A patient with severe nausea from her chemotherapy. A hospice patientwith brain cancer who has been readmitted to the hospital because his treat-ments at home have not calmed his delirium. Family members who can’tunderstand why their father, who has advanced pancreatic cancer, is distressedand unable to sleep – even after his pain has been controlled.

These are a few examples of people who will benefit from the Institute’snew Pain and Palliative Care Program for adults, a service that focuses a broadrange of expertise on issues of cancer-related symptoms and end-of-life care.

The program, led by Janet Abrahm, M.D., is an expansion of the Pain andSymptom Management Service established in the early 1990s at Dana-Farber.It will create a team of specialists from a variety of fields relating to pain andpalliative care (which addresses patients’ and families’ distress from diseasessuch as cancer or its treatment). Once fully staffed, the team will serve as a

Inside the INSTITUTE

D E D I C A T E D T O D I S C O V E R Y . . . C O M M I T T E D T O C A R E

February 6, 2001

IN THIS ISSUERenewing Sodexho’s contract 2Funding research onsurvivorship 3Supporting colorectal studies 3Honoring Dr. Nathan 4Sharing safety lessons 5Learning about Ayurveda 8

Seven-year-old Alexander Mufson may be theyoungest captain in the history of the BostonMarathon® Jimmy Fund Walk, but he’s also one ofthe best. The youngster’s “Team Histio” has raisedmore than $530,000 over the past four years andwas the Walk’s top fundraising team last year, gar-nering $183,000.

Not surprisingly, it is Alexander’s mom whohas been the real force behind this tremendouseffort. A full-time mother of two boys and a former

volunteer with Dana-Farber’s Blum ResourceCenter, Dorie Mufson spends several months eachyear crafting inspiring letters to sponsors and

Volume 6, Issue 9

see Histiocytosis, page 4

see Pain management, page 8

Team-based program to addresspain and palliative care issues

Annual Walk team enablesDFCI researchers to probethe rare histiocytosis disease

Dana-Farber prepares to act on issuesraised during the staff opinion survey

With results in hand from the staff opinion survey conducted this past September, Institute leaders are now taking steps to address areas of concernraised during the process.

Over the next few months, Dana-Farber will begin planning improvementactivities around Institute-wide and departmental issues identified during thesurvey. Among these are pay and performance recognition, communication andcollaboration across departments, and the satisfaction of certain groups withinthe DFCI community.

“The learning coming out of the survey is extremely important,” says ChiefOperations Officer Jim Conway. “People are proud to work here, and theirgeneral satisfaction is well above the national norm. But staff have to feel betterabout our pay system and other areas that surfaced in the process. It’s very clearwe have a lot of work to do.”

Nearly 1,000 staff members from throughout DFCI filled out the question-naire, which was administered by Baird/Melnick Associates of Chicago. Theturnout was somewhat below average, and consultant John Baird, Ph.D., specu-lates that some staff declined because they were too busy or felt the endeavorwouldn’t lead to change.

In December, staff received in the mail a letter from Institute PresidentEdward J. Benz Jr., M.D., and an overview of the findings; in January, results

In a study reflecting the growing interest in the long-term effects ofcancer treatment, researchers at Dana-Farber’s David B. Perini, Jr. Qualityof Life Clinic and Children’s Hospital have found that boys treated withhigh doses of a common chemotherapy agent are likely to experienceirreversible fertility problems as adults.

The study, published in the Feb. 1 issue of the journal Cancer,involved 17 adult males who, as children, had been treated with chemo-therapy drugs known as alkylating agents for a variety of sarcomas –cancers of the bone, cartilage, or certain muscles. The drugs are knownto produce fertility declines in adult cancer patients, but their long-termeffect on children had not been well studied previously.

The researchers, led by Lisa Diller, M.D., medical director of thePerini Clinic, found that 10 of the 17 study participants (60 percent ofthe group) had no sperm production, five (or 29 percent) had reducedsperm production, and only two (or 12 percent) had normal spermcounts. The two with normal sperm counts had received the lowest dosesof the chemotherapy drugs.

All the patients who had been treated prior to puberty had abnor-malities in their semen, a finding that contradicts doctors’ long-heldbelief that exposure to these drugs before puberty was safe for the malereproductive organs.

“The results indicate that exposure to alkylating agents prior topuberty is not protective, and that the risk of infertility increases withhigher doses of the therapy,” Diller says. “It’s important that parents ofyoung patients be informed about the potential for long-term side effectson fertility.”

Alkylating agents work by destroying fast-dividing cells in the body.These include cancer cells, as well as hair cells, cells in the digestive tract, and cells in the testicles that produce sperm. Because the sperm-producing cells in children have not begun to function as in adults, it

Study finds long-term effectsof chemotherapy on fertility

see Survey, page 5

see Perini, page 4

Team Histio leaders (left to right) Michael, Alexander, andDorie Mufson take a break after crossing the finish line of the1999 Jimmy Fund Walk. (Steve Gilbert photo)

Photo tributein memory ofEinar ‘Jimmy’Gustafson

See pages 6-7.

Members of the new Pain and Palliative Care Program for adults include (standing, left toright): Nina Gadmer, Maureen Lynch, and Janet Abrahm, and (seated) Nathaniel Katz, MaryJane Ott, and Susan Block. (Steve Gilbert photo)

https://livelink.dfci.harvard.edu

Hockey tournament scoresfor DFCI, see page 3.

