U.S. Oncologists Decry High Cost of Cancer Drugs

http://www.webmd.com/cancer/news/20150723/us-oncologists-decry-high-cost-of-cancer-drugs?ecd=wnl_can_072815&ctr=wnl-can-072815_nsl-promo_1&mb=QrA2jTNeXCYZ2bOd8brRkmdEpmNqbUHLhOmXrb8iv2s%3d

They suggest letting Medicare negotiate prices, back grassroots movement calling for change

WebMD News from HealthDay

By Robert Preidt

HealthDay Reporter

THURSDAY, July 23, 2015 (HealthDay News) -- Soaring costs for cancer drugs are hurting patient care in the United States, a group of top oncologists claim.

"High cancer-drug prices are affecting the care of patients with cancer and our health care system," Dr. Ayalew Tefferi, a hematologist at Mayo Clinic in Rochester, Minn., said in a Mayo news release.

Tefferi and his colleagues made a number of recommendations on how to address the problem in a commentary published July 23 in the Mayo Clinic Proceedings.

Allowing Medicare to negotiate drug prices is one of the suggestions the team of 118 leading cancer experts offered as a possible solution.

Along with their recommendations, the group also expressed support for a patient-based grassroots movement on change.org that is demanding action on the issue.

"The average gross household income in the U.S. is about $52,000 per year. For an insured patient with cancer who needs a drug that costs $120,000 per year, the out-of-pocket expenses could be as much as $25,000 to $30,000 -- more than half their average household income," Tefferi explained in the news release.

A study published earlier this year in the Journal of Economic Perspectives found that cancer drug prices have increased an average of $8,500 a year over the past 15 years.

"When you consider that cancer will affect one in three individuals over their lifetime, and [with] recent trends in insurance coverage [that] put a heavy financial burden on patients with out-of-pocket expenses, you quickly see that the situation is not sustainable," Tefferi said. "It's time for patients and their physicians to call for change."

The changes the commentary called for included:

• Create a review mechanism after a drug has been approved by the U.S. Food and Drug Administration that would propose a fair price for new cancer drugs that is based on the value to patients and health care.
• Allow the Patient-Centered Outcomes Research Institute -- established under the Affordable Care Act -- to evaluate the benefits of new cancer therapies, and let similar organizations include drug prices in their assessments of a treatment's value.
• Permit patients to import cancer drugs from other countries. For example, prices in Canada are about half that of prices in the United States, the experts said.
• Pass legislation to prevent drug companies from delaying the introduction of generic drugs, and reform the patent system to make it more difficult to unnecessarily extend patent protection of a drug.
• Encourage groups that represent cancer specialists and patients to consider the overall value of drugs and treatments when developing their treatment guidelines.

The group wrote that "it should be possible to focus the attention of pharmaceutical companies on this problem and to encourage our elected representatives to more effectively advocate for the interests of their most important constituents among the stakeholders in cancer -- American cancer patients."

 

 

 

Circulating BRAF may aid in papillary thyroid cancer diagnosis, follow-up

http://www.healio.com/endocrinology/thyroid/news/online/%7B51f45093-16a4-4afb-a643-e14a26bc358c%7D/circulating-braf-may-aid-in-papillary-thyroid-cancer-diagnosis-follow-up

Pupilli C. J Clin Endocrinol Metab. 2013;doi:10.1210/jc.2013-1072.  July 3, 2013 

 The evaluation of circulating BRAF V600E has the potential for use in the diagnosis and follow-up of patients with papillary thyroid carcinoma, according to researchers in Italy.

To determine whether the BRAF V600E mutated allele in cell-free DNA has a role in the diagnosis and follow-up of papillary thyroid carcinoma, researchers detected the allele and quantified it by an allele-specific real-time quantitative polymerase chain reaction assay in plasma from 103 patients affected by nodular goiter. Forty-nine healthy patients and 16 patients with non-nodular thyroid diseases were included as controls for the study.

The percentage of circulating BRAF V600E was significantly different between patients and controls and throughout different cytological categories of ultrasound-assisted fine needle aspiration (FNA). Specifically, percentages were higher among patients with follicular lesions (18.7%; P<.001) and those considered suspicious of malignancy (27.1%; P=.001) vs. controls.

Further, patients with a histopathological diagnosis of papillary thyroid carcinoma displayed a greater percentage of circulating BRAF V600E (P=.035) vs. those with benign histology, according to data.
Blood was drawn from 19 patients 3 to 6 months after surgery and after radioactive iodine treatment when necessary. Among these, circulating percentages of BRAF V600E were significantly lower than in presurgical samples (P<.001).

