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Mount Sinai Experts Discuss the Future of Cancer Care and Research

Updated on Mar 7, 2023 | Featured, Research

More than 50 years after the United States formally declared war on cancer, what is the prognosis for innovative cancer research and care?

Two Mount Sinai leaders in cancer care and research, Ramon Parsons, MD, PhD, Director of The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, and Cardinale Smith, MD, PhD, Vice President, Cancer Clinical Services for the Mount Sinai Health System, offered their perspectives as part of a recent 92nd Street Y online event. You can watch the video here.

The two agreed on this overarching message: Tremendous progress has been made in unraveling the complex biology of cancer and targeting its many forms with advanced new medicines, particularly immunotherapies. But looming just as large are the challenges that remain in areas like overcoming resistance to these medicines, early detection of cancer through screening, and ensuring the equitable distribution of cancer care to diverse and disadvantaged populations.

Ramon Parsons, MD, PhD

“After 50 years we have a much more sophisticated understanding of how genes are altered in the cancer cell and how cancer cells reprogram the tumor microenvironment,” said Dr. Parsons, the Ward-Coleman Chair in Cancer Research. “And that has pushed the envelope in terms of our knowledge of the biology of cancer and, just as importantly, how we treat it. We’re seeing better outcomes for more and more of our patients and believe cancer rates will continue to come down because of treatments we didn’t have in the past, and more informed prevention.”

Dr. Smith, who is also Chief Medical Officer for the Tisch Cancer Hospital and a Professor of Medicine (Hematology and Medical Oncology), described the dramatic changes in cancer care and treatment, particularly in her specialized field of lung cancer.

“When I finished my fellowship training 12 years ago we had just two drugs for lung cancer, and now there are so many more,” she said. “Patients I treated as a fellow are still alive today thanks to clinical trials for new investigative drugs they were able to enroll in.”

Immunotherapies have carved out many of the greatest gains, while also raising some obstacles for the research community. Immunotherapy refers to treatments that use a person’s own immune system to fight cancer.

“The next frontier is determining which patients are going to have a long-term response to immunotherapy, and how do we overcome the resistance we so often see with these therapies,” said Dr. Parsons. “That’s the biology we still need to figure out, and to that end some of the research we’re most excited about is aimed at helping us better understand the switches in the immune system and how they can be regulated therapeutically.”

Two other areas of research where Dr. Parsons sees great promise are tumor suppressors, which are genes that regulate a cell during cell division, and liquid biopsies, which can detect through a simple blood test at the doctor’s office circulating tumor cells and tumor DNA.

With a strong background in tumor suppressors, he sees great advantage in being able to develop gene therapy or other innovative approaches to restore tumor suppressors, a natural part of the body’s defense mechanism that becomes altered or mutated in almost every type of cancer.

Liquid biopsies, still in early-stage development, could be another significant development. “This idea of being able to catch cancers before they are recognizable is going to ultimately move the needle in improving patient survival,” he said.

Cardinale Smith, MD, PhD

For Dr. Smith, early detection includes more aggressive screening by the health care providers.

“Uptake of lung cancer screening has been slow,” she said. “A lot of the work we’ve been doing at Mount Sinai is connecting with the community to understand what their needs are and how they prefer to partner with us. As a result, we’ve increased mammographies for women to detect breast cancer, and improved colorectal cancer screening for both men and women. Now we need to make the same kind of progress with lung cancer screening.”

She noted that as part of its outreach, Mount Sinai in April 2022 launched the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit after noticing a high mortality rate for the disease in certain neighborhoods of New York City with a high Black male population. The purchase was funded by a $3.8 million donation from philanthropist Robert F. Smith. This successful effort between the Institute and the Department of Urology has been collecting blood samples to measure PSA levels and referring individuals for follow-up care when a problem is detected.

The nation’s war on cancer formally began with the National Cancer Act of 1971, which established the National Cancer Institute. As for the future of cancer care, Dr. Smith foresees patient care navigation and a palliative care workforce as movements with transformative potential.

Navigators with the ability to compassionately guide people through the often challenging cancer screening and treatment process would be an extremely beneficial allocation of resources, she maintains. So would development of specialized palliative care teams that could provide training and skills to oncologists and other clinicians, including nurses and advanced practice providers.

