Saturday, January 1, 2011
Memorial Sloan Kettering and The City College of New York Work have fostered a collaborations aimed at reducing cancer health disparities.
Good marriages are made in heaven — and elsewhere. The seeds of what is now known as the Partnership for Cancer Research, Training, and Community Outreach — a collaboration between Memorial Sloan Kettering and The City College of New York (CCNY) that seeks to reduce the unequal burden of cancer through research, training, and community outreach — were sown in 2002 on a train ride between Washington DC and New York City.
Psychologist Bruce D. Rapkin — then a member of Memorial Sloan Kettering’s Department of Psychiatry and Behavioral Sciences — and CCNY molecular biologist Karen Hubbard were returning from a meeting at the National Cancer Institute (NCI). “We’d learned that the ideas we had for a partnership would lend themselves to an NCI U56 planning grant,” Dr. Hubbard recalled. “So we pretty much hashed everything out on the train and filled in the gaps from there. In the beginning, Bruce and I worked on pulling people from both our institutions together. He called us yentas — there was a lot of matchmaking going on!” [Dr. Rapkin is now a professor and head of the Division of Community Collaboration and Implementation in the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine.]
Funded by the NCI U56 grant — which supports planning and feasibility studies for the development of interdisciplinary programs — the partnership bore fruit, and in 2009 the NCI awarded Memorial Sloan Kettering and CCNY a five-year $15.9 million grant under the NCI’s U54 program. The U54 program was developed to create partnerships between NCI-designated cancer centers and minority-serving institutions. This second grant expands the CCNY-MSKCC Partnership, building upon already-existing collaborations between the institutions and helping to develop and support new ones.
“The partnership draws on the strengths of both institutions and there are a variety of components,” said Tim A. Ahles. Dr. Ahles is Director of Memorial Sloan Kettering’s Neurocognitive Research Laboratory and the U54 Principal Investigator (PI) at the Center. (Dr. Hubbard is the Partnership’s PI at CCNY.) “The first is to stimulate long-term basic science and clinical research collaborations between Memorial Sloan Kettering and City College investigators. Our other key goals are to establish training and educational opportunities for minority students and community outreach programs to help reduce and ultimately eliminate cancer health disparities. There are a number of projects that were part of the original grant, and with the U54 we now have money to provide pilot funding for new investigators and partners, and to launch new and different projects.”
“In trying to understand cancer health disparities and develop ways to effectively deliver care to racially and ethnically diverse and underserved communities, one needs to explore everything from socioeconomic variables, to barriers to accessing good care, to more basic science questions,” said Dr. Ahles.
Currently, the Partnership’s research program funds one full research project, eight pilot projects, four pre-pilot studies, as well as two projects awarded to the Partnership through the American Recovery and Reinvestment Act. Research extends from basic science investigations in the areas of cell biology and immunology to clinical research into health disparities.
Collaborations are established in different ways. Some investigators have known each other for years and have worked informally together. In other cases “we may get a call from a CCNY or an Memorial Sloan Kettering investigator saying, ’I have a project I think would be a good fit for the Partnership — can you help match me up with someone?’” explained Memorial Sloan Kettering’s Alexandra R. Berk, the Partnership’s Clinical Research Manager.
Memorial Sloan Kettering immunologist Derek B. Sant’Angelo has had an informal research and mentoring relationship with CCNY immunologist Mark Pezzano for about a decade. “We have common research interests and we were starting to develop a deeper collaboration when the U54 grant allowed us to apply for money to support our project and formalize the relationship,” said Dr. Sant’Angelo. The project led by Drs. Pezzano and Sant’Angelo involves basic research that may someday contribute to treatment strategies for enhancing immune system reconstitution after bone marrow transplantation in cancer patients.
