Quit Smoking with the Comprehensive Smoking Treatment Program at Penn

Frank T. Leone, MD, MS, associate professor of medicine, is director of the Comprehensive Smoking Treatment Program at Penn Medicine.

Nicotine addiction is complex. People who are addicted to nicotine know it’s bad for them, yet they can’t stop. And those who aren’t addicted to nicotine can’t understand why smokers can’t quit. Even family members and friends have a hard time understanding nicotine addiction.

In this video, Dr. Leone discusses what patients can expect when they commit to a healthier lifestyle through the Comprehensive Smoking Treatment Program at Penn Medicine.





You can listen to Dr. Leone talk more about smoking-related health complications and how those who smoke find it hard to quit – even with the growing trend against smoking in public locations.

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Cancer-fighting Recipe: Winter Squash and Apple Soup

This recipe is for winter squash soup is great when you are trying to manage small bowel obstruction - especially for women with gynecologic cancers.

Winter Squash and Apple Soup

Serves 4 to 6
Roasting squash and apples intensifies their flavors. Use a mixture of winter squash varieties for a more complex taste. This recipe can be frozen which will be a welcomed treat if you aren’t up to cooking.

Ingredients

3 pounds (about 8 cups) winter squash such as butternut, kabocha, acorn or delicata, peeled and cut into 1-inch chunks
2 Granny Smith apples, peeled, cored and cut into 1-inch chunks
1 yellow onion, chopped
4 cloves garlic, sliced
1 teaspoon ground ginger
3 cups low-sodium vegetable broth
1/4 cup chopped fresh parsley (to garnish)

Directions

Preheat oven to 400°F. Line two rimmed baking sheets or shallow roasting pans with parchment paper. In a large bowl, toss squash, apples, onion, garlic and ginger until mixed well. Spread mixture on baking sheets in a single layer.

Roast squash mixture until tender and beginning to brown, about 45 to 50 minutes, rotating pans between oven racks halfway through baking. Remove from oven and puree squash mixture with broth, 1 cup water and nutritional yeast in a blender or food processor in 2 batches until smooth or transfer to a pot and puree with immersion blender until smooth. After pureed, bring soup to a simmer over medium heat. Add more water if needed to thin soup to desired consistency.

Serve garnished with parsley.

**Cutting squash can be a difficult feat, if you are feeling fatigued or short on time- look for squash that has already been peeled and cubed in the produce aisle.

For more recipes like this check out: www.wholefoodsmarket.com/recipes/ 

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Are you at risk for cancer?

When a friend or family member is diagnosed with cancer, one may wonder: Am I at risk for cancer?

What’s My Risk? is a comprehensive cancer risk tool at OncoLink designed to help individuals learn about the factors that determine their personal cancer risk and what they can do to decrease that risk. By completing a detailed questionnaire about their habits, lifestyle and health history, the program identifies their risk for cancer by creating a detailed report. The report includes information about each risk factor, how it affects cancer risk and resources to change those factors that can be changed.

Some good can come from a family member or friend being diagnosed with cancer. In the medical community, it is called a “teachable moment.” It is that time when a person is so affected by their loved one’s diagnosis that they vow, whether publicly or privately, to make changes in their life to reduce their risk of being in a similar situation. Maybe they’ll start exercising, make a diet change or quit smoking. So at this moment in time when they are most open to making changes, how do they know where to start? Do they really know what habits increase their cancer risk or how to go about changing them?

What’s My Risk? is a “teachable moment;” a chance to live healthier and reduce cancer risk.

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New Breast Imaging Has Advantage Over Traditional Mammograms

Penn radiologists are getting a new kind of clarity when it comes to breast imaging.

A revolutionary way to perform mammograms combining traditional mammography with 3D technology, called digital breast tomosynthesis (DBT), allows for more accurate pictures of breast health.

Every woman who comes to the Perelman Center for Advanced Medicine (PCAM) for their screening mammograms will get the new DBT test.

“DBT is more accurate – even more accurate than digital mammograms – because it uses traditional X-ray technology to capture images of the breast, while moving along a small arc around the breast to record images at different depths and angles,” says Emily Conant, MD, director of women’s imaging at the Hospital of the University of Pennsylvania. “In preliminary research, it has been shown to reduce the number of false-positives and some false-negatives making mammography more accurate.”

Like traditional mammogram, the breast is compressed for about four to five seconds while a series of low-dose X-rays are taken to capture high-resolution images of the breast. These images are then digitally “stacked” to construct a total 3D image of the breast. This 3D image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles. Radiologists can also magnify images to reveal minute details.

