Thursday, March 26, 2015

Cancer treatment and fertility

Living with cancer blog

Cancer treatment and fertility

By Sheryl M. Ness, R.N. March 24, 2015
Are you thinking about having a family? Certain cancer treatments and surgeries can affect fertility or cause sterility. Cancer treatment often is urgent and fertility may not be the first thing on your mind.
However, it's important to ask good questions and find out more about your individual situation prior to treatment when it comes to preserving your fertility options for later.
Cancer treatments may have temporary or permanent effects and may depend on your cancer type and your age. Common causes of infertility in cancer patients include:
  • Chemotherapy — can depend on drug dosage, length of treatment and type. Chemotherapy drugs called alkylating agents (such as busulfan, cisplatin, cyclophosphamide, ifosfamide and melphalan) are a class of drug that can have major effects on fertility.
  • Radiation — varies depending on the location and dose of radiation. The most severe damage occurs if radiation is given in the area of the ovaries or testicles.
  • Surgery — removal of the testicles for men and ovaries, uterus and cervix for women.
  • Age — women older than age 40 are more likely to go into early menopause as a result of cancer treatment.
To preserve fertility prior to treatment:
  • Both men and women should ask about chemotherapy effects and discuss options that may decrease the chance of permanent damage.
  • Women may want to explore embryo freezing, ovarian transposition and radiation shielding.
  • Men may want to discuss sperm banking prior to treatment and radiation shielding.
Fertility measures after treatment is completed may include:
  • Using frozen embryos or donor eggs
  • Pregnancy surrogate
  • Conception with the help of a fertility expert
  • Adoption
  • Testicular sperm extraction
  • Donor sperm
If you'd like to learn more about fertility options, resources include:
  • Mayo Clinic (www.mayoclinic.org/healthy-living/getting-pregnant/in-depth/fertility-preservation/art-20047512)
  • Fertile Hope (www.livestrong.org/fertilehope)
  • Oncofertility Consortium (www.myoncolfertility.org)
It's important to know that you may have options to preserve or protect your fertility. Feel free to bring this topic up early in the conversation with your treating doctor so that it can be addressed as part of your treatment plan.
I'd love to hear back from you. Please share your experiences on this topic.

