Monday, September 15, 2014
Mentoring for new cancer survivorsBy Sheryl M. Ness, R.N.
Living With Cancer
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This week, I'd like to put a call out to all of the veteran cancer survivors who are reading and participating on the blog. One of the primary goals for the blog is to support and reassure each other on this journey.
My question to you is this: "What do you know today that you wish you'd known in the beginning as a new cancer survivor?"
We frequently partner mentors with newly diagnosed cancer patients in person. I thought it would be interesting to try virtual mentoring through this discussion.
If you're interested in posting your pearls of wisdom for other survivors, keep a few things in mind as you write your comments.
In the first year after diagnosis:
- What did you experience that was most unexpected?
- What about your emotions in the first weeks and months? It's OK to talk about the negative feelings too — that way everyone knows this is a normal experience.
- What was the most difficult experience of the first year? What helped you get through?
Everyone's experience is unique — however, it can be a great comfort to hear from others who've already been down the path yet to come. Please share your words of support and wisdom.
Thursday, September 4, 2014
I'm on my third round of chemotherapy, and I've been diagnosed with anemia. I feel very tired and weak. Why does chemo cause anemia? Is there anything I can do to feel better?Answers from Timothy J. Moynihan, M.D.
Your bone marrow makes blood cells, including red blood cells. Chemotherapy can damage your bone marrow. When this happens, your body makes fewer red blood cells or destroys them before their normal life span is over.
Your body's ability to produce platelets — a blood cell that plays an important role in forming clots — also may decrease, so you're more likely to bleed, further reducing your red blood cell levels.
Your red blood cells contain an iron protein called hemoglobin, which carries oxygen from your lungs to the rest of your body. Anemia means you have too little hemoglobin, so parts of your body aren't getting enough oxygen, which is why you feel tired and weak a lot.
What you can do
Consider the following step to help manage your anemia.
- Talk to your doctor. Ask about getting a blood transfusion or certain medications to increase production of red blood cells, which can relieve your anemia.
- Prioritize your tasks. Do only the most important ones. Let your family and friends help with other tasks.
- Get plenty of sleep. Aim for at least eight hours a night. Take short naps during the day.
- Eat well. Foods high in iron such as red meat and leafy greens are good choices.
What's taboo to you as a cancer survivor?By Sheryl M. Ness, R.N.
Living With Cancer
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This week, let's talk about taboo topics. As a cancer survivor, you probably have certain topics that are taboo to either you, or your family and friends.
Taboo topics aren't easy to talk about. A few that come to my mind are diagnosis, prognosis, recurrence, and end-of-life discussions. Others include sex, body image, and feelings of guilt and loss. Perhaps you're returning to work after treatment and you need a way to update your co-workers on how you're doing.
Taboo topics are difficult to think about, talk about and confront. However, they're probably the ones that cause a lot of emotional pain or anxiety if you have no way of talking about them. This is true for both a person living with cancer and their family and close friends. We worry about each other, this is a natural reaction. We also have fear and anxiety over things that we can't control.
So, how do you bring up taboo topics?
One way is to first write out your thoughts so that you have a way of putting words to your feelings and emotions. Next, reflect on what you wrote, and next to each concern, identify one way that those around you might help you with the concern. Also think about what you can do to address the fear or concern on your own.
Practice bringing up the topic, like you would when you're with the other person. This is a practical way to lessen the fear and anxiety when the time comes to talk about it for real.
Many times, the people around you who love and care about you are waiting for a cue from you, to let them know it's OK to talk about the subject. Once you open up, you may find that they're ready to talk about it and provide the support you need. If you never bring it up, they may think you aren't worried about it or are also too afraid to bring it up.
What's taboo to you? Share on the blog the topics that you've found difficult to bring up to others around you. This is the perfect, safe place to talk about it with others who are probably feeling the same way. What worked best for you?
