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Welcome to UNC Hematology/Onc ology! Interview Day Morning presentations 3 Interviews Research Presentations with lunch Tour Last interview Wrapup UNC and Chapel Hill • • • • • Oldest public university in the US “Exceptional” Comprehensive Cancer Center Gillings School of Public Health #2 Eshelman School of Pharmacy #1 #7 in NIH funding in 2013 • Classic University setting within triangle of small gentrified city (Durham) and state capital • “Foodiest” small town in America (CH), small city in America (Durham) UNC Hematology / Oncology ~ 60 faculty, 18 fellows Oncologic subspecialties Classical Hematology UNC Lineberger “Exceptional” ranking from NCI Largest research entity at UNC McAllister Heart Institute Thrombosis/hemostasis/vascular research International leadership UNC Hematology / Oncology Create and Apply Knowledge Research ~ 305 publications last year (40% first or last author) $0 2002 2004 2006 2008 2010 $21,835,102 $29,367,175 $5,000,000 $23,064,732 $30,242,400 $10,000,000 $22,602,467 $29,792,274 $15,000,000 $18,836,235 $24,002,928 $20,000,000 $17,284,899 $22,554,760 $25,000,000 $20,788,036 $26,730,283 $30,000,000 $12,614,473 $16,303,802 125,000 Patient visits 4,500 New patients / year 650 on therapeutic trials $35,000,000 $9,003,689 $11,555,508 Clinical care 2012 2013 2014 Missions of the UNC Hematology/Oncology Fellowship Program • • To provide outstanding clinical training To provide outstanding research opportunities • • • • • Basic Science Translational Clinical Health Services For fellows to have successful careers in hematology/oncology Fellowship Program Structure Fellowship education committee* Associate Program Director: Billy Kim Fellowship Director Alice Ma UNC graduate medical education Associate Program Director: Frances Collichio *Consists of 2 members from each class, program directors, Lisa Carey, Tom Shea, Nigel Key, Bill Wood, Autumn McRee, Chad Pecot, Matt Milowsky, Brandi Reeves, and Matt Foster American Board of Internal Medicine Requirements Board Months in Training Clinical Months Continuity clinic A Oncology 24 12B 24 months BM Bx Chemotherapy CVC Hematology 24 12 24 months BM Bx Chemotherapy CVC Peripheral blood smear, apheresis Both 36 18 C Procedures 36 months A: ½ day per week B: 50% of the time outpatient months C: 12 months neoplastic dz and 6 months non-neoplastic heme ABIM Alternate Pathways Geriatrics and Medical Oncology Pediatric Hematology/Oncology and Adult Hematology or Oncology Infectious Diseases and Medical Oncology ABIM research pathway First year Clinical and inpatient focus Inpatient Consult Malignant Heme BMT 2 2 Coag Solid Tumors Total 3 Clinic Elective Benign Heme Solid Tumor Elective/S elective 1 1 3 Electives: solid tumor clinics, transfusion medicine, hematopathology, inpatient solid tumor oncology, outpatient BMT, palliative care (required 2 weeks) etc Vacation: 4 weeks Fellowship tracks Fellows select career pathway in late first, early second year Basic Science Research track Clinical and translational research track Health outcomes research track Clinical track Outpatient Year Continuity clinic 1St year 6-month rotating blocks (GI,breast) 2nd year Four 6 month rotating blocks (malignant heme, benign heme, lung and GU) 3rd year research track 0.5 day in clinic of interest 2nd or 3rd year clinical track B 5 month blocks of outpatient clinics per year A : Rotations defined as : thoracic, breast, GU, GI, melanoma, head and neck B: Clinical track fellows will have 0.5 day in one clinic of interest (e.g. GI) and then rotate through the areas (breast, thoracic, etc) for more prolonged exposure Research Training • NC TraCS (North Carolina Translational and Clinical Sciences Institute) – MSCR (Masters of Science in Clinical Research) • 2 year degree program training individuals to be principal investigators and collaborators in clinical/translational research – TCRC (Translational and Clinical Research Curriculum) • 2 year non-degree program providing training in biostatistics, epidemiology and career development