By Bayan Raji, Staff Writer
You may think the skeletal system is pretty stable, supporting the body but not changing much over the years.
Not so. The skeleton always is changing, and it's important, too. The skeleton is the body's source of calcium; without it the brain couldn't function.
"Bone health should be a concern for everyone, especially cancer patients," says Robert Gagel, M.D., professor in the Department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson.
Cancer, treatment are culprits
Some cancer treatments may lead to increased bone loss. These include:
• Breast cancer treatment
• Targeted therapy treatment
• Prostate cancer treatment
• Immunosuppressive agent treatment
Certain cancers, such as multiple myeloma, stimulate bone loss and inhibit formation of new bone.
Early menopause robs bones
Chemotherapy for breast cancer often induces early menopause (the end of a woman's menstrual cycles). Menopause leads to a deficiency in estrogen, which may cause bone loss. Many breast-cancer patients develop bone loss at a younger-than-normal age, which increases their risk of osteoporosis.
"If we don't do something to prevent bone loss at the beginning of treatment, a 45-year-old woman might begin to have bone fractures in 20 years," Gagel says.
Men are affected also
Testosterone in men helps protect bone, much like estrogen does for women. Although
several therapies are available to treat prostate cancer, they all lower testosterone levels.
In most cases, men begin with higher bone density than women, so it takes longer for them to reach levels of bone loss that might lead to fractures. However, the problem should be addressed.
Drugs deliver double punch
Patients who have bone marrow transplants and take immunosuppressive drugs, such as glucocorticoids, face two problems. High doses of these drugs, meant to decrease the risk of the body rejecting the transplant, may:
• Increase the rate of bone breakdown
• Decrease the rate of bone formation
Cancer patients often have decreased appetites, and if they receive chemotherapy they may be nauseated as well. As a result, they may not eat well, which may cause a calcium deficiency.
"If we don't take in enough calcium in our diet, our body will withdraw it from the skeleton. If unchecked, this will lead to osteoporosis," Gagel says.
Vitamin D is crucial
Many patients also have vitamin D deficiencies, either because they do not get enough in their diet, or they have liver or kidney failure so their body does not make it.
Vitamin D enables the body to absorb calcium from foods and supplements. While the minimum daily requirement is set at 400 to 600 IUs (international units), many researchers suggest it should be much higher.
Fifty percent of the population in the United States is vitamin D deficient, Gagel says.
This means that, even if they are getting the daily recommended amount of calcium, they are absorbing only about half of it.
Bone up on health
Take your bone health seriously. You may be able to prevent serious problems down the road if you:
• Add calcium-rich foods to your diet
• Exercise regularly
Gagel recommends that patients speak to their doctors about any bone health concerns. Ask if you should:
• Take calcium supplements
• Check your vitamin D level
• Have a bone density test
M. D. Anderson resources
Department of Endocrine Neoplasia and Hormonal Disorders
Chemotherapy Causes Bone Loss in Young Women (American Cancer Society)
Calcium (American Cancer Society)
September 2009 Archives
By Bayan Raji, Staff Writer
By Bayan Raji, Staff Writer
Continuing their quests for that bronze "summer" look into the fall and winter, many people walk away from the beaches and into indoor tanning salons when sweater weather rolls around.
While tanning beds may seem like a no-risk alternative to the sun, they carry many similar dangers.
UV rays are harmful
Tanning beds do their job with ultraviolet (UV) radiation. While these rays may not cause sunburn, they can thin the skin and make it less able to heal. This may increase previous skin damage caused by the sun.
"Tanning beds are dangerous," says Carol Drucker, M.D., associate professor in the Department of Dermatology at M. D. Anderson. "Advertising may make them seem like a safe alternative to tanning, but they're not."
Beds increase cancer risk
Skin cancer is the most common type of cancer in the United States, according to the American Cancer Society (ACS), and melanoma is the most dangerous form of skin cancer. More than 59,000 people in this country are diagnosed with melanoma each year, and 7,000 people die because of it.
The ACS found women who use tanning beds more than once a month are:
• 55% more likely to develop malignant melanoma
• 75% more likely to develop melanoma if they use tanning beds before age 35
Occasional use of tanning beds almost tripled the risk of developing melanoma.
Don't buy vitamin D claims
Some tanning salons try to counteract negative views of tanning beds by saying the UV rays can help increase the body's production of vitamin D. Vitamin D is necessary for strong bones and a healthy immune system.
"While it may be true that you get vitamin D from the UV rays in tanning beds, the danger far outweighs the positive aspects," Drucker says. "It's preferable not to get your vitamin D through a carcinogen. You can get vitamin D from much safer sources, including fortified milk, orange juice or cereals, or oral supplements."
Self-tanning products can give you the same look, without the negative effects. But, remember, most of them do not include sun protection. Be sure to wear sunscreen when you are outside.
M. D. Anderson resources:
Department of Dermatology
Tanning Beds Cause Serious Cancer Risk, Agency Says (American Cancer Society)
How Do I Protect Myself from UV? (American Cancer Society)
Can Melanoma Be Prevented?(American Cancer Society)
Melanoma (National Cancer Institute)
By Dawn Dorsey, Staff Writer
Cancer affects every member of the family. Children whose parents or other relatives have cancer may face emotional upheaval, doubt and anxiety.
