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Siteman Cancer Center ranked No. 10 among U.S. cancer centers

Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine has been named No. 10 among cancer centers nationally by U.S. News & World Report. The recognition is part of the overall ranking of Barnes-Jewish and Washington University, which are No. 11 on the news magazine’s 2022-23 “Best Hospitals” list, released today.

Siteman was named No. 10 in cancer care, based on a review of 914 hospitals. Health-care facilities are chosen largely on patient outcomes and other data and a national survey of physicians.

In addition to their national rankings, Siteman and Barnes-Jewish each were ranked No. 1 in the St. Louis region and No. 1 in Missouri in their respective categories.

“We are honored to be named in the top 10 cancer programs in the country,” said Siteman director Timothy J. Eberlein, MD, the Spencer T. and Ann W. Olin Distinguished Professor and Senior Associate Dean for Cancer Programs at Washington University School of Medicine and BJC HealthCare. “This recognition is proof of our commitment to providing world class care to our patients every day. At Siteman Cancer Center, we pride ourselves in delivering the most cutting-edge technologies and treatments through innovative clinical trials at one of the top cancer research programs.”

Siteman is Missouri and southern Illinois’ only NCI-designated Comprehensive Cancer Center and the only cancer center in that area to be nationally ranked by U.S. News & World Report. Since 2015, Siteman also has held NCI’s highest possible rating, “Exceptional.”

Siteman Cancer Center is one of the five largest cancer centers in the country based on the number of patients treated – 70,000 people each year, including 12,000 who are newly diagnosed. Care is provided at six locations in the St. Louis region: on the Washington University Medical Campus and at Northwest HealthCare, part of Christian Hospital; Barnes-Jewish St. Peters Hospital; Barnes-Jewish West County Hospital; Siteman Cancer Center-South County; and Memorial Hospital East in Shiloh, Ill. Siteman also partners with Siteman Kids at St. Louis Children’s Hospital in the treatment of pediatric patients. The facilities all are affiliated with BJC HealthCare and staffed by Washington University physicians. The Washington University School of Medicine is a leader in medical research, teaching and patient care, and currently is No. 4 in research funding from the National Institutes of Health (NIH).

Barnes-Jewish Hospital and its Washington University physician partners also are part of U.S. News & World Report’s elite honor roll of the country’s top 20 hospitals that excel in complex specialty care.

The 2022-23 “Best Hospitals for Cancer” list is available at https://health.usnews.com/best-hospitals/rankings/cancer.

Colon cancer surgery: what to expect and how to prepare

When it comes to colon cancer, surgery is the most common treatment. Types of colon cancer surgery depend on the stage of the cancer and where the cancer is in the colon. For early-stage colon cancers and young-onset colorectal cancer, surgeons may recommend minimally invasive surgery. For more advanced colon cancers, surgery may be performed to remove parts of the colon or to reconnect healthy parts of the colon. All types of colon cancer surgery involve the removal of nearby lymph nodes where the cancer may have spread.

How to prepare for colon cancer surgery

Prior to your surgery, there are steps you can take to prepare.

A week or more before your surgery:

  • Make a list of all your medications and any allergies you have.
  • Fill any prescriptions you will need after surgery.
  • Ask your surgeon about when you should stop taking your medications. Don’t stop taking your medications without speaking to your surgeon.
  • Ask your surgeon if it’s safe to take ibuprofen or aspirin.
  • Arrange for family or friends to help care for you while you’re in the hospital and after you go home.
  • Plan for a caregiver to drive you home after you are discharged from the hospital.

24 hours before your surgery:

  • Don’t eat any solid foods and only drink clear liquids.
  • You may be advised not to eat or drink anything (including water) after midnight.
  • Ask your nursing team about the specific eating and drinking guidelines you’ll need to follow the night before surgery.
  • Your colon must be completely empty before the procedure. Follow your surgeon’s “bowel prep” instructions. You may need to use laxatives and/or enemas to get all the stool out of your colon.

The day of surgery and your hospital stay

When you arrive at the hospital for your surgery, you will be escorted to the pre-operation (pre-op) area to prepare for the operation. A nurse will take your vital signs and will insert an IV to administer fluids, including antibiotics to decrease the risk of infection, anesthetic medications and pain medications.

You’ll also meet with an anesthesiologist who will review your medical history, speak with you about your safety during surgery, go over the type of anesthesia you’ll receive and answer any questions you may have. Your family and/or friends will then go to the waiting room, where they will remain throughout the procedure.

