2012 Research Article Summaries
Many Cancer-Related Symptoms Remain Undiagnosed and Undertreated for Survivors
Posted December 2012
Troublesome Symptoms in Cancer Survivors: Fatigue, Insomnia, Neuropathy and Pain. Journal of Clinical Oncology, October 2012, Vol 30, pp. 3687-3696.
This article addresses the management of four common, but often poorly controlled, symptoms in individuals diagnosed with cancer: fatigue, insomnia, peripheral neuropathy and pain.
Cancer-related fatique (CRF) occurs in approximately 60 to 90 percent of cancer survivors, with the highest rate in individuals undergoing chemotherapy. While several pharmacologic treatments, primarily psychostimulants and antidepressants, have been investigated for treatment of CRF with, at best, mixed results, the most promising treatments appear to be nonpharmacologic, specifically, physical exercise; psychosocial interventions, such as education about fatigue, learning self-care techniques and energy conservation or activity managment; and yoga. The evaluation and treatment of comorbid medical and mental health conditions (pain, depression, insomnia) is also recommended as certain conditions may contribute to CRF.
Insomnia reportedly occurs in 30 to 50 percent of individuals undergoing cancer treatment, and while symptoms may improve with time, they can persist for years post-treatment. Although pharmacologic agents are typically used to treat insomnia, the use of sleeping pills in individuals with cancer has been associated with lower quality of life and increased symptom severity. While research supports the effectiveness of hormonal or herbal products such as melatonin or ramelteon in the general population, studies have not been conducted with cancer survivors. Like CRF, the most promising intervention for insomnia appears to be nonpharmacologic, specifically, cognitive behavioral therapy for insomnia (CBT-I), which includes stimulus-control therapy, sleep-restriction therapy, relaxation therapy and training, cognitive therapy and sleep-hygiene education. Exercise and yoga have also demonstrated positive results with cancer survivors.
Chemotherapy-induced peripheral neuropathy (CIPN) is a peripheral sensory problem that often presents as paresthesias (tingling, burning, prickling sensation on skin) or pain and is caused by the toxicity of multiple commonly used chemotherapeutic agents. When possible, preventing CIPN is the best remedy since symptoms are difficult to treat. Intravenous calcium and magnesium for CIPN associated with oxaliplatin is a promising, well-studied strategy. In preliminary studies, glutathione also shows promise in preventing CIPN. For symptom management, pharmocologic agents appear most effective. The most promising are venlafaxine, an antidepressant, for oxaliplatin neurotoxicity and a topical preparation of baclofen, amitriptyline and ketamine for CIPN in general. There are a number of other pharmacologic agents that may be beneficial but require further study as well as nonpharmacologic interventions, specifically, scrambler therapy, a treatment that provides electrocutaneous nerve stimulation, and acupuncture.
Cancer-associated pain can contribute to depression, insomnia and decreased quality of life for many survivors, and it's estimated that 33 percent of cancer survivors continue to have pain after curative treatment. While pharmacologic agents currently appear to offer the greatest benefit for neuropathic and chronic pain, a multidisciplinary approach to treatment is recommended, including a combination of pharmacologic treatments, rehabilitative therapy, interventional procedures for refractory pain and psychosocial interventions. From a pharmacologic approach, some antidepressants and anticonvulsants have been shown to help with neuropathic pain, as noted with CIPN, and opioids, particularly morphine, oxycodone and fentanyl, may offer relief for survivors who suffer from chronic pain but not without adverse side effects for many. Rehabilitative therapies, such as physical and occupational therapy and psychological interventions (CBT, stress management) as well as complementary therapies like hypnosis and guided imagery have all shown benefit but require further study.
To read the article, visit http://jco.ascopubs.org/content/30/30/3687.long.
Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes Among Breast Cancer Survivors
Posted November 2012
Hot flashes are a significant problem for many breast cancer survivors, with reports that up to about 75 percent of female chemotherapy and tamoxifen recipients experience hot flashes. While estrogens are typically used to treat hot flashes, they are generally avoided with breast cancer survivors because of increased risk of breast cancer.
This study evaluated the effectiveness of hypnosis, a mind-body therapy with few negative side effects, for hot flashes in 60 female breast cancer survivors, 51 of whom completed the study. Survivors were randomly assigned to the hypnosis intervention (five 50-minute weekly sessions and instruction in self-hypnosis) or to no treatment.
By the end of the intervention, participants in the hypnosis intervention experienced a 68 percent decrease in hot flash scores (frequency x average severity) and an average reduction of 4.39 hot flashes per day. The women in the no-treatment group remained mostly unchanged. Women in the hypnosis arm also reported significant improvements in depression, interference of hot flashes with daily activities and sleep. As such, this study suggests that hypnosis may also improve the emotional and psychosocial adjustment of women who experience hot flashes. Finally, participant satisfaction with the hypnosis intervention was high, with no complaints about or study withdrawal due to negative side effects.
To read the article, visit http://jco.ascopubs.org/content/26/31/5022.full.pdf+html.
The Effect of Peer Counseling on Quality of Life Following Diagnosis of Breast Cancer: An Observational Study
Posted October 2012
Surveys show that women express the greatest need for support at diagnosis and that the support they most want is to speak with another survivor. Research also shows that supportive interventions help decrease distress in women with breast cancer. Recognizing that it can be difficult to actively seek support when dealing with a new cancer diagnosis, the authors in this study developed and evaluated a peer navigator program linking newly diagnosed women (sojourners) with women who had completed treatment (navigators). Sojourners were asked to rank a list of qualities they preferred in a match, and most often, individuals were matched on common diagnosis, treatment protocol, specific treatment concern and age. Navigators received extensive ongoing training in peer support and self-care and initiated contact with their match.
