WebMD: Experts Link Chemicals to Diabetes, Obesity

https://fepblue.webmdhealth.com/!newsletters?id=AD7jaLg1x2P97Mb5udhcAWrMK6Ql5BfFYnDzGqODA90w0&s=14148&mrdid=50f9b189-166e-e511-a515-a0369f30171a

By Brenda Goodman, MA

Reviewed by Brunilda Nazario, MD

Sept. 28, 2015 -- People who are trying to lose weight or manage diabetes should try to change their lifestyle not only to exercise or cut calories, but also to avoid chemicals that may be contributing to their condition, experts say.
“You may have a healthy meal, but if it’s in a plastic container, it’s leaching chemicals,” said Andrea Gore, PhD, a pharmacologist at the University of Texas at Austin in a webinar for reporters on Monday.
Gore is the chair of a task force that issued on Monday a new statement on the harm from hormone-disrupting chemicals. The statement, which is based on a review of more than 1,300 studies, says there’s convincing evidence to support a link between hundreds of hormone disruptors and several chronic health problems, including:

• Diabetes
• Obesity
• Heart disease
• Infertility
• Hormone-sensitive cancers in women (breast, endometrial, ovarian)
• Prostate cancer
• Thyroid problems
• Poor brain development and brain function in young children

Researchers say the statement is significant because it comes from a group of doctors that treat people for hormone problems instead of scientists who study the effects of chemicals in animals or on cells.
Gore said the evidence for these effects is now strong enough that everyone should take steps to avoid chemicals that block or mimic the action of hormones in the body.
She also called on doctors who are treating patients for infertility to tell their patients to avoid hormone disruptors, which are known to decrease semen quality and interfere with how ovaries work. She said doctors who are counseling pregnant women and the parents of young children should also warn about chemical exposures.
“In particular, we’re worried about fetuses, infants, children, etc.,” she said, because exposure to the chemicals during development could set the stage for disease down the road.
Avoiding these kinds of chemicals is easier said than done, however, since no one knows how many of them exist or exactly how they’re being used. That’s because chemicals aren’t tested for safety before they used in products that are sold to consumers.
There are about 85,000 chemicals known to be used in the U.S. No one knows how many might disrupt hormones.
“Not all of them are EDCs [endocrine-disrupting chemicals], but if even 1% of them were EDCs, that would be 850 chemicals,” Gore said.
Some of the best-known hormone-disrupting chemicals include:

• Bisphenol A (BPA) and bisphenol S, which are used in some plastics, metal food cans, and cash register receipts
• Phthalates, a class of chemicals that are used to soften plastic and also used in some perfumes, soaps, shampoos, and cosmetics
• Some pesticides, like DDT
• Triclosan, an antibacterial chemical

“They act at very low doses,” she said.
The statement calls for better safety testing to determine which chemicals could pose problems, tighter regulation, and more research on the health effects.
Environmental health experts cheered the new statement.
“I’m thrilled,” said Richard Stahlhut, MD, a visiting research scientist at the University of Missouri-Columbia.
“The endocrinologists had to be the first ones on board, and fortunately, they are,” he said. “If they’re not on board, then maybe people like me are crazy,” said Stahlhut, who studies the hormone-disrupting effects of chemicals like BPA.
Chemical manufacturers said the statement went too far.
“The statement incorrectly characterizes as settled the still-unproven hypothesis regarding risks of low levels of exposure to particular chemicals. In doing so, the [Endocrine] Society discounts the extensive reviews by experts at the U.S. Environmental Protection Agency and the European Food Safety Authority that were unable to substantiate the health significance of the so called low-dose effects,” said the American Chemistry Council in a statement.
“Furthermore, the Endocrine Society’s report fails to differentiate between chemicals that are 'endocrine-active,' meaning they interact with the endocrine system, and those that are 'endocrine disruptors,' meaning that the levels of exposure associated with that interaction cause scientifically-proven adverse health effects,” the statement said.
Some retailers and manufacturers aren’t waiting for the dust to settle on the chemical debate.
On Monday, Bloomberg News reported that Target is expanding the list of chemicals it would ask suppliers to take out of their products. The expanded list will included nearly 600 chemicals on Health Canada’s roster of prohibited cosmetic ingredients. It will include triclosan, which is found in antibacterial soaps and some toothpastes.
Walmart also has a list of substances it asks retailers to avoid, though it doesn’t post the list publicly, Bloomberg reported.
Until more is known, Gore said consumers could reduce their exposure to known endocrine disruptors by avoiding bottled water in plastic bottles and being careful not to heat or microwave food in plastic containers.
Stahlhut said people who are concerned about chemical exposure should try to do the best they can, but because it’s impossible to avoid all potential exposures, to “Try to be Zen about it. Don’t drive yourself crazy.”
He said he tries to eat and drink out of stainless steel or glass containers instead of plastic. He especially tries to avoid heating food in plastic. He said he tries to avoid chemicals in the nonstick coatings by cooking in cast-iron pans. And he steers clear of soaps and toothpaste with triclosan.
“Make the easy choices when you can. Make the harder choices when you can afford it,” he said.

