Monday, November 12, 2007

Overweight men with prostate cancer have a higher risk of dying

Men who are overweight when they have locally advanced prostate cancer have almost double the risk of dying from the disease compared with men of normal weight, new research says.

The study, led by a team at Massachusetts General Hospital, is the first to find that excess weight alone is associated with deaths in men whose tumors had grown beyond the prostate or spread to lymph nodes, according to the study, which appears in the journal Cancer.

"The prevalence of overweight and obesity continues to increase in United States, so it’s an issue that's perhaps more important than ever," author Dr. Matthew R. Smith said in an interview. "What we need to do from here are additional studies to understand the mechanisms by which overweight and obesity are associated with worse prostate cancer mortality."

For men with a normal body mass index of 25, the death rate from prostate cancer was 6.5 percent after eight years. For overweight men, with a BMI between 25 and 30, it was 13.1 percent, and for obese men, with a BMI over 30, the death rate was 12.2 percent.

Obesity is not a new suspect in prostate cancer. Previous work has linked being overweight to having more aggressive forms of the cancer and higher rates of recurrence after radiation and surgery to remove the prostate gland. But other potential reasons for the difference in outcomes, from difficulty examining obese patients to possible biases in screenings, had not been isolated in the observational studies.

The study reported in Cancer analyzed data from a large randomized trial originally conducted to study radiation and hormone therapy in about 900 men with prostate cancer. That means the men had similar disease characteristics to be included in the trial. The authors, who also include researchers from Fox Chase Cancer Center and UCLA, looked at the men's BMI at the start of the trial and what happened to them over about eight years of follow-up.

Dr. Oliver Sartor of Dana-Farber Cancer Institute said the researchers have made an important observation from a well-designed trial.

"Now the hypothesis-driven question to ask is whether or not weight loss after diagnosis with prostate cancer will lead to better outcomes," he said in an interview. "That's an important question."

Posted by Elizabeth Cooney at 07:00 AM

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Monday, October 8, 2007

Five Boston researchers named to Institute of Medicine

Five Boston researchers have been elected to membership in the Institute of Medicine, a prestigious group established by the National Academies of Science to analyze health issues and make recommendations on policy.

Among the 65 new US members, five are from Massachusetts (four from Harvard, one from MIT), three are from Connecticut (all from Yale) and one is from New Hampshire (Dartmouth). The current 1,538 active members chose new members from candidates nominated for achievement and commitment to service, the IOM said in its announcement of new members today.

The Massachusetts members are:

Dr. Emery N. Brown, professor of anesthesia, department of anesthesia and critical care, Massachusetts General Hospital; and professor of computational neuroscience, health sciences, and technology, Massachusetts Institute of Technology

Dr. William G. Kaelin Jr., investigator, Howard Hughes Medical Institute, and professor, Harvard Medical School, Dana-Farber Cancer Institute

Dr. David T. Scadden, professor of medicine and co-chair, department of stem cell and regenerative biology, and co-director, Harvard Stem Cell Institute; and director, Center for Regenerative Medicine, Massachusetts General Hospital

Jonathan G. Seidman, professor of genetics, Harvard Medical School

B. Katherine Swartz, professor of health economics and policy, department of health policy and management, Harvard School of Public Health

The three new members from Connecticut are:

Dr. Robert J. Alpern, dean, Yale University School of Medicine

Dr. Harlan M. Krumholz, professor of medicine and epidemiology and public health, and professor of internal medicine, Yale University School of Medicine

Dr. Mary E. Tinetti, professor of medicine, epidemiology and public health, and director, Yale Program on Aging, Yale University School of Medicine

New Hampshire has one new member:

Jonathan S. Skinner, professor of economics, Dartmouth College, and professor of community and family medicine, Dartmouth Medical School

Posted by Elizabeth Cooney at 11:44 AM

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Thursday, September 27, 2007

Notables

Researchers from Boston and Cambridge have won two of three prizes for young cancer investigators.

Angelika Amon (left) of MIT and Dr. Todd R. Golub of Dana-Farber Cancer Institute and the Broad Institute of Harvard and MIT will receive the 2007 Paul Marks Prize for Cancer Research from Memorial Sloan-Kettering Cancer Center. The prize recognizes contributions to understanding the treatment of cancer made by scientists under the age of 45.

Amon studies how chromosomes segregate during cell division and Golub uses genomic approaches to classify subtypes of cancer. They will share a $150,000 prize with the third winner, Gregory J. Hannon of Cold Spring Harbor Laboratory, who studies the biology and biochemistry of RNA interference. All three winners are also Howard Hughes Medical Institute investigators.

Posted by Elizabeth Cooney at 03:31 PM

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Thursday, September 13, 2007

Combining targeted drugs may work better against brain tumors, study says

Aggressive brain tumors receive more than one chemical signal telling them to grow, so more than one targeted drug should be used to shut these switches down, Dana-Farber researchers report.

Writing in the online edition of the journal Science, Dr. Ronald DePinho and his colleagues say they found many kinds of mutated cell-growth molecules sending abnormal signals at the same time, explaining why drugs such as Gleevec that target only one signaling pathway have only limited success.

The researchers were studying cells from glioblastoma multiforme, the most common kind of brain tumor and one of the most lethal forms of cancer people can have. The median survival time is about 12 months.

Testing a combination of three or more drugs, including Tarceva and Gleevec, the authors discovered they were able to block the abnormal signals and kill the cancer cells.

The authors recommend clinical trials to see if a combination of Gleevec, Tarceva and other compounds can thwart tumor cell growth. They also note that the signaling patterns they saw in brain tumors have been detected in cell lines of two other kinds of cancer with poor survival rates: lung and pancreatic.

And based on what they called proof-of-principle for personalized medicine, they suggest studying patients' tumor cells to see which switches are activated so the best drugs to block them can be used.

Posted by Elizabeth Cooney at 02:00 PM

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Monday, August 27, 2007

Dana-Farber leader welcomes presidential cancer plans

By Elizabeth Cooney, Globe Correspondent

A prominent Boston cancer researcher is encouraged that, for the first time in recent memory, cancer is taking center stage in a presidential campaign.

"It seems to me that it is a good thing for sure that this is part of the political debate," Dr. Eric Winer, director of the breast oncology center at Dana-Farber Cancer Institute, said in an interview. "We certainly want cancer to be in the forefront of what the candidates and what Americans are thinking about."

