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ChristianaCare Reduces Health Care Costs by $6.2 Million While Improving Care for Medicaid Patients
ChristianaCare’s Delaware Medicaid Partners Accountable Care Organization (ACO) has set the standard for innovative, high-quality care at lower cost for the State of Delaware’s Medicaid population. According to the most recent data available, ChristianaCare’s ACO reduced health care spending by $6.2 million in 2023 while improving care for nearly 30,000 Medicaid beneficiaries in Delaware, including approximately 8,000 children. “We’re demonstrating that population health works,” said Christine Donohue-Henry, M.D., MBA, chief population health officer, ChristianaCare. “Our neighbors count on us to take care of them — and we can improve their health while also helping the state reduce health care costs. We do this by delivering high-quality care that emphasizes preventive care and proactive management of health conditions, and by investing in our population health infrastructure. “In this way, we can keep people healthier and reduce the need for them to access the most expensive kinds of care, such as emergency care and hospitalization.” ChristianaCare’s Medicaid ACO includes more than 1,900 primary and specialty care clinicians who partner with patients and families to prevent illness, manage chronic diseases and help them achieve their health goals. The ACO makes it easy for adults and children to get the screenings and treatments they need, improving overall health. ChristianaCare’s Medicaid ACO is one of four authorized by the State of Delaware and the only one to voluntarily accept downside financial risk at its launch in 2021, which means that if ChristianaCare’s Medicaid ACO is not successful in reducing cost and improving care for a particular year, the ChristianaCare ACO is required to make a payment to the state. By sharing in both savings and losses, the ACO controls state health care costs while maintaining high-quality care. Bending the Cost Curve by Focusing on High-Quality Preventive Care Alongside financial savings, ChristianaCare’s Medicaid ACO has improved care quality and worked to reduce health disparities. By focusing on preventive care, the ACO has helped adults and children get the screenings and treatment they need, leading to better health outcomes and fewer unmet needs. Since launching in 2021, ChristianaCare’s ACO has met all required quality standards and consistently improved its performance each year on key measures like diabetes management, blood pressure control and breast cancer prevention. Year over year, breast cancer screenings have increased by 4%, while patients with high blood pressure (hypertension) have shown improvement in blood pressure control. Notably, healthy blood sugar levels (HbA1c less than 8%) have also improved in patients with diabetes by 7%. In collaboration with its Medicaid health plan partners, ChristianaCare primary care and imaging teams host patient-centered health and wellness day events to increase access to care, close quality gaps and improve the overall health of the communities they serve. These events help patients get preventive screenings and services, supporting the ACO’s goals of better care and health equity. The ACO’s success is driven by its focus on caring for entire families, including addressing the needs of pregnant mothers and supporting children and adults throughout their lives, according to Rose Kakoza, M.D., MPH, senior clinical network director, ChristianaCare Clinical Alliance. Key programs include enhanced maternity care to support mothers and infants, expanded mental health services and social support programs that address food and housing needs. By integrating clinical care with social support — such as help with food and housing — the ACO is working to break cycles of poor health across generations. This approach also has practical benefits. For example, the improved mental health of a parent strengthens the family environment, supporting children’s well-being and development. “By making significant investments in population health and addressing both medical needs and the social drivers of health, we’ve not only improved health outcomes but also more effectively managed costs for Delaware’s most vulnerable residents, helping to reduce state spending,” Kakoza said. About Delaware Medicaid Partners Delaware Medicaid Partners ACO, led by ChristianaCare, uses a family-centered approach to save money and improve care for Medicaid patients. By combining medical care with social support, the ACO addresses the unique needs of Medicaid patients, improving health and promoting equity. Care coordination is provided by ChristianaCare’s CareVio®, whose team of nurses, social workers, and pharmacists help patients with serious health conditions get the care they need. CareVio uses real-time data to prevent complications that could lead to unnecessary hospital stays or emergency visits. Through ongoing collaboration and innovation, Delaware Medicaid Partners ACO aims to set an example for other states working to improve care while managing costs.
