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Training Tracks - Hematology/Medical Oncology Fellowship

Supportive Care (SC) Fellowship Track

Outline: This is a 1 year educational experience, under the supervision of Dr. Steven Grunberg, available to a 2nd or 3rd year, largely clinic-based, Fellow with a special clinical or research interest in Supportive Care.

Educational Purpose: To complement the fellow’s training by developing a special understanding of and expertise in areas encompassing the diversity and depth of broadly defined supportive care including symptom management.

Spectrum of disorders, patient characteristics, procedures and services: Topics will include but are not limited to:

  • Evaluation and management of anemia, neutropenia, and thrombocytopenia
  • Evaluation and management of nausea and emesis
  • Assessment and control of cancer pain syndromes
  • Management of diarrhea and mucositis
  • Neuropathy and neurologic complications of cancer
  • Osteoporosis
  • Fatigue in the cancer patient
  • Assessment and treatment of hot flashes
  • Measurement of quality of life
  • Issues pertaining to cancer in the elderly
  • Prophylaxis and treatment of venous thromboembolism associated with cancer
  • Cognitive dysfunction and depression
  • Palliative surgery, radiation, and interventional pain control procedures

Teaching Methods: 

  • Attendance at local, regional, and national didactic lectures by experts. The fellow will develop a supportive care attendance ‘track’ along with the mentor at the ASCO meeting
  • Individual and group interactive discussions with mentor and faculty with specific strengths in selected supportive care areas
  • Practice-based learning (through caring for individual patients with a wide range of symptoms and supportive care needs along the entire palliative care continuum towards the end of life)
  • Systems-based practice (liaison closely with outpatient clinic pharmacist, nursing staff, and physicians to develop systematic plans and policies for a variety of common symptom and supportive care situations)
  • The Fellow will conceive, design, plan, and implement a clinical or research project,  analyze the data, and write a paper on the topic
  • Elective external rotations (up to 2 months)

 Educational Resources:

  • ASCO Symptom Control curriculum
  • Attend MAASC meeting
  • Dr. Steven Grunberg who will serve as the senior mentor
  • Textbook of Supportive Care (Klastersky, Weiss)
  • Subscription to Journal of Supportive Oncology
  • Up to 2 elective months away from the main institution for specialized experiences in supportive care, agreed upon by Dr. Grunberg

Teaching Rounds and Conferences:

The Fellow will research and assemble data and devise lectures for presentation at local and regional educational venues including but not limited to:

  • Annual Northern New England Fellows Conference
  • Vermont Cancer Center ASCO-ASH review
  • Journal Club
  • Fellows’ Tuesday AM seminar
  • Vermont Cancer Center Fellow Grand Rounds
  • Invited lectures at regional community hospitals

The fellow will attend Rounds or Conferences in other departments such as Psychiatry, Pharmacology, Palliative Care, and Ethics as appropriate and possible.


Evaluation Methods:  

  • Written evaluation by Dr. Grunberg
  • Additional written evaluations by pharmacist, nurse, co-fellows, and supervisors  of electives 

Hemostasis and Thrombosis Research Track

Outline
This is a 1-2 year experience available to a 2nd/3rd year Fellows in Hematology/Oncology interested in training in the fields of thrombosis, hemostasis and/or vascular disease epidemiology. Trainees at other levels or in other programs (fellows, residents, medical students) are welcome to participate by arrangement with a mentor. The program will consist of a unique experience designed by the trainee and their mentor to meet the trainee's goals using any elements herein.

Faculty

Hematology-Oncology
Mary Cushman, MD, MSc, Professor of Medicine and Pathology
Chris Holmes, MD, PhD Associate Professor of Medicine
Neil Zakai, MD, MSc, Assistant Professor of Medicine and Pathology

Pathology and Laboratory Medicine
Edwin Bovill, MD. Professor and Chair, Pathology; Director, Special Coagulation Laboratory, Fletcher Allen
Russell Tracy PhD. Professor of Pathology and Biochemistry
Sally Huber, PhD, Professor of Pathology
Nancy Jenny, PhD, Assistant Professor of Pathology

Biochemistry
 Paula Tracy, PhD. Professor and Interim Chair, Biochemistry
 Kenneth Mann, PhD, Professor, Biochemistry

Others as appropriate for specific projects

Goals
To train fellows in research through research projects in the general area of hemostasis and thrombosis. Projects relate to cardiovascular disease epidemiology or treatment, including arterial and venous disease, or to basic or translational aspects of hemostasis. Goals can be modified based on the needs of the candidate’s specific research project.

Possible Training Components:
1. Clinical:  Evaluation and management of patients with venous thrombosis. Principles of genetic counseling and treatment in those at high risk.

2. Epidemiology methods, including statistics and epidemiologic study design (primarily observational epidemiology, analysis of large data sets).