Today Democratic candidates Hillary Clinton and John Edwards presented their ideas at a forum in Cedar Rapids, Iowa, convened by cyclist and cancer survivor Lance Armstrong. His LIVESTRONG Foundation invited presidential hopefuls to explain what they would do to combat the disease that kills 600,000 Americans a year. New Mexico Governor Bill Richardson, Kansas Senator Sam Brownback and Arkansas Governor Mike Huckabee also agreed to speak at the two-day event.

Edwards's wife, Elizabeth, has breast cancer and has said she will probably die of the disease. Her illness has influenced his thinking, he told the Associated Press.

His plan promises more money for research and more support for cancer survivors and their caregivers, according to material supplied by his campaign. He also advocates monitoring chemical and environmental risks while promoting better diet, more exercise and smoking cessation.

Clinton's goals urge better access to health care, doubling the federal research budget, preventing disease through healthier lifestyles and increased screening, and reducing racial and ethnic disparities in care. Her plan would devote funds to comprehensive care for cancer patients and require insurance companies to pay for preventive measures such as mammograms, colorectal screening and HPV vaccination.

Without parsing each candidate's plan, Winer said the need for increased cancer research, some form of universal health coverage and a commitment to fight cancer are all critical.

"What we need is funding that has the potential to decrease the number of Americans and people around the world who die from cancer," he said. "We need a national commitment to fixing the cancer problem and this goes beyond just dollars for research and for care. My hope is that cancer would serve as a model for other diseases."

Posted by Elizabeth Cooney at 07:43 PM

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Harvard leader named dean of Duke medical school

A Harvard Medical School physician-scientist has been named dean of the Duke University School of Medicine, the North Carolina school announced today.

Dr. Nancy C. Andrews (left), dean for basic sciences and graduate studies at Harvard Medical School, is the first woman to fill the position, Duke said. She will succeed Dr. R. Sanders Williams, who was promoted to senior vice chancellor for academic affairs at Duke.

Andrews, 48, is a pediatric hematologist/oncologist at Children's Hospital Boston and the Dana-Farber Cancer Institute. She previously directed the Harvard/MIT MD/PhD program. A member of the Institute of Medicine of the National Academy of Sciences, she was a Howard Hughes Investigator from 1993 to 2006.

Andrews earned bachelor's and master's degrees in molecular biophysics and biochemistry from Yale University, a Ph.D. in biology from MIT, and an MD from Harvard Medical School. She completed her residency at Children's and a fellowship in pediatric hematology/oncology at Children's and Dana-Farber.

Posted by Elizabeth Cooney at 02:51 PM

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Tuesday, August 21, 2007

Dana-Farber wins genomic research grant

Dana-Farber Cancer Institute has won $16 million to explore how viruses and human genetic variations can disrupt cellular networks, causing disease.

The National Human Genome Research Institute will fund a research team led by Marc Vidal, director of the Center for Cancer Systems Biology at Dana-Farber and an associate professor of genetics at Harvard Medical School. The group will work with colleagues from Brigham and Women's Hospital, Harvard Medical School and the University of Notre Dame through the new Center of Excellence in Genomic Science.

"We decided to try to see how pathogens are affecting the complex networks formed by our molecules, and relate that back to the genetic differences between individuals," Vidal said in an interview.

Posted by Elizabeth Cooney at 10:10 AM

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Tuesday, August 14, 2007

This week in JAMA

Three studies by Boston authors appear in this week's Journal of the American Medical Association.

A study from Dana-Farber Cancer Institute found that a diet high in meat, fat, sweets and refined grains may be associated with a higher risk of colon cancer recurrence and death in people who had surgery and chemotherapy to treat stage III colon cancer.

Researchers from Brigham and Women’s Hospital report that people with diabetes have an increased risk of death in the first month and first year after they have a heart attack or unstable angina compared with people who have these acute coronary syndromes but do not have diabetes.

A new measure of a lipid protein ratio is no better at predicting coronary heart disease than traditional methods of measuring cholesterol, Boston University School of Medicine investigators from the Framingham Study say.

Posted by Elizabeth Cooney at 07:27 PM

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Wednesday, July 25, 2007

Hospice care misunderstood and underused, journal authors say

Hospice care for dying patients has entered mainstream medicine, but it is still misunderstood and underused, according to two opinion pieces in tomorrow’s New England Journal of Medicine. Attitudes and economic constraints are the reasons why, the authors say.

The median length of time a patient receives hospice care is 26 days; one-third of patients enter hospice in the week before they die. That means they have less time to have their unnecessary pain relieved or their families’ care-giving burden eased, both reviews said.

Physicians who equate death with professional failure or think hospice is appropriate only for people near death send patients to hospice too late, Dr. Gail Gazelle of Brigham and Women’s Hospital writes, citing previous research. And patients often think that hospice is only for people dying of cancer, although 40 percent of hospice admissions are for people with conditions such as advanced cardiac disease and dementia.

Patients and doctors alike may not realize that Medicare pays for home hospice care in 80 percent of cases, and private insurers also provide coverage.

But the limits of what hospice payments cover create another barrier, forcing patients to choose between medical treatments and palliative care, Dr. Alexi A. Wright of Dana-Farber Cancer Institute and Dr. Ingrid T. Katz of Beth Israel Deaconess Medical Center say in the other perspective appearing in the journal.

Citing the case of a Massachusetts woman dying of colon cancer, they say hospice care meant she had to give up the chemotherapy and intravenous feeding that kept her comfortable. Only large hospices –- with at least 400 patients -– are economically able to add patients’ current medical treatment to hospice care, but this option is not available in Massachusetts, the doctors write.

Only 2.5 percent of the country’s hospices have an average patient census of 400 or more that can sustain the costs of medical treatments using Medicare’s payment formula, they write.

While health experts worry that open access might bankrupt Medicare, "patients will simply have to hope for access to a hospice that is large enough to help them," Wright and Katz conclude.

Posted by Elizabeth Cooney at 05:00 PM

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Friday, July 13, 2007

MGH, Brigham make US News honor roll

Massachusetts General Hospital and Brigham and Women's Hospital held on to their honor roll positions in the annual rankings by U.S. News & World Report called "America's Best Hospitals." Nine Boston hospitals are featured in the guide.

