Living with Breast Cancer
5/16/2012 (9:52:59am)Tags: stats breast cancerComments: (0)
It is rather surprising for a therapist's office, but there is a lot of discussion of statistics in my space. Especially around diagnosis or when making treatment decisions, some women want as many statistics as possible, and then obsess about how to try to get themselves onto the wanted side of those numbers. As we all know, response or survival statistics refer to a large pool of people and are fairly meaningless to a single individual. For each person, the number is either 0 or 100--that is, either the treatment works or it does not. Still, having some sense about the probabilities can be helpful, but they can also be very distressing. We usually know how much we want to know and only ask the questions that we want answered.
This is an article about the value of statistics in considering cancer screening. Here is the beginning and then a link to read more:
A Closer Look
Crunching Numbers: What Cancer Screening Statistics Really Tell Us
Over the past several years, the conversation about cancer screening has started to change within the medical community. Be it breast, prostate, or ovarian cancer, the trend is to recommend less routine screening, not more. These recommendations are based on an emerging-if counterintuitive-understanding that more screening does not necessarily translate into fewer cancer deaths and that some screening may actually do more harm than good.
Much of the confusion surrounding the benefits of screening comes from interpreting the statistics that are often used to describe the results of screening studies. An improvement in survival-how long a person lives after a cancer diagnosis-among people who have undergone a cancer screening test is often taken to imply that the test saves lives.
But survival cannot be used accurately for this purpose because of several sources of bias.
Read more...
5/15/2012 (10:34:27am)Tags: noneComments: (0)
"Brain fog" is a new expression for me, and I am quite taken by it. I like it much better than "chemobrain" or "distracted" or "forgetful." "Fog" sounds gentle and almost soothing (okay, I admit that I have always liked foggy days near the ocean), and it also sounds temporary. These are comments from BreastCancer.org about an article published last fall that compared cognitive function of women post-breast cancer treatment with similar women who had not had breast cancer. Here is the beginning and then a link to read more from MedPage:
Breast Cancer Itself May Cause 'Brain Fog'
By John Gever; 2011-11-14
What breastcancer.org says about this article ... Breast Cancer Itself May Cause 'Brain Fog':
Many women treated for breast cancer say they have problems remembering, thinking, and concentrating during and after treatment. A small research study offers new evidence that being diagnosed and treated for breast cancer affects brain function; brain function is even more affected if a woman gets chemotherapy.
The research is published in the November 2011 issue of Archives of Neurology.
The memory, thought, and concentration problems associated with chemotherapy are commonly called chemobrain or chemofog. Doctors call these issues cognitive impairment or cognitive problems.
Whether or not chemotherapy is part of the treatment plan, some women treated for breast cancer may have trouble with:
- learning new tasks
- remembering names
- paying attention and concentrating
- finding the right words
- multitasking
- remembering where things are (keys, glasses, etc.)
Read more »
5/14/2012 (9:56:52am)Tags: noneComments: (0)
Fatigue is a very common problem that is very difficult to really understand. Of course we are all tired during cancer treatment, and there ae lots of good reasons: worry, difficulties with sleep, drugs that keep us awake, drugs that make us tried, etc. Most women continue to be tired for a while after treatment has ended. The rule of thumb is that it takes at least as long as the total duration of treatment to fully recover physically and emotionally. This means months. For some women, however, persistent fatigue is a very long-lasting problem. Here is an editorial from the Journal of Clinical Oncology about that kind of fatigue. Per usual, I give you the abstract and then a link:
Cancer-Related Fatigue in Women With Breast Cancer: Outcomes of a 5-Year Prospective Cohort Study
David Goldstein, Barbara K. Bennett, Kate Webber, Fran Boyle, Paul L. de Souza, Nicholas R.C. Wilcken, Elizabeth M. Scott, Ruth Toppler, Penelope Murie, Linda O'Malley, Junie McCourt, Michael Friedlander, Ian B. Hickie, and Andrew R. Lloyd
Purpose
Prolonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear.
Patients and Methods
A prospective cohort study of women receiving adjuvant treatment for early-stage breast cancer was conducted. Women were enrolled after surgery and observed at end treatment and at 1, 3, 6, 9, and 12 months as well as 5 years. Structured interviews and self-report questionnaires were used to record physical and psychologic health as well as disability and health care utilization. Patients with CRF persisting for 6 months were assessed to exclude alternative medical and psychiatric causes of fatigue. Predictors of persistent fatigue, mood disturbance, and health care utilization were sought by logistic regression.
