Monthly Archives: November 2004

Concurrent Radiation Chemotherapy for Locally Advanced Head and Neck Carcinoma: Are We Addressing Burning Subjects?

  • 11/30/2004
  • Houston, TX
  • K. Kian Ang
  • The University of Texas M.D. Anderson Cancer Center, Houston, TX

Improving the outcome for patients with locally advanced head and neck carcinomas (HNC) by rational modification of radiation fractionation regimens or combinations of radiation with chemotherapy has been the subject of intensive clinical investigations for more than three decades. The two prototypes of biologically sound-altered radiation fractionation regimens are hyperfractionation and accelerated fractionation.1 Hyperfractionation was based on preferential sparing of late-responding tissues when the radiation dose per fraction is reduced. Accelerated fractionation regimens emerged through the recognition that tumor clonogen proliferation occurring during radiotherapy has a detrimental effect on outcome. Results of large randomized trials addressing the optimization of radiation fractionation collectively show that a number of biologically sound altered fractionation schedules improve the locoregional (LR) control rate on the order of 10% to 15%, but have only a modest impact on overall survival. Although several altered fractionation regimens consistently induce more severe acute mucositis than standard 7-week radiotherapy, the general consensus is that late toxicities are not appreciably increased.

Scores of clinical trials testing combined-modality therapy have also been published. Meta-analyses of studies completed before 1995 reveal that cytotoxic agents given before or after surgery or radiation do not significantly improve the therapeutic outcome over LR treatment alone. In contrast, chemotherapy given concurrently with radiation improves 2- and 5-year overall survival rates by 8%. Although a variety of cytotoxic agents have been studied, cisplatin is the most extensively investigated, and will be the emphasis of this commentary. The data from four recent trials using standard radiation fractionation, with or without high-dose single-agent cisplatin given every 3 weeks, in the treatment of locally advanced non-nasopharyngeal HNC have been reported in the last 2 years. All four trials showed that the combined regimen was superior to radiation therapy alone in LR control or organ preservation; two trials also showed improvement in overall survival. A common finding, however, is that 100 mg/m2 of cisplatin given every 3 weeks during the course of radiotherapy substantially increases the severity of mucositis, apparently more so than altered fractionation regimens without chemotherapy. In addition, cisplatin induces systemic toxicity requiring intensive premedication and supportive care. Unfortunately, recording and reporting of the late morbidity of combined radiation-chemotherapy have not been sufficiently consistent and systematic. A thorough report of the long-term results of a French cooperative group (French Head and Neck Oncology and Radiotherapy Group [GORTEC]) trial revealed that the late complication rate of the combination of radiation with concurrent carboplatin and fluorouracil was significantly higher than that of radiation alone. Due to a lack of adequate reporting, there is controversy as to whether the late toxicity of the combination of standard radiation with 100 mg/m2 of cisplatin every 3 weeks might also be higher than radiation alone. Hopefully, longer and more complete follow-up data on late morbidities will be reported in the future.

Although the collective data are strong in establishing the superiority of the combination of radiation with concurrent chemotherapy relative to standard radiation fractionation alone in the management of locally advanced HNC, there is variability of clinical trials in patient selection and regimens, leading to continuing debate as to which combined regimen should be considered standard. Furthermore, many questions remain to be answered, including whether the cisplatin dose can be altered to reduce acute and late toxicities without diminishing efficacy, whether cisplatin has benefit when added to altered fractionation, whether newer cytotoxic agents such as taxanes have higher efficacy, and whether neoadjuvant chemotherapy further improves the outcome of concurrent radiation and chemotherapy.

The randomized trial coordinated by the Swiss Group for Clinical Cancer Research, reported by Huguenin et al in this issue of the Journal of Clinical Oncology, was designed to address two of these questions. Although the sample size is relatively small, the study generated many interesting findings. With regard to chemotherapy, the total cisplatin dose was reduced (ie, from the usual three to two cycles), and for each cycle its administration was fractionated into five doses of 20 mg/m2 given over 5 consecutive days, rather than 100 mg/m2 given in a single administration. Compared with other cisplatin trials, this approach seems to reduce the severity of systemic toxicity and mucositis without diminishing the impact on LR control and, potentially, on occult metastasis. The incidences of grade 3 to 4 nausea or vomiting, hematologic toxicity, and mucositis were relatively low. This finding is consistent with the data of a phase III trial in nasopharyngeal carcinoma from the National Cancer Center of Singapore, reported by Wee et al at the 2004 Annual Meeting of the American Society of Clinical Oncology, in which each cycle of concurrent cisplatin was 25 mg/m2/d given on 4 consecutive days. It is also in agreement with the data from another multi-institutional trial using cisplatin at 6 mg/m2/d, 5 days per week, for 7 weeks. The data from these three trials, along with the observations from other studies showing that a substantial fraction of patients could not receive the third planned cisplatin dose of 100 mg/m2, suggest that a cumulative cisplatin dose of approximately 200 mg/m2, independent of the schedule, might be sufficient to yield a beneficial antitumor effect.

