With foundation help, an Oregon doctor roots out low-value medical practices

Vinay Prasad (OHSU/Kristyna Wentz-Graff)

Vinay Prasad (OHSU/Kristyna Wentz-Graff)

Physicians have started to face up to an uncomfortable truth: their profession has often embraced new treatments that don’t really help patients.

“When you look at the balance of benefit and harm, some therapies provide no net benefit,” says OHSU assistant professor Vinay Prasad, M.D., M.P.H., who has landed a $2 million grant to go after the problem.

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A Native American health focus at the OHSU Knight Cancer Institute

Knight Cancer physician Amanda Bruegl, M.D., is leading an effort to understand health issues among Native American tribes and communities in the Pacific Northwest, with a special focus on gynecologic cancer.

 

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Amanda Bruegl, M.D. (OHSU/Fritz Liedtke)

Throughout medical training, Amanda Bruegl’s commitment to work with Native Americans never faltered. As a member of the Oneida and Stockbridge-Munsee tribes, she is one of two Native American gynecologic oncologists in the United States.

“When I was looking for a job,” she says, “it was really important to me to do something to advocate for Native American women’s health.” She saw a need for that in the Pacific Northwest.

“I was looking for places where there was a significant Native American population and the opportunity to do outreach,” she says.

Now, with support and help from her colleagues at the OHSU Knight Cancer Institute and the OHSU Department of Obstetrics and Gynecology, Bruegl has started building relationships with Native American tribes in the Pacific Northwest, especially through the Northwest Portland Area Indian Health Board. The board is an organization with delegates from each of the 43 federally recognized tribes of Oregon, Washington and Idaho. Its mission is to address multiple facets of the health and wellness of Native American people.


“Native Americans are chronically overlooked in the health care system. So our unique issues don’t get the attention they deserve.”


Bruegl has given talks about cancer prevention and treatment to Native American groups and health providers, and is working with leaders and members of the communities to share her knowledge of the disease. With her passion and personal mission to reach out to the community, she is also paving the way to help researchers learn more about Native American women’s gynecologic health. She is working to get approval for a retrospective study on Native American women’s health, which will take a new look at data that has already been collected, focusing specifically on details on gynecologic cancers in Native American women.

“I think Native Americans are chronically overlooked in the health care system,” Bruegl says. “So our unique issues don’t get the attention they deserve.”

Bruegl says if her proposed study can move forward, she will share the results with Native American communities. She hopes health care professionals can then work in concert with the communities to help Native American women prevent gynecologic cancers — like cervical and endometrial cancer — that are often preventable. In the meantime, Bruegl is continuing her outreach to Native American communities by having conversations, building relationships and sharing knowledge.

“For us to get to know each other, and for community providers in clinic to be able to simply text me about a case — asking ‘can I run this by you?’ — provides the frontline care that is incredibly helpful for both the patient and the providers treating Native American women,” she says.


A version of this article originally appeared in the OHSU Knight Cancer Institute’s 2016 Annual Report

The cancer drug that “changed everything”

Understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.

 

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Years of life expectancy at age 55 for people diagnosed with CML compared with the general population, from the work of Bower et al. (OHSU/Joe Rojas-Burke)

It transformed the outlook for people diagnosed with chronic myeloid leukemia. A disease with a three- to five-year life expectancy became, for most patients, a chronic, long-term condition managed with a daily pill.

And this week, researchers published the outcomes of people treated for more than 10 years with the drug imatinib (Gleevec), ushered from lab to clinical success by Brian Druker, M.D., director of the OHSU Knight Cancer Institute. The findings stand as a testament to the idea that understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.

Estimated overall survival at 10 years was 83 percent among patients receiving first-line imatinib treatment, Druker and co-authors reported in the New England Journal of Medicine. Many of the recorded deaths of people in the imatinib group were unrelated to CML. Among 134 patients with cytogenetic assessments at 10 years, 92 percent had a complete cytogenetic response, that is, they had no measurable sign of the chromosome alteration that causes CML.

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Oncology knows no borders: Unintended impact of the new U.S. travel ban

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Nima Nabavizadeh, M.D.

The travel ban issued by President Donald Trump could bring an unintended consequence for U.S. citizens: the loss of medical care givers serving rural communities and poor neighborhoods. “Immigrants have always done what no one else wants to do – and this includes providing high-quality medical care for underserved patients,”  say OHSU Knight Cancer Institute physicians Nima Nabavizadeh, M.D., and Charles Thomas, Jr., M.D., in a commentary in JAMA Oncology.

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When it’s time to stop a lifesaving cancer drug to find out if you are cured

Gleevec structure - Structure of Gleevec bound to the kinase domain (1)The depth of remission achieved with the targeted therapy imatinib (Gleevec) raises a tough new question for some leukemia patients: is it ever safe to stop taking the breakthrough drug developed at OHSU?

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Improving survival for patients with GIST

Average life expectancy had been no better than 18 months for people diagnosed with advanced gastrointestinal stromal tumors, or GISTs.

