Thursday, April 13, 2017

Don't let sex be forbidden topic after cancer

By Lonnie Fynskov, R.N. April 12, 2016
While you were growing up, how many of you were taught that sex was inappropriate for casual conversation? For some of us, the topic was not only absent from social conversation but also in our families.
Obviously, this has nothing to do with the importance of sex and intimacy in our lives but more to do with our cultural background and a discomfort related to openly talking about highly personal issues.
Unfortunately, that same discomfort may interfere with getting helpful information regarding changes in sexuality that may occur with various cancer treatments.
Several cancers or their treatments have the potential to impact sexual function and response. This may not be a concern for some, but if it is we want you to feel comfortable starting a conversation.
Physical or emotional changes such as grief related to the presence of surgical scars or removal of reproductive organs, the desire for sex, and the ability to reach climax or experiencing pain during intercourse are just some of the things that can create tension in relationships.
As healthcare providers, we know sexual concerns may be difficult to discuss. But frequently, there are suggestions that can help. A few people have told me that with a new cancer diagnosis, so much information is given that sex didn't even surface. Others said it was the first thing they thought about but were too embarrassed to ask about.
Some say that during treatment, they were either so sick or tired that it wasn't a concern. However, once they were feeling stronger any sexual problems were a significant concern for them and their partner. But even then, they were hesitant to mention it to their healthcare provider.
Our need for intimacy and closeness doesn't stop with a cancer diagnosis. Getting the information and support you need to live life to its fullest is important. Everyone's situation is different regarding when and how you like to receive information.
Some may want to have open conversations that are initiated by either person when a troubling situation occurs. Others are more private and prefer brochures or visiting a reputable website that provides reliable information.
I'd love to hear your thoughts about what would work best for you when you want information about your sexual concerns? If you prefer conversations with a healthcare provider on the subject of sex and intimacy, when is the best time for this to happen? Is it when making decisions regarding treatment options, during treatment or perhaps at follow-up appointments? Thank you for providing input on this important topic.

Friday, April 7, 2017

Breast Cancer: After surgery

Everyone reacts differently to surgery. In this section we look at some of the side effects and common problems that may arise. Most people recover well but there are some things to be aware of.

Chemo Brain Could Be Worse With This Type of Chemo Drug

Research from JAMA Oncology found differences in how the brain responds to certain chemotherapy drugs used to treat breast cancer. Researchers examined how the brains of breast cancer survivors functioned after treatments with anthracycline drugs, nonanthracycline chemotherapy and no chemotherapy whatsoever. What they found out should help people who suffer from “chemo brain,” or the fuzzy-headedness that patients feel during and after cancer treatments.
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METHODOLOGY

Researchers noted brain functions in 62 breast cancer survivors with an average age of 55 who stopped undergoing treatments at least two years before their participation in the study. Of the 62 women, 20 had anthracycline-based chemotherapy as a primary treatment, 19 received nonanthracycline regimens of chemotherapy and 23 had no chemo whatsoever, according to Medical Xpress. Doctors then found ways to measure the cognitive abilities of these former breast cancer patients.
Participants enrolled in classes at Stanford University from 2008 to 2014, and researchers conducted the analysis during this period. These breast cancer survivors underwent a battery of tests, including standard psychological tests that measure brain function and MRI scans to look at the brain's signalling network, notes JAMA Oncology. The results of these tests led to some alarming conclusions.

WHAT THEY FOUND

Women treated with anthracycline chemotherapy drugs had lower verbal memory skills compared to other forms of chemotherapy or no chemotherapy at all. This includes the ability to immediately remember facts. MRIs indicated that connections in the brain were lower in patients treated with chemotherapy compared to those who received no chemo during treatment for breast cancer, which means the brain processes information less efficiently after undergoing chemo. Patients self-reported greater psychological distress due to chemo treatments versus nonchemotherapy regimens.
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Anthracyclines are a class of antibiotic drugs that come from strains of certain Strep bacteria, notes the National Cancer Institute. These types of drugs treat cancer by damaging DNA in cancer cells and eventually causing these cells to die. Anthracycline-based drugs include daunorubicin, doxorubicin and epirubicin.
Overall, researchers suggest that anthracyclines may incur greater negative effects on the brain than chemotherapy without anthracyclines. Doctors at Stanford University and the University of Texas conclude more studies should follow up these conclusions due to this very small sample size (just 62 women), and so the doctors can get a better idea of how chemotherapy alters the brain.

