Experiments at University of Kentucky show that a plant grown mainly in the state has promise in treating deadly ovarian cancer

Patrick Perry of the UK College of Agriculture, Food and
Environment holds an Artemisia annua seedling grown at
UK's Spindletop Farm. (UK photo by Pete Comparoni)

By Jenni Ho

University of Kentucky

A new study at UK's Markey Cancer Center shows that Artemisia annua, a plant grown mainly in Kentucky to produce a substance used to treat malaria, shows promise in treating ovarian cancer.

The study, published in Diagnostics, found that artesunate, synthesized from artemisia, kills ovarian cancer cells in multiple systems designed to model possible clinical trials.

Ovarian cancer has a high death rate. It accounts for 1.3% of new cancer cases, but is predicted to be responsible for 2.3% of cancer deaths this year. The national death rate is about 60 percent, and Kentucky's rate is higher because Kentucky women are screened for it less than the national average.

The standard of care for advanced ovarian cancer is chemotherapy with carboplatin and paclitaxel. The researchers determined that artesunate, in combination with those two drugs and by itself, has anti-cancer activity at concentrations that are achievable in clinic patients.

“Artesunate is historically used as an anti-malarial, but with emerging evidence, it demonstrates its anti-cancer activity,” said Jill Kolesar, a pharmacy professor and administrative director of Markey’s Precision Medicine Clinic. “This supports bringing it into the clinic and we hope to have positive outcomes for these patients, based on our preclinical data.”

Kentucky is the only state growing substantial quantities of artemisia, so it could become a new epicenter for growing the plant worldwide. The plant’s growth process is similar to that of tobacco.

“We’re growing Artemisia on Kentucky farms, studying it in our Kentucky lab, and now moving it into Kentucky clinics,” Kolesar said. “Potentially improving the economy of the state and developing a cancer treatment for your patients – that’s truly a dream.”

Study: Rural women with ovarian cancer are more likely to be diagnosed later, but not because of greater distance to doctors

Rural women who have ovarian cancer are more likely to find out about it when it's already at stage IV than women who live in metropolitan areas, according to a study just published in The Journal of Rural Health.

That matters, because early detection makes survival more likely. From 2000 to 2015, the five-year survival rate of stage IV ovarian cancer was only 29 percent. The American Cancer Society estimates that 23,000 women were diagnosed with ovarian cancer in 2019, and about 14,000 died or will die from it. That includes 280 new cases in Kentucky, and 190 deaths.

Researchers at the University of Iowa and the Centers for Disease Control and Prevention studied about 1,000 women in Iowa, Kansas and Missouri who had been diagnosed with ovarian cancer in 2011-12. At the time they were diagnosed, 111 had stage IV and 889 had stages I-III. Stage IV patients were more likely to be older, rural, and have other health problems.

It is tempting to attribute that difference to poverty, or to difficulty in accessing care, but the study controlled for those factors. Rural women were more likely to be diagnosed with late-stage ovarian cancer regardless of the socioeconomic status of their census tract or the distance to their primary-care provider.

This disparity also isn't likely related to lifestyle factors such as smoking, obesity, or lack of physical activity; though such factors are more prevalent in rural areas, they aren't prominent risk factors for ovarian cancer. And though such lifestyle factors could create a higher incidence of cancer, they aren't likely to create geographic-survival or diagnostic disparities, researchers said.

Rural cancer patients generally have poorer outcomes than non-rural patients, including a lower survival rate. That's true of rural ovarian-cancer patients too, probably because of less access to specialty care and treatment after diagnosis.

The researchers suggest that if rural women had better access to gynecological specialists in urban areas, it could make a difference, since those doctors are highly trained and may be able to recognize the symptoms of ovarian cancer sooner than other health-care providers.

Most diagnosed with ovarian cancer die of it, but a special type of screening, free at six sites in Kentucky, can reverse the odds

State legislators joined University of Kentucky officials to promote ovarian cancer screening. (UK photo)

Ovarian cancer is deadly sneaky. When detected early, it is often curable, but most women who have it don't have any symptoms until it has progressed to an advanced stage, when survival is unlikely. Screening and early detection are critical to saving lives.

As part of National Ovarian Cancer Awareness Month, UK HealthCare is celebrating its Markey Cancer Center's Ovarian Cancer Screening Program, which screens women free of charge at six locations: Lexington, Elizabethtown, Somerset, Prestonsburg, Maysville and Paducah.

For 50 years, ovarian cancer has caused more deaths than any other cancer of the female reproductive system, and is fifth in cancer deaths among women.

