New study shows that grapefruit juice could help patients avoid side effects associated with high doses of anti-cancer drug. Photo courtesy Shutterstock.

A daily glass of grapefruit juice more than triples the benefit of taking an anti-cancer drug by itself, according to a new clinical trial funded by the National Institutes of Health. The combination could help patients avoid side effects associated with high doses of the drug and reduce the cost of the medication.

The preliminary study, published in Clinical Cancer Research, shows that eight ounces of grapefruit juice a day can slow the body’s metabolism of a drug called sirolimus, which has been approved for transplant patients but may also help many people with cancer.

“Grapefruit juice, and drugs with a similar mechanism, can significantly increase blood levels of many drugs,” says study director Ezra Cohen, MD, a cancer specialist at The University of Chicago Medicine, “but this has long been considered an overdose hazard. Instead, we wanted to see if grapefruit juice can be used in a controlled fashion to increase the availability and efficacy of sirolimus.”

Grapefruit juice’s pharmaceutical prowess stems from its ability to block intestinal enzymes that break down sirolimus and several other drugs (ask your doc and pharmacist if your pills interact with the juice). In Dr. Cohen’s study, participants who drank eight ounces of grapefruit juice a day increased their sirolimus levels by 350 percent.

“This is the first cancer study to harness this drug-food interaction,” the authors note.

Levels of sirolimus-inactivating enzymes in the body can vary, so testing the amount a patient produces may help predict his or her response to grapefruit juice. However, the ingredients found in grapefruit juices may vary even more than patients’ enzyme levels, Dr. Cohen says.

An early version of the study used canned grapefruit juice, generously donated by a Chicago-based grocery chain. But tests of the product found it lacked the necessary active ingredients. So the researchers shifted to a frozen concentrate product supplied by the Florida Department of Citrus. Further research is needed to confirm the promising findings.

Grapefruit Juice Supplements Anti-Cancer Drug The Saturday Evening Post

Ann Kim today: “Here I am with my two sons on New Year’s Day this year. We’re at Ocean Beach in San Francisco. They were just 3 and 7 when I was diagnosed, and now they are young men. I am so grateful for each day I have with them.” Photo courtesy Ann Kim.

Shortly before my 39th birthday, when I was taking a shower, I felt a lump about the size and shape of a pea in my right breast. I felt a chill go through my body. A week later, on my 39th birthday, I got a biopsy. When the doctor called with the results (I was setting out the birthday cake for my older son’s seventh birthday), the news was bad: I had breast cancer. I wanted to cry, but I couldn’t. It just felt surreal.

In literature and film, medicine is often depicted as a paternalistic profession, with patients given little information and expected to follow their doctors’ orders blindly. In real life, my experience was the opposite. Instead of having an all-knowing doctor telling me what to do, I found myself with a team of doctors relying on me to make the critical treatment decisions. I was like a president with advisors, but I knew nothing about the topics, and the choices and the information were overwhelming. What I expected was Dr. Brilliant Guide; what I got was Dr. Me.

My first appointment was with a pre-eminent breast surgeon at a top-rated comprehensive cancer center. She carefully laid out the options for me: lumpectomy with radiation or mastectomy with reconstruction. The lumpectomy would mean a less invasive procedure and a quicker recovery but also require several weeks of daily radiation and a lifetime of mammograms and MRIs. The mastectomy would entail more invasive surgery and a longer recovery time but eliminate the need for radiation and ongoing screening. Long-term survival odds were the same. My surgeon had no recommendation either way.

Anxious to get her to cast a vote, I tried a personal approach. I had Googled my surgeon before the appointment and found that we were of the same age and ethnicity, and we were both mothers. “You and I could be sisters—twins, even,” I told her. “If you were in my shoes, what would you do?”

Ann Kim during chemotherapy in 2005: “This is one of the few photos I have of myself when I was bald. My sons and I are cuddling together in bed during a trip to Yosemite in the winter.” Photo courtesy Ann Kim.

She paused before answering. “Whenever women ask me that, I tell them that it’s a personal decision, and that I can’t make it for them,” she said. “But when I look at you, I see myself. I would choose a mastectomy with reconstruction.”

I was grateful for her answer but also frustrated on behalf of other patients. Why do doctors express their much-more-informed opinion so reluctantly?

I had more decisions to make when I met with a plastic surgeon. He laid out the options: saline implant, TRAM flap (which uses skin, fat, and muscle from the belly region to construct a breast), or LAT flap (which uses skin, fat, and muscle from the back region to construct a breast). I chose to get an implant, but I developed severe capsular contracture, which is when scar tissue forms around the implant and causes painful stiffness and hardening of the tissue. After multiple surgeries, I had to remove the implant altogether. In retrospect, I wish I’d considered the choice of no reconstruction at all, but it was not something that I even thought to discuss with the plastic surgeon, nor did he mention it to me.

The hardest phase of my medical training was choosing an oncologist, the person responsible for administering chemotherapy and other systemic cancer treatments. Weeks had passed since my surgery, and I was convinced that the cancer was already beginning to spread. I wanted to begin chemotherapy right away. But the oncologist offered me the most intimidating set of choices yet.

I could take four rounds of Adriamycin plus Cytoxan, either at four-week or three-week intervals. I could add four rounds of Taxol or Taxotere, again at either four- or three-week intervals. I could participate in a clinical trial in which I would receive either a new drug called Herceptin or a placebo. After my chemotherapy ended, I could choose to take five years of an oral hormonal drug called Tamoxifen, or I could suppress my ovaries by taking a drug called Lupron or Zoladex and take five years of an Aromatase Inhibitor such as Letrozole (brand name Femara), Exemestane (Aromasin), or Anastrozole (Arimidex), or I could take five years of Tamoxifen and follow it up with another five years of an Aromatase Inhibitor.

My head was spinning. Having spent an hour describing the options, the oncologist had run out of time and had to move on to her next patient. Rather than recommending a particular course of treatment, the oncologist told me and my husband to go home and think about it and make an appointment to meet with her again.

I didn’t want to wait several more weeks mulling over treatments I didn’t really understand. At my friend’s suggestion, I met with another oncologist. He offered the same options as the first oncologist but recommended a specific course of treatment and gave strong supporting reasons for it. I appreciated that he was advocating an aggressive approach (adding a third chemotherapy agent and combining ovarian suppression with an Aromatase Inhibitor). But, mostly, I was grateful for a straightforward answer. He became my oncologist.

For young women with breast cancer, treatment decisions often extend beyond surgery, radiation therapy, and oncology to medical specialties such as genetic counseling, fertility planning, gynecology, psychiatry, physical therapy, and primary medicine. Unfortunately, even at a comprehensive cancer center, the patient must coordinate these various disciplines. And if you go “a la carte” like I did, mixing and matching doctors in different practice groups and at different hospitals, good luck.

In the end, I had to create an Excel spreadsheet just to keep track of my appointments: breast surgeon every six months; mammogram every year (ideally just before the breast surgeon visit so that we could discuss the results); MRI every year for the first two years (ditto, but scheduled six months from the mammogram); oncologist every four months for the first five years, then every six months thereafter; ditto for the blood test with tumor markers; PET/CT every year for the first three years; bone density test every year for the first five years (to track the bone thinning effects of the Aromatase Inhibitors); MUGA heart scan every few months for the year of Herceptin (owing to the cardio-toxic effects of Herceptin and Adriamycin); gynecologist every six months; primary physician every year; and so on. I was able to keep track of this because I’m fairly organized. But what about most people?

In many respects, the collaborative approach that doctors take to cancer treatment is welcome. No one wants a high-handed doctor making treatment decisions without the patient’s involvement or understanding. But a patient can’t in the end play the role of doctor. We might want to know why a doctor is recommending something; but we still want a recommendation. Also, many of us need a guide just to navigate all the appointments and logistics, which can be Byzantine.

