The continuing rise in cancer rates and longer survivorship underscores the need for effective symptom management. Based on current evidence, meditation is a promising modality for the relief of both psychological and physical symptoms associated with cancer and its treatments. Meditation can reduce stress, control anxiety, improve sleep, and improve emotional health and self-awareness.  It has also been reported to lengthen attention span and reduce age-related memory loss.

CaSfA recently hosted a Meditation Workshop utilizing the free app, Insight Timer.  Recommended by CaSfA members and psychosocial counselors, it contains over 19,000 meditations and offers the “largest free library of meditations and music tracks on earth.”  I’ve recently started using it, and now also recommend it!

 

The app allows you to select from many categories of guided meditations such as:

·     Recovery and Healing

·     Stress and Anxiety

·     Performance (clarity, creativity, leadership, etc.)

·     Health and Happiness

·     Relationships

·     Spiritual

·     Kids

The app allows you to pick a meditation based on time too, varying from less than 5 minutes to over 30 minutes.  

You can choose between verbally guided meditations or those with music.  We experimented with a few short meditations at our workshop.  It became clear that what works for one individual may not work for another, so you have to try different options to find the best meditations for you. 

 

The app also contains courses in meditation.  At our workshop we started the beginner course, “Learn to Meditate in Seven Days”.  The course consists of seven, easy-to-do, 12-minute lessons:

·     All You Do is Breathe

·     Here and Now

·     Witness Your Thoughts

·     Mind-Body Connection

·     Exploring Emotions

·     Power of Intention

·      Finding Inner Stillness

 

There are also courses for those who are more advanced in meditation (although there are fees associated some of these.)

 

New content is added every day, so you really cannot run out of free offerings!  Give it a try!

 

Much has been written in the past weeks about the American Cancer Society’s Annual Report.

(To read the 70+page report visit https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf)

 

Here are some facts from the report:

The Good News

·      The U.S. cancer death rate has hit a milestone, falling for the past 25 years.  The nation’s cancer death rate was increasing until the early 1990s. It has been dropping since, falling 27% between 1991 and 2016

·      This decline translates into more than 2.6 million fewer cancer deaths from 1991 to 2016.  This progress has been driven by steady declines in death rates for the four most common cancer types – lung, colorectal, breast, and prostate. 

·      More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, most of who were diagnosed many years ago and have no current evidence of cancer. 

·      Lower smoking rates are translating into fewer deaths. 

·      Advances in early detection and treatment also are having a positive impact.

·      The 5-year relative survival rate for all cancers combined has increased substantially since the early 1960s, from 39% to 70% among whites and from 27% to 63% among blacks. Improvements in survival reflect advances in treatment, as well as earlier diagnosis for some cancers. 

 

The Bad News:

·      Cancer remains the nation’s No. 2 killer

·      The ACS predicts there will be more than 1.7 million new cancer cases, and more than 600,000 cancer deaths, in the U.S. this year.

·      Obesity-related cancer deaths are rising.  Of the most common types of cancer in the US, all the ones with increasing death rates are linked to obesity, including cancers of the pancreas and uterus.  Another is liver cancer. Liver cancer deaths have been increasing since the 1970s, and initially most of the increase was tied to hepatitis C infections spread among people who abuse drugs. But now obesity accounts for a third of liver cancer deaths, and is more of a factor than hepatitis.  The nation’s growing obesity epidemic was first identified as a problem in the 1990s. It can take decades to see how a risk factor influences cancer rates, so we may just be starting to see the effect of the obesity epidemic on cancer.

·      Prostate cancer deaths are no longer dropping.  The prostate cancer death rate fell by half over two decades, but experts have been wondering whether the trend changed after a 2011 decision by the U.S. Preventive Services Task Force to stop recommending routine testing of men using the PSA blood test. That decision was prompted by concerns the test was leading to overdiagnosis and overtreatment.  The prostate cancer death rate flattened from 2013 to 2016. So while the PSA testing may have surfaced cases that didn’t actually need treatment, it may also have prevented some cancer deaths.

