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March 2010 Archives

Caring for a child with cancer can be overwhelming. Along with daily responsibilities, parents must manage their child's treatment, deal with additional financial burdens and care for their other children.

Often, parents don't know how to cope or help their child through a diagnosis. Patricia Wells, director of family-centered care in the Children's Cancer Hospital at M. D. Anderson, provides tips to help parents and patients cope with a cancer diagnosis.


How do you tell your child he or she has cancer?


There is no special method for telling a child that she or he has cancer because each child and family is different. The approach depends on your child's age and developmental level. Communication styles and religious beliefs also play a part in this process.

As a health care provider, I always encourage parents to be honest and open with the child and his or her siblings about the diagnosis and to look to the health care providers for guidance. Child, adolescent and young adult specialists, psychologists, nurses and physicians are well equipped to work with families as they search for the best way to break the news to the child and siblings.

Also, it is important to communicate in a way the child understands best. Children may learn through reading books, being shown educational materials or in conversation. For example, if your child learns best by reading, consider reading a book about a child diagnosed with cancer.

Again, there's no cookie-cutter approach. Remember these factors when speaking with your child: timeliness, honesty and openness. Have the conversation in a private and comfortable setting, and ask for help if you need it.  


What resources can help me find the best hospital?

There are three common resources that help parents choose the best care center and treatment for their child:

•    Pediatrician/health care provider
•    Internet
•    Word of mouth

The Internet is a great resource. With it, parents are more knowledgeable about treatment options, clinical trials and the latest news from the National Institutes of Health and the National Cancer Institute.

One of the best ways to learn about a treatment center is from other people's experiences. Seek advice from those around you and reach out to the potential institution as well. Sometimes a phone conversation can help you decide whether this particular hospital is the best place for your child.

Being familiar with the situation, your child's pediatrician may be able to suggest a cancer hospital that treats your child's type of cancer and provide a contact.


How do I choose the right treatment?

The best way to determine the right treatment is by asking questions. In fact, the more questions you have, the better. I suggest you keep a notebook to write down your questions, then bring it to all appointments.

I always encourage parents to ask questions. No question is too simple or stupid. If you need to ask a question more than once, then ask it until you understand the answer. As health care providers, we're responsible for helping parents understand what we are saying.


How do I manage my child's pain and side effects?

Pain and symptom control is a big thing for parents. No parent wants to see his or her child in pain. It's important to tell your health care provider about any pain or symptoms that your child may experience. No side effect or symptom is unimportant. Open communication allows everyone to work together and find alternatives that may help alleviate pain and side effects.


How do I help my child cope with his or her diagnosis?

Families have told me that their lives are never the same after a diagnosis. Normally, they adjust to their new lives and the emotional, psychosocial and financial needs, which allows them to cope with the disease in a healthful way.

After surviving the cancer, it's still a process adjusting. If a patient has follow-up appointments, then the family must deal with the anxiety that the cancer may return. When there's a cough or a sharp pain, the survivor will consider that the cancer has recurred. A long period of remission does help patients readjust.

The best way is to live day by day and focus on the positive.

Related articles:
Pediatric Cancer Survivor Is Living Her Dream (Cancerwise)

Pediatric and young adult care
Profile: Caring for Patients, Caring for Families (Annual Report)



Read all blog posts about childhood cancer


By David Berkowitz, Staff Writer

Obesity is a devastating public health crisis for the United States. Nearly one-third of all adults are now classified as obese, a figure that has more than doubled over the last 30 years.

During the same period, obesity has more than doubled among children ages 2-5 and more than tripled among those ages 6-11 and 12-19, according to the National Institutes of Health.

The most recent National Health and Nutrition Examination Surveys (2003-2006) indicate that 16.3% of children ages 2-19 are overweight. An additional 15.6% are considered at risk of becoming overweight.

Being overweight in childhood can lead to health problems, often for life. In adults, overweight and obesity are linked to increased risks of heart disease, type 2 diabetes, high blood pressure, certain cancers and other chronic conditions. Research has shown that overweight children are at high risk of being overweight or obese as adults.

CAN DO Houston
To help reverse what some experts are calling an "epidemic," many communities are rallying around their children to provide opportunities they need to lead healthy lives. One example is CAN DO Houston: Children and Neighbors Defeating Obesity.

Formed in 2008 by Houston organizations, including M. D. Anderson's Center for Research on Minority Health (CRMH), the effort is concerned about childhood obesity and its health effects. A recent $360,000 grant from the Robert Wood Johnson Foundation's Healthy Kids, Healthy Communities initiative will help CAN DO Houston expand its community-based efforts.

M. D. Anderson will oversee and manage the grant, which was one of only three awarded in Texas and 41 nationally. Efforts will focus on three Houston neighborhoods: Magnolia Park, Sunnyside and another neighborhood to be determined.

By tapping volunteers and existing resources, CAN DO Houston focuses on improving nutrition, physical activity and healthy behaviors for children ages 4-12.

"Our goal is to connect a school with a city park not only for physical activity, but as a connection point for parents and students to get advice, assistance and access to good nutrition," says Beverly Gor, Ed.D., executive director of CAN DO Houston and post-doctoral fellow in the CRMH, which is part of M. D. Anderson's Department of Health Disparities Research in the Division of Cancer Prevention and Population Sciences.

"We are fortunate to have the Houston Independent School District (HISD) and the City of Houston Parks and Recreation Department as partners in this initiative," she says.

Local efforts yield results
HISD's Briscoe Elementary, one of two pilot schools introduced to the CAN DO Houston initiative in 2008, bused children to a local park for exercise and sponsored student contests to win prizes for making healthy choices.

"We already noticed an improvement in standardized test scores as a result of improved rates of participation in physical activity among the students," says Briscoe Principal Juan Gonzalez, who is a CAN DO Houston board member.

Gor coordinates the various programs and volunteers that make the project work. "What we do at each school depends on the needs of the community and its children," she says. As these activities are implemented and evaluated, policy and environmental changes can be made to sustain efforts that address childhood obesity and the community's health.