HOW DO YOU COUNTER CHEMO BRAIN?

Chemo brain causes cancer patients to suffer impairment in thinking abilities and memory. Cancer Care has several ways patients can combat chemo brain to try to lead a more normal life while undergoing treatment.
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  • Carrying a pad of paper and a pen at all times to write down shopping lists, errands, chores, phone calls and appointments helps patients keep things straight. Patients should cross off each accomplished item and include as much information as possible such as times and dates for deadlines so you stay on top of things.
  • Daily planners, wall calendars and notebooks help organize daily schedules and offer plenty of space to write down tasks to accomplish on certain days. For more high-tech options, plenty of smartphone apps help to organize information and provide alerts to upcoming events.
  • Some patients find leaving a voice mail or answering machine message serves as a good reminder. For patients who prefer this option, a digital audio recorder can save a lot of time.
  • The best defense is to keep the mind and body active, healthy and alert through proper nutrition and exercise. This includes activities used to stimulate the brains, such as crossword puzzles, sudoku, word games or reading. The more patients can do to keep the brain and body in shape, the better they feel and less chemo brain takes over their life.
Chemo brain doesn't have to control you. Discuss your treatment options with your doctor and then see if he can recommend ways to help your brain and your body reduce the effects of treatment. Learn about the long-term and short-term effects of chemo brain by visiting this blog post.

The Breast Cancer Site is a place where supporters and survivors come together to help fight breast cancer. In addition to sharing personal stories of hope, shopping for the cause, and signing petitions, visitors can take just a moment each day to click on a pink button to provide free mammograms for women in need. Visit The Breast Cancer Site and click today - it's free!

http://blog.thebreastcancersite.com/cs-anthracycline-chemo-brain/

Thursday, March 30, 2017


Photo
Melinda Bachini, left, whose cancer treatment inspired Celine Ryan, right, with her sons Liam and Decklan, to pursue the same. CreditLeft: Lynn Donaldson for The New York Times Right: Laura McDermott for The New York Times
Times Insider delivers behind-the-scenes insights into how news, features and opinion come together at The New York Times. In this story, the science reporter Denise Grady provides human backstory about her article about a woman who, remarkably, recovered from colon cancer after treatment with cells from her own immune system.
I’ve been meeting more and more people with cancer lately who would be desperately ill — or worse — had they not taken matters into their own hands and found their way into clinical trials in which they received experimental treatments that put the disease in remission.
There were no guarantees. New treatments don’t always work, and experiments have risks. The patients I met are here to tell their stories because they’re among the lucky few, the successes. Still, the cancer landscape does seem to be brightening, if only just a bit, in large part thanks to immunotherapy, which includes various treatments that help the patient’s own immune system to fight cancer.
The latest good news from the cancer front came last week, from Celine Ryan, a 51-year-old woman from Rochester Hills, Mich., a suburb of Detroit. She homeschools her five children, the youngest of whom is seven years old. Ms. Ryan has colon cancer, and two years ago, doctors found that despite surgery, radiation and chemotherapy, the cancer had spread and invaded her lungs, where scans detected 10 tumors.
Ms. Ryan is an engineer and database programmer, and to her scientific mind, it seemed highly unlikely that more chemo would control the disease. Chemo made her sick the first time around, and she had every reason to belief it would do so again. She and her husband, who is also an engineer, agreed that she should forgo chemo and instead try to tap into a major research center for help.
“I remembered that I had read about another cancer patient, Melinda Bachini. It stuck in my brain,” Ms. Ryan said. “I found out about this trial she did, and I said, ‘That’s what I want to do.’”
A front-page article I wrote in May 2014 about Ms. Bachini, a paramedic in Billings, Mont., might have been the article that Ms. Ryan remembered. Ms. Bachini had a deadly cancer, cholangiocarcinoma, that had started in her bile duct; Ms. Bachini underwent surgery and several grueling rounds of chemo, but the cancer nontheless spread to her liver and lungs. In April 2012, her life expectancy was a matter of months. Ms. Bachini, 43 at the time, had six children and, like, Ms. Ryan, did not think further chemotherapy would help.
Instead, she combed the internet looking for clinical trials and came upon one, run by Dr. Steven A. Rosenberg, at the National Cancer Institute, that made sense to her.
She was accepted into the study, and got very lucky. Dr. Rosenberg’s team found that she had a type of cancer-killing immune cell that could destroy her tumors without harming normal cells. The researchers multiplied those cells in the lab and dripped more than 100 billion of them back into her. Ms. Bachini’s tumors melted away.
Inspired by Ms. Bachini’s story, Ms. Ryan called the cancer institute. She was deferred twice because her tumors were not big enough to yield enough immune cells. But she persisted, and even sent the researchers screen shots from her scans, with measurements of tumors that she and her husband thought met the trial criteria. Eventually, she was accepted into the study and, like Ms. Bachini, was one of the fortunate ones: Now, thanks to the cell treatment and surgery, she is cancer-free.
Ms. Ryan’s case made medical history, because it was the first time researchers found cells that could attack a common cancer causing mutation — a finding that may help thousands of other patients with the same mutation.
In November 2015, after the first scan showed that her tumors had shrunk markedly, Ms. Ryan tracked down Ms. Bachini and emailed her. “Call me!” Ms. Bachini replied. Ms. Bachini and Ms. Ryan have been friends ever since and stay in touch by phone and on Facebook.
“When Celine and I connected, I was so unbelievably happy for her,” Ms. Bachini said.
They hope to meet in person, maybe by coordinating their checkups at the cancer institute. Both try to help other patients who are looking for help and considering clinical trials.
Ms. Bachini needed more treatment recently, because tumors in her lungs began to grow again. She had surgery and was given an immunotherapy drug, a type called a checkpoint inhibitor, which has begun shrinking the tumors.
“I spend a lot of time talking to patients, doing cancer advocacy stuff,” Ms. Bachini said. “It’s how I can pay it forward.”
https://www.nytimes.com/2016/12/19/insider/cancer-free-one-recovery-inspires-another-and-could-help-thousands.html?rref=collection%2Fseriescollection%2Fimmunotherapy