Once the surgery is over, you will be taken to the recovery room. You will stay in recovery anywhere from one to two hours for observation and for the anesthesia to wear off. Then, you will be transferred to your room once you’re in stable condition.

You may stay in the hospital for two to five days after surgery. Depending on whether you have minimally invasive surgery or open surgery, your hospital stay may be shorter or longer. While you’re in the hospital, your nurses will teach you and your caregivers how to care for yourself during the recovery process.

Discharge and going home

Right after surgery, you will need to be on a clear liquid diet. This diet continues for the rest of that day. The day after surgery, you will get back to a regular diet. A dietitian will be available to help you while you’re in the hospital. Additionally, your nurses and physical therapists will help you move around and will teach you deep breathing and leg exercises. These exercises will help you regain mobility and improve your circulation.

Before discharging you from the hospital, your surgeon will write your prescriptions and give you written discharge instructions. Your surgeon will review these with you before you leave. Because medication and anesthetic can slow your reaction time and thought processes, make sure you have someone to drive you home.

Recovery at home

Once you’re home, you will be encouraged to steadily increase your activity level. Avoid strenuous activity – walking helps to prevent blood clots and keep your lungs clear, though you can climb steps and engage in light activity as soon as you feel up to it. Don’t take baths or submerge yourself in water until your incisions have healed.

Your surgeon will schedule a follow-up appointment after your surgery, but it’s a good idea to contact your surgeon right away if you experience any of the following:

  • Nausea/vomiting
  • Fever
  • Diarrhea
  • Wound is red, more painful or has drainage
  • No bowel movement within a few days of returning home

The Siteman approach to colon cancer surgery

With expert physicians, skilled support staff and the latest technology, we ensure that our colon cancer surgery patients receive the comprehensive care they need.

Our surgeons were the first in the region to perform laparoscopic colectomy for cancer. They use minimally invasive and robotic techniques whenever possible, making the recovery process easier while keeping risks down.

Our colon cancer specialist team

The multi-disciplinary colon cancer specialist team at Siteman comprises outstanding Washington University medical oncologists, radiation oncologists, surgeons, gastroenterologists, radiologists and others. The diverse expertise of our specialists allows them to create individualized treatment plans for all colon cancer patients.

While many colon cancers may be treated with surgery alone, some are treated with a combination of surgery, chemotherapy and radiation. Not all colon cancer patients will undergo the same course of treatment, so it’s important to have a team of providers across a wide range of disciplines.

You’ve been diagnosed with colon cancer. Now what?

If you’ve been diagnosed with colon cancer, you may be experiencing a wave of emotions including fear, anger and sadness. 50Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychology services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

If you are experiencing symptoms of colon cancer and are concerned about your risk, please make an appointment with your primary care provider. If you have been diagnosed with colon cancer and would like a second opinion from a colon cancer specialist at Siteman, please call 800-600-3606.

For Your Health: Enjoying summertime sun, safely

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For the last few years, summertime has felt even more special to me than usual. With the long, warm days, we’re finally able to get outside more and enjoy walks, bike rides and time at the park – often with family and friends we may not have seen for a while.

In our excitement to enjoy everything summer has to offer, it’s important that we don’t forget to protect our skin when we’re out in the sun.  The sun’s ultraviolet – or UV – rays can damage skin, increasing the risk of skin cancer, including the most serious type of skin cancer, melanoma.

Dr. Graham Colditz

“There are increasing rates of skin cancer on the whole,” said Dr. Lynn Cornelius, chief of dermatology at Washington University School of Medicine in St. Louis.  “Some of this may be due to aging populations, and some due to people not photo-protecting as well as they should.”

Key steps we can take to protect our skin from the sun include: using sunscreen (and re-applying), finding shade between 10 a.m. and 4 p.m. and wearing sunglasses, hats and long sleeve shirts.

For sunscreens, a 30 SPF (sun protection factor) or higher rating is good for shorter periods outside. For longer outings, a 50 SPF or higher is better.  Choose either a chemical sunscreen, which absorbs UV rays, or a mineral sunscreen, such as zinc, which blocks UV rays.  Despite some news reports that pop up occasionally, both types are safe for children and adults. So, pick whichever type you and your family prefer.

“Try different formulations; there are a lot of them out there,” Cornelius said. “The most important sunscreen is the one that you’ll use.”

For clothes, those made of fabrics that block the sun can be an especially good choice.  Similar to the SPF ratings of sunscreens, sun protective clothes often come with a specific UPF (ultraviolet protection factor) rating.  The higher the number, the better the protection.

“There’s great clothing out there now,“ Cornelius said. “They’re not heavy. They’re not expensive, and you can get them just about anywhere. We tell a lot of folks to wear those – particularly at the beach – or for little kids.”