At M. D. Anderson, the CLIMB® (Children's Lives Include Moments of Bravery) program helps children identify and express their emotions when a parent has cancer.
Marisa Minor, a social worker in the Department of Social Work and one of the program's facilitators, says children experience stressful situations differently than adults.
Tips help parents communicate
"In most cases, children aren't yet equipped with the coping tools to help them verbalize questions and seek help when they are worried or scared about what is happening to their parent and to their family," she says.
To help cancer patients guide children through the tough times, Minor recommends these tips:
• Use the three "C's"
o It's called Cancer
o The patient or child did not Cause the cancer
o Children cannot Catch cancer like a cold or flu
• Be honest but don't overshare; use age-appropriate information
• Reassure them there's a plan for their welfare and you will keep them informed
• Check in frequently; they may have questions even if they don't ask
• Ask the medical team or social worker for advice about talking to your children
• Look for resources, such as books, to help children cope
Children can develop tools
Minor says learning age-appropriate and healthy ways to cope with a parent's cancer early in the process can prepare children to:
• Normalize their feelings
• Communicate their concerns
• Identify personal strengths
"Working together as a family helps children become better equipped to express and manage their feelings," she says. "They can develop tools to help them cope with other life challenges that may come their way."
Program brings children together
Through guided conversations and art, CLIMB meetings allow children to bond with other children who are having similar experiences. They find ways to cope with and express sadness and anger. A concurrent parent support group also takes place.
CLIMB was developed by The Children's Treehouse Foundation, a nonprofit organization dedicated to the emotional support of children whose parents have cancer.
Partial funding support for CLIMB is provided by M. D. Anderson's Volunteer Endowment for Patient Support and the Department of Social Work.For more information about the program, contact Minor at 713-792-6826.
M. D. Anderson resources:
CLIMB Support Program
CLIMB Program Helps Children Whose Relatives Have Cancer (M. D. Anderson News Release)
Children's Treehouse Foundation
Helping Children When A Family Member Has Cancer: Dealing With A Parent's Terminal Illness (American Cancer Society)
When Your Parent Has Cancer: A Guide for Teens
A unique approach to understanding how cancer cells or microbes become capable of warding off drugs has earned a New Innovator Award from the National Institutes of Health for an M. D. Anderson scientist.
Gábor Balázsi, Ph.D., assistant professor in the Department of Systems Biology, will receive $1.5 million over five years under the highly competitive program. The NIH announced awards Thursday in three prestigious programs that fund bold ideas, with the potential to speedily translate research into improved human health.
"Therapy fails when cancer cells or disease-causing microbes become resistant to drugs. We will apply new, non-conventional methods to control expression of a drug-resistance gene in cells that are then treated with chemotherapy," Balázsi says. "We expect to discover new mechanisms underlying the emergence of drug resistance, which could improve treatment of cancer and of microbial infections as well."
Balázsi and colleagues are synthetic biologists who have created gene circuits that allow them to tightly control expression of a gene, dialing it from completely off through varying levels of expression to completely on.
A newly developed circuit also will permit them to control fluctuations in gene expression. This unique degree of control will allow more detailed investigation of the effects of genes involved in drug resistance.
"These are highly competitive awards for the most innovative science. Being chosen as a recipient is a significant accomplishment," says M. D. Anderson Provost and Executive Vice President Raymond DuBois, M.D., Ph.D. "His research concept is exciting and holds promise for improving our ability to adjust very specific cellular levels of a variety of genes and then test drug resistance, among other things."
Read the News Release
M. D. Anderson Scientist Wins NIH New Innovator Award
Leukemia Studies Earned Claudia Miller NIH National Research Service Award
By Sara Farris, Staff Writer
Brownsville native Claudia Miller, Ph.D., credits her father, a science teacher, for cultivating her interest in research. She wanted to do something to help people, and it was during a summer program at the University of Utah where she realized that research would be her answer.
"The program at Utah showed me the impact I could have with my research and that I didn't have to be a doctor to help people," Miller says. "I chose cancer research because I lived in Houston, and I knew of M. D. Anderson's reputation, but most importantly because cancer is a disease that affects everyone in some way, either directly or indirectly."
As a student in The University of Texas Graduate School of Biomedical Sciences at Houston (GSBS), Miller volunteered for two years with the school's outreach program, primarily working with and teaching disadvantaged youth in the classroom about science. She then served as coordinator for the program for four years.
Her commitment to science education, research and community service earned Miller the Butcher Award from the graduate school and led her to being selected as one of four President's Research Scholars.
In 2004, after completing her master's degree and starting work on her doctorate, Claudia joined the lab of Joya Chandra, Ph.D., associate professor in the Children's Cancer Hospital at M. D. Anderson.
"Now that I've worked in Joya's lab for five years, I can honestly say that her students are the luckiest," Miller says. "She is an excellent mentor, and she has really made a difference in my life as a researcher, student and as a person."
Miller has given four oral presentations at AACR and one at the American Society of Hematology annual conference. She also has been the first author on two papers published in the journal Blood for her work with a novel proteasome inhibitor, NPI-0052.