NEWS OF NOTE

Chief of CommunicationsSteven Singer

EditorDebra Ruder

Associate EditorSaul Wisnia

DesignMonica Briggs, Caroline

Woodcheke

Senior WriterRobert Levy

ContributorsKaren Cummings, KathleenBenoit Fuller, Janet Haley, Paul Hennessy, Chris Ingalls,Steven Skelton

PhotographersKaren Cummings, SteveGilbert, Laura Wulf

Inside the Institute is published semimonthly for staff membersand friends of Dana-Farber Cancer Institute. The next issue isscheduled for Wednesday, Feb. 21.

Story ideas and “News of Note” items are welcome and may besent to Debra Ruder or Saul Wisnia at 375 Longwood Ave., 5th floor, Boston, MA 02215, or call (617) 632-4090 or fax to(617) 632-5520. The Institute’s Web site is at http://www.danafarber.org; the intranet is at https://livelink.dfci.harvard.edu.

Dedicated to Discovery...Committed to Care

Inside the Institute is printed on recycled paper.

Inside the Institute2 February 6, 2001

Dianne McKay, M.D., of Pediatric Oncology leads one of five research teams in the United Statesreceiving grant awards from the Roche Organ Transplantation Research Foundation this year. The grants,which total approximately $1 million, support investigators working to advance the science of solid organtransplantation. The winning teams were selected from a field of 134 grants submitted by researchers aroundthe world. The title of McKay’s project is “Alterations in IL-2R signaling induced by anti-IL-2R antibodies.”

Anti-IL-2R antibodies provide an important new addition to the treatments available to prevent rejectionof solid organ transplants. McKay’s work is focused on understanding how these antibodies affect the bio-chemical signaling within immune system cells, called lymphocytes, that cause rejection. Her work willprovide insight into the mechanisms of rejection and its prevention.

One of Dana-Farber’s newest staff members is Li Cai, M.D., Ph.D., an information servicemanager in the Research Computing Department.He joins a staff of five experts who maintain thecomputing environment that supports research.

“We assist the researchers with all their hard-ware and software needs,” explains Cai. “Thegenomic analyses that researchers conduct here gen-erate a huge amount of data. That data doesn’t makesense if you don’t know how to analyze it, so I try toevaluate, select, and develop the needed softwaretools and biological databases. This will help scien-tists understand molecular bases that affect humanhealth and disease.”

Cai began working at DFCI on Dec. 18 aftercompleting his postdoctoral training in ConnieCepko’s genetics lab at Harvard Medical School. His work covers wide aspects of biological computing,including bioinformatics, UNIX system administration, and Web development.

He earned a medical degree at Yichun Medical School in his native China and arrived in the UnitedStates in July 1991, attending Rutgers University as well as the University of Medicine and Dentistry of NewJersey’s Robert Wood Johnson Medical School.

Although the complex nature of his work required him to “dive right in,” Cai is still getting familiar withDFCI and the projects that research groups are working on. “This an exciting and challenging job for me,”he reflects, “because it allows me to combine my interests and background in both biology and computers.”

Colleagues bid farewell last week to Michael Buckley, administrator for Nursing and Patient Care Services, and praised his love of family, politics, and Dana-Farber. Chief Operations Officer Jim Conway, for one, noted how Buckley “glowed” when speaking about the Boston Marathon® Jimmy Fund Walk andits Team Dana-Farber, which Buckley led for each of his three years here.

Buckley, who is leaving DFCI to pursue broader opportunities, thanked assistant Sandy Johnson andothers for their generosity. “I have felt enormously fortunate to be part of your great team,” he told a groupof well-wishers on Jan. 29. “You have enriched me as a professional, and you’ve enriched my family.” ITI

Sodexho/Marriott to upgrade food services under renewed contract

Li Cai, M.D., Ph.D., of Research Computing. (Chris Ingalls photo)

Some new ingredients will soon be added tothe Institute’s food services operation.

After 18 years at Dana-Farber, Sodexho/Marriott has prevailed in a competitive biddingprocess for DFCI’s food services contract. But it haspromised to invest more than $50,000 toupgrade the cafeteria and its other services,such as room service, vending, and catering.

Last year, the Institute put its foodservice (Dietary) contract out for bid for thefirst time in several years. Although pleasedwith the existing service, the leadership feltit was important to investigate othervendors to determine whether the Sodexho/Marriott contract was price-competitive,according to Director of Operations James A. Wall Sr.

A Food Service Contract EvaluationCommittee was formed to help with the selectionprocess; it included Wall, Anne Chiavacci, LouiseForrest Bowes, William Lowe, Steven Connolly,Libby Tracey, William Corbett, and JaniceSimmons.

At Dana-Farber, Sodexho/Marriott servesroughly 250,000 meals a year in the Austin andMarcia Cable Dining Hall, at catered events, and topatients receiving treatment and their families. Itsoperation here represents one of the largest out-patient food services in the area. The company also

manages the vending machines around the Insti-tute, whose revenues go to the Jimmy Fund.

Committee members were pleased with manyaspects of Sodexho/Marriott’s services. The vendorlabels, dates, and rotates all food products, values

employee training, and provides a high-qualitymenu. Its employees are also well loved. “Peoplefeel incredibly strongly about the staff who work inthe cafeteria and their commitment to ourmission,” Chief Operations Officer Jim Conwaysaid at a recent managers’ meeting.

Some of the most obvious changes will occurin the cafeteria, notes Darrell Swift, generalmanager of Dana-Farber’s food services. Theseinclude creating a more inviting dining environ-ment, new signage, and comment cards to solicit

customer concerns. New self-service equipment,such as a heated pizza display, will also beinstalled.

Sodexho/Marriott intends to continue its col-laboration with Institute dieticians. “We have part-

nered with Dana-Farber to complementits mission,” explains Swift. “This includeshaving a menu with many cancer-fightingfoods. We can also provide a breakdownof ingredients in the meals.”