The choice of radiation fractionation regimen by the Swiss cooperative group is rather surprising, as 74.4 Gy given in 1.2 Gy per fraction twice daily has not been tested against the standard fractionation in a phase III trial setting. Hyperfractionation regimens shown to be superior to the conventional 70 Gy in 7 weeks by the European Organization for Research on Treatment of Cancer and the Radiation Therapy Oncology Group (RTOG) phase III trials, deliver 80.5 Gy and 81.6 Gy, respectively. Given the exponential nature of radiation cell killing, an 8% to 9% reduction in the total dose represents a considerable reduction in biologic effect. The data from Huegenin et al are consistent with other studies showing that regimens combining variants of altered fractionation plus concurrent chemotherapy yield better LR control than altered fractionation alone. However, the study does not answer the question as to whether altered fractionation plus concurrent chemotherapy is better than standard fractionation plus the same chemotherapy regimen. Two ongoing cooperative group trials have been designed to resolve this issue. The RTOG trial (H0129) compares the efficacy of an accelerated fractionation regimen (concomitant boost: 72 Gy in 6 weeks) plus two doses of cisplatin to standard fractionation (70 Gy in 7 weeks) plus cisplatin. The three-arm GORTEC study (99-02) compares accelerated fractionation (70 Gy in 6 weeks) plus carboplatin-fluorouracil to a more pronounced accelerated fractionation (64.8 Gy in 3.6 weeks) without chemotherapy and to standard fractionation plus carboplatin-fluorouracil. Both trials are approaching completion of accrual and the results will likely be reported in 2 to 3 years.

Finally, it should be noted that advances in the understanding of tumor biology has opened an exciting era for translational research. Preclinical and correlative biomarker studies conducted in a few centers, for example, have revealed epidermal growth factor receptor (EGFR) as a predictor of radiation response of HNC and have identified EGFR and its downstream signaling molecules as appealing targets for therapeutic intervention. The results of a recently completed international trial reported at the 2004 Annual Meeting of the American Society of Clinical Oncology meeting validated the latter notion by showing that adding an anti-EGFR antibody to radiation yielded improved LR tumor control and overall survival without increasing mucositis and dysphagia, as compared with radiation alone. These data have generated tremendous enthusiasm for exploring more selective strategies for improving therapy for HNC. The results of the Swiss trial contribute by delineating the baseline data, against which outcomes of novel combined therapies should be measured, and in defining a less toxic radiation-chemotherapy platform to which novel agents can be added in the treatment of locally advanced HNC.

OCF NOTE: The author Dr. Ang, is a valued member of the Oral Cancer Foundations Scientific Advisory board, and was the treating radiation oncologist for OCF’s founder, Brian Hill.

November, 2004|Archive|

Vaccine Truth or Dare

  • 11/30/2004
  • Erika Jonietz
  • Technology Review, Nov. 2004

A new vaccine in the works could prevent cervical cancer. But will it ever reach those who would benefit most?

Before the end of the decade, preteens going to the doctor for the usual booster shots—tetanus, diphtheria, and perhaps an annual flu shot—may get a new jab. The vaccine would not only protect them against one of the most common sexually transmitted infections but also prevent cervical cancer—almost eliminating that form of malignancy, in fact, and saving the lives of nearly a quarter million women worldwide each year. But even before studies of the vaccine’s effectiveness are complete, conservative Christian groups are expressing concerns about inoculating adolescents against sexually transmitted infections.

A study published in the November 13 issue of British medical journal The Lancet showed that women who received all three doses of the vaccine, made by GlaxoSmithKline, maintained a strong immune response against the virus that causes cervical cancer, and that this immunity lasts for at least two years. The vaccine is one of two being developed against cervical cancer; Merck makes the second. “It’s fabulous,” says Diane Harper, who directed the study and who heads research on prevention of gynecological cancer at Dartmouth Medical School. “It’s safe, it’s easy to make, and it’s amazingly effective.”

Both the Merck and GlaxoSmithKline vaccines target human papillomavirus, or HPV, the virus that causes cervical cancer. Spread through intimate skin-to-skin contact, HPV can also cause genital warts. There are more than 100 strains of HPVs, many of them harmless; the Glaxo vaccine is aimed specifically at the two strains—known as HPV-16 and HPV-18—that account for about 70 percent of cervical cancers. Among women who received at least one of three scheduled doses, the vaccine was 95 percent effective at protecting against persistent infection with HPV-16 and HPV-18 throughout the 27 months of the trial. Merck’s version, which adds protection against HPV-6 and HPV-11 (the viruses that cause genital warts) has shown similar results. Both companies are conducting final, large-scale tests of their vaccines, and Merck plans to submit its vaccine for approval by the U.S. Food and Drug Administration by the end of 2005.