3. Opportunity to engage in Clinical Research training in the Masters or PhD program in Clinical and Translational Research or related course work toward another appropriate advanced degree.

4. Operational aspects of a laboratory doing translational or epidemiological research, including:

  • Logistical aspects of biological samples in multicenter studies
  • Clinical laboratory principles, including quality control and assurance
  • Assay methods including ELISA, chromogenic, automated coagulation tests, nephelometry, high throughput DNA analysis, multiplex technology  and novel assay development.
  • Quality assurance/quality control
  • Data analysis


5. Perform a research project to learn methods in molecular epidemiological research in vascular disease, including evaluation of phenotypic and genetic risk factors. Learn the role of this type of research for hypothesis formation about disease pathogenesis and public health applications.

6. Human Subjects research policy education.


Resources Available
1.  The Laboratory for Clinical Biochemistry Research (www.med.uvm.edu/lcbr) has over 40 ongoing independent and collaborative multi-site research projects focused on vascular diseases including heart disease, stroke, and venous thrombosis. Other interests are in obesity, diabetes, aging, dementia, frailty and HIV clinical course. We use a wide variety of assays in population and family-based research settings particularly in the areas of coagulation, fibrinolysis, thrombosis, inflammation, and immune system function, including cell manipulation assays. Results are linked to animal model studies, especially research in murine atherosclerosis. The main purposes are hypothesis formation about pathogenesis of vascular disease, but other interests involve public health applications. Over 2 million human biological samples are stored in the lab repository, for use in research. Projects here will usually involve development of collaborations with mentors at other institutions nationally or internationally. Office space at the LCBR or other site, and use of a computer with needed software (data analysis, word processing, endnote, etc), will be provided. PI’s include Drs. Bovill, R. Tracy, Cushman, Zakai, Huber, and Jenny.

2.  The Thrombosis and Hemostasis Program in the Division of Hematology-Oncology provides a clinical population of patients (primarily with venous thrombosis) in which clinical-translational research projects can be developed. Hospital-based projects related to quality improvement or other topics can be pursued. PI’s include Drs. Cushman, Holmes and Zakai.

3.  The Translational Research Laboratory of Dr. Holmes focuses on the role of the activated platelet in promoting coagulation and malignancy.  Projects focus on questions which bridge the clinic and laboratory and provide a unique opportunity to learn both laboratory research techniques and clinical research approaches. Opportunities for learning include 1) design and implementation of translational research and clinical trials, 2) introduction to the approval process for clinical trials through IRB submissions, 3) data management principles, 4) data analysis and 5) basic laboratory techniques. Based on trainee interest, projects may focus primarily on the clinical or basic science portions of a particular project or both. Ongoing collaborations are with the cardiology and oncology researchers.

4. Kenneth Mann. This program is aimed at understanding how thrombin is generated and how thrombin generation is regulated. Our approach comes via the convergence of four themes: 1) studies describing physical properties of coagulation enzyme complexes, their constituents and how these complexes assemble into efficient enzyme catalysts; 2) studies in which multiple coagulation catalysts/inhibitors are mixed to attempt to duplicate the performance of the combined catalyst system associated with the tissue factor pathway of thrombin expression (synthetic plasma); 3) studies in minimally modified biological systems (whole blood) to evaluate the correctness of hypotheses derived from purified systems; 4) studies with mathematical models (computer model) which can be used to quantitatively define the process of blood clotting both to aid in experimental designs 1,2,3; to evaluate pharmacologic agents, and to diagnosis and treat of hemostatic and thrombotic diseases. Other focused work relates to factor V structure and function, especially activated protein C resistance.

5. Paula Tracy. The principal objective of our laboratory is to develop a fundamental understanding of how platelets participate in and regulate the formation of the important bioregulatory effector molecule, thrombin. Thrombin generation is effected by a Ca2+-dependent, membrane-bound complex of the cofactor protein, factor Va, and the serine protease, factor Xa.

One specific goal is to provide a quantitative understanding of the integrally related kinetic and binding events regulating the functional interactions of factors Va and Xa with the platelet membrane surface. The membrane receptors, the intracellular signalling pathways and the enzymatic processes controlling these events are being identified using biochemical and molecular biological approaches. 

A second major goal is to define how megakaryocytes, platelet progenitor cells, developmentally regulate the endocytosis and possible synthesis of the required cofactor factor V(a), and to determine the cellular events regulating its endocytosis, its intracellular trafficking to storage granules and the phenotypic changes in the factor V molecule resulting from these interactions. Since the platelet-derived factor Va pool is essential for normal blood clotting, defining how platelets acquire this essential protein, process it and express it at their membrane surface is key in regulating thrombin generation.

The formation of thrombin at the surface of platelets is pivotal to the physiological and pathophysiological functions they provide as they localize to vascular and extravascular tissue sites.