New Trends and Treatments in Menopause Care
If you’re in your 40s and you menstruate, you may already be experiencing the effects of menopause: the point in life when your menstrual cycle stops permanently, which arrives for most people around the age of 50. This hormonal shift comes with numerous symptoms, some of which are manageable with at-home care and others—like intense mood swings, hot flashes or trouble sleeping—may need medical attention. Menopause has officially happened when a year has passed since your last period. The roughly two to eight years before that, when periods become irregular and fertility decreases, is known as perimenopause. Some people experience perimenopause in their 30s and some as late as their early 50s, but most reach perimenopause in their late 40s. Menopause is a naturally occurring life change, not a disease, and not everyone requires treatment for it. Many people seek medical help to deal with their symptoms. There are many new trends in menopause care, from hormones to drugs to supplements and beyond, and navigating them may feel overwhelming. What’s safest for managing side effects? Should I buy over-the-counter treatments or seek more involved care from a health care provider—or both? Read on for answers to these and other important questions on how best to treat menopause symptoms. Is hormone therapy right for me? Menopause happens to everyone who menstruates, and it’s important to bring up any symptoms of menopause as they occur at your annual primary care checkup. A gynecologist with special training or interest in the transition from ages 40 to 55 is an ideal specialist to seek additional care and treatment from, especially if you’d like to explore medical treatments like hormone therapy. Hormone therapy in the form of prescribed estrogen and progestin (both reproductive hormones that exist in the body naturally) has been used since the 1980s to treat the symptoms of menopause. A decline in estrogen is the culprit for many menopause symptoms, so adding estrogen back into the body through hormone therapy helps to diminish symptoms. Not all people who go through menopause need hormone therapy, but it has numerous positive side effects, including the lessening of some symptoms and lowering the risk of osteoporosis, a loss of bone density that can be exacerbated by natural estrogen decreasing over time as we age. These therapies can be administered in a cream, a patch, or even through low-dose birth control pills. However, hormone therapies can carry an increased risk of some cancers, including breast cancer. Non-hormonal, complementary medicine and lifestyle options Non-hormonal options to treat menopause symptoms are growing in popularity and represent an alternative to hormone therapies. Some of these include: Be sure to consult your provider before adding any new drugs or supplements to your daily routine. There are also many popular and effective options for treating menopause symptoms that come from Eastern and herbal medicine traditions. These include acupuncture, which has been shown to help with hot flashes and night sweats, as well as herbal supplements that often accompany treatment from a trained acupuncturist. A main downside to acupuncture can be cost, as the treatment is rarely covered by insurance. Eating mindfully and exercising regularly both also have proven benefits to treat menopause symptoms and to keep our bodies healthy more broadly as we age. This includes getting enough vitamin D and calcium through diet in order to keep bones strong as hormone levels change and to limit caffeine and alcohol consumption. Challenges in menopause care Despite the progress made in menopause treatment over the past years, there are still a few main challenges that you may face in menopause care. These include: Stigmas surrounding speaking openly about symptoms, especially sexual side effects like vaginal dryness and changes in libido that can affect intimacy. It’s important for you to feel empowered to discuss all symptoms with your provider. The increased availability of at-home tests, purchased online, for menopause and perimenopause. While these tests may be helpful in showing a snapshot of your hormone levels on a given day, more information is needed to diagnose menopause and perimenopause correctly, and at-home results can often be misinterpreted. It’s best to conduct these sorts of tests under the care of your provider, who can place them in the appropriate context. It can be hard to find the time needed to diagnose and treat menopause symptoms in a clinical setting, especially because it often takes time and communication outside of an office setting to ensure diagnosis and treat symptoms properly. Seeking out a provider who specializes in menopause care helps a great deal to expedite this process and get you the care you need. Not everyone experiences menopause the same way: for some people, symptoms are mild enough that at-home remedies will meet their needs. But for those with more intense symptoms—or anyone hoping for clinical support during this challenging time—working closely with a gynecologist will bring you relief and greater insight.
This Is a Critical Moment: Delaware Must Not Go Backward in Health Equity
The proposed Delaware House Bill 350 is well-intended but would have terrible consequences for Delaware’s most vulnerable populations. There is a better way. By LeRoi S. Hicks, M.D., MPH, FACP As a Black physician who has dedicated his 25-year career to understanding and addressing health equity, I am deeply concerned about Delaware’s proposed House Bill 350, which aims to address rising health care costs by establishing a body of political appointees that would oversee the budgets of Delaware’s nonprofit hospitals. While the goal of bending the cost curve in health care may be well-intentioned, this bill will have horrific consequences for Delaware’s most vulnerable populations, including Black people, Hispanic people and other groups that have been traditionally underserved in health care. We can and must work together to solve this problem and provide the right care, in the right place, at the right time. A tale of two cities To borrow a phrase from Charles Dickens, Delaware, like much of America, is a tale of two cities. The experience of life—including