Published September 26th, 2016 at 11:10 AM
Four years ago, former Kansas Gov. Kathleen Sebelius returned home as U.S. secretary of Health and Human Services with a prize the University of Kansas Cancer Center had been seeking for years: certification as a nationally recognized center through the National Cancer Institute (NCI).
But amid the hoopla, KU Cancer Center Director Dr. Roy Jensen declared the NCI designation “merely a water break and a rest stop” on the way toward earning higher-echelon status from the institute as a “comprehensive” cancer center.
Now it’s time for the nail-biting to begin anew, as the cancer center this morning electronically submitted its roughly 1,600-page application for that higher-level designation. NCI is expected to decide whether to grant it by summer 2017.
If the cancer center does earn comprehensive status, it would become just the 48th institution in the country to achieve the designation, joining the likes of The University of Texas MD Anderson Cancer Center and Yale Cancer Center.
To a large extent, the regional impact of NCI designation comes through the improvements in patient care, research and prevention that have accompanied the hefty investment it has required for the KU Cancer Center to even submit a credible application. The money has come from both public and private sources.
For instance, the cancer center secured nearly $30 million from the Kansas Bioscience Authority to upgrade research facilities in the Wahl/Hixon complex on the KU Medical Center campus in Kansas City, Kansas.
It’s state-of-the-art facilities like these that the cancer center uses to recruit and retain top-notch physician scientists like Dr. Raymond Perez, who came from Dartmouth Medical School to head the cancer clinical trials program.
The overall goal is to reduce the prevalence and mortality of cancer in Kansas and western Missouri, which see about 22,000 newly diagnosed cases and about a third that many deaths from cancer annually.
“We need an organization that gets up in the morning, and it’s the first thing they think about, and it’s the last thing they think about when they go to bed,” Jensen said in a recent interview. “And I can guarantee you, that is the KU Cancer Center.”
Cancer center officials are hoping that three different initiatives — including one involving a repurposed jock-itch medicine — will help convince NCI that the center is worthy of the higher-level designation. They say their efforts are wider, deeper and larger than they were in the first application.
Americans have been told for years that they are too fat and that obesity can lead to all sorts of health problems, including diabetes and an increased risk of stroke.
In fact, Jensen says, obesity is projected to overtake tobacco as the leading cause of cancer in the U.S. within the next decade or so.
While the smoking rate among American adults has dipped to below 17 percent, obesity is on the rise. More than a third, 36.5 percent, of U.S. adults are obese, according to the U.S. Centers for Disease Control and Prevention.
The rate is even worse outside metropolitan areas, which is bad news for heavily rural states like Kansas and Missouri.
Obesity is associated with a higher risk for several types of cancers, according to NCI, including cancers of the esophagus, pancreas and breast.
Fat tissue produces excess estrogen, high levels of which have been associated with the risk of breast, endometrial and some other cancers. Obese individuals also often have chronic low-level inflammation, which has been associated with increased cancer risk.
Public health messages about the dangers of obesity have yet to penetrate as much as warnings about the link between smoking and cancer, says Christie Befort, co-leader of cancer control and population health for the KU Cancer Center and principal investigator on a KU Med Center weight-management study.
Weight is also a sensitive issue for doctors.
“Few patients even get told they are obese,” Befort says. “People don’t like that word or that they need to lose weight. It doesn’t even come up in conversation as much as it should, and that is complicated in small towns, where you know your patient personally.”
That’s where Befort’s weight-management study comes in. It’s called RE-POWER, which is short for Rural Engagement in Primary Care for Optimizing Weight Reduction.
The five-year, $10 million study includes three dozen rural primary care clinics in Kansas, Nebraska, Iowa and Wisconsin.
Outside of its potential clinical benefits, KU Cancer Center officials hope NCI reviewers are impressed that competitive funding for the study came through the congressionally authorized Patient-Centered Outcomes Research Institute (PCORI).
The study is testing which of three treatment models works best in helping overweight patients slim down: office visits with an individual provider; group counseling via conference call with a KU Med weight-management specialist; or group sessions coordinated by a staffer at a clinic and via conference call.
Salina Family Healthcare Center, one of the Kansas clinics, is a RE-POWER site. It started its two years of work in March, according to Dr. Bob Kraft, a staff physician.
Group members receive counseling on proper nutrition and are given an exercise goal of 45 minutes of walking at least five times a week. A loss of even 5 percent of the patient’s baseline weight can improve their health, Kraft says.
His hope is that RE-POWER will encourage discussions about weight in the exam room.
“Part of the difficulty physicians have in talking about being overweight is the lack of services to help patients,” Kraft says. “It is hard to talk about things we can’t do something about, so hopefully programs like this will help us develop services that we can then refer patients to.”
Childhood cancer is not the killer it once was; the five-year survival rate for pediatric cancer now stands at more than 80 percent. NCI says there are now 15.5 million cancer survivors in the United States, hundreds of thousands of whom were first diagnosed when they were younger than 21.
But the life-saving treatments can cause medical issues years, or even decades, later.
Radiation for a brain tumor, for instance, might affect the growth and fertility functions of the pituitary gland. Some chemotherapy patients, too, face an increased risk of heart problems.