Funding Opportunities
Some of us are faculty on an NIH Training Grant in Hemostasis at the University of Vermont (PI, Kenneth Mann), which may be used for project support. Other funding may be pursued from the American Heart Association and the Vermont Cancer Center. The American Society of Hematology also offers funding for trainees in Hematology research (www.hematology.org/education/awards/training_fellows.cfm).

Experiences for Fellows in Hematology-Oncology
1. One year+ continuity clinic in Thrombosis and Hemostasis.

2. Attendance at following meetings:

  • Laboratory Meetings of the lab(s) where the fellow is affiliated.
  • Monthly Interdisciplinary Vermont Vascular Medicine Conference
  • Thrombosis and Hemostasis Program weekly clinical meeting
  • At least weekly meeting with research mentor.
  • Quarterly Thrombosis and Hemostasis Program – Maternal Fetal Medicine Service clinical meeting.

3. Research Project:  The Fellow will identify a research mentor in their first fellowship year. It is expected that they will carry out a project and publish the results, including at least one presentation at a national meeting. Fellows are encouraged to write a research grant proposal to support their project, under the guidance of their mentor.

4. Often the fellow will spend their full third year, apart from the required continuity clinic, working on their research project.

5. It is recommended, but not required, that fellows spend a fourth year, so their research experience consists of 2 years of full-time years of research training.

Experiences for Trainees at Other Levels
These will be determined on an individual basis depending on the level of the trainee and the project undertaken.

Student, Postdoctoral Fellow, Resident Peer-reviewed Publications in past 5 years:

Medical Student

1. Cushman M, Cornell A, Folsom AR, Wang L, Tsai MY, Polak J, Tang Z. Associations of the B-fibrinogen Hae III and factor XIII Val34Leu gene variants with venous thrombosis. Thromb Res 2007;121:339-45.

2. Holmes CE, Huang JC, Pace TR, Howard AB, Muss H.  Tamoxifen and aromatase inhibitors differentially affect vascular endothelial growth factor and endostatin levels in women with breast cancer. Clinical Cancer Research 2008; 14(10): 3070-3076.

3. Holmes CE, Huang JC, Cartelli C, Howard AB, Rimmer, J & Cushman, MC.  The clinical diagnosis of heparin induced thrombocytopenia in patients receiving continuous renal replacement therapy. J Thromb Thrombolysis 2009, 27: 406-412.

4. Mitchell C, Kamenini A, Palmas W, Saad M, Cushman M. Association of tissue factor pathway inhibitor levels with cardiovascular risk factors and subclinical atherosclerosis in four ethnic groups: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2009;207:277-83.

5. Zinke RA, Ornstein DL, Holmes CE. Factor VIII/von Willebrand factor concentrate for treatment of life-threatening epistaxis in Glanzmann's thrombasthenia. Haemophilia 2010; 16:701-4.

PhD / Masters Student or Fellow

1. Kennedy M, Cushman M, et al. Risk factors for worsening ankle-brachial index in the elderly: the Cardiovascular Health Study. Arch Intern Med 2005;165:1896-1902.

2. Kennedy M, Andreescu ACM, Greenblatt MS, Jiang H, Thomas CA, Chassereau L, Wong C, Durda P, Cushman M. Factor V Leiden, prothrombin 20210A and the risk of venous thrombosis among cancer patients. British J Haematol 2005;128:386-8.

3. van der Hagen PB, Folsom AR, Jenny NS, Heckbert SR, O’Meara ES, Reich LM, Rosendaal FR, Cushman M. Subclinical atherosclerosis and risk of future venous thrombosis in the Cardiovascular Health Study.  J Thromb Haemost. 2006;4:1903-8

4. Cao J, Peterson D, Psaty BM, Kuller LH, Barzilay J, Bleyer A, Manolio TA, Wexler J, Blaum C, Cushman M. The association of microalbuminuria with clinical cardiovascular disease and subclinical atherosclerosis in the elderly: the Cardiovascular Health Study. Atherosclerosis 2006;187:372-7.

5. Shrivastava S, Ridker PM, Glynn RJ, Goldhaber SZ, Moll S, Bounameaux H, Bauer KA, Kessler CM, Cushman M. Plasma D-dimer, factor VIII coagulant activity, low-intensity warfarin and the risk of recurrent venous thromboembolism. J Thromb Haemost 2006;4:1208-14.

6. Zakai N, Jenny NS, Tracy RP, Reiner AP, Psaty BM, Schwartz S, Cushman M. Comparison of multiple inflammatory markers in the prediction of cardiovascular disease in older men and women. J Thromb Haemost 2007;5:1128-35.