In an effort to improve catering effi-ciency, Sodexho/Marriott plans to pur-chase 200 sets of china, thus eliminatingrental costs for many events. It alsointends to use DFCI Online, the Institute’sintranet, to better publicize its servicesand menu.

To foster further confidence,Sodexho/Marriott will put 10 percent of its fee intoa “quality assurance fund.” Every quarter, the foodservice committee will decide whether thecompany is doing a satisfactory job, and the fundswill either be released or retained.

“We’re very pleased that we are continuing ourrelationship with Sodexho/Marriott,” says Wall.“The company’s commitment to excellence reflectsDana-Farber’s dedication to excellence in researchand patient care, and we look forward to workingtogether into the future.” SS

Sodexho/Marriott staff include (left to right) Julie Wilker, David Smith, Darrell Swift,Dallas Hudgins, Scott Bonnyman, Andrea Nei, Butch Thurber, and Carolyn Melchionna.

Get well, Ted

Youngsters in theJimmy Fund Clinic recently wrote “get

well” cards such as this one to baseball great TedWilliams, a longtime supporter of the Jimmy Fund who isrecovering from heart surgery.

3Inside the Institute February 6, 2001

Mayer research receives boost fromnational colorectal cancer alliance

Research by Robert J. Mayer, M.D., director of the Center for Gastroin-testinal Oncology and vice chair for Academic Affairs in Adult Oncology,recently received a boost – thanks to about $216,000 in support from theNational Colorectal Cancer Research Alliance (NCCRA).

The NCCRA is a charity organization launched last year by NBC television“Today” show co-anchor Katie Couric, cancer fundraiser Lilly Tartikoff, and theEntertainment Industry Foundation in an effort to increase public awareness,encourage preventive testing, and raise funds for physician-scientists engaged inpromising colorectal research.

One of eight physicians on the alliance’s medical advisory board, Mayer isdesigning studies focused on discovering causes and preventing the develop-ment of colorectal cancer. Additional funding from the NCCRA is anticipatedlater this year, and on an annual basis thereafter, to help Mayer and his col-leagues continue their investigations.

Since its launch, the alliance has garnered $11 million in gifts and pledgesfor colorectal cancer research and awareness. Mayer and his fellow investigatorson the NCCRA board are encouraged to seek out other physician-scientistsengaged in promising research for future alliance support.

“We are going to take this great responsibility very seriously,” says Mayer.“The NCCRA has made a commitment to make colorectal cancer screeningaccessible and to publicize itsimportance. The alliance hopes tochange the insurance coveragerules for everyone who is appro-priate for screening and to makethat testing as effective as possible.And, at the same time, it is fundingour basic research into what causesthis disease.”

Says Couric, whose husband,Jay Monahan, died of colon cancerin 1998, “I am thrilled to be able tomake this extraordinary contribu-tion to these dedicated scientists.We have spent the past ninemonths working on fundraisingand awareness efforts. Now our sci-entists will use the fruits of our labor to research better treatments and, Ibelieve, ultimately find a cure for colon cancer.”

According to the American Cancer Society, colorectal cancer is the second-leading cause of cancer deaths in the United States. An estimated 130,200 newcases were reported nationwide during 2000, and 56,000 people died from thedisease. It is more than 90 percent curable, however, if detected early throughregular screening. Men and women are equally at risk of dying from colorectalcancer, and Mayer says the most important step is finding ways to treat individ-uals before cancer develops.

“The philosophy here is to prevent colorectal cancer and keep it frombecoming a health hazard,” he explains. “If detected early, it is almost alwayscurable. But more importantly, polyps (which are not cancers but are often pre-cursors for cancers) can be found through careful screening and removed – significantly reducing the risk of ever developing colorectal cancer.”

For more information on the National Colorectal Cancer Research Alliance,call (800) 872-3000 or visit the alliance’s Web site at www.nccra.org.

JH

World champion cyclist Lance Armstrong is helping Dana-Farber investigators develop methods to improve care for cancer survivors.

Since forming a foundation just a few months after his own diagnosis withcancer in 1996, Armstrong has helped make a difference in the lives of manyothers who are fighting the disease and its aftereffects.

Now, the Lance Armstrong Foundation hasawarded Christopher Recklitis, Ph.D., of PediatricOncology and Craig Earle, M.D., of Adult Oncologynearly $250,000 combined to support their researchon behalf of childhood cancer survivors.

Recklitis, chief psychologist at Dana-Farber’sDavid B. Perini, Jr. Quality of Life Clinic, is slated toreceive $150,000 over the next three years to developa standardized screening program to identify sur-vivors who suffer from learning disabilities, anxiety,depression, and other psychological long-term effects of cancer treatment.

When Recklitis began his work at the clinic in 1998, there were no stan-dardized methods to determine the specific psychological needs of survivors. So he developed a clinical assessment program of his own. With the LanceArmstrong grant, he aims to improve his screening method to make it shorter,more accurate, and applicable to wider audiences.

“I’m pleased with the screening we have here,” says Recklitis. “But it won’tbe a major contribution to the field unless we can take our homegrownprogram and expand it into something that can be used at other places, such asclinics that do not have the psychosocial staff that we do.”

Earle, meanwhile, will use his $95,000 award (given over two years) tolearn whether cancer survivors receive adequate care for their non-cancer health needs.

By studying the interactions between colorectalcancer survivors and the health-care system, Earlehopes to determine if survivors use routine preven-tive medical services such as flu shots, breastscreenings, and cholesterol monitoring more orless than individuals with no history of cancer.

Earle says the findings will help providersdevelop guidelines for the appropriate clinical careof patients with prior cancer diagnoses and con-tribute to better comprehensive long-term healthcare for survivors.