Using the receiver operating characteristic curve analysis, researchers also reported that the diagnostic performance of circulating BRAF V600E resulted in an area under the curve of 0.797, with maximum specificity of 65% and sensitivity of 80%. They assessed the predictive value of BRAF V600E in patients with follicular lesions; the positive predictive value was 33% and the negative predictive value was 80%.

“The use of BRAF V600E as a circulating marker could have several important clinical applications. In the diagnostic setting, it would integrate the data obtained from cytological analysis of FNA, providing more complete information in particular cases such as multinodular goiters where it is not possible to sample all nodules by FNA,” researchers wrote. “The availability of circulating markers could play an important role also in the short- and long-term follow-up of patients with previous thyroid cancer.” 

Further research is warranted before this can be implemented in clinical settings, they wrote.
Disclosure: The researchers report no relevant financial disclosures.

 

FDA Grants Breakthrough Designation to Lenvatinib for Renal Cell Carcinoma

http://www.onclive.com/web-exclusives/fda-grants-breakthrough-designation-to-lenvatinib-for-renal-cell-carcinoma

Studies continue to assess lenvatinib for patients with RCC, including a phase I investigation of the combination of lenvatinib and everolimus in patients with unresectable advanced RCC (NCT02454478). Additionally, a phase Ib/II study is exploring lenvatinib in combination with the PD-1 inhibitor pembrolizumab (Keytruda) for patients with solid tumors, including RCC (NCT02501096). - See more at: http://www.onclive.com/web-exclusives/fda-grants-breakthrough-designation-to-lenvatinib-for-renal-cell-carcinoma#sthash.UUMGpSJl.dpuf

 

 

 

 

Silas Inman

 This article includes some discussion of using Lenvatinib for Thyroid Cancer.

Silas Inman

The FDA has granted a breakthrough therapy designation to lenvatinib (Lenvima) as a potential treatment for patients with advanced renal cell carcinoma (RCC) who have received a VEGF-targeted therapy, according to a statement from Eisai, the company developing the multikinase inhibitor.

The designation was based on findings from an open-label three-arm phase II study that demonstrated an improvement in progression-free survival (PFS) for lenvatinib compared with everolimus (Afinitor) in patients with advanced RCC. In findings presented at the 2015 ASCO Annual Meeting, lenvatinib monotherapy improved PFS by 39% versus everolimus monotherapy (HR = 0.61; 95% CI, 0.38-0.98; P = .048). Additionally, the combination of lenvatinib and everolimus demonstrated a 60% improvement in PFS over everolimus alone (HR = 0.40; 95% CI, 0.24-0.68; P <.001).

"We are excited and honored that the FDA has granted breakthrough therapy designation to lenvatinib for patients with metastatic renal cell carcinoma," Kenichi Nomoto, PhD, president, Oncology Product Creation Unit at Eisai, said in a statement. "We look forward to working closely with the FDA to expedite this clinical program and hope to offer an important additional treatment option to patients in need."

In the phase II open-label study, 153 patients were randomized in a 1:1:1 ratio to lenvatinib (18 mg/day) plus everolimus (5 mg/day), lenvatinib monotherapy (24 mg/day) or everolimus monotherapy (10 mg/day). No crossover was permitted within the context of the study. The primary endpoint of the study was to compare PFS in the lenvatinib arms with single agent everolimus.

The most common prior VEGF therapy received by patients in the trial was sunitinib, at 71%, 67%, and 56% in the combination, lenvatinib, and everolimus arms, respectively. The remaining patients had received either pazopanib or sorafenib. Thirteen percent of patients had received a prior cytokine or checkpoint inhibitor therapy, at 10%, 8%, and 14%, in the combination, lenvatinib, and everolimus arms, respectively.

The median PFS was 14.6 months for lenvatinib plus everolimus (n = 51), 7.4 months for lenvatinib alone (n = 52), and 5.5 months for everolimus (n = 50). The ORR in the combination arm was 43%, with lenvatinib it was 27%, and with everolimus it was 6%.

The median overall survival (OS) was 25.5 months in the combination arm, 19.1 months in the lenvatinib monotherapy arm, and 15.4 months in the single-agent everolimus arm. The combination of lenvatinib and everolimus reduced the risk of death by 49% compared with everolimus alone (HR = 0.51; 95% CI, 0.30-0.88; P = .024). Single-agent lenvatinib improved OS by 32% versus single-agent everolimus (HR = 0.68; 95% CI; 0.41-1.14); however this was not statistically significant (P = .118).

