Vol. 14, No. 1 - 2011 - Roswell Park Cancer Institute

table of contentsDEPARTMENTSFrom the Managing EditorLoyal Readers:Thirteen years ago, in the spring of 1998, we introduced Roswellness, RPCI’s quarterlyconsumer health magazine, to 200,000 households. Today, as I thumb through that firstissue–scarcely 24 pages long and heavily dependent on stock photos and images–it’shard to believe that it’s the same publication.18 Been There, Done ThatThe Patient Angle19 Joining ForcesPartners in Advocacy20 Lab NotesPromising Research at RPCI24 Nurses In ActionThey’re Everywhere!Over the years, Roswellness has changed its look several times, and in 2008, we gave itan extreme makeover, with a fresher, more contemporary look: we doubled its pages,shortened the articles, and added more topics, original photographs and artwork. And,with an ever-watchful eye on cost containment in these challenging economic times, wealso cut our circulation in half and switched from four issues a year to two. What hasremained constant, however, is our commitment to improving the magazine’s quality andreach by exploring new ideas, listening to our readers, and studying industry trends.25 Technology BuzzThe Mechanics of Innovation26 SparksGen-Y News28 PopWatchThe RPCI Read on National NewsTo sign up to receive alertson the digital Roswellness, sendyour email address tocolleen.karuza@roswellpark.org.Last year, the Pew Project for Excellence in Journalism reported that people’s relationship tonews is becoming “portable, personalized and participatory,” with 92% of Americans usingmulti-platform media to get their daily news. That’s a trend that caught our attention: Howcan we give the public the cancer information they need and want in a format they can use?Positive comments from our loyal readership continue to reassure us that there is a crowdof supporters behind our creative and editorial team and the decisions we have made. Thatsaid, and with fingers crossed, we are hoping that you will share our excitement as we takeRoswellness in a bold, new direction.I am pleased to announce that in 2012, Roswellness will be going digital. For our readers, thatmeans instant accessibility to a highly interactive publication, with streaming video and audio,hyperlinks, “flip-page” capabilities, archive search and much, much more. The content – andthe high quality of that content – will not change. Hosted on our website, Roswellness canbe accessed from your computer or through your tablet devices (such as iPads) and smartphones. In other words, cancer information when you want it, where you want it.For us, digital means going paperless, or “green,” amounting to significant savings in printingand postage costs. It means no caps on the number of subscribers, issues and pages, and amuch shorter production turnaround time. Members of the Marketing web staff will join theRoswellness team to ensure a smooth transition and minimal learning curve for both ourreaders… and us.FEATURE2 Quality MattersThe Potential Game-Changersof Quality Cancer Care30 Stop the Presses!Wow-Worthy News33 Voices CarryEmpowered and Aware34 Who? When? Where?Our Photo Album36 Donor DollarsDevelopment Update39 FrontlinersCareers at RPCIRoswellness is written, designed and published by the Department of Marketing, Planning andPublic Affairs, Roswell Park Cancer Institute. All rights reserved. No portion of this magazine may bereproduced without written permission of RPCI. Address changes should be sent to KimBonds, Development Office, Roswell Park Cancer Institute, Buffalo, NY 14263, or emailed toKimberly.Bonds@RoswellPark.org. Suggestions and comments regarding this publication maybe emailed to Colleen.Karuza@RoswellPark.org or mailed to Colleen M. Karuza, Director ofPublic Affairs, Roswell Park Cancer Institute, Buffalo, NY 14263.We’re still working out the details, and ask that you check our website (www.roswellpark.org)over the next couple months for updates and information. This is an exciting move forRoswellness, and I hope you’ll share in the excitement.Colleen M. KaruzaManaging EditorCREATIVE STAFFManaging Editor Colleen M. KaruzaFeatures Editor/Writer Sue BanchichDevelopment Editor John C. SenallCreative Services Director Benjamin RicheyContributing Writers Annie Deck-Miller, Kerry Jones,Colleen Karuza, Megan Militello, Amy ZintlGraphic Production Manager Hillary A. BanasPhotography Benjamin Richey, Bill SheffEDITORIAL BOARDChristine Ambrosone, PhD, Richard Cheney, MD, Stephen Edge, MD,Irwin Gelman, PhD, Maureen Kelly, RN, MS, Richard Matner, PhD,Tracey O’Connor, MD, Michael Zevon, PhDADMINISTRATIONPresident & CEO Donald L. Trump, MD, FACPVice President for Marketing, Planning & Public Affairs Laurel A. DiBrogVice President for Development Cindy A. Eller

quality mattersquality mattersfeature |game-changerSTreatment by a specialist whoperforms a high number of proceduresBut even as new technology and techniques are introduced, the physician’s skilland experience remain the most important considerations when choosingwhere to be treated. For example, research has shown that the risk of cancerrecurrence is lower in patients whose surgeons have extensive experience.“When you do a procedure only once in a while, you have to figure it out againevery time,” explains Dr. Guru. “Consistent high volume makes the operation| featureTreatment by physicians whoanalyze patient outcomes to improve careKhurshid Guru, MD, Director of RoboticSurgery, is both the founder and a memberof the International Robotic Cystectomyvery smooth.“If you have performed enough of these procedures, you have seen all thevariations—in the anatomy of the patients, in the disease processes—so thathelps us handle all sorts of issues.Consortium, a network of 43 surgeons fromnine countries who share and analyze theirsurgical data to identify ways of improvingthe surgical procedure. This information is“And being at a cancer center, where we treat cancer patients only, meansthat the people [in other departments] who work with you also take care of thisdisease specifically,” he adds. “Everybody has a lot of experience in cancer.”then used to create a “pathway” for patientswho undergo robotic cystectomy, ensuringthat every patient receives the very highestlevel of care.Greg Klubek underwent surgery at RPCI on June 30, 2010, and returned homejust a week later. “As far as pain goes, I used nothing more than Motrin ® whenI came home,” he says. Shortly after Labor Day, he was back to work. “I thinkI did pretty good.”Greg KlubekWhen he first learned that he needed a cystectomy, Mr. Klubek went to theAfter an accidental whack with a racquetballracquet exploded into severe back andabdominal pain, Greg Klubek, a 48-yearoldregistered nurse, thought he had akidney stone or urinary tract infection. A CTscan revealed that the problem was muchmore serious: “There’s something in yourbladder,” his doctor told him. “Somethingthat looks like a growth.”Additional tests identified it as bladdercancer—still in the early stages, butaggressive. When the tumor didn’t respondBecause cancer cells were alreadyinfiltrating the lining of Mr. Klubek’s bladderdespite the previous treatment, a cystectomy(removal of the bladder) was necessaryto prevent the cells from reaching into themuscle; the nearby prostate would have tobe removed as well.Stunned by the enormity of that news,Mr. Klubek gave in to despair. But RPCIput him in touch with bladder cancersurvivors who had undergone cystectomies,and seeing their progress enabled himHe focused on a scientific article Dr. Gurushared with him about patients who hadthe same type of aggressive, invasivebladder cancer that he had; scientificevidence made it clear that a cystectomywas essential to keeping the diseasein check. “Greg, if you get your cancerout now, before it hits any lymph nodes,you’ll have a high chance of knowingthere will be nothing there in five years,”Dr. Guru told him.Mr. Klubek knew that Dr. Guru is a worldAt RPCI, approximately 98% ofall bladder cancer surgeries areperformed with robotic assistance.RPCI’s outcomes for robot-assistedcystectomy are benchmarkedagainst national published surgicalaverages. To date, over 225robot-assisted cystectomieshave been performed at RPCI.For information on RPCI’s surgicaloutcomes for bladder cancer, visitwww.roswellpark.org/quality.cemetery to look at plots. One year later, he’s looking in another direction.“I thought my life was over,” he says. “But life has not stopped because ofthe cancer. There are people who had the same surgery I did four and fiveand six years ago, who are still doing very well today.“I’m blessed to know that I have a second opportunity at life. Dr. Gurugave me that.”to chemotherapy delivered directly to theto look past the date of the surgery andleader in the field of robotic cystectomy,“I’m blessed to know that I have a secondopportunity at life. Dr. Guru gave me that.”a minimally invasive approach that’sassociated with less pain, less blood lossand faster recovery. “I had seen Dr. Guru’sname on television about teaching roboticsurgery to other doctors,” he says, “and IWhat’s robotic surgery?Watch how it works, atwww.roswellpark.org/robotics-video.bladder, Mr. Klubek came to RPCI forahead to the future. He also credits RPCI’sknew it was the newest, most advancedevaluation by urologic oncologist KhurshidPsychosocial Oncology team with helpingway of doing surgery.”Guru, MD, Director of Robotic Surgery.him sort through his emotions so he couldforge ahead.Treatment by a world leader in robotic cystectomy made a difference for Greg Klubek, RN,here with daughter Brianna and son Louis.8 | roswellnesswww.roswellpark.org | 9