In response to the needs in Magnolia Park, CAN DO Houston will:
• Address safety concerns that are a barrier to physical activity
• Establish walking clubs for Briscoe staff and parents
• Support cooking classes for parents and students

In the Sunnyside area, CAN DO Houston will:
• Conduct a pilot project providing fresh produce through area churches on Sundays
• Provide parenting education classes
• Develop the community's gardening program

CAN DO Houston plans to expand the initiative to one other neighborhood during the four-year grant period.

CAN DO Houston is a private non-profit organization composed of representatives from M. D. Anderson, HISD, The University of Texas School of Public Health at Houston, Baylor College of Medicine, City of Houston's Department of Health and Human Services and Department of Parks and Recreation, Healthy Kids, Healthy Schools Summit, Houston Police Department, the Metropolitan Transit Authority of Harris County, the Houston Wellness Association and the Mayor's Wellness Council.

M. D. Anderson resources:

Center for Research on Minority Health

Department of Health Disparities Research


Additional resources:

CAN DO Houston

Healthy Kids, Healthy Communities


In 2007 for an article and video in M. D. Anderson's Conquest magazine, Anas Younes, M.D., talked about the "need for not only more effective treatment, but safer treatment" for Hodgkin's lymphoma patients.

Over the last few years, there have been significant changes in the treatment of patients with Hodgkin's lymphoma. According to Younes, "Ten years ago Phase I trials were designed to just see how well the patient could tolerate the drugs." Currently available clinical trials are more rationally designed. Today, even in Phase I clinical trials, it's expected that patients will see benefit from these treatments.




For these M. D. Anderson patients, their experiences as participants in targeted therapy clinical trials for Hodgkin's lymphoma are a far cry from the days of just tolerating a drug. They're most satisfied by the improvements in their quality of life while in treatment.

Resources

Hope Is On the Horizon (Conquest)
Advances in Lymphoma Treatment Through Targeted Therapy (Cancerwise)

For more information on current targeted therapies for patients with relapsed Hodgkin's lymphoma, please see the following links from ClinicalTrials.gov.

http://bit.ly/11QdMp
http://bit.ly/7CA5I
http://bit.ly/1apZxw
http://bit.ly/JIU5E


Contact Anas Younes M. D., via e-mail
Follow DrAnasYounes on Twitter
Become a fan of Dr. Younes on Facebook

Researchers from M. D. Anderson's Center for Research on Minority Health are part of a national project to better understand and address the barriers that limit participation and access to cancer clinical trials by minority populations.

Enhancing Minority Participation in Clinical Trials (EMPaCT) is an 18-month, $3.8 million program funded by the National Institutes of Health Center on Minority Health and Health Disparities with American Recovery and Reinvestment Act funds. NCMHHD Director John Ruffin, Ph.D., joined EMPaCT leaders from five institutions to announce the program Thursday at a news conference in Washington, D.C.

"While minorities make up one-third of the U.S. population, few participate in clinical trials for various reasons including cultural or religious factors, lack of awareness and a historical mistrust of the medical system," Ruffin said. "This research will start to identify and break down these racial and ethnic communications barriers, help to rebuild the community's trust, increase the participation and retention of racial/ethnic minorities in clinical trials, and will serve as a model that could be implemented at other cancer centers and hospitals nationwide."

According to the Centers for Disease Control and Prevention, racial and ethnic minorities suffer more from cancer than the U.S. population as a whole, developing certain types of cancer more often with a greater chance of premature death due to late-stage detection. Only about 3% of cancer patients participate in clinical trials, which are vital to developing new cancer therapies, and only about 10% of those are minorities.

The consortium takes a regional approach to assure representation of multiple minority groups.

"EMPaCT will allow us to coordinate efforts of recruitment and, more importantly, retention of minorities to clinical trials on a national basis with an emphasis on regional efforts," says Lovell Jones, Ph.D., the project's lead investigator for the south region, director of the CRMH and professor in M. D. Anderson's Department of Health Disparities Research. "It allows us to bring together all of the experienced site investigators who have a history of recruiting and retaining individuals in clinical trials.

"Additionally, the efforts will have direction from significant leaders, including American Cancer Society incoming President Edward Partridge, M.D., who has served as leader at the University of Alabama at Birmingham Comprehensive Cancer Center, and has a long history and interest in recruitment and retention to clinical trials," Jones says, "and Ernest Hawk, M.D., head of the Division of Cancer Prevention and Population Sciences at M. D. Anderson, bringing leadership experience from previously being directly responsible for all of the comprehensive cancer programs at the National Cancer Institute. It's a dream team for enhancing minority participation in clinical trials."   

Other members of the EMPaCT consortium are Johns Hopkins University (east region), University of Alabama at Birmingham (southeast), University of Minnesota (midwest), which is the EMPaCT lead institution, and University of California, Davis (west).  


M. D. Anderson Resources

M. D. Anderson Center for Research on Minority Health

M. D. Anderson Health Disparities Research    

M. D. Anderson Division of Cancer Prevention and Population Sciences


By Sheila Brown, Child Life Specialist, Children's Cancer Hospital

March marked Child Life Month, an annual acknowledgment of the work done by child life specialists across the nation.


Child life specialists are experts in child development. Our job is to help patients cope with their disease through play, preparation, education and self-expression. We provide emotional support and encourage the optimal development of children, adolescents, young adults and their families facing the cancer experience.

The Children's Cancer Hospital at M. D. Anderson Cancer Center celebrated Child Life Month by hosting a reverse medical play event for patients and their families. This was a day where the patients got to pretend that they were the medical team and the Children's Cancer Hospital staff and even some of the young adult patients pretended to be their patients.  

In the PediDome, we set up medical stations, equipped with syringes, Band-Aids, doctor's coats and all types of medical equipment. As the little doctors and nurses entered the room, they picked a medical station and gave checkups to their real-life doctors and nurses at the Children's Cancer Hospital. Following the checkups, everyone enjoyed pizza together.

