In 1998, the Robert H. Lurie Comprehensive Cancer Center at Northwestern University assembled a group of nurses and other oncology experts together for an inaugural oncology nursing conference. Every year since, this successful conference has highlighted emerging topics to oncology nurses from around the Midwest. This year’s 13^th Annual Oncology Nursing Conference will be held on Friday, December 3, 2010 at Northwestern University’s Prentice Women’s Hospital.

Oncology nurses act in diverse capacities for cancer patients as educators, navigators, and subject experts. As such, these oncology professionals must continually stay on top of advances in patient care. Megan Mitchell, manager of education programs at the Lurie Comprehensive Cancer Center states that the Oncology Nursing Conference will, “focus on topics that affect patient care and treatment experiences, including the new health care reform act, cancer-related fatigue issues, and managing anemia during cancer treatment.” Additionally, this year’s conference will provide oncology nurses with information on therapies for specific cancers, as well as information on FDA-approved prostate cancer immunotherapy.

The conference will also include a session on fertility with speakers from the Oncofertility Consortium. According to Mitchell, “The panel will provide attendees with unique insights into the decisions and questions that cancer patients encounter when faced with a cancer diagnosis.” Teresa Woodruff, PhD will provide an overview of existing and emerging fertility preservation options for cancer patients. Laurie Zoloth, PhD will discuss some of the complex ethical issues in oncofertility for patients and providers. A third panelist in the session will discuss her personal experiences undergoing oncofertility treatments.

More than 200 nurses are currently registered for the daylong conference, which will provide continuing medical education credits to attendees. While registration for this popular meeting is still open, it is close to reaching capacity so register today!

Day 2 with our embedded journalist.

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By Kirsten Tellam

I was really excited for my day at the oncofertility lab today– I actually got my hands in a pair of gloves and did some work!

First it was time for follicle isolation. Ovaries are composed of follicles, or aggregates of cells that usually hold a single egg. My job was to put an ovary under a microscope and, using syringes, separate the follicles. This was much more difficult than I thought–it was disconcerting to be moving my hands based on what I was seeing under the microscope and not with my own eyes! I was not a great follicle isolator, that’s for sure.

Courtesy of Huge Galdones

Then I got to encapsulate the follicles, which I had more fun with. Jen put some isolated follicles in alginate, which I then picked up using a pipette and put into a calcium solution. The word she used was “beading”–I dropped a bit of the alginate with the follicle in the shape of a bead into the solution. I successfully moved 7/8, which she said was pretty impressive for a first-timer. If done by someone who actually knows what they’re doing, the bead is then cultured and photographed, but they obviously couldn’t use my work–who knows what I inadvertently did wrong!

I had a great time in the lab today. It was really interesting to see the care and precision with which even the smallest of tasks must be done. And even though I don’t want to see dissections every morning, I did manage to survive without fainting, which I consider a plus!

Up for tomorrow: the social science day. I’ll learn about the history of oncofertility, social science issues, and patient navigation.

An aspiring science journalist, Kirsten Tellam, embedded herself at the Oncofertility Consortium last week. Tellam, a Masters of Science in Journalism candidate at Northwestern University’s Medill School of Journalism, agreed to share her experiences as a guest on our blog.

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By Kirsten Tellam

Apparently, in most cheap green olives, the pimento in the center isn’t actually pimento at all. Instead, it’s alginate–a gelatin-like substance that is also used in scientific experiments. Ew.

This wasn’t the only thing I learned in my first day at Dr. Teresa Woodruff’s oncofertility lab, but it certainly was the most surprising.

I started my day with a tour of the lab, which was much larger than I was expecting. I met at least fifteen researchers, each with a different job and responsibility (and felt a little embarrassed–I could only understand about half of their job descriptions).

After getting the grand tour, Jen Jozefik (my program coordinator and the lab’s director of training) showed me an alginate demonstration and explained how it’s used in oncofertility for follicle encapsulation. I also got to see slides of mouse testes being created and bacteria cultures being set up.

Jen gave me a few packets of light reading (“Identification of a Stage-Specific Permissive in Vitro Culture Environment for Follicle Growth and Oocyte Development,” anyone?) so I could better understand the lab’s mission. Then I watched a video about the Oncofertility Saturday Academy, a program for high school girls at the Young Women’s Leadership Charter School. The program teaches admitted girls the basics of science and then lets them research and perform experiments. The video was really moving–the program helps girls realize that boys aren’t the only ones who can be successful scientists. I think it’s really important that this world-famous lab is investing in tomorrow’s scientists, particularly those who might not otherwise have the chance to realize their dreams.