quality mattersquality mattersfeature |game-changerLong-term follow-up careServing some 400 pediatric cancersurvivors each year, the clinic offersa package of services designedspecifically for their needs:• Annual surveillance for the earlyRPCI is among 27 research institutions inthe U.S. and Canada that participate in theChildhood Cancer Survivor Study (CCSS),which tracks survivors to monitor the healtheffects of treatment. The institutions “pool Reproductive issuesare among the topconcerns of cancersurvivors.| featureidentification of medical conditionsdata and share information about those lateor problems related to their cancereffects,” says Martin Mahoney, MD, PhD,on the surveys will help point the way todiagnosis and/or treatment;who collaborates with Dr. Rokitka anda cure, and she’s determined “to take• Education to help them understandcares for pediatric cancer survivors afterwhatever steps I can as a survivor tothe possible long-term side effects ofthey reach the age of 30. “That becomesmake that happen.”treatments they received;very valuable information, especially for• Counseling to address such issues asrare childhood malignancies. It forms theToday she’s introducing Maxim to thedepression—common among cancerevidence base that tells us what the latestaff of RPCI’s Long-Term Follow-Upsurvivors—and post-traumatic stress;effects are and the kinds of monitoring andClinic, but someday she may visit withAnnamaria (above) during the time she was in treatment atRPCI. This year marked the 30th anniversary of her diagnosis.• Information and advice related toissues ranging from reproductionto employment or applying for lifeinsurance (which can be problematicsupportive services we need to offer.”Ms. Twarozek contributes information toboth the CCSS and the National Wilms’a grandchild in her arms. She’s actuallyamong the younger adult members of thelong-term survivors group, some of whomwere treated back in the ’60s and ’70s.after a cancer diagnosis).Tumor Study, which gathers information“I think our oldest survivor is now in hisspecifically about Wilms’ Tumor survivors.60s,” says Dr. Mahoney. “To me, thatAnnamaria visits the clinic once a year.She hopes that the answers she providesrepresents hope.”She began treatment when she was justtwo years old, undergoing a nephrectomyAnnamaria Masucci Twarozek with son Maxim(removal of a kidney) and 15 monthsof chemotherapy. When she and herVisit the National Cancer Institute website to learn more about the ChildhoodCancer Survivor Study, at www.cancer.gov/cancertopics/coping/ccs.If you want to measure how far we’ve come in treatingpediatric cancers over the last three decades, take a lookat Maxim Twarozek. He’s a 20-month-old dynamo, racingall over the place and trying out his new verbal skills. Hisvery existence testifies to the fact that today most pediatriccancers have a five-year survival rate of over 80%.hood, there’s a greater need to understandhow the cancer treatments they receivedas children might affect them over the longterm, and to monitor them regularly to keepthem healthy. That’s the idea behind RPCI’sLong-Term Follow-Up Clinic, created in 1986by Daniel Green, MD, then a pediatriconcologist at RPCI.husband, Joshua Twarozek, were readyto start a family, she turned to the clinicto find out how her cancer treatmentsmight affect her pregnancy.Reproductive issues “are among the topconcerns of cancer survivors,” notes Dr.Rokitka. “When you’re in treatment, it’ssomething you might not think about,But Maxim’s not the cancer survivor—it’s hismother, Annamaria Masucci Twarozek, whocame to RPCI for treatment 30 years ago, whenshe herself was a toddler. She was treatedsuccessfully for Wilms’ tumor, a rare type ofkidney cancer that affects mostly children. Nowthat she and so many other children have survivedonce fatal cancers and moved into adult-Today there are several hundred thousandpediatric cancer survivors in the U.S., andwith more effective treatments, the numbercontinues to grow. As children, they wentthrough treatment at “a tender time forgrowth and development,” says DeniseRokitka, MD, MPH, Clinic Director, “so theside effects may be different from what theywould be in already developed tissue.”because you just want to be cured.” But aspatients move beyond therapy and entertheir 20s and 30s, some may want to knowwhether they will be able to have biologicalchildren, and whether their own cancer riskmight be passed on to those children. TheLong-Term Follow-Up Clinic brings togethermembers of the Social Work, Psychologyand Clinical Genetics teams to provideguidance and support.Annamaria and Maxim visit with Denise Rokitka, MD, MPH (center), and Martin Mahoney, MD, PhD.Annamaria is a Data Manager in RPCI’s Department of Health Behavior.10 | roswellnesswww.roswellpark.org | 11

quality mattersquality mattersfeature |game-changerMultidisciplinary caregame-changerAccess to clinical research studies| featurePatientMedical OncologistSurgical OncologistPathologistRadiation OncologistRadiologistNurseWhat’s better than having the best cancerspecialist on your case? Having five ofthem—or six—or more. That’s the ideabehind the multidisciplinary team approachto cancer care at RPCI.Multidisciplinary cancer care means beingtreated by oncologists and other specialistsfrom several disciplines of medicine—ateam of physicians instead of just one.At RPCI, multidisciplinary teams includesurgical, medical and radiation oncologists,pathologists, diagnostic radiologists, nursesand nurse practitioners, and specialists innutrition, psychology, pain management,palliative care and social work.This “meeting of the minds” is importantbecause many cancer patients will needOccupational/Physical TherapistPsychologistSocial WorkerPastoral Care(all faiths)Pain SpecialistNutritionistmore than one type of treatment. “In somecancer patients, the best initial treatmentmay be surgery, chemotherapy orradiotherapy alone,” explains GrahamWarren, MD, PhD, Radiation Medicine,“but many patients may require acombination.” That means a patient mayneed to consult with experts in each ofthose areas, possibly continuing withOne study showed that a team approach resulted in achange of diagnosis or initial treatment recommendationsfor almost 65% of urology cancer patients.treatment and ongoing follow-up fromseveral different oncologists.At RPCI, they’re all under one roof.But the multidisciplinary approach isn’tabout convenience alone; it’s aboutbetter care. Studies show that anintegrated team approach results inbetter treatment planning, increasedlikelihood of accurate management andcare, a more comprehensive treatmentplan, and better outcomes.It begins with regularly scheduledmultidisciplinary conferences that bringthe team together to discuss patient cases,evaluate the risks and benefits of differenttreatment options, and develop the optimaltreatment plan. “This helps us achieveconsensus on what’s best for the patient,”says Dr. Warren. “Experts in each areadiscuss the latest recommendationsand put all potential treatment optionson the table. This is how we define thebest path to follow.”The impact of that model is especiallyevident in one study showing that amultidisciplinary team approach to cancerdiagnosis and planning resulted in achange of diagnosis or initial treatmentrecommendations for almost 65% ofurology cancer patients who soughtsecond opinions or treatment at a NationalCancer Institute (NCI) Cancer Center. Asone of the nation’s first NCI ComprehensiveCancer Centers, RPCI led the way inputting the multidisciplinary team systemin place, and today RPCI has teamscovering all tumor sites.“Every patient has a unique cancer, andevery patient has a unique set of needs,”says Dr. Warren. “Our multidisciplinaryapproach allows us to assess the patientas a whole, with experts from all fields ofcancer medicine.”Why is access to clinicalresearch studies importantto patients? It means that eligiblepatients have more treatment choices,including some that are not widelyavailable. RPCI has a robust clinicalresearch program, with more than 250treatment clinical research studies nowunderway—all based on the latest scientificevidence of the best ways to fight cancer.Research has yielded great advances incancer treatments in the past 25 years,but cancer is not yet cured, explainsAlex A. Adjei, MD, PhD, FACP, SeniorVice President of Clinical Research. “Wehave many new drugs, we can prolonglife, we have reduced side effects, butit’s still not a cure.”The current standard of care for cancertreatment leaves room for improvement.“If the standard of care were effective,everybody would be cured and they wouldstay cured,” adds Joyce Yasko, PhD, VicePresident, Clinical Research Administrationand Services, and Chief Clinical OperationsOfficer. “We continue to study new cancertreatments because standard of care is notthere yet.”Through the successes of the HumanGenome Project, launched in 1989 toidentify and map the 20,000+ genesof human DNA, scientists can nowdifferentiate cancer cells from normalcells at the molecular level and see thatsome cancers show a specific molecularabnormality, such as a mutation in a gene.For example, in somepeople with breastcancer, the cancercells have anabnormal proteincalled HER-2 thatstimulates theirgrowth. Researchersdeveloped thedrug trastuzumab(Herceptin), which Joyce Yasko, PhD, with patientblocks the action ofHER-2. Thanks toclinical studies at RPCI and othercenters, trastuzumab is now partof the standard of care for patientswhose breast cancer has theHER-2 abnormality. RPCI patientswere among the first to benefit.Public interest in rpci’sclinical studies increasesLast year, RPCI’s Call Center (1-877-ASK-RPCI) received704 calls regarding clinical research studies. This representsa 354% increase in calls (155 in 2009). The majority of thecalls came from Western New York. In 2009, there were8,655 unique visitors to RPCI’s clinical studies Web pagesand 10,078 in 2010.Molecular abnormalities and Search for clinical research studies at RPCI:markers have been found in www.roswellpark.org/clinical-trials/listother cancer types, such as lung,colon, melanoma, pancreas,“That’s where clinical trials have reallykidney, leukemia, lymphoma and multiple changed,” says Dr. Adjei. “It used tomyeloma. “It’s personalized medicine,” says be that people would participate in aDr. Yasko. “We look at what markers the clinical study after trying all other options.specific tumor has and match the treatment For the first time, we’re at a point whereto the marker. The science upon which this for cancers with a certain molecularis based is just amazing. It’s like the Star abnormality, treatment through aWars of cancer therapy.”clinical study is the first treatment, becauseit’s their best treatment.” RPCI’s phase IBefore these therapies can be opened up program is now testing more than 20to every patient who needs them, however, promising new compounds for the firstthey must be studied and tested through time in patients with a variety of cancers.extensive clinical research. That can take Most patients are offered specific drugsfive or 10 years or more. For a person that are tailored to their cancer.facing cancer, waiting years for treatmentis not possible.12 | roswellnesswww.roswellpark.org | 13

