USF’s Microbiome Research initiative continues to gain momentum as USF Health and Moffitt Cancer Center faculty met recently to begin exploring how both institutions might best use their collective resources to advance in the emerging, complex field.

A panel of faculty and staff from USF Health and Moffitt Cancer Center discuss infrastructure, equipment and expertise needed to facilitate collaboration and expand microbiome research.

The July 1 Joint Workshop on Microbiomes and Cancer followed USF Health’s first Microbiome Joint Workshop with the University of Florida in May. USF Health and Moffitt scientists and clinicians presented several research topics, ranging from the implications of gut bacteria on colorectal cancer and role of the microbiome in cancer-treatment induced cardiac complications, to microbes as potential biomarkers of cancer treatment outcomes.

Stephen Liggett, MD, associate vice president for research at USF Health, and Thomas Sellers, PhD, director and executive vice president of Moffitt, welcomed workshop participants.

“We hope to take advantage of the brainpower, informatics, facilities and instrumentation between Moffitt and USF Health to move our microbiome research initiative forward in a collaborative and synergistic manner,” Dr. Liggett said.

Thomas Sellers, PhD, director and executive vice president of Moffitt, told participants that one in five cancers is caused by infection. “That just signals how important this (microbiome initiative) can be.”

“This microbiome initiative is an excellent example of how no one institution and no one individual can do the science independently. It takes a village,” said Dr. Sellers, who noted USF and Moffitt’s longstanding history of working together on medical education and cancer biology.

“There’s a lot of strength among the people in this room, some of whom may not have known they were going to be the world’s future microbiome experts. I’m optimistic about this first step in what could be a long and productive collaboration.”

The growth of basic, translational and clinical research centered on microbial populations in environments and hosts is still in its early stages. Just last month, 36 universities identified their institutions as “highly focused” on microbiome studies at the National Microbiome Centers Meeting in Irvine, Calif.

“Most were created over the past two years, and not all focus on the human microbiome,” said Christian Brechot, MD, PhD, associate vice president for international partnerships and innovation, senior associate dean for research in global affairs, and professor of infectious disease and international medicine at the USF Health Morsani College of Medicine. “One characteristic shared by successful centers was that they all started with internal seed grants.”

Source: National Microbiome Centers Meeting, Irvine, CA, June 2019

At the workshop with Moffitt, Dr. Brechot confirmed that nine projects related to USF’s first call for Microbiome Research Awards, are being evaluated (two of the nine focused on cancer). These seed grants will support collaborative research between faculty members from at least two different departments or colleges.

USF Health has a foundation of microbiome research projects headed by individual investigators in medicine, nursing and public health and of supporting infrastructure, including the USF Genomics Program and Omics Hub, the Health Informatics Institute, and core facilities in proteomics and lipidomics. But, Dr. Brechot noted, achieving preeminence in microbiome research requires partnering with other leading institutions, like the University of Florida and Moffitt, to identify potential collaborative pilot projects, build stronger crossdisciplinary teams, and share resources needed to be competitive in attracting external grant funding.

Hua Pan, PhD, assistant professor of cardiovascular sciences at USF Health, is working with Washington University and Moffitt to study whether alterations in the gut microbiome can help predict which patients would be most susceptible to cancer treatment-induced cardiac complications.

A roundtable discussion moderated by Dr. Brechot and Anna Giuliano, PhD, director of Moffitt’s Center for Immunization and Infection Research in Cancer, began addressing the infrastructure, equipment and expertise needed to facilitate collaboration and expand research.

Charles Lockwood, MD, senior vice president for USF Health and MCOM dean, delivered the workshop’s closing remarks.

“Microbiome research is perfect for where we’re headed, because it literally impacts every other area of research,” said Dr. Lockwood, who cited the links between an imbalance in microbial populations (dysbiosis) and Parkinson’s disease, coronary artery disease, and infection-associated preterm births, as just a few examples. “We’ve got to be part of that… and we’re committed to (strategically) resourcing it.”

Anna Giuliano, PhD, director of Moffitt’s Center for Immunization and Infection Research in Cancer, said the challenge is translating complex microbiome research into interventions that will alter the course of disease. “Each cancer is unique… and molecular pathways can vary even within the same cancer.”

-Photos by Freddie Coleman, USF Health Communications and Marketing

Michael Fradley, MD, had finished medical school. He’d completed training in internal medicine and cardiology.   He decided to pursue further training in electrophysiology, and began observing a substantial number of cancer patients were experiencing abnormal heart rhythms.   Then, in the midst of his fellowship, the unthinkable happened.  He received his own cancer diagnosis – melanoma.

“I had to undergo certain procedures and treatments but fortunately now I’m fine,” said Dr. Fradley, associate professor of medicine at the USF Health Morsani College of Medicine.  “As a result of this experience, I had this very new perspective on my life and my career. I had been personally affected by cancer … and I have this passion for cardiology. Wouldn’t it be an amazing opportunity to try to bring the two together?”

USF Health cardiologist Michael Fradley, MD, speaks to a patient at the Cardio-Oncology Clinic at Moffitt Cancer Center.

While Dr. Fradley was finishing his electrophysiology fellowship, Roohi Ismail-Khan, MD, a medical oncologist at Moffitt Cancer Center, was noticing a worrying trend — many of her breast cancer patients experienced cardiac issues during and after treatment. “We were getting much better at treating cancer,” she said, but “why put patients through something that’s going to help them survive the cancer and then have [cardiac] issues to deal with later on?” So, in late 2014, about a year after Dr. Fradley joined the cardiology team at USF Health, the pair began a Cardio-Oncology Program jointly developed by USF Health and Moffitt. “It was all just a perfect fit,” Dr. Fradley said.

