Social Interaction

Patients often feel some trepidation about broaching the subject of their cancer diagnosis and treatment to their friends, bosses and co-workers. Although they hope that this new fact would not change their friends’ view of them, such is not often the case. Some friends may withdraw out of awkwardness, unsure as to how best to respond. Others may back away out of some innate fear of contagion. Still others may be overly inquisitive or obsequious, treating the patient as a fragile china doll and fearful that they may break. Employers may make plans to alter or lessen patients’ workloads, causing resentment from co-workers. For example, employers fearful of clients’ reactions to the patient’s diagnosis may move patients whose primary duties involve face-to-face interactions with clients away from such direct contact positions.

Just as is the case in dealing with the family, the best avenue for dealing with other people is to be honest and open in answering all questions. Patients should express their gratitude for those who express their sympathy and understanding. They should also be prepared to answer the concerns of those who may feel that the disease will impact their relationships, either personally or professionally. Patients can also take this opportunity to address any issues their employers may have in terms of both their ability and availability to carry out their duties during treatment.

Support groups also provide excellent avenues for a patient to have a level of social interaction. These groups can give the patient something that no other group involved in the process can: the voice of experience. For patients at the beginning of their treatment regimen, they can chat with (either in person or online) other group members who have moved into more advanced phases of treatment and can let them know what to expect as their treatment progresses. Such groups can pass advice, share stories and reinforce the idea that the patient is not alone in their process. Groups can serve the purpose of both emotional support and educational resource and many are tailored to the patient’s age, background and specific form of the disease.

The journal Social Science and Medicine published a study that showed a statistical link between social support and recovery:

“Coping was assessed half a year after surgery, while benefit finding was examined 12 months post-surgery. Correlational and path analyses showed a link between personal resources (self-efficacy) as well as social resources (received social support) and benefit finding. The effect of self-efficacy disappeared when coping was specified as a mediator between the resources and benefit finding. Social support retained a direct effect on benefit finding. The results emphasize the predictive quality of resources for recovery and adjustment after surgery and the mediating role of coping.“

Whether it is through family, friends or peer groups, patients should realize that they are not alone in their efforts. Any constructive social outlet can help patients understand that they have resources to communicate their ideas in spite of the disease. As patients at one highly esteemed cancer center say in their television commercial, “I have cancer, but it doesn’t have me.”

Emotional Health

After many of the more pressing issues have been resolved, some patients still deal with serious emotional issues during the various treatment phases. Depression, anger, anxiety and frustration often occur with patients as they carry out the long and arduous process. For those patients with a previous history of substance abuse, the impact of the diagnosis may lead to a relapse into addiction as a means of escape. With the frequent need for pain medication that most treatment regimens prescribe, such patients could do more damage to themselves by abusing the drugs that they need to manage their condition.

The emotional aspect of the treatment schedule is almost as important as treating the disease itself. Oncologists, nurses, mental health workers and family members can all participate in this portion of the process. Family members and friends can be observant of the patient’s behavior and watch for any signs of mood changes or alterations in attitude. The patient may be depressed about a lack of progress or frustrated about attending treatment sessions, so the family should do what they can to encourage a positive outlook during this trying time. Health care professionals involved in the treatment routine should also keep an eye on the patient’s emotional barometer. Mental health care specialists can help the patient work through their tumultuous emotional issues and give them the best opportunity to complete their treatment successfully.

Another source of anxiety that patients encounter is the changes in their appearance that often arise from their treatment. Weight loss, hair loss and skin conditions often appear as side effects of radiation treatments and chemotherapy. In the case of breast cancer, patients may require a mastectomy (removal of the breast tissue). These alterations can significantly affect the patient’s self-esteem and self-image; the patient may not feel as attractive, young or vital as they did pre-diagnosis.

Many hospitals and specialty stores carry wigs, makeup and prosthetics to help patients deal with the changes in their appearance. Some cancer patients use these changes as an opportunity to experiment with their self-image. A patient that started treatment with long, blond hair, for example, may want to try a brunette bob wig. Another may use different shades of foundation and lipstick for a new look. Such activities can serve as a distraction from the more painful effects of treatment and allow the patient to forget about their condition for a brief moment.

Financial Issues

Another major concern for cancer patients is the expense involved in treatment.  Chemotherapy drugs, radiation therapy and prescription medications, while all proven to be effective, are far from affordable for most patients.  Blood tests, biopsies and office visits add to the cost.  Not only do treatment schedules themselves carry a high price tag, many patients must miss work due to doctor’s visits and medical side effects in addition to the weakness brought on by the illness itself.  For those patients with employer-paid health insurance benefits, some of the treatment costs may still not be covered by their respective policies.  For those without health insurance, the financial burden may be too much to overcome.

