You've undergone chemotherapy and are now a cancer survivor. You find that you are physically and mentally exhausted. You are probably not too surprised at that. After all, you went through a lot during your battle with cancer.
You may be more concerned with the mental deterioration than with the physical exhaustion. You may be constantly in a fog. You may have difficulty concentrating, focusing and remembering things. You may even start to think that you have Alzheimer's disease. I jokingly used to say, "I have chemobrain". I don't know where I picked up that term but I thought it was a non-medical vernacular term.
Did you know that chemobrain is a real medical condition? A recent UCLA study shows that chemotherapy causes changes to the brain's metabolism and blood. According to that study, chemotherapy patients experience disrupted thought processes and confusion.
Hospitals and cancer organizations are unanimous in recognizing chemobrain as a very real medical condition. Recently oncologist Dr Patricia Ganz received a grant from the National Cancer Institute to conduct a five year study on chemobrain.
Researchers from New York's University of Rochester found several types of key brain cells were highly vulnerable to the drugs used in chemotherapy. According to Dr Mark Noble of the University of Rochester, "This is the first study that puts chemobrain on a sound scientific footing."
From the Science Daily, "Cancer survivors, take note. The mental fog and forgetfulness of "chemo brain" are no figment of your imagination."
Now that we recognize that chemobrain is very real medical condition, what can we do about it? Here are some suggestions:
Use a daily planner
Exercise your brain. Read, get a hobby, do volunteer work Take some courses.
Get sufficient rest and sleep.
Don't dwell on your chemobrain symptoms.
Talk to family, friends, and your healthcare team about your chemobrain
Remember, you are not dim-witted or nuts; you have a real side-effect to chemotherapy.
Researchers are also looking at different medications as possible treatments for chemobrain.
After undergoing chemotherapy, you may not want a medicine to treat the side effects of another medicine. Research suggests the following:
Exercise. It's a known fact that exercise can improve you mood, increase your energy and help your concentration.
A healthy diet.
Certain vitamins and supplements.
John Fink is a Stage IV Cancer Survivor
Article Source: http://EzineArticles.com/?expert=John_Fink
John Fink - EzineArticles Expert Author
World-renowned 6-time cancer survivor Phil Kerslake follows up his opening address to NZ's haematology & oncology nurses conference 2007 with this article, stating his case for oncology nurse advocacy for psychosocial (emotional) support measures applied tactically for cancer patients.
As increasing numbers and types of anti-cancer drugs are developed, oncologists become increasingly likely to misuse them in their practice. There is seldom a "standard" therapy which has been proven to be superior to any other therapy. When all studies are compared by meta-analysis, there is no difference. What may work for one, may not work for another.
Cancer chemotherapy could save more lives if pre-testing were incorporated into clinical medicine. The respected cancer journals are publishing articles that identify safer and more effective treatment regimens, yet few community oncologists are incorporating these synergistic methods into their clinical practice. Cancer patients suffer through chemotherapy sessions that do not integrate all possibilities.
Distinguishing between patients with a "high" or "low" risk for early recurrence after surgical resection and identifying those who may respond to correct adjuvant therapy have been topics of great interest for many years. Both genetic and functional assay analyses share a role in the development of "personalized" patient care.
A genomic test can help to find out if a cancer patient will likely have a recurrence after surgery. If a recurrence isn't likely, they don't need chemotherapy. Genetic tests have been developed for breast and lung cancers. Hopefully, there will be more tests for other types of cancer to guide physicians as to which "high" risk patient will likely have a recurrence if treated with surgery alone (1).
If the test finds a patient to be at "high" risk, it is impossible to design a single chemotherapy protocol that is effective against all types of cancer. The oncologist might need to administer several chemotherapy drugs at varying doses because tumor cells express survival factors with a wide degree of individual cell variability. A cell culture assay test, using a cell-death endpoint, can help see what treatments will not have the best opportunity of being successful (resistant) and identify drugs that have the best opportunity of being successful (sensitive).
