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If you're a caregiver, in the midst of your expanded role carrying intense emotions and challenges, it's vital that you learn to take care of yourself.

I've been an employee at M. D. Anderson Cancer Center for almost 10 years. Not long after I began working here, I learned about the well-woman exams given through the Cancer Prevention Center - a mammogram, a pap smear and a good ol' general going-over was included, along with the bonus of an official blue M. D. Anderson patient card. At that time, it seemed to me that this card might be a handy thing to have in my hip pocket - just in case, you know.

Really and truly, I never dreamed that it would be me who would become an "employee with cancer." Why on earth would something like that happen to a nice girl like me? I had no notion that it ever would, but sure enough, it did.

In truth, it wasn't that coveted blue card that got me in the doors of M. D. Anderson. It was just a simple call for an appointment. Rumor has it that it's impossible to become a patient in this cancer center, but I'm here to tell you that this isn't so.

If you have cancer, and I will always pray that this doesn't happen to you, M. D. Anderson is the place you want to be. M. D. Anderson is currently (and consistently) ranked by U.S. News & World Report as the No. 1 cancer center in the country - really in the world. M. D. Anderson knows all about cancer - the doctors, nurses and other staff here will give you the latest and greatest treatments available. Bottom line, you can count on M. D. Anderson.

I must be honest, my cancer journey has definitely been paved by my many friends here at the institution. But, it's an entirely different experience to walk through the front doors of Clark Clinic as a patient versus as an employee.

I'll never forget the first time I did that. I was greeted by a volunteer who I loved. She threw her arms out wide to hug me and said, "Ohhhhhhhh, Gail." I walked a few steps forward and ran into my favorite UT policeman, James. "Miss Gail, what's this I've been hearing about you?" he asked. Then, the other person in the elevator on the ride up to the Brain and Spine Clinic was another friend. My family was astonished and couldn't believe that I knew all of these people. M. D. Anderson is a huge place, you see.

But, if you want to know the truth, M. D. Anderson is a warm, caring family. The folks here usually take care of you like one of their own. Like I said before, brain cancer was never something that I expected to happen to me, but it's been a great way to expand my list of loved ones.

The New York Times article by Gina Kolata -- Forty Years' War, A Place Where Cancer Is the Norm -- made my heart swell with pride to be part of the M. D. Anderson team and my eyes well with tears for those whose struggles she wrote about.

I think about the thousands of patients I have had the honor to care for over the last 30 years. I wish Kolata could have met my patient Dorothy.

Flashback to 1979, I was a new oncology nurse at M. D. Anderson when I met this 38-year-old, petite and strikingly beautiful brunette who had advanced cervical cancer. Her doctors at home told her that she had only one year to live.

Dorothy came to M. D. Anderson searching for treatment that would allow her to live to see her 10-year-old daughter graduate from high school. She entered a clinical trial receiving intra-arterial chemotherapy using a then-new drug named Cisplatin. Dorothy received this drug for four months. It wasn't for the weak of heart. She lost her hair, vomited and was exhausted for two weeks after the chemotherapy was completed. Just as she began to feel "normal," it was time for the next round of therapy. Then the treatment regimen was complete. 

For the next five years or so, I saw Dorothy when she returned for her doctor's visits. We'd share stories about our families while she anxiously awaited her test results. After her doctor would give her the results of yet another "clean" CT scan, she would give us a hug and huge sigh of relief.

Dorothy beat her cancer with what I think Kolata would call "unconventional treatment." For Dorothy, this was a clinical trial.  

It's a matter of time. I have no doubt about it. The human will, determination and intellect that invented electricity, the phone, the radio, airplanes, the polio vaccine and penicillin, and that put a man on the moon, will definitely find the cure for cancer. Yet, I agree with most, including those who expressed their frustration in the recent New York Times article, that the war on cancer is taking too long to win. It's a war that we have to win. 

According to the American Cancer Society (ACS), 1,479,350 people in the United States will be diagnosed with cancer this year, and it's expected that 562,340 will die from it. In fact, cancer is the second most common cause of death in the U.S., accounting for 23% of all deaths. This means that one of four people living in the U.S. will eventually die of cancer.

By Tomise Martin, Staff Writer

When Patrick Williams was diagnosed with an aggressive form of brain cancer called glioblastoma multiforme, the three constants he'd always cherished -- family, laughter and colleagues -- helped him cope.

