Adding definition and minimizing puffiness
What is CRCI and how long will it last?
Observational vs. Interventional and how to decide
How Stephanie Hargis’ determination and mindset helped her overcome and achieve TAKE
How to say “yes!” and go
Spring has sprung and flexibility is needed! Here in Texas the weather is unpredictable, to say the least. In fact, our fabulous cover model learned this first-hand as we took shots for this issue. The plan was vacation attire, swimsuits with sunglasses and more. The weather had been ice cold for a week. Then we had temperatures in the 70’s and we were ready to embrace it in anticipation of our Spring issue. I have heard it said, however, “If you don’t like the Texas weather, wait.” The sunny warm was gone when it came time for this shoot, but that didn’t keep Stephanie down. Not much does, you’ll come to learn when you read her story. So we took to the streets in the cold, wet 40 degree weather in a sundress, rainboots and an umbrella. She had the best attitude, and it was such an amazing example for us to follow. Life is inevitably going to throw us curve balls. If you are reading this publication, you likely already know that all too well. The wonderful thing is, when the unexpected happens, we have the power to choose our outlook and attitude towards it all. We recognize that cancer is a physical illness, but we are all too aware of the mental burden that comes along with it. We are here for you, and believe you will find hope and renewed perspective throughout this issue.
We hope it inspires you, when the rain comes, to choose to play instead of staying indoors. You can fight cancer with your fists or with a smile. There is power in your choice!
Brighter Magazine is looking for women to help us grow. If you or someone you know is interested in volunteering to make a difference in the cancer community, reach out to us today! We can put your skills to use.
LiveLearnShine@brightermagazine.org
We love encouraging women affected by cancer, and we’re also intentional to provide opportunities and mentoring to students. Our interns bring so much value, energy and creativity to our team, and they help with so many aspects of the magazine and back office.
Several of our students will graduate this spring, and although we’ll be sad to see them move on, we’re so excited about their bright futures ahead! We know they’ll do great things in college and beyond.
Thank you, interns! We adore you!
Special thanks goes out this month to Jeanna Doyle at the Hopemore for connecting us to our cover model and doing makeup and hair for her on the day of our photo shoot.
Jeanna Doyle is a licensed cosmetologist and Medical Aesthetic Provider trained in oncology-focused aesthetics and corrective makeup. Her work in the medical community has taken her from private practice to hospitals, cancer centers and children’s hospitals working directly with plastic and reconstructive surgeons, dermatologists, oncologists, psychologists and social workers.
The Hopemore is a specialty spa that puts the care back in skincare. They offer customized services for people who are in treatment for cancer or who have experienced illness, injury or elective procedures.
If you find yourself in the Dallas Metroplex, you can visit the Hopemore, located in the downtown location of Neiman Marcus. If you are a bit further away but would like to benefit from some of the Hopemore’s knowledge, they offer online services as well. The Hopemore provides exemplary spa experiences during any season of life.
This issue’s cover and feature article include photography taken inside the downtown Dallas Neiman Marcus location. This is an iconic store known for its gorgeous architecture and fashion. We are so honored to feature our survivor in their beautiful space.
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Jennifer Gill MD Ph.D.
Jennifer Looney
Kathleen Bradford MS,RD, CSO, LD
Laura Urias, MCN, RD, LD
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Tawny Cooper
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Are you or is someone you know a writer, photographer, blogger, web designer or podcaster? Do you work with cancer survivors and have knowledge and wisdom to share with our readers? We would love to hear from you. Brighter magazine is always looking for people to help us with our mission. If you are interested in lending your talents and giftedness, please reach out to us today at contact@brightermagazine.org.
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Information in Brighter magazine is to provide you with encouragement, awareness and education. The articles reflect the opinions of the authors and are not to take the place of professional medical advice. There may be a variety of perspectives on the subjects covered in Brighter. Tips, treatment and advice that is found helpful for some may vary based on the person. All of us at Brighter suggest that you talk to your medical team before making any changes to your lifestyle or daily living.
By Melissa Flynn APR, MBA Cancer Support Community North Texas
Hope comes in many forms – especially when it comes to the cancer journey. For many women across the U.S., they’ve found hope within the walls – or virtual programs – of Cancer Support Community and its 175 affiliates. The longstanding emotional and social support nonprofit with the iconic red doors prides itself on being that “missing link” in cancer care for patients, their caregivers and families.
Picture a place where everyone knows your name – yep, like “Cheers” – but with people who also understand what it’s like to be on the journey from diagnosis to treatment (and surviving long term) and literally everything in between. Need a support group? A fantastic wig? An educational class about nutrition during treatment – or even intimacy? A yoga class or holiday get together with people who “get” what it’s like to go through the ups and downs of cancer? And all for free? That’s Cancer Support Community.
Take the Dallas-Fort Worth affiliate, Cancer Support Community North Texas, whatever cancer patients and their families need can be found at one of three clubhouses with comfy couches, a kitchen, learning areas, and support rooms across three counties.
Mirchelle Louis, long-time CEO of CSCNT and recently in treatment herself (and regularly sporting fun wigs and bandannas), believes that no one should face cancer alone, especially women. “Women are connectors, we need to see and talk with people like us – and during the cancer journey, it’s even more important,” she says. “The other thing is that we’re not always sad – sure I have tough days, but I really need to laugh, play games and eat with others sometimes, too. We want people to just be themselves when they walk through our doors or take a class online. No strings attached.”
Now layer onto a cancer journey a culture that maybe isn’t as accepting of illness or expects a person facing a cancer diagnosis to turn only to their family and not seek outside help.
The cultural stigmas around cancer and getting cancer support are a real barrier for many – and it’s why Cancer Support Community aims to find creative, inclusive ways to connect with women of all ethnicities and cultures.
To offer some perspective, while cancer is the leading cause of death among Asian Americans, they have the lowest rate of cancer screening among all ethnic/racial groups in the country. Why? Some Asian traditional beliefs say that illnesses, like cancer, stem from karma or bad choices, so sharing a cancer diagnosis is laden with shame and fear. In fact, 2019 research by MD Anderson Cancer Center/University of Texas/University of Hong Kong showed that Chinese Americans maybe be especially vulnerable to cancer self-stigma.
Yvonne Liu, a freelance writer and breast cancer survivor, wrote all about the pressures of keeping her cancer hidden in a 2021 NBCNews.com article about cancer stigmas for Asian Americans. “For 28 years, I kept my breast cancer a secret. I lived in fear that my Chinese-American friends would shun me if I told them what I had endured…instead of seeking the support of friends and fellow churchgoers, I suffered in silence.” For some cultures, like Hispanic Americans, the expectation
is that cancer patients will turn to their families to help them navigate their cancer journeys. For Native Americans, it’s more about accessibility of cancer support – unless it comes to the reservations, care isn’t an option.
CSCNT’s Louis says she learned many years ago that they needed to be creative and accessible to different cultural backgrounds to ensure people of all ethnicities feel comfortable reaching out.
Not surprisingly, the Spanish-speaking part of CSCNT has grown leaps and bounds in recent years. She and Spanishspeaking resource specialist Patricia (Trish) Callahan now run a dedicated group called Amigos Unidos (Friends United), which is very different from the rest of the affiliate’s programming. Callahan says that the Hispanic community wants to see this kind of emotional and social support as a family as opposed to individual support, so they have two-hour group meetings. The first hour is a potluck dinner where everyone reconnects and spends time together; the second hour is a formal support group and is tailored to what the group wants – from emotional support to educational demos to relaxation exercises.
Nationally, Cancer Support Community focuses heavily on health equity, accessibility and cancer care as well – from directing outreach to African-Americans whose chance of being diagnosed with cancer is two times greater than white men and women, to creating a full set of online educational resources and website support in Spanish, to establishing the first fulltime cancer care center on an American Indian Reservation in 2019. The national Cancer Support Helpline also offers help in more than 200 languages.
A smiling face at every turn, Juanita found the CSCNT affiliate because she was struggling to find the resources to be seen by an oncologist in a new country. She was first concerned about detecting a possible recurrence of her breast cancer, and then how to pay for treatment when the recurrence was confirmed this past June (2022). Callahan says that being newly married and not speaking much English left her fairly isolated, so she invited Juanita to Amigos Unidos. “She hasn’t missed a thing since. She just loves it and says ‘I felt a lot of relief from the first time I went to the group because you get to share your problems. For example, in addition to having the illness, what gives me so much anxiety is the economic aspect of it. They just did new scans and I looked at my bill and it was $15,000! I thought, how am I going to pay for this? The first time I went to the group, they told me, don’t worry, you can do a payment plan. And they tell me what to take for my side effects and share recipes with me and reach out and ask me how I’m feeling. Many women in the group have given me so much help!”