All patients experienced at least one treatment-emergent adverse event (AE) in each treatment arm. Treatment-related grade 3 AEs occurred in 71% of patients in the combination arm, 83% in the single-agent lenvatinib arm, and 52% in the everolimus arm. There were relatively few grade 4 events in any of the three arms.



Diarrhea was the most frequently occurring all-grade AE in the lenvatinib arms, at 84% in the combination arm and 71% with monotherapy. Grade 3 diarrhea occurred in 20% of patients in the combination arm compared with 12% for single-agent lenvatinib and 2% with everolimus. Outside of diarrhea, other common grade ≥3 AEs with the combination included hypertension (14%) and fatigue (10%).

"The high-response rate and the longer OS results speak to the high-level of efficacy observed in the study for the combination," lead investigator Robert Motzer, MD, an attending physician, Memorial Sloan Kettering Cancer Center, said when the findings were presented. "Adverse events were generally higher for the lenvatinib-containing arms compared with everolimus. These adverse events were predictable, and generally managed with dose modifications."

Dose reductions were required in 73% of patients treated the combination, 62% treated with single-agent lenvatinib, and for 26% in the everolimus alone arm. AEs were the cause of treatment discontinuation for 9%, 11%, and 5% of patients in the combination, single-agent lenvatinib, and everolimus arm, respectively.

The FDA initially approved Lenvatinib as a treatment for patients with progressive, radioactive iodine-refractory differentiated thyroid cancer in February 2015. The FDA's breakthrough therapy designation will help further expedite the development of the therapy for patients with advanced RCC.

Studies continue to assess lenvatinib for patients with RCC, including a phase I investigation of the combination of lenvatinib and everolimus in patients with unresectable advanced RCC (NCT02454478). Additionally, a phase Ib/II study is exploring lenvatinib in combination with the PD-1 inhibitor pembrolizumab (Keytruda) for patients with solid tumors, including RCC (NCT02501096).
- See more at: http://www.onclive.com/web-exclusives/fda-grants-breakthrough-designation-to-lenvatinib-for-renal-cell-carcinoma#sthash.UUMGpSJl.dpuf

Silas Inman @silasinman

Published Online: Tuesday, July 28, 2015

- See more at: http://www.onclive.com/web-exclusives/fda-grants-breakthrough-designation-to-lenvatinib-for-renal-cell-carcinoma#sthash.UUMGpSJl.dpuf

Silas Inman @silasinman

Published Online: Tuesday, July 28, 2015

- See more at: http://www.onclive.com/web-exclusives/fda-grants-breakthrough-designation-to-lenvatinib-for-renal-cell-carcinoma#sthash.UUMGpSJl.dpuf

Studies continue to assess lenvatinib for patients with RCC, including a phase I investigation of the combination of lenvatinib and everolimus in patients with unresectable advanced RCC (NCT02454478). Additionally, a phase Ib/II study is exploring lenvatinib in combination with the PD-1 inhibitor pembrolizumab (Keytruda) for patients with solid tumors, including RCC (NCT02501096). - See more at: http://www.onclive.com/web-exclusives/fda-grants-breakthrough-designation-to-lenvatinib-for-renal-cell-carcinoma#sthash.UUMGpSJl.dpuf

Silas Inman @silasinman

Silas Inman @silasinman

Published Online: Tuesday, July 28, 2015

- See more at: http://www.onclive.com/web-exclusives/fda-grants-breakthrough-designation-to-lenvatinib-for-renal-cell-carcinoma#sthash.UUMGpSJl.dpuf

TERT promoter mutations indicate poor outcomes in differentiated thyroid cancer | Endocrinology

TERT promoter mutations indicate poor outcomes in differentiated thyroid cancer | Endocrinology:

Melo M. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2013-3734.

Telomerase reverse-transcriptase promoter mutations could be a major indicator of tumor aggressiveness in differentiated thyroid carcinomas. In a retrospective observational study, they were associated with distant metastases, poor response to treatment and outcomes.

The study included 647 tumors and tumor-like lesions in 469 patients with follicular cell-derived thyroid carcinomas treated and followed in five university hospitals.

The telomerase reverse-transcriptase (TERT) promoter mutations were observed in 7.5% of papillary carcinomas (PTC), 17.1% of follicular carcinomas (FTC), 29% of poorly differentiated carcinomas (DTC) and 33.3% of anaplastic thyroid carcinomas, according to data.

“The detection of such mutations appears to be, per se, a promising prognostic indicator in DTC and PTC,” researchers wrote.