7. Cao JJ, Arnold AM, Manolio TA, Psaty BM, Hirsch CH, Polak JF, Kuller LH, Cushman M.  Association of carotid artery intima-media thickness, plaques and C-reactive protein with future cardiovascular disease and all-cause mortality:  the Cardiovascular Health Study. Circulation 2007;116:32-8.

8. Cao JJ, Biggs ML, Barzilay J, Konen J, Psaty BM, Kuller L, Bleyer AJ, Olson J, Wexler J, Summerson J, Cushman M. Cardiovascular  and mortality risk prediction and stratification using urinary albumin excretion in older adults ages 68-102: the Cardiovascular Health Study. Atherosclerosis 197;2008:806-13.

9. van Stralen KJ, Doggen CJM, Lumley T, Cushman M, Folsom AR, Psaty BM, Siscovick D, Rosendaal FR, Heckbert SR. Exercise in relation to venous thrombosis risk in elderly people. J Am Geriatr Soc 2008;56:517-22.

10. Olson N, O’Meara ES, Jenny NS, Folsom AR, Bovill EG, Furberg CD, Heckbert SR, Psaty BM, Cushman M. Lipoprotein-associated phospholipase A(2) and risk of venous thrombosis in older adults. Am J Hematol 2008;83:524-7.

11. Suzuki T, Katz R, Jenny NS, LeWinter MM, Zakai NA, Barzilay JI, Cushman M. Metabolic syndrome, inflammation, and the incidence of congestive heart failure in the elderly: the Cardiovascular Health Study. Circ Heart Fail 2008;1:242-8.

12. Suzuki T, Jenny NS, Solomon C, Furberg C, Psaty BM, Nelson JJ, Cushman M. Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) and Risk of Congestive Heart Failure in Older Adults: Results from the Cardiovascular Health Study. Circulation Heart Fail 2009;2:429-36.

13. Snoep JD, Gaussem P, Eikenboom JC, Emmerich J, Zwaginga JJ, Holmes CE, Vos HL, de Groot PG, Herrington DM, Bray PF, Rosendaal FR, van der Bom JG. The minor allele of GP6 T13254C is associated with decreased platelet activation and a reduced risk of recurrent cardiovascular events and mortaliy: results from the SMILE-platelets project. In press, J Thromb Haemost 2010.

14. Bambace NM, Levis JE, Holmes CE. The effect of P2Y-mediated platelet activation on the release of VEGF and endostatin from platelets.

Resident

1. Zakai NA, Katz R, Hirsch C, Shlipak MG, Chaves P, Newman A, Cushman M. Prospective study of anemia status, hemoglobin and mortality in the elderly: the Cardiovascular Health Study. Arch Intern Med 2005;165:1-7.

2. Sampson JE, Harmon ML, Cushman M, Krawitt EL. Corticosteroid-responsive Cronkhite-Canada syndrome complicated by thrombosis. Dig Dis Sci 2007;52:1137-40.

3. Influence of Preparative Procedures on Assay of Platelet Function and Apparent Effects of Antiplatelet Agents.  Am J 2007; 100: 727-7.

4. Rughani, A., Holmes, C.E., Penar, P.L. A novel association between a chronic subdural hematoma and a fibrinolytic pathway defect, Neurosurgery, 2009, 64(6):E1192.

5. Rughani AI, Holmes CE, Penar PL. A novel association between a chronic subdural hematoma and a fibrinolytic pathway defect: case report. Neurosurgery 2009, 21:85-93

6. Brooks EG, Trotman W, Wadsworth MP, taatjes Ds, Evans MF, Ittleman FP, Callas PW, Esmon CT, Bovill EG. Valves of the deep venous system: an overlooked risk factor.

Examples of Faculty Publications in Past Year

1. Holmes, CE, Levis, J, Ornstein, DL. Activated platelets enhance ovarian cancer cell invasion in a cellular model of metastasis, Clin Exp Metastasis 2009;26:653-61

2. Zakai NA, McClure L, Prineas R, Howard G, McClellan W, Holmes CE, Newsome BB, Warnock DG, Cushman MC. Correlates of Anemia in American Blacks and Whites: The REGARDS Renal Ancillary Study. Am Journal Epidemiol 2009, 169: 355-364.

3. Ganesh SK*, Zakai NA*, van Rooij FJA*, Soranzo N*, et al. Multiple loci influence erythrocyte phenotypes in the CHARGE consortium. Nature Genet 2009;41:1191-8 . *contributed equally as first and last authors.

4. Ho GYF, Xiu X, Cushman M, McKeown-Eyssen G, Sandler RS, Ahnen DS, Barry EL, Saibil F, Bresalier RS, Rohan TE, Baron JA. Antagonistic effects of aspirin and folic acid on inflammation markers and subsequent risk of recurrent colorectal adenomas.  J Natl Cancer Inst 2009;101:1650-4

5. Cushman M, O’Meara ES, Folsom AR, Heckbert SR. Coagulation factors IX through XIII and the risk of future venous thrombosis:  the Longitudinal Investigation of Thromboembolism Etiology. Blood 2009;114:2878-83.

