I have been to many conferences on Breast Cancer, and hearing Dr. Eric Winer speak on the topic is always fascinating. Every year, the information seems to have come a long way. The article explains the amazing research that has propelled us forward in understanding the disease.
When I think of breast cancer and dietary supplements, it takes me back to 1999. At that time, I was a “newbie” to breast cancer survivorship. I was having a conversation with the oncology social worker who facilitated the breast cancer support groups at a large teaching hospital where I was treated. I began to tell her how I wanted to take certain supplements that I thought would strengthen my immune system – I was, at that time, receiving chemotherapy for breast cancer. She listened intently, as she always did, then gently said – “you should talk with your oncologist about it before you do take anything”. I told her I was a little apprehensive to do so, as I wasn’t sure he’d understand my intentions. She said, “yes, he will”. I then asked her how she could be so confident to say that, and she proceeded to tell me it was because my oncologist was her husband!
During the months of receiving chemotherapy, I often did research to better educate myself about nutrition, exercise, and self care. As a registered nurse, I had a good foundation in all those topics, but I learned that “natural” does not necessarily mean it is harmless or good for you. More importantly, things that claim to fight cancer, often are not evidence based.
An excellent resource on herbs and supplements, I was fortunate to find, came from Memorial Sloan Kettering in New York. You can search any item and then read about benefits (if any) and possible risks. It also includes information on alternative treatments (used instead of mainstream therapies – most often unproven and expensive) and complementary medicine (therapies that are used as adjuncts to mainstream cancer care). Click on the” About Herbs” link below to learn more.
Fatigue is one of the most common, distressing, and complex symptoms experienced by some breast cancer survivors. It is a subjective sense of tiredness or exhaustion that interferes with usual functioning. Some describe the fatigue as weakness, unrelenting tiredness, or just worn out and feeling a loss of energy to participate in usual daily activities.
Up to 90% of cancer patients, in general, report some level of fatigue. Research indicates in some, the fatigue can persist for months or years after treatment – well in to survivorship. In one study of cancer survivors, 67% rated fatigue as among of the top 2 concerns, second only to the fear of cancer recurrence.
To Minimize Fatigue Here are Four Helpful Ways :
1. Getting Enough Seep
Experiencing sleep disturbances can actually worsen fatigue. If a survivor sleeps better, there is less of a feeling of fatigue.The standard nonpharmacologic approach is the use of cognitive behavior therapy. It helps one learn coping skills and ways for preventing or decreasing insomnia. Clinical trials in survivors with chronic insomnia showed weekly sessions of cognitive behavior therapy showed decreased fatigue and better sleeping.
The American Society of Clinical Oncology guidelines recommend survivors should engage in a moderate level of physical activity. The guidelines define this as 150 minutes of aerobic exercise such as brisk walking or cycling per week. In addition, 2-3 times a week engage in strength training. Of course, your physician should be consulted before any regimen is initiated.
Always remember to eat a nutrient-rich diet. Plant foods such as fruits, vegetable, nuts, seeds, bean, and whole grains are excellent food sources. Also key is maintaining adequate hydration.
4. Complementary Medicine
Ongoing studies suggests that some of the following modalities may be beneficial in improving quality of life for survivors: Meditation/mindfulness, acupuncture, reflexology, massage, reiki, aromatherapy, yoga, qigong, music and journaling. It is best to consult with practitioners that specialize in working with cancer survivors. In some centers, the integration of many of these modalities are part of an integrative healing approach.
Fatigue can successfully be managed, and it doesn’t have to greatly impact a survivor’s quality of life.
Launched in the Fall of 2015, The Metastatic Breast Cancer Project is lead by the Broad Institute of MIT and Harvard. At the helm is Dr. Nikhil Wagle, MD, a breast cancer oncologist and researcher, and Corrie Painter, PhD, a cancer researcher, cancer patient and patient advocate. This project has enrolled more than 2,000 patients from across the United States. The success of the enrollment has been credited by the use of social media and the involvement of several advocacy groups. It has enabled the project to recruit patients directly rather than engaging in contact with individual physicians and institutions that treat these patients.
Being able to work with patients directly through social media results in having access to tumor samples and medical information for biomedical research. This is a paradigm shift from the fact that most patients have never been asked if they would like to offer a tissue sample for research. Working collaboratively with metastatic breast cancer patients and the community focuses on cutting edge genomic science with hopes of understanding and treating this disease.