In the group with DTC, TERT-mutated tumors were associated with older age (P<.001) and larger tumors (P=.002). In addition, TERT promoter mutations were significantly associated with distant metastases (P<.001) and higher stage (P<.001), researchers wrote.

Patients with DTC and TERT promoter mutations tended to be exposed to more radioiodine treatments (P=.009) with a greater cumulative dose (P=.004), and administered more treatment modalities (P=.001), researchers wrote.

“The most important added value of the present study is that we found evidence showing that patients with TERT mutated tumors had decreased survival when compared with patients with tumors harboring wild-type TERT and, moreover, that this holds true for the whole DTC series, as well as for PTC and FTC independently,” researchers wrote.

At 7.8 years follow-up, researchers found that patients with TERT-mutated DTC were more likely to display persistent disease (P=.001); TERT promoter mutations were significantly associated with disease-specific mortality among patients with follicular cell-derived thyroid carcinomas (P<.001), DTC (P<.001), PTC (P=.001), and FTC (P<.001).

After adjustments for age at diagnosis and sex, researchers wrote that the HR was 10.35 (95% CI, 2.01-53.24) in DTC and 23.81 (95% CI, 1.36-415.76) in PTC.
“Our findings suggest a link between telomerase activity and metastatic capacity may exist,” researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.

Aggressive hormone suppression unnecessary in most thyroid cancers

http://www.healio.com/endocrinology/thyroid/news/online/%7Bb4c05f66-7bd3-40cc-a2d2-851c08ac823f%7D/aggressive-hormone-suppression-unnecessary-in-most-thyroid-cancers

Carhill AA, et al. J Clin Endocrinol Metab. 2015;doi:10.1210/JC.2015-1346.    July 22, 2015 

 Extreme thyroid hormone suppression offered no additional survival benefit for patients with high-risk thyroid cancer, whereas moderate thyroid hormone suppression therapy can benefit most patients, according to research in The Journal of Clinical Endocrinology & Metabolism. 

“Modest [thyroid-stimulating hormone] suppression may be the overall best target for many patients with thyroid cancer, and long-term complete TSH suppression may not be needed, even in patients with more high-risk thyroid cancer,” Bryan Haugen, MD, an investigator at the University of Colorado Cancer Center and head of the division of endocrine, metabolism and diabetes at the University of Colorado School of Medicine, told Endocrine Today. “Multicenter, controlled studies are needed to definitively answer this question.”

Haugen, Aubrey A. Carhill, MD, of the department of endocrine neoplasia and hormonal disorders at The University of Texas MD Anderson Cancer Center, and colleagues analyzed data from 4,941 patients with a diagnosis of thyroid cancer (88% with papillary thyroid cancer; 8% with follicular thyroid cancer; 4% with Hurthle cell variant) enrolled in the National Thyroid Cancer Treatment Cooperative Study (NTCTCS) registry between 1987 and 2012. Researchers followed participants for an average of 6 years. Within the cohort, 3,268 participants received thyroid hormone suppression therapy, including those with TSH values recorded at least 50% or more of their follow-up time.
Researchers examined the effect of continuing thyroid hormone suppression therapy beyond 1, 3, and 5 years of follow-up by calculating mean TSH scores during the course of each patient’s remaining follow-up.

Researchers found that aggressive thyroid hormone suppression therapy resulted in no additional overall survival advantage when compared with moderate suppression therapy. The overall survival risk ratios for moderate therapy were 0.13, 0.09, 0.13 and 0.33 for thyroid cancer stages I through IV, whereas risk ratios for disease-free survival with moderate therapy were 0.52, 0.4 and 0.18 for stages I through III.

“Previous analysis noted only [overall survival] benefit with moderate [thyroid hormone suppression therapy], whereas current analysis also demonstrates a [disease-free survival] advantage,” the researchers wrote. “In contrast with our previous report, aggressive suppression conferred no additional survival advantage in the high-risk stages as compared with moderate [thyroid hormone suppression therapy]. Even limiting the analysis to patients with distant metastatic disease, maintaining mean TSH levels in the moderate range rather than aggressive is still associated with the best outcomes.”