I got the opportunity to walk around and visit with some of the "young doctors," and there were some really amazing diagnoses this year. I heard them warn the new "patients" not to put things in their ears and not to give so much blood. I also learned that you always need extra tape no matter how hairy your arm may be. One of my favorites had to be the girl who made her own station sign and medical forms and brought her own supplies.



Patients of all ages love this event and look forward to it every year. It's fun for our staff and we always come away with a new perspective on how our patients feel when they go for a checkup.  


March 2nd marked Read Across America Day in honor of Dr. Seuss' birthday. NFL players with the Huddle Up Foundation visited pediatric patients at M. D. Anderson to celebrate the day and encourage reading.

Patients gathered in the Pi Beta Phi library of the Children's Cancer Hospital to hear some of their Dr. Seuss favorites read by NFL players. Houston resident and former player, Mickey Washington, made "Yertle the Turtle" come alive in the library while other players visited patients in their hospital rooms and read books at their bedside.

Daryl Gardener, who played for the Miami Dolphins, Washington Redskins and Denver Broncos, said reading to the children was his favorite part of the day.

After story time, the players and patients performed a special play with Theater Under the Stars in tribute to Dr. Seuss. They had a special art class, then they whipped up a Dr. Seuss favorite, green eggs and ham, in the family kitchen with the help of M. D. Anderson's chef.



Read Across America Day was hosted by the Pediatric Education Program and served as a fun way to encourage reading and motivate patients to stay on track with their education


Anas Younes, M.D., director of Clinical and Translational Investigation in the Department of Lymphoma/Myeloma at M. D. Anderson, takes us into his lab where he's researching new targeted therapies for people with Hodgkin and non-Hodgkin lymphoma. His focus is on identifying opportunities to cause cell death or slow the growth of cells for certain tumor types.

He identifies the process involved in getting these targeted therapy drug combinations from the lab into Phase I clinical trials and eventually into standard treatment. 




Younes.jpgAnas Younes, M.D., is a professor in the Department of Lymphoma/Myeloma in the Division of Cancer Medicine. For more information about targeted therapies for lymphoma, you can contact Younes via e-mail, Facebook or Twitter.
 

Follow DrAnasYounes on Twitter
Become a fan of Dr. Younes on Facebook

By François Pouliot, Ph.D., M.D., assistant professor and clinical ethicist, Department of Critical Care

Because M. D. Anderson strives to be the premier cancer center in the world, so too does it endeavor to be the premier leader in cancer ethics. What was known as the Clinical Ethics Service has a new name that fits with its new comprehensive mission: the Section of Integrated Ethics in Cancer Care.

The new program, partially inspired by the U.S. Department of Veterans Affairs' National Center for Ethics in Health Care program, improves the quality of ethics services in cancer care by targeting four areas of ethics through these core activities:

Ethics Consultation
Our clinical ethicists address ethical questions that arise when there's lack of clarity as to what's the right action to proceed with, or when there's disagreement about what's best for a patient. They help patients, families and health care teams identify and resolve specific ethical issues so that individuals responsible for decisions can make good choices.

Ethics Lighthouse.jpgOrganizational Ethics
Integrated Ethics calls on leaders to clarify through their words and actions the priority of ethics, to communicate clear expectations for ethical practices, to practice ethical decision-making and to support their facility's ethics program.


Specific improvement interventions in activities of preventive ethics may include decision support, evaluating organizational performance with respect to ethical practices, and developing policies and protocols that promote ethical practices.

Ethics Education
To support the study of ethics, the section offers a variety of academic opportunities, some providing CME and CEU credits. Areas of study include difficult case reviews, bi-annual Ethics Institutional Grand Rounds and a Psycho-Social Journal Club.

Ethics Research
The faculty of Integrated Ethics is actively conducting research in collaboration with internal and external researchers to advance the field of clinical ethics in cancer care and in the general field of bioethics.

Requests for general information, policy clarification, document review and ethical analysis of a question of an organizational nature or pertaining to research ethics also are part of our activities.

Our faculty also is available to researchers interested in the publication of scientific research, veracity and integrity of research data, animal management and conflict of interest issues.

For pilots at sea or on the inland waterways of cancer care -- patients, relatives or M. D. Anderson employees -- the Section of Integrated Ethics' goal is to aid their navigation.
 

A major new Phase II clinical trial for women with high-risk, rapidly growing breast cancers will help scientists quickly and efficiently test promising new drugs against the disease.

The Biomarkers Consortium, a public-private alliance that includes the U.S. Food and Drug Administration, the National Institutes of Health and major pharmaceutical companies, announced the start of the I-SPY 2 trial at a news conference this morning at NIH headquarters in Bethesda, Md. The project is led by the Foundation for the National Institutes of Health.

M. D. Anderson will be one of the first of 20 national clinical trial sites to open. The trial combines personalized medicine with an innovative adaptive randomization approach designed to match each woman's tumor with the drug most likely to control her disease.

Study participants will be randomized depending on their biomarker profile - specific biological aspects of their tumors, overexpression of the HER2 protein, for example ¬- and on the basis of the outcomes of treatment for patients with similar profiles. Outcome is pathological complete response, absence of disease, assessed at the time of surgery after receiving chemotherapy.

All study patients will receive either standard presurgical chemotherapy or the standard plus one of many study drugs under development. They will be monitored with a series of MRIs before surgery, which will help indicate whether eventual pathologic complete response is likely.

As the trial progresses, drugs will be dropped from consideration and others will be added. A drug that is working for patients who have a particular biomarker profile will be more likely to be assigned to future patients who have that profile. By the same token, the probability of future assignment decreases for drugs that are not helping patients. This approach allows drugs to more swiftly graduate to Phase III trials or to be dropped from the study.

 

The study is described in detail by this article in Clinical Pharmacology and Therapeutics, a Nature Publishing Group publication.