Today, nearly eight years after my initial diagnosis, I continue to be vigilant in monitoring my health. (Hormone-sensitive cancers like mine have a “long tail”—meaning they can recur 10, 15, even 20 years after diagnosis.) I read articles and books about cancer. I attend lectures and take notes about the latest treatments. And I participate in a breast cancer support group.

If, knowing what I know now, I were able to go back in time and advise myself on how to be Dr. Me, I would have said three things that I also say to new acquaintances in similar circumstances. The first is that you should always bring a family member or friend to your appointments and have him or her take notes. Often, we patients are so overwhelmed that we can’t remember what we were just told or don’t ask any questions. The second is that you must take care of your whole self. Treat yourself to delicious and healthful food every day. Watch a funny movie and laugh with your friends. Take naps and hot baths as needed. The third is that you should feel free to complain. I have seen too many friends suffer in silence, whether it’s nausea from chemo (doctors often prescribe the cheapest anti-nausea drugs before moving up to the more powerful stuff) or simply trouble getting an appointment. If the front desk or support staff are unhelpful, tell your doctor—doctors don’t want to lose you as a patient.

In an ideal world, of course, no patient would have to shoulder so many responsibilities along with trying to get well. One of the best improvements that could be made would be for patients with cancer to have a “patient advocate.” If you were diagnosed with cancer, the medical center would partner you with a professional patient advocate who would guide you through the cancer treatment process. The patient advocate would set up appointments for you, make sure your care was coordinated, and offer general health-related suggestions (alternative treatments, massage, nutrition classes, support groups). The advocate might even accompany you to appointments and help you with decision making. This would go a long way toward letting those with serious conditions have the luxury of being patients, so that they don’t have to be Dr. Me.

Ann Kim is the president of Bay Area Young Survivors (BAYS), a support group for young women with breast cancer in the San Francisco Bay area.

Article originally published at Zócalo Public Square (zocalopublicsquare.org).

Going it Alone The Saturday Evening Post

While it is well known that caregivers in general are more prone to depression and physical illness than the rest of the population, few have looked into the particular challenges for those who do so from afar. One who has is Polly Mazanec, Ph.D., assistant professor at Case Western Reserve and an advanced practice nurse at University Hospitals Seidman Cancer Center. I spoke to Mazanec about her findings, which were published recently in Oncology Nursing Forum.

Q:  Looking at the differences between local caregivers and distance caregivers, what jumps out at you?

A: Long distance folks were significantly more anxious and the female caregivers in particular had higher depressive symptomatology. But what was most concerning, both groups had distress scores that exceeded the National Comprehensive Cancer Center guidelines for intervention.

Q: In other words, they ought to be getting help. Are they?

A: Local caregivers are getting help. Distance caregivers are not. In my work as an advance practice nurse in a comprehensive cancer center, there is a whole team to support the patient. There are multiple opportunities for care, including emotional and spiritual support. The team can also assist the family, both with practical matters and general guidance. With distance caregiving, families are left out in the cold.

Q: What are the greatest sources of stress for the distance caregiver?

A: The uncertainty and the guilt. Not knowing exactly how a patient is doing from day to day; wishing one could be there to provide more support; not knowing when or how often to visit. In many ways, that last one is the hardest question: if one can only afford to come visit for one week, when should that be? There’s the cost of travel, the commitment to a job, and the competing needs of one’s own family.

Q: In your article, you described a caregiver whose mother had advanced cancer. She waited until after the chemo to make her visit, but found her mother terribly debilitated and barely able to communicate. This individual was filled with regret, and wished she had gone earlier. When is the best time to pay that visit?

A: Just as when people ask, “Is my loved one dying?” we can’t answer that question exactly. But, we can help the caregiver decide on the timing. Some have a relationship where they would like best to be helping with the details, cleaning, administering medications, and so forth. Others would like to be there when the patient is feeling better so they can talk, do a “life review,” or spend time going to lunch and doing something fun. It really boils down to the need for improved communication both with the nursing and support team and among the family.

Q: Not all families are good at communication. It’s not too hard to imagine some parents responding: “If you were a good son or daughter, you wouldn’t come for a one-week visit. I’m dying and I want you to move out here for six months.”

A: Every family has issues. If a parent were to say something like that, it would almost be a gift. I would look at that as an opportunity to have a family meeting, even if it had to be by video conference. At the meeting, the support team would encourage the patient to talk about the anxiety that was causing the patient to wish for something that wasn’t possible. It’s essential to address those disruptive feelings before all that guilt is placed on the caregiver.

Q: Is distance caregiving ever an advantage?

A: It can be. For our study, one person said a parent who was normally uncomfortable with personal matters seemed able to speak more freely over the telephone. I also hear from some people that the distance allows the relationship with a parent not to be all about the illness; the discussion turns to grandchildren or the patient’s relationship with people in the community.

Q: In communicating long distance, what’s most important?

A: Being upfront, expressing your true wishes to be able to help as best you can, despite the limitations. For the caregiver, it’s also important to remember that it’s okay to have those feelings of guilt and worry: that’s actually part of the job. It’s certainly not an easy one. Things are so different from 100 years ago when everyone lived next door.

Steven Slon writes a regular column about aging and caregiving for Beclose.com. He is the editorial director for The Saturday Evening Post.

Distance Caregivers Aren’t Getting Help They Need The Saturday Evening Post

“But you’re not religious,” said a female acquaintance. Her remark spilled across the tablecloth like a tipped-over glass of red wine.

“I used to go to church every Sunday,” I said, somewhat defensively. “And I went to Christian youth camp one summer.”

I went on to explain that Lourdes gets more than six million visitors each year, and I highly doubted every single person who visited the famous grotto of Massabielle was a staunch Catholic.

But who was I trying to convince, her or me?

True, her verbal stoning made me momentarily doubt my bonafides as a miracle seeker. But though not a devout Catholic, I had a good reason for the pilgrimage; being diagnosed with malignant melanoma at age 50 was reason enough. My cancer is what clinicians call Stage IIIB. Look it up. Words like “prognosis somewhat poor” and “very little chance” leap off the screen. Still, my decision to make the trek had been built on monumental hope. For months I had been imagining myself there, miraculously saved. In the end, I took this woman’s ugly remark as one of the many disconcerting side effects of having cancer and handled it the way I do with doctors’ sad faces and negative statistics—I ignored it.

I am running alongside track 19 through the Montparnasse train station toward the silvery vessel that will transport me from Paris to the Pyrenees to the place I’d been dreaming of since I was 15 when I watched the film classic The Song of Bernadette. The thought of standing at the grotto where a young peasant girl, Bernadette Soubirous, saw the Virgin Mary appear 18 times in the year 1858 makes me euphoric.

I have less than two minutes to find the designated rail car stamped on my ticket. It seems a never-ending distance. Traveling too fast, my suitcase tilts on its rickety wheels and falls over.

“S***!” I scream. As I collect my bloated baggage sprawled across the pavement, a nun crosses my path. Uh oh, I think. She’ll probably send up word on high that there’s a foul-mouthed American woman on the way. That won’t bode well for my chances for the “miracle” list. Boarding the train, I notice a sickly bald lady who looks as though she’s undergone intense chemotherapy treatments. Near her is an extremely frail teen boy in a wheelchair reading a French translation of The Hunger Games. Both of these angelic souls seem more worthy of a miracle than I. I’m certain neither of them has ever cussed in front of a nun.

Lourdes, France, became world famous after the Virgin Mary reportedly appeared to 14-year-old Bernadette Soubirous. Photo courtesy Jill Paris.