Integrating research into cardio-oncology care

Cardio-oncology is an emerging field — one in which there are still many questions left to answer. Dr. Fradley and Dr. Ismail-Kahn didn’t just want to treat patients; they wanted to research how to do it better. They enlisted the help of biomedical engineer Hua Pan, PhD, MBA, an assistant professor of cardiovascular sciences and member of the USF Health Heart Institute. Dr. Pan conducts basic and translational research on the molecular mechanisms through which cancer treatments damage the heart. This includes investigating genetic signals that may help predict which patients receiving new drugs to boost the body’s immune system response against certain cancers are likely to develop cardiovascular complications.

Biomedical engineer Hua Pan, PhD, a member of the USF Health Heart Institute, works with Dr. Fradley and collaborators at Moffitt Cancer Center to incorporate basic science and translational research into the joint Cardio-Oncology Program.

The cardiologist, oncologist and basic scientist came together to form a powerful academic research and training program. “It’s one of the first [cardio-oncology programs] in this nation to incorporate basic science and the translational component into a cardio-oncology program,” Dr. Pan said. “It connected the dots. This is very unique.”

There was a time when a cancer diagnosis was almost equivalent to a death sentence. Nowadays, nearly 70% of people diagnosed with cancer will survive, thanks to the advent of treatments like chemotherapy, radiation therapy, and immunotherapy, according to the National Cancer Institute. But those life-saving therapies have come at a cost. Up to 30% of cancer patients develop cardiovascular complications. The issue is so common that it’s become the leading cause of death in cancer survivors. Those therapies, which so effectively attack cancer cells, can also damage the heart and increase the risk of heart disease in the future. And if a patient is already at risk of heart disease due to obesity, diabetes, or genetics, that risk is amplified by cancer treatment.

A collaboration that optimizes treatment

That’s something Dr. Ismail-Kahn had to consider when treating patients. For patients with clear risk factors for heart disease, she might choose a less aggressive — and potentially less effective — treatment plan to avoid cardiac complications.

Now, when a patient comes to see Dr. Ismail-Kahn for cancer treatment, she sets the patient up with an appointment with Dr. Fradley as well. Dr. Ismail-Kahn determines the ideal treatment for the patient’s cancer. She’ll send that information to Dr. Fradley, who after reviewing the patient’s cardiac history and conducting various tests on the patient’s heart and blood, will develop a plan to monitor and prevent cardiovascular complications throughout treatment. That plan may require guiding the patient through preventive measures like changes in diet and exercise or starting the patient on cardiac medications. It will also include regular cardiac checkups with Dr. Fradley so he can identify any cardiac effects before they become severe and offer an intervention or suggest a temporary break from cancer treatment if needed.

Moffitt Cancer Center oncologist Roohi Ismail-Khan, MD

“Let’s just say I have an 80-year-old patient with history of heart disease and she needs certain chemotherapy and certain targeted therapy to help with her cancer,” Dr. Ismail-Kahn said. Before working with a cardio-oncologist, she might have chosen a less effective treatment plan in order to prevent heart disease. Now, she says she’s “braver in treating patients.” Working with a cardio-oncologist who understands how cancer drugs interact with the heart, can watch the heart closely, and knows what interventions can help, gives her confidence that any cardiovascular risks will be managed appropriately so that she can give the right treatment for each patient.

One of the nation’s first cardio-oncology fellowships

But there aren’t enough cardio-oncologists for all programs to offer such care. As such, Dr. Fradley developed one of the first cardio-oncology fellowship programs in the United States, focusing on training a new generation of cardiologists to specialize in this field. ‘It’s important for trainees to get dedicated exposure to the complexities of this patient population,” Dr. Fradley explained. “This is an excellent opportunity to disseminate knowledge to other institutions and organizations. And these individuals will become the future leaders of the specialty.”

Moving the field forward will take more than training new specialists. That’s why the program is set up to conduct multidisciplinary research while it offers its multidisciplinary treatment. The physicians treating patients every day see first-hand which questions need to be answered to improve care. Not only do they design studies to test clinical interventions, but they pass their questions along to Dr. Pan through a special communication channel designed by Dr. Fradley to facilitate conversations between the extremely busy team members. Dr. Pan can use their observations to guide her studies looking at what patients are experiencing on a molecular level. This understanding can then be used to develop better, more precise treatments.

“A combination of both clinical investigation and translational research is necessary to advance the field,” Dr. Fradley said.

Cancer survivor Abby Jones with her husband Ross on a recent vacation in Colorado. Jones, one of the first patients in the Cardio-Oncology Program jointly developed by USF Health and Moffitt Cancer Center, credits the program with playing a “huge part” in helping restore her health.

Heart healthy and cancer free

The future of cardio-oncology is exciting, but the program is already making a huge difference for patients in Florida, like Abby Jones of Ocala.  Jones was one of the very first patients to participate in the program for cancers of her lung and kidney (removed completely by surgery) and breast cancer. She was young and otherwise healthy, so Dr. Ismail-Khan decided to treat Jones’ bilateral breast cancer with the most aggressive therapy available.  During chemotherapy and targeted therapy with the drug trastuzumab (a combination with a high likelihood of cure, but that can have toxic effects on the heart), Jones received routine echocardiograms to monitor her cardiac function.  When one of echocardiograms revealed that her heart wasn’t pumping effectively, Dr. Ismail-Khan immediately referred Jones to Dr. Fradley in the Cardio-Oncology Clinic.

Dr. Fradley recommended a 7-week break from the chemotherapy, during which Jones took low-dose blood pressure medications. Soon, she was able to safely continue her chemotherapy. Today, she is cancer-free. (In fall 2016, a different type of breast cancer was detected early; Jones underwent a lumpectomy, her heart was closely monitored during another potentially cardiotoxic chemotherapy regimen, and the treatment succeeded without cardiac complications.)