Wednesday, March 25, 2015

How Exercise May Aid Cancer Treatment

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CreditGetty Images
Phys Ed
PHYS ED
Gretchen Reynolds on the science of fitness.
In a new study involving mice, aerobic exercise slowed the growth of breast cancer tumors and made the cancer more sensitive to chemotherapy. The results raise the possibility that exercise may change the biology of some malignant tumors, potentially making them easier to treat.
Scientists and clinicians have known for some time that solid tumors can create their own, peculiar ecosystem within the body. As a tumor grows, it sends out biochemical signals that prompt the creation of additional blood vessels to provide the expanding tumor with more oxygen. Oxygen is, of course, important for cell health, including in normal tissue.
But in some tumors, these new blood vessels begin to proliferate so wildly that they create a “jumble and tumble” of tubes that can curl around and choke one another, reducing blood supply and oxygen to the tumor, says Mark W. Dewhirst, the Gustavo S. Montana Professor of Radiation Oncology at Duke University School of Medicine and senior author of the new study.
As a result, the tumor becomes hypoxic; it exists in an environment with little oxygen.
That condition might seem desirable, since it is fundamentally unhealthy for living tissue to be starved of oxygen. But unfortunately, Dr. Dewhirst says, hypoxia also can make tumors relatively impervious to treatment. Chemotherapy drugs and radiation work better in conjunction with oxygen.
“It’s a bad sign from a clinical perspective when a tumor is hypoxic,” Dr. Dewhirst says.
For years, he and his colleagues have been looking for ways to increase oxygen flow to tumors. There have been trials in animals and people of substances that alter the biochemical signals from the tumors and lead to slower, more normal blood vessel growth to the tumor and reduced hypoxia. But the benefits of this approach have so far been fleeting; eventually the blood vessels leading to the tumor tend to overgrow again like untended vines and hypoxia returns.
So Dr. Dewhirst and colleagues from Massachusetts General Hospital in Boston and Memorial Sloan Kettering Cancer Center in New York City began to consider exercise.
Aerobic exercise is known to increase the flow of oxygen-rich blood to tissues. It’s one of the hallmarks of the activity.
So for the new study, which was published this month in The Journal of the National Cancer Institute, the scientists decided to formally test exercise as a means of altering tumor hypoxia. They began by surgically implanting mouse breast cancer cells into female mice. The scientists did not use human cells, because they would have had to dial down the animals’ immune systems to avoid rejection and wanted to be able to observe interactions between exercise and the animals’ normal immune response.
The mice were then divided into groups that either remained sedentary after surgery or ran at will on wheels in their cages.
In both groups, the tumors took hold and grew, but the growth was significantly slower in the runners. Additional testing showed that the blood vessels feeding the tumors in these animals were healthier than in the sedentary mice. As a result, the runners’ tumors were less hypoxic.
Next, using another group of mice with breast cancer, the scientists had a quarter of the animals remain sedentary. Another quarter of the animals ran on wheels. A third group received a standard drug used in chemotherapy treatment of breast cancer while remaining sedentary. And the final group exercised and received the chemotherapy drug.
After 12 days — a lengthy period in the life of an adult mouse — the animals were reassessed. The tumors in the sedentary animals were, as expected, large and hypoxic.
But exercise and chemotherapy each had slowed tumor growth. The group that had exercised had smaller tumors than did the sedentary mice. So did the animals that had received the chemotherapy drug.
However the mice that simultaneously had exercised and received chemotherapy showed the best outcome, with the smallest tumors by a significant margin.
That result suggests, Dr. Dewhirst says, that exercise had made the breast cancer tumors in the mice more amenable to the chemotherapy. By making the tumors less hypoxic — and paradoxically healthier, he says — exercise “also had made those tumors easier to kill.”
At the same time, exercise seems to have fought the tumors independently of the chemotherapy drugs. In the animals that ran but did not receive chemotherapy, Dr. Dewhirst says, the scientists found blood markers indicating a high degree of tumor cell death, although just how exercise was prompting cancer cells to die remains unclear.
Of course, this study was small and involved mice, not people. There is not yet scientific evidence showing that exercise affects tumor biology in people as it did in the mice in this study.
Still, exercise is advisable and generally tolerable for people undergoing cancer treatment, says study co-author Lee W. Jones, an exercise scientist at Memorial Sloan Kettering whose lab creates customized exercise regimens for patients undergoing treatment at the center. The American Cancer Society also recommends exercise to improve the quality of life among cancer survivors. Obviously, though, consult with your physician before starting any program.
Meanwhile, Dr. Dewhirst has begun follow-up mouse experiments using a different type of breast cancer cell that grows more slowly than the cells used in this study and is a better approximation of human breast cancer, he says. He also hopes to study other types of cancerous tumors in future studies.
http://well.blogs.nytimes.com/2015/03/25/how-exercise-may-aid-cancer-treatment/?ref=health

