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November 2010 Archives

By Lana Maciel, MD Anderson Staff Writer

Vitaminsundermicroscope.jpgIt seems that every day a new report is released announcing the discovery of an herb or supplement that can help fight disease. Fish oil, medicinal mushrooms, cranberries and vitamin D are just a few of the many natural supplements widely touted for their anti-inflammatory effects, ability to boost the immune system, improve health and even prevent cancer. But just how safe and effective are these over-the-counter products?

That's the question the federal government is asking as it begins a research initiative to better understand the specific effects of various supplements. The results will allow consumers to make more informed decisions on the risks and benefits of these products, which topped $5 billion in sales in 2009.

"Sometimes people assume because a product is natural, it is also safer," says Floyd Chilton III, director of the Center for Botanical Lipids and Inflammatory Disease Prevention at Wake Forest University Baptist Medical Center. "But these compounds can have benefits and potential side effects, and we need to understand both of those."

The Office of Dietary Supplements and the National Center for Complementary and Alternative Medicine, both branches of the National Institutes of Health (NIH), spurred the initiative by awarding $37 million in August to dietary supplement research centers. The NIH also provided funds to the National Cancer Institute for researching the role of botanicals in cancer risk and tumor growth.

Research continues


An investigation by the General Accounting Office earlier this year found that 37 of 40 herbal supplements tested contained trace amounts of potentially hazardous contaminants, prompting governmental bodies to begin the research initiative.

Given that herbal supplements do not require approval by the Food and Drug Administration to be sold, many consumers "are using supplements for purposes for which they were not intended," says Marguerite Klein, director of the NIH Botanical Centers Research program. Some buy supplements for self-diagnosed health conditions, or they may combine multiple supplements with other medications, which is not safe.

So far, federally funded studies have proven the benefits of some supplements and disproved the claims of others. For example, chamomile capsules may help reduce anxiety compared to a placebo, while ginkgo biloba does not prevent heart attack, stroke or cancer, as was previously claimed.

"It's important to view concentrated herbs and botanicals as drugs that have the potential to cause harm or benefit. The key is to conduct good research to determine what is safe and effective to incorporate into the standard of care," says Lorenzo Cohen, director of MD Anderson's Integrative Medicine Program.

Researchers continue to investigate the effects of different herbs and botanicals in an oncology setting.

Ongoing preclinical and clinical research at MD Anderson is examining the effects of fish oil, oleander, curcumin and many other natural products for their ability to prevent and treat cancer.

MD Anderson resources:
Complementary Therapies at MD Anderson

Integrative Medicine Program at MD Anderson


Additional resources:

Office of Dietary Supplements (National Institutes of Health)

National Center for Complementary and Alternative Medicine (NIH)

Drugs, Herbs and Supplements (NIH)

Attribution Photo by: bradley j Some rights reserved

By: Mary Brolley, MD Anderson Staff Writer

Look around a clinic's or physician's waiting room and you'll see that reading remains a favorite way for patients and caregivers to pass the time.

For avid readers, a bright side of cancer treatment is that it may provide extended stretches of time for plunging into a book.

Our colleagues at OncoLog recently ran a story on books cancer patients and survivors would recommend to others to help them during their cancer journey.

The top choice of the more than 100 Anderson Network members surveyed was the Bible. It was credited with providing guidance and inspiration and shoring up faith, hope and strength.

A number of respondents also cited Lance Armstrong's "It's Not About the Bike" and Bernie Siegel's "Love, Medicine and Miracles."

Two other books about cancer were quite popular: "Dr. Susan Love's Breast Book" and "Anticancer: An New Way of Life" by David Servan-Schreiber, M.D., Ph.D.

Some respondents were drawn to the self-help section, and listed books on meditation and relaxation. And many reported that they greatly enjoyed books that had nothing to do with what they were going through, such as the Harry Potter series, mystery novels and humor books.

Which books helped you during your cancer experience? We welcome your comments at the top of the post.


Read the full article House Call: Books Provide Comfort, Guidance, Relaxation in OncoLog

During a conference held Nov. 13-14 at MD Anderson's sister institution, the Chinese University of Hong Kong, it was evident that the desire to develop a better approach to cancer therapy is global. 


Speakers from MD Anderson, Harvard, Duke and CUHK, among others, explored the universal themes of teasing apart the complexities of the biology of cancer in order to allow doctors to pick the best therapy for each patient. Something that made this conference unique, in my experience, was the opening -- more on that later.
 
