Chapter 07: Seeing the Impact of Data Collection on MD Anderson Research

Chapter 07: Seeing the Impact of Data Collection on MD Anderson Research

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Mrs. Hermes begins this chapter by explaining how she came back to work at MD Anderson in 1973. Dr. Clifton F. Mountain had asked Dr. MacDonald who could manage a large lung cancer study he was conducting with the North American Lung Cancer Study Group. She then talks about the impact that data collection had on studies at the institution. She notes that there was little communication between researchers and clinicians at that time. This began to change through studies on sarcoma. She gives an overview of the evolution of different cancer treatments and how data collection and strategies for selection of patients to include in studies had an impact. She gives an example of a study that Eleanor MacDonald conducted: the duration of time between a patient’s first symptoms to seeing a physician and receiving a diagnosis had an impact on outcome of treatment.

Mrs. Hermes then comments on how technology has had an impact on the use of data. She notes that prior to 1956, Eleanor MacDonald would take her data on mortality rates to Texas A & M for computer analysis.

She talks about the surprising results of one study of cancer of the mouth: older women in rural Texas had high rates of mouth cancer because they dipped snuff.

Identifier

HermesKL_01_20180122_C07

Publication Date

1-22-2018

City

Houston, Texas

Topics Covered

Building the Institution; Portrait; Overview; Working Environment; MD Anderson History; MD Anderson Snapshot; Research; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Discovery and Success; Technology and R&D

Transcript

T.A. Rosolowski, PhD:

I was going to ask you what impact all of this data gathering had on research at MD Anderson.

Kay Hermes, BS:

Well, I think the research people, you know for many years… I’m trying to put it together. It was one of the things that was my main interests actually, after I was older and worked there again. In some respects, there was very little communication. As I remember it, there was very little communication between research people in clinic and clinical people, and what happened to the—we did question. I remember talking to Eleanor about this, well what happens to this research data, where does it go, what does it do? I’m trying to think of when it would have made a difference. The data collection and the ability to identify specific groups of patients, I’m just trying to think if I remember a specific research project. Well, a simple one that I did for Dr. Kelsey. We had the data on MD Anderson patients that were treated for benign thyroid tumors, and I did the tables and the analysis. It was a short paper, but I did that for him. I’m sure there were other things, like well, especially some of the sarcoma projects. I think the—I don’t know that it would have been researchers. Yes, it would have been, especially the people doing genetic research on inherited children’s tumors, bone tumors. So, you could identify, in the MD Anderson population, you could identify a pattern of diagnosis, treatment and survival on all those people. That would be very important for the geneticists who were trying to trace these families, and they did do some wonderful work. That is one of the ways that the data was used, I think it’s the primary way that researchers used the data, was to identify certain groups of patients. You see the clinician, for example, would identify that say everybody who had lung cancer smoked. The clinician could easily identify that, and the pathologist could identify what was the primary cancer in smokers. It was squamous cell cancer of the lung. So, you could identify specific groups of patients that research being done might apply to, or certain groups of patients that you would like to refer for a research project. Of course, the whole treatment of cancer became altered terrifically and became much more involved as time went on and more treatments were available. The whole evolution of surgery, from very radical surgery to removing a lung tumor with a biopsy, took place over time, so all that changed. And then of course, the advent of—well, that’s only been the last few years; the advent of chemotherapy that is effective for lung cancer, but that’s very recent. There was very little chemotherapy. I think the first chemotherapy, I did several reviews on this, the first chemotherapy for cancer was actually discovered by accident. There was a shipwreck where the personnel were all exposed to hydrogen sulfide, and that was a big clue, and I think further studies on those persons is what led to one of the first chemotherapy treatments was for hydrogen sulfide. Well, they called it something else.

T.A. Rosolowski, PhD:

Mustard gas.

Kay Hermes, BS:

But that was the compound, it was hydrogen sulfide. So, identifying groups of patients and being able to study the pattern of their treatment and their survival, and their length of survival. In Eleanor’s first code, one of the things she was studying was the duration of time for when a patient first had symptoms and saw their primary doctor, to the time that they were diagnosed. And she did show, I believe, I can’t remember the paper, but she did show that this was a significant factor in the person’s outcome.

T.A. Rosolowski, PhD:

Oh, wow.

Kay Hermes, BS:

So, many patients, in early years especially, and even today, I think, are treated before they come to Anderson, and then they’re referred to Anderson. Now there may be protocols for that now, but in earlier years, that was not a good idea. Your cure rate went up about 5 percent just by walking in the front door. I think that the concept of getting patients referred, and I think Eleanor did study that, patients that had their initial diagnosis and treatment at Anderson seemed to better, I think. I think they had a better survival rate. Well, but that all had to do with the extent of disease and diagnosis. The pathology and the extent of disease, the diagnosis, were the key factors in people’s survival.

