Pain Control for Cancer Patients

Defined by pain expert Margo McCaffrey, MSN, RN, FAAN, pain is, “whatever the experiencing person says it is, and exists whenever he says it does.” This certainly holds true in the treatment of pain associated with cancer. Approximately 30% to 50% of all people with cancer will experience pain while undergoing treatment and 70% to 90% of individuals with advanced cancer will have pain associated with the disease.

The good news is that cancer pain is completely manageable with a host of treatments that are readily available. The bad news is that many cancer patients are often under treated for pain due to a variety of common reasons.

Physicians treating cancer patients may focus solely on controlling or treating the disease and the accompanying pain is left untreated. Patients may minimize their pain symptoms or may think the pain is “normal” and neglect to inform the physician of this symptom. In other circumstances patients may fear becoming addicted to pain medications and therefore refuse to take them. These reasons, while understandable, are invalid and the current treatments available can help patients manage their pain.

Each cancer patient will experience different levels and areas of pain. There are three common types of pain associated with cancer. Acute pain usually sets in quickly and lasts only brief amounts of time. Chronic pain is consistent pain that sometimes worsens and lasts for long periods of time. Breakthrough pain occurs in chronic pain sufferers whose pain is normally controlled by medication. The plan for managing this pain is different for each individual. The goal is to provide the best pain relief while avoiding as many side effects as possible.

First-line pain medications are those medicines that are readily available over the counter or by a doctor’s prescription. First-line pain medications are used to treat mild forms of pain associated with cancer and include ibuprofen, aspirin and acetaminophen. These over the counter medications are not usually habit forming and can reduce inflammation in diseased tissue.

Fatigue and Mesothelioma

Fatigue is a common symptom of advanced mesothelioma. Fatigue is also commonly linked with cancer treatment and has an occurrence rate of 90% among patients receiving chemotherapy. There are many potentially underlying causes for both the symptoms. In majority of patients, the etiology of both the symptoms is multifactorial, with several of these contributing interrelated abnormalities. For instance, in a study involving patients with advanced cancer, it was noticed that fatigue correlated significantly with the intensity of dyspnea. This article will elaborate on the mechanisms, clinical features, assessment, and management of fatigue and dyspnea, which are two of the most common and often undertreated symptoms among cancer patients.

Fatigue

The National Comprehensive Cancer Network defines cancer-related fatigue as “a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.” Fatigue is often severe among cancer patients; has an identifiable anticipatory component; and results in general malaise, lack of energy, diminished mental functioning, and lethargy, all of which significantly impair quality of life. Fatigue can occur early during the progression of the disease; may worsen due to treatment, and can be found in almost all individuals with advanced cancer.

Sometimes, fatigue is referred to as tiredness, exhaustion, weakness, lack of energy, and asthenia. However, these terms may have varying implications for different patient populations. Further, different studies on fatigue and dyspnea have focused on different outcomes, which range from physical performance to just the subjective sensation.

Mechanism

The mechanisms involved in cancer-related fatigue are not clearly understood. It has been postulated that substances produced by the tumor result in fatigue. When blood from a fatigued subject was injected into a rested subject, it demonstrated manifestations of fatigue. When cytokines are produced in the host in response to the tumor, the same can also create a direct fatigue-inducing effect. Other potential causes of chemotherapy- or radiotherapy-induced fatigue include muscular or neuromuscular junction abnormalities. Hence, it can be concluded that fatigue results from not just one, but several different syndromes. In most patients with advanced cancer, multiple mechanisms are responsible for causing fatigue.

Clinical Features

In an individual patient, there are often multiple causes of fatigue with many interrelated factors.

Cachexia

A complex interaction of host and tumor products leads to cancer cachexia. Host cytokines, for instance tumor necrosis factor, interleukin-1 (IL-1), and IL-6 can potentially cause reduced food consumption, loss of body weight, a reduction in synthesis of both proteins and lipids, and increased lipolysis. Profound weakness and fatigue can be caused by the metabolic abnormalities responsible for the production of cachexia as well as the loss of muscle mass due to progressive cachexia. However, there are several abnormalities that can cause profound fatigue in patients who may not be experiencing significant weight loss.

