A Day in the Life of the Woodruff Enterprise

by Megan Carlson, Guest Blogger for the Oncofertility Consortium

My name is Megan, and I will be your guest blogger for today.

I’m a journalism graduate student who had the great pleasure of shadowing Dr. Teresa Woodruff Tuesday as part of my health and science reporting practicum.

As soon as I arrived at 8 AM, Dr. Woodruff and I hit the ground running– greeting and checking in with the entire staff, from the program managers to the researchers already diligently at work in the lab.  This daily process is part of Dr. Woodruff’s efforts to maintain open communication with the entire lab.

We next traipsed over to a large conference room, where a group of 15 mostly-female scientists were already gathered with coffee and notepads ready for the weekly staff meeting, called the “R3 Data Club.”  Dr. Woodruff insists the entire team (who are located in several different locations) meet via web conference each week to discuss developments in the lab and present their research.  This is another explicit effort by Dr. Woodruff to ensure her team acts on the same page and immerses younger team members in the mission and work of the lab.

While some of the nitty-gritty details flew over my head (my knowledge of science could probably fill a thimble), I was impressed by the engagement of the staff as they listened to and questioned postdoctoral fellow, Pam Monahan, PhD’s, presentation on interactions among signaling pathways leading to potential disruptions in follicle development (itself, a possible contributing factor topolycystic ovary syndrome).

After the meeting, we rushed off to a government relations teleconference where a group, including Sharon Green, executive director of the Women’s Health Research Institute (WHRI) and Nadia Johnson, a program manager, planned the Chicago and Springfield Women’s Health Week celebrations.  Dr. Woodruff quickly switched her hat from hard-nosed scientist, asking pointed questions to her researchers about gene signaling pathways, to politically-savvy division chief, strategizing about how to best promote gender-specific scientific research to legislators, scientists and other interest groups.

I spent the remainder of the day shadowing Dr. Woodruff as she discussed efforts to increase enrollment in the Illinois Women’s Health Registry–an initiative that seeks to overcome the lack of sex-specific scientific research by connecting female research participants and researchers— and then following program managers and researchers who introduced me to the work of the Oncofertility Consortium.

The day was an educational whirlwind.  I absorbed a flood of scientific information about infertility, fertility preservation, and the reproductive system (augmented by time I spent Monday in the reproductive fertility clinic of Dr. Mary Ellen Pavone, who works closely with Dr. Woodruff).  I also witnessed the behind-the-scenes political work, research, and coordination that function to produce the newest innovations in fertility treatment and women’s health.  It was fascinating to see all the cogs in the machine interact together to create these beneficial and progressive outcomes.

OMG2013 Cancer Summit Follow-Up: Talking Fertility

Many of you may already know about the widely popular organization, Stupid Cancer, but for those of you who are new to our blog, Stupid Cancer is the nation’s largest support community for young adult survivors of cancer. They support a global network of survivors, caregivers, providers and advocates to ensure that no young adult is unaware of the age-appropriate resources available to them. Stupid Cancer empowers young adults affected by cancer through innovative and award-winning programs and services, including Stupid Cancer Happy Hours, the Stupid Cancer Show, and the annual OMG! Cancer Summit for Young Adults.

The annual OMG! Cancer Summit for Young Adults is the premier oncology conference and social networking event for the young adult cancer movement. A pivotal healthcare event, OMG! is one of the largest gatherings of young adult patients, survivors, caregivers, professionals and advocates in the world. The event inspires thousands to get organized, build community and unite as one to drive change. In April, Stupid Cancer hosted its sixth OMG! Cancer Summit in Las Vegas, NV, and attracted over 600 attendees. As one would expect, Stupid Cancer makes the weekend-long event not only informative but also FUN, with events such as an ice cream social, and Stupid Cancer pub trivia.

Over the last few years, members of the Oncofertility Consortium have attended OMG! to help young survivors understand their fertility options and provide resources and pertinent information to young adults whose fertility may have been affected by their cancer treatment. This year, Consortium member, Laxmi Kondapalli, MD, MSCE, moderated two breakout sessions entitled, “Fertility: Rights & Options With, Through, And Beyond Care.” Dr. Kondapalli served as the clinical expert and reproductive health specialist alongside Alice Crisci, advocate and Founder of Fertile Action, and Jennifer Rockman, ovarian cancer survivor.