“We know that palliative care when combined with standard oncologic care can improve patients’ quality of life and mood by decreasing depression,” she said. “It also decreases unnecessary utilization of acute care, such as emergency room visits, hospitalizations, and readmission. Most importantly, it aligns cancer care with the goals and values of the patients, which all of us as clinicians need to hold as sacred in the years ahead.”

What Should I Do If My Child Has Norovirus?

Updated on Feb 24, 2023 | Adolescent Health, Featured, Pediatrics, Your Health

If your child has a stomach bug, it could be norovirus—a highly contagious stomach virus that causes diarrhea and vomiting. Cases of this virus are on the rise in New York City and much of the northeastern United States, according to the Centers for Disease Control and Prevention.

While typically mild in older children and adults, lasting usually only a few days, norovirus can cause severe dehydration in babies and kids with certain underlying conditions. Knowing how to care for them is crucial.

In this Q&A, Tessa Scripps, MD, a pediatrician at the Mount Sinai Kravis Children’s Hospital, and Assistant Professor of Pediatrics at the Icahn School of Medicine and Mount Sinai, answers your questions about the disease, including what to do if your child is sick.

What is norovirus, and what are norovirus symptoms?

Norovirus is a common contagious virus that inflames the intestines, causing nausea, diarrhea, and throwing up. Sometimes it can also cause fever. The disease is spread when particles from an infected person’s feces or vomit spreads to others, typically in bathrooms, but also by eating or drinking contaminated foods and beverages; using contaminated utensils; touching contaminated surfaces; or having any direct contact with someone who is infected. Norovirus is highly transmissible, and infected people can actually shed billions of norovirus particles at a time, but it can take fewer than 100 norovirus particles to make another person sick. People are most contagious when they actively have symptoms and in the few days after their symptoms have resolved.

Tessa Scripps, MD

How can I protect my child from catching norovirus?

The most common way norovirus is spread is through close contact with an infected person, so it’s a good idea to keep kids some distance from people who are sick, or who have recently recovered from being sick. Norovirus can infect an entire family at the same time, since even simple contact with others can lead to infection. So, the most important thing is for kids to wash hands frequently with soap and warm water, and for adults to do the same, especially if any of you have been in contact with a person who has symptoms. Alcohol-based sanitizers do not work as effectively against preventing transmission.

My child has norovirus. How does their age or health condition affect their risk for severe illness?

Newborn babies and children who have underlying chronic illnesses such as kidney disease and diabetes are at higher risk for becoming dehydrated and severely ill because excessive fluid losses can affect their kidney and their liver function. It’s important they get medical attention right away if symptoms last longer than three days or if they’re unable to keep hydrated.

What symptoms might indicate my child needs medical help?

Watch for symptoms of dehydration, such as decreased or less frequent urination and small volume- or very dark or strong-smelling urine. If it has been more than eight hours from when your child has had a wet diaper or used the toilet to pee, reach out to your doctor for advice. A rapid heart rate or a significant change in your child’s activity can also be a sign of dehydration. If you notice that your child seems very lethargic and listless, you should seek medical advice right away.

What can I do to help my child recover from norovirus?

Once the virus has passed and the vomiting and diarrhea have subsided, make sure they are well hydrated and rested. For newborns and infants, you can give them small amounts of breast milk or formula. Toddlers, older children, and adults should drink small volumes of fluids—about one to two ounces every one to two hours—to ensure fluids get absorbed and to prevent recurrent vomiting. Drinking water and electrolyte fluids like Pedialyte^®, Gatorade, or watered down apple juice can be very useful to maintain hydration, and can help prevent complications from norovirus. They can also have bland foods like rice, dry cereal, applesauce, bananas, and crackers.

Are there any medications I can give my child to ease their norovirus symptoms?

There are no over-the-counter anti-diarrheals or anti-nausea medicines that are recommended for children. In rare cases, pediatricians may prescribe Zofran, an anti-emetic, to help children stop vomiting so they can re-hydrate without the need for intravenous fluids.

How do I prevent norovirus from spreading to my other kids?

It is important that everyone in your house washes their hands regularly with warm water, and avoid sharing food and drinking cups with anyone who is sick. You should also wipe down any contaminated surfaces with a bleach-based disinfectant, especially toilets and sinks after an infected child has used them. And everyone should try to maintain some distance from infected household members while they’re actively sick.

Is there a test for norovirus I can give my child?