Miller's and Chandra's latest research with NPI-0052 showed, for the first time, that the proteasome inhibitor shares similar functions as the histone deacetylase (HDAC) inhibitor, vorinostat. These cross-over similarities between the two anti-cancer agents increased cell death in chronic lymphocytic leukemia five-fold in preclinical tests. For acute leukemia, the efficacy was even greater.
She was selected for the National Research Service Award from the National Institutes of Health based on her outstanding research in leukemia with proteasome inhibitors and HDAC inhibitors. The award is a fellowship grant that covers three years of research.
"Claudia is a very special student. She is very meticulous and pays attention to detail, which is the key to success in scientific research," Chandra says. "She has a high standard for quality, is very motivated and interested in finding the answers through research, and she is always willing to take the time to share her expertise and teach others about her findings."
Miller has received her doctorate and continues to work in Chandra's lab.
Today, let's discuss the fluctuating emotional aspects of caregiving. Below are a few examples of typical things that I hear from caregivers.
"My loved one is so irritable with me and I'm working as hard as I can to help. All I want to do is go home."
"I don't have time to take care of myself. Even if I did, I don't know where to go or what to do."
"I just want things to return to normal, to the way things used to be."
"Sometimes, I just have to get away."
Sound familiar? Sometimes caregivers feel as if their mood changes in relationship to managing the fluctuating nature of day-to-day medical circumstances.
"Help! I'm on an emotional roller coaster and I can't get off."
"Sometimes at night, I just lay there waiting for the next earthquake."
"If I don't sleep at night, I end up crying the next day."
Caregivers often work overtime to provide care to their loved ones. This has its pitfalls and blessings. It's often a job requiring 24/7 attention with many physical and emotional demands, filled with highs and lows. The most common complaints of caregivers are emotional and physical fatigue, exhaustion and sleep deprivation. The time and effort it takes to care for your loved one each day can, over time, become very stressful with a gradual wearing down of energy.
There's a high correlation between fatigue and depression in caregivers. When you're under such tremendous chronic stress, you can experience many emotional ups and downs on any given day. One minute you feel as if you have it all together and the next minute it seems like you're falling apart. Not only is physical fatigue a factor, but emotional overload is as well.
The Volcanic Feelings of Caregivers: Emotions to the Max
"My feelings bounce around all over the place. Sometimes they are positive and sometimes they are so painful I don't think I can stand it."
Sometimes you may feel like a virtual volcano when pressure builds without relief. Today may seem too difficult and tomorrow too uncertain. Where are you today on this spectrum of feelings?
The "Forbidden" Feelings of Caregivers
"Sometimes, I can't talk to anyone about how I feel. I don't want to burden them or take away the hope of my loved one. No one understands what this is really like unless they've been through it."
It's not unusual for caregivers to have intense feelings that they're hesitant to talk about, especially to their patient as caregivers may wish to protect their loved one from hearing about their distress. These feelings can be strong and seemingly in conflict with what you're trying to do. Although others may tell you to "think positive or be optimistic," there are times when this just doesn't seem possible.
Which of these "forbidden" feelings can you identify with?
• Yearning for "normal"
• Guilt, feeling trapped
What I noticed the First Time I Saw Patients on Rounds as a Medical Student
On a rainy weekend, I spent a few minutes looking through an old photo album with my kids. Tucked away in a folder within one album were letters that I shared with my parents during medical school. My mom, who died of lung cancer in 2006, had saved these letters.
One letter was written to a wonderful physician and mentor who allowed me to go on infectious disease rounds with him on a Saturday morning for the very first time, during my first month in medical school when everything was about book learning. I found a "thank you" letter to my mentor, Dr. Barry Farr, dated Oct. 27, 1986. In the second paragraph of my letter, I wrote:
I want to share with you some of the things that I learned on Saturday that I otherwise would not have known. I think that this may be interesting for you because it seems that physicians (and other medical students) do not always remember exactly what they did and didn't know when they were first-year students.
In the ensuing paragraphs, I listed seven categories of my observations. Topic six was about vocabulary:
I realized that my ability to understand what was going on hinged on my familiarity with the vocabulary. One way to categorize the vocabulary might be as follows:
a) Anatomical vocabulary (i.e. fourth metatarsal)
b) Vocabulary of disease (i.e. osteomyelitis)
c) Vocabulary of clinical medicine (i.e. nosocomial, iatrogenic)
d) Current jargon (i.e. "LCM," "PTC")
As you may recall, I think that one of Yogi Berra's quotes may apply here (if adapted to medicine). He said something to the effect that "Half of baseball is 50% mental." This can be adapted to read "Half of medicine is 50% vocabulary."
The following week after finding this old letter, a colleague, Dr. Daniel Epner, shared with me his correspondence with Dr. John Mendelsohn, M. D. Anderson's president, regarding his reflections on health care reform. Dr. Epner wrote:
... Many challenges that we face on a daily basis that we think of as biomedical, technical or logistical issues are essentially communication issues. For instance, I hypothesize that we can improve care tremendously and avoid uncomfortable and futile interventions at the end of life by implementing improved communication protocols and procedures that focus on discussions of goals of care throughout the spectrum of illness. ...