Immobility

Reduced physical activity has demonstrated to cause deconditioning and diminished endurance to both physical exercise and routine daily activities. In comparison, overexertion is often the cause of fatigue among non-cancer patients. At risk are younger cancer patients receiving aggressive antineoplastic treatments, for instance radiation therapy and chemotherapy, and those who are making efforts to maintain their professional and social activities.

Psychological distress

In case of non-cancer patients who experience fatigue, the final diagnosis in around 75% of patients is psychological (for instance anxiety, depression, and other types of psychological disorders). The occurrence rate of major psychiatric disorders among cancer patients is relatively low. Nonetheless, symptoms of adjustment disorders and psychological distress with anxious or depressive moods are more common. Fatigue is often the most prevalent symptom among patients with a major depressive disorder or adjustment disorder.

Anemia

Low red blood cell count, if induced due to chemotherapy or advanced cancer, has been linked with fatigue, and treatment of the same helps improve symptoms of fatigue and quality of life among these patients. However, treatment of anemia among terminally ill patients may not help improve fatigue satisfactorily due to the multifactorial characteristic of its etiology. Fatigue can also occur due to the relatively more intense characteristics of other contributory factors.

Autonomic failure

Autonomic insufficiency is a medical complication that occurs frequently among patients with advanced cancer. Instances of autonomic failure have also been seen among patients with a specific type of severe chronic fatigue syndrome. While the connection between fatigue and autonomic dysfunction has not yet been established among cancer patients, the same should be suspected among patients with signs of autonomic failure including severe postural hypotension.

Anemia Drugs May Decrease Survival Time Among Cancer Patients

Doctors need to exhibit extreme caution before prescribing a class of anemia drugs known as erythropoeisis-stimulating agents (ESAs) to cancer patients, according to an updated guideline endorsed by the American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO).

Anemia is a fairly common side effect of chemotherapy. As a result, ESAs such as Procrit, Epogen and Arenesp are frequently prescribed to stimulate the production of additional red blood cells. While such medications are typically preferred over the alternative of blood transfusions, experts warn that such drugs have been linked to reduced survival times of cancer patients. An increased risk of internal blood clotting has also been noted.

According to the new guidelines, physicians are urged not to recommend ESAs for any cancer patient who is currently not undergoing chemotherapy (with the exception of patients with myelodysplastic syndrome). For patients dealing with chemotherapy, new guidelines suggest physicians should discuss the many benefits and risks of ESAs directly with each patient. When discussing these risks, it is also important to discuss the alternative of blood transfusions and how this alternative may affect quality of life.

These updated recommendations are based on the analysis of a variety of information sources. These sources include analysis of published clinical trials, various medical literature and reviews of individual patient data.

Further recommendations for dosage levels, thresholds for initiation and modification of ESAs are also detailed in the new guidelines. According to ASH member Samuel Silver, MD, “These are issues that confront practicing hematologists and oncologists on a daily basis, and we hope that these evidence-based recommendations will influence practice standards and result in better care for patients.”

Complete data related to the revised guidelines can be found at the following website:
http://jco.ascopubs.org/content/early/2010/10/25/JCO.2010.29.2201.abstract

Complete guidelines will also be published in the November 18th issue of Blood and the November 20th issue of the Journal of Clinical Oncology.

Sources:
http://www.prnewswire.com/news-releases/new-guideline-from-ash-and-asco-recommends-caution-regarding-esa-use-in-cancer-patients-105765143.html
http://health.usnews.com/health-news/managing-your-healthcare/cancer/articles/2010/10/26/use-anemia-drugs-for-cancer-patients-with-caution-experts-say.html

Nearly Half of Deaths in Turkish Town Caused by Mesothelioma

In most of the world, mesothelioma is an extremely rare type of lung cancer that accounts for less than one of every 100,000 deaths. However, in the Turkish region of Cappadocia, instances of death related to malignant mesothelioma hover at an astonishing rate of 48 percent.