In addition to their roles as co-PIs, with oversight responsibility for the entire Partnership, Drs. Ahles and Hubbard are joint investigators on their own Partnership project studying
chemotherapy-related cognitive decline. “I study the cognitive effects of chemotherapy, primarily in breast cancer patients,” said Dr. Ahles. “There’s evidence that systemic chemotherapy can cause cognitive difficulties in a subset of these patients. The nagging question has been, How does chemotherapy — which really doesn’t get into the brain — have anything to do with cognitive function? One hypothesis is that chemotherapy may be accelerating the aging process.” As chemotherapeutic agents damage the DNA of tumor cells, killing them, they also damage the DNA of healthy cells and may influence a variety of other biological processes that contribute to aging.
Karen Hubbard studies cell aging.
“I’m very excited about the work I’m doing with Tim because it allows me to put some of the ideas I’ve had about aging at the cellular level into a real organism,” said Dr. Hubbard. As part of the study, rats are given chemotherapy drugs commonly used to treat breast cancer and then, using behavioral tests, their ability to learn is measured. Dr. Hubbard then looks at the expression of certain biomarkers that are related to aging in the brain and cell death.Back to top
“Part of Tomorrow is the Next Generation”
The Partnership also works to bolster the number of students who have not historically been represented in the upper echelons of cancer scientists and clinicians. ET CURE (Emerging Technologies Continuing Umbrella of Research Experiences) is one aspect of this effort. The program — sponsored by the Diversity Training Branch within the Center to Reduce Cancer Health Disparities at the National Cancer Institute — is a paid, mentored training program providing hands-on research and didactic training with enhanced educational opportunities in emerging technologies for undergraduates from underserved populations. At Memorial Sloan Kettering, the program provides specialized training in molecular imaging based on nanotechnology. “Education is the most important heritage that we can convey to the next generation,” said Hedvig Hricak, Chair of Memorial Sloan Kettering’s Department of Radiology, under whose auspices ET CURE falls. “But you’re going to help patients not only with cutting-edge clinical care today, but through the research that will contribute to better therapies tomorrow. And part of that tomorrow is the next generation.”
One of two students who participated in ET CURE in 2010 at Memorial Sloan Kettering was Nicole M. Burton. Ms. Burton is currently enrolled in a postbaccalaureate premedical program at CCNY. During her time in ET CURE, Ms. Burton worked in the laboratory of Memorial Sloan Kettering’s Michelle S. Bradbury, a clinician-scientist specializing in translational nanotechnology and molecular imaging. Dr. Bradbury’s research focuses on the design and development of tiny substances called nanoparticles that can be used to detect and treat both primary tumors and metastatic cancer. One of Dr. Bradbury’s specific interests has been the development of a new generation of nanoparticles called C dots.
“I’ve always wanted to be a doctor, but my interests range from biology, to chemistry, to physics, and when I saw there was a nanotechnology program at Memorial Sloan Kettering, I said, ’Wow! Let me see what this is all about!’” Ms. Burton recalled.
“I was impressed with Nicole because she actually wrote in her application that she wanted to work on C dots,” added Dr. Bradbury. Trained by Dr. Bradbury’s research scientist, Miriam Benezra, PhD, Ms. Burton contributed to the translational research that is beginning to take C dots from the laboratory into clinical use.
“A program like ET CURE is essential, as it exposes students to state-of-the-art technologies and their application in a translational setting,” said Dr. Bradbury. “It says to students, ’You’ve learned a lot in school, but here is how you can put it together in practice to really impact patients’ outcomes.’” And Ms. Burton observed that the experience exposed her to career possibilities of which she might otherwise have been unaware. “My time in Dr. Bradbury’s lab has shown me how I can be both a physician and a scientist.”
“Part of the educational mission is to educate ourselves,” Dr. Ahles noted. “And so we have several seminars throughout the year.” In 2009, the partnership hosted a symposium on aging and cancer at the New York Academy of Sciences, which included speakers from Duke University and the Albert Einstein College of Medicine, as well as Memorial Sloan Kettering and CCNY. A 2010 symposium called Cancer Health Disparities: A Translational Approach featured presenters including Harold Freeman, President and Founder of the Ralph Lauren Center for Cancer Care and Prevention, in Harlem, and Professor Erica Lubetkin of CCNY’s Sophie Davis School of Biomedical Education.