The key point from Dr. Epner is the focus on goals of care and attention to the topic of physician-patient communication. Nevertheless, the vocabulary of medicine itself is one part of the challenge in communication, and it is all too easy to forget when we, in health care, didn't understand all of these words (as I noted to Dr. Farr after my very first rounds).
By Tomise Martin, Staff Writer
Inspired by her passion to help others and her courageous fight with a rare disease, family and friends of Marnie Rose, M.D., have donated more than $1 million to brain cancer research at M. D. Anderson.
"The Dr. Marnie Rose Foundation is named after my daughter who died from a malignant brain tumor at age 28," said Lanie Rose, mother of Marnie. "She was beautiful, bright and as a pediatric medical resident, she devoted her life to caring for children. Through the foundation, we honor her legacy by helping both children and brain cancer patients in need."
All funds raised by the Dr. Marnie Rose Foundation for M. D. Anderson go directly to research of treatments. With guidance from Raymond Sawaya, M.D.and Alfred Yung, M.D., professor and chair of the Department of Neuro-Oncology the foundation has funded five research projects over the last seven years. Two of those therapies funded, PEP-3-KLH, a therapy that trains the immune system to attack brain tumor cells, and Delta-24-RGD, a modified adenovirus that targets the pathway of a specific protein, have shown promising results in the lab and are now in clinical trials.
"Since 2003, we've been able to sponsor brain cancer patients and fund clinical trials for immunotherapy and other research," Lanie said. "During M. D. Anderson's annual patient conference for brain tumor patients, a young man thanked our foundation for our help in his care. Because of the research our foundation supports, he joined a clinical trial that provided innovative treatment."
Run for the Rose 5K Fun Run
Co- Authors: Jerah Thomas, M.P.H., Peiying Yang, Ph.D.
Omega-3 and omega-6 essential fatty acids are necessary for normal human growth and development. However, the human body can't produce these "essential" fatty acids. The amounts found in our bodies are a direct result of the content in the food we eat.
There are three major omega-3 fatty acids: Alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ALA is primarily found in certain nuts and vegetable oils, while EPA and DHA are found in dietary fish and fish oil products. Sources include, but are not limited to:
• Fish and fish oils
• Vegetable oils (flaxseed, canola, soybean and olive oils)
• Green vegetables
• Grass-fed livestock and poultry (dairy products and eggs from grass-fed animals)
There's some evidence suggesting omega-3s may prevent and treat diseases of the heart and blood vessels: heart disease, heart attacks, atherosclerosis and blood pressure. Additionally, EPA and DHA specifically may reduce blood triglyceride levels, protect organ transplant patients from cyclosporine toxicity, and improve symptoms related to rheumatoid arthritis. In fact, the U.S. Food and Drug Administration has approved fish oil-derived omega-3s for the reduction of blood triglyceride levels.
As the benefits of omega-3s are unfolding, researchers are evaluating their unique role as anti-inflammatory and antiproliferative activities, both of which are critical mechanisms in cancer prevention and tumor growth. M. D. Anderson faculty are investigating the role of omega-3s in cancer prevention.
Omega−6 fatty acids (popularly referred to as ω−6 fatty acids or omega-6 fatty acids) are another family of essential fatty acids that have in common a final carbon-carbon double bond in the n−6 position. Omega-6s are important for maintaining human health because they provide energy and are also components of nerve cells, cellular membranes, and are converted to hormone-like substances known as prostaglandins. Excessive amounts of omega-6 fatty acids have been linked to promotion of various diseases, such as cardiovascular disease, cancer, inflammation and autoimmune disease. Sources include, but are not limited to:
• Vegetable oils (corn, soybean, sunflower and evening primrose oils)
• Hydrogenated (trans) fat
• Meat, egg and dairy products (from animals with diets consisting of grains, corn, soy or wheat)
Balance of omega-6 and omega-3
Certain foods that are part of the western diet have had a dramatic increase in the amount of omega-6s relative to the amount of omega 3s (15-20:1 current from closer to 1:1 prior to 1960) (Simopoulos, A.P, Exp Biol Med 233:674-688, 2008). This can lead to an increase in inflammation, which is potentially problematic for many chronic diseases including cancer. It's vital that we purposefully evaluate what we eat and select food items that promote health and wellness. While fatty acids are essential, it's imperative that we choose to integrate the healthy promoting, omega-3 fatty acids to our daily diets and ensure a proper balance (4 to 1 or lower) between omega-6 and omega-3 fatty acids.
Flash back three years to a urology examination room where my wife and I are sitting and my physician has just told us that I have a very aggressive prostate cancer. My wife immediately starts bawling, not crying, but bawling. I'm still not sure what he said after that. What I remember is taking my wife home and trying my best to calm her down. At some point, she fell asleep and I took a long walk outside and finally began to process the news.
Most of us, at an intellectual level, understand that stress is our reaction to the external environment. We decide, based on many different things, how we react. My wife's parents are alive, while I was raised in a family in which my mother died of cancer when I was just starting college and my dad died of prostate cancer in his late 70s. When I look back at that day in the exam room, I realize that I'd been preparing for the diagnosis all my life.
During my long walk I immediately became angry and then felt a grief I had not felt for a long time. But at some point on that very gray day, my body-mind connection linked up with my spirit -- a spirit forged by my parents' DNA and my life experience with them.
