LEXINGTON, Ky. (July 23, 2014) — Good nutrition is critical during cancer treatment, but side effects of chemotherapy and radiation can often cause patients to lose their appetites at a time when they need sustenance the most.
As a registered dietitian at the University of Kentucky Markey Cancer Center, Rachel Miller does all she can to help patients get the nutrition and calories they need.
"A lot of patients have trouble with weight loss and decreased appetite while they're going through various treatments," Miller said. "One of the things that's hardest to do when you don't feel like eating is getting that nutrition you need."
Much of Miller's time at Markey involves one-on-one counseling. She sees patients throughout the process of their treatment, provides them with nutrition education, and in some cases, assists patients with setting up their tube feeding.
In addition to the individual consults, Miller also tries to provide a more tangible example of healthy eating during cancer treatment. On the fourth Wednesday of each month, she hosts a smoothie demonstration in the Whitney-Hendrickson Building. The demonstrations are open to everyone at Markey, including patients, families and medical providers.
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Smoothies are an ideal way to boost nutritional value in a small volume of food, Miller said. Adding in healthy fats (for example, coconut milk) serves to improve the taste of the drink as well as pack in much-needed extra calories.
"Sometimes it's difficult to eat a full meal," Miller said. "So trying to fortify what you're eating, although it's a small amount, is one of the things I think is helpful to teach patients to do at home."
During the monthly demonstration, Miller tries to incorporate a variety of foods into the smoothies, testing out different tastes and textures. A common side effect of chemotherapy is a change in taste — many patients report a "metallic" taste in the mouth — so using strong flavors can be helpful in making the meal more appealing. As she prepares the drink, Miller talks her audience through the process, explaining the health and taste benefits of each ingredient.
Though she has regular medical staff who attend, her audience is often filled with families and friends of patients who are waiting for their loved one to complete an appointment or treatment. In addition to giving them information that will help them provide for their loved ones at home, Miller hopes the demonstrations also add a little levity to their day.
"I think the demonstrations have been very helpful," Miller said. "People have a lot of questions. It's easier to see and watch someone else do it, and then be able to implement that in your own home. I think it's also convenient, because a lot of patients have long days here so it can be a fun little break while you're waiting."
Smoothie demonstrations are offered on the fourth Wednesday of every month at 1 p.m. in the Psych-Oncology Services office, third floor, Whitney-Hendrickson Building. Miller also periodically partners with local chefs to host food demonstrations for patients and families.
For more information on good nutrition during cancer treatment, visit Miller's blog: the Markey Menu.
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LEXINGTON, Ky. (July 15, 2014) — A new study by University of Kentucky researchers shows how a genetic defect in a specific hormonal pathway may make people more susceptible to developing melanoma, the deadliest type of skin cancer.
Fair-skinned people who tend to burn (rather than tan) from sun exposure have a much higher risk for melanoma than darker-skinned people. On the surface, it appears that the amount of melanin, the natural substance in the skin that determines pigment and acts as the skin's "natural sunscreen," would be the only determinant of melanoma risk. However, the truth is more complicated.
Published in Molecular Cell, the study looked at the role of the melanocortin1 receptor (MC1R), the receptor on melanocytes in the skin that gets called into action following ultraviolet exposure to help the skin lay down more UV-blocking melanin to protect itself. Fair-skinned people are more likely to inherit a defect in this receptor, and as a result, cannot make enough melanin to fully protect themselves from UV damage.
Since UV from sunlight or tanning beds is a major cause of melanoma, inherited problems in the MC1R means that the skin lacks natural protection by melanin, which acts as a biologic sunblock. This leads to more UV light chronically getting through to the sensitive layers of the epidermis, where it can contribute to cancer.
However, the UK study showed that MC1R defects contribute to melanoma development in ways other than melanin production. Besides regulating the amount of melanin that gets made in the skin, MC1R also controls how well melanocytes can repair their DNA from UV damage. Having defects in MC1R signaling delays the body's ability to clear out existing DNA damage in the skin – leading to an increased potential for cancerous mutations.
“Knowing whether people have a specific genetic predisposition for melanoma could potentially save many lives”, says Dr. John D'Orazio, Associate Professor and the Drury Pediatric Research Endowed Chair at UK’s Markey Cancer Center. “If you happen to be born with a problem in this MC1R hormonal pathway, then you need to be extra careful with respect to UV safety.”
A good indication of a person’s MC1R status is what happens to the skin after sun exposure.
“If you tan well, then your MC1R probably works well,” D'Orazio said. “If you tend to burn, then you may have inherited a problem with your MC1R, and you probably should avoid purposeful UV exposure like tanning bed use or unprotected sun exposure."
D’Orazio and his research team found an important molecular link between MC1R signaling and DNA repair in their study. The team hopes to use this information to develop new melanoma-preventive treatments, like additives that can be included in sunblocks to ramp up the skin’s ability to deal with UV damage.
Melanoma incidence has increased steadily over the past few decades – in the 1930s, an estimated one in every 1,500 Americans developed the diseases. Today, the odds are about one in every 60. Having a problem with the MC1R pathway raises a person’s lifetime risk of melanoma about four-fold.
LEXINGTON, Ky. (July 11, 2014) — A year ago, a crowd of hundreds gathered in Pavilion A of the University of Kentucky Chandler Hospital to celebrate a long-awaited special announcement – the unveiling of the UK Markey Cancer Center as the state's first and only National Cancer Institute-designated cancer center.
