Inside the Tulane Cancer Center

Winter 1997/8
Headlines in this Issue:
A Message from the Director
Tulane's 100th Bone Marrow Transplant
Cancer Pain Management: Stop Suffering
Eating Disorders: One Woman's Dedication to Comprehensive Care
Louisiana State Employees Project
TCC Comprehensive Clinic Grand Opening is Looking "Sharp"
The Mind/Body Connection in Cancer
Calendar of Events
Recent Honors and Awards
Index to all archived issues
Index to archived articles by topic
Editorial Staff & Contacts

A Message from the Director
Roy S. Weiner, M.D.
Director, Tulane Cancer Center

Cancer can be cured. Early breast cancer, early colon cancer, early prostate cancer, many leukemias, lymphomas, childhood cancers and other cancers can be treated successfully, so that the patient can have a normal lifespan with no recurrence of that cancer. Sophisticated surgery, radiation and systemic chemotherapy, along with refined diagnostic techniques, have made major advances in our ability to cure cancers. Curing the cancer patient is even more complicated. The diagnosis of cancer, its physical effects, and the physical effects of therapy produce psychological injury that impairs the quality of life of every patient to a greater or lesser degree.

Our commitment to the cancer patient embraces the psychological injury, its prevention, its early detection, and its treatment. Almost thirteen years ago, Tulane declared its commitment to psychological support with the founding of the Patricia Trost Friedler Cancer Counseling Center. Since then, hundreds of cancer patients treated at Tulane and elsewhere have sought counsel and solace from the Cancer Counseling Center, its educational literature, its support groups, and the opportunities it provides for access to expert professionals committed to the psychological health of patients with cancer.

With the opening of our Comprehensive Clinic, new facilities are now available for patients and their families. Our Resource Library has a wealth of literature on health maintenance, coping skills, cancer, and how it is treated. The computers in the Resource Library are linked to the World Wide Web and provide unlimited access to information, chatlines, bulletin boards, interactions with other cancer patients and cancer experts, and links to cancer resources on the Web. The new Group Room is available for after-hours support groups, and the proximity of secure parking makes it an ideal location for community use.

The teaching and research missions of our academic cancer center are as important to our psychosocial support program as they are to our programs in molecular genetics and cancer treatment. Griselda Gutnisky, M.D., Associate Professor of Psychiatry, has active research programs studying the psychological impact of cancer and its treatment. Training programs for students, residents, fellows, and social workers are honing the skills of our next generation of cancer caregivers. Moreover, the resources and facilities of the the Tulane Cancer Center Comprehensive Clinic and its Patricia Trost Friedler Cancer Counseling Center are available to every member of the Tulane faculty interested in discovering ways of preventing, identifying, and treating the psychological impact of cancer on patients.

At the Tulane Cancer Center, we believe that both cancer and the cancer patient are treatable and curable.
Tulane's 100th Bone Marrow Transplant
Admitted on November 21st to the Bone Marrow Transplant unit of Tulane University Hospital & Clinic, Patricia Nethery became Tulane's 100th Bone Marrow Transplant patient. Mrs. Nethery, a 48-year old Alexandria native under the care of Dr. Ulla Ule, was referred to the Tulane Cancer Center to undergo the processof Autologous Stem-cell Transplantation for locally advanced breast cancer, with ten positive lymph nodes, on November 28, 1997.

As part of the transplant regimen, Mrs. Nethery was also the first patient on a new Tulane-designed treatment protocol that involved comparing a combination of chemotherapy agents given in the two to three months preceding the transplant to a standard single agent. This study was done cooperatively between the Tulane Cancer Center and our regional clinical trials network, so that Mrs. Nethery received the early stages of treatment in Alexandria, and only had to come to Tulane for the transplant portion of her therapy. Her physicians believed this plan would not only improve the outcome, but it would allow the patient to spend more time at home, and allow for participation in research by oncologists throughout the region.

