Cancer Center team.”

Alverson, who was selected December 2016’s Employee of the Month, was praised for her calm attitude that provides stability in an overwhelming system and for her dedication — she even sometimes plans vacations around important meetings — to her position.

In her role, Alverson oversees the administrative tasks of the scientific review process for cancer-related clinical trials, interacting with investigators, working groups and related committees and essentially moving clinical research protocols through the center’s process.

“She has incredible intention to detail working with scores of physicians and scientists performing clinical trials,” said Edward Partridge, M.D., then-director of the Cancer Center said in nominating her. “In spite of this challenge — akin to herding not cats, but tigers — I have never once seen her look frustrated or irritated, much less lose her temper. She is simply unbelievable.”

Alverson said that the biggest lesson she has learned in her 30 years at UAB is that everyone has a story, she said. “Everyone wants to be heard and respected; each person is important.”

For her, this was especially personified one spring, when she dressed as the Easter Bunny for the patients at Children’s Hospital. “I still clearly remember looking through the mesh eyes of the costume,” Alverson said, “and seeing sick children smile.”

Congratulations to the monthly award-winners

August: Kristen Dubose “embodies all that is genuinely good about working at UAB”

Each month, UAB recognizes an outstanding employee for their dedication, hard work and contributions to the university’s success. If you know of a great employee, you can learn how to nominate them for this recognition at uab.edu/humanresources.

September: Debby Frazer is “a champion of patients and their families”

October: Cynthia Helms “gets the job done” with a smile

November: Joy Lewis is a master of everything thrown at her

April: Will Callans brings enthusiasm and positivity to an oft-overwhelming field

May: Sharon Johnson “is a beacon of light” for Facilities division

June: Amie Traylor creates positive environment in nephrology lab

July: Rachel Schwartz “is always a team player” both with colleagues and patients

Pam Alverson, program director for the Office of Program Review and Monitoring Systems in UAB’s Comprehensive Cancer Center, has been named UAB Employee of the Year. Alverson was chosen from the Employee of the Month award-winners selected during the 12-month period ending July 2017.

Alverson will be the guest of honor at an invitation-only ceremony and reception honoring her with the highest non-academic employee award in January.

“I am deeply honored and humbled to receive this recognition,” Alverson said. “To be awarded for a job you enjoy and working with people you love and respect is incredible. I am proud to work for UAB and be a part of the on-mission Comprehensive Cancer Center team.”

Alverson, who was selected December 2016’s Employee of the Month, was praised for her calm attitude that provides stability in an overwhelming system and for her dedication — she even sometimes plans vacations around important meetings — to her position.

In her role, Alverson oversees the administrative tasks of the scientific review process for cancer-related clinical trials, interacting with investigators, working groups and related committees and essentially moving clinical research protocols through the center’s process.

“She has incredible intention to detail working with scores of physicians and scientists performing clinical trials,” said Edward Partridge, M.D., then-director of the Cancer Center said in nominating her. “In spite of this challenge — akin to herding not cats, but tigers — I have never once seen her look frustrated or irritated, much less lose her temper. She is simply unbelievable.”

Alverson said that the biggest lesson she has learned in her 30 years at UAB is that everyone has a story, she said. “Everyone wants to be heard and respected; each person is important.”

For her, this was especially personified one spring, when she dressed as the Easter Bunny for the patients at Children’s Hospital. “I still clearly remember looking through the mesh eyes of the costume,” Alverson said, “and seeing sick children smile.”

Congratulations to the monthly award-winners

August: Kristen Dubose “embodies all that is genuinely good about working at UAB”

October: Cynthia Helms “gets the job done” with a smileSeptember: Debby Frazer is “a champion of patients and their families”

November: Joy Lewis is a master of everything thrown at her

April: Will Callans brings enthusiasm and positivity to an oft-overwhelming field

May: Sharon Johnson “is a beacon of light” for Facilities division

June: Amie Traylor creates positive environment in nephrology lab

July: Rachel Schwartz “is always a team player” both with colleagues and patients

UAB Cancer Center’s lay navigation program honored with prestigious Innovator Award

The University of Alabama at Birmingham Comprehensive Cancer Center has received a prominent national Innovator Award from the Association of Community Cancer Centers for its Patient Care Connect Program. The award is given only to ACCC members who are recognized as forward-thinking in creating replicable solutions to improve access, quality and value of patient care. PCCP was selected for demonstrating creativity, innovation and teamwork in delivering cancer care.

Based on the premise that proactive management of distress for cancer patients leads to decreased overall cost and better health care for patients, the multidisciplinary teams at the UAB Comprehensive Cancer Center worked with local oncologists within the UAB Health System Cancer Community Network to emphasize the importance of coordination of care.