Faculty champions

The meeting was co-chaired by Professor Anthony Chan, director of the Hong Kong Cancer Institute & Sir Y.K. Pao Center for Cancer at CUHK, and Professor Alfred Yung, M.D., chair of MD Anderson's Department of Neuro-Oncology. They are the "faculty champions" of the MDACC-CUHK sister relationship. Having brought the two institutions together in 2008, we continue to make connections between our faculty to spark collaboration. One of the strongest interactions is between Dr. Vivian Lui of CUHK and Gordon Mills, M.D., Ph.D., chair of the Department of Systems Biology at MD Anderson. Lui learned RPPA, a key systems technique, in Mills' lab and together they are exploring signaling in nasophayngeal carcinoma, which recently resulted in a paper in Oncogene.
 
Similar experiences among our sisters
Remarkable to me was the similarity of patient outcomes and approaches across several of the institutions in our Sister Institution Network. Many of our SIs in Asia were represented at the meeting, including Fudan University Cancer Hospital (Shanghai), Tianjin Medical University Cancer Institute and Hospital (Tianjing), Sun Yat-Sen University Cancer Center (Guangzhou) and China Medical University Hospital (Taichung). Presentations from Dr. Zhong-Pin Chen from Sun Yat-Sen University, Dr. Danny Chan from CUHK and Charles Conrad, M.D., from MD Anderson showed broadly equivalent responses to current glioma therapies, and underlined the need for better therapy and markers. Such similarities also emerged in discussions of lung cancer by various speakers, including presentations by Dr. Qinghua Zhou from Tianjin and Dr. Guo Liang Jiang, president of Fudan University Cancer Hospital.
 
Lion Dance
Accompanying the legendary hospitality of Hong Kong, graciously orchestrated by our host, Dr. Anthony Chan, was the most fun opening to a conference I've ever seen -- the Lion Dance. This traditional ritual promotes a long life and a good conference, and it started the meeting with energy and fun. I was honored to be asked to paint the eyes of the lion, which wakes it up at the beginning of the dance. As you can see, the lion got up close and personal with the front row and welcomed us to Hong Kong with some real flair.
 

 
Hmm ... perhaps our own conference services department could add this to the list of available entertainment options.
 

MD Anderson's Institute for Cancer Care Excellence recently published an analysis of anticipated health care reform legislation in the noted journal CANCER and, along the way, illustrated why its research is vital to the future of MD Anderson and the cancer care community.

The review article, which appeared online Nov. 8 in CANCER, outlined the many implications of the 2010 Patient Protection and Affordable Care Act and the Health Care and Reconciliation Act on Cancer Care Delivery. Signed into law last March by President Obama, the two health care reform acts open insurance coverage and ensure access to health care services to millions more Americans.

While the authors write that the true impact of these reforms will not be realized for several years, the cancer care community should anticipate changes in the short-term related to quality reporting and measurement, health care delivery systems and payment structures. They also outline what reforms mean for cancer-specific interests such as hospital re-admissions, prevention services, molecular diagnostics, clinical trials and professional education and call on cancer care providers to  engage in ongoing discussions about quality reporting and care delivery.   

Read the full article in CANCER.

MD Anderson's Institute for Cancer Care Excellence, created in 2009, has been at the forefront of cancer patient care, exploring outcomes, delivery and cost of multidisciplinary care but there is much work to do. Led by Thomas W. Burke, M.D., executive vice president and physician-in-chief; Thomas W. Feeley, M.D., vice president for medical operations and head of the Division of Anesthesiology and Critical Care, and Ron S. Walters, M.D., associate vice president for medical operations and informatics, the Institute for Cancer Care Excellence will play a crucial role at MD Anderson in developing the next generation of cancer care delivery systems, keeping patients the focus of care, enhancing safety and delivering care at a reasonable cost.

Kopetz_Head.jpgFor metastatic colorectal cancer, there has been increasing recognition that certain molecular changes in the genes of the tumor (often called biomarkers) can help predict the benefit from certain chemotherapies like cetuximab

One of the most frequently used biomarkers is the KRAS mutation, which predicts lack of efficacy to cetuximab and panitumumab. This has been replicated in at least a dozen large randomized studies. Several recent developments have added complexities to what had appeared to be a clear biomarker and a consistent treatment algorithm. 

