Friday, February 26, 2016


Tips for safe food choices during cancer treatment

By Lonnie Fynskov, R.N. February 18, 2016
"Eat well to maximize your body's fuel for everyday tasks." This is a key behavior for a healthy lifestyle.
In treatment you may be advised to avoid any unnecessary bacteria to prevent food-borne infections. Meanwhile, you read and hear often about needing to eat more fruits and vegetables on a daily basis. But what happens when you are told to avoid fresh produce during treatment? Is it still possible to eat well while avoiding fresh fruits and vegetables?
In the past, you may have been told to follow a neutropenic diet if your white blood cell count was low during treatment. Over the past year, recommendations have changed and that's no longer necessary. However, it's still important to follow rules of good food safety during treatment.
Rather than remembering long lists of what's safe and what might be a problem, think about how these general guidelines to limit your risk of food-borne illnesses.
  • Make sure that meat and fish is fully cooked.
  • Choose cooked vegetables instead of fresh.
  • If eating vegetables at home, wash them well, even if they are pre-washed.
  • Eat hard cheeses instead of softer cheeses. Avoid those made from unpasteurized milk.
  • Choose fruits that are easy to clean well or are cooked, such as canned peaches, pears, applesauce, etc.
  • Use pasteurized eggs when preparing recipes that call for raw or undercooked eggs.
These suggestions may help you to eat healthy and avoid food infections during treatment. I’d love to hear what has worked well for you. Please share your suggestions with each other on the blog.

Brighter Days for Ambulatory Surgery Centers with Innovative Breast Care

Ambulatory surgery centers face plenty of financial (some might even say “existential”) challenges. Among these are a tightening reimbursement environment, competition from hospital systems, and high health insurance deductibles.
Cross in OR - XL-2
Dr. Michael Cross is establishing an international reputation for innovations in breast cancer surgery.
Nonetheless, breast cancer care is emerging as a bright spot for ASCs, including two centers we talked with recently.
In a large New York City surgery center, for example, breast care helps lead the way. In an Arkansas center, transparent pricing and use of a relatively new surgical marker called BioZorb are part of the story.
First, though, let’s talk about those challenges.
“The changes in healthcare have been accelerated with passage of the 2010 Affordable Care Act, a.k.a. Obamacare, the expansion of Medicaid programs, an economy that is improving at a slower than normal rate, and stagnant increases in wages,” Laura Dyrda wrote recently in Becker’s ASC Review, “Reimbursement is in flux for many surgical specialties,” and high-deductible
health plans – which are growing ever more common – create greater payment challenges.
Another elephant in the room is consolidation among providers. Hospital systems are scarfing up physician practices and turning doctors into employees. That alters referral patterns. It incentivizes hospitals and doctors to keep surgeries within their system rather than referring them to ASCs.
Now back to the bright spot of breast cancer care.
Gramercy Surgery Center, with offices in Manhattan and Queens, has an initiative to provide “ambulatory cancer care.” Leading that effort, says COO Jeffrey Flynn, is high-quality breast cancer care.
Rather than do lumpectomies in an expensive hospital setting, Gramercy’s four breast surgeons perform routine breast -conserving surgeries (in patients with no comorbidities and no need for lymph node dissection, for example) in a setting that is less than one-quarter the cost of a hospital operating room. In New York, Flynn puts the cost of Gramercy’s OR at $900 an hour, versus $4,100 an hour for a hospital OR.
Yes, Gramercy has competition from some hospitals that want to retain patients, Flynn acknowledges. But he quickly adds that many hospitals doing the math find they are in fact better off by referring some breast surgeries to an ambulatory center.
Gramercy both features its physicians in marketing efforts — including luminaries such as Dr. John Kehoe – and also sees its surgeons as clients in themselves. Happy doctors are more likely to deliver high-quality care, the thinking goes. Plus they will bring patients with them for future surgery those patients may need.
Flynn and colleagues make a point of stressing the financial effectiveness of their centers when they talk to payers. They partner with hospitals in some cases. And for patients, they emphasize the many advantages an ASC has over a typical big-city hospital. Those include lower complication rates and a calmer, boutique-type atmosphere.
Another innovative ASC, North Hills Surgery Center in Arkansas, adds other advantages to the list that ambulatory centers have in breast care.
North Hills is one of the few facilities in the country that actually posts its rates on its website. That kind of price transparency is appreciated by both patients and payers alike. This is especially true in an era of high deductibles, which many patients have to cover themselves. Insurers like it, too, in their never-ending efforts to know exactly what they are covering and what it costs.
North Hills also has the advantage of working closely with Dr. Michael Cross. He’s establishing an international reputation for innovative breast cancer surgery using theBioZorb surgical marker. Working within the ASC setting, Dr. Cross has placed well over 130 of these markers in lumpectomy patients.
BioZorb has a key role to play in the emerging trend of oncoplastic surgery, in what its co-inventor, Dr. Gail Lebovic, calls a “reconstructive lumpectomy.” By adding volume in the tumor bed once the cancer is excised, the 3D marker helps reduce the dimpling and deformity that can too often result from a lifesaving lumpectomy.
The marker is also used to mark the tumor site for follow-up radiation and for future monitoring with mammograms and other forms of imaging.  BioZorb has been linked instudies to the ability to do shorter courses of radiation.
When it’s used to more precisely mark the location of the tumor bed, Dr. Cross and colleagues have reported, they can shorten the length – and reduce the cost — of radiation treatment, using hypofractionated radiotherapy. For eligible patients, that means they don’t have to come in for the traditional, lengthy six weeks of radiation.
These successes at Gramercy and North Hills – in the Big Apple and in the middle America of Fayetteville, Ark. — demonstrate that despite all the tumultuous changes in healthcare, it’s not necessarily dark days for ASCs. In fact, with a strong focus on patients, innovative technology such as BioZorb, and the right combination of surgeons and facilities, brighter days are readily achievable.

