Inside the INSTITUTE

D E D I C A T E D T O D I S C O V E R Y . . . C O M M I T T E D T O C A R E

January 23, 2001

IN THIS ISSUEAdvanced care directives urged 2New law supports bone marrow gifts 3Ethics rounds, safety series offered 5Staff members walk labyrinth 7Colorectal cancer is explained 8

The patient, a 29-year-old farmer fromMaine, lies with his chest centered in the

“doughnut hole” of a CT scanner. At his side, EricvanSonnenberg, M.D., slowly works a thin needleinto his chest, watching its internal progress on avideo monitor. When the needle reaches a lemon-shaped tumor in the lungs, vanSonnenberg turnson a heating element in the needle, destroying thetumor and a narrow layer of surrounding tissue.

The procedure, performed in the Radiologysuite at Brigham and Women’s Hospital last week,marked one of the first times that “interventionalradiology” has been used to treat a tumor in thelungs. A few weeks earlier, vanSonnenberg and hiscolleagues had become the first to use the technique

Volume 6, Issue 8

see Radiology, page 6

see 406 Club, page 7

Ted Williams 406 Club gathers at Fenway Parkto honor the man and his mission of support

On the same weekend that Boston Red Soxlegend Ted Williams was awaiting open-heartsurgery, members of the Dana-Farber organiza-tion named in his honor met at Fenway Park todiscuss two of the sports icon’s favorite subjects:baseball and the Jimmy Fund.

Institute donors, staff, friends, and Red Soxpersonnel gathered for dinner on Jan. 12 over-looking Fenway’s snow-covered field for thefourth annual celebration of the Ted Williams406 Club. Many attendees were founding clubmembers who had each committed $5,000 overfive years to fund the Ted Williams Senior Inves-tigatorship at the Institute. The 82-year-old Hall-of-Famer and war hero was instrumental inthe early growth of the Jimmy Fund, and he has

Surgery without scalpels:interventional radiologycomes to Dana-Farber

Institute shrinks itsoperating deficit butremains cost-conscious

Amid the gloomy headlines dominating thefinancial news these days, there is a positive story –and it comes from Dana-Farber.

Although it still faces a shortfall, the Institutereduced its operating deficit by 21.5 percent lastyear over the previous fiscal year. That improvementis attributed to rising patient services, generousdonors, careful spending by staff, and a healthyreturn on DFCI’s investments.

“Fiscal 2000 showed strong improvement infinancial results,” reports Director of Finance KarenBird as she thumbs through financial statementsreleased earlier this month. “It was a good year.”

Says Chief Financial Officer Dorothy Puhy, “Weappreciate all the hard work staff members havedone to achieve these results.”

The operating deficit for 2000, budgeted at$19.5 million, actually amounted to $16.4 million –compared to last year’s $20.9 million level. Thedeficit represents the difference between revenuesfrom such sources as patient fees, research, andfundraising, and operating expenses from salaries,supplies, building maintenance, and other sources.

Dana-Farber has traditionally run a deficit fromoperations. The higher-than-usual shortfall in recentyears resulted from planned investments made in

https://livelink.dfci.harvard.edu

Carl Einar Gustafson of New Sweden, Maine, a long-distance truckdriver who went from public anonymity to near celebrity after comingforward as the original “Jimmy” of the Jimmy Fund, died Jan. 21 at a hospital in Caribou, Maine. He was 65 and had suffered a stroke.

The warm, soft-spoken cancer survivor was named honorarychairman of the Jimmy Fund in November 1999. He had, however, beenserving as an unofficial ambassador for the charity since May 1998, whenhe was welcomed back at Dana-Farber and Fenway Park as the JimmyFund turned 50. After his discovery, the father of three and grandfather ofsix made countless appearances on behalf of the Institute and providedhope and inspiration to those facing cancer today.

“Einar’s story –that he was cured at atime when so fewwere and led such afull life – is an inspi-ration to all of us,”said DFCI PresidentEdward J. Benz Jr.,M.D. “His story is thestory of our nation’swar on cancer, andover the past fivedecades, tens ofthousands of peoplehave rallied againstcancer in his name.

DFCI mourns death of Einar ‘Jimmy’ Gustafson, a symbol of survivorship

see Budget, page 4

see ‘Jimmy,’ page 3

Above, Red Sox third baseman John Valentin (left) joinscancer survivor Kate Shaughnessy at the Ted Williams 406 Club evening; at right, Red Sox catcher Jason Varitekautographs the shirt of Judy Nee during a recent visit toDana-Farber. (see story, page 4).

Inside:

spent more than half a century raising awarenessand millions of dollars for Dana-Farber.

Williams was still making pleas for supportdays before his operation – when (as reported inthe Boston Globe) he asked his son to tell fans,“No flowers. Instead of sending [me] things thatare gonna die, send donations to the JimmyFund.” Judging from the poignant words deliv-ered by young Jimmy Fund Clinic patients at theFenway event, Ted’s ongoing advocacy has beenwell worth it.

“The doctors and staff at the Jimmy FundClinic never made any promises to me, but thegreatest gift they gave me – and the one I stillhold on to today – was hope,” said 19-year-oldChris Johnson, a clinic patient who has under-

Gabby Lukas seeks stairclimbers, see page 2.

Sridmar Shankar, M.D., Kemal Tuncali, M.D., and EricvanSonnenberg, M.D., in the midst of an interventional radiol-ogy procedure last week. (Laura Wulf photo)

Red Sox players meet friends and fans

Einar Gustafson (left) and two other key figures in Dana-Farber history – DFCI President Emeritus David G. Nathan,M.D. (center), and Boston Red Sox legend Ted Williams –greet a youngster in the Jimmy Fund Clinic in July 1999.

Chief of CommunicationsSteven Singer

EditorDebra Ruder

Associate EditorSaul Wisnia

DesignMonica Briggs, Caroline

Woodcheke

Senior WriterRobert Levy

ContributorsHilary Bennett, KarenCummings, Kathleen BenoitFuller, Janet Haley, Paul Hennessy, Ellen Pothier,Steven Skelton

PhotographersKaren Cummings, SteveGilbert, Laura Wulf

Inside the Institute is published semimonthly for staff membersand friends of Dana-Farber Cancer Institute. The next issue isscheduled for Tuesday, Feb. 6.