Lastly, Louis adds, “Our doors are open, come live your life, laugh, cry and get the support you need. Every woman deserves this kind of support and friendship from people who understand what a cancer journey is like.”
Want learn more about CSC? Louis suggests searching for a local affiliate on cancersupportcommunity.org. Or, if women would rather call the national helpline (1-888-793-9355) to get support, it’s always available.
By Tawny Cooper Pixie
It’s easy to list all the reasons to put off taking a trip; money, time, hassle, health, the overwhelming amount of planning it takes, the kids are too young, it’s too late, it’s a little bit scary, we don’t speak the language, or even it’s too extravagant or selfish. But I can unequivocally tell you none of these reasons outweigh what you gain when you just go. The memories, experiences and deeper relationships that come with both the “perfect” and “disaster” vacation make all the reasons not to travel fall by the wayside. You come back from traveling tired but refreshed. You grow. You learn about yourself and the ones you love. And the memories you bring back are forever. From just one trip I took as a teenager nearly 25 years ago with my family, I have so many rich memories that connect me with everyone who shared the experience.
One of my favorite memories of my grandmother was when she took the whole family to Walt Disney World while I was in college. Meme decided a year after Grandfather died that she was taking us all (aunts, uncles, cousins, grandkids) as a tool to combat her grief and year of mourning. She had always wanted to visit Disney World but didn’t travel much at all and never splurged on extravagant things, especially for herself. But we stayed at Disney’s Grand Floridian Hotel and ate at Victoria & Albert’s, the fanciest restaurant I had ever been to. We experienced so many moments on that trip that our family still brings up and laughs about 25 years later.
My strongest memory from that trip was the utter joy she felt after riding Splash Mountain. Meme wasn’t the type of person who loved roller coasters. In fact, they scared her to death, but she was determined to ride it and was so proud of herself afterward that we took a picture of her triumphantly posing in front of the final drop. Almost immediately after we got off the ride, we stumbled upon the parade cutting through Adventure Land. We stopped and watched and she cried with joy at a lifelong dream come true while moving on from grief, if even just a little, as she felt like a kid again. And I cried with her, full of appreciation, that I got to experience these moments with her. To this day, I remember all the details.
I also remember my cousin Kellie’s laugh. She laughed so hard while we rode one of those dumb Surrey bikes that look like fun, but everyone ends up yelling at each other. She was a new mom to her third baby and I got to watch her be a mother and wife and do it beautifully. And of course, there were hiccups on the trip. It wasn’t perfect. There were blisters (my sister and I watched in astonishment when out of nowhere my mom passed by us all in line while pushing my younger sister in a wheelchair because of those “crippling” blisters), a snooty hotel clerk, overly-tired crying children and lots of complaining. My youngest sister washed her blonde hair with our mother’s color tinted shampoo and became a redhead for the next two weeks. And I’m pretty sure my cousins remember our one night out without the kids or the “old” people, and I forgot my ID, so we couldn’t go inside the club.
“For every reason you have to not take the trip, my answer is just go.”
The money spent on that trip is long gone (and it was significant), but those memories have not diminished one iota in my heart. I remember and know better each cousin, each sibling, each parent and especially my grandmother because we were smushed together and experienced fun and new things while living life together just for a week. Our dearest Meme and Kellie are no longer with us. We lost them both way too early, Meme from an aneurysm and Kellie from a vicious brain cancer. But I thank the Lord for that time we had together. Their laughs and smiles are still with me forever. That trip was a gift to each of us, and it continues to give.
Even when things go all wrong, the trip is worth it. It’s in those moments that we teach our kids (and ourselves) to look on the bright side, count our blessings, practice patience and grace, embrace unexpected adventures, step outside of our comfort zone, try something new and learn to problem solve. Traveling forces us to grow. We learn what we like and what we don’t like. We learn how much we love our friends and how much we love home.
So for every reason you have to not take the trip, my response is just go. If it’s overwhelming, hire an expert. A good travel advisor is passionate about what they do and will take care of you from beginning to end. They will handle the details, so you can just show up to have fun, and they can navigate the myriad of needs that come with a large group. If it’s too expensive, make a budget, book far in advance and make payments. Or pick your dream location and scale back the number of days you’re there. If you’re scared, find your courage. Be brave and book your bucket list destination or experience. Go to Europe or Japan or the Greek Isles or Egypt and a read a fabulous novel set in that location while doing it. Take a cooking class or learn to scuba dive or get really wild and bungee off a bridge. If it’s in a different language, get Google Translate. I’ve had whole conversations passing my phone back and forth between two people who shouldn’t be able to communicate, but we do anyway. It’s magical technology. If you’re nervous, reframe it as excitement. If health is an issue, don’t wait till it’s even harder. Go somewhere where you can take care of yourself. There are so many hotels and retreats that will take care of you, mind and body. Travel is good for the soul. The joy is worth it. The memories are worth it. You are worth it. Your family will be blessed.
Just go.
Tawny Cooper is a Travel Advisor with Pixie Vacations. She caught the travel bug early while traveling to Chile to visit the other half of her family. She loves helping other people travel as much as exploring the world herself. Tawny specializes in multi-generational vacations, family vacations, and has a special place in her heart for trips to Walt Disney World. If you need her to help take the first steps in just going, give her a call at 469.878.2753 or email her at tawnycooper@pixievacations.com
By Debbie Norris Ovarian Cancer Survivor and Advocate
It’s that time of year again. We’re all looking forward to the budding trees and flowers. Warmer weather, birds singing, open windows. Along with these things come cabin fever and the desire for spring cleaning.
Growing up, this meant my siblings and I spent several weekends going through our bedrooms and every other room in the house with my mom. We’d review all of our possessions and figure out what we didn’t want, need or use anymore and get them out of the house. Sometimes we’d give these items to friends and sometimes to local thrift stores.
As I’ve gotten older and now have my own house and a husband, we tend to do this as well. Usually we don’t have to take several weekends. Most of the time it’s one weekend in the house and one weekend in the garage. Then we spend another weekend working in the yard to get everything prepped for flowers and landscape. I’m really not sure how many people spring clean anymore. Today, I think more people call it “decluttering.” However, as I sit in the midst of the piles I’m going to purge this year, I’ve been thinking about the other areas of my life that could use a good “spring cleaning”. Those areas that are cluttered with things I’ve held onto for years; things that aren’t helping me in the least and just taking up room.
The first area I’m looking to start with is my social media accounts. What accounts don’t I use? Why do I have them in the first place? Are they valuable to me if I’m not using them? Why should I keep them? All the questions I ask about physical possessions before deciding to keep or get rid of them. Another hard question to ask is, does the social media I do use keep me from doing other important things? Does it keep me from being fully present with family and friends in real life? How much time could I redeem in my day if I’m not using certain social media?
The second area I’m looking at is my mind. This one is a bit tougher. I will add that I am going through this with my counselor. Examining my thoughts and the things I’m focusing on daily. Where am I focusing my thought energy? Are my thoughts leading my actions? Are they beneficial or are they making my life more difficult? Are my thoughts making me more negative? More emotional? More sensitive? If working to change the direction of my thoughts and cleaning out the negatives seems like a lot of work, will the end result be a more efficient me? Will I be more understanding? More positive? More fun to be around?
A third area I’m looking at is my health. What can I clean out of my diet? Am I really being the kindest to myself and my body? Am I really being a good wife to my husband with the food and meals we have in the house?
If I say I want to exercise or walk more and yet I never get up and out of the house to take a walk or go to the gym, am I really serious about wanting to improve my health? Being a cancer survivor, I really should be conscious of my health, what I put into my body and how I take care of it.
So how can we go about decluttering and spring cleaning these other areas? This doesn’t seem as easy as just packing a few boxes up and giving things away. These areas are going to take a lot more work.
Some ideas for starting points include: Looking at your social media accounts. What do you use them for? How often do you use them?
- Are you on social media “talking” to people more than you are talking to people in real life?
For mental clutter – start journaling your thoughts.
- Are most of your thoughts negative? Bad attitude? With diet and health – journal your food & water intake for a week, as well as physical activity.
- What are you eating and drinking? Are you sedentary or more active?
These simple things will give you some insight as to where to start. Choosing one area and making it your focus will also make you more successful. Also realize these three areas are not the only ones out there. We all have areas in our lives which could use refocusing. It’s a matter of taking the time to figure out what needs to be cleaned up.
Spring cleaning and decluttering is never easy. It always requires sacrifice and work. Starting with your house, basement or garage could be your big first step. Just remember –Spring Cleaning: It’s Not Just for Your House Anymore.”
