“Ten years ago, there were relatively few treatment options [for bladder cancer] compared to what we have today which is a relative wealth of options,” said Debasish Sundi, MD, a James urologist and bladder cancer specialist. In this episode, Dr. Sundi explained the function of the bladder (storing urine), the different types of bladder cancer (contained within the bladder and metastatic), how new immunotherapies have led to better options and outcomes, and his research which focuses on identifying the biomarkers in a patient’s bladder cancer by analyzing their urine, instead of a more invasive procedure using a scope.

There are about 80,000 new cases of bladder cancer diagnosed ever year in the United States and “about 75 to 80 percent are in males,” Dr. Sundi said, adding “the number one cause is exposure to tobacco smoke and tobacco products.” The primary symptom is blood in the urine. “If you see blood in your urine, even if it’s just pink, it is worthwhile to talk to your primary care doctor or see a urologist.”

Clinical trials have led to the development and approval of several new immunotherapy treatments. “The challenge is we do not have any good biomarkers to tell us how our patients will respond,” Dr. Sundi said. “My lab is developing an assay [test] to non-invasively make an assessment. We’ve learned that if we look at the immune cells in the urine of someone with bladder cancer, they are similar to the immune cells in their tumor … And this could lead to significantly improving the therapeutic options and helping doctors pick the best medicine for their patients from the start.”

Dr. Sundi said his research is motivated by his patients. “When I started in this field the experiences of patients with bladder cancer was something we could and should improve,” he said. “Working toward this is the fuel that is self-sustaining and there is so much excitement in terms of the innovation happening in the bladder-cancer field.”

Cancer impacts the entire family of a patient, including the children. To help parents help their children through these difficult time periods, the James has created a team of certified child life specialists (CCLS).

“We help parents navigate these situations and conversations,” said Sami Rundo, CCLS. The help comes in many forms, Rundo explained. “It starts with understanding the medical situation [of the patient] … And then we prepare the family to navigate discussions and conversations. What does that conversation look like? And do they want our child life services to have these discussions with their children or provide the resources they can use in these conversations.” Rundo explained how these discussions can trigger emotions and that parents can “embrace the fact there will probably be some tears and the need for breaks and walks.” She also detailed why it can be important to explain the medical procedures that will take place, such as surgery and radiation treatments, and how their parent’s treatment could impact a child’s daily routine. The team has a doll they utilize to visually show children different medical procedures and what a port that delivers chemotherapy looks like.

“We also talk about the ways in which the children can be helpers, caregivers,” Rundo said. “And what’s appropriate for that child. Can I get you a blanket if you’re cold, but maybe not taking care of their other siblings.” The James certified child life specialists can let parents know about cancer-themed children’s book they might want to utilize in their discussion with their children, and “we can create customized books for a family,” Rundo said.

The James certified child life services team is relatively new and growing. “Over time [with a family] we develop trust and an openness of communications,” Rundo said. “I’ve learned so much about families and to see them grow and become stronger during these difficult times is really profound.”

Because there are no symptoms in the early stages of pancreatic cancer “about 75 to 80 percent of patients are diagnosed in the later stages of the disease,” said Somashekar Krishna, MD, a James physician scientist who specializes in the early detection and screening of pancreatic cancer.

Krishna and the team of pancreatic cancer experts at the James are using enhanced screening and artificial intelligence (AI) to better identify pre-cancerous cysts and cancerous tumors in the pancreas; and are the first in the world to use high-tech ablation techniques to attack and kill pancreatic cysts and tumors in a new clinical trial. Most pancreatic cancer tumors begin as pre-cancerous cysts and are most commonly found in people 60 and older. “For people in their 50s there is about a 10-percent prevalence, this doubles in people 60 to 70 to 20 percent and is 25 to 30 percent in people 70 to 80,” Krishna said, adding, “most are small and never grow and become cancerous.”

Endoscopy procedures are used to better “see” these cysts and cancerous tumors, and the use of artificial intelligence is another tool to identify and determine the risk factor of pre-cancerous cysts. “The tip of the endoscopy probe can see even the tiniest structures in a very detailed manner, and we can pass a needle through the scope and do a biopsy and establish the risk,” Krishna said. Surgery is one option, but the procedure is quite invasive and not easily tolerated by older patient with other medical issues. “A new option is ablation, using heat, in a very precise and careful manner,” Krishna said. “We are the only ones doing this in the United States and have done this with nearly 30 patients in a clinical trial.” Krishna is determined to improve screening and treatment for pancreatic cancer and reduce the mortality rate. “Early in my career, 80 percent of patients diagnosed with pancreatic cancer did not make it more than a year,” he said. “We want to change these outcomes to intervene early and with better and better treatment options.”

“Primary care physicians are your first line of defense against cancer,” said Matthew Farrell, M.D., an Ohio State Wexner Medical Center primary care physician and a clinical associate professor of family and community medicine.

