Duke Cancer Center

National Cancer Institute Renews DCI Core Grant

Michael B. Kastan, MD, PhD, Executive Director of Duke Cancer Institute

After many months of preparation and an extensive review process, Duke Cancer Institute was renewed as a National Cancer Institute-designated Comprehensive Cancer Center for another five-year period.

The award means that DCI retains the elite NCI designation of “Comprehensive Cancer Center”— an honor currently held by only 51 institutions in the country. The accompanying five-year grant, known as the Cancer Center Support Grant (CCSG), supports DCI’s broad range of clinical, research, and educational programs, which aim to reduce the impact of cancer on the lives of people in North Carolina and beyond.

National Cancer Institute-designated cancer centers are recognized for scientific leadership and resources and must meet “rigorous standards” for research focused on new and better ways to prevent, diagnose and treat cancer.

The Duke Comprehensive Cancer Center, now Duke Cancer Institute, was established in 1972 and has benefited from continuous recognition and funding from the NCI since 1973, when it was named as one of the original eight comprehensive cancer centers.

The CCSG is one of the top five oldest continuous NIH grants at Duke. Michael Kastan, MD, PhD, is the executive director of DCI and has been the core grant’s principal investigator since he joined DCI in 2011.

“Under Dr. Kastan’s leadership and expertise, scientific accomplishments with impactful transdisciplinary and translational research that appropriately-address the cancer burden in the catchment area have been achieved,” wrote the NCI review team. “The Institution is nationally and internationally recognized for its high standard of education, and community outreach and engagement are progressing at an outstanding level… The discoveries of new molecular, genetic, genomic, and epigenetic targets and of biological processes in cancer, together with the support of strong shared resources, to the research programs and the accomplishments in clinical trials, add value to the DCI.”

The review documented eight scientific clinical advances — in understanding microenvironment modulation; differentiation therapy in graft versus host disease; vaccine development for brain tumors; drivers in glioma subgroups; discovery of a genetic variation in leukemia that confers risk for other cancers; caspase-3 and radiation carcinogenesis; a new approach to breast cancer radiotherapy; PIK3CA mutations in breast cancer; and the identification of 12 new variants for epithelial ovarian cancer.

And, the committee lauded DCI’s population-based research, including “important advances in cancer risk factors and biomarker discovery,” the refining of screening guidelines, interventions to enhance patient and family experiences, new tech to improve symptom management and patient outcomes, and clinical trials and research to improve transitions-of-care and end-of-life support.

Shaping Cancer Research and Care

Duke Cancer Institute’s catchment area covers more than eight million people in North Carolina (67 counties), southern Virginia (40 counties), and northern South Carolina (6 counties).

More than 70,000 unique cancer patients were seen in fiscal year 2019.

“During this past funding period, DCI structures and programs have matured and prospered, with demonstrable increases in the number of collaborative publications and investigator-initiated clinical trials, numerous examples of high impact science, and significant expansion of community engagement activities,” said executive director of Duke Cancer Institute and CCSG principal investigator Michael Kastan, MD, PhD. “This grant renewal means that DCI continues to be a leader in shaping cancer research and care.”

Duke Cancer Institute is consistently ranked among the top programs for cancer care in America. Its 315 members and 131 associate members include nationally and internationally known scientific and clinical leaders with a broad range of expertise.

Over the past decade, DCI has had two Nobel Laureates. There are nine members of the National Academy of Science, 10 members of the National Academy of Medicine, two members that have been recognized by Time Magazine as the most 100 influential people in the world, and seven members who hold NIH outstanding investigator awards. In addition, multiple DCI members are governor-appointed advisors to the state of North Carolina’s Advisory Committee on Cancer Coordination and Control.

Since 2014, five new strategic-priority centers or initiatives have been established: the Duke Center for Brain and Spine Metastasis at DCI, the Consortium for Canine Comparative Oncology (C30), the Personalized Cancer Medicine Initiative (which includes the Molecular Tumor Board), the DCI Center for Prostate and Urologic Cancers and the Center for Cancer Immunotherapy. These, in addition to the 82-year-old Preston Robert Tisch Brain Tumor Center, will continue to be central drivers of DCI’s activities in the coming years.

Sixty-seven training grants and fellowship awards worth $6.2 million were awarded during the past five years. Duke Cancer Institute remains committed, moving forward, to investing in career training and development for current and future cancer physicians, scientists and health professionals across all its programs.

Karen Kharasch, Director of Research Strategy and Operations, Duke Cancer Institute

Acknowledgements

Preparing for the CCSG and site visit is about an 18-month process, though planning for the next five years starts the day that the CCSG PI receives NCI’s final review.

From start to finish, a core team of seven prepared more than 2,200 pages of data, metrics, graphics and numerous pages of quality and exceptional science for a submission date of January 25, 2019. The May 2019 site visit included over 80 people, including 33 external reviewers from NCI and around the country.

“All Duke Cancer Institute faculty and staff have the shared objective to focus our skills, experiences, and compassion to relieving our community’s cancer burden,” said Karen Kharasch, associate director for Administration for the CCSG and director of Research Strategy and Operations at DCI. “While the majority of them are outward facing, I am privileged to see the vast number of talented people who are not patient facing or in positions designed to be behind the scenes at DCI. These individuals infrequently interact with the public or patients, but their commitment is no less than to fuel a pace of discoveries and advances previously thought impossible. I want to commend the entire CCSG team, led by Daven Ria, for an exceptional CCSG submission and site visit.”

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Gayathri Devi, PhD, professor of Surgery and of Pathology, Duke University School of Medicine, and Duke PhD student Larisa Gearhart-Serna are senior and lead authors of a paper that found that urban environmental exposures drive increased breast cancer incidence. (The poster behind them is unrelated to this specific study.)