My day was mostly an introduction to the lab and its practices. Tomorrow I get to do some actual research! I’ll be learning about follicle isolation and encapsulation and trying to isolate follicles and view follicle cultures all day. I’m excited to spend the day as a researcher would, but also a little nervous–I haven’t done any lab work since high school.

I feel like I know a lot more about oncofertility and actually have a good idea of what is happening in the lab after just one day there. And I learned a particularly important lesson: no more cheap green olives for me.

The National Mall in Washington D.C. was the place to be for inquisitive minds this past weekend–the USA Science and Engineering Festival held there on Saturday and Sunday drew crowds of nearly 1 million people who took part in over 1,500 hands-on activities, exhibits, and science shows.  Our own Institute for Women’s Health Research had one of these exhibits, where Cathryn Smeyers and I were able to share information about the Women’s Health Sciences Program and to help spread the word about Oncofertility.

Did you know that the “pimento” in most cocktail olives isn’t really a pimento at all–it’s actually made from a compound that comes from seaweed?!?  No?  Well you’re not alone–this came as a surprise to most of the 2000 visitors to our booth, each of whom diligently dissected that “little orange thingy” out of an olive and found out what in the world it has to do with women’s health.  They found out that the seaweed compound inside some olives is called alginate, and each visitor got to mix some alginate with a calcium solution and watch what happened.  Even kids as young as 2 were eager to give it a try and to squish the little beads that formed when the alginate came in contact with calcium.  Our slightly older audience members were also very interested to find out how researchers at the Oncofertility Consortium are using these little alginate blobs as a sort-of artificial ovary–allowing ovarian follicles placed inside them to hold their 3D shape as they grow, so that we can learn how to grow healthy eggs outside of the body.  To learn more about this process for yourself, check out this animation at myoncofertility.org.

The Festival was a very exciting and inspiring place to be!  It was invigorating to see so many young people excited about all kinds of science, and to hopefully encourage them to become part of the next generation of leaders in science and medicine.  This Festival was the inaugural run of what will hopefully become an annual event.  Be sure to check out the 2010 Expo Days Recap Video to get a taste of what the Festival had to offer!  In the words of President Obama, “Keep exploring, keep asking questions, keep having fun.  The future of this country and the advancements of the next century are in your hands.”  “My hope is that this festival is just the beginning for all of you–that’s not just the power of science, that’s the promise of America.”

The October 11, 2010 issue of TIME magazine highlighted the importance of fertility preservation for cancer patients. The article discussed the mission of the Oncofertility Consortium and interviewed a young cancer survivor, Holly, who underwent fertility preservation at Northwestern Memorial Hospital in Chicago, IL. Since Holly works down the street from us here at the Oncofertility Consortium, I recently had the opportunity to sit down with her and learn more about her triumph against cancer.

The TIME article told the story of Holly’s breast cancer diagnosis and treatment in 2009. In our lunch meeting, I was surprised to learn that this was not her first battle with cancer. At age 14, Holly was diagnosed with Hodgkin’s lymphoma. As we sat down for lunch, she described the rigorous treatment of that first cancer with, “six months of chemotherapy and an additional two weeks of radiation therapy.”

Due to the type of radiation treatment, Holly knew she was at increased risk for later breast cancer so when she was 25, she began annual screenings. According to Holly, “the first year I went for monitoring was the only mammogram that was normal.” After that first screening, every yearly exam found some kind of mass that ended up being benign. But in 2009, the newest mass was diagnosed as malignant. Holly remembers the day well because it was, “two months to the day after I got engaged.”

Over the next month, Holly worked with her doctors to develop a treatment plan for the cancer and to preserve her fertility. She and her fiancé, Rich, decided to undergo hormone stimulation for embryo banking before completing the cancer treatment that may have impaired her fertility.

More than a year later, Holly is cancer-free, a newlywed, and already looking forward to using her stored embryos. “It is very exciting that these embryos could become our babies,” she said. As she sat across from me at lunch, I could see the peace-of-mind that the frozen embryos give her. According to Holly, “With all of life’s uncertainties-why add more?”