Jones continues annual appointments with Dr. Fradley to ensure her heart remains healthy, and follows up with Dr. Ismail-Khan to make sure she remains cancer-free.

“I’m two years clean from the most recent diagnosis and celebrating life. The Cardio-Oncology team played a huge part in helping me get back to myself,” she said. “We welcomed newborn twins into our home as foster children earlier this year with a goal of adoption on the horizon.  And last month, I got to drop my oldest off at his first day of kindergarten… it was so fun to watch!”

Jones with Dr. Fradley and Dr. Ismail-Khan at a luncheon in February 2016, marking the first year of the newly established Cardio-Oncology Program.

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Moffitt Cancer Center and USF Health (with Drs. Fradley and Ismail-Khan as co-chairs) will host the fourth Cardio-Oncology Summit, Sept. 27 and 28, at the Hilton Tampa Downtown, alongside the International Cardio-Oncology Society, the Canadian Cardiac Oncology Network and the British Cardio-Oncology Society.  This is the summit’s first time in Tampa; previous conferences have been held in London, Vancouver and Nashville. More than 320 participants from 23 countries are expected to attend the summit, which models a leading-edge interdisciplinary approach to preventive and targeted medicine in cardio-oncology. Read more.

-Story by Emma Yasinski

U.S. News & World Report ranked Tampa General Hospital as one of the nation’s top 50 hospitals in six adult medical specialties led or co-led by USF Health physicians

Tampa General Hospital, the primary teaching hospital of USF Health Morsani College of Medicine (MCOM), was recognized this week by U.S. News & World Report (USNWR) as the No. 2 best hospital in Florida and No. 1 again in the Tampa-St. Petersburg metropolitan area.

In addition, TGH was ranked one of the nation’s top 50 hospitals in six adult medical specialties that are led or co-led by USF Health physicians:

– Diabetes and Endocrinology: No. 24 (Falls under Internal Medicine, Robert Ledford, MD, department chief)
– Gastroenterology and GI Surgery:  No. 25 (Patrick Brady, MD, section chief; Rene Gomez Esquivel, MD, vice chief)
– Nephrology: No. 18 (Elias Doumit, MD, section vice chief)
– Orthopedics: No. 39 (Roy Sanders, MD, department chief)
– Pulmonology:  No. 46 (Mark Rumbak, MD, section chief)
– Urology: No. 28 (Lucas Wiegand, MD, section vice chief)

Moffitt Cancer Center, a critical contributor to MCOM’s teaching and research programs, was ranked No. 8 among best cancer hospitals in the nation. Johns Hopkins All Children’s Hospital in St. Petersburg, a pediatric hospital partner, ranked nationally in five pediatric specialties: neonatology, cardiology and heart surgery, nephrology, neurology and neurosurgery, and orthopedics.

The USNWR 2018-19 rankings compared more than 4,500 medical centers nationwide across 25 specialties, procedures and conditions. This year, a total of 158 hospitals were nationally ranked in at least one specialty. Criteria such as patient survival and safety data, adequacy of nurse staffing levels and other measures largely determine the U.S. News rankings in most specialties.

For more information, visit https://health.usnews.com/best-hospitals/rankings.

Tampa General Hospital named one of top 50 hospitals nationally in six medical specialties by U.S. News & World Report

TAMPA, Fla. (Aug. 8, 2017) — U.S. News & World Report (U.S. News) has ranked Tampa General Hospital, USF Health’s primary teaching hospital, as one of the top 50 hospitals nationally in six medical specialties and second among hospitals in Florida for 2017-18.  For the second consecutive year, TGH was also named the top hospital in the Tampa Metro area, which includes Hillsborough, Pinellas, Pasco, and Hernando counties.

Morsani College of Medicine physicians hold leadership positions and/or serve as attendings in all six nationally recognized TGH medical specialties:

• Cardiology and Heart Surgery  (TGH is USF’s primary cardiology practice site for inpatient and outpatient services.)
• Diabetes and Endocrinology
• Gastroenterology and GI Surgery 
• Nephrology
• Pulmonology
• Urology

Two of the six specialties have rapidly climbed the ranks.  Diabetes and Endocrinology advanced 14 spots to No. 13 this year, while Pulmonology jumped 20 spots to No. 28.

“This winning recognition exemplifies our joint commitment to elevating the level of care in our region through excellence in academic medicine, and is a testament to the great pride our physicians take in providing high-quality, team and evidence-based care,” said Charles J. Lockwood, MD, senior vice president for USF Health and dean of the Morsani College of Medicine.

In addition, Moffitt Cancer Center, where USF continues to have a longstanding relationship and strong scholarly presence, continues to rank in the nation’s Top 10 Best Hospitals for Cancer.

Johns Hopkins All Children’s Hospital in St. Petersburg, USF’s primary pediatric hospital partner, was ranked nationally by U.S. News in three specialties for children:  cardiology and heart surgery, neurology and neurosurgery, and orthopedics.

The annual Best Hospitals rankings, now in its 28th year, are part of the U.S. News patient portal designed to help patients make informed decisions about where to receive care for life-threatening conditions or for common elective procedures.

Risk-adjusted survival and readmission rates, volume, patient experience and safety, quality of nursing care and other care-related indicators were among the factors weighed.  For the 2017-18 rankings, U.S. News evaluated more than 4,500 medical centers nationwide; only 152 were nationally ranked in at least one of 16 adult specialties.

The full rankings are available at health.usnews.com/best-hospitals.

