“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.’ ”


Melanoma Surgery Delays Are Common for Medicare Patients

“One in five Medicare patients with melanoma experience delays in getting surgery, a Yale study found. The research was published April 8 in JAMA Dermatology.

“Melanoma, a type of skin cancer, is a leading cause of new cancer diagnoses in the United States. A delay between diagnosis and surgery to remove melanomas may cause patients psychological harm and affect health-care quality. Using the national Surveillance, Epidemiology, and End Result-Medicare database, the Yale team conducted the first population-based analysis of delay of surgery among Medicare patients with melanoma.

“The researchers reviewed data on more than 32,000 Medicare patients diagnosed with melanoma. They found that 22% of patients waited longer than 1.5 months for melanoma surgery, and 8% were delayed more than 3 months. Although no gold standard exists, a timeframe of less than six weeks between diagnosis and surgery has been recommended.

” ‘Delay for melanoma surgery in this population is more common than we expected,’ said Jason Lott, M.D., who was first author of the study as postdoctoral fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at Yale School of Medicine.”


Dying Patients' Choices Not Always Aligned to Caregivers'

“Patients with advanced cancer or other life limiting illnesses often have to consider how much money they are willing to spend on high cost treatments that result in only moderate improvements in length or quality of life. These decisions are very difficult for patients to make, and in some cases the decision is entirely deferred to a family caregiver.

“Past research has shown that in addition to extending life, being free of pain and dying at home are important considerations for people nearing the end of their lives. However, the value that patients place on these considerations or their willingness to pay for either was not previously known.

“A team led by Professor Eric Finkelstein and Assistant Professor Chetna Malhotra from the LCPC in Duke-NUS Graduate Medical School (Duke-NUS) administered surveys to 211 patients with stage IV cancer and their informal caregivers to find out more about their end-of-life preferences.”


Physical Activity Benefits Lung Cancer Patients and Survivors

“Exercise and physical activity should be considered as therapeutic options for lung cancer as they have been shown to reduce symptoms, increase exercise tolerance, improve quality of life, and potentially reduce length of hospital stay and complications following surgery for lung cancer.

“Lung cancer is the leading cause of cancer deaths in the United States with an estimated 160,000 deaths each year and worldwide there are 1.4 million deaths. In the last two decades lung cancer therapy has improved, but the overall 5-year survival rate is still quite low at 17%. Lung cancer patients experience many debilitating symptoms including difficulty breathing, cough, fatigue, anxiety, depression, insomnia, and pain. A third of long term survivors, those >5 years from diagnosis, experience reduced quality of life and report lower physical and health scores compared to healthy patients. Given the incidence of lung cancer and the associated costs An inexpensive and relatively easy cancer therapy to reduce symptoms and improve quality of life, like physical activity, could be beneficial, especially for therapy, but clinicians underutilize exercise as a therapy, in part due to the lack of evidence-based consensus as to how and when to implement increasing physical activity.

“Dr. Gerard A. Silvestri, Dr. Brett Bade, and colleagues at Medical University of South Carolina have reviewed the safety, benefits, and application of increasing physical activity and exercise in lung cancer with the goal to summarize the effect on improved lung cancer outcomes. Their results are published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC).”


Androgen Deprivation Therapy Has Lasting Impact on Function

“For patients with prostate cancer, androgen deprivation therapy (ADT) has a lasting impact on physical function, according to a study published online March 24 in Cancer.

“Shabbir M.H. Alibhai, M.D., from the University Health Network in Toronto, and colleagues examined the impact of ADT on physical function and quality of life over 36 months. They enrolled 87 men with nonmetastatic  who were starting continuous ADT, and two control groups matched by age and education (86 prostate cancer patients without ADT and 86 healthy controls).

“The researchers found that in both control groups there was an initial improvement in the six-minute walk test which then stabilized, while there was no change for ADT users (P = 0.0030). In control groups, grip strength remained stable, but there was a sharp decline in the ADT group by three months, which then remained stable to 36 months (P = 0.0041). Over 36 months, Timed Up and Go scores declined gradually in the ADT group and did not change in control groups (P = 0.0001). In all groups, the aggregate mental quality of life was stable. Declines seen in the first year of ADT use were independent of age and generally persisted during 36 months.”


Stress Management Techniques Improve Long-Term Mood and Quality of Life

“A new study shows that providing women with skills to manage stress early in their breast cancer treatment can improve their mood and quality of life many years later. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the findings suggest that women given the opportunity to learn stress management techniques during treatment may benefit well into survivorship.

“At the turn of the century, 240 women with a recent breast cancer diagnosis participated in a randomized trial that tested the effects of a stress management intervention developed by Michael Antoni, Ph.D., professor of psychology in the University of Miami (UM) College of Arts & Sciences. Dr. Antoni and his team in the Department of Psychology found that, compared with patients who received a one-day seminar of education about breast cancer, patients who learned relaxation techniques and new coping skills in a supportive group over 10 weeks experienced improved quality of life and less depressive symptoms during the first year of treatment.

“In their latest report, the researchers found that the women who received the stress management intervention had persistently less depressive symptoms and better quality of life up to 15 years later.


Mental Training Exercises Shown to Help Mitigate the Effects of 'Chemo Brain'

“UCLA researchers have developed a program that could improve the day-to-day lives of women with breast cancer by addressing post-treatment cognitive difficulties, sometimes known as ‘chemo brain,’ which can affect up to 35 percent of women after their treatments.

“An estimated one in eight women will develop invasive breast cancer in their lifetimes, and following treatment, a mental fogginess can prevent them from being able to concentrate, staying organized and completing everyday activities, such as sticking to a schedule or planning a family gathering.

“The new study, led by breast cancer research pioneer and UCLA Jonsson Comprehensive Cancer Center member Dr. Patricia Ganz, builds upon her earlier research that found a statistically significant association between neuropsychological test performance and memory complaints among women with early stage breast cancer following treatment.

” ‘We invited the women to participate in a research study that assigned them to early or delayed treatment with a five-week, two-hour group training session, where a psychologist taught them strategies to help them with their memory and maintaining their ability to pay attention to things,’ said Ganz, director of prevention and control research at the cancer center. ‘These are activities we call executive function and planning, or the things all of us do in order to organize our day.’ “