National Cancer Institute NCI Cancer Bulletin: A Trusted Source for Cancer Research News
December 1, 2009 • Volume 6 / Number 23

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COMMENTARY

Due to the complexity of cancer research, cross-disciplinary teams, such as this, will become more prevalent in oncology.

Director's Update: Success Against Cancer Depends on a Vibrant, Well-trained Workforce

Having been an academic researcher and cancer surgeon for many years, working with a great many outstanding students, training is a topic that has always been a priority for me on a personal level, and one that I am deeply concerned about when it comes to the future of cancer research. Read more > >

Inside NCI: A Conversation with Dr. Jonathan Wiest about Cancer Research Training

Watch the Inside NCI Video

The Director of NCI's Center for Cancer Training discusses some of the challenges and opportunities of training the next generation of cancer researchers. Read more > >




 

NEWS

Academia and Beyond: Supporting the Biomedical Workforce of the Future

Reports show that staffing at colleges and universities has shifted somewhat from the employment of full-time, tenure-track faculty towards the creation of more full-time and part-time nontenure-track positions. But, said Dr. Jonathan Wiest, director of NCI's Center for Cancer Training, the trend may not be permanent, and in fact, there are plenty of opportunities on the horizon that point to a positive outlook for those who are in or considering entering the field. The key, he says, is a change in culture. Read more > >

HIGHLIGHTS

UPDATES

  • Cancer.gov Update

    • NCI's Recovery Act Web Site Features New Content
  • Notes

    • Understanding NCI Teleconference: Cancer as a Model for Research
    • Childhood Cancer Survivors Art Exhibit Opens in Israel
    • New State Cancer Legislative Database Newsletter and Fact Sheet Now Available

The NCI Cancer Bulletin is produced by the National Cancer Institute (NCI), which was established in 1937. Through basic, clinical, and population-based biomedical research and training, NCI conducts and supports research that will lead to a future in which we can identify the environmental and genetic causes of cancer, prevent cancer before it starts, identify cancers that do develop at the earliest stage, eliminate cancers through innovative treatment interventions, and biologically control those cancers that we cannot eliminate so they become manageable, chronic diseases.

For more information about cancer, call 1-800-4-CANCER or visit http://www.cancer.gov.

NCI Cancer Bulletin staff can be reached at ncicancerbulletin@mail.nih.gov.

Special Issue: Cancer Research Training

Director's Update: Success Against Cancer Depends on a Vibrant, Well-trained Workforce

Dr. John E. Niederhuber Dr. John E. Niederhuber

A 2007 study commissioned by the American Society of Clinical Oncology projected that the demand for oncologists—made particularly acute, in large part, by an aging population—will increase 48 percent by the year 2020. Yet, the study noted that the number of oncologists available to manage the increasing number of cancer patients will rise during those years by just 14 percent.

Statistics like these, stark as they may be, come into even clearer relief whenever I visit academic medical centers across the United States. In addition to concerns about clinical care in the years ahead, these outstanding places of scientific discovery also face the continual need to entice new minds to the field of cancer research.

When the outstanding young doctoral and postdoctoral students working in our labs look to their futures, in academia or in the private sector, they are not sure they see opportunities for jobs as assistant professors. Of even greater concern, they do not see with any degree of confidence a nation aggressively supporting opportunities for a successful career, appropriately supported by adequate grant funds. Having been an academic researcher and cancer surgeon for many years, working with a great many outstanding students, training is a topic that has always been a priority for me on a personal level, and one that I am deeply concerned about when it comes to the future of cancer research.

Clearly, our success against cancer—in basic research, in clinical and translational research, in treatment, and in survivorship care—depends on a vibrant, well-trained workforce. It is, however, a workforce that must meet the wide-ranging and unique needs of its patients. Those include, according to a 2008 Institute of Medicine report, “the wide range of treatment options employed, the number of medical specialists involved in treating each cancer patient, the ongoing medical monitoring required after acute treatment is complete, the psycho-social effects, the important role of family caregivers, and the frequency of clinical trials and experimental treatments.”

Understanding that cancer research and cancer care demand detailed and somewhat different solutions to complex problems, it gives me great pride to report just how strongly NCI continues to respond to the training challenge.

As you will read in this issue, NCI is pursuing multiple fronts: from investigator-initiated grants that bring research teams together from different cities and countries; to institutional grants that are meant to encourage team science on the NIH campus; and through exciting initiatives, such as the Integrative Cancer Biology Program and the Physical Sciences in Oncology Initiative.

Importantly, our traditional grant mechanisms continue to provide strong support for new, young investigators. For example, in the 2009 fiscal year, using appropriated funds supplemented by American Recovery and Reinvestment Act (ARRA) dollars, NCI’s R01 program added 209 new investigators. A cluster of other mechanisms support training and career development in basic biomedical and behavioral cancer research; clinical and patient-oriented research; and cancer prevention, control, behavioral, and population sciences. Another exciting program, the Howard Temin Award, bridges the transition from a mentored research environment to an independent research career.

Despite budget challenges in recent years, NCI has maintained a robust commitment to training, sustaining both extramural and intramural programs at consistent levels. In addition, training was a top priority for use of the funds NCI received under ARRA, particularly in an effort to help new academic researchers at the assistant professor level establish their university careers. Our ARRA spending included more than $76 million in faculty start-up packages made available to research universities; $20 million for programs to help build diversity in the cancer research workforce; and more than $14 million for cancer research training, career development, education, and re-entry into biomedical and behavior research careers.

We must maintain our commitment to training, not only to the next generation of researchers, but also to the continued professional education of established researchers who strive to stay current with technologies and techniques that are rapidly opening new vistas of scientific opportunity. The goals of the cancer research community will change in this new era, when patients will be genomically characterized and their treatments will be based on unique characteristics of individual patients and their cancers.

I hope that this special issue of the NCI Cancer Bulletin will help you connect with the multitude of resources that are available at NCI and from other important organizations.

Dr. John E. Niederhuber
Director, National Cancer Institute

Special Issue: Cancer Research Training

Inside NCI: A Conversation with Dr. Jonathan Wiest about Cancer Research Training

The director of NCI's Center for Cancer Training discusses some of the challenges and opportunities of training the next generation of cancer researchers.

  

Special Issue: Cancer Research Training

Academia and Beyond: Supporting the Biomedical Workforce of the Future

A recent report on the state of the higher education workforce in the United States underlines a trend that began decades ago: staffing at colleges and universities has shifted somewhat from the employment of full-time, tenure-track faculty toward the creation of more full-time and part-time positions that are not on a tenure track. A cost-saving measure, the new strategy allows universities to lower their overhead while mitigating hikes in tuition.

Employment of biomedical-sector Ph.D.s is greatest in academia, followed by industry and government, but the trends show that industry jobs are increasing at the fastest rate. Source: Education and Employment of Biological and Medical Scientists 2009: Data from National Surveys, FASEB Office of Public Affairs. Employment of biomedical-sector Ph.D.s is greatest in academia, followed by industry and government, but the trends show that industry jobs are increasing at the fastest rate. Source: Education and Employment of Biological and Medical Scientists 2009: Data from National Surveys, Howard H. Garrison and Kimberly McGuire, FASEB Office of Public Affairs. Click to Enlarge.

The effect on those who aspire to enter the field of cancer research—a path that invariably goes through academia and, in most cases, remains there—may be discouraging. But, said Dr. Jonathan Wiest, director of NCI’s Center for Cancer Training, the trend may not be a permanent shift, and there are plenty of opportunities on the horizon that point to a positive outlook for those who are in or considering entering the field. The key, he says, is a change in culture.

