eCancerTrials

Leading cancer researchers from all 50 states provide up-to-date information on over 2000 clinical trials in oncology. These clinical trials evaluate novel treatment approaches and new cancer drugs in all major cancer types including breast cancer, colon cancer, prostate cancer, lung cancer, lymphoma, leukemia, and many other types of cancer.
ECancerTrials.com is a free and confidential cancer clinical trials matching and referral service provided to cancer patients and their caregivers by leading cancer information specialists at CancerConsultants.com.

• Search for clinical trials applicable to your situation free of charge.
• Search without sharing any of your personal information until you find a trial that is appropriate. Then you can call or email the cancer clinic or center conducting the trial. In this manner your privacy is respected and ensured.
• ECancerTrials.com provides interested patients and their family members with additional services to help locate appropriate clinical trials.

Read more

Women & Cancer Magazine - Free Subscription

Keep better informed about the latest advances in the Screening, Prevention, and Treatment of Cancer as well as news about nutrition, wellness, support and survivorship!

New

sdfas

dflkasdf

Walking In Our Patients’ Shoes

What we can learn from women health professionals who develop breast cancer

By Kenneth D. Miller, MD
Director, Connecticut Challenge Cancer Survivorship Clinic
Assistant Professor of Medicine, Yale School of Medicine

Medical professionals who become breast cancer survivors have unique perspectives on illness: they have seen it through the eyes of the healers they are, and they have experienced it as patients in need of healing. Profound insights often result from the blending of these vastly different experiences.

These women find themselves forced to transition from being confident caregivers in control of the care of others to vulnerable patients filled with uncertainty—often in the same settings in which they comfortably worked for years. In their new role, they replace their white coats with thin hospital gowns and wait for test results, just as their patients do every day. Fortunately for us, many come away from their experiences as better, more empathetic caregivers, and—also fortunately for us—they are often willing to share what they have learned on their journeys.

In relating some of the stories and the insights that these physicians, nurses, social workers, and other health professionals have experienced while “walking in their patients’ shoes,” and through sharing the revelations I myself have had while walking alongside my wife, Joan, during her cancer journey, I hope I can pass along some of the key lessons we can gain from this unique population of survivors.

We All Carry Baggage

Women health professionals bring a form of personal baggage to their own situations; their training brings both essential and unnecessary weight—knowledge that is useful and knowledge that sometimes hinders them. Many have cared for patients with advanced cancer or other diseases, so, when faced with breast cancer diagnoses themselves—even if very early stage—they tend to be unnecessarily pessimistic.

Carole Seddon, LCSW, of the Johns Hopkins Avon Foundation Breast Center recalls: “What went through my mind at work was Am I going to wind up in one of these inpatient rooms like my patients? At that time a woman who had been the director of nursing in oncology at Hopkins was dying from cancer. I walked past her room many times, thinking, Is this going to be me? I also expe­rienced a time of hearing the voices and seeing the faces of many of the bone marrow transplant patients who had died. It happened several times, with one face and voice after another, and I could not stop it. It didn’t last very long, but it was very clear to me that I was on the other side, no longer just the professional but also the patient.”

In Carole’s case, she was letting her professional “baggage” get in the way of a realistic and important sense of optimism. As patients we can take an important lesson from her experience and remind ourselves not to get overwhelmed by the baggage of our own past experience. Having lost a friend or relative to cancer may cause tremendous worry and pessimism when you receive your own diagnosis. But that friend or relative may have had a type of cancer and stage of diagnosis that was dramatically different from yours. In addition, if the loss took place years ago, treatment options available then were much more limited. The prognosis for women with breast cancer continues to improve, and optimism is important!

Don’t Be Afraid to Ask Questions

Breast cancer survivors who are health professionals tell us that others often assume they understand information about breast cancer better than they actually do. And because they are caregivers, they may be especially embarrassed to admit their areas of ignorance. The reality is that the clinical experience of an orthopedic nurse does not necessarily give her an understanding of breast cancer. And an ophthalmologist may know little about breast cancer beyond what was taught on the medical wards 20 years prior. These women report that their own doctors often open their explanations by saying, “As you know about breast cancer…,” when really, as newly diagnosed patients outside their area of professional expertise, they don’t know this information at all.

The lesson we can learn from these women is to not be afraid to ask questions and to speak up when you don’t “get it.” Understanding as much as possible about your diagnosis and treatment options is crucial because it will allow you to make informed decisions. Surgeons and other specialists may take for granted that you know a lot about breast cancer because you may have mentioned that you read something about it or because they assume you have already received the information from another doctor. If you hear a doctor or nurse say, “As you know…,” consider interrupting him or her and saying, “I don’t know—so please tell me!” If you don’t understand something, say so. Don’t hesitate to request a different or simpler explanation from your doctor. If you need him or her to draw a chart or use an analogy that you can better relate to, ask for it.