The Tulane BMT Program officialy began with the first transplant on January 7, 1994. Today's program offers adults and children allogeneic and autologous transplants for a variety of malignant and non-malignant diseases including: leukemia, lymphoma, breast cancer, and bone marrow failure. The BMT Program is active in both clinical research as well as laboratory research in a concerted effort to improve the treatment and outcome in these serious diseases. Before arriving at Tulane, "I was frightened and had lots of reservations, but once admitted I found the physicians and nurses to be reassuring and generous of the time they spent with me," said Mrs. Nethery. The BMT staff work closely with the scientists of the Tulane Cancer Center in developing research questions that will one day be translated to patient care. The Tulane staff includes five transplant specialists (Drs. Alan Miller, Roy Weiner, Hana Safah, Suzette Cullins, and Marta Rozans), a committed transplant nursing staff, a full-time transplant physician's assistant and transplant coordinator, a laboratory specializing in bone marrow and stem-cell processing that is located on the Bone Marrow Transplant Unit and directed by Vincent LaRussa, Ph.D., a recognized expert in bone marrow growth and development. The BMT Unit is a dedicated seven-bed unit with special air-handling systems that minimize risk of serious infections when patients are at their most susceptible. Patients who have received transplants have come from as close as downtown New Orleans, and as far away as Anchorage, Alaska.

"I believe that the success of my transplant was due to the fact that everything I needed was in one location: facilities, equipment, and staff expertise. My family and I feel very fortunate." After being discharged two weeks following the transplant, Mrs. Nethery returned to Alexandria where she receives periodic CT scans and mammograms. She has had her final post-procedure visit at the Tulane Cancer Center, and is feeling positive about her progress.
Cancer Pain Management:
Stop Suffering
Great advances have been made recently in the field of pain management. Patients with cancer, and their families, are no longer forced to "suffer in silence." The Tulane Cancer Center offers patients the knowledge, skills, and understanding of practitioners dedicated to the treatment of cancer pain.

Cancer-associated pain has long been feared by patients and their families. Approximately half of newly diagnosed cancer patients are already experiencing pain. More advanced cancers are associated with an incidence of pain which may reach 90 to 95%. Overall, 75% of all cancer patients experience pain at some time during the course of their disease. It is reassuring to know that there are multiple approaches to dealing with this problem, and that something can be done to help manage cancer pain.

A group of international cancer pain experts met in 1982 and devised guidelines to manage cancer pain. They suggested the use of an "analgesic ladder" to treat mild, moderate, and severe pain. This protocol, the WHO Analgesic Ladder, is still deemed to be helpful in the treatment of cancer pain.

The treatment of cancer pain utilizes various types of medications and techniques ranging from relatively simple to complex modalities. Non-opioid, opioid, and adjuvant analgesics comprise the majority of medications used to treat cancer pain. The non-opioid analgesics include simple medications such as acetaminophen or a non-steroidal anti-inflammatory drug. The opioid analgesics such as morphine are the backbone of cancer pain management. A great deal of confusion previously existed concerning the use of the opioids, but we now know that they may be used safely and effectively to treat cancer pain. Exaggerated fears of the risk of addiction have been dispelled by our vast experience with their use in treating cancer patients. The adjuvant analgesics are used for specific purposes in concert with either the opioid or non-opioid analgesics. Other types of medications are used when required.

In addition to medications, various options such as nerve block therapy, physical therapy, psychological therapy, radiation therapy, and surgical therapies are available to help manage cancer pain. Recent work has focused on the potential role od N-methyl-D-aspartate receptor (NMDA) antagonists in the treatment of pain syndromes. The NMDA receptor antagonists suppress "wind-up," the abnormal activation of spinal cord neurons following repetitive C-fiber activation. They also suppress central sensitization, the phenomenon of lowering of response thresholds of sensory neurons, expansion of receptive fields of sensory neurons and spontaneous firing of sensory neurons after noxious peripheral stimulation. Additional recent work has explored the use of epidural conidine for the treatment of cancer pain refractory to other treatments. These approaches may offer great assistance to the management of cancer-related neuropathic pain syndromes. Alternative delivery systems for the treatment of cancer pain are being explored at the present time.

It is frequently helpful for multiple health care providers to work together to help solve a cancer pain problem. It is reassuring to know that at the Tulane Cancer Center Comprehensive Clinic it is rare for a cancer pain problem to defy effective treatment.

