Living With Cancer: Patients on Our Own

“I had to take my husband back to the hospital for a second operation on a torn tendon, but the pills from the cancer trial had not yet arrived. Surely doing without one or two days of the drug would not necessarily lead to a recurrence, I told myself in an effort to still rising waves of anxiety. There were more pressing matters to attend, namely righting wrongful care.

“Two weeks earlier, a fall on the basement steps led to an operation on Don’s knee. The surgeon called it a success and sent us home. After I wrote an essay about my welcoming the prospect of caring for my beloved caregiver, the first reader responded: ‘No one has training in these tasks, especially families who are too emotionally connected to really be effective.’ A nurse judged our being entrusted with home care ‘dangerous.’ They were both spot on.

“The first night home in a brace, Don’s leg buckled beneath him and he fell again. At the ER, he was given a longer brace. However two arduous weeks later — while we thought the knee was healing — the orthopedic surgeon explained that the tendon had torn again probably because of that fall two nights after surgery: Don would need a reoperation.”

IMRT, 3D-CRT Confer Similar Patient-Reported Outcomes in Prostate Cancer

“Intensity-modulated radiation therapy was not associated with improved patient-reported bowel, bladder and sexual function outcomes compared with 3-dimensional conformal radiation therapy given in similar doses for prostate cancer, according to study results.

“ ‘There is evidence suggesting that [intensity-modulated radiation therapy] may achieve higher [radiation therapy] doses with no increase or even with a lower dose to normal critical structures, such as bowel and bladder, compared with [3-dimensional conformal radiation therapy],’ Deborah W. Bruner, RN, PhD, of the Nell Hodgson Woodruff School of Nursing at Emory University, and colleagues wrote. ‘However, the cost of [intensity-modulated radiation therapy] may be more than twice that of [3-dimensional conformal radiation therapy] because of increased treatment planning.’

“No study had yet directly compared outcomes for patients with prostate cancer who received similar doses of intensity-modulated radiation therapy (IMRT) and 3-dimensional conformal radiation therapy (3D-CRT), according to study background.”

Dabrafenib plus Trametinib Improves Health-Related Quality of Life in Metastatic Melanoma

“The addition of trametinib to dabrafenib improved health-related quality of life and reduced pain in patients with BRAF V600-mutated metastatic melanoma, according to results of a randomized phase 3 study.

“The combination of dabrafenib (Tafinlar, GlaxoSmithKline) and trametinib (Mekinist, GlaxoSmithKline) received accelerated approval from the FDA in 2014 based on the results of a phase 1/2 study that compared the combination with dabrafenib monotherapy. Results from a phase 3 trial later demonstrated significantly improved PFS and objective rate response with the combination vs. dabrafenib monotherapy in patients with BRAF V600 metastatic melanoma.

“In the current analysis, Dirk Schadendorf, MD, of the department of dermatology at the University Hospital Essen in Germany, and colleagues sought to evaluate the effect of the combination on health-related quality of life among patients treated in the phase 3 study.”

When Should Palliative Care Be Integrated into Cancer Care?

“Palliative care should be integrated into cancer care during any cancer stage and in patients at any age.

“Palliative care is commonly confused with end-of-life care, but it is initiated at the time of a cancer diagnosis to relieve suffering throughout the duration of the disease.

“In a 2010 study published in The New England Journal of Medicine, researchers found that the early initiation of palliative care among patients with advanced lung cancer was not only associated with improvements in quality of life for patients, but that palliative care also decreased the need for aggressive care at the end of life and even increased survival in some cases.

“Yet, according to a 2014 study published in Journal of Clinical Oncology, patients are not always referred to a palliative care team or they are referred late during the course of illness.  According to the paper, feasible service delivery models are lacking in both the inpatient and outpatient setting.”

Surgery for Terminal Cancer Patients Still Common

“The number of surgeries performed on terminally ill cancer patients has not dropped in recent years­, despite more attention to the importance of less invasive care for these patients to relieve symptoms and improve quality of life. But new research from UC Davis also finds that the morbidity and mortality among patients with terminal cancer has declined because surgeons are selecting to operate on healthier patients.

“The study, ‘Current Perioperative Outcomes for Patients with Disseminated Care Undergoing Surgery’ was published online this week in the Journal of Surgical Research.

“ ‘Surgeons are becoming wiser,’ said study lead author Sarah Bateni, a UC Davis resident surgeon. ‘Our research suggests that surgeons may be operating on healthier patients who are more likely to recover well from an operation. These are patients who can perform activities of daily living without assistance, for example.’

“Bateni’s interest in the appropriate surgical care of people with late-stage cancer grew from observing terminally ill patients whose acute problems were addressed through surgery, and who then suffered complications resulting in lengthy stays in intensive care units, and even in death.

“ ‘It is common that patients end up dying in the intensive care unit instead of being managed with medication with hopes of returning home with their families, including with hospice care,’ she said.”