Prevention, screenings and early detection are crucial and begins with a patient’s family history with cancer and other medical issues. “We are thorough and ask about their first-degree relatives, their parents, siblings and children, and their secondary relatives, such as grandparents and aunts and uncles,” Farrell said. “If I see a pattern, a certain number of relatives with the same cancer, especially at an early age, there could be a genetic factor.”

A patient with an inherited genetic mutation will then be screened at an earlier age and more often. Dr. Farrell also talked about the importance of children receiving the Human Papillomavirus (HPV) vaccine that prevents certain types of cancer. He examines patients to detect skin cancer and melanoma in the early stages. “Skin cancer is the most common form of cancer and it’s personal for me; my mother was diagnosed with melanoma three times … and she’s doing fine.” Breast cancer and prostate cancer are two of the most common forms of cancer. Dr. Farrell discussed when women should begin getting yearly mammograms, and why and when men should begin to undergo regular Prostate-Specific Antigen (PSA) tests. Men and women without a family history of colorectal cancer should get their first colonoscopy at 45. “My brother-in-law was 52 when he had his first colonoscopy,” Dr. Farrell said. “They found a large tumor in his colon; it was removed, and he’s been cancer free for 20 years now.”

Lung cancer screenings are relatively new and recommended for long-time smokers. They are vital because “if you wait until there are symptoms it’s very hard to treat and cure,” Dr. Farrell said, adding “I’m fortunate to be part of the Ohio State system and the James where we have experts and specialists for every type of cancer and medical issue my patients have.”

Colorectal cancer can affect anyone, but healthy choices and timely testing can help reduce risk.

Ohio State gastroenterologist Peter Stanich, MD, explains how lifestyle choices like diet and exercise, combined with screening and genetic testing, can help everyone reduce their risk of colorectal cancer.

Learn more about colon cancer, including risks, symptoms and treatment: cancer.osu.edu/coloncancer

Watch The James Cancer-Free World Podcast on YouTube: go.osu.edu/CancerFreeWorldPodcastWatch

The reach of the James Cancer Hospital extends far beyond Central Ohio. As part of Ohio State’s Global One Health Initiative (GOHi), Robert Baiocchi, MD, PhD, is leading the research, vaccination and treatment efforts in Ethiopia for patients with lymphoma. “Lymphoma, a cancer of the white blood cells, is far more common in Sub-Saharan Africa, and afflicts people at a younger age” said Baiocchi, a James medical oncologist who specializes in treating patients with blood cancers. The prevalence of malaria and the Epstein-Barr virus (EBV) has led to the increased number of lymphoma diagnoses. “Starting in 2015 we opened a lab in Addis Ababa [the capital of Ethiopia] to study these viruses and how they cause cancers,” Baiocchi said, adding the initial research was to determine why the lymphoma rate was so high. “We’re zeroing in on a couple of interesting findings; children who get malaria and EBV, that seems to be the perfect storm [for lymphoma].” Differences in the genetic makeup of people in Sub-Sharan Africa could be another factor in the increased lymphoma rates. Baiocchi and his team, and their partners in Ethiopia, are working on vaccines for malaria and EBV. “Studies tell us the virus here [in the United States] is different from the viruses in Ethipia and the vaccines we use here won’t work there,” he said. “It’s important to understand the genetic makeup of EBV in order to develop a vaccine that will be effective in that region.” The standard of care at the James for lymphoma patients includes a combination of chemotherapy drugs – and has proven to be very effective. “The resources for this aren’t available in Ethiopia,” Baiocchi said, adding the James is developing a less-expensive, targeted therapy that shows promise. There are also plans to create a facility in Addis Ababa where lymphoma patients will be treated with cell therapy.

David Cohn, MD, described one of his goals for patients of the James. “When a patient and a family say we didn’t want to be diagnosed with cancer and we didn’t want to be at the James Cancer Hospital, but after this experience there’s nowhere else we’d rather be and that is the end result of empathetic care and compassion in the delivery of that care,” said Cohn, the interim chief executive officer and the medical director of the James. In this episode, Cohn and John Schaffner, MBA, the director of coaching at Ohio State’s Fisher College of Business, described a new coaching program for James physicians that’s part of the Physician Wellness Program. This coaching focuses on compassion and helps physicians better understand their careers and goals and utilize compassion when working with their colleagues and patients. “It’s not that our physicians had problems, they’re exceptional, it was rather, how can we support our people so they can flourish,” Cohn said, adding this type of leadership initiative was welcomed by his team. Schaffner, who leads the James coaching program, explained his definition of empathy. “There’s cognitive empathy, that’s noticing someone else’s emotions; there’s empathetic concern, which is an emotional reaction to someone else; and this empathy plus action equals compassion.” There are currently 15 certified coaches who work with the 240 attending physicians of the James. “I love working with physicians,” Schattner said. “They’re smart and ambitious, understand the idea of flourishing and they do the work.” Some of these physicians, he added, are new to leadership positions and coaching can help them communicate better and build comradery. The coaching program is new and funded through a philanthropic donation to the James. Cohn said the program is designed to help each physician be the best version of themselves they can be with the overreaching goal of delivering the best-possible care to James patients. “Everything we do is driven by the delivery of care to our patients and this is another process to help us get there,” he said.