Slideshow: Top Cancer-Fighting Foods

 A pretty good slideshow from WebMD.com

http://www.webmd.com/cancer/ss/slideshow-cancer-fighting-foods?ecd=wnl_wlw_092015&ctr=wnl-wlw-092015_nsl-ld-stry&mb=zx5tZaURVio3BH6wangXCQ%3d%3d

A few words, wryly spoken… My unlucky cancer journey, as told in The Washington Post

Follow up to the previous post.  I plan to check out his book. - JHH

http://blog.timesunion.com/davidkalish/my-unlucky-cancer-journey-as-told-in-todays-washington-post/1584/ 

By David Kalish on September 8, 2015 8:00 AM

 

When I was diagnosed with thyroid cancer twenty years ago, my doctors reassured me that I had the “good kind” of cancer. Ninety five percent cure rate! But this has hardly been my experience. Like thousands of unlucky patients out there, I suffer from a rare form of thyroid cancer that’s far more aggressive and harder to treat than the popular literature makes it out to be.

 

Given all this, I was delighted to see today’s article in the Washington Post: “Is thyroid cancer the good cancer? It doesn’t feel that way when you get it.” The article quotes me (among other survivors) and describes how my cancer journey—my years of surgery, chemo and clinical trials—contradicts the medical notion that thyroid cancer is one of the most curable around.

The reporter, Emily Mullin, who interviewed me over the phone, has written a sensitive and informative piece that also gives her personal connection to thyroid cancer (her mom has it).

As a former reporter for The Associated Press, I always appreciate when a news organization gives coverage to an urgent subject that gets far too little public attention. (Aptly, September happens to be Thyroid Cancer Awareness Month). The article mentions how my struggle led me to write a novel, The Opposite of Everything. The book is a comedic twist on what I went through, and writing it helped me work through the disruptive changes that cancer brought to my health and relationships.

As Emily writes in the Washington Post, my story began in spring 1994, when my family doctor felt a small lump in my throat during a routine checkup. Diagnosed with thyroid cancer, I underwent an operation to remove my thyroid, dozens of lymph nodes, part of my trachea, and a nerve that controls one of my vocal chords. The procedure left me permanently hoarse. A year later, I had another surgery to take out more cancerous lymph nodes. And in 1999 I had a third surgery to remove a tumor that had wrapped itself around my remaining laryngeal nerve, threatening my ability to speak.

After all that, my battle with thyroid cancer wasn’t over. By 2000, my cancer had metastasized to my lungs. I underwent three years of traditional chemotherapy, but the cancer continued to spread.
In 2008 I signed up for a clinical trial at the University of Vermont Medical Center that tests a novel treatment targeting the enzymes that tell cancer cells to grow. My cancer has stopped spreading, although some spots remain in my lungs.

Throughout my battle, the doctors’ words two decades ago have come back to haunt me: “You have the good kind of cancer.”

I beg to differ, though I do feel lucky in a backwards sort of way. I live in a time when medical technology has led to new novel treatments that have given me hope. I have a great family and my disease helped kick-start my career as a novelist. I start each day seeking meaning in everything I do, and sometimes succeed. My life is not the one I once imagined. But lumps and all, so far it’s a pretty good deal.

David Kalish is the author of The Opposite of Everything, a romantic comedy and cancer story rolled into one, inspired by the author’s simultaneous struggle to mend his heart, by finding new love, and his health, by finding new treatment.


 

Health & Science Is thyroid cancer the ‘good’ cancer? It doesn’t feel that way when you get it.