Kathleen Bradford, MS, RD, CSO, LD and Laura Urias, MCN, RD, LD
Produce. It’s the first thing that greets us at the grocery store when we walk through those automatic doors (generally along with fresh flowers and often a bakery or a Starbucks). The bright colors and enticing fragrances are meant to draw you in and stimulate your senses, with the hope that you, as the consumer, will shop with your stomach, not your head. We learn the importance of consuming fruits and vegetables sometimes as early as we can eat them, and the message of produce as it relates to good health is as consistent from infancy to adulthood. We have all experienced shopping for, buying, and consuming the variety of produce that we can afford and that we individually prefer. Like most things in life, simply shopping for produce has become more complicated than it used to be. With ever-changing marketing campaigns, stamps and stickers littering produce itself, and added information about where your produce is from and how it was farmed, consumers are growing more interested in food transparency. All we want is to consume a variety of nutritious fruits and vegetables to maintain our health and the health of our family, especially since research has found that increasing the amounts of fruits and vegetables in your diet provides a protective effect against cancer. Below are some tips related to shopping for and preparing produce so you can be a more educated consumer:
It is important to remember you can always eat frozen or canned fruits or vegetables, no matter what time of year it is. When these foods are frozen or canned, they are harvested at their peak ripeness (meaning they are fresh and full of nutrients!) so that you can eat them any time. If choosing something canned, we recommend choosing “low sodium” on the label and rinsing with water before consuming. Buy fruits that are canned in their natural juices or in water.
That’s right. There’s no need to use soap or an expensive produce wash! Rinse produce BEFORE you peel it, so dirt and bacteria are not transferred from the knife onto the fruit or vegetable. Gently rub produce while holding under plain running water. You can use a clean vegetable brush to scrub firm produce, such as melons and cucumbers. Remove the outermost leaves of a head of lettuce or cabbage.
Organic produce is not necessarily safer or healthier than the conventional alternative. You will find that on social media and in popular culture, there is a big debate about which type of foods are better, organic or conventional. “Organic” is the name of a particular farming practice, not a health and safety claim. Organic farmers often use pesticides, they are just derived from natural sources instead of being produced synthetically. Furthermore, some organic pesticides can be more harmful than the synthetic pesticides used by conventional farmers, which have evolved significantly since their development into being better for the environment. If you are one that chooses to spend your money on organic produce, this is completely fine. If you do not have the privilege of affording the organic label, you are not doing yourself or your family a disservice by buying conventional. Both options are nutritionally equal! Bottom line- wash all produce with water before consuming and eat fresh fruits and vegetables daily! Organic or conventional is your choice.
Kathleen Bradford, MS, RD, CSO, LD and Laura Urias, MCN, RD, LD are both oncology dietitians at UT Southwestern Simmons Comprehensive Cancer Center, one of the only NCI-designated comprehensive cancer centers in the state. They provide evidence-based nutrition counseling and recommendations to help support the nutritional needs of patients and caregivers before, during, and after cancer treatment. Both have a passion for helping clarify the complex topics related to nutrition and cancer in order to alleviate confusion and stress for their patients.
Are Organic Foods Safer or Healthier Than Conventional Alternatives? A systemic Review. Smith Spanger et. al. 2012
Organic Foods: Health and Environmental Advantages and Disadvantages. Foreman et. Al. 2012
Are organic foods really healthier? Two pediatricians break it down. UCDavis.edu 2019
Apples
Apricots
Artichokes
Asparagus
Avocados
Bananas
Beets
Broccoli
Cabbage
Carrots
Celery
Collard
Greens
Garlic
Herbs
Kale
Kiwifruits
Lemons
Lettuce
Limes
Mushrooms
Onions
Peas
Pineapples
Radishes
Rhubarb
Spinach
Strawberries
Sweet Potatoes
Swiss Chard
Turnips
1 Tbsp chopped and peeled fresh ginger
½ clove garlic, chopped
1 cup finely chopped pineapple
½ cup fresh cilantro
¼ cup chopped red onion
½ cup grape tomatoes, quartered
2 ripe avocados, chopped
2 Tbsp lime juice
Salt
Source: Foodnetwork.com
By Erin Gobin Erin Blair Beauty Studios LLC
Let me tell you about my friend Kellie. First of all, she was smokin’ hot. Total bombshell – always tan, curves that would make any girl jealous, high cheekbones and a killer smile. Kellie was hilarious, sarcastic and loud… always the life of the party. One time she showed up to a Christmas party with her hair sprayed into the shape of a Christmas tree (complete with lights and ornaments). She wasn’t afraid to call attention to herself (quite the opposite actually) and her outward appearance reflected this. She embraced glitter in all its forms and frequently sported a bright red lip.
Sadly, in 2019 she was diagnosed with a very rare and aggressive type of ovarian cancer. When she began chemo treatments and lost her hair and eyelashes and then subsequently developed “moon face” from the steroid treatments she received to strengthen her lungs, she felt unattractive for the first time in her life. She wondered aloud to me if maybe God gave her cancer to teach her a lesson about being too vain. Of course we all told her that was ridiculous, and not even a bald head or puffy face could make her unattractive.
Luckily, Kellie was a makeup enthusiast and I, one of her closest friends, was (and still am) a professional makeup artist. So whenever she was feeling less than pretty or had a special occasion we busted out the makeup palettes and were able to downplay the puffiness she was so self-conscious about, making her feel more like her normal vivacious self again.
Allow me to share some of our best tips and tricks to combat the dreaded “moon face” phenomenon.
By now you’ve probably seen some intimidating contouring videos on YouTube, or perhaps that viral image of J’Lo where she has dark brown and white stripes painted all over her face like war paint. Trust me, contouring is way less complicated than you think it is!
1) Start with two shades of face powder. One that’s just 1-2 shades darker than your skin tone and a second that’s 3-4 shades darker.
2) Using a large fluffy brush, take the first, lighter-colored powder, and buff over any areas you would like to appear less “fluffy” in a circular motion. This adds depth, creating an optical illusion that the area is smaller and further away from the viewer.
3) Use a smaller, pointed face brush to add additional depth with the darker face powder. This will create a more dimensional contoured effect.
Use this technique on the sides of your face under your cheekbones, under your jawline and on your neck.
If the perimeter of your face is puffier and larger than you’d prefer, call attention to the center of it. Add some big false lashes if you can, draw in your eyebrows a little bolder –bringing the insides just a LITTLE closer to your nose. Add some sparkly eyeshadow to your eyelids and around the tear ducts of your eyes. And my favorite Kellie tip – give yourself a bold red lip and don’t forget to SMILE!
Erin Blair Gobin has been a professional makeup artist since 2004. She is the owner of Erin Blair Beauty Studios LLC in McKinney, TX.
Elizabeth (Itzy) Otterbein, MS, CCC-SLP
Cancer related cognitive impairments (CRCI)- You may have heard it colloquially referred to as “chemo-brain.” Most individuals who have been through cancer treatment experience brain fog at some point in their journey and know it can be incredibly frustrating. But did you know that for some, the symptoms can last more than a year after concluding treatment? If this sounds like you, you’re not alone! Recent studies estimate that around 40% of individuals who go through treatment for cancer report long-term changes to their cognitive functioning. A speech pathologist, trained in cognitive rehabilitation, can help you manage these symptoms.
CRCI is defined as changes to memory, attention, processing speed, or executive functioning (problem solving, planning, self control, etc.) which begin at any point after a cancer diagnosis and impact daily function. In some cases, these changes are temporary. For many years, CRCI was believed to be an acute change due to the treatment toxicity which resolved with no lasting side effects after completing chemo; however, with higher survival rates, we now see more reports of cognitive changes beyond the first year after treatment.
The answer to this question is complicated and more research is needed to make a definitive answer, but here are some factors which likely contribute:
The cancer itself- Although it is often colloquially referred to as “chemo-brain,” research suggests some individuals with cancer experience changes to cognitive function before they start treatment. It is possible that the cancer itself causes systemic changes which stress the body and hamper cognitive function. This is especially true if the initial cancer is located in the brain or nervous system.
Chemotherapy- We now know that the chemicals involved in chemotherapy can cross the blood-brain barrier and can cause systemic inflammation including encephalopathy.
Radiation- This can cause changes to neural tissue, especially when delivered to the central nervous system.
Stress- Receiving a cancer diagnosis is one of the most stressful things that can happen to an individual. Research shows stress can impact cognitive function in a completely healthy system, causing racing thoughts and difficulty concentrating. It is likely that stress plays a role in the changes to cognitive function that cancer survivors experience as well.
If you are wondering what may qualify as cognitive changes here is a list of things that may indicate CRCI. If these sound like you, consider talking to your doctor about pursuing cognitive rehabilitation.
Changes to short-term and working memory: increased difficulty remembering names/ faces, frequently forgetting items such as phone/ wallet/
keys, walking into a room and forgetting why you are there, increased difficulty with mental math.
Changes to long-term memory: forgetting important dates, forgetting big events or important conversations.