skills. • https://tracs.unc.edu/index.php/services/education/translati onal-and-clinical-research-curriculum • K12 programs – For senior trainees and junior faculty in basic or translational research in hematology or oncology Research Support • Early Grants – – – – Hematology T32 (coagulation and BMT immunology) Other Institutional T32 awards Health Behavior/Health Outcomes T32-like Institutional Funding for well-qualified research track fellow • Later Grants – K12 for senior fellows/junior faculty – KL2 – BIRCWH • Other – Foundational Grants – NIH Loan Repayment Planning the Path to Research Independence…. Fellowship Faculty 1 2 3 4 X X X (X) (X) T32/NRSA K12 (Institutional) K08 or K23 or R21 (Individual) RO1 or other (Individual) X X 5 6 7 8 9 10 X X X X X X X X (X) X X X X (X) (X) X X Tyler Buckner • Combined Peds heme onc/Med Heme Fellowship • Interest: Patient Reported Outcomes in Hemophilia, especially pain • ASH CRTI 2012 • MSCR • Clinical Instructor July 2014 • Assistant Professor at University of Colorado Tyler Buckner • Grants – T32 Hematology 2011-2 – Cecil Sheps Health Services Research 2012-3 – Hemostasis and Thrombosis Research Society / Novo Nordisk Clinical Fellowship Award in Hemophilia and Rare Bleeding Disorders. 2013-14 – National Hemophilia Foundation – Baxter Clinical Fellowship. 2013-15; $100,000/yr – Observational Study of Postoperative Deep Venous Thrombosis (DVT) in Hemophilics Undergoing Major Orthopedic Surgery. Investigator initiated study, Nigel Key (PI). Baxter Healthcare Corporation. 2014-16; $10,000/yr (salary support) – National Institutes of Health Clinical Research Loan Repayment Program. 2014-16; Repayment of 25% of total medical education loan debt each year for 2 years Tyler Buckner • Buckner T, Amin C, Esserman D, and Key NS. African-Americans have a higher rate of proximal deep venous thrombosis at presentation. Thrombosis Research. 2010;126:e246-e2474. • Buckner T, Key NS. Clinician Update: Venous thrombosis in blacks. Circulation. 2012;125(6):837-9. • Buckner T, et al. Complete spontaneous remission of diffuse large B-cell lymphoma of the maxillary sinus after concurrent infections. Clin Lymphoma Myeloma Leuk. 2012 Dec;12(6):455-8. Epub 2012 Sep 29. • Buckner TW, et al. Patterns of symptoms and functional impairments in children with cancer. Pediatr Blood Cancer. 2014 Jul;61(7):1282-8. Epub 2014 Mar 15. • Buckner TW, Ataga KI. Evidence-based mini-review: Does hydroxyurea prevent pulmonary complications of sickle cell disease? Submitted for review to: American Society of Hematology 2014 Annual Meeting Education Program Jul 2014. • Buckner TW, Nielsen BI, Key NS, Ma A. Factor VIII inhibitory antibody in a patient with combined factor V / factor VIII deficiency. Submitted for review to: Haemophilia Aug 2014 Satish Gopal • Combined ID/Oncology Fellowship 2009-2012 • Interest: AIDs related malignancies in Sub-Saharan Africa • Clinical Assistant Professor 2013 • Awards: – Bristol Myers-Squibb Virology Fellows Research Training Program Award 2011 – UNC Lineberger Clinical Fellows Award 2012 – Fogarty Global Health Fellows Award 2012 – AIDS Malignancy Consortium Fellow (inaugural year) 2013 – North Carolina Cancer Hospital Endowment Award 2013 Satish Gopal • Grants – UNC Lineberger and CFAR Developmental Research Awards. Characterizing a large cohort of HIV-associated lymphoma in the CNICS network and examining correlates of clinical outcomes. 2012– NIH/FIC K01TW009488. Developing a prospective clinical cohort of histopathologically characterized lymphoma patients in Malawi . 2012-7. – UNC Lineberger and CFAR HIV Malignancies Pilot Award. Epstein-Barr virus and Kaposi sarcoma-associated herpesvirus in HIV-associated non-Hodgkin lymphoma (NHL) in Malawi . 2013-4. – NIH/NHLBI U01HL117659. Sickle Cell Disease in Malawi. 2013-8 – NIH/NCI R21CA180815 . Molecular profiling of HIV-associated lymphoma in the US and Malawi. 2013-5 – UNC Lineberger and CFAR Developmental Research Awards . A pilot clinical trial of R-CHOP in Malawi. 2013– NIH/NCI U54CA190152. Addressing herpesvirus-associated cancers through the UNC-Malawi Cancer Consortium. 