I-SPY 2 was designed by Donald Berry, Ph.D., professor and head of M. D. Anderson's Division of Quantitative Sciences, and by Laura Esserman, M.D., professor and director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco, co-principal investigators on the project.

"Between 60% and 70% of all Phase III clinical trials for cancer drugs fail," Berry says. "The main reason is that these trials treat all patients with, say, breast cancer. The problem with that is not all patients respond to any particular therapy. The critical aspect of cancer research is to identify which patients will respond to which therapies."

The goal of I-SPY 2 is to achieve an 85% success rate in Phase III trials by narrowing eligibility in those trials down to groups of patients most likely to respond to the drug based on the biomarkers of their disease.

"Using the I-SPY2 approach will make Phase III trials smaller, and therefore faster, and more successful because the focus will be on the patient population where a drug has been shown to be effective," Berry says.

By Laura Sussman, Staff Writer

For more than 100 years, clinicians have observed that thrombocytosis - elevated levels of blood-clotting platelets - occurs in patients with malignant tumors, suggesting that platelets might play a role in the growth and spread of cancer.

This week, Rebecca Lynn Stone, M.D., presented new findings from M. D. Anderson researchers about the clinical correlation between platelet dysfunction and cancer progression in ovarian cancer patients. The presentation was at a focused plenary session on ovarian cancer at the Society of Gynecologic Oncologists 2010 Annual Meeting on Women's Cancer in San Francisco.

Researchers collected and examined data from more than 600 patients across five institutions with a primary diagnosis of ovarian cancer to test associations between platelet count at initial diagnosis, clinical and pathologic factors, and outcome.

Findings showed that thrombocytosis (platelet count >450,000/µL) at initial diagnosis occurred in one in every three women. Further, when compared to patients with normal platelet counts, women with thrombocytosis were significantly more likely to have advanced stage disease, more likely to have their cancer recur and were less likely to survive.

The findings were then replicated in laboratory mouse models. Platelet counts were measured in healthy control and tumor-bearing mice, and data indicated that platelets increased ovarian cancer cell proliferation and that thrombocytosis remained an independent predictor of decreased overall survival. Researchers also examined the effects of platelet depletion on tumor size, proliferation, apoptosis and angiogenesis. Following the administration of an antibody to reduce platelet count in mice bearing invasive ovarian tumors, they observed a 50% decrease in ovarian tumor growth.  

According to the researchers, the findings offer a new understanding of the biological role platelets play in promoting ovarian cancer growth and suggest that platelet counts may be a good marker for predicting patient outcomes.

"Platelets represent one of the largest storage pools of angiogenic and oncogenic growth factors in the human body. But until now, there hasn't been a concerted effort to examine the clinical and biological significance of platelets in patients with ovarian cancer," says Anil Sood, M.D., professor in the departments of Gynecologic Oncology and Cancer Biology at M. D. Anderson, a senior author on the study whose own clinical observations motivated the effort.

According to Sood, the next step is to examine the potential to block the stimulatory effects of platelets, which could lead to new therapeutic approaches for treating women with ovarian cancer.  

Questionmark.jpgRecommended cancer screening guidelines across a range of disease sites have been revised by several organizations over the last several months, including M. D. Anderson, leaving many confused about when to get screened, or if they even should. The common denominator driving many of the new recommendations is personal cancer risk.

According to the National Cancer Institute (NCI), a risk factor is anything that raises a person's chance for developing a disease. Although science has yet to explicitly define why one person develops cancer and another does not, specific risk factors are known to increase one's chances of developing certain types of cancers.

According to Therese Bevers, M.D., medical director of the Cancer Prevention Center at M. D. Anderson, knowing your cancer risk is important because that information offers guidance about efforts to prevent and detect cancer at its earliest, most treatable stage.

Bevers encourages individuals to talk about their cancer risk with their doctors to determine an appropriate schedule for cancer screening. But how do you uncover your personal cancer risk? The NCI lists four main types of cancer risk factors - some controllable, some not.

Risk Factor #1: Behavioral

Do you smoke? Drink excessively? Eat poorly and never exercise? Lay out in the sun until you have a dark tan? Your cancer risk just increased. There is a reason these risk factors are called "behavioral." By changing these unhealthy behaviors and habits, you can significantly lower your risk for any number of cancers.

Risk Factor #2: Environmental
Believe it or not, where you live and work can affect whether or not you get cancer at some point in your life. If you work in the sun, are usually around secondhand smoke or are frequently exposed to asbestos, radon, pollution or pesticides, your risk of getting cancer increases.

Risk Factor #3: Biological
Biological risk factors are one set of factors that are truly out of an individual's control - they include gender, age, skin complexion and race. Some cancers are gender-specific: only women can get ovarian and cervical cancer, and only men get prostate cancer. In terms of age, cancer risk increases as an individual gets older. Light-skinned individuals are more susceptible to skin cancer than dark-skinned people, and studies have shown that African-American men are at higher risk for prostate cancer than other men.

Risk Factor #4: Genetic
Approximately 5% to 10% of cancer is inherited, which means that changes (or mutations) in specific genes are passed from one blood relative to another. Individuals whose close relatives were diagnosed with cancer have a much higher chance of developing cancer within their lifetime - and at an earlier age. Over the last 15 to 20 years, scientists have made progress in identifying the genes that predispose individuals to breast, colorectal, gynecologic and endocrine tumors. Individuals who have a hereditary predisposition to cancer are recommended to undergo high-risk cancer surveillance - perhaps even including genetic testing - in order to manage their increased cancer risk.

Questions will be answered live on Mar. 23rd

Do you have more questions about your cancer risk? Bevers will be available live on Twitter on Tuesday, March 23, at 1:00 p.m.CT to answer your questions.

Follow @Cancerwise on Twitter and the hashtag #CancerRisk, or join us on tweetchat.

By: Maurie Markman M.D.

The two most prevalent causes of head and neck cancers are tobacco use and human papillomavirus exposure. Maurie Markman, M.D., vice president for clinical research at M. D. Anderson, reviews a study reported in Clinical Cancer Research last month on what happens when a patient has HPV exposure and uses tobacco.