Researchers also found improved overall survival in patients with stage III thyroid cancer who received postoperative radioiodine (RR = 0.66; P = .04), and in stage IV patients who received a total (RR = 0.66) or near-total thyroidectomy along with radioiodine (RR = 0.7; combined P = .049).
“In my mind, this study might give doctors pause when prescribing long-term, extreme TSH suppression in thyroid cancer patients,” Haugen said in a press release. “Contrary to our results, there is evidence from previous studies that extreme suppression may help in high-risk patients, but maybe then after a few years, when there is no evidence of disease recurrence, this study suggests that doctors could back off when we wouldn’t have before.” – by Regina Schaffer

 

Thyroid Cancer?: When Testing vs. Surgery Makes a Whole Lot More Sense

http://www.endocrineweb.com/news/thyroid-diseases/15780-thyroid-cancer-when-testing-vs-surgery-makes-whole-lot-more-sense

Written by Laurie Tarkan   With commentary by Robert Ferris, MD, PhD, professor and chief of the Division of Head and Neck Surgery in University of Pittsburgh School of Medicine

The number of thyroid surgeries for suspected cancer has dramatically risen in recent years, and several new molecular thyroid cancer tests may be able to slow the trend. The total number of thyroid surgeries performed in the United States due to suspicious thyroid nodules increased from 99,613 to 130,216 between 2006 and 2011, according to a 2013 study. But experts believe many thyroid surgeries are performed unnecessarily.

Thyroid cancers are often slow growing and many don’t grow much at all and never become harmful. In addition, ambiguous results from fine needle biopsies, the first line of testing, contribute to the overuse of surgical biopsies.

Cancer in the thyroid, which is located in the lower area of the neck, is the fifth most common cancer diagnosed in women. But many of these cancers may never be problematic if left alone.

The American Thyroid Association is updating their 2009 guidelines for the management of thyroid cancer in an effort to rein in the surgeries and provide more appropriate care. The guidelines, which will be published this fall, will reference a statement on the use of molecular tests for thyroid nodules that are considered ambiguous.
Thyroid nodules are extremely common, but patients with thyroid nodules that grow to 1 to 2 cm., depending on other characteristics and risk factors, often have a needle biopsy to test for cancer, explains Robert Ferris, MD, PhD, professor and chief of the Division of Head and Neck Surgery in University of Pittsburgh School of Medicine.
The biopsied tissue is then classified as benign or cancerous, but about 20 to 30 percent are classified as “indeterminate.” Those patients with uncertain results are often told to surgically remove the thyroid or have a partial surgery, or lobectomy, to be on the safe side. But the new molecular tests can determine if a nodule is low risk and unlikely to grow to the size to cause problems.

Looking to Molecular Testing

“Minimally invasive molecular testing for thyroid cancer has improved by leaps and bounds in the last several years,” said Dr. Ferris, who is co-author of the new statement regarding molecular testing.

One of the commercially available tests, called the Afirma test, can rule out cancer with a high rate of accuracy on indeterminate tests. It looks at the levels of expression of 142 genes and can predict low risk nodules.  “If the test result is ‘likely benign,’ a patient can avoid getting surgery,” says Dr. Ferris.
Another test developed by the University of Pittsburgh, called ThyroSeq v2.0, allows pathologists to simultaneously test for multiple genetic markers of thyroid cancer. It looks at mutations of up to 60 single base oncogenes, which are thought to turn on the growth of the nodule and cause malignant behavior, explains Dr. Ferris. This test can not only rule out non-cancerous nodules, but it can also accurately identify cancers with 80 to 100% accuracy. In the future, the test will likely help differentiate between very high risk malignancies that would require surgery and low-risk malignancies which could take more of a wait and see approach.

A common approach today for someone with a suspicious nodule or a small thyroid cancer that shows no signs of spread beyond the thyroid gland is to have a lobectomy, the removal of the right or left lobe where the nodule is located, sparing the rest of the thyroid. If the biopsy is then graded as high risk, the patient would go back in for a second surgery to remove the rest of the thyroid. The ThyroSeq v2.0 can help people avoid that two step process by assessing the risk of the tumor from the needle biopsy sample. “The Pittsburgh test can determine if you have an 80 to 100% risk of cancer and can offer the patient a total thyroidectomy up front, to avoid two surgeries,” Dr. Ferris says.

“Thousands of thyroidectomies could be avoided and thousands of two-step procedures could be avoided every year if we adapted these tests,” he says. “We need to educate the doctors out there that these molecular tests are valuable.”

You may be interested in these related articles:

• Radioactive iodine therapy can improve survival for thyroid cancer patients with bone tumors
• Ectopic thyroid cancer is rare, but not beyond the realm of possibility
• Too little blood-borne adiponectin may boost risk of thyroid cancer

Singer beats cancer to regain voice

Singer beats cancer to regain voice: Brave Helen shares her story

SINGING has taken the Booyal local Helen Coleman around Australia and the world, but the woman from the Childers area has had to overcome cancer to regain her voice.

