Anchor lead: What can
be done about variable rates of diabetes among different ethnic groups?
Elizabeth Tracey reports

If you’re Hispanic, you have over a one in five chance of
developing diabetes, as is also the case for non-Hispanic blacks, a new study
looking at rates of type 2 diabetes among different ethnicities found. Rita
Kalyani, a diabetes expert at Johns Hopkins, says the study points to some
interventions that might help.

Kalyani: We have well-validated screening tools, risk tests
that have been demonstrated to be effective, but we need to make these
culturally tailored. We need to be able to disseminate them in a cultural
context, that makes sense to people of different races and ethnicities, so they
understand why it’s important to be screened, why it’s important to be treated,
and they can educate other members of their community. That would include
really targeting campaigns to different ethnic diets for instance, and what
parts of those diets, high carbohydrate, high rice, high bread, how they may
impact diabetes risk.  :32

Kalyani notes that one-third to one-half of people in this
study of all ethnicities did not know they had diabetes, putting them at risk
for cardiovascular problems. At Johns Hopkins, I’m Elizabeth Tracey.


Anchor lead: A new
approach to chemotherapy may help people with stomach cancer, Elizabeth Tracey

Many people diagnosed with stomach cancer have advanced
disease at the time of diagnosis, rendering treatment more difficult and
reducing the chances for survival. Now a new approach to chemotherapy may help.
Fabian Johnston, a stomach cancer surgeon and researcher at Johns Hopkins,
describes the intervention.

Johnston: For patients with stage 4 disease that’s spread
throughout the peritoneum or the abdomen, three or four out of ten patients
present like this, what we’re looking to do is called bidirectional therapy. They’re
getting chemotherapy via the IV or port, which is standard, and also in the
abdomen, in the peritoneum, on alternating weeks. What happens is chemotherapy
doesn’t always penetrate very well to those peritoneal linings so by providing the
right chemotherapy to those patients we’re hoping that that will give them
prolonged survival, also give them better quality of life overall.  :31

Johnston says surgery is also needed, and he’s optimistic that
this combined approach will help people with stomach cancer. At Johns Hopkins,
I’m Elizabeth Tracey.


Anchor lead:
Immunotherapy may be used for cancers of the stomach, Elizabeth Tracey reports

Stomach or gastric cancer is often associated with a poor
prognosis, frequently because the disease is advanced at the time of diagnosis.
One drug in the class of immunotherapy drugs is now being used to treat the
disease. That’s according to Katie Bever, an expert in immunology and
gastrointestinal cancers at Johns Hopkins.

Bever: In gastric cancer we have one drug currently which is
approved it’s called pembrolizamab, it’s available to patients with metastatic
disease who either have a tumor that overexpresses PDL1, which is that signal
that we’re blocking or that have a defect in their tumor called mismatch repair
or microsatellite instability. For those patients immunotherapy may be a good option
for treatment. A lot of our research is focused on how to get immunotherapy
into the remainder of patients and how to make it work better.  :32

Bever is hopeful that as more is learned about the genetics
of stomach cancers and new agents are developed more patients will benefit from
immunotherapy. At Johns Hopkins, I’m Elizabeth Tracey.


Anchor lead: A new
type of radiation therapy may now be used to treat cancers of the head and
neck, Elizabeth Tracey reports

Head and neck cancers, also called oropharynx cancers, may
now have a new treatment option with proton therapy. Ana Kiess, a radiation
oncologist at Johns Hopkins, describes the approach.

Keiss: On the radiation side there’s also a new technology,
proton therapy, that is becoming more available nationally that is not
established yet as a standard of care option for oropharynx cancers so we’ll be
starting to treat head and neck cancer patients by protons, which essentially
are a form of radiation that are a particle and actually stop in the tissue
compared to Xx-rays which is our typical type of radiation that passes through
tissues, has the potential for much less toxicity from collateral damage to
normal tissues..  :29

Keiss notes that most cancers of the head and neck in the
United States today are the result of infection with human papilloma virus or
HPV, which makes them more susceptible to treatment. With the advent of proton
therapy for these tumors she expects that long term consequences of treatment
may be minimized and overall survival extended. At Johns Hopkins, I’m Elizabeth


Anchor lead: Can
looking for a virus help spot recurrence of head and neck cancers? Elizabeth Tracey

Human papilloma virus or HPV is the cause of the majority of
head and neck cancers in the US, and renders the cancer much more amenable to
treatment. Carole Fakhry, a head and neck cancer surgeon and researcher at
Johns Hopkins, says now trials are underway to figure out if monitoring for the
virus may be an early indicator that the cancer is making a comeback.

Fakhry: After we’ve cured someone or they’ve been cured
elsewhere during the surveillance phase we are evaluating patients for whether
they have HPV in their blood or in an oral rinse, so it’s very analogous to PSA
and prostate cancer, so that we can understand the disease state of an
individual. And so we’re enrolling patients on a study like that to evaluate
whether or not they have HPV and hopefully detect early recurrence earlier with
the HPV, and along with that they get immunotherapy or a combination immunotherapy
and vaccine.   :30

Fakhry hopes HPV monitoring will give both patients and
clinicians an early warning that intervention is needed, and that therapeutic
vaccines will prove helpful. At Johns Hopkins, I’m Elizabeth Tracey.


Anchor lead: Can less
be more when it comes to treating head and neck cancers? Elizabeth Tracey

Aggressive treatment for cancers of the head and neck can
save lives, and it also produces a host of consequences people must live with. Now
that the majority of these cancers are related to infection with a virus and
are much more treatable, can shorter and less aggressive treatment still work?
Tanguy Seiwart, a head and neck cancer expert at Johns Hopkins, describes the

Siewart: With these older approaches which were developed
largely for tobacco-associated tumors, we cure 90+ percent of these
HPV-positive tumors and the big question is maybe we’re overtreating these
patients by giving too much therapy and these patients have decades of life
ahead of them, maybe we can actually go down on the intensity of the treatment,
still get very good cure rates, and at the same time decrease toxicity. So this
is an approach that is generally called de-escalation or deintensification and
we hope will dramatically improve functional outcomes and long term
toxicity.  :32

Seiwart notes that people are carefully monitored so more
aggressive measures can be used if needed. At Johns Hopkins, I’m Elizabeth


Anchor lead: Sending
a nurse to a person’s home helps manage heart failure, Elizabeth Tracey reports

People with heart failure often contend with complicated
self-care plans and are at high risk for repeated hospitalizations. Now a new
study shows that sending a nurse to the home of a patient with heart failure
improves both quality of life and the need for rehospitalization. Patricia
Davidson, dean of the Johns Hopkins School of Nursing, isn’t surprised.

Davidson: The first randomized controlled trial of
home-based visiting of people with heart failure was published in 1999. The
vast majority did not continue into usual care. I commend those authors for
continuing to demonstrate the evidence. We often hear this term it takes 17
years to get an innovation into usual care. It’s kind of heartbreaking because
if you think of the money that has been wasted, the suffering that has been
incurred because of what could be just a nurse going to the home.  :32

Davidson says such programs are gaining traction, and people
with heart failure should ask about them. At Johns Hopkins, I’m Elizabeth