The Lance Armstrong Foundation seeks to help people manage and survivecancer by promoting awareness, supporting survivor services, and fundingresearch projects that focus on two key areas: issues of survivorship and thebasic and clinical science of testicular and other forms of cancer.

Armstrong was 25 years old and one of the world’s top cyclists when hewas diagnosed with testicular cancer more than four years ago. By the time itwas detected, the cancer had spread to his abdomen, lungs, and brain. Aftersurgery and an aggressive course of chemotherapy, however, the cyclist beat thedisease and went on to win the Tour de France race in both 1999 and 2000.

“I am lucky, I’m a survivor,” says Armstrong on his foundation’s Web site.“But without continued research to better understand the causes of cancer,improve treatment options, and better educate individuals to recognize thesigns of cancer, others might not be so lucky. These grants from the foundationsupport my commitment to reaching the point when no one will ever have toendure what I went through.” KF

Robert Mayer, M.D. (Steve Gilbert photo)

Lance Armstrong Foundation supportsDana-Farber research on survivorship

Jimmy Fund Chairman Mike Andrews (second from right) greets (left toright) Boston Bruin Joe Hulbig, a St. Sebastian’s alumnus; Jack Doherty,director of the St. Sebastian’s School Jimmy Fund Hockey Tournament;and Bobby Cintolo, emcee of the 2000 tournament. (Steven Skelton photo)

Craig Earle, M.D.

Chris Recklitis, Ph.D.

Students who take part in the annual St. Sebastian’s School Jimmy Fund Hockey Tourna-ment have at least two goals: to score often and raise money for Dana-Farber.

Held this past Labor Day weekend, the latest tournament helped generate $7,500 for theJimmy Fund and brought to $40,000 the total amount raised for the cause by the collegepreparatory school for boys in Needham.

Punctuating the 2000 event was a moving ceremony featuring honorary master of cere-monies Bobby Cintolo, a St. Sebastian’s student who was diagnosed with a brain tumor lastApril, underwent treatment at Dana-Farber, and is now cancer-free. At the event, Cintolo presented the championship trophy to Brett Hayes, last year’s honorary emcee and a leukemiasurvivor.

“We look forward to continuing our efforts to raise money for the Jimmy Fund,” Tourna-ment Director Jack Doherty wrote to Jimmy Fund Chairman Mike Andrews. “It has been avery rewarding and gratifying experience for all of us at St. Sebastian’s. We hope that in somesmall way the St. Sebastian’s School Jimmy Fund Hockey Tournament will help contributetowards future success stories.” DR

Prep school’s hockey tourney nets Jimmy Fund contribution

Inside the Institute4 February 6, 2001

the pride and challenge he felt in suc-ceeding Nathan, another surpriseattendee “roasted” the guest of honor:Professor Sir David Weatherall, FRS,Emeritus Regius Professor of Medicine

In an evening filled with surprises for theguest of honor, Dana-Farber President EmeritusDavid G. Nathan, M.D., was lauded for his fiveyears of Institute leadership during a dinner at theMuseum of Fine Arts on Jan. 23.

Some 200 people, includingfamily members and DFCI staff,trustees, and friends attended the festivities, where they dined whileenjoying live operatic arias. Oneselection came from a trio of musi-cians that Nathan, now the Robert A.Stranahan Distinguished Professor ofPediatrics, didn’t know would be per-forming: daughter Deborah NathanCharness on flute; son-in-law MichaelCharness, M.D., Ph.D., on piano; and David Fisher, M.D., Ph.D., ofPediatric Oncology playing cello.

After current DFCI PresidentEdward J. Benz Jr., M.D., spoke of

at the University of Oxford, and one of Nathan’sdearest friends in medicine.

The night concluded when Benz and Board ofTrustees Chairman Gary Countryman delightedNathan, an avid sailor, with an oil lamp for hissailboat. It bears the inscription: “Presented withheartfelt gratitude to David G. Nathan, M.D., forhis tireless service as President of Dana-FarberCancer Institute.” SW

maintaining detailed spreadsheets of the team’s fundraising progress. She evenproduced a glossy newsletter last year from her family’s Sharon home to keepwalkers and supporters updated on new developments. Under her leadership,the team has grown from 24 members in its first year to 50 members – many ofthem Pacesetters (walkers who collect $500 or more apiece) – in 2000.

Yet, it’s clear that her oldest son is the inspiration behind it all. In February1997, just before his fourth birthday, Alexander was diagnosed with histiocy-tosis, a rare disease that affects an estimated one in 200,000 people each year inthe U.S. These patients have too many histiocytes, a form of white blood cellthat multiplies widely and can attack any part of the body, including bones,liver, lungs, skin, and lymph nodes. Similar in some ways to cancer, histiocy-tosis is treated with radiation and chemotherapy.

Because histiocytosis is an “orphan” disease affecting few people each year,it has not been a priority for federal funding. As a result, there has been littleresearch into the causes and treatment of the disorder. That is, until theMufsons got involved.

“It’s logical that federal funding is allocated to fight the more common dis-eases,” reasons Mufson. “It makes complete sense to focus on problems thataffect more people. But when it’s your child who has that rare disease, you can’t

just sit back and acceptit. You’ve got to do something.”

So, Dorie and herhusband, Michael,formed Team Histio justin time for the 1997Walk. As nearly $86,000in proceeds from theevent poured in, theMufsons met with DFCIChief of Staff StephenSallan, M.D., BarrettRollins, M.D., Ph.D, ofAdult Oncology, and Kim

Histiocytosis continued from page 1

hadn’t been known whether chemotherapy wouldimpair their future fertility.