The American Cancer Society estimates that in 2019, about 23,000 women will get a new diagnosis of ovarian cancer and about 14,000 of them will die from it. In Kentucky, the ACS estimates about 280 women will be newly diagnosed with ovarian cancer this year and 190 will die from it. Thus, the predicted national death rate is 61 percent, the Kentucky rate 68 percent, probably because Kentucky women don't get screened as much.

Dr. John R. van Nagell Jr., a gynecologic oncologist at the cancer center, said the five-year survival rate of women whose cancer was detected by screening is 86 percent, twice as high as the rate among those who don't get screened.

“While regular pelvic examinations are important and can detect many other abnormalities, including cervical cancer, they are not effective in detecting ovarian cancer in its earliest and most treatable stages,” he said in a release.

Van Nagell and his colleagues started the screening program in 1987 to see if the use of transvaginal sonography, a form of ultrasound, could detect ovarian cancer early. The painless, radiation-free procedure is able to detect tumors that are too small to be diagnosed during a gynecological exam.

Research from the screening program, published in the medical journal Obstetrics and Gynecology last year, found that annual ultrasound screening of women who are at risk of ovarian cancer and have no symptoms can save the lives of those who unknowingly have early-stage ovarian cancer.

tinaswish.org graphic

Over the program's 32 years, nearly 350,000 free screening examinations have been provided to more than 48,000 Kentucky women; 607 ovarian tumors, more than 100 of them malignant, have been detected.

Women from every county in the state have participated in the program, according to the release.

The Kentucky Extension Homemakers Association and the Telford Foundation provided the initial funding for the program.

“We are extremely proud of the Kentucky Extension Homemakers Association’s dedication to this life saving program,” Nancy Cox, dean of the UK College of Agriculture, Food and Nutrition, said in the release. “Their fundraising efforts have raised nearly $1.5 million but their work really goes beyond fundraising. They routinely participate in the screening program, organize trips to screening sites from around the state, promote ovarian cancer awareness, and host educational events regarding ovarian cancer. This program positively impacts Kentucky women and represents the kind of research that should be conducted by a state's land-grant university.”

The UK screening program is free and open to women age 50 or older, or women over 25 who have a family history of ovarian cancer. For more information, call 859-323-4687 or 800-766-8279.

In a state thick with cancer, leaders of screening and research organizations targeted for cuts make cases for state money

Mammograms are a screening for breast cancer. (WTVQ image)

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin's proposed budget for the next two fiscal years calls for cuts to five cancer research and prevention programs, including screenings for breast, colon, cervical, lung and ovarian cancer, and for research on lung cancer, all of which plague the state.

The programs are included in a list of 70 that Bevin proposed to eliminate to save the state $85 million, or less than 1 percent of the overall budget. He has said these cuts are necessary to help fund the state's ailing pension system.

Dr. Whitney Jones, a Louisville gastroenterologist and founder of the Kentucky Cancer Foundation, which provides funds for colon-cancer screening, said he recognizes the challenges of balancing a state budget, but hopes the state will reconsider eliminating the colon cancer screening and prevention program. He said of Bevin, "We hope this is just his first position."

Jones, who also founded the Colon Cancer Prevention Project in Louisville, called the state's improvement from 49th to 19th for colo-rectal screening in the past 15 years, "the best public health story" in Kentucky.

He added that this was only possible because the state offered screenings to uninsured and under-insured Kentuckians, expanded Medicaid to those who earn up to 138 percent of the federal poverty level, and has a unique, multi-partner screening program -- all of which he said makes Kentucky "the envy of most states in the nation."

But he also said there is still work to be done, because Kentucky still leads the nation in colon cancer and remains in the top 10 for colon-cancer deaths.

Doug Hogan, a spokesman for the state Cabinet for Health and Family Services, said the state's screening programs, including those for colon, breast and cervical cancer, are no longer needed because they are now covered by all insurance plans with no deductibles or co-payments.

Jones acknowledged that the program needs to be restructured because of the Medicaid expansion, but argues that it is still necessary for several reasons. He said Kentucky still has a large number of people without health insurance; the federal law that requires almost all Americans to have insurance or pay a tax penalty will be repealed at the end of the year; the coming work requirements and premiums in Medicaid will lead to some people going without coverage; and there will be a continuing need for education and outreach about cancer and screening.

"There has to be a better way to cut out the bad and support or maintain the good," Jones said. "And I would just suggest that the Kentucky Colon Cancer Screening Program is the baby, and not the bathwater."