Results
The case rate for CRF was 24% postsurgery and 31% at end of treatment; it became persistent in 11% at 6 months and 6% at 12 months. At each time point, approximately one third of the patients had comorbid mood disturbance. Persistent CRF was predicted by tumor size but not demographic, psychologic, surgical, or hematologic parameters. CRF was associated with significant disability and health care utilization.
Conclusion
CRF is common but generally runs a self-limiting course. Much of the previously reported high rates of persistent CRF may be attributable to factors unrelated to the cancer or its treatment.
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5/13/2012 (12:24:01pm)Tags: noneComments: (0)
You would think that on Mother's Day, I could back off from my standard lecture about exercise. That woud be wrong. One could even give it another twist and suggest that, especially on Mother's Day, it is good to think about taking care of ourselves. Turns out that regular exercise is a big part of that taking care. Here is a summary from Health Day about six decades worth of research into the possible survival benefit for breast cancer patients who engage in regular exercise. Convinced yet?
Exercise May Boost Survival in Breast, Colon Cancer Patients
Review looked at six decades of studies on cancer, physical activity
TUESDAY, May 8 (HealthDay News) Being physically active might lengthen the lives of people with breast and colon cancer, a new study suggests.
Exercise may also benefit patients with other cancers, but there is no substantial evidence to make that claim, the researchers added.
"We have lots of data that says physical activity after a cancer diagnosis is generally safe and is associated with many improvements in overall quality of life, and these data suggest that it may even be beneficial in terms of prolonging life," said lead researcher Dr. Rachel BallardBarbash, associate director of the applied research program in the division of cancer control and population science at the U.S. National Cancer Institute.
"For many years, we have tended to think of a diagnosis of cancer being fatal, but as we are diagnosing people much earlier and receiving effective treatment, they're living for a long time with their cancer," she said.
Cancer is becoming more of a chronic disease, BallardBarbash explained.
"Because of that, many people actually are at risk for other chronic diseases, like heart disease, diabetes and hypertension, and physical activity is well known to be beneficial for these conditions," she added.
The report was published in the May 8 issue of the Journal of the National Cancer Institute.
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5/12/2012 (7:41:58am)Tags: noneComments: (0)
A friend sent me this information about a new film that is coming to Boston next month. If you are a long-time reader of this blog, you know about my antipathy to the whole pink ribbon campaign--actually to the whole pink issue. This looks terrific, and I expect that it will also be showing in many cities across the country.
Pink Ribbons, Inc.
Opens Friday, June 22
Watch trailer
Breast cancer has become the poster child of corporate cause-related marketing campaigns. Countless women and men walk, bike, climb and shop for the cure. Each year, millions of dollars are raised in the name of breast cancer, but where does this money go and what does it actually achieve?
Pink Ribbons, Inc.is a feature documentary that shows how the devastating reality of breast cancer, which marketing experts have labeled a “dream cause,” has been hijacked by a shiny, pink story of success.
The film recently celebrated its World Premiere at the Toronto International Film Festival, where it was named one of the Top 10 Films.
Learn more »
5/11/2012 (9:09:38am)Tags: bone strength cancer long termComments: (0)
This is a summary from the New York Times about a recent study published in JAMA that suggests there may be rare problems with the long term use of bone strengthening drugs. Note that these worries are not specific for woman with a history of breast cancer, but apply to all women. The catch for us is that many of us are taking, for years, anti-estrogen/hormonal therapies that may weaken our bones. Those medications coupled with the normal changes from aging may put us at greater risk for "normal" bone fractures (as opposed to those described in this article.) This seems to be another one of those "talk to your doctor" about it issues.
Here is the beginning and then a link to read more:
New Cautions About Long-Term Use of Bone Drugs
By TARA PARKER-POPE
In an unusual move that may prompt millions of women to rethink their use of popular bone-building drugs, the Food and Drug Administration published an analysis that suggested caution about long-term use of the drugs, but fell short of issuing specific recommendations. Concerns about bone drugs were prompted by rare reports of an unusual thigh fracture.
The F.D.A. review, published in The New England Journal of Medicine online on Wednesday, was prompted by a growing debate over how long women should continue using the drugs, known as bisphosphonates, which are sold as generic versions of brands like Fosamax and Boniva, as well as Novartis's Reclast.
The concern is that after years of use, the drugs may in rare cases actually lead to weaker bones in certain women, contributing to "rare but serious adverse events," including unusual femur fractures, esophageal cancer and osteonecrosis of the jaw, a painful and disfiguring crumbling of the jaw bone.