The framework of their session revolved around all the different routes to parenthood available to young cancer survivors, including banking eggs, embryos, ovarian tissue, and semen; using a gestational carrier; and pursuing adoption. Dr. Kondapalli stated that the overwhelming theme that evolved from the sessions was the lack of information presented to newly diagnosed cancer patients regarding the potential impact on their fertility. Attendees were eager to learn about the different tests available to gauge fertility, such as ovarian reserve testing for women and semen analysis for men. They also wanted to learn more about their fertility options following cancer treatment and, specifically, how their treatment may have impacted their fertility. Participants left armed with information and resources, and even Dr. Kondapalli’s personal email address, should they need her clinical expertise at any point in their fertility journey.

To learn more about your fertility options, visit SaveMyFertility.org, or contact us at 1.866.708.FERT (3378).

May is National Skin Cancer Awareness Month

May is National Skin Cancer Awareness Month and this time of year brings skin, our body’s largest organ, into focus as the  weather warms up and people spend more time outside in the sun. Skin cancer is sometimes referred to as a “lifestyle disease” because its occurrence can be dramatically reduced through behavior modification, education, and early detection. Learning more about the disease and how it can be easily prevented and/or treated if found early, will hopefully inspire our readers to make some positive lifestyle changes and reduce their risk of skin cancer.

What is skin cancer exactly? Skin cancer is defined as the uncontrolled growth of abnormal skin cells. It occurs when unrepaired DNA damage to skin cells, most often caused by ultraviolet radiation from sunshine or tanning beds, triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors. Cancer of the skin is often divided into two categories: non-melanoma and melanoma. The American Cancer Society estimates there are well over 1 million unreported cases of non-melanoma (basal cell or squamous cell) cancers annually in the United States. Melanoma, the more-serious form of skin cancer, is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old. Furthermore, women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer, and up until age 40, significantly more women than men develop melanoma.

Current statistics show that skin cancer is the most common type of cancer in the United States, as well as some other countries, and unfortunately the incident rate continues to rise.  Although the frequency of melanoma and non-melanoma skin cancer diagnoses indicate that this disease remains a significant health concern, it’s important to note that, research and public awareness campaigns are promoting prevention and early detection of skin cancer. Staying informed with the latest news on prevention and screening are important steps in reducing your risk of developing skin cancer. Here are a few tips from the Skin Cancer Foundation for reducing your skin cancer risk:

  • Seek the shade, especially between 10 AM and 4 PM.
  • Do not burn.
  • Avoid tanning and UV tanning booths.
  • Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
  • Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
  • Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside.
  • Reapply every two hours or immediately after swimming or excessive sweating.
  • Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
  • Examine your skin head-to-toe every month.
  • See your physician every year for a professional skin exam.

Q&A With Clarisa Gracia: A Follow Up to “Case Studies in Oncofertility”

In April, the Oncofertility Consortium hosted a Virtual Grand Rounds with Clarisa Gracia, MD, MSCE, entitled, “Case Studies in Oncofertility,” in which she discussed five theoretical young cancer patients and how oncofertility could be incorporated into their medical care. These patients included pediatric girls, adolescents, and young adult women with a variety of diseases including lymphoma, leukemia, ovarian, breast, and bone cancer. Dr. Gracia’s talk not only included the clinical recommendations for each of these patients, but also the scientific evidence that supported such suggestions. If you didn’t watch the live Rounds you can view a recording of the talk, with an option to obtain CMEs from the recording.  Following are some of the questions and answers posed to Dr. Gracia that she was able to answer after the Rounds ended.

 

Question: Are there differences in the impact of chemotherapeutics on primordial vs. growing follicles?

Answer: There is destruction of both growing follicles and primordial follicles. The article, “How do chemotherapeutic agents damage the ovary?” by Morgan, Anderson, Gourley, Wallace, and Spears provides a good review of some of the evidence. Briefly, chemotherapeutics may affect a variety of cell types within the ovary. A reduction in primordial follicles may be caused by direct damage by chemotherapeutics. However, chemotherapy also damages growing follicles, which increases recruitment of the primordial pool of follicles to begin growing. This increased recruitment also means that chemotherapy may indirectly decrease primordial follicle numbers.