2014- Satish Gopal • Selected Publications – Gopal Et al, Clinical presentation, treatment, and outcome among 65 patients with HIV-associated lymphoma treated at the University of North Carolina, 2000-2010. AIDS Res Hum Retroviruses 2012 – Gopal, et al, Importance of concurrent CART in HIV-associated lymphoma. Blood 2012 – Gopal et al, Meeting the challenge of hematologic malignancies in subSaharan Africa. Blood 2012 – Gopal et al, Association of early HIV viremia with mortality after HIVassociated lymphoma. AIDS 2013 – Gopal et al, Temporal trends in presentation and survival for HIVassociated lymphoma in the combination antiretroviral therapy era. J Natl Cancer Inst 2013 – Gopal et al, Early experience after developing a pathology laboratory in Malawi, with emphasis on cancer diagnoses. PLoS One 2013 – Gopal et al, Lymphoma Immune Reconstitution Inflammatory Syndrome in the Center for AIDS Research Network of Integrated Clinical Systems Cohort. Clin Infect Dis 2014 – Gopal et al, Multicentric Castleman Disease in Malawi. Lancet 2014 – Gopal, et al, Moving forward in HIV-associated cancer. J Clin Oncol 2014 Katie Reeder-Hayes • • • • • • • MBA in Health Care Mgmt pre-med school Fellowship in Medical Oncology 2007-2010 Interest: Health Disparities in Breast Cancer Clinical Instructor 2010-2011 MSCR 2008-10 Clinical Assistant Professor 2011 Awards: – Outstanding Fellow Award, North Carolina Oncology Association , 2011 – ASCO Merit Award for Outstanding Abstract by a Fellow 2012 Katie Reeder-Hayes • Grants – Sheps CeAgency for Healthcare Research and Quality T32 in Comparative Effectiveness Research 2010-12 – Cecil Sheps Health Services Research 2012-3 – 5K12HD001441-12 University of North Carolina Building Interdisciplinary Careers in Womens Health (BIRCWH) Career Development Program 20122015 – Agency for Healthcare Research and Quality HHSA290200710056I Genomic Testing for Risk of Recurrent Cancer 2012-4 – National Institutes of Health Loan Repayment Program Award 2013-5 – UNC Translational and Clinical Sciences Institute Pilot Grant in Comparative Efficacy. Comparative Effectiveness and Toxicity of Trastuzumab-Based Chemotherapies in Older Women with Breast Cancer 2014-5 – ACS Mentored Research Scholar Grant . Improving Endocrine Therapy Utilization in Racially Diverse Populations . 2014-8 • Publications Katie Reeder-Hayes – Reeder-Hayes K, et al, Clinical Trials in Triple Negative Breast Cancer. Breast Disease. 2010 – Reeder-Hayes KE. A Piece of My Mind: Way Back When. Journal of the American Medical Association. 2011 – Reeder-Hayes KE, et al. Racial disparities in initiation of adjuvant endocrine therapy of early breast cancer. Breast Cancer Res Treat. 2014 – Reeder-Hayes KE, Carey LA. How Low Should We Go? The Search for Balance in Management of Small Human Epidermal Growth Factor Receptor 2-Positive Breast Cancers. J Clin Oncol. 2014 – Reeder-Hayes KE, et al. Comparative effectiveness of follow-up imaging modalities in pancreatic cancer. Journal of Comparative Effectiveness Research. 2014 – Green AK, Reeder-Hayes K, Corty R, Basch E, Milowsky MI, Dusetzina SB, Bennett AV, and Wood WA. The Project Data Sphere initiative: Accelerating Cancer Research by Sharing Data. Oncologist. 2015 May;20(5):464-e20. – Angela Green A, Corty R, Wood W, Meeneghan M, Reeder-Hayes KE, Basch E, Milowsky M, Dusetzina SB. Comparative Effectiveness of Mitoxantrone Plus Prednisone Versus Prednisone Alone in Metastatic Castrate-Resistant Prostate Cancer After Docetaxel Failure. Oncologist. 2015 May;20(5):516-22 – Tichy JR, Deal AM, Anders CK, Reeder-Hayes KE, Carey LA. Race, Response to Chemotherapy, and Outcome within Clinical Breast Cancer Subtypes. Oncologist. 2015 May;20(5):464-e20. – Meleth S, Reeder-Hayes K, Ashok M, Clark R, Funkhouser W, Wines R, Hill C, Shanahan E, McClure E, Burson K, Coker-Schwimmer M, Garge N, Jonas DE. Technology Assessment of Molecular Pathology Testing for the Estimation of Prognosis for Common Cancers. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 May. Fellow’s career choices Academic Private Industry Gov Unknown 1995-2009 22 23 2 1 1 2010-16 22 18 Geographic Distribution “BENIGN” OR “CLASSICAL” HEMATOLOGY AT UNC The Hemostasis and Thrombosis Program • Comprehensive Hemophilia Treatment Center (est. 1977) • 6 physicians, 3 clinical nurses, 1 research nurse, 3 research coordinators, 1 social worker, 1 pharmacist • Currently follows ≈250 adults, ≈100 children with hemophilia, several hundred vWD • ≈20 new thrombosis patients/week • Multi-disciplinary HHT Clinic The Sickle Cell Program • Inaugurated 1980 • 2 physicians, 2 physician extenders, 1 social worker, 2 research coordinators, 2 administrative personnel • Currently follows ≈350 adults and ≈225 children • NIH-funded “Excellence in Hemoglobinopathies” UO1 2013-2018 Hematology ‘Firsts’ at UNC • 1947: Hemophilia dog colony founded by Kenneth Brinkhous MD • 1952: Invention of the APTT • 1956: Discovery of factor X (‘Stuart Prower factor’) • 1962: Development of the first FVIII concentrate • 1972: Separation of plasma FVIII from VWF • 1978: Center for Thrombosis and Hemostasis founded by Harold Roberts, MD • 1987: First human trial of recombinant clotting factor (rFVIII) • 1989: First administration of rFVIIa in the US • 1991: Isolation of vitamin K carboxylase • 1994: Elucidation of the mechanism of action of rFVIIa • 1997: First mouse model of hemophilia B • 2004: Identification of the gene for Vitamin K epoxide reductase Hematology T32 Training Grant • Continuously funded since 1975 • An estimated 95 previous T32 scholars, (including 1 Nobel Laureate!) • Clinical or bench research in benign hematology – 5 slots Career Paths in Benign Hematology 1. ‘Traditional’ RO1 investigator - Clinical research - Basic research 2. Clinician, with additional focus: - Educator - Hemostasis/thrombosis/vascular medicine - Transfusion medicine/red cell disorders Clinical / Translational Research at UNC: Opportunities for Fellows Clinical / Translational Research as a Fellow: Your Goals • Complete the project(s) within your time frame – Ok to be part of an ongoing project (finish one, start the next) • Identify at least one mentor • Create a coherent body of work - “who are you?” • Have fun …. Outcomes Treatment trials Novel approaches to diagnosis or therapy Correlative studies on tumor samples or blood UNC Landscape • #7 in NIH funding in the country in 2014 • Opportunities – – 33 MD division members with a track record of working with fellows and clinical role – 6 PhD members with collaborative roles (esp benign heme) – 350 LCCC members (“Exceptional”) • Longstanding emphasis and focus on team science – #2 SPH in country across street, multiple joint appointments/collaborations – #1 SOP in country “ “ “ – Training grant opportunities across this landscape General Approach • Two phenotypes: – Testing the waters - e.g. database mining – Jumping in! • Laboratory or clinical trial setting • Health services / outcomes research • ~ 400 researchers in Heme / Onc • Alphabet soup programs for formal training - MSCR, MPH, TraCS… Example: BREAST CANCER Hy Muss Geriatric Oncology Lisa Carey Biomarkers Claire Dees Drug Development Katie Reeder-Hayes Health Services & Outcomes Carey Anders Brain metastases Trevor Jolly Geriatric Oncology Recent Clinical / Translational Breast Cancer Publications Led by Fellows J Natl Compr Canc Netw. 2013 Sep 1 Example: GU CANCER Tracy Rose GU Cancer Clinical Trials and outcomes Young Whang Prostate Cancer Ethan Basch Health Services & Outcomes Matt Milowsky Bladder Cancer GU Clinical Trials Paul Godley Prostate Cancer Disparities, Outcomes Billy Kim Translational Research Recent Clinical GU Manuscripts Led by Fellows Etc, Etc… Finding Your Research Niche Clinical trials Translational research Health Services research 1st year – conferences, seminars, informal chats with faculty Learning the ropes 1st-2nd year – Ongoing talks with Dr. Stinchcombe Facilitated discussions with relevant faculty Recommendations for specific training program Getting attached and funded 3rd (?4th) year - MAGIC Summary • UNC provides a rich resource for “clinical” research – Division of > 60 faculty, > ½ do clinical research of