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News from CaSfA's Director

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Resources for Meditation and Attaining Mindfulness

Posted on January 14, 2017 at 12:55 PM Comments comments (0)
A new website that offers FREE guided meditations has been created for cancer survivors.  Kara (https://thisiskara.com ) features 12 meditations including the four core qualities whose initials give Kara its name—kindness, awareness, rest and allowing.  The remaining eight tracks are designed to help with specific difficult emotions or challenges that survivors experience, such as feeling overwhelmed, afraid or angry; feeling alone or like you are a burden; or being in pain or sleepless.
 
Recommended by CaSfA member, TM:  Buddha in Blue Jeans by Tai Sheridan (https://www.amazon.com/Buddha-Blue-Jeans-Extremely-Sitting/dp/1466480033?ie=UTF8&dpID=61GkWLXz52L&dpSrc=sims&preST=_AC_UL160_SR104%2C160_ ).  You can download it for free to your kindle or buy the paperback for less than five dollars.  “Poet-philosopher and Zen Priest Tai Sheridan's 'Buddha in Blue Jeans' is an extremely short, simple and straight forward universal guide to the practice of sitting quietly and being yourself, which is the same as being Buddha. Sitting quietly can teach many ways to accept life, meet pain, age gracefully, and die without regret. The book encourages sitting quietly every day. Topics include: Sit Quietly; Care For Your Body; Accept Your Feelings; Give Thoughts Room; Pain is Natural; Be Who You Are; Live Each Moment Well; Love Indiscriminately; Listen to Others; Be Surprised; Wonder; Live gratefully; Do No Harm; Benefit life; A Wish for The World. The book is for people of any faith, religion, race, nationality, gender, relationship status, capacity, or meditation background.”
 
Another short, easy and helpful read is Jon Wortmann’s Mindfulness is Sublime:  9 Ways to Sleep Better, Shake the Nerves and Finally Get Happy (https://www.amazon.com/Mindfulness-Sublime-Jon-Wortmann/dp/1507602634/ref=sr_1_1?s=books&ie=UTF8&qid=1483999093&sr=1-1&keywords=mindfulness+is+sublime )
“The power to feel rested, in control, and happy already exists within your own brain. But too many of us are so busy and stressed we simply don’t enjoy our lives. We finish the week and can’t remember how we spent our time. Tired of missing the precious moments? Want to change? Now you can. The way is called mindfulness. Mindfulness is a philosophy, a series of exercises, and now a scientifically validated therapeutic treatment for emotional suffering like chronic stress and depression. But it doesn’t take a trip to a monastery or a 10-week class to begin experiencing the benefits of transforming your body and mind. Mindfulness Is Sublime is a series of nine invitations. Each invitation explores a different avenue into the most important thing too many of us ignore: this moment. Whether you need the scientific or the spiritual way into this essential discipline for every human being, this little book begins your journey. Buddha, Thoreau, and your favorite yoga teacher figured out how to grab the beauty of this moment. You can experience the same pleasure they discovered. Unwrap the present.”
 
BTW, CaSfA member, LW attended a workshop led by Jon Wortmann.  After hearing her glowing recommendation, I have been in contact with him and am hoping to schedule a FREE workshop for our group the end of April.  Stay tuned for more details….

Coffee and Colon Cancer

Posted on October 5, 2016 at 10:59 AM Comments comments (0)
Coffee addicts rejoice!! A number of reports in recent years have suggested coffee consumption may offer some protection against various types of cancer, including postmenopausal breast cancer, melanoma, liver cancer, advanced prostate cancer and colon cancer. A recent study looking at coffee consumption in colon cancer patients provides more evidence of this effect.  From: http://jco.ascopubs.org/content/early/2015/08/11/JCO.2015.61.5062.full
Observational studies have demonstrated increased colon cancer recurrence in states of relatively high blood insulin, including sedentary lifestyle, obesity, and increased dietary glycemic load. (Glycemic index is a value assigned to foods based on how slowly or how quickly those foods cause increases in blood glucose levels.  High glycemic load foods will quickly raise blood glucose.) Greater coffee consumption has been associated with decreased risk of type 2 Diabetes and increased insulin sensitivity. The purpose of this study was to see if the effect on insulin from increased coffee intake could reduce colon cancer recurrence.
During and after 6 months of chemotherapy, 953 patients with stage III colon cancer (in the lymph nodes but not metastasized) reported dietary intake of caffeinated coffee, decaffeinated coffee, and non-herbal tea, as well as 128 other items. Researchers examined the influence of coffee, non-herbal tea, and caffeine on cancer recurrence and mortality
The greatest benefit of coffee consumption was seen in patients who drank four or more cups daily – about 460 milligrams of caffeine. These patients had a 42 percent lower rate of disease recurrence than those who didn’t drink coffee, and were 33 percent less likely to die from cancer or any other cause.  Two to three cups of coffee daily had a more modest benefit, while little protection was associated with one cup or less. Neither non-herbal tea nor decaffeinated coffee intake was associated with these outcomes.
These associations between coffee and recurrence and survival were independent of other predictors of patient outcome, diet, and lifestyle factors. Moreover, the effect of total coffee intake was largely maintained across other known or suspected predictors of cancer recurrence.
This is the first study to examine the association between coffee intake and colon cancer recurrence and survival. The researchers hypothesize that coffee might reduce colon cancer recurrence through improved insulin sensitization and decreased blood insulin levels.
 
Upshot of this…if you drink 4 cups of coffee per day, your risk of recurrence of colon cancer (and perhaps other cancers too) may be lower. (More good news for coffee drinkers:  a recent study of over 6000 women that found drinking 3 cups of coffee per day may lower one’s risk of dementia http://www.medicalnewstoday.com/articles/313182.php ).  But if you don’t drink coffee should you start? The results of these studies may not provide enough evidence to do so….

 

Treatment Options in Early Prostate Cancer

Posted on September 18, 2016 at 7:53 PM Comments comments (0)
An important study looking at the treatment of early stage prostate cancer was published in the New England Journal of Medicine on Wednesday (http://www.nejm.org/doi/full/10.1056/NEJMoa1606220?query=featured_home#t=articleBackground ).   The use of prostate-specific antigen (PSA) testing has dramatically increased the diagnosis of prostate cancer.  Close to 181,000 cases of prostate cancer will be diagnosed in the US in 2016 and over 26,000 men will die of the disease.  But many cases of this cancer will progress slowly and not lead to death.  Studies have been trying to determine if some men can safely avoid radical treatments and their associated side effects and complications. This study looked at 3 different treatment approaches to men diagnosed with early prostate cancer:  surgery (radical prostatectomy), radiotherapy and active monitoring/surveillance.
 
Here are the basics of the study:
·      The study recruited men 50-69 years old in the UK
·      1643 men were diagnosed with localized prostate cancer and agreed to be in the study
·      The men were followed for a median of 10 years
·      The study looked at prostate-cancer mortality (deaths that were definitely or probably due to prostate cancer or its treatment) at a median of 10 years follow up.  It found that death from prostate cancer remained low, at approximately 1%, irrespective of the treatment assigned.
·      Of the 545 men assigned to the active monitoring/surveillance treatment arm, 291 men required intervention during the study (56 within 9 months of starting the study).  142 (49%) underwent surgery; 97 (33%) received radiotherapy according to the study protocol.  The rest received non-protocol radiotherapy, brachytherapy (insertion of radioactive pellets into the prostate), or other treatment.
·      The study also looked at mortality from all causes, rates of metastases, clinical progression of cancer, treatment failure and treatment complications.
·      There was no difference in mortality from all causes between the three treatment groups
·      204 men had disease progression, including metastases.  The incidence was highest in the active monitoring/surveillance group (112 men vs. 46 in the surgery group and 46 in the radiotherapy group).
·      There were no deaths attributable to surgery, but 9 men had blood clots/cardiovascular complications; 14 required multiple blood transfusions for blood loss; 1 had rectal injury; 9 had anastomotic problems (leakage of urine into the body from a damaged ureter).
·      One limitation of the study was a protocol that was developed almost 20 yrs ago (treatments and diagnostic techniques have evolved since then).  Also the men will need to be followed for a longer period of time to determine if any difference in survival rates will emerge.

The study authors conclude:  “At a median follow-up of 10 years, the ProtecT trial showed that mortality from prostate cancer was low, irrespective of treatment assignment. Prostatectomy and radiotherapy were associated with lower rates of disease progression than active monitoring; however, 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects. Men with newly diagnosed, localized prostate cancer need to consider the critical trade-off between the short-term and long-term effects of radical treatments on urinary, bowel, and sexual function and the higher risks of disease progression with active monitoring, as well as the effects of each of these options on quality of life. Further follow-up of the ProtecT participants with longer-term survival data will be crucial to evaluate this trade-off in order to fully inform decision making for physicians and patients considering PSA testing and treatment options for clinically localized prostate cancer.”

Music Therapy

Posted on September 9, 2016 at 11:58 AM Comments comments (0)
We were so fortunate to have cancer survivor and CaSfA member, Kathleen M. Howland, Ph.D., present CaSfA’s first evening presentation, “Music Therapy:  A Powerful Support for Cancer Treatment and Beyond". Dr. Howland is a true expert in the field of music therapy.  She teaches undergraduate and graduate courses in music therapy, neuroscience and positive psychology at Berklee College of Music and the Boston Conservatory. She is a certified music therapist and a licensed speech pathologist.  For over 30 years, she has worked with a variety of clinical
populations using music to enhance speech, language, cognition and movement.  She has developed therapy protocols to reduce stress and anxiety in order to improve general wellness, surgical preparation and oncology treatments.
 
Kathleen shared her experience fighting cancer.  She spoke of that awful moment of being told she had breast cancer, the fifteen months of chemotherapy and her mastectomy.
 
Her experience was similar to that of many of us—trying to maintain a “normal” life while undergoing treatment, balancing work, home, and hospital.  She spoke of those chemo days when she could barely get herself to walk out the door and go for treatment.  Then she turned to music.  She would sing herself a calming song and it gave her the strength and resilience to get through her treatments.  She also used music for deep relaxation and calm.  It elicited biological effects similar to meditation.
 
Music can be used for:
Motivation
Comfort
Relaxation
 
The type of music each person assigns to these categories is different.  One piece of music may provide relaxation to one person, but be motivational for another.
 
Kathleen next told us about the “Relaxation Response”, a term coined by Dr. Herbert Benson.  It is defined as the conditioning of the body to release chemicals and brain signals that make your muscles and organs slow down.  This response can be used to treat many stress-related disorders.
 
There are many methods to elicit the Relaxation Response including visualization, progressive muscle relaxation, acupuncture, massage, breathing techniques, prayer, meditation, tai chi, and yoga.  
 
Music can also be used to elicit the relaxation response.  Kathleen herself used it before her surgery and the anesthesiologist was able to reduce the amount of anesthesia she received, reducing her post-operative side effects.  She was able to use music to reduce anxiety, pain, and stress, greatly decreasing, and even eliminating the need for many medications.
 
Along with recommending Dr. Benson’s book, The Relaxation Response, Kathleen also suggested:
·      Her web site http://www.musictherapytales.com/oncology .  It features clinicians, including Kathleen, who share their experiences with music therapy.
·      Go through your music collection and create multiple playlists including a playlist for Comfort, one for Motivation and one for Relaxation.  You might also consider one for Dance—whatever gives you joy! 
·      Try to find a bit of laughter each day.  Kathleen shared a few videos from “Just For Laughs” https://www.youtube.com/watch?v=662KGcqjT5Q --we all enjoyed them!
·      Devote 12-20 minutes a day to training yourself to elicit the relaxation response—use music, meditation, t’ai chi, etc.—whatever works best for you.  (A member highly recommends Mark W. Muesse’s “Practicing Mindfulness” course available on http://www.thegreatcourses.com/courses/practicing-mindfulness-an-introduction-to-meditation.html )
 
Music Therapy is available at:
St. Vincent Hospital offers Music Therapy classes on Thursdays at 9:30am.  For more information email Lan Curtin at [email protected] or call the Cancer and Wellness Center at (508) 363-5000.
 
Many thanks to Kathleen for such an informative presentation!
Find out more about Kathleen and Music Therapy, including the services she offers and a contact form, at http://www.kathleenhowland.com and view her TEDx talk at https://www.youtube.com/watch?v=NlY4yCsGKXU
   

American Cancer Society's 2016 Facts and Figures

Posted on June 25, 2016 at 1:11 PM Comments comments (0)
CaSfA's most recent newsletter contains my notes from the American Cancer Society's 2016 Facts and Figures.  It's a lengthy document that summarizes current scientific information about cancer in the United States. To download the document visit: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf.

Here's just a few of my notes from the report:

Can Cancer Be Prevented?
“A substantial proportion of cancers could be prevented.” Tobacco use is a major cause of some cancers. “In 2016, about 188,800 of the estimated 595,690 cancer deaths in the US will be caused by cigarette smoking”.   It is also estimated “that about 20% of all cancers diagnosed in the US are related to body fatness, physical inactivity, excess alcohol consumption, and/or poor nutrition, and thus could also be prevented.” “Certain cancers are related to infectious agents, such as human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Helicobacter pylori (H. pylori). Many of these cancers could be avoided by preventing these infections through behavioral changes or vaccination, or by treating the infection. Many of the more than 5 million skin cancer cases that are diagnosed annually could be prevented by protecting skin from excessive sun exposure and not using indoor tanning devices.”
 
Incidence of New Cancer Cases and Deaths from Cancer in 2016                                     About 1,685,210 new cancer cases are expected to be diagnosed in the US; 37,620 in Massachusetts.  About 595,690 Americans are expected to die of cancer; 12,630 in Massachusetts.  Cancer is the second most common cause of death in the US, exceeded only by heart disease, and accounts for nearly 1 of every 4 deaths.
“The total cancer death rate rose for most of the 20th century because of the tobacco epidemic, peaking in 1991 at 215 cancer deaths per 100,000 persons. However, from 1991 to 2012, the rate dropped 23% because of reductions in smoking, as well as improvements in early detection and treatment. This decline translates into the avoidance of more than 1.7 million cancer deaths. Death rates are declining for all four of the most common cancer types-lung, colorectal, breast, and prostate.”

Risk of Developing Cancer
Cancer usually develops in older people; 86% of all cancers in the United States are diagnosed in people 50 years of age or older. Smoking, eating an unhealthy diet, or not being physically active will increase one’s risk of developing cancer. “Lifetime risk refers to the probability that an individual will develop or die from cancer over the course of a lifetime. In the US, the lifetime risk of developing cancer is 42% (1 in 2) in men and 38% (1 in 3) in women.”

Interested in reading more?  Join CaSfA to receive my newsletters containing relevant information about cancer!

Dealing with Breast Cancer

Posted on May 17, 2016 at 12:02 PM Comments comments (0)


A CaSfA member recently gave me The Silver Lining Companion Guide: A Supportive and Insightful Guide to Breast Cancer by Hollye Jacobs, RN, MS, MSW.  While this was written specifically for the breast cancer survivor, much is relevant to survivors of all cancers. (The companion guide is available free to all at:  https://www.directrelief.org/silverlining/).  This publication reminded me of a handout I developed a few years ago:

If you are Diagnosed:
Accept feelings-anger, guilt, denial, despair…
Try to stay in the moment-one day at a time
Network with survivors-will help you find doctors and the right treatment plan for 
      you
Try to find mentor-networking/ACS “Reach to Recovery”
Find the right doctor for YOU—Consider 2 opinions, change doctors if not happy
Be careful with internet-can make you crazy!
Get copies of all reports, x-rays, tests
Determine which friends and relatives you want to communicate with and how          
     (email, phone, blog)
Consider support groups/professional help for spouse/kids
 
Determining Treatment Plan:       
One of the toughest times-consider journaling
Write out questions before doctor appointments
Soul Search for your philosophy--what is most important to you (breast
     conservation/Aggressive therapy?)         
Ask to see before and after pictures of reconstruction procedures you are 
     considering
 
Surgery and Chemo:
Reconstruction is usually a process & rarely a single event
Get list from drs. what can/can’t do, can/can’t eat…
You will need help—ACCEPT IT!!—meals, errands, cleaning, kids
Get fresh air and exercise-helps even in small amounts
Take advantage of professional help available-PT, medications, psych counseling,              
     acupuncture,massage therapy, support groups, Healing Garden!!
Be patient—very hard to do, but recovery takes time-there will be a new “normal”  
     for you
Hair loss is very traumatic-You will need emotional support!!!
Keep a journal of medications—there will be many.  Log type, time taken and 
     reaction. Drs. can make adjustments for side effects
SAVOR THE GOOD TIMES—do something fun when you are feeling good
           
 
After Treatment:
Fear, anxiety can build-“What do I do now?”
Consider support groups, professional help
Check out Living Beyond Breast Cancer-lbbc.org

“Cancer may leave your body, but it never leaves your life”, Livestrong.org

Results from the TH3RESA trial

Posted on January 12, 2016 at 5:16 PM Comments comments (0)

Results from a study presented at the San Antonio Breast Cancer Symposium showed patients with metastatic, HER2-positive breast cancer who received a combination antibody/chemotherapy drug in a phase 3 clinical trial survived longer, on average, than patients receiving other treatments. (http://news.cancerconnect.com/conjugate-drug-extends-survival-in-patients-with-advanced-her2-positive-breast-cancer/ )“The TH3RESA trial, which enrolled more than 600 participants in the U.S. and overseas, compared survival times in patients randomized to treatment with the conjugate drug trastuzumab emtansine (T-DM1) to those randomized to treatment of their physician’s choice. All patients had metastatic breast cancer that tested positive for the human epidermal growth factor receptor 2 (HER2) protein – a feature in about 20 percent of all breast cancers – and had previously been treated with chemotherapy as well as the HER2-targeted drugs trastuzumab and lapatinib. The investigators found that those in the T-DM1 group lived a median of 22.7 months vs. 15.8 months for those in the treatment of physician’s choice group – a 44 percent improvement.”  In addition, serious side effects were lower in the TDM-1 group.

The Updated ACS Guidelines for Breast Cancer Screening

Posted on November 4, 2015 at 7:14 PM Comments comments (0)
The American Cancer Society (ACS) released its new breast cancer screening guidelines, raising the recommended age for beginning annual screening from 40 to 45, and endorsing biennial screenings beginning at age 55. In addition, the new guidelines suggest physicians should forgo clinical breast exams for women of any age. 

I have an admittedly biased opinion about these recommendations.  My breast cancer was found by a routine annual screening mammogram.  I had a very low risk of developing breast cancer.  I am thankful that the mammogram uncovered the tumor early, allowing me the best chance for a cure.  I was upset when the US Preventative Task Force recommended biennial screening mammography for women starting at the age of 50.  And I was disappointed when the ACS recently released their updated recommendations. 

Mammograms and breast exams are not the perfect screening tests.  They can diagnose tumors that are not cancer, and they can miss tumors that are cancer.  But they are all we have for screening now.  Until a better screening test is determined, the best we can do is to take these recommendations as mere guidelines.  Each individual woman should discuss with her personal physician her risk factors for breast cancer and try to determine when it would be best for her to start screening mammograms. 

The DCIS Controversy

Posted on October 20, 2015 at 3:07 PM Comments comments (0)
Ductal Carcinoma in Situ is diagnosed by examination of the biopsy of breast tumor.  The cancer cells are within the milk ducts and have not invaded the underlying tissue.  It is classified as Stage 0 breast cancer.  The incidence of DCIS has increased with the widespread use of screening mammography and it now accounts for 20-30% of all newly diagnosed breast cancers.
 
The treatment of DCIS has become controversial.  Even the name is a source of controversy.  Some believe it should not be called cancer at all, since it doesn’t involve tissue invasion.  The problem with DCIS is that somewhere between 25-50% of cases will progress to invasive disease. 
 
Because of this progression, most patients with DCIS are undergoing surgery—either mastectomy or lumpectomy with radiation.  A recent study in JAMA Surgery looked at the outcomes of women who did not have surgery, but instead were followed by active surveillance.  (JAMA article: http://archsurg.jamanetwork.com/article.aspx?articleID=2300045&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofSurgery%3AOnlineFirst06%2F03%2F2015)
 
Articles in The New York Times (http://www.nytimes.com/2015/09/29/health/a-breast-cancer-surgeon-who-keeps-challenging-the-status-quo.html ) and Time magazine (http://time.com/4057310/breast-cancer-overtreatment/ ) both quote practitioners who advocate renaming DCIS as well as changing to non-operative management of the disease. 
 
The surgeons followed in these articles, Dr. Laura Esserman of UCSF and Dr. E. Shelley Hwang of Duke, propose DCIS should be renamed “IDLE, indolent lesions of epithelial origin”.  They believe many women are erroneously deciding on aggressive treatments just because they are frightened and reacting to the word “carcinoma.”  Dr, Esserman follows many DCIS patients with active surveillance.  They receive yearly mammograms alternating with MRI’s.  Depending on receptor status of their tumors, some undergo ovarian suppression and hormonal therapy.
 
But many cancer specialists believe the aggressive treatments are warranted since DCIS can progress to invasive cancer.  They believe we don’t know enough to determine which cases of DCIS will progress and because of this we should continue to treat all cases of DCIS.
 
The JAMA study has again sparked the debate on how DCIS should be treated.  It was
a retrospective study of 57,222 American women with DCIS that showed no survival benefit from surgery in women with low-grade disease. (Tumor grade is the description of a tumor based on how abnormal the tumor cells and the tumor tissue look under a microscope. It is an indicator of how quickly a tumor is likely to grow and spread.)  1169 patients with DCIS in 10 health districts were managed without surgery from 1988 to 2011 and entered into the logs of Surveillance, Epidemiology and End Results (SEER) database. These exceptional cases were compared with the 56,053 patients who were treated with surgery.
 
They found that 10-year breast-cancer-specific survival was significantly better in patients with intermediate- and high-grade disease who had undergone surgery than in those who had not. For intermediate grade DCIS, there was an absolute difference in weighted 10-year breast-cancer-specific survival of 4.0% between the surgery and nonsurgery groups (98.6% vs 94.6%); for high-grade DCIS, there was an absolute difference of 7.9% (98.4% vs 90.5%).
 
But for women with low-grade DCIS, surgery appeared to be superfluous. Ten-year breast-cancer-specific survival was the same for patients who underwent surgery and for those who did not (98.8% vs 98.6%; P = .95).

Most clinicians are not convinced. Some do not feel tumor grade alone is a good enough predictor of which cases of DCIS will progress.  They also point out limitations in the JAMA study.  For example, it is not known how many women were diagnosed with low grade DCIS on biopsy, but after surgical excision were found to have invasive cancer.

So what if you are diagnosed with DCIS?  If your biopsy shows intermediate or high grade disease, surgical excision (+/-radiation and hormonal therapy) provides a higher percentage 10 year-breast-cancer-specific survival.  If it’s low grade DCIS, the decision is a bit more difficult.  There is a test available called the Oncotype DX DCIS test.  This test is a genomic test that analyzes the activity of a group of genes that can affect how DCIS is likely to behave and respond to treatment. The test is performed on a sample of DCIS tissue. The Oncotype DX DCIS test offers results as a recurrence score. Depending on the recurrence score number, the DCIS has a low, intermediate, or high risk of recurrence.   Other factors that should be considered are family history of breast cancer and genetic testing results.

Studies are constantly being conducted and sometimes the results change medical practice.   But we can’t see into the future.  The best any of us can do is to gather all the information available at the present time and choose what is best for ourselves.
 

Loved Ones' Perspectives

Posted on October 9, 2015 at 12:46 PM Comments comments (0)
Cancer doesn't just affect the patient.  It affects our loved ones too.  I recently read two very moving essays by loved ones and caregivers of cancer survivors.  Read them:  
http://blog.dana-farber.org/insight/2015/10/how-to-care-for-a-partner-with-cancer/
http://www.sarah-levy.com/blog-1/2015/10/7/mymomhercancerandme


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