Dr. Hubbard has also developed an undergraduate cancer biology course at CCNY at which Memorial Sloan Kettering faculty are invited to lecture. Derek Sant’Angelo has been among them. “It’s a great class,” he said. “The students are enthusiastic, engaged, and ask terrific questions. I look forward to teaching them every year.”Back to top
Involvement with Communities
Created in 2005, Memorial Sloan Kettering’s Summer Exposure Program for High School Students is an outgrowth of the CCNY-MSKCC Partnership and is now its own standalone program, part of an institutional effort to nurture interests in medicine and science careers for minority students. It was developed by Memorial Sloan Kettering gynecologic oncologist Carol L. Brown as part of her role as Director of the Center’s Office of Diversity Programs in Clinical Care, Research, and Training; Dr. Brown has since assumed co-leadership with CCNY psychologist Tiffany Floyd, PhD, of the Partnership Community Outreach Program (PCOP). This component of the Partnership is dedicated to helping communities take advantage of community-academic collaborations to improve public health. “We provide support and resources for investigators at both institutions interested in engaging in research that involves the community,” explained Dr. Brown. “So we have investigators who are looking at issues related to cancer health disparities, smoking cessation, cancer prevention, attitudes toward cancer screening — all types of research that involve community partners.”
PCOP acts as a liaison to put researchers in touch with community groups that have an interest in facilitating a particular research project, as well as fostering what is known as community-based participatory research. “The idea of community-based participatory research is that you work with a group of community members to learn from them what’s important to their community, what issues they want addressed, and pair them with investigators to engage in that research,” said Dr. Brown.
PCOP has developed a community action group called Community United to Reduce the Burden of Cancer (CURB-C) that consists of stakeholders including the American Cancer Society of Upper Manhattan, representatives from institutions that provide cancer care such as Harlem Hospital, Metropolitan Hospital, and the Ralph Lauren Center for Cancer Care and Prevention, and community-based organizations and individuals with interests in cancer health disparities. CURB-C identified cancer prevention and screening as areas that demand attention, with a specific focus on colorectal cancer.
“We identified colorectal cancer as an issue because the incidence and mortality rates for this cancer are much higher in the Harlem and Upper Manhattan communities than elsewhere in the city, and the rates of colonoscopy are much lower,” said Dr. Brown. A PCOP/CURB-C project in the planning stages is an education and awareness program in which members of a community will give presentations to fellow community members to encourage screening colonoscopies as well as to put them in contact with medical resources that provide the procedure at little or no cost. “We want people to know that these resources exist, but also educate them about what a colonoscopy actually is,” Dr. Brown said, “and one of the central ideas is having someone who has had a colonoscopy do the presentation.”
In September 2010, CURB-C sponsored a youth health and activity fair at a public school playground in Harlem. Called “Step Up, Harlem,” it was a way of “getting the message out about the relationship between healthy eating and exercise and the prevention of cancer,” explained Dr. Brown. Participating organizations including the Dance Theater of Harlem, Pathmark supermarkets, the New York Road Runners Club, Ballet Hispanico, Modell’s Sporting Goods, and the American Cancer Society offered demonstration classes, samples of healthy snacks, games, and crafts, and other activities. “It was very successful and we hope to repeat it,” said Dr. Brown.
“I’ve seen and participated in the evolution of the Partnership over eight years,” Dr. Hubbard concluded. “It’s been an extraordinary experience. Right now, Tim Ahles and I and others are in the process of thinking about what the Partnership will look like and where we want to be in the next several years. It’s wonderful to be able to look forward to a meaningful and productive future.”Back to top