Tuesday, March 24, 2015

The Road to Cancer Treatment Through Clinical Trials

Photo
CreditPaul Rogers
Personal Health
PERSONAL HEALTH
Jane Brody on health and aging.
In 1947, children who developed acute lymphocytic leukemia died. Dr. Sidney Farber, a pathologist at Boston Children’s Hospital, was so distressed doing autopsies on these children that he moved into the clinic and, against the advice of more conservative colleagues, began treating children with aminopterin, a highly toxic drug that starved their cancerous white blood cells of critical nutrients.
Miraculously, for many the disease went into remission, only to recur months later. But Dr. Farber’s last-ditch attempt to save these children began an era of ultimately remarkable progress — decades of clinical trials of progressively complex treatments that now cure nearly 90 percent of children with leukemia.
Olivia Blair of Baltimore, who will be 3 in May, is showing the benefits of this progress. After her T-cell acute lymphocytic leukemia was diagnosed when she was 17 months old, Olivia has weathered more than a year of treatment at Johns Hopkins Kimmel Comprehensive Cancer Center with about 15 different drugs plus radiation to her brain and spine.
With her disease undetectable months later, she is now in a study of an experimental drug to help maintain the remission and is back to a near-normal childhood, a thriving, happy toddler who plays with other children, goes to day care and accompanies her mother grocery shopping.
Kelly Blair, Olivia’s mother, said, “It was very hard for us to decide to participate in the new study, but we finally thought that even if it didn’t help Olivia, it’s going to help other kids.”
The tortuous road to the kind of treatments now saving more than half of all cancer patients is graphically depicted in a six-hour series, “Cancer: The Emperor of All Maladies,” produced by Ken Burns, to be broadcast on public television (PBS) March 30, March 31 and April 1.
The series is based on a Pulitzer Prize-winning book, “The Emperor of All Maladies: A Biography of Cancer,” by an oncologist, Dr. Siddhartha Mukherjee, who provides telling commentary throughout.
“The outcome in children is so stunning because 80 to 90 percent of young patients participate in clinical trials,” Dr. Mukherjee, of Columbia University, said in an interview. “Every trial taught doctors something that led to further trials and better results.”
But only about 5 percent of adults with cancer enter a clinical trial. “That’s not nearly enough to move cancer medicine forward,” he said. “No matter what you do in the lab or in basic science, the ultimate proof of which cancer medicines work comes from clinical trials.”
Although the backbone of today’s successful cancer treatments, clinical trials are poorly understood by the public, often viewed as treating people like guinea pigs instead of as giving them the best chance for survival.
Those who participate are randomly assigned to receive the innovative treatment being studied or the current standard of care. Through such trials, for example, highly disfiguring radical mastectomies for breast cancer have yielded to simple mastectomies or lumpectomies, typically followed by radiation and chemotherapy, with less trauma and far better survival rates.
Even metastatic cancer that has spread now sometimes yields to treatments being tested in clinical trials.
Doug Rogers of Lexington, N.C., was 58 in 2011 when he was found to have melanoma that, despite the best available chemotherapy, had spread throughout his leg and adjacent lymph nodes. He then went to the National Cancer Institute, where Dr. Steven Rosenberg and colleagues are testing an immunological remedy in which the patient’s own cancer-fighting T-cells are harvested, grown in a lab to billions strong and then given back to the patient.
Mr. Rogers, who is also featured in the TV series, said that repeated scans had shown no spread of his cancer and that he was “back to doing almost everything a 62-year-old man can do.”
Although it was once challenging to locate and join a clinical trial, patients and families can now easily find studies and determine eligibility without a doctor as intermediary. The Stand Up to Cancer website offers free information about and access to about 7,000 cancer trials in the United States and Canada. Or you can call the American Association for Cancer Research at 1-877-769-4829.
The American Cancer Society, at cancer.org/clinicaltrials, maintains a clinical trials matching service that is also free and can help locate studies most appropriate to a patient’s medical and personal circumstances. And at www.cancer.gov/clinicaltrials, the National Cancer Institute offers up-to-date descriptions of more than 12,000 trials currently accepting participants, as well as recent trial results by type of cancer, the costs involved and questions to ask about participation. The institute also has a 10-step guide to finding a cancer trial.
The best time to explore participation in a clinical trial is often right after a cancer diagnosis and before receiving any treatment. Some trials won’t accept patients who have already been treated, and sometimes the best chance for success lies in getting the most effective treatment first. However, there are also trials for patients already treated elsewhere without success.
Dr. Mukherjee recommends asking about a trial’s aim. Is it to test safety or effectiveness of a treatment? Why is the trial being done? What were the data that led to the trial in the first place?
“Knowing the answers to such questions allows people to manage their hopes,” he said. “If patients go into a trial with the wrong expectations, they can set themselves up for disappointment.”
Dr. Wendy Schlessel Harpham of Dallas, whose non-Hodgkin’s lymphoma was diagnosed in 1990, is today a highly productive author and speaker because she participated in early trials of rituximab, a monoclonal antibody. Despite intensive chemotherapy and radiation, her disease recurred and, with no other good options, she entered three successive trials that tested rituximab first for safety, then effectiveness.
She had further recurrences, all treated with rituximab, which was approved in 1997. With her last recurrence in 2007, she is now enjoying her longest remission and credits the trials with enabling her to see her three children grow up.
http://well.blogs.nytimes.com/2015/03/23/the-road-to-cancer-treatment-through-clinical-trials/?emc=edit_tnt_20150324&nlid=52389906&tntemail0=y&_r=0