Changes to attention: difficulty concentrating, feeling like you work harder to accomplish fewer tasks in a day, feeling overwhelmed when asked to juggle more than one task at a time.
Changes to executive functioning: struggling to create or stick to a plan, difficulty switching gears or feeling overwhelmed with rapid topic shifts in conversation, changes to your ability to self-regulate emotions or emotional outbursts.
It is important to note that everyone experiences bad days. None of us function at 100% all the time, but if these issues persist for several weeks and start to cause problems in your social, emotional, or work life, you may be experiencing CRCI.
There are many lifestyle changes which can have a positive impact on your cognitive function. Here are some things you can do to improve your success.
Stress management: Consider practicing progressive muscle relaxation (PMR) before attempting demanding tasks. There are videos available online for free that can walk you through this practice. Implement diaphragmatic breathing into your daily routine. It’s great for stress and releases happy hormones! Review your work-load and try to set realistic daily goals and
expectations to reduce pressure. Practice advocating for yourself at work if your productivity expectations are unrealistic. Practice cognitive restructuring. Negative self-talk and catastrophization piles on the stress. We all do it, but practicing positive thinking patterns can make a big difference in your overall mental and cognitive health. If you need assistance making this change, seek out a mental health counselor.
Fatigue: While it may seem counterintuitive, exercise is one of the most reliable ways to manage fatigue. Exercise helps to regulate our sleep/wake cycles which can lead to better sleep and improved alertness during the day. If you need help understanding how to work out safely and effectively, consider asking your doctor for a referral to a physical therapist who specializes in fatigue management.
Nutrition: What we take into our body has a huge impact on our overall function. It is recommended to increase your intake of foods high in antioxidants. A daily dose of blueberries, strawberries, or raspberries is a great place to start!
Self-talk: Speak out loud to yourself about everything you are doing to avoid getting off task. The auditory input also helps with short-term memory encoding.
Journal. A nightly journal is one of the single best ways to improve memory function. You don’t have to make long, involved entries to see the benefits. Keep it simple! Who did you see? What did you do? Did anything unusual happen that day?
Active Listening: 60% of individuals who experience CRCI report withdrawing from social situations due to feeling “lost” or “slow.” Practice frequently repeating back or reiterating what was said during a conversation. It will make your conversational partner feel heard, and help ensure you are focused and engaged!
Cancer related cognitive changes can feel overwhelming and scary. If you are going through treatments right now, know that they may resolve on their own! If you do have long-term changes, you do not have to face them alone. A speech therapist can help walk you through implementing the strategies and lifestyle changes mentioned in this article.
We so appreciate our Brighter interns, and we loved including them in this article. From web design and social media, to research, article writing, editing and now modeling, these bright students illuminate our pages even more!
By Jayna Dave
T-shirts: comfy, simple, and versatile - we all love wearing them! A t-shirt doesn’t need to be limited to lazy days or for sleeping, however. Keep reading for ways to show your advocacy and personality while styling your tee and elevating it while remaining comfortable!
Wearing a cropped t-shirt is one of the easiest ways to be on trend with your outfit. Rather than buying a cropped t-shirt or cutting a t-shirt you already own, try these options. For a shorter look, tuck the hem of the shirt into the bottom of your bra. If you want to create a slightly ruched look, gather your t-shirt until it sits tightly around your waist and tie a rubber band around the extra fabric. You have the option of keeping the knotted fabric as shown, or you can roll it underneath for a more polished look. Faux-cropping your t-shirt accentuates your waist, creating a slimming effect while making the shirt appear dressier.
Libby wore her favorite denim jeans with an oversized 5K tee pulled behind her snuggly with a rubber band and then tucked up into itself.
In the last few years, bike shorts have become increasingly popular, with many celebrities opting to wear them with oversized t-shirts. Bike shorts offer the comfort of athleisure as well as a cool, effortless look. This versatile pairing is perfect for a gym workout or a day out.
With so many options, don’t hesitate to add more t-shirts to your closet. V-neck styles also allow easier access for treatment without compromising comfort or style. Any way you choose, t-shirts can be a great closet staple!
Ella took this great Miracles Can Happen tee tied it in the front and tucked it. Paired with leggings or bike shorts, the shirt stands out to make a casual statement.
If you want to achieve a feminine look with your t-shirt, pair it with a maxi skirt. From florals to pleats, skirts add a touch of delicacy to complement your edgy t-shirt. Opting for a light, flowy skirt will help keep you cooler in warmer temperatures. If you’re hoping to wear a t-shirt for a “going out” look, try wearing one with a satin skirt. Satin’s shiny appearance will give your outfit a festive, dressier feeling, adding a fancier element to your style. A wide belt can help cinch the shirt at your waist or hide where you’ve tucked it in.
Couple any t-shirt, tight or baggy, with an oversized denim jacket to create a comfy yet cool outfit. To create an extra-sophisticated look, wear a slimmer denim jacket with a pair of your favorite baggy jeans. While the denim-on-denim style is vintage, it has made a comeback in the last few years, and you can’t go wrong with this pairing. In addition to denim jackets, leather jackets also elevate your t-shirt. Throw on a leather jacket with any t-shirt to instantly dress it up. Perfect for a night out, leather jackets add a touch of glamour to your t-shirt, especially when paired with black or colored denim and great shoes or boots.
Jayna styled her cropped tee with an oversized denim jacket. She paired them with flair jeans and wedges to add a little sass and a fun nod to the 70’s.
Ella paired the unexpected: a heavy biker jacket and leather booties with a springy floral skirt and bright smiley tee. We love the juxtaposition of the two!
Jayna paired this cute floral tee and tie die skirt with summery wedge heels to dress it up. For a more casual feel, pair it with white tennies.
Tucked t-shirts pair perfectly with wide leg pants. This fashion-forward outfit creates an hourglass effect, complementing both your waist and your legs. Match your favorite t-shirt with a pair of jeans or trousers to achieve the flattering look. Pair with a fun belt or scarf around your waist and chunky shoes to complete the look.
Allie Rose is sporting her support with her tee tucked into her highwaisted wider legged jeans.
To make your t-shirt appear more refined, wear a blazer over it. This combination is the ideal intersection of business wear and comfort. Because blazers have simple, sleek cuts, styling them with a t-shirt creates more structure to your outfit. Blazers also add an element of professionalism, allowing you to wear your favorite t-shirt to work! To further elevate this look, wear a pencil skirt or trousers. You can even wear your t-shirt with a monochromatic pantsuit to create a playful yet powerful outfit. Pair with a statement necklace, and nobody will ever notice your tee!
Allie Rose chose to pair this basic black light-weight blazer with a fun lightening bolt tee. It makes a fun power statement for those business casual days!
By Erin Schreyer
by Erin Schreyer
Hair and Makeup by Jeanna Doyle, The Hopemore
Understandably shocked by a cancer diagnosis at the age of 24, Stephanie Hargis had no warning, no genetic predisposition (or so she thought) and no idea how she would juggle treatment while being a full-time college student, wife and mother of a toddler. With so many questions and so much uncertainty and fear, she took control of what she could - her own thoughts. And she asserts, “good mental space” is the starting point for success.
Raised by a single mother after the passing of her father when she was just two-years-old, Stephanie had no idea the life lessons her mother instilled in her at a young age would become the prevailing mindset, not only to make her who she is today, but also to get her through her most difficult challenge. Her mother, a Mexican immigrant, didn’t know how to drive or speak English at the time of her father’s death.
“He took care of those things for her,” Stephanie explained. “So when he passed, she could have easily just taken me back to where she was comfortable, but she didn’t. Instead, she learned to drive. She learned to speak English. I’ve seen everything she’s gone through, so I used that. If she can do everything she puts her mind to, why can’t I? I can do that too!”
It’s this mindset that she used to pull herself back up after the shock of her diagnosis caused weeks of tears. She remembers feeling a lump in her breast while showering. Noting the difference, but still unconcerned, she later asked her husband if he could feel it. Believing it was simply a swollen lymph node, since Stephanie was so young and healthy with no family history of breast cancer, they went to the doctor for a sonogram, followed by a biopsy after the sonogram wasn’t definitive. This was the crack in the door that allowed negative thoughts to enter.
“I thought, gosh, this is kind of scary. This is way more than I thought was going to happen,” she admitted. “I thought they would give me some medicine to make it go away and that would be it. Then I got a call from the nurse saying the results from the biopsy were in, and they wanted to see me in the office. I could just tell by the tone of her voice that something wasn’t right. I asked her if it was bad, and she said ‘Well, it’s not good.’ And at that point I just started sobbing. I had to hand the phone to my husband. We grabbed my daughter, who was two, and we went straight to the doctor. The whole ride there, my husband held my hand while I cried.”