Looking at me, you’d never know my plight. People say I look “fantastic” six months after undergoing two major surgeries. The first excised the tumor on my upper left arm and removed two sentinel lymph nodes to determine if the cancer had spread. The cancerous culprits indeed had set up camp in the first node. And my physician, the world-renowned Donald L. Morton of the John Wayne Cancer Institute in Santa Monica, California, next recommended removal of my axillary lymph nodes (which form a sort of chain from the underarm to the collarbone) despite the painful side effects such as permanent nerve damage and the potential threat of lymphedema, or swelling.

“You don’t have to have chemo?” some people question. “No radiation?”

“Nope.”

“Wow, that’s great,” they say.

I guess that the thought that I won’t lose my long, blonde locks and shrink down to a skeletal frame or puke uncontrollably while sporting a headscarf is an upside. The downside is that there is no treatment or cure for this stage of melanoma—only more cutting should a new cancer emerge. My job is to be vigilant should I note anything suspicious, then to hightail it into the office for further study. This is, quite frankly, terrifying. No neon sign points to the location of a fresh melanoma. My doctor says that the next one will most likely not sprout directly on my skin, but just under it, so I’m supposed to gently rub my (numb) five-inch scar where the first growth emerged, feeling for a new invasion.

The chance of recurrence is quite high. In fact, when you’re Stage IIIB, it’s not a matter of if, but when. So every six months I undergo PET scans or chest X-rays to detect if the cancer has progressed to the dreaded Stage IV. I call it the “mean test.”

They tell me my five-year survival chances are 60 percent.

Melanoma—a cancer of the skin primarily caused by sunlight —is often confused with curable basal cell and squamous-cell skin cancers. But melanoma is the eighth most common malignancy in the U.S., and its frequency is rising faster than any other human cancer. In the 1930s the survival rate for this disease was extremely low; now 5- and 10-year survival rates of Stage I melanoma are well over 80 percent on average. But there are different forms, stages, and classifications that each have different prognoses.

I have nodular type, which is the most aggressive. Even when I discovered an abnormally large mole that quadrupled in size in less than three months, both the nurse and a dermatologist I initially visited assured me it was “nothing.” I sensed that they were both wrong and demanded its removal and biopsy. A case like mine—where skin cancers masquerade as something normal—is a perfect example of why people should get checked regularly. Don’t let your best friend, partner, neighbor, or even your family doctor discourage you from seeking expert attention. Had I listened to my healthcare team, I may have left that HMO allowing my already aggressive cancer to flourish, and I would not be writing this today.

Living with cancer is a learning experience. Part of that learning is to avoid the many misconceptions. Everyone knows somebody who has, or has had, cancer. They are quick to offer medical, herbal, even spiritual advice as well as clinical trial information. Truly, I am touched whenever someone offers any hope they feel may erase my diagnosis. But if I hear one more person tell me the story of their Aunt Jean who had skin cancer for four years and now is totally fine, I’ll lose it. (No offense Aunt Jean.) All melanomas are not alike.

“Is this your first time at Lourdes?”

I look up at a frail-looking pilgrim just beside me in the line for the sacred grotto.

“Yes,” I say.

Also in search of a miracle, Selam — whose name means peace — befriended Paris while at Lourdes. Photo courtesy Jill Paris.

The woman’s name is Selam. She has come from Vancouver, Canada, but originally hails from Ethiopia. She is 40 years old. Within seconds we are swapping war stories.

“Melanoma, Stage III,” I say.

“Colon cancer … I’ve been given six months to live,” she whispers.

I let her step in front of me and study how she grazes the grayish stone that leads to the niche with her left hand, stopping every few feet to kiss the rock. A white rosary entwined in her right hand swings gently from side to side.

I begin to copy her every move. If she makes the sign of the cross, I do, too. If she pats the water droplets that trickle from the cave-like surface and touches her face, I do the same. It is as if she’s been sent to me as a personal guide. Nearing the sacred spot, she begins to weep. I stroke her back the way a mother would soothe a child with a skinned knee.

She kneels before the statue of Mary resting high in an alcove. Dabbing moisture from the stone, my hand presses the gash on my upper left arm, but I forget to ask Mary for anything because of a deep concern for my new companion. Selam’s despairing sobs grow louder—agonizing wails echoing in an already hushed enclave.

Minutes later, she rises and turns toward me.

I open my arms wide and she collapses against me. We hold each other in a long embrace as though lifelong friends.

“I want you to have this,” I say, reaching into my bag for a vintage religious medal of Bernadette that a dear friend sent with me for luck. “Pin it over your heart. It will protect you.”

“Oh, thank you, my love,” she says. “I prayed I would meet someone here.”

Who knew my presence alone would answer a dying woman’s prayers? Fear of what I lacked spiritually had been eating away at me in the days leading up to this moment. But her words are like a salve.

Writer Jill Paris touches the smooth, moist walls of the Grotto of Massabielle, believed to be a source of healing. Photo courtesy Jill Paris.

As the two of us walk arm in arm, we sing aloud, butchering the lyrics to “Ave Maria,” giggling in between verses. We pass thousands of invalids, some on gurneys and many in wheelchairs, most assisted by unpaid hospitallers—volunteers who look like a combination of nun and nurse. I have a sudden, unexpected calling to be one of them.

Selam tries to disguise the immense pain she is suffering and insists on our sitting together for hours at a sidewalk cafe, wiling away the afternoon sharing our hopes, fears, and her desire to find one last love. As we sit and talk, any need to justify the depth of my religious belief seems to vanish.

I had arrived alone at the holy shrine, a restless soul beside those green fields, and rather than glimpse the image of the Virgin Mary I had my own singular and singularly valuable divine visitation. Melanoma had brought me to Lourdes and given me Selam, the woman whose name means “peace.”

Three days later, fighting back tears and promising we’d meet again, she gives me a final gift: a pocket Holy Rosary booklet complete with tiny red beads and crucifix.

“See? Now you never need worry,” she says sweetly. “You’ll always have the right words.”

Six months later, after a chest X-ray, I am classified as disease-free. I harbor much hope, but there is always my next scan. Upon returning from Europe, I would speak with Selam twice. Her cancer had rapidly spread, and she was bravely undergoing extreme bouts of experimental chemotherapy. Her last words to me were, “I’ll call you next week, my love.” That was several months ago.

Just recently I have signed up with Our Lady of Lourdes Hospitality North American Volunteers to become one of the thousands of companion caregivers that Selam and I had seen. Some of the pilgrims will understand English, and some will not. Yet I’m not too concerned about the language barrier. Selam showed me that faith does not require proficient verbal skills.

If she were here with me now I’d say, “Can you imagine? Me? Speaking French? Might as well be Swahili!”

She’d just smile and make the sign of the cross.

Miracle Seeker The Saturday Evening Post

According to Dr. Laura Garrett, veterinary oncologist at the University of Illinois Veterinary Teaching Hospital in Urbana, dogs and cats get cancer at the same rate that people do. But, she says, finding a lump or bump doesn’t automatically mean something malignant or fatal.

A lump that you may find on your pet could be one of several things: an infection, such as an abscess from a dog or cat bite; inflammation, like a small, localized reaction to a vaccine or a bug bite; or a tumor, meaning an abnormal growth of cells, which could be either benign (harmless) or malignant (invasive and potentially harmful to your pet’s health). The best way to determine the origin of the lump, and the best thing for your pet’s health, would be to have it examined by your veterinarian.

Typically, a veterinarian will measure the lump and then take a fine-needle aspirate. This is a process in which a small needle is used to take a sample of the cells in the lump. The veterinarian will then view the cells under a microscope to get an initial idea of what is causing this mass (another word for “tumor”). In most cases, the sample is then sent off to a lab of experts for a final evaluation.

“No doctor can determine if a mass is ‘safe’ just by looking at the lump itself or by feeling it,” Dr. Garrett says. That means that neither you nor your veterinarian can be certain that a mass is harmless without getting a microscopic look at the cells within via a fine needle aspirate or a biopsy.