The vaccines’ potential is undisputed. “It’s really exciting,” says Gillian Sanders, a medical decision analyst at Duke University who has evaluated HPV vaccination strategies. “It’s very clear these viruses are causing cervical cancer, and there’s a vaccine that’s showing to be very effective. That could make a huge difference in developing countries.” Globally, more than 500,000 women suffer cervical cancer each year. It is the third most common cancer in women worldwide and the leading cancer killer among women in developing countries. In the United States, widespread Pap screening has reduced deaths from cervical cancer dramatically, but the disease still strikes some 15,000 women each year and kills about 5,000. By targeting the forms of HPV associated with the majority of cervical cancer cases, the vaccines have the potential to save as many as 175,000 women annually.

The controversy begins with researchers’ efforts to determine the best vaccination program to protect the largest number of women. Several published studies have modeled possible programs; the consensus is that the most cost-effective strategy is to inoculate 12-year-old girls.

Researchers acknowledge the obvious: “The question in everybody’s mind is, will parents vaccinate their adolescent children against what is essentially a sexually transmitted infection?” says Evan Myers, chief of the division of clinical and epidemiological research at Duke University Medical Center ‘s department of obstetrics and gynecology. Myers co-authored a 2003 study of the potential health and economic benefits of an HPV vaccine program and has consulted for Merck’s HPV vaccine program. Most cases of HPV occur between ages 15 and 25, with a large increase beginning around age 19, Myers says; however, adolescents have proved difficult to reach with vaccines in the past. The hepatitis B vaccine, for instance, was originally recommended for adolescents but is now generally given as part of the infant series. Targeting 12-year-olds gives doctors the best chance to vaccinate the most children before they are at risk from HPV—and eventual cervical cancer

Ideally, Myers says, the vaccine companies would like to see the vaccine added to the recommended pediatric immunization schedule. According to Eliav Barr, who heads Merck’s clinical research program on the HPV vaccine, both the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and the American Academy of Pediatrics have expressed intense interest in the HPV vaccines. Barr also believes that making the inoculation part of the series required for school entry could be the most effective way to ensure widespread vaccination. These requirements are set by each state individually, usually in accordance with guidelines established by the Advisory Committee on Immunization Practices. “The key thing with vaccinations is reaching the hard to reach,” he says. “Middle-school entry and high-school entry requirements have been extremely effective at boosting coverage [for other vaccines] to levels really consistent with the best benefits available.”

Opponents of such a requirement note that it wouldn’t hurt Merck’s or Glaxo’s bottom line. “This thing is motivated by money as usual—and in a worldview that not everyone subscribes to,” says Leslee Unruh, founder of the Abstinence Clearinghouse. Unruh believes that abstinence-only sexual education offers a better approach to preventing the spread of all sexually transmitted diseases. Other Christian values groups, such as Concerned Women for America and the Family Research Council, echo her point of view.

“We know that there is what could easily be called an epidemic of HPV infection, and that needs to be taken seriously,” says Pia de Solenni, an ethicist who serves as director of life and women’s issues at the Family Research Council. “However, our concern would be that [a vaccine] really isn’t comprehensive, especially when you’re talking about administering it to 12-year-olds. It’s important to focus on abstinence.” Abstinence, Solenni notes, would prevent not just HPV, but an array of other sexually transmitted infections, including gonorrhea, chlamydia, and HIV.

Many find the idea of incorporating the vaccine into school-entry requirements particularly troubling. “We need to look at this with a serious moral perspective and talk about it some more instead of just imposing it on every parent and every child,” says Wendy Wright, senior policy director of Concerned Women for America . “We’re not saying don’t make this vaccine available.” But, she adds, giving the vaccine at an early age sends a message. “What they’ve done is told this 12-year-old, ‘You can now become sexually active,’” she says. “Perhaps they could adjust this vaccine so that it could be taken at a later age.” Solenni concurs, saying that although she still wouldn’t endorse it, the vaccine would best be offered only to people who are at least 18 years old. The only form of prevention she supports is abstinence from any sex outside marriage.

As a public health policy, delaying vaccination until age 18, an age before which many girls have become sexually active, fails. “In our study, we found that effectiveness was OK until age 15; then it decreased,” says Duke’s Myers. “It’s clear that waiting until 18 would reduce the overall benefits of the vaccine by a substantial proportion. I strongly doubt that those teens who aren’t having sex are being held back by a fear of HPV, and that being vaccinated would suddenly change behavior.”