some kind – Clinical / Translational / Health services research – Myriad training grants and support • Goals for fellows training in clinical research: – Develop a portfolio – Differentiate yourself – Develop the skills to run your own program Research Orientation to the Lineberger Comprehensive Cancer Center NORMAN E. SHARPLESS, MD Director, Lineberger Comprehensive Cancer Center Wellcome Distinguished Professor Of Cancer Research Departments Of Medicine And Genetics UNC Lineberger: NC’S PUBLIC COMPREHENSIVE CANCER CENTER. MATRIX CANCER CENTER EMBEDDED IN UNC-CH. AREAS OF FOCUS Basic Research Population Sciences Research Clinical and Translational Research Dissemination and outreach in NC Economic Development Clinical Excellence Facilities Lineberger Bldg: 79,000 nsf NC Cancer Hospital Clinical space increased 3-fold Research space: clinical trials unit, Protocol office, PK/PD Lab New Hillsborough Hospital 40 new inpatient beds Marsico Hall: 22,000 nsf (Opened 2014) Cancer Genomics: National Leadership LCCC 1108 –UNCseq Over 1,900 patients consented 28 tumor types 10,000 samples >100 trillion bases --Hoadley, Cell, 2014 CHUCK PEROU, KATIE HOADLEY NEIL HAYES https://www.youtube.com/watch?v=Y9HumO20GKc Discovering Cancer Drugs CENTER FOR INTEGRATIVE CHEMICAL BIOLOGY AND DRUG DISCOVERY (CICBDD) Many Cancer Projects: • Mer Inhibitors for Pediatric Leukemia • IDH1 Inhibitors for Glioma, Leukemia • >$14M in funded proposals Science Focus: • Chemical Biology of Chromatin Regulation • 55+ publications: Nature Chemical Biology, PNAS, Cell, Science • 2 Oncology start-ups with LCCC founders Ongoing Expansion: • New recruitment: Jeff Aubé (U of K), Tim Willson (GSK) • Leveraging $100M gift to Eshelman School of Pharmacy STEPHEN FRYE (MT) CICBDD DIRECTOR Studying Cancer in the Mouse COLLABORATIVE CROSS • 80+ publications since 2011 • Example: Pardo-Manuel de Villena et al., Nature Genetics, 2015 MOUSE PHASE I UNIT • • • • • • 50+ partners in academia and industry 40+ publications (e.g. Cell, Nature, Cancer Cell, Cancer Disco.) 32 funded grant proposals: $25M 5,000 cages for serial housing Small animal imaging (PET/CT, Optical, MRI, U/S) Pharmacokinetics and Pharmacodynamic Monitoring Sharpless et al., Cell 2013 Kinoming In progress trials in melanoma, lung, lymphoma and breast cancer FUNDING: NCI R01, Komen, MRA, LLS, V Foundation, Lustgarten LISA CAREY GARY JOHNSON STERGIOS MOSCHOS 2014 CANCER CLINICAL INVESTIGATOR TEAM LEADERSHIP AWARDEE Cellular Immunotherapy Program Developed the sixth CAR-T cell program in the United States cGMP facility built and functioning off HWY 54 on Quadrangle Boulevard Two CAR-T cell trials currently open at UNC Developing novel murine approaches to CD30-CAR therapy after autologous SCT CAR understanding efficacy in for patients with relapsed/refractory solid tumors Hodgkin and anaplastic large cell Identification of lymphoma neoantigens from SNV, CD30-CAR therapy for R/R patients not translocations and spliced variants undergoing autograft Plans for CAR therapy with suicide gene for ALL and NCI RO1 x 3, LLS, NCI CAR therapy for myeloma in 2017 Support SPORE, UCRF LCCC Entrepreneurship Growth in NCI Funding Annual NCI funding (in $M) $65 $60 UNC Top 30 Average $55 $50 $45 2014 NCI FUNDING: Stanford $55M Michigan $54M Wash U $42M Duke $34M UNC $58M (6th among matrix cancer centers) $40 http://report.nih.gov/award/index University Cancer Research Fund Funded $351M for cancer research through 20082014 (with $44M in FY2015). Institutional impact: • Recruitment/Retention >180 faculty • Major investment – genomics, NGS and bioinformatics • Built population and hospital cohorts • Created informatics and big data infrastructure • Developed therapeutics, devices and diagnostics https://unclineberger.org/ucrf/ucrf-annualreports/UCRFLegislativeReport2014FINAL.pdf • Statewide outreach and network support In 2014, the UCRF funding created 2,250 NC jobs and generated $333M in economic impact Division of Hematology/Oncology Members There are eleven divisional members who have space and or resource commitment for laboratory work in the