Shared Resources
Duke Cancer Institute Shared Resources provide access to technologies, services, and scientific consultation that enhance scientific interaction and productivity. The support of shared services for DCI provides stability, reliability, cost-effectiveness, access to specialized technology and methodology, and quality control. DCI Shared Resources are supported by the P30 Cancer Center Support Grant (CCSG).
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Novel Community Engagement/Research Effort in Head & Neck Cancer Launches
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 Scearce,CCC-SLP, MM, MS, a Duke speech pathologist and director of Community Engagement for the Department of HNS&CS, 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 Scearce. “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.”
Dr. Hwang was Chief of Breast Surgery at Duke at that time and Dr. Fayanju was an assistant professor of Surgery, Division of Surgical Oncology. Dr. Fayanju is currently Chief of the Breast Surgery Division at Penn Medicine.
DCI/NIH/DGHI-Funded Study Highlights Diversity Deficit in U.S. Surgical Leadership
A study initiated at Duke University School of Medicine lays bare significant racial and gender disparities in America’s surgical leadership. Of the 2,165 faculty members included across 154 departments, men overwhelmingly claimed the top spots in surgical leadership, making up 85.9% of department chairs, 68.4% of vice chairs, and a staggering 87% of division chiefs. What’s more a mere 8.9% of these leadership roles were filled by those from underrepresented racial or ethnic groups. While women made a modest showing as vice chairs at 31.6%, they remained underrepresented elsewhere. Many of these women and those from underrepresented racial or ethnic groups were clustered in roles linked to diversity and faculty development, which might not pave the way to top department positions. The study in JAMA Surgery — led by Oluwadamilola “Lola” M. Fayanju, MD — stands out because the research team of surgeons, trainees, and biostatisticians looked in detail at different leadership roles and the implications these disparities have for the pipeline to department chair. CONTINUE READING at the Duke University School of Medicine Newsroom
Duke and Leica Microsystems Establish Center of Excellence in Microscopy
Duke UniversityandLeica Microsystems, Inc., have formally established a Leica Microsystems Center of Excellence at the Duke University Light Microscopy Core Facility/Duke Cancer Institute Light Microscopy Shared Resource. The collaboration was made official at a signing ceremony on Wednesday, Feb. 19, betweenLawrence Carin, Ph.D., Duke’s Vice President for Research, and Greg Eppink, Leica Microsystems Americas General Manager of Microscopy, followed by a ribbon-cutting. The center supports a mission to drive new discoveries and insights from scientific research performed using three new Leica imaging systems — the stimulated emission depletion (STED) super-resolution microscope, the Deepin vivoExplorer (DIVE) multiphoton imaging microscope, and the Leica SP8 confocal. This technology allows researchers to capture images and digital movies of the cellular and molecular processes of life. “A scientist’s insight is only as good as their tools,” said Carin. “We’re very pleased to have this microscopy center on campus to help our investigators see ever deeper into the mysteries of life.”
National Cancer Institute Renews DCI Core Grant
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.