“DBT allows Penn radiologists to manipulate and see parts of the breast that we couldn’t before,” says Dr. Conant. “Therefore, we can reduce some unnecessary imaging and stress for some women.”

Breast images through DBT also allow radiologists to make new recommendations for follow-up screening and tests.

“DBT lets us to see the through some of the density of a breast,” says Dr. Conant. “For a woman with dense breasts we can personalize her screening and make different recommendations than we do for a woman who does not have dense breast tissue.”

Women who get their mammograms using the new DBT technology may find they are called les often for follow-up visits and more tests.

These new imaging advantages and advances in risk assessment are part of a collaborative effort between radiologists, medical oncologists and surgeons to try to improve breast cancer detection for women.

Technology continues to evolve, but collaborative research across all disciplines at Penn Medicine means patients who come to Penn for their mammograms benefit from the latest medical breakthroughs.

The DBT technology is still new and Penn researchers are studying ways to decrease its radiation exposure without losing image integrity.

“DBT is just one more step to improving breast care on an individual, personalized basis,” says Dr. Conant. “Combining personal history, genetic testing and new breast images creates a better, overall picture for breast health.”

For more information about breast cancer diagnosis and treatment at Penn Medicine, or to schedule an appointment, please visit PennMedicine.org/cancer/breast-cancer or call 800.789.PENN (7366).

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Proton Therapy Center at Penn Celebrates 2nd Anniversary

Dr. Stephen Hahn is Chair and Professor of the Department of Radiation Oncology at the University of Pennsylvania. He is board certified in radiation oncology, medical oncology, and internal medicine and is internationally renowned for his work in Photodynamic Therapy (PDT). At Penn, he was Director of the PDT program from 1996 until 2006, and he continues as a senior advisor to the program.

Since its opening in January 2010, Penn’s Roberts Proton Therapy Center remains the world’s largest proton therapy center physically located within a comprehensive cancer center and has treated hundreds of people with cancer using a most sophisticated and precise form of radiation therapy.

Proton therapy is radiation therapy that uses positive-charged protons accelerated at very high speeds to create a particle beam. While protons work very much like conventional radiation therapy in killing cancer cells, the speed and energy of the proton beam allows for more accurate targeting of tumors with, in many cases, the potential for less damage to surrounding normal tissue.

As the Roberts Proton Therapy Center enters its third year, Penn researchers continue to establish the optimal uses of proton therapy as an effective tool for treating a wide range of cancers including:

• Brain tumors
• Head and neck cancers
• Lung cancer
• Sarcomas
• Gastrointestinal tumors
• Pediatric cancers  
• Prostate cancer

One of the most exciting and emerging applications for proton therapy treatment is the retreatment of many cancers previously treated with radiation. For these patients, proton therapy can be a viable treatment option when other approaches have failed.

Currently, there are only nine proton therapy facilities in the United States, but even among this select group, the Roberts Proton Therapy Center stands out as a leader in treatment and research. The Roberts Center has the advantage of being part of a world class academic medical center, Penn Medicine, and an NCI-designated Comprehensive Cancer Center, Penn’s Abramson Cancer Center. The Abramson Cancer Center brings together top experts in every cancer-related specialty in one extraordinary facility. Penn’s team of cancer specialists works together to develop individualized treatment plans, ensuring that every patient has the benefit of the best treatment options available. The Roberts Center also offers advanced technologies such as multileaf collimators that are not available at any other proton center in the world.

In addition to an internationally recognized clinical and research faculty, both the Abramson Cancer Center and the Roberts Proton Therapy Center deliver care in a supportive and comfortable environment. Support services including patient navigation, social work, counseling and integrative healing modalities are readily available to all patients.

The delivery of exceptional, high quality patient care is the highest priority and all patients are treated with the highest level of clinical expertise combined with compassionate care for the patient, as well as family members and caregivers.

A variety of educational programs are available to patients before receiving radiation therapy treatment and Penn’s radiation therapy experts are always available to answer questions at any time.

To ensure the highest level of comfort to patients who are undergoing radiation therapy treatment, free valet parking is available at Perelman Center for Advanced Medicine, where the Penn Radiation Oncology is located. This service is available throughout the entire course of treatment.

The innovation of radiation therapy as a treatment for many types of cancer is at the core of Penn Radiation Oncology. Every day, Penn’s radiation oncologists work as part of a comprehensive cancer team dedicated to offering and delivering every possible treatment option to people with cancer. This team looks forward to continuing and enhancing the use of proton therapy in the fight against cancer.

Stephen M. Hahn, MD
Chairman, Department of Radiation Oncology
Penn Medicine

Watch Dr. Hahn discuss proton therapy at Penn Medicine in this video. 