Quality mattersQuality mattersfeature |19992000CML diagnosis;begins interferon;low-dosecytarabineadded later.Stem celltransplantconsidered;no matchfound.Suzanne, Dr. Meir Wetzlerand Laurie Ford, BS, CCRC,Clinical Research ServicesWhen Suzanne Carrow learned that she had chronicmyelogenous leukemia (CML), she was advised thatshe probably would not survive more than five years.Then she did three very important things. First, shecame to RPCI to get a second opinion about hertreatment. Next, she sat down with Meir Wetzler,MD, FACP, Chief of RPCI’s Leukemia Section, andmade a list of “some important milestones I had setfor myself. I wanted to see my daughter graduatefrom college, attend my son’s and daughter’s weddings,and just maybe be with them to welcome their childreninto this world.” Then she and Dr. Wetzler searchedfor clinical trials that might extend her life.That was 12 years ago. Since then, successive trialshave served as stepping stones to keep her movingforward, and she has marked every milestone onCML Patient Suzanne Carrow Refuses to be Written Off2001Begins Gleevec afterFDA approval; achievescomplete remission.2002Daughter Tracygraduates fromcollege.2003her list. The latest and most promising trial ofthe ChemGenex drug OMAPRO (omecetaxinemepesuccinate) has kept her in remission for nearlyfour years. It’s the first drug shown to overcome agenetic mutation that affects Ms. Carrow and a smallpercentage of other CML patients. Called T3151, themutation blocks specific kinds of therapies, such asGleevec (imatinib), Tasigna (nilotinib), and Sprycel(dasatinib), which can be effective for many CMLpatients—but not those who have the mutation.“I was one of the first people on the OMAPRO trialin the United States,” says Ms. Carrow. Now closed,the trial enrolled 100 patients, including 66—Ms.Carrow among them—who are still being followed.“We are pioneers,” she says.2005Son Travisgets marriedDisease relapses;enrolls on clinical trialof nilotinib (Tasigna),later FDA-approved;achieves completeremission.2006DaughterTracy getsmarriedLast year, Ms. Carrow traveled to Washington, DC,to address the Food and Drug Administration’sOncologic Drugs Advisory Committee as itconsidered giving OMAPRO the green light as atreatment for CML patients with the T3151 mutation.“My big concern is the person who’s going to bediagnosed today who has nothing,” she says.“I want to be a voice.”She found her voice shortly after her diagnosis,when she got involved with a support group foundedby Dr. Wetzler under the umbrella of the Buffalochapter of the Leukemia and Lymphoma Society. Sheattended one of the group’s first meetings, and sincethen has provided newly-diagnosed CML patientswith support, information and encouragement.Today, she’s extending her reach as an advocatefor patients with limited treatment options, and hasmet with legislators at the state and federal levels topromote support for potentially life-saving research.She and Dr. Wetzler were also the driving forces inestablishing a Western New York chapter of theNational CML Society, which supports patientsand families coping with a CML diagnosis.Dr. Wetzler says that although most CML patientsrespond to Gleevec, it’s not unusual for patients likeMs. Carrow to move from one clinical trial to the next,from relapse to remission. To keep those optionsopen for his patients, he works with cooperative20072008Disease relapses; testingreveals T3151 mutation,which blocks specific kindsof therapies. Enrolls onclinical trial of omecetaxine(OMAPRO); achievescomplete remission.Birth of first grandson,Thomas (to Tracy).2009groups and pharmaceutical companies to attract newtrials to RPCI, an effort that “involves being up to dateon the literature and understanding the mechanism ofaction of each drug,” he explains.Ms. Carrow is grateful. “He is behind me 150%,” shesays. “It hasn’t always been easy, but he has givenme quality of life.” She told the FDA committee, “I amhere today by the grace of great research and peoplewho are committed to providing options and choicesfor those who are dealing with a type of CML thatdoesn’t respond to [drugs like Gleevec]. Althoughthere are few of us, we need all the help we can get.“What does the future hold for me? Maybe this drugwill help me reach a stable, sustainable remission.I always try to take an opportunity like this to speakBirth of twingrandsonsBennett andOwen (to Travis).2010marchSpeaks before FDA inWashington, DC. (Hopingfor approval of the trialdrug from ChemGenex.)(Above, with fellow CMLpatients Cheryl-AnneSimoneau and Gerald Cox.)octoberAttends 50th Catholicgrammar school reunion.not only for myself but for my fellow CML patients.We are not out of the woods with this disease,and we need to know that research continues.”Following the meeting last March, the FDAconcluded that a decision about OMAPRO couldnot be made until certain conditions are met,including development of a test that can identifythe T3151 mutation in CML patients enrolled onclinical trials of the drug; the safety and efficacyof the drug are not in question.Though frustrated by the delay, Suzanne Carrowhasn’t lost any steam. “When I was first diagnosed,I couldn’t be a voice. I was too sick,” she says. “Butthis isn’t just about me; it’s about other people, too,and the legacy I want to leave my grandsons. That’swhat keeps me going.”novemberDisease relapses; OMAPROdosage increased accordingto protocol.2011marchAchieves cytogeneticremission.aprilBirth of grandsonAndrew (to Tracy).Makes new to-do list.| feature14 | roswellnesswww.roswellpark.org | 15

feature |quality matters“You may have the world’s best center forcancer treatment, but without programsthat reduce stress, control pain and promotepsychological and spiritual healing, youhave done nothing,” says Oscar DeLeon,MD, Professor of Oncology and Chief, PainMedicine, Department of Anesthesiology &Pain Medicine at RPCI.Treating the whole person rather thanjust the disease is the philosophy at RPCI,where programs and services such aspain management, social work andpsychological and spiritual counselingare part of the cancer care program.Moreover, it’s good medicine.A modern success storyAs many as 90% of patients experiencepain during the course of their disease,either from the tumor itself or the treatment’seffects. “Managing pain is one of the goodnews stories in the 21st century,” says Dr.DeLeon. “We have the ability, the resourcesand the ethical and moral responsibility torelieve suffering in all of our patients.”The Cancer Pain Management Serviceat RPCI has a dedicated multidisciplinaryteam of specialists, who provideindividualized care to patients andapply the right pain managment tools.Pharmacologic drug therapy, includingopioids, antineuropathics and topicalanalgesics—and employing differentstrategies at different stages—is successfulin 90 to 95% of cases. For the remainingcases, therapy may include: analgesics16 | roswellnessgame-changerPreserving, EnhancingQuality of Lifedelivered through a catheter, electricalimpulses to stimulate the spinal cord ornerves, or radiofrequency lesioning (usingheat) to produce changes in nerves. Physicaltherapy, biofeedback and relaxationtraining are also used to help manage pain.Reducing, preventing stressA diagnosis of cancer is one of the moststressful experiences any person canface, according to Michael A. Zevon,PhD, Chair, Department of Psychology.“It’s a life-threatening illness and has atremendous impact on the patient andfamily.” That’s why each clinical care teamat RPCI includes a medical psychologistto evaluate needs as the patient and familyprogress through treatment.“Some patients do fine initially,” says Dr.Zevon, “but as the effects and impact oftreatment are cumulative, there comes atime when they may struggle. Prevention iskey. We want to address needs right away,before the patient becomes profoundlydepressed or reaches a point ofbeing unable to continue treatment.”The Department of Psychology takes onmany psychosocial issues: depression,coming to terms with the diagnosis,changing roles in the family, schooloutreach and controlling pain and sideeffects, such as anticipatory nausea.RPCI has several programs to addressthe needs of certain groups, such aschildren, adolescents and young adults,Percentage of Patients1009080706050403020100patients undergoing leukemia treatmentand their caregivers, breast cancer patientstransitioning from active treatment tosurvivorship and long-term survivorsof childhood cancer.Breaking down barriersThe logistics of undergoing cancertreatment—getting to appointments,understanding the language and payingfor costly drugs—often demand moreresources than a family has, and that’swhere the Department of Social Workcomes in. “We see all newly-diagnosedpatients to assess whether they have anyneeds or face barriers that might preventthem from getting their care or being ableto return home,” says Rosa Scrivani,LCSWR, Director of Social Work Services.Social workers help line up appropriateresources for patients and their families,Eighty-five percent of patientswho recieve treatment for painmanagement at RPCI report “very”and “totally” successful outcomesin controlling or eliminating theirpain after three months.RPCI Patients’ Perception ofPain Management Strategies at 3 Months0% 0%NotSuccessfulMildlySuccessful15%ModeratelySuccessful68%VerySuccessful17%TotallySuccessfulsuch as transportation, interpreters, lodging,financial aid and at-home services.Seeking spiritual answersAsking life’s philosophical and mysteriousquestions, like “Why are we here?” and“Why do we suffer?” is part of the essenceof a person, explains Elizabeth Lenegan,PhD, Director of Pastoral Care at RPCI.“Asking these questions is fundamentalto who we are as human beings and acancer diagnosis often triggers us to seekthe answers.” Pondering these questionsis a spiritual journey, and the Pastoral CareDepartment, with five chaplains and 60volunteers, is there to accompany patientsand their families as a spiritual guidetoward hope and healing.You can download a pdf ofthe 122-page publication atwww.roswellpark.org/quality.Hard copies, which are inlimited supply, will be availablewhile quantities last, by calling1-877-ASK-RPCI (1-877-275-7724).The department’s annual Nurture YourHope retreat for patients and caregivers,held at the beautiful Chautauqua Institutionon the shore of Chautauqua Lake, offers aday of food and friendship, lectures, yoga,meditation and massage, music andart therapy sessions. Facilitated by a teamof professionals from Nursing, Psychology,Social Work and Pastoral Care, the retreathas become so popular that Dr. Leneganis working toward being able to run ittwice a year.“The meaning of the words ‘hope’ and‘healing’ may change as people travel thisroad,” says Lenegan. “Some will have aphysical healing and a cure. But everyonecan achieve a spiritual healing.”SupportiveCareProgramsat RPCIB Psychosocial SupportB Pastoral CareB Patient Education & AdvocacyB Artists in ResidenceB Support GroupsB Pet TherapyB Pain ManagementB RehabilitationB Social WorkB Palliative CareB Smoking CessationB Nutritionquality mattersRPCI Releases Report Card on QualityIn May of 2011, Roswell Park Cancer Institute released Quality 2011, its firstcomprehensive report card on its clinical trends and disease-site-specific treatmentoutcomes, as well as those key quality indicators that contribute significantly to apositive experience for RPCI patients and their families. Much of the content ismeasured against national benchmarking data.“With this publication,” said RPCI President & CEO Donald L. Trump, MD,“we hope to demonstrate that our cancer care and services are driven andsupported by science, are delivered safely with compassion and vision, areconsistently monitored and revised for quality assurance, and are in completealignment with our mission to understand, prevent and cure cancer.”www.roswellpark.org | 17| feature

een there, done that |The Patient AngleRPCI patientsoffer words to live byDonald Lo (p. 4):“My doctor had been after me about high cholesterol and lack of exercise, but I didnot have the incentive to change until I had prostate cancer. That was like acold-shower fact: I really had to do something to change my lifestyle. We switchedto a much healthier diet, which is basically vegetarian 97% of the time, regularexercise and a proactive mindset. I think those three elementshave had a very positive influence on my progress.”Kathleen Maxian (p. 6):“Some people say, ‘Going to a high-risk clinic justcreates a lot of anxiety.’ But these experts can catchyour cancer at an early stage, and for ovariancancer caught at stage I, the chance of survivalis 90%. I would like to have had those odds.”Do I haveaccess to thebest cancercare?Selecting the right healthcare plans and healthcare providersfor yourself and your family is an important decision thatrequires careful planning and thought. If you or a familymember has been diagnosed with a life-threatening illness,you need the peace of mind that comes with quality healthprotection. During open enrollment for insurance coverage thisFall, be sure to choose a healthcare plan that gives you andyour family access to the quality cancer care at Roswell ParkCancer Institute.The choices you make today can secure (or compromise) yourfamily’s medical and financial future tomorrow. Take a tip fromthe adage: An ounce of prevention is worth a pound of cure.Select the right insurance protection now when you don’t needit, so you don’t have to worry when you do.For more information, call 1-877-ASK-RPCI (1-877-275-7724).NYS Legislaturepasses oral chemo billBoth houses of the New York State Legislaturehave passed a bill requiring that insurance carriersprovide equal coverage for oral and intravenousor injected chemotherapies; the bill now awaitsGovernor Cuomo’s review.partners in ADVOCACYPlans for Economic GrowthOn July 26, RPCI hosted a visit from New York GovernorAndrew Cuomo as he announced the formation of his WesternNew York Regional Economic Development Council. “Withthe Regional Councils, we will empower individual areas likeWestern New York to chart their own course for job creationand growth, and we will send a clear message that New Yorkis open for business,” said Gov. Cuomo. “This is going to bethe foundation for changes across the state economically,”added Lt. Gov. Robert Duffy, who will chair the WNY panelas well as nine other Regional Councils. RPCI Presidentand CEO Donald L. Trump, MD, FACP, Deputy DirectorCandace S. Johnson, PhD, and several other RPCI seniorleaders were among the many area business and communityleaders invited to the event.drugs, resulting in much higher out-of-pocketcosts for the patient—sometimes amountingto thousands of dollars. Consequently, manypatients cannot afford their oral chemotherapyprescriptions.| joining forces18 | roswellnessGreg Klubek (p. 8):“Don’t hesitate to make an appointment for a second opinion.It’s your right to do that. The first physician wasn’t happy thatI was doing that. But it’s my body and my choice and my life.”The measure was introduced to addressinequities in insurance coverage for chemotherapy.While some patients receive chemotherapy throughinfusion or injection at a medical center, otherstake it in pill form, at home. Infused/injecteddrugs are usually classified as medical costsand are covered by insurance, with patientspaying a small co-pay. But oral chemotherapydrugs tend to be classified as regular prescriptionRPCI joined forces with the Leukemia &Lymphoma Society, American Cancer Society,Susan G. Komen for the Cure Advocacy Alliance,and 1 in 9: The Long Island Breast CancerAction Coalition to advocate for the bill.The bill was sponsored by New York StateSenator Andrew Lanza (R,C-Staten Island)and Assemblyman Vito Lopez (D-Brooklyn).www.roswellpark.org | 19