If you do find a mass on your pet, you should be prepared to answer a few questions for your veterinarian: Have any changes occurred since you first noticed the mass? Does the mass seem to bother your pet? Has it been oozing any fluid or blood? If you answer “yes” to any of these questions, it might be a cause of increased concern, but answering “no” does not eliminate the possibility that the lump is a health risk.

Fortunately for middle-aged to older dogs, the most common lump they get is a lipoma–a benign, fatty growth. Most lipomas never become a problem, and also have nothing to do with the weight of the animal. Dr. Garrett recommends, “Lipomas usually need to be removed only if they are in a spot that bothers the pet or the owner or if the lump begins to change quickly.”

If the lump is not a lipoma, your veterinarian will try to determine what type of tumor is. If this can’t be done at your clinic, a cell sample or larger biopsy may need to be sent to a specialty diagnostic lab for examination.

If a tumor is malignant, your veterinarian will determine whether it has spread to other parts of the body by taking a fine-needle aspirate of lymph nodes, taking chest X-rays, or sometimes doing an ultrasound of the animal’s abdomen. A specialty oncologist such as Dr. Garrett has the knowledge of what tumors commonly spread, where they spread to, and how to treat them. Your veterinarian may refer you to a specialist if testing or treatment can’t be done at your regular clinic.

Treatment for malignant tumors depends on what type of cancer it is, but the range of options is very similar to what is available for human cancer patients. If the location of the tumor permits, surgery may be performed to remove it. Other tumors may be treated with various forms of chemotherapy. Luckily, dogs and cats usually tolerate chemotherapy much better than people.

“About 20 percent of pets have mild gastrointestinal upset, such as vomiting, diarrhea, or decreased appetite. A similar percent of pets may have low white blood cell counts that can predispose to infections, but a count so low that it can be life-threatening happens less than 3 percent of the time. Hair loss may be seen in dogs whose hair coats grow continuously (like poodles), but most dog breeds do not experience hair loss. Cats may lose their whiskers and guard hairs, making their coats more of a fluffy texture,” Dr. Garrett says.

Many cancers in cats and dogs can be cured if caught early and treated appropriately, according to Dr. Garrett. Getting new lumps and bumps examined by your veterinarian may prevent a disease from becoming more severe. Be sure to check with your local veterinarian if you have questions or concerns about your pet’s lumps and bumps.

Julia Disney is an Information Specialist at University of Illinois’ College of Veterinary Medicine.

Lumps and Bumps on Your Pet: What Could They Be? The Saturday Evening Post

Results from PSA screening for prostate cancer or cholesterol tests can take one week or less.

“But Pap smears for cervical cancer must be specially prepared before slides can be reviewed by medical lab professionals,” said David Glenn, chair of the ASCP communications committee.  “Most people don’t realize that an average Pap slide contains tens of thousands of cells, and the lab specialist is required to look at every cell. That takes time.”

Glenn advises patients to ask their doctors the following questions about their laboratory tests:

• What tests are you ordering?
• What will they tell you about my health?
• When will I know the results?
• Should I call you for the results, or will you call me?

“If it’s been a week, and you were told you would have results by then, call the doctor’s office,” he said.

Why the Wait?

Accuracy. To help safeguard against inaccuracies, federal legislation known as the Clinical Laboratory Improvement Amendments (CLIA) sets standards for laboratories to assure the testing is being performed accurately.  CLIA limits the number of Pap slides that can be read in one day by a cytotechnologist (a specially trained lab professional who examines cells for early signs of cancer and other diseases). A pathologist (a medical doctor with an advanced specialty in laboratory medicine) must review Pap slides that show abnormal or suspicious cells.  In addition to reviewing these tests, a pathologist also must review a percentage of normal Pap tests to ensure continual accuracy, according to CLIA regulations.

Complexity. Some tests require multiple and time-consuming steps. For example, a mole sample must be fixed in preservative, embedded in wax, cut into extremely thin slices, placed on slides, stained, and examined under a microscope by a pathologist. Special stains or further studies may be needed to make the diagnosis, and complete the report. Tests for strep throat or a urinary tract infection involve placing a specimen in a substance that allows bacteria or other microorganisms to grow to a level that can be seen, separating the organisms, and testing them to see if they are causing disease and what medications will be effective.

Priority Testing. Tests that may have an immediate impact on the patient’s care are ordered by the physician as a priority and processed first in the laboratory.  For example, an emergency room patient who appears to be in a diabetic coma will have a glucose test ordered immediately and results will be available within a few minutes so the appropriate treatment can be given as soon as possible.  Routine, non-urgent tests are processed by lab professionals as part of their normal workload.

Another factor that may add to lab wait times is the anticipated shortage of lab professionals.

“The aging of the population has led to a growing number of lab tests and ASCP is concerned that the current shortage of lab professionals may make it difficult to meet the public’s demand for prompt results,” said John E. Tomaszewski, MD, FASCP, president of ASCP and professor and interim chair of the Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia. Lab tests are involved in more than 70 percent of medical decisions.

According to the U.S. Department of Health and Human Services, 138,000 new laboratory professionals will be needed by 2012, but fewer than 50,000 will be trained.

More Survey Findings
The ASCP survey, conducted in part to recognize National Medical Laboratory Professionals Week (April 24-30, 2011), also reports that 74 percent of adults in the U.S. believe that at least 50 percent of doctors’ decisions are based on lab tests; 84 percent recognize that lab tests are conducted by laboratory professionals; 57 percent expect to get routine test results within a week or more and 41 percent expect them in a day or less, and 63 percent expect the results of biopsies that test for serious disease should be received within a day or less and 37 percent expect to wait a week or more.

[The ASCP consumer survey was conducted March 10-13, 2011, by Opinion Research Corp., Princeton, N.J.  More than 1,000 male and female adults over the age of 18 were randomly selected to participate in a telephone survey that focused on knowledge of the medical laboratory profession and lab results.]

Waiting for Lab Test Results? The Saturday Evening Post

Earlier research suggests that fish oil—which contains omega-3 fatty acids such as eicosapentaenoic acid—may help patients maintain or gain muscle. To test the hypothesis, a research team led by Vera Mazurak, PhD, of the University of Alberta in Edmonton, Canada, compared the effects of fish oil with that of standard care (no intervention) on weight, muscle, and fat tissue in people newly diagnosed with non-small cell lung cancer.

In the trial, 16 patients took fish oil (2.2 grams of eicosapentaenoic acid/day) during initial chemotherapy treatments which lasted about ten weeks and 24 patients did not.

Data show that patients not taking fish oil lost an average of 2.3 kilograms (5 pounds, 1.13 ounces) whereas patients receiving fish oil maintained their weight. Sixty-nine percent of patients in the fish oil group gained or maintained muscle mass. In contrast, 29 percent of patients in the standard care group maintained muscle mass, and overall, patients in this group lost 1 kilogram (2 pounds, 3.27 ounces) of muscle. No difference in total fat tissue was observed between the two groups.

“Fish oil may prevent loss of weight and muscle by interfering with some of the pathways that are altered in advanced cancer,” said Dr. Mazurak. “This holds great promise because currently there is no effective treatment for cancer-related malnutrition,” she added.

In addition, the investigators think that fish oil may be beneficial to patients with other forms of cancer and chronic diseases that are associated with malnutrition, as well as to elderly individuals who are at risk for muscle loss.

Click here for more health benefits of fish oil.

Do you take fish oil? Tell us why.

Article Source: “Nutritional intervention with fish oil provides a benefit over standard of care on weight and skeletal muscle mass in non-small cell lung cancer patients receiving chemotherapy.” Rachel A. Murphy, Marina Mourtzakis, Quincy S.C. Chu, Vickie E. Baracos, Tony Reiman, and Vera C. Mazurak,. CANCER; Published Online: February 28, 2011 (DOI: 10.1002/cncr.25709).