The designation was the culmination of years of tireless work by the faculty and staff of Markey and its supporting service lines and colleges – all guided by Director Dr. Mark Evers, who came to UK in 2009 with the vision of propelling Markey to NCI designation.
"Even before earning the NCI designation, we'd already taken extraordinary steps in the past few years in terms of combating cancer incidence and mortality through preventative measures, treatments and research," Evers said. "But having the support and approval of the NCI has already made a huge impact in terms of both research and our clinical care."
Patient Care at Markey
As the word spread about Markey's NCI designation, clinicians and staff experienced an increase in the patient population in almost every clinical area. In 2014, Markey saw nearly 150 more new patients over the previous year, with total patient visits increasing from roughly 75,000 last year to more than 85,000 this year – which also marks a 29 percent increase in patient visits compared to just five years ago.
In particular, Markey's outpatient clinics are growing -- the Comprehensive Breast Care Center, the Multi-Disciplinary Clinic, and the Gynecology-Oncology Clinic saw unique patient growth of 29 percent, 10 percent, and 5 percent, respectively, over the past year.
With such an increase in patient volume – and variety – Evers and his team have also stepped up recruitment, seeking out the best cancer specialists in their fields to join the Markey Cancer Center. Markey's already vast team of specialists now includes a bevy of new team members added in the past year, including four medical oncologists; three hematology and blood and marrow transplantation specialists; three surgical oncologists; two genitourinary cancer surgeons; two oral and maxillofacial surgeons; and a specialist in oncofertility, a new program starting up at the cancer center.
Recruiting strong researchers is a major aspect of earning and maintaining an NCI designation, and this year Markey landed a major established research team in metabolomics. Rick Higashi, Hunter Moseley, Teresa Fan, and Andrew Lane joined Markey last fall, bringing with them more than $18 million dollars in funding. One of the major focuses of the team's work is to develop early diagnostic approaches for lung cancer based on metabolism markers, which is especially important in Kentucky, where we own the distinction of having the worst rates of lung cancer incidence and death in the country.
Over the past two years, Markey has increased its funding from the NCI by 27 percent and from other National Institutes of Health divisions by 16 percent. Overall, since the end of calendar year 2012, Markey's total research funding from both peer-reviewed and non-peer-reviewed sources has increased by $7.3 million.
Additionally, Markey researchers continue to push major findings out to their peers in academia – in 2014, Markey authors published 528 scientific articles, 49 more than the previous year.
Moving forward, Evers notes that his team will continue to seek out new clinician-scientists who have experience in clinical trials and early phase drug development, with the goal of significantly increasing the number of patients who participate in trials. Another emerging field of research for Markey is molecular epidemiology, the study of potential genetic and environmental risk factors for disease identified at the molecular level, which has the potential for great impact in Appalachia.
Markey's Reach Across the State
Though based in Lexington, Markey also strives to provide access to top-notch cancer care across the state and beyond through the Markey Cancer Center Affiliate Network. The Affiliate Network is a group of healthcare facilities that provide high-quality cancer services and programs in their communities with the support and guidance of the UK Markey Cancer Center, allowing patients to receive their care closer to home.
Currently, the network comprises nine hospitals across the state of Kentucky:
Since Markey earned the NCI designation, demand for new affiliations has grown. Two new ARH hospitals will be added this summer, moving Markey further into Eastern Kentucky, an underserved area known for some of the worst rates of cancer incidence and death in the country. Additionally, evaluations are under way for seven other hospitals, including two outside the state of Kentucky, extending Markey's reach further and establishing it as the destination cancer center for the region.
The Future of Cancer Care in Kentucky
Following last year's announcement of Markey's NCI designation, Evers joked with his staff that they had one day to celebrate – and the next day, they'd be back in full swing, ready to propel Markey to the next level of designation: an NCI-designated Comprehensive Cancer Center. Currently, 41 of the 68 total NCI-designated cancer centers in the country hold a comprehensive cancer center status.
To earn this top level of designation, cancer centers must show a depth and breadth of research in each of three major areas: laboratory, clinical, and population-based research, as well as substantial transdisciplinary research that bridges these scientific areas. Additionally, outreach is especially important, and comprehensive cancer centers must demonstrate professional and public education and outreach capabilities, including the dissemination of clinical and public health advances in the communities it serves.
NCI designations are renewable every five years, and Evers hopes that Markey's next application will be for comprehensive status. To reach that level, Markey has a long to-do list, including increasing cancer-related funding, accruing more patients into clinical trials (including pushing these trials out into the state via the affiliate network), and maintaining and increasing focus on Appalachian Kentucky.
"Our progress in the past year has been spectacular, but we can – and should – do more," Evers said. "As the only NCI-designated cancer center in Kentucky, it's our responsibility to be the leader in cancer care and to always seek out new ways to improve rates of cancer incidence and death in the state, and to make sure that we can also offer the best possible care for our patients right here in Kentucky. Earning a comprehensive cancer center designation from the NCI will be another big step in that direction."
LEXINGTON, Ky. (July 1, 2014) – UK HealthCare has been recognized by America’s Essential Hospitals for a patient safety initiative that has resulted in a significant decrease in mortality at the hospital compared with the general population.
America's Essential Hospitals, a national organization representing hospitals committed to high-quality care for all people, including the vulnerable, awarded UK HealthCare a 2014 Gage Award honorable mention for improving quality. The association made the award June 26, at its annual conference, in San Antonio.