Testing is available. However, norovirus is similar to other types of stomach infections, such as rotavirus, and symptom management is the same, so testing isn’t useful. If there has been an outbreak at your child’s school and they are sick, there is a good chance they have norovirus.

The Doctor’s Doctor Will See You Now: Students Learn the Role of the Pathologist Is Much More Than What You See on TV

Updated on Feb 24, 2023 | Featured

More than 60 students representing the medical and graduate schools of Icahn Mount Sinai recently toured the New York City Office of Chief Medical Examiner to gain a better understanding of the role of pathologist, often called the doctor’s doctor. Photo credit: Office of the Chief Medical Examiner

You may think you know all about the work of a pathologist from all the television shows and films that focus on forensic pathology and solving crimes.

Barbara Sampson, MD, PhD, has a slightly different view. She refers to pathologists as the doctor’s doctor. That’s because these doctors are the experts upon whom other doctors routinely rely when trying to reach a diagnosis for their patient.

Before joining Mount Sinai’s Pathology Department in December of 2021, Dr. Sampson served as New York City’s Chief Medical Examiner, the largest medical examiner’s office in the United States, for almost a decade. Now she is working with medical students to help them gain a better understanding of the role of pathologist.

“My mission is to enlighten first-year and second-year students about the fascinating field of pathology before they differentiate into other areas of medicine,” says Dr. Sampson, Vice Chair for Strategic Laboratory Initiatives and Academic Affairs in the Department of Pathology, Molecular, and Cell Based Medicine at the Icahn School of Medicine at Mount Sinai.

So far, her efforts seem to be paying off. Dr. Sampson recently organized a field trip to the New York City Office of Chief Medical Examiner to give medical students a window into the cutting-edge science of pathology and forensic biology. The event was attended by more than 60 students representing the medical and graduate schools of Icahn Mount Sinai.

Students learned about DNA crime evidence analysis, the ongoing effort to identify victims of the 2001 World Trade Center attacks, and molecular autopsies that can identify genetic mutations responsible for sudden natural deaths and alert family members about inherited medical conditions. They also toured the Medical Examiner’s DNA training lab facilities and learned about its history of innovations to analyze the most challenging items of evidence.

“My mission is to enlighten first-year and second-year students about the fascinating field of pathology before they differentiate into other areas of medicine,” says Barbara Sampson, MD, PhD.

For second-year medical students Walter Jacob and Lucy Greenwald, who lead the Pathology Interest Group for students, the visit was an eye-opener.

“The thing that stood out the most for me was the emphasis on the World Trade Center disaster and learning that they are still working on identifying multiple hundreds of people who have yet to be identified. It was just amazing to think that this office is still working tirelessly,” he said.

She added, “When they started telling us about their WTC work, the mood was intense. We were listening intently, with awe. It was inspiring to hear the personal relationships they had developed with families over the years and how they meet with families annually, around the time of the anniversary, to provide an update and to let families know they are still searching for answers.”

Since taking over as leaders of the Pathology Interest Group, the two have organized several events to introduce students to pathology. They recently invited students to a tie-dye T-shirt workshop to celebrate the work of pathology, which uses a variety of stains to enhance the appearance of cells under a microscope.

“In a similar event, we set up shadowing for pathology specimens that come in mid surgery, allowing students to see up close how a pathologist plays a critical role during an oncological surgery. The pathologist makes the final call on whether the surgeon has successfully cut out the cancer with clean margins,” she said.

“Most specialties are patient-facing but, for the most part, pathology aids clinicians in the diagnosis of disease, like a doctor’s doctor.”

The Pathology Interest Group has organized several events to introduce students to pathology, including a tie-dye T-shirt workshop to celebrate the work of pathology, which uses a variety of stains to enhance the appearance of cells under a microscope.

Increased Privacy and Care Await Patients in New Cardiac Unit at Mount Sinai Morningside

Updated on Mar 29, 2023 | Featured

If you’ve ever been hospitalized due to a heart problem, you may know that a little privacy and extra care can make a big difference in your recovery.

In fact, research has found that patients can expect to have a better recovery if they have a room to themselves rather than sharing with another patient; stay in rooms close to a nurses’ station on their floor; and are in a location that affords a clear line of sight from the nurses’ station.

That’s why Mount Sinai Morningside has opened a new inpatient unit, 4 West, for patients undergoing cardiac surgery and other cardiac procedures, and those needing a more intense level of heart monitoring, such as those who have experienced heart failure. The unit has 14 private rooms with bathrooms, flat-screen TVs, digital message boards, and a central monitoring station located at the nurses’ station.