In his book, "Achieving the Mind-Body-Spirit Connection," Luke Seward, Ph.D., suggests that it's the spirit that allows us to find the calming space we all seek. Without the connection to spirit, the body-mind connection acts like a teenager who's always self-absorbed. Immediately, I realized my life path had changed but it was mine, and like my parents I needed to find the strength to live it "well."
You can't experience that calm space unless you find a way to shut off the head chatter or self-talk that continually runs through our minds. Most of what we say to ourselves we would never say to anyone else. It can be fear-based or at times it's what gives us the necessary motivation to take a step forward.
How do you quiet it or at least turn the volume down? Or turn it into a positive guide?
Maybe it's a walk or a regular exercise routine that helps you focus and turn your self-talk into a positive guide.
Many read what I call the "little books," like Joan Lunden's "Wake-Up Calls" or Greg Anderson's "Cancer: 50 Essential Things to Do." These books help turn our negative self-talk into positive guides.
I have good friends who find it helpful to listen to slow jazz, classical music or good old church hymns.
Early morning and evening prayers are a form of meditation. If you add some short prayer/meditation sessions to your days, you'll immediately notice a change in the volume and guidance of your head chatter. The Patient/Family Library at M. D. Anderson has many books that can help you set up a regular daily meditation practice.
It doesn't matter if you're newly diagnosed, in treatment or now call yourself a cancer survivor. Managing your head chatter is critical to a "well" life.
There's another community consequence to the oncoming flu season besides lost time at work, more school absences and jammed doctors' offices. It means there are fewer healthy blood donors and decreased blood supplies for M. D. Anderson Cancer Center patients who so desperately need transfusions and platelets.
Already this school year, one Houston-area high school canceled a drive, one that was projected to yield up to 120 units of blood. Because that drive was canceled and others could be in the coming weeks, the M. D. Anderson Blood Bank needs your help to replenish its supply.
M. D. Anderson, the largest blood transfusion center in the world, relies heavily on blood drives at high schools and universities, especially during the fall and winter. The students are generous givers and because of their youth, they're rarely turned away for health reasons. That is until flu season strikes.
M. D. Anderson transfuses more than 190,000 units of blood and platelets per year. To keep the coffers well stocked for hundreds of children and adults who are undergoing chemotherapy, stem cell transplantation and major surgery, about 400 units of blood need to be collected daily.
If you live in the Houston area, please visit M. D. Anderson Blood Bank donation sites at 2555 Holly Hall or M. D. Anderson's Clinical Care Center in the Bay Area at 18100 St. John Drive, on the campus of CHRISTUS St. John Hospital. There is free and accessible parking at both sites. There also is a donation site at M. D. Anderson at the Mays Clinic on the second floor near The Tree Sculpture.
If you don't live in the Houston area, please consider giving blood at your local blood bank. The flu season affects donations all over the nation and the need for blood never diminishes.
For additional information about making an appointment to donate blood or platelets or making arrangements for a blood drive with your company or organization, please call 713/792-7777 or visit on http://www.mdanderson.org/how-you-can-help/donate-blood/index.html.
M. D. Anderson Resources
Learn more about M. D. Anderson's needs for blood donation.
Cancer Newsline audio podcast - Ways to give without money: Blood Donation
By Wendy Gottsegen, Director, External Communications
We also don't recommend that you don't drink the water, either. Confused? Well there seems to be buzz on the Internet about a type of water that a Dallas-based company is marketing and this water's relationship to M. D. Anderson.
So we thought we'd un-muddy the water for our patients, employees and supporters. M. D. Anderson doesn't recommend the water.
What we did do was test the water (this time the pun is not intended) for the company, who compensated us to do so. The tests were very specific, not comprehensive and the results were turned over to the company without interpretation by M. D. Anderson experts.
M. D. Anderson is focused on patient care, research, education and prevention of cancer. You'd be hard-pressed to get us to stray from that mission, so when you see us appear to recommend something not necessarily related to cancer, please ask questions. In fact, please call us at 877-MDA-6789 and let us know.
Our lawyers have crafted some nice language fully explaining this situation. Please share it with anybody who might ask you about M. D. Anderson and some new-fangled "nutraceutical" water from Dallas.
M. D. Anderson statement:
Recently, you may have heard or read about a company that sells Evolv, a "nutraceutical beverage," which is being promoted in part based upon testing done at The University of Texas M. D. Anderson Cancer Center, but also is being mistakenly viewed as endorsed by M. D. Anderson. M. D. Anderson conducted limited chemical analysis of the product to evaluate its anti-inflammatory activity for a fee at the request of the manufacturer. No efficacy or toxicity data were generated at M. D. Anderson nor was the product tested on humans. Moreover, M. D. Anderson does not have any involvement with the company, the product is not produced by M. D. Anderson, and M. D. Anderson does not endorse the product or recommend its use.
The problem with the current debate about health care reform is that it's no longer a debate, but has instead disintegrated into a free-for-all. All sides have become so frenetic about protecting their own interests and hurling politically based accusations that reasonable and reasoned discourse has been lost in the melee.
We're treating health care reform as if it were "The Blob" from the old sci-fi B-movie, terrifying citizens as it destroys everything in its path. Health care reform isn't a monster and could be a godsend -- a crucial improvement to a medical system that's one of the best in the world, but one that has become too unwieldy and expensive. Improving our health care system will aid many people who aren't receiving the standard of medical care they deserve as American citizens.
