April 2017 Newsletter

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April 2017
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department interview
Cynthia Owusu, MD, Associate Professor of Medicine at Case Western Reserve University and a renowned expert in geriatric oncology at University Hospitals Seidman Cancer Center, shares the updates on the $2.8 million research grant awarded by the National Institute (NIH) on Minority Health and Disparities she is leading, talks about the critical role of physical activity for oncology patients and importance of geriatric oncologists for the management of patients with cancer.

Recently you received a prominent grant for your work with older breast cancer patients. Can you update us on the progress of your research?

As a health outcomes researcher, I am interested in studying physical function in older women with breast cancer. Physician function is a measure of a patient's overall health, and one of the key measures used in oncology to determine whether an individual can tolerate the standard of care treatment. By measuring the physical function we can identify patients who are vulnerable, effectively intervene, and get them the treatment they need.
In 2010, I received a career development award from the Susan Komen Breast Cancer Foundation, funding my work to examine the functional status of older women with breast cancer from the time they were diagnosed to 12 months later. The study showed that within a year of diagnosis and treatment initiation 20 percent of women developed a significant decline in their physical function. Importantly, physical function is a marker of the ability to tolerate treatment, likelihood of hospitalizations, as well as a predictor of death within one year. We found that the patients who were more likely to develop a decline in their physical function were African Americans and women of low socioeconomic status.

After identifying this disparity, I applied to NIH to undertake a physical activity intervention study. We are currently enrolling patients into the 300+ participant study and aim to have an equal number of African Americans and Caucasian women with stage 1 to stage 3 cancers, who are within two years of having completed their treatment. In addition, we want to ensure half of the participants are of low socioeconomic status. It will be a randomized control trial; half of the women will be in the physical activity intervention group, while the other half will be in the control group. The key outcomes we are looking at are: physical function, body composition, as well as biomarkers that are thought to correlate with breast cancer prognosis.

Our patients had an input in the design of the exercise intervention. The first part of the study, which is already completed, consisted of individual interviews and focus group discussions, where we learned about our patients' attitudes, beliefs and preferences towards physical activity. We summarized and analyzed these findings, presented the data back to our patients and then further refined our proposed intervention using the insight we gathered. We learned that our participants wanted a group exercise activity and preferred morning sessions with a good variety of exercises.

Currently our participants meet at the Gathering Place, a center that offers support services to cancer patients and their families. We are collaborating with the Gathering Place to use their exercise facility and trainers who are certified in oncology. It is a very unique place and our patients benefit not only from the exercise programs but also take advantage of support groups, art and music programs.

When patients receive the cancer diagnosis, they tend to concentrate on the treatment, rather than physical activity. Given the toxicity of chemotherapy, what is the right time to start introducing physical activity to patients with cancer?

Physical activity should be talked about long before a patient is diagnosed with cancer. The obesity rates in the U.S. are close to 70 percent in adults. There is an abundance of evidence from observational studies suggesting that physical activity reduces the incidence of breast cancer and endometrial cancer. Therefore, we should concentrate on cancer prevention, rather than cancer treatment, educate our community on the benefits of physical activity and help acquire this beneficial habit.
When patients are diagnosed with cancer and discuss surgery, radiation or chemotherapy with the physician, we should be adding physical activity to their regimen as soon as possible. In addition, the only answer to cancer related fatigue is exercise. Patients who pull themselves together to exercise despite feeling weak and tired, notice that the more they exercise the less fatigued they become.

What role does patient education play in engaging African Americans as well as low socioeconomic status patients? Did mistrust play a role in the successful enrollment of African American patients in your study?

We have found in our original observational study that low socioeconomic status was associated with poor physical function and low physical activity among older women. Socioeconomic status involves education and household income level; patients with high school level education or less are more likely to have poor physical function; this also holds true for patients with median household income of $35,000 or less.