In 'Cancer: The Emperor of all Maladies' PBS and Ken Burns probe disease's unique status

NEW YORK DAILY NEWS
 
Monday, March 23, 2015, 2:00 AM
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Ken Burns talking during a New York Daily News editorial board meeting Aug. 7, 2012.

IF WE can't always beat cancer, says Ken Burns, at least we need to strip away some of its psychological power.
“No other disease has the same impact as cancer,” says Burns, executive producer of “Cancer: The Emperor of All Maladies,” a three-part PBS series that will air March 30-April 1. It's directed by Barak Goodman and based on a book by Dr. Siddhartha Mukherjee.
“If you say you have heart disease, which is very serious and kills people every day, it doesn't have the same effect as saying you have cancer,” says Burns.
Part of the reason for this, he suggests, is that pretty much everyone either has had or knows someone who has had cancer.
“It's a shared experience,” Burns says. “It connects all of us in a very visceral way.”
And a deeply troubling way.
“No other disease,” says Mukherjee, “carries the same strong sense of betrayal. Your own body, for some reason you don't understand, is eating you alive.”
What we need to do, they all say, is look at cancer as a serious disease that in an increasing numbers of cases can be beaten.
They also say that contrary to some beliefs, the treatment is not worse than the disease.
“It's a mythology that most people with cancer die a terrible death,” says Burns. “We've made tremendous advances in pain management.”
That aspect of cancer treatment is particularly critical, says Mukherjee, “because it isn't death we fear. It's dying. We can take away the pain.”
Unfortunately, cancer probably won't be cured by a single magic vaccine.
“There are so many types of cancer,” says Burns. “At some point almost all of us may get some form. But we can see a day when most cancers will at worst be manageable conditions not death sentences.”

The book weaves together Mukherjee's experiences as a hematology/oncology fellow at Massachusetts General Hospital as well as the history of cancer treatment and research.[3][4] Mukherjee gives the history of cancer from its first identification 4,600 years ago by the Egyptian physician Imhotep. The Greeks had no understanding of cells, but they were familiar with hydraulics, so they used hydraulic metaphors, of humors, which were fluids whose proper balance, they believed, produced health and sickness. According to the book, cancer existed in silence in history until 440 BC, where the Greek historian Herodotus records the story of Atusa the queen of Persia and the daughter of Cyrus, who noticed a lump in her breast. The tumor was excised by her Greek slave named Demasitis, where the procedure is believed to be successful at least temporarily.
In the 19th century, surgical approaches were developed to deal with tumors. William Halsted developed an aggressive, disfiguring breast surgery as a strategy for removing not only existing cancer cells but also places to which they might have spread.
Leukemia, a cancer of blood cells, was first observed by Rudolph Virchow, and Franz Ernst Christian Neumann localized the pathology to the bone marrow. Leukemia cells are dependent on the enzyme dihydrofolate reductase. Sidney Farber used molecules developed by Yellapragada Subbarow to block the enzyme and destroy the leukemia cells, producing a temporary remission in the disease.
The book proceeds right on through to the latest research and therapies.
According to Mukherjee, the book was a response to the demand of a patient: "I’m willing to go on fighting, but I need to know what it is that I’m battling."[5] Mukherjee states that two of his influences for the book were Randy ShiltsAnd the Band Played On and Richard RhodesThe Making of the Atomic Bomb, but the defining moment for him was "when he conceived of his book as a biography".[5]
It was described, by the magazine Time, as one of the 100 most influential books of the last 100 years, and by the New York Times magazine as among the 100 best works of non-fiction.