Mesothelioma has been linked to the inhalation of asbestos fibers – a naturally occurring mineral that is used in a variety of heat-resistant products. A similarly fibrous material – erionite – is abundant in the Cappadocia region and has been used for decades as a resource for building homes and roadways.

Unfortunately, the frequent use of erionite in the Cappadocia region has exposed most of the residents to hazardous levels of this toxic material. The towns most dramatically affected by the fiber include Tuzkoy, Sarihidir and Karain.

While erionite is found in a number of regions globally (for example, Nevada), “the cancerous material is generally found far deep underground,” according to Izzetin Baris (a retired professor with a long history of mesothelioma research). “In Turkey, however, it is very close to the surface.”

Look at the numbers, and it becomes evident that, “The number of cases of mesothelioma in Tuzkoy has been about 600 to 800 times higher than world standards,” says Murat Tuncer of the Turkish Health Ministry department.

Due to these alarming numbers, government authorities have initiated a relocation plan to move all 2,350 remaining residents of Tuzkoy to a nearby location. As with the 250 families that have already been relocated, the costs associated with the move will be subsidized by the state. The new housing facility is located approximately one mile away from the current city’s location.

While this relocation is believed to move Tuzkoy villagers properly out of harm’s way, officials are still unsure about plans to demolish the current city. Present plans suggest the entire village will be demolished, buried in a thick layer of uncontaminated earth and then re-planted. However, other ideas include paving over the city with asphalt or doing nothing and simply prohibiting entry into the area.

Sadly, the knowledge of environmental hazards in Tuzkoy has been known for quite some time. In fact, relocation efforts first began back in 1999. However, little progress has been made thanks to various government difficulties and financial constraints.

Currently, government authorities hope the relocation will be completed by 2012. Even when such relocation occurs, however, a decline of cancer rates may not be noted for decades – mesothelioma often does not manifest until 20 to 50 years following initial exposure.

Source: ABCNews

Cancer Stem Cells More Complex Than Previously Thought

Studies into cancer stem cells and how they might be targeted for cancer treatment have been fervent over the past ten years. Indeed, there is a lot of evidence that suggests these unique cancer cells may lead to significant breakthroughs in treatment. However, as more and more research is being put into stem cells, researchers are discovering that the path to successful drug development may be more complex than initially thought.

Like healthy stem cells, cancer stem cells serve as progenitors (at least that’s the theory). As progenitors, these cells are responsible for re-growing tumor cells following cancer-killing treatments such as chemotherapy. Clearly, finding drugs or treatments that diminish the effects of these stem cells could help improve cancer survival rates.

In the past, researchers believed that all cancers followed a cancer stem cell model. This model suggests that such cells initiate the growth of cancer tumors. However, such a belief is changing as more research suggests a number of different cell types may instigate tumor growth.

While early cancers linked to stem cell tumor growth – such as acute myeloid leukemia and other blood cancers – continue to show a string linkage, there have been mixed research results for other types of cancer. As Dr. Jean Wang of the University of Toronto explains, “most of the markers we have right now are still very rough.” While many of these markers suggest stem cell growth in such cancers as brain, breast, colon and pancreatic cancer, there is enough variation in studies to result in skepticism among some experts. In fact, according to Dr. Barbara Vonderhaar of the NCI Center for Cancer Research, “We still don’t have definitive proof that cancer stem cells exist.”

As such, the initial goal for cancer stem cell research is to clearly validate their presence and importance in tumor growth. Until this happens, it will be extremely difficult (and possibility even futile) to attempt to create cancer drugs that target these progenitors.