Interested patients can enroll on the project’s website: http://www.mbcproject.org. There is a 16- question survey about their cancer and treatment along with a consent form to allow researchers to obtain copies of their medical records. The consent also permits release of stored tumor tissue which undergo genomic analysis. Patients will also be asked to submit a saliva sample which can be accomplished by using at-home collection kit.
According to Dr. Wagle, the clinical data will be shared widely for other researcher to use. “It may not be my team that makes the next big discovery. We want other researchers to look at this, so that we can increase our chances of shared success,” said Wagle.
I wanted to write this blog and share with others since I belong to several breast cancer groups on social media. I hope this further propels this incredible study to reach those living with metastatic breast cancer who may not have known about it.
As I have spent the last few days doing a literature search and writing an abstract for the Society of Integrative Oncology Conference this Fall, it reaffirmed the enormity of life changes when one has been diagnosed with breast cancer. Of course, as a survivor, I know this full well, but when you put pen to paper it takes on even another dimension. I wrote about the many challenges of a breast cancer survivor: anxiety, fatigue, depression, cognitive impairment, nutrition, body image and sexual function issues and spiritual issues. These are common to many survivors of other types of cancer as well.
Fortunately, the American Cancer Society and American Society of Clinical Oncology established the Breast Cancer Survivorship Care Guidelines in 2015. This is a call to action that oncologists and/or primary care physicians should be addressing these issues in their patient follow up visits long into the years of survivorship.
A recent study shows that providing women with skills to manage stress early in their breast cancer treatment can improve their mood and quality of life many years later. Another study done by Harvard and Massachusetts General Hospital, along with the Benson-Henry Institute revealed that evoking the relaxation response helps alleviate stress and anxiety, reduces pain, boosts your immune system, while also affecting heart rate and blood pressure. Meditation can remove stress and replace it with a dose of inner peace.
Other integrative therapies useful in helping survivors are: yoga, massage, Qigong, acupuncture, creative arts therapy, music therapy, and nutritional counseling. Classes and workshops to learn these modalities are now easy to find, especially if one lives in or near a major city. With that said, it is not too difficult to find access to these integrative therapies even away from large metropolitan areas. If not possible, simply going for a walk and enjoying nature can bring a sense of calm and a feeling of peacefulness.
Who doesn’t remember the day they heard they have cancer? Whether it was yesterday, last week, last month, or years ago, the emotional upheaval is never forgotten. It is an event that changes your life forever. For many of us, like myself, we find we are more than the diagnosis of cancer and it is imperative to feel wholeness again. I was diagnosed more than 17 years ago, and as a Registered Nurse, I knew early on as a survivor, I wanted to someday use my nursing expertise and my cancer experience to guide and support the breast cancer survivors that follow.
If you have just begun your journey, the following points are helpful hints to consider:
First, and foremost, realize breast cancer is not a medical emergency. Yes, it is an emotional emergency and one just wants to get it “taken care of” and over with. Yet, there is time to make those very important decisions when you are going through such frightening uncharted waters.
Do your research. I say this for two reasons. First it is an avenue to feel you have some control in what is happening with you. Secondly, you want to make sure you are putting yourself in the hands of a very good breast surgeon and medical oncologist. There are many of those folks out there, and at the end of the day, you have to feel completely comfortable with the care you will receive. Many centers will have a multidisciplinary approach where you will meet with the surgeon, medical and radiation oncologist, nurse navigator and social worker all at one appointment. This team approach is to prevent any fragmented care and gives you the expert opinions of each of the professionals providing your care.
When it comes to your pathology report understand what it means and how your specific treatment is determined by the team. Not all breast cancer is the same – some are “good actors” and some are not. With the enormous amount of research in breast cancer, great strides have been made in the treatment protocols – understand yours as fully as you can.
Seek the support of others who have gone through this frightening experience before you. There are many organizations that offer tremendous support and resources for breast cancer survivors. I have some listed on my website http://www.janeedelman.com. Frankly, we are some of the luckiest survivors because as women, we are eager to be there to support one and other, without fear of talking and letting our raw emotions be known. As a Integrative Nurse Coach, I too am here to talk, guide and support. As a colleague of mine said, “A nurse coach is a light and compass in a dark world”.
If you are a survivor, or know someone who is and needs help through the process, contact us.