How Fish Oil Can Help Cancer Patients The Saturday Evening Post

But with so many choices, which treatments actually improve and protect the skin’s appearance, and which ones simply add a new wrinkle to the budget? The best way to answer that question is to look first at what it is you’re saving your skin from:

When outdoors, wear a wide-brimmed hat and tightly woven clothing that covers your body.

Block the Sun

Protecting your skin from ultraviolet (UVA/UVB) radiation exposure (including indoor tanning), extremes of heat and cold, and air pollution can significantly reduce your risk of wrinkles and skin cancer.

“Baby boomers didn’t know better and received a great deal of harmful sun exposure before sunscreens were available,” says Dr. C. William Hanke, an eminent dermatologist and past president of the American Academy of Dermatology. “Ultraviolet light causes malignant melanoma, as well as basal cell and squamous cell carcinomas, which are much more common skin cancers.”

Thankfully, broad-spectrum sunscreens protect against both UVA and UVB rays and are widely available today. They’re crucial for skin protection, and not just in the summer. While the sun’s UVB rays are strongest in the northern hemisphere May through September, UVA rays are present year round, penetrating windshields, light clothing, and office windows.

However, comparing the ingredients of one sunscreen to another can leave one bleary-eyed and confused.

“Check the product label,” advises Dr. Hanke. “Good broad-spectrum sunscreens have an SPF of 30 or greater and contain protective ingredients that include: avobenzone, ecamsule, oxybenzone, titanium dioxide, and zinc oxide.”

Choose a sunscreen that works best for you. People with oily skin may prefer an alcohol-based gel. Individuals with dry skin want a cream for moisture.

When applying sunscreen, don’t forget less obvious, but vulnerable areas, such as the ears, neck, and face—anywhere that is exposed.

“We see golfers in my clinical practice all the time,” says Dr. Hanke, who reports an increasing number of cancers on the lips, ears, and eyelids of outdoor enthusiasts who fail to adequately protect sensitive areas. “They golf for five or six hours at a time and need to wear sunscreens. The same advice applies to winter skiers as well.”

Clothing also adds an extra layer of protection. “Wear a hat,” stresses Dr. Hanke. “Men with hereditary hair loss who don’t wear hats are at higher risk for premalignant lesions and skin cancers—mostly squamous cell carcinomas—on their scalps. It can be a huge problem.”

When choosing sun-protective clothing, opt for dense, tightly woven fabrics.

“If you hold the hat or shirt up to the light and can see through it, so can the sun,” Dr. Hanke adds. “The hat should have a tight weave to protect the scalp.”

Today, most sporting goods companies, apparel stores, and online outlets sell sun-protective clothing.

Snuff Out Smoke

Aside from the serious health consequences, smoking and secondhand exposure is also bad for your skin—next in line to the sun in causing wrinkles. Nicotine impairs blood flow to the skin, accelerating the normal aging of epidermal tissue.

Keep It Clean

Science of Skin
Older skin is thinner and more fragile, and the deep layers 
contain less elastic tissue. Blood vessels are also less elastic, so that even minor injuries can cause bruising. The skin may be mottled with small, flat brown areas called lentigines (from the Latin word for lentils).

Young Skin: A thick outer layer and a large number of elastic fibers in the deeper layers help maintain the smoothness of young skin.

Older Skin: A thinner outer layer and fewer elastic fibers in the deeper layers result in skin that appears loose, with deeper creases and wrinkles.

Images reprinted from The Human Body, ©1995 Dorling Kindersley Ltd.

Facial hygiene is also critical. One of the first steps is choosing the right cleanser.

“If you have oily skin, you can use any soap you want, and it will probably not be irritating,” Dr. Hanke says. “The soap that I recommend for most people and use myself is plain white Dove. People with dry or oily skin can use it.”

For people with rough and scaly skin, occasionally using an exfoliant makes skin appear smoother and feel softer.

“As you age, dead cells build up on the skin surface,” Dr. Hanke explains. “Exfoliation removes the dead surface layer, and moisturizing helps keep skin soft.”

Cleanse your face twice a day—once in the morning and again at bedtime, then apply a moisturizer based on your skin type. For dry skin, opt for an occlusive moisturizer that covers the skin with a waterproof film through which water cannot evaporate or escape. For sensitive skin, some experts recommend applying a moisturizer containing soothing ingredients, such as bisabolol, a chamomile extract.

“As we get older, our skin is not the barrier that it once was,” says Dr. Hanke. “It dries out more easily. As a result, people need to moisturize their skin more frequently.”

Do high-end products equate with higher quality?

“Some inexpensive moisturizers such as Neutrogena and Oil of Olay are very good, as are some very expensive ones, such as La Prairie and LaMer,” notes the dermatologist. “Find one that works for you and does not irritate your skin.”

A word of caution: Don’t introduce too many products at the same time.

“Stick with one product line,” advises Dr. Hanke. “Different products can inactivate each other through chemical reactions and potentially irritate the skin surface.”

Rejuvenating Aging Skin

Innovations in anti-aging skin care are on the fast track to meet the growing demand of baby boomers (and their parents). From nonprescription “cosmeceuticals” to laser treatments, therapies are available that improve the skin’s surface texture, reduce irregular pigmentation, and help reverse the effects of sun damage.

Topicals: Typically used to address milder signs of aging. For example, retinol, a vitamin A compound, is the first antioxidant topical widely used in nonprescription creams and is the less potent cousin of tretinoin (Retin-A, Avage, Renova), a prescription-strength treatment for acne and fine wrinkles.The fastest growing segment of topical skin care, cosmeceuticals combine aspects of the cosmetic and pharmaceutical industries. Cosmeceuticals influence the function of the skin with biologically active compounds (vitamins, oils, herbs, and botanical extracts). Botanicals, for example, contain antioxidants that protect the skin’s surface. William Beeson, M.D., clinical professor in dermatology at Indiana University School of Medicine and noted facial plastic surgeon, has researched a cornucopia of compounds that rejuvenate skin tissues. His research led to the discovery of unique properties in rosemary, an herb that contains a potent antioxidant called carnosic acid. After demonstrating clinical efficacy, Dr. Beeson and colleagues developed a formulation called Effulgere (effulgere.com) that penetrates the skin surface more deeply and helps “protect the skin from further damage by enhancing the skin’s lipid barrier, brightening the skin, and improving its texture and tone.”

Chemical Peels: A chemical solution—such as phenol, tricholoacetic acid (TCA), or alpha hydroxy acids (AHAs)—that removes damaged outer layers of the skin, revealing the healthier layers below. Wrinkles from sun damage, aging, and heredity can be significantly reduced by undergoing a series of peels that also improve irregular skin pigmentation and remove early skin cancers (actinic keratoses).

Lasers: Many laser treatments are now used to minimize wrinkles, scars, skin discolorations (freckles or “age spots”), and blemishes on the face, neck, chest, and back of hands by removing the outer layer of skin (epidermis). The treatment simultaneously heats underlying tissues (dermis), stimulating the growth of new collagen fibers that form smoother, firmer skin. One of the more popular areas in minimally invasive cosmetic surgery, fractionated carbon dioxide (CO2) laser treatment is performed under topical anesthesia on select areas of damaged skin. The outpatient procedure creates microscopic holes in the skin, which then heal with new collagen that tightens skin and evens tone. Newer technologies offer surgeons a greater level of control in laser surfacing, permitting extreme precision, particularly in delicate areas.