Tuesday, September 2, 2014
Patient Voices: Pancreatic Cancer
It is estimated that 5 percent of patients diagnosed with pancreatic cancer survive past five years. What is it like to be faced with such statistics? To survive? Here, in their own words, are the experiences of seven men and women. (Join the discussion here. )
Saturday, August 30, 2014
'Strikingly Effective' Approach for Depression
in Cancer Patients
Roxanne NelsonAugust 28, 2014
A new integrated program for treating depression in cancer patients is reported to be "strikingly more effective" at both reducing depressive symptoms and improving quality of life than the current standard of care. The new approach, known as Depression Care for People with Cancer (DCPC), was tested in 2 clinical trials: the SMaRT-2 study, reported in theLancet , and the SMaRT-3 study, reported in the Lancet Oncology.
The integrated collaborative care model that was tested in these trials utilized a team of specially trained nurses, primary care doctors, and psychiatrists and showed that this strategy can greatly improve outcomes for depressed patients with cancer compared with usual care, David Kissane, MD, head of psychiatry for Monash University, Victoria, Australia, writes in an accompanying commentary in the Lancet Psychiatry.
"The approach used in the SMaRT Oncology trials combined with systematic screening provides an outstanding model of how to begin to deliver this much-needed care for patients with cancer everywhere," he says.
The commentary accompanied a new analysis published in theLancet Psychiatry showing that the majority of cancer patients (73%) with depression are not getting any treatment for their depression, as reported by Medscape Medical News.
This finding comes from a study of 21,000 cancer patients using clinics in Scotland, which found that major depression is substantially more common in cancer patients than in the general population. These symptoms were most commonly observed in lung cancer patients (13%) and were the least common in genitourinary cancer patients (6%).
"If unrecognized and untreated depression in patients with cancer shortens survival, harms quality of life, and increases risk for suicide, a compelling case emerges for using both screening and an integrated collaborative model of depression management," Dr. Kissane noted.
New 'Strikingly Effective' Protocol
One of the clinical trials that tested the new DCPC protocol was the SMaRT Oncology-2 randomized trial, which found that at 6 months, significantly more of the patients who received DCPC responded to treatment (with at least a 50% reduction in the severity of their depression) compared with those who received usual care. The overall response to treatment was 62% with DCPC vs 17% with usual care (P < .001).
"The huge benefit that DCPC delivers for patients with cancer and depression shows what we can achieve for patients if we take as much care with the treatment of their depression as we do with the treatment of their cancer," lead author Michael Sharpe, MD, from the Department of Psychiatry, University of Oxford, United Kingdom, commented in a statement.
Dr. Sharpe and colleagues compared the effectiveness of the DCPC for major depression in cancer patients with usual care. The integrated program is delivered by a multidisciplinary group working in collaboration with the patient's cancer team and general practitioner. The program includes both pharmaceutical and psychological therapy.
The study included 500 adults with major depression as well as cancer who had a good prognosis (predicted survival of longer than 12 months). The patients were randomly assigned to receive either DCPC or usual care. Treatment for the usual-care group consisted of informing the patient's primary care physician and oncologist of the major depression diagnosis; they were then asked to treat the patient under normal protocol. In the United Kingdom, this might mean antidepressant drug therapy or a referral to mental health services, the authors note.
When compared with those in the usual-care group, participants in the DCPC arm had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all time points (all P < .05).
During the study period, there were 34 cancer-related deaths (19 in the DCPC group and 15 in the usual-care group). In addition, 1 patient was admitted to a psychiatric ward, and 1 attempted suicide. Although both were in the DCPC group, the events were not deemed to be related to the trial treatments or procedures.
Effective for Good- and Poor-Prognosis Patients
The other trial, SMaRT-3, evaluated a version of DCPC that was specifically adapted for patients with cancer who had a typically poor prognosis. For this study, lead author Jane Walker, MBChB, PhD, a consultant psychiatrist at the University of Oxford, and colleagues randomly assigned 142 patients with primary lung cancer and with a predicted survival of at least 3 months to DCPC (n = 68) or usual care (n = 72).