A 27-year veteran of the fire department in Ocean Spring, Miss., he recalls feeling lightheaded and unable to find his balance one day after a staff meeting.

"I couldn't focus, and I needed to brace against a wall for support," Williams recalls. "All I wanted was to go home and take a nap."

Luckily a friend and colleague, trained as a registered nurse, noticed Williams' difficulty and quickly reacted.

"Initially, he and I joked about me slowing everyone down," Williams says. "The banter turned to concern once he heard my symptoms."

As the colleague was taking him to a local hospital, Williams had a seizure. Tests showed he had a brain tumor and would need surgery. It was unknown whether the tumor was cancerous or non-cancerous.

"When anyone mentions cancer, my family thinks of M. D. Anderson," Williams says. "There was no question about my next step."

His first appointment
Days later, surrounded by a group of friends and family, Williams arrived for his first M. D. Anderson appointment.

His surgeon, Sujit Prabhu, M.D., associate professor in the Department of Neurosurgery, told him the tumor was stage IV glioblastoma multiforme, the most common form of brain cancer, and was located in his right parietal lobe. Prabhu explained that the side effects from surgery could include blurry vision, impaired spatial orientation and headaches.

Three days later, Williams emerged from surgery unable to see images to the far left.

"If a board read 'nurse manager,' I would only see 'n rs  m nager,'" Williams says.

Although Prabhu described the possible side effects very clearly, Williams felt unprepared for the outcome. He still considers the experience unreal.  

Multidisciplinary care
With a team of brain cancer experts, including a neurosurgeon, neuro-oncologist and a radiation oncologist, Williams benefited from M. D. Anderson's multidisciplinary approach to cancer care.

After surgery, he met with Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology. She checked his neurological functions and discussed the remaining treatment options -- chemotherapy, radiation and clinical trials.

"With chemotherapy and radiation still available, I had no desire to try the third option," Williams says.

Loghin prescribed Temodar® (temozolomide), an oral therapy found to be effective for some patients with glioblastoma multiforme, and referred Williams to Anita Mahajan, M.D., associate professor in the Department of Radiation Oncoloy, for radiation therapy.

To complete his radiation treatments, Williams moved to Houston. While the side effects of treatment were hair loss and nausea, his spirits stayed high with frequent family outings and dining at his favorite restaurants.

Try, try again
During a follow-up appointment with Loghin about six weeks later, Williams learned that the brain cancer had not responded to chemotherapy. As a result, he chose to join a Phase II clinical trial studying the effectiveness of XL184, an investigational drug, on glioblastoma multiforme.

In January 2009, he received the good news that some tumors had disappeared or stopped growing.

Life as a brain cancer survivor
Life has changed. Williams has retired as fire chief of the Ocean Springs fire department and his energy level has dropped. But his vision has cleared enough so he's able to drive again on a limited basis.

"I plan activities with their needed recovery time," Williams says. "One day of fishing is followed by two days of rest."

But he doesn't let these new details hamper life. He's usually cracking jokes or surrounded by his friends and family. A brother-in-law always accompanies him to follow-up appointments, which are every four weeks.

"I'm fortunate to have the love and support of my family," Williams says. "Life is what you make of it. I choose to live mine filled with laughter and surrounded by my loved ones."

Related article:
Q&A: Coping With a Brain Cancer Diagnosis and Treatment

M. D. Anderson resource:

Brain and Spine Center

Additional resources:
Brain Tumors (American Cancer Society)

Brain Tumor (NCI)

A cancer diagnosis can be a shock. But a brain cancer diagnosis is even more challenging. A malignant brain tumor can impact patients' thoughts, speech and communication, and motor skills, and perhaps their ability to financially support themselves or their families.

Brain cancer is a rare disease that originates in the brain, spinal cord or nerves. According to the American Cancer Society, more than 22,000 people will be diagnosed and nearly 13,000 will die from brain cancer in 2009.

Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology at M. D. Anderson, answers questions on how to deal with a diagnosis and cope with the side effects of both the cancer and its treatment.

What can I expect during my first appointment?
During the first appointment, I always discuss the patient's diagnosis and treatment options. Many patients, however, feel overwhelmed during this appointment and may choose not to discuss details about treatment. In this case, I advise them to take it one step at a time and only gather information that they're able to cope with during their first visit. I suggest having a loved one present during appointments. They can provide emotional support through this process and be an extra pair of ears.