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Michael Heinrich, M.D.

The outlook changed dramatically in 2001 with the arrival of the targeted therapy drug imatinib (Gleevec). “Now we’ve learned that some might live a decade or longer. And we’ve come to understand which class of patients benefit the most,” said Michael Heinrich, M.D., first author of a new report on the long-term outcomes of women and men who enrolled in the pivotal clinical trial organized in 2000 by SWOG, the research consortium headquartered at the OHSU Knight Cancer Institute.

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Why breast cancer is more dangerous for new moms

Breast cancers that emerge after a woman gives birth are significantly more deadly. Those diagnosed within five years of childbirth are about three times more likely to spread and give rise to life-threatening metastatic tumors. Researchers now are closing in on the reasons why.

 
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Scientists at OHSU have discovered how the liver – one of the most common sites of breast cancer metastasis – becomes vulnerable to tumor invasion after childbirth. Using rodent models, they’ve shown that as the liver recovers from the demands of pregnancy and lactation it becomes an inviting landing spot for escaping cancer cells to take root and grow.

And the same process appears likely to occur in women. The researchers dug into the details of more than 500 cases of young women’s breast cancer and found a liver-specific increase in metastasis among those diagnosed within five years of giving birth. If confirmed by more direct evidence, the authors say their findings could help physicians choose more effective treatments for young mothers diagnosed with breast cancer. The researchers reported the findings in the February issue of Cancer Discovery.

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Mole Mapper brings open data for cancer research

A new report in Nature Scientific Data explains how researchers can access and use the growing trove of data coming from users of Mole Mapper, a mobile app for tracking suspicious nevi.

 

Mole_Mapper_Zones (1)Mole Mapper gives users the option to contribute to melanoma research by sharing anonymous images that show how moles evolve over time, potentially advancing toward malignancy. Investigators with Institutional Review Board oversight can access this user-generated data.

More than 11,000 users have downloaded the Mole Mapper app since its debut in October 2015. As of June 2016, nearly 2,800 (more than 25%) had chosen to enroll and contribute their data to the study, according to the Nature Scientific Data paper.

The app uses photographic comparisons to a reference item of known size, such as a coin, to measure moles in millimeters. Repeated measurements and images make it possible to assess longitudinal changes – a resource that should become more valuable as participants continue to contribute images.

The Mole Mapper project fits with an effort by Sage Bionetworks to make scientific data more open to sharing among qualified researchers. “It is truly a credit to the study participants who have agreed to broadly share these data with the research community,” study senior author Brian M. Bot told OHSU News. “We as researchers owe it to the participants in these studies to reimagine how data are collected and shared in an effort to accelerate the research process.”

Co-authors include OHSU’s Lisa Domenico, Tracy Petrie, Ph.D., and Sancy Leachman, M.D., Ph.D., director of the OHSU Knight Cancer Institute’s Melanoma Research Program and chair of the Department of Dermatology in the OHSU School of Medicine.

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Citations

The Mole Mapper Study, mobile phone skin imaging and melanoma risk data collected using ResearchKit by
Dan E. Webster, Christine Suver, Megan Doerr, Erin Mounts, Lisa Domenico, Tracy Petrie, Sancy A. Leachman, Andrew D. Trister and Brian M. Bot, Nature Scientific Data (February 14, 2017)

Mole Mapper app ‘crowd-sources’ photos for skin cancer research, prevention by Amanda Gibbs, OHSU News (February 14, 2017)

First in philanthropy: Phil and Penny Knight

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Phil Knight and Brian Druker, M.D., appeared on “Good Morning America” in June 2015, when the record-setting Knight Cancer Challenge raised $1 billion for cancer research at OHSU.

Nike co-founder Phil Knight and his wife Penny ranked no. 1 in The Chronicle of Philanthropy list of Americans who donated the most to charity in 2016.

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The rise of liver cancer deaths in Oregon

liver cancer mortality map

Change in the age-standardized liver cancer mortality rate, 1980-2014 (Mokdad et al.)

Seven of the 10 U.S. counties with the fastest growth in liver cancer deaths are in Oregon, according to an analysis by the Institute for Health Metrics and Evaluation at the University of Washington.

Oregon’s mortality rate from liver cancer, 6.74 per 100,000, is still lower than the national rate of 6.81. But Oregon’s death rate has risen 174 percent since 1980, while the national rate rose 88 percent. A news report in The Bend Bulletin notes that all but one county in Oregon had an above-average increase in its liver cancer death rate since 1980.

Barry Schlansky, M.D., M.P.H., an assistant professor in the OHSU School of Medicine, offered his perspective in The Bulletin:

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The cancer drug that “changed everything”

The cancer drug that “changed everything”

A New England Journal of Medicine report describes outcomes after more than 10 years with imatinib (Gleevec), the targeted therapy drug ushered from lab to clinical success by Brian Druker, director of the OHSU Knight Cancer Institute.