The answer, of course, is a resounding "NO"!  Interesting article.  -  JHH

https://www.washingtonpost.com/national/health-science/is-thyroid-cancer-the-good-cancer-it-doesnt-feel-that-way-when-you-get-it/2015/09/04/b1769e28-18f8-11e5-ab92-c75ae6ab94b5_story.html

By Emily Mullin September 7

My mother wouldn’t have known she had thyroid cancer had it not been for a routine checkup two years ago. She felt fine, but her doctor found a lump in her neck, and after several tests she got the diagnosis. I was worried, of course, but the research seemed encouraging: Thyroid cancer has one of the highest survival rates of all cancers — 97.9 percent five years after diagnosis, according to the National Cancer Institute.
This gives thyroid cancer a reputation as being a “good” cancer. But as I have learned, cancer survival statistics don’t tell the whole story.
These estimates are based on data from thousands of people, and as with all statistics they can’t gauge the actual risk for a particular individual. What the rosy survival outlook glosses over is the impact of thyroid cancer on a person’s quality of life, which studies have shown can be significant. For my mom, an outwardly healthy 51-year-old at the time of her diagnosis, thyroid cancer has been an emotional and physical challenge, though you wouldn’t know it by looking at her or talking to her.
Robert Smallridge, deputy director of the Mayo Clinic Cancer Center in Jacksonville, Fla., says patients often come to him very worried even though they’ve been told that thyroid cancer is the “good” cancer. This dichotomy often makes them feel that they’re not entitled to complain or even feel bad. “They’re told they’re supposed to feel lucky, but they don’t. They have cancer,” says Smallridge, who is president of the American Thyroid Association.
About 63,000 new cases of thyroid cancer are diagnosed in this country each year. Most of the tumors are slow-growing and small; they originate from cells that produce hormones in the thyroid, a tiny, butterfly-shape gland located in the front of the neck, near the Adam’s apple. Many people have no symptoms other than an enlarged gland, but some have pain in the front of the neck, trouble swallowing, persistent hoarseness or other voice changes, or constant coughing.

But other cases can be much more aggressive and are associated with worse outcomes, says endocrinologist Leonard Wartofsky,chairman of the Department of Medicine at the Washington Hospital Center. “Like all things in medicine, it depends on the individual case,” he says.

Surgery, then hormones

The first-line treatment is surgical removal of all or part of the thyroid, called a thyroidectomy. My mother had a total thyroidectomy, as well as removal of several cancerous lymph nodes, to prevent her cancer from spreading. The thyroid regulates a number of essential functions, including blood pressure, body temperature, heart rate and metabolism, so when the entire thyroid is removed, patients must take hormone replacement medication. This daily treatment replaces the organ’s vital role of producing and releasing necessary hormones.
The dosing of thyroid replacement hormones varies widely depending on the individual. Too much or too little can produce side effects including fatigue, chest pain, increased heart rate or pulse rate, sweating, nervousness and anxiety, headache, insomnia, diarrhea, vomiting, weight loss and fever.
“The biggest long-term adjustment that I went through — and most people with thyroid cancer go through — is modulating the medication,” says Cherry Wunderlich, 71, of Bethesda, director of outreach for ThyCa, a thyroid cancer survivors’ association.

[A medical student gets the disease she’d been studying]

Wunderlich was diagnosed in 1999 after noticing a hard protrusion on her neck, and she soon had her thyroid removed. But it took much longer to get her medication right, and for the first few years, Wunderlich experienced extreme fatigue.She needed to nap for two to three hours most afternoons during the first year. Eventually, after doctors fine-tuned her dosage, her health began to improve.
My mother also has experienced severe fatigue since going on thyroid replacement medication. She often has to rest after work, and she goes to bed early.
After a thyroidectomy, remnants of thyroid tissue or cancerous cells may be left behind. When this happens — as it did to my mother and Wunderlich — patients have to undergo radioactive iodine treatment to destroy these remaining cells.
After taking the isotope in liquid or pill form, patients are typically isolated at home for up to a week, while the body gives off low amounts of radiation. Patients must avoid close contact with people and pets, sleep alone, clean their dishes by hand, and wash their towels, sheets and clothes separately.

A further cancer risk

Although the radioiodine kills the thyroid cancer cells, it increases the risk of a secondary cancer because it exposes the kidney, bladder and pelvic organs to radiation, Smallridge says. The treatment also can cause short-term side effects including painful swelling of salivary glands, headache, nausea and appetite loss. The worst of my mom’s side effects was the metallic taste, which lingered long after her treatment. An avid cook, she didn’t enjoy food for months.
Even after thyroid cancer is gone, there’s a risk that it will come back: Ten to 30 percent of patients deemed disease-free after initial treatment will develop recurrence or metastases 10 to 20 years after treatment, according to the National Cancer Society.

