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The
Ohio State University |
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The
Ohio State University |
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Division of Gynecologic Oncology
Director
Jeffrey M. Fowler, M.D.
Regular Faculty
Larry J. Copeland, M.D.
Lynne A. Eaton, M.D.
David E. Cohn, M.D.
David O'Malley, M.D.
Joint Faculty
Barbara L. Andersen, Ph.D. (Psychology)
Robert O’Toole, M.D. (Surgical Pathology)
Fellows
Deborah Richardson, MD
Leigh Seamon. MD
Kimberly Resnick, MD
Office Manager, Data Manager & Patient Care Coordinator
Linda P. Havenar, CCRP
Assistant to Office Manager & Special Project Coordinator
Michele Vaughan
Data Coordinator
Rene Kistner
Nursing Research Coordinator
Bobbi Cobb, R.N.
Nursing Staff
Jodi Catanzarite, R.N.
Lois Dial, R.N.
Sheryl Freese, R.N.
Kristi Frenken, R.N.
Anabella Marshall, R.N.
Kori Payne, R.N.
Pamela Penzone, L.P.N.
PCRM
Terese Neff, L.S.W.
Shannon Thompson, R.N.
Patient Care Assistants
Carrie Castro
Jan Testa
Melody Shields
Stephanie Washington
Administrative Secretaries
Sally Bourne
Beverly Cochran
Account Representatives
Sheila Taylor
Jennifer Schmeisser
Carolyn Quinn
The Division of Gynecologic Oncology, in collaboration with the Arthur G. James
Cancer Hospital and Research Institute, continues to provide patients with the
highest level of gynecologic cancer care in an atmosphere which includes
teaching and research found only at top academic institutions. Established in
1990, the James continues to foster excellent care of the cancer patient. Our
Division is proud to be part of such a caring and productive institution. We are
also proud to announce the many accomplishments of our Division outlined below:
In partnership with Walter Reed Army Medical Center, the Division of Gynecologic
Oncology at the James Cancer Hospital was awarded $4.2 million beginning in
June, 2004, through June, 2007. The purpose of this program is to study
epidemiologic, psychosocial and biologic factors in women diagnosed with
gynecologic malignancies, emphasizing health care disparities. This program will
incorporate a sophisticated tissue/serum bank, psychological interventions, and
novel biologic therapy modalities. Principal Investigator is Dr. Jeffrey Fowler,
who will direct projects with multiple disciplines within the Comprehensive
Cancer Center.
During 2005-2006, Dr. Larry Copeland served as President Elect I of the Society
of Gynecologic Oncologists (SGO), and served as Vice Chair (Vice President) and
Treasurer of the Gynecologic Oncology Group (GOG). In addition, Dr. Copeland
serves as a Director of the American Board of Obstetrics and Gynecology.
Dr. Fowler was named Program Director for SGO, 2006. In addition, he completed a
rotation on the Executive Committee of the Gynecologic Oncology Group and is on
the Phase I in Developmental Therapeutics Committee. Dr. Fowler serves on the
Board of Governors of the American College of Surgeons. He is Chief of
Staff-Elect at the James. Dr. David Cohn serves on the Corpus Committee; Dr.
Lynne Eaton is on the Gyn Management Committee; and Dr. David O’Malley is a
member of the Developmental Therapeutics Committee of the GOG.
Our nurses are active in the GOG. Jodi Catanzarite serves on the Quality of Life
Committee, and Roberta Cobb serves on the Nursing Committee. Linda Havenar, our
Patient Care Coordinator, is active in the Data Management Committee of the GOG
and is instrumental in constructing data management around the country. The
Columbus Cancer Council, of which we are a part, is second in accrual in the GOG,
emphasizing clinical trials.
Since 1998, the clinical program of the Division has grown by 40-50% (new
patient visits and major surgeries). During 2005-2006, the Gynecologic Oncology
office staff consisted of six RN’s, one LPN, one office manager, three patient
care coordinators, one academic secretary, four account coordinators, and two
PCRM’s.