“Historically, the typical career track has been graduate student to postdoc to tenure-track investigator, with around 15 percent or so of trainees going on to tenure-track positions,” he said. “Tenured and tenure-track professors at universities are role models. If they’re telling the people who work for them that ‘success’ lies in tenure-track positions, and the culture of the institution supports that—which makes sense, since the research enterprise is supported by and large by highly skilled graduate students and postdocs—then people will be missing out on other avenues that help move science forward.”

There are advantages to an academic research career, Dr. Wiest pointed out, including the ability to pursue whatever project or interest a scientist can gain funding to pursue. But creativity and curiosity are also rewarded in the private sector, he added.

“There’s a stigma with industrial science. People believe that it’s driven by product with little intellectual freedom. That may be true in some cases, but in some settings it is quite different, and the change is spreading toward one that encourages more creativity and collaboration,” including publishing research results in academic journals, he said.

There’s also a growing need for people who have a scientific background to work in non-experimentalist roles. “To be a good science administrator, you have to tackle some of the same issues and questions that you would in a laboratory setting,” he said. Other related fields include technology transfer, science writing and editing, and policy.

The direction of cancer research itself is changing, explained Dr. Wiest. It is becoming a team-focused enterprise including researchers from a variety of backgrounds, from chemistry and physics to computer science, mathematics, epidemiology, and the allied health fields, such as psychology and social work.

Extramural grant mechanisms provided by NCI to encourage team-based science include the Cancer Education and Career Development Program and the Cancer Education Grants Program (the and awards). These grants are awarded directly to educational institutions to allow them to develop curricula and training programs for predoctoral and postdoctoral researchers interested in highly interdisciplinary and collaborative cancer research. The K12 grant is another mechanism. And NCI’s Integrative Cancer Biology Program, as well as the newly funded Physical Science-Oncology Centers, offer additional options for training.

According to data from the National Science Foundation, which were highlighted in a recent report from the Federation of American Societies for Experimental Biology, the bulk of biomedical jobs are still in academia, followed by industry and government. Jobs in industry appear to be increasing, while jobs in academia have decreased slightly.

“It’s hard to predict what is going to happen in the next 3 to 5 years,” said Dr. Wiest. “The job outlook will undoubtedly be affected by what happens with our country’s overall economic recovery.” However, he said, several other funding mechanisms at NCI can help those who want to stay in academic research to prepare for the future.

One such mechanism is the , the Transition Career Development Award, which helps researchers who are still in the mentored stage of their career take “protected” time to develop and receive support for independent projects in cancer prevention, control, and population sciences.

Another mechanism, the Howard Temin Pathway to Independence Award in Cancer Research (), allows non-tenured research faculty to compete more effectively for funding. The grants begin with 1 to 2 years of support while a trainee is still in a mentored postdoctoral position, followed by up to 3 years of independent support once the new researcher has obtained a faculty position at an extramural research institution. Though the transition from mentored to independent support is dependent on a review of an individual’s research training and career development accomplishments, this grant provides a hiring institution with some assurance that a new researcher’s work will be funded. 

On the institutional side of the hiring equation, the American Recovery and Reinvestment Act of 2009 has allowed NCI to expand the P30 program, which provided funding for the creation of new physician-scientist career positions at universities and NCI-designated cancer centers. “We had numerous applications for those grants,” noted Dr. Wiest, “which tells us that universities are interested in hiring new faculty, if they can just find the resources to make it happen.”

Even with expanded access to grants, resources, and new career positions, the number of available academic positions cannot come close to matching the number of newly minted research scientists, explained Dr. Roger Chalkley, senior associate dean of the Office of Biomedical Research Education and Training at Vanderbilt University School of Medicine. “If nobody is coming out of the hiring pipeline, no one is going in. So you have this workforce of trainees, waiting.”

Dr. Wiest believes it is only a matter of time before vacancies arise to be filled by new tenure-track investigators. But he also suggests that a broader perspective on opportunities in cancer research is a big-picture solution to this problem.

“People need to keep in mind there are lots of professions and career tracks for trainees to pursue,” he said, “all of which are important for the scientific enterprise and moving the science forward.”

Special Issue: Cancer Research Training

Intramural Training at NCI: A Wealth of Opportunities

People from all over the world and at various stages of their academic careers—high-school students through senior-level scientists—come to NCI to take advantage of a wealth of training opportunities. The knowledge and skills they acquire prepare them to undertake new challenges at NCI and beyond.

On-campus (intramural) research training at NCI is offered through the Cancer Prevention Fellowship Program (CPFP), as well as specific programs administered by the Center for Cancer Research (CCR) and the Division of Cancer Epidemiology and Genetics (DCEG).

People at all stages of their education and careers come to NCI for training, the greatest numbers as visiting fellows from foreign countries, summer interns, post-doctoral researchers, and postbaccalaureate trainees. People at all stages of their education and careers come to NCI for training. Data from NCI's Center for Cancer Training. Click to Enlarge.

The directors of these programs meet regularly through the Center for Cancer Training, which administers the CPFP and all extramural training through its Cancer Training Branch, so they can coordinate efforts and maintain the quality of the experience for those who come to NCI. A shared goal is to ensure each trainee is progressing scientifically. The directors also work to provide fellows with the tools necessary to identify and meet their long-term career goals.

"The training programs at NCI and NIH have really blossomed in recent years," said Dr. Jackie Lavigne, who has been involved with these training programs and currently directs DCEG's Office of Education. She notes that for many trainees, coming to NCI is the best way to learn about the full breadth of research opportunities.

Together, the programs span the cancer biomedical research spectrum, from population-based studies to investigational therapeutics. The largest program is run by CCR, which offers fellowships for training in the basic and translational sciences, as well as in the clinic. About a thousand fellows are enrolled in the program. For clinical fellows, CCR offers a place to visit patients and conduct lab work all under the same roof. "It is rare that a researcher gets to do both clinical and basic research on essentially the same research problem. That is what CCR is set up for," said former CCR Clinical Fellow Dr. Sunil Sudarshan, a urologist and now assistant professor at the University of Texas Health Science Center.

Another former fellow, Dr. Patrick Johnston, said that CCR provides an "environment where one can be mentored and further develop one's medical, scientific, and analytical skills to make fundamental discoveries that ultimately will benefit patients around the globe." Dr. Johnston is now a professor in the Centre for Cancer Research and Cell Biology and dean of the School of Medicine and Dentistry at the Queen's University in Belfast, Northern Ireland.

To focus specifically on the challenges of cancer prevention, NCI established the CPFP. CPFP offers postdoctoral fellowship opportunities for individuals from diverse disciplines, including behavioral, laboratory, and clinical sciences, epidemiology, ethics, and public health. The program enrolls approximately 10 fellows per year for a 4-year fellowship.

Population-based studies, findings from which inform basic, clinical, and prevention research, are supported through DCEG. Each year, the DCEG Fellowship Program provides a scientific home to about 90 pre- and postdoctoral trainees and another 30 in the summer. Working with DCEG scientists, fellows design, carry out, analyze, and publish research studies on the causes of cancer and related conditions in human populations, as well as explore new approaches to cancer prevention.