Melvin C. Gitlin, MD, FACPM
Professor of Anesthesiology
Tulane University School of Medicine
Director, Pain Management Center
Tulane University Hospital and Clinic

Eating Disorders
One Woman's Dedication to Comprehensive Care
When the Tulane University School of Medicine Eating Disorders Clinic began in 1982, at its helm was Susan Gold Willard. Fifteen years and thousands of patients later, Willard is honored as Newcomb College's 1997 Outstanding Alumna for her contributions as medical school professor, research, and clinician.

Dr. Willard, associate professor in Tulane's Department of Psychiatry and Neurology and in the Department of Pediatrics, specializes in the treatment of individuals with anorexia nervosa and bulimia nervosa. Over 90 percent of Dr. Willard's patients are female. Of the reasons that serve as the foundation for an eating disorder, Dr. Willard believes that society's emphasis on being slim plays a significant role. "Our culture dictates to little girls that being thin and beautiful is synonymous with being successful," she says. "Our children are starting to diet as early as third or fourth grade. The stigma of being overweight is present at younger and younger ages."

Dr. Willard's clinical practice revolves around a process of therapy for the whole person. "There is no quick fix," say Dr. Willard. "We help patients through cognitive and behavioral interventions to stop their negative behaviors that are so potentially devastating. But the most important part of the treatment is insight-oriented, aimed at resolving underlying conflicts that have created the symptoms."

In addition to the treatment offered by Dr. Willard and the nutritionists, therapists, and physicians who make up the Tulane Eating Disorders Clinic, research is also a large part of the staff's work. Dr. Willard is currently studying ways to prevent eating disorders in girls who are ta risk of developing them. She is also studying the relationship between eating disorders and plastic surgical prodecures. The Clinic now treats obesity as well as anorexia nervosa, bulimia nervosa, and related eating disorders.

As part of Dr. Willard's commitment to community education, she continues to be featured as an Eating Disorders authority locally, nationally, and internationally. Most recently, she volunteered with the Tulane Cancer Center to host a booth at the Touro Synagogue Sisterhood Family Health Fair on the dangers of disordered eating.

Louisiana State Employees Project
Kick-off Reception
A reception was held at the Governor's Mansion in Baton Rouge on December 7 to kick-off the Louisiana State Employees Project of the TCC Friends for Life Program. Aimed at increasing awareness of the benefits of early detection, health educators from the Tulane Cancer Center will provide worksite educational sessions to motivate employees to act responsibly in adopting healthy living and cancer screening behaviors. Serving as spokesperson for this project, First Lady Alice Foster has requested the commitment of state department officials to promote Friends for Life to all of their employees across Louisiana.


TCC Comprehensive Clinic Grand Opening is
Looking Sharp
Kevin Sharp's story of courage and triumph was the impetus for a New Orleans concert on October 1, as well as for the decision to create the Kevin Sharp Fund for Basic Leukemia Research in the Tulane University School of Medicine. Sen years ago, Kevin Sharp was just hoping to live until his next chemotherapy treatment, while undergoing intensive radiation, surgeries, and experimental drug therapy. Today, as a musician touching the lives of thousands, he delivers an important message of hope for cancer patients, survivors, and their families.

While the concert was truly memorable, and Sharp's debut album Measure of a Man is well on its way to becoming Platinum, the real triumph is for residents of the Greater New Orleans area and the Gulf South region who now have an extensive cancer treatment and research center. The Tulane Cancer Center Comprehensive Clinic has assembled an extraordiary team of physicians, research scientists, nurses, health educators, and other health care professionals to form a multidisciplinary approach to the early detection, treatment, and eventual cure of cancer.

The Mind/Body Connection in Cancer
In conjunction with the Tulane Cancer Center, the Patricia Trost Friedler Cancer Counseling Center presented "New Frontiers in Medicine: The Mind/Body Connection in Cancer" by Stephanie M. Simonton, Ph.D., on September 21 at Tulane University's McAlister Auditorium. Dr. Simonton, a psychologist who has specialized in the treatment of oncology patients for over twenty years and an Assistant Professor in the Departments of Otolaryngology and Psychiatry at the University of Arkansas for Medical Sciences, spoke to an audience of 75 on her latest research linking stress management and cancer treatment.