·      There’s been a decline in the historic racial gap in cancer death rates, but an economic gap is growing — especially when it comes to deaths that could be prevented by early screening and treatment, better eating and less smoking.  In the early 1970s, colon cancer death rates in the poorest counties were 20 percent lower than those in affluent counties; now they’re 30 percent higher. Cervical cancer deaths are twice as high for women in poor counties now, compared with women in affluent counties. And lung and liver cancer death rates are 40 percent higher for men in poor counties.

 

Tonight I will be attending a wake for a woman who was taken much too soon due to Stage IV Colon Cancer.  Please heed the advice of the American Cancer Society for screening:

From: https://www.cancer.org/latest-news/faq-american-cancer-society-colorectal-cancer-screening-guideline.html

Research has shown that the risk of colorectal cancer has been increasing in younger adults.  This finding spurred the American Cancer Society to update their screening guidelines for colorectal cancer:

The ACS recommends that people at average risk of colorectal cancer start regular screening at age 45. 

For screening, people are considered to be at average risk if they do not have:

·       A personal history of colorectal cancer or certain types of polyps 

·       A family history of colorectal cancer

·       A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

·       A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)

·       A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer 

People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75. 

For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history. 

People over 85 should no longer get colorectal cancer screening. 

 

Several test options are available for colorectal cancer screening: 

·       Stool-based tests

·       Highly sensitive fecal immunochemical test (FIT) every year

·       Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year

·       Multi-targeted stool DNA test (MT-sDNA) every 3 years

·       Visual (structural) exams of the colon and rectum

·       Colonoscopy every 10 years

·       CT colonography (virtual colonoscopy) every 5 years

·       Flexible sigmoidoscopy (FSIG) every 5 years

 

There are some differences between these tests to consider (see Colorectal Cancer Screening Tests), but the most important thing is to get screened, no matter which test you choose. Talk to your health care provider about which tests might be good options for you, and to your insurance provider about your coverage.

If a person chooses to be screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy.

 

People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. This includes people with:

·       A strong family history of colorectal cancer or certain types of polyps 

·       A personal history of colorectal cancer or certain types of polyps

·       A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

·       A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)

·       A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer

The American Cancer Society does not have screening guidelines specifically for people at increased or high risk of colorectal cancer. However, some other professional medical organizations, such as the US Multi-Society Task Force on Colorectal Cancer (USMSTF), do put out such guidelines. These guidelines are complex and are best looked at along with your health care provider. In general, these guidelines divide people into several groups (although the details depend on each person’s specific risk factors). 

 

1.  People with one or more family members who have had colon or rectal cancer

Screening recommendations for these people depend on who in the family had cancer and how old they were when it was diagnosed. Some people with a family history will be able to follow the recommendations for average risk adults, but others might need to get a colonoscopy (and not any other type of test) more often, and possibly starting before age 45.

2.  People who have had certain types of polyps removed during a colonoscopy

Most of these people will need to get a colonoscopy again after 3 years, but some people might need to get one earlier (or later) than 3 years, depending on the type, size, and number of polyps.

3.  People who have had colon or rectal cancer

Most of these people will need to start having colonoscopies regularly within a year of surgery to remove the cancer. Other procedures like ultrasound might also be recommended for some people with rectal cancer, depending on the type of surgery they had.

4.  People who have had radiation to the abdomen (belly) or pelvic area to treat a prior cancer

Most of these people will need to start having colonoscopies at an earlier age (depending on how old they were when they got the radiation), and might need to be screened more often than normal (such as at least every 5 years).

5.  People with inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

These people generally need to get colonoscopies (not any other type of test) every 1 to 2 years, starting at an earlier age.