At her general practitioner’s office, they were able to determine that Stephanie had cancer, but they needed to refer her to an oncologist to determine the exact type, stage and treatment. Through more tears, she chose a treatment path with the oncologist that included a double mastectomy and more than a dozen rounds of chemotherapy. She still didn’t want to tell others about her diagnosis, and she couldn’t even bring herself to say the word, “cancer”. “My mom was the only person I was able to tell, ‘I have cancer’, Stephanie shared. “I couldn’t tell anyone else. I didn’t want to tell anyone else.”
Within a month of her January 2022 diagnosis, Stephanie had surgery before her genetic test ultimately revealed she had a genetic link to breast cancer, even though no women in her family had ever been diagnosed. While immediately concerned for her own daughter, Stephanie began looking for any positives: “I realized, it’s good that we know now, so she can start getting checked earlier.”
While all of this had been happening in Stephanie’s life, she was in the midst of pursuing her degree in Social Work at the University of Texas, Arlington. On track for a December 2022 completion, she didn’t want anything to deter her from that goal. Not cancer. Not treatment. Not if she could help it. Without wanting to draw attention to herself, she learned how to “batch” her schoolwork around surgery and chemo regimens and the brutal after-effects of each. She wore a wig and ball cap to classes, and remarkably, she challenged her organizational skills and planned around downtime, where she knew she was going to need extra rest and recovery. As soon as she could, she would make up for lost time with a continued focus to stay in line with her graduation date goal.
“It was bad,” revealed Stephanie. “I would have chemo on Fridays and be there for six hours. I’d get home and fall asleep. I was so sick, I couldn’t feed myself. My whole weekend was sleep, and then I’d go to school on Mondays. Sometimes I’d still be physically hurting, but I’d still go, because I was so focused on graduating in December.”
Although it was extremely challenging, Stephanie felt it was worth the push not only to remain on schedule, but also to
“It doesn’t matter what I look like as long as I have good intentions, treat everyone fairly and lend a helpful hand. That will have more of a lasting image with others than what my hair looks like or what I’m wearing that day.”
keep her mind focused. She admitted that if she had more downtime, she would spend too much time thinking about her diagnosis and treatment. She didn’t want to allow herself to get pulled down, and the schoolwork was a great distraction and positive goal, although now much more ambitious, because her memory was affected by treatment.
“I took on an additional class at Tarrant County Community College in the summer, as well as an internship,” she explained. “It required so much memory. That’s what I struggled with the most. I’m still struggling with it. I would come home crying, because I was so frustrated. I wanted to have the same mental capacity I had before, and I didn’t.”
But every day, Stephanie would take her thoughts captive. No matter what the day held. She reminded herself over and over that she was going to walk across the stage for graduation and she was going to make her family proud. She kept visualizing that moment and how should would feel. It was a major motivator for her.
“I feel like I learned how to be hard-working from my mom,” Stephanie shared through tears. “She’s always taught me to focus on goals, put in hard work and you can achieve anything. So I focused on how proud would she be and how proud my dad would have been. I also wanted to be able to show my daughter, Olivia anything is possible as long as you put your mind to it. I had to believe it myself, too. I told myself I can’t be sad or think that I can’t do it when I have schoolwork to do. I have a graduation I want to go to!”
At her internship, Stephanie was known for her hard work and for getting things done. She recalled a time when one of her supervisors commented about typical office workload complaints when co-workers gathered at the water cooler. Soon, someone paused and said, “Wait. What are we complaining about? Let’s pull a Stephanie! We don’t have half as much going on as she does!” They quickly realized they could have a better attitude, and they changed their mindset. “It made me cry when they told me,” she said. “Because I didn’t even realize that anyone would see what I was going through and apply it to their lives, so that meant a lot.”
Stephanie is very close with her mother, and she’s tremendously grateful that she’s been able to be with her
family though her treatment. She’s helped enormously with Olivia, who Stephanie believes “came at the perfect time.” “She was still little, but she didn’t need as much of me as an infant. Sometimes she needed me to play, and it was a great distraction. Sometimes she would go into comfort mode. She could tell I was sad, and she would tell me it’s okay. Her words meant so much to me.”
Olivia rode along with Stephanie when she went to get her head shaved. Stephanie was nauseous the whole way there. She had tried to hold onto every bit of hair she had for as long as possible. She was so afraid of what she would look like and what others would think, especially Olivia, who waited in the car for her. After returning with the head cover of a ball cap, Stephanie asked her daughter, “Do you want to see my head?” Olivia asked, “Where did your hair go?” Stephanie explained that she cut it all off, and when they arrived at home, Olivia looked at her and said, “Mommy, you’re so beautiful!”
Stephanie explained that she tells her daughter every day that she’s beautiful, but she wasn’t expecting to hear it in return. Especially then. “Going through those physical changes, it was so helpful to hear, because kids can be brutally honest,” she said. “She helped me believe it.”
She was also reminded of a childhood memory of her own, when she was around the same age as Olivia. Stephanie would come home and tell her mom about other girls in class and how pretty they looked because of their hair color or style, or a perhaps a new clip or embellishment in their hair. She recalled her mom always being quick to remind her that just because she looked different doesn’t mean she’s any less pretty. Her mom would follow up with, “You’re pretty because you’re Stephanie. What you have inside is what makes you pretty. How you treat others matters most.”
Stephanie still thinks about that and added, “It doesn’t matter what I look like as long as I have good intentions, treat everyone fairly and lend a helpful hand. That will have more of a lasting image with others than what my hair looks like or what I’m wearing that day. My mom taught me how to love myself before all of this, and I’m teaching Olivia how to love herself. I actually feel so comfortable now. I don’t think I’ve ever felt more comfortable in my own skin (even without hair).”
When Stephanie was growing up, she was known as “Smiley.” Her friend had given her the nickname, and it stuck. When she was diagnosed, she found herself crying all the time, though. She shared that she would be awake in the middle of the night, thinking “where is Smiley? Where is the real Stephanie, because this is not her!”
One night, when everyone in her home was asleep and everything was quiet, she decided to have an honest conversation with God. She shared her frustration and asked for His help to learn through this process and to be taken care of. In addition, she asked Him for specific “little signs” that He was with her, and that she would be ok. “I want to be that smiley person again, but just help me,” she pleaded!
One morning, as she was receiving chemo treatment with ice packs on her hands and feet, she looked down and noticed a little heart had formed on the ice pack. She took a picture and texted it to her mom, who prayed every single time for her to be able to withstand the treatment. Stephanie’s mom received the text at the exact moment she finished praying and said “Amen!” They both thought it was no coincidence. This was one of many little signs she saw along the way.
And she’s learned a lot, too. Stephanie believes there are lessons she wouldn’t have been able to learn otherwise. She expressed a newfound peace about everything not needing to done a “certain way”. She’s found that it’s okay let people help, and it’s fine to relax when they do things differently than she would have done. She went so far as to say she’s less tense about many things, even hair. “I would never have cut my hair this short,” she giggled as she spoke and brushed her hand over her hair. “Now I’m so excited to experience all these different hair styles as it grows out!”
Her whole life, Stephanie has always tried to find one small positive in everything she does, but before her diagnosis, she had never had to endure anything this serious. Even so, she has still been able to find good in little things, and it has really helped. She stressed the importance of positive thoughts
and belief. “I know it can be hard,” she empathizes. “But whatever you’re going through can totally take over.”
“Try to see just a little bit of good in everything,” she encourages. “It’s so easy to focus on the negativity. It’s so easy to see what’s going wrong. Yes, it may be really bad, but find one good thing…focus on that. It feeds your brain all this positivity, to where you can say, ‘yes, I see the negativity, but it’s fine over there. I don’t want that here, in my head.”
Stephanie’s treatment was complete just weeks before her graduation in December. Yes, she did it - without delay. And even with Magna Cum Laude honors! This goal had kept her strong through treatment, and she was able to accomplish it (and even won a contest for the best graduation cap design!) “Once I crossed that stage it was even better than I thought,” she said with stars in her eyes. “It was so worth everything!”
After a semester break, Stephanie will begin grad school in August. She told Brighter, “I always thought I wanted to help kids, but after this, a switch has gone off in my head. I now want to work with kids or women who have been diagnosed with cancer. I’m so excited to help!” And we’re excited to see how she will use her experience and positivity to make a difference. We’re smiling just thinking about it. Wanna bet she is too?!
By Cara Price PN1 Nutrition Coach, CrossFit L1 Trainer
When you are going through cancer treatment or recovery, there are many things you can do to help your body heal. Now, science confirms what doctors and patients have noted for years, exercise during and after cancer treatment is beneficial to a patient.
Even if you were not active prior to your cancer diagnosis, beginning an exercise routine during or after treatment can greatly improve many areas of life, not the least of which are physical and mental health. And just as exercise, specifically with the use of weights, has proven longterm benefits for a general population, the same holds true for those who are in any phase of cancer treatment.