Fillers: These reduce the appearance of facial lines and wrinkles by “plumping” furrows and hollows in the face, giving the skin a more youthful-looking appearance. Fillers (Juvaderm, Restylane, Gore-Tex) are very effective at contouring specific areas on the face, such as around the lips, including long, vertical “marionette” lines that start at the corners of the mouth and extend down the chin. Botulinum toxin type A (Botox, Dysport) injections also diminish lines and wrinkles associated with facial expression, including vertical lines between the eyebrows and on the bridge of the nose, forehead lines and furrows, and crow’s feet.

Saving Face: Skin Care Tips The Saturday Evening Post

Protection is the key to saving your skin. Fortunately, consumers have a wide array of choices of sunscreens, sunglasses, sunless tanning products, and clothing that offers coverage from the No. 1 cause of all skin cancers and the primary cause of aging—the sun.

To learn more about current measures to preserve the skin and reduce the appearance of sun-damaged, the Post interviewed dermatologist Zoe. D. Draelos, M.D., F.A.A.D., vice president of the American Academy of Dermatology. A consulting professor of dermatology at Duke University School of Medicine, Dr. Draelos is also editor-in-chief of the Journal of Cosmetic Dermatology and has written eight dermatology textbooks, 32 book chapters, and more than 300 scientific articles. She has served as president of the North Carolina Dermatology Association and as a member of the board of directors of the American Society for Dermatology Surgery.

PP: Why do so many products use botanicals in their ingredients?

ZD: Botanicals are usually used as antioxidants, which are designed to prevent the damage that occurred from UV radiation striking the skin. But botanicals can be used for many purposes in anti-aging products—for their anti-aging properties, to color or scent the product, and many other purposes.

PP: What do you see as the major anti-aging breakthroughs in skin treatment today?

ZD: One of the big breakthroughs is understanding aquaporins, which are responsible for regulating the transport of water and other small solutes across plasma membranes, ultimately acting as pores within the walls of skin cells to keep skin moisturized and hydrated.

Old-fashioned ingredients, such as glycerin, actually affect the amount of water the skin holds. Many moisturizers now contain very high glycerin levels. Anti-aging moisturizers attempt to reduce the appearance of fine lines and wrinkles by enhancing the skin’s water-holding capacity. Glycerin is a well-known emollient and lubricant that is great for dry skin. Glycerin—a basic ingredient for Corn Husker’s Lotion—has been rediscovered for its water-holding ability. When you increase the water-holding capacity in the skin, you can get rid of the fine lines of dehydration.

Many sophisticated fillers (see below) that doctors use to rid wrinkles contain a substance known as hyaluronic acid (HLA), which soaks up water. Holding water in the skin is a very powerful cosmetic tool to improve skin appearance. This water balance is like the spigot on the hose. When you turn the spigot down, not as much water comes out, so the skin is better hydrated. If you open it up and let a lot of water out, the skin becomes dehydrated. It may be that the aquaporin channels are defective and the reason why the skin dries out is because too much water is leaving the body. Understanding how aquaporins work would allow you to develop therapeutic moisturizers to increase the water-holding capacity of the skin and alleviate dry, itchy skin that is especially found in elderly people.

Rejuvenating Aging Skin

Innovations in anti-aging skin care are on the fast track to meet the growing demand of baby boomers (and their parents). Therapies are available that improve the skin’s surface texture, reduce irregular pigmentation, and help reverse the effects of sun damage.

Fillers: These reduce the appearance of facial lines and wrinkles by “plumping” furrows and hollows in the face, giving the skin a more youthful-looking appearance. Fillers (Juvaderm, Restylane, Gore-Tex) are very effective at contouring specific areas on the face, such as around the lips, including long, vertical “marionette” lines that start at the corners of the mouth and extend down the chin. Botulinum toxin type A (Botox, Dysport) injections also diminish lines and wrinkles associated with facial expression, including vertical lines between the eyebrows and on the bridge of the nose, forehead lines and furrows, and crow’s feet.

Saving Face: Exclusive Web Update The Saturday Evening Post

Laser energy

A new laser-equipped scalpel system from OmniGuide allows surgeons to more accurately aim energy beams deep inside the body, including the middle ear.

The innovative system directs infrared energy from a high-intensity carbon dioxide (CO2) laser through a flexible fiber tube lined with reflective material. Rigid lasers used for the past 30 years operate in a straight line only.

“The CO2 laser has been utilized in middle ear surgery for the past two decades,” explains ear specialist Dr. Bob Owens of Dallas, Texas, “But the OmniGuide BeamPath CO2 laser system allows an otologist (specialty ear surgeon) to hold the laser in a handpiece. This creates the greatest degree of surgical precision that can be obtained while operating in a microsurgical environment such as the middle ear space.”

Kayla, age 14, developed hearing loss from multiple ear infections that gradually immobilized tiny bones inside her ear. After undergoing the new laser procedure, she no longer needs a hearing aid.

“Conductive hearing loss occurs when patients have scarring or bone growth that ‘tethers’ the eardrum or ossicles (small bones of hearing),” Dr. Owens told the Post. “The OmniGuide laser divides the scar tissue and obliterates abnormal bone growth to free up the structures and allow better conduction of sound to the inner ear.”

Patients with cholesteatoma (abnormal tissue in the ear), a perforated eardrum, or otosclerosis (abnormal bone in the ear) may also benefit from the new laser surgery, according to Dr. Owens, who is one of the first doctors in the U.S. to use OmniGuide for hearing loss in children.

The FDA-cleared system is also utilized for brain, throat, and GI tract problems. Click here for video clips of laser therapy in brain cancer.

Radiofrequency waves

Calypso Medical’s “GPS for the body” uses tiny electromagnetic transponders to pinpoint the exact location of prostate cancer cells during radiation therapy. 

Experts know that organs in the body may shift during radiation treatments for prostate cancer. As a result, tumors may not receive the optimal treatment dose and nearby urinary and rectal tissue may be damaged by unintended radiation exposure.

Credit: OmniGuide

How the Calypso Works

1.     Doctors implant 3 transponders about the size of rice grains into the diseased prostate.

2.     Radiofrequency waves from the transponders communicate with external components of the Calypso System.

3.     A display screen continuously monitors the position of the prostate gland during treatment and alerts the therapist when the prostate drifts out of position. 

Findings from a February 2010 study show that Calypso’s real-time tracking technology enabled physicians to direct increased doses of radiation to the tumor while sparing surrounding tissue—a treatment strategy referred to as “margin reduction.” 

“This is the first comparative study to show that margin reduction in prostate cancer radiation therapy has clinically significant and measurable benefits in decreasing acute toxicity and short-term side effects,” said Dr. Constantine Mantz, radiation oncologist at 21st Century Oncology in Cape Coral, Florida and lead investigator of the study. “By reducing acute toxicity, we hope these patients may also experience a significant reduction of long-term side effects.”

Click here for more about the Calypso System.

Energy in Medicine The Saturday Evening Post

1. Monounsaturated fats in olive oil are associated with lower rates of heart disease and colon cancer, and reduced risk of diabetes and osteoporosis.

2. Quercetin in onions is one of the most powerful flavonoids (natural plant antioxidants). Studies show it helps prevent cancer.

3. Rich in carotenoids, carrots may help lower cholesterol, regulate blood sugar levels, and protect against coronary heart disease and certain cancers.

4. An excellent source of potassium and manganese, zucchini provides your body with vitamins C, B1, and B6.

5. Several population studies associate an increased intake of garlic with a reduced risk of cancers, including stomach, colon, esophagus, pancreas, and breast.

6. Processing makes the cancer-fighting compounds in tomato paste more available to your body because heat breaks down the plant’s cell walls.

7. The type of soluble, cholesterol-lowering fiber found in chickpeas is not only heart-healthy, but helps stabilize blood sugars—particularly important for people living with diabetes.

8. Fresh basil boasts a healthy dose of blood-clotting vitamin K, and its oils and extracts are said to possess antibacterial and antioxidant properties.

