Study: Veggies may impact cancer recurrence

Chad Aschtgen, N.D., FABNO will be one of the presenters at the 2nd Annual Cancer Survivor Celebration. For more details on the event click here >> Registration is free for you and a guest.

Fear of recurrence is real, and something we spend a lot of time talking about with our patients.

Dr. Cobie Whitten has explored this topic in two posts:

• Understanding the fear your cancer will come back
• Five strategies for coping with fear of recurrence

Recently new research was presented at the American Association for Cancer Research Annual Meeting 2012. One study followed 1,807 cancer survivors for more than 18 years. Here are the facts:

• 1,807 cancer survivors followed for 18.2 years
• Over the course of the 18 year study, 776 individuals passed away, but only 51% of these individuals died from cancer. The other 49% died from other causes. Source.

So what does this mean?
As a cancer survivor it’s still important to pay attention to your overall health. How? A recent study at Vanderbilt University found modest results in decreasing recurrence among breast cancer survivors:

• Those who ate one or two servings a day of cruciferous vegetables were attributed a 21 percent decrease in recurrence risk.
• Those who ate more than two servings a day of cruciferous vegetables were attributed a 35 percent decrease in recurrence risk. Source.

Cruciferous vegetables include greens, cabbage, cauliflower and broccoli. However, there’s more to eating correctly than just adding in more green vegetables. If you are looking to improve your personal eating habits take a look at these other articles:

• A few guiding principles around food...
• Understanding whole foods

Customized treatments enhance breast cancer care

Editor's Note: This article originally appeared in the September/October 2011 issue of Vital Signs.

Not all breast cancers are the same, and tailoring treatments for different types is becoming increasingly common in cancer care. This approach has improved cure rates in some patients and allowed others to avoid unnecessary treatments.

At Providence Regional Cancer Center, medical oncologists utilize various methods to customize therapies. Gene analysis is one technique, which may be used when it’s not clear if a patient’s particular form of breast cancer will benefit from chemotherapy.

“The gene analysis test we use looks at 21 genes and gives us an idea of whether the patient has a low, intermediate or high likelihood of recurrence,” said Maury Blitman, MD, medical oncologist at Providence Regional Cancer Center (pictured left.) “Patients with a high recurrence score will typically benefit from chemotherapy, while those with an intermediate or low recurrence score will not gain additional benefit over the hormonal therapy they have already been prescribed.”

For other breast cancer patients, including the 20 to 25 percent who have what’s known as HER2-positive cancer, “targeted” therapies have shown success. This type of breast cancer occurs when the HER2/neu gene mutates, which can result in cancer that is often less responsive to chemotherapy.

However, says Dr. Blitman, physicians now know that combining chemotherapy with Herceptin®, a drug that specifically targets a protein created by the HER2/neu gene, can improve treatment response and increase cure rates.

As cancer physicians and researchers continue to discover new ways of tailoring treatments, the possibility of curing breast cancer – or at least managing it as a chronic medical condition – is becoming reality.

Part I: Understanding the fear your cancer will come back

Editor's Note: We have broken up Cobie's post into two parts, "Understanding the fear your cancer will come back" and "Five strategies for coping with fear of recurrence." We will post Part II on Friday. As always, feel free to leave comments or questions at the end of this post or in our Patient Discussion Forums.

One of the most troubling aspects of ending cancer treatment is worrying that the cancer will come back; indeed some studies suggest that up to 90% of cancer patients report fear of recurrence. Certain events may trigger or exacerbate the fear:

• Doctor visits
• Medical tests
• Media reports about cancer
• Anniversary dates of the diagnosis, ending treatment, etc.
• Hearing that a friend or loved one has been diagnosed

With time, the fear usually lessens. But it can be quite debilitating and disruptive. You may focus excessively on your body and/or ambiguous symptoms and leap to catastrophic conclusions. You may feel you cannot plan for the future, experience despair and feel emotionally paralyzed.

Life after cancer has been described as living with the sword of Damocles over your head. [Greek legend describes that Damocles was a courtier to King Dionysius. Damocles was in awe of the King's great fortune in life, so the King invited him to exchange places with him for a day. During a lavish banquet, Damocles discovered that a sword hung over his head suspended by a single hair. Only then did he understand the constant and anxious dread that a King truly feels. His fear was so great that he could no longer enjoy the riches around him.]

My doctoral dissertation focused on fear of recurrence. A major finding was that the stage of disease/prognosis was not related to anxiety about recurrence. Some women with early stage disease and an excellent prognosis were more fearful than those with later stage disease. Your fear may not align with data or statistics on recurrence likelihood, but that does not mean the fear is not real and upsetting.

Feeling fear that your cancer will come back is completely normal. In our next post I'll share with you five strategies for coping with the fear of recurrence.