6.  People known or suspected to have certain genetic syndromes

These people generally need to have colonoscopy (not any of the other tests). Screening is often recommended to begin at a young age, possibly as early as the teenage years for some syndromes – and needs to be done much more frequently. Specifics depend on which genetic syndrome you have, and other factors. 

 

End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This care does not happen only in the moments before breathing stops and the heart stops beating.  People living with one or more chronic illnesses may need a lot of care for days, weeks, and even months before death.  In addition, we don’t always know when death is near, so it is important that we figure out a plan in advance.

 

According to the National Cancer Institute, “End-of-life care includes physical, emotional, social, and spiritual support for patients and their families. The goal of end-of-life care is to control pain and other symptoms so the patient can be as comfortable as possible. End-of-life care may include palliative care, supportive care, and hospice care.”

 

Some interesting statistics:

·       90% of people say it’s important to discuss end of life care with their families, but only 27% have done so.

·       80% of people say it’s important to discuss end of life treatment with their physicians, but only 7% have done so.

·       82% of people say it’s important to put their wishes in writing, but only 23% have done so.

Visit these sites for help in documenting your end-of-life care wishes:

http://www.massmed.org/Patient-Care/Health-Topics/Health-Care-Proxies-and-End-of-Life-Care/Important-Differences-Between-Health-Care-Proxies-and-Living-Wills/#.WntrpGaZMzU 

CaSfA had such a wonderful evening of Yoga with Eileen Nikopoulos!  Gentle, simple poses and breath work started the class.  We were then guided into a few restorative poses and experienced a sample of Thai Yoga bodywork.  We all left the evening feeling much more relaxed and rejuvenated!!

Eileen Nikopoulos, RYT 500 is an experienced yoga teacher and Certified Thai Yoga Bodywork Practitioner who practices at several studios in the Central Massachusetts area.  Her private studio is at 14 South Street, Westborough, but she will also travel to your home or office.

Eileen specializes in private instruction in yoga, meditation and Mindfulness Based Stress Reduction, as well as Traditional Thai Yoga Bodywork.  Eileen applies these ancient arts to the problems of modern life – stress, sitting and the erosion of attention. Eileen will help you live life more fully, whether your goals are to cope with stress more effectively, reduce pain or regain strength and flexibility.

                                                                                                                                                                       You can contact Eileen to work with you privately.  What’s the benefit of working privately with Eileen? Group classes are helpful, but you can make more significant and faster progress in a private setting because Eileen customizes the each session to fit your goals.

Eileen is generously offering a special for CaSfA members:

Schedule any 90-minute session for the price of a 60-minute session.  This offer includes yoga bodywork, meditation and MBSR (mindfulness based stress reduction introductory session).

 

Please contact Eileen directly at 508 591-FLOW or email [email protected] .  You can also go to mountainbrookyoga.com to learn more and sign up for her newsletter to receive announcements about upcoming workshops, classes and special offers!

There is a physical (and mental) decline in our bodies as we age—and studies have shown that biologic aging begins in our 20’s!  Add cancer and the effects of its treatments to this decline and we can end up with significant weaknesses.

 

It can be extremely challenging to do any exercise or fitness program during treatment and even after treatment is completed.  I remember some days, just getting out of bed was a major accomplishment.  There is pain and limited abilities that may be secondary to surgeries and radiation.  Cancer and its treatments may also leave one with disorders of the nervous system, such as peripheral neuropathy, making even walking painful, and disrupting balance.  Many of these issues can take a very long time to improve, but research has shown that a program of fitness and exercise can not only aid in recovery, but also reduce the risk certain cancers forming and/or returning.

 

Here’s great info from National Cancer Institute:
(From: https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet; Go to link for references)

 

Physical activity:

·      Any movement that uses skeletal muscles and requires more energy than does resting

·      Can include working, exercising, performing household chores, and leisure-time activities such as walking, tennis, hiking, bicycling, and swimming.

·      Is essential for people to maintain a balance between the number of calories consumed and the number of calories used.

