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.’ “


Therapeutic Massage Takes on Cancer Fatigue

“In a continuation of clinical trials related to the biological benefits of massage therapy, Emory researchers are currently studying how massage may help reduce fatigue in breast cancer patients.

“Previous research conducted by Mark Hyman Rapaport, MD, Reunette W. Harris professor and chair of Emory’s Department of Psychiatry and Behavioral Sciences, has already shown that massage therapy can boost the immune system and decrease anxiety for people who do not have cancer.

” ‘We decided to look at massage therapy for cancer fatigue because cancer-related fatigue is one of the most prevalent and debilitating symptoms experienced by people with cancer,’ explains Rapaport, principle investigator for this study. ‘Many studies investigating massage for patients with cancer have been focused on depression, anxiety or pain.’ “


Easing Cancer's Effects through Focus on Relationships

“Cancer patients look to oncology specialists for highly skilled treatment. Yet others may affect their disease experiences – their partners, wives, husbands or close family members.

“In recent years, there has been growing recognition that close relationships are important to fostering good cancer care. Treating the whole patient transcends beyond physical medicine to address cancer’s psychosocial impact as well, including stresses on partnerships and families.

“Psychologist Sharon L. Manne, associate director for population science at the Rutgers Cancer Institute of New Jersey, studies cancer’s effect on relationships, especially couples. Her work explores emotional and psychological needs, ways to increase communication and methods of strengthening intimacy between partners.

” ‘Most people don’t expect to ever be diagnosed with cancer. Coping is important,’ Manne says. In her work, she has found that developing more relationship support and intimacy reduces stress and facilitates well-being. ‘As a research center, our goal is to improve quality of life for patients and families.’ “


Younger Men More Bothered after Prostate Cancer Treatment

“After treatment for localized prostate cancer, changes in quality of life will vary by age, as will men’s reactions to those changes, according to a new study.

“ ‘While older and younger men start with different baseline quality of life function, older men may be less bothered by certain declines that may affect younger patients more,’ Dr. Lindsay Hampson told Reuters Health in an email.

“Prostate cancer is the most common malignancy in men of all ages in the U.S. Almost 60 percent of new cases are diagnosed in men over the age of 65, and the average age is 66.

“Older men are often diagnosed with more aggressive disease and are less likely to get treatment, in part because they worry about the impact on their sexual and urinary function, Hampson and her colleagues write in European Urology.

“Determining quality of life priorities is vital to ensuring that patients make well-informed treatment decisions, said Hampson, a urologist at the University of California San Francisco.