Lineberger Cancer Center • Also a much larger number of PhD investigators in the Cancer Center who have trained MD/MD PhD fellows There are four divisional investigators with laboratorybased research in the Carolina Cardiovascular Biology Center Ned Sharpless MD • Studies the CDKN2a tumor suppressor locus • Genetic models of cancer using mice • Novel Drug Discovery and Commercialization thereof • Pathways important in melanoma growth and therapeutic targets • Cancer genetics and genomics Oncology Fellow Jonathan Serody MD • Evaluations of the role of migratory proteins during GVHD • Interactions of immune and stromal cells and their roles in tumor growth • Generation of clinical tumor Th17-mediated lung inflammation and GVHD Manuscripts in press with Ben vaccines against solid tumors Vincent in JNCI, JCI x 2 Oncology Fellow D. Neil Hayes MD MPH • Interested in correlating clinical outcomes with genetic mutations and epigenetic changes in patients with tumors of the aerodigestive tract • Leader of The Cancer Genome Atlas (TCGA) group evaluating panel of multiple tumors for genetic changes and how these affect downstream pathway activity William Kim MD • CLINICAL/TRANSLATIONAL RESEARCH • Cancer genomics (TCGA) • Discovery of luminal and basal molecular subtypes of bladder cancer • Genetic models of cancer using mice • Immunotherapy/immunogenomics • Tumor hypoxia and angiogenesis Oncology Fellow Nigel Mackman PhD • Laboratory focuses on the role of tissue factor, coagulation proteases and protease activated receptors in hemostasis, thrombosis and inflammation. • They have generated a variety of novel mouse lines and study mechanisms of thrombosis in cancer, the role of the clotting cascade in viral infections and in cardiac injury. Hematology Fellow Faculty Who Have Mentored MD Fellows in the Basic Sciences in the Cancer Center Individual Mentor Shannon Penland/Jessica Fu/**Patrick Dillon/**Hanna Sanoff Ned Sharpless **Ben Vincent, **Jay Coghill/**Hank van Deventer/Judy Ng-Cashin Jon Serody David Chism, Mingqing Li **Autumn Jackson, **Tracy Rose Billy Kim Jeremiah Boles Nigel Mackman **Brandi Reeves Rafal Pawlinski *Current fellows **Academic Faculty Members LCCC Core Facilities Animal models, Animal experiments and protocols, and Histopathology Genomics and Bioinformatics • Human and mouse microarrays, expression data from RNA from any source, custom arrays • Massive parallel sequencing (4 platforms on campus; Illumina, 454, PacBio and Ion Torrent) Flow Cytometry Proteomics Tissue Procurement Why MD Fellows: • Fellows better at making the work clinically relevant. • Fellows easier to fund. • Fellows good at bureaucracy needed for human studies. • LCCC scientists will be enthusiastic about working with you! Questions? Opportunities for Training in Population Research UNC Hematology/Oncology Training Program Paul Godley, MD, PhD UNC Cancer Research Training Programs Cancer Control Education Program NRSA Training Program in Health Services Research Cancer Care Quality Training Program UNC Cancer Research Training Programs Cancer Care Quality Training Program Why a Cancer Care Quality Training Program? • Cancer care quality is not as good as it could be • Patterns of underuse, overuse, and misuse exist for all forms of cancer…across care continuum • Improving cancer care quality requires a multidisciplinary approach • Aim: – Train clinician and non-clinician scientists to work in multidisciplinary research teams to improve the cancer care quality across the cancer care continuum What Kind of Training? • A specialized curriculum that involves: – Coursework (include 3 new courses designed for this program) – A journal club – An immersion experience in tumor board meetings – Training in the responsible conduct of research – Occasional special seminars and lectures • Hands-on research experience in multidisciplinary research teams focused on cancer care quality, with mentoring provided by experienced faculty members from diverse disciplines. • Career development experiences that enhance professional skills and build professional networks. Potential Quality