6. Cushman M, McClure L, Howard G, Howard, VJ, Jenny NS. Implications of increased C-reactive protein for cardiovascular risk stratification in black and white men and women in the US. Clin Chem 2009;55:1627-36.

7. Hasstedt SJ, Bezemer ID, Callas PW, Vossen CY, Trotman W, Hebbel RP, Demers C, Rosendaal Fr, Bovill EG. Cell adhesion molecule 1:  novel risk factor for venous thrombosis. Blood 2009;114:3084-91.

8. The Emerging Risk Factors Collaboration. Lipoprotein (a) concentration and the risk of coronary heart disease, stroke and nonvascular mortality: the Emerging Risk Factors Collaboration. JAMA 2009;302:412-23.

9. Jenny NS, Cushman M, , Solomon C, Furberg C, Tracy RP, Psaty BM, Nelson JJ. Association of lipoprotein-associated phospholipase A2 (Lp-PLA2) and coronary and cerebrovascular disease in older adults: results from the Cardiovascular Health Study. Atherosclerosis 2010;209:528-32. 

10. Cushman M, McClure L, Lakoski S, Jenny NS. Eligibility for statin therapy by the JUPITER criteria and subsequent mortality: the REGARDS cohort. Am J Cardiol 2010;105:77-81

11. Emerging Risk Factors Collaboration. C-reactive protein concentration and risk of coronary heart disease, stroke and mortality: an individual participant meta-analysis. Lancet 2010;375:132-40.

12. Holmes CE, Ramos-Nino ME, Littenberg B. An association between anti-platelet drug use and reduced cancer prevalence in diabetic patients: results from the Vermont Diabetes Information System Study. BMC Cancer 2010;10:289.

13. Cushman M, Callas PW, Denenberg JO, Bovill EG, Criqui MH.  Risk factors for peripheral venous disease resemble those for venous thrombosis:  the San Diego Population Study. J Thromb Haemost 2010;8:1730-5.

14. Jenny NS, Brown ER, Detrano R, Folsom AR, Saad MF, Shea S, Szklo M, Herrington DM and Jacobs D, Jr. Association of inflammatory markers with coronary artery calcification: results from the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2010;209:226-229

15. Levine GN, D'Amico AV, Berger P, Clark PE, Eckel RH, Keating NL Milani RV, Sagalowsky AI, Smith MR, Zakai NA. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. Circ Heart Fail. 2010;121(6):833-40.

16. Zakai NA, Lutsey PL, Folsom AR, Heckbert SR, Cushman M. Total tissue factor pathway inhibitor and venous thrombosis. The Longitudinal Investigation of Thromboembolism Etiology. Thromb Haemost. 2010;104(2).

17. Douketis J, Tosetto A, Marcucci M, Baglin R, Cushman M, Eichinger S, Palareti G, Poli D, Tait RC, Iorio A.  Patient-level meta-analysis: effect of measurement timing, threshold and patient age on ability of D-dimer testing to assess recurrence risk after unprovoked venous thromboembolism. Ann Intern Med 2010;153:523-31.

    Past and Current Trainees

    Past

    1. Matthew Hsieh, Medical Student Research. Epidemiology of Heparin-induced Thrombocytopenia in a University Hospital: Impact of a Pharmacy-based Surveillance Program.  1997-8. 1 publication. Current position: Staff Clinician, Hematologist, NIH/NIDDK.

    2. Kurt Oettel, MD, Internal Medicine Residency Research Project. Inflammation Markers and  Risk of Subsequent Cancer in an Elderly Cohort: the Cardiovascular Health Study. 1997-8. One abstract. Current position: Private Practice, Hematology-Oncology Gunderson Clinic Lutheran Hospital, La Crosse, WI.

    3. Astrid Andreescu, MD, MSc.  Hematology/Oncology Fellowship Research. Risk Factors for Venous Thrombosis. 1998-2000. Funding, American Heart Association, Northeast Consortium Fellowship. Four publications. Current position: Hematology-Oncology Section Head, Eastern Maine Medical Center, Bangor, ME.

    4. Jie J. Cao, MD. Cardiology Fellowship Research. Inflammation, Carotid Ultrasound, and Risk of Ischemic Stroke. 1999-2001. Funding, departmental. One abstract, one manuscript. Winner, Sandra Dougherty Award for Excellence in Cardiovascular Disease and Hypertension Epidemiology, American Heart Association Council on Epidemiology and Prevention, 2002. Current position: Assistant Professor State University of New York, Stony Brook, and Director of Cardiac MRI and CT Labs, St. Francis Hospital, Roslyn, NY.

