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Medical Forum / Diseases and Disorders / Cancer / January 2008

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Redskins coach Bugel's daughter fights cancer

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Mike - 04 Jan 2008 21:57 GMT
http://www.washingtontimes.com/article/20080103/SPORTS/735083145/1005/sports

Bugel's daughter fights cancer

January 3, 2008

By Bob Cohn - Like a lot of men at work, Joe Bugel called his wife
yesterday to hear the latest about the kids. The specific topic of
conversation was their middle daughter, Holly.

"I just talked to Brenda," Bugel, the Washington Redskins' assistant
head coach-offense and offensive line coach, said before practice.
"She said Holly's cleaning her house, whistling, singing.

"She is so upbeat. And that's why she's going to get well."

On and off the field, this has been a season like no other for the
Redskins, who have won four straight games to lift themselves off the
scrap pile and into the NFL playoffs.

In January, head coach Joe Gibbs' 2-year-old grandson, Taylor Gibbs
(now 3), was diagnosed with leukemia. In October, ex-NFL player Ron
Springs, the father of Redskins cornerback Shawn Springs, fell into a
coma and remains on life support. In late November, safety Sean Taylor
was shot during a robbery attempt at his Florida home and died a day
later.

And 2½ weeks before Christmas, Holly Bugel's left arm was amputated at
the shoulder. The 35-year-old has a rare form of osteosarcoma, or bone
cancer. According to the American Cancer Society, about 1,000 cases of
osteosarcoma were reported last year. For Miss Bugel's type of cancer,
"five or six cases" were reported, Brenda Bugel said.

The cancer was diagnosed in August 2006. Holly Bugel moved from
Phoenix to the noted University of Texas M.D. Anderson Cancer Center
in Houston, but despite intense chemotherapy and other treatment, some
of it radical, a large tumor continued to grow and eventually forced
the amputation.

A CT scan later this month will reveal whether the cancer has spread
or gone into remission, while helping determine the next course of
action.

"You pray for a miracle," Brenda Bugel said. "When she was diagnosed,
like when Coach Gibbs found out that Taylor had leukemia, you know
about cancer but you have no idea what it's like till you go through
it with a family member. And when it's with a child, you feel
helpless.

"When something like this happens, you can't protect them. You can't
stop it. You do the best you can. You try to make every day important
and happy, and you do the best you can."

After the Redskins beat the Dallas Cowboys on Sunday to earn their way
into the playoffs, Bugel planted a kiss on Gibbs' cheek. The two are
more than close. Bugel was right there during most of Gibbs' first run
as Redskins coach from 1981 through 1992, which produced four Super
Bowl appearances. It was Bugel who nicknamed and developed his
powerful offensive lines "The Hogs."

But Gibbs said after the game that Bugel's gesture was more about
their shared experience of coping with a loved one's illness. Today, 3-
year-old Taylor Gibbs' cancer is in remission. Holly Bugel faces an
arduous recovery and a new way of living.

"I've had a grandchild who was sick," Gibbs said. "But to realize
what's happened here. ... For somebody to experience that and go
through all of that, it's hard for me to comprehend."

Like so many coaches whose wives have tolerated their husbands' crazy
work hours and moves from job to job, Bugel says his wife has been the
strong one. Holly's surgery was on Dec. 7, one day after the Redskins
beat Chicago to start their improbable run. The next day, after Bugel
arrived in Houston to see his daughter for the first time without her
arm, he recalled Brenda telling him: "Do not break down when you see
her. No tears in your eyes. You've got to keep your composure" so that
Holly would be encouraged.

As a coach, the 67-year-old Bugel is animated and intense. But it
wasn't difficult to heed Brenda's advice when he saw his blonde
daughter, a vivacious, energetic former cheerleader at Oakton High
School in Vienna.

"I walked into her room, and she said, 'Hi Dad. Great going,'" Bugel
said. "I looked at her and I thought, 'Holy smokes, if she's upbeat,
I'm going to be upbeat.' We spent the whole day together. We kidded. I
said, 'Hey, you're going to be able to pull those slot machines, huh?
The one-armed bandit, you know what I mean?' She got a kick out of
that."

Added Brenda: "She's a beautiful girl, and she's always been such an
upbeat person. She still is. She always has a smile for people. She's
amazing. ... If you saw her, you wouldn't know she has cancer. Except
that her arm's missing now. She's beautiful, she's happy, but she's
fighting this terrible disease."

The Bugels have three daughters, Angie, 37, Holly and Jennifer, 31.
Along with Joe and Brenda and Holly's boyfriend, K.C., who moved from
Phoenix to be with Holly full time in Houston, the girls form the core
of an iron-clad support system for Holly. It also allows Bugel the
leeway he needs to do his job.

"My wife and kids have handled this in a great way," he said. "They
know I work. It's been my whole life."

Bugel said he makes up for the time during an annual monthlong family
vacation at the home that he owns near San Diego. And there will be
another get-together when the season ends, whenever that is.

"[Holly] knows my work schedule," Bugel said. And when we get a little
bit of a break, hopefully after the Super Bowl, I'll meet up with
them. She likes to spend four or five days with her dad."