USF to help meet critical demand, spurred by advances in genomics and precision medicine, for more trained professionals

Tampa, FL (Oct. 25, 2016) – The University of South Florida College of Public Health is the first in Florida to offer a graduate degree in genetic counseling. Last week, the college’s graduate program in genetic counseling earned a crucial accreditation from the Accreditation Council for Genetic Counseling. Accreditation as a new program by this national organization is essential for graduating students to be eligible to take the American Board of Genetic Counseling examination and become certified genetic counselors.

With that milestone met, the program leading to a master of science degree in public health and genetic counseling (MSPH) is now recruiting and expects to admit its first group of students in Fall 2017.

While more people with genetic predispositions for certain cancers or other conditions are seeking out testing, there is a critical shortage of certified genetic counselors to help guide patients and their families through the process.

Laura Barton, a genetic counselor at Moffitt Cancer Center and president of the Florida Association of Genetic Counselors, said the need for a genetic counseling training program has been long overdue. “It’s very exciting because now students won’t have to leave Florida to become a genetic counselor like I had to.”

Michael White, PhD, a professor in the College of Public Health who was instrumental in initiating this program pointed out, “We’re the third most populous state, but until now we didn’t have any genetic counseling training programs.”

Deborah Cragun, PhD, is director of the USF College of Public Health’s new genetic counseling graduate program.

The USF Genetic Counseling program is a 42 credit graduate degree (21 months) with estimated total tuition costs for Florida state residents of $19,000. The program is open to students with a bachelor’s degree; however, a few key undergraduate courses including molecular biology and genetics will be required to apply.

“We’re not restricting what their undergraduate major is, they just need to make sure they have certain prerequisites,” said Deborah Cragun, PhD, assistant professor in the Department of Global Health, and director for the new program.

COPH and the USF Health Morsani College of Medicine, Department of Pediatrics, teamed up with faculty across the university and throughout the Tampa Bay area to create the genetic counseling program. USF’s Division of Genetics & Metabolism, Moffitt Cancer Center, Orlando Health and other community partners will provide students with the hands-on counseling experience required for graduation.

Cragun said students of the program will be prepared to practice in multiple areas including cancer genetic counseling, prenatal counseling, pediatric counseling and newer specialties that are arising due to advances in genomics and precision medicine.

“Students go out and work with practicing genetic counselors so they can gain the experience they need,” Cragun said. “They will work with counselors who are certified themselves and who see patients in a variety of clinical settings. Currently we have partnered with all 10 clinical genetic counselors in Tampa and six clinical genetic counselors in Orlando. In addition, our students will gain experience shadowing and learning from several other counselors who work in industry or laboratory settings.”

“This program will help the state and the profession,” Cragun said. “It will be critical, because as we start doing more genetic tests, it’s really important that we have the expertise out there to help families accurately understand those results and make decisions that are right for them.”

According to the U.S. Bureau of Labor Statistics, employment of genetic counselors is projected to grow 29 percent from 2014 to 2024, which is much faster than the average for other occupations.

“Admissions across the country are actually highly competitive for genetic counseling training programs,” Cragun said. “To date, no other public or private academic genetic counseling program exists in Florida, and ours is one of only 35 accredited programs in the U.S.”

The COPH will host an open house for anyone interested in learning more about the field of genetic counseling and the new MSPH program. The open house will be 6 p.m., Wednesday, Nov. 9, in room 302 of the IDR Building on the main USF campus located at 3720 Spectrum Blvd, Tampa, FL 33612. Please contact Miki Pomeroy at mpomeroy1@health.usf.edu for more information and to obtain a parking permit for the event.

To learn more about the graduate program in genetic counseling, contact (813) 974-6505, preadmissions@health.usf.edu or visit http://health.usf.edu/publichealth/genetic-counseling.htm.

-USF College of Public Health-

Established in 1984 as the first college of public health in the State of Florida, the USF College of Public Health is a recognized leader in community health, online education, maternal and child health, social marketing, and global infectious disease research. The college offers multiple online and on-campus concentrations that lead to BSPH, MHA, MPH, MSPH, DrPH, and PhD degrees, as well several dual degrees, graduate certificates, and special programs. To learn more about the college and its 1800 students who commit to passionately solve problems and create conditions that allow every person the universal right to health and well-being, visit www.publichealth.usf.edu.

-USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Physical Therapy and Rehabilitation Sciences, the Biomedical Sciences Graduate and Postdoctoral Programs, and the USF Physicians Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

Media Contact:
Natalie D. Preston, USF College of Public Health
npreston@health.usf.edu, or (813) 974-7714

USF Health clinical and molecular geneticist Rebecca Sutphen, MD, has survived breast cancer and melanoma.

Genetic testing has been available since the mid-1990s to determine if a woman is likely to face one of her gender’s greatest fears: inherited breast and ovarian cancer. Yet, questions remain about whether common tests for the genes BRCA1 and BRCA2, which identify mutations that significantly increase a woman’s risk of breast and ovarian cancers, are reaching those who can most benefit and how the information learned from the testing is put to use.

USF Health medical and molecular geneticist Rebecca Sutphen, MD, a breast cancer and melanoma survivor, has broad expertise in genetic conditions affecting both adults and children. She has devoted much of her recent career working with Facing Our Risk of Cancer Empowered (FORCE), the leading national nonprofit advocacy organization for hereditary breast and ovarian cancer, to seek answers that will improve health outcomes of women at high risk for these cancers.

Dr. Sutphen’s research is guided in part by her own experiences as a patient, as well as Big Data’s emerging power to integrate electronic medical information and help build evidence about the effectiveness of clinical care. She emphasizes the need to ensure that patients help shape the investigative process.  In addition to her academic work, she is the chief medical officer of InformedDNA, a national genetic services organization.

The National Cancer Institute estimates only 3 percent of adults with cancer participate in clinical trials, with members of racial and ethnic minorities and low-income individuals particularly underrepresented.