“When developing PCCP, we wanted to provide the highest quality of life for people diagnosed with cancer, and while doing that, we wanted to reduce the cost of health care,” said Gabrielle Rocque, M.D., assistant professor in the UAB Division of Hematology and Oncology and medical director of the Patient Care Connect Program. Edward Partridge, M.D., former director of the UAB Cancer Center, is the principal investigator of the program.

The goal of the PCCP was to reduce unnecessary emergency room visits, hospital days and intensive care unit days. The program also aimed to encourage evidence-based clinical pathways and earlier adoption of hospice care, especially reducing the use of chemotherapy in the last two weeks of life.

To accomplish this outcome, a specialized navigation team including trained lay navigators, a supporting nurse manager and other support staff assisted the oncologists in each participating community cancer center or hospital in the community network.

Lay navigators are non medical professionals who go through extensive didactic and practical training ranging from health promotion and communication to data collection and conducting distress screenings. Navigators help to eliminate barriers, link patients with resources to get to appointments, connect patients to providers to address symptoms, and coordinate care between multiple providers. In addition, they ensure timely delivery of care and help patients navigate the health care system, especially assisting with access to care. “One of the novel and central elements of the PCCP was to use trained lay navigators to empower patients to take an active role in their health care,” Rocque said. “Navigators can identify resources, recognize clinical symptoms and triage to the clinical team, understand disease and treatment, and when appropriate and needed, help patients engage in end-of-life discussions with their providers.”

After conducting extensive research over a three-year period with more than 10,000 navigated Medicare patients age 65 and older with a cancer diagnosis, a $19 million total cost savings to Medicare was observed, which amounted to a $781.29 savings per quarter per navigated patient compared to non-navigated patients. Patient satisfaction with the navigation program was high, with 89 percent of navigated patients’ reporting they would recommend the program to another cancer survivor.

“We absolutely believe that integration of lay navigation as part of standard of care improved quality of care and reduced cost to Medicare,” Rocque said. “We also believe navigation will be a key element of future patient-centered, value-based health care redesign.”

The ACCC is the leading advocacy and education organization for the multidisciplinary cancer care team. More than 23,000 cancer care professionals from over 2,500 hospitals and practices nationwide are affiliated with ACCC.

UAB physician-scientist receives Komen grant to conduct HER2-positive breast cancer research

Erica Stringer-Reasor, M.D., assistant professor in the University of Alabama at Birmingham  Division of Hematology and Oncology has been awarded a $450,000 grant from Susan G. Komen to support a clinical trial investigating PARP inhibitors for the treatment for HER2-positive breast cancer.

HER2-positive breast cancer is a cancer that tests positive for a protein called human epidermal growth factor receptor 2 or HER2, which promotes the growth of cancer cells. In about one of every five breast cancers, the cancer cells have a gene alteration that makes an excess of the HER2 protein. HER2-positive breast cancers tend to be more aggressive than other breast cancers.

PARP is an enzyme in cells that helps repair DNA when it has become damaged, as in the case with cancer. PARP inhibitors work by keeping cancer cells from repairing themselves once they have been damaged by chemotherapy, while sparing healthy cells.

At UAB, Eddy Yang, M.D., Ph.D., professor and vice chair of Translational Research in the UAB Department of Radiation Oncology, discovered that PARP inhibitors may be particularly effective in HER2-positive breast cancer that has become resistant to anti-HER2 therapies.

“However, medications are still being tested in clinical trials, and are not yet FDA-approved for use outside of clinical research,” said Andres Forero, M.D., professor in the UAB Division of Hematology and Oncology, and head of the breast cancer research program.

Stringer-Reasor who is an associate scientist in the Experimental Therapeutics program at the UAB Comprehensive Cancer Center, will investigate the combination of PARP inhibitors with HER2-positive targeted therapies, which could improve patient survival.

“There is some evidence that different PARP inhibitors work differently, so not all may have similar results in clinical trials,” said Forero, a senior scientist at the UAB Comprehensive Cancer Center. “We are conducting the next level of research using combination therapies to get better outcomes and move the needle forward.”

BCRFA Awards Funds For Two Collaborative Breast Cancer Research Projects in Alabama

The Breast Cancer Research Foundation of Alabama (BCRFA) presented two awards for two-year collaborative breast cancer research projects. One award went to Dr. Gary Piazza of the University of South Alabama Mitchell Cancer Institute and Dr. Clinton Grubbs of the University of Alabama – Birmingham Comprehensive Cancer Center with the second award going to Drs. Joel Berry, Jessy Deshane and Andra Frost of UAB and Dr. Mark Suto of Southern Research Institute.