Ms Coleman now resides in the Scenic Rim area where she can focus on her amazing talent.

The talented soprano soloist started with humble beginnings with her piano and singing teacher Mrs Cunningham.

Mrs Cunningham, also a soprano, trained in London and retired to Childers, and saw talent in Helen as a young performer.

Ms Coleman is influenced by jazz, blues and gospel music.

Ms Coleman said it wasn't all smooth sailing.

Her career was hit with a hard blow when she was diagnosed with thyroid cancer in 2012.

"My biggest fear was I was never going to sing again," she said. 

The surgery resulted in her losing her voice completely.

Many friends from the singing community rallied around to show support in her time of need. "I really thought I would never sing or speak again, so I focused on my horses," she said.

Ms Coleman said that for 12 months after the surgery, "no words passed my lips".

It was during this time that Ms Coleman came to realise the infinite healing power of music.

"I have now spent two years working very hard to get my voice back," she said.

Her support and training has resulted in gaining her full voice once again.

Ms Coleman has recorded her debut album and it is due to be released this year.

"I want to be a positive influence on young artists and I hope my struggle can help others," she said.

Top Cancer Doctors Call for Lower Drug Costs (from Time Magazine)

http://time.com/3970420/cancer-doctors-drug-costs/?utm_medium=referral&utm_source=pulsenews

• Maya Rhodan    July 23, 2015

“It’s time for patients and their physicians to call for change"

A group of cancer doctors are joining grassroots organizers and politicians in pleading with pharmaceutical companies to reduce the cost of cancer treatments.

In an editorial that ran Thursday in the Mayo Clinic Proceedings journal, 118 cancer experts produced a series of recommendations they say would lead to a reduction in treatment expenses. The doctors say that one in three individuals will be burdened with cancer in their lifetime, but out-of-pocket drug costs could easily exceed the average household income of an insured patient.
Four doses of one particular cancer drug, according to a report published in Mayo Clinic Proceedings in 2012, costs a staggering $120,000.

“It’s time for patients and their physicians to call for change,” said Dr. Ayalew Tefferi, a Mayo Clinic hematologist in a press release.

Among the recommendations are allowing Medicare to negotiate prices, permitting cancer drug imports for individual patients, and passing laws to keep drug companies from delaying access to generic drugs.

The physician’s recommendations come on the heels of a change.org petition led by patients that calls for a reduction in drug costs, particularly for cancer patients

Eisai launches thyroid cancer therapy Lenvima in UK

Eisai launches thyroid cancer therapy Lenvima in UK

How Antidepressants Can Help During Treatment from WebMD

A pretty good overview on using anti-depressants while being treated for cancer.  I get the impression newly diagnosed cancer patients are pretty much prescribed an anti-depressant immediately upon receiving the diagnosis. 

http://blogs.webmd.com/cancer/2015/06/how-antidepressants-can-help-during-treatment.html?ecd=wnl_can_072115&ctr=wnl-can-072115_nsl-promo_1&mb=QrA2jTNeXCYZ2bOd8brRkmdEpmNqbUHLhOmXrb8iv2s%3d

By Wendy Baer, MD

When Lynn’s doctor prescribed an antidepressant during her cancer treatment, she was confused: “But I’m not depressed!”
Lynn’s reaction is fairly common. Many people think antidepressants are only for treating clinical depression. But actually, antidepressants can be helpful in managing a variety of symptoms that cancer patients experience during treatment – even if they are not clinically depressed.
In Lynn’s case, though she was not depressed, she was struggling with nightly worry about her cancer. Her thoughts would race through her mind so furiously she could not concentrate at work. She felt tense all day and was unable to sleep at night because of the worry. The antidepressant that the doctor prescribed for Lynn is a first line treatment for the kind of anxiety she was experiencing.
Antidepressants are used to treat other treatment-related symptoms as well. The antidepressant mirtazapine (Remeron) can help people fall asleep faster and may increase patient’s appetite. Venlafaxine (Effexor) is prescribed to help with neuropathy, nerve pain, and hot flashes. Some patients find they have more energy with bupropion (Wellbutrin) which is also used to help people stop smoking.
Keep in mind, though, that antidepressants must be chosen carefully for cancer patients because of potential drug interactions. Before getting diagnosed with cancer, Sue had been on an antidepressant, fluoxetine (Prozac), for years to treat her clinical depression. After going through chemotherapy, her doctor recommended tamoxifen to prevent breast cancer recurrence. Sue heard from the pharmacist that tamoxifen should not be taken with fluoxetine (Prozac) since the interaction between the two medicines could keep the tamoxifen from working well. So Sue met with a psychiatrist who switched her prescription to a different antidepressant, citalopram (Celexa), which is ok to use with tamoxifen. Avoiding drug interaction problems is important so that your medicines work as well as possible. Keep an up to date list of your medications in your purse or wallet, noting why you take each medicine and the dose. Bring all your medications to appointments. Go through your medications with the nurse or pharmacist to make sure you are taking the medications the cancer team thinks you are taking. Always feel comfortable asking your physician or cancer team if there any possible drug interactions you should know about.
For patients who develop clinical depression (weeks not being able to function because your mood is so low) or clinical anxiety (worry that keeps you from being yourself), antidepressants are an important treatment tool. And they can be helpful for management of other cancer-related symptoms, too. However, if the medicine is not clearly helpful for you to function well each day, be sure to talk to your physician about making a change. Making changes to your medications is especially important during cancer survivorship. Once your symptoms have cleared, you will likely not need to stay on as many medicines as you did during cancer treatment. Review your medication list and pill bottles with your cancer team.
And, of course, antidepressants are only part of a complete treatment plan. For optimal mental health, focus on eating nutritious food, getting a proper night’s sleep and exercising safely in order to feel your best.