Cornelius offered these additional tips for staying safe in the sun:

  • Protect your skin whatever your skin tone. People of color with darker skin have some natural protection, but darker skin can still burn, and it can still develop skin cancer.
  • Reapply sunscreen every couple of hours, or after sweating or going in the water. It’s important but something people often forget to do.
  • Rub in spray-on sunscreens. It’s easy to miss spots otherwise.
  • Keep a small container of sunscreen with you, so you always have it when you need it. Sunscreen sticks fit great in pockets and work well when you’re hot and sweaty.
  • Use sunscreen even if your makeup has UV protection. Most makeup has a lower SPF.
  • Don’t forget to protect your ears, including the tops. It’s a common spot for skin cancers, particularly in men.
  • Don’t forget to protect your scalp if your hair is thinning. Spray-on sunscreens can be good for this.
  • If you work outside, try to take particular care to protect yourself from the sun. Options may be limited, but whatever steps you take can help.

Enjoying the outdoors is one of the best parts of summertime.  And with just a few relatively simple steps, we can help protect ourselves and our family from the sun’s rays.   And that can make an already good time feel even better.

If your health – and your family’s health.  Take control.

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Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of the free prevention tool YourDiseaseRisk.com.

For Your Health: Add some steps to your spring

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Physical activity is good for us, we all know. Yet it can be hard to fit into our daily schedules – and it’s easy to understand why. Family, school, work and other important obligations can take up a lot of our time and energy.

But there is one healthy activity most of us can fit into a packed schedule – and it’s often hidden in plain sight: walking. You may not see it highlighted often by social media influencers, but for something so simple it has a huge amount going for it.

Dr. Graham A. Colditz

“Walking has far-reaching benefits, including reduced anxiety and depression, improved mobility and cardiovascular health, increased brain function, weight loss, and it adds years to life,” said Liz Salerno, an assistant professor in the division of public health sciences at Washington University School of Medicine in St. Louis.

And you don’t need to walk a huge amount to benefit. While a popular goal is 10,000 steps per day (about five miles), studies have found that walking even half of that can help people live longer. More, though, is usually better, but only up to a point.

Health gains begin to taper off when you hit 10,000 steps or more per day, Salerno continued. “The sweet spot – with the biggest gains – seems to be around 7,000-8,000 steps,” she said.

If you’re starting a new walking program, or are re-starting one after winter or extended pandemic time off, a good goal is just to get moving a little more than usual. Take things slowly and include some rest days between walking sessions, initially. And know that even short walks can add up to big benefits down the road.

“Start with a walk to the end of the block and back, then over time you can make your way around the block,” Salerno said. “Before long, you’ll be strolling around the neighborhood. And remember that you don’t have to break a sweat to benefit.”

Keeping track of your progress is easier than ever these days. Inexpensive pedometers do a great job of tracking steps, as do fitness trackers, smartphones and many watches. Just remember to take one on your walks.

And adding steps to your day can be easier than you think. You don’t need to log them in one big walk, unless you want to. Small bits add up, like taking the dog out for a quick walk after dinner, taking stairs instead of the elevator, getting off the bus a stop or two early and walking the rest of the way or walking your kids home after school or day care.

If it’s hard to walk safely around your area, some extra planning can help. Indoor malls or recreation centers are great places to get in some steps. At home, you can stream walking videos or listen to podcasts while pacing some laps in a hallway. And if you walk outside, try to choose safe routes, dress for the weather, wear bright or reflective clothes so cars and cyclists can see you and take a friend or two, which can make it more fun, as well.

After a long winter, the warmer, longer spring days can be just what we need to start adding steps to our days and giving our health an extra boost. While walking may not get much fanfare, it sure should.

“It’s a great way to live a physically active life without needing fancy equipment or a gym membership,” Salerno said. “No tools required besides your own two feet!”

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Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of the free prevention tool YourDiseaseRisk.com.

Subtle signs of ovarian cancer women should look out for

The first symptoms of ovarian cancer are easy to miss, which is why it has long been called the “silent killer.” But ovarian cancer isn’t really a silent killer; the early signs are often ignored or mistaken for other benign conditions. Gynecologic symptoms for cervical, uterine and ovarian cancers are all easy to brush off, but being able to identify early symptoms is crucial. While uterine cancer rates have recently climbed past ovarian cancer’s, it remains a gynecological cancer needing special attention. Spotting the signs of ovarian cancer earlier means catching the cancer when it’s easier to treat.

What is ovarian cancer? Who does it affect?