9. Omega-3 fatty acids found in salmon promote heart, skin, and joint health. A study in the British Journal of Ophthalmology suggests omega-3s could also protect against age-related macular degeneration (AMD).

10. Data from a study published in Diabetes Care reported that a dietary pattern incorporating more low-fat dairy products may lower the risk of type 2 diabetes in middle-aged or older women.

11. According to a USDA Human Nutrition Research Center on Aging in Boston report, blueberries may improve motor skills and reverse the short-term memory loss that comes with aging.

12. A limited study at the University of Memphis Exercise and Sports Nutrition Laboratory found honey to be one of the most effective forms of carbohydrate gels to ingest prior to exercise, also functioning well in post-workout recuperation.

Salmon with Chickpea Ragu

Salmon with Chickpea Ragu

(Makes 4 servings)

• 1 tablespoon olive oil
• 1 small onion, chopped
• 1 large carrot, peeled and diced
• 1 large zucchini, diced
• 2 cloves garlic, minced
• 2 tablespoons tomato paste
• 4 cups low-sodium chicken broth
• 1 (15.5-ounce) can low-sodium chickpeas, drained and rinsed
• 1 cup basil leaves, sliced into ribbons, plus more for garnish
• ½ teaspoon salt (optional)
• ½ teaspoon freshly ground black pepper
• 4 (6-ounce) skinless salmon fillets

Heat oil in large skillet over medium-high heat. Add onion and cook until soft, about 3 minutes. Add carrot, zucchini, and garlic and cook, stirring, until carrots are firm-tender, about 4 to 5 minutes. Add tomato paste and stir. Add chicken broth and chickpeas and bring to boil. Reduce heat to low and cook, covered, until liquid thickens, about 10 minutes. Remove skillet from heat, add 1 cup basil and ¼ teaspoon each of salt and pepper. Stir and cover to keep warm.

To cook salmon: preheat broiler. Season with remaining salt and pepper. Broil fillets for 8 to 10 minutes per inch thickness, turning once. Serve with 1 ½ cups chickpea ragu in shallow bowl. Garnish with basil.

Nutrition Facts

Per serving: 1 salmon fillet and 1 1/2 cups chickpea ragu

calories: 460

fat: 17 g (saturated: 2.5 g; monounsaturated: 7 g; polyunsaturated: 5 g)

protein: 46 g

carbohydrate: 30 g

fiber: 6 g

cholesterol: 95 mg

sodium: 550 mg

Ellie’s Blueberry Blast Smoothie

Blueberry Blast Smoothie

(Makes 1 smoothie)

• ½ cup nonfat milk
• ½ cup plain nonfat yogurt
• 1 cup frozen unsweetened blueberries
• 1 teaspoon honey

Put all ingredients into blender and process until smooth.

Nutrition Facts

Per serving: 1 smoothie
calories: 195
fat: 1 g (saturated: 0 g; monounsaturated: 0 g; polyunsaturated: 0 g)
protein: 10g
carbohydrate: 40 g
fiber: 4 g
cholesterol: 5 mg
sodium: 134 mg

Spice Things Up!

Krieger says spices such as turmeric (found in curry) and ginger provide anti-inflammatory effects—an observation especially important for anyone suffering from rheumatoid arthritis or inflammation-related ailments.

Healthier by the Dozen The Saturday Evening Post

“With more and more cancer patients (and people at risk for cancer) turning to self-help measures such as complementary, alternative, and integrative therapies, it is imperative that patients, their families, and care teams get on the same page about the safety and efficacy of these therapies alongside conventional cancer therapy,” says longtime ACS volunteer Dr. David Rosenthal, a Harvard professor of medicine and medical director of the Leonard P. Zakim Center for Integrative Therapies at the Dana-Farber Cancer Institute. “This book is a valuable resource for the public and the clinicians alike, offering just the right blend of Eastern and Western medical approaches.”

The 2009 second edition discusses the medical evidence for potential risks and benefits of more than 200 treatments in five broad categories: mind, body, and spirit; manual healing and physical touch; herbs, vitamins, and minerals; diet and nutrition; and pharmacologics and biologics.

The first-ever Patient’s Guide to Rare Cancer includes detailed information regarding rare cancers, treatment goals, check-ups, and patient assistance programs.

“Rare cancers befuddle not only patients, but their physicians and care team as well,” says Dr. Debu Tripathy, co-leader of the Women’s Cancer Program at the University of Southern California Norris Comprehensive Cancer Center. “The Patient’s Guide to Rare Cancer provides the information that patients need to ensure their diagnosis is being reviewed with the proper expertise and that the care plan reflects broad input from the multiple disciplines it take to maximize the chances for success.”

The online resource also helps patients with rare cancers and their health care providers collaborate and communicate more effectively.

“Our approaches to rare cancers are becoming increasingly complicated, with sophisticated new diagnostic techniques and tailored innovative therapies,” adds Dr. Tripathy, who is also editor-in-chief of CURE magazine. “The patient and care team must form a partnership to make sure all avenues are explored—this is the main intent of the Guide.”

Other helpful information is available online for people with chronic myeloid leukemia (CML) at CMLAlliance.com and gastrointestinal stromal tumors (GIST) at GISTAlliance.com.

Cancer Therapy: Know Your Options The Saturday Evening Post

Don,
CA

Cancer Vaccines The Saturday Evening Post

“Tessa has lost three other grandparents to cancer, so her qualifications for asking questions are very real,” says Fead, co-author of a new book, Nana, What’s Cancer? with 11-year-old Tessa Mae Hamermesh to help explain cancer in a way that children can understand (and handle).

“It’s important to talk about cancer with your kids so it’s less scary,” says Tessa. “It’s not a secret.”

The bottom line is that conversations about cancer are unsettling and potentially difficult. To help Post readers respond to the top five concerns of kids ages 8 to 12 about the disease, Fead provides the following information:

1. Cancer is not contagious.
You cannot catch cancer like you could a cold or the flu. It is not a sickness that moves from one person to another. You can hug and kiss me, hold my hand, and sit on my lap, and you will never ever catch my cancer.

2. My doctors are helping me get better.
They are special doctors trained to help people who have cancer. They are very smart when it comes to knowing just what the right medicine is for each type of cancer, and they are working hard to help me get better.

3. It’s OK to feel sad or mad, or whatever it is you’re feeling.
It is only natural to feel sad or angry or afraid when someone you love or care about is not feeling well. It’s okay to cry. Share your feelings with your family, friends, teachers or a counselor. And don’t feel guilty about having fun or being happy; I want your life to be as normal as possible.

4. This is no one’s fault.
No one can cause someone to get cancer. You did not cause my cancer, and I did not cause it to happen. While there are things we can all do to stay healthy, like eat well and exercise, sometimes people still get cancer. Even doctors don’t always know why people get cancer.

5. I will always be willing to talk to you about my cancer.
I will be happy to answer your questions, anytime. I will try to let you know how things are going with my treatments, so you don’t have to wonder how I am doing. But always feel free to come to me to ask me how I am feeling, talk about your feelings, or ask a question.

© American Cancer Society

5 Things Your Kids Need to Know About Cancer The Saturday Evening Post

When he was working at the National Cancer Institute (NCI) in the 1990s, Dr. Hwu and colleagues decided they needed an innovative way to retrain the immune system. What if they could inject into cancer patients the very “markers” that stud the surface of malignant cells? That’s how vaccines for infectious diseases such as measles and smallpox work, by training the immune system to recognize and attack the markers on disease-causing viruses. In this case, Dr. Hwu and others reasoned that injecting “tumor antigens” might train the immune system to recognize the tumor cells as foreign and destroy them. It would be a “cancer vaccine” — not a vaccine like that for measles, which prevents a disease, but one that treats it. (These cutting-edge cancer vaccines are not to be confused with Gardasil, a vaccine that primes the immune system to attack the virus that causes cervical cancer. Very few human cancers are known to be caused by viruses, so “cancer vaccine” has come to mean one that treats existing cancer.)

