Survey: UI Breast Cancer Research Group seeks input on research symposium

The Breast Cancer Research Group in the Holden Comprehensive Cancer Center is exploring the possibility of holding a research symposium this year. The purpose of this symposium would be to bring together current and future breast cancer researchers on campus to exchange ideas and form collaborations. Additionally, promising projects in breast cancer research will be identified from symposium participants and provided with pilot grant funding.

To facilitate planning, organizers request indications interest from faculty, students, and research staff in attending the symposium. Please complete the survey below.

Seeking experienced cancer epidemiologist

The Department of Epidemiology, College of Public Health and the Holden Comprehensive Cancer Center are seeking a dedicated and experienced cancer epidemiologist. The successful candidate will play a major role in the Cancer Center’s population science initiatives with substantial leadership opportunity and research resources in cancer epidemiology and population sciences.

The full job posting can be found at

Learn more about cancer epidemiology resources at the University of Iowa

Young, Complex, and Coping with Cancer

A new program strives to meet the life changes and special challenges of young cancer patients.

collage of young people's portraitsMia is in her last year of college carrying a full load of classes. When her thoughts aren’t consumed by applying for law school, she’s worrying about her dad who’s been laid off of his longtime job. She tries to keep her energy up by catching a Zumba class with a friend, but she’s been exhausted for most of the fall. She’s lost weight and chalks it up to stress, but she has to admit that something doesn’t seem right.

The doctor at student health furrows her brow and sends Mia to the ER for more tests. The results are quick and life altering: Mia has leukemia. She is admitted to the hospital and before her parents can arrive from Chicago, bone marrow tests are underway to figure out what kind of leukemia she has and next steps. In the midst of all this, a nurse talks to her about something called fertility preservation—freezing her eggs definitely had not been on her mind just a few days earlier.

Now Mia wonders if she’ll have to drop all of her classes and sublease her apartment. As the weeks go by, she finds herself in her childhood bedroom. Friends at college return her texts with emojis or silence. Except for grandparents, most of them have never known anyone with cancer and their discomfort is palpable.

Mia feels deeply alone—the only 20-year-old in the world who isn’t going to parties and thinking about school. Since most of her care takes place in an adult wing of the hospital surrounded by patients three times her age, she doesn’t realize that this is far from the truth. Every eight minutes, an adolescent or young adult in the United States is diagnosed with cancer.

Different Ages, Different Needs

Although Mia is fictional, her story represents what many young cancer patients go through. Hospitals are coming to understand that Mia and her cohort, identified as adolescents and young adults (AYA) who range from 15 to 39 years old, have different experiences and needs. They also have different survival rates.

While the survival rates for infants, children, and adults with cancer continue to improve, the rates for AYA cancer patients have remained stagnant. Starting with movements in the United Kingdom and Australia, hospitals are increasingly trying to provide whole-patient care that is focused on the particular needs of this group with the hope of giving them better odds.

In order to inform a new AYA cancer program that was initiated jointly by the University of Iowa Stead Family Children’s Hospital and the Holden Comprehensive Cancer Center, a series of focus groups was held with AYA patients. The result was a recently published article co-authored by Erin Mobley, a CPH doctoral student in health management and policy; Kristin Foster, a pediatric oncology nurse; and William W. Terry, a pediatric oncologist.

The paper, “Identifying and Understanding the Gaps in Care Experienced by Adolescent and Young Adult Cancer Patients at the University of Iowa Hospitals and Clinics,” was made possible by funding from the Iowa Cancer Consortium and the Iowa Department of Public Health.

An Understudied Age Group

The new AYA program started in 2015, the same year that Mobley arrived at the University of Iowa. As a pediatric cancer survivor, she has had a lifelong goal of working on the frontline of cancer care.

“First I wanted to be an administrator,” recalls the Florida native, “but after doing research following graduation around bone marrow transplant, I knew that I wanted to be able to do my own research.”

Terry, who directs the AYA program, invited Mobley to be part of the team that conducted the focus groups. The published paper is planned to be one chapter in Mobley’s dissertation, which focuses on young people and cancer.

“This is an age group that’s really under­studied in terms of their needs,” Mobley says. “There are a lot of changes that occur during this time of life that get overlooked. We want to create a program at Iowa that is aligned with what patients want and need.”