Both the DCEG Fellowship Program and the CPFP attract people at different stages of their careers. Dr. William Anderson, for example, practiced medical oncology in rural Louisiana for almost 20 years before pursuing a second career in population-based prevention research. "As a medical oncologist, I saw a lot of cancers recur after standard systemic treatments and began to think that prevention would be a better cure," said Dr. Anderson.

After studying epidemiology and biostatistics at Tulane University, he came to NCI and studied breast cancer as a Cancer Prevention Fellow. After the fellowship, Dr. Anderson stayed on and became a tenure-track investigator in DCEG. Much of his current work uses mathematical modeling of cancer risk and disparities, in the hopes of generating hypotheses for causes of cancer that can be further tested by laboratory and clinical researchers.

The relationship between the CPFP and DCEG fellowship programs remains close, and many prevention science trainees straddle both divisions during their fellowships. They include Dr. Laura Beane Freeman, who came to NCI as a Cancer Prevention Fellow, then worked as a DCEG research fellow before recently accepting a tenure-track position in DCEG.

"I came to NCI for the concentration of resources and expertise, and the chance to work with world-class experts in the field," she said. "What we do in epidemiology is collaborative research; it's very important to have access to people who are the world's experts." 

This sentiment is seconded by Dr. Nilanjan Chatterjee, who arrived at NCI as a trainee 10 years ago after earning a Ph.D. in statistics from the University of Washington, Seattle. Today, he is chief of DCEG's Biostatistics Branch.

"What really excited me about DCEG was the number of studies and the number of experienced scientists who were already here. A lot was going on and I wanted to be a part of it," said Dr. Chatterjee.

"A lot of trainees I meet are excited about the opportunities in DCEG and want to stay on after completing their training," said Dr. Lavigne. "That speaks well of what we try to provide for them, and also speaks to the rewarding career opportunities, both scientifically and administratively, at NCI."

Special Issue: Cancer Research Training

Ensuring a Diverse Cancer Research Workforce

African Americans and Hispanics make up nearly 25 percent of the U.S. population. Yet, in 2005, they made up just 3.2 percent of funded principal investigators on NIH research project grants and 5.5 percent of research trainees supported by NIH training grants.

A concerted move is under way to change that, particularly at NCI, where several programs, including one which dates back a decade, are singularly focused on increasing the diversity of the cancer research workforce.

These NCI programs fall under the Diversity Training Branch (DTB) in NCI's Center to Reduce Cancer Health Disparities (CRCHD). Since it was established in 2001, CRCHD's programs have enabled more than 1,000 individuals from ethnic or racial minorities and other underrepresented groups to begin or further their cancer research training.

These opportunities, said Dr. Alexis Bakos, chief of the DTB, complement the extramural training programs available through NCI's Cancer Training Branch by specifically targeting underrepresented populations. In addition to ethnic and racial minorities, DTB programs provide opportunities for first-generation college students and people with disabilities, as well as those from disadvantaged economic backgrounds and rural communities.

Increasing the proportion of underrepresented minorities and people from medically underserved groups in the cancer research workforce is important for a number of reasons, and could pay significant dividends, said Dr. Dihua Yu of the University of Texas M.D. Anderson Cancer Center. Dr. Yu co-chairs the Diversity Recruitment Committee of the Cancer Biology Training Consortium, a group that collaborates with research institutions and NCI's Center for Cancer Training to facilitate conversations around the topic of training.

"Scientists from underrepresented minorities or other medically underserved groups represent a source of talent that has not been fully explored," said Dr. Yu. "They may be more motivated to address cancer [disparities and other] problems in these groups, or they may bring a different approach to solving them."

CRCHD's flagship program, the Continuing Umbrella of Research Experiences (CURE), established in 1997 under the Comprehensive Minority Biomedical Branch, reflects the philosophy that research training and career development are a continuum, said Dr. Bakos. CURE programs offer support for budding cancer researchers at every level, from high school students to young scientists beginning their first faculty appointments.

"Training should culminate in competitive, independent investigators," said Dr. Bakos. "Regardless of where along the continuum trainees start, they should be enabled to compete successfully for investigator-initiated research grants."

CRCHD also provides research supplements to support diversity training in cancer research. Principal investigators holding other NIH research grants may apply for a supplement to recruit or support students, postdoctoral researchers, and junior scientists from underrepresented groups. The supplements must support work within the scope of the original research project. Approximately 120 supplements are funded per year. In 2009, thanks to the additional funds made available through the American Recovery and Reinvestment Act, CRCHD has funded more than 300 diversity supplements.

In addition, CRCHD's Minority Institution/Cancer Center Partnership program, established in 2001, enables colleges and universities serving minority students to partner with NCI-supported cancer centers to train scientists from diverse backgrounds in cancer research. CRCHD's Community Networks Program also provides training opportunities in community-based cancer research for junior investigators from underserved populations.

"Only when diversity in the cancer research workforce is no longer an issue will we know that our CRCHD diversity training initiatives have achieved their ultimate measure of success," said CRCHD director Dr. Sanya Springfield. "The investigators coming out of our diversity training efforts are also critically important to helping us achieve one of our most important missions at NCI—that of understanding and ultimately eliminating cancer health disparities."

Dr. Cathrine Hoyo

Dr. Cathrine Hoyo is a cancer epidemiologist whose research explores factors underlying differences in the occurrence of esophageal, cervical, and prostate cancers among individuals of African and non-African descent.

In 2001, as a visiting assistant professor at North Carolina Central University, Dr. Hoyo received research support through CRCHD's Minority Institution/Cancer Center Partnership program. The following year she moved to Duke University as a research assistant professor.

In 2004, she obtained a 5-year Mentored Research Scientist Development Award to Promote Diversity (K01), also supported by CRCHD. That award enabled her to generate sufficient preliminary data to compete successfully for an NIH Exploratory/Developmental Research Grant (R21) in 2006. And, in early 2009, she successfully obtained her first investigator-initiated research grant (R01).

The Mentored Research Scientist Development Award was "an incredible opportunity," Dr. Hoyo said. In addition to providing her with "protected time" for research, the award also brought her valuable scientific networking opportunities and—perhaps most useful—training in molecular techniques and in how to write a successful research grant application.

Special Issue: Cancer Research Training

Catalyzing a National Shift toward Translational Research

Translational research in oncology encompasses a wide variety of activities across many disciplines. What makes these efforts coherent is their goal: developing mature agents and approaches in the laboratory that are successfully translated to the clinic and used in diagnosing and treating cancer patients.

There is a growing consensus that this will become the new norm in health research, particularly for those studying complex problems such as cancer, and that it will replace the historic "silo" model, wherein researchers have come together only for meetings and research conferences but otherwise closely guard what happens in their laboratory.

Indeed, many of the research groups and training programs available on NCI's campus teach clinical and basic scientists how to work together in a team approach on specific problems in cancer research. The Translational Research in Clinical Oncology Course offered by CCR is one example. But there are resources available to the extramural community, as well, that enable the shift toward team science and collaboration that has become increasingly important for accelerating the pace of cancer discoveries.

NCI's K12 Paul Calabresi Award in Clinical Oncology is a grant designed for institutions with the primary mission of forging effective working relationships between basic researchers and junior- and senior-level clinicians in order to enhance their mastery of therapeutic research in oncology. Ideally, the Calabresi scholars will be prepared to independently conduct pilot/phase I, phase II, and phase III clinical trials when they complete their training.