Recently, investigators from Europe reported that this relationship may not be straightforward for one of the more common mutations in KRAS (Tejpar, Bardelli et al., JAMA '10). Related work has identified other less common, mutations in additional regions of the KRAS gene, but the clinical implications of this are also not clear for these mutations. Adding to this complexity is the recognition that additional genes, including BRAF and NRAS, may also modulate this sensitivity. 

Recently BRAF was included in the treatment recommendations from the National Comprehensive Cancer Network (NCCN) which are commonly used as a guideline for best practices in the community.   However, as additional data was acquired, this relationship became less clear and there are calls for this to be removed from the guidelines until further clarity is provided. 

These findings collectively reiterate several broad themes in clinical oncology: 

  1. Biomarkers are a constantly evolving field for colorectal cancer and many other tumor types.
  2. Dissemination of the best practice patterns for biomarkers will require a new model of physician education. 

An effort to include broader interpretation of biomarkers in test results to physicians is one necessary step to improve care. As the biomarker field continues to add complexity to clinical care, it provides opportunities for integration of electronic decision models into patient care.  Ultimately, this added complexity will improve the outcomes of patients, and should be embraced and included with recognition of the evolution of this field. 

For biomarkers, nothing is constant but change.

Black and White Hurdles David MorrisAfter a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband, Tom, was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective.
Read more posts in this series

Tom's doctor told him he knew he would make it when he stepped into the hospital room during his rounds and saw him shaving, just a day after he was moved from ICU.

"What a relief," I thought when Tom shared the news with me. "So, maybe he'll get through this, even though they hadn't been able to remove all the cancer."

But the harsh reality of our situation set in when one of the nurses at the pod told me, "We didn't think we would see him again." My heart skipped a beat and I realized how lucky I was to still have Tom with me.

He'd made it through the first challenge, but there would be plenty more in the next 2½ years. Another piece of great news was that John Hairston, M.D., Tom's urologist and surgeon, recommended he see Eric Jonasch, M.D., assistant professor in the Genitourinary Clinic at MD Anderson, for the next course of action.

The next hurdle

Once Tom was home, my mission was to get his records from the referring hospital to MD Anderson. Tom's journal on Sept. 28 says, "Hurry up records to MD Anderson." That wasn't so easy.

My notes from that period express frustration that someone in medical records at the first hospital was holding things up. On one hand, Tom needed to heal from the excruciating surgery, but he had an aggressive form of cancer -- a ticking time bomb, if you will -- that warranted immediate attention.

I did my level best to get his information to the institution that carries the mission of Making Cancer History®.

My temperament was at the boiling point, when five days later on Oct. 4, 2004, Tom's records still hadn't reached Susan, the MD Anderson liaison. She was as perplexed as I that they hadn't arrived. She reiterated the required laundry list: all diagnostic tests, pathology reports, patient history and a discharge summary.

Thankfully, the slides arrived the next day, but since nothing else had, I paid a visit to the referring hospital to pick them up in person. Unfortunately, I was advised that since I wasn't the patient, I couldn't take possession of them. Another cause for frustration that day appears in my journal entry, "Three weeks since Hairston contacted MD Anderson on Tom's behalf, and still no appointment!!!!"

A couple more days, void of progress and peppered with frustrating phone calls, passed before Tom's records made it to his next care team. On Oct. 8, 2004, my journal entry says, "Got an appointment Nov. 9 at 10:30 a.m., with Dr. Eric Jonasch. Finally! Yea!"

Some progress being made

Six years later, progress has been made at MD Anderson and other institutions with the development of the electronic medical record or EMR. This system allows referring physicians an opportunity to view patients' records, although it doesn't necessarily make it easier to get the records released from the hospital of origin or get a quicker appointment.

As you can imagine, any wait seems too long when a loved one's life lies in the balance.

Angels in the wings

During your journey, I hope you encounter someone like Laura James, now retired from MD Anderson's Health Information Management group, in the handling of patient medical records. I was lucky to meet James during the taping of a video about employees celebrating 40 years with the institution.

Although James didn't have direct patient or family contact, she always kept her mother in mind throughout her workday.

"I think of my mother being in the hospital," James says. "I would want all her information on the right patient chart, and I wouldn't want any problems."

We can all hope to have a Laura James looking out for our best interests. After all, there are plenty of other things patients and their caregivers must deal with in this curious game called life.

Photo By: David Morris CC  

Thumbnail image for snowflake.JPGBy: Laura Nathan-Garner, MD Anderson Staff Writer

This time of year, there's plenty to look forward to: Time with family and friends. Tasty food. Gifts. Holiday decorations and parties.

