Cancer Currents for February 2013

News and Notes from the Director
Photo: Mark Israel, Director of Norris Cotton Cancer Center

Contemporary cancer treatment in its many forms is complicated and all cancer professionals wage an important effort to stay current. At Norris Cotton Cancer Center we focus on two key ways for cancer professionals to be at the forefront of our field – continual education and teamwork.

At our Cancer Center, Grand Rounds is an educational pillar. During the presentation each week, we come together to learn from colleagues and our distinguished visitors. The audience ranges from our students to our most senior colleagues. Connections forged by taking that time together to ponder new ideas and be swept up by the enthusiasm of an energetic presenter last long after we leave the room.

Think of Grand Rounds as an intellectual gift – give yourself the gift of an hour to connect with colleagues and learn something new about an aspect of cancer. And if you can't be there, join the online crowd watching from the White River VA, our clinic in St. Johnsbury, and others places throughout the world where cancer professionals are learning from Grand Rounds. Last month, I connected from Germany and heard Sue Tanski's lively and informative talk on secondhand smoke. As a pediatrician, she meets frequently with young patients who smell like the smoke from adults' cigarettes. Watch her presentation, "Eliminating Exposure to Secondhand Smoke: Helping smokers protect their loved ones from a prevalent cancer risk," to understand from Sue more about how we can all influence adults to change their smoking behavior, particularly around children.

Our 14 tumor boards are the essence of teamwork in academic medicine. They constitute a significant differential when we compare NCCC to other oncology providers. A fully equipped team of experts ranging from a social worker to a pathologist and all the oncologists in between gathers to pool their knowledge about how to treat people with the most challenging cancers. Humility and an abiding commitment to do the very best for each patient are hallmarks of our tumor boards. Although Dartmouth medicine is at the top of national and international standards, there are still times when the tumor board seeks another opinion and puts a call in to a world expert on a very particular situation. And there are many times each month when doctors from around the U.S. call us for ideas, suggestions, and clarifications. We respond quickly and generously, offering all the benefits of our knowledge to help their patients. This is the ultimate in teamwork.

I hope you'll join me at Grand Rounds. The programs are Tuesdays from noon to 1 p.m. in Rubin Auditorium E. A light lunch is provided and all are welcome. Here are some of the upcoming speakers.

One-Stop Site for Information on Sustainable Health System
A resource page has been created to collect information related to the D-H strategic campaign to create a sustainable health system. The collections includes documents, PowerPoint's, presentations, and videos like "What is a Sustainable Health System?" which collects the thoughts of Dartmouth employees and physicians.

Ongoing updates are added to the site: (DH private network).

Toteson, Ernstoff, Meehan Receive Academic Appointments

Anna N.A. Toteson, ScD has been appointed to the James J. Carroll Chair of Oncology at Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth. She is Professor of Medicine, Community and Family Medicine at the Dartmouth Institute (TDI) and co-director of NCCC Cancer Control program.

MD Ernstoff Marc

Marc Ernstoff, MD, has been appointed the O. Ross McIntyre Chair of Oncology at Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth. He is the associate director for Clinical Research at the Cancer Center.

MD Meehan Kenneth

Kenneth R. Meehan, MD, has been appointed the fourth Steven B. Currier Clinical Oncology Scholar. The award facilitates and nurtures innovative and potentially translational science of outstanding research leaders at the Norris Cotton Cancer Center. He is the director of the Blood & Marrow Transplantation Program.

New NCCC Staff

Benjamin Markes Wilson, MBA, has joined the Cancer Center team as Practice Manager. He comes to NCCC from D-H Finance, and he brings expertise in grants and contracts development, market analysis, strategic planning, and broad experience with databases, report writing, spreadsheet modeling, and analysis. Markes received his BA from Cedarville University of Ohio, as well as his MBA from the University of Notre Dame.

Joshua Hickman, MHA will join the NCCC as Hematology/BMT practice manager on March 18, 2013. In this role he will work collaboratively with the section chiefs/medical directors/program directors and NCCC practice managers/directors in providing management support for the planning and day-to-day operations of the NCCC clinical sections. He will work with the NCCC leadership team to develop and implement tracking mechanisms related to performance metrics for NCCC clinical practices. Hickman received his BA from the Indiana University and his Masters in Health Administration from Ohio University and comes to NCCC from a practice manager position in Richmond, Indiana.