Proposals from across the state were reviewed in September and the winners were announced at the UAB Comprehensive Cancer Center Annual Research Retreat on October 30.

Piazza and Grubbs’ project, “A Novel Wnt/β-Catenin Inhibitor for Breast Cancer,” will focus on developing a promising experimental drug, MCI-030, for breast cancer prevention and treatment and further study its unique mechanism of action involving the suppression of Wnt/β-Catenin signaling.

Berry, Deshane, Frost and Suto’s project, “A Humanized 3D Immunocompetant Model of Breast Cancer for Precision Medicine and Immune Therapy Development” will develop a 3D humanized immunocompetent breast cancer model that will enhance cancer drug development and advance personalized cancer therapy.

The selected projects will each receive $50,000 annually for two consecutive years, totaling $100,000 each over the two- year period. The BCRFA will also continue a second year of support for the inaugural award to Sara Cooper, PhD, of HudsonAlpha Institute for Biotechnology, and Donald Buchsbaum, PhD, of UAB. Cooper and Buchsbaum’s project is characterizing the effects of immunotherapy in breast cancer models and explore new drugs to improve immune system response

The Breast Cancer Research Foundation of Alabama is a nonprofit organization raising funding and awareness for breast cancer research in Alabama.

“Since the organization began in 1996, the BCRFA has invested over $6.75 million in breast cancer research initiatives in Alabama. We are excited to award these two grants supporting collaborative breast cancer research,” stated Beth Bradner Davis, BCRFA executive director.

With these collaboration awards, the Breast Cancer Research Foundation of Alabama hopes to: encourage collaboration among top researchers in Alabama in the field of breast cancer research; help support basic research which can be emerge into translational research; offer financial support to promising breast cancer research in Alabama providing seed money to enable a project to secure additional funding from national providers; and offer hope to those affected by breast cancer and ultimately save lives through breast cancer research.

About the BCRFA

The Breast Cancer Research Foundation of Alabama supports a comprehensive approach to battling breast cancer through support of collaborative and innovative research to help diagnose, treat, prevent and eradicate the disease. Since its inception in 1996, the BCRFA has raised over $6.75 million to fund research at the UAB Comprehensive Cancer Center and with their collaborative partners. All funds raised stay here in the state of Alabama, but the research will have a global, life-saving impact. BCRFA.org

UAB Cancer Center honors researchers during 19th annual research retreat

Dr. Ralph Sanderson received the Albert F. LoBuglio Distinguished Faculty Award

With record attendance of more than 400 participants, fourteen UAB scientists and two Mitchell Cancer Institute researchers were selected for awards during the UAB Comprehensive Cancer Center’s 19th Annual Research Retreat. This year the event focused on the prevalent research area of Metabolism and Cancer.

The research competition enables junior investigators, resident trainees, postdoctoral fellows and graduate students to showcase their research in cancer prevention and control, biostatistics and bioinformatics, among other areas. The 2017 competition included 136 poster presentations. Awards were given in eight categories.

Ralph Sanderson, Ph.D., professor in the UAB Department of Pathology and co-leader of the Cancer Cell Biology Program at the UAB Comprehensive Cancer Center, received the Albert F. LoBuglio Distinguished Faculty Award. This award is presented annually by the director to a Cancer Center investigator who has made outstanding research contributions.

The John R. Durant Award for Excellence in Cancer Research was presented in three categories. Junior Investigator winners were Mohamed Khass, Ph.D., Renata Jaskula-Sztul, Ph.D. and Bing Zhu, Ph.D. of the Mitchell Cancer Institute. Resident Trainee/Postdoctoral Fellow winners were Shannon M. Kahan, Ph.D., Shyam Kumar Bandari, Ph.D., and Angela M. Carter, Ph.D. Graduate student winners were Caroline W. Cohen, M.S., Ph.D., Asmi Chakraborty, M.S., and Tejeshwar Rao, Ph.D.

Adam B. Keeton, Ph.D. of the Mitchell Cancer Institute, received the William C. Bailey Award for Excellence in Cancer Prevention and Control Research, with honorable mentions for Jacqueline B. Vo, Ph.D., and Karina Halilova, M.D., M.P.H.

Ritesh K. Srivastava, Ph.D., received the Tandra Chaudhuri Award for Excellence in Cancer Research.

The Seng-jaw Soong Award for Excellence in Biostatistics and Bioinformatics Research was presented to Sean M. Santos, B.S., and Amena R. Alkeswani received the Cancer Research Experiences for Students (CaRES) Award.

