Living With Cancer: Collateral Damage

“When I was invited to attend a prostate cancer group called ‘Us Too’ in my town, its members were meeting in a private room in our public library. About eight men, some accompanied by their wives, had great difficulty communicating their discomfort about urine leaks and diapers. They wanted to know what strategies my gynecological cancer group used to talk about sexual issues. To alleviate their daily problems, the participants needed professional help that I could not furnish.

“Sexual dysfunction and incontinence in prostate cancer survivors underscore a quandary that shadows oncology. As we all realize, procedures that prolong lives also impair them. Yet cancer patients who must forfeit quality of life to gain quantity of life rarely receive adequate warning before treatment or guidance afterward.”


Shorter Course of Radiation Improves Quality of Life for Breast Cancer Patients

“Women who receive a shorter course of whole breast radiation therapy for early stage disease experience less toxicity and improved quality of life compared to those who undergo a longer course of treatment, researchers report from The University of Texas MD Anderson Cancer Center.

“Published in JAMA Oncology, the authors believe these findings should be communicated to women as part of the shared decision-making between breast cancer patients and their physician.

“Historically in the management of breast cancer in the U.S., radiation treatment has been given in smaller doses over a longer period of time, in a method called conventionally fractionated whole breast irradiation (CF-WBI), rather than with higher doses over a shorter period of time, or hypofractionated whole breast irradiation (HF-WBI).”


Breast Cancer Survivors Who Experience Pain During Intercourse May Benefit from Lidocaine Treatment

Scientists at Oregon Health & Science University report that breast cancer survivors who experience pain during sexual intercourse, a common side effect of breast cancer treatment, may achieve comfort when liquid lidocaine is applied strategically to prevent pain. Their research was published online today in the Journal of Clinical Oncology.

“ ‘The physical and psychological consequences for the more than 2.8 million breast cancer survivors in the U.S. are very real and often misunderstood, or not treated,’ said Martha F. Goetsch, M.D., M.P.H., adjunct assistant professor in the OHSU Department of Obstetrics and Gynecology, the study’s lead author. ‘This noninvasive treatment will offer distinct help in alleviating the physical — and quite frankly the emotional — pain associated with sexual intercourse, making sexual function more enjoyable and fulfilling for them and their partner.’

“It is estimated that anywhere from 70 to 100 percent of breast cancer survivors, including those treated at OHSU Knight Cancer Institute, experience some sort of sexual dysfunction, including dyspareunia, which is the clinical term for pain during sexual intercourse. Breast cancer survivors are especially vulnerable to the condition because their treatment is focused on eradicating estrogen. This increases the severity of the typical menopausal symptom of pain with sex. A high proportion of women in menopause who have not had breast cancer also suffer from what is now termed vulvovaginal syndrome of menopause where estrogens decline.”


Benefit of End-Stage Chemotherapy Is Questioned

“It is an excruciating question for cancer patients with a prognosis of only months to live. Should they try another round of chemotherapy?

“Guidelines for oncologists say no for very sick patients, those who are often bedridden and cannot handle most daily needs themselves. But for patients who are more self-sufficient, chemotherapy is considered a reasonable option. Despite its well-known toxic side effects, many end-stage patients and their doctors have considered chemotherapy worth trying, believing it may ease discomfort or buy time.

“Now, a study suggests that even those stronger patients may not benefit from end-of-life chemotherapy — and that for many their quality of life may worsen in their final weeks compared with patients who forego last-ditch treatment.

“ ‘It worsened quality of life for those that are relatively healthy, and those are the ones that the guidelines support treating,’ said Dr. Charles Blanke, a medical oncologist at Oregon Health and Science University, who was not involved in the study. ‘Chemotherapy is supposed to either help people live better or help them live longer, and this study showed that chemotherapy did neither.’ “


Data Shows Disconnect Between Healthcare Professionals and Patient Perceptions of Impact of Chemotherapy and Radiotherapy-Induced Nausea and Vomiting

“Norgine B.V. has presented new data highlighting a perceptual gap between healthcare professionals and patients in terms of the incidence and impact on patients’ daily life of chemotherapy and radiotherapy induced nausea and vomiting (CINV/RINV).