When David Kalish, of Albany, N.Y., was diagnosed with a rare, aggressive type of thyroid cancer in 1994 at age 32, he had surgery to remove his thyroid, dozens of lymph nodes, part of his trachea, and one of his laryngeal nerves. That procedure has left Kalish permanently hoarse. A year later, he had another surgery to take out more cancerous lymph nodes. And in 1999 he had a third surgery to remove a tumor that had wrapped itself around his remaining laryngeal nerve, threatening his ability to speak.

After all that, Kalish’s battle with thyroid cancer wasn’t over.

“When I was diagnosed in 1994, all the literature said there was a 95 percent cure rate. What I was going through was definitely not in sync with that information,” says Kalish, whose type of thyroid cancer is more aggressive and more deadly than most.

By 2000, Kalish’s cancer had metastasized to his lungs. He underwent three years of traditional chemotherapy, but the cancer continued to spread.

In 2008 Kalish signed up for a clinical trial testing a novel treatment targeting the enzymes that tell cancer cells to grow. The cancer has stopped spreading, although some spots remain in his lungs.
Kalish wrote a comedic novel about his experience with cancer, “The Opposite of Everything,” and is hopeful that science will keep churning out drugs to keep him alive.

No ‘good’ cancer

What I’ve learned from my mother’s diagnosis is that while some other cancers are certainly more deadly, there is no such thing as a “good” cancer.

Or as my mother puts it: “Cancer diagnosis of any kind is still cancer.”

While she is relieved she doesn’t have a more serious type of cancer, it will be years before she’ll know whether she’s truly cancer-free. She needs regular tests to make sure the cancer hasn’t come back. When I ask her about the cancer, she almost always has a positive outlook, but she still regularly experiences fatigue and mood swings from her hormone medication.

Smallridge says patients’ quality of life tends to improve over time as they learn how to cope with what is essentially a chronic disease, the lack of thyroid hormones.

“It’s going to take a while for patients to get through the initial therapy,” Smallridge says. “It’s going to take several years before they can appreciate that they’re going to do well.”

Mullin is a freelance science writer living in the Washington area.

Combination Therapies Continue to Advance in Melanoma with BRAF Inhibitor

http://www.onclive.com/web-exclusives/combination-therapies-continue-to-advance-in-melanoma

Laura Martin @OncEditorLaura

Published Online: Monday, August 31, 2015

-
Both targeted therapy and immunotherapy regimens, as combinations, have shown significant benefit in the treatment of melanoma.

Combination treatment with the BRAF inhibitor vemurafenib (Zelboraf) and the MEK inhibitor cobimetinib showed promise in patients with BRAF^V600-positive advanced melanoma in both the BRIM7 and coBRIM studies.

Follow-up data for BRIM7 presented at the 2015 ASCO Annual Meeting continued to show a response rate of 87% in patients who had not previously received a BRAF inhibitor; however, investigators reported 4 additional complete responses (CRs), raising the CR rate from 10% (n = 6) to 16% (n = 10). Median progression-free survival (PFS) was unchanged at 13.8 months. With extended follow-up, median overall survival (OS) was reached at 28.5 months and 2-year OS was 61%. Despite these additional benefits after extended follow-up, the adverse event frequency and severity remained stable.

Updated results were also presented at ASCO for the phase III coBRIM study, showing a median PFS with the vemurafenib/cobimetinib combination of 12.25 months versus 7.20 months with vemurafenib plus placebo (HR = 0.58; 95% CI, 0.46-0.72). The overall response rate (ORR) was 69.6% versus 50%, respectively. Based on the coBRIM results, the FDA is currently reviewing an application for cobimetinib/vemurafenib for patients with BRAF^V600-positive advanced melanoma, with a decision deadline of November 11, 2015.

The frontline checkpoint combination of nivolumab (Opdivo) plus ipilimumab (Yervoy) has also shown promise for patients with advanced melanoma. In data from the phase II CheckMate-069 trial presented at ASCO 2015, ORR was 60% with the combination compared with 11% with ipilimumab alone in patients with BRAF–wild-type disease (P <.0001). There were 12 CRs with nivolumab/ipilimumab versus none with single-agent ipilimumab. Median PFS was 8.9 versus 4.7 months, respectively (P = .0012). Similar ORR and PFS results were reported in the BRAF-positive subgroup.

Toxicities were increased with the checkpoint combination, with grade 3/4 adverse events of 51% versus 20% in the control arm.

OncLive sat down with Anna Pavlick, DO, associate professor, Department of Medicine, Ronald O. Perelman Department of Dermatology, assistant director for Clinical Research Education, and co-director of the Melanoma Program at NYU Langone Medical Center, to discuss the future outlook of combination therapies in advanced melanoma and the challenges oncologists should consider regarding them moving forward.