Source:

http://www.cancer.gov/ncicancerbulletin/072710/page4

Face-to-Face Diagnosis Favored by Cancer Patients

Reported satisfaction of medical care for cancer patients improves when a diagnosis is provided in person and in a personal setting, according to a recent survey conducted by the National Institutes for Heath (NIH).

The survey also suggests that patient satisfaction improves when the doctor takes substantial time to discuss the diagnosis, as well as treatment options.

To come to these conclusions, the NIH team surveyed 460 cancer patients who were treated at the NIH treatment facility in Bethesda, MD. Of the 437 patients who responded, 54 percent were informed of their diagnosis in person at the physician’s office. In contrast, 18 percent were informed via telephone and 28 percent received a diagnosis while at a hospital.

Based on these settings, satisfaction scores were significantly higher for patients who were notified in person as opposed to telephone. On a 0-to-100 scale, those informed in person had a mean average satisfaction of 68.2, while telephone patients had a mean average of 47.2. Comparison of a personal doctor’s office setting to an impersonal hospital setting resulted in scores of 68.9 and 55.7, respectively.

Of all patients, 53 percent reported the conversation with the doctor lasted more than 10 minutes. Again, for all patients, 31 percent of participants distinctly remember that treatment options were not discussed.

Mean average satisfaction for those who had discussions of ten minutes or more came in at 73.5. This is compared to 54.1 for those with shorter conversations. When looking at discussion of treatment options, those who received such information returned a satisfaction score of 72.0. Those who did not receive treatment option details posted an average mean score of 50.7.

Resource:

http://oncolink.org/news/index.cfm?ID=1174&sort_year=2010&url.page=1&function=detail

Cancer Advocacy – Helping Yourself and Others

Cancer Advocacy – Helping Yourself and Others

Cancer advocacy is an activity that can positively affect both your own experience with cancer and the cancer experiences of others. Whether you have already gone through treatment or are just getting started, taking the time to become a cancer advocate can be rewarding on many levels. Learn how to become a cancer advocate so you can help yourself and others.

Self-Advocacy for Cancer

If you are currently undergoing treatment, then your primary interest may be taking an active role in your own treatment. Self-advocacy simply requires you to become more of a participant when it comes to planning your treatment regiment and seeking support when necessary. Ways that you can become an advocate for yourself include:

  • Asking additional questions while visiting with your doctor

  • Becoming an expert on your type of cancer by reviewing online websites and other resources

  • Investigating available cancer financial and support options via the National Cancer Institute and other resources

  • Reviewing medical journals to find alternative methods of treatment

  • Seeking the help of cancer support groups, counseling centers or fitness classes

  • Getting a second opinion

  • Getting proactive about health care costs and insurance

Cancer Advocacy for Others

Cancer patients often feel compelled to become a cancer advocate. Doing so can be a rewarding commitment, and ultimately help ease the pain and suffering of patients who are currently going through treatment. Cancer advocacy can come in a variety of ways, including:

  • Raising public awareness

  • Assisting with fundraisers

  • Providing assistance to individual cancer patients

  • Finding ways to advance cancer research

  • Informing others through online blogs

  • Lobbying for legislative changes

If you are interested in becoming an advocate, it is recommended you research all opportunities available in your area to find the best fit for your interests and skills. If you enjoy working one-on-one with patients, then helping to lead a support group may be a good option. If you are adept at public speaking, then raising awareness at local civic groups can be a good opportunity.

For those interested in getting involved with public policy and other advocacy goals on a state or national level, consider getting in touch with the American Society for Clinical Oncology (ASCO).

Resources:

http://www.cancer.net/

http://www.cancer.net/

How to cope with Cancer?

Most people value the care that is being provided by their health care team, but there are also those who want to play an active role in coping with their illness. Dr. Jimmie Holland, who has been involved with the care of cancer patients for nearly 3 decades now, offers some useful ideas on how to cope with cancer. These ideas have been categorized as those beliefs and attitudes that are evidently helpful (the Do’s) and those that may prove harmful (the Don’ts).

