WRNMMC, Bethesda, MD –
The Murtha Cancer Center (MCC) at Walter Reed National Military Medical Center hosted its 2022 Research Showcase virtually June 23. The MCC is the Department of Defense’s only Cancer Center of Excellence.
The event highlighted work underway in research, diagnosis, and treatment of cancer by staff affiliated with the MCC Research Program (MCCRP), Uniformed Services University (USU), and other institutes affiliated with the MCC, explained retired Army Col. (Dr.) Craig Shriver, MCC director.
He added the MCCRP and USU partner with eight other Department of Defense health-care facilities where patients receive care, and data, samples, and tissues are collected and studied.
Historically, the MCC has had a special relationship with WRNMMC, Shriver said. He explained WRNMMC is where the largest percentage of MCC’s research is performed because of the number of patients, samples, data, and tissues located at Walter Reed Bethesda.
“It’s not only that the MCC is taking care of patients at the flagship of military medicine -- WRNMMC, but it’s also engaging in research, advancing the best practices of cancer care across the entire medical infrastructure,” WRNMMC Director, Army Brig. Gen. Jack Davis, agreed.
The general also discussed readiness and cancer, stating that recent innovation in treatments have allowed many service members to return to duty following a diagnosis of cancer and receiving care within the U.S. Military Health System (MHS). Advances in treatment means for many troops that a diagnosis of cancer is no longer career ending, he said. “This is due in part to the research [and care] done by the MCC,” he added.
Julie Bytnar, a cancer epidemiologist with the MCC and the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), explained that compared to the general population, the military has lower rates of colorectal, lung, testicular and cervical cancers. Rates are higher in the military for locally staged prostate cancer and for breast cancer among older women, which is when cancer has not spread and is best able to be treated. “These differences may be related to the healthier status of service members and universal health care access and screening [in the MHS],” she stated.
Jie Lin, Ph.D., a senior epidemiologist with the MCCRP, discussed survival of lung cancer patients, comparing the MHS and the general population by insurance status.
“Health care accessibility is an important factor affecting cancer outcome in the U.S. general population,” Lin said. She added that “compared to patients with health insurance, cancer patients without insurance are more likely to present with advanced stage cancer; less likely to receive cancer-directed treatments; more likely to have treatments delayed; and more likely to have worse survival.”
Lin said the MHS provides universal health care to beneficiaries, which contributes to better cancer survival than similar patients from the U.S. general population.
She also discussed the survival in late-stage prostate cancer, comparing the MHS to the U.S. general population.
According to the American Cancer Society, prostate cancer is the second leading cause of cancer mortality in U.S. men. “Our study showed MHS beneficiaries with late-stage prostate cancer had improved overall survival compared to patients from the U.S. general population.”
Lin added that “the survival advantage was consistently observed in middle-aged and older men, both white and black, in patients regardless of tumor stage, tumor grade, surgery, or radiation treatment.”
Rachel Ellsworth, Ph.D., director of translational breast research at the HJF, agreed, stating that the MHS “can be used as a model of care to reduce breast cancer disparities within the U.S. general population.” She added that “increasing the availability of testing and clinical management for black women with hereditary forms of cancer may help reduce disparate survival seen in the U.S. general population.”
In discussing breast cancer among active-duty service women (ADSW), Ellsworth said the etiology is different for ADSW than civilian beneficiaries. She explained military active-duty females may face a higher risk of breast cancer because ADSW are employed more frequently in industrial jobs and missions, increasing the probability of exposure to industrial chemicals. Also, ADSW may use oral contraceptives for longer periods than women in the general U.S. population, which also increases the risk for breast cancer.
“Twenty-one percent of breast cancers in ADSW are heredity,” Ellsworth added. “While this does increase the risk of having additional cancers events, it also creates the opportunity for precision medicine,” she said.
“The cancer immunotherapy revolution is real, and it affects every kind of cancer,” added Dr. Henry C. Stevenson-Perez, an oncologist at WRNMMC.
In a study looking at survival of breast cancer patient by insurance status, Lin again explained that MHS breast cancer patients had an overall 24 percent lower risk of death than patients from the U.S. general population. In addition, active-duty breast cancer patients had 41 percent lower risk of death than their civilian counterparts from the general population, she added.
Data tracking, biobanking
Jesse Stratton, an IT developer, explained that there’s a lot of custom software, tools and entire systems to help support cancer research. In discussing the Data Tracking System for the Center for Prostate Disease Research (DTS-CPDR), he said more than 200,000 aliquots of tissue, urine and blood samples have been collected by the CPDR since its inception in 1992.
“Maintaining a robust biospecimen banking program is essential to the success of the entire CPDR program,” Stratton said. “DTS-CPDR will be a vital component to ensure continued accurate and reliable tracking of prostate cancer samples and their associated data. The studies performed in the CPDR program translate in advances that benefit active-duty military personnel and their dependents, veterans, and civilians who are affected by prostate cancer,” he added.
“Diagnosis with prostate cancer at younger age is a serious challenge in the MHS,” said Hua Li, Ph.D., of the CPDR, MCCRP and USU. “Prostate cancer represents the second highest non-cutaneous carcinoma among active component of the U.S. Armed Forces. Prostate cancer onset at a younger age is more likely to be an aggressive cancer in the African-American population,” he added.
Quality is the main focus regarding biobanking activities that support precision medicine research efforts for DOD, explained Stella Somiari, Ph.D., of the Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), which collaborates with MCCRP in biobanking, informatics infrastructure, bioinformatics, and translational research.
“Availability of quality samples is essential for accelerating personalized medicine,” Somiari stated. “With the establishment of an efficient quality system that meets or exceeds the industry standard, the CSSIMMW Biobank is well positioned as the preferred biobank for sample management for various DOD research projects. This supports the DOD’s efforts towards individualized medicine which leads to better disease diagnosis, treatment, monitoring and management to enhance military readiness,” she added.
Brenda Deyarmin, lead research associate at the CSSIMMW, explained that adopting digital pathology across the DOD workflow provides multidisciplinary integration of genomics, proteomic and pathology to incorporate research data in precision medicine. “This holistic approach to biomedical discoveries ultimately leads to improved accuracy in diagnostics and therefore, positively impacts health outcomes of military personnel and military readiness,” she added.
Speakers during the day-long showcase also addressed some of the research taking place within the APOLLO network. APOLLO, which stands for the Applied Proteogenomics Organizational Learning and Outcomes, is a collaboration among three federal agencies -- DOD, Department of Veterans Affairs and National Cancer Institute. The collaboration was formed to incorporate proteogenomics into patient care as a way of looking beyond the genome, to the activity and expression of the proteins that the genome encodes. Proteogenomics seeks to better determine how patients will respond to therapy by screening their tumors for both genetic abnormalities and protein information.
Previously called the MCC Research Summit, the Murtha Cancer Center has hosted the showcase for nearly a decade, Shriver said.