Thursday, March 23, 2017

The emotions of hair loss during cancer treatment

By Sheryl M. Ness, R.N. April 3, 2015
Many times when I meet with cancer survivors, we discuss the side effects of treatment. This includes both physical and emotional effects. If a person is receiving chemotherapy or radiation, hair loss may be a common side effect. For many people, losing their hair can have an emotional impact that they (and others) are not expecting.
Hair loss may be one of the most obvious signs that a person is having treatment for cancer. I have had many survivors tell me that when they started losing their hair, it made the cancer real to them and others around them.
One woman told me that first she cut her long hair shorter, followed by shaving her head in anticipation of losing her hair during treatment. She said the first hair cut had a much more emotional impact than she expected. Later, when her hair was gone, she said that it made her feel like she had no control — she felt vulnerable and exposed. She had shared her cancer diagnosis with those close to her, but now it was obvious to anyone who saw her that she was dealing with cancer.
Another woman decided to face the hair loss directly by using humor and social media. After she shaved her head, she quickly got her friends and family involved. She posted photos of herself with various wigs and had people vote on their favorite. She found support in the fact that she was open about her experience with others and even had some fun. In this way, she had some control over the situation. She was actively dealing with the hair loss by talking about it with her friends and family.
Fortunately, hair loss from cancer treatment is usually temporary. Hair loss may start within two to four weeks of beginning treatment; regrowth may start about three to six months after treatment ends. At times, the first hair growth you experience may be a different color or texture, with eventual return to your normal.
If you are a survivor dealing with hair loss, ask about local resources that provide hats, scarves and wigs to cancer patients. The American Cancer Society partners with the Personal Care Products Council and the Professional Beauty Association to offer "Look Good…Feel Better" programs for women, men and teens. For more information, call 1-800-395-LOOK (5665) or visit their website (www.lookgoodfeelbetter.org). This free program helps cancer survivors discover ways to deal with skin changes using cosmetic and skin care products, as well as hair loss by learning about scarves, wigs and other accessories.
Have you lost your hair due to cancer treatment? Share your personal story of what worked for you.