I remember when the test, Oncotype Dx, came on the horizon to aid in treatment decision making with a new diagnosis of breast cancer. I was working as a nurse navigator in a Breast Center in Las Vegas. In our monthly multidisciplinary conferences, the medical oncologists were somewhat apprehensive of relying on the test. Frankly, it was difficult for them not to offer chemotherapy to a newly diagnosed young woman or a woman found to have a large tumor, if indeed their Oncotype Dx score came back low. A low score would indicate neither one of these cases would benefit from being treated with chemotherapy. Much research and progress has been made with the genomic test over the past 10 years, and the article here indicates how it is now being considered in treatment of metastatic breast cancer. http://www.breastcancer.org/research-news/oncotype-dx-may-help-make-mets-tx-decisions
I was recently reading this article about triple negative breast cancer. It is encouraging to see the continued efforts to find better treatments and hopefully many more long term survivors.
This is among the first clinical trials that include immunotherapy in the treatment of early stage TNBC. Immunotherapies represent a new class of drugs that increase the anti-cancer activity of immune cells residing in cancer tissues. Chemotherapy kills some cancer cells and damages many more, but these damaged cells often survive and cause recurrence of the cancer months or years later
What is triple negative breast cancer?
Triple negative breast cancer (TNBC) occurs when breast cancer cells test negative (pathology report) for estrogen receptors (ER-), progesterone receptors (PR-), and HER2 (HER2-).
These results indicate the growth of the cancer is not supported by the hormones estrogen and progesterone. Hormonal therapy, often used in the treatment of breast cancer, as well as therapies that target HER2 receptors, are not helpful with this type of breast cancer (TNBC), since it does not respond to such treatment.
About 10 to 20% of breast cancers are shown to be TNBC. There is an intense ongoing effort for researchers to find new treatment strategies to treat this type of breast cancer.
Why is it so difficult to treat?
As mentioned above, receptors of breast cancer cells are the target for treating breast cancer successfully. Receptors are proteins found inside and on the surface of cells. They receive messages from substances in the bloodstream and tell the cells what to do. In the case of healthy breast cells, messages are received from the hormones estrogen and progesterone. In about 20-30% of breast cancers, another receptor HER2 – there are too many of the receptors. In normal, healthy breast cells, HER2 regulates the growth and division of cells, thus having too many cause the breast cancer cells to grow and divide too quickly.
Additionally, TNBC tends to be more aggressive that other types of breast cancer. It also tends to be a high grade than other types. What this means is, the higher the grade, the less the cancer cells resemble normal, healthy breast cells. Lastly, TNBC is a cell type called “basal-like” – resemble the cells that line the breast ducts and basal-like cancers tend to be more aggressive and higher grade.
Researchers have found that TNBC is more likely to affect:
African-American and Hispanic women
People with a gene mutation
What does the future look like for triple negative breast cancer?
Researchers are working to find the the best approaches in treating TNBC. As indicated in the attached article, targeted therapies are looking promising, but the research is at an early stage.
I was inspired to write this post after listening to a discussion about Reiki at Columbia University Medical Center in New York City. The Spirituality Mind Body Institute at Columbia is exploring the intersection of science, spirituality, and psychology. It is the first in the Ivy League to do so. The Institute is bringing together thought leaders, visionaries, healers, and psychologists.
Dr. Sheldon Feldman, Chief of Breast Surgery at New York Presbyterian/Columbia Medical Center , and Raven Keyes, a Reiki Master shared their decades of work together. Dr. Feldman reflected on the beginning of his career, with the loss of his young sister to breast cancer. That was the catalyst that changed his idea of becoming a heart surgeon, an instead becoming a highly respected and renowned breast surgeon. Throughout his career, he has learned that traditional medical treatment is very individualized, and alternative therapies are often explored. There is a paradigm shift where healing modalites are more and more accepted as mainstream. Reiki is one of those modalities. Raven Keyes works along side Dr. Feldman in the operating room giving Reiki to those women who wish to have it. Reiki is very beneficial during surgery as it helps to alleviate fear, pain, and the feeling of loss of control. As a nurse and a Reiki Master, myself, I have experienced first hand the enormous benefits before and after surgery, throughout treatment, and during life as a cancer survivor. Dr. Feldman and Raven offering Reiki in the operating room are true healers in every sense of the word.
Stress is unfortunately all too common when one is living with cancer. It manifests both emotionally and physically with anxiety, fatigue, and depression to name a few of the symptoms. Quality of life certainly takes a major hit as one endures treatment. What can one do to lessen the burden – begin a yoga class.
The ancient practice is not new. It has long been studied with cancer patients, resulting in enormous benefits. The practice of yoga can improve one’s mental, emotional and physical well-being. The following is a study from the University of Rochester where it reported an improved quality of life, reduced fatigue and improved sleep.