The benefits of adding in weightlifting (also known as strength training) will last far beyond the time period of cancer treatment or the recovery phase. Strength training can make a huge difference in the quality of your life. Some of those benefits include:
in turn causes the bone to make new cells, which can prevent and even reverse bone loss at any phase of life.
It improves the quality of your everyday activities – When your muscle strength increases, other every day tasks become easier and less risky. When you are stronger, you can move in ways that are more efficient and prevent injury. Things like carrying groceries or getting boxes down off shelves become less taxing on your body when you have good muscle stability. Building and maintaining muscle during and after treatment also allows patients to maintain more independence in everyday life.
Strength training can make a huge difference in the quality of your life.
It may decrease nausea – Many factors play a part in the fact that most people struggle with eating enough food at some point during their cancer journey, not the least of which is nausea. Though weightlifting may not completely change problems with nausea, an observational study published by the National Library of Medicine showed that patients participating in a physical training routine that included strength training reported a decrease in nausea symptoms.
It makes your bones stronger – Though it may seem that weightlifting will only increase muscle strength, it is important to know that it also improves bone strength. Everyone is susceptible to losing bone density as they get older, but this possibility increases for those who are dealing with a cancer diagnosis. When you lift weights, the muscles surrounding the bones contract and extend on the bones beneath them. This
Strength training isn’t the same as bodybuilding. When considering weightlifting, think about a manageable, moveable weight for a series of reps that is sustainable.
If you are just starting out in a weightlifting journey, I would strongly advise finding a qualified trainer to teach you proper form, rep scheme and cues to know what is best for your body, and always be sure you talk to your oncologist or general doctor about your specific situation before beginning a new workout routine.
No matter where you are on your journey during or after cancer treatment, an exercise plan will likely reap big benefits for you!
Ligibel, J., M.D., Bohlke, K., ScD, & Alfono, C., PhD (2022, July 5). Exercise, Diet, and Weight Management During Cancer Treatment. American Society of Clinical Oncology. https://ascopubs.org/doi/10.1200/OP.22.00277
(2019, November 8). A single exercise session improves side-effects of chemotherapy in women with breast cancer: An observational study. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842202/
“We delight in the beauty of the butterfly, but rarely admit the changes it has gone through to achieve that beauty.”
-Maya Angelou
By
The term “cancer survivor” has true relevance when you complete active treatment. For many of us, it’s hard to think of ourselves as survivors while still in the depths of active treatment. In reality, the term survivor applies to anyone who has or had cancer.
The cancer experience is different for everyone. For some, it’s a brief course of treatment that has minimal impact on your day to day to life. For others living with metastatic disease, it’s been awhile since you lived life like you did pre-cancer. Your experience impacts every facet of your life: past, present, and future.
As I embarked on survivorship, I was gifted a book from a longtime survivor and mentor who was part of clinical trials for rituximab, the magical medication that obliterated my small intestine non-Hodgkins tumor. She also happens to be the mother of a close friend and colleague. Dr. Wendy Schlessel Harpham’s book, “After Cancer: A Guide to your New Life” was exactly the message I needed to begin the survivorship phase of my life.
“Despite meeting the challenges of treatment, your situation is like that of a marathon runner, whose efforts are not over at the end of the race”, Dr. Harpham reminds us. “Successful runners are careful about their recovery. For days, they focus on getting extra fluids, nutrients and rest. They know it takes weeks to get their bodies completely back to normal.” Like a runner, as a survivor you will feel better and heal faster if you learn about the changes in your body and the ways to help it recover. Keep in mind that losses may be temporary or permanent; they may be visible to or unseen by others. They are all losses and should be acknowledged as just that.
The most common question I get from family and friends is, “what happens now?” Unfortunately many people view cancer as a short-term, temporary disease. Many feel that the cure can be worse than the disease. You may feel shame from others about the decisions you made to pursue traditional or holistic treatments. Regardless of their opinions, remember you’re the driver of the recovery bus. Educate yourself about the power of prevention, recognize the signs of a possible recurrence and learn how to cope with the aftereffects of treatment. Equipping yourself will reduce the anxiety when the unexpected arises. The fear of recurrence can be debilitating and compromise your quality of life. Dr. Harpham reminds us “repression is a healthy way of coping with physical and emotional pain as long as it does not prevent you from doing the right thing.”
When there are abnormal results or concerning findings that catapult you back to those vulnerable days of treatment, don’t let those events monopolize your mind. Remember that surviving cancer is not just being alive, it’s about how you live life!
Personally, I’ve accepted the collateral damage of lymphedema, suboptimal blood counts, prolonged physical therapy, routine imaging, chronic medications and port flushes. Push yourself to celebrate those baby steps in therapy, lab improvements and weeks without medical appointments. As your care team becomes less involved in your recovery, you will be more responsible for your own health and recovery. Adopt that renewed autonomy and control over your health.
You’ve now entered the threshold of a new journey to a new life, a “second spring” of sorts. A second spring represents choosing to live life while recapturing the zest and vitality of life. You can do whatever you want, dress the way you want and spend time with the people you love most. In essence, focus on controlling the controllable while accepting the things you can’t control. Focus on who you are now and make yourself better than before.
Many ask me, how do you get back to “normal”? For me, acknowledging the power of gratitude, strength, growth, joy and hope is key. Forming a constant evolving, better normal is the goal!
By Jennifer Looney Adenoid Cystic Carcinoma Survivor
by Cindy Bedford
Feeling like you’re at the end of your rope? We’ve all been there at some point. When fatigue and exhaustion rob us of strength and endurance during treatment, this common phrase marches through the minds of many a cancer patient. Fortunately, Cindy Bedford and her beloved golden retriever, Callie, are on a mission to provide comfort at the end of that rope.
First a care-giver for her late husband, now an advocate for cancer patients, Cindy shares her special gifts regularly as an American Cancer Society volunteer. This darling woman from Dallas, Texas is paying it forward by providing patients and staff with heartwarming visits from Callie, the therapy dog. My first encounter with this blonde dynamic duo was after a routine appointment at UT Southwestern Radiation Oncology. I heard others shout from across the valet parking area, “Is that Callie? Look, it’s Callie!”. The stress of my recent doctor visit vanished, as I found myself crouched down, face to face
with beautiful brown eyes staring deep into my soul. She was outfitted in a rainbow costume and sunshine headdress. Colorful Callie erased my scanxiety immediately. It’s as if she delivered exactly what I needed with the silent comfort only a loving dog could provide. As we continued to chat in the parking lot, Cindy told me something about her compassion for cancer patients that I will never forget. She proudly said, “I want to be part of the solution, not part of a problem.”
Cindy Bedford is not simply a volunteer. She has master’s degrees in Behavioral Analysis and Autism Intervention Specialization. Her professional history provided the perfect techniques with which she taught Callie the skills to become an impactful certified therapy dog. As Cindy explained, “Callie took those basic skills and added her sweet disposition. She added the love.” Cindy has a servant’s heart, yet she credits Callie for having the “heart knowledge” and intuition to comfort patients.
It’s no surprise that Cindy is a seasoned marathoner. At seventyone, this avid runner navigates medical facilities in Dallas with ease, keeping a busy schedule with Callie in tow. One particular winter morning, Callie and Cindy were asked to visit a woman receiving an infusion who had heard about Callie, but had yet to experience the joy of meeting her. “This is what warms my heart on an icy, cold day,” Cindy told me. Callie’s outstanding ability as a therapy dog resulted in requests by oncologists for her presence to help lower the blood pressure of certain patients before embarking on radiation therapy treatment for the day. The reach of Callie’s leash is not limited, however, to patients alone. Squeals of delight ring through the halls of Simmons Cancer Center as staff members recognize Callie sporting one of her many festive costumes. Cindy humbly explains that during each of her volunteer days, she hears, “I’m so glad I worked today.”
During the last eight years, Callie’s talents have also been shared outside the cancer community. She brightens the days of Dallas school children as a reading buddy. In addition, she calms nervous travelers as a member of the K9 Crew at DFW International Airport. I asked Cindy what motivates her to continue pet therapy with Callie. Without hesitation she said, “Patients often tell me this is a great ministry, but I also know it’s a calling, especially comforting cancer patients through Callie. I’m using this ministry and paying it forward knowing how proud my husband would be if he was still here.”
Callie significantly lifts spirits and offers love to those around her. She creates joy in spaces that have otherwise been marked with sadness. What is Cindy’s favorite part about volunteering with Callie? “I love being her human at the end of the leash.” I am grateful that cancer survivors and patients will continue to be comforted by this remarkable pair. As hope is demonstrated in many forms, this one is four-legged. Her name is Callie.