But getting ready for the holidays can be pretty nerve-wracking. Here are just a few reasons fans of MD Anderson's Focused on Health Facebook page are feeling a little stressed this holiday season:

"The expense of Christmas. I wish we would go back to singing carols and putting fruit in the stockings!"  -- Cindy R.

"I just started chemo again so I'm thinking of ways to make it less stressful but still create memories, eat good food, enjoy family and friends." -- Jean W.

"Just all the craziness during the holidays ... and by the time they get here everyone is so stressed out you don't even enjoy them ..." -- Marlene R.


The good news is that most holiday stress is short-term. But for the sake of your health, it's still important to curb your tension before it extends well into the new year.

Find quick tips for beating holiday stress in this month's issue of Focused on Health.

You'll also get tips for sneaking exercise into your holiday to-do list and recipes for healthy, mouth-watering snacks to serve at your next holiday gathering. Plus, you'll learn how to make your own family medical history tree, so you and your loved ones can boost the chances of celebrating many more holidays together.

For more tips on how to enjoy a healthier holiday season, follow us on Twitter and join our conversations on Facebook.

Beauty_barber_shop.JPGLike the patients who frequent it, the new Beauty/Barber Shop at MD Anderson is now a more beautiful place.

As part of the Alkek Hospital expansion project, which added nine inpatient floors to the existing building, patients can come to a larger, brighter and more attractive location for free haircuts, shampoos, shaves, scalp massages and wig fittings or stylings. It's also more accessible, now that it's on Floor 6 of Alkek Hospital.

The new shop, which opened last week, has been designed like a salon with five styling stations, two shampoo bowls, two stationary hair dryers and plenty of display room for wigs, scarves, turbans and other accessories. The shop is open and airy with windows looking out toward Reliant Stadium and the Texas Medical Center, and the wood paneling, pendant lights and rain-beaded glass add to a spa-like atmosphere.

The Beauty/Barber Shop is staffed by two certified cosmetologists who have worked at MD Anderson for many years and every day witness the lift that a shampoo or styling can bring a patient. Volunteers -- many who are survivors -- also work in the shop, helping patients with their choice of scarves or wigs.

The Beauty/Barber Shop is a program of MD Anderson's Department of Volunteer Services. All services are free and available on a first-come, first-served basis.

Coping With Cancer At Work

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Learning you have cancer is scary and confusing enough.

Thinking about how you'll manage to keep your job during cancer treatment adds another layer of worry and stress.

A three-part series in Network, MD Anderson's newsletter for patients, survivors and caregivers, is exploring ways to cope with your job after a cancer diagnosis.

From deciding whom to tell (or whether to disclose your diagnosis at all) to making a plan to deal with job responsibilities, to knowing your legal rights, the series aims to be relevant and meaningful.

marisaramirez_network1.jpgThe first article, in Network's summer issue, featured cervical cancer survivor Marisa Ramirez, who found her job a refuge in a time of uncertainty.

"I really didn't know who I was going to be as a cancer patient. But I knew how to go to work Monday through Friday, doing media relations for Interfaith Ministries," she recalls.

"I put my back up against that, and it helped me be more positive."

Ramirez says her coworkers offered prayers and support, but "followed my lead" when it came to dealing with her illness.

"I sensed that if I felt it was too much to handle, they would, too."

How did you deal with working through cancer treatment? Any tips for those newly diagnosed and facing this issue? Tell your story in the "Comments" link at the top of the article.

Read the Full Article in Network Newsletter

MD Anderson experts covered multiple aspects of cancer prevention at the American Association for Cancer Research Frontiers in Cancer Prevention meeting.

Powel Brown, M.D., Ph.D., professor and chair of MD Anderson's Department of Clinical Cancer Prevention, chaired a session on novel targets and strategies for breast cancer prevention.

In an AACR video interview, he also discusses early detection, the role of growth factors and hormones in the growth and metastasis of breast cancer and external risk factors for the disease that women can modify to help prevent it.




Provost and Executive Vice President Ray DuBois, M.D., Ph.D., presented a wide-ranging report on a joint think tank between AACR and the National Cancer Institute about the future of cancer prevention.

In a subsequent video interview with AACR, DuBois highlighted three areas among many addressed by the project:

  • Ensuring adequate federal funding for prevention clinical trials, which by their nature take longer than clinical trials that test new treatments.
  • Engaging pharmaceutical companies in chemoprevention development, which is expensive, time-consuming and has a higher bar for side effects than therapeutic trials.
  • Building public awareness of how cancer begins and develops and how to prevent it.