ACOG: Vaginal Estrogen Safe for Breast Ca Survivors

No increased risk of cancer recurrence

  • by Molly Walker 
    Contributing Writer

Vaginal estrogen is safe for breast cancer survivors suffering from such urogenital symptoms as vaginal atrophy, vasomotor symptoms, and lower urinary tract infections, and there is no evidence of increased risk of cancer recurrence with the treatment, according to a statement from the American College of Obstetricians and Gynecologists(ACOG).
However, the decision to use vaginal estrogen should be made in consultation with a woman's oncologist, and only if "first-line choices" for managing urogenital symptoms -- which should be nonhormonal products such as lubricants -- are ineffective for breast cancer patients, reported ACOG's Committee on Gynecologic Practice, writing inObstetrics and Gynecology.
Sexual medicine specialist Lauren Streicher, MD, of Northwestern University, who was not involved with the statement, said that although the treatment clearly eases vaginal dryness, many physicians are reluctant to prescribe it for breast cancer patients. But she said the response is quite different when gynecologists are asked about it.
"In 2011, I surveyed board-certified gynecologists about decisions they make regarding their own health care and asked, 'If you had breast cancer and had vaginal atrophy, would you personally use vaginal estrogen?' Ninety-three percent of female gynecologists said they would," Streicher wrote in an email to MedPage Today. "ACOG's position statement that it is safe to prescribe vaginal estrogen to women with breast cancer is long overdue, supported by solid data and is in fact a recommendation that many clinicians are already solidly behind."
The committee cited several studies that showed no increase in recurrence in cancer for breast cancer survivors using vaginal estrogen cream, and that vaginal estrogen may be appropriate for women using tamoxifen. The group cautioned, though, that "concerns remain about recurrence risk in women ... who use aromatase inhibitors." For this group, the statement said, urogenital symptoms not responding to nonhormonal therapies may benefit from "short-term use of estrogen with tamoxifen to improve symptoms, followed by a return to normal aromatase inhibitor therapy."
"These new recommendations are especially important and helpful because they provide the patient with the information needed to make an informed decision with the input of her health care provider," Diana Nancy Contreras, MD, chair, ACOG's Subcommittee on Gynecologic Oncology, said in a statement.
But there remains one major stumbling block to wider use of vaginal estrogen for breast cancer survivors: the current boxed warning on all estrogen products, including topical agents, indicating that increased risk of breast and endometrial cancer is a side effect.
"Even if a woman is given the go-ahead [to use vaginal estrogen], one look at the FDA black box warning is enough to dissuade all but the most motivated woman," said Streicher.
The North American Menopause Society (NAMS) recently presented evidence to the FDA in an effort to change the warning label. They argued that low-dose vaginal estrogen products, such as the type used to treat vulvar and vaginal atrophy, do not pose the same risk as higher doses of systemic hormone therapy.
The ACOG committee emphasized that decisions about treatment should include discussion of risks as well as benefits between a patient and her healthcare providers, so a patient can make an informed choice for herself. Vaginal estrogen should then be prescribed at the lowest dose and for a limited time, until symptoms improve.