Urban Environmental Exposures Drive Increased Breast Cancer Incidence

November 20, 2023

A Duke Health analysis of breast cancer in North Carolina showed that the state’s urban counties had higher overall incidences of disease than rural counties, especially at early stages upon diagnosis. The findings, appearing in the journal Scientific Reports, serve as a national template for assessing the impact of poor environmental quality across different stages of breast cancer, which is marked by highly diverse origins and mechanisms for spreading. Continue Reading

A group of 12 people pose at a park in front of a Duke Cancer Institute tent

In August 2023, a team of volunteers led by Trinitia Cannon, MD (third from left), Leda Scearce, CCC-SLP, MM, MS, and Dina Abouelella, MPH, which also included Tammara Watts, MD, PhD (center) and Katharine Ciarrocca, DMD, MSEd, partnered with North Raleigh International Baptist Church and Duke Raleigh Hospital to offer head and neck cancer screenings. Dozens of families from the Cedar Creek Apartment Complex community came out for the free screenings, education, and games, and Duke Raleigh Hospital donated backpacks full of school supplies.

Novel Community Engagement/Research Effort in Head & Neck Cancer Launches

November 20, 2023

TheDuke University School of Medicine Department of Head and Neck Surgery & Communication Sciences (HNS&CS) recently launched Project CHECKERS (Community Head and NEck Cancer Knowledge, Engagement, Research and Screening) a Duke Cancer Institute-funded pilot project to bring head and neck cancer resources and education to the broader Durham community. Led by DCI head and neck surgeon Trinitia Cannon, MD, an associate professor in the Department, the project will be the Department’s first community-based participatory research project and the first such head and neck cancer screening and cancer prevention education project in North Carolina. Evolving Community Research The Project CHECKERS team will use a mixed methodology, which includes traditional surveys and screenings as well as interviews and focus groups. One of their community partners will be the Cedar Creek Apartment Complex community in North Raleigh. Many of these families are refugees — from at least seven different countries in Africa, Asia, and the Middle East — who speak Farsi, French, Swahili, Arabic, and other languages. They are building new lives in North Carolina, in a culture and language that is new to many of them. As is the case with many similar communities, their healthcare needs often go unmet. The investigators believe that, compared to traditional methods, mixed-method research is an improved way to establish a community partnership, highlight gaps in the community’s knowledge and risk perception, and pave the way for successful future health interventions. According to co-PI Nosayaba (Nosa) Osazuwa-Peters, BDS, MPH, PhD, an associate professor in the Department of Head and Neck Surgery & Communication Sciences, Project CHECKERS takes an important step in improving community engagement. “Traditional research is very systematic, very top-down. The researchers have knowledge and decide what they believe the community needs. But these outside scientific experts do not know the values, the culture, the knowledge, or the risks inherent in that community,” he explained. For example, traditional surveys restrict participants to answering either yes or no; for many people, that binary does not tell a complete story. “Project CHECKERS will help us understand the lived experiences of people in these communities,” added Osazuwa-Peters. “We’ll learn about context, and we’ll learn to ask questions that allow community members to express themselves. We’ll get responses we would never get based on yes or no.” Building a Partnership Project CHECKERS kicked off this fall with focus groups and interviews with community members facilitated by Laura Fish, PhD, MPH, assistant professor in Family Medicine and Community Health, Duke University School of Medicine, and program director for the Behavioral Health and Survey Research Core (a DCI shared resource). An advisory board will provide feedback from both clinical and community perspectives. Lessons learned from these conversations will help the team develop a knowledge and risk factor survey that will be administered during two head and neck cancer screening events with the community in 2024. The CHECKERS team will also recruit providers outside the department to participate in these events to address other health concerns in the community such as primary care, mental health, and women’s health. The long-term goal of Project CHECKERS is to show the benefits of tailoring head and neck cancer screening programs to the communities being served, and how that personalization can improve prevention, early detection, and overall survival in high-risk individuals who have limited access to care. Noted Osazuwa-Peters, “The mixed-methods framework helps us understand not just whether an intervention works, but how, why, and for whom.” Community Partners Another plus to mixed-methods research is its appeal to community partners who might otherwise be hesitant to work with researchers. “The design places a high value on the stories behind the numbers,” explained Cannon, “so these projects are especially attractive to community partners such as faith-based organizations, whose priority is improving practice and outcomes, more so than research and advancing knowledge.” Project CHECKERS will provide a valuable bridge between Duke and the North Raleigh International Baptist Church (NRIBC), which ministers to a large immigrant community. NRIBC’s Pastor, Patrick Warutere, invited Duke to participate in the church’s inaugural Health and Dignity for All Fair in Raleigh in 2022. Cannon and CHECKERS co-PI Leda Searce,CCC-SLP, MM, MS, a Duke speech pathologist, recruited nurses, medical students, and resident volunteers to provide HNC screenings for the event. “We immediately felt a kinship with NRIBC’s Pastor Patrick Warutere and his leadership team,” shared Searce. “By the end of the day, we knew we wanted to continue to work together and set up a meeting the following week.” Duke HNS&CS and the NRIBC team worked closely to develop the research plan and ensure that the goals and expectations of each group were aligned and transparent. “That relationship with NRIBC has enabled us to incorporate the community’s perspectives into the development of Project CHECKERS,” said Searce. “Our aim was to amplify the assets and expertise of the community members themselves.” Cannon anticipates that Project CHECKERS will become a framework for future projects. “We are looking forward to similar initiatives in hearing health for older adults, right-hemisphere stroke awareness, and more.”