Jefferson Investigates: Colon Cancer, Health Disparities and Burnout

Searching for Colorectal Cancer’s Off Switch

Colorectal cancer is the third leading cause of death in men and women in the US, and second leading cause of death when men and women are combined. The disease is also on the rise in younger adults. As researchers search for better treatment options, one puzzling observation has led Jefferson researchers down a surprising path in cancer research. They observed that the vast majority of colorectal tumors lose the ability to make the hormone guanylin. While other cancers, like breast and prostate cancers, grow more in the presence of hormones like estrogen and testosterone, no other cancer has been found to grow more when a hormone shuts off

Dr. Scott Waldman and his graduate students, Jeffrey Rappaport and Ariana Entezari, have been investigating how this hormone functions in cancer. The trigger for guanylin’s shut-off has puzzled researchers for years, but in a recent study, the group found the piece of DNA that acts as an on/off switch for guanylin in cancer. They realized they could genetically revert that shut-off and restore the production of guanylin in colon cancer cells in the lab. The tool they used to flip the DNA switch in cancer cells, CRISPR/Cas9, is currently being developed as a therapy for other diseases, and could one day be tested for colorectal cancer, if further studies prove promising. In addition, the researchers currently have a clinical trial open to test how Linaclotide, an FDA-approved drug similar to guanylin, works in patients with colorectal cancer (ClinicalTrials.gov No. NCT03796884). Find out more about Jefferson clinical trials.
–By Edyta Zielinska

How COVID-19 Impacts the Wellbeing of Primary Care Teams

The COVID-19 pandemic has indelibly impacted frontline healthcare workers who are experiencing higher than ever levels of burnout, both physical and mental. Primary care doctors, often a patient’s first touchpoint into a healthcare system, experienced immense strain as they addressed COVID-19 and other concerns. Jefferson researchers led by Dr. Erin Kelly, interviewed 33 staff members from eight practices within the Jefferson Health system to gauge the main pandemic-related challenges and understand how to better support the wellbeing of staff. Participants said that they had to adapt to almost every aspect of care delivery, from patient scheduling and switching to telemedicine to adhering to new and increasing safety protocols.

During the first six months of the pandemic, while participants felt these increased demands, they also built team camaraderie and new skills, and few experienced feelings of burnout. Their stress was offset by support within their practices and consistent availability of protective equipment and testing. But this has not been the case nationally, where many systems have struggled to obtain PPE and experienced much higher infection rates and staff shortages. As the pandemic continues to strain healthcare workers, this study underscores the main concerns about safety and wellbeing, and how clinical leaders can try to prevent further burnout.
–By Karuna Meda

Racial Disparities Persist in Surgery for Lung Cancer

Research has shown that Black patients are less likely than white patients to receive surgery, which is the most effective form of therapy for early-stage lung cancer. Over the past few decades that difference has decreased on average, nationally. However, recent work, by Olugbenga Okusanya, MD, and colleagues shows that a closer look at the data reveals important trends that could help narrow that difference further. Their study revealed increasing disparities when hospitals were parsed by geography and the volume of patients treated.

Looking at a national cancer database, the researchers analyzed over 315,000 lung-cancer patients between the years of 2006 and 2016, 91.2% of whom were white, and 8.8% of whom were Black. They investigated the rates of surgery by race, geographic location and hospital type (community cancer program, comprehensive cancer center or academic research program). The researchers showed that when hospitals were separated out, facilities in New England, West North Central, and Pacific regions, and those institutions who treated the lowest numbers of patients, had persistent or increasing levels of disparity in the utilization of surgery for Black patients.
–By Edyta Zielinska