In addition, the Breast Cancer Research Foundation of Alabama also presented two awards for two-year collaborative breast cancer research projects. The selected projects will receive $50,000 annually for two consecutive years, totaling to $100,000 each. One award went to Gary A. Piazza, Ph.D. of the University of South Alabama Mitchell Cancer Institute and Clinton J. Grubbs, Ph.D. of the UAB Comprehensive Cancer Center with the second award going to Joel Berry, Ph.D., Jessy Deshane, Ph.D., and Andra R. Frost, M.D. of UAB and Mark J. Suto, Ph.D. of Southern Research Institute.

Meneses appointed to NINR position

karen meneses 2017University of Alabama at Birmingham School of Nursing Associate Dean for Research and Scholarship and Professor Karen Meneses, Ph.D., has been appointed to the National Institute of Nursing Research’s National Advisory Council for Nursing Research (NACNR), where she will directly impact the NINR’s continuing mission to promote and improve the health of the nation’s individuals, families and communities.

Meneses is co-director of the school’s Doctor of Philosophy in Nursing program — the only one in the state — and will serve on the 15-member NACNR, which meets three times a year to help guide NINR’s direction, through 2021.

“It is truly an honor for me personally to be named to a national advisory board for NINR,” Meneses said. “This is also recognition of the UAB School of Nursing and its impact as an institution of nursing research. It is a tribute to being a nurse and a researcher, and I believe it will bring even more acknowledgment of the work we do here at the UAB School of Nursing and universitywide.”

She will provide recommendations to the NINR director about the direction and support of research that serves as the evidence base for nursing practice.

To achieve its mission, the NINR supports and conducts clinical and basic research and research training on health and illnesses. This research spans and integrates the behavioral and biological sciences and helps develop the scientific basis for clinical practice.

Precision oncology in action: the UAB experience

Written by Matt Windsor for The UAB Mix

At UAB, "precision medicine is our standard of care," says oncologist Eddy Yang, M.D., Ph.D.

At UAB, “precision medicine is our standard of care,” says oncologist Eddy Yang, M.D., Ph.D.

 

The tumor is in the salivary gland, and it’s a tough one. All the typical treatments thrown at it have failed. With nothing left to try, the patient’s doctor turns to a pioneering new kind of cancer program at UAB: the Molecular Tumor Board.

The MTB, led by Eddy Yang, M.D., Ph.D., launched in 2013. It was funded by UAB Hospital and Blue Cross Blue Shield of Alabama to pay for gene sequencing in difficult cases like these. Sequencing can cost $4,000 or more, and because there is little available research on efficacy, insurers don’t usually cover it. But Blue Cross and UAB Hospital, like nearly everyone else in health care, appreciate the potential of gene sequencing in patient care. It’s up to groundbreaking programs like Yang’s MTB to help set the standard for how sequencing becomes part of standard practice.

A hit

The doctors send a small sliver of tumor to a specialized lab in St. Louis, where scientists look for mutations in more than 100 cancer-associated genes. A few weeks later, Yang has a hit.

The patient’s tumor turns out to be driven by a mutation in the BRAF gene. BRAF makes a protein, B-Raf, that signals cells to grow. That means the tumor cells are overproducing B-Raf and turbocharging their growth rate. This is actually good news. The doctors have drugs that block BRAF — they’re used to treat the skin cancer melanoma. So the MTB recommends a combination of BRAF inhibitors and MEK inhibitors, a related therapy.

“The cancer responded pretty well,” recalls Yang, who is ROAR Southeast Cancer Foundation Endowed Chair in Radiation Oncology, professor and vice chairman for translational science in the Department of Radiation Oncology and the UAB Comprehensive Cancer Center, and deputy director of the UAB Hugh Kaul Precision Medicine Institute. “The patient was in remission for more than a year.”

Precision oncology

Cancer is a disease with a thousand faces. Oncologists like Eddy Yang have to recognize which one they’re seeing with each new patient. In the last few years, the job has gotten both easier and harder. There are now hundreds of drugs available to treat cancer — as well as new tools like gene sequencing to help doctors find the most appropriate treatment for each patient.

But these tools have also demonstrated that cancer comes in many more varieties than the 100 or so named types, which are generally labeled by the organ where they are found. There isn’t just “breast cancer” or “uterine cancer,” for instance — there’s breast cancer driven by a BRCA2 mutation, and uterine cancer driven by a KRAS mutation. In May 2017, the FDA approved the drug Keytruda (pembrolizumab) to treat metastatic solid tumors with microsatellite instability — the first time any regulatory agency approved a drug based on a molecular target rather than a specific tissue type.