“UK HealthCare’s patient safety initiative stands out among the innovative approaches our hospitals take to avoid harm and improve the quality of care,” said America’s Essential Hospitals President and CEO Dr. Bruce Siegel.
The Gage Awards, named after association founder Larry Gage, honor and share successful and creative programs that improve patient care and meet community needs. The Gage Award for improving quality recognizes activities that improve the quality of care delivered, or reduce or eliminate harmful events to individual patients or groups of patients.
"UK HealthCare is continuously working to improve, driven by our high standards and our commitment to serve the people of the Commonwealth and beyond and the Gage Award represents national recognition of this work," said UK HealthCare Chief Medical Officer Dr. Bernard Boulanger. "It is recognition of our team’s relentless, rigorous approach to improving patient care, in a manner that directly benefits our patients"
UK HealthCare received the award for the development of an internal process called SWARMING to help the hospital improve overall patient safety. A SWARM is initiated shortly after the occurrence of an adverse incident or undesirable event, and the people directly involved are empowered to "stop the line" when they observe a problem. Since instituting SWARMs in 2009, the hospital has experienced an overall reduction in the observed to expected mortality ratio from 1.5 to 0.7, as reported in December 2013.
"The SWARM process has been a remarkable and successful team effort throughout the UK HealthCare enterprise and everyone should be commended for their role in what has become one of our best tools in improving patient safety," said Dr. Michael Karpf, UK executive vice president for health affairs. "This award is another example of our commitment to excellence in patient care and patient safety and in keeping our promise to Kentuckians that they can get the very best care right here regardless of the complexity or care needed."
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LEXINGTON, Ky. (June 18, 2014) — Facing a cancer diagnosis is no easy feat. Patients at the University of Kentucky Markey Cancer Center have always inspired the community with their strength and courage, and Friday, June 6th was no exception, as Markey honored the experiences of those who have battled cancer with a day of recognition and celebration.
June is National Cancer Survivorship Month, and to mark the occasion, Markey held its inaugural Expressions of Courage event, an art exhibit showcasing original, artistic expressions connected in some way to an experience with a cancer diagnosis, or crafted by or in memory of a Markey patient whose battle has ended.
"We sent out over 6,000 letters," said Cindy Robinson, a nurse practitioner at Markey and one of the organizers behind the event. "And we asked people for any type of creative modality that they wanted to share with us, to share their cancer journey, whether it be positive or negative."
More than 30 artists responded. Entries of visual arts included paintings, drawings, photography, sculpture, and quilting. The performing arts involved vocal music, instrumental music, and dancing, and poetry and short stories encompassed the literary arts.
The creations were on display all day in the Combs Research Building at Markey, with readings and performances starting in the afternoon and continuing into the early evening.
"The artwork is very moving and inspiring, and actually will bring tears to your eyes if you read some of the pieces," Robinson said. " We have some pieces here from patients that are no longer with us, and we personally know those people."
Expressions of Courage was made possible by gifts from the Markey Cancer Foundation and Biological Systems Consulting, Inc. With the help of Carla Repass, the assistant director for administration at Markey, and fellow Markey staff members Christie Daniels, Valeria Moore and Mincha Parker, Robinson said she felt they planned and pulled off the cancer center's first-of-its-kind celebration with flair.
"I think for our inaugural event, it's gone beautifully," Robinson said. "We have a lot of survivors here. They've shared their joy."
Shawna Cassidy Quan of Richmond, Ky., was one of the survivors in attendance, having been diagnosed with four different primary cancers over the course of fifteen years. Her expression of courage was an essay about her struggles with her multiple diagnoses.
"You figure out the answers to a lot of your problems even while you're sitting down writing," Quan said. "It's just been a wonderful, therapeutic thing for me."
Norton Cancer Center and Markey patient Phillip Meeks traveled nearly two hours from Jeffersonville, Indiana, to attend the event. Meeks' art piece, a drawing by his daughter, was inspired by the unlikely good fortune of his treatment. In 2012, he was diagnosed with acute myeloid leukemia, requiring a bone marrow transplant to survive.
As an African-American — a population which only makes up roughly 7 percent of the bone marrow registry — and an adoptee without biological siblings or parents to get tested, the odds of finding a match were against him.
The day he was admitted to the hospital, Meeks said, they found a token underneath his hospital bed: one side said "Believe in Miracles" while the other side said "Faith."
"To me, that was God's way of saying that I'm there with you, you know, don't be scared," Meeks said.
A donor match was found for him, and he received his life-saving transplant in January 2013. He notes that Expressions of Courage was not only a day to showcase talent, but a day that survivors could show their appreciation to the staff of Markey.
"I just want to give back," Meeks said. "That's my big thing. How can you thank so many people that are involved in saving your life? There's not a gift that you can give that's big enough. Hopefully this is my one little piece to say thank you for everything that everybody has done for me."
Many survivors and their families expressed their appreciation of the love and support of the UK and Markey community.
"You live life just as fully as you can, because you're not promised even another hour," Quan said. "I think we've done that today… I hope Markey does this again and keeps on doing it."
LEXINGTON, Ky. (June 5, 2014) -- The University of Kentucky Markey Cancer Center will host Expressions of Courage, a creative exhibit to honor those who have been affected by cancer on Friday, June 6.
Featuring the creative work of more than 30 participants, this inaugural event will take place in the atrium of Markey's Combs Research Building from 1 to 5 p.m. Cancer Center Director Dr. Mark Evers will give opening remarks and lead attendees in a moment of silence to begin the afternoon.