The study looked at 124 patients with advanced oropharyngeal cancer, or cancer of the tonsils or the base of the tongue. Of the HPV-positive patients who had never used tobacco, 6% had a recurrence of their cancer. Meanwhile, 19% of former tobacco users and 35% of current tobacco users had a recurrence.



Resources

Tobacco Use Linked to Worse Outcomes in HPV-Positive Head and Neck Cancer (Science Daily)

Head and Neck Cancers (MD Anderson)

BY Sara Farris, Staff Writer

They may come from all over the world, but recently, pediatric patients and their oncologists from M. D. Anderson fired up their pots of chili, donned their western wear and celebrated Go Texan Day

Go Texan Day is a long-standing tradition that marks the start of the Houston Livestock Show and Rodeo. People are encouraged to dress in their finest western wear as a means of cultivating the rodeo spirit.

The doctors traded their white coats for pearl snap shirts and competed for the prestigious "best chili" award. The young patients and their families taste-tested the varieties of chili and weighed in on their favorites. Twelve teams from the Children's Cancer Hospital at M. D. Anderson were entered in this year's cook-off.



The Children's Cancer Hospital Chili Cook-Off is another way that the hospital brings fun occasions to the many patients who aren't able to join the crowds due to compromised immune systems from cancer treatment. The cook-off not only distracts the patients from their treatment, but it's a cultural adventure for the many out-of-town patients who are new to our rich Texan culture.

By: Richard Lee, M.D., and Lorenzo Cohen, Ph.D.

Cancer patients often take herbs and supplements with the hope of improving their outcomes, and utilization is especially high in women with breast cancer.

One controversial area is the use of soy and soy-related products during and after treatment. Natural soy is known to contain phytoestrogens such as isoflavones, and these compounds in preclinical studies promote estrogen-dependent breast cancer growth. Thus, breast cancer patients are commonly advised to avoid all dietary soy.  

soybeans.jpgFindings from two recent studies are starting to question whether soy may in fact be helpful. A study published at the end of 2009 in The Journal of the American Medical Association by Shu et al., investigated the association between soy food intake and breast cancer survival among a prospective, population-based cohort of 5,042 Chinese women diagnosed with breast cancer between 2002 and 2006. In-person interviews were conducted at baseline, and 12 and 36 months about food consumption, including soy. Soy intake was inversely correlated with breast cancer recurrence and mortality (i.e., higher soy intake was associated with increased survival). The findings remained when comparing estrogen positive/negative and tamoxifen users/non-users subgroups.

Earlier in 2009, results from the Life After Cancer Epidemiology (LACE) study appeared. In this prospective cohort trial involving 1,954 women with breast cancer, those who consumed soy isoflavones at levels comparable to Asian populations actually had a reduced risk of recurrence, especially if they were on concurrent tamoxifen therapy. The authors concluded: "Soy isoflavones consumed at levels comparable to those in Asian populations may reduce the risk of cancer recurrence in women receiving tamoxifen therapy and, moreover, appears not to interfere with tamoxifen efficacy."

These studies provide further information that regular dietary soy as part of a normal diet is probably safe and, in fact, may be beneficial for women with breast cancer. These studies, as well as others, create a growing body of evidence that the current advice that all soy foods should be removed from the diet of a woman diagnosed with breast cancer is probably untrue.

The role of non-dietary soy products such as soy supplements, powders or pills and the use of heavily processed soy items such as soy cheese, soy hot dogs or soy turkey remain unclear and should be avoided.

As the research to date is observational in nature, future randomized trials are needed to verify if a beneficial effect truly exists for the use of dietary soy. 


1.  Shu XO, et al. Soy and intake and breast cancer survival.  JAMA 302(22):2437-2443, 2009.
2.  Guha N, et al. Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study.  Breast Cancer Res Treat 118:395-405, 2009.


"Should I get proton therapy?" is a question that my patients often ask me, and you may be thinking about it right now. The short answer is that "it depends." Only you and your oncologist should be making this decision.  

Before deciding IF you should receive proton therapy, you need to know WHAT it is. Proton therapy is a form of external beam radiation that uses particles (i.e. protons) instead of photons (i.e. X-rays) to treat tumors. Both forms of radiation can destroy cancer cells by messing up their genetic blueprint (DNA). This makes it difficult for cancer cells to continue to grow and divide, and they ultimately die.

Lee_Proton_small.jpgIn general, the higher the radiation dose, the better the tumor control will be. However, such high radiation doses  can affect normal tissue near the tumor, which is what we all want to avoid.  

Photons (x-rays) deposit the majority of their dose within the first inch after they hit the skin, and they continue to deposit dose after they reach the tumor.  Hitting a deep tumor with just one or two x-ray beams is hard (that would be like trying to power-wash your driveway with a water pick).  We often need to use many different beams to cover the tumor and this can result in more radiation exposure to normal tissues.  This is where proton therapy has the edge. Protons deposit most of their dose at the tumor and more importantly stop traveling after they hit the tumor. This reduces the radiation dose beyond the tumor, allows the use fewer beams, and subsequently greater sparing of normal tissue.

Proton treatment requires sophisticated machinery and expert professionals to deliver it. The synchrotron will accelerate protons to almost the speed of light for maximal penetration. Inside the synchrotron they may travel 300,000 miles, which is equivalent to circling the earth 12-13 times. The protons are then fed to the treatment gantry, which is a massive 190-ton device that directs the proton beam before it enters the patient. Despite its large size (over 40 feet in diameter), the gantries have a precision of 1mm. We also have a highly trained, dedicated group of professionals who operate and maintain the Proton Therapy Center to ensure that everything works to its best level.

Proton therapy is currently available in only seven centers in North America. M. D. Anderson has one of the largest and technically advanced centers in the world. We have four treatment rooms, including one of the only centers with spot-scanning  (a.k.a. pencil-beam scanning) capabilities.