T.A. Rosolowski, PhD:

Interesting. Well, you know, you came in and Eleanor MacDonald obviously was working on this—sorry. You know, there were kind of the creation of this new field of epidemiology focused on oncology, and then working with this kind of systemic challenge, which is that clinicians had a very individual focused, rather than a population focused, perspective on patients. And so, you’ve got to change the culture in medicine, you’re forming a new field, and suddenly all these things come together and people are getting their heads around, Well, what can we do with this new data, what’s possible? So, it’s kind of interesting that this begins to accelerate and take more shape, and people are doing different kinds of study as this data becomes more available.

Kay Hermes, BS:

Well, that’s true. Of course, a great deal of differences made by the development of technology. Well, it’s only been the last ten years, that the genetic code has been deciphered, and even now, nobody really knows what it means. My son in-law is a physician here in Tyler, and he was discussing it with me the other day, about the most recent findings in the field of genetics are that we were always looking for a gene for Alzheimer’s, genes for red hair, and whatever you had. And now they found out that there is a multiplicity of genes. One gene is not going to—a multiplicity of genes is going to affect all the different things. It’s a rather formidable project, to even conceive of how you unravel that. And then of course, we talked a lot about what it means for people’s privacy, to have—so you, you take a swab of your saliva and send it in to have it all diagnosed as to what your genetic code is. Well, somebody has that information then, on record, and I think that in years to come, the privacy issue will be enormous, because you know, who has control of that information? Well, like Hitler would have exterminated all the people that weren’t Aryan. Well, there’s still despots around in the world and you would hate to think that they would ever have access to that kind of—the evil people would have access to the data, and they could. So, I think the advances in technology have had a terrific impact in studying cancer and in studying the epidemiology of cancer. The last project that Eleanor did before I retired from working for her was to take the data from El Paso to A&M, where they had developed the first computer for analyzing medical data. We all had a lot of jokes about it, because we spent one summer with a hand calculator, calculating mortality rates by color, by age, by treatment, by whatever, and it took us all summer to do three months or something, and they did it in five minutes.

T.A. Rosolowski, PhD:

Oh my gosh.

Kay Hermes, BS:

That was a very landmark thing. There was not a big IBC computer at Anderson while I was there, but that came later. I think it was quite a bit later. I think Eleanor took her data to A&M, to their Statistics Department, I think it was in the Statistics Department, and these computers were enormous, they took up the whole room. I think IBM probably had the first one that they used. But that was an advance in the technology, because instead of sorting on a little tiny sorter machine, two or three thousand punch cards, or two or three hundred or whatever you wanted to find, instead of doing that, you could just put the punch cards in a computer, put the information in a computer and you would get the answer in five minutes.

T.A. Rosolowski, PhD:

Now was this mortality project, was that the only time she took her data to A&M, or did that become a regular occurrence?

Kay Hermes, BS:

This was a full-scale analysis, I think of the El Paso County studies of El Paso County. So, it was all the skin cancer studies. I think it was confined to El Paso, to El Paso County, because that was the most complete registry, because it had the pathology in it.

T.A. Rosolowski, PhD:

Okay, okay, interesting.

Kay Hermes, BS:

I mean, it had the records of the pathologists, along with the records of the clinical people.

T.A. Rosolowski, PhD:

Now, as you think back on the information that was coming out of the registry, was there any information or conclusions that really surprised you, that stuck with you? Something that was discovered about cancer in Texas that surprised you?

Kay Hermes, BS:

Yes, there was one thing that really surprised me, and that was that patients who were diagnosed with cancer of the mouth were all women. The majority of them were women and they came from this part of Texas, I think, a lot from rural east Texas, or rural places in Texas, and this is because in these areas, it was a common habit for women to dip snuff.

T.A. Rosolowski, PhD:

Oh, interesting.

Kay Hermes, BS:

I think the data analysis led to that, that it would be quite remarkable, that women, you know, you would expect more women to have cancer of the breast than men, even though there is sizeable database of male breast cancer. My niece actually, at Anderson, just did a big project on that not too long ago. Anyway, that was one thing while we were there, that I remember as being quite outstanding. I suppose the other thing that shocked me initially, you see I would have been just twenty-two at the time, was the fact that all those people that had melanoma died. I became kind of a melanoma-phobe. I was just going over myself, looking at moles. Anyway, I remember that being quite shocking, but also, the fact that the mouth cancer was related to elderly women who dipped snuff.

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