Here are some key questions to ask at a first appointment:
•    Is this a definitive diagnosis?
•    What type of tumor do I have?
•    What are my treatment options?
•    What support services are available to assist during my treatment?

What are the treatment options?
Depending on your diagnosis and type of cancer, a combination of the following treatments could be available:
•    Surgery
•    Radiation
•    Chemotherapy

Each treatment and the associated side effects are discussed with the specialist managing a patient's care.

As a neuro-oncologist, I manage the patient's chemotherapy. We discuss the side effects and concerns the patient or caregivers may have regarding therapy.

The selection of chemotherapy is based on the type of tumor and functional status of the individual diagnosed with the disease. If a patient is physically or mentally impaired, I choose a therapy with low toxicity. In addition, monitoring the individual's health during treatment is very important. When discussing treatment options with the patient, I share my reasons for choosing the chemotherapy, the side effects and any support M. D. Anderson offers.

What are the side effects of chemotherapy?
The usual side effects of therapy are:
•    Nausea
•    Constipation
•    Vomiting

How will treatment impact daily life?
Because chemotherapy impacts each patient differently, it's challenging to anticipate how each one will respond to treatment.

For some patients, chemotherapy may not impact their lives. They can continue working full time and maintain their full neurological functions. This isn't always the case, however. Those receiving treatment may be unable to continue working, which could impact their ability to financially support their families.

My goal is to help patients and family members cope with potential changes in their lives. I explain that treatment can leave patients unable to complete tasks that were once easy for them. They may not be able to think as quickly as before. When psychological effects like these arise, I involve our psychiatry team. The psychiatry team can help those diagnosed and their family members cope with these changes.

At M. D. Anderson, we have an education clinical pharmacologist on staff help monitor  each person's care. Every eight weeks, I evaluate patients' responses to treatment and the impact on their health. These evaluations allow me to make any necessary changes to the treatment schedule. If patients are responding to treatment, we discuss whether or not they can return to work -- or do so on a part-time basis.

What services can patients and caregivers seek to help them adjust and cope?
•    Look for social workers in your community. They can assist with transportation, parking or support at home. If patients exhibit neurological deficits, social workers can evaluate patients' at-home needs through home health support.
•    Sometimes a therapist can help patients and caregivers cope with a cancer diagnosis and the emotional side effects from treatment.
•    Many communities have support groups available to patients and their caregivers. These groups offer support and guidance from others who are facing or have overcome similar challenges.

Related article:
Love and Support Help Gulf Coast Resident Cope With Brain Cancer (November Cancerwise FA1)

M. D. Anderson resources:

Monica Loghin, M.D.

Brain and Spine Center at M. D. Anderson

Additional resources:

Brain Tumors (American Cancer Society)

Brain Tumor

By Bayan Raji, Staff Writer

For some cancer patients, reactions to certain medications and treatments create tingling sensations -- similar to when you sit on your foot too long -- that don't go away.

This tingling, known as neuropathy, typically begins on the palms of the hands or the soles of the feet. Eventually, it may become painful and debilitating.

About half of cancer patients who receive chemotherapy drugs experience neuropathy. In about one-eighth of patients, the pain may become chronic.

Drugs may play a role

Neuropathy can be caused by radiation, surgery or chemotherapy drugs, including taxanes, platinum, Oncovin® (vincristine) and Thalomid® (thalidomide). It often is irreversible and even may worsen over time.



Common symptoms of neuropathy include:
•    Numbness
•    Tingling
•    Prickling
•    Burning, shooting or pinching pain
•    Cramping

Patrick Dougherty, Ph.D., professor in the Department of Anesthesia and Pain Medicine at M. D. Anderson, says patients should bring these symptoms to the attention of their doctors.  

Cause may be elusive

Some doctors believe neuropathy is caused when the interaction between nerve endings and the surrounding tissue is affected during chemotherapy. However, no concrete evidence exists to explain the origins of the neuropathy some cancer patients experience.

"The cause may be difficult to determine because these drugs are very different from one another, and they work differently to kill the cancer cells," Dougherty says.

