Today marks the start of the 36^th annual APHON (Association of Pediatric Hematology/Oncology Nurses) Conference in Pittsburgh, PA. The conference is designed for pediatric and adolescent and young adult (AYA) hematology/oncology nurses and allied healthcare professionals who wish to explore ways to enhance their practice. This year’s expanded hematology offerings aim to provide an in-depth knowledge base and understanding of the principles of caring for patients with hematologic disorders. Educational sessions that focus on research, clinical management, and psychological issues are designed to provide attendees with the knowledge and support to enable them to influence pediatric and AYA hematology/oncology nursing and allied healthcare.

On Friday, Oct 5^th from 8-9am EST, Northwestern’s own, Barbara Lockart, MSN, RN, CPNP, CPON, will be presenting, “The Science and Hope of Fertility Preservation.” As the emerging field of oncofertility gains ground, we are thrilled to have a venue to discuss fertility preservation among healthcare providers that serve not only as clinicians, but often as advocates as well. It is imperative for parents and caretakers to understand that cancer treatment, including stem cell transplant, may put children and adolescents at risk for infertility. There is a growing awareness that maintaining fertility is important to families and that infertility is a concern for patients throughout the treatment continuum. Fertility preservation is a rapidly evolving field with lifelong implications for the physical, emotional, and spiritual health of patients. Barbara will examine the state of fertility preservation science, as well as guidelines for determining which patients are appropriate for intervention. She will also discuss the role of the nurse as advocate, educator, and researcher.

Overall, the conference seeks to teach the field about current trends and new information in pediatric and AYA hematology/oncology, as well as learning from shared experiences. It will be an exciting combination of speakers, posters, meetings, and preconference workshops and of course, the issues surrounding social media, technology, and therapeutic boundaries will be a hot topic for discussion. If you would like to attend this exciting conference, please visit the APHON Conference homepage for more information about registration, the agenda, and preconference workshops and education sessions being held.

According to the American Cancer Society (ACS), a woman in the United States is diagnosed with breast cancer every three minutes. This breaks down to a 12 percent, or 1 in 8, lifetime risk for women of developing breast cancer in the U.S. and right now, there are about two and a half million breast cancer survivors. Chances are, those of you who are reading this blog have been affected by breast cancer either personally or indirectly, through family and/or friends who have been diagnosed.

For those of you with questions about breast cancer treatment options, family history, diagnosis and support services, the Lynn Sage Breast Cancer Town Hall Meeting will take place on Sunday, October 2^nd at Northwestern University’s Chicago campus. It is an interactive discussion with Northwestern healthcare providers, providing you with an opportunity to have your questions answered by experts, learn about local and national support networks and meet with breast cancer advocacy groups.

Among the expert panel of healthcare providers will be our own, Kristin Smith, answering any questions you may have regarding fertility preservation and fertility options prior to and following cancer treatment. Joining Kristin will be a panel consisting of a cancer geneticist, radiation oncologist, survivorship and support expert, and a surgical oncologist. It’s a great venue to get more information and meet others, who may have gone through or are going through, a similar experience with breast cancer.

The town hall meeting is a free event and open to the public. There will be ample time provided for attendees to ask questions and get answers from our expert panel so come prepared with your most pressing concerns. For more information, including registration and directions, please visit www.cancer.northwestern.edu or call 312.695.1304. Walk-ins are always welcome so don’t let a little thing like registration hold you back! The most important thing is that you join us and get the answers and support you need.

In June this past summer, the Oncofertility Consortium partnered up with the Cancer Legal Resource Center (CLRC) for a one-day conference event kicking off their 2011 Cancer Rights Conference series. It was a great success and provided many attendees with valuable information regarding cancer-related legal and financial issues. One attendee at the conference said: “This program was awesome. Everything presented was valuable information. As a cancer survivor it is comforting to know there is someone out there looking out for us. Thank you so much CLRC for all you do. You make a difference in our lives!”

On September 23rd, the 2nd CLRC Conference is being held in Washington DC and there is still time to sign up for this informative and FREE event. The conference will provide patients, survivors, caregivers, advocates, navigators, health care professionals, and attorneys with valuable information about cancer-related legal issues, including: employment & taking time off work, health, disability and life insurance options, access to health care, insurance navigation and appeals, understanding health care reform, cancer community resources, genetics and the law, legislative advocacy, fertility preservation and education rights of children and young adults with cancer. Members of CLRC’s professional network are comprised of attorneys, insurance agents, and accountants able to answer a variety of legal concerns.