Although the concerns about the long-term safety of bone drugs are not new, the F.D.A. performed its own systematic review of the effectiveness of bisphosphonates after years of use. The agency's analysis, which found little if any benefit from the drugs after three to five years of use, may prompt doctors around the country to rethink how they prescribe them.
Read more...
5/10/2012 (9:25:48am)Tags: sexual problems breast cancer depressionComments: (0)
This study from Psycho-Oncology really has no new information, but it looks carefully at issues for couples in which the woman has metastatic/advanced breast cancer. Frankly, I think that the issues are the same for couples dealing with early breast cancer, but, in those situations, there is hope that things will improve. When a woman has advanced disease, the realities are difficult. She is on treatment, of one kind or another, for the rest of her life. We all know that cancer treatments, especially chemotherapy, come with side effects. It is pretty tough to feel sexy when you are sick, bald, fatigued, and probably quite worried about the future.
One irony is that couples often find it hard to be intimate at the very moments when that kind of closeness is especially needed. Instead, each person can easily end up feeling more alone, sad, and disconnected from one another. When I talk with couples, I always bring up the physical part of their relationship. If sex feels impossible, there are other ways to be close: back or foot rubs, showering together, spooning during sleep, holding hands while walking. Touch brings great comfort, and we need to reach out to one another.
Here is the abstract for this study and then a link. If you read it, remember that the concerns do apply, too, to women/couples with early cancer.
Sexual problems, communication patterns, and depressive
symptoms in couples coping with metastatic breast cancer
Kathrin Milbury, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Hoda Badr, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA
Abstract
Background: The treatment of breast cancer tends to result in physical side effects (e.g., vaginal dryness, stomatitis, and atrophy) that can cause sexual problems.Although studies of early-stage breast cancer have demonstrated that sexual problems are associated with increased depressive symptoms for both patients and their partners, comparatively little is known about these associations in metastatic breast cancer(MBC) and how patients and partners cope together with sexual problems. We examined the links between sexual problems, depressive symptoms, and two types of spousal communication patterns (mutual constructive and demand-withdraw) in 191 couples in which the patient was initiating treatment forMBC.
Methods: Patients and partners separately completed paper-and-pencil surveys.
Results: Multilevel models indicated that high levels of sexual problems were signi!cantly associated with more depressive symptoms only for patients who reported low levels of mutual constructive communication (p<0.01) and high levels of demand-withdraw communication (p<0.0001). In contrast, for partners, greater sexual problems were associated with more depressive symptoms regardless of the communication pattern reported. These associations remained significant when we controlled for patients' reports of average pain and functional and physical well-being and couples' dyadic adjustment.
Conclusions: Sexual problems were associated with depressive symptoms for both MBC patients and their partners. The way in which patients and partners talk with one another about cancer-related problems seems to in"uence this association for patients. MBC patients may benefit from programs that teach couples how to minimize demand-withdraw communication and instead openly and constructively discuss sexual issues and concerns.
Read more...
5/9/2012 (10:13:44am)Tags: breast cancer meditationComments: (0)
I wrote a few weeks ago about the possible benefits of meditation for cancer patients (actually, for everyone). Once again, the full disclosure is that I took a course in January and have been meditating twice daily since then. Therefore, I fit the description of a recent convert who is a zealot. To my astonishment, I have noticed a real change in myself with a greater sense of calm and an improved (although imperfect) ability to roll with the proverbial punches. This is an article from Oncology Nursing about various meditation techniques that may be helpful.
Before providing you with that link, however, let me also mention a new book by Elana Rosenbaum, LICSW. Elana is a senior teacher at the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. She is a presenter at our annual Celebration of Life and a lovely person. Her book, Being Well (even when you're sick) ,is (to quote the forward) "a masterpiece of simplicity, clarity, and caring" as she expertly teaches the reader to meditate. There is more information about her and the book here.
Meditation techniques for cancer patients
A CANCER DIAGNOSIS changes a person's life. It entails stress, pain, and anxiety. Meditation is the ancient practice of achieving a thoughtless alertness.
Research has shown that meditation can help reduce anxiety and stress. The classic definition of meditation is the deliberate self-regulation of attention through which the stream of consciousness is temporarily suspended.