Cory Howath, RN, OCN has joined NCCC as Clinical Informatics Specialist. He will serve as the clinical documentation system resource for the Cancer Center, providing education and training for all clinical care providers. An Oncology Certified Nurse (OCN) with five years of inpatient and outpatient oncology nursing experience, he is an active Oncology Nursing Society (ONS) national member and President Elect of the ONS NH/VT chapter. He comes from the Hematology/Oncology Infusion Suite, where as a staff nurse he represented nursing as part of the Beacon design and implementation team.

The NCCC communications team has two new members:

Web Producer Garrett Allen administers the NCCC web site, intranet, e-newsletters, multimedia, and social media. He brings ten years' experience as a web developer in content management systems, and most recently worked at the Student Conservation Association where he was web developer/online media manager for six years. He received a B.S. in Electronic Arts from Rensselaer Polytechnic Institute.

Communications Coordinator Robin Dutcher has coordinated news coverage, produced publications, and written for a range of media (print, web, social media) in communications positions at Keene State College, Vermont Law School, and the Community College of Vermont. Prior to this, she worked as an editor and as a correspondent for the Valley News, Rutland Herald, The Herald of Randolph, and Vermont Business Magazine. She has an MFA in Writing from Norwich University, and a BS in English from Vermont College.

SICC Season: Flu Transmission Reduction Efforts in Place

Hand washing flu

Dartmouth-Hitchcock remains in "SICC season:" Significant Influenza Circulation in the Community. SICC Season calls for heightened attention to routine strategies as well as implementation of extra measures to help prevent the spread of respiratory infections to our patients and each other. All personnel should be familiar with and adhere to the following measures to reduce the risk of transmitting flu or other respiratory infections:

  • If you have a flu vaccine exemption, you must wear a mask whenever you enter an occupied patient room or come within 3 feet of a patient.
  • If you have direct contact with patients, you must use droplet precautions whenever caring for a patient who is being treated for a potentially contagious respiratory illness, regardless of your flu vaccine status.
  • All D-H personnel regardless of flu vaccine status should monitor for flu-like symptoms and stay home if you have a fever (temperature greater than 100 degrees). If you develop flu-like symptoms with fever and have worked within 3 feet of patients or other personnel when you had symptoms or during the 24 hours prior to symptom onset, please contact Occupational Medicine to determine if you need to be tested for flu.
  • If you have a cough but no fever, wear a mask whenever within 3 feet of patients or other personnel, regardless of your flu vaccine status.
  • As always, clean your hands before and after contact with patients and their immediate environment, and during patient care, when hands become contaminated.

For the latest flu information, including an overview of flu symptoms, please visit the flu program site.

Mini Room opens in the Infusion Suite

The new "mini" procedure room, located in the Infusion Suite, opened on January 28, 2013. The mini room has two patient exam tables (with curtains to allow for patient privacy as needed) for increased capacity and less overflow into the infusion chairs.

Ice Chimes Sculpture Creates Winter Music

Ice Chimes Dartmouth

"Ice chimes," a 20-foot tall sculpture recently installed outside the class of1978 Life sciences Center, creates music from collected ice and snow.

The sculpture is constructed of heavy timbers that are bolted together, and has a perforated canopy on top to collect precipitation. Heating coils melt the collected snow and freezing rain, which then drips down through a grid of holes to form icicles on suspended metal rods. As the rods sway in the wind, clinking and chiming, the icicles break off and fall into the metal collection bucket below, which amplifies the sound and causes reverberations.

Created by 1983 Dartmouth graduate Keith Moskow and Robert Linn, of Boston's Moskow Linn Architects, "Ice chimes" was designed for the Rose Kennedy Greenway in Boston, where it was installed last winter. It is on loan to Dartmouth for this winter. For more photos and information visit the Ice Chimes website

Keep your Computer Secure: Update JAVA

A recent vulnerability for current versions of Java Runtime Engine (JRE) has been widely reported. Oracle has fully patched this issue but it remains up to end users to apply this patch. This vulnerability is critical and should be patched right away. Please take a couple of minutes to do so. No reboot is required and you normally won't have to close any programs.