By Sophie Wix BA, MPhil and Jennifer Gill MD, PhD
In the last decade, an explosion of new cancer drugs has occurred, and patients have more treatment options than ever before. This feat would not have been possible without the dedication and cooperation of scientists, clinicians, and patients through clinical trials. Currently there are more than 10,000 active clinical trials in the US that are related to cancer. This guide will help explain what kinds of clinical trials exist, how to find them, and considerations for determining whether enrollment might be right for you or a loved one.
Clinical trials refer to any type of research conducted with patient samples or data to advance our understanding of a disease. There are two main types of clinical trials as described further in the chart: observational and interventional.
As the name suggests, “observational” trials consist of observing and studying cancer patients through the normal course and
treatment of their disease. Sometimes this means involvement from patients in the form of surveys, bloodwork, donating cancer tissue, or extra clinic visits. Through these types of trials, patients help physicians and scientists learn about cancer with the goal of advancing the field.
“Interventional” trials are those in which patients receive a specific intervention (for example, a new treatment or type of surgery). While some of these trials are done to determine how effective a new therapy works, others may also test drug safety or dosing. Before these trials begin, extensive “pre-clinical” studies are done in the laboratory. Only the most promising strategies are taken into patients. Interventional trials are designed to protect the patient as much as possible with the goal that participant outcomes will be at least as good as the current standard and hopefully better.
Description
In observational or non-interventional trials, a patient’s clinical data or tumor samples support laboratory research for biological discovery; these trials do not change the patient’s treatment course.
Patient Involvement
Donation of blood samples, tumor biopsy samples, imaging data, or laboratory studies
Interventional trials tend to be more widely known by cancer patients, as they have been popularized for testing the safety, dosing, and efficacy of new therapies.
Examples of Study Goals
Study the biology of cancer cells within patients’ biopsy specimens
Use patient data to predict future cancer reoccurrence or disease progression
Develop new methods of detecting or tracking cancer progression
Enrollment in a study where a new drug or treatment is being tested
Determine the safety and effectiveness of a new drug or drug combination
Determine optimal drug doses
Study and minimize drug side effects
Study new, advanced surgical methods
Study alternative radiation methods and dosing
Examples of Previous Research Findings
Discovery of BRCA genes in breast cancer
Use of CEA and CA 19-9 labs for predicting colon cancer progression
Development of PET scans for cancer monitoring
Use of immunotherapy drugs for metastatic cancers
Replacing chemotherapy with new targeted therapies with fewer side effects
Advancing immune cell replacement therapy
Through clinical trials, patients can contribute to the scientific knowledge needed for understanding and treating their disease, now or in the future. Additionally, as a participant in interventional trials, a patient can gain access to new drugs or treatment regimens not yet available to the public. This can be especially helpful for patients who have failed all currently available therapies. Interventional trials are a way to try something that may be effective and, on a larger scale, could help thousands of other patients like them for years to come.
All clinical trials have strict “inclusion” and “exclusion” criteria which are established before a trial begins. These criteria vary widely depending on the goal and nature of the study. The first step as a patient is to gather details about one’s cancer (such as cancer type, stage, genetic mutations, and treatment history) and speak with one’s physician to determine eligibility.
In special circumstances, some patients may gain access to new drugs outside of clinical trials through “compassionate use.” Some drug companies are able to offer new and promising drugs (that have yet to be FDA-approved) at no cost to patients. A patient with limited options should speak with her doctor about any alternatives that may be available through “compassionate use”.
I’m interested in enrolling in a clinical trial. Where do I find one?
Many clinical trials take place in large, academic hospital systems with National Cancer Institute (NCI)-Designated Cancer Centers, which are often in major cities. However, many clinical trials have satellite sites in community practices or medical centers across the country, thus offering additional opportunities for patient participation.
Before embarking on any clinical trial, patients need to discuss all options as well as the risks/benefits with their physician. A patient’s doctor might be able to help them find a clinical trial that is right for them while evaluating all available treatment options. The best way to start looking for a clinical trial is in conjunction with one’s doctor.
How do I know if a trial is legitimate?
Patients should never be asked to join a trial without the assistance and support of their doctor(s). Steer clear of any scams, including any instance where a center asks the patient to pay to participate in a trial. Legitimate clinical trials never require patients to pay to receive a new treatment. In some studies, patients may actually be compensated for their time and involvement.
Enrollment in any clinical study is not a permanent or strict contract. If a patient decides to cease involvement at any time, for any reason, she can withdraw by informing the research team and doctor.
As with any new or exploratory treatment, an interventional clinical trial comes with the risk that the drug might not work as predicted or that the drug causes unforeseen side effects. However, very strict rules are in place to minimize risk to patients. The ultimate goal of any study is always to give patients the best alternative to any traditional treatment or a better one. Any ongoing trial will be immediately halted if the drug or treatment under investigation is proving to be ineffective or dangerous. Trials are flexible and patient safety will always be prioritized.
The benefits of participating in a trial include access to new drugs and treatment strategies that are unavailable to the general population of cancer patients, increasing options for those who have exhausted all others, and contributing to cuttingedge research. Many patients find satisfaction in knowing that they are helping provide scientific knowledge for future patients and generations to come.
Our understanding of cancer and the rapid development of new treatments today would not be possible without patients who contributed to research. While not all clinical trials can be “success stories”, each one strives to advance the field and improve the lives of future patients. The Nobel Prize-winning cancer treatment called immunotherapy was first implemented in a clinical trial starting in 2004 in a set of metastatic melanoma cancer patients, many of whom thought they had less than a few years to live. Decades later, many of these original clinical trial patients are still alive because they received a new drug that is now routinely used today. Through clinical trials, scientists, physicians, and patients will continue working closely together with the shared goal of conquering cancer.
“Book Lovers” by Emily Henry
Classic Emily Henry, this book is as breezy a beach read as they come, but also whip smart and cheeky.
You can’t help but root for the heroine, Nora, as well as the rest of the characters, not without their own entirely relatable issues and (sometimes) neurotic tendencies.
I still reflect on passages I read from it - something funny about Nora’s many multi-step skincare regimen, or a searing and truthful retort she lobs toward Charlie when he’s at his most irritating.
Enjoyable, funny and clever, Book Lovers is a story you’ll be glad you read long after turning the last page.
- Rebecca Walden Board Member & Editor
“We Spread” by Iain Reid
This novel about a sweet quiet woman, first living alone, then moved to a facility for full-time care is compelling and frightening. An innate fear in most of us is aging. The author does a beautiful job of allowing the reader to experience the loneliness and terror of losing trust in the reliability of your own mind. Worth the read!
- Teri Vedrenne Accountant
“Poisoner In Chief” by Stephen Kinzer
In this book, Sidney Gottlieb and the CIA Search for Mind Control, journalist Stephen Kinzer unearths a mysterious shadow in American history, holding its participants accountable through a surprising lens of empathy. After World War II, many CIA members believed the Soviets had mastered mind control. Sure, a handful of North Korean and KGB torture techniques yielded eerie behavior in their victims, but hindsight reveals the CIA exaggerated the crisis. Regardless, officers of the time truly believed that mind control stood between them and national survival. Through a mosaic of acuity, humor, and empathy, Kinzer retells the story of Project MKULTRA, an ultrasensitive CIA program that researched mind-altering drugs. CIA-sponsored LSD espionage? Surreptitious sex scenes? Magician-led classes on administering poison? Just as Kinzer noted, “some of our people were out of control in those days.”
- Libby Warren Intern
“Atomic
Habits” by James
Clear
This is a great book for anyone wants to gain ground with the adoption of a new habit or doing away with an engrained habit that is not helpful.
If you are struggling with changing your behavior in any area, likely this issue is not you but your approach. In this book, Clear talks of making bad habits unattractive and new habits rewarding and easy through things such as habit stacking with the “if, then” question.
I really enjoy the idea of reframing of behavior patterns and ended the book feeling empowered to make efforts in some of the more challenging areas of my life.
- Helen Bowles Founder
“Home Front” by Kristin Hannah
Home Front is a novel about a very courageous women that is hit with adversity from a young age. Her parents are killed when she’s just 18 and she has to enlist in the military. She finds her love of flying Black Hawk helicopters and falls in love with a wonderful man. At 41 years of age, she is deployed to Iraq, leaving her husband and two young daughters behind.
As with all of Kristin Hannah’s work, I struggled to put this book down the more I neared the finish. This is an incredible book about hardship, perseverance and strength, however, it may be received as too heavy hearted for a reader who is dealing with her own personal challenges.
- Liz Pounds Administrative Assistant
By Rondi Prowell ARRT RT (R)(T) MBA Keehan Dermatology-Dermatology
It’s overwhelming to hear a cancer diagnosis for the first time, and it can be equally intimidating to absorb the massive amounts of information that quickly follow the startling news. There are emotions and questions racing in circles through a patient’s mind, but there’s also a resounding desire to treat it quickly and effectively. The goal, of course, is to be as healthy as possible and ultimately cancer-free. According to the American Academy of Dermatology, 9,500 people in the U.S. face this scenario every single day, as skin cancer is the most common cancer in our country.