Saturday, March 18, 2017

Triple-negative breast cancer: 

Nanodelivery of new drug shows promise

MNT Knowledge Center
Published: 

Using nanoparticles to deliver an experimental drug directly into 
triple-negative breast cancer cells could be an effective way to 
fight this very aggressive cancer, which has very few treatment options. 
The drug is a peptide that is unstable, and delivering it directly into cells 
means that it can reach its target before degrading.
friendly female doctor reassures female breast cancer patient
The researchers hope that their nanodelivery method will lead to new treatments for triple-negative breast cancer - a particularly aggressive cancer that currently has very few treatment options.
So concludes a study led by Mohamed El-Tanani, a professor in the Institute for Cancer Therapeutics at the University of Bradford in the United Kingdom. He and his colleagues report their findings in the International Journal of Pharmaceutics.
The new drug - discovered by El-Tanani - is a protein fragment, or peptide, that blocks a cell-regulation protein called RAN, which promotes cancercell division and proliferation.
The researchers note that high levels of RAN are linked to aggressive tumor growth and spread (metastasis), resistance to chemotherapy, and poor outcomes in several cancers, including triple-negative breast cancer.
Around 10-20 percent of breast cancers are diagnosed as triple negative.
The term "triple negative" means that tumors test negative for the three most common receptors that drive the majority of breast cancers: human epidermal growth factor receptor 2, progesterone receptors, and estrogen receptors.

Nanoparticle capsule prevents degrading of unstable peptide

The lack of all three receptors limits the options for treating this highly aggressive cancer, resulting in poorer outcomes for patients and an increased risk of recurrence.
The new study builds on previous work by Prof. El-Tanani and colleagues, in which they showed that blocking RAN can prevent and perhaps even reverse chemotherapy resistance in small cell lung cancer.
When they ran tests in the laboratory, the researchers found that the drug was not as effective as predicted using computer models of cell processes, as Prof. El-Tanani explains:
"We knew we'd need a novel delivery mechanism for this drug because peptides on their own are unstable and they can degrade too quickly to be effective. Using a nanoparticle as a delivery mechanism was the perfect solution."
Medical researchers are increasingly turning to nanotechnology to develop new treatments because it allows them to work with and control molecules at a scale that is smaller than cells.

Two thirds of cancer cells died within 24 hours

For the new study, the team used a biodegradable polymer to make a nanoparticle that encapsulates the peptide. They tested a number of materials before they found one that effectively sustained the integrity and stability of the peptide.
When they tested nanoparticles charged with the peptide on triple-negative cancer cells in the laboratory, the researchers found that the cells actively took them in, reduced their growth rate, and stopped replicating. Within 24 hours, around two thirds of the cells were dead.
Adding either the peptide on its own, or the nanoparticle without the peptide load, had no such effects.
On closer examination, the researchers found that the peptide was killing the cancer cells in the same way as the computer models predicted - it was preventing RAN activation by silencing a gene called regulator of chromosome condensation 1, or RCC1.
The Bradford team is already testing the nanoparticle delivery method in a model of triple-negative breast cancer and considering how to progress toward clinical trials.
They are also looking at other RAN inhibitor candidates. One of these is a "repurposed" drug that they say has passed preclinical tests of breast and lung cancer and is ready for clinical trials, for which they are seeking funding.

http://www.medicalnewstoday.com/articles/316436.php?utm_campaign=trueAnthem:+Trending+Content&utm_content=58cd4e4204d3017b74a61feb&utm_medium=trueAnthem&utm_source=twitter
"By developing a nanoparticle that can help this peptide enter triple-negative breast cancer cells and block RAN we've brought this potential new treatment a step closer to the clinic."
Prof. Mohamed El-Tanani

Tuesday, March 7, 2017

VR provides distraction therapy for chemo patients

Individuals with cancer experience many anxiety-filled moments over their course of treatment. In order to alleviate some of this stress, one Australian hospital is using virtual reality to provide a therapeutic degree of relaxation and escapism to its chemotherapy patients.
Chris O'Brien Lifehouse is a cancer treatment center and hospital in Australia. It has partnered with Samsung Australia and the virtual reality studio Start VR to bring Samsung Gear VR headsets to patients waiting to receive chemotherapy.
The idea? Instead of worrying about their health and the hospital experience, patients may become absorbed in VR. Not only does this provide some relief to patients who want to escape the daily realities of a cancer diagnosis and the hospital setting, it does so without additional prescriptions or medical treatments.
At Chris O'Brien Lifehouse, patients may choose content from the Gear VR store or Start VR's catalog. Possible experiences include petting koalas, exotic travel destinations, boat rides and skydiving.
While this hospital is likely one of the first to use VR as "distraction therapy" to soothe and calm exhausted patients, VR is already being put to work in many other healthcare settings. For example, an MRI physicist at King's College Hospital in London has developed a VR app to help kids prepare for an MRI in a safe, low-anxiety way.
Learn more about the VR program at Chris O'Brien Lifehouse

