Friday, October 10, 2014

Resistance training helps cancer survivors

Living with cancer blog

Resistance training helps cancer survivors

By Sheryl M. Ness, R.N. October 3, 2014
Research shows that cancer survivors may benefit from weight training.  Resistance training is exercise that uses weights, weight machines or elastic bands.
The study, published last year in "Medicine & Science in Sports & Exercise", looked at both men and women who were being treated or had completed treatment for cancer (breast, prostate and head/neck cancers).
Participants did light to moderate resistance training two to three times a week. Early results after 12 weeks showed that participants increased muscle mass and decreased body fat.
After one year, the effects continued with participants reporting a positive effect on their quality of life with a notable decrease in cancer-related fatigue, which is a common and long-lasting symptom reported in cancer survivors.
Resistance training can help to increase strength, range of motion and balance which is important as survivors recover and move on to life after treatment. Exercising with free weights and resistance bands is inexpensive and easy to work into a home routine.
If you'd like to get started, ask for a referral to meet with an exercise physiologist, physical therapist or rehabilitation specialist who can provide the tools and knowledge you need to learn the proper technique. While resistance training is safe for most people, it's always wise to check with your provider to see if it's a good idea for you.
Remember to begin slowly with lower intensity until you feel comfortable moving up a level to higher intensity. Even low intensity exercises make a difference.
I'd love to hear from survivors who have tried resistance training. What's been your experience?
With
Follow on Twitter: @SherylNess1
Join the discussion at #livingwithcancer.