An image of a parthenote, courtesy of Alison Kim, PhD

An interdisciplinary team from the Oncofertility Consortium published a paper today in the journal Science on the intersection of politics and scientific research. The group, made up of a historian, a bioethicist, and scientists from the Oncofertility Consortium highlighted how a flawed U.S. law restricts research in fertility preservation for cancer patients. Specifically, the law prevents federal funding to pay for research that uses parthenotes in research.

Parthenotes are a group of cells derived from an egg that begins dividing without fertilization from sperm. The short policy article in Science describes the biology of parthenotes and explains their potential broad benefits for research in many aspects of cancer, fertility, and oncofertility. As we discussed in a previous blog post, parthenogenesis could be used for researchers to identify eggs that are healthy enough to begin the early stages of cell division. This activation would allow scientists to identify methods to successfully mature eggs outside of a woman’s body that are ready to be fertilized. This could help oncofertilty patients who have lost the ability to have biological children due to cancer and its treatment.

Tingen et al. also describe the history of the law-in-question, the Dickey-Wicker Amendment, which prevents the production, use, or destruction of embryos or parthenotes with federal money. In 1993, the U.S. Congress and President Bill Clinton gave the National Institutes of Health (NIH) the authority to provide financial support for human embryo research. Before funding such research, the NIH established a group of 19 experts in science, medicine, ethics, law, and social science, called the Human Embryo Research Panel to determine the moral and ethical issues raised by this research.

The panel found that the creation of parthenotes for research purposes was ethically acceptable while embryo research warranted additional review. As such President Clinton directed the NIH to prevent funding for most embryo research but allowed them to provide money for studies on parthenotes. A few years later the Dickey-Wicker Amendment was drafted to restrict all embryo research. Looking at prior legislation, these non-scientists included the term “parthenote” into the bill.

Recent legal rulings have brought embryo research and the Dickey-Wicker Amendment into the spotlight again. Rather than continue this mistake in the law, the authors in the Science article call for the removal of parthenotes from the Dickey-Wicker Amendment. They provide a more detailed explanation of their position in an upcoming article in the American Journal of Bioethics.

This upcoming November 12, 2010, the Northwestern University Feinberg School of Medicine and the STAR Program (Survivors Taking Action & Responsibility) are hosting a regional conference in downtown Chicago, IL. The event, titled Cancer Survivorship 101: Educating Primary Care Providers in their Treatment of Cancer Survivors will teach health care professionals how to better serve cancer survivors.

This event at the new Prentice Women’s Hospital (250 E. Superior Street, Chicago, IL) will highlight how physicians, internists, nurses, social workers and other caregivers can maintain the health of both adult and childhood survivors of cancer. Experts from around the country are presenting current knowledge on post-cancer health risks, racial disparities in cancer survival, and the psychosocial care of cancer survivors.

A member of the Oncofertility Consortium will also present her work with cancer survivors. Dr. Clarisa Gracia, an Assistant Professor of Obstetrics and Gynecology at the University of Pennsylvania, is an expert in reproduction and infertility in cancer survivors. Given the results of cancer treatment on fertility, do survivors have to worry about contraception? What other post-cancer effects do cancer survivors face that may impact their reproductive health? Dr. Gracia will present answers to questions such as these in an afternoon seminar.

The event will also allow like-minded health care professional discuss their experiences with cancer survivors and examine the different models of cancer survivorship follow-up care. Physicians who attend can earn continuing medical education credits for attending the daylong conference. To register for this event, click here.

On October 12, 2010 a special issue of the Journal of Clinical Oncology will highlight the importance of adolescent and young adult (AYA) cancer awareness. In an overview on AYA oncology, David M. Thomas, et al., emphasizes the “clear clinical need” for a new subfield of oncology. Issues that are important to AYA cancer patients are relevant to many clinicians, from oncologists (pediatric, medical, and radiation specialists) to nurses, psychologists, and reproductive endocrinologists.

In addition to the fertility issues that we often discuss on this blog, AYA patients need tailored approaches to care depending on their age. Unfortunately, there is a lack of data on the side effects of specific chemotherapy and radiation treatments on AYA patients. The quality of survivorship is also important to the AYA population and requires clinicians to have a broad understanding of the many life changes that patients may go through during or after treatment including attending college, entering the workforce, or starting a family.