The current clinical applications of in vitro chemosensitivity testing is ever more important with the influx of new "targeted" therapies. Given the technical and conceptual advantages of "functional profiling" of cell culture assays together with their performance and the modest efficacy for therapy prediction on analysis of genome expression, there is reason for renewed interest in these assays for optimized use of medical treatment of malignant disease (2).
The chemotherapy regimen chosen by most community oncologists is based on the type of cancer being treated. However, there are factors other than the type of cancer that can be used to determine the ideal chemotherapy drugs that should be used to treat an individual patient.
It is highly desirable to know what drugs are effective against particular cancer cells before these toxic agents are systemically administered. Pre-testing on "fresh" specimens of cancer cells to determine the optimal combination of chemotherapy drugs could be highly beneficial.
Following the collection of "fresh" cancer cells obtained at the time of biopsy or surgery, a cell culture assay is performed on the tumor sample to measure drug activity (sensitivity and resistance). This will pinpoint which drug(s) are most effective. The treatment program developed through this approach is known as assay-directed therapy.
At present, medical oncologists prescribe chemotherapy according to "fixed" schedules. These schedules are standardized drug regimens that correspond to specific cancers by type or diagnosis. These regimens, developed over many years of clinical trials, assign patients to the drugs which previously worked for some percentage of patients.
However, cancer is a disease whose hallmark is heterogeneity. It is well known that drugs which work for one patient often don't work for another and patients who fail to respond to first line chemotherapy with one regimen often respond to second or third line therapy with alternative drugs. Why not identify the right regimen before ever exposing a patient to a single course of chemotherapy? A failed attempt at chemotherapy is detrimental to the physical and emotional well being of patients, is financially burdensome, and may promote the onset of clinically acquired multi-drug resistance.
A "fresh" sample tumor can be obtained from surgery or biopsy (Tru-cut needle biopsies). Tissue, blood, bone marrow, and ascites and pleural effusions are possibilities, providing tumor cells are present, and only live cells should be used. At least one gram of fresh biopsy tissue is needed to perfom the tests, and a special kit is obtained in advance from the lab. Arrangements are made with the surgeon and/or pathologist for preparation and sending of the specimen.
Upgrading clinical therapy by using drug sensitivity assays measuring "cell death" of three dimensional microclusters of live "fresh" tumor cells can improve the conventional situation by allowing more drugs to be considered. The key to improving drug sensitivity tests is related to the number and types of drugs tested. The more anti-cancer drug types there are in the selective arsenal, the more likely the system is to prove beneficial.
In order to acquire sufficient data, tumors should be tested with at least two assay endpoints, and most often three, for sensitivity tests in any one patient. On average, up to twenty drugs and combinations at two concentrations in three different assay systems, is an effective way to avoid false-positive or false-negative data.
Assays based on "cell-death" occur in the entire population of tumor cells, as opposed to only in a small fraction of the tumor cells occurring in "cell-growth" assays. Drug "sensitivity" testing is merely a point a little farther along on the very same continuum upon which "resistance" testing resides, which has been proven to be accurate and reliable, as reported in numerous peer-reviewed publications.
Good review papers exist on cell culture assays and are increasingly appreciated and applied in the private sector by European clinicians and scientists. The literature on these assays have not been understood by many NCI investigators and by NCI-funded university investigators, because their knowledge has been based largely on an assay technique (cell-growth) that hasn't been used in most private labs for over fifteen years (3).
Data show conclusively that patients benefit both in terms of response and survival from drugs and drug combinations found to be "active" in the assay even after treatment failure with several other drugs, many of which are in the same class, and even with combinations of drugs found to have low or no activity as single agents but which are found in the assay to produce a synergistic and not merely an additive anti-tumor effect.
Patients receiving a drug that tested "sensitive" were 1.44 times [i.e. 44%] more likely to respond compared to all patients treated in studies, while patients testing "resistant" were 0.23 as likely to respond as all patients. Patients receiving treatment with drugs testing "sensitive" enjoyed a 6-fold advantage (1.44/0.23 = 6.23) over patients treated with drugs testing "resistant."