The goal is to achieve a thoughtless awareness of one's person and/or surroundings. Many types of meditation are practiced throughout the world. Some types are practiced in a sitting position (transcendental, mindfulness), and some types incorporate movement (aikido, qigong, tai chi). Patients, especially those with chronic conditions such as arthritis or heart disease, are advised to check with their health care team before beginning any type of activity that involves the joints or movement.
Read more...
5/8/2012 (9:44:52am)Tags: breast cancer clinical trialsComments: (0)
This is a thoughtful editorial from the Journal of Clinical Oncology about a different approach to clinical trials. Our current system of Phase I, II, and III trials for cancer agents was developed in the 1960s and has worked out pretty well. However, progress (blesssedly) has been made, and research continues to directions that could not have been imagined fifty years ago. The suggestion here is that the development of targeted therapies needs to be considered and tested in a different way. Here is the beginning and then a link to read more:
Cracking Open Window of Opportunity Trials
Kevin Kalinsky and Dawn L. Hershman, Columbia University Medical Center, New York, NY
Despite an increase in investment, only one in every 10 new molecular therapeutic agents that enters clinical development receives US Food and Drug Administration approval.1 The sequential phase I/II/III model that was developed in the 1960s for cytotoxic chemotherapy2 remains a common pathway for drug development, with anticancer agents often being investigated in metastatic disease before operable disease. However, with many new targeted therapies, there are limitations in measuring response
by traditional methods, such as response rate defined by RECIST criteria, which may lead to erroneous conclusions about a drug's benefit. Evaluating molecular end points can be hindered by difficulties in procuring tumor tissue before and after drug administration and by heterogeneity in previous exposure to cancer therapies. A method to circumvent this issue is to assess novel agents in presurgical (window of opportunity or phase 0) trials. In this model, women with newly diagnosed breast cancer, for instance, receive a study drug between the diagnostic breast biopsy and planned surgical resection. The goals of these trials include evaluation of target modulation after drug exposure and pharmacokinetic assessment of a potential anticancer agent. This is in comparison to neoadjuvant trials, in which an investigational agent iscommonlygiven preoperatively along with cytotoxicchemotherapy or hormonal therapy for a longer period of time than in a presurgical trial, and the primary end point is often, but not always, pathologic or clinical response. The ultimate hope is that presurgical studies can expedite the drug development process by improving the understanding of an agent's biologic effect early in its development, validating markers that may predict subsets of patients who will benefit, and targeting select patients in subsequent clinical trials that are powered to detect changes in clinical outcome.
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5/7/2012 (10:52:37am)Tags: lumpectomy high risk cancer breastComments: (0)
This is an interesting article from The American Society of Breast Surgeons about the safety of lumpectomy vs mastectomy for women with locally advanced breast cancers. Their bottom line is that the risk of a local recurrence depends on the biology of the specific tumor, not on the choice of surgical treatment. This seems completely obvious and brimming with common sense. We already know that, although other factors matter, the most important variable in continuing good health is how responsive a particular cancer is to treatments. There are breast cancers that respond (that is, shrink or disappear) to virutally all chemotherapy agents, and there are others that seem impervious to everything. The treatment resistant ones are the real dangers, and there is often no way to know in advance. To be reassuring: the overwhelming majority of breast cancers do respond to chemotherapy, and oncologists have some strategies to deal with those that don't.
Here is the beginning of the article and then a link to read more:
Women with High Risk Locally Advanced Cancers can be Safely
Treated with Lumpectomy
Abstract: Biology, Not choice of Mastectomy versus Lumpectomy, Dictates Recurrence in High-Risk Breast Cancer
May 4, 2012, Phoenix--Women with high-risk tumors can be safely treated with lumpectomy if their tumors respond well to chemotherapy prior to surgery (neoadjuvant chemotherapy), suggests a new study presented this week at the American Society of Breast Surgeons (ASBrS) Annual Meeting. The study examined cancer recurrence in areas near the original tumor site (local recurrence) in high-risk women who received multidisciplinary cancer therapies. It found that tumor biological characteristics,
reflected in part by response to neoadjuvant chemotherapy, and not choice of mastectomy or breast conserving lumpectomy was the major determinant of cancer returning locally.
"Traditionally, the choice of surgical treatment was thought to have the greatest impact on local recurrence, especially in women with significant tumor remaining after pre-surgical chemotherapy," explains Dr. Elizabeth Cureton, Breast Surgical Oncology Fellow, University of California, San Francisco Medical Center. "But this was not the case. In fact, the study found that tumor characteristics such as gene expression, advanced stage, and the poor response to neoadjuvant therapy itself were the major predictors of cancer recurrence."
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