Important:

The opinions expressed in WebMD Second Opinion are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD Second Opinion are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
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Slideshow: Top Cancer-Fighting Foods

Pretty good overview from WebMD, although it would be more helpful if it gave the size of a single serving of these foods.

http://www.webmd.com/cancer/ss/slideshow-cancer-fighting-foods?ecd=wnl_can_072115&ctr=wnl-can-072115_nsl-ld-stry&mb=QrA2jTNeXCYZ2bOd8brRkmdEpmNqbUHLhOmXrb8iv2s%3d

Impotence Linked to Risk of Type 2 Diabetes

Impotence Linked to Risk of Type 2 Diabetes

Poor sleeping patterns link to cancer

 http://www.bbc.com/news/health-33569161

By James Gallagher Health editor, BBC News website

The report, in Current Biology, lends weight to concerns about the damaging impact of shift work on health.

The researchers said women with a family risk of breast cancer should never work shifts, but cautioned that further tests in people were needed.

The data also indicated the animals were 20% heavier despite eating the same amount of food.
Studies in people have often suggested a higher risk of diseases such as breast cancer in shift workers and flight attendants.

One argument is disrupting the body's internal rhythm - or body clock - increases the risk of disease.
However, the link is uncertain because the type of person who works shifts may also be more likely to develop cancer due to factors such as social class, activity levels or the amount of vitamin D they get.

Mice prone to developing breast cancer had their body clock delayed by 12 hours every week for a year.
Normally they had tumours after 50 weeks - but with regular disruption to their sleeping patterns, the tumours appeared eight weeks earlier.
The report said: "This is the first study that unequivocally shows a link between chronic light-dark inversions and breast cancer development."
Interpreting the consequences for humans is fraught with difficulty, but the researchers guesstimated the equivalent effect could be an extra 10kg (1st 8lb) of body weight or for at-risk women getting cancer about five years earlier.

'Definitive experimental proof'

"If you had a situation where a family is at risk for breast cancer, I would certainly advise those people not to work as a flight attendant or to do shift work," one of the researchers, Gijsbetus van der Horst, from the Erasmus University Medical Centre, in the Netherlands, said.

Dr Michael Hastings, from the UK's Medical Research Council, told the BBC: "I consider this study to give the definitive experimental proof, in mouse models, that circadian [body clock] disruption can accelerate the development of breast cancer.

"The general public health message coming out of my area of work is shift work, particularly rotational shift work is a stress and therefore it has consequences.

"There are things people should be looking out for - pay more attention to your body weight, pay more attention to inspecting breasts, and employers should offer more in-work health checks.
"If we're going to do it, then let's keep an eye on people and inform them."

30-year study shows that moderate hormone suppression may be enough in thyroid cancer | EurekAlert! Science News

A study of long-term thyroid cancer outcomes
shows, among other findings, that moderate suppression of
thyroid-stimulating hormone (TSH), which drives the disease, may be as
beneficial as more extreme hormone suppression. Extreme TSH suppression
is associated with increased side effects including osteoporosis and
heart rhythm irregularities. Results are published online ahead of print
in the journal Thyroid.