What were the goals of the extended follow-up study of BRIM7?

Dr Pavlick: We looked at the 2-year OS of patients who participated in the BRIM7 study. The BRIM7 study examined vemurafenib, which is a BRAF inhibitor, in combination with the MEK

inhibitor cobimetinib. We knew the correct dose of vemurafenib, but we dose escalated the cobimetinib.

We also investigated scheduling. The outcome was that it was safe to administer vemurafenib at a full dose of 960 mg twice daily in combination with 60 mg daily, 21 days on with a 7-day drug-free break during every 28-cycle.

The longer we followed these patients, the more complete responses we were able to see. The time to progression was also extended and the patients were alive for much longer than we had predicted. The toxicities were also very tolerable.

What do you think the impact of these findings will be for patients?

The combination studies have clearly shown that the excitement we had about single-agent BRAF inhibitors was very much quelled when saw all these patients starting to progress after 9 months. However, we are more confident now that we are starting to understand that you can treat patients with combination therapy if they have very aggressive disease; immunotherapy might not be the right choice for them. There is a clear subset of patients who are going to go on and have durable responses from inhibitor therapy, without ever having to receive immunotherapy.

What questions still remain after this analysis?

The phase III study of vemurafenib and cobimetinib [coBRIM] has already been published. Our follow-up analysis confirms the data from almost 7 years ago. However, a few questions remain to be answered. How do we identify the patients that will be the complete responders? How do we better integrate immunotherapy into the inhibitor platform, so that we can give the patients who progress the ability to have longer responses?

Were there any concerning or new toxicities determined in this follow-up?

Toxicities were what we expected for the most part. We actually had fewer toxicities than we predicted. We were very nervous about giving two different targeted therapies at that point, because we did not know what the overlapping toxicity might cause. Our biggest concern was rash, as there were a significant amount of rashes with vemurafenib as well as with cobimetinib. However, the level of rash was actually very tolerable. Interestingly, the combination did not diminish the photosensitivity side effect we had with vemurafenib. However, it did decrease the rate of invasive squamous cell skin cancers that patients might develop.

The CheckMate-069 study also examined a significant combination regimen for patients with previously untreated advanced melanoma. What are your thoughts on the impact of these findings?

Clearly, we have taken a huge stride in combining two immunotherapies. Ipilimumab has a more dynamic toxicity profile than nivolumab, and so we had to tread lightly when we combined the two to make sure we could administer them safely. We found out we can give them safely if we adjust the dose of nivolumab when we combine it with ipilimumab.

Even with this adjustment, we still ran into challenges with managing toxicities. Giving the two drugs together gave at least 50%-60% toxicities that we needed to manage. Most of those toxicities did not preclude us from continuing therapy; however, there were a good number of patients who did need to come off the study right in the beginning of the trial because of toxicity.

The interesting thing about that is, even when patients were never able to get any more combination therapy due to toxicities, many still went on to have strong, durable responses. Because of this, many of us feel very comfortable stating that, if a patient has a toxicity that causes them to discontinue treatment, they may still go on to have a durable response if they received at least 50% of the combination regimen before discontinuing.

What were the most common toxicities found in this trial?

Toxicities include rash, itching, and diarrhea. What we were not expecting to see that we did was an early unset of endocrinopathies, which normally occur with ipilimumab 16 to 20 weeks after starting therapy. In the combination, the endocrinopathies occurred much earlier, at about 6 to 8 weeks after starting therapy. When using these treatments together, we now know to be prepared for that.

What role do you believe this combination will have in the future?

Although the response rate was clearly outstanding, this should not become the standard of care for everyone due to the toxicities. The toxicities can be serious, and they need to be managed promptly and effectively so that patients do not end up in the hospital. Deciding who gets this treatment is really where the art of medicine is going to come into play. Doctors need to look at the patients’ comorbidities, their overall performance status, and the bulk of their disease, and decide if they will be able to withstand the toxicities. The benefit is there, but doctors really need to select the right patients and have the right staff in place to handle this combination.

- See more at: http://www.onclive.com/web-exclusives/combination-therapies-continue-to-advance-in-melanoma#sthash.eJGTwxPn.dpuf

BRAF May Be a Good 'Target' in Nonmelanoma Cancers

http://www.medscape.com/viewarticle/849854

Jimmy Carter Health Crisis: What to Do When Cancer Runs in Your Family

http://www.newsmax.com/Health/Headline/jimmy-carter-cancer-genetic/2015/08/18/id/670590/

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."