The first patient was treated with proton therapy at M. D. Anderson on May 4, 2006, and since then we have treated more than 1,700 patients. We have a lot of experience treating patients with lung cancer, esophageal cancer, brain tumors and prostate cancer, as well as various other tumor sites. Also, we're one of the most active centers in the world for treating children  with proton therapy.

Since the Proton Therapy Center is part of M. D. Anderson Cancer Center, we can provide our patients not only with outstanding proton therapy but also outstanding cancer therapy.

So, should you receive proton therapy? Please consult with your radiation oncologist or check out our website for more information.

Other Resources

ProtonPals is a support and outreach group for those who choose proton therapy treatment at The University of Texas M. D. Anderson Cancer Center Proton Therapy Center 



By Lora Shea, Staff Writer

The debate continues on the value of cancer screening. The latest target: prostate cancer.

The American Cancer Society has issued new prostate cancer screening guidelines that encourage doctors to better communicate the risks and benefits to their patients before testing is pursued. The guidelines question the value of mass prostate screening.

M. D. Anderson urologist John Davis, M.D., says the new guidelines represent "a growing shift from the more simplistic days when doctors told men to go get screened, and we'll deal with the results as needed."

Studies show that more men die with prostate cancer than because of prostate cancer. Screening for prostate cancer may be the right choice for some men, but that decision should be made after careful consideration of a man's personal and family health history, and the risks and benefits of the specific tests. M. D. Anderson's screening guidelines affirm the need for men to discuss testing with their doctor and give specific recommendations based on a man's risk, should he decide to be tested.

The ACS guidelines also call into question the value of community screening events, in which large groups of asymptomatic men are tested. M. D. Anderson has replaced mass screening with education events for the past few years, Davis says. "These events give us the opportunity to talk to men not only about the issues around screening, but also about the variety of treatment and disease management options available to them if they are found to have prostate cancer."

Davis worries that the ACS guidelines "paint a very negative picture of prostate cancer treatment, that harm is inevitable." He says that for those properly evaluated, treatment in the right hands can offer the best outcomes.

"Furthermore, the guidelines are mostly based on two randomized trials. The American trial showed no benefit to screening, but unfortunately has numerous flaws (especially contamination between the treatment arms) and therefore is not conclusive," he says.

"On the other hand, the European study, which did not suffer from as many problems as the American trial, demonstrated a 20% lower risk of dying of prostate cancer as early as nine years from diagnosis. Given the slow natural history of prostate cancer, the percent of men who benefit from screening should go up as these patients are followed to the 15- and 20-year marks."

So who will choose to screen versus not screen? Davis predicts that "for most men who have greater than 10 years of life expectancy and work with their physicians to minimize their cancer AND cardiac disease-related risks, the result will be the well-informed decision to screen."

"Those who are not screened may be due to other more threatening health concerns, or the occasional patient who places a high personal value on avoiding any treatment-related side effects -- even if that means accepting a higher risk of dying of prostate cancer," Davis says.
 
If you've been screening already, should you stop? According to Davis, "The guidelines provide concise summaries of the relevant data, and it's probably best to let your screening physician talk to you about what age is best to stop."

 

By: Lorenzo Cohen, Ph.D., and David Servan-Schreiber, M.D., Ph.D.

Integrative medicine aims to enhance cancer care by creating a comprehensive, integrative treatment plan that addresses all dimensions of care: physical, psychological-spiritual and social. It makes use of all appropriate therapeutic approaches, providers and disciplines to improve quality of life, help to manage symptoms, and achieve the best possible treatment results.

Recent research shows that tumors grow and become malignant not only through genetic anomalies in the cancer cells themselves, but also through factors in the cells' microenvironment. These microenvironmental factors include, but are not limited to:

• The ability of the cells to form blood vessels to feed the growing tumor (angiogenesis).
• The propensity for inflammation and stimulating inflammatory pathways, and suppressed cell-mediated immunity.

The tumor microenvironment is the terrain that largely determines whether cancerous cells will grow or not. The body possesses a number of natural defenses that can create a barren, inhospitable terrain for cancer growth. These natural defenses are influenced and strengthened by healthy lifestyle choices such as a proper diet, physical activity, stress management, social connection, and limiting exposure to environmental pollutants.  

Modern oncology treatment is focused on destroying cancer cells or blocking cancer-related pathways. This is an essential aspect of therapy. However, it's becoming increasingly clear that truly effective cancer care should simultaneously foster a strong anticancer terrain by strengthening the body's natural defenses.

Existing initial research that follows the tenets of integrative oncology -- making changes in lifestyle and behavior -- shows evidence that this approach can, in fact, strengthen natural defenses, modify the terrain of the body, and have an impact on long-term treatment results.  

It's time to provide our patients the education and clinical tools necessary to support an anti-cancer lifestyle to help them remain cancer free and to improve clinical outcomes, quality of life, and symptom control for those with cancer and cancer survivors.

We need to empower people to become active participants in their own health. We need to show them how to best care for themselves; not only because they will feel better if they get involved, but because it's good science and good medicine.

Further Reading:

David Servan-Schreiber: "Anticancer - A new way of life." (Viking)

Andersen, B.L., et al., Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer, 2008. 113(12): p. 3450-8.

Ornish, D., et al., Increased telomerase activity and comprehensive lifestyle changes: a pilot study.[see comment][erratum appears in Lancet Oncol. 2008 Dec;9(12):1124]. Lancet Oncology, 2008. 9(11): p. 1048-57.

Ornish, D., et al., Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proceedings of the National Academy of Sciences of the United States of America, 2008. 105(24): p. 8369-74.

Ornish, D., et al., Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology, 2005. 174(3): p. 1065-9; discussion 1069-70.

Saxe, G.A., et al., Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction. Integrative Cancer Therapies, 2006. 5(3): p. 206-13.

Saxe, G.A., et al., Biological mediators of effect of diet and stress reduction on prostate cancer. Integrative Cancer Therapies, 2008. 7(3): p. 130-8.


