A pair of grants from the American Cancer Society will support two University of Rochester Medical Center researchers to improve patient-centered care and communication; and to gain a better understanding of mutations that occur in the early stages of liver cancer.
For more than 65 years the Society has funded all spectrums of cancer investigations, from the training of health professionals, to new treatment development, to end-of-life care. This cycle funds ongoing projects beginning July 1, 2013.
Robert Gramling, M.D., DSc., associate professor of Family Medicine, Public Health Sciences, and Nursing, and at the URMC division of Palliative Care, received $1.3 million to study palliative care consultations among people with advanced cancer.
He leads a four-year project that plans to enroll 300 patients while they are in the hospital. The goal is to investigate how patients, families, and palliative care doctors and nurses work together to craft treatment plans that match the patient’s values and options.
Much of the research will take place at Strong Memorial Hospital and Highland Hospital at URMC, although other local hospitals may also be involved. The Strong and Highland palliative care units each has earned special certifications of excellence from the Joint Commission, the nation’s main accrediting body in health care.
“The professionals we’re observing are excellent communicators and we want to better understand what it looks like in this setting,” Gramling said. “There may be a hundred right ways to have these types of discussions, and it’s important to recognize that what works for some people may not work for everyone.”
For example, he said, some patients want to know many details and others are comfortable with less information. Often, the palliative care team, patients and families feel their way along as the conversation progresses. The best communicators learn to adapt to different situations and to “be fully present along the way,” Gramling said.
“Information exchange is only one piece,” he added. “Expressions of compassion, acknowledging people’s worries, and partnering in the process of decision-making also are part of the equation.”
Finding ways to improve patient-centered care is a national priority in an era of health-care reform. In the context of palliative care, good communication might be the single most important element for achieving this goal, Gramling said.
Key collaborating investigators include Sally Norton, Ph.D., R.N., of the UR School of Nursing, and Ronald Epstein, M.D., and Kevin Fiscella, M.D., M.P.H.*, of the URMC Department of Family Medicine. Collaborators from Duke University, University of Arizona, University of Wisconsin, Boston University, and University of Colorado will also participate.
*Dr. Fiscella received American Cancer Society research grant in 2008 for $1,060,000.
Aram Hezel, M.D., associate professor of Hematology/Oncology and vice chief of the division of Hematology/Oncology at the James P. Wilmot Cancer Center at URMC, is the leader of the second four-year project.
He received $720,000 to use a recently developed mouse model as a tool to further investigate Intrahepatic Cholangiocarcinoma (IHCC), a primary cancer of the liver with poor outcomes. Using the model and samples of liver tumors from patients, Hezel’s research team is studying two important and poorly understood aspects of this disease:
1) The early stages of this cancer type, which they hope will lead to an early detection plan;
2) The energy and recycling pathways activated in IHCC tumors and other cancers, which could eventually lead to promising new treatments.
Hezel and his team created a model in 2012 to study two of the most common gene mutations in humans – activating mutations of Kras and deletion of p53 oncogenes. (An oncogene is a modified gene that increases the malignancy of a tumor cell. Oncogenes are usually involved in early stages of cancer development, increasing the chance that a normal cell will transition into a tumor cell.)
“The tool we developed last year uses a new model of an uncommon liver tumor that previously we did not have good ways to study,” Hezel said. “Going forward, though, it’s also important to recognize that IHCC disease shares a number of similarities with our other main research focus -- pancreatic cancer. On a genetic and molecular level, we’ve been able to extend what we’ve learned about pancreatic cancer to liver cancer, and similarly use what we learn about liver cancer to better understand pancreatic. The ACS award will allow us to continue this important work.”
IHCC is thought to arise from the bile ducts, a series of branching tubes within the liver that delivers bile to the gallbladder and small intestine. The disease is diagnosed in approximately 6,000 people each year. Its occurrence is rising, which may be due in part to better diagnostic tests. IHCC tumors tend to be aggressive and prone to metastasis at an early stage; the biology of this cancer has eluded scientists for many years.
Both Hezel’s and Gramling’s grants were awarded based on merit and following an expert peer-review process.
“The greater Rochester community generously supports the American Cancer Society’s Relay For Life, Making Strides Against Breast Cancer, and distinguished events,” said Matthew Flanigan, regional vice president for the American Cancer Society’s Lakes Region. “In turn, the money raised makes these cancer research grants possible. The University of Rochester researchers are among the best and the brightest in the country. Their awards will allow them to focus on new discoveries to help achieve the Society’s mission to save lives and end suffering from cancer.”
For more information about the American Cancer Society Research Program, please visit cancer.org/research.