Story ideas and “News of Note” items are welcome and may besent to Debra Ruder or Saul Wisnia at 375 Longwood Ave., 5th floor, Boston, MA 02215, or call (617) 632-4090 or fax to(617) 632-5520. The Institute’s Web site is at http://www.danafarber.org; the intranet is at https://livelink.dfci.harvard.edu.

Dedicated to Discovery...Committed to Care

Inside the Institute is printed on recycled paper.

Inside the Institute2 January 23, 2001

It has been 10 years since the Federal PatientSelf-Determination Act was passed. This law gaveeach state the authority to develop and implementa program to support residents’ rights to specifythe kind of medical care they would want if, atsome point, they become unable to make or com-municate their wishes directly.

Massachusetts responded to the federalmandate by assembling a task force of patients’rights experts.This group developed an outline forthe Massachusetts Health Care Proxy Act andcreated a customer-friendly proxy form madeavailable to all residents. This is the officially rec-ognized Massachusetts Advance Care Directive.

Over the past 10 years, health-care consumeradvocates have been working with communitygroups and health-care providers to raise aware-ness about advance care directives, which includehealth care proxies and “living wills.” (A livingwill is not legally recognized in Massachusetts; itis an optional statement of instructions to help theproxy agent in decision making.)

Many Massachusetts residents have not takenthe time to complete health care proxy forms,which are routinely available in hospital admittingoffices. These easy-to-use documents do notrequire notarization or a visit to a lawyer.

The most important thing to do when fillingout the form is to have a focused and open con-versation with the person you choose as yourproxy. This individual must agree to take on thisresponsibility and be willing to communicate yourwishes to providers (if you ever become unable todo this yourself).

Your proxy agent needs to know your defini-tion of “quality of life.” The discussion should alsoinclude your feelings about the use of moderntechnology in heath care, such as cardiopul-monary resuscitation, mechanical ventilators,feeding tubes, kidney dialysis, and other life-sus-taining treatments. In addition, you should informyour physician about your advance directive andprovide him/her with a copy.

Putting your wishes in writing and appointing

a health care proxy agent are as important ascrafting a will or legally appointing someone totake care of your finances if you become incapacitated.

Heath-care workers have an opportunity toserve as role models in this area. When you learnmore about advance care directives, set one upfor yourself, and discuss the process with friendsand family, you will help the community betterunderstand the peace of mind that comes whenyou take the time to formally appoint a proxyand make your wishes known.

DFCI staff members who would like moreinformation on advance care directives may callEllen Pothier, the Institute’s patient representa-tive, at (63)2-3417. Health care proxy forms areavailable in the Access Management Departmenton Dana 1. ITI

Each day, the boxes of caps kept coming. At one point they reached the ceiling in the Dana-Farber office of Candace S. Lowe, Sc.D., administrative director of the Women’s Cancers Program,but eventually each hand-woven winter hat wound up where it belonged – on the heads of

Boston-area children.In its second year of teaming up with Brigham and Women’s Hospital as part of the nationwide “Caps

for Kids” program, Dana-Farber provided 423 caps to youngsters at the Franklin Square Day Care Center inMission Hill and the Tobin Elementary School in Boston. In addition to Institute employees, the DFCI con-tingent of knitters and crocheters included parents of staff members, patients, their friends and family, andothers. Seventy-two caps were turned in by residents of the Jack Satter House senior citizens facility inRevere, who heard about the undertaking through Inside the Institute.

All told, DFCI and Brigham and Women’s delivered 590 hats to the kids on Dec. 20, and several of theyoungsters responded with thank-you notes after the holidays.

“It was a spectacular effort and exceeded anything we could have hoped for,” says Lowe, who has spear-headed Dana-Farber’s program the past two years after spending several years knitting with the BWH groupwhile an employee there. “Last year we donated just over 100 hats, and we were hoping to double thatnumber. We wound up nearly quadrupling it, which says a lot about the generosity of spirit inherent inpeople associated with the Institute. The children and teachers were thrilled that Dana-Farber was involved,and they assured us every hat would be used.”

The “Caps for Kids” program starting nationally in 1984. Brigham and Women’s has been taking partunder the direction of Joan Casby for 12 years, and it has now combined with DFCI to turn out more than4,500 hats to help families through the frigid New England winters. Elissa’s Creative Warehouseof Needham has donated yarn toward the DFCI endeavor each of the past two years.

Those interested in getting an early start for next year’s effort – or in obtaining patterns andyarn – are invited to contact Candace Lowe at (63)2-2675. SW

Take part in one of Dana-Farber’s most energetic evenings byjoining or volunteering for theNextel Jimmy Fund Stair Climb onThursday, Feb. 8. Last year, morethan 500 climbers and 100 volun-teers worked together to raise morethan $100,000 for the Jimmy Fundand DFCI at this annual event, inwhich participants can climb up to99 flights of stairs in office build-ings at 53, 60, and 75 State St. indowntown Boston.

Here’s how you can help usachieve a record-breaking year:

Climbers: If you would like tojoin Team Dana-Farber, please contact AlyssaAdreani, team captain, by e-mail or at (63)2-3611. Registration will be in the Great Hall

at Fanueil Hall from 4 p.m. to 6 p.m., when the event begins. All climbers will receive a T-shirtand medal, and are also invited to the post-climb victory party atthe Bay Tower Room. The per-person fundraising minimum,which can be made up of col-lected pledges, is $75.

Volunteers: Those wishing tovolunteer can do so from either 3 p.m. to 7 p.m. or from 5 p.m.to 8:30 p.m. Please contact MurielMathieu at (63)2-5008 and indi-cate which shift you prefer. Allvolunteers will receive a T-shirt

and are invited to the post-climb party. ITI

A message from Ellen Pothier, R.N.

The value of planning ahead for health-care decisions

Your opinions can help make a differencefor patients with advanced cancer. We’relooking for people with the disease to takepart in a focus group as part of a study spon-sored by the National Cancer Institute. Wewant to know what you think about thequality of treatment that patients withadvanced cancer receive.

The focus group will be about two hourslong, but one-on-one interviews can also bearranged for those who can’t attend the group.

For more information, please contact CraigEarle, M.D., at (63)2-5564 or craig_earle@dfci.harvard.edu. We hope to hold the focus groupthe week of Jan. 29. ITI

Help us helppeople with

cancer!