FREE CLEs will be offered to eligible attorneys in attendance and CEUs will be offered to social workers and nurses. Please visit www.CancerRightsConference.org to register and/or for more information. The 2012 locations will be Los Angeles, Chicago, Houston, and Boston.  Dates and exact agendas have not been determined thus far, but you can visit CLRC’s website to register or find more information.

If for some reason you are unable to attend this conference, but need to speak with a legal professional regarding a cancer-related legal issue, CLRC provides a toll-free telephone assistance line (866-THE-CLRC). Callers can receive free and confidential information about relevant laws and resources for their particular situation.

Mary Zelinski, PhD finishes her reports from the annual meeting of the Society for Cryobiology held from Corvallis, Oregon with a final blog about the keynote talk from Alison Ting, PhD. In this post, she relay’s Dr. Ting’s findings about advancing ovarian tissue cryopreservation techniques in one species of monkey.

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By Mary Zelinski, PhD-Dr. Alison Ting, Post-doctoral Fellow, Division of Reproductive Science and Development, Oregon National Primate Research Center, wound up this interesting session with an update on “Optimization of Rhesus Macaque Ovarian Tissue Cryopreservation.”  She outlined the importance of ovarian tissue cryopreservation as an important option for fertility preservation in prepubertal cancer survivors or those without partners.  She also pointed out that in vitro development of follicles from cryopreserved ovarian tissue was an important method of fertility preservation that would not transmit cancerous cells back to the patient, a current risk of tissue transplantation in patients with blood-born cancers.

Dr. Ting summarized various conditions that she and her colleagues examined to develop cryopreservation of the ovarian cortex in a closed system using high security tissue straws to circumvent the clinical issue of cross-contamination between samples in open systems during liquid nitrogen storage.  She determined the threshold cryoprotectant concentration for vitrifying solutions in straws, compared vitrification solutions containing various concentrations of permeating cryprotectants, such as glycerol and ethylene glycol, in the presence or absence of nonpermeating cryoprotectants (with awesome names like super-cool X-1000, polyvinylpyrrolidone K12 and supercool Z-1000, PXZ) and determined the time needed for vitrification of samples at various temperatures (4 degrees Celsius, room temperature, and 37 degrees Celsius).  She reported preservation of both follicular and stromal morphology (based on histology), and noted that the addition of the non-permeating PXZ cyroprotectants preserved not only primordial and primary follicles, but also secondary and multilayered follicles. In addition, growth, survival and antrum formation of secondary follicles derived from thawed tissue cryopreseved with PXZ polymers was achieved using an encapsulated, 3-dimensional culture system.

Through careful and systematic experimentation,Dr. Ting identified a vitrification protocol for macaque ovarian tissue in a closed system using 54% cryoprotectant in the presence of PXZ polymers with gentle cooling and warming.  Vitrification of ovarian tissue in a closed system with minimal tissue toxicity can be achieved with effective dehydration and cryoprotectant penetration, which are tissue- and cryoprotectant-specific and also dependent on cryoprotectant exposure time and temperature.

Efforts continue to optimize the 3D encapsulated follicle culture system to yield mature oocytes derived from cryopreseved follicles, develop methods for vitrification of individual secondary follicles in closed systems, and examine follicular function in vivo following heterotopic transplantation of ovarian cortex in macaques.  This is the first demonstration of vitrification of primate ovarian tissue in a closed system and offers a significant technical advancement as a method for fertility preservation in cancer survivors.

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Read the earlier posts on Cryo2011 here:

• Reports from the 2011 Society for Cryobiology Conference
• Steven Mullen Discusses History of Oocyte Cryopreservation
• Fertility Preservation for Endangered Species

Thanks for the reports Dr. Zelinski! We look forward to hearing more from the Society for Cryobiology.

In this blog, Mary Zelinski, PhD continues her reports from the annual meeting of the Society for Cryobiology held in Corvallis, Oregon, July 24-27. In this post, she relay’s the findings of Dr. Pukazhenthi, on the importance of fertility preservation for endangered species. Read the first and second posts on Cryo2011 here.

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By Mary Zelinski, PhD-Dr. Budhan Pukazhenthi, Reproductive Physiologist at the Center for Species Survival, Department of Reproductive Sciences, Smithsonian Conservation Biology Institute, gave a fascinating presentation on “Cryopreserving Endangered Species Gametes, Embryos and Gonadal Tissue:  Challenges, Successes and Future Directions.”  He noted that the field of cryobiology has long been touted as a valuable tool for the conservation of endangered wildlife species, and that in the last 25 years cryobiology has gradually emerged as a contributing science to the field of conservation.  The systematic collection, storage and use of biomaterials, i.e. “Genome Resources Banking”, has yielded a dynamic repository of biological specimens being used to enhance genetic management of sustainable populations.