This data includes both patients with solid tumors (e.g., breast cancer, lung cancer) and hematological (blood system) tumors (e.g. leukemia, lymphoma). In the case of solid tumors only, the advantage to receiving sensitive versus resistant drugs was 9.3 fold. In the case of breast cancer, it was more than 10-fold. Furthermore, patients receiving "sensitive" drugs were shown in many studies to enjoy significantly longer durations of survival than patients treated with "resistant" drugs.
Patients treated with a "positive" (sensitive) drug would respond 79.1% of the time, while patients treated with a "negative" (resistant) drug would respond only 12.6% of the time. Once again, there would be a huge advantage to the patient to receive a "positive/sensitive" drug, compared to a "negative/resistant" drug (4).
Profiles from DNA and RNA expression analysis can help define patients at risk for early recurrence. Cell Culture Assays with "functional profiling" have a role in eliminating ineffective agents and avoid unnecessary toxicity and in directing "correct" therapy.
An ASCO tech review of drug sensitivity and resistance assays, concluded that the use of these assays for selection of chemotherapeutic agents for individual patients is not recommended outside the clinical trial setting (5).
However, Medicare contractor National Heritage Insurance Company spent six months reviewing everything about the cell culture assay, read all of ASCO arguments, and upon reviewing all available information, made the decision to reverse trend and go on record as formally approving the service and providing coverage.
They found that even back in 1999, the Medicare Advisory Panel concluded that cell culture assays tests offered clinical utility. After listening to detailed clinical evidence, the Medicare Coverage Advisory Committee found that these assay systems can aid physicians in deciding which chemotherapies work best in battling an individual patient's form of cancer (6).
Although Medicare had been reimbursing for cell culture drug "resistance" tests since 2000, it wasn't until the beginning of this year that they abandoned the artificial distinction between "resistance" testing and "sensitivity" testing and are providing coverage for the whole FDA-approved kit. The decision had been made that the assay is a perfectly appropriate medical service, worthy of coverage on a non-investigational basis (7).
1. J Thorac Cardiovasc Surg 2007;133:352-363. Chemotherapy Resistance and Oncogene Expression in NSCLC. http://jtcs.ctsnetjournals.org/cgi/content/abstract/133/2/352
2. J Clin Onco, 2006 ASCO Annual Meeting Proceedings Part 1. Vol 24, No. 18S (June 20 Supplement), 2006: 17117. Genfitinib-induced cell death in short term fresh tumor cultures predicts for long term patient survival in previously-treated NSCLC. Link
3. Eur J Clin Invest, Volume 37(suppl. 1):60, April 2007. Functional profiling with cell culture-based assays for kinase inhibitors and anti-angiogenic agents. http://weisenthal.org/Weisenthal_ESCIa.pdf
4. Weisenthal Cancer Group, Huntington Beach, CA and Departments of Clinical Pharmacology and Oncology, Uppsala University, Uppsala, Sweden. Current Status of Cell Culture Drug Resistance Testing (CCDRT) May, 2002. http://weisenthal.org/ccdrtrev.pdf
5. Journal of Clinical Oncology Reviews on Chemotherapy Sensitivity and Resistance Assays, September1,2004. http://weisenthal.org/jco_response.htm
6. Verbatim Transcript of Medicare Coverage Advisory Committee (MCAC) Meeting, November 15-16, 1999. http://weisenthal.org/hcfa_1.htm http://weisenthal.org/hcfa_2.htm http://weisenthal.org/hcfa_3.htm
7. Centers for Medicare & Medicaid Services http://www.medicarenhic.com/cal_prov/articles/chemoassaytest_0107.htm
An excellent low iodine cookbook, complete with basic guidelines, for those with thyroid cancer who will be undergoing radioactive iodine treatment.
The "LID" - low iodine diet - deprives your body of iodine, and is normally done for a period of 2 weeks prior, and 24-48 hours following radioactive iodine treatment doses. It is important to carefully adhere to the diet particularly for the 7 days prior to treatment.