He also addresses possible scientific priorities for Stand Up to Cancer.

Follow Ray DuBois, M.D., Ph.D. on Twitter

Rivera.jpgThe appointment of Edgardo Rivera, M.D., as medical director of Banner MD Anderson Cancer Center is a critical milestone in the ongoing development of the specialty medical center, which is scheduled to open in the fall of 2011 on the Banner Gateway Medical Center Campus in Arizona.

"Dr. Rivera comes to the center with a diverse clinical background, not only with strong ties to MD Anderson in Houston but with extensive experience interfacing with community physicians and other health care institutions," says Thomas Burke, M.D., executive vice president and physician-in-chief at MD Anderson. "We're confident that he'll successfully build, and effectively lead, the team that will deliver expertise in cancer care at Banner MD Anderson Cancer Center."

Rivera is a medical oncologist who most recently worked at Methodist Hospital's Breast Center in Houston as the medical director. He also has served as chief of the Breast Medical Oncology Section and associate professor of medicine in the Department of Breast Medical Oncology at Methodist Hospital.

Rivera received his post-graduate training at MD Anderson and joined the faculty here as an instructor in the Department of Breast Medical Oncology in 1996. He progressed through assistant professor and associate professor positions in that department. In addition to his patient care responsibilities, Rivera trained oncology fellows and medical students, and he received the 2003 MD Anderson Outstanding Educator Award. He also served in numerous administrative positions at MD Anderson, including medical director of the Breast Medical Oncology Long Term Follow-Up Clinic, supervisor of the Breast Medical Oncology Anticoagulation Clinic and associate medical director for the Nellie B. Connally Breast Center.

In his medical director role at Banner MD Anderson Cancer Center, Rivera will develop the center's clinical vision, strategy and focus. He will direct all cancer program clinical activities and act as the lead clinical representative.

"I'm so excited for this opportunity," Rivera says. "We have two excellent organizations in Banner Health and MD Anderson partnering to offer the best quality in cancer patient care, which will also bring MD Anderson's multidisciplinary vision and practice to the Southwest."

When the cancer center opens, patients will be cared for in a new three-story, 120,000-square-foot outpatient center supported by 76 beds on two floors inside Banner Gateway Medical Center. The outpatient center will house physician clinics, medical imaging, radiation oncology, infusion therapy and many support services.


Just as cancer treatment is becoming more tailored to better strike a patient's tumor with minimal side effects, so cancer prevention is on the path to a more personalized approach.

Scott Lippman, M.D., professor and head of MD Anderson's Department of Thoracic/Head and Neck Medical Oncology, led a plenary session on the topic at the annual meeting this week of the American Association for Cancer Research Frontiers in Prevention in Philadelphia.

"We focused on various biomarkers that predict a person's cancer risk or response to a preventive intervention that are in clinical trials or are very close to clinical trial," Lippman says.

Lippman cited a model of head and neck cancer risk prediction that combines behavioral and medical history factors with genetic variations associated with susceptibility to recurrence or development of a secondary cancer. He reviewed research by Xifeng Wu, M.D., Ph.D., professor in MD Anderson's Department of Epidemiology, and colleagues that has honed the model's predictive ability by steadily adding single-point genetic variations that are linked to a patient's vulnerability to recurrence or a new cancer.

"We are moving toward having the ability to put individuals in specific risk groups that reflect their likelihood to benefit from an intervention, not only in chemoprevention but also with other interventions, such as smoking cessation options," Lippman says.

He covers these topics, including challenges to personalized prevention and other issues in a video podcast filmed at AACR. Lippman also is editor in chief of the AACR's journal Cancer Prevention Research.



Lippman also moderated a news briefing on the emerging science of chemoprevention Monday. That podcast also is available from AACR.

The Emerging Science of Chemoprevention
Moderated by Scott Lippman, M.D., editor-in-chief of Cancer Prevention Research and professor and chair in the Department of Thoracic/Head and Neck Medical Oncology at The University of Texas MD Anderson Cancer Center.

Resources

Links to releases about work presented at the AACR briefing:

Alkek team roomThe surroundings may be new, but their same care team will be their constant as 48 patients wake up today on the first floor to open as part of the Albert B. and Margaret M. Alkek Hospital expansion.