Thursday, October 9, 2014

The Most Important Breast Cancer Findings Of 2014

Posted: Updated: 
BREAST CANCER
It's estimated that 1 in 8 U.S. women will develop invasive breast cancer in their lifetimes, and about 40,000 American women are expected to die from the disease this year.
Learn more about the potentially life-saving research that has been published from research centers around the world.
The "Angelina Effect" Is Real
angelina jolie
Actress and humanitarian Angelina Jolie made waves in May 2013 when she opted to have preventive double mastectomy after testing positive for the BRCA1 gene mutation, a mutation that greatly increases one’s chances of developing breast cancer in the future.
This year, a study published in the journal Breast Cancer Research reveals that Jolie’s announcement may be responsible for inspiring a wave of requests for genetic counseling and tests for breast cancer risk. In the U.K., referrals for genetic testing more than doubled after Jolie went public with her surgery, and they were mostly women who had a good reason to be concerned; many had a family history of breast cancer, just like Jolie. It was no one-time spike, either -- data from 12 different clinics and 9 genetic testing centers in the U.K. showed that a doubling of genetic test referrals for BRCA1 lasted from immediately after the announcement through October of that year.
A Simple Blood Test Could Soon Predict Breast Cancer Risk 
Testing for the BRCA1 gene mutation isn’t the only way to test for elevated breast cancer risk. A simple blood test is currently being developed by researchers at University College London that will be able to predict a woman’s likelihood of developing the cancer by testing for a certain epigenetic signature -- the way certain genes express themselves, or the way genes are turned “on” or “off” -- that is present in women who had breast cancer but didn’t have the BRCA1 gene mutation.
"The data is encouraging since it shows the potential of a blood based epigenetic test to identify breast cancer risk in women without known predisposing genetic mutations,” said lead researcher Prof. Martin Widschwendter, Head of University College London's Department of Women's Cancer. The test was already being evaluated in human trials back when it was announced in June.
3-D Imaging May Be The Future Of Cancer Detection
A new kind of 3-D imaging technique called tomosynthesis could make the tumor search more accurate. A study published in JAMA found that in over 170,000 examinations that used both digital mammography and tomosynthesis, doctors were able to increase cancer detection rates while decreasing the amount of times they needed a patient to return because of an inconclusive reading (referred to in the study as “recall”).
Researchers found that using mammography and tomosynthesis together was better able to detect cancer than just mammography alone (the norm) at a rate of 5.4 per 1,000 vs. 4.2/1,000. The combined detection technique also detected invasive cancer at a rate of 4.1/1,000 vs. 2.9/1,000. As for recall, which wastes time and resources, mammography and tomosynthesis reduced the rates from 107/1,000 to 91/1,000.
Certain Birth Control Pills May Increase Risk
birth control pills
Women who had recently taken certain kinds of oral contraceptives -- specifically high-estrogen pills -- had a 50 percent higher risk of breast cancer than women who had never taken birth control pills or who stopped taking birth control pills. But the results should be interpreted with caution, said lead researcher Elisabeth F. Beaber, PhD, MPH of Fred Hutchinson Cancer Research Center in a press release about her study.
"Breast cancer is rare among young women and there are numerous established health benefits associated with oral contraceptive use that must be considered,” Beaber said. "In addition, prior studies suggest that the increased risk associated with recent oral contraceptive use declines after stopping oral contraceptives."
Instead of asking women to report how much birth control they had taken, which is the norm in these sorts of studies, Beaber culled information about pill brands, doses and length of time taken from pharmacies. She analyzed data from 1,102 women with breast cancer and compared them to 21,952 control women and found that pills with high estrogen increased breast cancer risk 2.7-fold, while pills with ethynodiol dictate increased risk 2.6-fold. Low-estrogen pills did not increase cancer risk. The study waspublished in the journal Cancer Research.
Common Fertility Drugs Do Not Increase Risk
Women who take the common infertility drug Clomid or gonadotropins (e.g. Pregnyl, Novarel, Profasi) needn’t worry that their quest for a baby opened them up to increased breast cancer risk. A study that followed women over 30 years finds that taking those drugs did not increase breast cancer risk, except for a very small amount of women who took Clomid for 12 or more cycles, who had more than 1.5 times the risk of contracting breast cancer as women who had never taken fertility drugs. Women who weren’t able to conceive after taking Clomid or gonadotropins had almost twice the risk of breast cancer as those who have never taken either medication, which suggests that the conditions that made them infertile could also have contributed to their eventual breast cancer diagnosis.
Doctors today recommend taking only six cycles of Clomid at up to 100 mgs per dose before moving on to other fertility strategies. In the past, Brinton pointed out, doctors used to prescribe up to 250 mgs per dose, and for many years. The research analyzed data from more than 12,000 women being treated for infertility between 1965 and 1988. The study was published in the journal Cancer Epidemiology, Biomarkers & Prevention.
Diabetes May Increase The Size Of Breast Tumors
Adult onset diabetes could be making breast cancer tumors grow bigger, faster. A study presented at the European Breast Cancer Conference found that patients with Type 2 Diabetes were more likely to have advanced tumors when doctors first diagnose them with breast cancer.
"We think that hyperinsulinemia -- where there are increased levels of insulin circulating in the blood -- may encourage the growth of tumour cells by providing them with large amounts of glucose, said lead researcher Dr. Caterina Fontanella, MD in a press release. "We therefore believe that strict control of blood sugar levels is essential to the successful treatment of breast cancer."
Skirt Size Is Linked To Breast Cancer Risk
It turns out that a growing “skirt size” makes women more likely to be diagnosed with post-menopausal breast cancer, according to a study published in the British Medical Journal.
Analyzing results from almost 93,000 women, researchers found that going up one skirt size every 10 years was linked to a 33 percent greater risk of breast cancer, while going up two skirt sizes in 10 years was linked to a 77 percent greater risk. Measuring “skirt size” isn’t really a proxy for weight gain; instead, think of it as a gendered way to describe waist circumference. Researchers already know that bigger the waist circumference is, the higher the risk for cancers like colon cancer and cancer of the uterus, as well as health risks like obesity, diabetes and cardiovascular disease.
The study doesn’t establish cause and effect, but researchers speculate that because abdominal fat is more “metabolically active” than fat in other parts of the body, it could be increasing estrogen levels, which can fuel the grown of breast cancer cells.
Good Quality Sleep Is Really Important For Recovery
sleep cancer
Not only will being well-rested keep your immune system stronger, but it may predict a better recovery for breast cancer patients. Researchers at Stanford University found that “sleep efficiency,” or the ratio of actual sleep compared to total time spent in the bed, predicted survival time for patients with advanced breast cancer. Adjusting for factors like age and treatments for a pool of 97 women with advanced breast cancer, they found that efficient sleepers survived an average of 68.9 months, while inefficient sleepers survived an average of 33.2 months after studying them for six years.
"Good sleep seems to have a strongly protective effect, even with advanced breast cancer,” said researcher Oxana Palesh, PhD, assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University in a press release.
Another sleep study demonstrated how melatonin, the hormone that makes you sleepy at night, is absolutely crucial to the success of tamoxifen, a widely used breast cancer drug. The only problem is that exposing yourself to light from your TV, mobile phone or computer at night shuts off that melatonin production, which in turn could weaken tamoxifen. To show this, researchers from Tulane University implanted rats with human breast cancer cells and then regulated their light to alternate between 12 hours of light and 12 hours of total darkness for several weeks. Then they repeated the light/dark cycles, but this time they shone a very dim light during the dark portion, which suppressed melatonin production. Tamoxifen was most effective in rats that had 12 hours of unadulterated darkness, or rats who received melatonin supplements.
"High melatonin levels at night put breast cancer cells to 'sleep' by turning off key growth mechanisms,” explained researcher David Blask of Tulane University in a press release. "These cells are vulnerable to tamoxifen. But when the lights are on and melatonin is suppressed, breast cancer cells 'wake up' and ignore tamoxifen.” 