So, let's step back, calm down and refocus. At M. D. Anderson, we see the sickest patients with the worst prognoses.
Ensure availability of best treatments
1) We'd like to be sure that all of our patients receive the best treatments available, if they choose to be treated. Our policy isn't to give up on our patients. We have witnessed many instances where patients were told they had no options, only to be treated at our medical center or to be enrolled in a clinical trial and respond to treatment. In a few cases, these patients were completely cured. In many cases, their lives were prolonged for years. And in innumerable cases, their lives were prolonged for several months to a year. The vast majority of families we work with say that they appreciate the extra time their loved ones were given, and their out-of-pocket costs were worth their extra days together.
As a result, the health care debate must revisit the issue of reasonable costs for a family with a seriously ill loved one. Guidelines need to be established for treating these patients appropriately, without crossing the line with unneeded tests or treatments that will have no impact on their outcome. Legislators should also factor in what's learned in academic medical center clinics -- that scientists and physicians track patient responses and return to their labs and clinics to improve their medications and refine their protocols. Our health care reform package must be flexible enough to allow for growth in knowledge and encourage strong support of biomedical research.
Establish a set of measures
2) A new health care plan must include a set of metrics that can measure the success or failure of its component parts. This means that the health care reformers must decide now what it is they're aiming to improve. If "reform" simply means "cost cutting," then the task will be fairly simple and the debate will center around "how much to cut." If the reform includes improving the clinical outcomes of patients cared for in the United States, then a completely different and much more intricate set of measures will need to be evaluated.
We must have a full understanding of the costs and benefits of different treatment options. We must also evaluate prevention measures and whether patients who smoke, overeat and avoid screening procedures should be penalized by the system, or whether patients who don't smoke and lead healthy lifestyles should be rewarded instead. In other words, reform might mean placing a "value" on different health care options or a relative "value" on different treatment options. On the other hand, through the very exercise of creating measures, we'll begin to see areas where we can truly cut costs and other areas where we must maintain a certain standard of care.
Make room for science, discovery
3) It's crucial that any measure of reform provide an opportunity for new science and discovery. There are many hospitals in this country that are focused more on research and academic endeavors. We must ensure that the health care reform agreed upon doesn't do away with the academic/research segment of our health care system.
Fifty years ago, childhood leukemia (ALL) was essentially a death sentence with only a 4% survival. Today, it's one of the most curable cancers in our armamentarium (75-80% survival) thanks to the devotion of generations of scientists and physicians who wouldn't give up. Funding this research wasn't cheap and it took a lot of faith before breakthroughs began to emerge. But today, what parent who has a child being treated for ALL wouldn't say those resources weren't well spent? What active, productive, happy adult who was cured of ALL would say the benefits to society weren't worth the costs?
In other words, we cannot lose sight of our goals in this stewing cauldron of arguments about American health care. We shouldn't become sidetracked or weary because the noise is so loud and the confusion so disheartening. We shouldn't be afraid of change. We shouldn't stymie progress just because we can't foresee the future.
By the same token, we will have to regain control of the issue. That means calming down, listening to all sides, making reasonable decisions, building in measurements for outcomes, and reconnoitering when the results are less than excellent. We will only succeed through acts of bravery, determination and compassion.
I believe that Americans are up to that task.
By Tomise Martin and Dawn Dorsey, Staff Writers
Growing up in Louisiana, Roger Giles ate plenty of farm-fresh vegetables. But, true to Southern cooking traditions, they often were fried in bacon grease and served with high-fat foods like buttered cornbread and biscuits.
"When I graduated from high school, I was athletic and weighed 195 pounds," Giles says. "But, as I entered my early adult years, I started having 'yo-yo' weight gain. By my mid-50s, my weight had ballooned to the 270-plus range."
Pain was the first sign
Last year, Giles had two attacks of acute pancreatitis, a sudden inflammation of the pancreas that frequently is painful. When he felt the symptoms returning in October, he went back to the doctor, hoping for some answers.
"We did a lot of tests, but none of them were conclusive," he says. "They couldn't find the problem, and I really wanted to know what was going on. We suspected cancer, so I went to
M. D. Anderson." Giles was admitted to M. D. Anderson on Dec. 15, and two weeks later he was diagnosed with adenocarcinoma, the most common form of pancreatic cancer.
Diagnosis was not a shock
"To be quite honest, I wasn't the least bit surprised," he says. "I recognized I had some kind of serious problem internally; I just didn't know what it was."
To treat the cancer, Giles had eight weekly treatments of chemotherapy, followed by six weeks of daily radiation treatment.
"From the beginning, my sole goal has been to attack this disease with the most aggressive treatment available," he says.
Weight, cancer are linked
In addition, Giles participated in a study at M. D. Anderson that showed a relationship between high body mass index (BMI) and pancreatic cancer.
According to the American Cancer Society, pancreatic cancer is the fourth leading cause of cancer death in the United States. More than 42,400 people will be diagnosed with this disease, and more than 35,400 will die from it this year.