In Her Own Words ... by Rebecca Esparza

esparza.jpgThanksgiving Day 2007 couldn't have been more non-traditional: my fiancé Robert Marraro and I spent it in Las Vegas. Ever since my diagnosis of late-stage ovarian cancer at Thanksgiving in 2001, the holiday has never been the same, so we've tried unique and different ways to celebrate over the years.

But there was something special about this trip: It marked my five-year, cancer-free anniversary. We visited the Grand Canyon, stayed at a luxurious suite in a five-star casino and experienced a decadent spa day. On the way home from our week-long trip, we stopped in San Antonio for an extra evening of fun.

That night, I was horribly sick.

The signs are there
Robert later told me it was at that moment, he knew something was seriously wrong with me.

But I was cancer-free. The five-year mark was monumental, especially for an ovarian cancer survivor. For the next five months, I carried on despite being extremely lethargic, gaining weight and losing tremendous amounts of hair. Plus, there were still a host of side effects I was suffering as a result of my chemotherapy, like chronic joint pain, fibromyalgia and neuropathy.

I refused to let my disabilities dampen my spirits for fighting cancer at the grassroots level. The year prior I had been selected as a "Hero of Hope" by the American Cancer Society, which entailed traveling to Relay For Life events across Texas as a survivor spokesperson. I was at a Relay event in Alice, the hometown of my grandmother, Elida Garcia, who had passed away in December 2007 of lung cancer.

As soon as I stepped on the track that night, I could feel her spirit.

An hour later, I tripped and fell, hit my head and passed out. When I awoke, I was in traction and emergency personnel were loading me into an ambulance.

My body demands attention
CT scans of my head and neck revealed no head injuries, but there was something suspicious in my thyroid. The exact verbiage: "Small hypodensity and tiny adjacent calcification within left lobe of thyroid may represent nodule versus cyst."

Despite the fact my doctor at the emergency room was not concerned about it, I decided to take my health in my own hands. I called my gynecologic oncologist at M. D. Anderson, Pamela Soliman, M.D., assistant professor in the Department of Gynecologic Oncology. She advised coming to M. D. Anderson for a fine needle aspiration.

The procedure itself was painful, but the radiologist, nurses and technicians all made sure I was comfortable. The next day I met Camilo Jimenez, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders.

He and I had an instant connection. Looking back on this meeting, I think he sensed the news I had thyroid cancer would be particularly difficult for me.

"Two of the samples came back negative for cancer," he said slowly. "And one ... one came back positive."

I was completely stunned: I had cancer. Again. Two primary cancers and I was only 37.

Dr. Jimenez couldn't have been more caring and sympathetic. He assured me I would receive excellent care, immediately putting my mind at ease. We discussed surgery to remove the thyroid and subsequent radioactive iodine treatment.

In June 2008, Randal Weber, M.D., professor and chair of the Department of Head and Neck Surgery, performed a three-hour surgery to remove my thyroid, one parathyroid and 50 lymph nodes. Seven of those lymph nodes came back positive for cancer and my radioactive iodine treatment was scheduled for November -- around Thanksgiving.

Everything seems to go back to Thanksgiving
After enduring a low-iodine diet for two weeks to ensure proper uptake of the radioactive iodine and undergoing several diagnostic tests to see where the cancer still existed, I was mentally prepared for the treatment.

At this point, I knew Dr. Jimenez was preparing to send me to the hospital for the treatment. He entered the room with the biggest, broadest smile I have ever seen on a physician.

"There is no evidence of cancer. So since there's no cancer, there's nothing to radiate.
This rarely happens, so go home and enjoy your life," he said happily.

I thought I would literally bounce off the walls. And although today I have numerous "reactive" lymph nodes in my neck that are being closely monitored for signs of cancer, I don't spend much time worrying about it.

I like to relish the fact I am a walking miracle that kicked cancer to the curb twice. I'll do it as many times as I need to in the future, but I'll make sure I have my invaluable medical teams at M. D. Anderson by my side every step of the way.

And I believe my grandmother was with me that night in Alice. She gave me a gentle, loving push that would eventually help save my life.


In 2008, Esparza was honored for her networking efforts with other cancer patients by Lance Armstrong when she received the Livestrong Challenge Award.

Related story:
Q&A: Thyroid cancer

M. D. Anderson resources:
Thyroid cancer

Endocrine Care Center

Thyroid cancer survivor (video)


Additional resources:
Thyroid cancer (National Cancer Institute)

Detailed guide: thyroid cancer (American Cancer Society)


Q&A: Thyroid Cancer

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Thyroid cancer is a disease in which cancer cells are found in the tissue of the thyroid gland.

Camilo Jimenez, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson, answers questions about this disease.

Are there several types?
Yes, there are four types. The most common is papillary thyroid cancer; the second is follicular thyroid cancer; the third, medullary thyroid cancer; and the rarest, anaplastic thyroid cancer.

In general, papillary thyroid cancer exhibits the best survival rate and prognosis with survival rates up to 100% after five years of initial diagnosis, even in patients with metastatic disease.

Anaplastic thyroid cancer is perhaps the most aggressive cancer that humans may suffer from. Almost 100% of patients survive fewer than three months after its diagnosis. Fortunately it is very rare.

How common is thyroid cancer?
Papillary thyroid cancer is very common. Its incidence has increased during the last decade, and now it's one of the 10 most common cancers in the United States.


What causes it?

In most papillary and follicular thyroid cancer cases, we do not know the cause.
Approximately 3% of papillary thyroid cancer cases have predisposition because other family members have been affected by this disease. Exposure to sublethal radiation, such as that observed in survivors of radiation from Hiroshima, Nagasaki or Chernobyl, is another risk factor for the disease.

In the case of medullary thyroid carcinoma, up to 35% of patients may have a genetic predisposition.

The causes of follicular and anaplastic thyroid carcinomas are unknown.

What are the symptoms?
These tumors are usually found because of the presence of a palpable or visible neck mass. Frequently, they're accidentally found by radiographic studies recommended to evaluate diseases that are not related to thyroid cancer.