Trial and error may be necessary

Allen Burton, M.D., chair of the Department of Pain Medicine, says doctors may try several methods to reduce neuropathy symptoms.

"When the symptoms are acute, and the patient is receiving, or has recently finished, chemotherapy, the oncologist may lower the dose or extend the time between doses of the drug that are suspected of causing neuropathy," Burton says. "Often, the problem drug is a component of a combination chemotherapy regimen."

Drugs used to treat severe or chronic neuropathy cases include:
•    Opioids (pain medications)
•    Anticonvulsants such as Neurontin® (gabapentin) and Lyrica® (pregabalin)
•    Antidepressants such as Cymbalta® (duloxetine) or Elavil (amitriptyline)

These medications, in conjunction with physical therapy, often help reduce pain and restore the patient's ability to function, Burton says. Occupational therapy may be useful if the patient's hands are affected by neuropathy.

Alternative therapies may help

In addition to medication, doctors may advise patients to try integrative medicine approaches. These may include:

•    Physical therapy
•    Acupuncture
•    Aromatherapy
•    Heat therapy

Dougherty recommends patients work down the list to find therapies that work for them. The most helpful place to access information to these and other alternative therapies is a multidisciplinary pain center, he says.

"It's important to note that certain methods may work really well for some patients but make the pain worse for others," Dougherty says.

Risk isn't clear

Doctors aren't able to determine fully who is at risk for neuropathy. Dougherty says his general impression is that younger patients are more likely to experience it than older patients, but no real explanation exists.

Clinicians at M. D. Anderson are working to develop a pain level chart to better categorize the sensations of neuropathy.

In addition, researchers are conducting several clinical trials for patients with or at risk for neuropathy. Contact askMDAnderson at 1-877-MDA-6789 for information.

Related articles:

Bridging the Divide (Conquest)

Cancer and Neuropathy (Patient Power webcast)


M. D. Anderson resources:
Peripheral Neuropathy

Department of Pain Medicine


Additional resource:
Peripheral Neuropathy Caused by Chemotherapy (American Cancer Society)

By Dawn Dorsey, Staff Writer

Getting a good night's sleep when you have cancer can be a challenge. In addition to treatment side effects and anxiety, a condition known as restless leg syndrome (RLS) gives some sleepers fits.

As many as one-tenth of adults are affected by RLS, according to the American Academy of Sleep Medicine. It's likely that figure is even higher among cancer patients.

What is RLS?

RLS, which happens most frequently at night when a person is at rest, causes a strong, undeniable urge to move the legs. Many people with RLS also have paresthesia,  uncomfortable feelings deep in the legs that often are described as burning, tingling or prickling.

Many people with RLS also have periodic limb movements, in which muscles tighten, twitch or flex when they are resting. These movements may wake them or another person sleeping nearby.

RLS and its accompanying conditions are roadblocks to sleep quality and quantity, which is so important to the health of cancer patients. Among other dangers, sleep disruption may affect the immune system and endocrine (hormonal) function, since hormones are produced during certain levels of sleep.

Triggers are varied

RLS causes may include:

•    Iron deficiency
•    Medications including:
•    Nonprescription allergy and cold medicine like Benadryl®
•    Antidepressants like Elavil® and Prozac®
•    Major tranquilizers like Haldol®, Mellaril®, Thorazine®
•    Family history of RLS

Solutions depend on severity

For mild cases of RLS, try:

•    Establishing a regular daytime exercise program
•    Taking hot baths
•    Getting leg massages
•    Using a heating pad
•    Avoiding alcohol
•    Doing stretching exercises like yoga or Pilates late in the day

If your iron levels are low, talk to your doctor about oral or intravenous iron treatments.
More severe RLS may be treated with drugs including:

•    Requip® (ropinirole) or other dopaminergic agents
•    Benzodiazepines, such as Valium® or Xanax®
•    Opiates, such as Vicodin®

If you experience RLS symptoms, tell your doctor or health care provider.

Related article:

Cancer Patients Need to Treat Sleep Disorders

By Laura Sussman, Staff Writer

While older women with early invasive breast cancer are increasingly undergoing breast conserving surgery (BCS), commonly known as lumpectomy, significant socioeconomic and geographic disparities still preclude some from receiving the therapy, according to a study published in the Journal of the American College of Surgeons.