Mass. General finished fifth in the standings, down one rung from last year, and the Brigham took tenth place, up one from last year. Once again, Johns Hopkins Hospital and the Mayo Clinic finished first and second. UCLA Medical Center moved up to third from fifth and the Cleveland Clinic slipped to fourth from third.

The magazine evaluated 5,462 hospitals in 16 specialties, excluding pediatrics, and came up with 173 hospitals that met standards in one or more specialties based on reputation, care-related factors such as nursing and patient services, and mortality rate. Eighteen hospitals scored at or near the top in at least six specialties to make the honor roll.

Other hospitals were ranked in the specialty areas, but not in a cumulative score. Beth Israel Deaconess Medical Center was in the top 50 for 10 categories: diabetes (in conjunction with the Joslin Clinic); digestive disorders; respiratory care; heart and heart surgery; cancer care; kidney diseases; geriatrics; gynecology, urology; and ear, nose and throat care.

Boston-area hospitals known for their specialties also made the top 50. Dana-Farber Cancer Institute placed fifth in the list for cancer care. Joslin Clinic, with its partner Beth Israel Deaconess, was ranked 12th for endocrinology. New England Baptist Hospital was 17th for orthopedics and Spaulding Rehabilitation Hospital ranked eighth for rehabilitation. Massachusetts Eye and Ear Infirmary placed fourth in ophthalmology and in the ear, nose and throat specialty.

Boston Medical Center was ranked 41st in geriatrics.

Mass. General's winning specialty areas were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; heart and heart surgery; gynecology; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; psychiatry; and rheumatology.

The Brigham's top specialties were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; gynecology; heart and heart surgery; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; and rheumatology.

Posted by Elizabeth Cooney at 06:27 AM

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Friday, June 22, 2007

Harvard researcher wins MERIT Award from NIH

Xihong Lin (left), professor of biostatistics at the Harvard School of Public Health, has won a MERIT Award from the National Institutes of Health.

Lin will develop statistical methods for analyzing cancer research data, including long-term and family data as well as genomic and proteomic information in epidemiological studies and population sciences, NIH said in a statement.

Fewer than 5 percent of NIH-funded investigators are selected to receive the awards.

Current MERIT recipients in Massachusetts and their instituions are:

Beth Israel Deaconess Medical Center: Benjamin G. Neel
CBR Institute for Biomedical Research: Timothy R. Springer
Children's Hospital Boston: Michael Klagsbrun and Bruce R. Zetter
Dana-Farber Cancer Institute: Stanley Korsmeyer and David M. Livingston
Harvard: John Blenis, Stephen C. Harrison, Peter M. Howley and Andrew G. Myers
Massachusetts General Hospital: Daniel Haber
MIT: Michael R. Lieber, Stephen J. Lippard and Alexander Rich
Tufts: John M. Coffin
Whitehead Institute for Biomedical Research: Rudolph Jaenisch

Posted by Elizabeth Cooney at 11:05 AM

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Thursday, June 21, 2007

NCI cancels breast cancer prevention study

By Elizabeth Cooney, Globe Correspondent

In an unusual step, the National Cancer Institute has canceled a $130 million clinical trial to compare how well two drugs prevent breast cancer.

Called the P-4 trial because it is the fourth such prevention study undertaken by the federal agency, it would have enrolled more than 12,000 women at high risk for breast cancer at 500 sites and followed them for years. The termination of the study before it began recruiting patients comes at a time when NCI is straining under four years of tight budgets.

The women would have received either raloxifene, an estrogen-blocking drug approved to treat osteoporosis but now prescribed to stop breast cancer, or letrozole, a compound from a newer class of drugs called aromatase inhibitors that deplete the production of estrogen. Both target estrogen because it promotes the growth of cancer cells.

Dr. Bruce Chabner, clinical director of the Massachusetts General Hospital Cancer Center, was on a scientific panel that last week advised NCI director Dr. John E. Niederhuber to pull back the P-4 trial. Niederhuber, who called for a review of the trial in January, visited Mass. General Monday and discussed the trial in previously scheduled sessions with Boston researchers and clinicians.

Chabner said the trial's cost was considered along with scientific concerns, including the desire to better match powerful drugs with the individuals who can be helped by them.

"I think in times when the budgets were really generous the NCI would probably have gone ahead with the study. It's not so much a criticism of the trial as it's expensive when there are other priorities that are very important," he said. "It is an unusual step. But these are unusual times."

The NCI's June 19 letter to the study's principal investigators at the University of Pittsburgh cited troubling complications caused by the two cancer prevention drugs and the relatively small number of women -- 3 or 4 out of 100 -- who benefit from them. The decision not to go forward with the study was first reported in Wednesday's Washington Post.

"While the P-4 study may provide another possible option for women at risk for breast cancer, the dangers of introducing these drugs, with their many known side effects, outweighs their potential until we are better able to determine who will benefit from these interventions and what the longer-term effect may be," the letter said.

Tamoxifen -- studied in 20,000 women in the P-1 trial of the early 1990s -- is currently the only drug approved for the prevention of breast cancer. Doctors prescribe it to treat women with breast cancer, to avoid a recurrence or in some cases to prevent it in the first place. Tamoxifen and raloxifene were compared in a large trial that last year reported they had just about the same effectiveness in preventing cancer, but raloxifene had fewer side effects.

Tamoxifen is linked to uterine cancer, blood clots and cataracts. Raloxifene was associated with a lower risk of these complications. Aromatase inhibitors are known to cause brittle bones, a particular worry for older women who might be taking them.

Chabner said the advisory panel's consensus was that this expensive trial was "not going to change the practice of medicine."

"Everybody agrees that the number-one priority is not to compare drug X to drug Y," he said. "It's to really define who is at highest risk for breast cancer so we don't have to treat 100 patients to prevent three or four or five cancers. If we can treat 10 patients and prevent 5 cancers, then it's going to be more reasonable."

NCI holds out hope for personalized medicine to better fit treatments to patients.

"Targeted chemoprevention must rely on individual genomic and proteomic signatures to identify those patients for whom the risk-benefit ratio justifies using a chemopreventive drug," its letter said. "NCI will continue to have a strong commitment to cancer prevention and search for ways in which such patients can be provided highly personalized approaches to prevention."