Last night, leukemia patients housed on the Alkek Hospital's 10th floor were moved to the 16th floor where they were settled into spacious rooms each with a large picture window, a cozy sitting area for family complete with pullout sleeping accommodations, Internet connections, expanded work desk and business area, and two flat screen televisions. The rooms have cherry hardwood-look flooring and are painted in soft earth tones. A full private bathroom is located between the patient's bed and the family's sitting alcove.  

Nurses and health care teams reported to work this morning in new surroundings as well with decentralized work stations much closer to patient rooms, rather than a single nursing station.

The nurses' work areas are complemented by meeting areas for multidisciplinary teams that feature new technology. Nurses also are able to check on patients through a small observation window with blinds in each room, allowing patients more privacy.

Also new for families and visitors is a family waiting area, nearby but separate from the inpatient unit.  The waiting area features large picturesque windows, wireless Internet connection, a television lounge, pantry and selection of vending machines.

Alkek Family Waiting AreaThe newly opened 16th floor is the first inpatient unit to open as part of the nine floors added to the Alkek Hospital. Additional inpatient floors will open gradually after the first of the year, as well as an observation deck and patient sitting area on the 24th floor.

The Alkek Hospital expansion project includes 503,000 square feet of new construction and will provide an additional 389 inpatient beds, bringing the current available beds to 702. Future build-out will increase the total number of beds to 962,which includes inpatient units in the adjacent Lutheran Pavilion.



Krystal Sexton, Ph.D., talked to Time Magazine about her research last Friday morning,   then reviewed it again for a room full of colleagues, friends and family that afternoon to complete the final step for her doctorate.

 
Monday, her results were displayed on a poster at the annual American Association for Cancer Research Frontiers in Prevention meeting in Philadelphia.

Sexton found that obesity is not associated with breast cancer risk at any age for Mexican-American women. And unexpectedly found that gaining weight during adulthood reduces breast cancer risk.

"Obviously, we aren't recommending that women go out and gain weight," Sexton said. "These results are preliminary and need to be validated in a larger study. Obesity remains a risk factor for cardiovascular disease."

Sexton studied 148 Mexican-American women who had breast cancer and 330 in a control group who did not have it.  "We found that risk fell by 8 percent for every 5 kilograms (11 pounds) gained," Sexton said.  Weight was analyzed at ages 15, 30 and at diagnosis or an equivalent age in controls.

One hypothesis for the risk reduction: Women who are overweight or obese enter menopause earlier, which reduces their lifetime exposure to estrogen, thus decreasing their cancer risk.  Women who did not have breast cancer in Sexton's study entered menopause two years earlier.

Her study highlights an important point, that you can't study one population group and assume that the findings apply to others. Most previous research showed that obesity reduces breast cancer risk for premenopausal women and increases risk for post-menopausal women, but focused on non-Hispanic white women almost exclusively.

A massive literature search by Sexton turned up hundreds of studies of white women, but only a handful that looked at Mexican-American or African-American women.

Sexton said her career will be devoted to understanding such health disparities.  She will continue the breast cancer study as a postdoctoral fellow working with Melissa Bondy, Ph.D., professor in MD Anderson's Department of Epidemiology in the Division of Cancer Prevention and Population Science.

She conducted her research with Bondy as a Susan G. Komen fellow in breast cancer disparities research at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health.

By: Lorenzo Cohen, Ph.D. and Anil Sood, M.D., Ph.D.

Cohen_relaxmediation.jpgWe live in a world filled with stress. Everything from the pace of daily living to more difficult life situations, such as loss of a job, divorce and health issues, make it almost impossible to avoid stress.


The event itself (the stressor) is not what causes the feelings of stress, but rather our response to the stressor. This is an important distinction as we are not always in control of the stressors we encounter, but we can control how we react to them. 

The big problem is that the prolonged experience of stress affects almost every biological system in our bodies. 

It all begins in the brain with a cascade of neuropeptides and stress hormones that flood the body. These changes dysregulate the immune system, negatively affect intracellular functioning of all cells in our body and can directly affect gene expression. For example, chronic stress has been found to shorten telomeres (which are on the ends of our chromosomes), which are intricately involved in the process of aging.

Yes, unmanaged chronic stress will speed the aging process. And that's not all. Chronic stress increases your risk for heart disease, sleep difficulties, digestive problems and depression. It also makes you more likely to forego healthy eating and exercise habits that help prevent cancer and other diseases.

At MD Anderson we're often asked if stress can influence risk of cancer and progression of disease once you have cancer. While short-term or acute stress is adaptive in our lives, chronic stress can result in adverse effects on health.