“We’re so fortunate to have so many individuals come to us and want to share their time and help our patients and families,” said Kathleen Kiene of the 300 James Cancer Hospital volunteers. Kiene is the Administrative Associate Director of System-Wide Volunteer Services, and she recruits, trains and mentors her small army of volunteers, who include a large number of former James patients … such as Laura Schoettmer. “I just want to make people feel hopeful, because there is so much hope here,” said Schoettmer, who was diagnosed with lymphoma several years ago and is now in remission. Kiene described all the different ways in which volunteers contribute to patient care, which includes: wayfinding and escorting, interacting and helping patients while they receive chemotherapy, in the surgical visitor’s lounge, as waiting room ambassadors, in the James’s outpatient facilities. “In our Restful Nights program volunteers are there from 5:15 to 7:15 p.m. and they man carts and visit patients and offer amenities,” Kiene explained. “Conversations start and there are bonding moments between the patients and our volunteers. One volunteer watched Jeopardy with a patient and another patient played the guitar and our volunteers were there to listen and be part of that.” Schoettmer began volunteering in 2015, three years before she was diagnosed with cancer. She lost a cousin to breast cancer “and I was very angry and wanted to do something.” Some volunteers may initially be concerned interacting with cancer patients can be difficult emotionally. “It’s so fulfilling and so rewarding and every Thursday morning when I walk into the James [to volunteer] I feel exhilarated,” said Schoettmer, who volunteers in the chemotherapy clinic. For more information of becoming a James volunteer: https://cancer.osu.edu/for-donors-and-volunteers/volunteering/volunteer-opportunities

The James Cancer Hospital is a leader is helping cancer patients deal with the pain that can be associated with treatment. “Our inpatient oncology rehabilitation service is the first in Ohio, the second in the United States and the third in the world to be accredited,” said Whitney Luke, MD, medical director of oncology rehabilitation at Ohio State. “We now have an inpatient and an outpatient oncology rehabilitation program, and I could not have developed these programs if I wasn’t at a comprehensive cancer center like this,” added Luke, who led the creation of these programs and is a pioneer in the field of pain management for cancer patients. “I’m so fortunate to be at a hospital where I could grow these programs and where we have so many experts in so many different fields.” Luke described how some cancer treatments can lead to varying levels of pain for patients, and why it is important to work with each patient to develop a plan to reduce their pain. “Our team includes oncologists and physicians, physical, occupational and speech therapists, social workers, psychologist; the goal is to improve functional outcomes for patients so they will better tolerate treatments and get them home doing the things they normally do.” Some of the many medical options for treating pain include: injecting joints with a combination of steroids and anesthesia; implanting a device in the spine that provides electrical stimulation at regular intervals; an internal pain pump that releases medication directly to the points of pain; and the use of ablations (heat) to clock nerves. “When I have a patient who was in severe pain come back and tell me they were able to go to their daughter’s wedding and feel normal, that opportunity to help patients during their cancer journey, that’s what motivates me,” Luke said.

Scientists have known for many years that smoking tobacco products greatly enhances the lung cancer risk and is the number-one cause of this deadly disease But what about vaping and electronic cigarettes? “Vaping is so new, and it takes years and years for lung cancer to develop so we don’t yet know the effects,” said Marisa Bittoni, PhD, MS, BS, an Ohio State scientist whose research focuses on how lifestyle choices such as diet, exercise and smoking/vaping can impact and increase the risk of lung cancer. Bittoni and her colleagues at the James are pioneers in researching the cancer-related effects of e-cigarettes. She led a new study that has shown the combination of smoking and vaping greatly increases the lung cancer risk. The study looked at Ohio State patients already diagnosed with lung cancer and a control group of people who had not been diagnosed with this disease.“Compared to non-smokers, smokers have about a 10 times higher risk of lung cancer,” Bittoni said. “And people who smoke and vape have about a 40 times higher risk than non-smokers.” Bittoni said that further, follow-up research is needed to confirm these initial findings and find out even more. “We’re at the start of a new wave of research [on the effects of vaping],” she said. “The tobacco industry wants to promote vaping as a safer alternative to smoking, but we don’t really know if that’s true yet.” This new research is another step forward for Bittoni. “My whole career has been looking at risk factors and survival,” she said. “By improving your diet and exercising and not smoking you can reduce your cancer risk, and, even after diagnosis and treatment improvements in diet and exercise can help people live longer. There are estimates that 30- to 40percent of all cancers could be avoided by better lifestyle choices.”