Eighteen institutions around the country (16 programs were funded in FY 2008, 18 programs were funded in FY 2009) currently have K12 grants that last for 5 years and can be renewed. Under the supervision of a principal investigator and a number of faculty mentors, a handful of scholars from fields such as hematology-oncology, surgical oncology, radiation oncology, gynecologic oncology, and neuro-oncology are exposed to a curriculum and training regimen designed by the grant program to reflect that particular institution's strengths, interests, and needs.

Many of the programs are also designed to collaboratively train basic scientists in dual-track translational research programs. Ideally, the scholars master a model they can embody and disseminate as their careers unfold, and they go on to lead or participate in teams and projects in the larger research community.

"The ability to work in teams is not something that is typically part of the culture in science," said Dr. Jonathan Wiest, director of NCI's Center for Cancer Training. "Learning how to interact with large groups and keep everyone engaged, and giving people credit where credit is due, those are skills that people sometimes struggle to learn." Discussions among members of the team early on can make a big difference, he said. Everyone has a sense of their responsibility, the teamwork process, and the recognition that will be given to each participant.

Despite the culture shock that may occur as cross-disciplinary teams come together, data from the Association of American Medical Colleges, analyzed by the Federation of American Societies for Experimental Biology, show there are increasing numbers of Ph.D. researchers working in clinical departments.

"In fact, this demonstrates that people are doing more translational science," said Dr. Wiest, "because they're in the department, much in the same way that CCR is structured here at NIH." The trend is happening in industry as well, he noted, with companies sharing data, reagents, and tissue samples across states and even overseas.

Video teleconferencing, international shipping, and electronic transfer of data for cross-team analysis are making research collaborations easier. Even the way that grants are funded—with co-PIs, for example, so that multiple researchers can receive credit for the award within their institution and enhance their eligibility for career advancement and tenure—is making the process run smoother, Dr. Wiest said.

But there's still room for improvement. "There are avenues that we haven't pursued yet to encourage this type of research," he said. "With time, we will undoubtedly find new ways to ease the shift."

Dr. Lia Gore

"I wouldn't be where I am today without the K12," said Dr. Lia Gore, associate professor of pediatrics and medical oncology at the University of Colorado Denver School of Medicine. She was one of the first scholars selected to participate in the school's first K12 grant in 2001; she had just finished her postdoctoral fellowship work.

"I wanted to marshal resources that were not then organized around developing drugs for pediatric oncology. It's not the kind of thing junior faculty would normally get support for, but our K12 had its own set of goals that kind of dovetailed with that," she said. "Essentially, I was encouraged to find mentors and advisors who were experts in all of the pieces that were needed to create a do-it-yourself curriculum." The activity was novel yet driven by a palpable need at Denver's Children's Hospital.

Over the course of a year Dr. Gore traveled to NCI in Bethesda, MD, for a month at a time, where she says "people in the Investigational Drug Branch of NCI's Cancer Therapy Evaluation Program (CTEP) provided a kind of 'mini-fellowship' and taught me drug development from the ground up." They also steered her to the Pharmaceutical Management Branch in CTEP and to the FDA, where "I got a very privileged insider's view of what happens," she said. Back in Denver, Dr. Gore's idea began to take shape, and in 2004 she co-founded and is currently co-director of the Pediatric Oncology Experimental Therapeutics Investigators Consortium.

Since the late 1990s, Dr. Gore has directed more than 100 clinical trials in pediatric hematology/oncology, won numerous awards, and remains active in the University of Colorado's K12 program, now serving as a mentor for a new class of young scholars.

"The K12 positions allow you to meet the kind of people you might otherwise not have access to," she said. "I've been incredibly privileged, getting wisdom and support from some great people all along the way. I'm really a modest example of the kind of results the program can produce. It's an honor to be able to encourage others coming up to follow that path, because I really believe in it."

Special Issue: Cancer Research Training

NCI Trains Future International Research Leaders

Nearly 500 Visiting Fellows trained on the NCI campus at NIH in 2009, representing 59 different countries, most commonly China, India, Japan, South Korea, France, Italy, Israel, Germany, and Poland. Nearly 500 Visiting Fellows trained on the NCI campus at NIH in 2009, representing 59 different countries. Those with the greatest number, 4 or more, are represented here, but also included in the list are Visiting Fellows from Indonesia, Singapore, Thailand, Austria, Brazil, Bulgaria, Czech Republic, Egypt, Finland, Greece, Iceland, New Zealand, Philippines, Romania, Venezuela, Belgium, Bolivia, Colombia, Iran, Kenya, North Korea, Lebanon, Macedonia, Malaysia, Mexico, Mongolia, Netherlands, Niue, Norway, Peru, Serbia, Slovakia, South Africa, Sri Lanka, Tunisia, Ukraine, and Uruguay. Click to Enlarge.

Since passage of the National Cancer Act of 1971, NCI has taken seriously its statutory mandate to support the training of foreign scientists in the United States. In FY 2008, the institute welcomed 926 visiting scientists from 84 countries who trained as fellows in NCI's laboratories and clinics or took intensive summer courses.

"Certainly, if you go to leading cancer centers around the world, it's not at all uncommon to find individuals there in leadership positions who have a history of having passed through NCI's labs and facilities," noted Dr. Joe Harford, director of NCI's Office of International Affairs (OIA). A good example is Chinese scientist Dr. Qimin Zhan, who trained at NCI, and recently co-chaired a U.S.-China conference to expand the two countries' cancer research collaborations.

China currently sends the most visiting scientists to NCI each year, followed closely by Japan, India, and South Korea, which make up roughly half of NCI's international trainees. European nations and Canada are also heavily represented. Many scientists from these industrialized countries are postdoctoral researchers, such as Dr. Zhan, who work under multi-year fellowships in NCI's intramural research centers.

In recent years, Dr. Harford and the OIA have been "trying proactively to increase the number of scientists from low- and middle-income countries (LMC)" who can benefit from NCI training programs. The Summer Curriculum in Cancer Prevention, which is supported and operated by the Cancer Prevention Fellowship Program, has proven to be a good way to accomplish that goal. "The program started out as a U.S.-oriented initiative, but around 1998, we saw it as an opportunity to expand and train international scientists as well," he noted. Prevention and cancer control are also top priorities in the developing world, where treatment facilities are often insufficient or lacking entirely.

Currently, roughly half of enrollees in the Summer Curriculum are international students. OIA has promoted the program directly in the developing world and has also enlisted the United Nations' International Atomic Energy Agency (IAEA) to recommend candidates through IAEA's PACT program. "We've had enrollees fairly well represented from all the major developing regions of the world, including Asia, sub-Saharan Africa, North Africa/Middle East, Latin America, and Eastern Europe," Dr. Harford noted.

NCI has conducted educational outreach as well, particularly in the area of training in population-based cancer registries. For example, through its involvement in the Middle East Cancer Consortium, NCI has been helping educate staff with the registries in Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and Turkey.

OIA also works closely with the global cancer organization International Union Against Cancer (UICC) in its international fellowship program, which Dr. Harford oversees for UICC on a volunteer basis. OIA sponsors the International Cancer Technology Transfer Fellowships (ICRETT). "The ICRETT fellowship is only for 1 to 2 months and it is designed to aid researchers in remote locations who run into a specific barrier of some sort," he explained. "The researchers can apply at any point in the year for an ICRETT fellowship to go some place in the world where that specific technology can be transferred to them." UICC provides a stipend to the ICRETT fellows and covers their travel expenses.