    5. Margaret Kennedy, MD. Hematology/Oncology Fellowship Research. Genetic Risk Factors for Venous Thrombosis in Cancer Patients. 2000-01. Funding, CALGB Foundation Clinical Research Award. 2001-03. NHLBI Hemostasis and Thrombosis Training Grant. Two abstracts. Two manuscripts. Finalist, Jeremiah and Rose Stamler Research Award for New Investigators, American Heart Association Council on Epidemiology and Prevention, 2003. Current Position: Assistant Professor, Temple University; Private Practice, Hematology/Thrombosis. Assistant director of coagulation laboratory, Western Pennsylvania Hospital, Pittsburgh, PA.

    6. Alexandra Cornell. Medical Student. Summer Research Fellowship. Polymorphisms of Factor XIII and Fibrinogen as Risk Factors for Venous Thrombosis. 2001. Funding, University of Vermont College of Medicine Dean’s Office. 1 abstract. 1 manuscript. Trainee Travel Award, American Heart Association. Current Position: Fellow in Pediatric Pulmonology, Columbia University.

    7. Neil Zakai, MD & John Wright, MD. Internal Medicine Residency Research Project. Efficacy of Deep Venous Thrombosis Prophylaxis in Medical Inpatients.  2003-04. 1 paper. Current Position:  Zakai see below. Wright, Private Practice Internal Medicine, Burlington, VT.

    8. Neil Zakai, MD, MSc. Internal Medicine Residency Research Project. Anemia and the risk of mortality in the elderly. 2004. 1 paper. Current Position. Assistant Professor of Medicine, Hematology-Oncology Division, University of Vermont (7/2007).

    9. Erik Rufa, MD & Peter Ward, MD. Internal Medicine Residency Research Project. The Impact of Purple Grape Juice on Platelet Activation. 2004-2006. Winner, Harriet Dustan P. Award for Residency Research. 

    10. Chad T. Mitchell. Medical. UVM Dean’s Office Student Summer Fellowship. NHLBI Hemostasis and Thrombosis Training Grant, T32 HL07594. Association of Tissue Factor Pathway Inhibitor with Cardiovascular Risk Factors and Subclinical Atherosclerosis: the Multiethnic Study of Atherosclerosis. 2004-6. 1 abstract, 1 paper. Current Position:  Hospitalist, Fletcher Allen Health Care, Burlington, VT.

    11. Joe Huang.  Medical Student.   Tamoxifen and aromatase inhibitors differentially affect vascular endothelial growth factor and endostatin levels in women with breast cancer.   The clinical diagnosis of heparin induced thrombocytopenia in patients receiving continuous renal replacement therapy. 2 papers.  Current position:  Hematology / Oncology Fellow, University of Washington, Fred Hutchinson Cancer Center.

    12.  Philippine van der Hagen. Visiting MS student from Leiden University. The association of atherosclerosis with risk of venous thrombosis. 2005. 1 paper. Current position: Clinical Research Associate, Pfizer, Amsterdam, the Netherlands.

    13. Nels Olson. Doctoral candidate, Molecular Biology, UVM. Association of LpPLA2 with risk of venous thrombosis (epidemiology project to complement basic research training). 1 paper. 2005-6. Current Position:  PhD student, UVM.

    14. Takeki Suzuki, MD. Cardiology Fellow Research / Masters of Public Health Research Project (Johns Hopkins University). Funding: NHLBI T32 in Cardiovascular Medicine. Inflammation, metabolic syndrome and risk of congestive heart failure in the elderly. 2007-9. 3 papers. Current Position: PhD student in molecular biology, University of Tokyo.

    15. Nadia Bambace, MD, Internal Medicine Residency Research. Impact of ADP on VEGF and endostatin release from platelets. Funding: American Society of Hematology Trainee Research Award. 2006-7. 1 paper. Harriet P. Dustan Award for Residency Research.  Current Position:  Hematology/Oncology Fellow, UVM, Fletcher Allen.

    16. Rick Zinke. Medical Student.  Factor VIII/von Willebrand factor concentrate for treatment of life threatening epistaxis in Glanzmann’s thrombasthenia.  2009 National medical students competition award for clinical research, American College of Physicians.  2008-9. 1 paper.  Current Position:  Internal Medicine Resident. University of Wisconsin.

    17. Steven Emmons, MD. Hematology/Oncology Fellowship Research. Quinine-induced Intrasvascular Coagulopathy with Features of both Thrombotic Thrombocytopenia Purpura and Disseminated Intravascular Coagulation. 1 abstract.  Current Position:  Assistant Professor, University of Vermont, Hematology Oncology.

    Current

    1. Nadia Bambace, MD, Fellow in Hematology-Oncology. Two projects: Impact of platelet agonists and antagonists on angiogenic protein release from platelets in women with breast cancer. Clinical trial of complex lymphedema therapy to treat post-thrombotic syndrome.