“If research started with the questions that patients want answered, it seems likely there would be more participation in clinical studies, and it would be more obvious to patients how the research is relevant to them,” said Dr. Sutphen, professor of genetics at the USF Health Morsani College of Medicine’s Health Informatics Institute.

Cancer studies still largely focus on determining what treatments contribute to longer life, she said.

“Obviously survival is very important, but patients with cancer often have several options for treatment. What we learn from patients is that they also care about maintaining quality of life – things like the ability to get in their cars and continue to go to the grocery store, or to sleep at night… So, how can we better tailor the treatment options available to match each individual’s preferences?”

 Dr. Sutphen discusses the powerful potential of Big Data.

Dr. Sutphen works out of the Morsani College of Medicine’s Health Informatics Institute led by Jeffrey Krischer, PhD. She is pictured here with clinical research associate Beth Ann Clark, right.

USF helps lead way in BRCA testing and counseling

Dr. Sutphen, proficient in sign language, has a brother and sister who were both born deaf. She says her interest in genetics was sparked as a medical student when she accompanied her sister and her sister’s husband to Johns Hopkins medical genetics clinic for an evaluation of her 2-month-old nephew, also born deaf.

What the family learned about genetics and the probabilities of inheriting certain conditions was informative and fascinating, Dr. Sutphen said. “I saw genetics emerging as a new, growing area of science with the opportunity to impact the lives of people who really need information and can use it in a proactive way to make better decisions for themselves and their families.”

After earning an MD degree from Temple University School of Medicine, she completed a pediatrics residency at All Children’s Hospital in St. Petersburg and a fellowship in human genetics at USF. She is certified by the American Board of Medical Genetics in both clinical and molecular genetics.

In 1995 Dr. Sutphen joined the USF College of Medicine as a faculty member and shortly thereafter became the director of clinical genetics at All Children’s Hospital and at Moffitt Cancer Center.   As BRCA testing became commercially available, she helped USF establish one of the first programs in the state to offer clinical genetic testing and counseling for cancer.

For the first time, a test could identify if a person had inherited a defect in BRCA1 or BRCA2, and therefore tell who was at greater susceptibility for developing breast and ovarian cancer. Also, even if a woman with the inherited mutation never developed cancer herself, she would know she had a 50 percent chance of passing down the mutation, and increased risk, to any offspring.

But many more questions could not be answered. Was the risk the same for everyone who inherited a mutation? Was there a certain age the cancer would be likely to emerge? Could anything modify the risk? Will intensive screening (mammograms, MRIs, ultrasounds) catch a cancer early enough? Should a woman have her breasts or ovaries removed?

“While there was great excitement about the clinical availability of this new testing, there was a huge gap in what we could tell people about their own particular situation and what to do about it,” Dr. Sutphen said.

 Dr. Sutphen comments on engaging patients in the research process.

In the 1990s, Dr. Sutphen helped USF establish one of the first programs in the state to offer clinical genetic testing and counseling for hereditary breast and ovarian cancer.

Meeting begins enduring research collaboration, friendship

Dr. Sutphen began working with Distinguished University Health Professor Jeffrey Krischer, PhD, now director of the Health Informatics Institute, to develop NIH project proposals that would meaningfully address some of these unanswered questions. And in 2004, Dr. Sutphen invited Dr. Sue Friedman, founder and executive director of FORCE, to meet with the USF team to discuss how to best integrate “the patient voice and community” into the group’s hereditary cancer research.

After that initial meeting and learning about USF’s advanced health informatics capabilities, Dr. Friedman said, she quickly drafted a proposal to move her fledging nonprofit organization and family from South Florida to Tampa to work more closely with the USF team.

“When we first started looking at what a collaboration for hereditary breast and ovarian cancer research would look like, we included things like a yearly conference, a patient registry, research grants, writing a book. And, while there have been challenges along the way, in the last 12 years we’ve accomplished a lot of what we dreamed about and continue to build upon it,” Dr. Friedman said. “Aligning with USF has enhanced our organization’s ability to deliver meaningful research to the community, not just in terms of recruiting patients and reporting study results, but to actually help drive the research at every level.”

Along the way, Dr. Friedman, also a breast cancer survivor, and Dr. Sutphen became best friends as well research partners. “Rebecca has been visionary in recognizing the value of including health plan data in the research, and extraordinarily open to bringing in patients as equal stakeholders.”

Sue Friedman (left), founder and executive director of Facing Our Risk of Cancer Empowered, or FORCE, and USF’s Dr. Sutphen have worked together for the last 12 years. They have become friends who share a commitment to making patients equal stakeholders in driving hereditary cancer research.

 Inherited breast and ovarian cancer community’s influence on personalized medicine.

Research and advocacy join forces

Combining their complementary expertise in research and advocacy, USF Health and FORCE have attracted several highly competitive grants. Currently, Dr. Sutphen is the lead investigator for two national research awards focused on hereditary breast and ovarian cancer research.

• Impact of BRCA Testing on Newly Diagnosed U.S. Breast Cancer Patients. This landmark study, supported by a $2.8-million NIH RO1 award, is conducted in collaboration with the commercial health insurance plan Aetna. Researchers previously examined de-identified data on thousands of Aetna members across the country who received BRCA testing and surveyed them about factors associated with the use of this testing including genetic counseling services. Now, analyzing de-identified health claims information, Dr. Sutphen and colleagues will track the outcomes of consenting patients with increased risk for breast and ovarian cancer syndrome — including what types of health care professionals the women saw and how the positive genetic test results affected their decisions about managing cancer risk (including preventive treatment options), which patients subsequently were diagnosed with cancer and their medical treatment choices.