Lung cancer research targeted in a state that has the most of it

Another program set to lose about $5 million is the Lung Cancer Research Grant Program, a collaboration between the University of Kentucky and University of Louisville that is funded by funds from states' 1998 settlement with cigarette manufacturers. UK's portion is $2.4 million, spokesman Jay Blanton said.

Dr. Mark Evers of UK's Markey Cancer Institute said this statewide initiative seeds a number of pilot projects and "spans the gamut" from new lung-cancer therapies and treatments to new clinical trials and prevention strategies, such as lung-cancer screening. He said such pilot programs are often used to help get larger grants from the National Institutes of Health and other sources.

Evers noted that the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative (the Kentucky LEADS Collaborative for short), now funded by a $7 million Bristol-Myers Squibb Foundation grant, is a great example of how a pilot project from this research grant program was able to get a larger grant to further its work.

"It really is a valuable mechanism for us to provide pilot funding for investigators to get the initial data so that they can carry that forward in larger extramural grants," Evers said.

He also noted that the research grant program is responsible for the Kentucky Clinical Trials Network, which he described as another joint venture with U of L that "pushes out" clinical trials for lung cancer, which have been conducted in about 90 percent of Kentucky's counties.

Asked if the program could survive without the state funding, Blanton, who sat in on the telephone interview with Evers, said, "We're just trying to get our arms around the numbers right now."

Asked why the program is important, Evers pointed to the state's high smoking rate, second in the nation, and its No. 1 rank in number of lung-cancer cases. "We've got a terrible problem with this in the state," Evers said.

When Kentucky researchers made a pitch to the National Cancer Institute, Evers said, "The first words out of their mouth were, 'What are you guys doing about your smoking problem?' So, it's really incumbent upon us to be able to have the resources to attack this by screening, prevention and treatment."

While Kentucky LEADS is on Bevin's list of programs that would get no state funding in the next two fiscal years, it has never received any, said Jamie Studts, a UK professor of behavioral science and the lead investigator for the collaborative. He said it had been slated to get $10,000 in each year of the current budget, but that Bevin had "red-lined" the allocation.

Studts said that the cut "doesn't directly affect us in terms of dollars, but indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Breast and cervical cancer: state squeezes local health departments

As for the screening programs for breast and cervical cancer, Hogan said that in addition to these screenings now being covered by insurance, they are also operated by federal funds, so elimination of any state funds would not impact them.

Allison Adams, president of the Kentucky Health Department Association, said that while it's true that the breast and cervical screening programs have not received any state dollars for several years and get some federal funds, most of their funding for these programs come from local tax dollars.

For example, she said that in the fiscal year that ended in June 2017, local health departments received about $607,000 in federal funding for breast and cervical cancer screening, and the rest came from $2.3 million in local dollars. The programs serve about 20,000 patients a year.

Adams said the real challenge for health departments to continue such programs, or any of the other initiatives that involves direct patient care, is that Bevin's budget has added $38.5 million to their annual pension liability. She said that will force the departments to provide programs that focus on overall health, safety and prevention and look for ways to spend $1 to affect 10 people, instead of $10 to affect one.

"Local health departments need to be working on the prevention piece, and less on the treatment and intervention," Adams said, but they "will have to do their own prioritization and determine which programs have the absolute most health benefit for all of Kentuckians. We really have to make some tough decisions of where we are going to spend our money that's going to have the greater impact over the health of Kentucky."

The Ovarian Cancer Screening Program is also slated to be cut. Linda Blackford of the Lexington Herald-Leader reports that this UK program offers free vaginal ultrasound screenings to women for ovarian cancer and has provided nearly 50,000 free screenings since its creation 30 years ago.

Blackford notes that the Pediatric Cancer Research Trust Fund, established in 2015 by Sen. Max Wise, R-Campbellsville, has been approved to receive $2.5 million in each year of the biennium to fund pediatric brain cancer research at UK and U of L. Bevin's budget calls for each of the universities to provide a minimum of $1.2 million a year for the program.

Bevin's budget boosts efforts against opioid abuse but would cut several health programs, including poison control center

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Gov. Matt Bevin's proposed budget would boost programs that fight substance-use disorders and the state's over-burdened social-services system, but calls for cuts to other health-related programs, including the state's only poison control center and one that trains doctors in rural parts of the state.

Bevin's proposal to the General Assembly calls for an additional $34 million to fight the opioid epidemic, with a focus on helping pregnant women addicted to drugs. It also includes $24 million to hire more social workers and give raises to those already employed.

Medicaid, which covers about one-third of the state's population, is the state's largest health expense. The governor's budget recommendation for Medicaid is around $11.5 billion in the first year and $11.8 billion in the second year, mostly from federal funds. The Kentucky Hospital Association told Kentucky Health News that it was pleased with the numbers.