a healthy, safe environment and access to good-quality health care—is vastly different depending on where you live and your demographic background. In the city of Wilmington, for example, ZIP codes that are just a few miles apart represent more than 20 years difference in life expectancy. This is not OK—it’s a sign that we have serious structural problems in our communities that are causing harm to people and making their lives shorter. Importantly, chopping $360 million out of Delaware’s hospital budgets, as House Bill 350 would do in year one, is not going to help this problem—it’s going to make it worse. And in doing so, it would ultimately make health care in Delaware more expensive—not less expensive. The key to lowering health care costs is to improve quality, access and equity Data show that about 5% of patients in the United States account for more than 50% of all health care costs. These are primarily patients who have complex and poorly managed chronic conditions that cause them to end up in the most expensive care settings—hospitals, operating rooms, emergency departments. The key to driving down health care costs is to improve quality and equity so that everyone is supported in achieving their best health, and these high users of the most expensive kinds of care are better supported in managing their health conditions such as diabetes or heart failure in the appropriate way. In doing so, they prevent the need for costly emergency or “rescue” care. Let’s do more—not less—of what we already know works Health care is not a one-size-fits-all industry. The delivery of care for patients across a diverse population requires multiple interventions at the same time. These interventions are designed not only to improve the quality of care but also to close the gap in terms of health care disparities. That’s important, because when we improve care and outcomes for the most vulnerable populations, we tend to get things right for everyone. One type of intervention is about doing exactly the right things for a patient based on the evidence of what will help—and doing nothing extra that will cause harm or generate additional costs without providing additional benefit. An example of this might be ensuring that every patient who has a heart attack gets a certain drug called a beta blocker right after their heart attack, and they receive clear guidance and support on the actions they must take to reduce their risk of a second heart attack, such as regular exercise and good nutrition. The second type of intervention is for the highest-risk populations. These are patients who live in poor communities where there are no gyms and no grocery stores, and people commonly have challenges with transportation and lack of access to resources that makes it difficult—sometimes impossible—to follow their plan for follow-up care. They lack access to high-nutrient food that reduces their risk of a second heart attack. They also live in areas where there are fewer health care providers compared to more affluent areas. These interventions tend to be very intensive and do not generate income for health systems; in fact, they require significant non-reimbursed investment, but they are necessary to keep our most vulnerable patients healthy. The medical community has developed interventions for these populations that are proven to work. A local example is the Delaware Food Pharmacy program, which connects at-risk patients with healthy food and supports their ability to prepare it. The program helps patients improve their overall health and effectively manage their chronic conditions so they can prevent an adverse event that would put them back in the hospital or emergency department. When we work together, we succeed We’ve seen incredible examples of how this work can be successful right here in Delaware. Delaware was the first state in the country to eliminate a racial disparity in colorectal cancer, and we did this by expanding cancer services, including making it easy for vulnerable people to get preventive cancer care and screenings. This is an incredible success story that continues to this day, and it was the result of thoughtful, detail-oriented partnerships among the state and the health care community. The work continues as we collaborate to reduce the impact and mortality of breast cancer in our state. Unfortunately, these kinds of interventions are the first thing to go when health care budgets get slashed, because they don’t generate revenue and are not self-sustaining. These kinds of activities need to be funded—either through grants or an external funder, or by the hospitals and health care systems. By narrowly focusing on cost, we risk losing the progress we have made Delaware House Bill 350, as it’s proposed, would cause harm in two ways: First, it would compromise our ability to invest in these kinds of interventions that work. Second, it increases the risk that higher-cost health services and programs that are disproportionately needed by people in vulnerable communities could become no longer available in Delaware. In states where the government has intervened in the name of cutting costs, like Vermont and Massachusetts, we see the consequences–less quality and reduced equitable access to much-needed services. House Bill 350 will widen the gap between those who have means and those who are more vulnerable. These changes will lead to increased disease burden on these populations. They will end up in the emergency room more and hospitalized more, which is by far the most expensive kind of care. That’s not what anyone wants—and it’s the opposite of what this bill was intended to accomplish. At this moment, in Delaware, we have an opportunity to put our state on a sustainable path to better health for all Delawareans. House Bill 350 is not that path. However, the discussion that House Bill 350 has started is something that we can build on by bringing together the stakeholders we need to collaborate with to solve these complicated problems. That includes Delaware’s government and legislators, the hospitals and health centers, the insurance, pharmacy and medical device industries, and most importantly, patients and the doctors who care for them. LeRoi Hicks, M.D., is the campus executive director for ChristianaCare, Wilmington Campus.