promising research at rpcipromising research at RPCIlab notes |3 newangles of attackagainstpancreatic cancerWen Wee Ma, MBBS2With no major breakthroughs in the treatment of The hypothesis: A “signaling pathway” calledpancreatic cancer over the past several decades, mTOR has been found to be active in many patientsWen Wee Ma, MBBS, Department of Medicine, with pancreatic cancer. Dr. Ma describes mTORis intensifying efforts to develop new treatments as akin to “a nutrient sensor,” which helps directthat will be more effective against the disease. “food” to the tumor. Some drugs are designed toHere he describes three theories and strategies shut down mTOR and starve the tumor, “but recentthat he and his colleagues are pursuing in the studies indicate that just hitting this pathway doessearch for a cure:not affect the disease dramatically,” he says. That’sbecause the tumor turns to a backup defense by1The hypothesis: A glimpse through theengaging another pathway, the mitogen-activatedmicroscope reveals that pancreatic cancers consist protein kinase (MAPK) pathway, allowing cancerof a large amount of fibrous connective tissue called cells to evade the attack. Dr. Ma makes an analogy:stroma. “It could be that we have an effective drug, mTOR and MAPK are like twin waterfalls, and “if youbut the stroma is a barrier that prevents the drug dam one up, the water flows through the other side.”from reaching the cancer cells,” surmises Dr. Ma.The strategy: Dr. Ma and colleagues fromRPCI and the University at Buffalo are joiningforces and collaborating with pharmaceuticalcompanies “to analyze the effects of drugs onboth the cancer cells and the stroma,” andlooking at ways to penetrate and shrink ordestroy the connective tissue in pancreaticcancer. Eliminating that barrier could makeit easier for cancer drugs to reach the tumorcells and kill them.The strategy: “The idea is that pancreatic tumorswill stop growing if you block both pathways at thesame time,” says Dr. Ma. He and his colleagues arecurrently conducting a clinical trial to do just that,by delivering a double blow to the cancer withtwo new drugs, everolimus and sorafenib, whichinterrupt both pathways.3The hypothesis: Even though many treatmentshave been tested in pancreatic cancer over the past10-20 years, not many have improved outcomesWhile some institutions purchase“cell lines” from commercialvendors, this homegrownRPCI resource is unique andbiologically diverse. Because it“closely resembles patients’actual tumors, it can give usa better read on how drugs willbehave in patients.”dramatically, so the scientific community concludedthat the treatments don’t work. “But if you lookcarefully, you will find that a small subgroup ofpatients actually did seem to benefit from thesetreatments,” says Dr. Ma. “So are you throwing thebaby out with the bathwater?”The strategy: Dr. Ma says biomarkers—uniquecell characteristics rather like fingerprints—mayhelp identify patients for whom specific drugswill work well, taking treatment for pancreaticcancer closer to the goal of “personalizedmedicine.” RPCI researchers aim to pinpointimportant biomarkers in patients’ pancreatictumors for use in matching patients to the rightdrugs. The team has a powerful resource in thelab of Bonnie Hylander, PhD, and ElizabethRepasky, PhD, Department of Immunology—a“library” of tumor cells provided by pancreaticcancer patients who were treated at RPCI.While some institutions purchase “cell lines”from commercial vendors, this homegrownRPCI resource is unique and biologically diverse.Because it “closely resembles patients’ actualtumors, it can give us a better read on how drugswill behave in patients” says Dr. Ma. “This resourcewill help us develop strategies to better matchthe best drug to the patient much earlier on, andpotentially shorten the drug development processand dramatically improve the lives of pancreaticcancer patients.”“I think of PDT asjump-starting theimmune response.Our goal is to findways to enhance thatimmune responseto treat metastaticdisease.”-Sandra Gollnick, PhDBeyond skin deepUnexpected PDT action opensthe door for new vaccinesPhotodynamic therapy (PDT),a cancer treatment developed atRPCI, kills cancer cells in solidtumors by combining light-activateddrugs with laser light. But RPCIresearchers have discovered thatPDT also stimulates the patient’simmune system to attack the canceron another front. That discovery isopening the door for the creationof PDT-generated therapeutic vaccines,the first of which will targetadvanced melanoma.FDA-approved for the treatmentof specific types of cancer, PDTcenters on a class of drugs calledphotosensitizers, which areabsorbed by tumor cells but not byhealthy cells. Activated by exposureto laser light, the drugs kill tumorcells selectively.PDT has long been considered alocal treatment—one that worksonly at the tumor site. But severalyears ago, an RPCI team led by Sandra Gollnick, PhD,took PDT research in a new direction when theydemonstrated that tumor cells could be treated withPDT and then used to create a vaccine that promotesantitumor activity. Pre-clinical studies showed that thevaccine “enhances survival post-surgery,” she says.Then, in 2009, Dr. Gollnick’s team published in ClinicalCancer Research the results of a controlled clinicalstudy of 25 patients with basal cell carcinoma. Thearticle showed for the first time that PDT “induces anacute inflammatory response that promotes antitumorimmunity,” stimulating the production of antitumorT-cells, explains Dr. Gollnick, member of the Departmentof Cell Stress Biology, the PDT Center and the BiologicalTherapies Program.Dr. Gollnick and her team are working with John M.Kane III, MD, FACS, Chief of Melanoma/Sarcoma,Surgical Oncology, to determine the potential of a PDTvaccine for treating advanced melanoma. How would itwork? Dr. Kane would surgically remove the patient’stumor, which Dr. Gollnick and her colleagues would thentreat with PDT. “Then we would give the treated cellsback to the patient as a vaccine,” says Dr. Gollnick. Sheand her team are still collecting preliminary data, butshe estimates that they’re about a year away from filingan application to open a clinical trial.She’s enthusiastic about the potential for using PDTin combination with surgery. Since laser lights cannotalways reach deep enough into the tumor to activate thephotosensitizer, “sometimes PDT is not a very effectivefrontline therapy, especially because most of the tumorswe see are large by the time people come here,” shesays. “And [surgery alone] has little or no effect on theimmune response. But what if we could do both [surgeryand PDT] simultaneously—treat with PDT either beforeor after surgery?“I think of PDT as jump-starting the immune response.Our goal is to find ways to enhance that immuneresponse to treat metastatic disease.”| lab notes20 | roswellnesswww.roswellpark.org | 21

promising research at rpcipromising research at rpcilab notes |Agents ofChangechemotherapy alone. Building on datafrom that study, a larger study in Franceshowed that adding rituxan to a “cocktail”of chemotherapy drugs known as CHOPsignificantly improved the cure rate fordiffuse large B-cell lymphoma, an aggressivedisease. Chemotherapy plus rituxanis now the standard of care for B-cellcancers, such as non-Hodgkin lymphomaand chronic lymphocytic leukemia.But that was just the beginning. “We don’thave 100% cure rates; we can alwaysimprove,” says Dr. Czuczman. “We needto have an understanding of what makesthe cancer cell tick, what’s important withinit that we can block. We have new toolsand agents to do that. There are so manyof these new agents that the research isother treatments failed. But if laboratorystudies show that an agent works wellagainst difficult-to-treat diseases, why notgive it to the patient earlier, at the time ofdiagnosis? Following that line of reason,investigators are now evaluating manysuch agents as first-line therapies—thefirst treatments instead of the last. Often,as in the rituxan/chemotherapy trial,the new agents are given along withstandard treatments.“The most exciting of these agents aremoving into patient trials approved bythe FDA,” says Dr. Czuczman, who headsRPCI’s Lymphoma Translational ResearchLab. These new agents “are the buildingblocks for improved treatments forpatients who have lymphoma, myeloma,Clinical and laboratorystudies now underwayat RPCI include:• Studies of agents and combinations ofagents with the potential to overcomedisease resistance to previous treatments.“We’re looking at a whole new class ofdrugs called proteasome inhibitors to[combat] resistance in the most commontype of lymphoma, diffuse large B-celllymphoma,” says Dr. Czuczman.• Studies of immunomodulatory drugs,including revlimid and other thalidomidederivatives, which stimulate the immunesystem, calling “natural killer cells” intoaction and shutting down the productionof new blood vessels that “feed” cancercells along with other mechanismsof activity.• Studies of ofatumumab, a monoclonalantibody evaluated extensively inDr. Czuczman’s lab. Ofatumumab isdifferent from rituxan, and its differencesmay prove to be important clinically.| lab notesexploding at the seams. Now we have tofigure out how to best optimize them.”chronic lymphocytic leukemia andHodgkin lymphoma.”For information about open22 | roswellnessDr. Myron Czuczman talks about thesurge in new, targeted drugs—and whatit means for patients with lymphomaMyron Czuczman was in highschool when he first read aboutmonoclonal antibodies—“magicbullets” that might hold the key to curingcancer. His fascination with the ideapropelled him toward medical school andgroundbreaking research that is altering thecourse of treatment for lymphoma patients.Monoclonal antibodies are “targetedtherapies.” Created in the lab, they attachthemselves like magnets to proteins onthe surface of a tumor cell. Then they eitherstimulate the immune system to kill thecell, or—depending on the target—deliveran agent designed to kill the cell. “Often,but not always, antibody-associatedtumor-cell killing is achieved withoutmajor impact on normal cells in the body,”explains Dr. Czuczman. That strategytranslates into more effective therapiesthat produce fewer side effects thanhigh doses of toxic drugs.Dr. Czuczman has been at the forefrontof research exploring the potential ofmonoclonal antibodies for treating cancer.In 1999, he led a clinical research studythat was the first in the world to combine themonoclonal antibody rituxan with standardchemotherapy for treating lymphoma.Patients who received the combinationtherapy experienced remissions that weretwice as long as those who receivedTiming is one possibility: investigatorsare reconsidering the point at whichthose agents should be introduced in thetreatment plan. In the past, most phase Iclinical research studies were open only topatients whose disease had returned afterMyron Czuczman, MD, is Professor of Oncology,Chief of the Lymphoma/Myeloma Service, andhead of the Lymphoma Translational ResearchLab, Department of Immunology.Dr. Czuczman says that further developmentof that expanding arsenal of drugsand agents will eventually enable cliniciansto perform specialized testing of tumorsusing biomarkers to determine whichcombinations will work best for eachperson, hitting the disease hardestwith the fewest and mildest side effects.“Although that’s not ready for prime time,I envision ‘personalized cancer care’ inmy career,” he says. “Eventually it willcome to that. The future is very brightfor our patients.”clinical research studies at RPCI:www.roswellpark.org/clinical-trials/list.Lymphoma is on the riseThe incidence of non-Hodgkinlymphoma shot up more than 20%in the last 20 years alone, and casesof Hodgkin lymphoma are rising aswell. Why? “It’s believed to be relatedto environmental factors, in particularto the increasing use of pesticidesand herbicides in our society,”notes Dr. Czuczman.www.roswellpark.org | 23hhhhhh