Although most patients believe stress had a role in causing their cancer, the evidence doesn't support a direct link. This may in part be because of the difficulty in conducting this kind of research, but also due to the multitude of factors that influence cancer growth. However, research has found a stronger association between chronic stress and the progression and spread of existing cancer.

Recent studies using animal models have shown that in addition to contributing to a weakened immune system, stress hormones can directly impact the tumor micro-environment and speed the progression of disease. More research is needed to further understand the biology of this effect in humans, as well as therapeutic strategies that may help combat the deleterious effects of chronic stress.

There are many ways to help reduce the stress we feel in our everyday lives. Some factors that cause stress cannot be controlled. But for the things you can control, it's important to find ways to avoid them or balance them with stress-reducing activities. For the stressors in your life you can't control, you have to focus on yourself, make time to do things you enjoy and engage in regular stress management.

Try these strategies for stress management:

1. Practice yoga or seated meditation.
Movement-based mind-body activities like yoga are very helpful forms of stress management. Yoga's focus on gentle movements, breathing and meditation helps relax both the mind and body. Yoga's benefits include improving sleep, mood and quality of life. Any kind of mind-body practice can get the job done. This includes practices from the Chinese tradition, such as Tai Chi or Qigong, or practices from Tibetan traditions that focus on meditation and quieting the mind. In fact, meditation has been found to influence gene expression

2. Sign up for art or music therapy.
People have been making music and art for thousands of years to heal -- and express -- themselves. Today, many people are working with art and music therapists to curb stress and improve self-esteem and communication. Best of all, you don't need to be a talented artist or musician to reap the benefits.

3. Take a hike.
Ward off the stress of urban crowds, noise and traffic by putting on your tennis shoes and taking a hike. People who spend time walking through the forest experience far less stress and have a lower heart rate, pulse rate and blood pressure than those stuck in the city, according to a recent study. Regular physical activity is, of course, important for overall health and it also reduces stress.

4. Get a massage.
By stroking, kneading or stretching different muscle groups, a masseuse can relax areas that have tensed up. Plus, research shows that massage can reduce pain and anxiety. Massage won't eliminate stress in the long run, but it can help reduce short-term tension.

5. Resist sugar cravings.
While sugar may cheer you up and give you a big energy boost, it's very short-lived. When the sugar rush disappears, you end up feeling worse than before and in many cases, people end up feeling depressed or guilty for eating unhealthy, which just feeds their stress. If you really need your sugar fix, eat a piece of fruit. The fiber will keep you from crashing after your sugar high and keep you full longer. Plus, you won't feel guilty about making unhealthy food choices -- and you'll pack on cancer-fighting nutrients, according to the American Institute for Cancer Research.

6.  Accept help and support from others.
Having a network of friends, family, neighbors and others in your life to rely on can provide you support and help you to manage stress. Several studies have found that cancer patients with the most social support had better quality of life and lived longer than those with the least amount of social support.

It is OK if these stress-reduction strategies don't appeal to you. Different things work for different people. You can reduce stress just by doing your favorite hobby. The most important thing is to find what works for you and regularly make time for relaxation.

Many people think they do not have time to manage their stress. But five minutes a day is often enough, and the reality is we need to make time to take those five minutes.

Excerpts of this post originally appeared in Focused on Health, MD Anderson's healthy living newsletter.


Related Links:

Department of Integrated Medicine at MD Anderson

J Clin Oncol. 2010 Sep 10;28(26):4094-9. Host factors and cancer progression: biobehavioral signaling pathways and interventions.

Cancer Res. 2010 Sep 15;70(18):7042-52. The sympathetic nervous system induces a metastatic switch in primary breast cancer.

J Soc Int Oncol. 2010 8(2): 43-55. Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer


By Will Fitzgerald, MD Anderson Staff Writer

A first-of-its-kind study has found that CT scans detect lung cancer at an earlier, curable stage in the population at highest risk compared to traditional X-rays -- resulting in 20% fewer deaths from the disease. Until now, there's been no recommended screening tool to detect early lung cancer. However, these results may be a major breakthrough.

 

MD Anderson was one of 33 sites that participated in the NCI-led trial. Reggie Munden, M.D., professor in the Department of Thoracic Imaging, is the study's principal investigator at MD Anderson. In this video, he explains the findings, significance and hope that could transform the way lung cancer is detected and treated.