He outlined four specific challenges facing reintroduction of genetic diversity into future generations of wildlife:  1) limited fundamental knowledge about individual species, including the difficulty of collecting gametes from some species; 2) species diversity in gamete and embryo structure, function and cryosensitivity; 3) variation among donors; and 4) influence of lack of heterozygosity on cyrosurvival.  Since results from one species rarely translate to another, there is a critical need for continuous, species-specific cryobiological research.

Use of this overall approach has resulted in a number of conservation success stories that go beyond milestone births of one or two offspring from frozen sperm or embryos.  He cited examples such as the use of cyropreserved sperm for the past two decades in the recovery program of the black-footed ferret and the production of multiple litters of two felid species, Brazilian ocelot and caracal, from cryopreserved embryos.  He predicted that wildlife programs will benefit from fertility preservation strategies currently being developed for humans.  Initial efforts in cryopreservation of ovarian tissue, seminiferous tubules and testicular tissue, in follicle maturation and germinal-vesicle storage show potential for use in species conservation.

Dr. Pukazhenthi also noted that most cyro-tools are considered in the context of mammals, but that there has been significant progress in other taxa, including birds, amphibians and marine life.  His laboratory has made progress in cryopreservation of coral sperm and fish embryos.  He concluded by saying that an appreciation for Genetic Resources Banking is emerging beyond the immediate interest of cyrobiologists and reproductive biologists wherein cryobiology is not only being recognized as a method for storing and moving important genomes, but as an essential component of the ability to monitor genetic diversity and diseases in rare populations.

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Stay tuned next week to hear reviews of the final keynote speakers at this year’s meeting of the Society for Cryobiology or read the first and second posts on Cryo2011.

Last week, Mary Zelinski reported to us about the annual meeting of the Society for Cryobiology held in Corvallis, Oregon, July 24-27. She continues her review of the meeting and the keynote presentation by Dr. Steven Mullen, below. Read the first blog post on Cryo2011.

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By Mary Zelinski, PhD-Our Oncofertility colleague, Dr. Steven Mullen, Head of Reproductive Cryobiology, 21^st Century Medicine, started the keynote session with his excellent presentation on “The Evolution of Methods to Cryopreserve Human Oocytes”.  He discussed how the initial attempts in the 1980’s to cryopreserve human oocytes using dimethyl sulfoxide (DMSO) as the permeating cryoprotectant followed by the slow-cooling method yielded poor outcomes.  This raised clinical and social concern for the health of potential children derived from this technique, thereby essentially halting research until the late 1990’s when it was discovered that inclusion of propylene glycol as a cryoprotectant could improve outcomes.  Follow-up reports using slow-cooling methods confirmed that reasonable survival and embryonic development can be achieved when propylene glycol and sucrose (at the appropriate concentrations) were used.

In the late 1990’s, the first case report on successful vitrification of human oocytes was followed by studies indicating successful cow oocyte vitrification using extremely fast cooling and warming rates.  Remarkable success based on developmental potential was achieved when similar vitrification techniques were applied to human oocytes in the mid-2000’s. Since then, numerous clinics applied vitrification, using various methods to achieve “ultra-rapid” cooling and warming, with good outcomes.

Direct comparisons between slow-cooling and vitrification reveal, in most instances, that vitrification can provide a better outcome.  Dr. Mullen noted that vitrification has its drawbacks including the use of very small volumes of solution applied to the surface of a thin carrier device that is directly exposed to liquid nitrogen for the fastest cooling rates poses a potential cross-contamination between patients.  Development of closed systems lags behind the open systems in terms of success.  Furthermore, a steep learning curve is required to obtain technical expertise, thus repeatability among clinics remains variable.  Nonetheless, some studies using large numbers of young patients have reported comparable pregnancy rates between vitrified and fresh oocytes.  Studies with similarly large cohorts of older patients as well as cancer survivors remain to be demonstrated.  Furthermore, long-term follow-up of the health of offspring health is also unknown at the present time.

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Stay tuned to hear reviews of the other keynote speakers at this year’s meeting of the Society for Cryobiology or read the first Oncofertility blog post.