A position statement in the same issue calls for increased training for health professionals that work with AYA populations. Specifically the authors recommend that professionals have AYA-specific clinical knowledge and can deliver appropriate care to their patients. In the case of oncofertility, this would require the clinical community to know all of the currently available fertility preservation options and deliver care by referring them to appropriate reproductive specialists. The Oncofertility Consortium tries to facilitate this process through the FERTLINE that helps providers and patients understand the fertility preservation options available in their area.

The Young Adult Alliance was started to mobilize the many organizations that care about AYA issues and holds an annual conference every year. This November, members of the Oncofertility Consortium will attend the conference and present their knowledge on navigating oncofertility patients and the different perspectives in oncofertility. We look forward to meeting with the AYA community and hearing their insights on the issues!

I’m a huge football fan, so most Sundays in the fall and winter are spent watching games.  Starting this past Sunday and running until the end of the month, all of the NFL teams will accent their uniforms and gear with pink, in support of the American Cancer Society’s breast cancer awareness campaign.  During one of the games, my friend commented, “I’m all about pink and bringing attention to a cause, but is this really what my donation to cancer research is paying for?”  Her question really got me thinking about how awareness campaigns are run and whether or not they fulfill their mission improve health outcomes.

Coincidentally, the Los Angeles Times published an article questioning the benefits of awareness campaigns.  The author highlighted a few reasons why awareness campaigns, specifically breast cancer awareness campaigns, may not have the impact they promise: little improvement in breast cancer mortality rates; lack of alignment of the goals of the campaign with developments in breast cancer research, which may lead to women being over-diagnosed and undergoing unnecessary treatments; and conflict of interest between purpose of the campaign (i.e. increase and improve early detection of breast cancer) and sponsorship by pharmaceutical companies that provide breast cancer drugs.  Her compelling arguments made me think about whether the Oncofertility Consortium’s own awareness efforts have similar characteristics and what could be done to strengthen its campaign.

The Oncofertility Consortium raises awareness on all different fronts by approaching solutions to fertility impairment from cancer treatment in partnership with basic scientists, clinicians, and social scientists and humanists.  Basic scientists involved in fertility preservation research use the newest, groundbreaking materials and techniques to increase cancer patients’ likelihood of having children after fertility-threatening cancer treatment.  Clinically speaking, the impact of the Oncofertility Consortium occurs at the time of a young patient’s cancer diagnosis when information is exchanged about what fertility preservation options are available.  Whether or not the patient decides to pursue fertility preservation, the critical element is that the patient, regardless of prognosis, socioeconomic status, and race, is made aware that her cancer treatment may affect her fertility and that now is the opportunity to act.  Consortium social scientists and humanists examine case studies and conduct “thought experiments” to reflect on the historical, ethical, and social implications of fertility preservation.  In all, the Oncofertility Consortium’s education and dissemination efforts avoid the potential pitfalls of awareness campaigns by staying on top of the science, respecting the patient’s wishes regarding her fertility, and examining the societal and ethical conflicts that surround fertility preservation.

Of course, the Consortium’s awareness campaign is a dynamic work in constant progress and growth.  The Oncofertility Consortium strives to engage trainees and fellows in the basic, clinical, and social sciences and humanities to become the next generation of fertility preservation experts.  Outreach to cancer support and advocacy communities continues to develop in order to spread the message of the Oncofertility Consortium through existing local and nationwide networks.  Resources such as publications, patient and provider testimonies, training videos, and conference presentations are regularly updated and added on the Oncofertility Consortium and MyOncofertility.org websites.  Through consistent vigilance and self-evaluation, the Oncofertility Consortium ensures that its awareness campaign remains effective and valuable to cancer patients and their families.

The Oncofertility Consortium finds new ways to prevent life-saving cancer treatments from destroying fertility through multiple avenues of scientific research. But this emerging field does not live in isolation and the consortium addresses larger issues in oncofertility through discussions with communicators, economists, historians, and religious and legal scholars. A compilation of these conversations results in a new book that is now available for sale. The book, entitled “Oncofertility: Ethical, Legal, Social, and Medical Perspectives,” can be found at Amazon.com. Over the next few weeks, we will give you a taste of some of the interesting ramifications in this cutting-edge field through our blog…so stay tuned!