Earlier this year, NCI joined the Leadership Development Initiative (LDI), largely funded by the Open Society Institute. "This is for people who have been working in palliative care but who lack leadership skills, such as team-building or strategic planning," Dr. Harford explained. Initially, 22 individuals from LMCs were chosen for the new program and will receive leadership training at the San Diego Hospice in California.

OIA has also provided some funding for a companion Web site of palliative care resources for LMCs, including the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) curriculum, a comprehensive train-the-trainer program developed specifically for cancer care practitioners.

Dr. Qimin Zhan

Chinese scientist Dr. Qimin Zhan believes the 7 years he spent training at NCI’s laboratories from 1991 to1998 played a critical role in his successful scientific career. He subsequently returned to China and is now vice-president of the Chinese Academy of Medical Sciences (CAMS) and the Peking Union Medical College.

As part of his research leadership role, Dr. Zhan recently chaired the 30th anniversary celebration of U.S.-China collaborations in cancer research in Beijing.

Dr. Zhan came to NCI as an NIH visiting scientist and worked in the laboratory of Dr. Albert Fornace, helping with pioneering work on the role of the tumor suppressor gene p53. He became a senior staff fellow leading his own laboratory during his final 2 years at NCI. Dr. Zhan left to join the NCI-designated cancer center at the University of Pittsburgh, where he received research grant funding from NCI.

Dr. Zhan returned permanently to China in 2004 to accept his post with CAMS. He is proud of his current role helping expand Chinese collaborations with NCI and said, “I try to send my special thanks back to NCI.”

Special Issue: Cancer Research Training

Opportunities in a Nontraditional but Much-needed Science Workforce

It's unclear how many men and women with Ph.D.s in disciplines like molecular biology or electrical engineering engage in speed dating. Well, at least this kind of speed dating. In early November, in a hotel conference room in downtown Sacramento, a group of scientists from around the country are having rapid, one-on-one meetings with members and staffers from the California State Assembly and Senate. The meetings' purpose: to determine who might be the best fit in each legislator's office for the first class of California Council on Science and Technology (CCST) policy fellows.

The event was just one part of the fellows' intensive 3-week training program. The program's goal, explained CCST Executive Director Dr. Susan Hackwood, is to immerse experts in science, technology, and engineering directly in the policy process. "There are huge scientific issues facing our state legislature in medicine, genetics, transportation, energy," she explained. "We saw firsthand a vacuum between those who have knowledge in these fields and those making the policies. The fellowship program will be the bridge between them."

Inspired by the long-running and highly successful American Association for the Advancement of Science (AAAS) Science and Technology Policy Fellowships program, through which scientists have migrated into policy positions of numerous types, the CCST initiative represents one way for scientists to put their knowledge to use—and perhaps pursue a career—in areas beyond those that many in the biomedical or physical sciences would traditionally consider.

In terms of science careers, those having to do with policy have been the road less traveled, but, Dr. Hackwood believes, that is beginning to change. "We have a feeling that this is an untapped career path for highly trained Ph.D.s who are willing to be flexible and have an interest in bridging these two cultures," she said.

Policy is not the only avenue where scientists looking for somewhat nontraditional opportunities can get training. Another example: technology transfer. At NCI's Technology Transfer Center (TTC), more than 3,000 agreements between scientists, academia, and industry are brokered each year, explained TTC Director Karen Maurey. With the expanded application of patents and the explosion of technologies being developed as part of modern biomedical research, she said, technology transfer has become integral to moving promising research forward.

The TTC fellowship program provides the chance to learn more about technology transfer by getting intimately involved in it, Ms. Maurey said, including responsibilities such as drafting and negotiating Cooperative Research and Development Agreements between NCI and outside research partners or working with NCI scientists to report inventions so that promising technologies can be patented, licensed, and developed into new products and interventions.

"Typically the scientists who join our program love science and want to be part of it, but they aren't interested in continuing a career at the bench," she said.

That was exactly the case for Dr. Lisa Finkelstein, who, prior to enrolling in the TTC fellowship program 4 years ago, worked at the National Human Genome Research Institute. Dr. Finkelstein went from the TTC fellowship program into a technology transfer specialist position in the TTC, a decision she has not regretted. Technology transfer "allowed me to be involved in a broad array of things," she said.

Another cross-functional training option that came online just a few years ago is the NCI-FDA Interagency Oncology Task Force (IOTF) Joint Fellowship Program. The program's aim is to develop a group of scientists who can help to bridge the gap between research and regulation, and, in the process, improve the efficiency with which research can be translated from the clinic to the bedside.

Past IOTF fellow Dr. Arindam Dhar is now an associate medical director at Bristol-Myers Squibb. In his position, Dr. Dhar explained, he focuses on bringing small molecules from the preclinical setting into first-in-human clinical trials.

His IOTF training set the stage for the move into translational medicine. "The training really gave me a better perspective of how drugs are developed through preclinical studies to first-in-human trials, the use of biomarkers, and the regulations that guide the studies for FDA approval," he said. At the present, there is a huge need for and an emphasis on bringing more effective and safer drugs to the bedside quickly, he added, and the IOTF program provides experience to scientists and clinicians to address these pressing issues.

As Dr. Dhar's experience suggests, pursuing these types of fellowships does not necessitate transitioning to a new career path altogether. He noted that anybody from the industry or academia involved in translational research who trained with the IOTF program could return to their position "with a better understanding of the whole drug development process, from preclinic to the market, and definitely be better prepared to support or run any phase of clinical trials."

Dr. Hackwood expressed similar sentiments about the policy fellowship. Even if the fellows go back to their former positions, she said, "the skills they have learned and how to deal with policy and policymakers will be invaluable."

Special Issue: Cancer Research Training

Oncology Training Resources

NCI supports training for people at all levels of expertise, ranging from summer internships for high school and college students to focused training in new disciplines for tenured scientists. For a complete listing, visit NCI's Center for Cancer Training Web site at http://www.cancer.gov/cct. Click here for a PDF version of the table (PDF 77kb).