"In these patients, if TSH levels are elevated, recurrence rates are
higher. Moderate TSH suppression tends to bring the level just below
the normal range and what we show is that heavily suppressing TSH even
further may have diminishing returns," says Bryan Haugen, MD,
investigator at the University of Colorado Cancer Center, professor and
head of the Division of Endocrine, Metabolism & Diabetes and Kern
Chair of Endocrine Neoplasms Research at the University of Colorado
School of Medicine. Haugen is also chair of a task force currently
updating guidelines that define the standard of care for the treatment
of thyroid cancer.


The international, multi-center study, which began in 1987, collected data from 4,941 thyroid cancer patients.


"This is a unique data resource," Haugen says. "Previous studies
have been limited to the small number of patients that could be enrolled
at a single center or to studies that mine data from more general
cancer registries. Because we combined the patient data from about 14
participating centers and collected the data ourselves, we have a large
set of high-quality, prospectively collected data."


For example, Haugen points out, the group could be sure that terms
like "progression-free survival" and "recurrence" were measured the same
way for every patient.


"Basically, because we built the database ourselves, we could be sure we were comparing apples to apples," Haugen says.


Additional findings include confirmation of previous, smaller
studies showing that patients with stage III and IV disease had improved
survival when treated with radioactive iodine after surgery. Also,
while the study showed that extreme hormone suppression offered no
additional survival benefit in high-risk patients, it showed that mild
suppression was useful even with low-risk patients.


"In my mind, this study might give doctors pause when prescribing
long-term, extreme TSH suppression in thyroid cancer patients. Contrary
to our results, there is evidence from previous studies that extreme
suppression may help in high-risk patients, but maybe then after a few
years, when there is no evidence of disease recurrence, this study
suggests that doctors could back off when we wouldn't have before,"
Haugen says.


In Haugen's opinion, this study shows the necessity of a
prospective, randomized control trial testing extreme versus moderate
TSH suppression in high-risk thyroid cancer patients.

###

Disclaimer: AAAS and EurekAlert! are
not responsible for the accuracy of news releases posted to EurekAlert!
by contributing institutions or for the use of any information through
the EurekAlert system.

6 Ways Oncologists and Dermatologists Can Work Together to Improve Cancer Care

http://www.hcplive.com/contributor/beth-mclellan-md-/2015/07/5-ways-oncologists-and-dermatologists-can-work-together-to-improve-cancer-care-

Study: Type 2 Diabetes Reduces Brain Function Within Just Two Years

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A new study published in the journal Neurology shows that Type 2 diabetes triggers a significant reduction in cognitive ability within just a two-year period. The main culprits appear to be increased tissue inflammation and decreased blood flow to the brain.
Researchers conducted several tests on 65 participants (average age 66) at the beginning of a two-year study, roughly half of whom had already been diagnosed with Type 2 diabetes. All of the participants took tests to assess cognitive function and memory performance, and underwent MRI scans and blood tests to measure blood flow and pressure, rate of tissue inflammation, and brain volume.
The tests were repeated after two years, with the following results:
Thinking and memory test scores for participants with Type 2 diabetes dropped 12% over the two-year period. Test scores for participants without diabetes remained steady.
Participants with Type 2 diabetes experienced a 65% decrease in blow flow regulation.
The diabetic participants also experienced a 50% decline in “vasoreactivity” – the ability of blood vessels to contract in response to stimuli, a key indicator of blood vessel health.
“People with type 2 diabetes have impaired blood flow regulation,” according to study co-author Vera Novak, MD, PhD, of Beth Israel Deaconess Medical Center in Boston. “Our results suggest that diabetes and high blood sugar impose a chronic negative effect on cognitive and decision-making skills.”
Negative effects of diabetes on blood flow and blood vessel function are well-evidenced in prior research, but this study added the dimension of linking these effects to changes in brain function over a brief window of time.
“These correlations provided the link between altered cerebral vasoregulation and cognitive deterioration in participants with type 2 diabetes that can be tracked prospectively even over a relatively short time period of 2 years,” according to the research team.
Although this was a small study that should be validated with larger groups of participants, the results further substantiate a link between diabetes and cognitive impairment. Previous studies have found a similar link, including a potential link between diabetes and Alzheimer’s disease.

“Early detection and monitoring of blood flow regulation may be an important predictor of accelerated changes in cognitive and decision-making skills,” Novak said in a statement.

The study was published in the journal Neurology.

What Is Chemo Brain?

Interesting article.  I find most of what is says to be true.  Many seem to doubt the existence of "Chemo Brain", but in my experience it definitely exists and is a very real problem for those of us who suffer from it.

http://www.webmd.com/what-is-chemo-brain

Can Your Dog Smell Cancer?

http://coloncancer.about.com/od/research/fl/Can-Your-Dog-Smell-Cancer.htm