Kroenke

patient is newly diagnosed, undergoing treatment, or is a cancer survivor, according to researchers from the Indiana University schools of medicine and nursing and the Regenstrief Institute.

Common symptoms include fatigue, pain, weakness, appetite loss, dry mouth, constipation, insomnia, and nausea. These physical symptoms are associated with substantial functional impairment, disability, and diminished quality of life.

The study of 405 patients was reported in the Oct. 11 issue of the Archives of Internal Medicine. Numerous physical symptoms, rather than just a few, were prevalent in patients with cancer and this prevalence did not diminish after completion of therapy.

“We found that regardless of where they are in the course of their diseases, many individuals with cancer have a high symptom burden,” Kurt Kroenke, MD, the study’s principal investigator and first author, said. Dr. Kroenke is a researcher at the IU Simon Cancer Center, an investigator at the Regenstrief Institute, and a Chancellor’s Professor of Medicine in the IU School of Medicine.

“These symptoms impact them at home and at work throughout their lives,” he said.

Study participants – all of whom had pain, depression, or both – experienced substantial disability, reporting on average 17 of the past 28 days as either bed days or days in which they had to cut down on activities by at least 50 percent. Almost all patients reported feeling tired (97.5%) and most (78.8%) were bothered “a lot” by this symptom. Of the 22 symptoms studied, 15 were reported by more than half of the study participants.

In spite of high symptom prevalence, the researchers did not uncover greater use of the health care system. There may be several explanations for this, including patients’ inclinations to focus on cancer treatment while with their physicians or to accept the symptoms as an inevitable result of the disease or its treatment. Alternatively, the explanation may lie with the fact that those in the study, as cancer patients or former patients, were already frequently interacting with many parts of the health care system.

“Patients and their families should be encouraged to bring up symptoms like pain or insomnia with physicians. But because oncologists are necessarily focused on treatment of the cancer itself, they often have insufficient time to optimally evaluate and manage symptoms and other factors impacting quality of life. We have shown in an earlier study that one effective solution might be a partnership between a telephone-based symptom management team and community-based oncology practices,” Dr. Kroenke said.

The previous study, published earlier in 2010 in the Journal of the American Medical Association, reported that an economical, centralized approach is feasible to conduct and significantly improved symptoms of pain and depression in patients in any phase of cancer. That approach gave patients, many of whom lived in underserved rural areas, one-stop assistance they probably wouldn’t have had access to unless they went to a major cancer center, Kroenke said.

Recognizing and managing physical symptoms such as fatigue, pain, nausea, and insomnia may make a significant difference regardless of type or phase of cancer. The researchers plan to investigate medical and behavioral strategies and combinations of both approaches to control these symptoms.

In addition to Dr. Kroenke, co-authors of “Somatic Symptoms in Patients with Cancer Experiencing Pain or Depression” are Xin Zhong, RN, and Janet Carpenter, PhD, RN, of the IU School of Nursing; Dale Theobald, MD, PhD, of Community Home Health Hospice and Symptom Management Group; Jingwei Wu, MS, of the IU School of Medicine; and Wanzhu Tu, PhD, of the Regenstrief Institute and the IU School of Medicine.

The study was supported by a grant from the National Cancer Institute.

Four days of luxurious rain, my grandkids gone (it’s Sunday), and a perfect time for writing and maintenancing my site.  This is the longest period of inactivity (blogwise) since I started.   So it’s time to get back down to business.

First off I have added a Captcha plug-in to the site.  Captcha is that feature that requires site users to correctly copy a series of letters.  The theory is that only real humans can read these.  Lately I have been getting 2-3 news users registering each day, all with questionable user names and many from eastern European countries.  Most of these, if not all, are registered not by humans, but by automated “bots” or robots, programmed to log onto multiple sites in order to market questionable products, services, or pornography.  Other “bots” are designed just to set up a link to multiple blogs in effort to artificially inflate their ranking in search engines.