He's found the right weight
When the pancreatitis hit last fall, Giles weighed 272 pounds. Within a week, he started losing weight at an alarming rate.
"I was losing a pound a day; within four weeks I lost more than 20 pounds," he says. "I couldn't eat solid foods because the pain was excruciating, and I put myself on Ensure to maintain nutrition."
Now, after losing even more weight during treatment, Giles' weight has leveled off at 185 pounds, and he says he feels comfortable there.
"My diet has changed drastically," he says. "I've lost 90 pounds. I'm at a healthy weight, and I understand the importance of staying fit."
It's time to change
Giles has always enjoyed gardening, and now it serves as more than just a favorite pastime that occupies his thoughts during and between treatments. It contributes to his diet and is a reminder to be healthy.
These days, he sticks to a low-fat diet built on fresh vegetables from his garden and stays active. He's also on somewhat of a one-man mission to convince people of the importance of healthful eating.
"Statistics say more than half the people in our country are overweight," he says. "It's time we awakened to that fact. As a nation, we all need to change the way we eat, especially fast food, and high-fat and high-calorie diets. It's an ongoing struggle."
Q&A: Pancreatic Cancer and Obesity
M. D. Anderson resources
Gastrointestinal Cancer Center
Pancreatic cancer (National Cancer Institute)
Recent research at M. D. Anderson shows that obesity is a risk factor for pancreatic cancer, and being overweight may play a role in the outcomes of people who develop the disease.
Donghui Li, Ph.D., professor in M. D. Anderson's Department of Gastrointestinal Medical Oncology and the study's senior author, answers questions about this landmark investigation.
What inspired you to do this study?
We know obesity is a risk factor for pancreatic cancer, but few studies have looked at body mass index (BMI) throughout a patient's lifetime rather than just when they are adults or the year they are diagnosed. We wanted to show the relationship between BMI and the risk of developing pancreatic cancer across a patient's life span and determine if being overweight in a specific time period raised that risk.
Also, we were curious about the links among BMI, cancer occurrence and overall survival.
Why is this study important?
Pancreatic cancer is one of the most dangerous types of cancer. It's the fourth leading cause of cancer death in men and women in this country. Median survival is less than 10 months, and the five-year survival rate is less than 5%.
Obesity and smoking are known risk factors for the disease, and while smoking is on the decline, obesity is increasing.
This study helps us understand the cause-and-effect relationship between obesity and pancreatic cancer, and we hope it will help identify high-risk people and specific ways to prevent them from getting the disease.
What were the research methods?
First, we enrolled 1,595 people:
• 841 pancreatic cancer patients treated at M. D. Anderson from 2004 to 2008
• 754 cancer-free people
We interviewed each person about his or her:
• Smoking history
• Family cancer history
• Alcohol use
• Medical history
Participants were asked to recall their height and body weights at 14 and 19 years old; in their 20s, 30s, 40s, 50s, 60s and 70s; and the year prior to their pancreatic cancer diagnoses or enrollment in the study.
We then calculated each person's BMI during each decade and compared the healthy patients with the pancreatic cancer patients.
Among the cancer patients, we also looked at the average age of diagnosis and the overall survival time, then compared those to their BMIs.
What were the results?
As we suspected, the research confirmed an association between obesity and pancreatic cancer.
People who were obese when they were young had a higher risk of developing pancreatic cancer than those who became overweight later in life.
For example, people who became overweight:
• Between 14 and 19 years old had 100% increased risk
• In their 20s had 65% increased risk
• In their 30 had 27% increased risk
The risk of developing the disease diminished for those who gained excess weight in their 40s and later in life.
Also, we found an association between excess weight and earlier onset of pancreatic cancer. Median age at diagnosis was 64 for those at normal weight, compared to 61 and 59 for overweight and obese patients respectively.
Obesity later in life, especially within a year before a patient's cancer diagnosis, reduced overall survival time.
Did these results surprise you?
It was surprising that overweight and obese pancreatic cancer patients were diagnosed at a younger age. This underscores the impact of obesity on loss of life, especially in productive years.
What do these results mean for pancreatic cancer?
Obesity is a risk factor that can be controlled. This study shows that we should try hard to help people control their weight at an early age to reduce the risk of pancreatic cancer.
We need to further investigate the links among obesity, pancreatic cancer and poor outcome, looking at insulin resistance as a possible mechanism.
We also will research factors, such as heredity, diet and others, that might affect the relationship between excess body weight and the disease. One day, we hope to develop ways to prevent this dangerous cancer and detect it earlier.
After Pancreatic Cancer, 'Southern Style' Gets A Healthy Makeover
M. D. Anderson resources:
Pancreatic Cancer (M. D. Anderson)
M. D. Anderson Study Finds Even Stronger Relationship Between High Body Mass Index,
Pancreatic Cancer (M. D. Anderson News Release)
By Bayan Raji, Staff Writer
Fourteen years ago, Julie Gomez had surgery to remove a gastrointestinal carcinoid tumor, her gallbladder, and parts of her liver and small intestine. Since then she's been living with this rare and chronic cancer that is controlled -- but not cured.
Illness affects immunity
Although Gomez, a volunteer in M. D. Anderson's Hospitality Center*, has checkups every six months, there isn't much she or doctors can do to get rid of her cancer or to prevent the tumors from growing.