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Managing Small Bowel Obstructions

Some gynecological cancer survivors are at high risk for a small bowel obstruction.  This may be due to surgical adhesions or the tumor itself.  First, it is important to know what the signs and symptoms are of a partial small bowel obstruction.

Symptoms may be cramping, gas, bowel changes, nausea and vomiting.  Vomiting, increased abdominal girth and pain may indicate a total obstruction.  Keep in mind that symptoms may vary by individual and the severity of the obstruction.  It is important to notify your doctor immediately if you notice these symptoms.

Dietary Changes

With a partial small bowel obstruction, there may be dietary changes to minimize discomfort.  Here are some tips and strategies to help minimize discomfort:

• Eat smaller meals, more frequently throughout the day.  Think appetizers, all day long.
• High fiber foods may be more gas forming and be harder to pass through a narrow opening.
• Follow a low fiber diet.  Avoid the skins on fruits and vegetables; avoid whole grains, nuts and seeds. 
• Switch to white bread, white flour pasta and peeled potatoes which may be better tolerated.  
• Eat lower fiber cereals (cereals with less than 3 gm of fiber per serving.) Some low fiber cereals include: puffed rice, Cheerios, cream of rice or cornflakes. 
• Avoid fatty and greasy foods. These are much more difficult to digest and may stay in the stomach longer causing greater discomfort.
• Drink plenty of fluids: water, broth, tea, gelatin and juice may help you stay well hydrated.  Some people find that “full” liquids: hot cereals, cream blended soups, puddings, milkshakes and nutritional drinks are tolerated.  If nausea is persistent, switching to nutritional concentrated liquids is worth trying.
• Avoid lactose containing drinks if gas or milk intolerance is a problem.
• Avoid gas-forming foods such as gassy vegetables (beans, brussels sprouts, cabbage, onions, and cauliflower), soft drinks and chewing gum.

If the above strategies do not work, reach out to a registered dietitian with a CSO credential (certified specialist in oncology) who is well versed in symptom management of partial small bowel obstructions.

For more individualized assistance, contact the registered dietitian for Pennsylvania Hospital’s Joan Karnell Cancer Center at 215-829-6560.

For the Abramson Cancer Center, the contact number is 215-615-0538.

If you are not within this system, you may ask your oncologist for a referral or visit Eatright.org to identify a nutrition professional in your area.

Debra DeMille, MS, RD, CSO is a nutritional counselor at the Joan Karnell Cancer Center. Debra has worked at Pennsylvania Hospital since 1988 with the last 12 years specializing in oncology. Debra guides individuals receiving chemotherapy and radiation as well as addressing survivorship issues including the use of integrative therapies.


She conducts cooking programs and group counseling sessions for cancer survivors.

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Immunotherapy - a Personalized Approach to Medicine

Researchers at Penn’s Abramson Cancer Center recently published study results considered to be a major breakthrough in cancer treatment for chronic lymphocytic leukemia. The study, published in The New England Journal of Medicine, used patients’ own T cells genetically engineered to kill cancer tumors, and has been hailed as a cancer breakthrough 20 years in the making.

“What we’re doing falls under the area of personalized medicine in the extreme sense – using a person’s own white blood cells or tumor cells to develop a personalized vaccine,” said Carl H. June, MD, director of translational research at the Abramson Cancer Center (ACC), who is overseeing the development of these vaccines.

Dr. June, widely regarded as one of the world’s leading cancer immunologists, has spent years conducting research at the ACC with modified T-cells, cells in the body that are capable of recognizing, attacking, and destroying foreign invaders, and assembling a team of physician-scientists to advance immunotherapy for many types of cancer.

Immunotherapy removes cells from patients and modifies them in Penn’s Clinical Cell and Vaccine Production Facility (CCVPF), a Abramson Cancer Center Core Facility under the direction of Bruce L. Levine, PhD. The modified cells are infused back into the patients following chemotherapy.

“This isn’t a drug in a bottle or a vaccine in a vial,” Dr. June said. “This is more like a next-generation blood transfusion.”

The recent immunotherapy discovery in chronic lymphocytic leukemia is an exciting turning point in the way cancer is treated and will provide hope to thousands of cancer patients and their families, according to Dr. June.

Here are a few examples of leading-edge treatments for cancer being developed right here at Penn Medicine.