“These data were sponsored by Norgine and presented at the joint Multinational Association of Supportive Care in Cancer (MASCC) / International Society of Oral Oncology (ISOO) 2015 Annual Meeting.

“The data demonstrate that physicians and oncology nurses overestimate the incidence of CINV/RINV, but underestimate the impact of the condition on patients’ daily lives (p1

“In addition, just 38% of patients reported full compliance with physicians’/nurses’ guidelines when self-administering anti-emetic medication, compared with 60% estimated by physicians and nurses. Leading factors given for poor patient compliance included reluctance to add to a pill burden and fear that swallowing itself would induce nausea/vomiting.”


Important New Research on Early Palliative Care for Advanced Cancer Patients Published

“Researchers at Trinity College Dublin and Mount Sinai in New York have just published new research which for the first time provides strong evidence on the economic benefits of early palliative care intervention for people with an advanced cancer diagnosis. Their findings were published today in the highly esteemed international peer reviewed Journal of Clinical Oncology.

“Previous research has shown the clinical benefits of early palliative care, but this new study robustly demonstrated how early access to expert palliative care decision making resulted in very significant cost reductions of up to 24%. The intervention reduced both the length and intensity of hospital stay for patients with advanced cancer.

“The researchers from Trinity’s Centre for Health Policy and Management and Mount Sinai’s Icahn School of Medicine, led by Peter May, HRB Economics of Cancer Fellow at Trinity, studied over 1000 patients’ pathways of care in five major US hospitals and looked at costs associated with their care based on whether they saw a specialist palliative care consultation team or received standard hospital care.”


Study Supports Early Intervention for Prostate Cancer Patients Who Experience Significant Emotional Distress

“A study led by the University at Buffalo and Roswell Park Cancer Institute has identified beliefs and personality traits that are associated with higher levels of distress in newly diagnosed prostate cancer patients.

“The findings support the value of emotional and informational support for patients and perhaps early counseling for some who are the most distressed.

“Factors that were associated with greater distress included a lack of confidence in deciding how to treat the cancer, being concerned that the cancer will progress, feeling that one’s masculinity was under threat and tendencies to be less optimistic and resilient.

“The study, ‘Factors Associated with Emotional Distress in Newly Diagnosed Prostate Cancer Patients,’ was first published online in Psycho-Oncology in January 2015. The results are from a larger longitudinal study of prostate cancer patients, ‘Live Well Live Long!’ The research was based on assessments of 1,425 men newly diagnosed with prostate cancer at five different centers.”


When Pain Persists After Breast Cancer Surgery

“I could hear the anxiety in my sister’s voice. A week after her double mastectomy and breast reconstruction for breast cancer, she had developed a burning sensation under her right arm where her surgeon had removed several dozen lymph nodes for a postoperative biopsy. The throbbing and itching were so intense it felt ‘like poison ivy lit by a blowtorch.’ ”

“The physician assistant at her reconstructive surgeon’s office told her it was probably “neuropathic in origin” — probably arising from nerve damage during surgery — and that the condition, known as postmastectomy pain syndrome, or PMPS, would subside over time. And luckily for my sister, five weeks out from surgery, the pain began to wane.

“But for many of the estimated 20 to 50 percent of women who develop pain after a mastectomy, it may never go away.”


Living With Cancer: Keep On Cooking

“Julia put a glass jar of turkey-tail mushrooms on the restaurant table. Drinking home-brewed tea helps her combat the side effects of treatment. The day before a blood test — which would reveal whether or not an experimental drug was working — I placed one delicate bit on the center of my palm. The ridged striations and concentric ruffles reminded me of the tiny angel-wing shells that Leslie’s partner had collected on Sanibel Island for our cancer support group.

“When I put down the mushroom to pick up a menu, nothing on it resembled the foods I had been enjoined to eat at a cancer conference I had just attended.

“Next to the podium a speaker stood beside a blender in which she put almond milk, half of an avocado, a banana and flax seeds. Conference participants were told to eat fresh fruits and vegetables, to abstain from sugar and dairy and meat. We were urged to avoid white foods and instead to consume dark greens, bright oranges, vivid reds and glowing yellows. Raw and organic are the way to go, or slow roasted and locally grown. Whole grains should be a staple, but turmeric, garlic and ginger can be added abundantly, along with blueberries, walnuts, wild salmon and especially kale.”