 

Question: How do you build relationships with oncologist to ensure they are willing to start the fertility preservation discussion with patients?

Answer: It is important to reach out to oncologists and oncology nurses and let them know that you provide fertility preservation services for their patients. Provide flyers, letters, and make an effort to give presentations to oncology groups in your area. Please refer to the oncofertility website for more information.

 

Question: Are there functional analyses after uterine or whole body irradiation to determine if the uterus will be able to carry a healthy growing fetus to term?

Answer: The studies have focused only on uterine size and blood flow post radiation exposure, not functional in vitro studies.

 

Question: What do you/your patients consider a good number of oocytes? If a patient doesn’t get enough after one stimulation protocol, will you allow them to delay treatment in order to do another?

Answer: That is a difficult question and depends on a patient’s age and egg quality. We generally think getting more eggs is better than few eggs, but there is no guarantee of pregnancy even with many eggs. Ideally, a patient gets at least 10 oocytes in an egg retrieval. It is reasonable to pursue another stimulation cycle only if the oncologist feels comfortable delaying therapy.

 

Join the next Oncofertility Virtual Grand Rounds in June on the topics, “Sexuality After Cancer” with Dr. Kamaljeet Murthy and “Hormonal impact of cancer treatment and management of hormonal symptoms in female cancer survivors” with Dr. Catherine Stika.

2013 National Infertility Awareness Week: April 21st-27th

Did you know that this week is National Infertility Awareness Week (NIAW)? NIAW is a movement that began in 1989 to raise awareness about the disease of infertility and encourage the public to understand their reproductive health. RESOLVE: The National Infertility Association founded this movement to:

  • Ensure that people trying to conceive know the guidelines for seeing a specialist when they are trying to conceive.
  • Enhance public understanding that infertility is a disease that needs and deserves attention.
  • Educate legislators about the disease of infertility and how it impacts people in their state.

Infertility is a disease of the reproductive system that impairs the body’s ability to perform this basic function.  Pediatric and young adult cancer patients undergoing treatment are at high risk of having impaired fertility as a result of their disease or its treatment. Reproductive medicine provides a number of sophisticated options for assisted reproductive technologies (ART) such as egg, embryo, and sperm banking, ovarian tissue cryopreservation, and third party reproduction options (egg, sperm, and embryo donation, and gestational carrier/surrogacy) which help many people achieve parenthood.

Studies show that fertility preservation can bring hope to a patient undergoing cancer treatment, that there will be options and renewed life beyond their cancer diagnosis. Studies also indicate that individuals who do not receive fertility preservation information or treatment options following a cancer diagnosis are more likely to experience profound emotional consequences once they began to navigate family planning. While adoption and third party options make parenting possible, it does not always eradicate the feeling of loss one can suffer as a result of impaired fertility.

In support of NIAW, we ask you to help us and join the movement to increase and protect access to all family building options, and to help make fertility preservation counseling part of comprehensive cancer care in pediatric and young adult patients. For more information about your fertility options, please visit www.SaveMyFertility.org.

 

TOMORROW: Virtual Grand Rounds with Dana Gossett, MD

Tomorrow, April 25th, we are excited to be hosting Dana Gossett, MD, Chief of the Division of Obstetrics & Gynecology at Northwestern University’s Feinberg School of Medicine, for our Virtual Grand Rounds (VGR) at 2 PM CDT. Please take note that her presentation entitled, “Management of Abnormal Uterine Bleeding During Cancer Treatment,” will be taking place at 2 PM CDT as opposed to our regular morning VGR schedule. Dr. Gossett’s research projects focus on delivery of health care and patient outcomes and she has co-authored several publications analyzing the clinical outcomes of patients with gynecologic cancers.  Click HERE to watch Dr. Gossett present her Virtual Grand Rounds, tomorrow at 2 PM CDT.

Our LIVE Virtual Grand Rounds provide researchers, clinicians, and others the opportunity to hear emerging research findings in cancer and fertility from anywhere across the globe and participate through a live video chat. Virtual and in-person attendees to the rounds can receive free continuing medical education (CME) credits by following the instructions HERE.  Participants can also receive free CME’s by watching a recorded version of the Virtual Grand Rounds which can be found on our website HERE. To read more about receiving education credits from the Oncofertility Consortium, read about the Oncofertility Online program.