Vitamin D Levels Predict Breast Cancer Patient Survival
Patients with high levels of vitamin D were more than twice as likely to survive breast cancer than women with low levels of vitamin D, according to a study published in the journal Anticancer Research. Researchers from University of California, San Diego analyzed five past studies of breast cancer patients, which altogether had data from 4,443 people. Women who had a greater chance of surviving breast cancer had an average vitamin D level of 30 nanograms per milliliter, while the women who had less chance of surviving had an average of 17 nano grams per milliliter. Unfortunately, the average breast cancer patient in the U.S. has vitamin D levels that mostly resemble the latter, not the former.
Because this was an observational study, the researchers recommended randomized clinical trials to confirm the causal relationship, but added that there’s no harm in adding vitamin D supplements to strengthen a breast cancer treatment regime now.
Breast Cancer Vaccines Could One Day Be A Reality
An experimental breast cancer vaccine called GP2 is showing a lot of promise in human trials and could one day be an important option to prevent recurrence in breast cancer survivors. Researchers divided 190 breast cancer survivors into two groups: a control which received only an immune stimulant and an experimental group which received the immune stimulant and the vaccine. The group which received the experimental vaccine had a 57 percent reduced breast cancer recurrence rate as compared to the control group.
"The ultimate goal is to develop a preventative tool that will minimize the risk of recurrence in women who have already had breast cancer and for whom standard therapies have failed,” wrote principal investigator Elizabeth Mittendorf, M.D., Ph.D. of the University of Texas.
It’s Never Too Late To Make Lifestyle Changes
Two studies from Yale Cancer Center find that breast cancer survivors who start regularly exercising and eating healthier can decrease their risk for breast cancer recurrence and death, as well as improve overall quality of life.
The first study divided obese or overweight female cancer survivors into two groups: those who got help and counseling about weight loss, and those who received simply a brochure. In addition to losing more weight, the women who got help with weight loss experienced a decrease in C-reactive protein, which is linked to a higher risk of breast cancer recurrence.
The second study divided breast cancer survivors into two groups: those who strength-trained twice a week and did 2.5 hours of aerobic activity per week, and those who did not exercise. After a year, the exercisers had also experienced a significant decrease in C-reactive protein compared to the control group -- as well a decrease in body weight and body fat.