During our study we noticed that it is easier for us to enroll low-income and African American women because the study is free of charge. Through our interaction with participants we have found that access to the gym plays the key role in the frequency of physical activity. Many African American women cannot afford to go to the gym, and even if they have the interest, they do not have the time as they have to go to work to provide for their families. In addition, because the study is non-interventional, the African American population does not exhibit mistrust and is more willing to enroll in our study than the Caucasian population.

In your opinion, what is the key to getting older breast cancer patients to survivorship?

Cancer is really a disease of older adults, as they are more likely to be diagnosed with a new cancer compared to young people. In addition, older patients are more likely to die from cancer than younger patients. Yet, older patients are undertreated and are not included in clinical trials. We end up translating the result from the trials we did with younger patients to the older population that is biologically very different. As a geriatric oncologist I believe that in order to get older patients to survivorship we need to offer them the benefits of newer treatments with the prerequisite to improve older patients' overall health and physical function to ensure they can tolerate treatment. Currently the National Comprehensive Cancer Network (NCCN) recommends that an older adult with cancer should go through a comprehensive geriatric assessment that examines a number of domains including physical function, cognitive status, nutritional status, etc. When the comprehensive evaluation is completed, it is possible to identify hidden weak areas and intervene before starting the treatment. Oncologists should also be aware of the fact that older adults have diminished and declining reserves, so a comprehensive evaluation is needed to determine a balance between the risk of treatment and its benefits. Finally, I believe there is a pressing need for more geriatrics oncologists to be trained so that they can better serve the needs of older adults with cancer.

How do you see your work developing over the next few years?

We would like to initiate a similar exercise intervention study concentrating on older patients as they are going through cancer treatment. We want to be able to use our intervention to prevent the process of functional decline by taking it into the active treatment phase. We are also looking to develop an exercise intervention that is pragmatic, easy to implement and replicate within the communities nationally, so that it can be effectively disseminated. Ultimately we want to secure evidence-based data that allows exercise to become a prescription. In the long run, it would be ideal to have a mini gym for patients in our cancer center, so that when patients come to get their chemotherapy, they can also exercise.
department news report
Division of Cardiovascular Medicine

Sanjay Rajagopalan, MD, was awarded a $350,000 grant for his project titled "Air Pollution and Hypertension: Vascular Mechanisms" from the National Institute of Health (NIH). Previously Dr. Rajagopalan demonstrated that short-term exposure to PM2.5 results in elevation of blood pressure in humans as well as in an animal model. This pro-hypertensive response may be a key mechanism linking PM2.5 to an increase in both short and long-term cardiovascular risk, highlighting its importance for further investigation.




Division of Gastroenterology & Liver Disease
Fabio Cominelli, MD
Fabio Cominelli, MD, PhD, received 2017 Distinguished Research Award from Case Western Reserve University. Dr. Cominelli is an international expert in the inflammatory bowel disease and led significant efforts in the understanding of Crohn's disease; the award recognizes Dr. Cominelli's contributions to positioning Case Western Reserve University as a premier research institution. Dr. Cominelli received $10,000 to further advance his research and continue his groundbreaking discoveries.




Division of Geriatrics & Palliative Care
Gowrishankar Gnanasekaran, MD, and Taryn Lee, MD, will lead the division as new Interim Chiefs.






Division of Hematology & Oncology
Shigemi Matsuyama, PhD, received a three-year grant for his project titled "High-Throughput Screening of Novel Cyto-Protective Small Chemicals Protecting Retinal Cells from Bax and Bak" from the Gund-Harrington Scholar program. The initiative focuses on accelerating the translation of research findings in retinal degenerative diseases with the ultimate goal of developing new therapies to improve and restore vision.

Jennifer Eads, MD, Neal Meropol, MD,
and Sandford Markowitz, MD, PhD, received a grant from the Stand Up 2 Cancer Foundation to study the inhibition of glutamine metabolism in colorectal cancer.The Case Western Reserve University team, led by John Wang, PhD (co-Leader of the Case Comprehensive Cancer Center GI Cancer Genetics Program), joins a "Dream Team" with investigators at Cornell, Yale, and Sloan Kettering on this $12M award. The work in Cleveland will build upon Dr. Eads and Dr. Meropol's ongoing clinical trial of glutaminase inhibition, that is being conducted at UH Seidman Cancer Center through the Case GI SPORE program (led by Dr. Markowitz).




