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Inside research
Women and cancer
Cathy J. Bradley, Ph.D.
Economics of sickness
The cost of treating cancer can reach into the hundreds of thousands of dollars for patients, their families, insurance companies and hospitals. But what about the economic cost to patients, employers and society?
Cathy J. Bradley, Ph.D., professor in VCU’s Department of Health Administration and a health economist for the VCU Massey Cancer Center, conducts the majority of her research into the economic outcomes — and work loss in particular — of people diagnosed with cancer.
Bradley’s research, often quoted in news media throughout the country, looks at cancer treatment in terms of workplace experiences, racial disparities in outcomes, health insurance, treatment costs and other issues. As both a principal and a co-investigator, Bradley holds about $12 million in grants from the National Cancer Institute and the National Institutes of Health.
A 2006 study, published in the Journal of the National Cancer Institute, followed 267 employed men with prostate cancer and showed that 10 percent were less likely to be working six months after their cancer diagnosis than men without the disease. Significantly, two-thirds of those men still working reported they did so out of fear of losing their health insurance coverage.
Bradley also found in the study that one-third of 500 women with breast cancer were not working six months following their diagnosis. However, by 12 months, many had returned to the workforce.
“Many cancer patients work because they can’t afford not to,” Bradley says, adding that it’s often single mothers with cancer who suffer in particular. “If they can’t work and do their cancer therapy at the same time, they may quit therapy, not their job.”
A recent study published in the journal Health Economics explored the relationship between returning to work and the source of a woman’s health insurance following treatment for breast cancer. The study among 209 women showed that some — even those with advanced stages of the disease — do not fully complete their treatment because they have to continue working to maintain their health insurance. However, women who were covered under their spouse’s health insurance plan were more likely to take time off from work during treatment.
Next, Bradley is leading a $3 million study funded by the National Cancer Institute to more fully examine the health consequences of employer-based health insurance. The study, currently under way, will include approximately 500 women from the Richmond area with breast cancer and will compare married women who have insurance through their spouses to those that have it through their employer and the choices they make with respect to treatment and work.
“There are strong concerns for the 43 million Americans who are uninsured, but if people who are insured are also neglecting their health in order to maintain their health insurance, we may have set up the wrong mechanism or system to sponsor health insurance. Findings from this study may translate to a larger health policy issue,” Bradley said.
“In this country, we have sort of accepted the employer-based mechanism as a way to provide health insurance. Through this work I’d like to find out if this is really the best way. If not, we should have alternative methods to supply health insurance so that when someone becomes ill, there’s another way for health care coverage to continue if they have to leave work for an extended period of time,” she added.
Nancy L. McCain, RN, DSN
Improving immune system’s response to breast cancer treatment
Through a $3 million grant from the National Cancer Institute, Virginia Commonwealth University researchers are evaluating whether stress-management techniques such as tai chi training and spiritual-growth groups can ease psychological distress, reduce fatigue, positively affect physical symptoms and enhance immune function in breast cancer patients.
Nancy L. McCain, RN, DSN, director for the Center for Biobehavioral Research at the VCU School of Nursing, Harry Bear, M.D., Ph.D., medical director of the VCU Massey Cancer Center Breast Health Center, and Thomas Smith, M.D., chair of VCU’s Division of Hematology/Oncology and Palliative Care, are combining bench research with the study of spiritual and physical interventions to see how they might improve the immune system’s response to treatment in women with early-stage breast cancer.
“In addition to assisting patients and families to deal with the stress of cancer diagnosis and treatment, this research may reveal psychological and behavioral approaches that improve their health and well-being,” said McCain, a professor in adult health and nursing systems and member scientist for Massey.
In the study, 180 women undergoing chemotherapy will be randomly assigned into one of three groups: tai chi, spiritual growth or a control group with no stress-management training. Participants who are involved with the tai chi training or spiritual-growth groups are asked to attend a 90-minute group meeting once a week for 10 weeks during their chemotherapy treatment. In addition, they provide urine and blood samples seven times during a two-year period.
According to McCain, both tai chi and spiritual growth approaches should influence stress-related hormones like cortisol and endorphins. Based on her previous National Institutes of Health-funded research demonstrating enhanced lymphocyte proliferative function following these types of interventions in persons with HIV infection, these interventions also may attenuate immune dysfunction during chemotherapy.