Exhibits include visual art, poetry readings, dance exhibitions, and vocal and instrumental performances by patients, survivors, and friends and family. Everyone Is encouraged to attend, enjoy the artwork and performances, and show their support. Light refreshments will be served.
Expressions of Courage was made possible by gifts from the Markey Cancer Foundation and Biological Systems Consulting, Inc.
LEXINGTON, Ky. (May 30, 2014) -- A multidisciplinary team of doctors, researchers, and informaticists at the University of Kentucky is working to improve identification of lung cancer patients who are eligible to participate in clinical trials for novel treatments.
Clinical trials are critical for advancing research into new and better treatments for patients, and the need for improved treatment of lung cancer is dire: Lung cancer is the leading cause of cancer death worldwide. Its burden is especially significant in the Commonwealth, where rates of lung cancer incidence and mortality are the highest in the country. In Appalachian Kentucky, the situation is even worse, with incidence rates nearly twice the national rate.
Despite high rates of lung cancer, less than 1 percent of lung cancer patients enroll in clinical trials. This is partly due to the difficult and tedious business of identifying and recruiting patients who are eligible for trials, a task currently conducted by research staff who manually reviews patient information for a multitude of (often complex) eligibility factors. The process is time consuming and inefficient, with studies showing that manual identification can overlook up to 60 percent of eligible patients. Furthermore, patient eligibility can vary by study and change over time.
And, unfortunately, the severity of the disease also contributes to the exceptionally low rates of lung cancer patient enrollment in clinical trials. Lung cancer is often diagnosed so late that the median survival time is only eight months, leaving little time for patients to explore treatment options or for doctors to identify patients who are eligible for novel therapeutic interventions offered through clinical trials.
The combination of the burden of lung cancer in Kentucky and the urgency of identifying patients who are eligible for clinical trials motivated Dr. Eric Durbin and his team to devise a more efficient method for screening patient eligibility. Durbin, an assistant professor in the division of biomedical informatics at the UK College of Public Health, is the director of the Cancer Research Informatics Shared Resource Facility at the UK Markey Cancer Center and director of cancer informatics at the Kentucky Cancer Registry.
With pilot funding from the Kentucky Lung Cancer Research Program (KLCRP), Durbin and his team are leveraging the rich and unique electronic data sources managed by the UK Center for Clinical and Translational Science (CCTS), the UK Institute for Pharmaceutical Outcomes and Policy (IPOP), the Markey Cancer Center, and the Kentucky Cancer Registry (KCR), which is housed at UK, to design, develop, pilot, and evaluate an innovative, electronic informatics system to automatically identify patients who are eligible for clinical trials. The outcomes of the automated identification system will then be compared to those of the manual identification methods. If successful, the automated system could dramatically increase the speed, completeness, and efficiency of identifying patients for lung cancer clinical trials.
"The need for improvement was pretty obvious, and my colleagues and I thought it would be an ideal project for KLCRP pilot funding," said Durbin, who is the principal investigator on the project. "We're trying to leverage existing and new electronic data sources to improve the efficiency of the identification and recruitment process."
The pilot project will specifically focus on identification of eligible patients at the UK Markey Cancer Center. Due to its designation as National Cancer Institute, Markey offers unique clinical trials that are only available through NCI centers.
"Clinical trial recruitment is critically important to the Markey Cancer Center if we're going to get lifesaving therapeutics to our patients," said Dr. Susanne Arnold, associate professor in medical oncology and radiation medicine at the Markey Cancer Center and member of the project team. “It’s also how we make progress in cancer treatment.”
It is particularly important to identify and recruit clinical trial participants from the entire pool of eligible patients in order to remove any potential bias from the study results and to ensure that the findings are applicable to the general population. Additionally, under-recruitment in underserved populations, such as Kentucky's Appalachian residents, can be perceived as unequal access to the most cutting-edge treatments and technologies.
"We want to ensure that all patients have the opportunity to enroll in clinical trials," said Durbin.
The two-year project is currently in its seventh month, and the team is in the discovery phase of evaluating the multiple data sources and testing different query methods. In addition to using discrete data elements, such as lab values, the team is utilizing natural language processing methodology to incorporate more conceptual data, such as patient performance status, from the qualitative notes that doctors make in their medical records.
"We are combining discrete data elements with natural language processing approaches to extract complete information," said Durbin. "This is a very important area of informatics."
The objectives of the project align perfectly with the mission of the Kentucky Lung Cancer Research Program, who funded the project and whose mission is to reduce the burden of lung cancer in Kentucky.
"A critical component to reducing this burden is clinical research," said Dr. Nathan Vanderford, assistant director for research at the Markey Cancer Center and the center's liaison to the Kentucky Lung Cancer Research Program.
"The potential to greatly improve enrollment in studies will ultimately translate into improved lung cancer detection, diagnosis, and treatment in the future."
Vanderford recognizes the distinctive capacity of Durbin's team to capitalize on the robust data, expertise, and technology available at UK. In addition to the wealth of electronic health data at UK, the Kentucky Cancer Registry (KCR) is housed at the university by legislative mandate. The KCR operates a population-based electronic pathology reporting system that captures 90 percent of all histologically confirmed cancer cases in Kentucky within days of diagnosis.
"We are very uniquely situated in terms of the data sources and technology we have at UK. And this team is uniquely skilled to do this project. They have a significant number of years of experience and are very familiar with all the data sources. We're very cutting edge in being able to apply all these different data sources to achieve our objective in a much better way," he said.