One notable exception to the abstinence only refrain of the family-values groups is Focus on the Family. Reginald Finger, a public health physician and the medical issue analyst for the organization , serves on the CDC’s Advisory Committee for Immunization Practices. “If three doses of HPV vaccine is going to produce efficacy over a young-adult lifetime, then [age 12] might be a good time to reach them, just because they’re easier to reach and you can implement a system for doing that with the adolescent visit,” he says. “I do not think that you necessarily need to infer that if you’re giving it to 12 year olds, that 12 year olds are suspected to be at risk right then.” HPV, he notes, can be a long-lasting infection, to the point that it may be a risk even to people who have been abstinent until marriage. “With HPV, you could have a person in their 20s, never sexually active before marriage, marrying someone who has had a sexual history in their teens, who has turned around their lifestyle and had been abstinent for eight years,” he says. “Then all of a sudden, you have a situation where it’s possible HPV could be an issue.”

Both Merck’s Barr and Dartmouth ‘s Harper are optimistic that education may help change the perspectives of some of the more conservative groups. “The key thing is that neither Merck nor any other organization is interested in promoting sexual activity among adolescents, but we are interested in promoting the public health,” says Barr. Although HPV is transmitted sexually, it is as common as any other disease for which people are vaccinated, with approximately 5.5 million cases in the United States every year; the lifetime risk of HPV infection approaches 70 percent.

Ultimately, Barr says, “I think that parents, regardless of their political, religious, or cultural background, want to prevent cancer in their kids.” While that is undoubtedly true, a divide remains about whether vaccination or teaching only abstinence is the best way to do that.

November, 2004|Archive|

DNA content as a prognostic marker of oral lichen planus with a risk of cancer development.

  • 11/30/2004
  • R Mattila, K Alanen, and S Syrjanen
  • Anal Quant Cytol Histol, October 1, 2004; 26(5): 278-84

Objective:
To assess the presence of aneuploidy in oral lichen planus (OLP) and its usefulness as a prognostic marker.

Study Design:
Eighty-one formalin-fixed, paraffin-embedded biopsy samples taken from atrophic-erosive OLP from 70 patients were studied. Approximately 150 random nuclei in basal and/or parabasal epithelia were analyzed with static cytometry.

Results:
Aneuploidy was detected in 41% of samples. OLPs with ulcerations or location in the tongue had significantly higher values, respectively, for the 2.5c exceeding rate (ER) (p<0.001 and 0.001) and proliferation index (PI) (p = 0.012 and 0.013) than did lesions without ulcerations or at other locations. 2.5c ER was significantly higher in dysplastic OLP lesions (p < 0.001), and the significant value (p = 0.001)for 2.5c ER discriminating DNA aneuploidy was 15.3%. In multivariate analysis only the G2/M ER (G2/MER) was a significant independent predictor of developing cancer in OLP (OR 2.349, 95% CI 1.39-3.97, p = 0.001).

Conclusion:
Ulcerated atrophic-erosive OLPs of the tongue and with dysplasia are at increased risk of cancer development. 2.5c ER, PI and G2/MER might be useful in prognosticating the increased risk of malignancy in OLP.

November, 2004|Archive|

YM BioSciences’ TheraCIM Granted US Orphan Drug Status

  • 11/30/2004
  • Mississuaga, Ontario, Canada
  • Press release
  • Yahoo! Finance

YM BioSciences Inc. the cancer drug development company with an advanced-stage portfolio, and its majority-owned subsidiary CIMYM Inc., today announced that the Office of Orphan Products Development of the U.S. Food and Drug Administration (FDA) has granted Orphan Drug Designation to their EGF receptor monoclonal antibody, TheraCIM hR3, for the treatment of glioma (brain cancer).

The U.S. Orphan Drug Act is intended to assist and encourage companies to develop safe and effective therapies for the treatment of rare diseases and disorders. Orphan Drug Designation is granted to products that treat conditions affecting fewer than 200,000 people in the U.S. Orphan Drug Designation provides eligibility for a special seven-year period of market exclusivity at marketing approval, potential tax credits for research, potential grant funding for research and development, the possibility of reduced filing fees for marketing applications and, particularly, assistance with the review of clinical trial protocols.

TheraCIM hR3 is currently undergoing two Phase II trials in Europe and is expected to become a Phase III candidate in early 2005. The Company’s European licensee, Oncoscience AG, is enrolling children in a trial for pediatric brain cancer; and another trial is underway in metastatic pancreatic cancer. Oncoscience also expects to initiate the Phase III trial in adult glioma in early 2005. Orphan Drug Designation for glioma in Europe has already been conferred.