Other ongoing studies are examining how well other aromatase inhibitors protect women against breast cancer compared with placebos. One trial, funded by the National Cancer Institute of Canada and looking at exemestane, is led by Dr. Paul E. Goss, also of Mass. General.

"I feel strongly that aromatase inhibitors should be tested in prevention but always believed that the trial should be against a placebo," he said in an e-mail. "I am not privy to all the forces that fed into the NCI director's decision but I have no doubt that competing priorities were a big part of it. It is true that our trial would have reported before (P-4) and I agree that (P-4) may therefore not have changed practice."

Chabner said another weakness of the P-4 trial was that letrozole, the aromatase inhibitor being compared with raloxifene, will no longer be protected by its patent in 2011, meaning its manufacturer will have no incentive to seek FDA approval if it is shown to be effective.

Dr. Harold J. Burstein, a breast cancer specialist at the Dana-Farber Cancer Institute, said oncologists will have to infer from other studies in other countries how the different kinds of chemoprevention drugs compare. Dana-Farber would likely have been one of the many sites for the P-4 trial, he said.

"There's no doubt we need more studies in breast cancer prevention and the study being proposed was a very practical strategy to compare two likely effective strategies," he said. "There will be a void when a patient comes to see a doctor eight years from now and says, 'Which one should I take?'"

Posted by Elizabeth Cooney at 10:27 AM

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Tuesday, June 5, 2007

Anderson named Clinical Cancer Research editor

Dr. Kenneth C. Anderson (left) of Dana-Farber Cancer Institute has been named editor-in-chief of the journal Clinical Cancer Research, the American Association for Cancer Research said.

Anderson, who had been a senior editor of the oncology journal, is a professor of medicine at Harvard Medical School and chief of the division of hematologic neoplasia and director of the Jerome Lipper Multiple Myeloma Center at Dana-Farber.

Posted by Elizabeth Cooney at 09:34 AM

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Tuesday, May 22, 2007

Eric Winer adds role at Susan G. Komen for the Cure

Dr. Eric P. Winer (left) today was named chief scientific adviser to Susan G. Komen for the Cure, the breast cancer advocacy group.

He will remain director of breast oncology at Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School while taking on the new role at Komen. He explained in an interview why he is excited about the opportunity and about the future of breast cancer research.

Why did you agree to join Komen?
It’s a way of helping an organization that I view as a very strong organization to do even better in the future. Komen is about raising money for research and increasing those funds to answer the most appropriate questions as quickly as possible. This is now a way for me to have a slightly larger influence beyond the exam room, beyond my own institution and to work in an organization that is really trying to do good.

What are some of the questions that need answers?
We have new treatments that are better treatments, but one of the issues that arises is, the better the treatments get, the more important access to care gets. When you have a disease that is very poorly treated, it almost doesn’t matter whether people have access if they’re not going to get well. When you have a disease that can be more effectively treated, access to care — and this applies in the United States and worldwide — becomes increasingly important. Among the various goals that Komen has is trying to improve access to care.

What’s important on the research agenda?
This is a time when there really have been advances in our understanding of breast cancer biology that we need to translate into treatments in the clinic that will actually help patients with breast cancer and cure women with breast cancer. This is occurring at a time when federal funding for research has gone down, so organizations like Komen become even more important in terms of their ability to support research.

How will you influence the research that gets done?
Research funds will still be given out to investigators based on the peer review system. However, we can put out requests for applications in specific areas, as has always occurred with federal funds. It’s an important way to ask for proposals in areas where we think there can be the biggest bang for the buck.

What are the significant advances in breast cancer research over your 20-year career?
There are really two major areas: One is that we have finally understood that breast cancer isn’t one disease but a family of fairly distinct diseases that each requires different treatments. One-size-fits-all doesn’t work. And our understanding of that is paired with the increasing ability to identify treatments for each of those different subtypes. An example is the drug Herceptin for HER-2 positive breast cancer. HER-2 positive breast cancer is a distinct entity and we have treatments that work based on that.

What do you see for the future?
One of the exciting things about the work I’ve been able to do, by no means by myself but with hundreds of others, is that there really will have been a dramatic change in breast cancer. For a disease that was terrifying to women and that took many lives, I think that it will be a disease that takes very few women’s lives by the time I’m at the end of my career.

How old are you?
I’m 50. I don’t view this as preparation for retirement.

Posted by Elizabeth Cooney at 05:38 PM

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Wednesday, April 18, 2007

Dana-Farber nurses easily approve new, generous contract

By Scott Allen, Globe Staff

Nurses at the Dana-Farber Cancer Institute yesterday approved a contract that will make them the highest paid nurses in New England, according to the Massachusetts Nurses Association, with senior nurses making more than $140,000 a year by 2009.

The three-year contract, settled after only five bargaining sessions, will give the cancer center's 225 nurses cumulative pay increases of from 9 to 23 percent, depending on their specialty and experience, the union said. A fulltime registered nurse with 15 years experience would make $67.78 an hour, which translates to $141,000 annually.

Nurses at most other teaching hospitals in Boston make at least several dollars an hour less, according to the nurses association.

"The Dana-Farber Cancer Institute is an awesome place to work and they really value their nurses," said Kathleen McDermott, the Dana-Farber nurse who chaired the bargaining committee for the nurses' association. "They have a lot of very experienced nurses and they ... want to keep us."

Officials at Dana-Farber also praised the new contract. "We value our nurses, their skill and the high quality of care they provide our patients and their families," said Patricia Reid Ponte, senior vice president for patient care services and chief of nursing at the hospital.

The harmony at Dana-Farber is a striking contrast to last fall's negotiations at neighboring Brigham and Women's Hospital. At the Brigham, nurses threatened a strike last November and narrowly averted a work stoppage after a 14-hour bargaining session produced a contract that will give senior top scale nurses more than $126,000 a year.

But reaching a labor agreement may be easier at Dana-Farber which has only 225 nurses compared to 2,700 at the Brigham and all of them practice cancer medicine, giving the Dana-Farber nurses both a narrower focus and a closer relationship with hospital management. In the past, McDermott said contracts have been wrapped up in as few as three bargaining sessions.

In addition, Dana-Farber officials have particular reason to keep labor peace this year after announcing an ambitious $1 billion fundraising program to pay for expansion, research and improved cancer care. As nursing association spokesman David Schildmeier said, "The last thing they would need is .. nurses who are out there on the street talking about their dissatisfaction," he said.