Thankfully, there is an extraordinary modality available to face it head on without substantially intruding on one’s daily life. Electronic Brachytherapy (Ebx) was introduced in 2009, presenting a non-invasive alternative to the earlier standard of care. This miniaturized x-ray source brings enormous hope to patients with non-melanoma skin cancer (NMSC) and may be available at a Dermatologist near you. Xoft has developed this treatment, which has been known to cure NMSC at approximately 97 percent, while causing minimal, if any scarring, no restrictions to daily life, and radiation delivery in as little as five minutes. “Brachytherapy was well tolerated with acceptable toxicity and high local control rates (median: 97%)” in a review by Delishaj.
The comparison to other treatment modalities can assist patients in making an informed decision on which option is
best for them. Mohs, a micrographic surgery alternative, can leave a patient with the need for further plastic surgeries and extensive scarring in some cases. This modality results in an excision with sutures that must be cared for properly for adequate healing. Anatomy such as the nose and ears can sometimes be disfigured with the Mohs procedure, due to the amount of tissue needed to completely excise the cancer. Other options, such as cryotherapy (freezing) and Electrodesiccation and curettage (ED&C-scrape and burn), are only utilized for pre-cancer or “in situ” cancer lesions. In situ lesions are the earliest possible stage of a cancer cell where the abnormal cells have not spread beyond where they were first formed. As well, Traditional Superficial Radiation Therapy can require extensive time commitments with the average number of treatments being 20-30 fractions. By comparison, Electronic Brachytherapy can eliminate numerous concerns that the other modalities bring, with qualities of shorter protocols, a noninvasive approach, and minimal-to-no scarring. This modality is accessible within the Dallas-Fort Worth metroplex as well as other states across the country.
Xoft® Axxent® Electronic Brachytherapy System® is a high dose rate (HDR) unit that uses a low energy, miniaturized electronic x-ray source. Ebx can be delivered in as few as
eight fractions up to 12 fractions for the various protocols. The protocol that will deliver the best results for the specific lesion due to size, location, and histology, is prescribed by a Radiation Oncologist. “The treatments are typically painfree and well-tolerated with fast recovery times relative to protracted external beam radiotherapy (EBRT) during which schedules are frequently 20 to 30 daily fractions to 50 to 60Gy”. Licensed Radiation Physicists calculate and calibrate the precise prescription of radiation dose prescribed by the Radiation Oncologist. Licensed Radiation Therapists are the medical professionals that will interact, treat, and care for the patients in the dermatology clinic while they undergo the treatment protocol. A post-biopsy patient with a pathology report confirming the evidence of cancer can schedule a consultation and simulation to begin. From there, the medical team will develop a treatment plan to begin electronic brachytherapy radiation treatment. The patient can begin treatments within a week of consultation, in most cases, once insurance benefits have been processed. The treatments are delivered at least 36 hours apart for two treatments per week over a four-to-five-week period for most patients. In comparison to MOHS surgery, the most common toxicity between the two modalities is hypopigmentation. Radiation can cause mild side effects such as erythema, dry and moist desquamation (skin peeling), hypo and hyperpigmentation, and telangiectasia (dilated small blood vessels on the skin). The most common side effect is very comparable to phases of sunburn, ranging from mild to severe. Despite the skin
changes the patient undergoes during electronic brachytherapy, “physicians rated cosmesis of the treatment sites as “excellent” or “good” in 98% of EBT-treated lesions”. Radiation related side effects are confined to the targeted area and do not extend to other anatomy of the body.
The consultation consists of extensive information about this modality shared with the patient. Question and answer session between the patient and the therapist comprises most of the time during this appointment. The essential goal is to assist the patient in making an informed decision on the treatment option that best suits them personally. Every patient is unique, as is their cancer journey. If the patient decides to continue with electronic brachytherapy to treat their cancer lesion, the next step is simulation. The simulation consists of deciding which standard surface applicator is adequate, flexi-shield cutout size and placement, if applicable, and prescribed fractionation. This is a process of measuring the skin cancer lesion and including a 5mm (about 0.2 in) margin to encompass any residual disease that is not visible to the naked eye. Photographs are taken and uploaded to the patient’s medical chart to document the precise location and setup for treatment. The information gathered is accessible by the Radiation Oncologist and physics team to create a radiation treatment plan.
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Once the patient has undergone consultation and simulation, treatment appointments are scheduled appropriately. Treatments are routinely scheduled on a Monday/Wednesday or a Tuesday/Thursday regime over the four- or five-week duration. The information gathered in the simulation is utilized for treatment setup. The standard surface applicators range in size from 10mm, 20mm, 35mm, and 50mm diameter. Lesions up to four centimeters in diameter are treatable by the Xoft® Axxent® Electronic Brachytherapy System®. The typical dose depth is 3mm (about 0.12 in) for most lesions. This system has the capability of customizing up to a 5mm dose depth, if required for optimal coverage. The patient is positioned on an exam chair or table to perform the treatment. A Vac-Lok™ bag, a bean bag immobilization pillow, is used to stabilize the area of anatomy that will undergo treatment. The patient is encouraged to relax to minimize the amount of movement during treatment. The Xoft radiation controller is then positioned to accommodate the patients’ comfort while treatment is delivered. The standard surface applicator and flexi-shield cutout, if applicable, are placed flush on the lesion as determined from the simulation. The beam on time, actively administering radiation, varies from approximately three to eight minutes. Most appointments, the patient is checked in, treated, and out within 10 to 15 minutes. Once the treatment has concluded, the patient can continue their daily routine as usual. Showering, facial routine, and normal activities can resume without restriction in most instances. Exposure to direct sunlight should be limited and paired with protective apparel and sunscreen.
During the treatment process, typical maintenance of the radiation site is satisfied with Aquaphor Healing Ointment®. Aquaphor contains petroleum jelly and other ingredients that soothe the skin during all phases of radiation treatment. After the full treatment protocol is complete, the patient will schedule a six week follow up to allow the skin time to regenerate and heal. The dermatologist will visually examine the treatment site to ensure proper healing and rule out any recurrence. The follow up regime schedule is at six weeks, three months, six months, and then annually to monitor the area. The research gathered from proven treatment protocols dating back to 2010, demonstrates 40Gy distributed in eight or ten fractions has shown a local control rate of ~97 percent.
Patients diagnosed with basal or squamous cell carcinomas that are four centimeters or less in diameter are potential candidates for electronic brachytherapy. Common anatomy treated are ears, noses, cheeks, forehead, scalp, hands, arms, legs, and back. If you would like more information on this treatment modality for non-melanoma skin cancer, contact your dermatologist.
Stegman, Lauren D. MD, PhD, DABR. Electronic Brachytherapy for Nonmelanoma Skin Cancer. Oncology Times 39(9):p 38-39, May 10, 2017. | DOI: 10.1097/01.COT.0000516752.51518.13
Delishaj D, Rembielak A, Manfredi B, Ursino S, Pasqualetti F, Laliscia C, Orlandi F, Morganti R, Fabrini MG, Paiar F. Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature. J Contemp Brachytherapy. 2016 Dec;8(6):533-540. doi: 10.5114/jcb.2016.64112. Epub 2016 Dec 2. PMID: 28115960; PMCID: PMC5241375.
Patel R, Strimling R, Doggett S, Willoughby M, Miller K, Dardick L, Mafong E. Comparison of electronic brachytherapy and Mohs micrographic surgery for the treatment of early-stage non-melanoma skin cancer: a matched pair cohort study. J Contemp Brachytherapy. 2017 Aug;9(4):338-344. doi: 10.5114/jcb.2017.68480. Epub 2017 Jun 23. PMID: 28951753; PMCID: PMC5611452
Bhatnagar A, Patel R, Werschler WP, Ceilley RI, Strimling R. High-dose Rate Electronic Brachytherapy: A Nonsurgical Treatment Alternative for Nonmelanoma Skin Cancer. J Clin Aesthet Dermatol. 2016 Nov;9(11):16-22. Epub 2016 Nov 1. PMID: 28210385; PMCID: PMC5300713.
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Patel R, Strimling R, Doggett S, Willoughby M, Miller K, Dardick L, Mafong E. Comparison of electronic brachytherapy and Mohs micrographic surgery for the treatment of early-stage non-melanoma skin cancer: a matched pair cohort study. J Contemp Brachytherapy. 2017 Aug;9(4):338-344. doi: 10.5114/jcb.2017.68480. Epub 2017 Jun 23. PMID: 28951753; PMCID: PMC5611452.