“TheraCIM is currently undergoing a robust clinical program in Europe, which we anticipate will be paralleled by additional North American trials that we propose to initiate in 2005,” said David Allan, Chairman of YM BioSciences. “With Orphan Drug Designation in Europe and now North America, TheraCIM will benefit from regulatory assistance and marketing exclusivity in both territories (10 years in Europe and seven in the USA), ensuring that our efforts to bring this promising new treatment to market are well supported.”

TheraCIM hR3 (nimotuzumab), Theraloc in Europe, is a humanized monoclonal antibody that targets the Epidermal Growth Factor receptor (EGFr). Head and neck cancer Phase II trial results, reported in the Journal of Clinical Oncology, showed that the drug doubles a patient’s response to radiation treatment. TheraCIM with radiation (immunoradiation) appears to be equivalent to aggressive chemo-radiotherapy without the burden to the patient of high toxicity from chemoradiation. It has also demonstrated a superior side-effect profile to functionally equivalent, already approved, EGFr antibody drugs.

YM BioSciences Inc. is a cancer drug development company. Its lead drug, tesmilifene, is a small molecule chemopotentiator (for taxanes and anthracyclines) currently undergoing a pivotal Phase III trial in metastatic breast cancer. Tesmilifene has completed a previous Phase III trial with positive results. In addition to tesmilifene, the Company is developing an EGFr humanized monoclonal antibody that is being tested in glioma and pancreatic cancer in Phase II trials, has completed Phase II trials in head & neck cancer, and is expected to enter a Phase III trial in 2005. A GnRH anti-cancer vaccine is in earlier stage clinical trials.

November, 2004|Archive|

Coverage and quality of oral cancer information in selected popular press: May 1998 to July 2003.

  • 11/30/2004
  • Bethesda, MD
  • JA Graham, AM Horowitz, and MT Canto
  • J Public Health Dent, September 1, 2004; 64(4): 231-6

Objectives:
A 1998 study demonstrated a lack of coverage about oral cancer in the popular press between April 1987 and April 1997. Since that study, several oral cancer-related activities took place, many of which could have increased the media’s attention to oral cancer. Therefore, this study analyzed coverage and quality of oral cancer information in selected popular press between May 1998 and July 2003.

Methods:
Articles from magazines and newspapers were retrieved from three databases and were analyzed by specific topics and subtopics for adequacy of content and accuracy of information. Articles were categorized as either “primarily oral cancer-related” or “primarily tobacco-related.”

Results:
Sixty articles were identified, 39 of which were included in the analysis (14 magazines; 25 newspapers). Seventeen articles were “primarily oral cancer-related,” and 22 were “primarily tobacco-related.” Seventy-two percent of the articles mentioned at least one risk factor for oral cancer, the most common being tobacco use (69%). Far fewer articles noted alcohol (10%) or the combined use of tobacco and alcohol (5%) as risk factors. Only 8 percent of the articles recommended an oral cancer examination.

Conclusion:
Despite local and limited national efforts and activities aimed at increasing public awareness of oral cancer, the popular press coverage of those activities was minimal or nonexistent.

November, 2004|Archive|

Indian-American wins outstanding scientist award.

  • 11/29/2004
  • New York, NY
  • no attribution
  • The Hindu (hinduonnet.com)

Bhimu Patil, Associate Professor at the Texas A&M University-Kingsville and Associate Director of the Vegetable and Fruit Improvement Center, has received the 2004 Outstanding Young Scientist Award from the Division of Agriculture and Food Chemistry.

Dr Patil, who received the award at a ceremony in Philadelphia, has credited his accomplished work in citrus, other fruits and vegetable health benefits research to his father who died 15 years ago.

“My father was diagnosed with cancer when he was already in the third stage,” He told The Valley Morning Star on his return to Texas from Philadelphia. “I could not help him, but through my research I hope to help others. That’s my goal.”

Dr Patil and his eight-member staff are working to isolate compounds found in certain citrus fruits in the Rio Grande Valley, including Rio Red grapefruit, that may help reduce the risk of colon and oral cancer and help lower cholesterol, the Texas newspaper said.

“I was happy to hear the news about the award,” Dr Patil said. “I owe the success to the students who work with me.”

Last year, Patil won the Research Excellence Award from the university. He also has received the Paul Harris Fellowship from the Rotary Foundation in appreciation of “significant assistance for the better understanding and friendly relations among people in the world.”

November, 2004|Archive|

Tougher action needed to stop cigarette sales to children.

  • 11/29/2004
  • Australia
  • no attribution
  • News-Medical.Net

Retailers should be licensed to sell cigarettes, and the licence revoked if they are caught selling tobacco to children, the Australian Medical Association (WA) said today.

“The State Government is relying on heavy fines to deter retailers, but the threat of losing their licence would be a far stronger deterrent,” said AMA (WA) President Dr Paul Skerritt.