 

Consistently expending fewer calories than are consumed leads to obesity, which is linked to increased risks of 13 different cancers:

            Adenocarcinoma of the esophagus

            Colon and Rectal cancer

            Gastric cancer

            Liver cancer

            Gallbladder cancer

            Pancreatic cancer

            Breast cancer (postmenopausal)

            Uterine cancer (endometrial)

            Ovarian cancer

            Renal Cell (Kidney) cancer

            Meningioma (Brain)

            Thyroid cancer

            Multiple Myeloma (Blood cancer)

 

Evidence also indicates that physical activity may reduce the risk of getting several cancers through other mechanisms, independent of its effect on obesity. 

(From: https://www.health.harvard.edu/exercise-and-fitness/does-regular-exercise-reduce-cancer-risk)

Exercise has a number of biological effects on the body, some of which have been proposed to explain associations with specific cancers, including:

·      Lowering the levels of hormones, such as insulin and estrogen, and of certain growth factors that have been associated with cancer development and progression [especially important for reducing risk of breast and colon cancer]

·      Helping to prevent obesity and decreasing the harmful effects of obesity, particularly the development of insulin resistance (failure of the body's cells to respond to insulin)

·      Reducing inflammation

·      Improving immune system function

·      Altering the metabolism of bile acids, resulting in decreased exposure of the gastrointestinal tract to these suspected carcinogens [especially important for reducing risk of colon cancer]

·      Reducing the amount of time it takes for food to travel through the digestive system, which decreases gastrointestinal tract exposure to possible carcinogens [especially important for reducing risk of colon cancer]

 The benefits of physical activity/fitness for cancer survivors (and remember, by current definition, you are considered a survivor from the day you are diagnosed):

·      Not only reduces chance of getting certain cancers, but also reduces incidence of recurrence

·      Improves prognosis and likelihood of survival

·      Improves quality of life—including self-esteem, emotional well-being, sexuality, sleep disturbance, social functioning, anxiety, fatigue, depression and pain

·      Reduces incidence and severity of other chronic conditions which may complicate care, such as cardiovascular disease and Type 2 diabetes

·      Reduces body weight and body mass index (which may have increased as a result of cancer therapy)

·      Improves cognitive function

(https://www.ncbi.nlm.nih.gov/pubmed/25444575 )

·      Reduces side effects of some cancer therapies (Dr. Ligibel of Dana Farber has done studies that showed exercise reduced the side effects of aromatase inhibitors used to treat some breast cancers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372849/ and http://www.breastcancer.org/research-news/exercise-helps-ease-ai-side-effects)

 

How much exercise should we be getting?

From https://www.cdc.gov/physicalactivity/basics/adults/index.htm

 

CaSfA members learned a lot of useful information at "Cancer Survivorship: Sexual Health and the Pelvic Floor", a presentation by Stacey Berger, PT. Stacey specializes in women’s health, men’s health, pelvic pain, pelvic floor rehabilitation, continence control, and musculoskeletal conditions.  She is STAR (Survivorship Training and Rehabilitation) Certified in Oncology Rehab.

Here are some take home pelvic health tips:

To read all the notes from the presentation, join CaSfA to receive our newsletters.

 

 

The US Preventive Services Task Force recently released a draft statement with updated advice for the use of Prostate Specific Antigen (PSA) in screening for prostate cancer.  They will be accepting public feedback regarding their recommendations until May 8, 2017, after which time a final recommendation will be released.

Back in 2012, the USPSTF unequivocally told doctors to discourage patients from getting PSA testing.  They stated that the risks of false positives and overtreatment outweighed the benefits.  But after much debate, the USPSTF has backed off that advice. 

 

Here is the upshot of their updated recommendations from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/prostate-cancer-screening1

 

▪   PSA tests for men age 70 and older and men under age 55 are still discouraged

▪   For men between 55 and 69, the panel is punting the decision to doctors. 