 

 

 

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

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.

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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

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."

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

No kidding!  Interesting article.  It's something that's bothered me the entire time I've been on treatment.  Click on the link below for the article from Curetoday.com- JHH

Chemobrain - It's Real, It's Complex, and the Science is Still Evolving

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.

BY SUSAN KRIGEL, PHD

PUBLISHED TUESDAY, FEBRUARY 17, 2015

- See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.

BY SUSAN KRIGEL, PHD

PUBLISHED TUESDAY, FEBRUARY 17, 2015

- See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.

BY SUSAN KRIGEL, PHD

PUBLISHED TUESDAY, FEBRUARY 17, 2015

- See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf

 

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Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.

BY SUSAN KRIGEL, PHD

PUBLISHED TUESDAY, FEBRUARY 17, 2015

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that  that fuzzy, murky state that patients blame for impaired memory. When physicians first began hearing patients complain about chemobrain, they may have wondered whether it truly existed. As time has passed, they may now be wondering why science hasn’t found a solution.

A review of the research documenting cognitive decline after chemotherapy indicates that the most common complaints have concerned learning and memory, processing speed, verbal and spatial abilities and executive function (planning and decision-making).

Interestingly, about half of the studies reviewed documented cognitive decline even before the initiation of chemotherapy. Cognitive impairment due to chemotherapy can significantly impair a patient’s quality of life. A recent review of 17 qualitative studies focusing on patients’ experience of chemobrain documented that patients reported fearing that they “were going crazy,” or developing Alzheimer’s. Patients noted they had difficulty learning and had to work harder to accomplish tasks. As a result, they were less confident in work and social situations.

[Read "Finding Solutions for Chemobrain" from CURE's winter 2013 issue]

Estimates vary on the prevalence and duration of chemobrain, due in part to timing of assessment and degree of impairment. A recent meta-analysis demonstrated that about 16 percent to 75 percent of breast cancer patients had moderate to severe impairment. As may be expected, deficits are most evident during treatment, with most patients returning to baseline within a few months of completing chemotherapy. However, a subset of patients has been found to have ongoing deficits, even after 20 years. Older patients with lower cognitive reserve at baseline are most likely to have higher levels of impairment. Co-occuring factors may also contribute to chemobrain. Approximately 30 percent of cancer patients experience depression, anxiety or distress during treatment, and depressed individuals score lower than non-depressed individuals on neuropsychological tests in attention, sustained attention, processing speed, recall, fluency, and speed of retrieval.

Fatigue, an almost universal symptom during and shortly after cancer treatment, may impair memory by decreasing attention, processing speed, and motivation. In addition, about 30 percent to 60 percent of cancer patients report having insomnia, which may cause poor concentration and memory.

What Is the Evidence Behind Chemobrain?

Although cancer patients have been reporting symptoms of cognitive impairment for many years, the first scientific studies began appearing in the mid-1990s. Some of the first studies began exploring the impact of particular chemotherapy protocols on cognition.

But as studies progressed, it seemed that more questions arose than were being resolved. There were so many confounding factors, such as age, hormonal status, baseline cognitive performance, educational level, genetic predisposition, comorbidities that impact oxygenation, depression, anxiety, fatigue, pain, anemia, time since treatment and dietary factors. How would it be possible to control for all those factors?

- See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf

Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving - See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf

Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving - See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpu

Facing the (Very Real) Financial Fears of a Cancer Diagnosis

 Interesting subject that doctors should be more aware of when planning treatments with their patients

 Facing the (Very Real) Financial Fears of a Cancer Diagnosis

 

 

Updated January 30, 2015.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Hearing “You have cancer” unleashes a tornado of fears.  Will my hair fall out?  Will I spend days dry-heaving over the toilet?  Will I need surgery?  Will I die?  But when first hearing the diagnosis, many cancer patients and their loved ones don’t immediately fear financial ruin.  But, sadly, the enormous financial threat that faces many cancer patients is all too real, and the statistics and implications of financial stress are tragic.
If you have cancer, you’re more than twice as likely to file for bankruptcy as someone without cancer.  Among cancer patients, this bankruptcy risk is even more pronounced for young adults, who are likely to have less income, greater expenses (kids, school loans), and private insurance payment obligations than are Medicare age patients.  In fact, bankruptcy rates in the youngest adults can reach ten times that seen in the older cancer population.  Bankruptcy risk of is also increased in women and non-Caucasians with cancer.  Overall, about six out of 1,000 cancer patients ultimately declare bankruptcy.