“One has to question how effectively we can police the fines system and how often the courts have imposed the maximum penalty in the past.”

Dr Skerritt said banning point-of-sale-advertising, limiting displays of tobacco products and restricting cigarette vending machines to licensed premises were welcome initiatives by the State Government – but they should have been introduced much earlier.

“The measures being announced now by the Health Minister were advocated by the Health Department more than 18 months ago,” said Dr Skerritt.

“The Government refused to act because it did not want to upset the tobacco and liquor industries. On the eve of an election they have promised a raft of reforms which will do nothing to reduce passive smoking for at least another 18 months.”

Dr Skerritt said the AMA (WA) was disappointed that Mr McGinty had attacked the association’s zero-tolerance attitude to passive smoking as “playing politics”.

“We are not prepared to compromise on this issue and we make no apology for putting the health of the community ahead of everyone else’s business interests,” he said.

“Sadly, our members deal directly with the victims of lung cancer, throat cancer, heart disease and all the other smoking-related illnesses.

“They don’t have a lot of sympathy for those who will only take action when the Australian Hotels Association says it is comfortable with the timetable for new regulations to be introduced.

“Many more lives will be lost while we wait for the new rules to take effect.”

November, 2004|Archive|

A poet for the people

  • 11/28/2004
  • Garland, Nebraska
  • John Mark Eberhart
  • Kansas City Star (kansascity.com)

The new U.S. poet laureate, Nebraska’s Ted Kooser, wants to bring verse back to the masses.

Just north of this nondescript village, the pavement ends and the gravel begins. Down one of those gravel roads stands a roomy farmhouse. Built into the wall of one of those rooms is a ladder. At the top of the ladder lies a lair.

A writer’s lair.

One side stands open; one “wall” is slanted ceiling. This is the place the new poet laureate of the United States does his work.

Six years ago there were days Ted Kooser had no need of that lair. He wasn’t writing poetry; he was too busy fighting for his life. He had oral cancer, and it was advanced.

“Tumor of tongue on the back side,” he recalls, “and it had spread into the lymph nodes and upper part of my neck, so I had to have radiation. (But you) keep yourself in the present. (You) wake up and say, ‘You know, I don’t think I’m going to die today. I’m probably not going to die this week. I may not die for months and months, so what am I going to do?’ You can’t just sit around and stare into space.”

Instead Kooser made not one but two books out of cancer.

As he recovered, he began taking two-mile treks each morning and by 2000 had produced Winter Morning Walks: One Hundred Postcards to Jim Harrison, a fellow poet and author of the “Legends of the Fall” novella collection. Braided Creek: A Conversation in Poetry was a 2003 collaboration with Harrison, who had observed that Kooser’s diagnosis had strengthened his writing to the point that it had become “overwhelmingly vivid.”

“I wasn’t a slouch at writing before,” Kooser says of Harrison’s comment. “But there’s a heightening of attention to the world that comes out of this. We all spend an enormous amount of time just worrying about what’s coming next and regretting what’s gone before. Then you get this sort of shock, and you begin to appreciate all kinds of nuances, studying textures, where the light falls on things.”

Now 65, Kooser is cancer-free. His new book, Delights & Shadows, is receiving critical raves. But it’s this U.S. poet laureate gig that has him fired up.

Ted Kooser wants to bring poetry back to the masses.

A mission

The farmhouse Kooser shares with his wife — Lincoln Journal Star editor Kathy Rutledge — has big rooms, clean lines, modern appliances. It was built on the site of a too-small “old bachelor farmhouse,” but the couple kept the original porch.

It’s a chill fall day. With Nebraska’s cornfields shrouded in silver mist, it’s a fine day to be indoors.

Kooser’s dogs, Howard the yellow Lab and Border collie Alice, shamble around the living room, looking for attention — but his eye is on that ladder.

He wants to retrieve a book he’s been talking about. He zips up the rungs with no trace of weakness from his illness.

He’s going to need that kind of energy in 2005.

In early October, Kooser took over as the “Poet Laureate Consultant in Poetry to the Library of Congress.” It’s a flexible job. Kooser’s predecessor, Louise Glück, made it clear she wasn’t going to be as visible as her predecessor, Billy Collins, who had spent his two one-year terms (2001-03) as a roving ambassador for poetry.

Kooser, though, is taking Collins for his model. That means readings around the country, spreading poetry like gospel. And Kooser doesn’t fly — not because he’s afraid, he says, but because he feels intense discomfort on airplanes. He prefers to drive, which means he’ll log thousands of miles next year.

But the longest mile may be persuading America that poetry still matters — that it doesn’t have to be “hard.” He says the education system is partly to blame for that perception. For decades, educators emphasized material such as “The Waste Land,” T.S. Eliot’s poem-as-scholarly-cathedral. Many teachers seemed bent on convincing students that poetic merit equaled vexation.