Cancer Program Earns CoC Commendation
Duke University Hospital’s NCI-Designated Comprehensive Cancer Program recently earned a three-year accreditation rating, with commendation, from the Commission on Cancer (CoC). Established in 1922 by the American College of Surgeons, the CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care. “Duke University Hospital’s cancer program, now organized under the auspices of Duke Cancer Institute, has held CoC accreditation since 1939,” said Steve Power, MBA, administrative director of Quality & Outcomes for Duke Cancer Institute (DCI) and a member of the DCI Cancer Committee. “While most of our peer institutions are also CoC-accredited, it’s great to be recognized with commendation. It shows we have investments and strengths in the right places. Our faculty and staff are to be congratulated.” Every three years, the cancer programs are judged by as many as 34 quality care standards. They must meet or exceed all applicable standards (in Duke’s case, 24 standards) in order to earn voluntary CoC accreditation. Three-Year Accreditation with Commendation is only awarded to a facility that receives a commendation rating for one or more standards and with no discrepancies. There are six quality care standards eligible for commendation. Duke earned four — for Clinical Research Accrual, Public Reporting of Outcomes, Oncology Nursing Care, and Data Submission and Accuracy of Data. “The opportunity to enroll in clinical trials is why patients come to an academic medical center, so we’re living up to our name,” said Power, explaining that enrolling more than 30% of cancer patients in clinical trials was what qualified the DUH cancer program for a commendation in that area. For the three years surveyed, Duke’s accrual rate in fact ranged between 35 and 54%, he explained. According to the accreditation report, the inclusion, in three successive Duke Cancer Institute Annual Reports, of the number of patients screened via mammography, Pap smears, colonoscopy and prostate specific antigen (PSA), automatically earned the DUH cancer program a commendation for the outcomes reporting standard. The Duke University Hospital (DUH) cancer program also qualified for a commendation for the nursing care standard. That's because 25% or more nurses are certified OCNs. “The number of oncology-certified nurses shows our program’s dedication to this field,” said Power, noting that in Duke’s case more than 35% of nurses were certified OCNs. Duke Cancer Institute’s Tumor Registry data submissions to the National Cancer Database (NCDB), meanwhile, exceeded the terms and conditions for the NCBD 2016-2018 Calls for Data; earning a commendation for the data standard. Power credits the leadership of Tumor Registry director Wendy Gregory, BS, RHIA, CTR, for this commendation. "She and her team worked very hard to achieve this," he said. Jointly run by the American College of Surgeons and the American Cancer Society, the National Cancer Database is a nationwide oncology outcomes database for the more than 1,500 CoC-accredited cancer programs in the U.S. and Puerto Rico. Registry data from some 70 percent of all newly diagnosed cancer cases — including patient characteristics, cancer staging, tumor histological characteristics, type of first course treatment administered, and outcomes information — are submitted to the NCDB, which now contains approximately 34 million records from hospital cancer registries. A cancer liaison physician at each CoC-accredited institution monitors and evaluates the cancer program’s performance using NCDB data and reporting tools and conveys his findings quarterly to the DCI Cancer Committee. The CoC surveyor assigned to evaluate DUH’s cancer program commended the cancer liaison physician, Dan Blazer III, MD, for “a great job mining the NCDB data for academic projects,” as well as for “improving program performance.” The DUH cancer program also earned CoC praise for meeting all three Continuum of Care Services standards — the patient navigation process (including a demonstrated commitment to address barriers and disparities), psychosocial distress screening, and survivorship care plans. CoC-accredited cancer programs are required to show evidence of providing disease site-specific survivorship care plans to more than 50% of eligible patients. While many large programs struggle with this requirement, the surveyor described the DUH cancer program as particularly “robust” in this area. "The surveyor told us that programs our size generally don’t meet the 50%, but that we seemed to have met it easily," recalled Power. "I told him that we worked really hard to achieve this. It wasn’t that easy.” As part of the triennial accreditation process, the CoC surveyor makes a one-day site visit to Duke Cancer Center and Duke University Hospital. The surveyor attends a tumor board and tours the facilities, among other things. The latest site-visit, held on March 5, began with the surveyor’s attendance at a hepatobiliary tumor board led by surgical oncologists Blazer and Sabino Zani, Jr., MD. The surveyor noted that the tumor board, which was discussing many pancreatic and liver cases that day, was “clearly a meeting of highly experienced professionals sharing opinions of the best approach to difficult problems.” In the accreditation comments he also mentioned Duke Cancer Center’s “spacious and attractive” physical spaces — singling out its elaborate patient resource center, the fireplace, the (Belk) boutique, the quiet space for contemplation, the memorial floor, and the piano playing. As CoC standards evolve, staying up-to-date and in compliance are important, explained Power. Even better, earning commendations. “Right now, our committee is learning what adjustments we need to make for the next iteration of standards that have just come out for comment,” said Power. The next survey date for DUH’s cancer program will take place in February 2022, covering years 2019, 2020 and 2021.