It can be challenging for these late-term-effect patients to find primary care physicians who are knowledgeable about treating cancer survivors.
For younger patients, the struggle comes as they get too old to see their pediatrician. For older patients, they might be geographically removed from the medical providers they saw in their hometown.
Enter the Survivorship Transition Clinic, which opened two years ago in the medical office building on the University of Kansas Medical Center campus. It’s a companion program to the pediatric Survive & Thrive program at Children’s Mercy Hospital in Kansas City.
Its relevance to the quest for comprehensive designation comes through its origins as a project of the Midwest Cancer Alliance, the “outreach division” of the KU Cancer Center. With 21 members stretching throughout the region, it extends the cancer center’s capacity to treat patients throughout its primary service area of Kansas and western Missouri.
The clinic has tripled — to more than 100 — the number of patients it serves since it opened its doors, says Dr. Becky Lowry, medical director of the clinic.
“We have had a number of patients who show up in their 40s and 50s and who were treated in their childhood, and had a number of health conditions that had either not been diagnosed or had been dismissed, that turned out to be related to their treatment,” Lowry says.
That was not the case with Morgan Goodman, a 23-year-old new mom living in Gladstone, Missouri.
Born and raised in Topeka, Goodman was treated at Children’s Mercy after she was diagnosed with non-Hodgkin’s lymphoma as a high school freshman.
Seeing familiar faces from Children’s Mercy in the transition clinic made for a warm handoff into adult care, she says. Lowry is her primary care physician.
Goodman has a lot going on. She’s caring for 4-month-old Harper and studying for her nursing boards. So she doesn’t dwell on the health problems she might face as a result of her chemotherapy.
“I can’t worry about that,” she says. “There are so many other things to worry about in life. If it’s going to happen, it’s going to happen. That’s kind of what my treatment taught me.”
The clinical name is tinea cruris, and it’s a fungal infection that crops up in warm, moist areas of the body, making uncomfortable places you don’t want to be scratching in polite company.
Outside the medical field, it’s known as jock itch. And the ring-shaped rash figures prominently in the NCI application because of KU Cancer Center’s role in leading the development of a new drug, which it has patented and hopes to begin testing in clinical trials early next year.
Work on the drug came through the Institute for Advancing Medical Innovation (IAMI), which is the product development arm of the cancer center.
IAMI has a long-standing relationship with the Leukemia & Lymphoma Society, which is how the institute got involved with Canadian research showing that ciclopirox, the active ingredient in a common jock-itch cream, effectively combated a certain type of leukemia.
The leap to bladder cancer occurred in 2010-11, prompted by the early results of a clinical trial. Researchers found that upping the dosage of the orally administered drug to potentially effective levels irritated the digestive systems of patients with acute myloid leukemia.
But IAMI Director Scott Weir was loath to quit on a compound that had killed leukemia cells in the lab merely because it couldn’t be given orally.
So the real coup for IAMI and the cancer center came as they drew on an established practice that chemically cloaks the key parts of the drug molecule when it is injected into the body. Then, naturally occurring enzymes in the blood cleave off the protective coat, leaving the active ingredient.
This delivery mechanism avoids the irritation of the digestive system caused when the drug is taken orally. It also offers the hope of a new therapy that will avoid the excruciating sloughing off of the urinary tract lining that can happen with the established treatment for non-muscle-invasive bladder cancer, which has remained largely unchanged for 50 years.
Bladder cancer is one the most common cancers among men and women. A 2009 study published in the World Journal of Urology pegged it as the most expensive cancer to treat (costing more than $200,000 per patient in some countries) because it has the highest recurrence rate among all cancers, thus requiring ongoing monitoring.
IAMI scientists also made a breakthrough by separating out a salt from ciclopirox to make it more soluble.
Weir’s epiphany about the drug’s potential for bladder cancer came during his afternoon commute one day in 2012.
“Our bodies consider drugs foreign things, so our bodies have ways of either preventing them from getting into the bloodstream or, once they are in our bodies, getting rid of them,” Weir says. “And our bodies are really, really good at getting rid of ciclopirox. So I am driving and going, ‘The entire dose that gets into the body is out in the urine in 12 hours.’ So it hit me: What about bladder cancer?”
Weir says this is exactly the kind of breakthrough that the NCI is looking for in evaluating centers seeking comprehensive designation. In their approval of the cancer center’s first application, the reviewers called it an area offering real potential.
Ultimately, however, Weir says the real satisfaction will come if and when the drug proves to be a safe, effective treatment for bladder cancer.
In surveying the totality of the cancer center’s initiatives, Jensen, the cancer center director, argued his operation is positioned to make a strong case to the NCI for the upper-level designation. Other efforts he noted included smoking cessation, working to close the health gap between rich and poor, and vaccinating teenagers against the human papillomavirus (HPV).
“What we are going to be able to demonstrate in the (application) is that we have moved forward across a pretty broad front of cancer control and prevention,” he said. So, it’s tobacco, it’s HPV, it’s obesity, it’s health disparities. I think we have a really good story to tell.”
— Mike Sherry is Flatland’s Online News Editor, and a member of the Heartland Health Monitor collaboration. Find him at firstname.lastname@example.org.