 High
School
Students
UndergradGraduate/
Medical
Students
Post-
docs
Clinicians
/Fellows
Senior-
level
Scientists
From NCI
CCT Cancer Training BranchGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
In addition to coordinating intramural training through the respective divisions at NCI, CCT offers extramural training through the Cancer Training Branch. These include 10 individual training and career development awards for 1 to 5 years, and 4 institutional training awards that provide support for 1 to 3 years.
See: http://www.cancer.gov/researchandfunding/cancertraining/outsidenci
Center for Cancer Research FellowshipsHigh School Program AvailableUndergraduate Program availableGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program Available
CCR and NCI offer postgraduate, doctoral, and postdoctoral fellowships, clinical residencies, and programs in basic cancer, HIV/AIDS, and clinical and translational research. Clinical training opportunities are also available in anatomic pathology, medical oncology, pediatric hematology/oncology, surgical oncology, and more.
See: http://ccr.cancer.gov/careers/ and
http://www.cancer.gov/researchandfunding/cancertraining/atnci/howtoapply
and http://home.ccr.cancer.gov/ccrat aglance/training.asp
Division of Cancer Epidemiology and Genetics FellowshipsHigh School Program AvailableUndergraduate Program availableGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program Available
Postgraduate, doctoral, and postdoctoral fellows work with scientific mentors to design, carry out, analyze, and publish research studies on the causes of cancer and related conditions in human populations, as well as explore new approaches to cancer prevention. The DCEG summer research experience is an 8-week program for high school, college, and graduate students, including medical and dental students, who are interested in exploring careers in cancer epidemiology, biostatistics, and genetics.
See: http://dceg.cancer.gov/fellowships
Cancer Prevention Fellowship ProgramPost-doctorate Program AvailableClinician/Fellows Program Available
The CPFP provides advanced training opportunities in cancer prevention and control for individuals from a variety of health sciences disciplines. Training opportunities include earning a Master of Public Health degree, participating in NCI's Summer Curriculum in Cancer Prevention, mentored research opportunities at NCI and the FDA, and professional development and leadership training.
See: http://www3.cancer.gov/prevention/pob/
Center to Reduce Cancer Health DisparitiesGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
The Diversity Training Branch in CRCHD coordinates multiple research training and funding opportunities for scientists and clinicians from backgrounds that are underrepresented in research, including minorities, women, people with disabilities, those from socioeconomically disadvantaged backgrounds, and others.
See: http://crchd.cancer.gov/diversity/diversity-index.html
Division of Cancer Control and Population SciencesGraduate/Medical Program AvailablePost-doctorate Program AvailableSenior-level Scientists Program available
DCCPS provides training opportunities for graduates of postdoctoral, master's, and bachelor's degree programs with education and interest in cancer control research, including health promotion, health communications, informatics, and other areas of behavioral and social science. The Cancer Research Training Award offers stipends to support research training.
See: http://dccps.nci.nih.gov/brp/about/career_training.html
Health Communications Internship ProgramGraduate/Medical Program Available
The HCIP gives highly qualified graduate students and recent graduate school graduates the opportunity to participate in vital health and science communications projects. Interns plan, develop, and promote cancer education programs and materials for the public, cancer patients, or health professionals, and they gain experience in evaluating cancer prevention and treatment messages, publications, materials, and programs.
See: https://hcip.nci.nih.gov/
Interagency Oncology Task Force Joint Fellowship Training ProgramPost-doctorate Program AvailableClinician/Fellows Program Available
This joint NCI-FDA fellowship trains scientists in preclinical oncology research, cancer prevention, and clinical trials methodology, as well as medical product and other regulatory research and review, helping fellows learn to bridge the development and review processes.
See: http://iotftraining.nci.nih.gov/
NCI-Frederick Training OpportunitiesHigh School Program AvailableUndergraduate Program availableGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
The NCI-Frederick campus provides postdoctoral and predoctoral fellowship opportunities, as well as internship opportunities for college and high school students who are interested in biomedical research. A number of NCI-Frederick principal investigators and laboratories also participate in the Cancer Research Training Award.
See:  http://web.ncifcrf.gov/careers/default.asp and
http://web.ncifcrf.gov/careers/student_programs/internships/CRTA.asp
Office of International AffairsGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
This office coordinates intramural and exchange training programs for scientists from around the world, as well as international courses and workshops.
See: http://oia.cancer.gov/training-research.shtml
Sallie Rosen Kaplan FellowshipsPost-doctorate Program AvailableClinician/Fellows Program Available
This is a competitive program for female postdoctoral fellows applying to train in any of the NCI's intramural research settings, including basic, clinical, epidemiological, and prevention sciences. The fellowship is normally 2 to 5 years in length, and applicants must have earned a doctorate degree within the past 5 years, such as a Ph.D., M.D., Dr.PH, or equivalent.
See:
Technology Transfer FellowshipsGraduate/Medical Program AvailablePost-doctorate Program Available
This fellowship provides advanced training in the application of state-of-the-art techniques of technology transfer. On-the-job training includes drafting and negotiating Cooperative Research and Development Agreements for NCI scientists and their industrial/academic research partners. Fellows may also develop technology transfer educational programs for scientists and oversee patent-related issues.
See: http://ttc.nci.nih.gov/employment/crtafe.php
 High
School
Students
UndergradGraduate/
Medical
Students
Post-
docs
Clinicians
/Fellows
Senior-
level
Scientists
At NIH
Emerging Leaders ProgramGraduate/Medical Program Available
This 2-year paid internship provides an opportunity for those working on or finished with a graduate degree to begin a professional career in the U.S. Department of Health and Human Services (HHS) by rotating through the agencies overseen by the department, including NIH and the institutes and centers that compose it. The program offers seven career tracks that target occupational specialties, including science, public health, information technology, human resources, and others. Participants select one of these tracks, based on their previous experience and career goals within HHS.
See: http://hhsu.learning.hhs.gov/elp/
NIH Management Intern ProgramFor NIH Employees
A 1-year paid internship for current NIH employees (grade 5 or higher) who are interested in transitioning their career to a new field at NIH and preparing for a leadership position at one of the respective institutes or centers.
See: http://www.jobs.nih.gov/intern/about.html
Presidential Management Fellows ProgramGraduate/Medical Program Available
This 2-year paid fellowship for those who have completed a graduate, law, or medical degree, allows recipients to explore career opportunities within a broad spectrum of specialties at NIH, as well as other HHS agencies, and in Congress. Fellows are matched with a mentor and receive an additional training stipend of $2,500 per year.
See: http://www.jobs.nih.gov/intern/about_pmi.html
Other Training Resources at NIHA complete directory is available at:
http://www.training.nih.gov/index.asp
 High
School
Students
UndergradGraduate/
Medical
Students
Post-
docs
Clinicians
/Fellows
Senior-
level
Scientists
Outside NIH
American Cancer SocietyGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
Fellowships and training programs are available in basic, preclinical, clinical, epidemiological, psychosocial, behavioral, and health policy research. Career development awards for clinicians and social workers, special initiatives in palliative care and cancer health disparities, and stipends for international professors to train in the United States for a year are also available.
See http://www.cancer.org/docroot/RES/RES_5_1.asp?sitearea=RES
American Association for Cancer ResearchHigh School Program AvailableUndergraduate Program availableGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program Available
Career development awards are given to junior faculty members, clinicians, and graduate students according to specific topics in cancer research, such as cancer sites or mechanisms of tumorigenesis. Other programs are designed to encourage high school and undergraduate students to pursue careers in cancer research, with awards to attend the annual research conference, as well as programs that match students with mentors at the conferences.
See: http://www.aacr.org/home/scientists/research-funding--fellowships.aspx and
http://www.aacr.org/home/scientists/science-education-for-the-next-
generation-of-cancer-researchers.aspx
American Society of Clinical OncologyGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
Opportunities for clinicians and clinician scientists to obtain CME credits online or in person; attend symposia, workshops, and meetings; and receive awards and grants for career development through research and training in the United States or internationally.
See: http://www.asco.org/ASCOv2/Education+%26+Training and
http://www.ascocancerfoundation.org/TACF/Professional+Education+and+Support
Oncology Nursing SocietyClinician/Fellows Program Available
The Oncology Nursing Society's foundation funds research grants, research fellowships, academic scholarships, lectures, public education projects, career development awards, and Congressional scholarships.
See: http://www.onsfoundation.org/funding.shtml
The Leukemia & Lymphoma SocietyPost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
Online CME and Webcasts for oncology nurses, clinicians, and social workers. Career development awards for junior and senior cancer researchers. There are also workshops for cancer patients and caregivers to help with a variety of survivorship issues.
See: http://www.leukemia-lymphoma.org/all_page?item_id=8433 and
http://www.leukemia-lymphoma.org//all_page.adp?item_id=488765
American Society of HematologyGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program Available
Online resources for hematology professionals (Ph.D. and clinical), including teaching cases and case studies, career guidance, and an online grants "clearinghouse" that references research and training funds available from a wide variety of sources specifically for hematology.
See: http://www.hematology.org/Training/
Damon Runyon Cancer Research FoundationPost-doctorate Program AvailableClinician/Fellows Program Available
Research and career development awards for cancer researchers and clinical scientists in the early stages of their careers.
See: http://www.damonrunyon.org/why_us/categories/category/our_award_programs/
Department of DefenseGraduate/Medical Program AvailablePost-doctorate Program AvailableClinician/Fellows Program Available
Congress appropriates money each year to the Department of Defense Congressional Special Interest Medical Research Programs for biomedical research, including studies of several types of cancer. Opportunities are available for clinical and postdoctoral fellows, with special funds to encourage mentoring and translational research. For more information, see the Congressionally Directed Medical Research Programs site at: http://cdmrp.army.mil/.
UICC International Cancer FellowshipsPost-doctorate Program AvailableClinician/Fellows Program AvailableSenior-level Scientists Program available
The International Union Against Cancer (UICC) offers fellowships and links to outside resources for training that are meant for researchers, clinicians, epidemiologists, and public health professionals from around the world. More than 200 fellowships are awarded each year.
See: http://www.uicc.org/index.php?option=com_content&task=view&id=16&Itemid=116.
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Cancer Research Highlights