Overall findings showed significant decreases in trauma symptoms and desire for breast cancer information and increases in emotional well-being and cancer self-efficacy for sojourners. Navigators didn’t report significant improvement or detriment, suggesting they weren’t negatively impacted by providing support to a newly diagnosed woman. Sojourners and navigators rated expression of feelings as the most frequently discussed topic, twice as much as requests for information and three times more than request for resources. Discussion about active coping was rated as the second most frequently addressed topic. Sojourners rated feeling understood as the most helpful aspect of the intervention.
To read the entire article, visit http://www.ncbi.nlm.nih.gov/pubmed/16555366.
From Cancer Patient to Cancer Survivor: Lost in Transition
Posted September 2012
In 2006, the Institute of Medicine (IOM) released the report "From Cancer Patient to Cancer Survivor: Lost in Transition," which examined the medical and psychosocial issues faced by cancer survivors and recommended actions to improve survivors' health care and quality of life. The IOM issued 10 recommendations for cancer survivors as they transition from active treatment to post-treatment care, recognizing that survivors are often left without knowledge of their short- and long-term risks and a coordinated plan for follow-up care. While this report was released six years ago, most of the recommendations have yet to be implemented at a systematic level. Given the need and desire for survivorship programs, as evidenced by the IOM report and our own needs assessment conducted in February 2012, and YWBCP's renewed focus on survivor programs (survivor exercise group, creative arts program, survivorship planning workshop), it's the right time to review these important recommendations. A summary of each follows:
- Providers and other stakeholders should work to raise awareness of survivor needs, make cancer survivorship a distinct phase of cancer care and ensure effective delivery of survivorship care.
- Upon completion of primary treatment, survivors should receive a comprehensive care summary and survivorship care plan effectively explained by primary cancer care providers.
- Providers should use evidence-based guidelines and assessment tools to identify and manage late effects of cancer and its treatment.
- Tools and programs to measure and assure the quality of survivorship care should be developed.
- Funding agencies should support programs to test coordinated, interdisciplinary models of survivorship care.
- Federal and state legislatures should support the development of comprehensive cancer control plans that include survivorship care as well as the evaluation of existing plans to ensure the inclusion of survivorship care.
- Health care providers should receive education and training on the unique issues facing cancer survivors.
- Employers and advocates should act to eliminate workplace discrimination and minimize the negative impact of cancer on employment.
- Federal and state policy makers should ensure that all cancer survivors have access to adequate and affordable health insurance.
- Funding and research institutions should increase support for cancer survivorship research, particularly effective and necessary components of survivor follow-up care.
To download the report, visit http://www.nap.edu/catalog/11468.html.
Nine Findings That Have Rocked Cancer Prevention Research
Posted August 2012
The 100th issue of Cancer Research Update (July 2012) highlights nine research developments making a significant impact on cancer prevention and survivorship:
- When Diet Meets Gene – Our genes may influence diet's role in cancer and other chronic diseases.
- Diet, Microbes and Cancer Prevention – Diet's link to cancer prevention may, in part, depend on the trillions of microbes living in our gut.
- The Tiny World around a Cancer Cell – A cell's surroundings can drive or stifle cancer growth.
- Cancer Risk: The Fit or Fat Debate – Can physical activity reduce cancer risk regardless of weight?
- Diabetes Increases Cancer Risk: Lifestyle Connections – People with type 2 diabetes have an increased risk of several types of cancer, including liver, pancreas and endometrium cancer.
- Seven Successful Weight Loss Strategies –Top 7 habits of people maintaining lower weight for more than five years.
- Inactivity: Hidden Cancer Risk – If physical activity lowers the risk of developing several cancers, can inactivity increase the risk.
- Cancer Survivors: Getting Active and Healthy – New recommendations urging survivors to avoid inactivity, even while undergoing treatment.
- Building a Database for Cancer Prevention: Keeping the Science Current – Largest ongoing review of cancer prevention and survival research of its kind in the world has published first progress report, providing an overview of research on food, nutrition, physical activity, weight and cancer.
To register to receive Cancer Research Update, visit http://aicr.org.
How Helpful is Expressive Writing for Breast Cancer Survivors?
Posted July 2012
The Feasibility and Effectiveness of Expressive Writing for Rural and Urban Breast Cancer Survivors. Oncology Nursing Forum, Vol 37(6), pp. 749-57.
This study examined an in-home writing program aimed at helping with some of the physical and psychosocial issues that accompany breast cancer survivorship. The authors proposed that women who participated in the one-time writing exercise would have better physical and psychosocial health three and nine months after writing compared to a group of survivors who didn't participate in the exercise. The findings showed that women who participated in the writing group reported significantly fewer physical symptoms and significantly lower levels of depressive emotion and mood disturbance three months after the writing exercise but not nine months after writing. As such, the authors suggest that survivors may experience more lasting benefits from writing at multiple times throughout treatment and survivorship rather than just once. To link to the article, visit ons.metapress.com/content/0190-535X.
Younger Women Experience Distinct Treatment-related Effects
Posted June 2012
Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review. Journal of National Cancer Institute 2012, Vol 104, pp. 1-20.
Researchers at the University of California, Los Angeles, recently published a comprehensive review of studies on young women with breast cancer and found that quality of life, fertility and menopausal side effects, and behavioral health top the list of concerns and issues. Specifically, the studies reviewed found younger women experience more significant changes in emotional well-being (i.e., anxiety and depression) than physical functioning. However, menopausal symptoms – such as hot flashes, vaginal dryness and lack of sexual desire – were concerns for many young women, as was infertility and weight gain. Reviewers noted the relationships between key areas of concern may be important and require further study, such as how weight gain and premature menopause may contribute to emotional distress. To link to the article, visit www.jnci.oxfordjournals.org.