Tuesday, October 7, 2014

The "eye popping" cost of cancer drugs

Lesley Stahl tells 60 Minutes Overtime about another "devastating" side effect of cancer: the bill

This week on 60 Minutes, Lesley Stahl reports on what she calls, the "eye popping" cost of cancer drugs.
The story was brought to Stahl's attention when she received an email from a close friend suffering from cancer. In the email, he told her about the astronomical bill he'd just received for his treatment and suggested Stahl do a story "on the backbreaking cost of cancer drugs."
She asked her producer, Rich Bonin, to look into the story.
What Bonin found surprised him: "The first thing I never really thought about was how expensive cancer drugs are. Secondly, I never knew that for many oncologists, when they prescribe cancer drugs, they actually get a commission."
But Bonin says the story is far more complicated than "good doctors" versus "evil drug companies."
He paraphrases one doctor's analogy, comparing it to the complex relationship with a mother-in-law: "We love them, we need them, they do good, but you know, there's this other side to the relationship that also makes it complicated."
As the 60 Minutes team reports, cancer drug prices have the potential to bankrupt a family.
"People don't just take one drug. It accumulates. They take two, or sometimes three. And each drug can cost $100,000," Stahl tells 60 Minutes Overtime. "It's really heartbreaking."
The above video was produced for 60 Minutes Overtime by Magalie Laguerre-Wilkinson and Craig Crawford.


Targeted treatment may be key to metastatic breast cancer patients 'beating the odds'