Gabriella “Gabby” Lukas is helpingpromote the Stair Climb.

Staff members encouraged to ‘step up’ forNextel Jimmy Fund Stair Climb on Feb. 8

DFCI ‘caps’ off second year of knittingwinter hats for local schoolchildren

Have you opened your intranet account?

If not, go to https://livelink.dfci.harvard.edu and

follow the directions for doing so. Remember

to “bookmark” the URL for future visits to

DFCI Online.

We certainly pledge to continue that fight.” “Jimmy’s” tale began in 1948, when Gustafson

was a 12-year-old patient of Sidney Farber, M.D.,founder of the Children’s Cancer Research Founda-tion (eventually renamed Dana-Farber Cancer Institute) and the father of modern chemotherapy.Dubbed “Jimmy” to protect his privacy, the boy wasvisited by players from the Boston Braves baseballteam and featured on Ralph Edwards’ national radioprogram, “Truth or Consequences.”

His publicized fight against cancer, spearheadedby the Variety Club of New England, helped raiseawareness that this deadly disease struck childrenand helped generate more than $200,000 withinmonths to support Dr. Farber’s research.

Following that brush with celebrity and theremission of his cancer, Gustafson returned to hisfamily’s farm in northern Maine. He later lived formany years in Massachusetts, yet didn’t reveal that hewas the original “Jimmy” until a letter from his sister,Phyllis Clauson, alerted officials at Dana-Farber.

Despite clues over the years to Gustafson’s fateand identity, everyone at Dana-Farber had assumedthat “Jimmy” had died, because cure rates for pedi-atric cancers were so low during the era when he wastreated. According to Institute physicians, Gustafsonprobably survived because his cancer (non-Hodgkin’slymphoma, which had a 15 percent cure rate in the1940s) was operable. Once the tumor was removedfrom his intestines, chemotherapy was used toprevent spread of the disease.

Today, the improvement in cure rates for child-hood cancers, from less than 10 percent togreater than 70 percent (and as high as 90percent for some forms of the disease) standsas one of the greatest medical successes of thepast half-century.

Gustafson never intentionally concealedhis role as “Jimmy,” but because of his family’sprivate nature and the remoteness of his child-hood home, he remained anonymous until1998, the 50th anniversary of the radio broad-cast. When he stepped forward that spring,staff, patients, and volunteers lined up forautographs, and fans at Fenway Park cheered

3Inside the Institute January 23, 2001

New law aims to increase bone marrow donationsThe Massachusetts legislature gave patients needing bone marrow trans-

plants at Dana-Farber and other area hospitals a belated holiday gift recently by mandating that insurance companies cover the cost of testing unrelated,potential bone marrow donors.

Governor Paul Cellucci signed a bill into law last month that requireshealth insurance companies to reimburse the $100 cost to individuals under-going the one-time tissue-typing procedure known as Human LeukocyteAntigen (or HLA) testing, which provides the necessary information to listpeople in the national registry of potential donors.

In a supportive letter to the Chair of the House Ways and Means Com-mittee, Beth Charney of Dana-Farber, National Bone Marrow Donor Programcoordinator, predicted that “this [legislation] will increase the rate of successfulmatches for patients needing bone marrow transplants.”

Charney offered a point-by-point rebuttal against opposition to the bill thathad been mounted earlier by the Massachusetts Association of HMOs. The asso-ciation later reversed its position and supported the bill after some languagechanges were made.

State Representative Michael Rodrigues (8th Bristol District), who wasinstrumental in writing and pushing the bill through the legislature’s JointInsurance Committee, was another vocal advocate for its approval. So were staffat Michael’s Fund, a Fall River charity that raises money to cover the costs ofHLA testing for those seeking bone marrow donors. Cindy and Thomas Wrobelset up the fund in memory of their son, Michael, who died in 1996 at age 11from lymphoma while seeking a bone marrow donor.

“This law is a meaningful and important step toward helping cancerpatients survive,” says Charney. “The cost of being typed has deterred peoplefrom joining the registry. This new program not only rewards healthy individ-uals who want to help others, but helps those individuals seeking matches.”

The new law follows similar legislation in Rhode Island, the first state inthe nation to pass such a bill. During the recent legislative fight in Massachu-setts, 22-year-old Dana-Farber patient Nicholas Arruda of Fall River testifiedabout his inability to find a match.

More than six million people are currently registered as volunteer donorsworldwide, and about 3,000 patients are searching the registry for a bonemarrow match at any given time. Over the past year, an average of 150 patientsa month have received transplants with registry matches. TR

At a Jan. 5 press conference to celebrate the passage of the state’s HLA testing bill are (left toright) Beth Charney DFCI donor coordinator; DFCI patient Nick Arruda; State Sen. Joan Menard;Thomas and Cindy Wrobel; Patricia Lang, donor center coordinator for Rhode Island; and StateRep. Michael Rodrigues. (Linda Turner photo)

For scientists, the body’s instruction manual forfighting infections is like a book with large sectionswhited out. Much about how the immune systemidentifies and arms itself against foreign invaders isstill unknown.

A new study by researchers at Dana-Farber andBrigham and Women’s Hospital fills in a critical gap.

The study, led by Arlene Sharpe, M.D., Ph.D.,of Brigham and Women’s and Gordon Freeman,Ph.D., of Dana-Farber, found that a recently discov-ered structure on immune system T cells helpsprepare the cells to fight specific invaders.

The research, performed on mice, involves astructure called the inducible costimulatory(ICOS) receptor. The receptor comes into playafter T cells have been activated against infectionand helps them specialize in attacking particularinfectious agents.

This finding may one day lead to new treat-ments for autoimmune diseases such as rheumatoidarthritis, in which the immune system mistakenlytargets the body’s own tissue. ICOS may be particu-larly relevant to treating asthma. Manipulation ofthe ICOS receptor may make it possible to dampenor shut down theimmuneresponse evenafter it hasbegun, therebyalleviatingautoimmuneconditions.

The studywas published inthe Jan. 4 issueof the journalNature. ITI

Gordon Freeman, Ph.D., ofHematologic Oncology

Newfound structurehelps prepare immunesystem to fight invaders

RESEARCH NEWS “Jimmy” continued from page 1

this symbol of survivorship before a Red Sox-Yankees game.

“Einar was generous and unselfish with histime,” said Jimmy Fund Chairman Mike Andrews,“and he had a huge impact on everyone who caresabout the Jimmy Fund.”

Gustafson’s many efforts included recordingpublic service announcements for radio and tele-vision, visiting patients, and appearing at JimmyFund events, such as the Pan-MassachusettsChallenge, the Boston Marathon® Jimmy FundWalk, and golf tournaments throughout NewEngland. He literally began carrying the Dana-Farber message across the country in December1999, after receiving a refrigerator trailer for histruck, provided by Chancellor Corporation,emblazoned with the Jimmy Fund logo.

His story was featured in People magazine,Sports Illustrated, and newspapers nationwide, andthe state of Maine held a recognition day for him inApril 1999. Gustafson also made frequent appear-ances at cancer survivor rallies.

“Einar made a big difference 50 years ago andcontinued to make a big difference over the pastthree years,” added David G. Nathan, M.D., presi-dent emeritus of Dana-Farber and the Robert A.Stranahan Distinguished Professor of Pediatrics. “Weare very grateful that he came forward, and that wehad the privilege of working with him again. Wewill all miss him deeply.”

Information about services and memorial dona-tions were not available at press time. KC

Einar “Jimmy” Gustafson poses in front of the new trailer he received inDecember 1999 and that he used to spread the word about DFCI.

Inside the Institute4 January 23, 2001

Catchers Jason Varitek and ScottHatteberg, outfielder Trot Nixon, firstbaseman/designated hitter Brian

Daubach, third basemanLou Merloni, coachesRick Down and GeneLamont, and team mascotWally the Green Monsterwere all in attendance.The trip was part of the“Monster RefreshmentCaravan,” a week-longevent sponsored by Coca-Cola in which Red Soxpersonnel travelthroughout New Englandand interact with fans atstops along the route.

The caravan is a big hit whereverit goes, but Red Sox players say theyalways look forward to eventsinvolving the Jimmy Fund – which isthe team’s official charity. During this

visit, players and coaches took time to meet witheach young patient receiving treatment, as well aswith a larger group assembled in the clinic play-room. Merloni and Nixon even took a detour tothe infusion room on Dana 10 to shake hands

with a few adult patientsthere.

“Just to be here withthem makes us feelgood,” said Hatteberg. “Iknow what it means tohave children and be ayoung fan, and giving thekids some time like thisbrightens our day as wellas theirs.”

Continuing traditionSmiles abounded as

the players joked withthe children and askedwhen they might nexttravel to Fenway Park.

“I was going to go to agame last year, but then I gotsick,” said 12-year-old P.J. Terrelong of Roxbury, who was

Red Sox ‘Caravan’ makes stop at Jimmy Fund ClinicJack Nee was not scheduled for a visit to the

Jimmy Fund Clinic on Jan. 11, but the 8-year-old from Winthrop wasn’t going to miss this

opportunity. His family has season tickets to theBoston Red Sox, and Nee was about to meet someof the sports heroes he watches at Fenway Parkeach summer.

“I’m a second baseman, and this year I’mplaying for the Red Soxin Little League,” saidNee, an outpatient at theclinic. “Nomar [Garcia-parra] is my favoriteplayer, but I love themall. I can’t wait to seethem.”

Baseball season is stillthree months away, but acontingent of Red Soxplayers stopped by theclinic that afternoon tovisit with young patientsand their families. Neeand his mother, Judy,both clad in authenticRed Sox jerseys, wereamong those who talked and posed for pho-tographs with the athletes, who also autographedteam calendars, caps, balls, and even shirts thekids (and some adults) were wearing.

visited in an infusion room. “But I did hit atFantasy Day [a fundraising event held eachsummer at Fenway], and I raised $500 for theJimmy Fund with my hits.” Upon hearing this,hitting coach Down pointed at the players and said,“Hey, P.J., can you teach these guys a thing or two?”

Lamont, who joined the Red Sox as third basecoach this winter after coaching or managing forseveral other teams, enjoyed helping continue thenearly 50-year relationship between the team andthe Jimmy Fund.

“I always saw the Jimmy Fund sign at FenwayPark when I came to play the Red Sox, and I often

wondered what it was,” he recalled. “Now Isee what a wonderful charity it is, and howmeaningful it is for us to be here.” SW

research and patient care to keep the Institute at the forefront of the battle againstcancer. Reimbursements for services also have been lower than expected becauseof the shift to lower-paying insurers.

To address the deficit, DFCI has made concerted efforts to review the way itoperates and to undertake only the most critical renovations.

Deficit reductions last year also came from expanding research programs,increased patient volume and related services (such as radiology), favorablemarket conditions, and an extremely fruitful fundraising year that saw contribu-tions and royalty income climb more than 32 percent to over $61 million.

But, Puhy cautions, “We’ve been fortunate to have strong returns on ourinvestments to help us subsidize the deficit. We can’t count on those marketconditions continuing in the future. We need to make some additionalimprovements in our financial performance so that we are not so dependent onour investment returns.”

Here are some of the year’s financial highlights:

• The operating deficit dropped by 21.5 percent, from $20.9 million to$16.4 million.

• Fundraising activities, including trademark income, yielded $61.2 million,up from $46.1 million in fiscal year 1999. Additionally last year, direct fund-raising expenses declined as a share of contributions to 12 percent – a level morein line with previous years.

• Adult and pediatric outpatient visits grew 14.1 percent to 118,533 in fiscalyear 2000. On the adult side, Dana-Farber expanded its outpatient services while

Amanda Olivera (in bandana) is visited during treament by her mother, Maria, andsister, Jennifer (both beside her), along with a Red Sox contingent including (fromleft) coach Rick Down, first baseman/designated hitter Brian Daubach, catcherJason Varitek, outfielder Trot Nixon, coach Gene Lamont, and (with hand on leg)catcher Scott Hatteberg. (Laura Wulf photos)

Francisco “Popeye” Giboyeaux (left) shares a smile with his mom, Ilya (right), andBrian Daubach in the Jimmy Fund Clinic.

“Giving the kids some time likethis brightens our day as well as theirs.”

— Scott Hatteberg, Red Sox catcher

Brigham and Women’s Hospital closed its adult outpatient oncology clinics. Asa result, DFCI treats all adult oncology patients previously seen at both institu-tions, as planned under a joint venture agreement with Partners HealthcareSystem. Dana-Farber now has 27 licensed inpatient beds at BWH.

• The Institute’s total assets swelled 14.7 percent, from $616.6 million lastyear to $707.6 million in FY 2000 as a result of both the increased fundraisingand strong investment performance during the year.

• Dana-Farber spent almost $5 million on charity care, which includes freecare to indigent patients and contributions to a state pool for needy patients.

In other financial developments last year:

• Dana-Farber and six other Harvard-affiliated institutions formed theDana-Farber/Harvard Cancer Center (DF/HCC) to foster cancer-related collabo-ration among 800 researchers. The institutions – DFCI, Harvard MedicalSchool, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital,Children’s Hospital, Massachusetts General Hospital, and Harvard School ofPublic Health – conduct more than $235 million in cancer-related researcheach year.

• The National Cancer Institute awarded the Dana-Farber/Harvard CancerCenter $52.3 million over the next five years and extended Dana-Farber’s des-ignation as an NCI Comprehensive Cancer Center to DF/HCC. Fundingawarded in the grant will be used in part to support large, highly technical corelaboratories critical to genetic research in cancer. DR

Madison Nannery (center) gets a boost from her mom, Mary,to obtain Scott Hatteberg’s autograph.

Budget continued from page 1

5Inside the Institute January 23, 2001

In an effort to promote awareness of cervicalcancer risk and improve access to screening andtreatment, five physician-researchers from Dana-Farber/Partners CancerCare are meeting with com-munity health center clinicians in Dorchester,Jamaica Plain, Mattapan, and Roxbury this winter.

Most of the talks are taking place in January aspart of National Cervical Health Awareness Month.

The physicians – who include Ursula Matu-lonis, M.D., and Ross Berkowitz, M.D., of Dana-Farber and Brigham and Women’s Hospital – aresharing the latest information on treatment andrisks for cervical cancer, and are emphasizing theneed to increase the number of women screenedannually for the disease.

Cervical cancer is nearly 100 percent curablewhen diagnosed early. But the key to early diag-nosis is an annual Pap test, and public health datareveal racial and income disparities in cervical

cancer screening rates and deaths from the disease.A 1998 Massachusetts Department of Public

Health survey shows the Commonwealth rankedfourth highest nationally in the number of womenage 18 and over who had a Pap test during theprevious three years. But, compared to 92 percent

Dana-Farber/Partners CancerCare teams with communityhealth centers to promote awareness about cervical cancer

of all other races, only 46 percent of Asian womenage 18-39 had undergone a Pap test during thepast three years.

Furthermore, while 94 percent of Massachu-setts women and 89 percent of Boston women age 18 and over report having had a cervical Paptest at some point in their lives, women withannual incomes of less than $25,000 were muchless likely to have ever been screened.

Whereas nearly 95 percent of African-Amer-ican women in Boston say they have had a cervicalPap test at some time in their lives, the BostonPublic Health Commission reports that from1993-98, African-American women had twice themortality rate from cervical cancer of Caucasianwomen.

The cervical cancer lecture series is made pos-sible by Dana-Farber/Partners CancerCare’sGillette Centers for Women’s Cancers. The presen-tations are scheduled for the Geiger-Gibson,Upham’s Corner, and Neponset CommunityHealth Centers in Dorchester; the Martha EliotHealth Center in Jamaica Plain; the MattapanCommunity Health Center; and the Whittier

Street Health Center in Roxbury. In addition toMatulonis and Berkowitz, participating physiciansare Christopher Crum, M.D., of BWH, and Naj-mosama Nikrui, M.D., and A.K. Goodman, M.D.,of Massachusetts General Hospital.

Inaugural seriesThis is the first time DF/PCC has organized a

lecture series on cervical cancer for communityhealth center clinicians. The five centers areamong 14 Boston-area community health centers

that teamed with Dana-Farber/Partners CancerCaretwo years ago to expand the availability of freebreast and cervical cancer screening to uninsuredwomen age 40 and above.

Last year, with Department of Public Healthfunding, the health centers used mobile mammog-raphy or on-site mammography to check 1,200uninsured women for breast cancer; they also per-formed Pap smears to screen for cervical cancer.Nearly 20 percent of the women had never had aPap test.

Recent state changes now enable uninsuredwomen age 18 and over to receive a free annualPap test, and the 14 community health centersinvolved are urging women in their community tobe screened.

Radio spots produced by Partners HealthCareSystem in five different languages are also airing inJanuary. The ads promote the importance ofannual screening and the availability of freescreening for uninsured women. The radio ads arevoiced by JudyAnn Bigby, M.D., of BWH andhealth professionals from community healthcenters who speak Khmer, Haitian-Creole, Por-tuguese, and Spanish. ITI

More calendar listings for theInstitute and other affiliated orga-nizations can be found on DFCIOnline, at https://livelink.dfci. har-vard.edu, under “Calendars.”

Parenting Workshop on the MCAS Tests DebateTuesday, Jan. 30, noon to 1:15 p.m.Room 447, Tosteson Medical Educa-tion Center, 260 Longwood Avenue,Harvard Medical School

Speaker: Jackie King, Coordinator ofthe statewide Coalition for AuthenticReform in Education (CARE)

Join this discussion about the contro-versial high-stakes MCAS tests – theirorigins in education reform, content,and use to determine graduation – andthe efforts of concerned parents,teachers, and students to foster acomprehensive approach to assess-ment of student and school progress.Feel free to bring your lunch.

Presented by the Harvard MedicalCenter Office of Work and Family. For more information about thisprogram or for other parenting

resources, call Barbara Wolf at theOffice of Work and Family at 432-1615.

Sexual Harassment Prevention Training SessionsFeb. 6, 10 – 11 a.m., Shields Warren 1Feb. 26, 2 – 3 p.m., D1620March 6, 10 – 11 a.m., Shields Warren 1

Attendance at a sexual harassmenttraining session is a one-time manda-tory requirement for all staff. Pre-reg-istration is required. To register, senda message to Leigh Holden atdfci_training@dfci.harvard.edu. If youhave any questions or would like toschedule a separate training sessionfor your department, please callHolden at (63)2-6137.

DFCI Ethics RoundsMonday, Feb. 26, noon – 1 p.m.Smith Family Room (D1620)

Topic: Should insurers pay for early-stage clinical trials?Presenter: Sarah W. Alexander, M.D.Discussant: Norman Daniels, Ph.D.,

Happenings

Professor of Philosophy, Tufts UniversityModerated by Edward J. Benz, Jr.,M.D., President of Dana-Farber

For more information, please contactSteven Joffe, M.D., M.P.H., DFCIEthics Advisory Committee, at (63)2-5295

Patient Safety Lunchtime Lectures Feb. 15, March 15, May 17 noon – 1 p.m.Smith 304

Hear several Dana-Farber leaderspresent what we’ve learned, done, andare currently doing to support contin-uous improvements in patient safety.Through these and many other relatedlectures, our efforts have been wellrecognized by health-care staff nation-wide. At the request of staff, we arenow presenting these lectures to theDFCI community.There will be plenty of time for ques-tions and discussion. Bring yourlunch; soda and cookies will be provided.

“Systems and Error Prevention”Thursday, Feb. 15, Speakers: Sylvia Bartel, R.Ph.,M.H.P., Director of Pharmacy, andRobert Soiffer, M.D., Chair of thePharmacy and Therapeutics Com-mittee; Clinical Director, HematologicOncology; Co-Director, Stem CellTransplantation

“Critical Event Analysis”Thursday, March 15 Speakers: Maureen Connor, R.N.,M.P.H., Director Risk Management,and Deb Duncombe, M.H.P., RiskManager

“Update on Systems for PediatricChemotherapy Safety”Thursday, May 17 Speaker: Amy Billet, M.D., Chief,Oncology Inpatient Service, Children’sHospital; Assistant Professor of Pediatrics, Harvard Medical School

For more information, contact LeighHolden in Human Resources, at(63)2-3052.

Ross Berkowitz, M.D. (Steve Gilbert photos)

Ursula Matulonis, M.D.

Public health data reveal racialand income disparities in cervi-cal cancer screening rates anddeaths.

At Brigham and Women’s, interventional radi-ology is used on a wide range of patients; at Dana-Farber, it will be reserved for cancer patients. Thatdoesn’t mean, however, that the technique will beemployed at the Institute only for tumors.

“Cancer patients can have a wide variety ofproblems other than tumors that can be treated byinterventional radiology,” vanSonnenbergobserves. “They may have an abscess that needs tobe drained, or blockage or stones in their kidneys,bile ducts, or gallbladder that need to be removed.Having the service available at Dana-Farber willenable many patients to have such proceduresperformed on the same day they come in for otherappointments.”

The inauguration of a service at the Institutewill require the hiring of additional radiologistsand nurses skilled in interventional techniques, headds. Anesthesiologists often participate in theprocedures, and pathologists are frequently onhand to undertake an immediate laboratoryanalysis of removed tissue.

At the forefrontFor vanSonnenberg, part of the field’s appeal is

the opportunity to participate in an area at thecutting edge of medical practice. “During my resi-dency and fellowship in radiology at Mass GeneralHospital [in the 1980s], interventional radiologywas so novel that practically every week we weredoing brand-new procedures. You couldn’t lookthem up in the medical literature, because they’dnever been done before.”

Much of that excitement persists, he adds,citing the recent “first” of removing a tumor froma patient’s adrenal gland. VanSonnenberg and his

colleagues also conduct research intonew techniques with colleagues at otherHarvard-affiliated hospitals.

This research, combined with ever-more-sophisticated technology, promisesto expand the interventional radiologyfield even further, vanSonnenberg notes.Dana-Farber, in fact, plans to obtain acombined CT-PET (positron emissiontomography) scanner in the near future,which will provide even more options forpatients.

and analyzing images ofinternal tissues, they nowbecame direct caregivers topatients, working withother physicians whoprovide consultations andfollow-up care.

A great deal of trainingis required for radiologiststo become interventionalradiologists, vanSonnenbergsays, as is true of the entire

interventional radiology team – other physicians,nurses, and radiology technologists.

In a typical procedure, a patient is sedated andgiven a local anesthetic where a needle or otherslender instrument will be inserted. If the aim is tokill (or “ablate”) a tumor, the radiologist will guidethe needle and probes to the site of the tumor, aidedby a live image produced by a CT or MRI scanneror ultrasound device. With current technology,

radiologists can targettumors or other physicalabnormalities as small as3-5 millimeters in diam-eter. They can destroy atumor by heating it,freezing it, injecting itwith chemicals, or a com-bination of techniques.

Interventional radi-ology can also be usefulfor clearing blockages inthe body, whether in ablood vessel, airway,kidney, bile duct, or intes-

Inside the Institute6 January 23, 2001

on an adrenal gland tumor.In a few months, another innovation is

planned: interventional radiology will becomeavailable at Dana-Farber.

Sometimes known as “scalpel-less surgery,”interventional radiology involves the use ofimaging technology such as CT (computed tomog-raphy) or MRI (magnetic resonance imaging) scanners and ultra-slender needles, wires, andcatheters to perform procedures that once couldbe done only by surgeons. First developed in the 1980s, the technique is now one of the fastest-growing areas of medicine.

“At Brigham and Women’s – andsoon at Dana-Farber – we use inter-ventional radiology (or IR) to targetabnormalities, make diagnoses, andtreat problems in a variety of organs,”says vanSonnenberg, of the Depart-ment of Radiology. “We use IR to takebiopsies [extract tissue for laboratoryanalysis], drain fluids, treat nervepain, and remove obstructions orstones from organs such as thekidneys, bile ducts, gallbladder, andintestines. Most recently, we’ve startedusing it to kill tumors.”

The technique is favored bysome patients and physicians becauseit can be less traumatic, less costly,and require less hospitalization than conventionalsurgery. In some cases, IR may represent the onlymeans of diagnosing and treating a condition, van-Sonnenberg says.

At Brigham and Women’s and soon at Dana-Farber, interventional radiology procedures alwaysare/will be performed in consultation with, andwith cooperation from, surgeons or other referringphysicians, according to vanSonnenberg.

A meeting of technologyInterventional radiology became possible

thanks to a convergence of technologicaladvances. On the one hand was the introduc-tion of CT scanners and ultrasound machinesthat enable radiologists to locate tumors andother abnormalities deep within a patient’sbody. On the other hand were advances inminiaturization that led to the development ofskinny needles, catheters, and guidewires withwhich radiologists can reach diseased tissue anddeliver treatment.