A few weeks ago, this blog discussed some of the ins and outs of cryopreservation, or highly specialized freezing of tissues for long-term preservation, in oncofertility. Scientists in this scientific field and members of the Oncofertility Consortium recently attended a meeting on this technology and our own Mary Zelinski has agreed to tell us about it through this blog.

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By Mary Zelinski, PhD-The keynote session on Cryobiology in Assisted Reproductive Technologies at the annual meeting of the Society for Cryobiology held in Corvallis, Oregon, July 24-27, was a big success.  A session of 7 oral presentations by an international cadre of speakers followed, on topics, including:

• Cryopreservation of individual macaque monkey follicles
• A role for oocyte aquaporins (proteins that regulate water flow in cells) during vitrification in mice
• The importance of the warming rate on developmental ability of vitrified mouse embryos
• Inexpensive methods for long-term embryo storage
• Thermal and mechanical damage of oocyte intracellular lipid droplets
• Osmotic properties of sperm membranes during cooling
• Ultra-rapid vitrification of human oocytes using micro-capillary tubes

Much lively discussion occurred after the various presentations, with major contributions by two distinguished founders of reproductive cryobiology, Drs. Peter Mazur and Stanley Leibo.

Those of us who were not trained as ‘classical’ cryobiologists were welcomed with open arms by members of the Society for Cryobiology.  The members are very diverse in their individual interests which made for some interesting lunch-time discussions.  For example, we were exposed to presentations on the importance of cryobiology for blood banking, plant preservation, freeze-drying of pharmaceuticals and food (those backpacking meals), cryopreservation of many different cell types and tissues, cryosurgery, biorepositories, biophysics, and mathematical modeling of ice formation (the latter two topics we definitely struggled with).

While socializing with the Society’s Secretary and past President, Dr. Andreas Sputtek from Hamburg, Germany, we agreed that a workshop on the principles of cryobiology would be useful for those who use this technique and follow protocols, but don’t really know why, or how to trouble-shoot or optimize their procedures based on sound cyrobiological principles.  He will present this suggestion to the Board of Directors and maybe this will be a feature of future annual meetings.

A lively BBQ at a beautiful park (complete with a soccer game among the young investigators and some ‘old’ ones, too) as well as a banquet at a local winery were opportunities for more friendly conversations.  We will definitely consider attending this meeting again to further expose cryobiologists to oncofertility specialists, and equally as important, oncofertility specialists to cryobiologists.  You never know when fruitful collaborations can develop.  Our own research would not be making advances without the advice from experts on our Cryobiology Advisory Board, who are members of this wonderful Society.

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Over the next few days, we will be providing an overview of the presentations from the 3 keynote speakers at this year’s meeting. If you would like more information or to become a member of the Society for Cryobiology, please visit their website.

Comprehensive cancer care employs an interdisciplinary approach to providing expert diagnosis, treatment, and support to individuals with cancer. A team of radiologists, surgeons, pathologists, oncologists, fertility specialists, social workers, psychiatrists, support groups and other health care professionals work collaboratively to deliver individual treatment plans to every patient with cancer. One of those groups, the thoracic surgical oncology nurses, act in diverse capacities for cancer patients as educators, advocates, and subject experts. As such, these surgical oncology professionals must continually stay on top of advances in patient care.

In 2004, the Robert H. Lurie Comprehensive Cancer Center at Northwestern University launched the first Thoracic Surgical Oncology Nursing Conference. Every year since, this successful conference has highlighted emerging topics to surgical oncology nurses and wellness care professionals including nutritionists and dieticians. This year’s 7th Annual Thoracic Surgical Oncology Nursing Conference will be held on Thursday, April 7th at Northwestern University’s Prentice Women’s Hospital.

Susan Collazo, a Nurse Practitioner at Northwestern Memorial Hospital, explains that the Thoracic Surgical Oncology Nursing Conference this year will focus on lung cancer and introduce the healthcare community to the latest findings in that area. Additionally, this year’s conference will focus on the relationship between patients with a history of smoking and chronic obstructive pulmonary disease (COPD) to lung cancer.  The conference will also include a testimonial from a young lung cancer survivor, Jill Feldman.  As part of their advocacy work, any time a person of reproductive age is diagnosed with cancer, a nurse practitioner ensures that the patient is given a fertility preservation consultation with an oncofertility specialist.

Any interested RN, Respiratory Therapist, fellow APNs/PAs and other health care professionals are welcomed to register for this dynamic interdisciplinary conference held on April 7^th in Prentice Hospital. Registration for this popular meeting is still open so please call Physicians Services at 877-926-4664 to ensure your spot today.