We have instituted a research section for pharmaceutical studies, which includes
Michelle Vaughan, program coordinator, and Lois Dial, R.N., research nurse.
Academically, our program has grown due to collaboration with basic scientists
at the James. Dr. Cohn has committed a portion of his time to translational
research developing a VEGF vaccine with Dr. Pravin Kaumaya. Dr. Fowler is a
co-investigator on an NIH-funded grant with Tim Huang, Ph.D., the research
initiative being investigation of epigenetic phenomena in ovarian cancer to
assess prognosis, chemo resistance, and early diagnosis.
Teaching
Medical students spend valuable time on the Gynecologic Oncology Service at the
James. Third year medical students are on the service for a two-week period and
receive four hours of didactic lectures on the prevention, diagnosis, and
treatment of pre-malignant and malignant gynecologic tumors. An integral part of
their training includes direct patient care involvement and instruction on the
in-patient unit, the out-patient clinic, and in the operating room. Patient care
seminars and Tumor Board Conference are valuable educational experiences for all
students on our service. Fourth year students are offered a one-month elective,
during which time they are provided teaching and patient care responsibilities
similar to those of the junior housestaff.
Over the past few years, the Gynecologic Oncology Division has participated in a
senior elective in the DOC 3 (Differentiation of Care) Program with emphasis on
how acute and chronic medical problems impact the psychosocial aspects of both
the patient and her family. The students taking the DOC3 elective are introduced
to a number of patients with a diagnosis of ovarian cancer and at various stages
of their disease management. Overall, the students obtain a unique perspective
of how a serious life-threatening disease process impacts not only the patient
but also her family and friends. Many of the students conduct home visits and
interviews in an attempt to gain a full appreciation of the psychosocial aspects
of the medical problem.
First, third and fourth year residents in our department rotate through the
Gynecologic Oncology Service yearly. Responsibilities are based on level of
training, with the first year resident focusing on outpatient, preoperative and
postoperative care, in addition to participating in minor operative procedures.
Third and fourth year residents are given the additional responsibilities of
preparing Tumor Board presentations, presenting at Quality Assurance
conferences, and participating in radical pelvic surgeries.
Much to the credit of our gyn onc faculty, since 1998, six residents have been
placed in gynecologic oncology fellowship programs, including the University of
Texas, M D Anderson, and UCLA.
Our faculty also lecture to the medical oncology fellows on gyn cancer topics in
their didactic series. In addition to our residents and fellows, the medical
oncology fellows spend a one-month rotation on our service learning evaluation,
diagnosis, management, counseling and treatment of gynecologic malignancies.
Faculty members in our division gave many local, regional, national and
international presentations at scientific meetings, grand rounds, and
postgraduate courses.
Dr. Susan Valmadre, from the Royal Hospital for Women in Sydney, Australia,
joined us as an international fellow in July, 2005. While at Ohio State, Dr.
Valmadre participated in a number of peer-review submissions. In July, 2006, Dr.
Valmadre returned to Sydney and joined the University of New South Wales as an
attending gyn oncologist.
An American Board of Obstetrics and Gynecology (ABOG) approved fewllowship of
three years was instituted in 2005, with fellows participating in one year of
research and two years of clinical medicine.
During 2005-2006, Drs. Copeland and Fowler were named in the publication “Best
Doctors in America.”
Patient Care
The Division continues to enhance patient care through service at the James
Cancer Hospital and the Camelot Women’s Cancer Center. While members of the
Division are nationally recognized in multiple arenas, including research and
education, the foundation of our program is comprehensive, compassionate, and
state-of-the-art care for women diagnosed with gynecologic malignancies.
The Division of Gynecologic Oncology, in collaboration with the JamesCare for
Life Program, created patient education notebooks for surgery and chemotherapy.