Share Your Feelings and Ask for Support

Some women in the healthcare profession describe the important need to express personal upset and how difficult their journey became when they weren’t given that opportunity or if their attempts were met with awkward or absent responses. Lillie Shockney, RN, administrative director of the Johns Hopkins Avon Foundation Breast Center, shares her experience when she was brought to the operating room prior to undergoing a mastectomy: “The nurses who were in the pre-op greeted me: ‘Oh, hello, Mrs. Shockney. How are you?’ The expression on her face was I feel sorry for you, and I am so thankful I am not you. It was just all over her face. The anesthesiologist was someone I knew, and she had been torn about whether to be my anesthesiologist. She was in my pre-op cubicle with me when I looked at my bra and said, ‘I will never be able to wear this again.’ She later told me, ‘I was speechless. I didn’t know what to say. I just stood there feeling like an idiot and not knowing what to say.’”

In Lillie’s case, when she expressed herself—sharing her sadness before her surgery—her colleagues’ response was awkward. But the fact that Lillie did say what she felt at that point was important, and the lesson here is that as a survivor you should know that it’s okay to tell people how you’re feeling. Your worries, your sadness, and your sense of loss are all important expressions of your feelings, whenever they occur. Your healthcare team as well as your friends and family may not always be able to provide you with quite the right response or comfort that you may need just at that moment, but sharing your feelings at least gives them a chance to try!

Sometimes it’s helpful for family and friends to know in advance that their support will be important throughout your cancer journey. If they know ahead of time that you are comfortable talking to them about these issues and that they need not worry about saying the wrong thing, they may be more comfortable in their support role. And don’t forget—sometimes it’s okay to just let people know that all you need is a sympathetic ear or a loving hug.

Concentrate on the Most Important Issue: Getting Well

We all wear different hats in our lives, as spouses, partners, parents, friends, and in our careers. Women often feel the need to be many things to many people all at the same time. Breast cancer survivors like Carole Seddon, from Johns Hopkins, tell us that during treatment it is important, and even necessary, to focus not on our careers (or whatever else might otherwise take precedence in our lives) but on being healthy. In Carole’s case it meant allowing herself to be a patient returning to good health rather than a social worker caring for others. One particular interaction with her surgeon allowed her to embrace her role as a patient: “One of the best things my surgeon did early on in treatment was to say to me, ‘You know, you can take your professional hat off here.’ He liter­ally said that to me, and I needed him to say it. I said to him, ‘No, I don’t know.’ He said, ‘You’re a patient here.’”

For women like Carole who juggle many roles, the lesson is to be a patient first and to put some of life’s responsibilities on a back burner during cancer therapy so that you can focus on getting well. In addition, Like Carole, other survivors might also want to take the opportunity to develop personal relationships with their physicians, oncology nurses, and radiation technologists. It is these human connections that help many survivors through the healing process.

The Importance of Humor, Positivity, and Optimism

There are some significant insights that woman health professionals who have had breast cancer share about the profound importance of positivity, hope, and even humor. Lillie Shockney shares her own discussion with her mother: “When I got fit­ted for my breast prosthesis, I took my mother with me. On the way I said, ‘Mom, getting a prosthesis is like getting a puppy. She’s going to be my bosom buddy. I’m going to take her everywhere I go, so she should have a name.’ We selected the name ‘Betty Boob,’ and I sent out adop­tion notices to these nurses and to my best friends that I had gotten Betty Boob.”

The diagnosis of breast cancer is unexpected and scary. Women have to navigate unfamiliar waters and be involved in decision-making that is complex. During my 20 years as an oncologist treating breast cancer patients, I have seen many women rely on humor to get them through some of the difficult times, to ease tension, and, ultimately, to heal.

Breast cancer survivors who are nurses and doctors, as well as their families, also remind us that optimism and a positive attitude play an important role. When my wife, Joan, was being treated for acute leukemia, I would come to visit every morning and tell her, “I hear a noise—it’s the leukemia cells popping; the cancer cells are dying and the healing has begun!” Positivity and optimism are powerful allies!

Unfortunately, breast cancer is an epidemic. More than 250,000 women are diagnosed with the disease each year in the United States. Some of these patients are health professionals. They face many of the same challenges as women in other occupations and some that are different. We are fortunate that many are willing to share their experiences of walking in their patients’ shoes so that we may learn from them. Many say that as survivors they are better able than before to impart hope­—a powerful prescription—to their own patients and that they have a renewed respect for each patient’s strength and individuality. One of the lessons I learned as the husband of a cancer survivor that I share with my patients is that there is no one right way to go from sickness to health—there are many right ways—and that different women make different, wise choices.