    Thursday, February 25, 2016


    Pancreatic cancer 'breakthrough' hailed

    Anmar Frangoul | Special to CNBC.com,CNBC 7 hours ago 

    How Exercise May Lower Cancer Risk

    Photo
    CreditGetty Images
    Phys Ed
    PHYS ED
    Gretchen Reynolds on the science of fitness.
    The relationship between exercise and cancer has long both intrigued and puzzled oncologists and exercise physiologists.
    Exercise is strongly associated with lowered risks for many types of cancer. In epidemiological studies, people who regularly exercise generally prove to be much less likely to develop or die from the disease than people who do not. At the same time, exercise involves biological stress, which typically leads to a short-term increase in inflammation throughout the body. Inflammation can contribute toelevated risks for many cancers.
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    Now, a new study in mice may offer some clues into the exercise-cancer paradox. It suggests that exercise may change how the immune system deals with cancer by boosting adrenaline, certain immune cells and other chemicals that, together, can reduce the severity of cancer or fight it off altogether.
    To try to better understand how exercise can both elevate inflammation and simultaneously protect the body against cancer, scientists at the University of Copenhagen in Denmark and other institutions decided to closely examine what happens inside mice at high risk for the disease.
    So, for the new study, which was published this month in Cell Metabolism, they began by gathering a group of adult lab mice. These animals generally like to run.
    The scientists then implanted melanoma skin cancer cells into the mice before providing half of them with running wheels in their cages while the other animals remained sedentary. After four weeks, far fewer of the runners had developed full-blown melanoma than the sedentary mice and those that had been diagnosed with the disease showed fewer and smaller lesions. They also were less prone to metastases, even if scientists injected some of the cancer cells into their lungs to stimulate metastases.
    In effect, running seemed to have at least partially inoculated the mice against the cancer.
    Next, the scientists undertook the far more challenging task of reverse-engineering the process by which exercise might be helping to fight off the tumors. To start, they drew blood from both the exercising and sedentary animals and cells from any tumors in both groups. Then they looked microscopically at how the various samples were different.
    As expected, they found much higher levels of the hormone adrenaline in the blood of the exercising animals, especially right after they had been working out on the wheels but also at other times of the day. The body releases adrenaline in response to almost any type of stressful experience, including exercise.
    They also found higher levels of interleukin-6 in the blood of the runners. This is a substance that is released by working muscles and is believed to both increase and decrease inflammation in the body capriciously, depending on where and how it goes to work.
    Perhaps most important, they found much higher numbers in the bloodstreams of runners than in the sedentary mice of a type of immune cell named natural killer cells that are known to be potent cancer fighters.
    Somehow, the scientists speculated, these elements in the runners — their elevated adrenaline, IL-6, and natural killer immune cells and their lower cancer risk — must be entwined, but it wasn’t clear how.
    So the scientists repeated their original experiment multiple times, inducing cancer while allowing some mice to run and others to sit. But in some of these follow-up experiments, they injected the runners with a substance that blocked the production of adrenaline and gave sedentary animals large doses of added adrenaline.
    Then they again looked at the animals’ blood and other cells.
    What they now saw was that when running mice could not produce adrenaline, they developed cancer at the same rate as the sedentary animals, while the sedentary animals that had been injected with extra adrenaline fought off their tumors better than other sitting mice.
    More remarkably, by studying the action of various genes within the cells of the mice, the scientists determined that adrenaline seemed to be sending biochemical signals to some of the animals’ IL-6 cells, making them physiologically more alert, so that when a tumor began to develop in the affected animal, those IL-6 cells in turn activated the natural killer cells in the bloodstream and actually directed them to the tumors, like minute guide fish.
    Because the runners’ blood generally contained more adrenaline, more IL-6, and more natural killer cells than did the blood of the sedentary mice, this process was intensified. A larger number of natural killer cells were directed to tumors in the runners, allowing their immune systems, it seems, to more effectively combat the malignancy.
    With these results, “we show that voluntary wheel running in mice can reduce the growth of tumors, and we have identified an exercise-dependent mobilization of natural killer cells as the underlying cause of this protection,” said Pernille Hojman, a researcher at the University of Copenhagen who oversaw the new study.
    But mice, obviously, are not people, and it is impossible to know from this study whether a similar process occurs in humans, although exercise, particularly moderately intense exercise such as jogging, has been shown to increase adrenaline and the production of natural killer immune cells in people, Dr. Hojman said.
    “So the mechanisms,” she said, that seemed to partially protect the running mice in this study from malignancies, “can also happen in people,” perhaps providing one more incentive, if we still need it, to get up and move.
    http://well.blogs.nytimes.com/2016/02/24/how-exercise-may-lower-cancer-risk/?emc=edit_tnt_20160225&nlid=52389906&tntemail0=y