Today I deleted over 300 users.  I may have inadvertently deleted some legitimate site users.  I apologize for this.  In any case any new or deleted users will have to copy the Captcha phrase in order to register or post a comment.  I apologize for any inconvinience.  The situation was just getting out of hand.  I was filtering almost 10,000 spam messages annually.

Also woefully behind was my replies to emails.   Valerie Bosserman, The World As I See It….,  wrote me to say that she is a finalist in the CureToday Extraordinary Healer Award for my essay on Megan’s chemo nurse.  Megan, her daughter, died just two years ago of ACC.  Copy and past the link below to see the story.  (http://www.curetoday.com/index.cfm/fuseaction/cureEvent.HealerOverview/id/43)  I sure support any organization that recognizes the efforts of oncology nurses.  CureToday.com – Combining science with humanity, CURE makes cancer understandable.

I added a few new blogs to my lists.  Gillian Anstey is from South Africa and writes about her breast cancer at From under my hat.   Of special interest to me is a new T-PLL patient (that’s my disease) preparing for a stem cell transplant – Curing Vancura.  Tracey Hawker writes about her husband’s esophageal cancer at CaringBridge / johnhawker / Welcome.  Selena is an APL survivor maintaining a blog at Oh My Aches and Pains! Kristal writes a blog about life after cancer and training for a triathlon as a cancer fundraiser: TriathlonKrista.  A 37 year old single mom fighting Colon cancer for 5 years, has gone from stage 3 to 4 now, has metastasized to liver, and diaphragm – I’m Still Here…

The American Institute for Cancer Research will hold its annual Conference on Food, Nutrition, Physical Activity & Cancer in DC in late October.  Check the Events Calendar above for details.  Stand Up 4 Cancer has released two new videos as part of their Innovation Research Grant Profiles.  Check them out.   (http://tiny.cc/su2cIRGDrWalensky) and (http://tiny.cc/su2cIRGDrSilva).  Click and past in your browser address bar.

Julien Lieb, MD offers the following information on the effect of antidepressants on selected cancer.  Prostaglandins are infinitesimal, ephemeral and powerful molecules regulating the chemistry of every cell in the body, including cells regulating mood, and those regulating immune function. When produced within normal limits, prostaglandins regulate the chemistry of every cell; when produced excessively, physiology becomes pathology. When brain cells produce excessive concentrations of prostaglandins, they depress mood and immunity. In 1973, David Horrobin showed that antidepressants inhibit prostaglandins, and in 1977 that prostaglandins regulate nucleic acids (DNA and RNA).1,2 Others subsequently showed that prostaglandins regulate the synthesis, inhibition, and expression of genes, and the growth, differentiation, and replication of cells, with cancer the accelerated replication of abnormal cells.1,2 Excessive synthesis of prostaglandins induces cancer, with genes determining the variations. In 1998, Brenda Penninx showed that at age 70, chronically depressed people have an increased risk of 88% of developing cancer, and 50% of dying of it.
More than seventy clinical, laboratory, and epidemiological studies have shown that antidepressants kill cancer cells, inhibit their proliferation, convert multidrug resistant cells to chemotherapy sensitive, augment chemotherapy, protect nonmalignant cells from damage by radiation and chemotherapy toxicity, and target the mitochondria of cancer cells while sparing those of healthy ones.1,2 Antidepressants have therapeutic potential in many cancers that are often treatment resistant, such as gliomas, cancers of the lung, kidney, liver, and uterus, inflammatory breast cancer, and multiple myelomas.2 Antidepressants are capable of arresting lung cancer in advanced stages, and even reversing it. That antidepressants are effective for a multitude of malignancies, decries the myth that cancer is a hundred diseases, when it is one disease with a hundred variations.
Antidepressants alleviate cancer pain, alone or combined with narcotics, remit nausea and vomiting, promote sleep, relieve anxiety and depression, and combat fatigue. Other inhibitors of prostaglandins, such as COX-1 and COX-2 inhibitors, also have potential value in defeating cancer. The components are in place for a revolution in cancer prevention and treatment, as may be confirmed by accessing �Medline� or �Pubmed,� and entering �antidepressants� and �cancer.�
The history of medicine is littered with the suppression of innovation. Today many cancer organizations rely on the opinions of medical advisors, some of whom are political operatives of vested interests disguised as healers. It is not for a lack of innovation that we are in our predicament, but the suppression of it. In â��Against Methodâ�� Paul Feyerabend wrote that suppressing a paradigm in preference to one politically favored could permanently damage society, and that resistance to progress could be so intractable that political intervention might be needed. ** This is certainly a viewpoint, if a bit out of the mainstream.  It must be assessed within a broader medical and scientific context which is beyond my expertise.  As with all such information, you should discuss it with your medical doctor.