“The goal of precision oncology is not to think about cancer according to its type, but as a cancer with a specific defect or driver,” such as a BRAF mutation, says Yang. In an intriguing new paper, Yang and colleagues report on three years worth of data from the MTB. It provides a glimpse into the future of medicine.

mix mtb graphic

“Better treatment options”

During that three-year window, 191 cases were discussed at the MTB, and 132 cases were approved for testing. Out of 124 cases with results available:

  • 46 patients had predictive or prognostic mutations.
    • The most common mutation site was the tumor suppressor gene TP53.
  • 56 patients had mutations reported in cancer (but with no current predictive or prognostic significance).
    • The number of mutations present in those two groups ranged from 1–6.
  • 22 patients had no clinically significant mutations.

The results make clear that “sequencing isn’t a magical cure at this point,” Yang says. “We’re not going to find drugs for every person whose tumor we sequence.” Some mutations aren’t targeted by any current drugs, or may require a combination of treatments that hasn’t been identified yet. But the MTB experience, Yang says, demonstrates that “we may be able to offer better treatment options for some patients.”

New opportunities at UAB

More patients have the option to receive sequencing, at no cost, thanks to UAB’s participation in the Strata Trial. Patients with metastatic or unresectable tumors, glioblastoma multiforme or pancreatic cancer, or a rare cancer are eligible to participate in the trial. Tumors are sequenced at no cost, with doctors selecting the most appropriate therapy based on the results. Another UAB-affiliated study, the TAPUR trial run by the American Society of Clinical Oncology, gives patients access to more than a dozen new targeted therapies.

mix strata graphic 1

More than 300 patients at UAB have been sequenced as part of the Strata Trial. “We are now sequencing 50–60 patients per month,” Yang says. At this point, the “hit rate” — patients who have an actionable mutation — is around 70 percent. Of those, around 20 percent will get an offlabel drug or be enrolled in a clinical trial of a new drug, Yang notes. For a sizable number, sequencing lets doctors “know what drugs not to give,” he adds. For instance, patients with colon cancer are often treated with the drug cetuximab. “But if you have a KRAS mutation, we don’t use cetuximab,” Yang says.

The new standard of care

For patients with lung cancer, melanoma and colorectal cancer, the value of genetic sequencing for stage IV tumors upfront has already been demonstrated, Yang says. Insurance companies cover testing costs, and doctors specializing in these conditions now routinely order sequencing.

“That’s the beauty of trials like Strata,” Yang explains. “For lung and colon cancer, ordering sequencing is now almost reflexive for doctors. Now at UAB, we can be reflexive for other types of cancer as well. Precision medicine is our standard of care.”

Metastatic breast cancer treatment: what really matters?

Written by Matt Windsor for The UAB Mix

Metastatic breast cancer treatment: what really matters?

Every cancer treatment, whether it’s an experimental drug or a trusted standby, comes at a cost. There is the literal cost, in dollars. “But schedules, toxicities, the burden on a family or other caregivers,” are all part of the equation as well, says Gabrielle Rocque, M.D., an assistant professor in the UAB School of Medicine Division of Hematology and Oncology and UAB Comprehensive Cancer Center.

Rocque specializes in the treatment of metastatic breast cancer. Thirty percent of women with early stage breast cancer develop recurrent or metastatic disease, when the cancer has spread to other organs and is much more complicated to treat (typically because it has become resistant to the first-line treatments). More than 150,000 women in the United States are now living with metastatic breast cancer. Every year, more than 40,000 will die from the disease, but the median survival is now more than two years.

mix metastatic breast cancer 1 wheader

“That number continues to increase as new treatment options become available,” Rocque says. (See Game-changing therapies.) The growing number of therapies make treatment of metastatic breast cancer very complex. “There are different options for what you can do at any given time,” Rocque says. And each has its own schedule of required clinic visits, follow ups and side effects, she adds. “For patients with a limited life expectancy, hours spent in hospitals and clinics may cost them valuable time with their loved ones.”

In two new studies, Rocque is examining how to give patients a more informed role in those treatment decisions.

With a grant from the American Cancer Society (ACS), Rocque is piloting a new model for shared decision making in metastatic breast cancer using treatment plans. These are documents, written in lay language, that provide patients with a game plan for their care. “Treatment plans have not been tested in metastatic cancer, where they may provide the greatest benefit,” Rocque noted in her grant application.

mix metastatic breast cancer 2

As part of its participation in the Oncology Care Model program from the Center for Medicare and Medicaid Innovation, UAB is already using software called Carevive to give patients treatment plans once treatment begins. With her ACS study, Rocque is testing what happens when patients have input before the plan is set. To begin, she and her team are interviewing patients, patient navigators, nurses and physicians at UAB to gather a picture of the most important topics to consider, including personal and treatment goals, along with concerns such as being a burden to others.