Many avenues are open for patients who may be overcome by rising medical bills.  Federal and state government programs such as Medicare and Medicaid offer coverage to eligible applicants.  The Veterans Administration has several programs available to those who have served in uniform.  Non-profit organizations such as CancerCare and the Patient Advocate Foundation can provide information on how to obtain financial aid for cancer treatments.

One avenue that many patients use to soften the financial impact of treatment is to participate in clinical trials.  Most cancer research facilities and pharmaceutical firms conduct clinical trials to judge the efficacy of new cancer treatments.  After they have successfully completed the animal testing stage, they look for human volunteers to test out their new therapies.  Patients incur no costs during these trails and receive careful supervision from the trial administrators and physicians during the course of the experiment.

For those patients concerned about cost issues during treatment, some questions that the American Society of Clinical Oncology recommends to ask are:

  • Will the person in charge of billing for services help me work with my health insurance company/provider?
  • If I need multiple visits to a doctor’s office, is there a policy where I can pay the co-pay only once or not at all (called a waiver)?
  • Are there ways to change my treatment schedule, if necessary, to work around my job or child care?
  • What expenses will I have if I join a clinical trial?
  • For medications for side effects, is there an over-the-counter medicine that has the same effect as the prescribed drug? Is it less expensive?
  • Is there free or low-cost transportation for patients at the medical center where I will have treatment?
  • If I have trouble paying for basic items, like food or heat, due to the cost of my cancer treatment, are there organizations that can help me?
  • Should I plan financially for long-term medical care, such as a nursing home or hospice care?
  • Where can I find out if my medical and related expenses can be deducted from federal income taxes?

Patients can find a comprehensive list of questions at Cancer.Net.

Another task that comes with managing the financial portion of treatment is dealing with the paperwork and bureaucracy involved in the process.  Hospital bills, insurance claims and other forms that require the patient’s attention can take away the vital energy that they need during treatment.  Financial professionals such as CPAs can help navigate through the red tape, pay household bills and keep everything on budget.  They can also help with finding out which treatment costs are tax-deductible and where to locate additional funding for treatment.

Internet Research and Telling the Family

Of course, many patients will begin their search for more information via the Internet.  Most hospitals, research clinics and treatment providers offer news and resources through their web sites.  Also, organizations such as the American Cancer Society and the National Cancer Institute give visitors access to a wealth of information on how to manage the various aspects of their treatment.   

One aspect of Internet research of which patients should be aware is the prevalence of misinformation, lies and outright scams that some unscrupulous people can perpetrate on someone desperate for a “miracle cure”.  Many websites that promote themselves as resources for cancer patients often contain misleading information, either as a result of incomplete or inaccurate research or as an attempt to sell their product.  These books, pills and diet plans, in the best cases, are as effective as placebos or, in the worst instances, can cause great harm to a cancer patient’s sensitive metabolism. 

Telling the Family 

After patients receive their diagnosis and their treatment information, the next step often involves telling their spouses and families.  For many patients, this step may be as emotionally difficult as when they first heard the news themselves.  Spouses may often feel the same sense of helplessness as patients; they may feel that this disease will take away their partner and that they can do nothing to stop it.  Young children may not entirely comprehend all of the physical ramifications of what could happen to their parent, but they will pick up on the emotional distress and become depressed, sad or angry.   

Most experts agree that the best way to combat these feelings is to keep the lines of communication open throughout the treatment schedule.  The patient should answer any questions, especially from younger children, as openly and honestly as possible.  One of the best ways to combat the feelings of helplessness that family members may experience is to include them in the therapeutic process.  Simple actions, such as organizing task lists and completing simple chores, can both alleviate the mental stress and add to the family’s feelings of contribution to the patient’s well being.   

The patient’s relationship with their spouse will undergo many of the more serious changes during treatment.  The patient may experience both physical and mental exhaustion during this time, so the spouse may have to take care of their normal household duties (taking out the trash, cooking dinner, dressing the children for school).  In addition, the nature of the couple’s physical relationship will also change.  Along with the lack of energy, the patient may have either lost their desire for sex or may be physically unable to perform.  These changes could cause resentment and anger to disrupt the relationship and add more stress onto their situation.  The spouse may then feel a measure of guilt for harboring these feelings against their ill partner.

Many psychologists, counselors and mental health professionals specialize in therapy for cancer patients and their families.  Even with the technology available to modern medicine, the idea of cancer is still very traumatic for both the patient and their loved ones.  These specialists can offer outlets for all the members of the family affected by the disease, the treatment and the consequences.  With the opportunities to alleviate much of the emotional stress caused by the illness, the patient and the family can focus on the other aspects of cancer therapy and potential recovery. 

Fertility or reproductive health may be an issue with patients and their spouses during treatment, especially if the reproductive organs are the ones affected by the cancer.  Doctors can give information on potential risks and outline options for couples that still hope to have children either during or after treatment.  Some techniques include protection of the reproductive organs during radiation treatment, tissue preservation of the organs for later reimplantation, hormone therapy and sperm/egg banking. 

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