Living With Cancer: In and Out of the Closet

“In a memoir, ‘The Summer of Her Baldness,’ the visual artist and theorist Catherine Lord finds ‘the cancer closet . . . at least as complicated as the sexuality closet’: ‘You can never get entirely out and you can never get entirely back in.’

“Does my deployment of careful costumes to conceal scars, hair loss, an ostomy bag, a port and other signs of treatment put me in a closet like the one in which many lesbians and gay men once felt they needed to be confined?

“Only a few decades ago, both homosexuals and cancer patients frequently needed to lie about their lives — to keep their jobs and their social standing. Happily, physicians today no longer define homosexuality as a sickness. But cancer is a disease that continues to afflict one of four Americans. And it can still be accompanied by a sense of shame and with economic as well as physical and emotional liabilities.

“While coping with cancer, I often feel like an impersonator of my former self. In a number of contexts and for various reasons, I am a sick person trying to appear healthy. While the contest between destructive cells and aggressive therapies persists, it seems strategic to pretend to be normal. All sorts of props — a wig, make-up, hats, billowing pants and shirts — provide a semblance of what I used to look like.”

“Why Did This Happen to Me?”

“That question is perhaps the most common one raised by patients facing a diagnosis of cancer for the first time. There are so many campaigns about how to ‘avoid’ cancer: no white sugar, no chemicals, all-plant diets, regular exercise, don’t smoke, don’t drink. I can see how one can get the impression that if one does all of it, cancer will never touch him or her. Yet, every once in a while, someone comes to my office who drives home the message that all most people can do—and all most clinicians can advise—is risk reduction, not prevention. Such was the case with Laurie*.

“Laurie was in her early fifties, the mom of twin girls. She had prided herself on being a health nut—aerobic exercise in the morning, yoga in the evening. She did not eat red meat and didn’t drink alcohol. Her family adopted an organic diet; she even grew her own vegetables. She was proud of her reputation as the ‘healthiest mom on the block.’ She had told me that others in her little town often sought her counsel about how to get healthier.

“Then, she found a mass in her breast. At first, she couldn’t believe it, thinking it must have been a blocked duct. However, it grew with time, and eventually, a mass appeared under her axilla.

“By the time she was diagnosed she had a 5cm breast mass and at least two sonographically suspicious nodes. A biopsy confirmed triple-negative breast cancer. She was devastated. Even more, she just couldn’t understand how this happened to her.”

After Prostate Cancer, Start Walking: Walking Routine Improves Health-Related Quality of Life

“Walking at an easy pace for about three hours every week may be just enough physical activity to help prostate cancer survivors reduce damaging side effects of their treatment, according to a new Northwestern Medicine study.

” ‘Non-vigorous walking for three hours per week seems to improve the fatigue, depression and body weight issues that affect many men post-treatment,’ said Siobhan Phillips, lead author of the study. ‘If you walk even more briskly, for only 90 minutes a week, you could also see similar benefits in these areas.’

“Phillips is a kinesiologist and an assistant professor in the department of preventive medicine at Northwestern University Feinberg School of Medicine. The paper will be published April 16, 2015 in the Journal of Cancer Survivorship: Research and Practice.

“This is one of the first papers to investigate how different intensities and types of physical activity affect the health-related quality of life of men after prostate cancer treatment.

” ‘This study shows that you don’t have to engage in high-impact, vigorous activities to improve your quality of life after a prostate cancer diagnosis,’ Phillips said. ‘Since many prostate cancer survivors might find vigorous activities hard to stick with, the good news is that simply focusing on walking more may be enough to make them feel better.’ “

ADT Affects Long-Term Quality of Life in Patients with Prostate Cancer

“The physical adverse effects associated with continuous androgen deprivation therapy persisted long-term in patients with nonmetastatic prostate cancer, according to study results.

“Approximately 50% of men with prostate cancer will receive ADT, and most of those men will undergo the treatment for 2 to 3 years, according to study background. ADT is associated with several adverse effects that affect the quality of life in patients, such as sexual dysfunction, fatigue, anemia, osteoporosis and muscle loss.

“Shabbir M.H. Alibhai, MD, MSc, FRCPC, of the department of medicine at the University Health Network in Toronto, and colleagues previously evaluated the physical effects of ADT after 12 months. Researchers evaluated data from the same cohort for an additional 2 years to examine long-term adverse effects of the therapy.

“The analysis included 87 men with nonmetastatic prostate cancer who received continuous ADT and two age- and education-matched control groups, one composed of 86 men with prostate cancer who did not receive ADT and one composed of 86 healthy men. The mean age of all participants in the population was 69 years…

“ ‘A reasonable interpretation of our findings is that most of the deleterious effects of ADT on physical function in middle-aged and older men is seen with 6 months of ADT use,’ the researchers wrote. ‘An additional 12 to 30 months of ADT does not appear to lead to much additional decline. …This may be particularly relevant to clinicians who are debating the merits of shorter or longer courses of ADT because it provides more information about physical toxicities of ADT.’ ”