The resulting low iodine dietary content ensures your body 'soaks up' as much of the radioactive iodine treatment as possible, in all 'thyroid like' tissues, including cancerous ones.
This free resource is yet another valuable contribution to us, provided by the folks at THYCA, located at www.thyca.org
Some Oncologists Look for New Ways To Profit From Cancer Treatments, according to a New York Times article. They examined how limits placed on profits that physicians can make on cancer drugs have left some oncologists "searching for new income," such as by "performing additional treatments that" have "the best reimbursements, whether or not the treatments" benefit the patients. Medicare until 2005 paid a markup of 20% to 100% for many cancer drugs, along with injectable treatments for arthritis and other diseases.
In 2005, Congress changed the reimbursement system to pay physicians 6% more than the average price for a given treatment. The reduction in reimbursements "did not reduce overall federal spending on cancer care," which has increased slightly in the last two years, and the difference in spending "mostly represented profit that doctors had made on the drugs," the Times reports. However, cancer doctors say the "change did nothing to reduce a larger problem in cancer treatment," according to the Times.
The decrease in payments has made it difficult for smaller practices to break even on cancer drug purchases because the practices often do not buy enough of any drug to receive rebates or discounts from drug manufacturers. Some oncologists have attempted to increase profits by "performing chemotherapy more often or installing multimillion-dollar imaging machines where they profit when their patients receive diagnostic scans" and by "putting new pressure on cancer patients to make out-of-pocket drug copayments," according to the Times.
The situation "offers a vivid example of how difficult it may be to rein in the nation's runaway health care spending without fundamentally changing the way doctors are paid," the Times reports. Robert Geller, a former oncologist and senior medical director at Alexion Pharmaceuticals, said oncologists likely will continue to find ways to profit from Medicare as long as they are paid by procedure and not for time spent with patients.
In related news, the Times examines how before the change to Medicare reimbursements for cancer treatments, pharmaceutical companies "sometimes calculated to the penny the profits that doctors could make from their drugs" and sales representatives from the companies "shared those profit estimates with doctors and their staffs," according to industry documents that have become public in a federal civil lawsuit against drug makers. The lawsuit, filed by cancer patients and health insurers, alleges that marketing practices of drug companies caused them to be overcharged for oncology medicines because list prices for the drugs were higher than the actual cost of the drugs for physicians.
After my own diagnosis and battle with Advanced Stage III Inavasive Ductal Carcinoma (Breast Cancer) I began writing as a form of therapy while learning to cope positively with my current life situation.
There are numerous tools that can be used while coping with any hardship or adversity -- for me, Yoga taught me some incredibly valuable lessons about my body / mind / spirit. I have continued to write about my daily experiences and my thankfulness for the lessons that I gained through my own battle with cancer.
The key is for each individual to become their own health care coordinator / manager. We must take care of our bodies and begin questioning what goes in / on / around our body and our mind. Making conscious efforts to eat healthier, excercise, release stress and anger, and enjoy each day that is given. Life has no guarantees ONLY opportunities.
Connecticuts Compassionate Use medical marijuana bill will be heard in its next committee tomorrowTuesday. So, we need to keep the same momentum going that pushed this through the General Law Committee like last week for the Public Health Committee for tomorrows hearing!
A phone call can also make a big impression on legislators. You can call the Public Health Committee before 9 a.m. on Tuesday to express your support for HB 6715. The number is 860-240-0560.
For more info on the bill, heres a piece that I worked with the Drug Policy Alliance on, advocating for the passage of the CTs Compassionate Use Bill on Huffington Post today.
You can also take action here:
National Heritage Insurance Company (NHIC), the contractor that administers Medicare programs in California, has established a positive coverage policy for Cell Culture Assay Tests known as Chemosensitivity (Resistance) Testing or Oncologic In Vitro Chemoresponse Assays for a tumor specimen from a Medicare patient obtained anywhere within the United States, but submitted for testing by one of the approved laboratories located within Southern California. Medicare bills for this testing are billed through NHIC because the test is conducted by the approved laboratories in California.