Oncotype DX® Accurately Determines HER2 Status in Breast Cancer

Oncotype DX® appears to determine HER2 status as accurately as standard laboratory testing methods. By the end of 2008, Genomic Health intends to provide HER2 status with results from all Oncotype DX testing. These results were recently presented at the 2008 American Society of Clinical Oncology (ASCO) Breast Meeting. Read more

Management of breast cancer

Breast Cancer - Overview

Breast cancer is a common malignancy, with ~180,000 new cases diagnosed in the United States each year.[1] The disease occurs most frequently in women and rarely, in men. The breasts are glands that produce and release milk in women in association with pregnancy. Breast cancer develops from cells in the breast.

The normal breast has 6 to 9 overlapping sections called lobes and within each lobe are several smaller lobules that contain the cells that produce milk. The lobes and lobules are linked by thin tubes called ducts, which lead to the nipple in the center of the breast. The spaces around the lobules and ducts are filled with fat. Lymph vessels carry colorless fluid called lymph, which contains important immune cells. The lymph vessels lead to small bean-shaped structures called lymph nodes. Clusters of lymph nodes are found in the axilla (under the arm), above the collarbone, and in the chest.

The suspicion of breast cancer first arises when a lump is detected in the breast during breast examination or a suspicious area is identified during screening mammography. In order to diagnose the cause of the suspicious area or lump in the breast, a physician will perform a biopsy. A biopsy can be performed on an outpatient basis. During a biopsy, a physician removes cells for examination in the laboratory to determine whether cancer is present. Other information obtained from the biopsy sample will play an important role in treatment decisions. If the biopsy indicates that cancer is present, additional surgery may be performed after the patient and doctor select a course of treatment.

There are many types of breast tumors. Some breast tumors are benign (not cancerous). Benign breast tumors such as fibroadenomas or papillomas do not spread outside of the breast and are not life threatening. Other breast tumors are malignant (cancerous). The most common type of breast cancer is called ductal carcinoma and begins in the lining of the ducts. Another type of cancer is called lobular carcinoma, which arises in the lobules.

Personalized Cancer Care Center

When cancer is identified in the biopsy specimen, several other tests may be performed on the specimen in order to further classify the cancer and determine the optimal treatment strategy. Based on the stage of the cancer and the results of these tests, treatment of breast cancer is personalized for each individual. Treatment may involve surgery, radiation therapy, chemotherapy, targeted therapy, and/or hormonal therapy.

Stage: Stage is a measure of the extent of the cancer, and is based on the size of the tumor and the presence or absence of lymph node metastases and distant metastases. Determining the stage of the cancer may require a number of procedures, such as blood tests, chest x-rays, mammography, computed tomography (CT), or magnetic resonance imaging (MRI). For patients with early-stage cancer, the spread of the cancer to the axillary (under the arm) lymph nodes may be assessed through either sentinel lymph node biopsy or axillary lymph node dissection. Axillary lymph node dissection involves the removal of many axillary lymph nodes; the procedure can be associated with chronic side effects such as pain, limited shoulder motion, numbness, and swelling. Sentinel lymph node biopsy is a more recent procedure that involves the removal of only a small number of nodes, or even a single node. If the sentinel lymph nodes are negative (show no evidence of cancer), then no further lymph node surgery is required. Sentinel lymph node biopsy is becoming more widely adopted in the clinical setting for determining whether cancer has spread to the lymph nodes in women with localized breast cancer.

HER2 status: Twenty to thirty percent of breast cancers overexpress (make too much of) a protein known as HER2. Overexpression of this protein leads to increased growth of cancer cells. Fortunately, the development of treatments that specifically target HER2-positive cells – such as Herceptin® (trastuzumab) and Tykerb® (lapatinib) — has improved outcomes among women with HER2-positive breast cancer. For this reason, HER2 status should be accurately measured on all breast cancers.

Hormone receptor status: Some breast cancer cells express an abundance of receptors for the female hormones estrogen and/or progesterone. These cancers– called hormone receptor-positive –are typically associated with a better prognosis and are treated differently from breast cancers that are hormone receptor-negative. Patients with hormone receptor-positive breast cancer often receive treatment with hormonal therapy, such as tamoxifen or an aromatase inhibitor. For more information, go to Hormonal Therapy.

Predicting the need for chemotherapy: Among women with early-stage breast cancer, the expression, or activity, of certain genes has been linked with the likelihood of cancer recurrence and chemotherapy benefit; testing tumor tissue for the expression of these genes can provide important information about prognosis and likely response to treatment.