“To date,” Dr. Sutphen said, “there has been no similar study evaluating the health outcomes of a national sample of women undergoing BRCA testing in community settings.”

• Patient-Powered Research Networks, American BRCA Outcomes and Utilization of Testing Network (ABOUT Network). The project, totaling $2.4-million in support from the Patient Centered Outcomes Research Institute (PCORI) for Phases I and II, continues the work led by USF and FORCE to advance a national patient-centered research network of individuals with hereditary breast and ovarian cancer. The ABOUT Network was created to identify this patient community’s unmet needs, promote their governance in research and focus on the questions and outcomes that matter most to patients and their caregivers. USF’s ABOUT patient-powered research network is one of 20 nationwide participating in PCORI’s initiative to help individuals access their electronic health records data through existing patient portals and share it for research that could improve care for their conditions.

“We are establishing mechanisms to allow any patient in the U.S. who has hereditary breast and ovarian cancer to participate in studies relevant to them,” Dr. Sutphen said. “Harnessing the power of Big Data with guidance from patients enables a scale of research never before possible.”

Some early findings have begun to be disseminated. In a study published last year in JAMA Oncology, which attracted national media attention, Dr. Sutphen and co-authors found that most women who underwent BRCA testing did not receive genetic counseling by trained genetics professionals — and lack of physician recommendation was the most commonly reported reason. Yet, those who did get this clinical service before testing were more knowledgeable about BRCA and reported more understanding and satisfaction than women who did not.

This demonstrates gaps in services to be addressed, Dr. Sutphen said, because consultation with a trained genetics clinician is widely available (by phone or in person) and now covered as a preventive health service by most insurers with no out-of-pocket costs to patients.

 Dr. Sutphen talks about her breast cancer diagnosis.

Researcher confronts breast cancer as patient

Dr. Sutphen was diagnosed with breast cancer in 2008, following a routine mammogram. She was premenopausal and had no family history of cancer.   The radiologist who read her mammogram, a colleague, pulled her out of clinic at the Moffitt Lifetime Cancer Screening Center to alert her to the abnormality on her X-ray. The biopsy confirmed early-stage breast cancer.

“I was shocked,” she said. “I remember the part of the conversation ‘you have cancer,” seeing the doctor’s mouth moving and then not hearing any words after that.”

She called her best friend Sue Friedman, herself a breast cancer survivor, for support and after careful consideration of her treatment options decided to undergo a bilateral mastectomy with reconstruction.   The choice worked well for her, Dr. Sutphen said, but another friend with the same type of breast cancer chose lumpectomy instead.

“The first thing to look at is whether the likelihood for a recurrence of the cancer is the same if you have a lumpectomy or a mastectomy – and if the answer is yes, then beyond that it’s a matter of personal preference,” Dr. Sutphen said. “So, two people can make very different choices, but the right choice for each of them.”

In 2013, after having a “mole that looked different” on her arm checked out, Dr. Sutphen was diagnosed and treated for melanoma.

Her own experiences as a two-time cancer survivor have added perspective to her research, Dr. Sutphen said. “It really emphasized to me just what it’s like to be a patient, how difficult the decisions are to make, and how challenging your emotional state becomes.”

To make the often confusing and complex journey a little easier for patients and their families, Dr. Friedman and Dr. Sutphen collaborated with freelance writer Kathy Steligo on a book titled Confronting Hereditary Breast and Ovarian Cancer: Identify Your Risk, Understand Your Options, Change Your Destiny. They wanted to integrate into one book the latest evidence-based information to help women with cancer-susceptibility genes maximize their long-term survival and quality of life.

“The book was published in 2012, but it’s still 95 percent relevant today,” she said.

Dr. Sutphen with her daughter Serenity, 11.

Something you may not know about Dr. Sutphen

Dr. Sutphen was named one of the top 10 cancer medical geneticists in the United States in Newsweek’s “Top Cancer Doctors 2015” list. In 2012, she was selected by TEDMED to be the advocate leading its “Shaping the Future of Personalized Medicine” program, part of the Top 20 Great Challenges annual conference.

For many years she enjoyed the scenic adventure of flying paraplanes, or powered parachutes, ultralight aircraft with a motor, wheels and a parachute. But these days Dr. Sutphen prefers remaining on the ground to cheer on daughter Serenity, 11, a horseback rider who competes in barrel racing.

Photos by Eric Younghans, and audioclips by Sandra C. Roa, USF Health Communications

At Tampa General Hospital, USF faculty physicians play leadership roles in the six medical specialties that made the Top 50 list.

 U.S. News & World Report (U.S. News) has ranked Tampa General Hospital, USF Health’s primary teaching hospital, as one of one of the top 50 hospitals nationally in six medical specialties and the number one hospital in the Tampa Metro area for 2016-17.   The Tampa Metro area includes Hillsborough, Pinellas, Pasco, and Hernando counties.

Dr. Charles Lockwood, MD, senior vice president for USF Health and dean of the Morsani College of Medicine is a member of TGH’s senior executive team, and TGH President and CEO Jim Burkhart, DSc, is a member of USF Health’s senior leadership team.  USF faculty physicians often hold leadership positions as division chiefs or medical directors in the nationally ranked TGH medical specialties.  Five of those six medical specialties received higher U.S. News spots this year:

• Cardiology and Heart Surgery ranked #30, climbing five spots from last year.  TGH is USF’s primary cardiology practice site for inpatient and outpatient services.
• Diabetes and Endocrinology jumped from not ranked (NR) last year to #27 this year.
• Gastroenterology and GI Surgery ranked #26, up 13 spots from last year.
• Urology ranked #18, up 11 spots from last year.
• Nephrology ranked  #18, rising 6 spots from last year.
• Pulmonology ranked # 48, remains in the top 50.