Ovarian cancer is an overgrowth of abnormal cells that start in the ovaries, fallopian tubes or peritoneum. According to the American Cancer Society (ACS), ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. While this statistic may seem daunting, ovarian cancer rates have been slowly falling over the past 20 years.

This cancer is more common among white woman than Black women. It also primarily affects older women who have already gone through menopause. In fact, about half of women diagnosed with ovarian cancer are age 63 or older.

Types of ovarian cancer

There are three types of ovarian cancer. The type of cancer you have – and the best course of treatment for you – will depend on the type of cell where the cancer begins.

  • Epithelial ovarian cancer: this is the most common type of ovarian cancer. It develops in the tissue surrounding the ovaries.
  • Stromal tumors: these rare tumors form in the ovaries’ structural connective tissue cells that produce estrogen and progesterone.
  • Germ cell tumors: these rare tumors begin in the ovarian cells that develop into eggs.

Wondering if you might have ovarian cancer? You’re not alone.

If you are concerned that you might have ovarian cancer, you may have fears about fertility; relationships and sexual health; the physical, emotional and financial impacts of treatment; and death.

While your fears and concerns are entirely valid, it’s important to keep in mind that many women with ovarian cancer go on to lead full lives. Being able to spot the subtle signs of ovarian cancer ultimately gives you the best chances for a positive outcome.

Signs of ovarian cancer

Symptoms of ovarian cancer include:

  • Bloating
  • Abdominal discomfort or back pain
  • Pelvic pain
  • Irregular bleeding
  • Change in bowel or bladder habits
  • Feeling full too quickly or lack of appetite

Risk factors for ovarian cancer

Certain factors may increase a woman’s risk of ovarian cancer. These include:

  • Getting older. Generally, most ovarian cancers develop after menopause.
  • Being overweight or obese. Obesity raises the risk of ovarian cancer. It may also have a negative impact on the overall survival of women with ovarian cancer.
  • Having children later or never having a full-term pregnancy. Women who have their first full-term pregnancy after age 35 or who have never had a full-term pregnancy are at higher risk for ovarian cancer.
  • Undergoing hormone therapy after menopause. Women who take estrogen alone or with progesterone are at higher risk for ovarian cancer than women who have never taken hormones.
  • Having a family history of ovarian, breast or colorectal cancer. Ovarian cancer runs in families. Additionally, due to gene mutations, a family history of breast or colorectal cancer increases a woman’s risk for ovarian cancer. Genes linked to hereditary ovarian cancer include ATM, BRCA1, BRCA2, BRIP1, RAD51D, PALB2, MLH1, MSH2, MSH6 and PMS2.
  • Having a family cancer syndrome. According to the ACS, up to 25 percent of ovarian cancers are a part of family cancer syndromes caused by inherited gene mutations.

Types of family cancer syndromes

  • Hereditary breast and ovarian cancer syndrome (HBOC). This syndrome results from inherited mutations in the genes BRCA1 and BRCA2. Mutations in these genes are responsible for most inherited ovarian cancers. BRCA1 and BRCA2 gene mutations are about 10 times more common in women of Ashkenazi Jewish descent.
  • Hereditary nonpolyposis colon cancer (HNPCC)/ Lynch syndrome. The lifetime risk of ovarian cancer in women with this syndrome is up to 10 percent. In addition, up to one percent of all ovarian epithelial cancers occur in women with HNPCC.
  • Peutz-Jeghers syndrome. This rare genetic syndrome causes polyps to form in the stomach and intestine during adolescence. It is linked to a high risk of cancers of the digestive tract. Women with this syndrome are at increased risk for both epithelial ovarian cancer and a type of stromal tumor called sex cord tumor with annular tubules (SCTAT).
  • MUTYH-associated polyposis. This syndrome causes polyps to form in the colon and small intestine. People with this syndrome are at high risk for colon cancer. They are also more likely to develop cancers of the ovary and bladder.

When should I talk to my doctor?

Symptoms of ovarian cancer can be mild and may be confused with other issues. Just because you’re experiencing one or more symptoms doesn’t mean that you have ovarian cancer. Still, if your symptoms last three weeks or longer, you should make an appointment with your provider.

What will happen at my initial doctor’s visit?

First, your provider (typically a gynecologist) will perform a pelvic exam. They will also ask questions about your medical and family history.

Next, your provider may use one or more of the following tests to screen for ovarian cancer:

  • Ultrasound. This test uses sound waves to create pictures of structures inside the body. Your provider will be able to see if either ovary looks abnormal. If something abnormal is found, further testing will be recommended.
  • CA-125 blood test. This test looks for CA-125, a protein that may be found at higher levels in women with ovarian cancer. However, just because a woman has a high CA-125 level does not mean she has ovarian cancer. Many other conditions can raise CA-125 levels, such as pregnancy and liver problems.
  • Surgery. In some cases, an ovary will need to be surgically removed and tested for signs of cancer to confirm a diagnosis.
  • Genetic testing. Your provider may recommend testing a sample of your blood to look for gene mutations that increase ovarian cancer risk. Knowing you have an inherited gene mutation will help your provider when putting together your treatment plan.

The Siteman approach to ovarian cancer

Our nationally renowned gynecologic oncology program is the largest in the Midwest. With expert physicians, nurses, skilled support staff and the latest technology, we ensure that our ovarian cancer patients receive the comprehensive care they need. Our physicians are also actively involved in clinical trials that investigate new therapy approaches. Patients who undergo ovarian cancer treatment at Siteman have access to new therapies that are as good as – or even better than – current standard therapies available at other cancer centers.

In addition, Siteman Cancer Center and WashU Medicine offer the latest fertility preservation treatments for women undergoing ovarian cancer treatment.

Our ovarian cancer specialists

The ovarian cancer specialist team at Siteman comprises outstanding WashU Medicine gynecologic oncologists, radiologists, genetic counselors, psychologists, pathologists and nurses. The diverse expertise of our specialists allows them to create personalized treatment plans for all ovarian cancer patients.

Be your own ovarian cancer care advocate

If you are experiencing any early symptoms of ovarian cancer, don’t brush them off. While other conditions could be causing them, it’s important to rule out the possibility of ovarian cancer. Being aware of these subtle signs and understanding your own individual risk increases your chances of catching ovarian cancer early, when it’s easier to treat.

You’ve been diagnosed with ovarian cancer. Now what?

If you have received an ovarian cancer diagnosis, you may be feeling a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychology services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

If you are experiencing symptoms of ovarian cancer, or if you have received an ovarian cancer diagnosis and would like a second opinion from an ovarian cancer specialist at Siteman, please call 800-600-3606.

Novel treatment makes pancreatic cancer susceptible to immunotherapy, mouse study shows

Pancreatic cancer is one of the most aggressive and deadly tumor types and notorious for its resistance to virtually all types of treatment, including newer immunotherapies.

A new study — in mice — from Washington University School of Medicine in St. Louis suggests that blocking a major inflammatory pathway that is activated in pancreatic cancer makes the tumors sensitive to chemotherapy and a type of immunotherapy that prompts the immune system’s T cells to attack the cancer cells. The therapy more than doubled survival in a mouse model of pancreatic cancer.

The study’s results, published March 7 in the journal Gastroenterology, lend additional support for the rationale behind a new national clinical trial that will evaluate the same treatment strategy in patients with pancreatic ductal adenocarcinoma — the most common malignant tumor of the pancreas. The researchers plan to enroll about 50 patients nationwide.

Washington University researchers at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine will lead the national trial that is part of the National Cancer Institute’s (NCI) Experimental Therapeutics Clinical Trials Network, a collaboration of industry, academic medical centers and researchers focused on early clinical investigations of innovative cancer therapies. The network includes more than 30 clinical sites in the U.S. and Canada.

“Washington University has a lot of strengths in bringing science from the lab to the clinic,” said senior author Kian-Huat Lim, MD, PhD, an associate professor of medicine and principal investigator for translational science on the national trial. “With this therapy, we are going after a pathway that we know is involved in driving the aggressiveness of pancreatic cancer. The results of this study are promising in that it showed a way to break through the defenses of this tumor type, making it susceptible to our therapeutics, including combinations of chemotherapy and newer immunotherapies that stimulate T cells to fight the cancer.”

The researchers, including first author Vikas Somani, PhD, a postdoctoral research associate in Lim’s lab in the Division of Oncology in the Department of Medicine, found that a protein called IRAK4 drives inflammation in pancreatic tumors and leads to T cell exhaustion, meaning the T cells can’t function as they should to attack harmful cells, including cancer. The researchers tested an IRAK4 inhibitor, called CA-4948, and found that the treatment reduced inflammatory signaling in the tumors in mice and improved the ability of T cells to infiltrate the tumors and kill pancreatic cancer cells. The therapy also sensitized the tumors to a type of immunotherapy called checkpoint immunotherapy, which “take the brakes off” T cells, improving their ability to attack tumor cells.

The researchers found that the IRAK4 inhibitor shuts down a key pathway called NF-kappaB, which has long been known for its roles in driving cancer. Much research is focused on shutting down this pathway and its downstream effects after it becomes activated. A novel element of this therapy is that the IRAK4 inhibitor prevents the harmful pathway from becoming activated in the first place.

In mice with a common aggressive model of pancreatic cancer, the researchers found that the IRAK4 inhibitor alone increased survival compared with a placebo or chemotherapy. In combination, the IRAK4 inhibitor plus chemotherapy increased survival further compared with placebo or chemotherapy alone. In addition, when combined with two immunotherapies, the IRAK4 inhibitor significantly extended survival from an average of 25 days with the inhibitor alone to an average of 46 days with the inhibitor plus immunotherapy combination. Some of the mice survived as long as 100 days on the combination therapy.

The IRAK4 inhibitor is already in national clinical trials investigating its use against blood cancers.

“We look forward to beginning the national clinical trial of this drug in patients with pancreatic cancer — the trial is a direct translation of this particular paper,” said Haeseong Park, MD, an associate professor of medicine and principal investigator of the new trial. “We are excited to be working with the NCI and clinical sites in the Experimental Therapeutics Clinical Trials Network so that we can harness our innovative homegrown science and bring it to the national level.”

Soon, Park’s team also will begin a single-center trial at Siteman Cancer Center to test the safety and efficacy of the IRAK4 inhibitor CA-4948 in gastric cancer.

For Your Health: A common eye disease you can take steps to prevent

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Macular degeneration is a disease many of us have heard of but may not know much about. So, it may be surprising to hear that the disorder significantly impacts the vision of millions of people in the U.S. – and that there are steps to help prevent it.

Macular degeneration is an eye disease that damages the central part of the retina, called the macula, which is the tissue at the back of the eye that is responsible for sharp, straight-ahead vision. At first, macular degeneration may go unnoticed, but as it advances, vision loss can get increasingly worse and have a real effect on people’s daily routines and quality of life.

Dr. Graham A. Colditz

“It impacts independence and the ability to read, write, drive a car and watch TV,” said Dr. Johanna Seddon, director of the Macular Degeneration Center of Excellence at the University of Massachusetts Chan Medical School. “And most important to many patients, they’re not able to recognize family members and other people they love.”

The disease is more common as people age. Rare in those under age 40, the risk of macular degeneration begins to increase in people in their 50s and 60s, and most cases are diagnosed in those 70 and older. Family history also plays an important role in the disease. If your mother or father has had macular degeneration, for example, you are at increased risk.

But research shows there are important steps most of us can take that can help lower the risk of the disease, whether we have a family history or not.

“Not smoking is probably most important,” Seddon said. “Other steps include exercising, maintaining a healthy weight and eating more green, leafy vegetables, like spinach, collard greens and kale.”

Getting eye exams is also key for eye health, especially as you age, or if you have a family history of eye disease. This can help find macular degeneration earlier so it can be better managed over time.

In people who’ve already been diagnosed with later stages of macular degeneration, taking specific supplements have been found to slow down vision loss from the disease. “These formulations are often labeled ‘eye vitamins,’ and contain antioxidants, such as lutein, zeaxanthin, vitamins C and E and zinc,” Seddon continued.

Talk to an eye doctor or other health-care provider for more information about such supplements.

Other treatments can actually help improve vision in those with advanced macular degeneration but are now available for only one of the two main types of the disease, called “wet type.” While there are no treatments for the other type of macular degeneration, “dry type,” promising studies are underway.

For those with significant vision loss due to either type of the disease, there are practical steps that can help with maintaining daily routines and overall well-being.

“We recommend what we call ‘visual rehab,’ where people are evaluated for magnifiers and other visual aids, like high-contrast knobs on ovens, and they can also get instruction on how to prevent falls, which is a real danger when someone loses depth perception,” Seddon said.

As the population grows and gets older overall, macular degeneration is expected to become an increasingly important condition, with wide-reaching impact on individuals and their families and caregivers. But research continues to work to find more and better treatment options. Also, a number of healthy behaviors can help lower the risk of developing the disease in the first place. And that’s clearly some good news.

It’s your health. Take control.

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Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of the free prevention tool, YourDiseaseRisk.com.

For Your Health: Overcoming hurdles to healthy habits

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Looking after our health isn’t always easy. And, if we’re honest, it can feel a bit overwhelming at times. But one thing we’ve been reminded of lately is the importance of good health.

Despite how it may feel when scrolling through news or social media, taking steps to improve our health can be easier than you might think. Let’s look at four concerns about making healthy changes, and why they may not be as hard as they can seem.

There are so many health recommendations, it’s hard to keep up.

Without a doubt, many different groups offer health recommendations. While there are many reasons for this, it can make it hard to know which advice to follow. The good news is, many steps for improving health and lowering the risk of cancer, heart disease and other conditions are really pretty simple. They include:

  • Eating a diet rich in fruits, vegetables and whole grains – and keeping red meat, sugary drinks and alcohol to a minimum
  • Moving your body some amount every day
  • Trying to keep weight gain in check
  • Not smoking
  • Seeing a health-care provider about screening tests or other important care

Dr. Graham Colditz

I have trouble reaching my health goals.

Whether it’s eating three servings of whole grains a day, getting seven hours of sleep a night or working on something else altogether, it’s great to have health goals. But it can feel frustrating if we don’t reach them. A good way to help avoid that is to set smaller, more achievable goals along the way to your bigger goal. The success of reaching smaller goals builds and keeps you going. Plus, even small changes can have health benefits all on their own.

Healthy behaviors are expensive.

There are a lot of ways to spend a lot of money on healthy activities – and they’re often on full display on social media. But just as the basics of healthy living are pretty simple, they can also be affordable. Walking is a great exercise, which only really takes a good pair of athletic shoes. Indoor exercise classes can be streamed for free on different platforms. And while healthy foods can cost more than less healthy choices, you can often find affordable, healthy options with a little extra effort.

I don’t always feel motivated to be healthy.

Motivation can sometimes be hard to find any time of year. But in the middle of winter, entering the third year of a global pandemic, it may feel particularly difficult. To help, take a moment and remind yourself why you want to be healthier. Maybe family and friends or an activity you’re passionate about will spark motivation. Many times, just getting started on a behavior can create its own motivation. Instead of waiting for motivation to strike, make a plan to get started on a behavior instead. Commit to walking for just a few minutes, or to starting the first steps of a veggie chili recipe, and you may find the boost you need to keep going. It might not always feel easy to do, but it can help.

The world around us can feel increasingly complicated, but a handful of relatively simple behaviors can go a long way to improving well-being and lowering the risk of disease. And small changes can have important benefits – today and in the future.

It’s your health. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of the free prevention tool, YourDiseaseRisk.com.

Boosting T cells improves survival in mice with glioblastoma

Glioblastoma, an aggressive cancer in the brain or spinal cord, has proven stubbornly resistant to newer immunotherapies. And radiation and chemotherapy, the standard treatment for glioblastoma, result in fewer than 10% of patients surviving longer than five years after diagnosis.

But a new study from researchers at Washington University School of Medicine in St. Louis shows that treatment with an immune-boosting protein called interleukin 7 (IL-7) in combination with radiation improves survival in mice with glioblastoma. The new mouse study shows that IL-7 increases the number of T cells in the tumor and other immune organs. Such immune cells can then attack the cancer cells and improve survival.

The findings are published Jan. 14 in Clinical Cancer Research, a journal of the American Association for Cancer Research.

The study in mice suggests promise for a phase 1/2 clinical trial at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis that is investigating a long-acting type of IL-7 in patients with glioblastoma.

Radiation in combination with chemotherapy is the standard of care for various cancers including glioblastoma. Although beneficial against cancer, these treatments also can impair patients’ T cells, known as lymphocytes, that are important for fighting infections. Many glioblastoma patients have low levels of T cells. Glioblastoma patients who have chronically low lymphocyte counts don’t survive as long as patients with higher numbers of these T cells.

“Previously, a multicenter study from the American Brain Tumor Consortium showed a six-month shorter survival for patients with low versus normal numbers of T cells,” said first author Jian L. Campian, MD, PhD, who conducted the research at Washington University School of Medicine and the Brain Tumor Center at Siteman. “We knew that glioblastoma patients with low lymphocytes surprisingly also have low IL-7, which is a growth factor that supports T cells. Normally, people with low T cells should have a high level of IL-7. We wanted to find out if giving IL-7 to patients could increase the numbers of T cells and, in the process, have a positive impact on survival.”

The researchers found that mice with glioblastoma tumors treated with a combination of chemotherapy, radiation and IL-7 lived longer than mice that received only chemotherapy and radiation. On average, control mice that received no treatment lived about 20 days after tumor implantation. The mice that received IL-7 alone lived about 30 days, and those that received radiation alone lived about 35 to 40 days. The mice that received a combination of radiation and IL-7 lived at least 40 days, and many were still alive at 90 days. The longest survival was in the mice that received the triple combination of chemotherapy, radiation and IL-7, most of which lived at least 45 days, with many still alive at the 90-day mark.

“It’s difficult to know how these increases in survival in mice might translate to people,” said co-senior author Milan Chheda, MD, an associate professor of medicine. “If many of these mice are surviving at least three months by adding IL-7, we’re hoping to see some type of improvement in our patients who are treated with IL-7. As a basis for comparison, the chemotherapy given for glioblastoma is called temozolomide, and it was first approved because it improved patient survival by an average of slightly over two months.”

In addition to increasing T cell numbers in the tumor and the tumor’s environment, IL-7 treatment increased T cells in the blood and immune organs, including the thymus, spleen and lymph nodes, the investigators found. The therapy also reduced T regulatory cells, which are known to suppress the immune system in the microenvironment of brain tumors.

“We are encouraged by the results we are seeing in the mice,” said senior author Dinesh Thotala, PhD, an associate professor of radiation oncology. “We also see evidence that IL-7 could be considered as a replacement for temozolomide, especially among the nearly 70% of patients who have a type of tumor that does not respond well to this chemotherapy.”

The researchers explained that current immunotherapies called immune checkpoint inhibitors work by taking the brakes off immune cells that are already present. Since so many glioblastoma patients have depleted T cell numbers, it is perhaps not surprising that immune checkpoint inhibitors have not proven effective.

“If we are able to increase the number of T cells by giving IL-7, we would like to find out if adding immune checkpoint inhibitors would then increase T cell activity against the cancer cells,” said Chheda, who treats patients at Siteman Cancer Center.

Campian, who is now with the Mayo Clinic, said the researchers have plans to launch a follow-up study in glioblastoma patients at Washington University and the Mayo Clinic to determine whether combining immune checkpoint inhibitors with long-acting IL-7 boosts survival.

For Your Health: Better sleep for better health

For Your Health Graphic 2020



We may not think about sleeping as a healthy behavior like we would exercising or eating a healthy diet, but we probably should.

Sleep can play a key role in health and wellness, and studies show that many of us just aren’t getting enough of it.

Dr. Graham Colditz

“Short sleep and poor-quality sleep are linked to increased risk of depression, obesity, diabetes, hypertension, heart disease and some cancers,” said Yikyung Park, associate professor in the Division of Public Health Sciences at Washington University School of Medicine in St. Louis. “A lack of sleep also weakens immune function, making you vulnerable to common infections such as the common cold.”

How can sleep problems have such a wide-ranging effect on health?

For one, they can disrupt the circadian rhythm, our natural “body clock” that controls all biological functions in a 24-hour period, Park said. That disruption can lead to many different reactions in the body that can increase the risk of certain diseases and conditions.

Less directly, sleep problems can also simply make it harder for us to make choices that are good for our health. Lack of sleep can impact decision-making, energy levels and a number of other factors that can make us more likely to stay on the couch rather than get outside for a walk, or choose a fast food meal over making something healthier at home.

About a third of U.S. adults are short sleepers, getting fewer than seven hours of sleep a night. But it’s an issue more common in some groups than others. “There is a significant disparity in sleep duration by race and ethnicity, and income,” Park said. “Short sleep is a particularly important problem for African Americans, multiracial non-Hispanics, American Indians/Alaska Natives and Native Hawaiians/Pacific Islanders – as well as those with lower incomes.” A range of issues can contribute to these differences, including stress, discrimination, job schedules and neighborhood conditions that can make it harder to get good quality sleep.

It’s recommended that most adults get about seven to eight hours of sleep each day. But what counts as healthy amounts of sleep can vary.

“For some people, six hours of sleep a day is enough, but others may need nine hours. And although it’s important to get enough sleep, sleep quality is also crucial,” Park said.

While some of the factors that impact the quality and length of sleep are out of our direct control, there are simple approaches we can take to improve the chances of getting good sleep regularly. As a first step, Park recommends we:

  • Put away electronic devices such as smartphones, tablets and TVs at least 30 minutes before bed
  • Have a routine sleep schedule – that is, go to bed and wake up at the same time – every day
  • Avoid large meals within a couple hours of bedtime
  • Avoid caffeinated beverages and alcoholic drinks before bed
  • Get regular physical activity, though not close to bed time

In our busy, round-the-clock world, these changes can be an adjustment. But you don’t need to tackle them all at once. Pick just one to start, and then go from there. Small changes build on each other. And like other healthy behaviors, improving the quality of sleep is something well worth the effort and can provide a real boost to health and well-being.

And that may just help you rest a bit easier.

It’s your health. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of the free prevention tool, YourDiseaseRisk.com.