Still another prerequisite was a rethinking ofthe role of radiologists themselves. Whereas radiol-ogists traditionally had been limited to making

Radiology continued from page 1

Eric vanSonnenberg, M.D., studies a CT scan image in theRadiology suite in the Dana building.

(From left) Drs. Sridmar Shankar, Eric vanSonnenberg, and Kemal Tuncali discussa patient’s condition as shown on a CT scan.

Above, Drs. Shankar, Tuncali, and vanSonnenberg performa procedure. At right, among the tools used in interven-tional radiology are slender needles, probes, and catheters.

tine. Radiologists can pass a tiny stent – a tubemade of wire mesh – to the blocked area and allowthe stent to expand to hold the passageway open.

Many interventional radiology procedures canbe done on an outpatient basis, although somepatients spend a night or more in the hospital as asafety precaution.

Text by Robert LevyPhotos by Laura Wulf

7Inside the Institute January 23, 2001

gone three surgeries for an incurable brain tumorin six years. “Maybe in the near future, there willbe a cure for cancer, but until then I’m thankfulthat there is a place like the Jimmy Fund Clinicand people like you who support it.”

survivors Kate Shaughnessy and Danny Pardi, whospoke at past 406 Club evenings. Another young-ster, 11-year-old Chris Horn of Simsbury, Conn.,was recognized by Andrews for giving the JimmyFund $180 he earned from collecting soda cans.

Red Sox players Trot Nixon and Brian Daubachalso attended the event, which is sponsored eachyear by the Thomas and Jean Yawkey Foundation.

“This club is a wonderful opportunity for us tohelp a place that does great work,” said Ken Lasdenof Lexington, a founding member of the 406 Clubwho spent much of the evening acquiring auto-graphs with his 12-year-old daughter,Danielle. “We cancome to greatevents like thisand help theJimmy Fundat the sametime.” SW

D’Andrea, whose research is focused on Fanconianemia – a rare disease that often leads tocancer.

“I am very proud to be appointed the TedWilliams Senior Investigator,” he told the crowd

in Fenway’s 600 Club, “but evenmore so, I’m very proud that youhave assigned the name of a true heroto people in my profession.”

An ardent baseball fan whose twoyoung children wore Red Sox shirtsand caps to the event, D’Andrea drewlaughs in recalling his dismay when,as a Harvard College student, he wasoffered a ticket to Game Six of the1975 World Series the night beforehis organic chemistry mid-term. Hedeclined, and missed the Sox andCincinnati Reds battle in what manynow call the greatest game everplayed.

Posing questionsAfter speeches by

D’Andrea, Johnson,and Jimmy FundChairman MikeAndrews, Red Soxplayers and coachesled a lively baseballquestion-and-answersession with thecrowd. Red Sox per-sonnel participatingincluded thirdbaseman JohnValentin, coachesTommy Harper andJoe Kerrigan, managerJimy Williams, generalmanager DanDuquette, and execu-tive vice presidentJohn Buckley. Teamradio broadcaster JoeCastiglione served asmoderator, andhelping pass themicrophone amongaudience memberswere young cancer

Hyundai Motor America and its dealers recently got help from youngsters Celina and SalvatoreValenti of Revere in presenting the Jimmy Fund with $347,000 to support cancer research atDana-Farber. Here, Jimmy Fund Chairman Mike Andrews (center) and the youngsters accept acheck from Hyundai’s Eastern Region General Manager Michael Tocci (left) and Tom O’Brien, along-time Jimmy Fund supporter and owner of Tom O’Brien Hyundai in Quincy. Celina, 6 (left),donated bone marrow tissue to her brother, Salvatore, 2, who was treated for an immune defi-ciency disease by Eva Guinan, M.D., and Sung-Yun Pai, M.D., at the Jimmy Fund Clinic.

Patients and staff take a moment to meditate as they walk the labyrinth set up in theSmith Family Room on Jan. 18. Dana-Farber patient Beth Mace facilitated the walk to helppeople generate peace and harmony in their lives. “The labyrinth helped me a lot,” saysMace. “It put me on the path to recovery.” The event was sponsored by the Leonard P.Zakim Center for Integrated Therapies. (Laura Wulf photo)

Red Sox first baseman/designated hitterBrian Daubach (rear left) poses with TedWilliams Senior Investigator Alan D’Andrea,M.D., of Pediatric Oncology and his children,Erika, 6 (front left), and Vincent, 8.

Jimmy Fund Clinic patient Chris Johnson, 19, moved the audiencewith his story of courage and perseverance.

Hyundai helps in fight against cancer

406 Club continued from page 1

Taking a labyrinth journey

Saluting a HeroRecognizing in its name the

phenomenal .406 batting averagereached by Williams in his bestseason, the 406 Club has raisedmore than $2 million since its 1995inception. With its original 406founding pledges now filled, theclub has become integrated intoDFCI’s Annual Leadership GivingProgram.

Alan D’Andrea, M.D., of Pedi-atric Oncology, the current TedWilliams Senior Investigator, sharedhis feelings about the position atthe event.

“To me, heroes are people whocare tremendously about what theydo, love their profession, and havethe discipline to pursue the talentthey were born with,” explained

Jimmy Fund Clinic patient Danny Pardi (front),keynote speaker at last year’s event, takes in thefestivities with Red Sox outfielder Trot Nixon. (Steve Gilbert photos)

Inside the Institute8 January 23, 2001

Colorectal Cancer

Every year, more than 56,000 Americans diefrom colorectal cancer, making it the third

leading cause of cancer deaths among both men andwomen. Yet thousands of lives could be saved everyyear if more people took advantage of colorectalscreening and made lifestyle changes to reduce theirrisk of this disease. Because even though colorectalcancer is one of the most common and potentiallydeadly types of cancer, it is also one of the mostpreventable and, if detected early, one of the mostcurable.

To raise awareness about the latest advances incolorectal cancer prevention, screening, and treat-ment, Dana-Farber/Partners CancerCare (DF/PCC)recently presented a workshop titled “What YouNeed to Know about Colorectal Cancer.” It was thethird in a four-part series of free educational pro-grams offered this fall by DF/PCC.