“These are patients who are going to be on treatment for the rest of their lives,” says Rocque. “It’s important to consider both quantity and quality of life.”

mix metastatic breast cancer 3

Rocque will use information from these patient interviews to create an electronic treatment planning tool, then test it in a randomized controlled trial against the current standard of care. Follow-up surveys will examine how the treatment plans affect patients’ experience of shared decision making in their care.

mix rocque portrait 700

Gabrielle Rocque, M.D.

Previous studies of treatment plans in other diseases have found that both patients and their providers appreciate having these tools available. But the costs of implementing treatment plans are an important factor in adoption as well, Rocque notes. “Any change has to work for all participants in the health-care system, including patients, providers and payers, such as insurance companies,” she says. “Otherwise it’s not sustainable.” So Rocque is also conducting an economic analysis as part of her study. New Medicare rules are tying doctor’s payments to a number of metrics, including patients’ rating of shared decision making. Rocque’s analysis will examine whether the costs of software and time involved in treatment planning will be outweighed by improved payments from Medicare and other payers.

The entire national debate about health-care revolves around financial costs. But surprisingly little is known about the true costs of metastatic breast cancer care, in money and time, Rocque says. She is looking to fill that gap with an unprecedented analysis — a combination of Medicare and private claims data, patient surveys, and a process known as time-driven activity-based costing, which charts how long each step takes in a clinic visit, from the wait at reception to the consultation with the oncologist and any treatment infusions.

“We’re tracking anything that a patient is doing related to health-care that is taking up time,” says Rocque. “That includes the time it takes to drive to appointments, going to pick up prescriptions, talking to staff on the phone to set up future visits.” By charting the staff time involved in each step of the treatment cycle, Rocque will also be able to quantify the true cost of treatment to a health system.

mix process chart example

Hypothetical example of a time-driven activity-based costing process chart.

The study, funded by a grant from biotechnology company Genentech, will feed invaluable data to doctors that they can use to improve care, Rocque says. “We don’t talk to patients a lot about how much time and effort some of these treatments require,” she notes. “That’s because we don’t have a great idea of the magnitude of time involved.

“If someone is going on a clinical trial, we know that will take more time, but how much? It may be where we’ll be able to say, ‘There are two different treatments available: over the next six months, on one you’ll spend 20 hours in the clinic, and with the other, you’ll spend 150 hours in the clinic.’ That might be something patients really care about, and I’ve never seen people be able to quantify that. It won’t be perfect, but it will give them an idea.”

mix metastatic breast cancer 4

UAB first in U.S. to use HyperArc High-Definition Radiotherapy on brain cancer

Last week, the University of Alabama at Birmingham treated brain cancer patients for the first time utilizing Varian HyperArc High-Definition Radiotherapy, making the academic medical center the first in the United States to use this technology for complex radiosurgical procedures.

With HyperArc, which Varian Medical Systems tested and partly developed in collaboration with UAB, clinicians can deliver more compact radiation doses that closely conform to the size, shape and location of brain cancer tumors while sparing more surrounding healthy tissue.

HyperArc web

Photo courtesy of Varian Medical Systems.

About 20-40 percent of cancer patients will develop brain metastases. More than half of them will have more than one tumor in the brain. The risk of a metastatic brain tumor depends on the kind of cancer and how advanced it is when it is diagnosed. Typically, an increasing number of patients return for retreatment of their disease.

“HyperArc allows us to plan and deliver state-of-the-art radiosurgery to highly complex cases efficiently with a very high degree of dose compactness and conformity, and has made it possible to treat patients with larger numbers of brain metastases very aggressively,” said John Fiveash, M.D., professor and vice chair for academic programs in the UAB Department of Radiation Oncology. He is also a senior scientist at the UAB Comprehensive Cancer Center.

“Five radiosurgery patients were treated with HyperArc therapy the first day,” Fiveash said. “Most of these patients had multiple brain metastases. We were impressed with the quality and efficiency of the plan creation and treatment delivery. Patients are excited to be treated in a normal time slot of 15-20 minutes without the requirement of an invasive stereotactic head frame.”

HyperArc contains a prescriptive workflow that includes simulation guidelines, patient immobilization, treatment planning, patient setup, imaging and pre-determined delivery sequence.

“HyperArc allows us to irradiate multiple tumors at the same time without repositioning the patient, which provides better management of patient movement while saving time for the patient and the clinical team,” Fiveash said.

“Basically, HyperArc is designed to enable consistent, high-quality planning and seamless one-click delivery,” said Richard Popple, Ph.D., professor and assistant vice chair for Physics in the UAB Department of Radiation Oncology. He is also an expert in novel treatment planning techniques and clinical implementation of new technologies and a senior scientist at the UAB Comprehensive Cancer Center.

HyperArc addresses concerns about complexity, patient safety, cost and human resources that can make radiosurgery inaccessible for many patients and unfeasible for many institutions.