That’s all the news that is my news.  Later this week, look for a cancer book review, cancer website reviews, and a few guest posts.  Hopefully I am back on track.

Papa & Isabel

~ I have received a few emails lately that you might be interested in.  The first came from a new website called Drugwatch.com.  I am reprinting their email below and will be adding the site to the Cancer Resources list.  I looked at the site.  I get the impression that they are still adding to their listing.  I entered a number of cancer-related drugs and the search came up empty.  On the other hand, when I typed in clarithromycin, the antibiotic I am on, fairly complete information was listed.  This included an understandable (not too technical) explanation of the drug’s use and the way it works on the body.  There is a list of common interactions with other medications, a standard dosage, and recall or “black box” warnings that are not always so accessible.  An second tab lists an extensive list of side effects, things to avoid when taking the drug, and a some questions you might want to ask your doctor.  In all I think the site serves as an excellent adjunct to your personal approach to your cancer.  Since it is written in clear, understandable language, it can serve as a springboard to discuss any concerns with your nurses, physician, and pharmacist.  (Pharmacists are excellent sources of information that are probably underutilized.  Besides, I have found that they seem enjoy the opportunity to get out of their dispensing routine and do some interacting and teaching with the public.)

I am the Social Media Coordinator for DrugWatch.com . Lately I have been reaching out to cancer & drug education web sites (blogs) in efforts of getting our link resource added to your web site. We also have a team of writers dedicated to providing free, unique content for your website.

Drugwatch.com has achieved HON certification and is dedicated to educating the public about the details of prescription and over the counter medications by aiding patients and consumers about any associated side effects with drugs used to treat several conditions. It is our pledge to never be affiliated with any drug or pharmaceutical company. If you would be interested in creating consumer and patient awareness, please let me know. With your help we can keep the public informed about important drug information.       ~ Drug Information, Side Effects & Interactions | Drugwatch.com

~ A few weeks back in our review of breast cancer sites, we met Sisters Network, an organization serving African-American women dealing with breast cancer.  Their annual conference is coming up the second weekend in April in Houston.  You can register online at Sisters Network Inc. : A National African American Breast Cancer Survivorship Organization.

~ Speaking of conferences, Tish and I are traveling to Boston next month to attend a symposium by BMT Infonet, the “Blood and Marrow Transplant Information Network”.  The fact that we have 3 month-old twin granddaughters in Boston has nothing to do with it.  Of course, it does but we did attend one of their symposiums and found it quite valuable.  So if you have had a transplant or anticipate the possibility in your treatment future, this would be an excellent experience to sign up for.  BMT InfoNet Homepage

~ I just saw an interesting movie (DVD) last week that I plan to review.  It is called I’ve Loved You So Long.  I thought it was excellent and plan to write a review later.  The cancer theme is peripheral to the main theme of a woman dealing with tragedy.  The performance by Kristen Scott Thomas (The English Patient) is extraordinary.  The film won a number of awards last year.  The movie is in the French language with subtitles.  Order from Amazon: I’ve Loved You So Long