There is no central ranking of hospital nurse salaries -- and who is on top often depends on which Boston hospital negotiated the most recent contract -- but Schildmeier said there is little doubt that the Dana-Farber nurses are the top paid in the region and among the best paid in the United States.

He said nurses at the Brigham and Boston Medical Center -- all of them working under contracts signed in the past year -- are probably ranked second and third in the region with top pay scales just above $60 per hour.

Posted by Karen Weintraub at 03:11 PM

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Friday, April 13, 2007

This week in PLoS and JCI

Harvard researchers including Dr. Todd R. Golub report in PLoS Medicine, the online Public Library of Science journal, that, using a molecular biology technique called microarray expression profiling (an example of a detail is at left), they were able to identify compounds that could target genes involved in Ewing sarcoma, the second most common childhood cancer of bone and soft tissue.

In the Journal of Clinical Investigation, Dr. Alan D'Andrea and colleagues at Dana-Farber Cancer Institute show a new therapeutic target for the treatment of Fanconi anemia, which carries the risk of cancer and bone-marrow failure.

Also in the Journal of Clinical Investigation, Dr. Rong Tian and colleagues from Brigham and Women's Hospital report that in mice, mutations in a protein that triggers cells to generate more energy are associated with heart failure.

Posted by Elizabeth Cooney at 11:02 AM

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Wednesday, April 4, 2007

Dana-Farber Cancer Institute gets second largest gift ever

By Scott Allen, Globe Staff

Officials at the Dana-Farber Cancer Institute today announced the second largest gift in the hospital's history: $30 million from a philanthropy dedicated to the memory of the longtime owners of the Boston Red Sox, Tom and Jean Yawkey.

The gift from the Yawkey Foundation will help pay for the first new patient care building in more than 30 years at Dana-Farber, the Yawkey Center for Cancer Care, which is scheduled to open in 2011.

The Yawkey Foundation's endowment skyrocketed in value after the family sold the Red Sox in 2002, enabling the board to give away more than $150 million in the past five years, including $15 million for improved cancer care at Boston Medical Center and $25 million for Massachusetts General Hospital's Yawkey Center for Outpatient Care.

But Dana-Farber always had a special relationship with the late Tom and Jean Yawkey, who made the hospital's Jimmy Fund the official charity of the Red Sox back in 1953, and today's gift is the largest in foundation history.

"More than 50 years ago, Tom and Jean Yawkey and our founder Dr. Sidney Farber shared a vision of one day conquering cancer," said Dr. Edward J. Benz, Jr., president of Dana-Farber, in announcing the donation. "The Yawkey's longstanding support of Dana-Farber and the Jimmy Fund has enabled us to move much, much closer to this goal and has helped save countless lives along the way."

The new 275,000 square foot outpatient treatment center to be constructed near the intersection of Brookline Ave and Jimmy Fund Way, will house 100 examination rooms, 150 beds for cancer treatment and a new front entrance for the entire Dana-Farber campus, located in the Longwood Medical Area.

Posted by Karen Weintraub at 10:49 AM

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Tuesday, March 27, 2007

Boston doctors comment on another cancer recurrence

By Elizabeth Cooney, Globe Correspondent

Presidential spokesman Tony Snow's colon cancer has returned and spread to his liver, news that comes less than a week after Elizabeth Edwards, wife of presidential candidate John Edwards, revealed her breast cancer has come back in her bones.

Two Boston oncologists, speaking only in general terms, said medicine has more to offer patients with metastatic cancer -- cancer that spreads -- today than before, but that may not be enough.

"In the past 10 years we've really gotten better at this. There are more effective drugs that allow patients to live longer and better with colon cancer than 10 years ago," said Dr. Charles Fuchs, a medical oncologist who specializes in treating gastrointestinal cancer at the Dana-Farber Cancer Institute. "I would emphasize that what we have is not adequate. It's not where we want to be, but we're able to allow patients to live longer."

Snow had surgery in 2005 to remove his entire colon, followed by six months of chemotherapy. A growth that was first spotted in his lower right pelvic area last year was removed yesterday and found to be cancerous. Cancer was also in his liver.

Patients whose cancer has spread from the colon to their lymph nodes have a 35 percent to 40 percent chance of it recurring, despite the surgery and chemotherapy, Fuchs said. That recurrence typically happens within three years and the liver is the most common organ to which colon cancer migrates.

Some patients who have cancer that is confined to one portion of their liver might have chemotherapy to shrink it so it can be removed by a surgeon.

"Regrettably that tends to be only a subset of patients," he said.

For patients with metastatic, or stage IV, colon cancer, the average survival is about two years. That compares to 10 months' survival average from 10 years ago, Fuchs said.

"Clearly that is not sufficient, but we are making some measure of progress with some of the newer drugs we are now testing," he said.

For metastatic breast cancer, newer treatments make it difficult to predict survival rates, said Dr. Ann H. Partridge, a medical oncologist at Dana-Farber who focuses on breast cancer. Average survival rates are five years, but that's based on old data that don't reflect current therapies that allow improvements in both quality and quantity of life.

"Some women live a very long time -- decades -- with metastatic breast cancer and some women die within the first few months," she said. "Those two extremes are extraordinarily rare. Most women are somewhere in between."

Elizabeth Edwards said Sunday she had a "hot spot" of metastatic cancer in her hip bone as well as one rib. Breast cancer commonly spreads to more than one place in a woman's bones, Partridge said. For a woman with her type of cancer, surviving 10 years would be "possible but not probable," she said.

"But never say never," she said. "I say to women, 'I can give you an average but you are a single individual, and for you it's all or nothing. Your cancer either gets better or worse or stays the same. Our goal is to control it to stay the same or get better.' "

Posted by Elizabeth Cooney at 03:29 PM

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Thursday, March 22, 2007

Local doctors comment on the return of Elizabeth Edwards' cancer

By Scott Allen, Globe Staff

Elizabeth Edwards this week got the news that all breast cancer survivors dread: her cancer is back.

Less than two years after she finished treatment for invasive ductal cancer in her right breast, doctors told the wife of presidential candidate John Edwards that she now has a small tumor in a rib on her right side. The diagnosis means that Edwards likely will never be cancer-free and she may require chemotherapy or other treatment for the rest of her life.

However, oncologists said that Edwards, 57, could live with cancer for many years.