While the pilot project focuses specifically on lung cancer patients at Markey Cancer Center, the automated identification system could be easily applied to a broad range of cancers and other disease conditions in the future.
"What's really exciting about Dr. Durbin's study is that it has the potential to greatly improve clinical research not only in lung cancer but in other cancers and disease conditions as well," said Vanderford.
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LEXINGTON, Ky. (May 23, 2014) – The future looks bright for cancer research in Kentucky – on May 22, the University of Kentucky Markey Cancer Center held its annual Markey Cancer Center Research Day, highlighting the work of UK students, postdoctoral fellows and faculty from the past year.
As the cancer center has grown, Markey’s research programs have become even more robust, helping propel the center into becoming the state’s first and only National Cancer Institute (NCI) designated cancer center.
“The NCI is pretty much all about research – it’s a huge part of what they’re looking for when they award the designation,” said Markey Cancer Center Director Dr. Mark Evers.
Research Day not only provides an opportunity for investigators to showcase their work, it also helps educate researchers about other ongoing projects at UK that they may not have known about before – and this often leads to new, fruitful collaborations for future research projects. Kathleen O’Connor, Markey’s associate director for cancer education, notes that providing opportunities for researchers to discuss their work with others is key for growth and improvement.
“If we don’t communicate the research that we do, then there’s no point in us doing it,” said O’Connor, who has been tasked with planning Markey Research Day for the past five years. “What we need to do is talk about our research, translate our research, and learn about opportunities to collaborate.”
Evers, who arrived at UK in 2009 with the goal of molding Markey into an NCI-designated cancer center within five years, agrees.
“It gives our students, fellows and faculty an opportunity to present their latest work, and it’s also turned out to be a great venue for collaboration,” Evers said. “Because even though we’re a very collaborative, collegial university, sometimes people working across the street don’t know about each other’s research. This gives them the opportunity to see what else is going on.”
This year’s event featured 141 posters; one student and two postdoctoral fellow oral presentations; and faculty oral presentations from Jon Thorson, Vivek Rangnekar, Mary Vore, and Mark Dignan, co-leaders of the four major research programs at Markey. Additionally, Evers presented his annual State of the Cancer Center Address and Dr. Harold Varmus, Nobel Laureate and director of the National Cancer Institute, gave the Susan B. Lester Memorial Lecture.
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The event finished with an award ceremony. Awards were presented in two different categories - basic science and clinical science - for both graduate and postdoctoral fellows. A Researcher's Choice Award was also presented, based on a popular vote by people who attended Research Day.
The winners are:
Graduate Basic Science
First place: Wei Zhang
Second place: Hedy Chawsheen
Postdoctoral Basic Science
First place: Jin Dai
Second place: Stuart Jarrett
Graduate Clinical Science
First place: Sally Ellingson
Second place: Shaoying Wang
Postdoctoral Clinical Science
First place: Rachel Stewart
Second place: Pallavi Sethi
Researcher's Choice Award
Winner: Emil Khisamutdinov
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LEXINGTON, Ky. (May 14, 2014) - Painful blisters and glowing red skin after a day outdoors are the short-term consequences of a child's overexposure to the sun. While sunburn heals with time, the long-term effects to the skin are irreversible. It's often years - even decades - later when the more dire consequences of sunburn can resurface in the form of malignant melanoma.
Because 80 percent of lifetime sun exposure occurs before the age of 20, efforts to prevent melanoma, the deadliest form of skin cancer, must begin early in life. For a variety of reasons, melanoma incidence has increased steadily since the 1930s when only one out of 1,600 Americans were diagnosed with the disease.
Today, melanoma affects one in 60 Americans and is appearing more frequently in teenagers and young adults. In fact, melanoma is the most common cancer of young adults ages 25-29 and is the leading cause of cancer death in women ages 25-30. Because it can spread quickly through the body to places such as the brain and the liver, melanoma accounts for three-quarters of total deaths caused by skin cancer. Ironically, as much as melanoma is a growing public health concern, it is also largely preventable. Ultraviolet (UV) radiation from sunlight and tanning beds plays a major role in melanoma development.
Dr. John D'Orazio, a researcher at the Markey Cancer Center and a pediatric oncologist at Kentucky Children's Hospital, rarely sees skin cancer in children but says the pediatric years are a critical period for preventing melanoma later in life. Melanoma risk correlates especially with sunburns, and since the skin is more delicate in childhood, children are especially susceptible to sunburns. Having at least five sunburns increases the lifetime risk of melanoma, and blistering sunburns are particularly risky.
Know Your Child's Skin Type
According to D'Orazio, skin pigmentation and amount of exposure to UV rays are the predominant risk factors for developing melanoma. People who have dark pigmentation have high amounts of melanin pigment in their skin. Melanin acts like a natural sunblock and protects the skin very effectively against UV damage. Those who have fair skin and a lighter complexion are born with lower amounts of melanin in their skin and are much more vulnerable to UV penetrating deeply and altering skin cells. There is overwhelming evidence to show that skin cancers such as melanoma are caused by UV radiation that penetrates into the skin and causes mutations in skin cells.
Therefore, the more UV rays that penetrate into the skin without the protection of natural or artificial sunblocking agents, the higher the person's risk of developing melanoma. Children with fair complexions are most vulnerable to damaging effects of UV rays. It's important to notice whether a child is prone to sunburning or tanning. Knowing a child's skin profile will help parents determine level of protection that should be enforced during outdoor activities. Parents and caregivers must be vigilant about restricting sun and tanning bed exposure to ensure the long-term skin health of children and teens.