Cervical Cancer Screening Can Be Done Later and Less Often, According to ACOG

Women can be screened less frequently for cervical cancer with the Pap test (cervical cytology) than previously recommended, according to newly updated evidence-based guidelines issued November 20 by the American Congress of Obstetricians and Gynecologists (ACOG). Previously, adolescents were advised to begin screening within 3 years of becoming sexually active or at age 21 (whichever was younger) and to continue annually. Now, AGOG recommends that women wait until age 21 and then be screened every 2 years until age 30. Thereafter, following three consecutive negative tests, women should be screened once every 3 years. Women 30 and older can be screened with Pap tests and human papillomavirus (HPV) DNA tests every 3 years if their results are negative. The new recommendations appear in the December issue of Obstetrics & Gynecology.

These guidelines do not take into account whether a woman has been vaccinated against HPV, which is the cause of most cervical cancers. (Vaccinated women might be shown eventually to need even less frequent screening.) More frequent screening might be needed for women with certain risk factors, including those with weakened immune systems. Women who have had a total hysterectomy (and therefore have no cervix) and no history of high-grade cervical intraepithelial neoplasia should discontinue cervical cancer screening altogether.

This change to a more conservative approach is designed to “avoid unnecessary treatment of adolescents, which can have economic, emotional, and future childbearing implications,” the organization explained in a news release. “Although the rate of HPV infection is high among sexually active adolescents, invasive cancer is very rare in women under age 21.” And while HPV infections occur more often in younger women, their immune systems nearly always clear the infections and the associated cervical intraepithelial neoplasia within 1 to 2 years. If, however, these lesions are treated with surgery, adolescents who have most of their childbearing years ahead of them face an increased risk of premature births, as well as a greater need for caesarean sections.

Long-term Follow-up Provides New Insights on Adjuvant Therapy for Lung Cancer

Longer-term follow-up reports from two large, randomized clinical trials of chemotherapy delivered after surgery in patients with non-small cell lung cancer (NSCLC) have yielded disparate results. Published online in the Journal of Clinical Oncology, the findings come 2 years after clinical guidelines strongly recommended the use of post-surgical, or adjuvant, chemotherapy in certain patients with NSCLC.

The initial reports from both trials, based on 5 years of follow-up, found that adjuvant chemotherapy resulted in a statistically significant improvement in overall survival compared with observation following surgery. With longer-term follow-up (a median of 9.3 years), results from the smaller of the two trials, JBR.10, continue to show a benefit from adjuvant chemotherapy, with an absolute improvement in overall survival of 11 percent compared with observation. The survival improvement was strongest for patients with stage II NSCLC.

However, in the other trial, called IALT, after 7.5 years of follow-up, the initial survival improvement was not sustained, although there was a small but statistically nonsignificant improvement in overall survival. This was due in large part to an excess of deaths unrelated to cancer in the patients who received chemotherapy compared with those in the observation arm. In the JBR.10 trial, the authors noted, there was no difference between the groups in the rate of death from other causes or second cancers.

The results demonstrate that “longer follow-up is needed in the adjuvant setting…to assess cure,” wrote Dr. Jean-Yves Douillard of the Centre Rene Gauducheau in St. Herblain, France, in an accompanying editorial. Dr. Douillard explained that the JBR.10 trial only used the third-generation chemotherapy drug vinorelbine, along with cisplatin, whereas patients in the IALT trial received any of four chemotherapy agents along with cisplatin, including vinorelbine. In comparison with the other three agents (vindesine, vinblastine, and etoposide), he wrote, patients with lung cancer treated with vinorelbine have had a “consistent improvement in survival on a long-term basis.”

It is worrisome that the longer-term follow-up from the IALT trial did not show a sustained benefit, said Dr. Giuseppe Giaccone, head of the Medical Oncology Branch and Thoracic Oncology Section in NCI’s Center for Cancer Research. But some of the regimens used in the trial were “suboptimal,” he continued. Dr. Giaccone agreed with the recommendation on the adjuvant regimen of choice. “The largest experience is with cisplatin/vinorelbine,” he said, “and this is the regimen that should be used, unless there are contraindications.”

No Evidence that Hookah Smoking Is Less Harmful than Cigarette Smoking

Waterpipe smoking is a global phenomenon, especially among adolescents and young adults, driven in part by the belief that this method of tobacco smoking is associated with less exposure to toxic substances and fewer health risks than cigarette smoking. However, a recent study by Drs. Thomas Eissenberg of Virginia Commonwealth University in Richmond and Alan Shihadeh of the American University of Beirut, Lebanon, found that waterpipe tobacco smoking, commonly known as hookah smoking, is associated with greater exposure to carbon monoxide (CO), similar nicotine levels, and “dramatically more smoke exposure” than cigarette use.

The study, published in the December 1 American Journal of Preventive Medicine, involved 31 adults who were each tested after smoking one cigarette and after a 45-minute waterpipe smoking session. CO levels in the blood increased on average by 23.9 parts per million (ppm) after waterpipe smoking, versus 2.7 ppm after smoking a cigarette. The waterpipe smoking session generated more than 40 times the smoke volume compared with a cigarette. Peak nicotine concentrations were similar for cigarette and waterpipe use, but due to the longer duration of waterpipe sessions, “participants were exposed to 1.7 times the nicotine dose” relative to the dose from a cigarette, the researchers reported.

“These data provide no support for the notion that waterpipe tobacco smoke is less lethal than cigarette smoke,” Drs. Eissenberg and Shihadeh concluded. Instead their findings, along with other published studies, “suggest that waterpipe tobacco smoking is likely associated with many of the same tobacco-caused diseases as cigarette smoking, including cancer, cardiovascular and lung disease, and nicotine dependence,” the authors stressed. “Today’s challenge is to reduce current waterpipe tobacco smoking and prevent its further spread.” They expressed hope that their findings will be used by physicians and health authorities to counter public misperceptions about the relative harm of this type of tobacco use.

No Significant Change in Smoking Rate from 2007 to 2008

Although cigarette smoking in the United States declined by 3.5 percent from 1998 to 2008, the percentage of adults who smoke did not change significantly from 2007 (19.8 percent) to 2008 (20.6 percent), the CDC reported in its November 13 MMWR Weekly.