Dr. Eric Winer, director of breast oncology at the Dana-Farber Cancer Institute, said Edwards has good reason to be optimistic about her treatment. He said that nearly half the patients he saw today were facing a recurrence of their cancer, adding, "Many women we take care of are living with metastatic breast cancer for many years."

Up to one-quarter of breast cancer survivors eventually face cancer again, depending on the type of cancer. Oncologists say that Edwards may have been at above average risk of recurrence, in part because the original tumor had grown so large.

Edwards admitted she had not undergone a routine mammogram for years before she discovered a lump that "felt nearly as big as a plum" while showering during the last days of John Edwards' vice presidential campaign in 2004.

"When the tumor has gotten up to that size, already the tumor has had more chances to break off and spread to other places," explained Dr. Thomas Caughey, an oncologist at Mt. Auburn Hospital in Cambridge. "Some cancer cells that started in her breast escaped before they took the tumor out." Doctors cannot detect such escaped cancer cells until there are millions of them, clumped in a tumor.

Edwards' cancer is "metastatic stage 4," meaning that it is the return of her original cancer and that the disease has traveled through her blood or lymph system to other parts of her body. Statistically, people with metastatic cancers have a lower survival rate than those with localized tumors, but there are no precise survival statistics for someone with Edwards' characteristics.

Far from discouraged, Elizabeth Edwards said at a press conference today she felt thankful that the bone cancer was detected while it was still small and readily treatable. Radiologists found the tumor on Monday when she underwent an X-ray for a suspected broken left rib. John Edwards said that a subsequent CT scan showed no evidence that the cancer had reached other organs, which would have sharply reduced her prospects for survival.

"We're going to always look for the silver lining," said Elizabeth Edwards, the mother of one adult and two young children. "That's who we are as people."

Dr. Beverly Moy, an oncologist at Massachusetts General Hospital, where Edwards was first diagnosed, said that her treatment will likely be less draining this time. During her first battle with cancer, she shaved off all her hair rather than lose it to chemotherapy.

Because doctors won't be attempting to eradicate all cancer cells this time, Moy said, Edwards may receive less intensive chemotherapy, localized radiation or various hormone treatments that have relatively few side effects.

Posted by Karen Weintraub at 06:09 PM

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Boston oncologist picked to lead Fox Chase

Dr. Michael V. Seiden, a leading cancer clinician and researcher, is leaving Boston to become president and CEO of Fox Chase Cancer Center in Philadelphia, the center announced today.

Seiden, 48, is head of the gynecological cancer program at the Dana-Farber/Harvard Cancer Center and chief of clinical research in cancer medicine at Massachusetts General Hospital. An associate professor of medicine at Harvard, his research focuses on ovarian cancer tumor biology. He is the physician coordinator of the cancer stem cell project at the Dana-Farber/Harvard Cancer Center.

On June 1 he will succeed Dr. Robert C. Young, 67, who is retiring from Fox Chase, which treats about 6,500 new patients a year and employs about 2,500 people.

Seiden is a graduate of Oberlin College and earned his M.D. and Ph.D. at Washington University in St. Louis. He completed his internship and residency at Mass. General, was a fellow in medicine at Harvard, did a three-year clinical fellowship in medical oncology at Dana-Farber Cancer Institute and was a postdoctoral fellow in molecular pathology at Brigham and Women's Hospital.

Posted by Elizabeth Cooney at 05:55 PM

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Wednesday, March 7, 2007

Hot stuff: Three local researchers rank high

When you're hot, you're hot.

Three researchers from Boston and Cambridge ranked among the world's most highly cited scientific authors in 2005 and 2006, according to the March/April issue of Thomson Scientific’s Science Watch newsletter. Its Web of Science database identifies a paper as "hot" if it is cited in scientific journals at a much higher rate than similar papers over a two-year period.

Richard D. Gelber of Dana-Farber Cancer Institute had six hot papers in biostatistics and oncology; Max Tegmark of MIT had six in space science; and Mark J. Daly of Harvard Medical School had five in genetics.

They finished behind Shizuo Akira of Osaka University, who had 7 hot papers in immunology. Akira and Tegmark are the only two researchers who stayed hot for the second list in a row.

Here is the complete list of the hottest researchers:

Shizuo Akira, Osaka University, Immunology, 7
John L. Bryant, University of Pittsburgh, Biostatistics/Oncology, 6
Norman Wolmark, Allegheny General Hospital, Oncology, 6
Richard D. Gelber, Dana-Farber Cancer Institute, Biostatistics/Oncology,6
Max Tegmark, Massachusetts Institute of Technology, Space Science, 6
Mikhail Kopytine, Kent State University, Physics, 6
Basanta K. Nandi, Indian Institute of Technology, Bombay, Physics, 6
Thomas Peitzmann, Utrecht University, Netherlands, Physics, 6
Mark J. Daly, Harvard Medical School, Genetics, 5
John F. Forbes, University of Newcastle, Australia, Oncology, 5
James N. Ingle, Mayo Clinic Cancer Center, Oncology, 5
Aman U. Buzdar, University of Texas M.D. Anderson Cancer Center, Oncology, 5
Scott M. Grundy, University of Texas Southwestern Medical Center, Nutrition/Metabolism, 5
John Cuzik, Cancer Research United Kingdom Clinical Center, Epidemiology/Oncology, 5
Aron Goldhirsch, European Institute of Oncology, Milan, Oncology, Louis Mauriac, Institut Bergonie, Bordeaux, France, Oncology, 5
Louis Fehrenbacher, Kaiser Permanente, Oncology, 5

Posted by Elizabeth Cooney at 12:22 PM

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Monday, March 5, 2007

Faculty of 1000 Medicine interprets research

A new online research tool called The Faculty of 1000 Medicine aims to help researchers and clinicians make sense of the flood of scientific information available online. Tomorrow its 100 Boston members are invited to Dana-Farber Cancer Institute to discuss how its interpretive approach can help speed research advances along the path to patient care.

"The thing that's missing from a lot of online publications is the role of interpreter who is an expert in the field and who objectively puts things in the right perspective," Dr. Edward J. Benz, president of Dana-Farber and one of the hematology editors for the online resource, said in an interview. He and Dr. M. Rashad Massoud, senior vice president of the Institute for Healthcare Improvement, will speak at the 4 p.m. reception.