All patients seen in the Division of Gynecologic Oncology receive a personalized
educational notebook during their initial visit to our office. Each notebook is
personalized to describe the patient’s diagnosis and their prescribed therapy.
In order to facilitate patient referral and enhance education prior to the
patient’s first visit with us, folders are distributed to target referring
physicians’ offices in Ohio and West Virginia. These folders provide information
describing our physicians and medical staff, which can be given to patients when
they are at the referring physician’s office. This information is also available
on our website. Once a patient has been referred to our office, the referring
physician’s office can provide the patient with educational materials about the
patient’s cancer diagnosis, “What to Expect,” on their first visit to our
office, and biographical information on each physician. This information has
been very much appreciated by our referring physicians’ offices.
Outpatient services at Camelot Women’s Cancer Center provide easy access and
personalized care in a comfortable setting every weekday. Services included are
new and follow-up visits, chemotherapy administration, and support groups. A
portion of Camelot is also dedicated to the Gynecologic Cancer Center program.
This includes space for epidemiologic and psychosocial researchers, a conference
room, and space for our research nurses.
The support group “Patient to Patient” consists of gyn oncology patients who
have received chemotherapy from our physicians. They volunteer to help newly
diagnosed patients and answer any questions prior to initiation of chemotherapy.
The volunteers also offer to assist patients at any point during their
treatment. We currently have 12 volunteers in this group.
The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J.
Solove Research Institute at The Ohio State University is one of only 38
National Cancer Institute-designated Comprehensive Cancer Centers in the United
States and the only freestanding cancer hospital in the Midwest. Members of the
Division of Gynecologic Oncology provide comprehensive services for patients
diagnosed with gynecologic malignancies, including radical pelvic surgery,
pelvic and vaginal reconstruction, advanced laparoscopic surgery, and care for
complications of disease and/or treatment.
The following are some of the unique clinical services available to patients:
Intraoperative radiation therapy, making it possible for selected patients to
receive advanced radical pelvic surgeries in combination with intraoperative
radiation therapy.
Advanced laparoscopic surgery in gynecologic oncology, making it possible for
patients with adnexal mass and/or cancer diagnosis to be managed with this less
invasive surgical technique.
Drs. Fowler and Cohn have become certified to perform robotic surgery, the most
recent and least invasive of current surgical techniques.
Gynecologic Oncology Statistics
July 1, 2005 – June 30, 2006
Clinic/office visits: 6911
Chemotherapy (Camelot): 2311
Surgical Procedures:
minor: 152
major: 638
Total: 790
Research
Our division remains active and emphasizes participation in clinical trials.
Most of our clinical trial participation is through the Gynecologic Oncology
Group (GOG). However, we also participate in additional phase II pharmaceutical
trials, as well as other novel clinical trials available only at the James
Cancer Hospital. In addition to clinical trials, we are actively involved in
basic science and clinical research involving multiple important issues in
gynecologic oncology. During FY 2005-2006, our division had 40 active GOG trials
and five pharmaceutical trials. Members of the Division of Gynecologic Oncology
were responsible for the presentation of seven abstracts at the Society for
Gynecologic Oncology annual meeting in 2005. In 2006, there were three oral
presentations and 10 poster presentations by members of the division. Of these
13 abstracts, eight describe our basic science and translational research, while
five are relate to clinical research projects.
Dr. David Cohn achieved the rank of Associate Professor with tenure of
Obstetrics and Gynecology during fiscal year 2005-2006, effective October 1,
2006. Dr. Cohn is the principal investigator of many Phase II trials in ovarian
cancer. Specifically, these trials evaluate novel therapeutic agents or new
chemotherapy combinations. Dr. Fowler is a Co-PI on a Phase I study at Ohio
State evaluating active immunotherapy with a HER2/neu peptide vaccine in
patients with advanced gynecologic cancers. Recently, Ohio State was awarded a
contract through the National Cancer Institute (N01, Miguel Villalona, M.D. as
PI) to study novel therapeutics in phase II studies. Dr. Cohn is the leader of
the gynecologic cancer section who will be responsible for the development of
protocols to study these agents in patients with gynecologic malignancies.