Pediatric oncologists at Dana-Farber and Children’s plan several avenues of research in aneffort to reduce the chances that patients will expe-rience abnormal sperm counts later in life. Amongthem are using lower doses of alkylating agentsand using other chemotherapy agents that havefewer side effects on fertility. For patients whohave already reached puberty, banking spermbefore treatment may offer a chance to father chil-dren biologically later in life, researchers say.

“We continue to search for ways to use current

therapies to minimize side effects,” says the study’slead author, Lisa Kenney, M.D., M.P.H., of PediatricOncology. “The more we learn about the long-termramifications of cancer treatments from pastpatients, the better we can manage patients today.”

Also contributing to the study were Mark Laufer, M.D., of Children’s and Brigham andWomen’s Hospital; Frederick Grant, M.D., of Children’s; and Holcombe Grier, M.D., of Dana-Farber and Children’s. RL

Perini continued from page 1

Nichols, M.D., formerly of Pediatric Oncology, to assemble a research andclinical care team to tackle histiocytosis.

The research program, one of the first of its kind in the Northeast, aimsto improve understanding of the causes of histiocytosis and to designimproved treatments for children and young adults with this disorder.

“Without Team Histio’s generous contribution, we could only work onthis problem in our spare hours,” says Rollins. “Their support has allowed meto devote a significant amount of my time to this area of research, as well ashire a postdoctoral fellow (Marcia Fournier, Ph.D.) to focus on it full-time.”

Rollins adds that the research they are now able to conduct on histiocy-tosis may lead to discoveries about cancer as well as other diseases – whichcould produce more opportunities for federal funding in the future.

Histiocytosis care at Dana-Farber, led by Sarah Alexander, M.D., of Pediatric Oncology, is coordinated between the Jimmy Fund Clinic and Children’s Hospital. Approximately 10 to 20 new patients come for treatmentor consultation each year. Several of them and their families are members ofTeam Histio.

Meanwhile, Alexander Mufson’s disease has been in remission since September 1997, and he’s been able to do the three-mile Patient/Family Walkfor the past two years. As two of the team’s top fundraisers, he and his 5-year-old brother, Wyatt, received a standing ovation at the Walk’s PacesetterReception last June.

“We have been so blessed that he hasn’t had a recurrence,” says DorieMufson. “But what we do know about this disease is that it’s chronic, it waxesand wanes, and it could come back at any time. So, until there’s a cure, we’llcontinue to be involved.” KF

A microscopic view of Langerhans Cell Histiocytosis. The cellshave been stained to express a chemokine receptor, a struc-ture being studied in Barrett Rollins, M.D.’s lab. (Courtesy ofBarrett Rollins, M.D.)

Pictured at right, Lisa Kenney, M.D., M.P.H, of Pediatric Onc-ology is lead author of the study on long-term effects of chemo-therapy given to boys with sarcomas. (Steve Gilbert photo)

“When it’s your child who has that rare disease,you can’t just sit back. You’ve got to do something.”

— Dorie Mufson

David G. Nathan, M.D., saluted andserenaded at appreciation dinner

Attending the dinner for David Nathan, M.D. (right), were hiswife, Jean Nathan (center), and Samuel Lux, M.D., chief ofPediatric Hematology/Oncology at Children’s Hospital.

As a gesture of thanks, Board of Trustees Chairman Gary Countryman (left) presented Nathan with an oil lamp for his sailboat. (Steve Gilbert photos)

5Inside the Institute February 6, 2001

The tragic overdoses of two breast cancerpatients at Dana-Farber in 1994 made the Institute“Exhibit A” in discussions of medication errors athospitals around the country. Today, DFCI isknown as a leader in the effort to reduce sucherrors and respond appropriately when they occur.

How the Institute made the journey from cau-tionary example to admired exemplar – and how itcontinues to work to reduce clinical errors – wasthe topic of a talk by Chief Operations Officer JimConway on Jan. 18. Delivered in Smith 304 to agroup of about 25 staff members, the presentationwas the first in a series on patient safety scheduledfor the next few months.

The lunchtime events are modified versions oftalks that Institute leaders have given to health-care management groups around the country.Delivering them to Dana-Farber staff is a way of“celebrating what we’ve achieved as an organiza-

tion,” Conway said, but also serves as a realitycheck against “romanticizing” those accomplish-ments to outside groups.

Conway reviews Institute’s ‘journey’ of quality improvementConway began his Jan.18 discussion by

recalling that when he interviewed for his currentposition, shortly after the overdoses becamepublic, he was impressed by the approach thatInstitute leaders intended to take toward theproblem. “They made clear that they wanted touse this terrible tragedy to move the Institute to avery different place,” Conway said. “In three years,they wanted Dana-Farber to be viewed as a leaderin quality improvement.”

That this is precisely what happened is atribute to people throughout Dana-Farber whosubjected every aspect of clinical care to intensescrutiny and identified ways of making improve-ments, Conway noted.

In many respects, the approach taken by Dana-Farber was atypical, he continued. “Elsewhere inthe country, people tend to respond to a crisis ofthis kind by getting into the bunkers and lying low.

But it’s been proven over and againthat this doesn’t work. Whatworks is to be open about theproblem and use what you’velearned to make improvements.”

Lessons and strategiesConway reviewed some of the

lessons the Institute has takenfrom the incident and thechanges made in its wake. Hedivided those lessons into fivecategories:

• Emphasize the role of exec-utive leadership. Leaders need toset a tone in which the responseto errors isn’t one of personalblame and punishment. Thefocus should be on finding theshortcomings in clinical systems –

whether medication ordering, drug dispensing, orelsewhere – and then correcting them. “As leaders,we have to make clear that it’s safe to stick yourneck out [to report errors or potential problems]

Chief Operations Officer Jim Conway has traveled around the country describing Dana-Farber’s successful efforts to enhance clinical safety. (Gina Iannacchero photo)

were presented to managers, supervisors, and the Executive Committee of theBoard of Trustees.

This month, reports about individual departments are being distributed tothe respective department heads, and the Joint Quality Improvement and RiskManagement Committee also plans to discuss the data that has emerged.

(The survey was conducted anonymously, and to ensure that individualstaffers cannot be identified in the analysis, Baird/Melnick has broken down theinformation into groups of 10 people and larger.)

Next stepsLooking ahead, members of the Executive

Management Group (EMG) will take a three-pronged approach to address major concernshighlighted in the process, according to Directorof Quality Improvement Charley Borden – whosedepartment led the survey project with HumanResources.

Institute-wide initiatives will be undertakenwith the active involvement of staff members,although those details have not yet been worked out.

Departments and work groups, meanwhile, willbe encouraged to hold discussions to “dig deeper intothe results, identify projects, and then launch them,”Borden says.

The third prong involves “easy fix” items, andHuman Resources and Quality Improvement now arelooking for ways to accommodate those suggestions.

Of those who filled out the questionnaire, 68 percentsaid they were extremely or generally satisfied with their work life at Dana-Farber. Another 8 percent said they were slightly satisfied, and the rest wereeither neutral or dissatisfied. Only 1 percent marked “extremely dissatisfied,”

versus the national norm of 5 percent for comparable institutions (researchand outpatient health-care organizations).

Those results are especially gratifying when one considers that competitive and financial pressures have driven down employee satisfactionin the health-care industry nationally over the past 15 years, according toBaird, whose company surveys hundreds of health-care institutions a year.

Among those areas receiving positive ratings at Dana-Farber wereexecutive leadership, supervisors, patient care and research, benefits,communications about the organization, and the DFCI culture andclimate. Most staff who filled out the survey said they like their col-leagues and are pleased they chose to work here.

Items that drew negative scores included salaries and perfor-mance recognition, communication and collaboration acrossdepartments, workloads, decisions about promotions and transfers,and workspace.

The results reveal lower DFCI satisfaction among severalgroups of employees, and there will be follow-up to betterunderstand and act on concerns aired by those groups, Borden notes.

Leaders believe the survey showed how well the staff andInstitute have withstood the changes and challenges of the pastfive years, and they believe the improvements resulting fromthis process will help strengthen DFCI’s position for the future.

“The survey results are very encouraging overall, butthey are also a clear call for action to do even better,” states

Benz. “There is a universally felt need for us to do better at communicatingacross our academic and administrative units and to find even better ways torecognize outstanding performance. We regard these results as our guide tomake Dana-Farber the very best place in which to work.” DR

Survey continued from page 1

and tell the truth without fear of retaliation,”Conway said. “When an error happens, theresponse should not be to send in a SWAT team toprobe what happened, but to bring peopletogether to review the problem and find a solu-tion. The people with the best ideas are usuallythose who know the system best.”

• Design systems to prevent errors. Examplesat Dana-Farber include the creation of a compu-terized system for entering drug orders, and aprogram in which pharmacists are part of the clinical decision-making team.

• Change the organizational approach toerrors. Instead of thinking that “everything’s fine,”health-care institutions should see endless oppor-tunities for enhancing quality and reducing thechances for error. Encourage staff to voice theirconcerns. Keep medication-ordering systemssimple without compromising safety.

• Promote teamwork. Reducing mistakes andimproving patient care depends not only onpeople working hard, but on working together,Conway said. Committees should include all thoseinvolved with a particular problem or procedure.

• Involve patients and family members.“Patients and families have to be treated as ourpartners, not just in responding to particularerrors or incidents, but in the very way we design,deliver, and process clinical care,” Conway said.“Patients can tell us a massive amount about thequality of care we provide and help us prioritizechanges that need to be made.”

Conway noted that error reduction should bepart of the intrinsic culture of health-care institu-tions, not something that springs into action solelyin response to a mishap. As evidence, he citedDana-Farber’s ongoing quality improvementprogram for all its operations.

The next presentations in the patient safetyseries are scheduled for Feb. 15, March 15, andMay 17 at noon. Please contact Leigh Holden inHuman Resources for more information. RL

Whether transporting bicycles across the state in his 18-wheeler during the Pan-Massachusetts

Challenge, joining Jimmy Fund Clinic patients for the last three miles of the Boston

Marathon® Jimmy Fund Walk, or simply greeting people with a warm word and hand-

shake at numerous other Institute-related events, Carl Einar Gustafson seemed always to be spreading

a message of triumph and hope to Dana-Farber patients, staff, and friends.It was less than three years ago that this gentle, 6-foot-5 giant from New Sweden, Maine,

emerged after a half century of anonymity as the original “Jimmy” who inspired the Jimmy Fund’screation in 1948. In that short period of time, however, Gustafson made a tremendous impact.From the moment he was “discovered” until he died at age 65 on Jan. 21 following a stroke, hegave selflessly to the organization that had saved his life years ago. In doing so, he helped manyothers face their own disease with courage and confidence.

“My favorite part of coming forward has been going to the Jimmy Fund Clinic and seeing thekids,” Gustafson said in 1998. Fifty years earlier, as a 12-year-old, he had been treated for what isnow known as non-Hodgkin’s lymphoma by Institute Founder Sidney Farber, M.D. “The kids areall so young, they don’t think about what’s happening to them or what made their treatments pos-sible. They just want to go home, like I did.

“You know, I’ll do anything to help the Jimmy Fund,” continued Gustafson. “This year, I’ve metpeople who ride their bikes all over Massachusetts, walk a marathon, golf – you name it – all to raisemoney to beat this darn disease. If they can devote that much of their time and effort, then I figure I can, too.”

Thank you, Einar, for doing just that – and so much more. ITI

Inside the Institute6 February 6, 2001

In July 1999, two of the Jimmy Fund’s most valuable players– Gustafson (far left) and Boston Red Sox baseball legendTed Williams (center) – had a historic meeting in the JimmyFund Clinic and reached out to fans of all ages.

A tribute to Einar ‘Jimmy’ Gustafson1935-2001

The summer following his 1948 radio broadcast that launched the Jimmy Fund,a young and healthy Einar Gustafson (above) sported the Boston Braves baseball uniform given him by the team. At left and below, during the May 1998“Welcome Back Jimmy” celebration at the Institute, Gustafson signed auto-graphs for hundreds of DFCI staff and friends during his first public appearanceas the rediscovered “Jimmy” – including volunteer Fifi Swerling Kellum (at left)and Philomena Grannell-Coburn of the Jimmy Fund Clinic.

“If we had tried to create agrown-up ‘Jimmy,’ we couldn’thave come up with a better onethan the real one, Einar. He wasabsolutely genuine – a completelykind, gentle, and generous man.”

– Jimmy Fund Chairman Mike Andrews

“Einar Gustafson’s story is the story of our nation’s war on cancer, and over the past five decades, tens ofthousands of people have ralliedagainst cancer in his name.”

– President Edward J. Benz Jr., M.D.

Photos by Mark Ostow, Steve Gilbert,

Jerry LeBlond, and Karen Cummings

7Inside the Institute February 6, 2001

“Jimmy” connected with people ofall ages and backgrounds. At his 1998 “Welcome

Back” celebration, he greeted pediatric patients (above) and, atright, then-DFCI President David G. Nathan, M.D. (far right), andJimmy Fund Chairman Mike Andrews.

During the two-and-a-half yearsbetween his “rediscovery”and his death, Gustafson wasan integral part of many Dana-Farber events. Above, he ledthe Patient and Family Walkcontingent during the 1998Boston Marathon Jimmy FundWalk; at left, he transportedbicycles for the 2000 Pan-Massachusetts Challengebikeathon with help from hisgrandson, Conor McLeod.

Gustafson always said hewould “do anything for theJimmy Fund,” but he didn’tbargain on skiing – which hedid for the first time in manyyears (above) at the 1999Sugarloaf Celebrity Cup inMaine to benefit the charity.

“Carl Einar Gustafson, a.k.a. ‘Jimmy,’ leaves his wife, threechildren, six grandchildren, and a legacy of hope for millions.”

– Dan Shaughnessy, Boston Globe

Thanks to the Chancellor Corp., Gustafson was able to take theJimmy Fund message nationwide after receiving a trailer (above)emblazoned with the charity’s slogan, “Because it takes morethan courage to beat cancer.”

Gustafson’s story touched people throughoutNew England, including a crowd at FenwayPark in May 1998, where he was introducedbefore a Red Sox–Yankees game (below)marking the 50th anniversary of the original“Jimmy” radio broadcast.

consultations with Nathaniel Katz, M.D., a neurol-ogist who is an attending physician at Brighamand Women’s Pain Management Center anddirector of the Pain Clinical Trials Center.

Materials are being prepared describing thenew program and listing the phone and pagernumbers of team members.

Research and educationAbrahm, who has written extensively on pal-

liative care issues, said she was attracted to Dana-Farber and Brigham and Women’s by the twoinstitutions’ commitment to palliative care and bythe opportunity to blend clinical care, education,and research into a single program.

“A great deal needs to be done, nationally, toeducate medical professionals about palliative andend-of-life care,” she says. “Palliative care is onlyrarely included in the educational curriculum forphysicians, nurses, and other caregivers. I’mhoping that the training program we develop canserve as a national model in this area.”

The new program will build on research andeducation activities already under way at Dana-Farber and its affiliates. “Research studies will helpus expand the knowledge base in this field,” saysSusan Block, M.D., chief of Adult Psychosocial

Oncology at Dana-Farber, who has been instru-mental in creating the new program. Current pro-jects include a study of caregiving relationshipsand end-of-life care, and a new model for edu-cating physicians in palliative care.

The Pain and Palliative Care Program will beallied with the Harvard Medical School Center forPalliative Care, which has developed a variety oftraining programs for clinicians, nurses, medicalstudents, and others.

“In Janet [Abrahm] we have a tremendousleader who will be able to build an effective teamfor working with patients and educating our staff,”Block says. “Palliative care addresses the sources ofsuffering that many people are most afraid of.Through this program, we can provide crucialsupport for patients and families as they gothrough this profound human crisis.” RL

Inside the Institute8 February 6, 2001

consultation service for both inpatient and outpatient care.

“Dana-Farber and Brigham and Women’s arefortunate to have in place a wealth of expertiserelating to pain and palliative care,” says Abrahm,a hematologist/oncologist who joined the Institutein January after 20 years at the University of Pennsylvania Health System.

There, in addition to leading a pain andsymptom management consultation service forpatients undergoing anti-tumor therapy, she devel-oped a disease-management program for patientsat the end of life. She also served as medicaldirector and director of education and research fora university-owned hospice center.

“This new program will build on the pain-management and palliative care services already

being provided here,” explains Abrahm, whosebook, A Physician’s Guide to Pain and SymptomManagement in Cancer Patients, was published lastyear by Johns Hopkins University Press. “Our goalis to enable Dana-Farber patients to have the bestpossible quality of life as they go through treat-ment or approach the end of their lives – whereverthey happen to be: in a hospital inpatient unit, anoutpatient setting, at home, or in a hospice.”

Allied expertsThe new program’s team will be available to

advise physicians or other caregivers who havequestions or concerns about pain or palliative careissues in individual patients.