Problems across the Cancer Care Continuum Risk Assessment Age Family Hx Exposure Hx Genetics Lifestyle Screening HX Primary Prevention Lifestyle counseling Chemoprevention Detection Screening (Asymptomatic) Appropriate testing (Symptomatic) Failure to Identify Need to Screen or Counsel Primary Prevention Failure Failure in Access to Care Failure in Detection Failure to Screen Cancer or Precursor Treatment Recurrence Surveillance End-of-Life Care Imaging Biopsy Repeat Exams Lab tests Other procedures Excision Surgery Radiation Adjuvant Chemo Palliation Testing Follow-up Care Palliation Survivorship Care Palliative Care Advanced Care Planning Bereavement Support Failure during Diagnostic Evaluation Failure of Treatment Failure in Surveillance Failure in Care Diagnosis Failure during Follow-up of Abnormal Result Failure during Follow-up of Diagnostic or Treatment Plan Failure to Followup Surveillance Plan Failure to Access Care POTENTIAL FAILURES DURING THE PROCESS OF CANCER CARE Adapted from Zapka et al. (2003) Evidence of quality problems in cancer care available on request ([email protected]) UNC Cancer Research Training Programs NRSA Training Program in Health Services Research Cancer Care Quality Training Program Post-Doctoral Training Program in Health Services Research • The postdoctoral program is intended to provide advanced, specialized training in the methods of health services research • Trainees will gain experience in applying research methods to the systematic analysis and evaluation of health care services and health policy issues. The emphasis of the training program is the organization, financing, utilization, quality and evaluation of personal health care services and public policies for ensuring access to such services. Post-Doctoral Training Program in Health Services Research • The postdoctoral program is intended to provide advanced, specialized training in the methods of health services research • Trainees will gain experience in applying research methods to the systematic analysis and evaluation of health care services and health policy issues – aging, disablement and long-term care; health workforce policies and programs; health care organization; medical practice and health care outcomes; child health services; health care economics and finance; health disparities; rural heath care; mental health services; preventive health services; and heath policy analysis. • Trainees may elect to pursue one of several degrees through the UNC-CH School of Public Health as part of their training program. UNC Cancer Research Training Programs Cancer Control Education Program NRSA Training Program in Health Services Research Cancer Care Quality Training Program Cancer Control Education Program • The CCEP trains pre- and postdoctoral fellows for careers as independent investigators in interdisciplinary and collaborative cancer prevention and control research. • The UNC Lineberger Comprehensive Cancer Center and the University of North Carolina at Chapel Hill constitute an ideal setting for a training program in cancer prevention and control that emphasizes multidisciplinary, collaborative research. – Established, well-funded scientific research programs in Cancer Prevention and Control and Cancer Epidemiology – Core resources established to support the population sciences (Rapid Case Ascertainment, High-Throughput Genotyping, Dissemination); – Other core resources that support the population sciences as well as other research (Biostatistics, Tissue Procurement, Oncology Clinical Protocol Office) and – A developmental/seed grants program dedicated to cancer prevention and control/cancer epidemiology. Patient-Oriented Research Training Programs NC TraCS Institute CTSA KL2 Program (K12) Paul Calabresi Career Development Award for Clinical Oncology (K12) Mentored PatientOriented Research Career Development Award (Parent K23) NIH Research Grants (R01, R03, R21) You are a newly-trained clinician transitioning to more advanced support mechanisms, e.g., K08 and K23. You have completed specialty or subspecialty training and are seeking salary and research support for a full-time supervised career development experience in patientoriented research University of North Carolina Adult and Pediatric Bone Marrow and Stem Cell Transplant Program Program History • Over 2000 HCTs performed since November 1992 • 1/3 allogeneic and 2/3 autologous • Stem cell sources: Bone Marrow, PBSC, & UCB • 1992/1995: NMDP Bone Marrow Collection and Transplant Center for URDs • BCBS and United Resource (Optum) Centers of Excellence • 2005, 2008, 2011: FACT Accreditation for both adult and pediatric patients • NIH/L&LS/SBC Study Sections & CCSG Core Grant Site Reviews • Over 120 articles published and numerous national presentations Program History • 2010-14: Dr. Thomas Shea elected to role of Chair of the CIBMTR Executive Committee & Scientific Advisory Board • 2011: Dr. Kimberly Kasow elected NMDP Council Officer VicePresident from a Transplant Center • 2012: UNCH identified as one of only 14 “overperformimg” CIBMTR centers with OS > 2 SDs above expected for allografts • 2012: CTN consortium site with OSU, UCSF, RPCI, and VCU • 2014: Certificate of Need obtained for new 24-bed BMTU Adult Faculty • Thomas C. Shea, Program Director, Professor; clinical research in stem cell mobilization, auto and allo grafting • Jon Serody, Thomas Professor; NIH funded investigator in chemokines and pre-clinical models of GVHD; Director of Hematologic Malignancy and Immunotherapy Programs (former UNC Fellow) • Jay Coghill, Assistant Professor; L&LS / NCI funded laboratory investigator in cell homing and GVHD (former UNC Fellow) Adult Faculty • Paul Armistead, Assistant Professor; NCI funded investigator studying MRD and identification of minor alleles that are important in GVHD and GVT effects • William Wood, Assistant Professor, NCI funded investigator in outcomes research and effects of exercise (former UNC Fellow) • Katarzyna Jamieson, Associate Professor, clinical research in leukemia and BMT • Marci Riches, Associate Professor, clinical research in and BMT • 7 adult NP/PAs 220 Total BMT Transplants 2009-2013 200 184 182 180 170 Total Transplants 160 148 140 122 120 121 121 Auto 92 100 80 102 Allo 80 60 40 63 20 42 56 68 61 0 2009 2010 2011 2012 2013 UNC PROJECT-MALAWI CURRENT HEME-ONC ACTIVITIES Malawi country profile • Population ~15.3 million (NC ~9.7) • Surface area ~45,700 square miles (NC ~48,600) • Life expectancy 56 years (US 78 years) • Annual GDP per capita 318 USD (US 47,199) • Human Development Index rank 171 out of 187 countries (US 4) • • HIV prevalence 11% in 2009 Severely limited cancer facilities – – – – – No RT 4 pathologists 2 clinical oncologists 2 hematologists 1 medical oncologist MALAWI United Nations UN Development Program UNAIDS UNC Project-Malawi • • • • • • • • >20-year collaboration between UNC and Malawi Ministry of Health, established in 1991 Based in the capital Lilongwe at Kamuzu Central Hospital (KCH) 1000-bed public tertiary care hospital 1 of 2 national teaching hospitals serving a catchment area of 4-5 million people >350 employees, 40,000 square-feet, extensive community engagement Longstanding involvement of UNC IGHID, Lineberger, Surgery, Women’s Health, Gillings School of Global Public Health Training site for Fogarty AIDS International Training and Research Program Clinical trial site for protocols implemented through numerous multinational NIH-sponsored networks (ACTG, HPTN, IMPAACT, CHAVI, AMC) Malawi National Cancer Registry (n = 18,946; 2007-2010) Men Women Msyamboza et al, BMC Res Notes 2012 KCH Pathology Laboratory • • • • • • • UNC Project-Malawi and KCH collaboration 200,000 USD renovations and installation of new equipment Aperio virtual microscopy system installed for long-distance virtual consultation Operational since July 2011 Specimen review provided by Prof. George Liomba Immunohistochemical staining implemented >10,000 specimens reviewed to date Gopal et al, Lancet Oncol 2013; Gopal et al, PLOS ONE 2013; Montgomery et al, USCAP 2015 KCH Pathology Laboratory Jul 2011-Feb 2013 Gopal et al, Lancet Oncol 2013; Gopal et al, PLOS ONE 2013; Montgomery et al, USCAP 2015