Friday, February 17, 2017

Photo
Titian’s “Sisyphus,” from the collection of Museo del Prado, Madrid.CreditFine Art Images/Heritage Images, via Getty Images
For most people with cancer, life has conventional stages that I can sum up with acronyms: B.C. (before cancer), A.D. (at diagnosis), S.S.N. (some surgical nightmare), RATS (radiation therapies), ICH (in chemotherapy), followed by IRS (in a remission of some number).
Like a growing number of patients today, I inhabit a less familiar state: maintenance. This new phase presents a viable alternative to remission which, I sometimes feel, is not everything it is cracked up to be.
Why does cancer’s version of “IRS” spawn fears that can rival those spiked by a letter from the other I.R.S.? The short answer: remission is challenging. It comes with fear of recurrence. It’s impossible not to worry: Will it last? Throughout three cycles of chemotherapy for ovarian cancer, I longed for the moment when the infusion of toxins would cease, only to discover that all sorts of physical and psychological aftereffects dampened my spirits during remission.
First, consider the all-consuming issues of hair and weight. “It’s just hair and it will grow back” is a theme song many of us hum in treatment. But if it grows back curly when it had been straight or white when it had been brown or thin when it had been thick, it can be distressing to look in the mirror. Also, it does not always grow back, as I can unfortunately attest. Similarly, the weight lost or gained (yes, it can be gained) during chemo may continue falling or rising after its cessation.
Continue reading the main story
Even when the women in my support group managed to look nearly normal at the start of a remission, their families’ belief that they were as good as new bred dismay. Dana and Traci’s teenagers wanted them to host social events and go hiking. Kids relieved that they no longer have to parent their parents may feel they have earned the right to think, “Hey, we didn’t have any fun during treatment so it should be party time now.” But fatigue, muscle loss and neuropathies, not to mention the insecurity they spawn, make such expectations daunting.
After I told Dana and Traci’s stories to my husband, he said, “You have the advantage of being married to an older man: joint decrepitude.”
Before cancer I would cook for a dinner party of eight planned for the same evening. During chemo, I could not stomach the meals that friends provided. In remission it took a week of planning and concocting foods that could be reheated or else I would keel over while proposing a toast. Before cancer, I could walk a few miles. During treatment, I lay on a blue couch. In remission, I forced myself to bring in the mail. Whereas during chemo I had a good excuse for not changing the sheets every Sunday, in remission I judged myself an incorrigible sluggard.
Then there is the real kicker of being an ingrate. Surely remission should be the promised end. So why did I experience it as another version of the horrors of treatment?
Oddly, then, it comes as some relief to inhabit a state outside the normative categories. I am now neither in chemotherapy nor in remission because I am being treated with an experimental, targeted drug. While the cancer can be controlled with daily pills, I am “on maintenance”: Stable until the medication fails to work. Whereas in remission I worried about not being regularly checked by my oncologist, on maintenance I know that I will be monitored.
It is hard for many acquaintances to grasp my situation. People often congratulate me on being “cancer-free.” The comment puts me in a funk. But who wants to be a pedantic downer insisting that her disease requires constant treatment or it would come roaring back? Such a bad attitude would make me vulnerable to the all-too-common view that pessimism breeds disease and that I deserve the cancer I dread.
Thinking logically, I know that it is far better to be in a remission than on maintenance. After all, a lengthening remission may signify a cure. Nancy K. Miller, a writer and friend dealing with lung cancer, says, “The problem with maintenance is it has no plot.” But I’m not sure I agree. The plot of remission — will it last? — seems more anxiety-producing than the plot of maintenance: how long will it last?
I often feel relief at not being burdened by hope of a cure — as if Sisyphus got a chance to admire the view from the mountain after someone else erected a temporary barrier to stop the boulder from rolling down. It probably will eventually roll down, flattening me. But did I mention the view?
Assuming that the cancer will return means one less thing to worry about, weird as that might sound. Once cure has been crossed off my list of priorities, other goals spring up: visiting with family and friends as much as possible; making loud noises on any and all occasions about the need for better detection and prevention; standing up to look at the longer vista as a grateful representative of what contemporary science can do.
Having lived with incurable but not terminal cancer for some years, I try not to torture myself with suspense. Why waste the precious time granted? On good days, feeling meditative, I conceptualize being on maintenance as inhabiting the incantatory zone of “OM.”
https://www.nytimes.com/2017/02/16/well/live/in-maintenance-mode-living-in-the-moment.html?emc=edit_tnt_20170217&nlid=52389906&tntemail0=y&_r=0