Dr. Simonton pioneered a psychotherapeutic model of treating cancer which considers a patient's emotional health as a significant factor in combating the disease. She founded and is currently the Director of the Behavioral Medicine Program of the Arkansas Cancer research Center. This unijue program provides psychological research, treatment, and medical education within a university-based cancer center. In addition, Dr. Simonton is a consultant and visiting lecturer to the Behavioral Medicine Program at Harvard Medical School's Cambridge Hospital.

Upcoming Events
March 20, 1998
Friends for Life Program: First Day of Spring Membership Drive
Tulane University Hospital & Clinic, second floor

March 25, 1998
Tulane Cancer Center and Lilly Oncology present:
"An Update in Non-Small Cell Lung Cancer"
featuring Lawrence H. Einhorn, M.D.

March 26, 1998
Patricia Trost Friedler Health Seminar Series
featuring Jennie McNeill (Virginia H. McNeill Cancer Research Foundation, Inc.)
"Turning Adversity into Advantage"
12:00 noon, TCC Comprehensive Clinic
150 So. Liberty St.

March 28, 1998
AACR Public Forum
"Progress and New Hope in the Fight against Cancer" 9:00 am to 1:00 pm
Click here for further information

April 4, 1998
Tulane Bone Marrow Transplant Patient Reunion

April 13, 1998
Friends for Cancer Research Townhall Meeting with Rep. Bob Livingston

May 8, 1998
"A Tribute to Breast Cancer Survivors & Other Heroes"
The Breast Cancer Fund will host its second annual luncheon and fashion show, "A Tribute to Breast Cancer Survivors & Other Heroes," on May 8, 1998 at the Sheraton Hotel on Canal Street in New Orleans. The Breast Cancer Fund is a non-profit organization devoted to creating awareness and new sources of funding for cutting-edge programs and research. For event ticket information, please contact Joann Abbott at (504) 525-4795 or Angela Latino at (504) 599-6592

June 7, 1998
National Cancer Survivors Day
Survivors Plaza, Poydras and Loyola Streets, New Orleans
A Salute to TCC Members & Friends:
A Sampling of Awards & Accolades
Krishna C. Agrawal, Ph.D.
Barbara S. Beckman, Ph.D.
Matthew E. Burow, Graduate Student in Molecular and Cellular Biology
Laura S. Levy, Ph.D.
Raja Mudad, M.D.
Rusty Robinson, M.D.
Raju Thomas, M.D., F.A.C.S.
Roy S. Weiner, M.D.
The Tulane Cancer Center extends a special WELCOME to Michael W. Wolfe, M.D.
Appointed as an Associate Member, Dr. Wolfe is Assistant Professor of Orthopaedic Surgery and Director of Orthopaedic Oncology. His practice will include both adult and pediatric orthopaedic oncology, the treatment of primary and metastatic tumors of the musculoskeletal system. (More information on sarcoma research and treatment to come in the next issue of Inside the Tulane Cancer Center.)
INSIDE THE TULANE CANCER CENTER
 Your Partner for Life!
 Editorial Staff & Contacts
EDITORIAL
Editor: DR. ROY S. WEINER
News & Features Editor: ANGELA M. LATINO
Art/Production: STEVEN D. PIERRE

How to Contact Us

Tulane Cancer Center
(504) 988-6060
(504) 988-6077 fax
Box SL-68, 1430 Tulane Ave., New Orleans, LA 70112-2699, USA
WWW homepage: http://www.som.tulane.edu/cancer

Friedler Cancer Counseling Center
(504) 988-2120
WWW homepage: http://www.som.tulane.edu/cancer/friedler.html

Tulane Access
Physicians' referral line: (800) 588-5300
WWW homepage: http://www.tuhc.com

The Professionals
Patients' referral line: (800) 588-5800
WWW homepage: http://www.tuhc.com


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