The DCPC arm and the usual-care arm followed protocols and care similar to those followed in the SMaRT Oncology-2 study. The primary outcome was depression severity (on the Symptom Checklist Depression Scale [SCL-20], range 0 - 4) averaged over the patient's time in the trial (up to a maximum of 32 weeks).
Of this group, 43 (30%) of the patients had died of cancer-related causes by 32 weeks. Outcome data were based on 131 (92%) of the cohort (59 in the group receiving depression care for people with lung cancer and 72 in the usual-care group).
The authors found that the average depression severity was significantly lower in the DCPC group (mean score on the SCL-20, 1.24 [SD, 0.64]) than in those who received usual care (mean score, 1.61 [SD, 0.58]; difference, -0·38). The self-rated depression improvement, anxiety, quality of life, role functioning, perceived quality of care, and proportion of patients achieving a 12-week treatment response were also significantly higher among patients in the DCPC group, compared with usual care.
"Patients with lung cancer often have a poor prognosis," said Dr. Walker in a release. "If they also have major depression, that can blight the time they have left to live. This trial shows that we can effectively treat depression in patients with poor-prognosis cancers like lung cancer and really improve patients' lives."
Both studies were funded by Cancer Research UK and Chief Scientist Office of the Scottish Government. None of the authors or the editorialist have reported any relevant financial relationships.
Lancet. Published online August 28, 2014. Abstract
Lancet Oncol. Published online August 28, 2014. Abstract
Lancet Psychiatry. Published online August 28, 2014. Commentary
Friday, August 15, 2014
Wednesday, August 13, 2014
Synthetic molecule uses salt to trigger self-destruction of cancer cells
By Nick Lavars
August 13, 2014
A team of international researchers has developed a molecule capable of triggering cancer cell death by carrying chloride into cancer cell membranes. The molecule flushes the cells with salt and causes them to self-destruct, potentially paving the way for new types of anti-cancer drugs.
The international effort involves researchers from the UK, Texas and South Korea who have collaborated to develop a synthetic ion transporter with a chloride payload. Once it reaches the cancer cells, the chloride interacts with the sodium in the cell membranes and leads to its demise.
"This work shows how chloride transporters can work with sodium channels in cell membranes to cause an influx of salt into a cell," says the University of Southampton's Professor Phillip Gale, one of the study's co-authors. "We found we can trigger cell death with salt.”
The survival of cells in the human body is reliant on the regulation of ions inside their membranes. Upsetting the balance causes them to self-destruct through what is known as apoptosis, a mechanism the body uses to dispose of dangerous or damaged cells.
We have seen apoptosis form the basis of a number of cancer researchefforts. The most recent being a cloaked DNA nanodevice that evades the body's immune system to hone in on leukemia and lymphoma cells to activate the suicide switch. The chloride-carrying molecule is the first to demonstrate the effects of salt on cancer cells, however, with the researchers also claiming it could bring benefits to sufferers of cystic fibrosis.
The molecule works by binding to the chloride ions in the cell's membranes. It then draws on the membrane's sodium channels, creating a blanket surrounding the ion and causing it to dissolve. The researchers first found this to be effective in a model with an artificial membrane, a team from South Korea's Yonsei University then tested its efficacy in cultured human cancer cells. An important finding was that the cell's ion balance was disrupted prior to the death of the cell, rather than resulting from the apoptotic process, indicating it was indeed the chloride payload causing its death.
"We have thus closed the loop and shown that this mechanism of chloride influx into the cell by a synthetic transporter does indeed trigger apoptosis," said Professor Jonathan Sessler from the University of Texas and one of the study's co-authors. "This is exciting because it points the way towards a new approach to anticancer drug development."
One complication the researchers will have to overcome for its molecule to be used in cancer treatments is limiting it to cancerous cells. As it stands, the molecule triggers the death of both cancerous and healthy cells so the team will need to modify the synthetic transporter to bind only to the more cancerous ones.
The team's research was published in the journal Nature Chemistry.
Source: University of Southampton