“Working closely with leading institutions like UAB played an important role in the development of HyperArc,” said Kolleen Kennedy, president of Varian’s Oncology Systems business. “We value their continued contributions to the advancement of cancer care, and we are excited that HyperArc treatments have now begun in the U.S.”

Planning through the workflow

For the past several years, UAB has been working with Varian to bring HyperArc technology to fruition. UAB has been involved with four other institutions in developing optimization tools to enhance the dose and treatment delivery. They developed dedicated algorithms to ensure efficient workflow, and new ways of looking at multiple targets simultaneously, all while reducing the complexity of the planning process for clinicians. In addition, UAB helped devise metrics to use for single and multiple targets that can be customized.

Maximizing cost and efficacy

“We are able to help more patients without the need to invest in additional or new equipment,” Popple said. HyperArc capitalizes on the unique capabilities of Varian’s TrueBeam and EDGE treatment systems, which UAB already uses.

The advanced HyperArc treatment can be completed within a conventional treatment timeslot, making it an efficient approach compared to other radiosurgery techniques that treat each target individually or separately and take considerably longer.

HyperArc 2

Photo courtesy of Varian Medical Systems.

Addressing patient safety

Patient safety was a central pillar in the product design philosophy. “Fully automated treatments present operational challenges because of patient safety concerns,” Popple said. “We address this challenge by using virtual dry runs and collision avoidance systems integrated into the treatment machine.” Specifically calculated arcs and couch positions are compatible with patients’ clearance to the machine. Even the hardware that the patient wears is digitally modeled in the treatment planning system for safe delivery and ensuring minimal patient movement.

Moving the needle in brain surgery

Tumors in the brain are usually distributed throughout the brain and can affect many basic functions, making it one the most complex of all surgeries. This technique provides an alternative targeted approach when surgery might not be possible, or the tumor is located in a compromising area.

“HyperArc treats all the patient’s tumors at once, allowing for a more efficient and comfortable radiosurgery procedure,” said Bart Guthrie, M.D., professor in the UAB Department of Neurosurgery. “Since we can easily treat more than 10 tumors, more patients will be able to avoid the cognitive side effects of whole brain radiation therapy.”

“We are very excited about these first treatments using HyperArc as we usher in a new era of precision in radiotherapy and radiosurgery for cancer patients,” Fiveash said. “Bottom line, we want to be able to make high-quality treatments available to more patients. We want to capitalize on this technology because ultimately it’s our patients who benefit from the most advanced care possible.”

The Art of Hope and Joy: Kirstin’s Story

Story from UAB Medicine News 

UAB Medicine cancer survivor Kirstin Hoff creates art to raise awareness, support charities, and lift spirits through volunteer work at The Kirklin Clinic and elsewhere.

When Kirstin Hoff was diagnosed with breast cancer in 2013, she chose right then to focus on the positive. It was a good strategy, not only because what she calls “a spirit of hope and joy” comes naturally to her, but also because her journey from diagnosis to survivorship met many obstacles. Without the positive attitude that Hoff would maintain through each level of treatment or setback, her experience might have been far more difficult. After getting through that struggle, however, she decided to go even further by utilizing her positive energy for the benefit of other cancer patients and their families. She established Chick4acause, her very own private mission of hope and joy.

The “chick” refers to the whimsical characters of her mixed media paintings of chickens, each of which includes found “treasures” attached to the work. Hoff’s non-profit company Chick4acause is promoted via social media, and proceeds from the sale of any works go to four cancer organizations. Customers may select which organization receives proceeds from any purchase they make. As Hoff insists, however, the mission goes well beyond the matter of fundraising.

“My mission is less about raising money and more about setting an example,” Hoff says. “I hope patients see that, after my own battle with breast cancer, I’m energetic and fully engaged with volunteer work at The Kirklin Clinic, awareness work, and fundraising. I hope I’m an example of survivorship as well as a messenger.

My main message is that our little efforts of kindness and joy can make a difference. I would like to show others that, very often, if we choose the mood and outlook of that journey, then we aren’t letting cancer make all the decisions. I’m hoping to form a community of people who can share their own stories about making positive choices.”

Hoff understands the benefits of making those choices, because she ran into what she calls “roadblocks” at various points in treatment.

“I was hospitalized with a C. diff infection at one point, serious enough that, while I was in intensive care, the doctors were wondering if I would survive it. I came down with shingles while getting radiation treatment. We kept hitting every obstacle that my body could find. But I chose to focus on the good things surrounding that terrible situation. The number of people supporting me, and the friends and family looking after my kids, were blessings that I kept in mind. I tried to go through this with the most positive, joyful attitude I could manage.”