And while people can eventually recover financially, bankruptcy has additional implications which are potentially even more devastating, as it is unlikely that bankrupt patients can afford to complete their recommended cancer treatment.
Severe financial stress on cancer patients and their loved ones causes significant damage in the many who don’t go the bankruptcy route.  An astonishing 10% to 20% of cancer patients may ultimately choose to not receive the recommended therapy or may deviate from the recommended treatment plan due to personal financial constraints…10% to 20%!
Why does this happen?
For the many cancer patients not yet of Medicare age, a major portion of treatment payment obligation falls directly on them.  Out of the $20.1 billion annual cost of care, non-Medicare cancer patients personally pay more than $1.3 billion (6.5% of total cost).  On average, cancer patients pay about $9,000 annually for treatment, with some paying significantly more.

The main driver of this massive and accelerating cost of cancer care is new cancer drugs.  And simply replacing newer agents with older generics doesn’t always make clinical sense, as newer drugs are often significantly better, providing targeted killing of malignant cells and reduced toxicity.  Thus, patients may have not clinically equivalent but cheaper alternative, and breakthrough drugs now routinely cost $10,000 per month of treatment, twice the cost of newer agents only a decade ago, with patients regularly paying a portion, including some who must cover up to 20% of costs.

We can bash the pharmaceutical industry for these seemingly outrageous prices, and many have.  Cancer physicians have led the vocal outcry, depicting drug manufacturers as profiteering off the desperation of cancer patients.  Backing their accusations are up to 40% lower costs abroad for the same chemotherapy agents.  Drug manufacturers fight back, countering that their companies spend billions on drug research, only a small percentage of which eventually translate into commercialized products which, therefore, must cover the significant cost of the many dead ends.
There are several ways to seek help if your cancer treatment or treatment of a loved one is causing significant financial stress, and I encourage you to pursue them long before deciding to alter or abandon the treatment most likely to be of benefit.

First of all, speak with your oncologist to learn if there are less expensive treatment alternatives that offer similar potential clinical benefit in treating your malignancy.  Ask to receive your chemotherapy in the doctor’s office rather than at the hospital, as hospital chemo administration is routinely more expensive.  Next, reach out to the drug companies that manufacture the chemo agents you are receiving.  Several pharmaceutical companies have financial assistance programs for patients who specifically need their drugs but are financially stressed.  In addition, many U.S. states offer State Pharmaceutical Assistance Programs for financially stressed patients.  And for those enrolling in a new health insurance plan or changing plans through a state health insurance marketplace (as part of the ACA, or “ObamaCare”), you should definitely use the Cancer Insurance Checklist to guide your decisions before we reach the February 15^th enrollment deadline.
Finally, although it is an additional expense, getting advice from a qualified financial advisor is often a good investment.  These specialists can quickly understand your assets and projected expenses (including treatment-related) and offer guidance on managing your financial risk, protecting you and your family.
In following any of these paths, remember that you are the cancer owner and, therefore, you must drive the process.  At times while searching for financial alternatives and support, you may become frustrated, even angry.  Take a deep breath, try to be patient and, when necessary, be assertive (while remaining respectful).  In the end, you will hopefully discover real options to reduce your financial exposure without giving up your best chance at fighting your cancer.

ASCO Guidelines Address Key Symptoms Affecting Cancer Survivors | Cancer Network

ASCO Guidelines Address Key Symptoms Affecting Cancer Survivors

News | April 30, 2014 | Survivorship, Practice & Policy

By Anna Azvolinsky, PhD

New guidelines from ASCO address key symptoms affecting survivors of c...

The American Society of Clinical Oncology (ASCO) has released its first ever guidelines for prevention and management of symptoms that affect many cancer survivors. In three separate publications based on available medical literature and other guideline sources, ASCO members have published clinical practice guides for anxiety and depression, fatigue, and chemotherapy-induced neuropathy.

These guides are part of a planned ASCO series that addresses cancer survivorship issues.

A cancer survivor is a broad term defined by the American Cancer Society (ACS) as any person diagnosed with cancer starting from the time of their diagnosis through the course of his or her life, but is mainly focused on the period of time after active cancer therapy ends. ACS estimates that a total of 13.7 million Americans who have had a history of cancer were alive as of January 1, 2012. This population is projected to increase to 18 million (9.2 million women and 8.8 million men) by 2022.

Among male survivors, the most common cancers are prostate (43%), colon and rectal (9%), and melanoma (7%). For female survivors, the most common cancers are breast (41%), uterine (8%), and colon and rectal (8%).