This pre-test can help see what treatments have the best opportunity of being successful for "high" risk cancer patients. The test measures the response of "live" tumor cells to drug exposure. Following this exposure, the assays measure both cell metabolism and cell morphology (Functional Profiling). The integrated effect of the drugs on the whole cell, resulting in a cellular response to the drug, measuring the interaction of the entire genome. Assays based on "cell-death" occur in the entire population of tumor cells.
This cell culture assay technology has been clinically validated for the selection of optimal chemotherapy regimens for individual patients. It is a laboratory analysis based on tumor tissue profiling that uses "fresh" human tumor biopsy or surgical specimen to determine which drugs or combinations of chemotherapeutic agents have the highest likelihood of response for individual cancer patients.
Following the collection of "fresh" tumor cells obtained from surgery or tru-cut needle biopsies, a cell culture assay is performed on the tumor sample to measure drug activity (sensitivity and resistance). This will pinpoint which drug(s) are most effective. Tissue, blood, bone marrow, and ascites and pleural effusions are possibilities, providing tumor cells are present. At least one gram of fresh tissue is needed to perform the tests, and a special kit is obtained in advance from the lab. The treatment program developed through this approach is known as assay-directed therapy.
Individualized assay-directed therapy is based on the premise that each patient's cancer cells are unique and therefore will respond differently to a given treatment. This is in stark contrast to standard or empiric therapy, which chemotherapy for a specific patient is based on average population studies from prior clinical trials.
The decision had been made that the assay is a perfectly appropriate medical service, worthy of coverage on a non-investigational basis. What is of particular significance is that they abandoned the artificial distinction between "resistance" testing and "sensitivity" testing and are providing coverage for the whole FDA-approved kit. Drug "sensitivity" testing is merely a point a little farther along on the very same continuum which "resistance" testing resides.
Cell cuture assay tests based on "cell-death" have proven very effective in identifying novel treatment combinations for a variety of cancers. The value of cell-death assays is that they can and do accurately predict clinical outcomes and define novel chemotherapeutic synergies. It can help see what treatments will not have the best opportunity of being successful (resistant) and identify drugs that have the best opportunity of being successful (sensitive).
The current clinical applications of in vitro chemosensitivity testing is ever more important with the influx of new "targeted" therapies. Given the technical and conceptual advantages of "functional profiling" of cell culture assays together with their performance and the modest efficacy for therapy prediction on analysis of genome expression, there is reason for renewed interest in these assays for optimized use of medical treatment of malignant disease.
The payment provided will be sufficiently realistic that all Medicare patients for whom this testing is indicated will be able to get it with only the routine 20% co-payment, as Medi-gap insurance secondaries are mandated to provide payment for co-pays for Medicare-approved services.
The coverage became effective for claims for services performed on or after February 19, 2007. The decision is posted at:
NHIC Medicare Services reimburses qualified laboratories in Southern California for cell culture assay tests on a Medicare patient anywhere in the United States.
Likewise, Highmark Medicare Services reimburses a qualified laboratory in Pennsylvania for cell culture assay tests on a Medicare patient anywhere in the United States.
NHIC has jurisdiction over Southern California, so that is who gets billed when the laboratory is located in California.
Highmark has jurisdiction over laboratories in Pennsylvania, so that is who gets billed when the laboratory is located in Pennsylvania.
The coverage decision is posted at:
YOU can get cancer more than once and live, says a six-time cancer survivor Phil Kerslake. Mr Kerslake, who will be a guest speaker at the Cancer Society Daffodil Day Dinner next week, first discovered lumps under his arms when he was just 15...
Living with the constant threat of cancer has given Phil Kerslake a rare clarity about the things that matter in life. Phils life has been punctuated with six separate cancer diseases over the last 26 years but it was his latest cancer, requiring the removal of his spleen, which caused him to make a big leap in his career thinking and direction.