Two dozen AYA patients participated in the conversations, responding to questions that ranged in focus from finances and insurance, to relationships with family and friends, to spirituality and suicide. The results give a much more robust picture about what this group has not been receiving in terms of care and infor­mation, what it needs, and what it wants.

Finding the Gaps

Mobley knew that gaps in care would surface, but she was surprised by some of the results. For example, many participants noted that they would have liked more frequent information about risky behavior, such as drug and alcohol use, domestic violence, and emotional distress. They shared that they hadn’t used the Internet to research their illness very much and would appreciate a list of reputable sources. And although cancer affected their body image, this topic wasn’t touched on by care providers.

One area of the AYA experience that Mobley says might be related to the lower improvement rate for survival is less access to clinical trials.

“Nationally, we know that about 80 percent of adolescents and young adults are treated in community cancer centers,” Mobley says, noting that such centers do not have access to trials. As patients at the UI Hospitals & Clinics, this is not the case; nonetheless, many of the young people interviewed did not seem to sufficiently under­stand the studies, whether they were part of one, and if they’d been offered the opportunity.

“How do we better educate them?” wonders Mobley. “How do we present information in a way that matters to them and that conveys what is most important?”

Thinking Ahead to the Future

Building a strong, patient-driven program is the goal of the UI’s burgeoning AYA cancer program. This means taking into consideration both the quantitative and qualitative realities of this age group. It’s a fact that many AYA patients are underinsured as they move from their parents’ health coverage to their own while entering the workforce. It’s more subjectively understood that this is a group in flux in terms of personal identity, often trying on different friend groups and belief systems, all of which can make them less tethered to the community than older patients.

Mobley and her co-authors point out that AYA patients must be viewed as eventual older cancer survivors. How can the treatment today of a 20-year-old like Mia provide the best overall outcomes for all parts of his or her life?

One new approach of the AYA cancer program that tries to be more mindful of the future is the nurse coordinator who, among other things, presents fertility information to all patients. This task used to be left to individual doctors, and the information was too often skimmed over or presented inconsistently.

A diagram in the paper shows four over­lapping circles of relationships: Self, Cancer, Others, Future. The flower-like symbol that the circles create portrays the multiple facets that the AYA program is striving to address. By treating the whole patient at a complex time of life, the Iowa team hopes for better outcomes in each sector.

This story originally appeared in the fall 2018 issue of InSight magazine

A Shot of Protection

A network of cancer researchers are investigating ways to boost adolescent HPV vaccination rates.

portrait of smiling kidsIf a form of cancer could be prevented through a vacci­nation, why wouldn’t that vaccination be as widely given as those for diphtheria or the mumps? The primary cause of cervical cancer is the Human Papillomavirus (HPV), and the HPV vaccine is 90 percent effective at preventing it. Yet less than half of the adolescents in the United States who are eligible to receive the HPV vaccination do so. Why?

This question underlies the work of Natoshia Askelson and her Cancer Prevention and Control Research Network (CPCRN) team at the University of Iowa.

“Currently,” says Askelson, CPH assistant professor of community and behavioral health, “we know that only 49 percent of U.S. teens and 54 percent of Iowa teens are receiving the complete HPV series. How can we increase those numbers?”

Vaccination Rate Disparities

The Centers for Disease Control and Prevention (CDC) recommends three vaccines for adolescents: meningo­coccal (meningitis); tetanus, diphtheria, and pertussis (Tdap); and human papillomavirus (HPV). The HPV vaccine is one of the biggest breakthroughs in cancer prevention in the last decade, providing nearly complete protection from HPV-related cancers—including cancers of the mouth and genitals, as well as the more prevalent cervical cancer. Yet recent studies have shown that while national adolescent vaccination rates are fairly high for Tdap and meningococcal, the rates are substantially lower for HPV.

Figuring out the disparity in these numbers and how to shift them is at the heart of the work of the CPCRN. Initiated in 2002 with funding from the CDC and the National Cancer Institute, the network includes eight funded research institutions. Together, these institutions seek to translate research into practice to prevent and control cancer.

The University of Iowa joined the CPCRN in 2014. Being part of the network allows the UI to access com-munity-based cancer research across geographic boundaries.