“One of the things we did wrong for many years (was that the) poem was presented as a problem, like an algebraic equation. And you had to find the one answer to that poem. That would discourage anybody from enjoying poetry in adult life. What kind of pleasure can you take in that?”

In his printed words, Kooser lives by those spoken ones. Most of his poems are short, direct. And he’s not afraid to use humor, as in “The Necktie.” In six lines, Kooser gently tweaks the modern man for the silly practice of fastening silk around his neck as a sort of corporate armor, standing “at the mirror/dressing for work, waving hello/to himself with both hands.”

It helps, too, that Kooser is the first U.S. poet laureate from the Great Plains, as Librarian of Congress James H. Billington noted in making the appointment. He called Kooser “a major poetic voice for rural and small-town America.” You don’t have to be an East Coast academician or an Eliot scholar to relate to him.

And when Kooser talks about bringing poetry to the people, he enthuses about other poets’ work. His is not a vanity trip.

“Joe Hutchison’s a poet in Denver, runs a bookstore out there, not well-known, unfortunately,” Kooser says. “But I use (a poem of his) a lot in talking to people. He has a one-line poem called ‘Artichoke,’ and it goes, ‘O heart weighed down by so many wings.’

“How could you ever look at an artichoke again, in a grocery, without seeing that? That’s the kind of thing you can do for people. They’ll walk through the grocery with a little spark of recognition. (With poetry,) people’s lives all of a sudden are brighter and richer and more interesting.”

Natural avenues

Much of Kooser’s inspiration comes from his rural surroundings. His farmhouse stands on 62 acres. On his walks, Kooser can see deer, coyotes, raccoons, opossums, even a badger now and then — “not that you really want to, especially when you’re out with the dogs, because the dogs are not smart about badgers.”

This open but creature-haunted landscape fuels poems such as “A Winter Morning,” in which Kooser describes the light from a farmhouse window speaking “to the darkness in a small, sure voice.”

“Against this stillness, only a kettle’s whisper,” he writes. “And against the starry cold, one small blue ring of flame.” Human or animal, the denizens of his poems find some sort of unity with their world.

After a lot of sweat and toil, that is, on the part of their creator.

“It’s not unusual for a poem of 12 lines to go through 30, 40 versions before I’m done with it.”

In other words, it’s like ham cubes. Kooser, grinning, explains that grocery stores used to sell ham cubes with the plastic stretched over a gob of cubes piled on a flat piece of Styrofoam. Now they leave the Styrofoam out, and somehow shrink-wrap the plastic very closely over the cubes.

Poetry, he says, should be like that new package: “If you write a sonnet and you’ve got too much grocery-store air in there and not enough ham, it isn’t going to work.”

Or maybe poetry is like the method he uses to trim trees. Kooser doesn’t hunt much anymore; he doesn’t like the noise and has grown tired of killing. But firearms still come in handy: “I use my shotguns now for trimming trees. If I get a limb I can’t reach with a ladder, I go out there with half a box of shells and shoot it off.” Not bad, and it’s a lot like his multiple revisions — if you’re working on a stubborn poem, just keep blasting away at it.

But if Kooser has one disquieting thought about being poet laureate, it is that his duties will take him away from home, hearth and pen. He offers a rueful smile. “I’m not going to get much writing done this year, I’ll tell you that.”

No, he’ll be helping teachers teach poetry and persuading librarians to keep it in mind when making recommendations in the stacks and reading his own verse on his tour stops.

He’ll also try to get poetry back into newsprint. With the exception of this one, The New York Times Book Review on occasion and Washington Post Book World, the nation’s papers have all but abandoned publishing poems.

“Poetry was in newspapers for 150 years before we started taking it out of them, and I think modernism had something to do with that.” In other words, it’s that poetry-as-vexation thing again.

He’s working on a plan he hopes will offer smaller papers around the country a syndicated package of short, clear poems to be used wherever and whenever they have the space.

Humbled by fate

Kooser smiles easily these days, and the eyes behind his glasses gleam when he talks about his life and his work. There’s a contented modesty in his demeanor, not a shred of it false. But then, the last few years have thrown him some humbling situations — starting with the cancer.

“You sit in those oncology waiting rooms, and you may have walked in there as a smart-ass … but (you realize) you and everybody else are complete equals in that situation.”

Not that this man ever was encouraged to put on airs. Born in 1939 in Ames, Iowa, he grew up in the Hawkeye State, went to college there, then went to graduate school in Nebraska. He’s lived there since the 1960s, working most of that time for a couple of insurance companies. All his life, he has been shaped by a middle-class, Midwestern upbringing.