Managing Menopause: Mind-Body Solutions for Hot Flashes, Sleep and Well-Being
In recognition of World Menopause Day, Baylor psychologist shares research on hypnotherapy's beneficial effects in relieving hot flashes (Image credit: Rana Hamid via Getty Images) The natural aging process of perimenopause and menopause can create a wide range of symptoms for women, with hot flashes and poor sleep being the most frequently reported – and most disruptive – symptoms. World Menopause Day is recognized on Oct. 18, and one Baylor University researcher has been on a 20-year mission to identify safe and effective options to hormone replacement therapy (HRT) to help women find relief from hot flashes and improve sleep and well-being during the menopause transition. Gary Elkins, Ph.D., professor of psychology and neuroscience and director of the Mind-Body Medicine Research Laboratory at Baylor University, is among the nation’s leading researchers on hypnotherapy and mind-body approaches, including continued funding by the National Institutes of Health (NIH) to evaluate the efficacy of a self-hypnosis intervention to reduce hot flashes and improve sleep, as well as other outcomes. “It is important to recognize that hot flashes are a natural part of menopause,” Elkins said. “They are not caused by stress or personality but are due to the decline in estrogen that occurs naturally with aging.” Perimenopause (the hormonal transition leading up to menopause) and menopause (the cessation of menstrual cycles) is the natural aging process marked by the decline in the reproductive hormone estrogen and progesterone in women and can last anywhere from seven to 20 years. Menopause usually begins around age 52 or can result from breast cancer treatment or hysterectomies. Although HRT remains the most effective treatment for hot flashes, it is not appropriate for everyone. A major NIH study found that HRT led to an increased risk of breast cancer and cardiovascular disease in some post-menopausal women and breast cancer survivors. Elkins’ research is aimed at giving women choices for their own healthcare, including alternatives such as hypnotherapy. “While hypnotherapy is not widely understood by many people, it can regulate hot flashes and improve sleep by managing how temperatures are perceived and regulated in the brain,” Elkins said. “Hypnotherapy is a mind-body therapy, similar to mindfulness and guided imagery, that involves the focus of attention, a relaxed state and therapeutic suggestions.” Elkins’ research on hot flashes and sleep and hypnotherapy has been clinically shown to reduce hot flashes by up to 80%, more effective than any other hot flash management tool available, with the exception of HRT. He also has found that hypnotherapy, as a mind-body intervention, can reduce hot flashes to a degree comparable to HRT, improve sleep quality by over 50% and reduce anxiety while increasing well-being. “Hypnotherapy involves daily practice of 15-minute hypnotic relaxation sessions that teach your brain to adapt to your body’s changing hormone level. Mental images for coolness and control are used to empower women to take control of the two most troublesome menopause symptoms – hot flashes and sleep,” Elkins said. Elkins offers the following suggestions for women to empower them and help them find relief from hot flashes, anxiety and interrupted sleep. Remember that hot flashes are a normal part of the perimenopausal/menopausal transition, and the effects a woman experiences are real. Talk to your doctor about options that may work for you. Everyone is an individual, and it is important to find what works best for you. A combined approach of mind-body hypnosis therapy along with low-dose medications can be helpful for some women. It can be helpful to keep a daily diary of your hot flashes to monitor them. Get good sleep. Poor sleep and night sweats can make hot flashes worse. Be knowledgeable about things that have not been shown to work, such as fans, cold packs and certain herbs. Seek support from family and friends. Elkins has developed the Evia from Mindset Health App to give women easy access to hypnotherapy for hot flashes. The app comes with a free trial that delivers evidence-based hypnotherapy intervention for women during the menopause transition and beyond.
The annual Healthy Georgia Report has been released by Augusta University’s Institute of Public and Preventive Health and it gives a snapshot of how Georgians stack up against not only neighboring states, but the country when it comes to a variety of health topics. This year’s report has added information on adult dental health, poor mental health, skin cancer and overdose deaths. Information on HIV risk behaviors, breast cancer screenings and colon cancer screenings have also returned. The report has been delivered to lawmakers, community leaders and researchers in Georgia to provide them with tangible figures on how Georgia is faring in numerous topics. The goal is to stimulate conversations about public health needs and, in turn, promote action, such as policy changes, greater community engagement and the appraisal of funds. Biplab Datta, PhD, assistant professor in the IPPH and the Department of Health Management, Economics and Policy, has collaborated with other IPPH faculty and staff to update the report. Datta has seen the impact this can have with state leaders. “They have a good appetite for data driven policy changes. I think this report actually helps them in that direction,” said Datta. “We tried to present data in a way that policy makers may find helpful in deciding on appropriate policy choices.” Overdose deaths is one of the new categories this year and is a hot topic nationwide. The report shows Georgia has the sixth lowest rate of overdose deaths in the country. Datta said that’s good, but the number is trending upwards and now should be the time to take steps to prevent it from getting worse. “We cannot be satisfied. We are doing a good job but need to be on our toes to prevent it from further ascending,” Datta said. Another category that Georgia is trending in a good direction is cigarette smoking. But the opposite is true for the obesity rate in the Peach State. The data shows Georgia has the 14th highest rate of obesity in all of the U.S. and the number is on the rise. The data also shows it’s related to household income and education. Adults who are below the federal poverty line and without a college degree are significantly more likely to be obese. Also, those in the 18-to-49 age group have a high rate of obesity compared to the national and regional average. “That is problematic because if someone is developing some cardiometabolic conditions in this age group, they will be at high risk for adverse cardiovascular events at an older age. So we need to focus on food habits, physical exercise, and other health promoting behaviors to prevent and control obesity,” Datta said. Another interesting topic is those in Georgia who have health insurance coverage. While coverage in adults is second lowest in the nation, there is a slight uptick in the number of people who have coverage from the past few years. The number is much better for children with health insurance. He points out that many state programs like PeachCare for Kids may account for the differences. Datta said one topic that definitely needs to be investigated more is cancer rates. He said we observe a low prevalence rate, despite the common perception and other data sources suggest a relatively higher incidence rate of cancer in Georgia. He believes we may be seeing lower survival rates that are not included in the survey. “I think we need more investigation into this particular issue,” said Datta. “Why are we seeing so low numbers of cancer prevalence when we know that cancer incidence rates are very high in Georgia?” The Healthy Georgia Report is the only report of its kind in the state Looking to know more or connect with Biplab Dhatta? Then let us help. Biplab is available to speak with media regarding this important topic. Simply click on his icon now to arrange an interview today.