Eight years ago, Dian Corneliussen-James had surgeons cut out half of her right lung, a risky procedure she believes saved her life.
Though she thinks the surgery saved her from death from metastatic breast cancer, which had spread to her lung, she said she is "terrified to go off" the drug, Faslodex, that doctors say could be keeping her alive.
Her survival has prompted doctors and others to call her and patients with metastaticbreast cancer like her "outliers" because they don't know why some patients with the incurable disease live a long time. Some say the answer to a longer life with metastaticbreast cancer lies in targeted treatments, such as Faslodex, a drug designed to treat the cancer in women after menopause.
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Metastatic, or stage IV, breast cancer is cancer that has spread to another organ. The median life expectancy of someone with metastatic breast cancer is 26 months, said Dr. Katherine Tkaczuk, professor of medicine and director of the breast evaluation and treatment program at the University of Maryland Cancer Center. About 155,000 Americans are living with metastatic breast cancer, and about 40,000 patients die annually in the United States, according to the Metastatic Breast Cancer Network.
A change of pace from chemotherapy, which targets all dividing cells in the body, such targeted treatments home in on just cancer cells, said Dr. Robert Donegan, a medical oncologist at Greater Baltimore Medical Center.
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Targeted treatments were used first in the 1970s and, in some patients today, they are believed to control metastatic disease so it becomes more like a chronic illness than a fast-moving deadly one, Donegan said.
Targeted treatments have fewer side effects than chemotherapy and help patients maintain their quality of life, he said.
Corneliussen-James, who was diagnosed with HER-2 negative breast cancer in 2006, is beating the odds with injections of Faslodex every 28 days. She goes to her Johns Hopkins doctors from her Annapolis home to get the injections, which produce few side effects.
Though her doctors have offered the option, Corneliussen-James isn't willing to forgo the drug. "It doesn't negatively impact my quality of life," she said.
Going off it could have grave results. The drug appears to suppress the cancer and discourage it from reactivating, placing Corneliussen-James in a "remission" of sorts.
"We don't know if the cells are just dormant on their own or because of the drug," she said.
Marlene King, a friend of Corneliussen-James' and fellow member of Metavivor, an advocacy and support group Corneliussen-James founded with other survivors of the stage IV cancer, has had a different experience with targeted treatment.
She was diagnosed with breast cancer in 2008, and was told it had spread, or metastasized, in 2012. King went off treatment for the cancer in May, after trying several treatments that each worked for a few months and then stopped working, she said.
King decided in May that she didn't want any more drugs, at least for the time being. Her health wasn't great and her stomach and body couldn't handle the drugs.
"I decided it would be nice to take a break for a while," she said.
After a scan in July, her doctors told her there didn't seem to be any major growth of her tumors. Pending results of another scan at the end of September, she said, she will decide whether to continue her break.
While targeted treatments haven't worked for King, there is hope that with targeted therapies, the disease will begin to act more like a chronic illness, Donegan said.
"There's no guarantee," he said. "We need to clinically study. ... We really need good evidence and science to know drugs are going to work in less common genetic abnormalities."
Research on HER-2 positive breast cancer, a type 20 percent to 25 percent of patients with metastatic breast cancer have, is producing new and better drugs. Because so many exist, Donegan tells his patients diagnosed with HER-2 positive that it's possible the cancer can be managed to more like a chronic illness with the right drug.
Patients with HER-2 positive "live sometimes years," said Dr. George Raptis, associate chief of oncology and hematology at North Shore-LIJ Health System in New York. "We had never seen that in the past."
Raptis had a patient who lived 18 years with metastatic breast cancer before dying in 2012. Raptis said that that particular patient benefited from multiple therapies and that the biology of her cancer was sensitive.
Though some types of metastatic breast cancer have relatively successful targeted therapies, much work remains to be done, Donegan said.
"We'll ideally develop medicine that can target those less common types of breast cancer," he said.
There's room for the development of more therapies, which may mean looking more closely at the biology of cancer cells. Now, developing targeted therapies means finding ways to deny a fuel source that causes the cancer to grow and spread, Donegan said.
Doctors emphasize that the women who survive longer remain outliers. Even with targeted drugs such as Herceptin for HER-2 positive breast cancer, some patients respond to the treatment and some don't.
Tkaczuk gives her patients, some of whom have lived for years after diagnosis, different targeted treatments.
While many patients are not ready to deal with the diagnosis, she said, "the main misconception is that someone with metastatic disease is going to die right away."
That's not how Tkaczuk's patient Dianne Harrod reacted when she was diagnosed with stage IV cancer that had spread to her lungs in 2009.
"I said, 'What are we going to do about it?'" said Harrod, 65, who credits her positive attitude and her diet for her survival. "It's what you eat and what you do and don't feel sorry for yourself."
Since she was diagnosed, she's done a lot of targeted therapy, which she said "kind of keeps [the cancer] under control."
"I expect to live a long time," she said. "I just can't go out like that, you know, dying from breast cancer."
Copyright © 2014, Chicago Tribune



Why some women with breast cancer dread October
CHICAGO TRIBUNEblbrotman​@tribune.com 


Breast cancer awareness


Twelve thousand women wearing pink T-shirts participate in the "The Young Ladies" race against breast cancer at the Le Mans racetrack in western France. (Jean-Francois Monier, Getty-AFP)
'I feel like I'm the wet dishrag. There's a party, but I'm just a damper on the party.'
'The pain of October is knowing that you don't fit in with the predominant happy theme.'
The pink ribbons, pink T-shirts, pink carnations, a pink bra sculpture — there's pink seemingly everywhere, promoting mammograms, raising funds and celebrating survivors in October's Breast Cancer Awareness Month.
But there are some people who are not uplifted by the annual campaign.
Including some who are breast cancer patients.
Not the ones with triumphant stories of finishing treatment with apparent cures. The ones with metastatic breast cancer — cancer that has spread, and is incurable.
Their stories are rarely told during Breast Cancer Awareness Month, said Katherine O'Brien, 48, of La Grange, a board member of the Metastatic Breast Cancer Network.