This survivor population has physical and mental health challenges as a result of the effects of the specific cancer and treatment, as well as psychological effects from the diagnosis and treatment process. Studies and evidence from real-world clinical care show that the transition from active treatment to post-treatment is important, including addressing unique health issues and health risks for these patients. How patients care for themselves and whether their concerns are addressed clinically affect their long-term health outcomes.

The anxiety and depression guideline was adapted from the Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer. The guidelines on cancer survivors’ fatigue combined a pan-Canadian guideline on cancer-related fatigue and two National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines on cancer-related fatigue and general cancer survivorship. The ASCO guideline on chemotherapy-induced neuropathy is novel, developed by a group of experts from different disciplines and based on a review of 48 randomized controlled trials for neuropathy treatment, as well as outcome and quality of life reports.

Key Guideline Recommendations

For anxiety and depression:

• All patients should be periodically evaluated for depression and anxiety symptoms using validated protocols.

• Treatment of patients with depression or anxiety should be tailored based on severity of symptoms and history of depression. Follow-up of patients is crucial, as many symptomatic patients are less likely to comply with referrals and treatments.

• Health care providers should be aware of their institutions’ resources for treatment of depression and anxiety and should have patients make use of supportive care services, including those that facilitate prevention and mitigation of symptoms.

For fatigue:

• Regular screening is highly recommended, starting at the time of diagnosis and continuing after completion of primary treatments, at least annually and using semi-quantitative or quantitative measures.

• Patients should be offered education and advice about managing fatigue following treatment. Maintaining adequate levels of physical activity are encouraged, particularly walking.

• Other non-drug treatments such as psychosocial interventions and mind-body interventions (yoga, acupuncture) are encouraged.

• Pharmacological interventions for post-treatment patients are not encouraged, as there is limited evidence that drugs are effective in reducing fatigue in those who have completed therapy and are currently disease-free.

For neuropathy:

• Duloxetine is recommended for treatment of chemotherapy-induced peripheral neuropathy (CIPN).

• No agents are recommended for prevention of CIPN during active chemotherapy treatment.

• No strong clinical evidence for benefits from other agents such as tricyclic antidepressants, gabapentin, and topical gels containing baclofen, amitriptyline HCL, and ketamine are seen, but they may be tried in certain patients.

- See more at: http://www.cancernetwork.com/survivorship/asco-guidelines-address-key-symptoms-affecting-cancer-survivors?GUID=E358377C-D8F1-436F-BD73-94728AA319FB&rememberme=1&ts=01052014#sthash.RGHCopy9.dpuf

Man, is this ever true!  Unless you have an oncologist who has been through chemo, I don't think they understand what a problem fatigue is.

Cancer-Related Fatigue Often Overlooked, Study Finds

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THURSDAY, Dec. 27 (HealthDay News) -- Too few cancer patients receive care for debilitating fatigue that can last for months or even years after treatment, a new study finds.

"Fatigue is a factor that not only significantly diminishes quality of life but is also associated with reduced survival," study author Dr. Andrea Cheville, a physiatrist with the Mayo Clinic Department of Physical Medicine and Rehabilitation, said in a clinic news release.

The study, published in the January issue of the journal Supportive Care in Cancer, included 160 lung, breast, colon and prostate cancer patients who had moderate to severe fatigue. They were asked if their oncology teams had mentioned any of the cancer fatigue treatments recommended by the National Comprehensive Cancer Network, such as counseling, medications and getting more exercise.

Only 10 percent of patients said they were told to get more exercise or to try other non-medication ways of reducing fatigue. More than 35 percent of the patients were offered sleep medications, even though drugs have been shown to be the least effective way to treat fatigue in cancer patients.

The researchers also found that the type of cancer was a factor in whether patients received treatment for fatigue. Only 15 percent of colon cancer patients and 17 percent of prostate cancer patients received treatment for fatigue, while 48 percent of breast cancer patients were told about counseling.

"We found the vast majority of patients were not engaging in behavioral practices that could reduce fatigue and potentially enhance quality of life," Cheville said. "And almost a third reported napping during the day, which can actually worsen fatigue."

"We could be doing a much better job addressing fatigue, with more reliable instruction for patients and offering treatments that have been shown to work," she said.

Oncologists, however, may not have the time or resources to deal with patients' quality-of-life issues. There may be a need for specialists who focus on helping cancer patients deal with issues such as fatigue, depression and pain, the researchers said.

More information

The U.S. National Cancer Institute has more about fatigue in cancer patients.

SOURCE: Mayo Clinic, news release, Dec. 18, 2012

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