In his role as an editor, Benz gathers colleagues who are experts in particular areas of hematology such as anemia or clotting disorders, relying on them to track their specialties and compile packets of information online. Users can supply keywords that will be used to send them notices of articles they might find interesting. Other editors do the same thing in other fields of medicine, sometimes writing commentaries or pointing to key points that may be overlooked.

"This is one of the many ways people are trying to accelerate the conversion of research knowledge into clinical practice," Benz said. "A multi-disciplinary awareness is important for seeing where the clues are that might not ordinarily appear in front of you if you keep your head down in your own area."

Boston has a high concentration of medical experts, but that doesn't mean they always see one another face to face, Benz said.

"The nice thing about the Web is you can do a lot of work from your desk, but you often don't meet the people who work in other fields," he said. "They might be three hospitals away. So this can be a way to get together face to face."

Posted by Elizabeth Cooney at 11:28 AM

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Thursday, March 1, 2007

Snub of the universe? Postdocs pick elsewhere

Not a single institution on either side of the Charles cracked the Top 15 places to work in a survey of postdoctoral life scientists, the March issue of The Scientist magazine says.

Training and experience matter the most to these researchers, who have finished their Ph.D.s but don't have faculty positions, the survey reports. They ranked access to books and journals next, followed by affordable medical insurance and then equipment and supplies for research.

The closest Boston or Cambridge came was Beth Israel Deaconess Medical Center's 28th-place finish, shooting up from 97th last year.

Harvard Medical School, Brigham and Women's Hospital, Woods Hole Oceanographic Institute and Dana-Farber Cancer Institute also made the top 40. MIT dropped out of the top 40, placing 53rd.

M.D. Anderson Cancer Center in Houston topped the list, zooming up from 29th last year. The J. Gladstone Institutes in San Francisco slid to second place from first. The U.S. Environmental Protection Agency in Research Triangle Park, N.C., stayed in third.

Here's how postdocs ranked area institutions, with the 2006 ranking in parentheses:

Beth Israel Deaconess: 28 (97)
Harvard Medical School: 31 (17)
Brigham and Women's: 35 (41)
Woods Hole: 38 (11)
Dana-Farber: 39 (67)
MIT: 53 (26)
Harvard University: 71 (45)
Massachusetts General Hospital: 81 (64)

A total of 96 institutions in North America were ranked this year. Research centers with too few responses were not listed, including some in the Boston area.

For its "Best Places to Work 2007: Postdocs," the magazine polled its readers about conditions in their research facilities. The Web-based questionnaire pulled in 2,555 usable responses from people who identified themselves as non-tenured scientists working in academia or other non-commercial research organizations.

So, postdocs, White Coat Notes wonders what you think about where you work. Send us your thoughts at whitecoat@globe.com.

Posted by Elizabeth Cooney at 08:03 AM

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Tuesday, February 20, 2007

Should doctor-patient conversations be taped?

Interesting suggestion from Blog, MD, the blog of Dr. Samuel C. Blackman, a Boston pediatric oncologist. He discusses a recent study in the British Medical Journal, which looked at whether mothers of infants in the ICU were able to recall information better when given audiotapes of their conversations with doctors.

"A couple of years ago, when I was a relatively new 1st year fellow, a family brought a tape recorder into the room and set it down right in front of me," he writes. "I can’t remember whether or not they asked me if I would mind being taped (I think they did), but I remember being weirded out by it and telling them that I’d prefer not to have my every word recorded."

But he's had a change of heart. "One would think that a tool as simple as a tape recorder would be more widely used for complex discussions such as informed consent for chemotherapy," he writes. "I believe that offering parents the opportunity to tape one’s important discussions with them telegraphs a message of confidence and trust, and would go a long way to establish rapport at a very important moment in a family’s life."

He's eager for comments from parents of children with cancer and from cancer patients themselves.

Posted by Gideon Gil at 08:19 PM

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Yearning is primary emotion after death of a loved one

Contrary to traditional notions of grief after the death of a loved one, a new study finds that yearning is felt more powerfully than depression.

Researchers from Harvard Medical School and Yale University School of Medicine found that yearning was the strongest negative emotion after loss, they report in tomorrow's Journal of the American Medical Association.

Negative emotions associated with grief peaked within six months, meaning people with more prolonged symptoms might need more help after that point. And the researchers recommend that the standard psychiatric reference, the Diagnostic and Statistical Manual of Mental Disorders, be revised to focus less on depression after the death of a loved one.

"Yearning is reacting to the loss of someone or something, and once that is gone, you miss it, you pine for it, you hunger for it, you crave it. That was the primary emotional experience after bereavement, rather than depression," Holly G. Prigerson, one of the authors, said in an interview. "This suggests that the DSM reconsider what the natural response to loss is, especially with respect to depression and yearning."

Prigerson is an associate professor of psychiatry at Harvard and director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute.

Prigerson and her colleagues were testing the theory that people respond to loss by moving through disbelief, yearning, anger, depression and acceptance, with depression being the dominant negative emotion. To do that they interviewed 233 people in the Yale Bereavement Study for up to two years following the death of a loved one from natural causes.

The participants in the study, mostly widows, did experience the five stages of grief in the sequence popularized by Elisabeth Kubler-Ross's description of terminally ill patients, but yearning was the most powerful negative emotion and, on average, participants' worst feelings peaked within six months. The level of acceptance -- the strongest emotion of all -- rose steadily over six months.

In contrast, the DSM focuses exclusively on depressive symptoms, saying they should be expected two months after a loss, Prigerson said.

Prigerson emphasized that the people in the study had lost loved ones to natural causes, reflecting 94 percent of deaths in the United States. People who had lost a child or a loved one after a traumatic death, such as a car crash or suicide, were excluded from the study.

The ones who knew for six months or more that their loved ones had a terminal illness reached acceptance sooner than those who had less time to prepare for the death, the study found.

"People never get over a loss, they just get used to it," Prigerson said. "Even years after someone dies, they get pangs of grief, they need to think about the person, and they miss them with heartache," she said. "That's normal. But intense levels beyond that become problematic."

Posted by Elizabeth Cooney at 04:14 PM

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Monday, February 12, 2007

Narrowing the search for cancer genes

The road to personalized medicine is a bumpy one, but researchers at the Dana-Farber Cancer Institute and the Broad Institute have found a method that might smooth the way.