“The decision about whether to be screened for prostate cancer should be an individual one. Screening offers a small potential benefit of reducing the chance of dying of prostate cancer. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and impotence. The USPSTF recommends individualized decision making about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.” 

▪   The task force backed down on its earlier advice in light of new evidence. Back in 2012, the best evidence suggested that for every 1,000 men screened, 0.8 prostate cancer deaths would be prevented in the next 10 to 15 years. But a longer look at the participants in prostate cancer studies has raised that to 1.3 deaths prevented in the same time frame.  Additionally, studies have since reported that screening 1,000 men ages 55 to 69 years may prevent approximately 3 men from developing metastatic prostate cancer.

▪   The panel also took into consideration that how men seek treatment has shifted. More men now who receive cancer diagnoses are opting for active surveillance — watching their cancer closely — rather than treatment. That lessens the potential harms, such as impotence and incontinence after surgery; compared to the last time the task force evaluated the screenings.

More detailed information is in CaSfA's April 18, 2017 newsletter.  Join CaSfA to receive our newsletters!!

 

CaSfA members were fortunate to have Holly Brown of Looking and Feeling FAB, Inc.(http://lookfeelfab.org) for a presentation, “Skin Care After the Diagnosis of Cancer”.  This non-profit organization offers those with cancer and other serious illnesses FREE skin care products, treatments and education at multiple locations in Massachusetts (including Westborough!!).  We learned how our skin changes with cancer and what we can do to preserve and protect our skin.  We even received gift bags with sample products!

My notes from the presentation, as well as how to access Looking and Feeling FAB’s services, were distributed in the April 4, 2017 newsletter.

Join CaSfA to receive this and all future CaSfA newsletters! 

In a recent Facebook webchat, Dr. Ursula Matulonis, medical director of Gynecologic Oncology in Dana-Farber’s Susan F. Smith Center for Women’s Cancers, and Dr. Colleen Feltmate , director of minimally invasive surgery in Gynecologic Oncology at Brigham and Women’s Hospital, discussed what is new in Cervical Cancer. You can access the webchat at: http://blog.dana-farber.org/insight/2017/01/what-you-should-know-about-cervical-cancer-webchat/?utm_source=newsletter&utm_medium=email&utm_content=What%20you%20should%20know%20about%20cervical%20cancer&utm_campaign=spotlight

Here are my notes: 

About 13,000 women are diagnosed with cervical cancer each year in the US

 

Screening for cervical cancer:

·      Is a bit of controversial

·      Can be confusing even for doctors.

·      Should include screening for Human Papilloma Virus (HPV), especially for age 

           30 and over            

·      All agree women should see gynecologist by the time become sexually active

·      Now using HPV and pap test in combination for screening women over 30 yo.

 

Where do you find out about screening?

ASCCP (American Society for Colposcopy and Cervical Pathology web site (http://www.asccp.org/asccp-guidelines) guides doctors and patients with practical algorithms

 

Risk factors for cervical cancer:

·      HPV-sexually transmitted through direct contact.

·      Increased sexual partners—increases risk of HPV

·      Smoking

·      Immunosuppression—don’t clear the virus well

·      Skipping pap smears/no access to medical care for pap smears—one of biggest factors is not having pap smear for five or more years

 

Vaccination for HPV:

·      As young as 9-11 up to age 26

·      Important to get before exposure (sex activity)

·      Boys and girls should be vaccinated

·      Anal, throat, and oral cancer—risk for women and also risk for men

·      Three shot series—some immunity to HPV if do partial series, but need to complete all for it to work best [when I was looking for more information, I found the CDC is now recommending two doses, 6-12 months apart.  If a child received the second dose within 6 months of the first, then a third dose should be given.  Here’s the link with info: https://www.cdc.gov/hpv/parents/vaccine.html ]

 

Many women will have precancerous changes on their pap smear—it is a screening test, meant to pick up any abnormalities

·      If abnormal pap, next step is colposcopy (procedure that uses a binocular-like          tool to get a closer look at the cervix). 