"It looked like there was just a minimal reduction so we were pleased that the budget maintained the funding for Medicaid," said Nancy Galvagni, senior vice president of the association. "We understand from talking with people at the Cabinet [for Health and Family Services] that they consider it funded going forward."

Administration officials told reporters at a Jan. 17 budget briefing that the Medicaid budget had been included in the governor's across-the-board 6.25 percent cuts, but the cut was taken from the projected need of the Medicaid program, not current funding.

The governor also proposed that 70 state programs lose all of their funding, with a projected savings of $85 million a year. At least nine of them related to health. Some haven't received state funding in recent years, but others have depended on it.

One of those is Norton Kosair Children's Hospital Poison Control Center, which is the state's only poison control center, serving all 120 counties. It received $729,000 in each of the past two fiscal years from the state, Joe Sonka reports for Insider Louisville.

Maggie Roetker, a spokeswoman for Norton Healthcare, told Sonka that the funding amounts to 43 percent of the poison center's $1.7 million annual budget. She said the federal government provides $234,000 and Norton makes up the rest.

Sonka reports that according to the center's current service contract with the state, it fields about 70,000 callers a year; saves Kentuckians more than $10 million a year by keeping people out of emergency rooms; and saves Kentuckians $3 to $5 million per year by consulting with patients who are already hospitalized by a poison, which decreases the length of their stay.

Another program set to lose funding is Madisonville's Trover Clinic, for a program that allows medical students from the University of Louisville to complete the last two years of medical school in rural communities. The Kentucky Center for Economic Policy reports that this program is scheduled to receive $910,000 in the fiscal year that ends June 30.

Two other health-related programs on the governor's chopping block include the Lung Cancer Research Grants Program at U of L and the University of Kentucky, which is getting $5,176,100 in the current fiscal year and the Autism Training Center, now getting $119,300, according to KCEP.

The budget would "eliminate state funding for five cancer research or prevention programs, including . . . screening programs for colon, breast, cervical and ovarian cancer," Linda Blackford reports for the Lexington Herald-Leader. But it includes $2.5 million each year in new money for the Pediatric Cancer Research Trust Fund, for brain-cancer research at the two universities, which would have to each provide $1.2 million to match the state appropriation.

The fund was created in 2015 by Sen. Max Wise, R-Campbellsville, whose son Carter, now 10, had cancer when he was six months old. Wise said he and the universities asked for $9.8 million over two years. "It shouldn't be a competition, but unfortunately it is," Wise told Blackford. "We were not trying to play priorities or favorites."

The screening programs for breast and cervical cancer are operated with federal funds, so elimination of any state funds would not impact it, said Doug Hogan, spokesman for the Cabinet for Health and Family Services. Hogan said the colon-cancer screening program had not received state funds for several years.

"Health screenings for preventive services are covered by all insurance plans and there are no deductibles or co-pays," Hogan said. "That applies to various preventive screens including those for colon, breast and cervical cancers."

Jaimie Studts, professor of behavioral science at the UK College of Medicine, said the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative, also called the Kentucky LEADS Collaborative, has never received any state funding. He said it was slated to get $10,000 in each year of the current budget, but Bevin "red-lined" the allocation, saying the health secretary would need to determine how best to spend that money.

Including the program among the list of 70 to be cut "doesn't directly affect us in terms of dollars," Studts said. "But indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Some other health programs on the list hadn't received any funding from the state for the past several years: ARC of Kentucky, a group that supports people with intellectual and developmental disabilities, and Madison County Early Intervention Services. They were not scheduled to get any funding in the 2018 fiscal year, according to KCEP. It has published a list of programs proposed for elimination and the current appropriation for each.

Bevin says his cuts are necessary to fully fund the state's pension obligations, with his budget setting aside about $3.3 billion, or 15 percent of state spending, for that purpose.

Opponents of the governor's budget cuts are calling for raising new tax revenue through comprehensive tax reform, which the governor said could happen in 2018. However, his office said in his budget news release that "He is calling for genuine tax reform that will make Kentucky more competitive with its neighboring states -- not merely a bump in the sales tax or an increase in the cigarette tax."

Ovarian cancer screening is critical in detecting tumors that don't show up on clinical exams, and increases chance of survival

Kentucky First Lady Jane Beshear joined some of the state's female legislators to highlight the importance of screening for ovarian cancer, which can be done for free through the University of Kentucky Markey Cancer Center's ovarian cancer screening program.