Led by Grace Li Smith, M.D., Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Radiation Oncology, the study compares the use of lumpectomy to that of the other surgical option available to women with early invasive disease, mastectomy.

Combined with radiation, lumpectomy has proven to be as effective as a mastectomy for the treatment of early invasive breast cancer, yet previous studies have reported that less than half of all patients eligible receive this option, said Smith.

"Treatment of nonmetastatic invasive breast cancer has improved significantly over the past several decades, but we continue to fall short of the goal to treat every woman with the highest quality of care," said Smith.  "Our study suggests that barriers exist that may prevent may women with breast cancer - especially those in poorer areas, areas with low education levels, rural communities and counties with few radiation oncologists - from being offered every treatment that should be available to them."

For the retrospective study, Smith and her M. D. Anderson colleagues used Medicare claims to examine the treatment history of women 65 and older who were surgically treated for invasive breast cancer in 2003.

Of the 56,725 women identified, 59 percent underwent a lumpectomy, compared to 41 percent who received mastectomy. BCS was used most frequently in women younger than 70 and had no lymph node involvement. In contrast to mastectomy, the study also found BCS more prevalent in areas with low poverty, high education, a high population of treating radiation oncologists and/or in larger metropolitan areas. Looking at geographic regions, the researchers found that women in the Northeast and Pacific West were most likely to receive the procedure, while the South and parts of the Midwest were the least likely.

Smith hopes that results from the study may prompt physicians and patients to work together to overcome some of the barriers to treatment.

"Physicians may be able to help women identify specific barriers to their care and be influential in helping patients overcome such obstacles," suggested Smith. "Or, if there are concerns or misconceptions about surgical options, patients themselves may play a role by becoming educated about the value of lumpectomy as an appropriate therapy, and helping to disseminate this information into their communities."

Sitting with the boys from Little League and their parents on Saturday night, a parent (and friend) surprised me when he said, "I know a lot about your Dad." He told me my Dad's name and he knew that his birthday was on Valentine's Day. It turns out that he had met the spouse of a former patient of mine, and she remembered me fondly and recalled this information that I had shared. I wondered ... what was the context for me sharing this about my Dad and was that appropriate?

The next morning, I read the front page article in the New York Times about M. D. Anderson Cancer Center. The question on my mind after reading this article is whether or not the story captured the essence of our top-ranked institution. 

There are many perspectives on the story, depending on whether you talk to faculty and staff or patients familiar with M. D. Anderson, or other people who are mesmerized by the story but unfamiliar with our center. To me, of the images and various vignettes in the story, the most striking was that of a singular mission -- to eliminate cancer in Texas, the nation and the world -- and an ambitious and compassionate approach.

You would have to be living on a deserted island these days not to hear about health care reform. Reforming the American health care system was a key aspect of President Obama's domestic agenda and Congress is moving this initiative forward.

 But advocacy and industry groups, the public and elected officials, and even policy wonks have been talking about the need to make reforms to our nation's health care system for years. While one group's interest may be slightly different than the next, all are voicing their opinions on what's working and what's not working. One voice that needs to be heard is that of cancer survivors.

So as health care discussions continue this fall, be sure to let your family and friends know your perspective about what's important. Attend any health reform town hall sessions scheduled in your area and voice your opinion. Talk with or write to your elected officials and let them know to consider cancer survivors' needs as they set about reforming the system.

This is the story of one cancer survivor's effort to ensure her voice was heard. http://www.allbusiness.com/government/elections-politics-politics-political-parties/13000980-1.html

At a loss of what to say? Most of the time, our elected officials just need to hear our stories. But if you want to say more than that, an advocacy group for cancer survivors, the National Coalition for Cancer Survivors, has posted Lance Armstrong foundation posted its cancer policy platform. Also read the National Conference of State Legislatures Cancer Survivorship: State Policy Issues

Maurie Markman, M.D., vice president for clinical research at M. D. Anderson, talks about a study in Japan with Paclitaxel and Carboplatin, a standard regimen for the treatment of ovarian cancer.

The study results, published in The Lancet on Sept. 20, indicate that dose-dense weekly Paclitaxel plus Carboplatin improved survival of women with epithelial ovarian cancer and may represent a new treatment option.

Markman says, "Here's an example of where we take an established drug and simply learn how to give it better, and we have an important impact on our patients' lives."




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