“My dad was the manager of a department store; my mother was a homemaker — pretty traditional, you know. I suppose there are things about my personality that are a result of my upbringing. I was taught not to put myself forward, that sort of thing.

“Matter of fact — and this is very typically Midwestern, I think — the minute I got this phone call about being appointed poet laureate, the first thing I started thinking was of all the reasons it shouldn’t be me. That’s the way we are out here, you know. … I was just completely staggered by it.

“And I’m still surprised. It’s not something I imagined would ever happen to me. But it’s certainly a great honor, and I’m delighted to have it.

“And I’m really throwing myself into trying to do some good with it.”

November, 2004|Archive|

Antioxidant supplementation may reduce risk of cancer in men, not women

  • 11/28/2004
  • no attribution
  • Mediacal News Today

Low-dose antioxidant supplementation may reduce the risk of cancer among men, but not in women, according to an article in the November 22 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, antioxidants including beta carotene, ascorbic acid, vitamin E, selenium, and zinc may prevent some of the harmful effects caused by free radicals – reactive molecules produced by metabolism in the body. It has also been suggested that a low dietary intake of antioxidants increases the incidence of cancer and cardiovascular disease.

Serge Hercberg, M.D., Ph.D., of the Institut National de la Sante et de la Recherche Medicale (INSERM) and Unite de Surveillance et d’Epidemiologie Nutritionnelle, Paris, and colleagues tested the efficacy of dietary supplementation with a combination of antioxidant vitamins and minerals in reducing the incidence of cancer and cardiovascular disease among 13,017 French adults. There were 7,876 women aged 35 to 60 years old, and 5,141 men ages 45 to 60 years old included in the study. Participants were randomly assigned to take either a daily capsule containing 120 milligrams of ascorbic acid, 30 milligrams of vitamin E, six milligrams of beta carotene, 100 micrograms of selenium, and 20 milligrams of zinc; or a placebo capsule. Participants were followed-up for a median of 7.5 years.
The researchers found no differences between the antioxidant and placebo group in terms of cancer incidence (4.1 percent of the antioxidant group vs. 4.5 percent of the placebo group), or in cardiovascular disease incidence (2.1 percent for the antioxidant group vs. 2.1 percent for the placebo group) or all-cause death (1.2 percent for the antioxidant group vs. 1.5 percent for the placebo group).

However, when the researchers looked at cancer incidence according to sex, they found a significant protective effect of the antioxidants in men, who were 31 percent less likely to develop cancer than women. A similar trend was seen in men for death rates.

“After 7.5 years, low-dose antioxidant supplementation lowered total cancer incidence and all-cause mortality in men but not in women. Supplementation may be effective in men only because of their lower baseline status of certain antioxidants, especially of beta carotene,” the researchers write.

The authors conclude: “… our results suggest that an adequate and well-balanced supplementation of antioxidant nutrients, at doses that might be reached with a healthy diet that includes a high consumption of fruits and vegetables, had protective effects against cancer in men.”

November, 2004|Archive|

PET Scan Could Help Cancer Survivors

  • 11/28/2004
  • Chicago, IL
  • no attribution
  • cbs2chicago.com

Follow-up care is extremely important for survivors of head and neck cancer. Blood tests, X-rays, CT scans and MRI’s can spot a recurrence of the disease. Now new findings suggest a PET scan may provide other life-saving information.

Ed Menassaka, 50, had to face the music two years ago when he was diagnosed with head and neck cancer. “It was in the base of my tongue, in my right tonsil, was in my neck and my lymph nodes,” Menassaka said.

After chemotherapy, radiation and surgery, Menassaka is now cancer-free. But he still needs frequent checkups to see if the disease comes back.

“Essentially if you have a cancer that occurs in this area, the most likely area where it’s gonna recur is in this area,” said Suresh Mukherji, a neuroradiologist at the University of Michigan Health System. But even if that area is clear, University of Michigan researchers say, the cancer can recur somewhere else.

“What we found out with our PET study was that unknowingly to anyone else, patients may have done fine here but some of them popped up with disease in their lungs,” Mukherji said.

Unlike other imaging tests, positron emission tomography – or PET – shows metabolic changes in cells.

“With the CAT scan or an MRI, you see basically the anatomy that’s before you. With a PET scan, what it allows you to do, it actually allows you to look inside the molecule,” said Mukherji. Because of the findings, Dr. Mukherji recommends patients at high risk for recurrent cancer have pet scans on a routine basis.

“There is so much reassurance knowing that you’re cancer-free and clearly the PET scan can give you that in a more objective method,” Mukherji said. Just knowing can help patients like Menassaka feel less strung out about the disease.

Head and neck cancers account for three percent of all cancers in the United States. Tobacco and alcohol are considered the major risk factors for the disease.

November, 2004|Archive|