Program addresses disparities in breast cancer between Black and white women ChristianaCare’s Helen F. Graham Cancer Center & Research Institute is partnering with Susan G. Komen®, the world’s leading breast cancer organization, in an expansion of Komen’s screening and diagnostics program to income-eligible residents of Delaware. Under the program, Delaware women who meet income qualifications will be able to access no-cost breast cancer screening mammograms and necessary diagnostic follow-up tests. Once approved by Susan G. Komen for care, they can select ChristianaCare for services. ChristianaCare is one of 20 health systems nationwide partnering with Susan G. Komen in the program, which seeks to reduce disparities in areas where the breast cancer mortality gap between Black and white women is the greatest. “The Graham Cancer Center is proud of its longstanding partnership with Susan G. Komen to bring breast cancer screenings to our community and to reduce disparities and save lives,” said Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “This new partnership with Komen is an innovative way that we are stronger together as we continue to reduce barriers to care and help more Delaware women access timely breast imaging and treatment,” he said. “The screening and diagnostics program is critical for individuals who may have been putting off their breast cancer screening due to concerns about cost,” said Nora Katurakes, RN, OCN, manager of the Graham Cancer Center’s Community Outreach & Education program. “Early detection saves lives, and cost should not be a barrier to accessing high-quality health care services for anyone in need. This program seeks to achieve health equity for all.” “Early detection saves lives, and cost should not be a barrier to accessing high-quality health care services for anyone in need,” said Nora Katurakes, RN, OCN, manager of Community Outreach and Education According to the Delaware Division of Public Health, breast cancer is the most common cancer diagnosed among women in Delaware, and Black women are disproportionately more affected by breast cancer than white and Hispanic women and have a higher mortality rate. In addition, Black women in Delaware have among the highest incidence rates in the U.S. of triple negative breast cancer, an aggressive form of the disease that is harder to treat and more likely to return. The Komen screening and diagnostics program is a service provided through the Komen Patient Care Center. Last year, Susan G. Komen provided nearly 3,000 screening and diagnostics services. Komen hopes to serve another 3,000 individuals in 2023. To be eligible for the program, individuals must have a current annual household income at or below 300% of the Federal Poverty Level. For one person that is $43,740. A two-person family must have a $59,160 household income to be eligible. The Tatiana Copeland Breast Center at the Helen F. Graham Cancer Center & Research Institute is one of the few facilities in the region devoted exclusively to breast care, diagnosis and treatment, and was the first center in the state to offer high-definition 3D mammography imaging. About Breast Cancer Screening Screening mammography tests are used to find breast cancer before it causes any warning signs or symptoms. Regular screening tests along with follow-up tests and treatment, if diagnosed, reduce an individual’s chance of dying from breast cancer. Mammography is a test that uses X-rays to create images of the breast. These images are called mammograms. A radiologist trained to read mammograms studies the images and looks for signs of breast cancer. A mammogram may show: No signs of breast cancer. A benign (not cancer) condition or other change that does not suggest cancer. An abnormal finding that needs follow-up tests to rule out cancer. Income eligible people seeking access to a breast cancer screening mammogram or diagnostic service should contact the Komen Breast Care Helpline at 1-877-465-6636 or helpline@komen.org to learn more. Individuals who would like more information about breast cancer screening in Delaware can also call ChristianaCare Community Health Outreach & Education at 302-623-4661.