~ A book I am reading and recommend to your attention is The Year of Magical Thinking by one of America’s iconic writers, Joan Didion.  The book covers her year of recovery and introspection after losing her husband – their marriage, the dimensions of a loving relationship, and the meaning of death.  I will try to write a review of this book later. The Year of Magical Thinking

~ Finally this miscellaneous post gives me the opportunity to do some grandparent bragging.  Four year old Sophia had her adenoids out and ear drains put in last week, a condition that was affecting not only her hearing but her speech development.  Afterward her daddy asked her if she could hear better now.  Sophie replied “Yes, can you understand me better now?”  Her sister Isabel and I spent the day together.  We were playing at the computer and made the photo above.  All for now.  Take care, Dennis

cancer

Castle in Cashell

Clinic Visit

Today I had my clinic appointment for transplant follow-up, labs, and, today, a cortisone stimulation test.  I knew the appointment was approaching and I acknowledged to myself yesterday that I was not anxious about it as I usually am.  By yesterday evening my throat was starting to hurt and a head cold seemed to reemerge. Then I started thinking about the successions of flu episodes,  sinus infections, sore throats, and ear aches I have been having over the last months.

Every leukemia patient I have ever known, and I have known hundreds, related to me this very same history – lingering cold and flu symptoms – prior to their diagnosis.  Of course I knew that the overwhelming probability is that my still inefficient, immature immune system was to blame.  But I also that my relapse, if and when it does occur, might resemble this same pattern of recurrent infection.  But my counts cam back okay – normal albeit low-normal, but normal just the same.  So my anxiety has subsided, at least for another three months (a record by the way, if I can keep it).

AMAS Test

I received another odd email inquiry.  The writer asked “it is possible … to get a post about an innovative aid in early cancer detection and follow-up: the AMAS test.

Even though the test has existed for over a decade, many people don’t know about it. I would like to start spreading the word around.

The principle is simple: the test measures the level of a specific antibody (the Anti-Malignin Antibody) in a blood sample. The antibody would be elevated regardless of the location and cell type of the malignancy. It is used by many doctors to increase the accuracy of other standard tests (MRI, PSA, CA125, or mammograms); and as a follow-up tool for recurrences.

Many studies have been done over the last 20 years supporting the theory. The test had been proven 95% accurate (see publications for details of the studies).

Odd, I thought, that I, being a cancer nurse since 1987, had never heard of this.  Sounds too good to be true!  So I googled the term.  Not a lot came back, at least from the medical literature.  Proponents are few and far between.  Such a test would indeed be a boon to the cancer community, the professional community included.  If true, the discoverers would had long ago been offered millions of dollars for the rights.  Unfortunately when exposed to scientific scrutiny and rigor, the claims do not hold up, not for the test, not for the existence of the “anti-maliginin anitbody.”

So from what I read this is the only post I can responsibly publish.  And, no way, can I recommend this test to readers.

Snap Shots

I have been working on the blogroll.  If you look at the Brain Cancer” section, you will see that I have added more information about the specific diagnosis, year of diagnosis, country the blog is written from (if not the US), whether the patient is a child, and whether the blog is currently inactive.  I always look at blogrolls seeking new entries for “Cancer Blogs. I look as well for interesting features.  When looking at one blogroll, I noticed that by merely hovering the cursor over the blog name, a window popped up showing the recent entries.  A cool feature, I thought.

So I just installed this nice little tool on my site called Snap Shots that enhances links with visual previews of the destination site, interactive excerpts of Wikipedia articles, MySpace profiles, IMDb profiles and Amazon products, display inline videos, RSS, MP3s,  and photos,

Sometimes Snap Shots bring you the information you need, without your having to leave the site, while other times it lets you “look ahead,” before deciding if you want to follow a link or not.

Should you decide this is not for you, just click the Options icon in the upper right corner of the Snap Shot and opt-out.

I’ll be interested in your feedback on this.

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