The CDC based its conclusion on results from the 2008 National Health Interview Survey (NHIS). Respondents were selected by random probability sampling, and the survey included questions on cigarette smoking and cessation attempts.

In 2008, an estimated 20.6 percent (46.0 million) of U.S. adults were current cigarette smokers. Of these, 79.8 percent (36.7 million) smoked every day, and 20.2 percent (9.3 million) smoked some days. In 2008, as in past years, smoking prevalence was higher among men (23.1 percent) than women (18.3 percent), and also varied by race/ethnicity, age, and poverty status. Pronounced differences were seen by level of educational attainment: 41.3 percent of individuals with a General Educational Development certificate (GED) and 27.5 percent of individuals with less than a high school diploma were current smokers, compared with 10.6 percent of individuals with an undergraduate degree and 5.7 percent of individuals with a graduate degree.

Between 1998 and 2008, the overall quit ratio (the ratio of former smokers to ever smokers) varied little and ranged from 48.7 percent to 51.1 percent. Here, too, differences were seen by level of educational attainment. “Persons with an undergraduate degree and persons with a graduate degree had quit ratios consistently higher than 60.0 percent,” the CDC stated. In contrast, “adults with education levels at or below the equivalent of a high school diploma, who comprise approximately half of current smokers, had the lowest quit ratios (39.9 percent to 48.8 percent).”

The CDC notes that effective population-based strategies for preventing tobacco use and encouraging cessation are outlined in the World Health Organization’s MPOWER package, and that “despite partial bans on some forms of advertisement, the tobacco industry continues to conduct targeted marketing towards socially disadvantaged subgroups and vulnerable populations, such as persons with low socioeconomic status and youth.”

Home Care Nursing Improves Cancer Symptom Management

Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology. Researchers in the United Kingdom randomly assigned 164 patients with colorectal or breast cancer who were receiving capecitabine to either standard care or HCN and followed them for 4.5 months (6 chemotherapy cycles).

The study found that patients who received HCN experienced significant improvements in symptoms of oral mucositis, diarrhea, constipation, nausea, pain, fatigue, and insomnia compared with those in the standard care group. The benefits were most significant during the first two cycles of treatment. Individuals in the standard care group also had far greater unplanned use of health care resources, particularly days of inpatient hospital care (167 days versus 57 days for HCN patients).

An experienced nurse trained in home care and cancer care visited the patients assigned to HCN during their first week of chemotherapy. The nurse provided information about capecitabine and its side effects and answered questions during a 1 to 1.5 hour visit. Patients then received a weekly phone call from the nurse to assess side effects and discuss strategies for overcoming them. Patients who experienced multiple severe side effects (grade 3 or higher) or who otherwise had difficulty dealing with their chemotherapy received subsequent home care visits. Those assigned to standard care were provided with oral and written information about capecitabine by their physician and were prescribed medicines to deal with likely side effects. Patients who received standard care were assessed at baseline and then via a weekly telephone call from a research associate who did not provide medical advice.

Oral anticancer drugs are increasingly becoming part of the standard treatment regimens for many cancer types, so “it seems imperative to find ways to support patients at home,” the authors noted. A symptom-focused HCN program appears to be an effective way of providing that support, they concluded.

Cancer.gov Update

NCI's Recovery Act Web Site Features New Content

Screenshot of Recovery Act Funding at NCI

NCI recently added a wealth of new content to its Recovery Act Web site, including reports on NCI’s investment of ARRA funds, and feature stories about institutions that have benefited from funding.

The Web site showcases the many research and community programs being funded, the people behind these initiatives, and the innovations shaping the future of cancer care. Among the highlights are:

Impact on Communities: Testimonials from grantees and articles on select projects that examine the research being funded and how these programs are benefiting their local communities, as well as the cancer community at large

News: Up-to-date features on Recovery Act funding at NCI, as well as headlines from news outlets around the country

Investment Reports: Specialized “investment reports” that outline specific areas in which NCI Recovery Act grants have been awarded, such as efforts to reduce health disparities and grants awarded by cancer type, such as breast, childhood, lung, and pancreatic cancers

Search Tools: Interactive tools to help find grants by keyword, state, Congressional district, or type of award

Notes

Understanding NCI Teleconference: Cancer as a Model for Research

NCI’s Office of Advocacy Relations’ (OAR) next “Understanding NCI” toll-free teleconference, “Cancer as a Model for Research,” will take place December 9 from 1:00–2:00 p.m., ET.

This teleconference will illustrate how cancer research impacts research as a whole, leading to advances in HIV/AIDS, diabetes, heart disease, and Alzheimer disease. In addition, participants will learn how NCI works with partners to accomplish research goals.

The featured speakers are Dr. Lee Helman, scientific director for clinical research at NCI’s Center for Cancer Research (CCR), and Steve Wakefield, associate director of the HIV Vaccine Trials Network at Fred Hutchinson Cancer Research Center.

To join the teleconference toll-free within the United States, dial 1-877-918-9240; the passcode is “CCR.” Toll-free playback will be available through January 10, 2010 at 1-866-435-1319.

Childhood Cancer Survivors Art Exhibit Opens in Israel

Tracy's Kids Pediatric Art Therapy Program logo

The Tracy’s Kids International art exhibition, “The Art of Healing,” opened on November 11 in Tel Aviv, Israel. The collection of drawings by children with cancer was on display at NIH in February and in Ireland at St. James’s Hospital and Our Lady’s Children’s Hospital, Crumlin, in May.

Created during 2007 and 2008 in response to the theme, “The day I will never forget,” the more than 200 thought-provoking drawings were made while the children were being treated for cancer in Egypt, Israel, Jordan, Turkey, and the United States. The art was produced through Tracy’s Kids, the art therapy program affiliated with Georgetown University Medical Center’s Lombardi Comprehensive Cancer Center. The exhibit in Israel was sponsored by NCI’s Office of International Affairs and the Middle East Cancer Consortium (MECC).

The opening ceremony took place at the Tel Aviv Opera House under the patronage of U.S. Ambassador James Cunningham. In addition to representatives of the Israeli Ministry of Health, the opening ceremony was attended by Ambassadors to Israel of the Arab Republic of Egypt, the Hashemite Kingdom of Jordan, and the Republic of Cyprus, along with representatives from the Turkish embassy in Tel Aviv. All major cancer hospitals in Israel were represented, and a delegation from the West Bank, Palestinian Authority, also attended.

The exhibit will move to the Sheba Medical Center (the largest in Israel). In January, it will move to the Schneider Children's Hospital, Beilinson Medical Center, and thereafter, to Haifa at the Museum of Arts. In 2010, the art show will travel to other sites within the MECC membership. Examples of the children's art can be viewed online.

New State Cancer Legislative Database Newsletter and Fact Sheet Now Available

Cover of SCLD Update

NCI’s State Cancer Legislative Database (SCLD) Web site has been updated. A fact sheet on out-of-package sales of cigarettes and the summer 2009 issue of the SCLD Update have been added to the site. This latest issue of the SCLD Update includes a summary of enacted legislation and adopted resolutions between April and June 2009, as well as a legislative data “byte” highlighting the number of states with laws addressing youth access to tobacco products through vending machines.

The SCLD program contains information synthesized from state laws. SCLD does not contain state-level regulations; measures implemented by counties, cities, or other localities; case law; Attorneys General opinions; or data addressing the implementation of state laws—all of which may vary significantly from the laws reported by the SCLD.