Do

  1. Rely on coping methods that may have helped you resolve problems and issues in the past. Understand that most individuals need to have family members, friends or others around them who will be able to provide the required help when needed. You need to find someone with whom you may be comfortable sharing your thoughts and feelings. In case you do not wish to talk about the illness, you may notice that meditation, relaxation, listening to music, or other activities that comfort you are helpful. Use methods that may have helped you earlier, but in case what you are doing does not help, you need to find a different coping method, or seek counseling.
  2. Try to cope with your cancer “one day at a time”. Try not to think about what may happen in the future. The task of dealing with cancer is less overwhelming when you divide that into “day bites” that are easier to manage. This way, it becomes easier for you to make the most of each day, irrespective of your illness.
  3. Rely on self-help or support groups if you feel better because of them. Conversely, if any group is making you feel worse, you need to leave that group.
  4. Try to find a doctor who allows you to discuss all your concerns. Ensure that there exists a feeling of trust and mutual respect. Let them know that you want to work with them as a partner in your treatment. Talk to them about expected side effects and be ready to face them. Knowing about the problems that you may face in the future often makes it easier to deal with them as and when they happen.
  5. Explore religious and spiritual beliefs and practices, for instance prayer, which you may have found helpful in the past. In case you are not a religious or spiritual person, you can seek support from any other belief system that you may find useful. You may find them comforting. They may also help you find meaning in your present experiences related to your illness.
  6. Maintain a proper record of your doctor’s contact numbers, treatment dates, symptoms, lab values, scans, x-rays, medications, side effects and general medical status. It is important to have complete details about your cancer and its treatment and no one else can maintain such records better than you.
  7. Maintain a journal if you feel the need to express your feelings and vent your frustrations. It can help you work around your experiences and you will be surprised by how useful and therapeutic they turn out to be.

Don’t

  1. Trust the conventional thinking that “cancer equals death.” Currently, there are around 11 Americans alive who have had cancer earlier.
  2. Hold yourself responsible for causing the cancer. No scientific evidence is available which links specific personalities, painful life events and emotional status to the development of cancer. Even when you may have increased your risk of developing cancer by smoking or some other habit, it still won’t help to blame yourself or hold yourself responsible.
  3. Feel guilty when you are not able to maintain a positive outlook all the time, especially if you don’t feel alright. The belief “patients need to be positive to overcome cancer” is not true. Understand that low periods will come, irrespective of how good you may be at coping. No evidence exists to prove that those periods adversely affect your health or contribute to tumor growth. However, if they persist or become severe, you need to seek help.
  4. Suffer in silence. Try not to do everything on your own – seek support from family members, friends, doctor, nurse, clergy, or people you meet in support groups who can better understand what you may be going through. When you are around people who care about you and who constantly support and encourage you, it is more likely that you will be able to cope better and take proper care of yourself.
  5. Feel embarrassed to seek counseling support from a mental health professional for depression or anxiety that may be interfering with your sleep, eating habits, ability to function normally, ability to concentrate, or in case you think that your distress levels are getting out of control.
  6. Try to keep your symptoms (physical or psychological) and worries to yourself and choose not to share the same with the person who may be close to you. Request this person to accompany you to doctor appointments to discuss your treatment options. Research has shown that it is often difficult for people to hear or absorb information if they are feeling anxious. A family member or friend may help you recall what was said and also interpret it in a better manner. In a practical sense, your loved one or friend can also get you home after your appointment or medical test.
  7. Choose an alternative therapy in place of your regular treatment. In case you choose to use a treatment that was not recommended by your doctor, make sure you rely on those that may not be harmful. Check if the alternative treatment can be used in a safe manner alongside the standard therapies (as a complimentary treatment), in order to augment your quality of life. Make sure you inform your doctor about alternative treatments that you may be using along with your regular therapies because there are some that should not be used with radiation treatment or chemotherapy. Discuss the advantages and disadvantages of alternative or complementary therapies with a person you can trust and who can analyze these therapies more objectively as compared to what you may be able to achieve under stress. Safe and helpful methods include social, psychological and spiritual approaches, and often doctors encourage patients to use them. Activities such as meditation and relaxation are safe and helpful.