In addition, Moffitt Cancer Center, where USF continues to have a longstanding relationship and strong scholarly presence, was ranked the sixth best hospital for cancer in the nation — up from its 18th place spot last year.

Johns Hopkins All Children’s Hospital in St. Petersburg, USF’s primary pediatric hospital partner for training of medical students and residents, was ranked nationally by U.S. News in six pediatric specialties:  cancer, cardiology and heart surgery, neonatology, orthopedics, pulmonology, and urology.

The annual U.S. News Best Hospitals ranking,  now in its 27th year, recognizes hospitals that excel in treating the most challenging patients.

U.S News sifts through data from nearly 5,000 medical centers and survey responses from more than 30,000 physicians to rank hospitals in 16 adult specialties. Death rates, patient safety and hospital reputation were among the factors weighed. Only 153 hospitals were nationally ranked in a specialty in 2016-17.

The full rankings are available at http://health.usnews.com/best-hospitals.

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Tampa, FL (June 6, 2016) – A meditation-based stress reduction intervention significantly improved psychological and physical symptoms among breast cancer survivors, a University of South Florida College of Nursing study reports.

The interdisciplinary study, led by Cecile Lengacher, PhD, professor and predoctoral fellowship program director at the USF College of Nursing, found that mindfulness-based stress reduction for breast cancer survivors, or MBSR(BC), significantly reduced psychological symptoms of anxiety and fear, and physical symptoms of fatigue severity among participants. The intervention also showed improvements in quality of life.

The randomized controlled trial was part of Dr. Lengacher’s five-year R01 grant, funded by National Cancer Institute (NCI). The findings were recently published online in the Journal of Clinical Oncology.

“The results of this study are crucial for breast cancer survivors and their overall health,” Dr. Lengacher said. “As the largest identified randomized controlled trial yet, MBSR(BC) showed simultaneous effects on multiple symptoms and outcomes – an important contribution to clinical treatment.”

USF College of Nursing Professor Cecile Lengacher, PhD, led the interdisciplinary study.

Dr. Lengacher and her research team recruited 322 breast cancer survivors, who were randomly assigned to a six-week MBSR(BC) program or a usual care group. The MBSR is a non-pharmacological stress reduction intervention, which involves group interaction and practice techniques including sitting and walking meditation, yoga and body scan.

Researchers assessed the participants’ psychological, physical and quality of health at baseline, and at six and 12 weeks. Results showed improvement in the MBSR(BC) group compared to the usual care group in both psychological and physical symptoms including anxiety, fear of cancer recurrence, and fatigue severity and interference. Participants with high levels of stress at baseline were also found to experience significant benefits from the intervention.

“There are more than 14.5 million cancer survivors living in the United States, with an estimated increase to 19 million by 2024,” Dr. Lengacher said. “These numbers show the need for more research on interventions that may help alleviate distressing psychological and physical symptoms experienced by these survivors. Our team of researchers from USF College of Nursing, USF Morsani College of Medicine, USF College of Public Health and Moffitt Cancer Center is committed to conducting more research and collecting more data – to help improve the health and well-being of those effected by breast cancer.”

In 2015, Dr. Lengacher received a $2.8 million grant from NCI to continue her research with breast cancer survivors – and focus on memory and concentration using the MBSR treatment. 

-USF Health-
USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Physical Therapy and Rehabilitation Sciences, the Biomedical Sciences Graduate and Postdoctoral Programs, and the USF Physicians Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

Media Contact:
Vjollca “V” Hysenlika, USF College of Nursing Communications
(813) 974-2017, or vhysenli@health.usf.edu

Abby Jones was diagnosed with breast, kidney and lung cancers at Moffitt Cancer Center two years ago – all at age 29.

“Who knew I would have to deal with the threat of cardiovascular disease while I was being treated for cancer,” said Jones, a healthy non-smoker who through genetic testing discovered she had a rare disorder that greatly increased her risk of developing several types of cancer.

Jones shared her personal story about overcoming cancer and a chemotherapy-associated cardiac complication Feb. 17 during a luncheon marking the first year of the Cardio-Oncology Program jointly developed by USF Health and Moffitt Cancer Center. More than 130 community, USF and Moffitt leaders attended the educational event, along with several patients and their families.

Abby Jones of Ocala, Fla., center, was one of the first cancer patients to benefit from the Cardio-Oncology Program jointly established in late 2014 by USF Health and Moffitt Cancer Center. She poses here with here with her doctors, Moffitt oncologist Dr. Roohi Ismail-Khan, right, and USF Health cardiologist Dr. Michael Fradley.

The Ocala resident was one of the first patients to participate in the USF Health-Moffitt program, which aims to reduce the risk of cardiovascular complications and prevent cardiovascular disease in cancer patients and survivors.

Jones’ kidney and lung cancers were completely removed surgically. But, research has shown that Herceptin (trastuzumab), one of the chemotherapy drugs administered to help treat Jones’ breast cancer, can have significant toxic effects on the heart. So, Roohi Ismail-Khan, MD, Jones’ oncologist at Moffitt, made sure Jones’ heart was monitored routinely during chemotherapy. When an echocardiogram indicated reduced heart pumping function, Dr. Khan referred Jones to colleague Michael Fradley, MD, a USF Health cardiologist.

After a 7-week “vacation” from Herceptin until her heart function returned to normal and the addition of a low-dose blood pressure medication, Jones said, she was able to successfully complete the optimal chemotherapy regimen for her type of breast cancer last year without cardiotoxic side effects. She will continue to see Dr. Fradley and have her heart tested yearly.

Last weekend, Jones and her husband took their 3-year-old son on a trip to Disney World. “I definitely benefitted from this program,” she said.