In some cases, thyroid cancer is found because of manifestations related to metastatic disease (for example, a fracture due to skeletal metastases).

Papillary, follicular and anaplastic thyroid carcinomas usually do not secrete hormones. Medullary thyroid carcinomas secrete excessive amounts of calcitonin (a hormone produced in the thyroid) making some patients susceptible to flushing and chronic diarrhea.

What are the most common treatments?
Surgery is the most important treatment for thyroid cancer. In a vast majority of papillary and follicular thyroid carcinomas, once surgery is performed, ablation therapy with radioactive iodine is recommended.

Thyroid suppressive therapy with a dosage of thyroid hormone -- enough to suppress the thyroid-stimulating hormone -- is required after ablation therapy in almost every patient. For medullary thyroid cancer, ablation with radioactive iodine and thyroid suppressive therapy are not necessary.

What other information can you share?
We've noticed that both the incidence and aggressiveness of thyroid cancer have increased over the last decade. Some tumors present with metastases that are not possible to remove by surgery.

To attack these tumors, we now have drugs that target molecular pathways important for the tumor development and survival. Many of these drugs are under evaluation in clinical trials, and they include names such as sorafenib, sunitinib, motesanib, XL184, E7080 and others. A new era for thyroid cancer has begun.

Related story:
Patient deals with ovarian, then thyroid cancer

M. D. Anderson resources:
Thyroid cancer

Endocrine Care Center


Thyroid cancer: questions and answers (PDF)

Thyroid cancer survivor (video)


Additional resources:
Thyroid cancer (National Cancer Institute)

Detailed guide: thyroid cancer (American Cancer Society)


Although colorectal cancer is often preventable and many are aware of the disease, most people still fail to get screened.

Colorectal cancer remains the fourth most common cancer in the United States. According to the American Cancer Society, more than 148,800 people were diagnosed with the disease in 2008 and 49,960 died because of it.

That's why every March there's a concerted effort to raise awareness of this disease and to encourage people to get screened.

New guidelines for screening
A multidisciplinary panel of M. D. Anderson experts in medical oncology, surgical oncology, radiation oncology, cancer prevention, imaging and other areas have developed new risk categories and related guidelines for colorectal cancer.

For men and women at average risk who are 50 years and older, M. D. Anderson recommends a colonoscopy every 10 years (preferred screening), and either a virtual colonoscopy every five years or a yearly fecal occult blood test (FOBT).

For men and women at increased or high risk, the type and frequency of exams, including colonoscopy and flexible sigmoidoscopy, depend on the following factors:
•    Personal history of precancerous (adenomatous) polyps
•    Personal history of colorectal cancer
•    Family history of colorectal cancer or precancerous (adenomatous) polyps
•    Genetic diagnosis of familial adenomatous polyps
•    Genetic history of hereditary nonpolyposis colorectal cancer, or clinical history suggesting such
•    Inflammatory bowl disease (ulcerative colitis or Crohn's disease)

If you fit these guidelines, celebrate March with a check-up and chat with your primary physician about getting screened for colon cancer.

Related stories:
Metastatic Colon Cancer Survival Jumps Dramatically Almost a Third of Patients May Live Five Years

Colorectal Cancer Survivors' Stories Become More Common


M. D. Anderson resources:
Colonoscopy versus Virtual Colonoscopy (podcast)

Colorectal Cancer Treatment and Screening (podcast)



Additional resources:
Colon and Rectal Cancer (National Cancer Institute)

Colon and Rectum Cancer (American Cancer Society)

National Health Observances Toolkit (U.S. Department of Health & Human Services)


By Laura Prus, Staff Writer

Lung_Pistachios200.jpgAccording to a recent study, adding pistachios to your diet may help lower your risk of lung cancer. However, researchers caution that more research is still needed.

Among the most commonly consumed nuts in the United States, pistachios also are one of the best dietary sources of gamma-tocopherol, a form of vitamin E.

Results of a study aimed at discovering if these nuts have anti-cancer properties was presented in December 2009 at the American Association for Cancer Research's Frontiers in Cancer Prevention Research conference.

Conducting the study
The six-week controlled clinical trial investigated the effect of pistachio consumption on serum levels of gamma-tocopherol. It was divided into three two-week blocks, allowing for a two-week pre-intervention period and a four-week intervention period.

Involved in the study, conducted by researchers at M. D. Anderson and Texas Woman's University, were 36 healthy participants who were randomly assigned to either a normal diet or a diet consisting of 68 grams of pistachio per day. Data for each participant were recorded in a diet diary.

Results show promise
Participants in the pistachio-diet group showed a significant increase in energy-adjusted dietary intake of gamma-tocopherol at weeks three and four. At the end of the study, this group also had a significantly higher value of cholesterol-adjusted serum gamma-tocopherol compared to baseline.

Ladia Hernandez, senior research dietitian in the Department of Epidemiology and the study's first author, says this positive outcome shows promise of the anti-cancer properties of pistachios. "Because pistachios are a good source of gamma-tocopherol then eating them may help to decrease lung cancer risk," she says.

Pistachios are good for you
Although results are encouraging, Hernandez says the chemopreventative effects of pistachio consumption need further clarification. In particular, she says, the effects related to the targeted molecular pathways need to be studied.

However, she does recommend adding gamma-tocopherol to your diet. "Pistachios are one of those 'good-for-you' nuts, and 2 ounces per day could be incorporated into dietary strategies designed to reduce the risk of lung cancer without significant changes in body mass index," she says.

She also states that foods such as peanuts, pecans, walnuts, soybean and corn oils are rich sources of gamma-tocopherol and could prove beneficial for your health as well.

M. D. Anderson resources:

Department of Clinical Nutrition


Additional resources:

Energy Value of Macronutrients From Pistachio Nuts and Mechanisms of Nutrient Action (National Cancer Institute)

Pistachios May Reduce Lung Cancer Risk (AACR)

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