Immunotherapy for Lymphoma

Stephen J. Schuster, MD
Director, Lymphoma Translational Research Center
Lymphomas can be a complex and difficult-to-treat cancers and treatments are often toxic to normal organs and not entirely effective. However, Dr. Schuster and researchers at the Abramson Cancer Center may have found a way of improving the therapy available in the treatment of lymphoma and related diseases. A clinical trial using expansion technology to test infusions of T-cells, following chemotherapy for chronic lymphocytic leukemia is showing promising results. In another study, personalized vaccines made with patients own tumor cells, were found to significantly improve the average remission period for patients with the disease.

Immunotherapy for Mesothelioma and Pleural Malignancies

Steven M. Albelda, MD
Vice Chief, Pulmonary, Allergy, and Critical Care Division
A current phase I/II trial investigates the effectiveness of gene therapy when used in combination with chemotherapy for the treatment of mesothelioma. There is evidence that this method of treatment will prove quite effective, and the hope is that it may someday be integrated into the standard of care for mesothelioma patients. This trial is specific to mesothelioma, but Dr. Albelda and his team are hopeful that this therapy will show practical applications for other cancers of the pleural cavity.

Immunotherapy for Pancreatic Cancer

Robert H. Vonderheide, MD, DPhil
Associate Director for Translational Research
An early-stage clinical trial may lead to new treatment options for patients with advanced pancreatic cancer. The treatment appears to work differently than expected, attacking tumors primarily by altering their surrounding tissue. This means that attacking the dense tissues surrounding the cancer is another approach to consider. Similar to attacking a brick wall by dissolving the mortar in the wall, the immune system is able to eat away at this tissue surrounding the cancer, and the tumors fall apart as a result of that assault. These results provide fresh insight to build new immune therapies for cancer.

Immunotherapy for Ovarian Cancer

George Coukos, MD, PhD
Director, Penn’s Ovarian Cancer Research Center
The treatment for ovarian cancer usually involves a combination of surgery and chemotherapy, but for the majority of women with the disease the standard treatment stops working. New approaches to treating ovarian cancer are necessary to improve survival rates and immunotherapy is proving to be hopeful for patients. At the time of surgery, the patient’s tumor is saved for future use in a vaccine. After completing standard chemotherapy, patients will then have access to individualized immunotherapy treatments using their own tumor tissue to fight their cancer should it recur. Dr. Coukos is leading a number of phase I and II clinical trials testing the effectiveness of these vaccines and is seeing promising results. In addition, Dr Coukos and his colleagues at the Ovarian Cancer Research Center are launching T cell based immunotherapies using blood-derived, engineered T cells, or tumor-derived T cells.

Immunotherapy for Prostate Cancer

Jihyun Lee
Post Doctoral Researcher in Dr. June’s lab
While hormone therapy has worked to delay the progression of cancer, it is not curative and in some advanced malignant forms of prostate cancer, the cancer will progress. Dr. Lee’s research focuses on the development and optimization of an anti-PSMA CAR that would be used in adoptive T cell clinical trials to treat malignant and recurring prostate cancers.

Dr. Lee is optimistic that it is now possible to develop and deliver a sufficient number of properly activated T cells that have sufficient power to overcome tolerance and eradicate prostate cancer. A clinical trial will soon be in place, which would determine the effectiveness in patients.

Immunotherapy for Breast Cancer

Brian Czerniecki, MD, PhD
Co-Director, Rena Rowan Breast Center
Surgical Director, Immunotherapy Program
A phase II clinical trial sheds new light on how vaccines can inhibit tumor growth, lessen the severity of the disease, and prevent its recurrence in patients with early stage breast cancer, ductal carcinoma in-situ (DCIS). Over-expression of the HER-2/neu gene is linked to about 50 to 60 percent of DCIS cases, and helps predict the severity of the disease, as well as the risk of recurrence of invasive breast cancer. By treating dendritic cells, specialized white blood cells that play a major role in activating immune response, with HER-2/neu, Dr. Czerniecki produced a vaccine that may prompt an immune response. Results have shown that nearly all patients exhibited an initial immune reaction to the vaccine, and half showed markedly reduced levels of HER-2/neu expression, leading to overall improvement in the severity of the disease.

Immunotherapy for Chronic Lymphocytic Leukemia

David L. Porter, MD
Director, Blood and Bone Marrow Transplantation Program
The latest ground-breaking clinical trial among advanced chronic lymphocytic leukemia (CLL) patients treated with genetically engineered versions of their own T cells showed extreme promise demonstrating sustained remissions of up to a year. The findings are the first demonstration of the use of immunotherapy to create “serial killer” T cells aimed at cancerous tumors, providing a tumor-attack roadmap for the treatment of other cancers.

“The therapy could replace the need for bone marrow transplantation. This is currently the only curative therapy for most patients with leukemia” says Dr. Porter.

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