Chemotherapy Hats and Turbans

One of the most noticeable side effects of chemotherapy treatment is hair loss. Chemo drugs are designed to attack and kill quick-replicating cancer cells. Unfortunately, healthy cells that also replicate quickly, such as those dedicated to hair growth, often become innocent victims of your fight with cancer.

Hair loss can make cancer patients feel self-conscious in public. Due to this fact, many patients choose to hide their bare heads beneath hats, turbans or wigs. Unfortunately, the majority of headwear made for the general public is either too large to fit on a head with no hair, or not adequately sized to cover the entire hairline.

In response to this, numerous companies have sprung up to offer hats and turbans specifically designed for chemotherapy patients. Previous cancer patients who were unhappy with the hat options available to them during treatment started many of these companies. These chemo hats come in a number of styles and sizes, and are fabricated for all-day comfort.

When people think of turbans, they may think of the classic style worn by Middle Eastern Sikhs, or perhaps those worn by wish-granting genies. While chemo turbans of this variety are available, there is also a variety of more modern-styled chemo turbans. Regardless of your personal style and preferences, you’re likely to find a chemo hat that fits your needs.

One issue that many cancer patients have with hats is that they sit low on the head due to the lack of hair. Innovations such as the Scarf Pad, available at www.softhats.com, can be worn under hats to provide additional lift at the base of the hat.

A number of online stores offer a good selection of chemo hats, including www.headcovers.com and www.chemosavvy.com. Other sites provide instructions so that you can make your own chemo turbans (http://www.sewing.org/html/turban.html).

While chemotherapy is certainly not an easy process, there are smart and comfortable products available that can help diminish embarrassment. Regardless of whether or not you think it’s necessary to cover your hair loss, it’s good to know that there are options out there for those who want them.

Understanding What An End-Of-Life Cancer Prognosis Means

All cancer patients, for better or worse, are confronted with a prognosis from their doctors. A prognosis serves as a prediction of how the illness is expected to progress over time. It may also include how different treatment methods may affect survival. For those that are confronted with a fatal type of cancer, an end-of-life prognosis also estimates how long a patient can expect to survive.

However, just because a doctor suggests a survival time of 6 months, 1 year or whatever, that does not mean patients necessarily need to start counting down the days. Though an end-of-life prognosis can provide a good estimate of survival time, it is important to understand the data and downfalls associated with where these numbers come from.

A prognosis is based on how a patient’s particular type of cancer has advanced in past patients. Since 1973, the National Cancer Registry has painstakingly tracked survival statistics and treatment effectiveness for all types of cancers. From this vast mountain of data, means and averages for survival can be culled.

While data collection and number crunching are both extensive, the process is not without its flaws. For example, many prognoses are based purely on a single variable, most likely the stage of cancer progression. However, there are multiple variables that can affect survival time, including histology of the tumor, how early the cancer was detected, attempted treatments and age/general health of the patient. These facts are sometimes not taken into account when collecting data.

With this in mind, cancer patients are encouraged to ask doctors what factors were considered when determining their prognoses. Even when patients are further broken down into smaller subgroups, patients need to be aware of what exactly a prognosis means.

Most doctors hand down a prognosis that aligns with the median survival time of past cases of the patient’s particular cancer. Therefore, if a median survival time for a type of cancer is 1 year, that means half of all patients survived less than 1 year. In contrast, half of all patients also survived longer than 1 year. In some cases, patients survive significantly longer than the median average.

Another issue at hand is a doctor’s general inclination to not want to be overly optimistic about survival. This may lead him or her to offer conservative estimates in relation to an end-of-life prognosis. To counter this, patients may wish to talk to their oncologists about the probabilities of survival over different ranges of times.

Resource:

http://www.newsweek.com/id/208057/page/2