Bugel has remained low-key about his daughter and her condition. He
told his fellow coaches but only one or two players. Veteran offensive
tackle Chris Samuels, the Redskins' best lineman and a favorite of
Bugel's, had no idea until a reporter mentioned it.

"This just shows the character and the toughness of that guy, to fight
through this," Samuels said.

"I think it's killing him inside," said center Casey Rabach, one
player in whom Bugel has confided. "Being a father, to be in that
situation ... I don't know how I would deal with it, and I think it's
amazing."

But Joe and Brenda know who is truly the amazing one.

"When you see her, her face hasn't changed, her personality hasn't
changed," Bugel said of Holly. "She doesn't want you to feel sorry for
her. She wants to talk about football."
J - 05 Jan 2008 02:32 GMT
> And 2½ weeks before Christmas, Holly Bugel's left arm was amputated at
> the shoulder. The 35-year-old has a rare form of osteosarcoma, or bone
[quoted text clipped - 7 lines]
> of it radical, a large tumor continued to grow and eventually forced
> the amputation.

???
http://www.nature.com/ejhg/journal/v11/n8/full/5201012a.html#bib20
Osteosarcoma is the most frequent nonhaematogenic malignant bone tumour

Based on histological criteria, osteosarcomas can be subtyped as common,
chondroblastic, teleangiectatic, fibroblastic, small cell, giant cell rich and
sclerotic/osteoblastic. The histological subtype of osteosarcoma is a predictive
factor for response to chemotherapy,20,21 is related with disease-free
survival22 and tends to be related with overall survival.21

Review and classification

Subtyping of the osteosarcomas was performed by two review pathologists of the
European Osteosarcoma Intergroup (PCWH and EH). Osteosarcomas were classified as
conventional, chondroblastic, teleangiectatic, small cell, fibroblastic,
osteoclast rich, anaplastic and sclerotic/osteoblastic well differentiated, as
defined by the established criteria

http://www.ncbi.nlm.nih.gov/pubmed/12044509?dopt=Abstrac
   * Eur J Cancer. 2003 Mar;39(4):548-9.

Does the histological subtype of high-grade central osteosarcoma influence the
response to treatment with chemotherapy and does it affect overall survival? A
study on 570 patients of two consecutive trials of the European Osteosarcoma
Intergroup.

Hauben EI, Weeden S, Pringle J, Van Marck EA, Hogendoorn PC.

Laboratory for Pathology, Stichting Pamm, Michelangelolaan 2, 5623 EJ Eindhoven,
The Netherlands. e.hauben@pamm.nl

Large randomised trials are mandatory when one wants to examine the effects of
different aspects (such as the treatment modality) of a pathological condition
on the overall outcome. This is especially true when studying a disease in which
there is a multifactorial influence on progression and outcome such as
osteosarcoma. Data on 570 patients with biopsy-proven primary central
osteosarcoma of an extremity included in two consecutive studies of the European
Osteosarcoma Intergroup (EOI) were analysed in order to evaluate if the
histological subtype of the biopsy specimen correlated with the subtype of
osteosarcoma represented in the resected specimen, if there was a relationship
between the histological subtype and overall survival and if there was a
relationship between the histological subtype and histological response to
chemotherapy. High-grade osteosarcoma, as defined by established criteria, was
subtyped as either conventional, chondroblastic, teleangiectatic, small cell,
fibroblastic, osteoclast rich, anaplastic and sclerotic/osteoblastic well
differentiated. A panel of experienced pathologists with a special interest in
bone pathology was appointed to review the histological diagnosis and to assess
the tumour response to chemotherapy on the resected specimen of each patient
entered into the trials. Subtyping on the biopsy specimen proved to be highly
representative for the subtype of the whole tumour. In 102 patients for which
subtyping was performed on the biopsy and the resected specimens, there were
only two discrepancies. Of the 568 patients for whom subtype was available, 404
(71%) were of the conventional type, 54 (10%) were chondroblastic, 53 (9%) had
fibroblastic tumours and the remainder consisted of rare subtypes. A good
response to preoperative chemotherapy was defined as 90% or more necrosis. The
proportion of patients responding well to chemotherapy differed significantly
between subtypes (Chi-square test statistics=11.44, P=0.01 on 3 degrees of
freedom (d.f.)). In comparison with the conventional subtype, there was a higher
proportion of good responders in the fibroblastic group and a lower proportion
of good responders in the chondroblastic group. Good responders had a
significantly better survival than patients who responded poorly to the
pre-operative chemotherapy (logrank statistic=25.20, P<0.01 on 1 df). Survival
did not differ significantly according to subtype (logrank statistic=2.72,
P=0.44 on 3 df), although there was a suggestion that patients with
chondroblastic tumours experienced a better long-term survival. This large set
of prospectively-collected data provides important information on the
relationship between pathological subtype, histological response and survival.
Histological response has a known prognostic effect on survival, and we have
shown that the rates of response differ by subtype. There is some evidence from
this study that the specific histological subtypes, i.e. the chondroblastic
subtype, experience better survival. However, despite this large
multi-institutional study, we have insufficient numbers of non-conventional
tumours to examine this unambiguously for these subsets.

> A CT scan later this month will reveal whether the cancer has spread
> or gone into remission, while helping determine the next course of
> action.
 
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