McCain, Bear and Smith are using multiple biological markers in addition to lymphocyte proliferation, such as cytokine levels and natural killer cell cytotoxicity, to determine whether a patient’s health status changes with time due to these interventions.
“As we gain greater understanding of immunocompetence, behavioral triggers and the integrated hormonal and biochemical functions of the body, there is great potential for lessening the physical and psychological symptoms associated with diseases such as breast cancer,” McCain said.
Bear is chair of the Division of Surgical Oncology at the VCU School of Medicine and Smith is also the medical director of the Massey Cancer Center Thomas Palliative Care Unit.
The BIRCWH scholars
Last fall, the VCU School of Medicine received a nearly $2.5 million grant from the National Institutes of Health to continue a program that provides mentorship and training support to young scientists researching women’s health.
VCU was one of 15 programs nationwide to receive the Building Interdisciplinary Research Careers in Women’s Health, BIRCWH, funding. It is designed to promote the career development of independent researchers working on women's health issues by pairing scholars with senior investigators in a mentored, interdisciplinary scientific environment.
In the field of surgical oncology, Amelia Grover, M.D., assistant professor in the Department of Surgery, is paving the way for research involving breast and endocrine health.
Recognized as a scholar for the BIRCWH program, Grover is focusing on two areas that she hopes one day will lead to information that can be used in the treatment of cancer and help identify patients who might be at higher risk.
“In the laboratory at VCU’s Massey Cancer Center, we look at the biology of how blood vessels are being recruited to a tumor and how this can help us try to find better ways to treat patients. We also look at the modifications that can silence gene expression and try to help prevent those in order to prevent the development of cancer,” she said.
Though the research is in its early stages, Grover feels the amount of research on the biology of cancer is growing exponentially.
“I don’t see that there will be one magic item that will be the answer to all of our questions, but the communication of all of our efforts and our collaborations will help us find better treatment for patients,” Grover said. “I’m thankful to all of the patients that come to the Massey Cancer Center and who are willing to participate in clinical trials — we couldn’t do this without the patients.”
Aylin Rizki, Ph.D., assistant professor in the Department of Radiation Oncology and a scholar for the BIRCWH program, is working with a team of researchers and clinicians whose efforts are aimed at helping breast pre-cancer patients — those who have tumors in a certain area that have not yet invaded the surrounding tissue or progressed to malignancy.
Rizki’s research focuses on issues such as how breast pre-cancers advance to become invasive, malignant and life-threatening. In addition, she and her team are investigating the true risk associated with each pre-cancerous tumor.
“Breast cancer treatment is most effective if the disease is diagnosed early,” Rizki said. “Our efforts aimed at finding markers that predict future recurrence and progression risk in patients with breast pre-cancers can result in treating high-risk patients with more aggressive therapeutics, while preventing low-risk patients from being exposed to toxic therapies.”
Rizki is gaining insight into the interactions between extracellular factors and those that are relevant to the maintenance of a stable genome as breast cells progress toward malignancy. She also investigates how these factors respond to radiation, similar to what is used in radiotherapy.
Her research has discovered a new pathway by which extracellular matrix, or material that surrounds the cell, regulates DNA-repair processes related to radiation response. She also is investigating a new class of genes that function in both DNA repair and cell invasiveness. The collaborative project includes Michael Idowu, M.D., and Lynne Elmore, Ph.D., from the Department of Pathology; Masoud Manjili, Ph.D., from the Department of Microbiology and Immunology; Nitai Mukhopadhyay, Ph.D., of the Department of Biostatistics; and colleagues acting as clinical consultants, including Harry Bear, M.D., Ph.D., from the Department of Surgical Oncology and medical director of the VCU Massey Cancer Center Breast Health Center, and Doug Arthur, M.D., and Laurie Cuttino, M.D., from the Department of Radiation Oncology, who are also affiliated with the VCU Massey Cancer Center.
According to Rizki, the goal is to use the valuable, archived tissue resources VCU offers to find markers of breast pre-cancers that predict which ones will progress to malignancy.
“We are a lot closer to personalized therapies, as well as to developing better tools for early detection,” Rizki said. “We have recently seen the cancer death rates decrease since the war on cancer was declared. This is only the beginning of an era of faster discovery that promises to lead to better outcomes for all cancer patients, including those with breast cancer.”