Writing in yesterday's Nature Genetics, they report on a faster, cheaper method of screening for multiple mutations that turn on cancer genes.

Taking advantage of mass spectrometry, a tool researchers use to detect variations in genes, they were able to narrow down their search for relevant mutations in 1,000 samples of tumor tissue by examining only regions of genes where most troublesome mutations occur.

"You don't have to sequence the entire cancer genome," said Dr. Levi A. Garraway, a medical oncologist at Dana-Farber and an associate member of the Broad, a joint MIT-Harvard institute. "All you need to do is look in specific locations."

The researchers discovered that some tumor samples showed mutations not normally expected for the kind of cancer the patient had been diagnosed with. If a patient with pancreatic cancer showed a mutation more commonly found in lung cancer, for example, there might be a treatment to use that would not otherwise have been considered, Garraway said.

The screening method could be used along with the Cancer Genome Atlas, a large, complex project to sequence cancer genes.

There are two barriers to making individualized cancer medicine a reality, the paper says. One is to identify all the genes involved in the spectrum of cancers, and the other is to translate that knowledge into therapies for patients.

"We're trying to pave a way to get past both bottlenecks," Garraway said.

Posted by Elizabeth Cooney at 06:00 AM

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Thursday, February 8, 2007

Cancer patients' spiritual needs unmet, study says

Nearly three-quarters of patients with advanced cancer felt their spiritual needs were not met by the medical system, including chaplains, a survey by Harvard researchers shows. Nearly half of the patients thought their religious communities gave them little or no support.

People who had spiritual support tended to have better quality of life, according to the Coping With Cancer study, based at Dana-Farber Cancer Institute. And people who described themselves as religious were twice as likely to want more aggressive treatment to extend their lives, it said. The survey of 230 patients is reported in Saturday's Journal of Clinical Oncology.

"These findings provide further evidence that oncology practitioners really should include a spiritual history as part of a patient's history of social support and culture," Dr. Tracy A. Balboni said in an interview today. She is a senior resident in the Harvard Radiation Oncology Program and the paper's lead author. "It allows the practitioner to know whether something's important to the patient and also makes the statement, 'We understand this might be an important part of dealing with your illness.' "

Most of the people in the study (88 percent) said religion was at least somewhat important to them. More African Americans (89 percent) and Hispanics (79 percent) than whites (59 percent) said it was very important.

As people got sicker, they were less able to attend religious services. Just over half (52 percent) reported getting visits from chaplains or other clergy members.

Most patients (72 percent) said the medical system offered little spiritual support, and 47 percent said the same about their religious community.

Physicians may be leery of overstepping their bounds by asking their patients about religion, the authors wrote. In an accompanying editorial, Betty Ferrell, a research scientist in the City of Hope Cancer Center's department of nursing research and education, urges doctors to take a different approach.

"This report is a strong statement of a seriously unmet need in the vast majority of patients in our care," she wrote. "The oncologist who dares to ask about spirituality imparts a vital message to patients that they are being cared for by someone who has not forgotten that a broken patient remains a whole person, and that healing transcends survival."

Posted by Elizabeth Cooney at 06:00 PM

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Wednesday, January 31, 2007

Today's Globe: Dana-Farber sets $1B campaign, Tufts HMO cuts jobs, FDA pilots drug report cards

Dana-Farber Cancer Institute plans to raise $1 billion for research and patient care, the largest hospital fund-raising campaign in New England history.

Tufts Health Plan will reduce its staff by about 10 percent, laying off about 100 people and leaving about 75 jobs vacant.

In a pilot program the Food and Drug Administration will issue drug safety report cards detailing unexpected side effects that emerge within 18 months of a drug's approval.

Posted by Elizabeth Cooney at 06:47 AM

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Tuesday, January 30, 2007

More than half Boston hospital workers got flu shots

More Boston hospital workers may be getting flu shots this season than the national average, but beyond that it’s hard to figure out how they measure up.

Public health officials have been pushing for virtually all hospital workers to get flu shots because they can easily be exposed and infect vulnerable patients. But each of six hospitals that answered a White Coat Notes query today counts health care workers involved in direct patient care in its own way. And they don’t necessarily know who might have gotten a flu shot outside their hospitals' programs.

Here are the results:

Boston Medical Center: 71 percent
Dana-Farber Cancer Institute: 63 percent
Beth Israel Deaconess Medical Center: 60 percent
Massachusetts General Hospital: 59 percent
Brigham and Women’s Hospital: about 48 percent
Tufts-New England Medical Center: more than 50 percent, according to a preliminary count

"The national average is 38 percent," said Dr. Robert Goldszer, associate chief medical officer at Brigham and Women’s. "We feel we’re doing better than average, but we know we don’t have an accurate rate."

Beth Israel has a broad definition of who comes into direct contact with patients. It’s not just the people who have day-to-day hands-on contact, but it also includes people who see patients face-to-face, such as ward secretaries, people who sit at the front desk in clinics, and workers who clean floors in patients’ rooms, said Dr. Sharon Wright, director of the infection control and hospital epidemiology program.

Beth Israel tries to track who gets a flu shot elsewhere, she said, asking employees to use an internal web site to state explicitly why they are declining to get a flu shot.

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to at least offer flu shots. The Infectious Diseases Society of America recommends that hospitals and other health care facilities mandate flu shots for employees, except for religious or medical reasons.

"JCAHO told us to immunize 100 percent of health care workers who don’t have a contraindication," Beth Israel's Wright said. "We’re trying to get to that 100 percent in three to five years. The goal this year was 60 percent and we did it."

Dr. Al DeMaria, assistant commissioner of the state Department of Public Health, said health care workers are exposed to the flu more often, they are difficult to replace if they get sick, and they put their patients at risk if they have the flu.

"Obviously we think everybody should get vaccinated against the flu, but it’s especially important for health care workers," he said.

Posted by Elizabeth Cooney at 08:32 PM

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Too young to face cancer

Fighting cancer under 40 raises special challenges, the first of which is believing it can happen to you. Dr. Karen Albritton of the Dana-Farber Cancer Institute, Dr. Bruce A. Chabner of Massachusetts General Hospital Cancer Center and Dr. Nadine Tung of Beth Israel Deaconess Medical Center comment in a New York Times story.

Posted by Elizabeth Cooney at 06:11 AM

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