Hoff says she wasn’t sure what to expect after being diagnosed with ductile and metastatic breast cancer, being unfamiliar with the vocabulary of cancer, her options, and what approach her doctors might take.  After meeting with an interdisciplinary team at UAB’s Comprehensive Cancer Center, under the care of Andres Ferero, MD, and Helen Krontiras, MD, Hoff  was relieved to learn that the team shared her upbeat attitude.

“It’s sad to say, but before I was immersed in this world of cancer, I didn’t even know about UAB’s center,” Hoff notes. “I can’t fully convey the emotional impact of my team’s positive energy. It was a source of comfort and security, almost like I had an entire army fighting for me. Their approach instantly put me at ease.  My team completely sympathized with my desire to delay chemotherapy until our family could get back from a beach trip. I think they knew, especially under those circumstances, how important that vacation would be to us. I also had tickets to a concert. The doctors understood that I needed some positive moments of joy and normalcy before treatment started. Dr. Ferero has this unbelievable energy; he’s so supportive and upbeat, so passionate about his work, and so humble. I don’t think I have the words to express how much he means to me.”

She may not have found words yet, but Hoff did find a way to express her personal message of joy and hope. Hoff says the means of doing so was there all along.

“I had been painting these chickens as art gifts for friends and family during the holidays. I started paying attention to people who visited my house during December who might say, ‘I would purchase one of those,’ or ‘I didn’t know you painted.’ It sort of clicked with me that I could sell this artwork as a fundraiser. I wanted the chicks to be whimsical and fun, but with a message of hope. Each piece has a special personalized “surprise” on the back to get the joy started for someone. So I apply items to each painting that convey these things, such as re-purposed children’s clothes, or re-purposed books I find at thrift stores that have positive quotes or messages.”

Very soon after her treatment, Hoff was determined to get involved with volunteer work at The Kirklin Clinic, as well as creating Chick4acause and sharing her story of survivorship. Her first efforts were with The Angel Squad, a group of volunteers who offer compassionate services to breast cancer patients and their caregivers.

“When I was undergoing treatment, the interaction with my Angel and the others was incredible. I started working with them as soon as I was well enough. From that point I wanted to find a way to make an impact by spreading some kind of positive message. The world, especially recently, already seems filled with negativity, and that’s a big driving point. You can get caught up in the larger view and see yourself as insignificant. How could you possibly make a difference? But the mission grows over time. I now have four organizations that proceeds go to. I’ve also sent pieces to Arizona and Canada for charities that conduct silent auctions. I’m getting so much response by word of mouth and through Facebook and Instagram.”

Hoff insists that the fundraising effort is by no means the whole story of her work. She sees her mission to build awareness and establish a community of story-sharing survivors as the primary function of her efforts. For Hoff, the small measures add up.

“It’s something I’m trying to teach my kids right now. Don’t wait for the big opportunity for some huge project. Do the little things. My 13-year-old daughter goes with me to visit elderly residents of memory care facilities with the Good Samaritan groups from our church; my 12-year-old son goes with me to thrift stores to search for little treasures and objects we can attach to the paintings. They are learning about the satisfaction and joy these small efforts can bring. I have tried to emphasize that everyone has some gift or ability that they can use.

“My kids also have a sense of humor about me and my mission, which is its own kind of joy. The other day my daughter asked, ‘Mom, why do you have to turn everything into a life lesson?’ You have to be able to laugh about it. But I still believe in choosing your role. I have a piece of art I found at Southern Makers that reads, ‘Kindness is a choice. It’s not a random act.’ That speaks to me so deeply. This is how we make neighborhoods or hospitals or schools a happier, healthier place to be. More than that, I think it’s contagious. Even the individual who buys one of the chicks gets a measure of joy by contributing to a good cause. They have, in a sense, been brought into a community where hope and joy are so vital and crucial to any of us dealing with cancer.”

Hoff still faces a long-term regimen of medication and checkups, but she’s approaching that with the same hope and upbeat demeanor with which she tackles all the work that Chick4acause entails. She says her appreciation for the community of survivors grows as well.

“I think everyone goes through it in their own way,” she says. “I know how many people have undergone much more intense radiation, harsher chemo, and greater loss than I have. I lost my mother to colon cancer last year. My mother-in-law battled with intestinal cancer. My message is that it’s much more bearable if we make the effort to share hope. When I’m working with the Angel Squad, or if I’m in mammography or in the clinic, I tell patients I meet that I let my doctors do the worrying while I put as much joy and happiness into my life as possible. That’s the partnership that I feel I have established with UAB. They know what they are doing, so I trust them. I never think in terms of breast cancer recurrence, or ‘what if.’ They have a wealth of knowledge, so they don’t need me for the medical end of handling my care. I handle the cheerleading!”