ChristianaCare Names Its Breast Center: The Tatiana Copeland Breast Center
ChristianaCare has named its Breast Center The Tatiana Copeland Breast Center at the Helen F. Graham Cancer Center & Research Institute in recognition of Gerret and Tatiana Copeland’s generous financial support. The Copelands, local philanthropists and business entrepreneurs, provided a $1.2 million gift to the Graham Cancer Center in 2019 for breast cancer prevention and research for underrepresented women. Tatiana Copeland previously provided $800,000 to fund the purchase of two 3D mammography units. As a result of their philanthropic leadership, the Graham Cancer Center was one of the first facilities in the nation to offer 3D mammography. “ChristianaCare is deeply grateful to the Copelands for their generous support of the Helen F. Graham Cancer Center & Research Institute,” said Janice Nevin, M.D., MPH, ChristianaCare president and CEO. “They have made a tremendous difference in the lives of so many women in and around Delaware. We are deeply honored to name the Breast Center after Tatiana.” In a private event celebrating the naming, Dr. Nevin read a personal letter from President Joe Biden and First Lady Jill Biden that was sent to Tatiana about her support of the Breast Center. “Tatiana is a woman with extraordinary vision and a compassionate heart,” wrote President Biden. “As a breast cancer survivor, she has taken her pain and turned it into purpose, ensuring that all those who come in for testing at the Breast Center will receive extraordinary care. She has put lifesaving and life-altering care within the reach of those who need it most. And through it all, she has pushed for progress, fought for patients and kept hope alive.” “The Copelands share our commitment to providing our patients with the very best breast care, diagnosis and treatment,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “Their generous gifts have enabled women from Delaware and surrounding communities to receive expert, compassionate care right here at the Breast Center without ever having to leave the state. The Copelands have a way of discovering a need and then making the impossible possible.” “As longtime Graham Cancer Center supporters and as a breast cancer survivor myself who received wonderful treatment here, we are confident our investment in the Breast Center will continue to enable women to receive the same care that I did,” Tatiana Copeland said. “The atmosphere of the Breast Center is very comforting — like a nurturing hospital,” she said. “Everybody is very caring and attentive. Dr. Petrelli has created a team effort that is truly admirable. We hope our support inspires others to join us in the fight against cancer.” At The Tatiana Copeland Breast Center, patients are supported by an exceptional care team that includes radiologists, surgeons, radiation oncologists, genetic counselors and support staff. On-site capabilities include: 3D mammography. Digital mammography. Dedicated breast MRI. Breast ultrasound. Minimally invasive breast biopsies. Financial resources. Delaware’s first Center for Breast Reconstruction. According to the Delaware Division of Public Health, breast cancer is the most common cancer diagnosed among women in Delaware and the second leading cause of cancer death among women in the state after lung cancer. The Graham Cancer Center conducts community outreach to educate women about the importance of breast cancer detection and early prevention, including specially designed programs for underrepresented communities, including Black, Latinx and Asian women. “The Copelands’ ongoing generosity and support have helped us elevate the level of care at the Breast Center,” said Dia Williams, vice president of Philanthropy at ChristianaCare. “This gift will have an impact for generations to come.” To learn more about ChristianaCare’s philanthropy opportunities, visit https://christianacare.org/donors.
Findings point to potential new therapeutic targets for this highly aggressive, drug-resistant breast cancer subtype In breakthrough research at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute, scientists have discovered that a protein secreted by tumor cells can switch off the body’s natural defenses against triple negative breast cancer (TNBC). The study, led by Jennifer Sims-Mourtada, Ph.D., lead research scientist at the Cawley Center for Translational Cancer Research (CTCR), at the Graham Cancer Center, is reported in The Journal of Translational Medicine, available online. “What we found is that TNBC tumor cells can effectively shut down the body’s defense systems against the tumor by secreting a type of protein called IL-10,” Dr. Sims-Mourtada said. “The presence of this immune system protein forces the antibodies that would normally be created to attack the tumor to become non-reactive and not do what they are supposed to do.” The study was initiated in partnership with The Wistar Institute of Philadelphia, Pennsylvania, in collaboration with the late Raj “Shyam” Somasundaram, Ph.D., a cell biologist at the Melanoma Research Center. “Dr. Sims-Mourtada and her team have brought us tantalizingly close to understanding what drives the aggressive nature of triple negative breast cancer, a treatment-starved disease that disproportionately affects Delaware women,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “Their work underscores our belief that scientific collaborations such as this one between our Cawley CTCR clinicians and Wistar scientists can smooth the way for new findings to become effective therapies, especially for hard-to-treat and aggressive forms of cancer like TNBC.” Understanding the mechanism behind TNBC Delaware ranks highest in the nation for incidence of triple negative breast cancer. TNBC is an aggressive form that affects Black women at twice the rate of white women with poorer outcomes. Patients have higher rates of early recurrence than other breast cancer subtypes, particularly in the first five years after diagnosis. Currently there is no targeted therapy for TNBC. “One of our missions within the Cawley CTCR is to understand the mechanisms behind TNBC and find a treatment for it,” Dr. Sims-Mourtada said. “Our study sheds new light on what is prompting the body’s immune response to the cancer cells and offers clues to potential new therapeutic targets.” Normally it is the job of the B cells to regulate the immune response against foreign invaders like cancer. Among other jobs, they control inflammation at the site of