From left, Dr. Fradley speaks with Dr. Arthur Labovitz, chair of cardiovascular sciences at USF Health, and Dr. Charles Lockwood, senior associate vice president for USF Health and dean of the Morsani College of Medicine.

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Since its creation in late 2014, 520 patients have used the USF Health-Moffitt program – Florida’s first comprehensive academic cardio-oncology program. It is overseen by Dr. Fradley, assistant professor of cardiology at the USF Health Morsani College of Medicine, and Dr. Khan, a medical oncologist with the Center for Women’s Oncology at Moffitt.

“Based on our first year, this comprehensive and collaborative program is definitely filling a need,” said Dr. Fradley, a pioneer in the emerging field of cardio-oncology and director of the joint program. “It’s a partnership that will continue to strengthen as our patient volume grows and we expand our research and clinical efforts to reduce cardiac risk and improve outcomes for patients battling cancer.”

Today’s targeted cancer treatments are saving and extending lives, but some chemotherapy and radiation therapies can significantly damage the heart by aggravating preexisting heart disease or creating new cardiovascular problems.

Community leaders and officials from USF Health and Moffitt, as well as patients and their families, attended the educational event to raise awareness about the academic partnership that aims to reduce the risk of cardiovascular complications during cancer treatment.

Up to 30 percent of patients receiving cancer treatment experience cardiovascular complications – some not apparent until 10 to 20 years later, Dr. Fradley said. These cardiotoxicities may include heart failure, abnormal heart rhythms, heart attacks, high blood pressure and valve disease.

Moffitt and USF Health have begun research to find more effective ways to eliminate cardiac disease as a barrier to effective cancer therapy.

“Ultimately, our goal is to prevent these cardiotoxicities from ever happening,” Dr. Fradley said. “The last thing we want is for someone to survive their cancer and be left with lifelong cardiovascular disease.”

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The Cardio-Oncology program serves male and female patients equally, but Dr. Ismail-Khan adds that breast cancer patients are at extra risk for cardiotoxicity. A single breast cancer patient may receive several chemotherapeutic drugs (including such agents as anthracyclines, trastuzumab, pertuzumab and tyrosine-kinase inhibitors) as well as radiation therapy — all of which may cumulatively increase the individual’s risk of heart disease, she said. Age and pre-existing heart conditions add to the risk.

Dr. Lockwood called the academic partnership in the emerging field of cardio-oncology a “model” for other collaborations between USF Health and Moffitt.

Moffitt and USF Health have already conducted an exploratory study to determine whether patients with mutations of the BRCA1 and BRCA2 genes also have a higher risk for cardiotoxicity. The researchers found that breast cancer patients with these genetic mutations may be at higher risk than the general population for heart failure, and plan to delve deeper into the reasons why.

Another research question to be investigated, Dr. Ismai-Khan said, is whether risk stratification and cardiac rehabilitation can improve the outcomes of patients undergoing chemotherapy with cardiotoxic drugs.

Dr. Labovitz thanked the cancer survivors who shared their experiences and recognized the Moffitt partners who “have been instrumental in the success of the program.”

“The relationship between cardiology and oncology is an absolute must for the future of cancer survival,” she said. “Many novel Phase 1 drugs fail due to cardiotoxicity. If we can control the (damaging) side effects, we may have more treatment options for our patients.”

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Joining Dr. Fradley and Dr. Ismail-Khan as speakers at the luncheon were Arthur Labovitz, MD, FACC, chair of cardiovascular sciences at USF Health, Charles Lockwood, MD, senior vice president of USF Health and dean of the Morsani College of Medicine, and G. Douglas Letson, MD, executive vice president at Moffitt.

Among the luncheon speakers was Dr. G. Douglas Letson, executive vice president at Moffitt.

Recognizing that cardiovascular disease and cancer are the two leading causes of death, they praised the academic multidisciplinary partnership that seamlessly combines the expertise of cardiologists and medical and radiation oncologists.

“Just a few years ago, the field of cardio-oncology didn’t even exist and yet in a very short time our two institutions have developed a partnership to offer our community this unique and important resource,” said Dr. Labovitz, co-director of the USF Health Heart Institute.

“I see this Cardio-Oncology Program as a model for other collaborations between USF Health and Moffitt to make sure our patients collectively get the very best care than can,” Dr. Lockwood said.

In addition to comprehensive care and research, the partnership includes an educational component to teach Moffitt staff how to recognize signs of cardiotoxicity and patients the importance of reporting symptoms as well as healthy lifestyle changes to help reduce cardiac risk. A cardio-oncology fellowship training program has also been established, Dr. Letson said.

For more information on the Cardio-Oncology Program, please visit https://moffitt.org/tests-treatments/treatments/cardio-oncology/

Abby Jones shared her personal story about overcoming cancer and a chemotherapy-associated cardiac complication.

The event included lifestyle information about how to reduce the risk of cardiovascular disease, including a display of fat and sugar content in some popular foods.

Bernadette Shields, Moffitt nurse coordinator for the Cardio-Oncology Program, provides support and education to patients.

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Photos by Eric Younghans, USF Health Communications and Marketing

The University of South Florida continues to rise in the national rankings for research, now ranked 25th among all public research universities nationwide in total research spending, according to the latest data released by the National Science Foundation (NSF).  The university ranked 27th last year.

In the category of medical sciences, USF topped the list in funds spent on research and development among all Florida public universities ranked by NSF — with $96.6 million in expenditures by USF Health and affiliate Moffitt Cancer Center.  Only the University of Miami, a private institution, ranked higher in medical research expenditures.

In the rankings for all universities, both public and private, USF moved to No. 41 nationally for total research expenditures, up two places from No. 43, where the university was ranked the previous two years, and is ranked No. 2 in Florida.

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