You might also like:

• Tales of a cancer control freak
• Who is a cancer survivor? What's in a name?

Yoga decreases stress for patients undergoing radiation therapy

A recent study by MD Anderson in Texas revealed that patients undergoing treatment for breast cancer benefit from participating in the practice of yoga.

Here are the facts:

• 163 women
• Average age = 52 years
• Diagnosed with breast cancer ranging from early onset to stage three
• Actively undergoing radiation therapy

Each woman was randomly assigned to one of three groups:

• Yoga: one-hour sessions, three times a week during six-weeks of radiation therapy
• Simple stretching: one-hour sessions, three times a week during six-weeks of radiation therapy
• No instruction in either

One month after each woman completed radiation therapy she was asked to report on her health and well-being. The same questions were asked three and six months after therapy. In addition, each woman was tested to measure heart functions and stress hormone levels.

Both the women in the yoga and stretching groups reported less fatigue than the non-exercise group.

Additionally, the women who studied yoga during their six-week radiation therapy reported, “greater benefits to physical functioning and general health and were more likely to perceive positive life changes from their cancer experience than either [group]” Source. 

The yoga group also benefited from a steep decline throughout the day in the stress hormone cortisol. Why does this matter? An increase in cortisol prepares your body for potential flight or fight from danger; it is released during times of stress, and its benefits are only for short term release. Extensive release of cortisol for prolonged periods of time can result in alteration of bodily functions, impairment of the immune system, and alterations in the reproductive systems. (see “What is yoga and how can it help me”)

At Providence Regional Cancer System we believe strongly in the healing power of yoga, which is why it is part of our integrative cancer care program. “Participants of our yoga classes continue to sign up session after session, and continually tell us that it is the highlight of their week. It offers not only relaxation, toning and strengthening, but a sense of community as well,” Rosemary Spyhalsky, nurse coordinator of Providence Integrative Cancer Care.

You might also like:

• What happens in a yoga class for cancer survivors?
• 4 obstacles to yoga defeated

All cancer is genetic, but few cancers are inherited

Editors Note: We realize the content of this article is incredibly scientific. However, we strive to bring you the most factual information we can and in this case all the information provided helps to paint a complete picture of Dr. Whitten's article.

If you have questions please don't hesitate to comment.

All cancers have genetic abnormalities. This means the cancer cell’s DNA or genes (which reside in the chromosomes) show alterations. In some cancers it seems to take only a single change to cause the cancerous growth.

For example, one type of leukemia (chronic myelogenous leukemia, or CML), shows a characteristic break between two separate chromosomes with abnormal joining of part of one (chromosome 22) to part of the other (chromosome 9) creating a new abnormal fused chromosome (the famous Philadelphia chromosome).

This break and reconnection brings together, or fuses, two normally separate genes that now behave abnormally, creating uncontrolled cancerous cell growth.

What does this mean, exactly?
All cancers have genetic abnormalities in the cancer cells themselves, but the person who has the cancer does not show these abnormalities in any other cells of their body including their germ cells (eggs and sperm), so they are not passed on to future generations or inherited.

What about the “breast cancer gene”?
There are uncommon hereditary cancers, however. Abnormal genes that were present in the parent’s eggs or sperm can mean an individual inherits an increased risk to develop cancer.

An example is the famous BRCA-1 mutation that increases the risk of breast, ovarian and other cancers in those who inherit a mutated BRCA-1 gene. All cells have 2 copies of every gene and if one inherits mutations in both copies of an important gene like BRCA-1, then the embryo usually does not survive and is spontaneously aborted early in pregnancy, often before the mother knows she is pregnant.

If one inherits a mutation in only one of the copies of the gene then the embryo lives, but has an increased risk of problems such as developing breast cancer in the case of BRCA-1. Most breast cancers do not occur in patients with this hereditary risk, but if you do inherit a mutation in BRCA-1, then your risk is many times higher that you will develop breast or ovarian cancer in your lifetime. That is, most breast cancers arise in patients without a hereditary BRCA-1 mutation or other family history of early or frequent breast cancer.

Another example is an inherited mutation in one of the copies of a DNA repair gene (one that fixes mistakes that invariably occur during copying of DNA to make a new cell) that is inherited and leads to an increased lifetime risk for colon cancer called the Lynch syndrome. Like the BRCA-1 situation, this inherited risk accounts for only a small fraction of all colon cancers (15%), but if you have this mutation, your lifetime risk is much higher than someone who did not inherit the mutation.

What do I do?
If several close family members have developed these cancers at unusually young ages (that is you have a family history of these cancers), then you may carry one of these mutations. Laboratory tests are available to look for the BRCA-1 and Lynch syndrome mutations and several others that are known to lead to an increased hereditary risk for cancers. Talk to your doctor about the appropriateness of genetic testing and counseling for your individual situation.

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