“This wonderful new unit has the look and feel of a five-star hotel,” said John D. Puskas, MD, Chair of the Department of Cardiac Surgery for Mount Sinai Morningside, Mount Sinai West, and Mount Sinai Beth Israel. “The real benefit though is that all the private rooms are clearly visible from, and located in relatively close proximity to, the nurses’ station.”

These rooms are designed to support patients’ rapid recovery. In addition, patients will be discharged directly from 4 West, so they don’t have to be transferred between hospital units.

“This unit ensures the environment the patients recover in matches the outstanding quality of care they receive from our surgeons, physicians, nurses, technicians, and more,” said Sean P. Pinney, MD, FACC, FAST, FHFSA, Chief of Cardiology, Mount Sinai Morningside. “Treating patients is both about care and comfort. We excel in providing the care, and with this unit, we give patients the privacy needed to fully recover.”

In addition, patients receive treatment from the unit’s highly skilled nurses. “They serve as advocates for their patients and work with the rest of the team to provide the best possible outcomes,” said Beth Oliver, DNP, RN, FAAN, Senior Vice President and Chief Nursing Executive, Mount Sinai Health System.

All rooms are modern with large windows that look across to the Columbia University campus, and are equipped with advanced medical technology. The unit also includes a family lounge, pantry, and a conference room for interdisciplinary consultation.

“Mount Sinai Morningside has become an important hub for cardiology and cardiac surgery, especially coronary bypass surgery,” said Arthur A. Gianelli, President, Mount Sinai Morningside. “The high level of care we are providing warranted this investment in our hospital and our community.”

Mount Sinai Heart at Mount Sinai Morningside offers a full range of cardiology services including cardiac surgery, cardiac catheterization, cardiac rehabilitation, catheter ablation, computed tomography angiography, electrophysiology, cardiac positron emission tomography/computed tomography, and other non-invasive diagnostics to treat coronary artery disease, atrial fibrillation and other abnormal heart rhythms; peripheral artery disease; and peripheral vascular disease.

Dubin Breast Center Annual Benefit Honors a Tennis Champion Who Is Also a Breast Cancer Survivor

Jan 25, 2023 | Featured, Patient Stories

Mary Joe Fernandez was one of the top professional tennis players in the United States during the 1990s in both singles and doubles. She won two Grand Slam doubles titles, first at the 1991 Australian Open and then at the 1996 French Open. She also won two Olympic Gold medals in doubles. After retiring in 2000, she became captain of the U.S. Fed Cup team and a television commentator for ESPN.

But after her annual mammogram in 2017, everything changed. She was diagnosed with breast cancer. Fortunately, a friend suggested she call the Dubin Breast Center. Once she arrived and met with the team, she knew she had found the right place for her treatment and recovery.

Mary Joe Fernandez and her husband, Anthony Godsick

“My journey with the Dubin Breast Center has been one of compassion and caring—and of confidence,” she says. “They really have mastered how to make a really difficult time in a woman’s life into something they can get through and have hope.”

Ms. Fernandez was one of two women honored at the Dubin Breast Center Annual Benefit, which celebrated its 12th anniversary. She recounted her story in an emotional video that was presented during the event.

The event was held Monday, December 12, at the Ziegfeld Ballroom in New York. More than 300 guests attended, and the event raised more than $3 million to support the Dubin Breast Center of The Tisch Cancer Institute at Mount Sinai Health System.

The second honoree was Hanna Yoko Irie, MD, PhD, Associate Professor of Medicine (Hematology and Medical Oncology, and Oncological Sciences) at the Icahn School of Medicine at Mount Sinai. She was honored for her contributions to the field of breast cancer research—most notably her work in triple-negative breast cancer, which is both more aggressive and harder to treat than other types—and for the care she provides to her patients at the Dubin Breast Center.

“We’ve been able to find new genes that promote or drive the growth of a subset of these triple-negative breast cancers,” Dr. Irie says, “targeting specific pathways but also understanding better how we can help boost the immune system.” Dr. Irie’s contributions to the Center as a physician-scientist were also described in this video.

The event was hosted by Mount Sinai Health System Trustee Eva Andersson-Dubin, MD, who founded the Center, and Elisa Port, MD, FACS, Chief of Breast Surgery and the Center’s Co-Director.