D'Orazio says to use common sense when it comes to sun safety and to avoid sunburns as much as possible. Avoiding or limiting outdoor activities during the time of day the sun is most intense, between 10 a.m. and 4 p.m., is a good strategy. If sunburn-susceptible children are outdoors during this time, seek a shady spot and wear UV-protected items, such as bathing suits, rash guards, sunglasses and hats to escape the sun. Apply sunscreen with a minimum SPF of 15 designed to block both UVB and UVA rays. Make sure all exposed areas of the body are coated, including the feet and the tops of ears. At a minimum, sunscreen should be applied every 90 minutes and immediately after sweating or swimming. Because their components break down over time, sunscreens should be replaced annually.
Get Teens Out of Tanning Beds
Despite having a strong link to melanoma, the use of tanning beds in adolescents and young adults continues to skyrocket. Sixty-seven percent of teens think they look better with a tan and 2.3 million American teens are estimated to visit tanning beds at least once a year. D'Orazio said research has shown a connection between frequent use of tanning beds and other addictive behaviors.
"The problem with the tanning bed is once you start, it’s hard to stop," D'Orazio said. "Many tanning bed patrons say they look and feel better with a tan… and there’s a good reason for this. When your skin tans, your body makes natural endorphins, which are morphine-like compounds."
One visit to the tanning bed under the age of 30 increases the chance of developing melanoma by 75 percent. In fact, the UV output of a tanning bed can be 10 times stronger than the sun. Currently there is no way to get a tan without the increased risk of melanoma and other skin cancers. In spite of those risks, in the greater Lexington area, tanning beds outnumber McDonald's restaurants and Starbucks combined.
Regulation of the tanning bed industry, including UV lamp output and restrictions on use by minors, is highly variable among states. Currently in Kentucky, there is no ban in place for indoor tanning by minors. Children under the age of 14 are allowed to use indoor tanning facilities if accompanied by a parent, and those ages 14-17 can come alone if they have signed parental consent. Sunless tanning products are healthier alternatives to tanning, but users should be aware such products don't provide much UV protection. Parents should strongly consider the risks when a teen expresses an interest in a tanning beds and other tanning products.
Fortunately, skin cancer in children is very rare, and D’Orazio has only seen a handful of children with melanoma. However, risk starts to rise in late adolescence and increases as people age. Death from this aggressive cancer is all too common in people in the prime of their lives. In his laboratory, D'Orazio is currently investigating ways to replicate the protective melanin mechanism for people who are especially vulnerable to sunburn and reverse the negative effects of UV exposure.
“By understanding what happens in the skin during sun tanning, we hope to develop new drugs to make tanning possible without the risk of cancer.”
For now, however, tanning remains a very risky business, especially for fair-skinned people who get sunburns. For these people, it is especially important to do regular skin surveys to get an early jump on problems. Early detection of melanoma can save lives. Since most melanomas develop in moles, guidelines focus on mole awareness. Be aware of the ABCDEs of moles to detect problematic or irregular patterns on the skin:
Skin surveys should start sometime in adolescence and be done at regular intervals, depending on melanoma risk. Since children and teens still associate beauty with tanning, a cultural change will be required for young people to fully embrace sun protection.
With the opening of pools, proms, graduations and warm-weather events, teens are focused on tanning in the spring and early summer seasons. Parents and pediatricians should look for “teachable moments” this time of year, such as discussions about tanning or sunscreen use, to share the dangers of sun exposure with children who are at high risk of sunburn.
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LEXINGTON, Ky. (May 2, 2014) -- We all know alcohol is closely linked with some major health problems, including diseases of the liver. But does alcohol also play any role in developing cancer?
Unfortunately, it appears there is a relationship between alcohol use and certain types of cancer. Scientists believe the increased risk comes when the body converts alcohol into acetaldehyde, a potent carcinogen.
According to the American Institute of Cancer Research, studies show evidence that alcohol consumption increases the risk of head and neck cancers of the oral cavity, pharynx (throat) and larynx, and the esophagus. It also is linked to colorectal and liver cancers, unsurprisingly. And for women, alcohol use may contribute to breast cancer.
If you have certain other vices, the news is even worse. Per the National Cancer Institute, those who use alcohol in combination with tobacco products have been found to greatly increase their risk of cancer of the oral cavity, pharynx, larynx, and esophagus, as opposed to those who use either alcohol or tobacco products alone.
How much alcohol is "safe" to consume?
There is no actual safe recommendation for alcohol consumption, though you may have heard that alcohol in moderation may reduce the risk of heart disease. The American Heart Association recommends that if you drink alcohol, do so in moderation.
"Moderation" is defined as an average of one to two drinks per day for men and one drink per day for women. A drink is defined as one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits.
I'm undergoing treatment for cancer — can I have a drink?
Although it may be tempting to "relax" by imbibing, if you or a loved one are undergoing cancer treatment, it's best to avoid drinking altogether as alcohol may have some adverse effects during certain cancer treatments.
We also recommend avoiding alcohol during radiation therapy for head and neck cancer. Patients who undergo this specific treatment are already likely to experience difficulty swallowing due to the location of the radiation. Alcohol consumption can be extremely drying to the mouth and throat, which will worsen painful swallowing and will also contribute to dehydration.
Staying hydrated is very important during chemotherapy as well, so alcohol may be more detrimental during a course of chemo. Even in small amounts, alcohol can irritate mouth sores or potentially interact with any drugs you may be receiving.