They aren't happy stories. People with metastatic breast cancer spend the rest of their lives, however long they last, undergoing repeated rounds of treatments and scans. The disease is always on their minds; the shadow of death is always on the horizon.
And eventually, the shadow falls.
Who wants to hear about that?
"I feel like I'm the wet dishrag," said O'Brien. "There's a party, but I'm just a damper on the party.
"I'm happy, of course, for people who are doing well and have finished treatment, but I don't feel like I'm a part of that."



"It's a very solitary feeling," said Rebecca del Galdo, 46, of Wheaton. "You hear the word 'survivor' and that doesn't apply to someone with metastatic breast cancer. It's hard, at least for me, to not take it personally when people say, 'I beat this. I didn't let cancer get me.'
"I didn't do anything different than anyone else who has had breast cancer. It's just how it happened in my body. It wasn't that I didn't eat right or I didn't exercise enough or I was negative."
She is constantly aware of her illness. "I don't think I go more than five minutes without it at least popping into my head," she said. "And during this month, it really is everywhere."
October is so hard for many metastatic breast cancer patients that a New York survivors' group called SHARE is holding a webinar Monday on "Coping With October" to help them deal with feelings of anger, isolation and depression.
O'Brien recalls another suggestion.
"Somebody in one group I'm in said, 'Does anyone know anyone that owns a private island? It would be great! We'll get a nurse and an oncologist and just stay there until October is over.' "
"The pain of October is knowing that you don't fit in with the predominant happy theme of what is portrayed normally in the media," said Shirley Mertz, 68, president of the Metastatic Breast Cancer Network, who lives in suburban Chicago.
That happy theme has grated on others, including author Barbara Ehrenreich, who has written of her own anger at facing the illness amid "our implacably optimistic breast-cancer culture."
  • @franniescarp The problem with statements such as yours, as mentioned by several in the article, is the implication that those who died of cancer were somehow deficient in their fight. No, they were just the unlucky ones, and the ones who survived happened to have an iteration of the disease...
CHIGIRL72
AT 6:43 AM OCTOBER 07, 2014
Mertz, on the other hand, sees value in the pink movement, praising it for raising awareness and funds and encouraging celebrations for ending treatment for early stage cancer.
But she would like more people to be aware of metastatic breast cancer — although one group in particular, she said, does not want to be.
"We are many times shunned by people who have early stage disease because metastatic disease makes them uncomfortable," she said.
She understands.
"I didn't want my cancer to come back. I didn't want to hear about people dying with breast cancer because I thought, 'Oh my gosh, I could be that person.' So I understand where they're coming from."
For Breast Cancer Awareness Month, and every month, the Metastatic Breast Cancer Network wants to raise awareness about facts like these:


•Between 20 percent and 30 percent of people with early stage breast cancer will develop the metastatic disease.
•-Early detection does not promise a cure. Metastatic breast cancer can occur five, 10 or 15 years after diagnosis and successful treatment of early stage breast cancer.
•Though most people will eventually die of the disease, some people can live with it for many years.
These women encourage people to direct their breast cancer dollars to research that could help treat or someday cure the metastatic disease.
And they don't begrudge anyone a pink-themed celebration for successfully completing treatment for early stage breast cancer.
"I was one of them in 1991," Mertz said.
"I would love to celebrate finishing treatment," O'Brien said. "If I could, I'd be out there dancing. But I would try to have compassion for people who won't finish their treatment."
The project management company where Del Galdo works, which to her gratitude has rallied around the cause of metastatic breast cancer, will have a group of employees marching in Chicago's Columbus Day parade and handing out literature on the disease.
They will be wearing matching Metastatic Breast Cancer Network T-shirts.
They are purple.
National Metastatic Breast Cancer Awareness Day is Oct. 13. On Oct 19, the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and the Metastatic Breast Cancer Network will hold a meetup on metastatic breast cancer. It is free and open to the public. More information is at cancer.northwestern.edu/metastatic.
Copyright © 2014, Chicago Tribune