“The team will be available to consult onmany kinds of physical problems or other sourcesof distress,” Abrahm says. “Patients may haveuncontrolled cough or nausea or troubling combi-nations of psychological, social, or spiritualissues.” In addition to Abrahm, Maureen Lynch,M.S., R.N., CS, AOCN, CHPN, and Mary Jane Ott,M.N., M.A., RNCS, serve as core members of thegroup, along with psychiatrists, chaplains, socialworkers, clinical pharmacists, and anesthesia painmanagement specialists.

“By having experts in each of these fields, we’llbe able to ensure that patients and families receivethe best palliative care,” Abrahm remarks. “We’llalso be equipped to teach the various componentsof palliative care both to interested staff membersand to each other.”

The team will also include a community coordinator – a nurse who helps the primaryoncology team keep in contact with patients whoare being cared for at home by family or withassistance from an agency. And the programmembers will work closely with the Institute’s palliative care resources nurses, who are based inmost disease centers.

“Our aim is to provide support for the primaryoncology teams, particularly in difficult orcomplex cases,” adds Abrahm.

Outpatients can also have appointments in thePain and Palliative Medicine clinic on Fridaymornings. In addition to team members listedabove, patients in the clinic will also have access to

Pain management continued from page 1

“Our goal is to enable patients to have the best possible quality of lifeas they go through treatment or approach the end of their lives.”

— Janet Abrahm, M.D.

The new program will build onresearch and education activitiesalready under way at Dana-Farber and its affiliates.

Volunteers are needed for theannual Fleet Scooper Bowl tobenefit the Jimmy Fund andDana-Farber Cancer Insti-tute.

June 6 - 8, 2000 (Tuesday - Thursday)11:30 AM to 6:00 PM Boston City Hall Plaza (Gov-ernment Center T Stop)

Shift 1: 11:00am to 1:30pmShift 2: 1:30pm to 4:00pmShift 3: 4:00pm to 6:30pm

Volunteers will receive a free T-shirt and all the ice creamthey can eat!

Please make sure to tell yourfriends and family that they

Volunteers are needed forthe annual Fleet ScooperBowl to benefit the JimmyFund and Dana-FarberCancer Institute.

June 6 - 8, 2000 (Tuesday - Thursday)11:30 AM to 6:00 PM Boston City Hall Plaza (Gov-ernment Center T Stop)

Shift 1: 11:00am to 1:30pmShift 2: 1:30pm to 4:00pmShift 3: 4:00pm to 6:30pm

Volunteers will receive a free T-shirt and all the ice creamthey can eat!

Please make sure to tell yourfriends and family that they

Volunteers are needed forthe annual Fleet ScooperBowl to benefit the JimmyFund and Dana-FarberCancer Institute.

June 6 - 8, 2000 (Tuesday - Thursday)11:30 AM to 6:00 PM Boston City Hall Plaza(Government Center TStop)

Shift 1: 11:00am to 1:30pmShift 2: 1:30pm to 4:00pmShift 3: 4:00pm to 6:30pm

Volunteers will receive a free T-shirt and all the ice creamthey can eat!

Please make sure to tell

More calendar listings forthe Institute and other affiliated organizations canbe found on DFCI Online, athttps://livelink.dfci.harvard.edu. Lookunder “Calendars.”

Seminars in Oncology

Tuesday, Feb. 6, 4 p.m.Smith Family Room, D1620

Speaker: Michael Greenberg,Ph.D., Professor of Neurologyand Neurobiology, Children’sHospital

“Signal Transduction PathwaysThat Regulate Differentiationand Survival in the DevelopingNervous System”

This is a Dana-Farber/HarvardCancer Center Seminar.

Tuesday Feb. 13, 4 p.m.Smith Family Room, D1620

Speaker: Joan Massague,Ph.D., Chair, Cell BiologyProgram, Memorial Sloan-Kettering Cancer Center“How Cells Read TGF-betaSignals”

Tuesday, Feb. 20, 4 p.m.Smith Family Room, D1620

Speaker: Frederick Alt, Ph.D.,Charles A. Janeway Professorof Pediatrics, Children’s Hospital“Impaired V(D)J Recombina-tion, IgH Class Switching andGenomic Stability in NHEJ-Defi-cient Mice”

This is a DF/HCC Seminar.

Tuesday, Feb. 27, 4 p.m.Jimmy Fund Auditorium“

Speaker: Tyler Jacks, Ph.D.,Professor of Biology, MITCenter for Cancer Research

“Modeling Cancer in theMouse”

The Leonard P. Zakim Centerfor Integrated Therapies presents:A lecture on Ayurveda, anancient Indian system of medicineThursday, Feb. 15, 3-4 p.m.Smith Family Room, Dana 1620

Ayurveda integrates the pre-vention and treatment of

illness by trying to maintainor reestablish the harmonybetween the mind, body, andforces of nature. It combinesa variety of interventionssuch as changes in lifestyle,exercise, and meditation.

Program Lecturer AbbasQutab, M.D., Ph.D., N.D., isthe founder of Elan VitalAyurvedic Medical Centers,with locations in Worcesterand Boston. He is a prac-ticing Ayurvedic physicianwho is internationally recog-nized in Ayurvedic Medicine.Qutab holds degrees in medi-cine, oriental medicine, chiro-practic, and Ayurvedicmedicine, and he is presidentof the Massachusetts Naturo-pathic Medical Association.

All patients, families, andstaff are invited. Refresh-ments will be provided; RSVPis appreciated.

For more information, pleasecontact the Zakim Center at(63)2-3322.

Happenings

Janet Abrahm, M.D., is director of the Institute's new Painand Palliative Care Program for adults. (Steven Skelton photo)