“The advantage of being in the network is that we get to use the expertise of people across the country,” Askelson explains. “If we are looking at rural data, for example, we can pool our resources and talents and compare or combine experiences from different states.”

Iowa is not alone in finding that HPV vaccinations are lower in rural and less affluent communities. One issue is that health care providers do not relay the same level of surety regarding the vaccines as they do others. As Askelson notes, a health care provider will say, “‘You’ll get the Tdap and the meningitis; then there’s this other vaccine that you can get if you want.’ That really leaves the door open.”

Reaching Families

To be most effective, the immunization is administered at 11 and 12 years of age, a time when a young person’s immune response is highest. It also needs to be given in a series of two to three vaccinations spread over several months. Unlike infants who don’t have a routine filled with soccer practice and music lessons, adolescents and their working parents are much harder to schedule.

Culture and gender also play a role. Parents may not realize that HPV can infect both males and females, and forego vaccinating their son. Another member of the UI’s CPCRN team, Jason Daniel-Ulloa, clinical assistant professor of community and behavioral health, has focused on rural Latino communities, including developing collaborations between clinics, public health, and community organizations.

Daniel-Ulloa has worked hard to build relationships within the community and to better understand hindrances to the vaccination and find creative ways to overcome them. Noting that Latinos in general, but especially boys, receive the HPV vaccine at a much lower rate than their non-Latino peers, he started a men’s group to develop conversations about health and masculinity. He also helped to bring the UI’s Mobile Clinic to West Liberty, Iowa, a Latino-majority community, to make vaccinations more accessible for busy families.

Amplifying the Message

In addition to collaborating with the other CPCRN institu­tions, Askelson says that the Iowa Department of Public Health Immunization Bureau, the American Cancer Society, and Iowa’s Medicaid managed care organizations have been excellent partners in helping pilot projects that amplify information about the HPV vaccine to health care providers.

Another recent theme of the CPCRN has been increasing the rate of colorectal screenings, especially among people with limited health care insurance. As with the HPV vaccine, Askelson and her colleagues have found that it is effective when providers increase reminders, such as phone messages and texts, as well as establishing flags in people’s charts who are overdue for a colonoscopy, the gold standard for detecting colon cancer.

Askelson hopes that both projects will lead to better information and better health for all Iowans.

“Getting kids vaccinated now against HPV,” she says, “could eliminate HPV-related cancers from ever happening in an entire generation of people.”

This story originally appeared in the fall 2018 issue of InSight magazine

Teaming Up to Fight Cancer

Researchers from across the College of Public Health and UI campus are working together to prevent, detect, and treat cancer.

photo illustration of hands around a cancer cellWhen Kim Merchant learned she had breast cancer in January 2018, she “was a little shell-shocked.” As an active person with a healthy diet and no family history of the disease, she was stunned to be diagnosed with stage II invasive ductal carcinoma at the age of 61. “It just wasn’t on my horizon,” she says.

An annual mammogram detected the first of two spots on her left breast, setting off a chain of additional tests, biopsies, diagnosis, two surgeries, and six weeks of daily radiation treatment and its side effects. Cancer consumed six months of Merchant’s life, during which she continued to work as much as possible.

Although Merchant is extremely grateful for the support and care shown by her friends, family, and coworkers, she’s honest about the difficulties of coping with cancer: “It’s really a frightening and lonely time.”

Merchant says the experience was made easier thanks to the excellent care she received at the University of Iowa Hospitals & Clinics. “Knowing you’re in good hands takes away a lot of stress,” she says.

A Multidisciplinary Approach

A portrait of Kim Merchant of the University of Iowa College of Public Health.
Kim Merchant

Merchant is one of an estimated 17,800 Iowans diagnosed with a new cancer in 2018 and among thousands of cancer patients who receive treatment at the UI Hospitals & Clinics. The University of Iowa is home to the Holden Comprehensive Cancer Center, one of the nation’s top cancer research and treatment centers and Iowa’s only National Cancer Institute (NCI)-designated comprehensive cancer center.

The center coordinates all cancer-related research, education, and patient care by faculty from 41 departments and six colleges, as well as UI Hospitals & Clinics and UI Stead Family Children’s Hospital. The center is committed to making breakthrough scientific discoveries and turning them into improved approaches to cancer prevention, early detection, and treatment that directly benefit cancer patients.