The Oncofertility Consortium at Northwestern University is officially closed today due to a record-breaking blizzard in Chicago. The snow day gave me an opportunity to read a chapter in Malcolm Gladwell’s book What the Dog Saw about John Rock, MD, an American doctor and scientist who was integral to many of the advances fertility medicine has seen in recent generations.

From the 1920’s through the 1960’s, John Rock worked as an obstetrician and gynecologist in Massachusetts. As a clinician, Rock saw many patients and couples dealing with infertility. These cases motivated the Harvard-trained doctor to research possible treatments for infertility, some of which are now used to preserve the fertility of young cancer patients.

In the 1940’s, Rock worked with Miriam Menkin to attempt in vitro fertilization with human eggs, or oocytes. In 1944, they published their work in the journal Science. In those experiments, Menkin and Rock described their efforts to fertilize 138 oocytes with sperm and, in three cases, recorded changes in the oocytes that appeared to be post-fertilization cell division. Since, the team never attempted to implant the presumed embryos in a woman, it is not known if the eggs were actually fertilized and viable. Despite this uncertainty, the work that Rock and other scientists performed in these early years was integral to the birth of Louise Brown, the first child born from in vitro fertilization, in 1978.

John Rock also researched techniques now used to preserve the fertility of male cancer patients. In the 1950′s, he worked to perfect sperm banking, which requires freezing and then thawing a sperm sample without damaging the motility or mobility of the sperm. Again, Rock was ahead of his time and successful sperm cryopreservation methods were not developed until the 1970’s.

Dr. Rock may be most well-known for his true scientific passion, birth control. A devout Catholic, Rock first became involved in the contraceptive movement during the 1930’s when he founded a birth control clinic that taught the rhythm method, a church-sanctioned technique that calculates a woman’s reproductive cycle and limits sex between a couple to the infertile period of the cycle. Rock also collaborated with researchers who developed the first hormonal birth control pill and was convinced that this technique, like the rhythm method, was a natural form of contraception and would also be approved by the Catholic church. Needless to say, that did not happen.

Next Thursday, February 10, the Oncofertility Consortium will host Margaret Marsh, PhD, and Wonda Ronner, MD, as they discuss their research on John Rock in a Virtual Grand Rounds at 10 am CST. Join the discussion here through Adobe Connect .

Four times a year, the Oncofertility Consortium hosts its Virtual Grand Rounds series, a public online forum that addresses topics in oncofertility. These clinical, research, and patient presentations engage the diverse oncofertility community to understand broader fertility issues for cancer patients. On November 18, the fall grand rounds, “Clinical Management for Pediatric and Young Adult Cancer Patients and Survivors,” included discussions by two experts in cancer survivorship, Barbara Lockart, APN/CNP, CPON and Karen Kinahan, RN, PCNS-BC.

Barbara Lockart, a pediatric nurse practitioner at Children’s Memorial Hospital in Chicago, Illinois, focused her talk on the survivorship issues of children, as pediatric cancer survival rates are on the rise and approach 80% for some cancers. When dealing with young children, Lockart stressed the importance of having age-appropriate discussions with both children and their parents. While children may not understand the intricacies of fertility, she stressed that even preschoolers have some concept of parenthood. Additionally, it is important for parents to act as surrogate decision-makers independently from their own desires.

Lockart differentiated the long-term effects of cancer care, which begin during treatment and continue throughout the rest of a survivor’s life, from late effects. The late effects of treatment may not begin until years after beginning remission. Some cancer patients may lose fertility immediately during treatment while others may find themselves entering premature menopause years later. Survivors may not be aware of either of these effects on their fertility and Lockart stressed the role of nurses, such as herself, in educating parents and patients.

Lockart frequently works with Karen Kinahan, an experienced clinical nurse practitioner at Northwestern Medical Faculty Foundation and the Survivors Taking Action and Responsibility (STAR) Program who helps childhood cancer survivors transition into adulthood. In Kinahan’s Virtual Grand Rounds presentation, she noted that over time, long-term follow-up for survivors decreases as the late effects of cancer treatment increase. By highlighting case studies and further research, Kinahan showed that infertility is one of the most common chronic medical problems reported by survivors of childhood cancer.

Like previous Virtual Grand Rounds, the full video of the November 2010 seminar is available on the Oncofertility Consortium’s Website. Stay tuned for the next Virtual Grand Rounds: The History of Infertility to be held on February 10, 2012 with Margaret Marsh, PhD and Wanda Ronner, MD. To receive further information about participating in this Adobe Connect session and additional oncofertility events, contact us!