They’re everywhere!The mechanics of innovationnurses in action |Left to right: RPCI Patients Madisyn Tolfa, Jason Nicpon, Brooke Harris“Over the course ofan average two-yeartreatment plan, childrencollect between 500 and1,000 beads. That’s howmany times they’vebeen poked; receivedchemo, antibiotics, bloodproducts; had surgery or aline placed; spent the nightat the hospital or workedwith a therapist...”24 | roswellnessBead It!Watch a CBS feature about Beads of Courage atyroswell.com/copingHelping kids through their cancer journey, one bead at a time“One, two, three, four, five, six…” counts five-year-oldMadisyn Tolfa, moving her fingers along a string of beadsheld up by her mother, Ashley. These aren’t ordinarybeads, and this isn’t any ordinary five-year-old. Madisynearned each bead for enduring something momentous,but all too familiar, in the world of a child facing cancer.Each bead marks a procedure, test, chemotherapy, bloodtransfusion, hair loss or other step in her cancer treatment.These are Beads of Courage.Beads of Courage is a national arts-in-medicine program,now at RPCI, that honors a child’s bravery in coping with cancerand helps build hope through the creative act of stringingbeads. Children tell their stories using beads to symbolizetheir experiences. A white bead represents a chemotherapytreatment; a yellow one, an overnight hospital stay; aglow-in-the-dark bead, radiation treatment. A star-shapedbead signifies surgery, while a purple heart marks completionof treatment.The Beads of Courage program provides each child with alength of string, lettered beads to spell out his or her firstname, a personal bead journal, and a tally sheet for keepingtrack of experiences. Generous donations to Carly’s Club forKids & Cancer Research fund the program at RPCI, wherepediatric patients also receive a special bead featuring theCarly’s Club logo.“Over the course of an average two-year treatment plan,children collect between 500 and 1,000 beads,” says LoreneBarulich, RN, a pediatric nurse who helped bring the programto RPCI. “That’s how many times they’ve been poked;received chemo, antibiotics, blood products; had surgery ora line placed; spent the night at the hospital; worked with atherapist [or had a similar experience].”As a form of art therapy, Beads of Courage aims to decreasestress, boost coping strategies, help kids find meaning inillness and restore a sense of self. “The kids absolutelylove collecting them and picking out their special milestonebeads,” says Ms. Barulich. “Most bring their beads fromhome to hang from their IV poles while they’re in the hospital.The beads are often a starting ground for some difficultconversations about their fears.”“Seventy-nine, eighty, eighty-one,” says Madisyn, triumphantly.“Eighty-one beads in forty-three days,” adds her mom.“Almost as many as me!” says 16-year-old SiobhanDochstader, holding up several heavy strings drapedaround her neck. “I have 1,116.”For these exceptional patients, the creations are more thanstrings of pretty beads—they’re a tangible testament to theirexperiences during treatment and afterward.Madisyn points out her favorite bead, a large one handcraftedof swirled glass with a surface of raised dots. “I got this onefor using the wheelchair.”Today, at the official Beads of Courage launch party at RPCI,several young patients gather in the 6 North playroom tostring the newest beads on their necklaces, includinga new kind—a silver duck with wings spread wide.“It’s called the Wingman,” Madisyn explains.“It means I’m never alone.”Practice makes perfect, whether you’re training to flya supersonic jet 20 miles above the surface of theearth or remove a large tumor in a tricky location.Sergei Kurenov, MS, Director of Surgical Simulation,Department of Surgical Oncology, has helped pilotsmaster the first skill, and surgeons, the second.The engineer and former flight-simulator designeris working closely with RPCI physicians to developcomplex simulators that will take physician trainingand surgical planning into another dimension.With a hefty surgery textbook close at hand andsurgeons popping into the office throughout the dayto test-drive system updates, Mr. Kurenov and hisassistant, Postdoctoral Fellow Sukitti Punak, PhD,tie together the mathematical, computer andmedical worlds to create a virtual operating room.Mr. Kurenov has even ratcheted things up a notchKurenov’s system will enable RPCIdoctors to create a customizedsimulation using a patient’s actualCT scan so they can do a dry runand plan ahead for what they’llencounter in the OR.with “hapticfeedback,” whichgives users the feelof actually makingan incision in skin,muscle or organs, orclosing a wound withthreads of differentthicknesses.His three simulation systems are geared for differentlevels of surgical skill. The first, for medical students,involves a basic lesson in sewing an incision closed;the second provides residents with more advancedexercises in minimally invasive surgery; and the third,for very experienced surgeons, simulates complexoperations.Liver surgery can be especially challenging, and thesimulator will provide a powerful tool for RPCI’s newLiver Center (see p. 38), notes Center Co-DirectorBoris Kuvshinoff II, MD, MBA, FACS. Ultimately,the system will enable Dr. Kuvshinoff and hiscolleagues to create a customized simulation using apatient’s actual CT scan so they can do a “dry run”and plan ahead for what they’ll encounter in the OR.The liver is the only internal organ that can growPRACTICEMAKES PERFECTJason Wilson, MD (left), Clinical Fellow in Surgical Oncology, tries outthe surgical simulator developed by Sergei Kurenov, MS (right), Directorof Surgical Simulation, Department of Surgical Oncology.back after much of it has been removed, and “whenyou do the simulation, you can see how much will beleft behind,” says Dr. Kuvshinoff. “The simulator cantell you if the percentage would be adequate for thepatient to safely recover.”For users at the intermediate simulation level—thosejust beginning to do minimally invasive, or laparoscopic,surgery—Mr. Kurenov connected the handle of areal laparoscopic suturing device to the simulator’shaptic controls, so novice surgeons can practiceexactly the same hand movements they’ll use withthe instrument in the OR. Before the creation of thetraining device, they had to open a brand-new $500instrument when they wanted to practice. “It’s lessexpensive, and less stressful than learning in theOR with a patient under anesthesia,” says JasonWilson, MD, one of the surgical fellows who’sproviding feedback about the prototype.Dr. Kuvshinoff says he also sees great potential inusing the system for patient education. “You coulddescribe to patients in much more vivid detail whatyou’re going to do, using computer animation asopposed to drawing a picture on a dry-erase boardor trying to describe it.”www.roswellpark.org | 25| technology buzz

gen-y newsgen-y newssparks |The AYA program focuses primarilyon patients, ages 15-29, and providesa minimum of three consultations,patient’s treatment plan, and collaborateswith other cancer centers and clinicalresearch organizations to make available| sparksin addition to regular visits with thean expanded portfolio of studies targetingdisease-site specialists who managethe AYA age group.their care; all patients can requestadditional consultations as needed.For Kali, who went on to finish herbachelor’s degree and complete a“We assess psychoscial needsmaster’s degree during treatment,and educational needs, andthe AYA program means others in theLynda Kwon Beaupin, MDevaluate the risks of infertilityassociated with cancer therapy,”same boat won’t have to feel alone.“I felt alone when my fiancé and IWhat About Us?RPCI Creates Center of Excellencefor Adolescents and Young Adults with CancerLife changed for 21-year-old collegestudent Kali Mordaunt when shereturned to her dorm room after joggingone day. “My whole body shook untilI lost consciousness,” she says. “WhenI awoke, I slowly remembered what hadoccurred and dismissed it as nothing.But after telling my best friend, whowas pre-med, I found myself in hercar on the way to the ER.”Kali learned that she had a braintumor—news that was even moredifficult to take because her olderbrother, Keith, had died of brain cancerat age six. “That was the beginningof a long learning process of how tolive a ‘new normal,’” she explains.“It was hard to stop my whole lifeon the brink of its entire beginningand just wait to feel better.”Lynda Kwon Beaupin, MD,Department of Pediatrics, says helpingpatients like Kali was the impetus forcreating RPCI’s new Adolescents andYoung Adults (AYA) with Cancerprogram. Funded by The SteadfastFoundation, the program is the firstof its kind in New York State.“Nearly 70,000 American youngadults and adolescents are diagnosedwith cancer each year,” says Dr.Beaupin. “And while dramaticprogress has been made forchildren with cancer, survival ratesfor adolescents and young adults havenot improved significantly since 1975.”Dr. Beaupin says that trend is likelyto continue, because this age groupis affected by especially aggressivetypes of cancer, including sarcomas,leukemias, brain tumors and germcell tumors, but is poorly representedin clinical research studies. At thesame time, diagnosis is often delayedbecause the patient, parents orhealthcare providers are unaware thatcancer could be causing the symptoms.says Martin Brecher, MD, theWaldemar J. Kaminski Chair inPediatrics. “In addition, patients aregiven avenues to network with otherAYA patients, and we address anysurvivorship issues upon completionof their treatment.”He adds that the program ensures thatboth pediatric and adult clinical studieshave been considered as part of thefound out that our insurance companywouldn’t pay to preserve our embryos,since I wasn’t infertile, even though Iwould be soon, due to my chemotherapy,”she says. “I felt alone when I hadto stop working, or thought I was theonly one like me. These new programswill help make sure that no youngadult goes unaware of the resourcesavailable. The more we band together,the stronger we will be.”For more information about the AYA program at RPCI,contact Lynda Kwon Beaupin, MD, at 716-845-2333or email lynda.beaupin@roswellpark.org.The Steadfast Foundation, established byBuffalo Sabres goalie Ryan Miller, supportsthe psychosocial pediatric and young adultprograms of RPCI and Carly’s Club.You may not have a Bill Gates-sized checkingMaybe you’re working on a science reportaccount, but you and your friends can stilland need information about cancer. Maybemake major contributions to the fight againstIf you’re a young adult who has cancer,you’re thinking about a career in oncologycancer. Find out about our awesome Streetif you know someone else who’s battling(cancer medicine) or other jobs in theTeams! Help us educate the public aboutcancer, or if you’re the parent or teacherhealthcare field. The Learning pages havecancer or organize special events to fuel cancerof a young cancer patient, this is thethe facts, ideas and inspiration you’reresearch and patient-support programs.place to connect with others like you.looking for.Check out the Giving section for great ideasYroswell.com is a social networkingon getting started.site, but it’s even more—it’s a placeto share your story and learn how othersare dealing with their diagnosis, treatmentand survivorship.When it’s time to think about a career, rememberthat people in many fields play important andParents will find tips for talking withexciting roles in RPCI’s mission to “understand,their children about a cancer diagnosis;prevent, and cure cancer.” Our team includeseducators can learn how to bring cancerdoctors, nurses, scientists, psychologists, socialawareness into the classroom, to helpworkers, dietitians and cooks, lab technologists,students better understand how a recentwriters, artists, photographers, information technology specialists—a whole communitycancer diagnosis is affecting a classmateworking together toward the same goal.or teacher. Coaches, teachers, andcommunity leaders will discover creativeThe Yroswell.com Careers Pathway Guide enables teachers, guidance counselors and studentsways to bring students together toto find out about the types of job opportunities available at RPCI—and the education andraise money for a cause that affectstraining each requires. It’s the ultimate guide for scouting career possibilities, both medical andnearly everyone.non-medical, at a major cancer center.Yroswell.com is changing constantly; soon you’ll be able to sign on,join the community and turn up the volume against cancer. Be there!26 | roswellnesswww.roswellpark.org | 27