“The mission of the Dubin Breast Center has always been to deliver the most cutting-edge, groundbreaking research combined with the most compassionate care,” says Dr. Port. You can hear more from Dr. Port in a video that was also presented at the gala.

The Dubin Breast Center is also leading the way in early detection and was the first in New York City to offer 3D mammography. The Center performs more than 12,000 mammograms a year.

“Under the direction of Dr. Eva Andersson-Dubin and Dr. Elisa Port, the Dubin Breast Center will transform breast cancer research and care for decades to come,” says Kenneth L. Davis, MD, President of the Mount Sinai Health System.

See all the videos and read more about the Gala

What You Need to Know About the Latest COVID-19 Variant

Jan 24, 2023 | COVID-19, Featured, Vaccines, Your Health

You may have noticed that more people you know have gotten COVID-19 recently. One reason is the virus that causes COVID-19 continues to evolve into variants that are more contagious.

The latest one is known as XBB.1.5, and since early December it has become the predominant variant in the New York metropolitan area, according to the Centers for Disease Control and Prevention (CDC).

This variant is thought to be highly transmissible due to its ability to partially evade antibodies produced through vaccines or past infections. However, the vaccines still offer excellent protection against severe illness and death.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

In this Q&A, Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, explains more about the new variant and how to protect yourself.

No matter the variant, it is important to remember that COVID-19 is not going away. The key is to reduce transmission to those who are at risk of getting seriously ill:

If you feel sick, stay at home.
If you want to be more vigilant, wear a high-quality mask, avoid being unmasked at large indoor gatherings (such as eating at restaurants), especially when infection rates in your area are very high.
If you are at high-risk for a serious infection, talk with your medical provider so you are prepared should you get infected.
Don’t forget to get your flu shot; you can get that at the same time you get your COVID-19 booster shot.

How does this new variant differ from the earlier variants?

The nature of COVID-19 is that the new variants are likely going to be more contagious than the older ones. There is currently no evidence that this latest variant is more dangerous. The symptoms do not appear different.

Does the newest, updated booster shot help protect me from this new variant?

According to the CDC, being up to date with the bivalent booster that became available in September 2022 offers the best protection against COVID-19. (It is the only booster now available.) The updated bivalent booster specifically targets both the BA.5 sub variant of Omicron, of which XBB.1.5 is a descendent, and the original SARS-CoV-2 virus. The original COVID-19 monovalent vaccines, and the monovalent booster that became available in the fall of 2021, only target the original virus, and therefore potentially offer less protection against the Omicron subvariants.

I was recently infected with COVID-19. How long should I wait to get the latest bivalent booster?

You may consider waiting up to 90 days from your last infection before getting the bivalent booster. Reinfection is less likely in the weeks and months after infection. But you may want to talk with your provider if you are at increased risk of severe disease.

I never got any vaccines. Can I skip the first and second monovalent vaccines and just get the bivalent booster?

No. Before you can get the bivalent booster, you still need to get two doses of the monovalent vaccine.

I received my bivalent booster more than two months ago. Has my immunity started to wane?

Your immunity does begin to wane after three to four months, probably more so if you’re older, such as older than 50.

Can I get another dose to bolster my immunity?

No. Currently, there are no more recommended doses after you have already gotten the bivalent booster, regardless of how long it has been.

Will the bivalent booster and antiviral medications prevent me from developing long COVID?

We do not have definitive data yet to know how much protection the bivalent booster and antiviral medications such as Paxlovid™ offer against the development of long COVID. But we do know that being vaccinated certainly reduces your risk of developing it.

I am at high risk for complications from COVID-19. What should I do to protect myself from the latest subvariant?

Because COVID-19 is so widespread now, it’s hard to avoid getting infected or exposed. While it is reasonable to take precautions to avoid a COVID-19 infection, the goal should be to reduce the severity or prevent complications when you do get COVID-19. High-risk individuals should have a plan for how to get antiviral medications, which can prevent severe illness or death. For this to work, you must take the medications within the first five days of symptom onset. If you have not done so already, you should talk with your doctor or your care provider to create a plan for what antivirals you would need and how to get them. Having a plan is also important because you may be on medications that interact with certain antivirals, and you may need to stop taking those medications temporarily to prevent drug interactions. Those at high risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.

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