Could alcohol use contribute to cancer "relapse"?
It is not yet clear whether alcohol use is linked to recurrence after cancer treatment; though, as discussed above, it may increase your risk for a new cancer.
In short, moderation is always key, but if you drink alcohol, be sure to discuss your intake with your physician.
Rachel Miller is a registered dietitian at the UK Markey Cancer Center.
This column appeared in the April 27, 2014, edition of the Lexington Herald-Leader
LEXINGTON, Ky. (April 17, 2014) — The University of Kentucky Markey Cancer Center and the Leukemia and Lymphoma Society hosted their third annual "Meet the Researchers Day" on Tuesday. Meet the Researchers Day is a field trip given as a prize to two schools in the region who successfully raise more than $1,000 for the LLS's Pennies for Patients campaign.
This year, students from Meece Middle School (MMS) in Somerset, Ky., and Lexington Traditional Magnet School (LTMS) won the opportunity to visit the Biomedical/Biological Sciences Research Building (BBSRB) on UK's campus and learned more about how the money they raised for Pennies for Patients will help further cancer research.
After a formal introduction by Kathleen O'Connor, researcher and associate director of cancer education for the UK Markey Cancer Center, the students had the opportunity to rotate between presentations by pediatric hematologist/oncologist Dr. John D'Orazio and biochemist Craig Vander Kooi. Additionally, researchers Tianyan Gao and Garretson Epperly assisted O'Connor in giving the students a tour of O'Connor's research lab space in the BBSRB.
Pennies for Patients is the annual fundraiser for the School & Youth division of the Leukemia & Lymphoma Society. It encourages students to collect spare change during a set three-week time frame early in the year. Funds raised support leukemia, lymphoma and myeloma research; patient and community service; public health education; and professional education.
For this year's campaign, 233 schools across the region raised a total of $264,062.03. Kentucky schools participating in Pennies for Patients had to raise a minimum of $1,000 to win the chance to attend Meet the Researchers Day. MMS and LTMS were chosen in a random drawing, raising $1,216.55 and $2,505.21, respectively.
To learn more about the Pennies for Patients program, visit www.schoolandyouth.org.
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LEXINGTON, Ky. (March 24, 2014) — Your vote could help improve integrative cancer care here at UK HealthCare — the University of Kentucky Music Therapy Program is currently a finalist in competition for a major music therapy grant through the LIVESTRONG Community Impact Project.
The grant is awarded through the Jeffrey Frank Wacks Music Therapy Program, one of the longest-running programs of its kind in the country and a key component of the Morristown Medical Center's Carol G. Simon Cancer Center in New Jersey. The program's overarching goal is to facilitate relaxation, decrease anxiety and stress, enhance wellness, improve pain management, and provide comfort and support for cancer patients and their caregivers. The LIVESTRONG Foundation has partnered with Morristown Medical Center to replicate this program across the U.S., offering 13 grants of $15,600, along with a year of paid consulting services to awarded sites.
The grant pays for a board-certified music therapist and consulting services to provide clinical services on an inpatient and outpatient basis for cancer patients. Adult and pediatric patients at the University of Kentucky Markey Cancer Center and Kentucky Children's Hospital would benefit from these services. Music therapy is proven to reduce stress and pain levels associated with illness and hospitalization. For many patients, the simple act of listening to music provides a therapeutic release, promoting healing and overall well-being.
“Music therapy can have a significant impact on the quality of life of cancer patients, and this grant will allow us to provide much needed services for Markey Cancer patients and their families," said Lori Gooding, director of the UK Music Therapy Program. "Because music is such an important part of Kentucky culture, I cannot think of a better way to provide support for our patients as they move through their cancer treatment.”
Voting begins at 11 a.m. EST Monday, March 24, and ends at 6 p.m. EST Friday, April 11, and voters may cast up to three votes — via email, Facebook, and/or Twitter. To cast your vote, visit http://vote.livestrong.org/applicant/35-university/.
For a transcript of this video, click here.
LEXINGTON, Ky. (March 17, 2014) — Hardin Memorial Hospital in Elizabethtown, Ky., is the latest medical center to join the University of Kentucky Markey Cancer Center Affiliate Network (MCCAN).
The affiliation means more cancer patients across Kentucky will be able to receive the advanced specialty and subspecialty care of the UK Markey Cancer Center, recently named the 68th National Cancer Institute-designated cancer center in the country, and the only one in Kentucky. Other benefits include access to clinical trials and advanced technology while allowing patients to stay closer to home for most treatment.
"The Markey affiliate agreement provides a great opportunity for professional education and training for our staff and physicians," said Ray Poston, director of the Cancer Care Center at Hardin Memorial. "Collaboration with Markey and their affiliates across the state allows our team to stay up-to-date on the newest cancer treatments and research."
Hardin Memorial becomes the ninth hospital to join MCCAN. Other affiliates include ARH Cancer Center in Hazard, Frankfort Regional Hospital, Georgetown Community Hospital, Harrison Memorial Hospital in Cynthiana, the Norton Cancer Institute in Louisville, Our Lady of Bellefonte Hospital in Ashland, Rockcastle Regional Hospital in Mount Vernon, and St. Claire Regional Medical Center in Morehead.
Visit the UK Markey Cancer Center Affiliate Network website for more information.
LEXINGTON, Ky. (March 17, 2014) — After 39 years of working in the University of Kentucky's Department of Chemistry, you might suspect one would get bored with the work. But professor Allan Butterfield describes his current project as "one of the most intellectually stimulating projects I've ever worked on."