an attack by releasing proteins including IL-10 to signal the defender cells to stand down. “Previously it was thought that the immune cells were the ones to express IL-10 to regulate themselves,” Dr. Sims-Mourtada said. “But our study shows that the tumor cells also release this protein, which means they are driving how the immune system behaves.” Within the tumor microenvironment, IgG4 is one of four antibody subclasses expressed and secreted by B cells. Whereas another type of antibody would urge the immune system to press on with the attack, activation of IgG4 signals the job is done. TNBC and activation of IgG4 “Our findings support that TNBC may create a tumor environment that supports activation of IgG4, and messaging from IL10 is triggering the switch,” Dr. Sims-Mourtada said. As previously reported with other cancers, such as melanoma, this study confirms that the presence of IgG4-positive B cells within the tumor associates with advanced disease increased recurrence and poor overall breast cancer survival. It is also possible that IL-10 expression by tumor cells may also be a cause of poor outcomes in TNBC, and this may be independent of IgG4+ B cells. “At this point, we don’t know what causes tumor cells to start secreting IL-10, but we know that B cell-tumor cell interactions are involved,” Dr. Sims-Mourtada said. “We still have to look at what is really going on in the B cell population to determine which subtypes of B cells are affected by this tumor crosstalk and why some forms of TNBC express IL-10 (the ones with poor outcomes) and others do not. “We think that the presence or absence of other immune cells in the microenvironment may affect how B cells interact with tumor cells to drive IL-10 expression,” she said. Resources for the study, including blood and tissue samples from consenting patients, were obtained through the Graham Cancer Center’s Tissue Procurement program. Interestingly, in a small subset of samples, the researchers found that IL-10 expression was significantly higher in Black patients than non-Hispanic white patients. These findings need to be confirmed in a larger more diverse population with different TNBC subtypes. Understanding tumor-infiltrating B cells “Our growing understanding of the contribution of IgG4+ cells to the immune microenvironment of TNBC and what drives IL-10 expression may reveal ways in which tumor-infiltrating B cells can contribute to tumor growth and provide new targets to increase the immune response to TNBC,” Dr. Sims-Mourtada said. As partners for more than a decade, Graham Cancer Center research clinicians and Wistar scientists collaborate across disciplines to translate cancer research into more effective therapies for patients everywhere. In addition to providing high-quality, viable tissue samples for Wistar research studies, Graham Cancer Center clinicians actively participate in concept development, sharing their unique understanding of the everyday patient experience.
Questions about colon cancer? Our experts are here to help with your coverage
Every year, National Colorectal (colon) Cancer Awareness Month is observed during the month of March in an effort to raise awareness of the importance for colon cancer screenings. The recognition offers health care providers the opportunity to educate the general public about a disease that can be preventable, but can sometimes be seen as difficult for patients to discuss with their doctors. In the spirit of education, one of Augusta University’s experts has provided some insight into the subject of colon cancer. Dr. Asha Nayak-Kapoor is an associate professor of medicine in the Division of Hematology/Oncology in the Department of Medicine at the Medical College of Georgia at Augusta University. Nayak is certified by the American Board of Internal Medicine in Hematology and Oncology Specialties. Q: What are the primary risk factors for colon cancer? “Risk factors for colon cancer include: being overweight or obese, not being physically active, certain types of diets, smoking, alcohol use, being older, a personal history of colorectal polyps or colorectal cancer, a personal history of inflammatory bowel disease, a family history of colorectal cancer or adenomatous polyps, having an inherited syndrome. Common symptoms of colorectal cancer include: bloody stool or rectal bleeding, an ongoing change in bowel habits (diarrhea, constipation, chance in stool consistency), abdominal pain or cramping, gas or persistent abdominal discomfort, you feel like your bowels are not voiding completely, weakness, fatigue, or unexplained weight loss.” Q: How can a person protect themselves from the risks of colon cancer? “Colon cancer is largely preventable if patients undergo screening tests, like a surveillance colonoscopy starting at 45 years or earlier depending on family history. Many lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer. Getting to and staying at a healthy weight may help lower your risk. A diet that's high in red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some luncheon meats) raises your colorectal cancer risk. Cooking meats at very high temperatures (frying, broiling, or grilling) creates chemicals that might raise your cancer risk. It’s not clear how much this might increase your colorectal cancer risk. Stop smoking. It is best not to drink alcohol. People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 50, or if more than one first-degree relative is affected.” Q: It sometimes seems that colon cancer prevention is aimed more towards men compared to women, but cancer.org lists the risks at 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. Is there a reason why perhaps a stigma about colon cancer affecting men more has been created? “According to focus group studies, it can be seen as a taboo topic that is uncomfortable to discuss, and it is not discussed as openly in public as prostate and breast cancer screenings. It can seem embarrassing or humiliating, and can be seen as distasteful dealing with prolonged bowel preparation.” Nayak is a member of several committees, including Onyx and Bayer Speaker Bureau for Nexavar, MCG Cancer Center Molecular Oncology Programme, and MCG Cancer Center Gastrointestinal Tumor Board Committee. If you are a journalist looking to know more about colorectal cancer and would like to speak with an expert for your stories, then let us help. Nayak is available to speak with media about this important subject. Simply click on her icon now to arrange an interview today.