Division of Infectious Diseases & HIV Medicine
Robert Bonomo, MD, became the Director of the new Case VA Center for Antimicrobial Resistance and Epidemiology. Dr. Bonomo will lead the efforts in fighting the antibiotic resistant bacteria, focusing on projects ranging from basic science to drug discovery and novel therapeutic treatment.



Federico Perez, MD, was elected to the School of Medicine Academy of Scholars Educators of the Case Western Reserve University. This award is a recognition of Dr. Perez's significant contributions to excellence and innovation in medical education and strong commitment to continue his outstanding work.




Division of Rheumatology



Charles Malemud, PhD, will lead the talk on "Articular Carilage as Target in Autoimmune Disorders" at the Synergy International Conference titled "Autoimmunity 2017: Where Are We Now?"
department conferences & events
Research Day 2017
Date: Friday, May 12
Time: 12:00 - 3:30 p.m.
Location: Wolstein Research Building & Lobby
Register: Click here
Abstract Submission Deadline: Monday, May 1
Submit Your Abstract: Click here

Spring Dinner 2017
Date: Friday, May 26
Time: 6:00 - 9:00 p.m.
Location: Tinkham Veale University Center Ballroom, 2nd Floor, Room 234
Register: Click here

Master Clinical Educator 2017
Deadline: Monday, May 15
Nominate a faculty member: Click here

Grand Rounds
Time: 12:00 - 1:00 p.m.
Location: Kulas Auditorium
May 2
"Does Chronic Hemodialysis Really Work?" by Thomas Hostetter, MD
May 9
"Redesigning the End-of-Life Experience with a Specific Focus on Population Health and Community-Driven Innovation" by Kenneth Rosenfeld, MD
May 16
"ACA" by JB Silvers, PhD
May 23
"Success of UH Cleveland Medical Center PRIDE Program" by Gowrishankar Gnanasekaran, MD
department development & diversity
How Women Decide: Book Discussion with the Author
Date: Wednesday, May 10
Time: 6:00 - 8:00 p.m.
Location: Tinkham Veale University Center, Suite 248
Speaker: Therese Huston
Sponsor: Flora Stone Mather Center for Women; Women Faculty School of Medicine; Cleveland Clinic Women's Professional Staff Association
Audience: Free and open to all campus members interested in what strategies spark the best choices for women (Hors d'oeuvres and networking)

Creating LGBT Quality and E-Quality of Health Care Services in the Workplace
Date: Thursday, May 11
Time: 7:00 - 8:30 a.m.
Location: Wolstein Auditorium
Speaker: Henry Ng, MD, Assistant Dean for Admissions, Clinical Director, PRIDE Clinic, MetroHealth Medical Center
Sponsor: Case Western Reserve University School of Medicine
Audience: All faculty and trainees interested in improving their knowledge of healthcare equity and in creating a culture of inclusion and diversity (Continental breakfast provided)
RSVP: This e-mail address is being protected from spambots. You need JavaScript enabled to view it (RSVP by May 4th)

Mentoring and Sponsorship for Mentors
Date: Tuesday, May 16
Time: 12:00 - 1:00 p.m.
Location: Frohring Auditorium, BRB 105
Sponsor: School of Medicine Office of Faculty Affairs
Audience: Faculty wishing to become better mentors and improve visibility and career advancement for their mentees

Spring Dinner: Women Faculty School of Medicine
Date: Wednesday, May 24
Time: 5:00 p.m.
Location: Allen Memorial Library
Speaker: Ambereen Sleemi, MD, FACOG
Sponsor: Women Faculty School of Medicine
Audience: All faculty, especially women faculty, wishing to network with other women faculty throughout the School of Medicine and its affiliates and to meet School of Medicine leadership, and hear a presentation from a nationally recognized woman physician leader