Butterfield, whose many titles include director of the UK Markey Cancer Center's Free Radical Biology in Cancer Shared Resource Facility, studies oxidative stress in the brain. This includes the effect of oxidative stress on the development of Alzheimer's disease, and, in collaboration with Daret St. Clair, Markey's associate director for basic research, the study of chemotherapy-induced cognitive impairment (CICI), known colloquially as "chemo brain" by the cancer patients who experience it.
This research is not only stimulating, but groundbreaking, as well — Butterfield was recently awarded the 2014 Alkmeon International Prize for his work, an accolade that puts him in the same company as many Nobel Laureates and members of the National Academy of Sciences. In April, he will be presented the award in Rome, Italy, by Professor Giussepe Nistico of the University of Rome on behalf of the European Brain Research Institute, which sponsors the Alkmeon International Prize. In addition, he will be giving a lecture about his work at the University of Rome II (Tor Vergata) and a seminar in biochemistry at the University of Rome I (La Sapienza).
"I am truly honored to receive this award," Butterfield said. "The Alkmeon International Prize represents worldwide peer recognition of the decades of brain research by our highly talented graduate and undergraduate students, postdoctoral scholars, and visiting scientists in our laboratory that has led to numerous discoveries illuminating molecular mechanisms of brain disorders like AD and CICI."
UK's research into these two major neurological problems has the potential to affect millions of patients in the U.S. More than 5 million Americans are living with Alzheimer's disease, and one of every three senior citizens dies with Alzheimer's or another form of dementia. Butterfield's research has blazed the trail for research on the concept of oxidative stress as a potentially fundamental underlying aspect of Alzheimer's disease, and many other labs across the country have begun pursuing their own studies into the field. Advancements in these studies could lead to better treatment and understand of this devastating disease.
Additionally, among the 14 million cancer survivors in the U.S., many suffer from symptoms of CICI, which include negative impacts on reasoning and multitasking, confusion, and fatigue — all major quality-of-life issues. These side effects can be long lasting — decades, in extreme cases — and can have a significant negative impact on a patient's ability to function and even work post-treatment.
Since Markey earned its status as a National Cancer Institute-designed Cancer Center, this problem has become even more of a focus for Butterfield, St. Clair, and many other researchers and physicians at UK. The term "bench to bedside" is often used when describing research at an academic medical center like UK, but St. Clair describes CICI research as "bedside to bench and back," noting that to try and find solutions to the problems patients were reporting, the team had to go back to the lab and recreate the problem in animal models so that they could begin their basic science testing.
Facilitating these types of back-and-forth investigations means a great deal of collaboration between basic science and physician researchers. Drs. Jeffrey Moscow and John Hayslip are heavily involved in the CICI research from the clinical side.
"We are very fortunate that at Markey we have physicians who not only focus on the cure of cancer with the best available methods, but are also interested in finding ways to improve the quality of life for patient during and after cancer therapy," St. Clair said. "Our physicians work as a team with basic scientists to research ways to improve cancer treatment with reduce side effects."
There is hope on the horizon for finding methods to prevent CICI. A recent UK clinical trial showed promise for a drug called Mesna, which had previously been used in conjunction with other drugs during cancer treatment to help prevent bladder problems. The team's work showed that Mesna blocked CICI in animal models, and the research was translated into a two-year clinical trial, completed in late 2013. While their teams are currently analyzing the data and preparing for a possible expanded trial that would include UK Markey Cancer Center Affiliate Network hospitals, Butterfield and St. Clair say that the drug looks promising.
Butterfield has received numerous honors for his research over the years, but he is quick to point out that research is not a one-man show — it takes a strong infrastructure that allows collaboration from experts across many areas and disciplines across campus. UK's position as an academic medical center fits that bill. Individual medical centers like the Markey Cancer Center and the Sanders-Brown Center on Aging — both of which utilize Butterfield's expertise in redox research — benefit from the resources of eight colleges across UK's campus.
Butterfield says that Markey's Free Radical Biology in Cancer Shared Resource Facility is especially unique, noting that only the University of Iowa has a comparably robust program.
"The FRBC is unique because Markey researchers can directly test the roles of free radicals and oxidative stress in cancer and cancer chemotherapy," Butterfield said. "Samples from cancer patients can be examined on-site for oxidative damage, redox metabolism, and identification of altered proteins, all providing new insights into the molecular bases of cancer and its treatment."
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LEXINGTON, Ky. (March 6, 2014) — University of Kentucky faculty and students are invited to share their latest work in cancer research by submitting abstracts and attending Markey Cancer Center Research Day on May 22, 2014.
For the fifth consecutive year, the Singletary Center for the Arts will play host to a daylong event that showcases the work of cancer researchers from all disciplines at the University of Kentucky. Last year, Markey Research Day featured 142 posters and more than 350 attendees.
This year, Nobel Laureate Dr. Harold Varmus, director of the National Cancer Institute, will present the Susan B. Lester Memorial Lecture. As always, UK Markey Cancer Center Director Dr. Mark Evers will present the “State of the Cancer Center Address.”
Those interested may register and/or submit abstracts online. Deadline for the call for abstracts is Monday, March 17.
Dr. Mark Evers: what the National Cancer Institute (NCI) designation says about Markey's quality of care »
Markey patient named LLS "Man of the Year" »
Homemade "survival bracelets" honor late UK coach, raise money for cancer research »
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