·      Depending on result of colposcopy, may biopsy to test if pre or cancer

·      Often if cervical cancer is picked up early can do limited excision

·      If your pap smear shows precancerous changes, you can get medical care with general gynecologist

·      Sometimes gyn will refer to oncologic gynecologist

 

Cervical cancer

Almost 100% cervical cancer is driven by HPV

Two types of cervical cancer: squamous cell carcinomas—begin in the flat cells of the cervix; and Adenocarcinomas – begin in the glandular cells of the cervix.  Some argue adenocarcinoma can be more virulent and come back more often.  Others argue they are the same.

Another type is combination of both, but this type is very rare

HPV types 16 & 18 cause the vast majority of cervical cancers.  Initial HPV vaccine covered these types only. Now the vaccine protects against 7 types-covers about 99% cervical cancer causing HPV. [Again, this is a bit off from the CDC info: “All three licensed HPV vaccines protect against types 16 and 18, which cause the majority of cervical cancers across racial/ethnic groups (67% of the cervical cancers among whites, 68% among blacks, and 64% among Hispanics). The 9-valent HPV vaccine protects against seven HPV types that cause about 80% of cervical cancer among all racial/ethnic groups in the United States.”  From https://www.cdc.gov/hpv/parents/questions-answers.html ]

 

When cervical cancer is first diagnosed:

Staging of Cancer- Imaging techniques may be ordered—CT/MRI/PET scans

Is having children a concern?—may change approach of treatment

Is the cancer a visible or a microscopic lesion?

 

Minimally invasive surgery—has come along way

 

Stage 1—in past did a radical abdominal hysterectomy—removed uterus, cervix, much of vagina.  Had a lot of surgical complications, long recovery and no longer able to have children.  Now if don’t want children will do a laparoscopic hysterectomy—less bleeding, less pain and less late side effects.  Patients can even go home the next day.  And in younger women, doctors are doing less surgery so that many can still have children. [Radical trachelectomy—removes cervix, top 1-2cm of vagina and surrounding tissue, but leaves uterus].  Research continues to look at ways to map the cancer so only take out the cancer, and leave behind healthy tissue.

 

In later stages, cancer may be in the lymph nodes and pelvis. If surgery isn’t curative—chemo and radiation may be needed

 

Quality of life:

Side effects of treatment—trouble with intercourse due to changes in tissue—Multidisciplinary approach is most beneficial (used at Dana Farber):

Includes biofeedback techniques, sometimes local estrogen creams, dilators, and counseling. 

 

Racial disparity a big concern with cervical cancer. Rate of cervical cancer in African Americans is almost double that of Caucasians--probably due to limited access to medical care among African Americans.

 

Audience Questions:

Is there any age when a woman can stop cervical cancer screening?

If a woman has had normal pap smears, has no evidence of HPV infection, and has had the same sex partner, probably can stop screening after age 65.  However, women and men are living longer and longer, and often having new partners later in life.  In this case, screening is still necessary after age 65 [According to the American Cancer Society, more than 15% of cervical cancers are diagnosed in women over 65.https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html ].

 

When should someone seek a second opinion?

Consider it before any major intervention or surgery

If anything a doctor does or says doesn’t feel right to you

It is always reasonable to decide between medical practitioners—no reasonable doctor should feel slighted when patient gets a second opinion

 

Where is the field going?

Looking into molecular mechanisms driving cervical disease

Immunotherapy may play a larger role in the future

A trial is now being conducted at Dana Farber looking at using a vaccine to treat HPV-16 in patients with HPV 16 anal and oral cancer [https://clinicaltrials.gov/ct2/show/NCT02865135?term=HPV+and+anal+cancer&rank=2 ]

Another trial is looking at using a HPV vaccine in patients who are at high risk for cancer recurrence.