the rpci read on national newsThe rpci read on national newspopwatch |waves red flag“Asian flush” for cancer riskAfter pediatric chemo, fertilitystill possible for some menSome cancer treatments can cause infertility in pediatric cancer patients,so young men who hope to become fathers in the future are oftenadvised to bank their sperm before starting treatment. But what aboutsurvivors who didn’t do that ahead of time? A study published recentlyin the Journal of Clinical Oncology reveals that microsurgical testicularsperm extraction, a procedure pioneered 10 years ago, can makebiological children a possibility for men considered infertile as a resultof childhood chemotherapy. Although the procedure doesn’t work foreveryone, it’s a source of hope.Dr. Hahn notes that “some peoplerespond better to written materials,and others are aural learners, wholearn better by hearing information.”If numbers and percentages make| popwatchBefore and after: “Asian flush” in a 22-year-old manFor some people of East Asian descent, drinking an alcoholic beverage cantrigger a red face, often called “Asian Flush,” “Asian Red,” or “Asian Glow.”But the facial flushing, which can extend to the arms and chest, isn’t justembarrassing—it’s also a sign of a genetic trait that can put heavy drinkersat increased risk of alcohol-related health problems, including esophagealcancer. That risk is the focus of an article in the online journal PLoS Medicineby investigators with the National Institute on Alcohol Abuse and Alcoholismand the Kurihama Alcohol Center in Japan.The condition, which affects about 8% of the world’s population, centers ona deficient enzyme, aldehyde dehydrogenase 2 (ALDH2), which controls howthe body processes alcohol. About half of all East Asians have an inactivevariety of the enzyme. Those with two copies of the inactive variety usuallyexperience such strong reactions to alcohol—facial flushing, rapid heartbeat,headache and nausea—that they avoid imbibing, because “often they do notfind alcohol consumption pleasant,” notes James Marshall, PhD, SeniorVice President, Cancer Prevention and Population Sciences.The danger is greater for those with only one copy, because they tend to havemilder symptoms and may therefore consider the flushing to be nothing morethan a nuisance. But drinking as many as two beers per day can increase byup to 10 times their risk of developing esophageal cancer, say investigators.While some websites advise those who experience “Asian flush” to preventthe red face by taking an antacid before drinking alcohol, the effect isonly skin deep. Warns Dr. Marshall, “Those who have the condition butstill drink heavily may be more vulnerable to health risks imposed by theiralcohol consumption.”How does it work? Surgeons extract sperm hidden in the man’s testiculartissue and then implant it in his partner through in vitro fertilization. Thestudy’s authors report that 27 of 73 men who underwent the extractionprocedure had viable sperm which resulted in the births of 20 children,including five pairs of twins.Denise Rokitka, MD, MPH, Director of RPCI’s Pediatric Long-TermFollow-Up Clinic, notes that improvements in cancer therapies over thepast few decades have increased the number of survivors of childhoodcancer, a group that includes many young men facing treatment-relatedinfertility. “In the past, if sperm banking wasn’t performed prior to thestart of chemotherapy and/or radiotherapy, the only options forfatherhood were adoption or sperm donation,” says Dr. Rokitka.“With novel therapies, such as testicularsperm extraction, survivors may haveanother option to father children. Thesepatients and survivors had limitedchoices in the past.”RiskandRealityAre you off basein estimatingyour cancer risk?How well do you understand your personal riskof developing cancer? You might be surprised.According to the National Cancer Institute, peopleoften estimate their risk to be lower or higher thanit really is—and the problem seems to be linkedto our understanding of statistics.A recent study by researchers at the University atBuffalo (UB) suggests that many of us have troubleinterpreting risk statistics. “You need a math brain,”says Theresa Hahn, PhD, Departments of Medicineand Cancer Prevention and Population Sciences.Dr. Hahn has a math brain. As an epidemiologist,she uses statistics to look for patterns that can showwhat causes or prevents cancer, what puts somepeople at higher-than-average risk for cancer, andwhat factors may predict how well or how poorlya patient will respond to a particular therapy.She knows firsthand the importance of expressingrisk in a way that’s easy for patients and theirfamilies to understand, and natural frequency isone key. While many of us have trouble graspingrisk statistics that are expressed as probabilities(“The average person has a 6% lifetime risk ofyou dizzy, ask your doctor to tryalternative ways of helping you putyour cancer risk in perspective.RPCI’s high-risk clinics can help, too. To find outwhether you might be at high risk for cancer,call 1-877-ASK-RPCI (1-877-275-7724), orvisit the website of RPCI’s Clinical GeneticsService to learn about genetic and inherited risks:www.roswellpark.org/specialized-services/clinical-genetics-service.Learn more about understanding cancer risk athttp://understandingrisk.cancer.gov/.Read the UB study about understanding risk atwww.ncbi.nlm.nih.gov/pubmed/21412897.5Are you atrisk forthese cancers?fiveThis cancer risk assessment tool canhelp you gauge your personal risk forfive common cancers—breast, colon,lung, melanoma, and prostate:www.webmd.com/cancer/health-check-cancer-risk/Photos courtesy PLoS Medicine; published under the Creative Commons Attribution License.Brooks PJ et al. (2009) The Alcohol Flushing Response: An Unrecognized Risk Factor forEsophageal Cancer from Alcohol Consumption. PLoS Medicine 6(3): e1000050. doi:10.1371/journal.pmed.1000050.getting colon cancer.”), we tend to understandbetter when the numbers are illustrated in termsof natural frequency (“Five out of 100 people will28 | roswellnessdevelop colon cancer.”).www.roswellpark.org | 29

State of Breast Cancer, Roswell Park Amherst Centerwow-worthy newswow-worthy newsstop the presses! |Mother to Daughter, Sister to Sister: Let’s talk about Breast Cancer, Roswell Park Cancer InstituteVisit a participating salonduring the month ofOctober to purchaseyour “Paint Me Pink”feather hair extension.30 | roswellnessBuffalo Jills Alumni Breast Cancer Awareness Buffalo Bills gamed’art modaHair Salon & Day Spa7032 Transit Rd, Williamsville, NY 14221BUFFALOCHEERLEADERSALUMNAE ASSOCIATIONParticipating SalonsSALON &AESTHETICS475 Ellicott St, Buffalo, NY 14203All proceeds benefit breastcancer research at RPCI.For event details and more ways to“Go Pink”visit Roswellpark.org/GoPink.Follow #GoPink on Twitter for the latest updates.gScan with yoursmartphone to sign up foremail invites andnotifications aboutPledge to Go Pink events.National Metastatic Breast Cancer Awareness DayBreast Cancer Expo, Boulevard MallEvery Sunday inOctober Listen to Roswellness Radio at 6:30am on WBEN 930 AM and 107.7 FM for a differentdiscussion about breast cancer every week.ACS grant moves researchforward as FDA weighsbrain cancer vaccine trialA four-year, $945,000 American CancerSociety (ACS) Research Scholar Grantawarded to Michael Ciesielski, PhD,Department of Neuro-Oncology, willadvance development of the SurVax-Mvaccine for treating brain tumors.Dr. Ciesielski has been working withRobert Fenstermaker, MD, FACS,Chair of Neurosurgery, on the vaccine,which targets survivin, a proteinexpressed by most tumors, including 90%of malignant gliomas, the most commontype of primary brain cancer in adults.The FDA is currently reviewing RPCI’sapplication to begin a phase I clinical trialof the vaccine. It’s hoped that, if approvalis granted, results from the phase I trialwill lay the groundwork for a phase II trialaimed at identifying “the types of patients19who may benefit qmost from the vaccine,”NCCN updates prostatecancer guidelinesActive surveillance or immediate treatment?Many prostate cancer patients and theirclinicians struggle with that question,which continues to be a focus of theupdated National Comprehensive CancerNetwork (NCCN) Guidelines for ProstateCancer. Speaking at the NCCN’s 16thAnnual Conference, James L. Mohler,MD, Chair, Department of Urology, andChair of the NCCN Guidelines Panelfor Prostate Cancer, introduced recentchanges to the guidelines, which includemore intense monitoring of men undergoingactive surveillance. He also outlined newtreatment options for advanced prostatecancer that have been added to the guidelines.Learn more at www.roswellpark.org/news-prostate-guidelines.qOlder patients live longerafter less extensive surgeryfor kidney cancerElderly patients with renal cell carcinoma,a type of kidney cancer, tend to survivethe disease longer when they undergopartial nephrectomy (removal of part ofthe kidney) instead of radical nephrectomy(removal of the entire kidney), report RPCIresearchers in the February 2011 issue ofthe Journal of Urology. RPCI Clinical FellowNicholas Hellenthal, MD, was leadauthor of the study, which was co-authoredby Clinical Fellows Ahmed Mansour, MD,and Matthew Hayn, MD, and ThomasSchwaab, MD, PhD, Departments ofUrology and Immunology.“Partial nephrectomy is standard of carefor the vast majority of kidney tumors,yet it is widely underutilized in the generalpopulation, in particular the elderly,”notes Dr. Schwaab. “We now show thatit actually improves not only overall butalso cancer-specific survival for elderlypatients with kidney cancer.”Great Expectations!Photolitec, LLC, the latest life-sciencescompany to spin off from RPCI, has signeda long-term, multi-million-dollar agreementwith Zhejiang Hisun Pharmaceutical Co.,Ltd., of China. Under the agreement,Hisun will provide capital to accelerate thedevelopment and refinement of Photolitec’sphotodynamic therapy (PDT) technologies,with the goal of securing FDA approval toinitiate phase I clinical trials.FDA-approved for the treatment of specifictypes of cancer, PDT was pioneered atRPCI by Thomas Dougherty, PhD, ChiefEmeritus of the Institute’s PDT Center. (Seep. 21). The PDT technology transferredfrom RPCI to Photolitec was developedprimarily by an RPCI research group ledby Ravindra Pandey, PhD, founder,Chief Scientific Officer, and member ofthe board of Photolitec, and DistinguishedMember of the PDT Center and Directorof Pharmaceutical Chemistry at RPCI.Photolitec concentrates on developingagents that have multiple applications fortumor imaging and PDT, with a currentfocus on imaging and treating brain, headand neck, oral and pancreatic cancers. Dr.Pandey says the company “will conduct allthe work required by the FDA for initiatingphase I clinical trials” of the agents.The Photolitec/Hisun agreement wassigned in March by Dr. Pandey and HuaBai, President and CEO of Zhejiang HisunPharmaceutical Co.www.roswellpark.org | 31| stop the presses!