As with any other chronic illness, Gomez says she's learned to deal with side effects and lifestyle changes. In 2002, she contracted Still's disease, a form of rheumatoid arthritis.
"I went from being perfectly fine to immobile in a matter of weeks," she says. "That experience completely humbled me as far as my immune system goes and made me realize I have to be careful."
Symptoms are life-changing
Fatigue is a constant. Gomez, who spends each Wednesday talking to fellow patients and caregivers at the Hospitality Center, doesn't schedule any outings or appointments for Thursday because she knows she won't have the strength.
"You only have so much energy," she says. "It's important to listen to your body, or you'll end up getting sick."
Everyone needs an outlet
Gomez says it's important to talk about her cancer, and the conversations in the Hospitality Center tend to be uplifting and positive.
"I volunteer once a week and talk about my experience with cancer, and it's almost like therapy," she says. "I think everyone needs to connect with people who've had similar experiences."
Mantra helps her make it
Life with an incurable cancer isn't all doom and gloom, but when a bad day strikes Gomez has a motto to get through it.
"I know there will be a bad day, but there won't be a bad week or month," she says.
*The Hospitality Center, a program of Anderson Network, are on-campus oases hosted by cancer survivors and caregivers where patients and caregivers can relax and enjoy refreshments.
M. D. Anderson resources:
People Profile: From Workaholism to Penguins and Volcanoes
Prevention: Patient Profile
Gastrointestinal Carcinoid Tumor (National Cancer Institute)
What Is a Gastrointestinal Carcinoid Tumor? (ACS)
By Tomise Martin, Staff Writer
Once a radio station owner, talk show host and Texas senator, colorectal cancer survivor Mike Richards looks forward to a future enjoying life with his wife, children and eight grandchildren.
At 72, Richards has no physical restrictions and plenty of energy.
"I'm fortunate to enjoy my favorite pastimes still," Richards says. "I walk outside or on a treadmill about five times a week, and my wife and I recently celebrated our 50th wedding anniversary with an Alaskan cruise. And I just returned from a month in Colorado."
Cancer comes calling
Healthy most of his life, Richards became concerned when he found himself short of breath from climbing just a few stairs and had abdominal pain.
When doctors found a tumor during a colonoscopy, Richards was referred to M. D. Anderson, where he was diagnosed with stage II colorectal cancer and scheduled for surgery. The tumor was removed in January 2006, and no additional therapy was needed. His surgeon was Lee Ellis, M.D., professor in M. D. Anderson's Department of Surgical Oncology.
About a year later, however, the cancer had metastasized (spread) to his liver. In March 2007, Richards had surgery to remove tumors from his liver, followed by a six-month regimen of chemotherapy.
More people live to tell the tale
Survivors of metastatic colorectal cancer (colorectal cancer that has spread to other parts of the body) are becoming more common.
To better understand this increase, investigators decided to study databases of metastatic colorectal patients, says Scott Kopetz, M.D., assistant professor in the Department of Gastrointestinal Medical Oncology at M. D. Anderson and the study's senior author.
In the study, which was published in the Journal of Clinical Oncology, Kopetz and his team found the overall survival rates for metastatic colorectal cancer patients like Richards had tripled since two distinct occurrences in treating the disease:
• Increased use of liver resection (surgery to remove part of the liver)
• Advancements in chemotherapy
Large patient sample examined
Researchers analyzed data from tumor registries at two institutions. These included:
• 1,614 patients at M. D. Anderson
• 856 patients at Mayo Clinic
Patients were diagnosed between 1990 and 2006 with follow-up through 2008.
As a comparison, 45,459 metastatic colorectal cancer patients from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) database were evaluated. These patients were diagnosed between 1990 and 2005.
Data show good news
Prior to 1990, when the combination of two drugs, 5-FU and leucovorin, was the sole therapy, overall survival for metastatic colorectal cancer patients was eight to 12 months.
Survival for patients diagnosed in 1990 through 1997 increased to 14.2 months.
Since then, survival has continued to increase. It was:
• 18 months in 1998 through 2000
• 18.6 months in 2001 through 2003
• 29.3 months in 2004 through 2006
Better treatments, surgery make a difference
Overall five-year survival showed a similar increase. It was:
• 9.1% for patients diagnosed from 1990 through 1997
• 13% for patients diagnosed from 1998 through 2000
• 19.2% for patients diagnosed from 2001 through 2003
The five-year survival rate is not available yet for people diagnosed after 2003, but Kopetz projects it will be approximately 30%.
"This is a dramatic change in survival that can compare to the success story for breast cancer 10 years ago," Kopetz says. "The efforts to develop and use better chemotherapies, as well as better identify patients for liver surgery, contribute to these findings."
Cancer worry decreases
Since completing chemotherapy in September 2007, Richards has been free of cancer.
"I feel great," he says. "My cancer diagnosis doesn't cross my mind until I have my follow-up every six months. I've done everything I could to beat this disease. Without my faith and the great team at M. D. Anderson, I wouldn't be here today."
M. D. Anderson resources:
Advances in the Treatment of Colon Cancer
Department of Gastrointestinal Medical Oncology
Journal of Clinical Oncology
Colon and Rectal Cancer (National Cancer Institute)
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