    cindyweiss

    What makes a cancer survivor?

    Posted by @cindyweissJun 1, 2014
    Cindy Weiss in a photo from 2005, during her initial treatment for ovarian cancer.
    Cindy Weiss in a photo from 2005, during her initial treatment for ovarian cancer.
    June 1 is designated National Cancer Survivor Day – a time to celebrate those living with cancer. It seems ironic, though, for one day to be called out as cancer survivor’s day. Let's be honest – once you receive a diagnosis of cancer, regardless of what kind, every day is essentially survivor’s day.
    As a two-time ovarian cancer patient, I know this. But the word "survivor" brings some dilemma. Exactly who is a survivor? What defines a survivor? Are you a survivor after you've completed a six-month chemo regime? Finished weeks of radiation? Lived for x-number of years cancer-free? The question or definition of a survivor is something I and others have grappled with for years.
    “Survivor” is a strong and powerful word. According to one definition, a survivor is one “who continues to function or prosper in spite of opposition, hardship, or setbacks.” Sounds like every cancer patient I've ever known. But it’s also a label I’d apply to family members and friends. It takes a village to raise a child, they say. So, too, I believe to fight cancer. By that definition, aren't we all survivors?
    Today is a great opportunity to honor those living with cancer as well as acknowledge friends and family and pay tribute  to the healthcare providers and researchers who work daily to increase the length and quality of life of survivors.
    As an employee at Mayo Clinic in Jacksonville, Fla., I've had the chance to work with many of these amazing individuals. I am in awe of the work they do, aiming for a day when we no longer have to define ourselves.
    Seven years ago, I had just started my career at Mayo Clinic when I received my second diagnosis. I recall people saying “Well, you couldn't be in a better place.” I’d smile and nod, but inside I was scared and confused. Just because I worked at a well-known healthcare institution didn't mean I wanted to be there as a patient. I didn't want to have cancer. Again. Besides, I didn't know these people and their research like I do today.
    Over the years, I've personally come to know many of the selfless and caring doctors and nurses, technicians and therapists at Mayo Clinic's Cancer Center, all of whom share a passion for their patients and survivorship.  I've also had the privilege to meet some world-renowned researchers who work daily to solve the mysteries of cancer and identify new therapies.  I know I'm in a good place – should I ever need it.
    But alas, as I think about survivorship, I can’t help but think about those who are no longer with us.
    My grandmother Rae, my aunt Martha, my friends KellyMary and Debbie and... the list is unfortunately long. These individuals ultimately lost their battles, but they are survivors, too. They survive in our hearts and in our memories. And we, in turn, survive because of them. They are the reason we do our work, our research, share our stories.
    So today I raise a glass and say l’chaim - to life! To mine, to yours, to theirs. We are all survivors.
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