New Research Suggests No Link Between Ovarian Cancer and Fertility Drugs

Since the 1990s, researchers have published conflicting results about the connection between cancer risk and fertility drugs. As a result, there has been a lingering concern among women that using fertility drugs may increase their risk for later developing hormone receptor positive cancers. Hormone receptor positive tumors consist of cells that express receptors for certain hormones such as estrogen or progesterone, but are most commonly known as estrogen receptor tumors. These types of tumors depend on the presence of estrogen in order to grow and spread throughout the body, making the risk for gynecologic cancers cause for concern in some women undergoing IVF treatment.

Fertility drugs have come under scrutiny because they stimulate hyper-ovulation, meaning they cause a woman’s body to produce more eggs. They have been linked to certain gynecologic cancers, such as breast and ovarian cancer. One reason research published in the 1990s may have suggested a link between fertility drugs and cancer risk, is due to the drugs that were being prescribed 20 years ago. Researchers have also blamed the mixed nature of the findings on the studies’ relatively short length, or on including women who have not given birth as they are known to have an increased risk of some cancers.

New research, however, suggests that using fertility drugs does not have an impact on your risk for developing ovarian cancer down the line. Lead author of the study and clinical fellow in the Division of Reproductive Endocrinology at the Mayo Clinic in Rochester, Minnesota, Dr. Albert Asante and his colleagues gathered medical information on 1900 women from an ongoing ovarian cancer study at the Mayo Clinic. The researchers compared 1,028 women with ovarian cancer to 872 women of similar age who did not have cancer. As reported in Fertility and Sterility, approximately 24 percent of the women who did not have ovarian cancer reported having used fertility drugs, while roughly 17 percent of women who had ovarian cancer had used fertility drugs.

The researchers took into account factors that can influence the risk for ovarian cancer, such as age and use of the birth control pill, and found no difference in cancer rates between the groups. Dr. Asante looked specifically at whether women in the study who reported being infertile- whether or not they had taken fertility drugs – had a greater chance of developing ovarian cancer, and found no added risk. He said one explanation for the result is that most of the women in his study had infertility issues, but eventually became pregnant. According to Dr. Albert Asante, “One important message [from this study] is women who need to use fertility drugs to get pregnant should not worry about using these fertility drugs.”

To read more about this new study, click HERE for the full text. To learn more about your reproductive options when faced with a cancer diagnosis, please visit www.SaveMyFertility.org.

 

2013 National Minority Cancer Awareness Week, April 15th-21st

Next week in the United States is designated as National Minority Cancer Awareness Week. While cancer affects men and women of every age, race, ethnic background, and economic class, the disease has a disproportionately severe impact on minorities and the economically disadvantaged. National Minority Cancer Awareness Week promotes increased awareness of prevention and treatment among those segments of the populations that are at greater risk of developing cancer. The week’s emphasis gives clinicians, healthcare professionals, and researchers an opportunity to focus on high-risk populations and to develop creative approaches to battling cancer problems unique to these communities.

The Centers for Disease Control and Prevention (CDC) report that cancer death rates for women are highest among African Americans, followed by Caucasians, Hispanics, and Asian/Pacific Islanders. Cancer is the leading cause of death for female Asian Americans since 1980. Colon cancer continues to kill more African Americans than Caucasians for reasons that are not completely understood. According to the Intercultural Cancer Council, this is due in large part to delayed diagnosis coupled with less than appropriate patient care. In addition, individuals of all ethnic backgrounds who are poor, lack health insurance, or otherwise have inadequate access to quality cancer treatment experience higher cancer incidence, higher mortality rates, and lower survival rates. As a result, members of these populations may put off the expense of seeing a doctor until they are very sick and are diagnosed at a later stage, and thus have a poorer chance of survival.

