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.”


Exercise Offers Cancer Survivors Significant Improvements in Quality of Life

“For many cancer survivors, a better quality of life is as close as the nearest pair of sneakers. That’s because a growing body of research, including two recent studies led by Yale Cancer Center, show that exercise is a powerful way for survivors to improve quality of life.

“The studies were presented at the 2015 Annual Meeting of the American Society of Clinical Oncology in Chicago. The first evaluated the effect of the LIVESTRONG at the YMCA program on cancer survivors who participated in twice-weekly, 90 minute exercise sessions for 3 months at local YMCAs. The other study explored whether home-based exercise programs that encouraged brisk walking could improve fatigue and quality of life for ovarian cancer survivors. Both studies showed exercise to be a potent tool for survivors to improve life in many areas.

“The LIVESTRONG at the YMCA study was conducted by Dr. Melinda Irwin, associate professor of Epidemiology in Yale School of Public Health and associate director of population sciences at Yale Cancer Center; and Dr. Jennifer Ligibel of Dana Farber Cancer Institute. It evaluated 186 participants for quality of life, physical activity and fitness. After 12 weeks, participants were shown to experience significant increases in physical activity (71 percent exercising a minimum of 150 minutes/week vs. 26 percent for the control group); and improvements in both overall quality of life and fitness performance (according to a six- minute walk test). The participants had been diagnosed with stages I-IV of cancer and 50 percent had breast cancer. In addition, at the outset of the program, the majority of the participants had been inactive.”


New Screening Method for Prostate Cancer Recurrence

“The American Cancer Society estimated that 220,800 new cases of prostate cancer will be diagnosed in the United States in 2015. Approximately 27,540 men will die of the disease, accounting for 5 percent of all cancer deaths.

“A common treatment for prostate cancer is a , in which all or part of the is removed. Recent studies have shown that this procedure is often over-prescribed. As early as 2010, the New England Journal of Medicine reported that such a procedure extended the lives of just 1 patient in 48. Side effects from the surgery, including urinary incontinence and impotence, can affect the quality of life of the patient.

” ‘For every 20 surgery procedures to take out the prostate, it is estimated that only one life is saved,’ said Gabriel Popescu, director of the Quantitative Light Imaging Laboratory (QLI) and senior author on the study. ‘For the other 19 people, they would be better left alone, because with removing the prostate, the quality of life goes down dramatically. So if you had a tool that could tell which patient will actually be more likely to have a bad outcome, then you could more aggressively treat that case.’ ”


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.”