Research at Holden is organized into four programs: cancer genes and pathways, experimental thera­peutics, free radical metabolism and imaging, and cancer epidemiology and population science. The latter category—cancer epidemiology and population science (CEPS)—is where public health really shows its strengths.

Population-Based Research

CEPS is a multidisciplinary team of more than 50 faculty members and researchers from the Colleges of Public Health, Nursing, Medicine, Pharmacy, and Liberal Arts and Sciences. Their research focuses on cancer etiology, including studies that explore genetic and/or environmental risk factors for cancer at the population level; cancer prevention and control; and cancer health services and outcomes.

“The goal of the CEPS program is to conduct population-based research that improves our understanding of what causes cancer, how cancer can be prevented and, if not prevented, how it can be detected early in its course, and to increase quantity and quality of life for cancer survivors,” says Charles Lynch, CPH professor of epidemiology and the CEPS program co-leader along with Richard Hoffman, professor of internal medicine.

Given that “population science” is in the research program’s title, it’s not surprising that public health researchers make up almost half of the CEPS team. Public health plays an important role in addressing cancer by reducing risk factor exposure and enhancing protective factors, getting more people screened for the early detection and treatment of cancer, and in evaluating health services and outcomes, says Lynch.

CEPS members are highly productive researchers. To give a snapshot, between January and August 2018, CEPS investigators produced 74 publi­cations and secured 35 grants totaling $4.4 million. Current research projects involving CEPS members include studies on breast and ovarian cancer, environmental exposures such as PCBs and nanomaterials, and smokeless tobacco use in rural veterans.

Big Data and Cancer Research

photo illustration of pills, computer, dataA key component of cancer research is large data sets such as those provided through the Surveillance, Epidemiology, and End Results (SEER) Program funded by NCI. SEER collects and publishes cancer incidence and survival data from population-based cancer registries, including the Iowa Cancer Registry based in the College of Public Health.

Wrangling big data requires the expertise of biostatisticians. Brian Smith and Gideon Zamba, CPH professors of biostatistics, frequently collaborate with investigators in Holden Comprehensive Cancer Center on the design, analysis, and reporting of cancer research projects.

Smith directs the Biostatistics Core within the center. The core’s services include consultation on study design, selection of outcome variables, and formulation of hypotheses; sample size estimation; protocol development; data analysis; and education and training.

One initiative designed to harness the power of big data to make it faster, easier, and less costly to conduct clinical research is the National Patient-Centered Clinical Research Network (PCORnet). PCORnet is a national “network of networks” that collects data routinely gathered in a variety of health care settings. These data are used to answer practical questions that help patients, clinicians, and other stakeholders make informed health care decisions.

Linking Data

Elizabeth Chrischilles, CPH professor and head of epidemiology, co-leads PCORnet’s Cancer Collaborative Research Group. The collaborative places special emphasis on developing standardized electronic heath record data across multiple sites so they can be linked together to support cancer research.

“In real-world practice, doctors and patients often have questions about which drug is best for a certain situation,” says Chrischilles, who also serves as associate director for population sciences in the Holden Comprehensive Cancer Center. “A lot of these questions never get answered in a clinical trial. Organizing data into a standard structure makes conducting comparative effectiveness research into these questions much more efficient.”

Data that are coded consistently across sites enable researchers to study how new treatments compare in effectiveness and safety to other therapies, understand how patients differ in response to specific treatments, and identify optimum drug dosages and regimes, along with many other questions.

Chrischilles is co-principal investi­gator of a PCORnet-funded project that is examining the patterns of use of molecular biomarkers and associated targeted cancer therapies for patients with invasive solid tumors. The project involves nine participating sites and is designed to test and expand the capacity of PCORnet to describe the details of cancer pathology, test results, and cancer treatment outcomes.

Living with Cancer

Almost a year after her diagnosis, Kim Merchant is actively engaged with work and life, although life is different than it was before cancer. She’ll be taking medication for years and will continue to have follow-ups with her care team. “I’m still a cancer patient,” she says. “Every time I get ready to have my annual checkup, I’m going to think about concerns I never had before.”