    2. Marissa J. Engbers, MD. PhD student in Epidemiology, Leiden University. Age and Thrombosis: Acquired and Genetic Risk Factors in the Elderly. Funding: Fondation Leducq Transatlantic Network of Excellence in Cardiovascular Research (grant 04 CVD 02)

    3. Locke Bryan, MD. Resident in Internal Medicine. P-selection and Risk of Chronic Venous Disease. Funding:  American Society of Hematology Research Training Award. 1 abstract.

    4. Sarah Gillett. MD, PhD Student. Inflammation and the Risk of Cognitive Decline. Funding: NHLBI T32 Hemostasis and Thrombosis Training Grant.

    5. N. Brad Adams, MD, Fellow in Hematology-Oncology. Association of Statin Use with Hemostasis Factors: the Multi-Ethnic Study of Atherosclerosis. Funding: departmental. 1 abstract.

    6. Jagoda Jasielec, M.D.  Internal Medicine Resident.  The impact of aspirin therapy on angiogenic protein levels in women receiving tamoxifen therapy.

    7. Irina Arkhipova-Jenkin. Medical Student. Predictors of use of  Venous Thrombo-embolism Prophylaxis in Medical Patients.

    8. Catherine Mygatt. Medical Student. Pathology Student Fellowship. Fatal Venous Thromboembolism in Medical Patients. 

    Cancer Genetics Fellowship Track

    Outline: This is a 1-2 year experience available to a 2nd/3rd year Fellow in Hematology/Oncology interested in intensive training in the field of cancer genetics including clinical, research, and educational components.

    Faculty:

    • Marie E. Wood, MD, Professor of Medicine, Director, Familial Cancer Program, 
      Track Supervisor)
    • Marc S. Greenblatt, MD, Associate Professor of Medicine
    • Wendy McKinnon, MS, Cancer Genetic Counselor
    • Sandy May, Research Assistant, Molecular Diagnostic Laboratory
    • Marcus Bosenberg MD, PhD, Assistant Professor of Pathology
    • Cheung Wong, MD, Associate Professor, Dept. of OB/GYN, Director of GYN/ONC
    • Richard Zubarik, MD, Assistant Professor of Medicine, Chief of Endoscopy
    • Robin Hayden, MSN, APRN

    Goals:

    The overall goal of this program will be to educate physicians regarding the practice of cancer genetics and become familiar with basic science and clinical research issues in cancer genetics. Participants will:

    • Learn how to identify and evaluate patients with a strong family history of cancer.
    • Learn how to perform individualized cancer risk assessment based on family histories.
    • Gain an in-depth understanding of high-risk cancer screening for individuals with hereditary/familial risk for cancer.
    • Become knowledgeable about cancer prevention strategies for high-risk individuals
    • Understand how and when to use genetic testing for hereditary cancer
    • Gain an understanding of available options (research and clinical) for cancer genetic testing.
    • Become familiar with risks, benefits, and limitations of cancer genetic testing
    • Learn how to manage patients with hereditary cancer with special emphasis on breast and colon cancer
    • Develop cancer genetics counseling skills
    • Appreciate the scientific and ethical principles of conducting research in the field

    Responsibilities

    1. One weekly half-day cancer genetics continuity clinic in addition to regular continuity clinics

    2. Attendance at following meetings:

    a.  Twice monthly Familial Cancer Program meetings (1st/3rd Wed of the month)

    b.  Molecular Diagnostic weekly laboratory meeting

    c.  Weekly Breast (Thursday-noon) and monthly Gastrointestinal (1st Monday AM) Tumor Board.

    3. Clinical/Laboratory Research Project

    4. The Fellow will identify a research mentor and is expected to carry out a project with the intention of publishing the results. Fellows are encouraged to either write a research grant proposal under the guidance of a mentor or a clinical trial and submit to the institutional review board.

    Didactic Lectures/Topics

    Topics will include:

    1. Laboratory Methods in Genetic Testing
    2. Principals of Genetics
    3. Genetic Counseling/Testing
    4. Risk Assessment
    5. Ethical, Legal, and Social Implications of Cancer Genetic Testing
    6. Cancer Genetic Syndromes
          a.  Hereditary Breast/Ovarian Cancer
          b.  Hereditary Colon Cancer
          c.  Hereditary Melanoma
          d.  Pediatric Cancer Genetic Syndromes
          e.  Multiple Endocrine Neoplasia
    7. Complete review of ASCO Cancer Genetics curriculum


    Breast Oncology Fellowship Track

    Outline: This is a 1-2 year experience available to a 2nd/3rd year Fellow in Hematology/Oncology interested in intensive training in the field of Breast Oncology including clinical, research, and educational components.

