2015 vision may newsletter

VISION, MAY 2015

South Africa's first robotic assisted nephrectomy A state-of-the-art da Vinci Si robotic technology was used to assist in the surgical removal of the patient's cancerous kidney. The first ever-robotic assisted procedure of its kind in South Africa is known as a radical nephrectomy and took place at Netcare Waterfall Hospital in Midrand on 7 April 2015.

South Africa's first robotic assisted nephrectomy was a triumph.

Three days later, the patient, a consultant who prefers not to be named, was discharged home where he was able to quietly celebrate his 51st birthday with his family. "I feel so much better," said a relieved 51-year-old father of five following his discharge 72 hours after having his cancerous kidney removed.

The highly complex operation was completed through small incisions in the skin and was by all appearances a great success, according to Dr Marius Conradie, an urologist who practises at the hospital and who performed the surgery with the assistance of a team of specialists and nursing staff.

"The patient's right kidney, which was badly diseased, was removed.

Despite the fact that a nephrectomy is a major procedure, the patient had recovered to the extent that he was moved from intensive care to a general ward and had regained his mobility just 24 hours after the operation. With traditional open surgery we expect a patient to take about a week to get back on his or her feet."

"The use of this robotic technology in this specific procedure is an important development in the field of urology in South Africa. It was a great honour to have been able to, for the first time on our continent, assist a patient with cutting edge treatment that has been proven internationally for its effectiveness."

The da Vinci Si system consists of a surgeon's console offering three-dimensional, high definition display and a patient side cart featuring robotic arms with wristed surgical instruments. These instruments are controlled by the surgeon, improve and steady the natural motion of the hands.

Collective South African Voices for Cancer www.canceralliance.co.za The Cancer Alliance is a collective group of cancer control non-profit organisations and cancer advocates brought together under a common mandate, to provide a platform of collaboration for cancer civil society to speak with one voice and be a powerful tool to affect change for all South African adults and children affected by cancer.

Lonehill community support CanSurvive and Cancer Buddies The Lonehill Village Fair kindly offered a stand to CanSurvive at their event held on 16 May so that we could promote support for cancer patients and supporters. A lovely autumn day made it a pleasant outing for some of the committee and friends and many interested people stopped by.

CanSurvive had intended to organise a Walk for Cancer in June, but this has had to be postponed at the request of our sponsors. More details of this exciting event will follow in our June issue.

Cancer Buddies appoint new National Buddy Coordinator Introducing Elfrieda Strydom, an oncology social worker, who is based in Bloemfontein.

Elfrieda has extensive HIV aids experience and currently works part time in a private oncology unit.

Cancer Buddies are very excited to have her on our team and look forward to growing our Buddy network to cover more areas.

Elfrieda will be contacting existing Buddies to hear of their experiences and whether they have any ideas for improving and expanding the service.

VISION, MAY 2015

Affordable medicine in South Africa Get involved and help us advocate for improved legislation Have you struggled to get, or pay for, the medicine(s) you need?

Please take this five-minute survey to tell Doctors Without Borders, the Treatment Action Campaign, and SECTION27 about your experiences getting, and paying for, the medicines you need. This is applicable for both public and private sector patients. Your participation will help us to advocate for affordable medicine in South Africa.

About Fix the Patent Laws Often people don’t have access to the medicines they need in South Africa because life-saving drugs are priced out of reach. This affects all types of drugs: treatments for drug-resistant tuberculosis, cancer, hepatitis, newer antiretroviral medications for HIV, contraceptives, mental health, and more.

Doctors Without Borders, the Treatment Action Campaign, and SECTION27 incorporating the AIDS Law Project, are together advocating for the South African government to adopt laws which promote affordable medicine. With this survey, the campaign is seeking to find people who have not been able to get the medicines they need, or are paying a lot out of pocket for their medicine. Please note that all stories will be kept 100% anonymous and confidential if required.