wow-worthy newsempowered and awarestop the presses |Another Firstfor RPCIRPCI has become the first US institutionto earn accreditation by the SociétéInternationale d’Urologie (SIU), based inMontreal, Quebec, as a Training Institute inRobot-Assisted Surgery. The accreditationallows RPCI to participate in the SIUscholarship program for young urologists,which provides promising physiciansearly in their careers with three-monthmini-fellowships to develop laparoscopicand robot-assisted skills.“As new technologies and tools changethe look, feel and structure of urologicpractice, high-impact training withexperienced surgeons becomes evermore vital,” says Khurshid Guru, MD,Director of RPCI’s Center for RoboticSurgery. Since 2005, surgeons fromaround the globe—including teams fromSaudi Arabia, Egypt, Switzerland, Germanyand top US universities—have come toRPCI for expert training and mentoring.Movin’ On Up!RPCI‘L ea pf rog s’to TopThe Leapfrog Group’s annual class ofTop Hospitals — 65 from a field of nearly1,200 — was announced Dec. 1, 2010, inWashington, DC, and RPCI was includedfor the first time. The Leapfrog Group(www.leapfrogroup.org), a coalition ofpublic and private purchasers of employeehealth coverage, focuses on improvedhealthcare safety, quality and affordability.Hospitals named to the list are evaluatedon the basis of four critical areas of patientsafety: the use of computer physician orderentry to prevent medication errors; standardsfor doing high-risk procedures, such asheart surgery; protocols and policies toreduce medical errors, and other safepractices recommended by the NationalQuality Forum; and adequate nurse andphysician staffing. Hospitals are alsoevaluated based on their progress inpreventing infections and other hospitalacquiredconditions and adopting policieson the handling of serious medical errors,among other points.Roswell Park Cancer Institute has again been ranked among the top cancer hospitalsin the nation in U.S. News & World Report’s 2011-12 Best Hospitals. RPCI jumped sixspots, to #27, on the publication’s annual roster of Top-Ranked Hospitals for Cancer.In addition to its national ranking, RPCI captured first place as the best hospital inthe Buffalo metro region, and was recognized as “high-performing” in the medicalspecialties of Gynecology, Urology, and Ear, Nose and Throat Diseases.“In a field like oncology that is so highly specialized and where emerging therapies cansave lives, healthcare consumers should select their care providers very carefully,” saidJudy Smith, MD, FACS, Medical Director of RPCI. “Increasingly, they’re able to factorquantitative indicators like outcomes data as well as rankings like U.S. News’ into theirdecision-making. The more trusted resources they have, the better.”RPCI named Blue Distinction ®Center for TransplantsBlueCross BlueShield has named RPCI aBlue Distinction ® Center for Transplants, adesignation accorded only 100 transplantcenters in the United States. RPCI is oneof only three centers in New York Stateand 68 across the country to achieve thedistinction specifically for bone marrowand stem cell transplants.Headed by Philip McCarthy, MD,Medical Director of the Transplant Program,RPCI’s Blood and Marrow TransplantCenter performs over 100 transplants ofbone marrow and blood hematopoieticstem cells every year. About 40% of thoseare autologous, meaning that the procedureuses the patient’s own marrow or bloodstem cells; the other 60% involve cellsfrom another person or donor.As a National Cancer Institute ComprehensiveCancer Center, RPCI engages in ongoingresearch to refine the transplantationprocess. Among other projects, currentresearch supported by a $5.2 million grantfrom the National Institutes of Health aimsto improve the survival rates of patients whoundergo transplants with marrow or stemcells from unrelated donors.This is the second such designation forRPCI, which is also recognized as a BlueDistinction ® Center for Complex andRare Cancers.For prostatecancer patientsin Nigeria, theworld is aboutto changeImagine learning that you have prostatecancer and need to undergo a radicalprostatectomy—but in order to have thesurgery, you’ll have to travel to India orEngland. That’s the reality for prostatecancer patients in Nigeria, and it putsthe treatment out of reach for the vastmajority of men who need it.But things are beginning to change,and it all started in an operating room atShawsand Medical Centre in Port Harcourt,Nigeria. That’s where Willie UnderwoodIII, MD, MPH, MSci, Department ofUrology at RPCI, recently performedthe country’s first documented radicalprostatectomy. At his own expense, and onhis own time, he traveled to Port Harcourtat the request of the Nigerian UrologicSociety and IVUmed, an internationalnot-for-profit organization that works toimprove urological care around the worldthrough projects that reflect its motto,“Teach one, reach many.”An IVUmed board member for severalyears, Dr. Underwood put that motto intopractice as he performed the prostatectomywith two Nigerian surgeons assisting byhis side. By the end of his visit, his Nigeriancolleagues were ready to do the procedurethemselves and are now teaching othersurgeons in turn.Above, Dr. Willie Underwood III, left, performsthe first documented radical prostatectomy inNigeria with the assistance of Nigerian surgeons.The number of Nigerian surgeons trainedfor radical prostatectomy will start to growexponentially in November 2011 when Dr.Underwood returns to Port Harcourt withother volunteer surgeons he has recruited.In a multi-phase process, the Nigeriansurgeons will assist and observe, thenperform the surgery themselves with anAmerican surgeon assisting, and then goThe number of Nigerian surgeons trained forradical prostatectomy will start to grow exponentially inNovember 2011 when Dr. Underwood returns to PortHarcourt with other volunteer surgeons he has recruited.it alone with an American surgeon availablefor consultation. “By the time we’re done,they’ll feel comfortable doing these casesindependently,” says Dr. Underwood.Providing specialized surgical training is justpart of IVUmed’s broader goal of improvingcare for Nigerian patients with urologiccancers. During his visit, Dr. Underwoodmet with some 30 Nigerian surgeons toprovide advice on such matters as designingan efficient system for diagnosing andtreating prostate cancer in a country withlimited resources and medical facilities.Research is another focus of the IVUmedinitiative. “Cancer has not been wellstudied in the African population,” notesDr. Underwood, so plans are underway forthe creation of a tissue repository that willprovide information “to begin to build theknowledge and understanding of cancerin West Africa.” The repository will linkNigerian surgeons and institutions withresearchers in the United States.Dr. Underwood developed great respectfor his Nigerian colleagues as he workedside-by-side with them. “They’re extremelywell trained; I was amazed by their talent,”he says. “Their training is so broad.”After returning to RPCI, he learned that thepatient on whom he operated is doing well.“We’ve had a great outcome with this case,”he says. For prostate cancer patients inNigeria, that’s the beginning of hope.| voices carry32 | roswellnesswww.roswellpark.org | 33

Our photo albumOur photo albumwho? when? where |A Culture of Inclusion“Get up and make something happen” was the motivating message of a promotionalvideo produced by RPCI’s Marketing Department in conjunction with the Office ofDiversity and Inclusion. Featuring staff and faculty, the video celebrates the manydifferences among employees, and raises awareness on how those differences enrichMWAH!Members of the Yroswell Street Team (above) pose with thetop-earning Goin’ Bald For Bucks student fundraisers, whowere recognized on stage at Kiss 98.5’s Kiss the SummerHello concert at Bison Field in downtown Buffalo.| who? when? where?the RPCI work experience. To view the entire video, go to: http://goo.gl/Glqt2.Record-Breaking Year For The RideCelebrate Life!After weeks of planning, RPCI welcomed 3,000 patients, family membersand volunteers to its annual Cancer Survivors Day celebration, June 12.This year’s event once again boasted a carnival theme, with activitiesranging from cooking classes and therapeutic drumming to face-painting,children’s games and a “Dunk the Doc” tank. At left, this young participantMore than 7,200 cyclists and 1,750 volunteers and supportersparticipated in the 16th annual Ride for Roswell on Saturday,June 25 and raised over $3.1 million for cancer research andpatient care programs at RPCI. Routes ranged from the 3-mileFamily Fun Ride to the 100-mile Century Ride, plus a 12-milePeloton ride for top fundraisers.takes a “cat nap” after a full day of fun!Senator Grisanti visitsIn recognitionRPCI President and CEO Donald Trump, MD, FACP, accepts aDistinguished Alumnus Award from Edward Miller, MD, Deanof the Johns Hopkins University School of Medicine. Dr. Trumpreceived the award from the JHU Alumni AssociationJune 10 during his alma mater’s 2011 Reunion Weekend.New York State Senator Mark Grisanti (right) made his first official visit toRPCI July 13, meeting with President and CEO Donald L. Trump, MD, andgetting a behind-the-scenes tour of the Therapeutic Cell Production Facility,the only laboratory of its kind in the world. During his visit, Senator Grisantilearned from Facility Director Christopher Choi, PhD, how RPCI is workingto bring personalized treatments to cancer patients.Summer StudentsThis summer, 25 “rising seniors” participated in RPCI’s 59th annual ResearchParticipation Program for Young Scholars, a competitive program designed fortalented high school students throughout the USA. The program, which ranfrom June 27 through August 12, helps these aspiring scientists develop theskills, habits and attitudes needed to conduct scientific research and to assistin career planning.Studio RPCIIlene Rothman, MD, Assistant Professor in the Departmentof Dermatology (with host Tim Wenger), takes the mic duringthe taping of a “Roswellness Radio” show on tanning and skincancer. Recordings for the weekly show, which airs onWBEN-AM 930 and WBEN-FM 107.7 Sundays at 6:30 am,recently moved to an on-campus studio.34 | roswellnesswww.roswellpark.org | 35