Ovarian cancer is fifth among cancer killers of American women and accounts for more cancer-related deaths, causing more deaths than any other cancer of the female reproductive system, says the federal Centers for Disease Control and Prevention.

SYMPTOMS OF OVARIAN CANCER (CDC)

When ovarian cancer is found in its early stages, treatment is most effective, but most women with ovarian cancer don't have symptoms of it until the disease progresses into a more advanced stage. As it progresses, survival rates drop sharply, making screening and early detection critical. Data from the screening program at UK shows that regular screening increases survival rates, says a UK news release.

"This preventative ovarian cancer screening is free, quick and confidential – an easy way for women to protect themselves from this life-threatening illness," Jane Beshear said. "This simple procedure is available to women in all parts of Kentucky, not just the Lexington area, and I encourage all who are at-risk for the disease to participate in the program."

Dr. John van Nagell, professor of obstetrics and gynecology at the Markey Cancer Center, said "While regular pelvic examinations are important and can detect many other abnormalities, including cervical cancer, they are not effective in detecting ovarian cancer in its earliest and most treatable stages."

Van Nagell started the screening program in 1987 to test the use of transvaginal sonography to detect ovarian tumors that are too small to be detected during an annual exam, says the release. Over the program's 26 year period, more than 241,000 free screening examinations have been provided to more than 41,000 Kentucky women, and 558 ovarian tumors and 86 malignancies have been detected.

Women from every county in the state have participated in this program, says the release. Screenings through the program are now being performed in Lexington, Elizabethtown, Somerset, Prestonsburg, Maysville, Paducah and Greenup County.

All women are at risk for ovarian cancer, but older women are more likely to get the disease. About 90 percent of women who get it are older than 40, says the CDC.

The UK screening program is free and open to women age 50 or older, or women over the age of 25 who have a family history of ovarian cancer. For more information, call (859) 323-4687 or (800) 766-8279. Click here for more CDC information.

Markey Cancer Center at UK gets National Cancer Institute designation, opening up new treatment options for patients

The University of Kentucky annouced Friday that its Markey Cancer Center has earned a prestigious National Cancer Institute designation. With this designation, the center becomes one of 68 in the U.S., and the only one in Kentucky, with special access to clinical trials, new treatments and new drugs for patients.

Kentucky ranks first in the nation in cancer deaths per 100,000 residents, and cancer is especially problematic in Appalachia, where the overall cancer rate is 12 percent higher than in the United States.

The designation signifies national excellence in clinical care and cancer research, a UK news release said. It allows Markey patients to join specialized drug or treatment trials that are open only to NCI centers, and it also opens up funding for researchers at UK, said Michael Karpf, UK's executive vice president for health affairs.

"It's the ultimate recognition for academic cancer centers," Markey Executive Director Mark Evers said. It will help UK battle cancers that plague the state, particularly lung and colorectal cancers, Evers said in a story by Linda Blackford of the Lexington Herald-Leader. To earn the designation, the center had to pass a rigorous review that began four years ago and will be renewed every five years, says the UK release.

UK officials said the designation will boost the state and local economy through research funding, and advanced cancer research could also generate more high-tech, health care jobs in the state.  "It strengthens Markey’s reputation as a frontrunner in cancer treatment and research," the UK release said.

Clinic in Greenup will offer free ovarian cancer screenings for Northeast Ky. women

Women in Northeastern Kentucky will be able to receive free ovarian cancer screenings thanks to funding that will set up a clinic in Greenup County.

The clinic is intended for women in Lewis, Carter, Elliott, Greenup and Boyd counties, as well as two counties in Ohio, but "certainly anyone who arrives at the clinic who meets the requirements will be eligible for screening," said Parry Barrows, spokeswoman for Gov. Steve Beshear's office. Eligible women must be age 50 and older or over the age of 25 who have a family history of ovarian cancer.

The clinic will be an expansion of a program that has been in place in Lexington since 1987. As of September, more than 200,000 screenings have been performed on more than 37,000 Kentucky women as part of the program.

To build the clinic, which will be located in the Greenup County Health Department, a $200,000 Appalachian Regional Commission grant will be combined with $45,000 from UK. The health department will contribute $66,600.

"Funding will go toward purchasing required equipment and furnishings, as well as provide program operations for up to 3 years," saysa press release from Beshear's office. "UK will train local ultrasound technicians to facilitate the scans and the UK Markey Cancer Center will read the scans and deliver patient reports."

"Establishing this satellite clinic ... will help save lives by giving women in northeast Kentucky and southern Ohio better access to free ovarian cancer screenings," said Chris Crum, director of the Greenup County Health Department. (Read more)