Resources
Lung cancer trial results show mortality benefit with low-dose CT (NCI news release)

Video from ABC News

A good thing about Hodgkin lymphoma is that frontline combination chemotherapy cures 80% of patients. A bad thing about Hodgkin lymphoma is that there has been no standard therapy for the other 20% after chemotherapy, radiation and blood stem cell transplant fail.

A new, highly targeted therapy seems on course to change that. The drug is an antibody that homes in to a surface protein found almost exclusively on Hodgkin lymphoma and other rare lymphomas. Once there, the drug enters the cell and unloads a toxic chemical.

Of 45 patients in a Phase I clinical trial, 17 (38%) had an objective response to the drug, 11 complete remissions and six partial. Results from a Phase I trial of SGN-35 are reported in the Nov. 4 New England Journal of Medicine. CT scans showed 36 of 42 patients (86%) had their tumors shrink.

"That level of objective responses to a drug is impressive for a Phase I trial," says study lead author Anas Younes, M.D., professor in MD Anderson's Department of Lymphoma/Myeloma. "These encouraging results are being confirmed in a large Phase II trial, the results of which are expected to be released in December."

Seattle Genetics developed the drug, also known as brentuximab vedotin, by linking an antibody to the CD30 protein with a potent cytotoxin to form a conjugate medication.

For years, drug companies neglected Hodgkin lymphoma because the population of people with relapsed or resistant disease is small. The American Cancer Society estimates that 8,490 new cases will be diagnosed in 2010 and 1,320 people will die of the disease.

"Hodgkin lymphoma patients have waited 40 years for a new therapy," Younes says. "The potential impact on years of life saved is huge because the median age for this disease is in the 30s."

BryanCrowell.jpgBryan Crowell, 41, a lawyer in Atlanta, remains in remission more than two years after completing the trial. This video includes Bryan's story.

Jason Sonnier, 35, moved home to Louisiana after his computer tech job at Enron disappeared with the company in 2001. Two years later, a sore throat led to a Hodgkin lymphoma diagnosis. He went through chemotherapy and radiation, a brief remission, followed by more treatment, finally undergoing high-dose chemotherapy and a blood stem cell transplant. Relapse occurred, more radiation followed.  

In early 2008, Jason entered the clinical trial. He had an allergic reaction to the second dose and went off the drug. However, about a month later, his disease went into remission.

"It's been a long road and this is one of my longest stints without treatment," Jason says. "I'm clean and clear, and that's good."



Resources
Armed Antibody Triggers Remissions for Hodgkin Lymphoma  (News release 10/3/2010) 
MD Anderson Lymphoma Resources on Facebook
Follow Dr. Younes on Twitter



MD Anderson Cancer Center offers an internship in clinical ethics. Interns in the program learn more about clinical, research and/or organizational ethics and truly contribute to activities and projects of the Section of Integrated Ethics here. 

One of the interns, Lilian Alvarez, tells us more about her experience in clinical ethics.

Lilian, tell us more about yourself.

I have a background and degree in philosophy and more than five years of community health education experience. 

I have worked for several other health organizations, including the UT Medical Branch in Galveston and various breast cancer non-profit organizations, managing and developing health education programs. I have also worked extensively with local communities, providing health education and organizing local health coalitions.

My main interest is to help strengthen individuals and communities to become sufficiently empowered so as to make well-informed health decisions. My interest in clinical ethics stems from a desire to see that every patient's rights and autonomy is well respected in the health setting given their medical situation.

Why did you apply for a clinical internship?

My goal was to obtain first-hand knowledge of clinical ethics in practice and observe situations with major ethical dilemmas. Also, to learn the method for analyzing ethical dilemmas in the hospital setting and how to participate in the decision-making process.

What have you done so far during your internship?

I've attended weekly clinical rounds with physicians, social workers, patient advocates and clinical ethicists to discuss patient cases. I've also attended several monthly events where physicians visit the community to provide palliative and hospice care to patients.

The "easiest" part of this internship was having the opportunity to attend all activities and rounds related to clinical ethics. The most challenging part of the internship has been to maintain focus without becoming too involved with the varying cases and not "take home" the patient issues and dilemmas of the day.
    
What are the most important things you've learned during this experience?

I have truly learned what it means to be a clinical ethicist and about the current status of the field. It was refreshing to know that many others within the field have the same passion to protect patient rights. Also, I've gotten very good advice from my mentor on the best academic route to becoming a clinical ethicist.

What comes next?

I want to utilize my law degree in combination with my experience as a clinical ethics intern to better protect the rights of the patient in and out of the hospital setting.

 

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