Presenting the workshop were Matthew Kulke, M.D., an oncologist at Dana-Farber andBrigham and Women’s Hospital, and David P. Ryan,M.D., an oncologist at Massachusetts General Hospital. Kulke focused on the risk factors andscreening tests for colorectal cancer, while Ryan discussed the latest treatments.

Risk factors Kulke reviewed the anatomy of the colon and

rectum, explaining that cancer can originate at anypoint along this approximately six-foot long tubeknown as the large intestine. He pointed out thatcolorectal cancer is quite common, with some130,000 new cases occurring every year in the U.S.,primarily among people 50 years of age and over.

The lifetime risk of developing colorectal cancerfor the average American who lives to age 85 isabout 5-6 percent, said Kulke. However, the risk ishigher for certain groups, suchas individuals with a familyhistory of colorectal cancer, par-ticularly among first-degree rela-tives such as a parent or sibling.A rare condition called familialadenomatous polyposis (FAP),which represents less than onepercent of colorectal cancers,increases the risk of the diseasedramatically.

Screening recommendationsAccording to American

Cancer Society (ACS) guidelines,most people at average risk andwithout symptoms should bescreened for colorectal cancerbeginning at age 50. This typi-cally includes a fecal occultblood test, a simple procedurethat checks a stool sample forhidden blood; a digital rectalexamination; and either a flexible sigmoidoscopy ora colonoscopy.

Until recently, most people were advised toundergo a flexible sigmoidoscopy rather than acolonoscopy. The former is a procedure in which agastroenterologist inserts a flexible, lighted scopeinto the rectum and lower colon to look for polyps,precancerous growths that can eventually developinto cancer. While studies indicate that sigmoi-doscopy helps prevent colorectal cancer, it provides

a view only of the lower third of the colon; thereforeit cannot detect polyps in the upper two-thirds.

For an unknown reason, over the past fewdecades cancers have been originating higher in thecolon, beyond the view of sigmoidoscopy. As aresult, the ACS now recommends that people age 50 and over at average risk for colorectal cancerconsider having a colonoscopy every 10 years. Thisprocedure provides a view of the entire colon andpermits the removal of any accessible polyps thatare discovered.

Screening is designed to removepolyps before they become cancerousor, if cancer is found, to diagnose thedisease early when it is more treat-able, Kulke stressed. If colorectalcancer is detected at its earliest stage,the five-year survival rate is about 90 percent. If, however, the disease isnot found until it has spread to adja-cent organs or lymph nodes, the five-year survival rate drops to roughly 50 percent. This rate plummets toabout 5 percent if the disease hasmetastasized to distant sites.

Lifestyle changesIn addition to screenings, people can make

lifestyle changes that may reduce their risk ofdeveloping colorectal cancer, said Kulke. Theseinclude taking a daily multivitamin containingfolate (also called folic acid), getting at least 30minutes of exercise daily, eating less red meat,avoiding smoking, and reducing alcohol con-sumption or eliminating it altogether.

Aspirin use has also been shown to protectagainst colorectal cancer, but it must be taken for

decades to confer anybenefit. Estrogen replace-ment therapy also appears tolower colorectal cancer riskto some extent.

For many years, it wasbelieved that consuming ahigh-fiber diet reduced therisk of colorectal cancer, butrecent studies have shownthis has no protective effect.However, diet still plays animportant role in colorectalcancer risk: people who eatlarge amounts of animal fat,specifically red meat, appearto increase their risk ofdeveloping the disease.

Treatment optionsIn his overview of treat-

ment options, Ryanexplained that surgery is still

the mainstay of therapy, but that chemotherapy,radiation therapy, or a combination of all three maybe used, depending on the location and stage of thedisease and other variables.

The goal of surgery is to remove the canceroustumor, along with adequate margins of tissue toensure that no diseased tissue remains. In manyinstances, this entails removing a section of thecolon, after which the two ends are joined together.Fortunately, most patients today do not require a

Matthew Kulke, M.D. (Steve Gilbert photo)

Text by Hilary Bennett

permanent colostomy, in which a portion of thecolon is routed through a surgical opening in theabdomen to provide an exit for waste material.

Because colorectal cancer has a predilectionfor spreading to the ovaries (as well as the liverand lungs), some women may need to have theirovaries removed.

Whether or not to use chemotherapy drugs inthe treatment of colorectal cancer depends, in largemeasure, on the stage of the disease. According toRyan, most oncologists use the TNM system to stage

cancers. This system indicates howdeep the tumor has invaded thewall of the colon or rectum (T),the involvement of nearby lymphnodes (N), and whether distantmetastases (M) have been found. If, for example, the disease has notspread outside the colon, surgerymay be all that is necessary. Today,so-called “adjuvant” chemotherapyis often advised for patients whohave no obvious signs ofmetastatic disease, but whosecancer might have spread. Thegoal is to improve the odds of

killing any tumor cells that might be presentthroughout the body.

The mainstay of chemotherapy for colorectalcancer is a combination of the drug 5-fluorouracil(5-FU) and leucovorin (folinic acid), whichenhances the action of 5-FU. Recently, the U.S.Food and Drug Administration (FDA) approved theuse of Camptosar (irinotecan) in combination with5-FU and leucovorin as a front-line treatment forcolorectal cancer. Recent studies indicate that thisdrug trio delays tumor progression and improvessurvival rates. A new drug, oxaliplatin, is alsoshowing promise in the treatment of colorectalcancer, but it is currently available in the U.S. onlythrough clinical trials.

Treatment goalsWhile chemotherapy will not cure patients

whose colorectal cancer has metastasized to distantsites, it is sometimes used to help these patients feelbetter and prolong their lives.

Most patients tolerate chemotherapy for thedisease quite well, experiencing only mild or moderate side effects, said Ryan. In fact, manypatients are able to continue working throughouttheir treatment.

Radiation therapy is often used for patients withcancer of the rectum or to relieve symptoms, suchas pain, resulting from cancer that has metastasizedto the bone or liver. It may also be used to helpreduce the risk of local recurrences.

Ryan emphasized the importance of patientsconsidering participation in clinical trials, as this isthe only way to answer questions that may lead totreatment advances. Joining a clinical trial has twobenefits, Ryan noted: it offers patients access to new,promising therapies, and it gives them a uniqueopportunity to help improve the care of all patients.

Another set of workshops are to start in March; formore information, call the DF/PCC consumer educationline at (800) 553-3787.