Key Statistics about Cancer in Minorities from the American Cancer Society:

  • African-Americans have the highest death rate and shortest survival following diagnosis of any racial and ethnic group in the U.S. for most cancers.
  • It is estimated that about 169,000 new cancer cases will be diagnosed among African-Americans by year’s end. Approximately 66,000 African-Americans will die from cancer.
  • The most commonly diagnosed cancers among African-American men are prostate, lung and colorectal.
  • Among African-American women, the most common cancers are breast, lung and colorectal. 
• Nearly 99,000 new cancer cases in Hispanic men and women were diagnosed in 2009. Among Hispanics, there were 29,000 cancer deaths.
  • Prostate cancer is the most commonly diagnosed cancer in Hispanic men, while lung cancer accounts for the largest percentage of deaths in that group.
  • Breast cancer is both the most commonly diagnosed cancer and the leading cause of cancer death among Hispanic women.
  • Among Asian Indian and Pakistani women, breast cancer is the most diagnosed cancer and the leading cause of cancer death. (National Cancer Institute)

For more information about how cancer affects minority populations, please visit the Intercultural Cancer Council or click HERE.

Tomorrow’s Virtual Grand Rounds: Case Studies in Oncofertility

Tomorrow, April 11th, we are excited to be hosting Clarisa Gracia, MD, MSCE, Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania, for our Virtual Grand Rounds at 10 AM CDT. Her presentation entitled, Case Studies in Oncofertility, will analze indviduals who have undergone fertility preservation following a cancer diagnosis, and the developmental factors related to their decision. Dr. Gracia is also a contributing author in the Oncofertility book series, lending her clinical expertise and experience to the subfield, and she is an integral member of the Oncofertility Consortium. Click here to watch Dr. Gracia present her Virtual Grand Rounds, tomorrow at 10 AM CDT.

For those who are not aware of these special rounds, they are live videoconferences with experts in the fields of reproduction, cancer, and oncofertility. The rounds provide researchers, clinicians, and others the opportunity to hear emerging research findings from anywhere across the globe and participate through a live video chat. Virtual and in-person attendees to the rounds can also receive free continuing medical education (CME) credits by following the instructions here. Within one week of the rounds, a video recording will be posted on the Oncofertility Consortium website and CME credits will be available to online viewers. To read more about receiving education credits from the Oncofertility Consortium, read about the Oncofertility Online program.

California Bill AB 912: Mandated Fertility Preservation Coverage

Wouldn’t it be great if insurance companies were required to provide coverage for medically necessary expenses for standard fertility preservation services when a medical treatment may directly or indirectly cause infertility to an enrollee or insured? California Assemblywoman Sharon Quirk-Silva, thinks so too and recently introduced CA bill AB 912, which proposes to do just that.  On behalf of the Oncofertility Consortium, we support bill AB 912, and we encourage others to learn more about the positive implications of this bill as well.

AB 912 provides for insurance and HMO coverage of fertility preservation services when future fertility will be put at-risk by treatment of a disease such as cancer, sickle-cell anemia or lupus. While the numbers of people who will need the services is likely to be small, for those people facing a life-altering disease which could require chemotherapy or radiation or both with a high potential for causing infertility after treatment, this coverage could make all the difference. People who have the option for these services score much higher on quality of life measures after treatment. Probably more importantly is that by providing this coverage, the patient is able to keep focus on what would be the best therapy for their disease, without having to worry about the effect on their future fertility.

Mandating insurance coverage for fertility preservation will transform the quality of life for cancer survivors. Fortunately, the relatively small numbers of people in their reproductive years who will need this care will only minimally impact insurance premiums when spread out amongst all insured persons. Without insurance coverage, patients may forgo fertility preservation, which may result in compounded costs for the survivor years later when trying to build a family.

While the cost to preserve fertility is relatively modest, most patients are unable to afford this unexpected out-of-pocket expense, especially at a time when they may be facing other significant cost pressures surrounding the treatment. A short time frame between diagnosis and treatment that does not allow time to seek appeal when insurance companies deny fertility preservation coverage further complicates this.

As survivorship for a typical cancer improves, the ability to bear children after therapy is an understandable and expected concern. For some patients, cancer treatment options may be decided based on its risk of fertility loss rather than fully focusing on its effectiveness to cure the cancer. AB 912 will provide fertility preservation insurance coverage for patients undergoing treatments known to compromise fertility. This is an equitable and cost-effective solution to a foreseeable harm from medically necessary treatment. Please support bill AB 912, ensuring fertility preservation coverage for those who may lose their reproductive potential through no fault of their own.

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