The NCI scientists were hardly alone in dreaming of a cancer vaccine. The appeal was obvious: Oncologists’ cancer-fighting arsenal consisted of surgery, radiation, and chemotherapy — or as critics like to say, cutting, burning, and poisoning. Not only did the three weapons come with serious side effects, but they were far from universally effective. Perhaps harnessing the immune system would vanquish tumor cells with little to no collateral damage to the rest of the body. The idea took hold in a serious way in the 1970s, recalls Dr. Len Lichtenfeld of the American Cancer Society, “and it was going to be a slam dunk. We were going to cure cancer.” Obviously, that did not happen. Instead, vaccine after vaccine failed. But with advances in their understanding of both cancer and immunology, scientists finally scored some notable successes: Three large-scale studies, called Phase III clinical trials, presented at the 2009 meeting of the American Society of Clinical Oncology (ASCO), suggest that cancer vaccines may one day play a role in cancer treatment.

Vaccine Renews Hope—Dr. Patrick Hwu meets with Hilde Stapleton, who credits the trial vaccine plus interleukin-2 with knocking her melanoma into remission. In May 1999, Stapleton found a suspicious mole behind her left knee. After surgery to remove the mole and lymph nodes (the cancer had spread) at M.D. Anderson, she enrolled in an early cancer vaccine study. But by 2006, the melanoma had returned. Because the cancer had metastasized to her lungs, her earlier experience in a vaccine trial led her to volunteer for Hwu's trial the following spring. She has been in full remission ever since. "I'm, pleased with the results," she says. Image: © AP Photo/David J. Phillip.

In one study, a vaccine based on the work of Dr. Hwu and his NCI colleagues extended what’s called progression-free survival — how long patients live before a cancer that has been treated with chemotherapy or radiation returns — in people with advanced melanoma, one of the most lethal cancers. The vaccine consists of antigens that stud melanoma cells. By injecting these “gp100” molecules into patients, “the vaccine activates the T cells of the immune system to recognize the antigens on the surface of the tumor,” says Dr. Hwu. “The T cells then secrete enzymes that poke holes in the tumor cells’ membrane, causing it to disintegrate” and the cancer cells to die.

This was the first time a melanoma vaccine had shown any benefit in a Phase III trial, but even with this distinction, it was no “slam dunk.” The 93 patients who received a standard therapy called interleukin-2 and no vaccine remained in remission for an average of 1.6 months. The 86 patients who received the vaccine plus interleukin-2 remained in remission for just under three months; hardly a big improvement. And on what every cancer patient cares about most — staying alive — the vaccine fell short. Vaccinated patients lived 17.6 months, on average, while unvaccinated patients lived 12.8 months, a difference that statistical analysis determined could be due to chance.

Why wasn’t the benefit greater? It’s possible that the patients did not have enough T cells to mount an effective immune response, says Dr. Hwu. Or maybe, for some reason, the T cells do not find the melanoma cells. Perhaps the tumor disguised itself, hiding the antigen that the T cells were trained to look for. “It’s possible that we did not have enough soldiers, or that they were not well-enough trained, or that they were not able to find the battlefield,” says Dr. Hwu. It’s also possible that a vaccine needs to contain more than the gp100 antigen. “Unique antigens specific to a patient’s cancer do exist, and using them might stimulate a more effective immune response,” he says. “But it would take months to synthesize such a custom-made vaccine,” and advanced melanoma patients do not have months.

Another study unveiled at ASCO this year, however, took the customization approach. Invented by M.D. Anderson’s Larry Kwak when he, too, was at NCI, the vaccine contains markers from each patient’s cancer — in this case, a form of non-Hodgkin’s lymphoma called follicular lymphoma, which is a cancer of (ironically) immune-system cells called B cells. After a biopsy harvests a patient’s malignant B cells from the lymph nodes, it takes about one month to make the vaccine. “The vaccine uniquely recruits the patient’s immune system to seek and destroy only tumor B cells,” said Stephen Schuster of the University of Pennsylvania, who led the study.
“It’s the ultimate in personalized therapy,” adds Dr. Kwak. “Even if patients have the same type of lymphoma, the tumors will still have different antigens, and that’s what you want your vaccine to contain.” The 76 patients who received the custom-made vaccine after a standard course of chemo remained disease-free just over one year longer than the 41 patients who received the chemo alone (44.2 months compared to 30.6 months). In an earlier Phase II study at NCI, patients have remained disease-free for an average of eight years.

Crucially, all the patients in the latest study were in complete remission or had no detectable cancer when they received their personalized vaccine. That is, they had responded to standard chemo and sustained a remission for six months. To skeptics, that raises the possibility that these patients’ cancer might have been less aggressive, and that fact — not the vaccine — accounts for their longer survival. In addition, the vaccine was compared to chemo that has now been superseded by something more effective. Oncologist Ron Levy of Stanford University, a founding father of cancer vaccines, gives BioVax ID “a qualified yes” in terms of effectiveness, but only a “maybe” on whether it will find a meaningful role in treating patients with follicular lymphoma.

Dr. Larry Kwak from M.D, Anderson are working on "personalized" vaccines that prime the immune system to go after a unique biological tag found only on tumor cells. Photo © Wyatt McSpadden Photography.

Dr. Kwak sees it differently. He admits that the vaccine — and possibly all cancer vaccines — work best in patients whose tumor has shrunk to almost nothing or who are in complete remission. “Then you bring in the vaccine to mop up any remaining cancer cells,” he says. “That’s the strategy, and it should work for other cancers.” If he’s right, then the failures of other cancer vaccines might be because the patients in those studies had active and sometimes widespread cancer. “We now suspect that cancer vaccines will not work very well against advanced tumors,” says Dr. Kwak. “Tumors have the ability to turn off the immune response, and the more tumor you have, the more factors that can do that.”

That may explain why a vaccine for prostate cancer has fallen short. Called Provenge, it failed to beat back disease, let alone improve survival, in early tests, and the Food and Drug Administration refused to approve it in 2007. But the manufacturer, Dendreon, has spent an estimated $560 million on it and isn’t giving up. In a new trial, also presented at ASCO this year, the company announced that among men whose prostate cancer was no longer responding to hormone treatment or chemo, those who received Provenge lived four months longer than those who did not, 26 months versus 22 months. Just under one-third of the Provenge men were still alive after three years, compared to just under one-quarter of the men who did not receive the vaccine — 31 percent versus 23 percent. That’s far from a cure, but Dendreon is hopeful that it will get a green light from the FDA in 2010.

But don’t expect that to open the floodgates for cancer vaccines. So many have failed that it seemed as if they were going to be yet another therapy that looked terrific on paper, and even in lab animals, but which crashed and burned when tested in people. For instance, in 2006 a pancreatic-cancer vaccine called PANVAC-VF failed to improve overall survival. Considering that it was being compared to chemotherapy that keeps patients alive for a median three months, the result was a big disappointment.

The encouraging results for the melanoma and follicular lymphoma vaccines — and, to a lesser extent, for Provenge — have definitely been heard, breathing new life into a field that had been hanging by a thread. “Looking to the future, I think we’ll see a role for vaccines where the cancer is found very early, when the disease burden is small [because the patient is in remission], or when there are circulating cancer cells that can’t be eliminated any other way,” says Dr. Lichtenfeld. “But it looks unlikely that cancer vaccines will produce a response in people who have cancer throughout their system.” The latter, of course, are the sickest of the sick, so there is no small irony in the likelihood that this most innovative of cancer treatments will help not those who need it most, but those with an already hopeful prognosis.

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