A genomic test that is included in guidelines from both the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) is Oncotype DX®. Based on the expression of 21 genes, this test provides information about recurrence risk and likely chemotherapy benefit among women with newly diagnosed breast cancer that has not spread to the lymph nodes (node-negative) and is hormone receptor-positive. Oncotype DX has also shown promising results in women with node-positive breast cancer.[2]

For more information about OncotypeDX, visit http://www.mytreatmentdecision.com/

Predicting drug metabolism: Another type of test that may prove important is the assessment of inherited genetic variation that influences drug metabolism (the processing of drugs by the body). In the case of tamoxifen, for example, differences in effectiveness may be explained at least in part by inherited differences in a gene known as CYP2D6.[3] Most people have two functional versions of this gene and are able to effectively process tamoxifen. Some people, however, have versions of this gene that are less effective at processing tamoxifen. Testing patients for these gene variants could help doctors identify patients who are less likely to respond to tamoxifen. A currently available test is AmpliChip®, which assesses CYP2D6 as well as CYP2C19 (another gene involved in drug metabolism). Additional data are required, however, before formal recommendations can be developed about this type of testing.[4]

For more information about AmpliChip, visit http://www.amplichip.us/.

Learn More

Patients who have already undergone surgery and lymph node evaluation and know their stage of cancer may select from the options below. In order to learn more about surgery and sentinel lymph node dissection, go to Surgery for Breast Cancer.

Carcinoma In Situ: Approximately 15-20% of breast cancers are very early in their development. These are sometimes referred to as carcinoma in situ and consist of two types: ductal carcinoma in situ (DCIS), which originates in the ducts and lobular carcinoma in situ (LCIS), which originates in the lobules. DCIS is the precursor to invasive cancer and LCIS is a risk factor for developing cancer.

Stage I: Cancer is confined to a single site in the breast, is less than 2 centimeters (3/4 inch) in size and has not spread outside the breast.

Stage IIA: Cancer has spread to involve underarm lymph nodes and is less than 2 centimeters (3/4 inch) in size or the primary cancer itself is 2-5 centimeters (3/4-2 inches) and has not spread to the lymph nodes.

Stage IIB: Cancer has spread to involve underarm lymph nodes and/or the primary cancer is greater than 5 centimeters (2 inches) in size and does not involve any lymph nodes.

Stage IIIA: Cancer is smaller than 5 centimeters (2 inches) and has spread to the lymph nodes under the arm or the lymph nodes are attached to each other or to other structures or the primary cancer is larger than 5 centimeters (2 inches) and has spread to the lymph nodes under the arm.

Stage IIIB: Cancer directly involves the chest wall or has spread to internal lymph nodes on the same side of the chest.

Inflammatory: Inflammatory breast cancer is a special class of breast cancer that is rare. The breast looks as if it is inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals or it may have a pitted appearance. Inflammatory breast cancer tends to spread quickly.

Stage IV: Cancer has spread to distant locations in the body, which may include the liver, lungs, bones or other sites.

Recurrent/Relapsed: The breast cancer has progressed or returned (recurred/relapsed) following an initial treatment.

References:

---

[1] American Cancer Society. Cancer Facts & Figures 2007. Available at: http://www.cancer.org/docroot/stt/stt_0.asp (Accessed December 10, 2007).

[2] Albain K, Barlow W, Shak S et al. Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal, node-positive, ER-positive breast cancer (S8814,INT0100). Presented at the 30^th Annual San Antonio Breast Cancer Symposium. San Antonio, TX, December 13-16, 2007. Abstract #10.

[3] Schroth W, Antoniadou L, Fritz P et al. Breast cancer treatment outcome with adjuvant tamoxifen relative to patient CYP2D6 and CYP2C19 genotypes. Journal of Clinical Oncology. 2007;25:5187-5193.

[4] Desta Z, Flockhart DA. Germline pharmacogenetics of tamoxifen response: have we learned enough? Journal of Clinical Oncology. 2007;5147-5149.

Copyright Breast Cancer Information Center on CancerConsultants.com

Last modified: 2/1/2008

Hope in Bloom

Roberta Hershon and her friend Beverly Eisenberg spent many wonderful hours together immersed in their Massachusetts gardens—planning, visiting nurseries, and working together in the dirt. When Beverly was diagnosed with breast cancer in 2004, her close circle of friends made sure that her garden was cared for, and, when she was unable to enjoy the outdoors, they ensured that she was still surrounded by the flowers and the green growing things that brought her so much joy and peace. Read more

Do Fruits and Vegetables Really Reduce Breast Cancer Risk?

Women who have been diagnosed with breast cancer often pay extra attention to their diet as a way to prevent recurrence of their cancer. Healthcare professionals and researchers alike have long suspected a correlation between healthful eating patterns and reduced risk of chronic diseases such as certain forms of cancer and heart disease. Read more