  • Dartmouth users
  • DHMC users: Please visit at your earliest convenience. Once there click the large button to download Java. Once the download is complete, double-click it to run the installer. Make sure that you UNCHECK the option to install the toolbar.
Events to Note for Your Calendar

Get ready to Prouty! 2013 Registration Is Open

This year's Prouty will take place on July 12 and 13. All the details for this bike, walk, row and golf (new this year!) event:

Design the 2013 Prouty T-shirt

Attention Dartmouth faculty, staff, students: Submit T-shirt art for the 2013 Annual Prouty T-shirt Design contest by February 15, 2013—your design could be worn by more than 6,000 people on July 13! Submission details.

Dartmouth Employee ArtWorks submissions due February 11

Dartmouth College's annual employee art show, ArtWorks, will be held on March 21, 2013. The deadline for submissions in February 11, 2013. For information contact (guidelines, FAQ's, and submission forms)

Prostate Cancer Ski Challenge February 21

The NH Prostate Cancer Coalition's 4th Annual Ski challenge will be held at McIntyre Ski Area, Manchester, N.H., on Thursday, February 21, 2012, from 6 to 9:30 p.m.

In addition to the Ski Challenge race, events will include the Mayor's Tube Race, with Manchester Police and Firefighters competing against each other, and the public, for the coveted Mayor's Trophy, open tubing and skiing for all, free food for racers, prizes, a 50/50 raffle and the Charlie Sherman Auction at 8:30 p.m. Auction items will include a basketball signed by long time Celtic's player, coach and announcer, Tommy Heinsohn, a stay at a Loon Mountain ski condo, Red Sox tickets, a golf arcade game and dozens of other valuable items.

For friends, family and non-racers, the general admission fee is $35 for adults, $99 for a family, $20 for students and no there is charge for children aged 6 and under to enjoy tubing, food and soft drinks.

American Cancer Society Daffodil Days (order by March 1)

It is time for Daffodil Days again with the American Cancer Society (ACS). All staff and volunteers are encouraged to pre-order their daffodils online.

Orders must be placed no later than Thursday, March 1, and will be available for pick-up during the week of March 18. You can order daffodils as cut stems, potted bulbs, or with a gift bear. And did you know you can send an anonymous gift to a patient? If you have any questions, please contact Cyndy Benoit:, 650.7751.

Fresh Veggie 2013 Information Sessions

Local farms will hold information sessions for DHMC staff interested in purchasing fresh produce at the Lebanon DHMC campus. Cedar Hill Circle Farm (Thetford), Blue Ox Farm (Enfield), Cedar Mountain Farm (Hartland) and Autumn Harvest Farm (Grafton) will be offering produce for sale on Tuesdays and Fridays during the 2013 growing season. Stop by the North Stairway Atrium (above the main cafeteria) from 11 a.m. to 1 p.m. on February 6, February 21, March 5, and March 20 for information.

Pilot Awards Announced

Norris Cotton Cancer Center has announced ten 2012 Cancer Center Developmental Fund Awards totaling $510,000. Funds were provided by The Friends of Norris Cotton Cancer Center, through its annual signature event, The Prouty, and from a generous gift from the Hopeman Foundation. The purpose of developmental funds is to support preliminary studies that demonstrate novel approaches and provide preliminary data necessary for planned grant applications. In this way, money raised locally helps leverage support from outside the area—at a national or even international level.

In 2012, awards were selected based on their perceived ability to generate research that has the potential to be translated rapidly into clinical care or community implementation. Investigators must be a current member of the Norris Cotton Cancer Center.

Cancer Site

Study Title



Lead Investigators

Grant Type/


Identification of accessible biomarkers of bladder cancer treatment response, recurrence, and progression

Through studies of tumors, blood, and urine, researchers will identify biomarkers that can predict which bladder cancer patients are most likely to progress or recur

A comprehensive panel of molecular markers and epidemiologic factors could help define which patients respond to various treatments.

Marsit (PI), Schned, Seigne

Hopeman Population Science



Inducible proteasome subunit AIRAP and its potential role in myeloma resistance to bortezomib

Despite a 90% initial response rate of bortezomib-containing regimens, all patients are expected to become resistant. This study will determine if bortezomib-induced AIRAP contributes to resistance.

Understanding resistance to drugs, and developing approaches to overcome them, is of utmost clinical significance.

Kisselev (PI)

Prouty Pilot



Developing a novel nano-fabricated system for in vivo delivery of anti-microRNA therapy against glioblastomas

To explore findings demonstrating the ablation of established tumors and preventing recurrence by developing a novel, nano-fabricated, regulatable and targeted delivery system for anti-mir-10b therapy.

Researchers hope to overturn the dismal prognosis for gioblastomas, which are extremely aggressive, incurable brain tumors.

Gaur (PI) Fadul, Gimi

Prouty Pilot



Molecular profiling to identify targeted therapeutics for patients with advanced breast cancer

This study will determine whether the mutational profile of circulating tumor DNA in plasma is representative of the profiles of multiple tumors within a patient, to determine whether plasma DNA could be used as a surrogate for tumor biopsy.

This study will lay the groundwork for future studies into the feasibility of using DNA sequencing to identify tumor mutations that then dictate treatment with a corresponding targeted therapy.

Miller (PI), Chamberlin

Hopeman Clinical Research Award



Imaging surface dose in post lumpectomy breast irradiation

We will utilize a recently discovered method to image the surface skin dose of radiation treatment, using a specially designed camera, which can capture the radiation emission as blue light coming from the tissue.

This would be the first time that imaging of surface dose became practically possible in routine patient use.

Jarvis (PI) Gladstone, Pogue

Hopeman Clinical Research Award


Head and neck

Interferon-Alpha 2b for the treatment of ocular surface squamous neoplasia

We will develop a quantitative modeling framework to compare use of interferon alpha 2B versus surgical management in the treatment of ocular surface squamous neoplasia (OSSN),

This is an area of ophthalmology in which changes in clinical practice patterns have outrun the supporting data. The systematic synthesis and modeling of the existing evidence in the literature will be a valuable scientific contribution.

Zegans (PI) T. Tosteson

Comparative Effectiveness Research



Multimodal imaging for enhanced partial nephrectomy guidance

To develop an enhanced intra-operative, multi-modal image guidance platform for use in identifying surgical margins during robot-assisted kidney surgery.

MRI/CT scans will be merged on to an intraoperative surgery screen to allow surgeons to more precisely remove only damaged tissue from the kidney and preserve healthy tissue during surgery

Halter (PI), Seigne, Hartov

Prouty Pilot



A comparative transciptome approach to elucidate drivers of carcinogenesis in ovarian cancer subtypes

Recent findings identified four high grade serious subtypes of gene sets in ovarian cancer in Caucasian populations. This study will explore whether these four subtypes can be found in Ugandan women.

Exploring gene set sub-types in African women, because existing studies have been performed almost exclusively on women of European descent.

Doherty (PI), Tafe, Amos, Greene, Moore, Williams

Prouty Pilot



Patient-derived xenografts as tools for drug discovery and individualized therapy for pancreatic cancer

Scientists will use samples of patients' pancreas tumor cells to create "model" tumors in the lab to test which cellular signaling pathways in the body might be receptive to drug treatments.

Drugs that block signaling pathways may help block cancer cell growth and kill cancer cells.

K. Smith (PI), Sanchez, Gardner, Gordon, Suriawinata, Pipas

Prouty Pilot


Solid Tumor

Discovery of peptides as molecular therapeutics targeting the immune checkpoint protein VISTA

To develop peptides (e.g., fluorescently labeled, site- specific mutant controls) as molecular therapeutic agents for the recently discovered immune checkpoint protein VISTA.

Blockage of VISTA has been shown to enhance the body's ability to fight or suppress tumor growth.

Spaller (PI), Wang

Prouty Pilot