Merchant found it helpful to reflect on her experience by journaling. Following a radiation treatment, she wrote:

It is a strange sisterhood. As I walk into the pavilion, a female patient I’ve seen in the clinic patient waiting area is walking out. We smile and nod. Some women talk while waiting… Some don’t talk. Some have hair; some don’t or have a fuzzy buzz. Even out of the hospital, women who are survivors want to help, reach out, encourage—from my cousin’s friend to my banker.

She also met with a psychologist who specializes in working with cancer patients. “I thought, What can I learn from this?” says Merchant. “How can I help others, and help myself?”

Part of that process has been openly sharing her experience. “I hope that honesty helps others,” she says. “I don’t want there to be a stigma about having cancer.”

This story originally appeared in the fall 2018 issue of InSight magazine

Improving Rural Cancer Care

Stronger collaborations, better information sharing, and innovative approaches are enhancing cancer care in rural areas.

Corn and soybean fields in Minnesota

When it comes to progress against cancer, there’s good news to celebrate. Between 1990 and 2014, the overall cancer death rate in the United States fell by 25 percent. But not all parts of the country shared these improvements equally. Disparities in cancer outcomes continue to be an issue, including in rural areas where death rates are higher than urban areas. Cancer mortality also is decreasing more slowly in rural areas than urban areas.

Mary Charlton, CPH assistant professor of epidemiology and an investigator with the Iowa Cancer Registry, studies rural–urban cancer disparities. In 2015, she and colleagues published a paper that outlined numerous challenges of rural cancer care in the U.S. The barriers to receiving care included limited availability of cancer treatments and cancer support providers (such as oncologists, social workers, mental health care providers, and palliative care specialists), long travel distances for care, transportation barriers, and financial barriers, including having no insurance or insufficient insurance coverage.

Three years later, “a lot of the challenges are the same,” says Charlton, “but now there’s a bigger push, especially at the National Cancer Institute (NCI), to put funding and resources into projects to improve rural cancer care.”

Strengthening Rural Cancer Research

Charlton, along with Anjali Deshpande, CPH clinical associate professor of epidemiology, are co-leading an initiative supported by NCI supplemental funding to the UI Holden Comprehensive Cancer Center (HCCC) aimed at strengthening cancer control research in Iowa’s rural underserved populations. George Weiner, HCCC director, serves as principal investigator.

The goal of the project is to establish a statewide research infrastructure, based at HCCC, that will support rural hospitals and other rural health care providers in their search for new, sustainable cancer-control methods.

“We’ll be working with six Critical Access Hospitals located in rural counties that will serve as the core of a rural cancer research advisory board,” says Charlton. “We want to hear what their biggest challenges and interests are.”

Critical Access Hospital (CAH) is a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services. The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to health care by keeping essential services in rural communities. These hospitals receive certain benefits, such as cost-based reimbursement for Medicare services.

Every three years CAHs conduct a Community Health Needs Assessment and develop a strategic plan to address their findings.

“We’ve looked closely at many hospitals’ needs assess­ments, and a lot don’t mention cancer as one of their priorities, or if they do mention it, they don’t have a lot of data in their plan to help guide them,” Charlton explains. “The Iowa Cancer Registry has great data and resources that we can help provide to these hospitals.”

The Iowa Cancer Registry gathers statistics on cancer incidence and mortality at the county level. This information can be used to generate maps and reports that provide actionable, relevant evidence to guide community health assessments and cancer control decision-making in the six identified counties.

The project will rely on established collaborations among HCCC, the Iowa Cancer Consortium, and the Iowa Cancer Registry, while building new relationships with the UI Rural Policy Research Institute’s Center for Rural Health Policy Analysis and the UI Cancer Prevention and Control Research Network.

The supplemental funding will lay valuable groundwork for additional grants and projects going forward, Charlton adds.

From Diagnosis to Treatment Decision

Patient consulting a doctor in the hospitalCharlton’s research isn’t limited to specific cancers, but “the cancers that tend to be the bigger numbers in rural areas are breast and colorectal cancer because they can be treated by any hospital that has a general surgeon,” Charlton says. “So we see a lot of cancer patients in Iowa—about 40 percent—who go to hospitals that have no specific cancer accreditation.”

Charlton and colleagues recently published a paper that examined rectal cancer patients’ decision-making process about where to receive surgery. Although colon cancer and rectal cancer tend to get grouped together, the two diseases are very different.

“Rectal cancer is much rarer, and it’s a much more complicated surgery and course of treatment than colon cancer,” Charlton points out.

