By Sara Bondell - November 29, 2018
Arthur Kropp calls himself a two-time survivor.
While serving in World War II, the Navy veteran’s fighter plane went down during the Battle of Leyte Gulf, one of the fiercest battles of the war. He and two others were listed as missing in action and survived on a life raft until they were rescued several days later.
And now he is a cancer survivor.
Kropp was diagnosed with pancreatic cancer at 91. Every doctor refused to take him on as a patient because of his age — all but one.
Pamela Hodul, MD, who Kropp affectionately calls “my gal,” told him age is just a number and performed his surgery. After all, Kropp was determined to outlive his mother who passed at age 104.
The man who spent an entire military career relying on other men had his life saved this time by a woman. And he couldn’t be prouder.
According to the American Cancer Society, about 55,440 people will be diagnosed with pancreatic cancer in 2018. Only about 11,000 are expected to survive, giving pancreatic cancer the lowest five-year survival rate of any cancer. It’s not clear what causes pancreatic cancer in most cases and it is hard to diagnose in early stages.
Only about 20 percent of pancreatic cancer patients are eligible for surgery at the time of diagnosis because most patients have advanced cases. Moffitt Cancer Center is one of the highest volume centers in the United States treating the disease, performing about 100 surgeries annually.
If surgery isn’t an option, a patient can be treated with chemotherapy, radiation or a combination thereof. Chemotherapy can be challenging with many side effects and patients may require more attention and follow-up appointments than those fighting other types of cancer. For medical oncologists
Rutika Mehta, MD, and Estrella Carballido, MD, a successful treatment plan relies on collaboration.
“We have a great multidisciplinary approach at Moffitt,” says Carballido. “All of the different aspects of treatment can be overwhelming for patients, so we work together to meet all their needs, from nutrition to pain management, at once.”
Moffitt has a top-notch team fighting pancreatic cancer, and women are at the helm. The Gastrointestinal Oncology Clinic boasts eight female researchers and physicians who focus on the disease. As of this publication, this clinic is the only one at Moffitt that has a woman playing a lead role in every aspect of care: research, pathology, medical oncology, radiation oncology, surgery and supportive services.
“Pancreatic cancer is nonbiased and affects young and old, women and men, and wealthy and poor alike,” says Hodul, who performs about 50 pancreatic surgeries a year. “So it’s by chance we all happen to be female sharing the same passion for the prevention, treatment and cure of pancreatic cancer.”
Even though it’s by chance, it is rare. Hodul says she’s proud to be working alongside other extraordinary women in a field that is often dominated by men.
“There is equal intelligence and capability between men and women, but I think that compassion and empathy are stronger in women,” she reasons. “At my clinic, it’s hugs, kisses, tears and laughter. We are just free to express our emotions more and I think the patients are more comfortable doing that with women.”
Bench to Bedside
Currently, there are no biomarkers to help accurately detect pancreatic cancer at an early, operable stage. Moffitt researchers Karen Mann, PhD, and Jennifer Permuth, PhD, are working to solve the early detection riddle that is critical to improving patient outcomes.
Permuth started her career in genetic counseling, but after meeting countless patients and families affected by pancreatic cancer, she pursued a career in epidemiology so she could develop formal training to design and conduct robust studies to help those affected by or at risk for the disease.
As a founder of the Florida Pancreas Collaborative, a statewide partnership that aims to advance pancreatic cancer research, Permuth is focused on developing a combination of minimally invasive approaches that can accurately detect pancreatic cancer as early as possible. This includes studying incidentally detected pancreatic cysts that can develop into
pancreatic cancer. It’s a topic that is close to her heart because her father was diagnosed with a premalignant pancreatic cyst in 2009 and was successfully treated at Moffitt.
Permuth hopes to be part of the team that can develop a test to help differentiate cysts that should be removed from those that can be safely monitored.
Permuth is also studying racial and ethnic disparities that have been reported for pancreatic cancer. She was recently awarded more than $1 million in grants to tackle this understudied and important area.
Mann was recently awarded a $200,000 grant from the Pancreatic Cancer Action Network to study pancreatic ductal adenocarcinoma, a highly metastatic disease with poor patient outcomes. The study focuses on RNA, a nucleic acid found in all living cells, and if RNA splicing, a process that edits the RNA to alter the message that will be made into a protein, can play a role in disease development.
For both researchers, translation is key. While working in their labs or at their desks, they always have the bedside in mind and how their research will directly benefit patients. They also both participate in the Pancreatic Work Group, a collaboration of researchers, oncologists, pathologists and personalized medicine specialists who meet every other week to discuss challenges and advancements.
“My goal is to see pancreatic cancer off the map in the future,” says Permuth. “I don’t want to see anyone dying from it or families worried about developing it.”
Mentoring the Future
When Jessica Frakes, MD, was a radiation oncology resident at Moffitt, she had trouble deciding what specialty to go into because she “liked everything.” But it was gastrointestinal oncology that ultimately won her over.
“I think one of the things that drew me to GI was the mentorship that I had, the people who were involved in treating patients,” says Frakes.
That includes Sarah Hoffe, MD, the section head of GI Radiation Oncology at Moffitt. Frakes says she was drawn to Hoffe’s excitement, enthusiasm and creativity when it came to dealing with the challenges of GI cancer, including radiation of the pancreas. It’s a difficult task since the pancreas sits next to multiple sensitive organs like the stomach and small bowel. Radiation oncologists have to find ways to maximize control of the tumor while minimizing the toxicity to the surrounding organs. The team at Moffitt does that with high-dose radiation called stereotactic body radiation therapy. A collaboration with pathologist Barbara Centeno, MD, revealed up to 10 percent of patients can have a complete or improved response to treatment when this radiation is given prior to surgery.
Now three years into her career at Moffitt, Frakes says she has recognized an increase in medical students and residents coming to her for advice. “I hope I can be as successful as a mentor as Dr. Hoffe has been,” she says. “Cancer in general is changing rapidly and we are learning so much each year. I think having a mentor there to help you sort through the information is the guidance you need early in your career.”
Mentorship and collaboration are the groundwork the women are laying when it comes to pancreatic cancer. While they all work individually in their field, they are also working together in a multidisciplinary setting. Even though they may not see changes in the disease during their lifetime, they know they are blazing the trail for others — regardless of gender — to continue to fight for the cure.
They also hope to continue to see changes in the health care landscape. For the first time in history, women outnumbered men in medical school in 2017, according to the Association of American Medical Colleges. At Moffitt, both Hodul and Hoffe have been recipients of the prestigious Dr. Charles C. Williams Physician of the Year Award.
Saving the Future
Kropp may not be on active duty anymore, but he’s still in a fight of sorts. He’s helping other patients battle their fears when it comes to pancreatic cancer treatment.
Hodul once asked him to contact a patient who wasn’t sure if he wanted to go through with surgery. Kropp says he was happy to be the reassuring voice on the other end of the line, telling the truth about his gal: “If anyone can help him, she’s the only one.”