For more information on this survey or the campaign, please call Doctors Without Borders at 011 403 4440, and ask for Julia Hill (julia.hill@joburg.msf.org). Learn more at: www.fixthepatentlaws.org. Follow us on Twitter @FixPatentLaw Patient survey: https://www.surveymonkey.com/s/GBP8C6Z Doctor survey: https://www.surveymonkey.com/s/GKM7KVW

2

VISION, MAY 2015

Of cancer, pain and addiction

Head and Neck Support Group The CanSurvive Head and Neck Support Group is for anyone who has had trauma to the head or neck – not only cancer related – although that applies to the vast majority. The Group is for patients who are just starting this journey, as well as those who are many years down the treatment and recovery road.

In the movies, pain is glorious. The runner pushing to the edge. The magic of childbirth. The soldier battles impossible odds to conquer.

Pain? “Suck, it up, maggot, pain is nature’s way of telling you that you’re alive.” But, to the cancer patient, in the real world? Pain is nature’s way of saying “you may soon be dead.”

The objective is to provide information, share experiences, and help with coping mechanisms. It is run FOR the patients BY the patients. There is always a medical member of the Morningside Head and Neck Oncology Team present. Partners are encouraged to attend the meetings as well.

For a patient suffering from the dread disease, pain means more than torn tissues, invading needles and post-op wounds. It is more than nerves firing, fractures grinding and constricting bowels. To have pain for a cancer patient is to be reminded of the threat, the danger, the deepest intrusion. It is to be reminded that you are acutely mortal.

The informal and supportive meetings are usually held on the first Thursday of each month at Rehab Matters, 1 De la Rey Rd. Rivonia from 18h00 to 20h00. The next meeting will be on Thursday 8 September .There is also a Facebook group: South African Head and Neck Support Group

Pain threatens not only the body, but the soul. Pain destroys life. It steals not only movement and healing, but hope. It is very hard, perhaps impossible, to truly live, let alone find peace or joy, while gripped with pain from the dread disease. We must control pain.

For more information, contact Kim Lucas, on 082 880 1218 or e-mail: lct@global.co.za.

Nonetheless, we are faced with a crisis of abuse and injury from prescription opioids. Each recent year, almost 20,000 people die in the US from legal narcotics and over 8000 die from heroin addiction, which is often a descent from prescription oxycodone or morphine. Such destruction and waste is unacceptable, and is a true health care catastrophe; it must be resolved. As such, a number of federal, state and local programmes are in process to address this problem.

physician accessible online controlled substance databases. Good practice dictates that prescribers check those databases for patterns of prescription fulfillment, duplication, and falsification, and repeat such inquiries on a regular basis. In areas where online access is not available, a phone call to the local dispensing pharmacy may be extremely valuable.

We seem to be caught in a Solomon’s choice. Control pain and people will become addicted and die. Limit access to prescription medications and allow our patients, friends and family to suffer the deepest sort of agony. Our challenge is to avoid significant obstacles to access for desperately needy patients while, simultaneously, we address addiction as a disease to be prevented and when it does occur, requires treatment.

Prescribers should only write as many doses of medications as are needed. For example, this might be six tablets of Percocet for a patient recovering from a minor injury or surgery, instead of 30 or 40 tablets.

The extra pills will lurk in a medicine cabinet awaiting the curious hand of a teenager or anxious adult. If there is a risk that six pills may not be enough, having access to the doctor for renewals is important.

The lion’s share of the responsibility for addressing this crisis falls to prescribing physicians. By practicing safe and adequate prescription procedures, doctors can be the first and major champions both for pain control and abuse prevention.

On the other hand, a patient with advanced cancer in continuous pain should never have to worry that they might run out of medication and should have the flexibility to adjust their dosing based on immediate need. Such a patient needs an adequate supply of medication. The risk of addiction or abuse in patients treated for cancer pain is extremely small, therefore our goal must be to preserve access for these needy patients.

First, they should confirm the need for these powerful agents in each patient. This means understanding these drugs, both their benefit and risk. While opioids are incredibly valuable and, properly prescribed, safe, often anti-inflammatory, antispasmodic or non-pharmaceutical techniques can be used.

It is vital that physicians educate their patients on the proper storage and disposal of drugs, especially addictive medicines. Meds should not be stored in a place where people other than the patient can gain access. It is vital that drugs designed for a patient in need not be stolen or used by unintended individuals who would be at a significantly greater risk for dependence and addiction.

When there is any doubt about how a patient may use prescribed medications, or if there is question whether the patient is actually taking the drugs, physicians must endeavor to confirm compliance and decrease the risk of deliberate diversion. A number of states now have Dr. Salwitz is a Clinical Professor at Robert Wood Johnson Medical School.

Unused prescriptions should be discarded and destroyed in an effective and safe manner. Many states have “medicine drop” programmes where unused medications can be disposed at police stations or hospitals. When it is not possible to discard of narcotics in that way, they should be thrown-out using CDC recommended techniques, such as being mixed with used coffee grounds or moist kitty litter.

He lectures frequently in the community on topics related to Hospice and Palliative Care and has received numerous honours and awards, including the Physicians Leadership Award in Palliative Care.

The prescription drug epidemic is a complication of needed therapy and we must prevent and treat addiction. At the same time, we must recognise that opioids give patients not only relief, but the opportunity to share each day with their families. They give not only the chance to move, but also the opportunity to hope. When used properly, they give the chance to live.

His blog, Sunrise Rounds, can be found at http://sunriserounds.com

3

VISION, MAY 2015

Complementary therapies People who are living with cancer may consider using complementary therapy to reduce the side effects of cancer treatment and improve their physical and emotional well-being. Complementary therapies are added to conventional medicine. Complementary medicine is also called integrative medicine. The American Society of Clinical Oncology offers the following information on complementary therapies that have been researched.

School education campaign we need your help During the second school term ending on 26 June, Cape Town schools are asked to help Can-Sir collect as many 10c coins as possible as part of our Schools Education & Cancer Awareness Campaign.

You may hear about many different types of complementary therapies. However, researchers have found that the following therapies work to reduce pain and improve well-being:

Use old plastic bottles, jam tins, coffee tins etc what ever you have, and fill them with 10c coins to help us educate our young scholars and higher learning girls and boys as to the dangers of cancer.

p Physical activity. Participating in physical activity can help many people with cancer gain strength and endurance, relax, and cope with stress. Being active may help relieve pain, fatigue, anxiety, and depression. Research also shows that it may help lengthen the lives of people with cancer after diagnosis. Talk with a physical therapist or trainer experienced in working with people with cancer to find the best exercise plan for you.

Cancer education and early detection saves lives.....

Contact us on: 079 315 8627, email: info@can-sir.org.za – our website is www.can-sir.org.za

p Acupuncture. This is the use of very tiny needles and/or pressure to stimulate points on the body. Research shows the therapy releases chemicals in the brain, such as beta-endorphin and serotonin, to relieve pain. Acupuncture can help reduce chemotherapy-induced nausea and vomiting. It may also help relieve hot flashes, dry mouth, headache, fatigue, sleep problems, appetite loss, diarrhea, constipation, weight changes, anxi-

p

p

LET’S TALK ABOUT CANCER!

p

Join us at a CanSurvive Cancer Support Group meeting

p

- have a cup of tea/coffee, a chat with other patients and survivors and listen to an interesting and informative talk.

Upcoming meetings: starting at 09:00 at MIDRAND - 23 May - in the Boardroom (follow the signs) at Netcare Waterfall City Hospital HEAD and NECK Group - 4 June at Rehab Matters, Rivonia PARKTOWN - 13 June, Hazeldene Hall (opp. Netcare Park Lane Hospital) Enquiries: Bernice 083 444 5182 or bernicelass@gmail.com Chris 083 640 4949 or cansurvive@icon.co.za www.cansurvive.co.za

p

ety during procedures, swallowing difficulties, and lymphedema.

In addition, it may help people quit smoking.

Yoga uses a combination of breathing exercises, meditation, and poses to stretch and flex various muscle groups. Researchers have found that yoga can relieve chronic pain, headaches, and insomnia.

Massage. Research shows that massage can reduce pain, tension, and stress. It may also help with symptoms after surgery, anxiety, depression, sleep problems, and fatigue.

Meditation. Meditation is a way for a person to learn to focus attention to calm the mind and relax the body. It decreases chronic pain and improves mood and other aspects of a person’s quality of life. There are many different types of meditation, and it can be self-taught or guided by others.

Music therapy. Trained therapists familiar with the emotional and social concerns of patients and their families guide a person through music therapy. It can help with a patient’s recovery and general well-being. It works well for patients receiving palliative treatments and for those staying in the hospital.

Nutrition. Professional nutrition counseling with a registered dietitian helps patients manage weight changes and cope with nausea. They can also learn about herbs and supplements that may interfere with cancer treatment.

It’s important to discuss with your doctor the types of complementary therapies best for you, as it may depend on the treatment you are receiving. For instance, people who are using anticoagulant medicine or are at risk of getting infections should be cautious about using acupuncture. http://tinyurl.com/nx34dx3

CONTRIBUTIONS FOR PUBLICATION IN “VISION” NEWSLETTER Comments, articles, letters and events submitted for publication in VISION are welcomed and can be sent to: cansurvive@icon.co.za.

The Groups are run in association with the Johannesburg Branch of Cancer Buddies and is hosted by Netcare. The Group is open to any survivor, patient or caregiver. No charge is made.

Let us know what items you would like to see more of in VISION.

4

VISION, MAY 2015 battling cancer such as lymphoma, melanoma, pancreatic, ovarian, brain, lung, breast and colorectal cancer.

IBM Watson researches cancer treatment

The move follows several collaborations with hospitals to pilot its data analysis technology for cancer treatment. For example, last year it worked with New York Genome Centre in a genomic research initiative for glioblastomas, an aggressive, frequently malignant brain tumour that kills more than 13,000 people in the US each year. The idea for the initiative was that by applying cognitive computing power to the massive amount of clinical data using the patient’s genomic data as a compass, IBM Watson’s technology could help clinicians develop personalised treatments for each patient.

IBM Watson unveiled a new chapter in its cancer research work, this time for genomic analysis at the World of Watson conference in Brooklyn in May. It will work with 14 institutions spanning research institutes to teaching hospitals to provide access to its data analysis tool.

Watson Genomic Analytics looks for variations in the full human genome and uses Watson’s cognitive capabilities to examine data sources such as treatment guidelines, research, clinical studies, journal articles and patient information, according to a company statement. It provides a list of medical literature relevant to the case with drugs that have been identified in the literature. The patient’s doctor reviews the information alongside underlying evidence to make more informed treatment decisions. Watson Genomic Analytics constantly gets smarter, as the system learns from patient data, the statement said.

Maine Centre for Cancer Medicine and New York’s Westmed Medical Group also worked with Watson to teach it how to interpret clinical information to diagnose lung cancer.

In an entry on the IBM’s Building a Smarter Planet blog, Dr Lukas Wartman, a clinician and leukemia survivor at McDonnell Genome Institute, said it would start using the Watson Genomics solution with patients when traditional treatment options prove ineffective.

It will also use the technology in clinical trials of new medications.

In the initial phase of the precision medicine programme, the 14 organisations will apply Watson to the DNA data of patients who

“Ultimately, if it proves to be successful, oncologists will be able to help a great number of patients with cancer who have run out of options and are running out of time,” he said.

Broccoli – more nutritious raw or cooked?

You don’t need to face cancer alone!

Actually, raw broccoli is not necessarily more healthful than cooked. Broccoli is part of the cruciferous vegetable family and a great food to include in your diet either raw or lightly cooked.

These vegetables provide many nutrients but their unique contribution is a group of compounds called glucosinolates. When we chew or chop these vegetables, glucosinolates are exposed to an enzyme stored elsewhere in the plant that converts these inactive compounds to isothiocyanate compounds which studies suggest may reduce cancer risk.

You are invited to join our Cancer Buddies Groups in: p Rondebosch Medical Centre, Klipfontein Road p Vincent Pallotti Hospital in the GVI Oncology unit: Contact Linda Greeff 082 551 3310

The latest research shows that you can get high amounts of these protective compounds if you blanche the vegetables first.

Blanching is a quick dip in boiling water, followed immediately by cooling. You can also preserve both nutrients and the enzyme needed to form protective isothiocyanates if you steam broccoli for three or four minutes (just until crisp-tender) or microwave for less than one minute.

p Bloemfontein: Contact Elfrieda Strydom 051 4008000 p George: Contact GVI Oncology Engela van der Merwe tel 04488400705

Epecially if you won’t be consuming the cooking liquid (as in soup), boiling broccoli - or other cruciferous vegetable - is not the optimal method. Boiling leaches out the vegetable’s watersoluble vitamins in these vegetables, such as vitamin C and folate, as well as many of the glucosinolate compounds, which are water-soluble, too. Moreover, too much exposure to high temperatures destroys the enzyme that converts the inactive glucosinolates to active compounds. Serving broccoli raw is an excellent option, since it retains these nutrients and the enzyme that forms isothiocyanate compounds. Before serving on a relish tray or salad, quickly blanching and cooling allows you to get even a bit more of these compounds. When you want cooked broccoli, steaming or very brief microwaving are excellent choices.

p Nelspruit: Contact Winnie Stiglingh, 013-755 2145, counsel@hnoncology.co.za p Johannesburg. Contact Chris Olivier 083 640 4949, cansurvive@icon.co.za p Johannesburg. Head and Neck Group. Contact Kim Lucas, on 082 880 1218 or lct@global.co.za.

WE LOOK FORWARD TO MEETING YOU

We are here to help

American Institute for Cancer Research

5

VISION, MAY 2015 However, I have to confess that, perhaps unsurprisingly, my worst outburst to date has been reserved for my long-suffering husband.

This combination of temper and depression was my worst to date.

When I asked my cancer nurse if this was a normal side effect she replied in the affirmative. My husband just said very quietly, “But that does not make if acceptable.” Of course he is right and none of the victims of my temper deserved it.

The psychological effects of cancer There are other effects of cancer and its treatment that are not so widely known or discussed. I have only discovered this recently and these are side-effects that affect not only me but also those close to me. These are the psychological effects of cancer that make everything doubly hard for everybody.

Depression is a persistent sadness that interferes with usual activities and ability to carry out roles at home, work, community, or school.

Depression may also be known as sadness, feeling “down,” despair, or hopelessness. Depression and its side effects affect both men and women. There are several risk factors that increase the potential for development of depression in the patient with cancer. Medications commonly prescribed for cancer patients can be one of those risk factors. There are many classes of medications that may have depression as their side effects. Some examples are: analgesics, anticonvulsants, antihistamines, anti-inflammatory agents, antineoplastics, chemotherapy agents, hormones, immunosuppressive agents, and steroids.

It was only when I was chatting to my cousin about cancer suffered by another member of our family and the outbursts of temper they displayed, that I began to understand that cancer results not only in physical, but also psychological effects. The emotional effects of chemotherapy can be just as debilitating as the physical effects. From the initial diagnosis of cancer to the final dose of chemotherapy, patients undergo levels of emotional distress well beyond a healthy limit. The emotional effects of chemotherapy can be directly related to the medication or to external factors such as family, work and social life. The range of emotional distress felt by patients depends a lot on their particular support network and their rate of recovery.

Emotions run high for the whole family during chemotherapy. It made sense when I thought about it, but I never had.

Depression during chemotherapy, and generally can be managed, but it has to be admitted first. You need to recognise what puts you at risk of depression. Triggers include – p p p p p p p p p

I asked my husband if I had ever displayed any outbursts of temper. I was sure I had not, until he reminded me of an uncharacteristic and ugly diatribe to which I subjected my daughter during a telephone conversation. I felt so guilty because he was right.

The outburst to which I subjected my daughter is not the only evidence of my fragile mental state during cancer treatment, at present.

When the District Nurse arrived to clean my hickman line and take my pre-chemo bloods at a time different to that arranged I lost the plot and ended up asking her to leave. Oh dear! The problem is it all seemed so logical at the time.

p p

Chemotherapy can have an emotional impact on patients because the treatment itself is a sign of emotional self-preservation. The choice to fight cancer does not end with the first dose of the medication and patients often feel emotionally taxed when recovery is slow.

The physical side effects can contribute significantly to emotional distress. