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Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

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Thu, Jul 9 6:00am · "Opt-Out" Policy Increases Tobacco Treatment Visits Among Cancer Patients

Clinician investigators with Mayo Clinic Nicotine Dependence Center and Mayo Clinic Cancer Center report that automatically referring cancer patients to tobacco treatment services increases their use of this resource, while also increasing documentation of tobacco use status in the electronic health record.  Results of their pilot study were recently published in the International Journal of Environmental Research and Public Health.

The investigators designed a process using patient electronic health records to automatically identify and refer cancer patients who use tobacco to a tobacco treatment specialist. Supported by a best-practice advisory alert in the electronic health record, clinic staff handled the referrals and scheduled the tobacco treatment appointments while preparing patients to see a clinician. A co-signature from a clinician was not required. The research team piloted this process for six weeks starting in July 2019 at Mayo Clinic in Rochester, Minnesota.

During the pilot, clinic staff referred 210 oncology patients for tobacco use treatment. One hundred fifty, or 71%, of patients referred were scheduled for a tobacco treatment appointment. Twenty five, or 17%, of patients referred completed the appointment. While 25 may seem like a small number, it’s an improvement. In the six weeks prior to the pilot, just nine patients were scheduled for a tobacco treatment appointment and only four of those patients completed the appointment. These results demonstrate the feasibility of an electronic-health-record-based referral approach for tobacco use treatment that does not require active involvement from a clinician.

The best-practice advisory alert used in the pilot also increased documentation of patients’ tobacco use status.

A screen shot of the best-practice advisory alert used in the pilot study to prompt clinic staff to record tobacco use and refer patients for tobacco treatment.

“Although further work is needed to increase the number of patients who complete appointments, this EHR-based opt-out approach could be implemented in other specialties, further expanding the reach of tobacco use treatment in outpatient clinical practices,” says Thulasee Jose, M.D., lead author of the study and a research fellow at Mayo Clinic in Rochester.

This work was part of the National Cancer Institute (NCI) Cancer Center Cessation Initiative. Launched in 2017 as part of the NCI Cancer Moonshot program, the long-term goal of this initiative is to help cancer centers build and implement sustainable tobacco cessation treatment programs to routinely address tobacco cessation with cancer patients. Mayo Clinic joined the NCI Cancer Center Cessation initiative in 2018 when the NCI awarded the Nicotine Dependence Center a supplement to the Mayo Clinic Cancer Center’s NCI Cancer Center Support Grant, under the leadership of principal investigator, David O. Warner., M.D. 

For cancer patients, quitting tobacco is particularly important. “We know that people who have cancer will do better with regard to chemotherapy complications and radiation therapy complications. They’ll have less toxicity from those,” says  J. Taylor Hays, M.D.,  study co-author and director of the Nicotine Dependence Center. “They’ll have better quality of life after their cancer treatment if they’re not smoking. They’ll have longer life.”


Thu, Jul 2 7:00am · Read About Mayo Clinic's Latest Cancer Research in the June 2020 Issue of Forefront

decorative banner image from Forefront magazine, includes text Research Update - Highlighting Mayo Clinic Cancer Center's research and its translation to clinical advances.

Forefront is the complimentary magazine of the Mayo Clinic Cancer Center. Published in email and online newsletter editions quarterly, Forefront highlights Mayo Clinic’s cutting-edge cancer research and the latest Cancer Center news.

The June 2020 email newsletter highlights COVID-19 resources from Mayo Clinic:

Both email and online June 2020 editions feature:

Subscribe.


Thu, Jun 25 8:00am · "Sponge on a String" Test for Barrett's Esophagus and Esophageal Cancer Continues to Show Promise

Mayo Clinic researchers have confirmed the accuracy of a minimally invasive method to detect and help prevent esophageal cancer in patients at risk for Barrett’s esophagus and esophageal cancer.  Results of their study have been published in the American Journal of Gastroenterology.

In Barrett’s esophagus, tissue in the esophagus is replaced by tissue similar to the intestinal lining. Often diagnosed in people who have long-term gastroesophageal reflux disease (GERD), Barrett’s esophagus is associated with an increased risk of developing esophageal cancer, the sixth most common cause of cancer deaths worldwide, according to the American Cancer Society.

Illustration comparing a normal lower esophagus with an esophagus that has developed Barrett's esophagus.

“The challenge with the most common type of esophageal cancer in the West, adenocarcinoma, is that 80 to 90 percent of cases come to us at an advanced stage,” says Prasad Iyer, M.D., a gastroenterologist at Mayo Clinic in Rochester, Minnesota.  “These patients can’t swallow. When esophageal cancer is diagnosed at that point, only about 20 percent of patients survive five years.”

If esophageal cancer is found early, the survival rate is much higher. “If you diagnose this cancer before the onset of symptoms, survival is 80 or 90 percent,” says Dr. Iyer. “Early detection is a real opportunity to save lives.”

The only symptom of Barrett’s esophagus is reflux, and while patients with reflux often take medication to relieve symptoms, they are rarely tested for Barrett’s esophagus or esophageal cancer. These conditions are currently diagnosed using an endoscope, which involves an invasive, expensive procedure that requires sedation.

Dr. Iyer and his team developed a method to diagnose Barrett’s esophagus and esophageal cancer using a compressed sponge on a string inside a capsule covered with a dissolvable shell. A patient undergoing the test swallows the capsule with a few sips of water. Within eight minutes the capsule dissolves, releasing the sponge, which is then pulled out using the attached string. The sponge provides cell samples of the entire esophagus, which are then tested for biomarkers consistent with cancer or precancer.

Photograph of Prasad Iyer, M.D.
Prasad Iyer, M.D.

In this new study, 268 participants swallowed the sponge capsule and the expanded sponge was removed with the attached cord eight minutes later. Patients then underwent endoscopy within 24 hours. The sponge on a string was well-tolerated – 95% of participants preferred it to endoscopy. And the five biomarkers used in the sponge test accurately identified 92% of Barrett’s esophagus or esophageal cancer cases, while correctly determining no presence of precancer or cancer 94% of the time.

Patients were recruited for the study at Mayo Clinic’s campuses in Rochester, Minnesota, and Jacksonville, Florida and at Mayo Clinic Health System in Austin, Minnesota. The sponge test was administered by both physicians and nurses, with comparable success rates.

“The whole procedure takes about 10 minutes, doesn’t require sedation, will be substantially less expensive than endoscopy and can be completed by a nurse in in a primary care office,” says Dr. Iyer.

The research team initially documented the discovery and validation of novel methylated markers along with results of a pilot study in the American Journal of Gastroenterology in 2018. Dr. Iyer and his colleagues used the data they compiled from these two studies to obtain a grant from the National Cancer Institute to conduct a trial with 1,500 participants in the Mayo Clinic Health System. John Kisiel, M.D., also a gastroenterologist at Mayo Clinic in Rochester, Minnesota, will partner with Dr. Iyer on this grant. Drs. Iyer and Kisiel are developing biomarker assays for the trial in collaboration with Exact Sciences.

Photograph of John Kisiel, M.D.
John Kisiel, M.D.

“We are making great progress in developing a minimally invasive tool to detect esophageal cancer and its precursor early,” says Dr. Iyer. ”This test has the potential to dramatically alter the accessibility, cost and feasibility of testing.”

An abstract on this study was also accepted for Digestive Disease Week 2020: “Independent Validation of an Accurate Methylated DNA Marker Panel for the Non-endoscopic Detection of Barrett’s Esophagus: A Multisite Case Control Study.”

This study was partially supported by grants from the National Cancer Institute (CA214679 to JBK and CA241164 to PGI and JBK). Materials, reagents and blinded TELQAS assays were provided by Exact Sciences.

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Oct 22, 2019 · Meet the Investigator: Donald W. Northfelt, M.D.

At the Mayo Clinic Cancer Center, hundreds of researchers dedicate their professional lives to reducing the burden of cancer. Each one has a unique story. In this issue, Donald W. Northfelt, M.D., an oncologist and breast cancer researcher at Mayo Clinic in Phoenix, Arizona, talks about his research, his mentors and promoting equity in clinical trials.

Read about Mayo Clinic Cancer Center.

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Sep 27, 2019 · Read the Latest Research News from Mayo Clinic Cancer Center

Forefront is the complimentary magazine of the Mayo Clinic Cancer Center. Published in email and online newsletter editions quarterly, Forefront highlights Mayo Clinic’s cutting-edge cancer research and the latest Cancer Center news.

The September 2019 issue features:

Stay connected to Mayo Clinic Cancer Center

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Sep 9, 2019 · Mayo Clinic Cancer Center Renews National Cancer Institute Research Funding

Mayo Clinic Cancer Center has once again successfully renewed its National Cancer Institute (NCI) Cancer Center Support Grant. The grant award provides roughly $28.7 million in funding over five years through 2024, which will mark Mayo Clinic’s 49th year of NCI funding.

Mayo Clinic Cancer Center’s NCI designation as
a comprehensive cancer center was also renewed. To earn the comprehensive
cancer center designation, an institution must demonstrate scientific
leadership, resources, and depth and breadth of research in basic, clinical
and/or population science, as well as substantial transdisciplinary research.

The NCI has recognized Mayo Clinic Cancer Center as the only comprehensive cancer center with three geographic sites in Arizona, Florida and Minnesota. Today the Cancer Center is one of 51 NCI-designated comprehensive cancer centers across the country.

“We’re pleased that the NCI recognized our strong performance over the past five years,” says Robert Diasio, M.D., director of the Mayo Clinic Cancer Center. “These results would not be possible were it not for the efforts of hundreds of clinicians, researchers and support staff who come to work every day looking to improve the lives of patients with cancer.”

The NCI Cancer Center Support Grant has provided more than $146 million to Mayo Clinic Cancer Center over the past 44 years.

Read more about the Mayo Clinic Cancer Center.

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Jul 17, 2019 · Read the latest research news from Mayo Clinic Cancer Center

Forefront is the complimentary magazine of the Mayo Clinic Cancer
Center. Published in email and online newsletter editions quarterly, Forefront
highlights Mayo Clinic’s cutting-edge cancer research and the latest Cancer
Center news.

The June 2019 issue features:

View the online edition.

View the email newsletter.

Subscribe.

May 29, 2019 · Celebrate World No Tobacco Day -- Learn About the NCI Cancer Center Cessation Initiative at Mayo Clinic

The World Health Organization recognizes Friday, May, 31, as World No Tobacco Day – the perfect time to celebrate Mayo Clinic’s participation in the National Cancer Institute (NCI) Cancer Center Cessation Initiative

Launched in 2017 as part of the NCI Cancer Moonshot program,
the long-term goal of this initiative is to help cancer centers build and
implement sustainable tobacco cessation treatment programs to routinely address
tobacco cessation with cancer patients.

David Warner, M.D.,
David Warner, M.D.

Mayo Clinic joined this initiative in 2018 when the NCI awarded the Nicotine Dependence Center a supplement to the Mayo Clinic Cancer Center’s NCI Cancer Center Support Grant under the leadership of principal investigator David Warner, M.D. Mayo Clinic is now working with 42 other cancer centers across the nation to:

  • Refine electronic medical records and clinical workflows to ensure the systematic identification and documentation of smokers and the routine delivery of evidence-based tobacco cessation treatment services
  • Overcome patient, clinician, clinic, and health system barriers to providing tobacco cessation treatment services
  • Achieve institutional buy-in that treating tobacco use is a component of organizational “Standard of Care”
  • Create mechanisms to sustain tobacco cessation treatment services so that they continue beyond the funding period of the initiative

Armed with best practices gathered from other cancer centers, the Nicotine Dependence Center is working with care providers across Mayo Clinic to design a system for identifying tobacco users and enrolling them in cessation treatment.

To learn why it’s important for cancer patients to stop using tobacco, watch this Mayo Clinic Minute video:

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