    Faculty:

    Medicine – Hematology/Oncology

    • Marie E. Wood, MD, Professor of Medicine, Director, Familial Cancer Program  (Track supervisor)
    • Patricia O’Brien, MD, Director of Lymphedema Clinic
      • 

    Surgical Oncology

    • Seth Harlow, M.D., Associate Professor of Surgery, Director of Breast Clinic
    • David Krag, MD, Professor of Surgery
    • Ted James, MD, Assistant Professor of Surgery

    Pathology

    • Donald Weaver MD, Professor of Pathology 
    • Gladwyn Leiman, Professor and Director of Cytopathology
    • Abiy Ambaye, Assistant Professor of Pathology 
      • 

    Radiology

    • Robert Oppenheimer, MD, Professor of Radiology  
    • Susan Harvey, MD, Assistant Professor of Radiology
      • 

    Radiation Oncology

    • Ruth Heimann, MD, Professor of Radiology 
    • Deborah Rubin, MD, Associate Professor of Radiology
      • 

    Vermont Cancer Center

    • Russ Hovey, PhD, Assistant Professor  (mammary gland biology)
      • 

    Office of Health Promotion Research

    • Berta Geller PhD, Research Assoicate Professor

    Goals:
    The overall goal of this program will be to educate physicians regarding the multidisciplinary practice of breast oncology and become familiar with basic science and clinical research pertaining to breast cancer. Participants will:

    • Learn how to evaluate and make multi-modality decisions for treatment of early breast cancer, develop expertise in management of advanced breast cancer as well as breast cancer in the elderly
    • Become familiar with  the principal issues in pathologic and other prognostic assessments, as well as special imaging studies employed specifically for the evaluation of breast cancer
    • Understand cancer risk assessment, develop cancer genetic counseling skills and gain experience in use of genetic testing in the prevention and management of hereditary breast cancer syndromes (see related Cancer Genetics Track goals)
    • Appreciate local and national clinical research processes and directions, as well as the scientific and ethical principles of conducting research in the area

    Responsibilities

    • One weekly half-day session at Breast Multidisciplinary Clinic in addition to regular continuity clinics for a minimum period of 6 months
    • One weekly half-day session at Cancer Genetics clinic in addition to regular continuity clinics for a minimum period of 6 months
    • At least one year of a Fellow continuity clinic will be with Dr Muss, Dr Burdette-Radoux, or Dr Wood caring for breast cancer patients.
    • At least 4 sessions at Lymphedema Clinic
    • Accrue and follow patients on CALGB, NSABP, and Vermont Cancer Center breast cancer protocols
    • Observe examples of breast biopsies, surgical procedures (lumpectomy, partial and total mastectomy, and reconstructive surgery)
    • Observe treatment planning for breast irradiation.
    • Attendance at following meetings:

              Twice monthly Familial Cancer Program meetings (1st/3rd Wed of the month)

              Weekly Breast Tumor Board (Thursday 12-1pm)

               Monthly Breast Protocol Review Committee (4th Thursday 8-9am)

               Clinical/Laboratory Research Project (REQUIRED)

    The Fellow will identify a research mentor and is expected to carry out a project with the intention of publishing the results. Fellows are encouraged to either write a research grant proposal under the guidance of a laboratory research mentor or design and begin accrual to a clinical trial

    Meeting attendance with poster or abstract submission to:

    • ASCO breast cancer sessions and present high impact abstracts at ASCO ASH Review conference (usually fully funded)
    • Miami Breast Cancer Conference (fully funded)
    • San Antonio Breast Cancer Conference (Partial travel and Dues)
    • Cancer and Leukemia Group B Breast and Cancer in the Elderly Committee meetings (Fully funded)
    • Observe breast cancer support group meetings, attend Schwartz Rounds (when pertinent and possible), present to survivors at Stowe Weekend of Hope as well as to breast cancer health care providers and staff at annual Vermont Cancer Center breast cancer symposium. 

     Educational Methods

    Didactic Lecture Topics

    • Evaluation and management of early and advanced breast cancer
    • Principles and practice of cancer genetics and counseling
    • Palliative and End of Life Care
      • 

     Self study

    • Review of ASCO MKSAP curriculum in Breast Cancer
    • Textbook of Breast Diseases

     Conferences and meeting attendance

    • University of Vermont Medicine, Pathology and Surgical Grand Rounds as well as Vermont Cancer Center Research Seminars pertaining to breast cancer.
    • Miami Breast Cancer Conference (Fully funded)
    • San Antonio Breast Cancer Conference (Partial travel and Dues)
    • Cancer and Leukemia Group B Breast committee

    Evaluation Methods:

    • Written evaluation by Dr. Marie Wood
    • Additional written evaluations as pertinent by research mentor, and supervisors of pertinent electives