Several studies have shown that rectal cancer patients treated by specialized surgeons who perform large volumes of rectal cancer resections have better outcomes and survival rates compared to patients treated at lower volume centers. Despite evidence of a volume-outcome relationship, less than half of rectal cancer resections are performed by high-volume surgeons in comprehensive facilities.

Charlton’s research team interviewed 15 rectal cancer patients about their decisions regarding where to receive surgery. All lived in Iowa, averaged 63 years of age, and a little more than half resided in non-metropolitan areas.

Overall, the researchers found that advice from primary care physicians, gastroenterologists, friends, and relatives was the most critical factor in choosing a surgical center. And while almost all of the respondents indicated that surgeon experience was important, most didn’t research their surgeon’s experience and none sought a second opinion.

Because Iowa is a very rural state, distance was a factor in the decisions of some of the patients. However, in most cases where patients chose more local, lower volume centers, it wasn’t because they were unable to travel to a higher volume center. Rather, they chose the closer, low-volume centers because they were recommended to them by a local physician or because they were just more familiar with local providers. This highlights the importance of referrals received from physicians who diagnose rectal cancer.

The researchers noted that primary care physicians and gastroenterologists aren’t typically involved with staging, treatment, or follow-up of rectal cancer; are often unfamiliar with the specifics of rectal cancer surgery; and may not be aware that there is a difference in care and outcomes at high-volume versus low-volume centers. As a result, they may base referrals on their professional relationships with surgeons rather than on expertise.

The findings suggest that developing educational inter­ventions to help guide more informed decision-making by patients and referring providers could be beneficial.

Innovative Approaches

Technology offers additional tools for enhancing rural cancer care. Telehealth is the use of electronic information and telecommuni­cations technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration, according to the Health Resources and Services Administration.

Instead of remotely connecting rural cancer patients to specialists, it often makes more sense to link rural health providers to oncology specialists, says Marcia Ward, CPH professor of health management and policy and director of the Rural Telehealth Research Center.

“Oncology specialists can serve as consultants and be a resource for primary care providers and other frontline health professionals in rural areas,” Ward explains. “Using telehealth, a family physician can ask questions or say, ‘I have this case, what would be the best referral?’”

But, Ward notes, the telehealth consultant role “raises all sorts of issues about reimbursement” in the current fee-for-service health care system. “There are still challenges to putting this approach into place,” she says.

Other solutions for rural cancer care include outreach clinics, where specialists travel to certain rural sites several times a week or month, thereby reducing cancer patients’ travel time; and incentives and programs to increase recruitment and retention of the oncology workforce.

Although rural cancer disparities can be addressed in a number of ways, Charlton summarizes the goal behind these efforts into one overarching question: “What is the best way to get everyone the best care without making them go farther than they need to go?”

This story originally appeared in the fall 2018 issue of InSight magazine

Video highlights community-based efforts to increase HPV vaccination

A new video from the University of Iowa’s Cancer Prevention and Control Research Network (CPCRN) highlights community-based participatory research approaches that began in 2014 to increase human papillomavirus (HPV) vaccination rates in the east central Iowa community of West Liberty. “Despierta a Tu Salud” (Wake Up to Your Health), a cancer prevention project for rural Latino communities, was developed in response to community concerns about cervical cancer.

Jason Daniel Ulloa, clinical assistant professor of community and behavioral health, led a team of UI students and community partners that included schools, churches, volunteers, and the UI Mobile Clinic. In the video, Daniel-Ulloa provides an overview of the project, emphasizing his commitment to community involvement and mentoring, and student researchers share their experiences.

Register by Sept. 16 for the 2018 Iowa Cancer Summit

The Iowa Cancer Summit, the state’s only comprehensive cancer control conference, will be held in Ankeny, Iowa, on Sept. 24-25, 2018, and students are encouraged to attend! The annual event connects health educators, health professionals, and other cancer and public health advocates to network and exchange best practices in cancer prevention, screening, treatment, and quality of life.

This event is a great opportunity for students to network and learn more about how they can get involved with various projects going on right now. Students are eligible for a discounted registration rate of $60.

Early registration deadline is September 16.

The conference agenda, complete registration details, and further information is available on the Iowa Cancer Summit web page: