The management of breast cancer in women under the age of 40 continues to challenge oncologists despite many recent therapeutic advances. The higher rates of breast cancer recurrence and death in this cohort strongly correlate with unfavorable clinicopathologic features. The author is to be complimented on a comprehensive overview of breast cancer management in young women. In this review, we discuss pregnancy following a diagnosis of breast cancer, fertility concerns related to treatment, and the potentially life-threatening complications cardiotoxicity and leukemogenesis.
Pregnancy-Associated Breast CancerPregnancy-associated breast cancer, which is defined as breast cancer developing during or within 1 year after pregnancy, complicates approximately 0.2% to 3.8% of pregnancies.[1] More specifically, 10% of women under 40 with breast cancer develop the disease while pregnant.[2] Those women with pregnancy-associated breast cancer appear to have more advanced disease at diagnosis when compared to a control population, which may be partly explained by delays in diagnosis.[3] Pathologic evaluation is more likely to reveal a poorly differentiated tumor with a higher proportion of hormone receptor negativity.[4] Contrary to prior opinion, the prognosis for patients with pregnancy-associated breast cancer appears similar when compared to age- and stage-matched nonpregnant controls.[5]
Therapy During PregnancyCurative surgery in the third trimester is recommended as there is no known increased fetal risk related to anesthesia. Breast conservation is an option if appropriate and axillary dissection is preferred over sentinel node mapping due to a lack of safety data to support the latter in this setting.
The indications for systemic chemotherapy for the pregnant patient are similar to those for the nonpregnant patient. In a large prospective trial, 57 pregnant breast cancer patients were treated with FAC (fluorouracil [5-FU], doxorubicin [Adriamycin], and cyclophosphamide) in the second and third trimesters.[6] At a median follow-up of 38.5 months, 40 women remained alive and free from disease; no significant short-term complications detected in those children exposed to chemotherapy in utero. Long-term effects, if any, are yet to be determined.
Only case reports exist for the use of other agents during pregnancy, including the taxanes, vinorelbine, trastuzumab (Herceptin), and lapatinib (Tykerb); their routine use is not recommended until after delivery.[7] However, the choice and timing of chemotherapy largely depends on the clinical situation. Consideration should be given to whether delaying effective therapies will result in a worse outcome for an individual patient. Radiation and hormonal therapy should be deferred until after pregnancy. Finally, reports to date do not indicate that termination of pregnancy results in improved outcome for pregnant breast cancer patients.[2,8]
Pregnancy After Breast Cancer DiagnosisThere is no evidence thus far that pregnancy after a diagnosis of breast cancer is associated with worse long-term maternal survival. On the contrary, certain studies suggest a reduced risk of death in such women vs matched controls.[9,10] Whether there is a biologic explanation for this such as a protective effect of high levels of estrogen or whether it indicates a “healthy mother effect” is unclear. In general women are advised to avoid pregnancy in the first 2 years following a diagnosis of breast cancer, as this period is associated with the highest risk of recurrence. For those with hormone-sensitive disease, this also allows at least 2 years of adjuvant hormonal therapy. However, there is no evidence that this strategy reduces recurrence risk in this population.
Fertility Preservation: Ovarian Suppression vs ChemotherapyAs age is an important feature that helps define risk of recurrence, an aggressive adjuvant chemotherapeutic approach is employed in many young women.[11] The author describes how the aim of therapy in the premenopausal population is to maximize breast cancer outcomes, while minimizing both short- and long-term toxicities.
For those who wish to become pregnant or avoid the effects of premature menopause, chemotherapy-induced amenorrhea is a significant and yet often underdiscussed side effect. In a prospective trial, the rate of menstruation after adjuvant chemotherapy was found to be dependent on age, the chemotherapy administered, and the period of time since treatment. Recovery of menses, a surrogate marker for fertility, occurred in approximately 60% of women receiving AC alone at 1 year of follow-up. Far lower rates of recovery were observed with the addition of a taxane or adjuvant treatment with CMF (cyclophosphamide, methotrexate, and 5-FU).[12] Even temporary cessation of menses after chemotherapy appears to predict earlier onset of menopause.[13]
In light of these findings, the role of ovarian suppression as an adjuvant treatment for premenopausal women with hormone-receptor–positive breast cancer has been investigated as an alternative to chemotherapy. Adjuvant goserelin (Zoladex) alone in this patient population results in recovery of menses in the majority of patients after completion of 2 years of therapy.[14] This and other studies have indicated no survival advantage for CMF over ovarian suppression in both node-positive and node-negative cohorts.[15] The PERCHE (Premenopausal Endocrine Responsive CHEmotherapy) trial planned to investigate the efficacy of modern chemotherapy regimens in addition to ovarian suppression in this population, but unfortunately it was closed due to poor accrual.
Based on the available evidence, ovarian suppression may be offered as an alternative to chemotherapy in young women, in particular where fertility is a concern.
Cardiotoxicity and LeukemogenesisTwo other serious and potentially life-threatening complications briefly mentioned in the article by Peppercorn include cardiotoxicity and leukemogenesis. The incidence of cardiotoxicity after AC (doxorubicin [Adriamycin] and cyclophosphamide), for example, can be as high as 5% to 7%.[16] The addition of trastuzumab to adjuvant regimens can further potentiate anthracycline-induced cardiotoxicity, at times precluding subsequent trastuzumab administration in relevant populations. Future assessment of molecular predictors of response to anthracyclines, such as topoisomerase II expression and administration of equally effective non–anthracycline-containing regimens in the management of early breast cancer, may limit this serious adverse effect.[17,18]
The absolute risk of developing treatment-related acute myeloid leukemia at 10 years after any adjuvant chemotherapy for breast cancer has been shown to be 1.8% vs 1.2% for women who have not received chemotherapy.[19] In a recent population-based study of 420,076 women with a diagnosis of breast cancer, both age < 50 (relative risk [RR] 4.14; P < .001) and stage 3 disease at diagnosis (RR 2.19; P < .001) were associated with an increased risk of AML. It was suggested that these patients may have received more intensive adjuvant regimens or may be more likely to have germline mutations in BRCA1, BRCA2, and other genes involved in DNA repair.
Recent evidence has also suggested that the use of colony-stimulating factors may double the risk of hematologic malignancies among women with early breast cancer.[20] This association needs confirmation, but is thought-provoking when we consider the widespread use of adjuvant “third-generation” anthracycline-based chemotherapy regimens incorporating growth factors.
ConclusionComplex and multidisciplinary treatment planning is often required in young women with early breast cancer because of concerns relating to pregnancy, fertility, long-term toxicities, quality of life, and psychosocial issues. It is imperative that the available evidence is portrayed clearly at initial assessment in order to formulate a treatment plan that will be both safe and acceptable to each individual. Future research should aim to improve on breast cancer outcomes while minimizing toxicity associated with adjuvant therapy.
Saturday, August 22, 2009
Health Tapioca treatment for cancer
For many adults, tapioca is inextricably linked to school dinners Tapioca pudding - widely known as frog's eggs by many school pupils - may after all be good for you.
Scientists say the plant from which it is derived may help cure cancer.
Tapioca is derived from the cassava plant.
It is one of many plants which manufactures cyanide to deter animals who might want to eat it.
It does this by producing a chemical called linamarin which releases hydrogen cyanide when it is broken down by the linamarase enzyme.
Geneticists at Newcastle University have been taking genetic material from the cassava plant and adding it to a virus.
This is then introduced into cancer cells which have been impregnated with linamarin from the cassava plant.
The aim is for the cancer cells to produce hydrogen cyanide in high enough doses so that they commit suicide.
Hydrogen cyanide
Professor Monica Hughes has been studying cassava and cancer for seven years.
She has cloned the genes from the plant which are responsible for producing hydrogen cyanide.
Her objective is to reduce the toxicity of the cyanide so that it will not harm humans.
Cassava is a staple crop for many people in Africa, Asia and South America, but, if it is processing wrongly, it can lead to cyanide poisoning.
Because the plant is rarely used in Western diets, it has not been subject to much scrutiny by geneticists.
Professor Hughes has been working with a research team in Madrid to modify the cassava gene and transfer it to a retrovirus.
This gives the retrovirus the ability to produce linamarase.
The Spanish researchers found that a brain tumour in a rat was totally eradicated after one week of the genetic treatment.
It allowed the localised release of small doses of cyanide through the breakdown of linamarin by linamarase.
Neighbouring cells
The team found that part of the reason the tumour was so quickly destroyed was that the cells containing the retrovirus also affected surrounding cells.
They say tests on human tissue samples for certain cancers also look promising.
Professor Hughes' research has been funded by the European Union, but her funding has now run out and she is looking for other sources.
She says her next step is "to modify the genetic material with a view to making the treatment more effective when applied to mammalian cells".
A spokesman for Newcastle University said the research showed how genetically modifying plants could bring beneficial effects.
Scientists say the plant from which it is derived may help cure cancer.
Tapioca is derived from the cassava plant.
It is one of many plants which manufactures cyanide to deter animals who might want to eat it.
It does this by producing a chemical called linamarin which releases hydrogen cyanide when it is broken down by the linamarase enzyme.
Geneticists at Newcastle University have been taking genetic material from the cassava plant and adding it to a virus.
This is then introduced into cancer cells which have been impregnated with linamarin from the cassava plant.
The aim is for the cancer cells to produce hydrogen cyanide in high enough doses so that they commit suicide.
Hydrogen cyanide
Professor Monica Hughes has been studying cassava and cancer for seven years.
She has cloned the genes from the plant which are responsible for producing hydrogen cyanide.
Her objective is to reduce the toxicity of the cyanide so that it will not harm humans.
Cassava is a staple crop for many people in Africa, Asia and South America, but, if it is processing wrongly, it can lead to cyanide poisoning.
Because the plant is rarely used in Western diets, it has not been subject to much scrutiny by geneticists.
Professor Hughes has been working with a research team in Madrid to modify the cassava gene and transfer it to a retrovirus.
This gives the retrovirus the ability to produce linamarase.
The Spanish researchers found that a brain tumour in a rat was totally eradicated after one week of the genetic treatment.
It allowed the localised release of small doses of cyanide through the breakdown of linamarin by linamarase.
Neighbouring cells
The team found that part of the reason the tumour was so quickly destroyed was that the cells containing the retrovirus also affected surrounding cells.
They say tests on human tissue samples for certain cancers also look promising.
Professor Hughes' research has been funded by the European Union, but her funding has now run out and she is looking for other sources.
She says her next step is "to modify the genetic material with a view to making the treatment more effective when applied to mammalian cells".
A spokesman for Newcastle University said the research showed how genetically modifying plants could bring beneficial effects.
Phase III Trial Initiated for BLP25 Liposome Vaccine in Breast Cancer Patients
Merck KGaA of Darmstadt, Germany, has initiated a global phase III trial of BLP25 liposome vaccine (L-BLP25, Stimuvax) in patients with hormone receptor–positive, locally advanced, recurrent or metastatic breast cancer. L-BLP25 is an investigational therapeutic cancer vaccine being developed by Merck KGaA under a license agreement with Oncothyreon.
The phase III placebo-controlled trial, named STRIDE (STimulating immune Response In aDvanced brEast cancer), is anticipated to enroll more than 900 patients at approximately 180 sites in over 30 countries. The primary endpoint of STRIDE is progressionfree survival. Overall survival, quality of life, tumor response, and safety will also be assessed.
The phase III placebo-controlled trial, named STRIDE (STimulating immune Response In aDvanced brEast cancer), is anticipated to enroll more than 900 patients at approximately 180 sites in over 30 countries. The primary endpoint of STRIDE is progressionfree survival. Overall survival, quality of life, tumor response, and safety will also be assessed.
Pregnancy Hormone HCG Protects Against Breast Cancer Even In Short-term Treatments
ScienceDaily (Apr. 25, 2009) — One of the most effective ways to prevent breast cancer is through a full-term pregnancy at an early age. Studies out of Fox Chase Cancer Center have linked this protective effect to the presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta to maintain the early stages of pregnancy.
Their findings in an animal model of breast cancer showed that rats exposed to hCG over a 21 day period (the length of rat pregnancy), are far less likely to develop breast cancer when exposed to a known carcinogen.
Today, at the 100th Annual Meeting of the American Association for Cancer Research. Johana Vanegas, M.D., a research associate at Fox Chase, presents findings suggesting that even a much shorter exposure to hCG can prevent breast cancer in rats.
Venegas is a member of the laboratory of Jose Russo, M.D. and Irma Russo, M.D., who were the first scientists to propose hCG as an anti-cancer agent. Their studies have shown that hCG offers lasting, protective changes within breast tissue. Clinical trials of hCG in women, based on their work, are currently under way at three locations, nationally, including Fox Chase Cancer Center, and in one European country. The hCG hormone is an FDA-approved agent frequently used for fertility treatments.
"The ability to replicate the naturally protective effects of pregnancy against breast cancer will hold a significant public health value," says Vanegas. "In order to translate our finding into humans, a clinical trial with hCG as a preventive agent against breast cancer, is already ongoing in pre-menopausal women with no previous pregnancy."
Vanegas and her colleagues studied virgin female rats, which had been divided into four groups: a control group, which did not receive hCG, and three groups that received hCG for five, ten or fifteen consecutive days. Following the treatment, each rat received a single dose of a breast cancer-inducing agent.
According to Vanegas, 90.9 percent of the rats in the control group developed breast tumors, compared to 71.4 percent, 57.1 percent, and 15.4 percent in the five, ten and fifteen day-treated animals, respectively. In addition, the average tumor size was also smaller in all the animals that received any of the three hCG treatments.
"The animals that received hCG, but still developed breast cancer did so much later than the control group, which further demonstrates the protective effects of hCG," Vanegas says. "While we don't foresee side effects among humans in using hCG, it is helpful to know that even smaller doses confer benefits on breast tissue."
Funding for this research comes from grants from the National Institutes of Health and the National Cancer Institute.
Their findings in an animal model of breast cancer showed that rats exposed to hCG over a 21 day period (the length of rat pregnancy), are far less likely to develop breast cancer when exposed to a known carcinogen.
Today, at the 100th Annual Meeting of the American Association for Cancer Research. Johana Vanegas, M.D., a research associate at Fox Chase, presents findings suggesting that even a much shorter exposure to hCG can prevent breast cancer in rats.
Venegas is a member of the laboratory of Jose Russo, M.D. and Irma Russo, M.D., who were the first scientists to propose hCG as an anti-cancer agent. Their studies have shown that hCG offers lasting, protective changes within breast tissue. Clinical trials of hCG in women, based on their work, are currently under way at three locations, nationally, including Fox Chase Cancer Center, and in one European country. The hCG hormone is an FDA-approved agent frequently used for fertility treatments.
"The ability to replicate the naturally protective effects of pregnancy against breast cancer will hold a significant public health value," says Vanegas. "In order to translate our finding into humans, a clinical trial with hCG as a preventive agent against breast cancer, is already ongoing in pre-menopausal women with no previous pregnancy."
Vanegas and her colleagues studied virgin female rats, which had been divided into four groups: a control group, which did not receive hCG, and three groups that received hCG for five, ten or fifteen consecutive days. Following the treatment, each rat received a single dose of a breast cancer-inducing agent.
According to Vanegas, 90.9 percent of the rats in the control group developed breast tumors, compared to 71.4 percent, 57.1 percent, and 15.4 percent in the five, ten and fifteen day-treated animals, respectively. In addition, the average tumor size was also smaller in all the animals that received any of the three hCG treatments.
"The animals that received hCG, but still developed breast cancer did so much later than the control group, which further demonstrates the protective effects of hCG," Vanegas says. "While we don't foresee side effects among humans in using hCG, it is helpful to know that even smaller doses confer benefits on breast tissue."
Funding for this research comes from grants from the National Institutes of Health and the National Cancer Institute.
Precious Metal Could Lead To Next Generation Of Cancer Treatments
ScienceDaily (Dec. 10, 2008) — A precious metal which has never before been used in a clinical setting is being developed as an anti-cancer agent by University of Warwick researchers.
The metal, osmium, is closely related to platinum, which is widely used to treat cancers in the form of the drug cisplatin. Most famously, the cyclist Lance Armstrong was treated with cisplatin for testicular cancer.
Now the researchers, based in the Department of Chemistry, at the University of Warwick, are working closely with Warwick Ventures, the university’s technology transfer office, to seek partners to help develop the potential of osmium through more extensive biological tests. The team will be presenting their work on 9 December at the national university technology showcase event, Bioversity.
Professor Peter Sadler, of the Department of Chemistry, explained: “Although cisplatin has been proven to be a very successful treatment; it is not useful for all kinds of cancer. It is also quite a toxic therapy, which can produce side effects and, from a clinical point of view, cells can also become resistant to platinum.”
Osmium, with its special chemical properties, offers a new potential solution to an unmet clinical need. It has shown huge promise in treating several different types of cancer cell, including ovarian and colon cancers which have been developed and tested in the laboratory. The metal also has another advantage in that it is a much cheaper alternative to platinum.
Professor Sadler, along with post-graduate researcher Sabine van Rijt, is working to develop new compounds using Osmium, which they hope will lead to the development of drugs which could be used in combination therapies alongside existing drugs such as cisplatin.
“The compounds we have been developing are very promising,” says Sabine van Rijt. “We’re building a picture of how different compounds might interact with DNA in cancer cells. By making changes to the coating, or ligand, on the metal, we can also affect not just how it interacts, but the rate of interaction. During this design process we can also make changes which can control the activity of the compound.”
She added: “Another advantage is that these compounds are not cross-resistant with platinum. They kill the cancerous cells in a different way, so they could be used alongside platinum in combination therapies.”
The team’s research is being presented on 9 December at Bioversity 2008, a national university technology showcase event. Bioversity is part of the biotechnology conference, Genesis 2008, organised by The London Biotechnology Network.
The metal, osmium, is closely related to platinum, which is widely used to treat cancers in the form of the drug cisplatin. Most famously, the cyclist Lance Armstrong was treated with cisplatin for testicular cancer.
Now the researchers, based in the Department of Chemistry, at the University of Warwick, are working closely with Warwick Ventures, the university’s technology transfer office, to seek partners to help develop the potential of osmium through more extensive biological tests. The team will be presenting their work on 9 December at the national university technology showcase event, Bioversity.
Professor Peter Sadler, of the Department of Chemistry, explained: “Although cisplatin has been proven to be a very successful treatment; it is not useful for all kinds of cancer. It is also quite a toxic therapy, which can produce side effects and, from a clinical point of view, cells can also become resistant to platinum.”
Osmium, with its special chemical properties, offers a new potential solution to an unmet clinical need. It has shown huge promise in treating several different types of cancer cell, including ovarian and colon cancers which have been developed and tested in the laboratory. The metal also has another advantage in that it is a much cheaper alternative to platinum.
Professor Sadler, along with post-graduate researcher Sabine van Rijt, is working to develop new compounds using Osmium, which they hope will lead to the development of drugs which could be used in combination therapies alongside existing drugs such as cisplatin.
“The compounds we have been developing are very promising,” says Sabine van Rijt. “We’re building a picture of how different compounds might interact with DNA in cancer cells. By making changes to the coating, or ligand, on the metal, we can also affect not just how it interacts, but the rate of interaction. During this design process we can also make changes which can control the activity of the compound.”
She added: “Another advantage is that these compounds are not cross-resistant with platinum. They kill the cancerous cells in a different way, so they could be used alongside platinum in combination therapies.”
The team’s research is being presented on 9 December at Bioversity 2008, a national university technology showcase event. Bioversity is part of the biotechnology conference, Genesis 2008, organised by The London Biotechnology Network.
Must providers scare patients into cancer screening? By Greg Freiherr
“If you are a woman over 35, be sure to schedule a mammogram. Unless you’re still not convinced of its importance. In which case, you may need more than your breasts examined.” —From an old American Cancer Society Poster For every 1000 women aged 40 to 74 years who participated in screening, 3.9 diagnosed with breast cancer died compared with 5.0 among those who did not participate. The absolute benefit in terms of reduced deaths due to mammography screening, therefore, is about one in 1000. This may not come as a surprise to women's health experts. Patients are another story. In a survey of more than 10,000 people in nine European countries, researchers at the Max Planck Institute for Human Development in Berlin found that 92% of women reported they either did not know how much mammography reduces mortality or they vastly overestimated the benefit, believing the benefit to be one in a hundred rather than one in a thousand. Many thought the benefit was even greater. The results, published online Aug. 12 in the Journal of the National Cancer Institute, showed that more than 40% of women surveyed in France, the Netherlands, and the U.K. believed the reduction in mortality was one in 10 or even one in 5. This kind of faith in cancer screening is not restricted to women and mammography. The researchers found that 89% of men quizzed about the benefits of screening for prostate-specific antigen overestimated the benefit by as much as women did for mammography. The problem stems from the widespread campaigns, particularly in Western nations, aimed at increasing participation in screening programs. These campaigns try to persuade not through reasonable arguments but with emotional ones. When considering that mammography uses ionizing radiation and that multiple exposures over extended periods of time carry long-term risks of cancer, the inability of patients to properly assess the benefits of this exposure raises questions about whether they can provide informed consent. Adding to the downside for both mammography and PSA screening is the harm that may come from false positives that lead to unnecessary invasive follow-up procedures, such as biopsy and treatment. In an editorial accompanying the research results, Drs. Lisa M. Schwartz and Steven Woloshin of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH, suggested that messages promoting the use of screening should be based on facts. In the context of results citing the lower than widely believed benefits from prostate and breast cancer screening, they noted that prostate screening leads to overdiagnosis of between 10 and 30 patients for every 1000 screened and to unnecessary biopsy from false-positive mammograms in 50 to 200 of every 1000 women screened. Schwartz, a Dartmouth associate professor of medicine and community and family medicine, told Oncology News International that screening advocates should describe the benefits as well as the risks associated with overdiagnosis and overtreatment. "I think they should say something like: ‘Mammograms (PSA tests) have been shown to lower the chance of dying from breast cancer (prostate cancer). But (these tests) also have harms. We'll give you the information about the benefits and the harms so you can make a decision that is right for you.'" Doing so would mark a quantum shift in screening advocacy. Decades of ad campaigns designed to increase the number of women participating in routine mammography, for example, have created the perception of mammography as a powerful tool for reducing deaths from breast cancer. In their JNCI editorial, Schwartz and Woloshin state that "selling screening can be easy. Induce fear by exaggerating risk. Offer hope by exaggerating the benefit of screening. And don't mention harms." But is this how healthcare should be practiced? Not according to Schwartz and Woloshin: "We need to move from selling screening to helping people realize that screening is a genuine choice. That means routinely giving people the information needed to make these choices."
Enhancing The Effects Of Platinum-based Anti-cancer Drugs
ScienceDaily (June 2, 2009) — Researchers have now identified a way to enhance the in vitro anticancer effects of the commonly used platinum-based drug cisplatin and hope that it might be possible to translate these data into the development of a clinical strategy to enhance the anti-cancer effects of platinum-based drugs.
Daqing Li and colleagues, at the University of Pennsylvania School of Medicine, Philadelphia, have identified in vitro and in mice a way to enhance the anticancer effects of the commonly used platinum-based drug cisplatin.
For many forms of cancer, including testicular, ovarian, and lung cancer, platinum-based drugs that cause DNA damage are the first choice treatment. However, the utility of these drugs is often limited by the enhanced ability of cancer cells to repair their DNA. As the MRN protein complex, which contains the protein RAD50, has a key role in the molecular pathways that control DNA repair in human cells, Li and colleagues set out to test the hypothesis that attenuating the function of the MRN protein complex might sensitize cancer cells to the effects of cisplatin.
The hypothesis was proven using a genetic approach to disrupt MRN function. Specifically, human squamous cell carcinoma cells resistant to the toxic effects of cisplatin became sensitive to the drug when it was combined with an adenoviral vector that drove expression of a dominant-negative RAD50 protein in the cancer cells. Importantly, the combination therapy had potent anti–cancer cell effects in vitro and in mice transplanted with human squamous cell carcinoma cells resistant to cisplatin. The authors therefore hope that it might be possible to develop a clinical strategy to attenuate MRN function and enhance the anticancer effects of platinum-based drugs.
Daqing Li and colleagues, at the University of Pennsylvania School of Medicine, Philadelphia, have identified in vitro and in mice a way to enhance the anticancer effects of the commonly used platinum-based drug cisplatin.
For many forms of cancer, including testicular, ovarian, and lung cancer, platinum-based drugs that cause DNA damage are the first choice treatment. However, the utility of these drugs is often limited by the enhanced ability of cancer cells to repair their DNA. As the MRN protein complex, which contains the protein RAD50, has a key role in the molecular pathways that control DNA repair in human cells, Li and colleagues set out to test the hypothesis that attenuating the function of the MRN protein complex might sensitize cancer cells to the effects of cisplatin.
The hypothesis was proven using a genetic approach to disrupt MRN function. Specifically, human squamous cell carcinoma cells resistant to the toxic effects of cisplatin became sensitive to the drug when it was combined with an adenoviral vector that drove expression of a dominant-negative RAD50 protein in the cancer cells. Importantly, the combination therapy had potent anti–cancer cell effects in vitro and in mice transplanted with human squamous cell carcinoma cells resistant to cisplatin. The authors therefore hope that it might be possible to develop a clinical strategy to attenuate MRN function and enhance the anticancer effects of platinum-based drugs.
Study Supports DNA Repair-blocker Research In Cancer Therapy
ScienceDaily (Aug. 20, 2009) — Scientists at Dana-Farber Cancer Institute have uncovered the mechanism behind a promising new approach to cancer treatment: damaging cancer cells' DNA with potent drugs while simultaneously preventing the cells from repairing themselves.
The findings being reported in the Aug. 14 issue of Molecular Cell help explain the promising results being seen in clinical trials of compounds that force cancer cells with genetic damage to self-destruct instead of "resting" while their DNA undergoes repairs.
"What we have shown suggests that you can use these drugs to sensitize cancer cells to DNA-damaging chemotherapy," said Geoffrey Shapiro, MD, PhD, senior author of the report. "This is a mechanism by which these inhibitory drugs may be synergistic with DNA-damaging agents."
Interestingly, Shapiro said, when the same repair-blocking drugs were administered to normal, non-cancerous cells, the cells became less sensitive to DNA damage from a chemotherapy drug. This is an encouraging indication that repair-blocking drugs may selectively make cancer cells vulnerable to chemotherapy while protecting normal cells from DNA damage, the scientists said.
Cells' native capacity for fixing DNA damage is normally beneficial, but it can be problematic for cancer therapy as it enables tumor cells to become resistant to a number of standard drug agents. All cells progress through a series of phases -- called the cell cycle -- including quiescence, or resting, growth, and cell division. The transition from one phase to the next is regulated by "checkpoint" proteins that, among other things, are designed to prevent damaged, potentially dangerous cells from reproducing.
The body deals with DNA-damaged cells in two ways. It can order them to self-destruct through "programmed cell death," also known as apoptosis. Or, it can issue signals from the checkpoint proteins to put the cells into "cell cycle arrest," causing them to remain quiescent while the broken DNA is fixed before they resume normal activity.
Repair-blocking drugs are designed to squelch the checkpoint proteins' signals, preventing the chemotherapy-damaged cancer cells from initiating the rest phase and undergoing repairs. Instead, they're forced to progress through the cell cycle and, because of their broken DNA, self-destruct through apoptosis. Accordingly, the tumor loses much of its power to develop resistance to drugs that attack DNA.
When a cell senses damage to its DNA, it triggers a series of events, called a "checkpoint cascade." Two major checkpoint proteins, cdk1 and cdk2, send signals that stop the cell cycle. At the same time, a flock of repair proteins are recruited to the site of the DNA damage.
In clinical trials aimed at disrupting the DNA-repair process, scientists are using inhibitor drugs to block cdk signaling. The drugs cause the damaged cells to bypass the checkpoint control and continue to grow and divide -- and ultimately die. Those trials are showing promising results, said Shapiro. He and his colleagues, in their new paper, demonstrate the molecular mechanism by which cdk inhibitors work, and they say that the explanation bodes well for continued research on the drugs.
Previously, it was known that cdk1 and cdk2 were virtually interchangeable in most cancer cells, and if one of the proteins malfunctioned or was knocked out, the other could compensate for it.
To find out if this overlap might pose a problem for cdk-inhibitor therapy, the researchers disabled just one of the proteins -- cdk1 -- in cultured lung cancer cells and treated the cells with cisplatin, a DNA-damaging agent. Even though the partner cdk2 protein was still active, the cdk1-depleted cancer cells failed to stop, rest, and repair themselves; it was evident that they were now more vulnerable to death from the cisplatin.
But how did the loss of just the one checkpoint protein disrupt the repair process?
The investigators showed that a key player in DNA repair -- the BRCA1 protein best known in its mutated form as an inherited breast cancer risk factor -- couldn't fulfill its mission in lung cancer cells lacking cdk1.
Going a step further, the researchers administered a cdk-inhibiting drug to lung cancer cells that hadn't been stripped of their cdk1 protein. In these cells, BRCA1 activity was reduced, demonstrating that the cdk inhibitors work in large part by keeping BRCA1 on the sidelines, weakening the DNA repair team.
"These results explain the observations seen in clinical trials" currently being conducted at Dana-Farber and elsewhere, said Shapiro, who is also an associate professor of medicine at Harvard Medical School. "The data give us confidence to go ahead with testing of cdk inhibitors in combination with DNA-damaging chemotherapy."
Lead author of the report is Neil Johnson, PhD, in Shapiro's lab. Others include Alan D'Andrea, MD, of Dana-Farber, and Jeffrey Parvin, MD, PhD, of Ohio State University.
The research was supported by grants from the National Institutes of Health as well as the Susan G. Komen Post-Doctoral Fellowship Award and an AstraZenica Sponsored Research Agreement.
The findings being reported in the Aug. 14 issue of Molecular Cell help explain the promising results being seen in clinical trials of compounds that force cancer cells with genetic damage to self-destruct instead of "resting" while their DNA undergoes repairs.
"What we have shown suggests that you can use these drugs to sensitize cancer cells to DNA-damaging chemotherapy," said Geoffrey Shapiro, MD, PhD, senior author of the report. "This is a mechanism by which these inhibitory drugs may be synergistic with DNA-damaging agents."
Interestingly, Shapiro said, when the same repair-blocking drugs were administered to normal, non-cancerous cells, the cells became less sensitive to DNA damage from a chemotherapy drug. This is an encouraging indication that repair-blocking drugs may selectively make cancer cells vulnerable to chemotherapy while protecting normal cells from DNA damage, the scientists said.
Cells' native capacity for fixing DNA damage is normally beneficial, but it can be problematic for cancer therapy as it enables tumor cells to become resistant to a number of standard drug agents. All cells progress through a series of phases -- called the cell cycle -- including quiescence, or resting, growth, and cell division. The transition from one phase to the next is regulated by "checkpoint" proteins that, among other things, are designed to prevent damaged, potentially dangerous cells from reproducing.
The body deals with DNA-damaged cells in two ways. It can order them to self-destruct through "programmed cell death," also known as apoptosis. Or, it can issue signals from the checkpoint proteins to put the cells into "cell cycle arrest," causing them to remain quiescent while the broken DNA is fixed before they resume normal activity.
Repair-blocking drugs are designed to squelch the checkpoint proteins' signals, preventing the chemotherapy-damaged cancer cells from initiating the rest phase and undergoing repairs. Instead, they're forced to progress through the cell cycle and, because of their broken DNA, self-destruct through apoptosis. Accordingly, the tumor loses much of its power to develop resistance to drugs that attack DNA.
When a cell senses damage to its DNA, it triggers a series of events, called a "checkpoint cascade." Two major checkpoint proteins, cdk1 and cdk2, send signals that stop the cell cycle. At the same time, a flock of repair proteins are recruited to the site of the DNA damage.
In clinical trials aimed at disrupting the DNA-repair process, scientists are using inhibitor drugs to block cdk signaling. The drugs cause the damaged cells to bypass the checkpoint control and continue to grow and divide -- and ultimately die. Those trials are showing promising results, said Shapiro. He and his colleagues, in their new paper, demonstrate the molecular mechanism by which cdk inhibitors work, and they say that the explanation bodes well for continued research on the drugs.
Previously, it was known that cdk1 and cdk2 were virtually interchangeable in most cancer cells, and if one of the proteins malfunctioned or was knocked out, the other could compensate for it.
To find out if this overlap might pose a problem for cdk-inhibitor therapy, the researchers disabled just one of the proteins -- cdk1 -- in cultured lung cancer cells and treated the cells with cisplatin, a DNA-damaging agent. Even though the partner cdk2 protein was still active, the cdk1-depleted cancer cells failed to stop, rest, and repair themselves; it was evident that they were now more vulnerable to death from the cisplatin.
But how did the loss of just the one checkpoint protein disrupt the repair process?
The investigators showed that a key player in DNA repair -- the BRCA1 protein best known in its mutated form as an inherited breast cancer risk factor -- couldn't fulfill its mission in lung cancer cells lacking cdk1.
Going a step further, the researchers administered a cdk-inhibiting drug to lung cancer cells that hadn't been stripped of their cdk1 protein. In these cells, BRCA1 activity was reduced, demonstrating that the cdk inhibitors work in large part by keeping BRCA1 on the sidelines, weakening the DNA repair team.
"These results explain the observations seen in clinical trials" currently being conducted at Dana-Farber and elsewhere, said Shapiro, who is also an associate professor of medicine at Harvard Medical School. "The data give us confidence to go ahead with testing of cdk inhibitors in combination with DNA-damaging chemotherapy."
Lead author of the report is Neil Johnson, PhD, in Shapiro's lab. Others include Alan D'Andrea, MD, of Dana-Farber, and Jeffrey Parvin, MD, PhD, of Ohio State University.
The research was supported by grants from the National Institutes of Health as well as the Susan G. Komen Post-Doctoral Fellowship Award and an AstraZenica Sponsored Research Agreement.
Childhood cancer treatment may raise diabetes risk
CHICAGO (Reuters) - Cancer survivors who got radiation treatments as children have nearly twice the risk of developing diabetes as adults, U.S. researchers said on Monday.
They said children who were treated with total body radiation or abdominal radiation to fight off cancer appear to have higher diabetes risks later in life, regardless of whether they exercise regularly or maintain a normal weight.
The odds of surviving childhood cancer have improved with better therapies but several research teams have found that some treatments pose health risks later in life.
Dr. Lillian Meacham of Emory University in Atlanta and colleagues compared rates of diabetes in nearly 8,600 childhood cancer survivors diagnosed between 1970 and 1986, and nearly 3,000 of their siblings who did not have cancer.
After adjusting for other risk factors, including body mass index -- a ratio of height and weight -- they found the childhood cancer survivors overall were 1.8 times more likely to have diabetes.
And the more radiation that was used, the greater the diabetes risk. For those treated with total body radiation -- a treatment often used before bone marrow transplants to treat childhood leukemia -- the diabetes risk was more than seven times greater.
Cancer survivors already have higher risks of heart and kidney disease. A study last year found children who survive cancer while they are young are five to 10 times more likely than their healthy siblings to develop heart disease.
"It is imperative that clinicians recognize this risk, screen for diabetes and pre-diabetes when appropriate, and approach survivors with aggressive risk-reducing strategies," the team wrote in the Archives of Internal Medicine.
They said more study was needed to understand how radiation could promote diabetes in cancer survivors.
Type 2 diabetes -- the most common form of diabetes -- develops when the body makes too much insulin and does not efficiently use the insulin it makes.
(Reporting by Julie Steenhuysen, Editing by Patrick Rucker)
They said children who were treated with total body radiation or abdominal radiation to fight off cancer appear to have higher diabetes risks later in life, regardless of whether they exercise regularly or maintain a normal weight.
The odds of surviving childhood cancer have improved with better therapies but several research teams have found that some treatments pose health risks later in life.
Dr. Lillian Meacham of Emory University in Atlanta and colleagues compared rates of diabetes in nearly 8,600 childhood cancer survivors diagnosed between 1970 and 1986, and nearly 3,000 of their siblings who did not have cancer.
After adjusting for other risk factors, including body mass index -- a ratio of height and weight -- they found the childhood cancer survivors overall were 1.8 times more likely to have diabetes.
And the more radiation that was used, the greater the diabetes risk. For those treated with total body radiation -- a treatment often used before bone marrow transplants to treat childhood leukemia -- the diabetes risk was more than seven times greater.
Cancer survivors already have higher risks of heart and kidney disease. A study last year found children who survive cancer while they are young are five to 10 times more likely than their healthy siblings to develop heart disease.
"It is imperative that clinicians recognize this risk, screen for diabetes and pre-diabetes when appropriate, and approach survivors with aggressive risk-reducing strategies," the team wrote in the Archives of Internal Medicine.
They said more study was needed to understand how radiation could promote diabetes in cancer survivors.
Type 2 diabetes -- the most common form of diabetes -- develops when the body makes too much insulin and does not efficiently use the insulin it makes.
(Reporting by Julie Steenhuysen, Editing by Patrick Rucker)
Denosumab Effective in Patients with Bone Metastases
Among patients with bone metastases from cancers other than breast cancer or prostate cancer, the investigational drug denosumab was as effective as Zometa® (zoledronic acid) at reducing the risk of bone complications such as fracture. The results of this Phase III clinical trial were made available in a press release from Amgen.
Metastatic cancer refers to cancer that has spread to distant sites in the body. Several types of cancer have a tendency to spread to the bone. Bone metastases can lead to serious problems such as fracture and spinal cord compression and may require treatment with surgery or radiation therapy.
Bisphosphonate drugs such as Zometa are commonly used to reduce the risk of complications from bone metastases. Researchers continue, however, to explore new approaches to treatment.
Denosumab is an investigational drug that targets a protein known as the RANK ligand. This protein regulates the activity of osteoclasts (cells that break down bone). Denosumab has shown promising results in the management of patients with bone metastases as well as the management of bone loss due to cancer treatment. Among women with bone metastases from breast cancer, denosumab appears to be more effective than Zometa at reducing the risk of bone complications.[1]
To directly compare denosumab to Zometa among patients with bone metastases from cancers other than breast cancer or prostate cancer, researchers conducted a Phase III clinical trial among more than 1,700 patients.[2] Study participants were assigned to receive either denosumab or Zometa.
The objective of the study was to determine whether the occurrence of bone complications (“skeletal related events”) differed between the two study groups. The bone complications that were evaluated were fracture, radiation to the bone, surgery to the bone, and spinal cord compression.
The results indicated that denosumab and Zometa were similarly effective against bone complications. Overall survival and time to cancer progression were also similar in the two study groups.
Osteonecrosis of the jaw (ONJ)—an uncommon but serious condition involving death of bone in the jaw—occurred with similar frequency in the two study groups. Out of the more than 1,700 study participants, ONJ developed in ten patients treated with denosumab and 11 patients treated with Zometa.
The results of this study suggest that denosumab is as effective as Zometa in the management of patients with bone metastases from cancers other than prostate or breast cancer. Full results are expected to be presented at an upcoming medical meeting.
References:
[1] Amgen press release. Denosumab demonstrates superiority over Zometa in pivotal phase 3 head-to-head trial in breast cancer patients with bone metastases. Available at: http://wwwext.amgen.com/media/media_pr_detail.jsp?year=2009&releaseID=1305355 Accessed July 8, 2009.
[2] Amgen Press Release. Amgen announces positive top-line results for denosumab in trial for delay of skeletal related events in bone metastases patients compared to Zometa®. Available at: http://wwwext.amgen.com/media/media_pr_detail.jsp?year=2009&releaseID=1316081 Accessed August 5, 2009.
Metastatic cancer refers to cancer that has spread to distant sites in the body. Several types of cancer have a tendency to spread to the bone. Bone metastases can lead to serious problems such as fracture and spinal cord compression and may require treatment with surgery or radiation therapy.
Bisphosphonate drugs such as Zometa are commonly used to reduce the risk of complications from bone metastases. Researchers continue, however, to explore new approaches to treatment.
Denosumab is an investigational drug that targets a protein known as the RANK ligand. This protein regulates the activity of osteoclasts (cells that break down bone). Denosumab has shown promising results in the management of patients with bone metastases as well as the management of bone loss due to cancer treatment. Among women with bone metastases from breast cancer, denosumab appears to be more effective than Zometa at reducing the risk of bone complications.[1]
To directly compare denosumab to Zometa among patients with bone metastases from cancers other than breast cancer or prostate cancer, researchers conducted a Phase III clinical trial among more than 1,700 patients.[2] Study participants were assigned to receive either denosumab or Zometa.
The objective of the study was to determine whether the occurrence of bone complications (“skeletal related events”) differed between the two study groups. The bone complications that were evaluated were fracture, radiation to the bone, surgery to the bone, and spinal cord compression.
The results indicated that denosumab and Zometa were similarly effective against bone complications. Overall survival and time to cancer progression were also similar in the two study groups.
Osteonecrosis of the jaw (ONJ)—an uncommon but serious condition involving death of bone in the jaw—occurred with similar frequency in the two study groups. Out of the more than 1,700 study participants, ONJ developed in ten patients treated with denosumab and 11 patients treated with Zometa.
The results of this study suggest that denosumab is as effective as Zometa in the management of patients with bone metastases from cancers other than prostate or breast cancer. Full results are expected to be presented at an upcoming medical meeting.
References:
[1] Amgen press release. Denosumab demonstrates superiority over Zometa in pivotal phase 3 head-to-head trial in breast cancer patients with bone metastases. Available at: http://wwwext.amgen.com/media/media_pr_detail.jsp?year=2009&releaseID=1305355 Accessed July 8, 2009.
[2] Amgen Press Release. Amgen announces positive top-line results for denosumab in trial for delay of skeletal related events in bone metastases patients compared to Zometa®. Available at: http://wwwext.amgen.com/media/media_pr_detail.jsp?year=2009&releaseID=1316081 Accessed August 5, 2009.
Strike Out Cancer; MLB’s Commitment to Cancer Prevention & Advocacy
Major League Baseball partners with players, fans, and advocacy organizations across the country to raise awareness and funds in the battle against cancer.
By Diana Price
What do a bunch of guys swinging bats have to do with the future of cancer prevention and treatment? Actually, if Major League Baseball (MLB) has anything to do with it, the answer is quite a lot. Tim Brosnan, MLB executive vice president, business, says that MLB has long recognized the impact the organization can have on promoting prevention and advocacy. “Commissioner [Allan H. “Bud”] Selig, who is himself a skin cancer survivor, has often said that Major League Baseball is a social institution with important social responsibilities.” As such, Brosnan says, MLB is committed to supporting important social causes, and “partnering with organizations in the fight against cancer is a priority.”
With 78.5 million fans at MLB games last year (and hundreds of millions more tuning in via television, radio, and the Internet), the organization has an extraordinary platform from which to educate and inspire. And the goal, says Brosnan, is to use the opportunity both to raise awareness among fans about how they can detect and prevent cancer and to raise funds for critical cancer research.
In a major step toward accomplishing these goals, MLB partnered with Stand Up to Cancer (SU2C) in 2008 to raise funds and promote awareness. With an initial contribution of $10 million, MLB took the lead in supporting this initiative aimed at accelerating groundbreaking research. The organization followed that contribution with the decision to air an SU2C public service announcement at the 2008 All-Star Game at Yankee Stadium and at all 30 MLB parks across the country throughout the season, reaching a potential audience of more than 200 million. “Stand Up to Cancer has an admirable goal of uniting various cancer organizations to further the latest research and development and find new treatments,” says Brosnan. “Their groundbreaking broadcast last fall demonstrated the power of the organization. We are proud to be a founding, lead partner for this innovative campaign.”
In addition, MLB has established several annual initiatives geared toward bringing cancer awareness, education, and fundraising opportunities to its ballparks. Each year on Mother’s Day, MLB and Susan G. Komen for the Cure partner to bring breast cancer awareness to fans and players through their “Going to Bat Against Breast Cancer” program. The initiative includes the use of pink bats and bases on the field (which are later auctioned off to benefit Komen for the Cure), along with special programs to honor survivors. MLB has made a $50,000 pledge to Komen for the Cure as part of its commitment to the program.
MLB has also joined forces with the Prostate Cancer Foundation to create a Father’s Day initiative aimed at supporting prostate cancer awareness. MLB players, coaches, trainers, umpires, and groundskeepers wear blue wristbands, blue-ribbon uniform decals, and temporary blue-ribbon tattoos and raise funds through the “Home Run Challenge,” whereby fans can make donations for each home run hit during 60 select MLB games in the weeks surrounding the event. In 2008 MLB donated $50,000 to the Prostate Cancer Foundation as part of this initiative. Finally, MLB also designates a day to promote skin cancer awareness through its annual “Play Sun Smart” program, now in its twelfth year. In this partnership with the American Academy of Dermatology, skin cancer screenings are conducted at ballparks across the country.
In all the ways that MLB supports cancer awareness, it does so knowing the profound impact it can have. By promoting prevention, detection, and fundraising messages among fans, players, and staff, the organization fulfills its sense of social responsibility and works to save lives and honor survivors.
PLAYER PROFILES
Mark Gardner, San Francisco Giants
Mark Gardner was pitching for the San Francisco Giants when his wife, Lori, was diagnosed with liver cancer. Over the next six years, Lori endured two liver transplants and multiple rounds of chemotherapy. Though Mark was able to take time off as needed throughout Lori’s treatment to be there for her and their two young sons, the experience ultimately took its toll. “Performing at that level became more difficult,” Mark says of continuing to play professional ball, and he retired in 2001. It was Lori who got him back in the game by suggesting a coaching position. Following his wife’s suggestion, Mark became the Giants’ bullpen coach in 2003 and is still coaching today.
Though Lori passed away from her illness in 2004, her memory continues to inspire Mark and his sons today. “The loss of Lori was a great loss to my sons and me, but I feel we have become stronger men because of her strength and courage.” To honor Lori’s memory, Mark has remained an active advocate for cancer patients and for organ donor awareness. Through his Step Up to the Plate Foundation, which he founded with Lori, Mark has been able to offer financial assistance to families undergoing treatment. But in an ideal scenario, Mark says, he would be able to close the foundation’s doors: “I hope that a cure is discovered someday and the foundation is no longer needed.” Until then Mark will continue to honor Lori’s memory and offer hope to all patients and families.
Joey Devine, Oakland A’s
Not a day goes by that Joey Devine does not call his mom. For the Oakland A’s relief pitcher, the daily calls are a chance to connect and to tell his family how much he loves them, but they also mean a little more these days. Expressing his love and gratitude took on special meaning in 2002 when his mom was diagnosed with breast cancer.
“It’s a tough thing to face,” Joey says of a loved one’s cancer diagnosis. “It was like a punch to the stomach.” A freshman at North Carolina State University at the time, Joey wanted to head home right away to be with his mom, but she had other ideas. “She insisted that I stay there and focus on school and baseball. Being 1,200 miles away from her was pretty difficult, but we communicated through the whole process.” It was an ordeal, Joey says, that included 30 rounds of radiation.
Throughout, Joey was able to lean on his college coaches, who took him under their wings and helped him through. It was tough to remain focused, he says, but his mom’s frequent trips to see him in North Carolina helped ease his fears: “The more I got to see her, a sense of comfort started coming back.”
Today Joey’s mom is well, but the lessons learned through that difficult time have not been forgotten. “Life’s too short,” Joey says, and recognizing the value of loved ones and the beauty of every day is a priority. “I learned to take each day at a time and to reach out to loved ones and tell them on a daily basis how much they mean.” Fortified by his commitment to his family and by a strong faith in God, Joey now hopes to inspire other survivors and their families: “Don’t give up on anything,” he says, “whether it’s an illness or anything in life—keep fighting.”
Jason Schmidt, Los Angeles Dodgers
Los Angeles Dodgers pitcher Jason Schmidt says that losing his mom to brain cancer in 2002 reorganized his priorities pretty quickly. “It put the game into perspective. Before this happened I thought baseball was everything; now I realize that it’s a game.”
For Jason what became most important in the wake of his mom’s passing was family. “We get caught up in life, and we take our family for granted,” he says, until cancer makes you stop and really take stock. “You never think it can happen to you, but when it does you realize just how important family is.”
To work through his grief and to honor his mom and other family members who have faced cancer, Jason became an advocate. During his time with the San Francisco Giants, he was an active volunteer for the National Brain Tumor Foundation and the Ronald McDonald House, playing host at the ballpark to families undergoing treatment. “We’d invite families who were in town to get treatment or a diagnosis to come out to a game. We’d spend some time talking to them before the game and just let them vent and escape the stress of what they were going through.”
The opportunity to help other families and survivors was inspiring and difficult, Jason says. But what has become clear through his experience and his advocacy efforts is how important advocacy and support are. “Now I realize that awareness and early detection are huge. When I was thrown into this, we didn’t know anyone who had dealt with this, and it was the hardest thing I’ve gone through in my life. Now when I see people dealing with this, I want to be there for them.”
Nick Swisher, New York Yankees
Among his fellow ball players, Nick Swisher has displayed a unique take on cancer advocacy over the past several years. In fact, you won’t find many Major League players who have gone to the lengths—literally—that this New York Yankees player has. Nick grew out his hair for nearly a year (from 2006 to May 2007) to donate it to the Pantene Beautiful Lengths program, which provides wigs to patients who are experiencing hair loss as a result of cancer treatment. During the annual MLB Mother’s Day event last year, Nick dyed his goatee pink in support of breast cancer survivors, and on Father’s Day he turned it blue in support of prostate cancer awareness.
So where does Nick’s passion for cancer advocacy come from? From one very special woman. Nick lost his grandmother, Betty Lorraine Swisher, to brain cancer in 2005. Betty had raised Nick, and dealing with her passing was incredibly tough. But her legacy lives on: “I have her initials, BLS, tattooed across my chest, and I always look to heaven before every at-bat. She is always with me. Because of her I do all I can to help the fight against any cancer.”
As he works hard on the field and in his advocacy work, it’s the lessons learned as a result of Betty’s journey that sustain him: “I learned to not waste a moment—that every day is a gift; and I learned to do for others and to be more patient and to give love always.” One of the ways Nick gives love these days is through his own charitable foundation, Swish’s Wishes, which he created “to help all children in need with vital medical care, education and recreational activities, and other essential programs that will make a difference in a child’s life.”
As Nick continues to honor Betty’s memory and forge his own path, he is hopeful that the future will be brighter for other families facing cancer: “I pray that with awareness, the latest information, and the right research lives can be saved.”
Matt Guerrier, Minnesota Twins
Like all professional baseball players, Matt Guerrier knows about strength and endurance under pressure, but it wasn’t until his mom was diagnosed with breast cancer in 2001 that the Minnesota Twins player recognized that his mom knew a thing or two about those qualities herself. “She was always very strong,” Matt says, “not just for herself but for her family.”
It was his mom’s confidence that she would survive and thrive in the face of cancer that inspired the rest of the family to be similarly positive. “She was always confident that she would beat it and never gave it a second thought,” Matt says. And because his mom kept the family informed about her experience, they felt empowered with the knowledge that she was being taken care of. “When she would get checkups, she would update us on what was going on and how she was doing, and that made it easier for us to handle.”
Matt’s mom is healthy today, and her son remains in awe of her ability to get through the ordeal. “It was pretty impressive to see what she could do and how she could battle through something like that,” Matt says. Now, in gratitude, Matt and his family honor their strong survivor by donating to Susan G. Komen for the Cure. Having been personally affected, the family knows that it’s important to help in any way they can.
How Is MLB Helping Fight Cancer in Your Town?
Los Angeles Angels
Through a partnership with the Leukemia & Lymphoma Society, the Angels sponsor the Light the Night Walk each year. This fundraising event, held at Angel Stadium, is an annual celebration and commemoration of lives touched by cancer. All walkers carry balloons: cancer patients and survivors carry white illuminated balloons while cancer supporters carry red illuminated balloons. To participate in this year’s walk, please visit www.lightthenight.org.
Los Angeles Dodgers
ThinkCure, an innovative, community-based nonprofit that raises funds to accelerate collaborative research to cure cancer,was launched in July 2007 by the Los Angeles Dodgers, the McCourt family, the City of Hope, and Childrens Hospital Los Angeles. With a broad foundation of motivated support, inspired by the search for a cure for cancer and built upon by the passion of all those who have been touched by the disease, ThinkCure and its sponsors hope to create a civic entity that—like the Dodgers—will become the property and the concern of the entire Los Angeles community.
There is a precedent for a partnership between a beloved sports franchise and those dedicated to finding a cure for cancer. The Jimmy Fund, launched in 1948 by the Boston Braves (later the official charity of the Boston Red Sox) and the Variety Club of New England, in conjunction with Dr. Sidney Farber (founder of the first hospital unit devoted exclusively to caring for children with cancer), is one of the most enduring and successful charities of its kind, having united New England in the search for a cure for nearly 60 years now.
ThinkCure will create a similar dynamic in southern California by combining its reach as the official charity of the Los Angeles Dodgers with the world-class research of both the City of Hope and Childrens Hospital Los Angeles and by galvanizing the community to find a cure for cancer and eradicate this disease.
For more information about ThinkCure or to make a donation, visit www.thinkcure.org or call (866) 554-CURE [2873].
New York Mets
The Mets’ Annual Welcome Home Dinner fundraiser, which occurs each year in April, is attended by the entire Mets organization, including manager Jerry Manuel, players, and coaches. This year’s dinner benefits the New York Mets Foundation, which will donate all proceeds to Katz Women’s Hospital/Women’s Health Institute North Shore–LIJ Health System Foundation and the Leukemia & Lymphoma Society. The evening features a silent auction and raffle and concludes with an autograph session with the Mets.
Oakland Athletics
Over the past 10 years, the Oakland A’s Breast Cancer Awareness Day has raised more than $1 million for breast cancer education and research. Funds are raised through the sale of special ticket packages, commemorative pins and hats, and an A’s autographed quilt raffle. Pregame ceremonies include more than 500 Bay Area breast cancer survivors forming a symbolic human ribbon on the field in dedication of hope and survival and the release of white doves as a symbol of hope. This year’s A’s Breast Cancer Awareness Day is set for September 5, 2009, at the Oakland-Alameda County Coliseum.
Tampa Bay Rays
The Rays partnered with Ed Randall’s Bat for the Cure in 2008 to offer free prostate cancer screenings for men at Tropicana Field. The National Prostate Cancer Coalition (ZERO) provided a recreational vehicle for the 10-minute tests, which were under the supervision of doctors and nurses from H. Lee Moffitt Cancer Center.
An estimated 400 to 500 men took advantage of the free screenings, which did not require insurance or an appointment. Men gave small blood samples for a PSA test and underwent a physical, with results and a recommendation for a possible follow-up examination sent to them in about four weeks.
Every man who was screened for prostate cancer also received two free tickets to a Rays game. One in six men will get prostate cancer but, if it’s caught early, nearly 100 percent survive. African-American men have an even higher risk, with one in four developing the disease. Because early prostate cancer has no symptoms, screening is especially important.
The Rays plan to continue this program during the 2009 season. Please check http://tampabay.rays.mlb.com for more information.
Kansas City Royals
The Kansas City Royals host two annual Girls’ Night Out events. The first will benefit Susan G. Komen for the Cure; the second will benefit the American Heart Association.
Female fans are treated to free massages and manicures, can sample pink cocktails, and receive pink Royals baseball caps. For more information visit http://kansascity.royals.mlb.com/kc/ticketing/girlsnightout.jsp#details.
Atlanta Braves
Breast Cancer Awareness Day, presented by Publix Super Markets, will take place on Sunday, September 20, 2009. The event is a daylong celebration of survivorship honoring those who have courageously battled breast cancer. Survivors receive one free lower-level ticket (additional tickets are $12), a commemorative Atlanta Braves Breast Cancer Awareness T-shirt, access to a pregame reception with family and friends, and the opportunity to take part in a Walk in the Park—an on-field ceremony for survivors. In addition, five breast cancer survivors and community activists will be presented with the Diamond of Hope Award to honor the exceptional contributions they have made in the fight against breast cancer through their volunteer efforts, advocacy work, and support of breast cancer education and research. For more information visit www.braves.com/bc_awareness.
By Diana Price
What do a bunch of guys swinging bats have to do with the future of cancer prevention and treatment? Actually, if Major League Baseball (MLB) has anything to do with it, the answer is quite a lot. Tim Brosnan, MLB executive vice president, business, says that MLB has long recognized the impact the organization can have on promoting prevention and advocacy. “Commissioner [Allan H. “Bud”] Selig, who is himself a skin cancer survivor, has often said that Major League Baseball is a social institution with important social responsibilities.” As such, Brosnan says, MLB is committed to supporting important social causes, and “partnering with organizations in the fight against cancer is a priority.”
With 78.5 million fans at MLB games last year (and hundreds of millions more tuning in via television, radio, and the Internet), the organization has an extraordinary platform from which to educate and inspire. And the goal, says Brosnan, is to use the opportunity both to raise awareness among fans about how they can detect and prevent cancer and to raise funds for critical cancer research.
In a major step toward accomplishing these goals, MLB partnered with Stand Up to Cancer (SU2C) in 2008 to raise funds and promote awareness. With an initial contribution of $10 million, MLB took the lead in supporting this initiative aimed at accelerating groundbreaking research. The organization followed that contribution with the decision to air an SU2C public service announcement at the 2008 All-Star Game at Yankee Stadium and at all 30 MLB parks across the country throughout the season, reaching a potential audience of more than 200 million. “Stand Up to Cancer has an admirable goal of uniting various cancer organizations to further the latest research and development and find new treatments,” says Brosnan. “Their groundbreaking broadcast last fall demonstrated the power of the organization. We are proud to be a founding, lead partner for this innovative campaign.”
In addition, MLB has established several annual initiatives geared toward bringing cancer awareness, education, and fundraising opportunities to its ballparks. Each year on Mother’s Day, MLB and Susan G. Komen for the Cure partner to bring breast cancer awareness to fans and players through their “Going to Bat Against Breast Cancer” program. The initiative includes the use of pink bats and bases on the field (which are later auctioned off to benefit Komen for the Cure), along with special programs to honor survivors. MLB has made a $50,000 pledge to Komen for the Cure as part of its commitment to the program.
MLB has also joined forces with the Prostate Cancer Foundation to create a Father’s Day initiative aimed at supporting prostate cancer awareness. MLB players, coaches, trainers, umpires, and groundskeepers wear blue wristbands, blue-ribbon uniform decals, and temporary blue-ribbon tattoos and raise funds through the “Home Run Challenge,” whereby fans can make donations for each home run hit during 60 select MLB games in the weeks surrounding the event. In 2008 MLB donated $50,000 to the Prostate Cancer Foundation as part of this initiative. Finally, MLB also designates a day to promote skin cancer awareness through its annual “Play Sun Smart” program, now in its twelfth year. In this partnership with the American Academy of Dermatology, skin cancer screenings are conducted at ballparks across the country.
In all the ways that MLB supports cancer awareness, it does so knowing the profound impact it can have. By promoting prevention, detection, and fundraising messages among fans, players, and staff, the organization fulfills its sense of social responsibility and works to save lives and honor survivors.
PLAYER PROFILES
Mark Gardner, San Francisco Giants
Mark Gardner was pitching for the San Francisco Giants when his wife, Lori, was diagnosed with liver cancer. Over the next six years, Lori endured two liver transplants and multiple rounds of chemotherapy. Though Mark was able to take time off as needed throughout Lori’s treatment to be there for her and their two young sons, the experience ultimately took its toll. “Performing at that level became more difficult,” Mark says of continuing to play professional ball, and he retired in 2001. It was Lori who got him back in the game by suggesting a coaching position. Following his wife’s suggestion, Mark became the Giants’ bullpen coach in 2003 and is still coaching today.
Though Lori passed away from her illness in 2004, her memory continues to inspire Mark and his sons today. “The loss of Lori was a great loss to my sons and me, but I feel we have become stronger men because of her strength and courage.” To honor Lori’s memory, Mark has remained an active advocate for cancer patients and for organ donor awareness. Through his Step Up to the Plate Foundation, which he founded with Lori, Mark has been able to offer financial assistance to families undergoing treatment. But in an ideal scenario, Mark says, he would be able to close the foundation’s doors: “I hope that a cure is discovered someday and the foundation is no longer needed.” Until then Mark will continue to honor Lori’s memory and offer hope to all patients and families.
Joey Devine, Oakland A’s
Not a day goes by that Joey Devine does not call his mom. For the Oakland A’s relief pitcher, the daily calls are a chance to connect and to tell his family how much he loves them, but they also mean a little more these days. Expressing his love and gratitude took on special meaning in 2002 when his mom was diagnosed with breast cancer.
“It’s a tough thing to face,” Joey says of a loved one’s cancer diagnosis. “It was like a punch to the stomach.” A freshman at North Carolina State University at the time, Joey wanted to head home right away to be with his mom, but she had other ideas. “She insisted that I stay there and focus on school and baseball. Being 1,200 miles away from her was pretty difficult, but we communicated through the whole process.” It was an ordeal, Joey says, that included 30 rounds of radiation.
Throughout, Joey was able to lean on his college coaches, who took him under their wings and helped him through. It was tough to remain focused, he says, but his mom’s frequent trips to see him in North Carolina helped ease his fears: “The more I got to see her, a sense of comfort started coming back.”
Today Joey’s mom is well, but the lessons learned through that difficult time have not been forgotten. “Life’s too short,” Joey says, and recognizing the value of loved ones and the beauty of every day is a priority. “I learned to take each day at a time and to reach out to loved ones and tell them on a daily basis how much they mean.” Fortified by his commitment to his family and by a strong faith in God, Joey now hopes to inspire other survivors and their families: “Don’t give up on anything,” he says, “whether it’s an illness or anything in life—keep fighting.”
Jason Schmidt, Los Angeles Dodgers
Los Angeles Dodgers pitcher Jason Schmidt says that losing his mom to brain cancer in 2002 reorganized his priorities pretty quickly. “It put the game into perspective. Before this happened I thought baseball was everything; now I realize that it’s a game.”
For Jason what became most important in the wake of his mom’s passing was family. “We get caught up in life, and we take our family for granted,” he says, until cancer makes you stop and really take stock. “You never think it can happen to you, but when it does you realize just how important family is.”
To work through his grief and to honor his mom and other family members who have faced cancer, Jason became an advocate. During his time with the San Francisco Giants, he was an active volunteer for the National Brain Tumor Foundation and the Ronald McDonald House, playing host at the ballpark to families undergoing treatment. “We’d invite families who were in town to get treatment or a diagnosis to come out to a game. We’d spend some time talking to them before the game and just let them vent and escape the stress of what they were going through.”
The opportunity to help other families and survivors was inspiring and difficult, Jason says. But what has become clear through his experience and his advocacy efforts is how important advocacy and support are. “Now I realize that awareness and early detection are huge. When I was thrown into this, we didn’t know anyone who had dealt with this, and it was the hardest thing I’ve gone through in my life. Now when I see people dealing with this, I want to be there for them.”
Nick Swisher, New York Yankees
Among his fellow ball players, Nick Swisher has displayed a unique take on cancer advocacy over the past several years. In fact, you won’t find many Major League players who have gone to the lengths—literally—that this New York Yankees player has. Nick grew out his hair for nearly a year (from 2006 to May 2007) to donate it to the Pantene Beautiful Lengths program, which provides wigs to patients who are experiencing hair loss as a result of cancer treatment. During the annual MLB Mother’s Day event last year, Nick dyed his goatee pink in support of breast cancer survivors, and on Father’s Day he turned it blue in support of prostate cancer awareness.
So where does Nick’s passion for cancer advocacy come from? From one very special woman. Nick lost his grandmother, Betty Lorraine Swisher, to brain cancer in 2005. Betty had raised Nick, and dealing with her passing was incredibly tough. But her legacy lives on: “I have her initials, BLS, tattooed across my chest, and I always look to heaven before every at-bat. She is always with me. Because of her I do all I can to help the fight against any cancer.”
As he works hard on the field and in his advocacy work, it’s the lessons learned as a result of Betty’s journey that sustain him: “I learned to not waste a moment—that every day is a gift; and I learned to do for others and to be more patient and to give love always.” One of the ways Nick gives love these days is through his own charitable foundation, Swish’s Wishes, which he created “to help all children in need with vital medical care, education and recreational activities, and other essential programs that will make a difference in a child’s life.”
As Nick continues to honor Betty’s memory and forge his own path, he is hopeful that the future will be brighter for other families facing cancer: “I pray that with awareness, the latest information, and the right research lives can be saved.”
Matt Guerrier, Minnesota Twins
Like all professional baseball players, Matt Guerrier knows about strength and endurance under pressure, but it wasn’t until his mom was diagnosed with breast cancer in 2001 that the Minnesota Twins player recognized that his mom knew a thing or two about those qualities herself. “She was always very strong,” Matt says, “not just for herself but for her family.”
It was his mom’s confidence that she would survive and thrive in the face of cancer that inspired the rest of the family to be similarly positive. “She was always confident that she would beat it and never gave it a second thought,” Matt says. And because his mom kept the family informed about her experience, they felt empowered with the knowledge that she was being taken care of. “When she would get checkups, she would update us on what was going on and how she was doing, and that made it easier for us to handle.”
Matt’s mom is healthy today, and her son remains in awe of her ability to get through the ordeal. “It was pretty impressive to see what she could do and how she could battle through something like that,” Matt says. Now, in gratitude, Matt and his family honor their strong survivor by donating to Susan G. Komen for the Cure. Having been personally affected, the family knows that it’s important to help in any way they can.
How Is MLB Helping Fight Cancer in Your Town?
Los Angeles Angels
Through a partnership with the Leukemia & Lymphoma Society, the Angels sponsor the Light the Night Walk each year. This fundraising event, held at Angel Stadium, is an annual celebration and commemoration of lives touched by cancer. All walkers carry balloons: cancer patients and survivors carry white illuminated balloons while cancer supporters carry red illuminated balloons. To participate in this year’s walk, please visit www.lightthenight.org.
Los Angeles Dodgers
ThinkCure, an innovative, community-based nonprofit that raises funds to accelerate collaborative research to cure cancer,was launched in July 2007 by the Los Angeles Dodgers, the McCourt family, the City of Hope, and Childrens Hospital Los Angeles. With a broad foundation of motivated support, inspired by the search for a cure for cancer and built upon by the passion of all those who have been touched by the disease, ThinkCure and its sponsors hope to create a civic entity that—like the Dodgers—will become the property and the concern of the entire Los Angeles community.
There is a precedent for a partnership between a beloved sports franchise and those dedicated to finding a cure for cancer. The Jimmy Fund, launched in 1948 by the Boston Braves (later the official charity of the Boston Red Sox) and the Variety Club of New England, in conjunction with Dr. Sidney Farber (founder of the first hospital unit devoted exclusively to caring for children with cancer), is one of the most enduring and successful charities of its kind, having united New England in the search for a cure for nearly 60 years now.
ThinkCure will create a similar dynamic in southern California by combining its reach as the official charity of the Los Angeles Dodgers with the world-class research of both the City of Hope and Childrens Hospital Los Angeles and by galvanizing the community to find a cure for cancer and eradicate this disease.
For more information about ThinkCure or to make a donation, visit www.thinkcure.org or call (866) 554-CURE [2873].
New York Mets
The Mets’ Annual Welcome Home Dinner fundraiser, which occurs each year in April, is attended by the entire Mets organization, including manager Jerry Manuel, players, and coaches. This year’s dinner benefits the New York Mets Foundation, which will donate all proceeds to Katz Women’s Hospital/Women’s Health Institute North Shore–LIJ Health System Foundation and the Leukemia & Lymphoma Society. The evening features a silent auction and raffle and concludes with an autograph session with the Mets.
Oakland Athletics
Over the past 10 years, the Oakland A’s Breast Cancer Awareness Day has raised more than $1 million for breast cancer education and research. Funds are raised through the sale of special ticket packages, commemorative pins and hats, and an A’s autographed quilt raffle. Pregame ceremonies include more than 500 Bay Area breast cancer survivors forming a symbolic human ribbon on the field in dedication of hope and survival and the release of white doves as a symbol of hope. This year’s A’s Breast Cancer Awareness Day is set for September 5, 2009, at the Oakland-Alameda County Coliseum.
Tampa Bay Rays
The Rays partnered with Ed Randall’s Bat for the Cure in 2008 to offer free prostate cancer screenings for men at Tropicana Field. The National Prostate Cancer Coalition (ZERO) provided a recreational vehicle for the 10-minute tests, which were under the supervision of doctors and nurses from H. Lee Moffitt Cancer Center.
An estimated 400 to 500 men took advantage of the free screenings, which did not require insurance or an appointment. Men gave small blood samples for a PSA test and underwent a physical, with results and a recommendation for a possible follow-up examination sent to them in about four weeks.
Every man who was screened for prostate cancer also received two free tickets to a Rays game. One in six men will get prostate cancer but, if it’s caught early, nearly 100 percent survive. African-American men have an even higher risk, with one in four developing the disease. Because early prostate cancer has no symptoms, screening is especially important.
The Rays plan to continue this program during the 2009 season. Please check http://tampabay.rays.mlb.com for more information.
Kansas City Royals
The Kansas City Royals host two annual Girls’ Night Out events. The first will benefit Susan G. Komen for the Cure; the second will benefit the American Heart Association.
Female fans are treated to free massages and manicures, can sample pink cocktails, and receive pink Royals baseball caps. For more information visit http://kansascity.royals.mlb.com/kc/ticketing/girlsnightout.jsp#details.
Atlanta Braves
Breast Cancer Awareness Day, presented by Publix Super Markets, will take place on Sunday, September 20, 2009. The event is a daylong celebration of survivorship honoring those who have courageously battled breast cancer. Survivors receive one free lower-level ticket (additional tickets are $12), a commemorative Atlanta Braves Breast Cancer Awareness T-shirt, access to a pregame reception with family and friends, and the opportunity to take part in a Walk in the Park—an on-field ceremony for survivors. In addition, five breast cancer survivors and community activists will be presented with the Diamond of Hope Award to honor the exceptional contributions they have made in the fight against breast cancer through their volunteer efforts, advocacy work, and support of breast cancer education and research. For more information visit www.braves.com/bc_awareness.
Breath by Breath; How Meditaiton reduces stress & anxiety during treatment
Meditation may reduce stress and anxiety during cancer treatment while keeping focus on the positive.
By Mia James
The flurry of tests, procedures, appointments, and drug regimens that accompany a cancer diagnosis—never mind the fear and the stress of facing cancer—leave little chance for tranquility and peace of mind. The good news is that healthcare providers and patients are increasingly aware of the importance of treating the whole patient (body and mind), so complementary therapies that address the psychological as well as physical aspects of cancer are increasingly assuming a more significant role in overall care.
Many such modalities are termed mind-body medicine, which refers to the interaction between psychological and physical health. Meditation is one such practice that can reduce stress and bring comfort to cancer patients and, according to the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM), may even contribute to improved overall health and wellness.[1]
What Is Meditation, and What Are the Benefits?
Meditation has been practiced in every culture throughout human history in both spiritual and secular (non-religious) contexts. There are many forms of meditation; each provides different techniques to help people focus attention and free the mind from distracting thoughts or emotions. Attention to breath, for example, is a popular and common route to help direct awareness to the present moment, which promotes what is called a “relaxation response.” According to NCCAM, meditation can contribute to physical relaxation, mental calmness, and psychological balance as practitioners become more aware of the mind’s activity and how thoughts and emotions affect their overall state of being. As for the benefits of meditation for cancer patients specifically, the American Cancer Society states that although meditation does not treat the tumor, “it may help improve the quality of life for people with cancer.”[2]
Robert Schmehr, LCSW, manager of the Mind-Body Therapy Program in Memorial Sloan-Kettering Cancer Center’s Integrative Medicine Department in New York City, describes their special program called “Training for Treatment and Beyond” as “training” that involves the dual approach of physical activity and mind-body medicine. The latter includes an emphasis on helping patients learn self-hypnosis, a deeper form of meditation.
Schmehr goes on to explain that the calming, focused nature of this easily-learned practice helps patients better regulate stress and anxiety and address depression, a normal reaction to a cancer diagnosis. Meditation can also play an important role in preparation for surgery, says Schmehr: “People who meditate before surgery fare better physically as well as emotionally after surgery because their self-regulatory processes work better.” He explains that hastened physical recovery may be due to “meditation’s ability to enhance autonomic nervous system functioning, which enables the body and mind to share information to reduce pain, normalize blood pressure, and manage emotional distress.”
The benefits of meditation continue throughout treatment. Schmehr explains that meditation is thought to improve quality of life in many ways, including aiding post-surgery healing, reducing the pain of routine procedures such as the insertion of intravenous (IV) lines, and relieving tension and stress.
For patients the benefits are not only clinical. Endometrial cancer survivor Elizabeth Colman says that she looked to meditation during treatment as a way of relieving stress but that the practice also allowed her to “learn all I could from the cancer experience”—a process that she says has “opened up the door to living mindfully and fully.”
Schmehr adds that such benefits need not be limited to cancer patients and that meditation can address stress, anxiety, and fear in patient’s loved ones as well: “Going through cancer is a family event; it’s not just the person receiving the treatment,” and meditation can be an effective way to reduce the stress and tension of anyone touched by a cancer diagnosis.
Elana Rosenbaum, LICSW, has both an expert and a patient perspective on meditation and cancer treatment. She is the meditation teacher at Dana Farber Cancer Institute in Boston, has authored a book (Here for Now: Living Well with Cancer Through Mindfulness [Satya House, 2007; $16.95]), and has produced CDs about meditation during cancer treatment; she is also a lymphoma survivor. It was during her stem cell transplant for lymphoma that she experienced firsthand the powerful benefits of meditation during treatment.
Rosenbaum describes her approach to meditation as the practice of “mindfulness,” which she explains as “a way of being present and opening into experience rather than fighting it.” Such awareness, she says, directs focus toward “celebrating what is possible.” Patients turn to meditation, she says, in an effort to improve well-being and also to gain a sense of control at a time of vulnerability. Such a practice—“something within your realm that you do”—can give patients a sense of control during the treatment process and “increase a sense of self-efficacy.” As well, Rosenbaum explains that by focusing on the present moment where patients do have a sense of control, anxiety over a future that can’t be controlled is lessened.
Rosenbaum found strength and solace in meditation when she developed pneumonia following her stem cell transplant. She says that she was on oxygen and that her life was at risk, but instead of fighting she allowed herself to slow down and become present—or mindful—of the experience and thus achieved a sense of calm and peace that she believes enabled her to survive. Simple pleasures like looking through her window, hearing children’s voices outside, and enjoying a glass of water gained profound meaning. It was, she says, “a wonderful way to feel peaceful.” Meditation brought her into a state of acceptance, where she was better able to receive care and was overcome with appreciation and gratitude for being alive. “The little things just became wonderful,” she says.
Finding Focus
According to Schmehr and Rosenbaum, most people are capable of some degree of meditation. Both acknowledge that sitting still for long periods of time isn’t for everyone, and that many people would find this a challenging introduction to meditation, so they encourage individuals to look to activities and elements of their daily lives and see where a level of meditation might be incorporated.
Among the options for increasing mindfulness that Rosenbaum suggests are spending time in nature and creative expression. Meditation and mindfulness, she explains, can come in many forms so long as they bring focus back to the present moment. This can be done, she says, by simply “stopping and noticing what’s here right now.” She adds that one of the keys is “trusting your own resources, your own wisdom.”
Schmehr says that though he often hears people claim they can’t meditate, he also encourages looking for ways to add meditation to your existing activities and interests. “Whatever meditation technique you find, it should be enjoyable and it should be something that can fit into your daily life.” He offers the example of sitting with a cup of coffee first thing in the morning and pausing to take several breaths and enjoy the aroma before starting your day.
Survivor Elizabeth Colman, who was so positively affected by meditation that she now teaches it, backs up Rosenbaum and Schmehr’s message that meditation is widely accessible and highly beneficial: “Everyone can benefit from meditation, and everyone can do it.”
[sidebar]
Looking for Inner Peace? Start Here.
“Peace. It does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of those things and still be calm in your heart.”
—Anonymous
If you have been diagnosed with cancer, you may feel anything but peaceful. Try using your breath along with imagery to enter into a state of peace. Here’s how to begin:
Find a comfortable seated or reclining position.
Close your eyes and begin to deepen your breath.
As you begin to deepen your breath, imagine that you are inhaling the color yellow. As you inhale, draw in yellow, healing energy and allow it to fill your entire body. See this yellow energy filling every crevice of your body, down to your fingertips and toes.
Pause after your inhale and visualize yourself full of this yellow breath.
Slowly begin to exhale. As you exhale, imagine that you are exhaling the color black. The yellow inhale has filled up your body and is now pushing this black exhale out. You may even imagine that this black energy forms into a dark storm cloud and, as you exhale, you push this cloud away from you, out to sea.
Continue to inhale yellow and exhale black, relaxing into your breath and visualizing health.
Variations
Find whatever works for you. You can use your mind and breath to find peace in many ways:
Inhale love; exhale fear.
Inhale peace; exhale anxiety.
Inhale pink; exhale blue.
Inhale healthy cells; exhale cancerous cells.
For additional guidance in increasing mindfulness during your daily activities and bringing meditation into your life, consult your healthcare team or look into meditation and mind-body programs at your cancer center. Rosenbaum offers a free “Loving Kindness” meditation on her Web site, www.mindfulnessforcancer.com, which can help you get started.
By Mia James
The flurry of tests, procedures, appointments, and drug regimens that accompany a cancer diagnosis—never mind the fear and the stress of facing cancer—leave little chance for tranquility and peace of mind. The good news is that healthcare providers and patients are increasingly aware of the importance of treating the whole patient (body and mind), so complementary therapies that address the psychological as well as physical aspects of cancer are increasingly assuming a more significant role in overall care.
Many such modalities are termed mind-body medicine, which refers to the interaction between psychological and physical health. Meditation is one such practice that can reduce stress and bring comfort to cancer patients and, according to the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM), may even contribute to improved overall health and wellness.[1]
What Is Meditation, and What Are the Benefits?
Meditation has been practiced in every culture throughout human history in both spiritual and secular (non-religious) contexts. There are many forms of meditation; each provides different techniques to help people focus attention and free the mind from distracting thoughts or emotions. Attention to breath, for example, is a popular and common route to help direct awareness to the present moment, which promotes what is called a “relaxation response.” According to NCCAM, meditation can contribute to physical relaxation, mental calmness, and psychological balance as practitioners become more aware of the mind’s activity and how thoughts and emotions affect their overall state of being. As for the benefits of meditation for cancer patients specifically, the American Cancer Society states that although meditation does not treat the tumor, “it may help improve the quality of life for people with cancer.”[2]
Robert Schmehr, LCSW, manager of the Mind-Body Therapy Program in Memorial Sloan-Kettering Cancer Center’s Integrative Medicine Department in New York City, describes their special program called “Training for Treatment and Beyond” as “training” that involves the dual approach of physical activity and mind-body medicine. The latter includes an emphasis on helping patients learn self-hypnosis, a deeper form of meditation.
Schmehr goes on to explain that the calming, focused nature of this easily-learned practice helps patients better regulate stress and anxiety and address depression, a normal reaction to a cancer diagnosis. Meditation can also play an important role in preparation for surgery, says Schmehr: “People who meditate before surgery fare better physically as well as emotionally after surgery because their self-regulatory processes work better.” He explains that hastened physical recovery may be due to “meditation’s ability to enhance autonomic nervous system functioning, which enables the body and mind to share information to reduce pain, normalize blood pressure, and manage emotional distress.”
The benefits of meditation continue throughout treatment. Schmehr explains that meditation is thought to improve quality of life in many ways, including aiding post-surgery healing, reducing the pain of routine procedures such as the insertion of intravenous (IV) lines, and relieving tension and stress.
For patients the benefits are not only clinical. Endometrial cancer survivor Elizabeth Colman says that she looked to meditation during treatment as a way of relieving stress but that the practice also allowed her to “learn all I could from the cancer experience”—a process that she says has “opened up the door to living mindfully and fully.”
Schmehr adds that such benefits need not be limited to cancer patients and that meditation can address stress, anxiety, and fear in patient’s loved ones as well: “Going through cancer is a family event; it’s not just the person receiving the treatment,” and meditation can be an effective way to reduce the stress and tension of anyone touched by a cancer diagnosis.
Elana Rosenbaum, LICSW, has both an expert and a patient perspective on meditation and cancer treatment. She is the meditation teacher at Dana Farber Cancer Institute in Boston, has authored a book (Here for Now: Living Well with Cancer Through Mindfulness [Satya House, 2007; $16.95]), and has produced CDs about meditation during cancer treatment; she is also a lymphoma survivor. It was during her stem cell transplant for lymphoma that she experienced firsthand the powerful benefits of meditation during treatment.
Rosenbaum describes her approach to meditation as the practice of “mindfulness,” which she explains as “a way of being present and opening into experience rather than fighting it.” Such awareness, she says, directs focus toward “celebrating what is possible.” Patients turn to meditation, she says, in an effort to improve well-being and also to gain a sense of control at a time of vulnerability. Such a practice—“something within your realm that you do”—can give patients a sense of control during the treatment process and “increase a sense of self-efficacy.” As well, Rosenbaum explains that by focusing on the present moment where patients do have a sense of control, anxiety over a future that can’t be controlled is lessened.
Rosenbaum found strength and solace in meditation when she developed pneumonia following her stem cell transplant. She says that she was on oxygen and that her life was at risk, but instead of fighting she allowed herself to slow down and become present—or mindful—of the experience and thus achieved a sense of calm and peace that she believes enabled her to survive. Simple pleasures like looking through her window, hearing children’s voices outside, and enjoying a glass of water gained profound meaning. It was, she says, “a wonderful way to feel peaceful.” Meditation brought her into a state of acceptance, where she was better able to receive care and was overcome with appreciation and gratitude for being alive. “The little things just became wonderful,” she says.
Finding Focus
According to Schmehr and Rosenbaum, most people are capable of some degree of meditation. Both acknowledge that sitting still for long periods of time isn’t for everyone, and that many people would find this a challenging introduction to meditation, so they encourage individuals to look to activities and elements of their daily lives and see where a level of meditation might be incorporated.
Among the options for increasing mindfulness that Rosenbaum suggests are spending time in nature and creative expression. Meditation and mindfulness, she explains, can come in many forms so long as they bring focus back to the present moment. This can be done, she says, by simply “stopping and noticing what’s here right now.” She adds that one of the keys is “trusting your own resources, your own wisdom.”
Schmehr says that though he often hears people claim they can’t meditate, he also encourages looking for ways to add meditation to your existing activities and interests. “Whatever meditation technique you find, it should be enjoyable and it should be something that can fit into your daily life.” He offers the example of sitting with a cup of coffee first thing in the morning and pausing to take several breaths and enjoy the aroma before starting your day.
Survivor Elizabeth Colman, who was so positively affected by meditation that she now teaches it, backs up Rosenbaum and Schmehr’s message that meditation is widely accessible and highly beneficial: “Everyone can benefit from meditation, and everyone can do it.”
[sidebar]
Looking for Inner Peace? Start Here.
“Peace. It does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of those things and still be calm in your heart.”
—Anonymous
If you have been diagnosed with cancer, you may feel anything but peaceful. Try using your breath along with imagery to enter into a state of peace. Here’s how to begin:
Find a comfortable seated or reclining position.
Close your eyes and begin to deepen your breath.
As you begin to deepen your breath, imagine that you are inhaling the color yellow. As you inhale, draw in yellow, healing energy and allow it to fill your entire body. See this yellow energy filling every crevice of your body, down to your fingertips and toes.
Pause after your inhale and visualize yourself full of this yellow breath.
Slowly begin to exhale. As you exhale, imagine that you are exhaling the color black. The yellow inhale has filled up your body and is now pushing this black exhale out. You may even imagine that this black energy forms into a dark storm cloud and, as you exhale, you push this cloud away from you, out to sea.
Continue to inhale yellow and exhale black, relaxing into your breath and visualizing health.
Variations
Find whatever works for you. You can use your mind and breath to find peace in many ways:
Inhale love; exhale fear.
Inhale peace; exhale anxiety.
Inhale pink; exhale blue.
Inhale healthy cells; exhale cancerous cells.
For additional guidance in increasing mindfulness during your daily activities and bringing meditation into your life, consult your healthcare team or look into meditation and mind-body programs at your cancer center. Rosenbaum offers a free “Loving Kindness” meditation on her Web site, www.mindfulnessforcancer.com, which can help you get started.
Mammography Screening Important After Lumpectomy for DCIS
Surveillance mammography after breast-conserving surgery for ductal carcinoma in situ (DCIS) appears to decline over time, despite the increased risk of invasive cancer, according to the results of a study published in the Journal of Clinical Oncology.[1]
Ductal carcinoma in situ is the earliest stage of breast cancer, during which the cancer is small and confined to an area within a duct of the breast. Previously, DCIS was often considered a “pre-cancerous” condition that had the potential to turn into cancer. Now, however, DCIS is largely accepted as an early stage of breast cancer and is treated accordingly, often with breast-conserving surgery.
DCIS is considered a precursor to invasive breast cancer, so it is important for women to continue to be screened with mammography for either recurrence of DCIS or newly diagnosed invasive breast cancer. Approximately 20% of women with DCIS will have a recurrence within five years, with almost half of those recurrences being classified as invasive breast cancer. Furthermore, these women are two to four times as likely to develop cancer in the opposite breast. Despite the increased risks, it is unclear whether women in this population continue to be vigilant about screening.
Researchers reviewed the medical records of 2,676 women diagnosed with DCIS between 1990 and 2001 and treated with breast-conserving surgery. They found that women were more likely to undergo surveillance mammography during the first year of follow-up—79% of the women had at least one mammography during this period. However, surveillance declined from there—at five years, 69% of women underwent surveillance and at 10 years, 61% were screened.
Surveillance mammograms were more likely among women age 60 to 69, women who used hormone therapy, and those treated with radiation and/or tamoxifen (Nolvadex®). Obese women were less likely to undergo surveillance mammography. Among the women observed for five years, only 34% of women had a surveillance mammogram during every year of follow-up, and of those observed for 10 years, only 15% underwent yearly mammograms.
The researchers concluded that despite the known increased risk of invasive cancer, surveillance mammography declined over time among women treated with breast-conserving surgery for DCIS. They recommend stronger monitoring efforts to ensure that women in this high-risk population are being adequately screened.
Reference:
[1] Nekhlyudov L, Habel LA, Achacoso NS, et al. Adherence to long-term surveillance mammography among women with ductal carcinoma in situ treated with breast-conserving surgery. Journal of Clinical Oncology. 2009; 27: 3211-3216.
Ductal carcinoma in situ is the earliest stage of breast cancer, during which the cancer is small and confined to an area within a duct of the breast. Previously, DCIS was often considered a “pre-cancerous” condition that had the potential to turn into cancer. Now, however, DCIS is largely accepted as an early stage of breast cancer and is treated accordingly, often with breast-conserving surgery.
DCIS is considered a precursor to invasive breast cancer, so it is important for women to continue to be screened with mammography for either recurrence of DCIS or newly diagnosed invasive breast cancer. Approximately 20% of women with DCIS will have a recurrence within five years, with almost half of those recurrences being classified as invasive breast cancer. Furthermore, these women are two to four times as likely to develop cancer in the opposite breast. Despite the increased risks, it is unclear whether women in this population continue to be vigilant about screening.
Researchers reviewed the medical records of 2,676 women diagnosed with DCIS between 1990 and 2001 and treated with breast-conserving surgery. They found that women were more likely to undergo surveillance mammography during the first year of follow-up—79% of the women had at least one mammography during this period. However, surveillance declined from there—at five years, 69% of women underwent surveillance and at 10 years, 61% were screened.
Surveillance mammograms were more likely among women age 60 to 69, women who used hormone therapy, and those treated with radiation and/or tamoxifen (Nolvadex®). Obese women were less likely to undergo surveillance mammography. Among the women observed for five years, only 34% of women had a surveillance mammogram during every year of follow-up, and of those observed for 10 years, only 15% underwent yearly mammograms.
The researchers concluded that despite the known increased risk of invasive cancer, surveillance mammography declined over time among women treated with breast-conserving surgery for DCIS. They recommend stronger monitoring efforts to ensure that women in this high-risk population are being adequately screened.
Reference:
[1] Nekhlyudov L, Habel LA, Achacoso NS, et al. Adherence to long-term surveillance mammography among women with ductal carcinoma in situ treated with breast-conserving surgery. Journal of Clinical Oncology. 2009; 27: 3211-3216.
Hormone Therapy Increases Ovarian Cancer Risk
Women who use postmenopausal hormones have an increased risk of developing ovarian cancer, according to a study conducted in Denmark. These results were published in the Journal of the American Medical Association.
Estrogen, with or without progestin, is an effective treatment for many menopausal symptoms. During the last several years, however, studies have raised concerns about the health effects of postmenopausal hormone therapy.
Use of estrogen plus progestin has been linked with an increased risk of heart disease, breast cancer, stroke, and blood clots and a decreased risk of fractures and colorectal cancer.[1] Use of estrogen alone, which is generally reserved for women who have had a hysterectomy, has been linked with an increased risk of strokes and a decreased risk of fractures.[2]
Studies have also suggested a possible increase in ovarian cancer among women who use postmenopausal estrogen.[3] To further evaluate the potential link between ovarian cancer and postmenopausal hormones, researchers in Denmark conducted a study among more than 900,000 women between the ages of 50 and 79.[4]
During an average of eight years of follow-up, there were 3,068 diagnoses of ovarian cancer, 2,681 of which involved epithelial ovarian cancer (the most common type of ovarian cancer).
Compared with women who had never used hormone therapy, current users of hormones were 38% more likely to develop any ovarian cancer and 44% more likely to develop epithelial ovarian cancer.Risk was greatest among current users of hormones and declined with years since last use.
Risk was increased among users of estrogen alone as well as among users of estrogen plus progestin. Risk did not vary by duration of use.The researchers estimate that hormone use results in one extra case of ovarian cancer for every 8,300 women taking hormone therapy each year.These results provide additional evidence that use of postmenopausal hormones increases the risk of ovarian cancer.
References:
[1] Rossouw JE, Anderson GL, Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. Journal of the American Medical Association. 2002; 288:321-33.
[2] Anderson GL, Limacher M, Assaf AR et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. Journal of the American Medical Association. 2004; 291:1701-1712.
[3] Million Women Study Collaborators. Ovarian cancer and hormone replacement therapy in the Million Women Study. The Lancet. 2007;369:1703-10.
[4] Steinrud Mørch L, Løkkegaard E, Halm Andreasen A, Krüger-Kjær S, Kidegaard Ø. Hormone therapy and ovarian cancer. Journal of the American Medical Association. 2009;302: 298-305.
Estrogen, with or without progestin, is an effective treatment for many menopausal symptoms. During the last several years, however, studies have raised concerns about the health effects of postmenopausal hormone therapy.
Use of estrogen plus progestin has been linked with an increased risk of heart disease, breast cancer, stroke, and blood clots and a decreased risk of fractures and colorectal cancer.[1] Use of estrogen alone, which is generally reserved for women who have had a hysterectomy, has been linked with an increased risk of strokes and a decreased risk of fractures.[2]
Studies have also suggested a possible increase in ovarian cancer among women who use postmenopausal estrogen.[3] To further evaluate the potential link between ovarian cancer and postmenopausal hormones, researchers in Denmark conducted a study among more than 900,000 women between the ages of 50 and 79.[4]
During an average of eight years of follow-up, there were 3,068 diagnoses of ovarian cancer, 2,681 of which involved epithelial ovarian cancer (the most common type of ovarian cancer).
Compared with women who had never used hormone therapy, current users of hormones were 38% more likely to develop any ovarian cancer and 44% more likely to develop epithelial ovarian cancer.Risk was greatest among current users of hormones and declined with years since last use.
Risk was increased among users of estrogen alone as well as among users of estrogen plus progestin. Risk did not vary by duration of use.The researchers estimate that hormone use results in one extra case of ovarian cancer for every 8,300 women taking hormone therapy each year.These results provide additional evidence that use of postmenopausal hormones increases the risk of ovarian cancer.
References:
[1] Rossouw JE, Anderson GL, Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. Journal of the American Medical Association. 2002; 288:321-33.
[2] Anderson GL, Limacher M, Assaf AR et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. Journal of the American Medical Association. 2004; 291:1701-1712.
[3] Million Women Study Collaborators. Ovarian cancer and hormone replacement therapy in the Million Women Study. The Lancet. 2007;369:1703-10.
[4] Steinrud Mørch L, Løkkegaard E, Halm Andreasen A, Krüger-Kjær S, Kidegaard Ø. Hormone therapy and ovarian cancer. Journal of the American Medical Association. 2009;302: 298-305.
Breast Cancer Patients Use Antioxidant Supplements During Treatment
Although the consequences of supplementing with antioxidants during cancer treatment remain unknown, many patients with breast cancer continue to use the supplements in an effort to maintain health and diminish the side effects of treatment, according to the results of a study published in Cancer.[1]
Antioxidants found in many foods (including fruits, vegetables, grains, nuts, as well as some meats, poultry, and fish) are often praised for their health benefits, namely the slowing or preventing of damage to cells caused by unstable molecules known as free radicals. For cancer patients, however, use of antioxidants, such as vitamins A, C, and E; beta carotene; lycopene; and selenium, in supplemental form (as opposed to food sources) is controversial. High doses of antioxidants may reduce the ability of radiation or chemotherapy to kill tumor cells, potentially reducing the effectiveness of treatment.
Despite the controversy, many patients continue to supplement with antioxidants. Between 2002 and 2004 researchers with the Long Island Breast Cancer Study Project conducted a follow-up interview of 764 women with breast cancer who had participated in a case-control study between 1996 and 1997. Of the 764 women, 663 reported receiving adjuvant treatment for breast cancer.
Approximately 60% (401) of the women who underwent adjuvant treatment reported using antioxidant supplements during the treatment. Furthermore, of these 401 women, 278 (69.3%) reported using high doses of antioxidants. More specifically:
-120/310 women (38.7%) used antioxidants during chemotherapy.-196/464 women (42.4%) used antioxidants during radiation therapy.-286/462 women (61.9%) used antioxidants during tamoxifen (Nolvadex®) therapy.
The researchers concluded that the use of antioxidant supplements during breast cancer treatment is common and future studies should evaluate the effects of antioxidants on breast cancer outcomes. In the meantime women who are considering using dietary supplements should be sure to discuss their supplement use with their physician. It’s important that the physician be aware of anything the patient is using that could potentially interfere with treatment.
Reference:
[1] Greenlee H, Gammon MD, Abrahamson PE, et al. Prevalence and predictors of antioxidant supplement use during breast cancer treatment. Cancer. 2009; 114: 3271-3282.
Antioxidants found in many foods (including fruits, vegetables, grains, nuts, as well as some meats, poultry, and fish) are often praised for their health benefits, namely the slowing or preventing of damage to cells caused by unstable molecules known as free radicals. For cancer patients, however, use of antioxidants, such as vitamins A, C, and E; beta carotene; lycopene; and selenium, in supplemental form (as opposed to food sources) is controversial. High doses of antioxidants may reduce the ability of radiation or chemotherapy to kill tumor cells, potentially reducing the effectiveness of treatment.
Despite the controversy, many patients continue to supplement with antioxidants. Between 2002 and 2004 researchers with the Long Island Breast Cancer Study Project conducted a follow-up interview of 764 women with breast cancer who had participated in a case-control study between 1996 and 1997. Of the 764 women, 663 reported receiving adjuvant treatment for breast cancer.
Approximately 60% (401) of the women who underwent adjuvant treatment reported using antioxidant supplements during the treatment. Furthermore, of these 401 women, 278 (69.3%) reported using high doses of antioxidants. More specifically:
-120/310 women (38.7%) used antioxidants during chemotherapy.-196/464 women (42.4%) used antioxidants during radiation therapy.-286/462 women (61.9%) used antioxidants during tamoxifen (Nolvadex®) therapy.
The researchers concluded that the use of antioxidant supplements during breast cancer treatment is common and future studies should evaluate the effects of antioxidants on breast cancer outcomes. In the meantime women who are considering using dietary supplements should be sure to discuss their supplement use with their physician. It’s important that the physician be aware of anything the patient is using that could potentially interfere with treatment.
Reference:
[1] Greenlee H, Gammon MD, Abrahamson PE, et al. Prevalence and predictors of antioxidant supplement use during breast cancer treatment. Cancer. 2009; 114: 3271-3282.
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