Dr. Cohn is the principal investigator on two funded research grants (by the
Gynecologic Cancer Foundation and the Ovarian Cancer Research Fund,
Incorporated). The aim of this research is to establish a vaccine for the
treatment or prevention of ovarian cancer. Specifically, in collaboration with
Pravin Kaumaya, Ph.D., immunogenic regions of the VEGF protein have been
identified that have been incorporated into an ovarian cancer vaccine. Ongoing
in vitro and in vivo studies will be expected to continue through 2007, with the
goal of submitting an application to the FDA for Phase I clinical trials with
this vaccine if it appears to be a successful immunization strategy in ovarian
cancer. An application for funding through the Sidney Kimmel Cancer Research
Foundation is currently pending, and an application for funding through the
Ovarian Cancer Research Program (OCRP) from the Department of Defense was be
submitted in April 2006.
Collaborations with Tim Huang, Ph.D. in the Department of Molecular Virology,
Immunology & Medical Genetics into the epigenetic changes in ovarian
carcinogenesis have led to submission of three abstracts for presentation at
local and national meetings in 2006. Currently, a gynecologic fellow is spending
a year in the laboratory of Dr. Huang prior to her two years of clinical
fellowship.
The Gynecologic Cancer Center for the Study of Health Care Disparities with Dr.
Fowler as the PI is currently performing epidemiologic, psychosocial and basic
science research projects. The grant was awarded in 2003 and will continue
through 2006. This multidisciplinary effort involves basic scientists and
clinicians from genetics, epidemiologist, psychologist, immunologist,
pathologist and gynecologic oncologists from the Comprehensive Cancer Center.
Dr. Cohn is a co-investigator in a trial entitled “Reducing cervical cancer in
rural populations,” funded through the Centers For Population Health And Health
Disparities. This study is aimed at determining the basis of increased cervical
cancer rates in Appalachian Ohio, and establishing an intervention strategy to
reduce the rates of cancer. Specifically, lay health educators will be
introduced in communities to reduce rates of smoking and risky sexual activity
in Appalachian women. Correlative basic scientific studies will evaluate the
role of HPV in this population, as well as the immunologic basis of cervical
neoplasia in these women. The study will continue through 2007.
Multiple clinical projects have been performed and/or are presently active. This
includes a large surgical-pathologic-clinical database in endometrial cancer
collected in a prospective fashion. Analysis of this database has produced four
clinical papers evaluating traditional outcomes in patients surgically staged
with endometrial cancer. Multiple translational projects are underway, including
evaluating genetic risks and mechanism of disease, as well as the role of COX-2
and aromatase in endometrial cancer. Ongoing translational research
collaborations with members of the Human Cancer Genetics group has led to the
publication of three manuscripts and many abstracts at local and national
meetings describing the role of DNA mismatch repair in predicting outcome of
women with endometrial cancer. Three manuscripts were generated from this
research in 2006.
Members of the division have a long history of mentoring fellows and residents
in many such research projects.
New Patient Accrual
New Diagnosis
Carcinoma of cervix
Invasive 70
Pre-invasive 18
Carcinoma of uterine corpus 156
Atypical hyperplasia 10
Carcinoma of ovary 92
Borderline ovarian tumors 20
Extraovarian papillary serous 10
ca of peritoneum
Fallopian tube ca 3
Carcinoma of the vulva
Invasive 27
Pre-invasive 13
Carcinoma of the vagina 7
Chorio ca 2
Gestational trophoblastic disease 7
Double primary 12
Unknown primary and non-gyn primary 21
Subtotal new patients 468
Recurrent carcinoma
Cervix 9
Ovary & peritoneal CA 18
Endometrium 11
Vulvar 12
Vagina/VAIN III 16
Subtotal recurrent ca 66
New total 534