ChristianaCare and The Wistar Institute advance partnership with new cancer research strategies
ChristianaCare’s Helen F. Graham Cancer Center & Research Institute is advancing its historic partnership with the Ellen and Ronald Caplan Cancer Center of The Wistar Institute in Philadelphia with three new research projects under way. The new research projects consist of a population health study targeting triple negative breast cancer. Other projects focus on a new therapeutic target for epithelial ovarian cancer, the most lethal gynecologic cancer in the developed world, and the development of “mini organs” derived from stem cells. Targeting triple negative breast cancer Delaware has one of the highest incidence rates of triple-negative breast cancer in the United States. This highly aggressive cancer has few treatment options, because the cells test negative for three known treatment targets – estrogen, progesterone and HER2 protein receptors. Working with patient data from the Graham Cancer Center, researchers are investigating potential contributing factors such as diet, alcohol use and genetic variants among women, and the effects of these on cancer metabolism. The team will also examine spatial relationships between cancer “hot spots”—geographic areas with a higher-than-expected prevalence—and modifiable risk factors. Key resources for the study are blood and tissue samples from the Graham Cancer Center’s Tissue Procurement Center and its statewide High-Risk Family Cancer Registry. The research team will be led by Director of Population Health Research at ChristianaCare Scott Siegel, Ph.D., and Lead Research Scientist Jennifer Sims Mourtada, Ph.D., at the Graham Cancer Center’s Cawley Center for Translational Cancer Research (CTCR). They will join Zachary Schug, Ph.D., at Wistar’s Molecular and Cellular Oncogenesis Program. Researching novel therapy for ovarian cancer The latest study supported by the Graham Cancer Center’s Tissue Procurement Program targets KAT6A expression as a novel therapy for ovarian cancer caused by a specific genetic mutation, called PP2R1A. Epithelial ovarian cancer is the most common form of ovarian cancer and the leading cause of gynecologic cancer deaths in the United States. Chemoresistance to currently available platinum-based drugs like cisplatin represents a major treatment challenge, as more than 50 percent of affected women ultimately relapse and die from this disease. Wistar’s Rugang Zhang, Ph.D., leader of the Immunology, Microenvironment and Metastases Program, is focused on developing novel therapeutics for subtypes of ovarian cancer that currently have no effective therapies and on improving the current standard of care. Dr. Zhang’s previous work suggests that KAT6A signaling plays a critical role in ovarian cancer progression. Targeting this signaling pathway could be an effective strategy for treating ovarian cancer. Working with Dr. Zhang on this project are Graham Cancer Center gynecologic oncologists Mark Cadungog, M.D., director of Robotic Surgery, and Sudeshna Chatterjee-Paer, M.D., and Cawley CTCR’s Stephanie Jean, M.D., director of Gynecologic Oncology Research. Also collaborating with the team is Wistar’s Alessandro Gardini, Ph.D., assistant professor in the Gene Expression & Regulation Program. ‘Mini organs’ offer hope for therapeutics Dr. Sims-Mourtada at the Cawley CTCR will lead a new program to culture organ-specific tissue from stem cells that could change the way diseases are studied and treated. These so called “mini organs” or “organoids” are three-dimensional tissue cultures grown in the lab that replicate the complexity and functions of a specific tissue or organ found in the body. Organoids offer scientists a better model for how drugs and other therapeutics might interact with a patient’s particular type of tumor, opening new avenues for precision medicine. “The ability to grow each patient’s tumor in a three-dimensional organoid along with our capability to create patient-derived xenograft or animal models as part of our PDX core, will allow us to fully capture the effects of genetic as well as gene altering behavioral and environmental influences that are lacking in current research models,” said Dr. Sims-Mourtada. “Our collaboration with Wistar to build these programs raises our clinical platform to the next level for studying new cancer biomarkers and treatments.” Advancing a Pioneering Partnership The Graham Cancer Center made history when it signed a first-of-its-kind agreement in 2011 with The Wistar Institute, pairing a National Cancer Institute, NCI-designated basic research institution with a community cancer center that is also an NCI Community Oncology Research Program (NCORP). “Our partnership with Wistar has attracted national recognition as a model of collaboration that leverages cutting-edge research to benefit cancer prevention and therapy statewide,” says Nicholas J. Petrelli, M.D., Bank of America endowed medical director of ChristianaCare’s Helen F. Graham Cancer Center and Research Institute. “With Wistar, our productive collaborations over the last decade continue to drive discovery research toward clinical trials to benefit patients here at the Graham Cancer Center and in communities everywhere.” “The Graham Center has been an ideal partner in our mission,” said Dario C. Altieri, M.D., Wistar president and CEO and director of the Ellen and Ronald Caplan Cancer Center. “Our scientists at Wistar have access to clinically-annotated primary patient specimens of the highest quality. As the majority of patients at the Graham Cancer Center are treatment naïve, this collaboration affords an opportunity to conduct unique, high impact mechanistic and correlative studies that will ultimately advance important scientific discoveries that hopefully will lead to better cancer therapies.”