Development UpdateDevelopment updatedonor dollars |Circle of TenHelp plantthe seeds of hopeThe fight against cancer is daunting, but everyday, we see glimmers of hope—hope that urgesus forward in our mission to find a cure.Through the continued support of donors like you, we can find acure for cancer—if not in our lifetime, then in our children’s lifetime.RPCI researchers are working on hundreds of promising studiesso you and your loved ones can benefit from the earliest and mostaccurate diagnosis and the very best treatment and care. Your| donor dollars$10 million gift lays thefoundation for clinical expansion“seed money” will enable them to continue this critical work.With a 39% increase in active patients in thepast five years and a 95% rise in outpatientappointments since 1999, RPCI is launchinga strategic initiative to help keep pace with its clinicalneeds. The Campaign to Build a Greater Roswell Parkhas had a surge in momentum as it heads toward thatgoal, thanks to a combined $10 million gift from 10Western New York families.Creating a “Circle of 10,” the 10 families stepped forwardwith gifts of $1 million each to help build RPCI’s ClinicalSciences Center (CSC). The 10-story, 123,500-squarefootCenter will rise on the corner of Michigan and Carltonstreets, joined via bridges to RPCI’s main hospital next door.A June 8 celebration recognized the generosity of the Circleof 10, with representatives of each donor family signing aceremonial steel beam to commemorate the occasion.Construction of the CSC comes with a price tag of$40 million. With $10 million provided by the Circle of 10,another $10 million committed by RPCI Corporation, and$12.1 million raised thus far in additional gifts, volunteersnow seek to raise the balance of $7.9 million to see thebuilding through to completion.For details on how you can help, call Linda Kahn at716-845-7606 or visit RoswellPark.org/campaign.36 | roswellnessMembers of theCircle of 10 Include:Scott R. BielerThe William and Nancy Gacioch FamilyThe Garman FamilyRichard and Anne Gioia and Anthony and Donna GioiaG. Wayne and Charline (Bunkie) HawkThe Jacobs FamilyPatrick P. Lee FoundationStanford and Judith LipseyThe late Lawrence Minet, PhDRalph Wilson, Jr.(The Ralph C. Wilson Foundation)Artist’s concept for RPCI’s futureClnical Sciences CenterProud to Play a Part“I was looking to do somethingwith charities, since I do nothave any children, and RoswellPark was my first choice,” saysMr. Balnis. “We’re up against acancer beast. Much progressis being made, but we needto do more, and I am proud toplay a small part.”To make a gift, visit support.roswellpark.org,call 716-845-4444 or mail your check to theRoswell Park Alliance Foundation,PO Box 2808, Buffalo, NY 14240-2808.RPCI patient Dwight Balnis has been battling prostate cancerfor 15 years. By the time he underwent a prostatectomyin 1996, his cancer had already spread, so radiation andhormone therapy were necessary. Recently his PSA levelshave begun to climb again, and he is receiving vitamin Dtherapy under the care of Donald Trump, MD, FACP,President and CEO.Inspired to share what he can to help fellow cancer patients,Mr. Balnis has donated $1 million to RPCI to fund a charitablegift annuity. The annuity will provide him with an incomestream during his own lifetime and afterward to his sister,Ellen, during her lifetime. After that, it will provide a significantgift to support research at RPCI.www.roswellpark.org | 37

Development updatecareers at rpcidonor dollars |The CenterThat Generosity Built“I am so grateful forthe care I receivedat Roswell—I knowthat it saved my life.”–Anne ViragDebraProfile:MigaVolunteer Services AdministratorWhether it’s you or a loved one facing cancer, walking through thefront doors of RPCI may take more than the physical strength ofputting one foot in front of the other. That’s why there’s always avolunteer holding the door open, inviting people in with a greetingand a smile. The front-door volunteers are an important part ofhope and healing at the Institute, and nobody understands thatbetter than Debra Miga, Volunteer Services Administrator, whomanages the more than 500 volunteers at RPCI. Their purpose: toprovide a helping hand to patients, their families, and RPCI staff toimprove the quality of life for people with cancer.| frontlinersAnne Virag, with Boris Kuvshinoff, MD, andbelow with Nate Benderson, left, andDonald Trump, MD, RPCI President and CEO.A generous donation from a grateful liver cancer survivor has providedthe remaining funds needed to create a $1.1 million Comprehensive LiverEvery volunteer touches the life of a cancer patient in some wayand plays a vital role in maintaining RPCI’s commitment to qualitypatient care. What do volunteers do? Plenty, says Ms. Miga. Theystaff the gift shop, entertain with music and dance in the hospitalatrium, provide assistance to patients and visitors, and performclerical work.Every volunteer touches the life ofa cancer patient in some way and playsa vital role in maintaining RPCI’scommitment to quality patient care.and Pancreas Tumor Center at RPCI.Volunteers also staff a hospitality room, offering beverages andAnne Virag and Nate Benderson have made a joint gift of $500,000 toinitiate the Center’s work. The gift recognizes Ms. Virag’s RPCI doctor,Boris W. Kuvshinoff, MD, MBA, who serves as Co-Director of theCenter with Renuka Iyer, MD. RPCI had already committed $600,000for the new Center.Dr. Kuvshinoff says the new Center will help improve the RPCI entry processfor patients with tumors of the liver or biliary (bile ducts and gallbladder) tracts.“It will also provide our patients with greater access to clinical research studies,expanded treatment options and complementary medicine,” he explains.Dr. Iyer adds that the Center will collect data needed to analyze clinical outcomesfor different therapies. It will also advance RPCI’s surgical-simulation programto improve the training of surgeons (See p. 25), and create community-outreachprograms to educate prospective patients about the resources available to them.The gift from Ms. Virag and Mr. Benderson will help the Center provide newtreatments for patients who are not candidates for surgery and who have fewremaining treatment options, notes Dr. Kuvshinoff.snacks, books and magazines, and friendly conversation. In theChemo Infusion area, they fetch blankets, run errands for patients’families, and even deliver lunch from the cafeteria for patientswho have to stay in place during an infusion. In the Surgical/ICUwaiting area, “volunteers are liaisons between the surgical staffand the families waiting for their loved ones, providing informationand updates,” says Ms. Miga.Some volunteers lift patients’ spirits with a wag of the tail; they’rethe canine friends in RPCI’s therapy-dog program, and Ms. Migawould like to recruit more of them. “The patients really enjoy it,” shesays. “If anyone has a dog who is certified [for pet therapy], or theywould like to get them certified, we’d love to have them visit.”Ms. Miga also oversees the Alliance Art Committee, responsiblefor the more than 800 works of art displayed throughout theInstitute; the Artists-in-Residence Program, offering artisticactivities and diversions for patients; and the Music in the Lobbyprogram, providing 1,300 performances a year. Both programsare supported by RPCI donations.Managing such a large volunteer staff requires top-notchorganizational skills and the ability to match volunteers’ talentsand interests to the right opportunities. That’s second nature toMs. Miga, who came to RPCI as Community Volunteer Specialistmore than seven years ago, when there were about 350volunteers. Now the ranks number 550 active volunteers, including60 college students and 30 high school students. And Ms. Migarecently formed a Volunteer Advisory Council of team leadersfrom key areas to help mentor new volunteers and makevolunteering even more rewarding. “Our volunteers have reallygreat ideas about how to improve things, and the council hasunleashed that,” she says. “It will help us make a great programeven better.”Helping to “make it better” is a key part of volunteering that Ms.Miga knows from personal experience. Her son, Keith, is an18-year cancer survivor who was treated at RPCI as a young man.“I never forgot how nice everyone was to me, no matter what myattitude,” says Ms. Miga. “This is my little piece of giving back.”38 | roswellnesswww.roswellpark.org | 39

on the calendaron the calendarevents |Call 716-845-8788 or visit roswellpark.org/giving for details.| eventsBenefiting the WNY BreastResource Center at RPCIDate:September 17, 2011Location:East Aurora Middle SchoolDate:October 23, 2011Location:Niagara Falls, NY, and OntarioAll-Star Night 2011“Starstruck for Roswell Park”Event options:1.5-, 3- or 5-mile routesFundraising Minimum: $25Pre-registration Fee: $10Day-of Registration: $15Event options:5K, 10K, Half Marathon,Marathon, RelayRegistration/FundraisingMinimum: $400Date:November 12, 2011Location:Buffalo Niagara Convention CenterSponsorships: Starting at $3,500KNOW YOUR STATSAbout Prostate CancerSaturday, September 24, 201110:00 am - 4:00 pmRoswell Park Cancer InstituteElm & Carlton StreetsDate:December 4, 2011Location:Las Vegas, NVCancer Cures CollectionCheck out our customizable HolidayCollection, featuring colorful card designsby our pediatric patient-artists! Plus, viewour all-new Breast Cancer AwarenessCollection of products, our Weddingand Showers and Flowers Collectionswith invitations, save-the-dates, favors,napkins and more! Your purchase willhelp support programs for cancerpatients and their families.FREEProstate CancerScreeningTuesday, October 4, 2011 | 3 - 7 pmRalph Wilson Stadium | Paul McGuire ClubScreening Event & Family Activity DayOffering free prostate cancer screenings for all men 40years and older. If you’d like to register for a screening,please email jarrett.johnson@roswellpark.org, orregister online at www.manupbuffalo.org by 9/16/11.Additional Activities:Entertainment & FoodHealth Fair“Community Showcase”Farmer’s MarketDoor PrizesRafflesEvent options:Half Marathon, MarathonRegistration/FundraisingMinimum: $3,800Disney WorldMarathon WeekendDate:January 6, 2012Place your order today atwww.paintboxproject.orgThe Paint Box Project ® is generously supported by UpstatePharmacy, ModPac, The Buffalo News and WIVB-TV.Location:Walt Disney World Resort,Orlando, FLEvent options:5K, Half Marathon,Marathon, “Goofy’s Raceand a Half”Registration/FundraisingMinimum: $3,800Stop by RPCI’s Prostate Cancer Expoon September 10 at the Boulevard Mall for moredetails and to register. RoswellPark.org/ExpoVehicles & Vendors WantedVehicles: Open to all special cars, trucks, motorcyclesand snowmobiles. Clubs are welcome and can parktogether. $25 per vehicle admission. All proceeds will bedonated to Minorities Allied for the Need to UnderstandProstate Cancer (MAN UP).Vendors: Email jarrett.johnson@roswellpark.orgor call 716-845-8641 for space, availability and cost.40 | roswellnesswww.roswellpark.org | 41