Monthly Archives: February 2015

5 Things You Need to Know When You Finish Cancer Treatment

Eating Healthy is part of the Top 5

Eating Healthy is one of the 5

Now what? Is that it? Am I done with cancer? How do I keep it away? How do I know it’s not back? Why do I feel lonelier now than I did during treatment?

These questions often plague a cancer survivor. It can be frightening to finish treatment. For the past few months you have seen physicians, nurses, therapists and other health care professionals sometimes daily; and now you are on your own. Here are 5 things I tell my patients.

  1. Make sure you have a treatment summary and a survivorship plan from each of your cancer specialists. And make sure that your primary care physician has a copy too.
  2. Understand that the transition from cancer specialists back to your primary care physician may result in a lot of anxiety for you and your family. That is normal. And o.k. Trust this doctor.
  3. Make sure you and your primary care physician keep a watch for signs of late treatment side effects. Let your primary care physician know about any new symptoms that you may experience. While I don’t want you to become paranoid, I do want you to communicate with your doctor. If your physician has any concerns, he will send you to see your cancer specialist. You can always contact your specialist if you are not satisfied.
  4. Keep up to date screening recommendations for people with your type of cancer. Follow the survivorship plan carefully. Also continue to have the recommended screenings for other types of cancers. Just because you had one type, unfortunately doesn’t make you immune to others.
  5. Embrace new healthy habits, like a good diet and daily exercise. You have been given another chance. Make the best of it.

Many survivors have a New Normal. It will take some time for your body to find this new normal. Your energy levels, eating habits, and appearance may have changed. Find out what is best for the new you. Worrying about recurrence is a part of this new normal. It can be healthy as long as it doesn’t consume you. Following these 5 steps can help you to be a healthy, happy survivor.

 

Releasing Your Body’s Own Immune System to Combat Cancer

Using your own body to fight cancer.

Using your own body to fight cancer.

After decades of painstaking research, a number of recent clinical trials have shown that the patient’s own immune system can be used to attack cancer cells. In the January 22nd issue of the New England Journal of Medicine, two separate reports provide even more data on the emerging role of immune therapy in the treatment of metastatic cancer. Immunotherapy for cancer has now focused on the class of drugs called immune checkpoint inhibitors. These drugs are actually antibodies themselves, and inhibit the body’s own natural brakes on the immune system.

The first article described better survival for patients with metastatic melanoma, the deadliest form of skin cancer, who received the drug nivolumab. Results of this study strongly support the approval of nivolumab as first-line treatment for many patients with metastatic melanoma. The second article showed a very high response rate of 87% to nivolumab for patients with Hodgkin’s lymphoma in whom chemotherapy failed.

Dr. Drew Pardoll, M.D. PhD, co-director of the Johns Hopkins immunology program, stated that “I divide pharmaceutical companies into two categories. They’re in immunotherapy up to their eye balls or they want to be.” This is an exciting time in medical research. We are just beginning to understand how powerful our own immune system can be with the right help.

Another class of drugs focuses on inhibiting immune cell molecule called CTLA-4. There are now at least 3 examples of successful immune mediated tumor rejection after treatment with radiation therapy and CTLA-4 checkpoint blockade. Importantly, each of these studies used short course/high dose radiation therapy combined with the CTLA-4 antibody. Two studies again focused on metastatic melanoma, and another one focused on metastatic lung cancer. I believe that we are just at the dawn of integrating short course/high dose radiation therapy, such as that delivered by the CyberKnife, with immunotherapy. In the coming decade, there will continue to be exciting advances with these new modalities to improve patient’s quality of life.

It now looks like the time and money spent in tumor immunology is paying real dividends for patients. The hope is that the immune checkpoint drugs can be combined with traditional forms of cancer therapy, like surgery and radiation therapy, to treat even more cancers. Stay tuned.

Exercise Each Day Will Keep Cancer Away

Exercise is More Fun Together

Exercise is More Fun Together

February is National Heart Month. We are all wearing red to increase heart health awareness. What is good for the heart, is good for cancer prevention. You can reduce cancer recurrence by up to 40% by making this one simple lifestyle change!

We all know that exercise can help prevent heart disease. What’s equally true is that routine exercise can not only prevent cancer, but also help to prevent cancer recurrence. Exercise has proven to decrease the risk of colorectal cancer, postmenopausal breast cancer, uterine cancer and possibly prostate cancer. Other major studies have shown that routine exercise can also reduce the risk of cancer recurrence once you have been cured of the disease. Major studies in breast cancer and colorectal cancer have shown that routine exercise can reduce the risk of recurrence by as much as 25-40%. Let’s look at breast cancer, specifically triple negative breast cancer, the most deadly form of the disease. A study published in January 2015 in the Journal of Cancer, showed that routine vigorous exercise can increase the levels of a hormone called Irisin. Irisin was shown to have 2 major effects. First, irisin decreases cancer cell movement, an essential component of metastasis or cancer spread. Second, irisin was shown to increase programmed cancer cell death or cancer cell suicide. These results were shown in the test tube, but may have profound effects for cancer patients.

Doctors say do “routine vigorous exercise”. Does that mean you need to run marathons to prevent cancer? I don’t think so. But I do know that 3-4 hours per week of exercise is better than 1-2 hours. I don’t know whether aerobic exercise is better than strength training for cancer prevention. So what do I tell my patients? I tell them to exercise 30-45 minutes each day for 6 days of the week. I recommend alternating “strength days” with “aerobic days”.

I practice what I preach.  I take my dogs for long walks on Monday, Wednesdays and Fridays; and do Pilates on Tuesdays, Thursdays and Saturdays. It is never too late to start. At every age, at every stage of cancer prevention, or cancer survivorship; there are far reaching benefits.  Keeping Cancer Away is one of them!

Prostate Cancer Survivor Gives an Unexpected Gift at an Unexptected Time

Just the other day I was reading in “Dr. Blogs” a very disturbing article titled “Are We Witnessing the Death of the Modern-day Physician.” The author, Dr. Jordan Grumet, is an internal medicine physician who owns his own private practice in Northbrook, Illinois. Dr. Grumet laments the changing face of American medicine “the cost of education has exploded while salaries are taking a nose dive… respect in the community is waning… the morale of the profession is faltering…” With all of the changes in American medicine, it is a constant challenge to remain upbeat , to focus on patients and not paperwork.

That very same day one of my former patients, a survivor of stage IV prostate cancer, paid me an unscheduled visit. Immediately I was concerned for his health. But he had come to give me an unexpected gift at an unexpected time.

I was overwhelmed at his caring and thoughtfulness. I am not used to being on the other side of giving. He told me that he remembered at his initial consultation, my remarking on the words on his t-shirt. He had worn the shirt many times before and didn’t think anyone noticed its words. He remembered that I told him, “I really like your t-shirt. I need to do that myself.” I can only hope to abide by its meaning each and every day. It reads “Life is good. Keep it simple.”

Life is Good. Keep it Simple.

Life is Good. Keep it Simple.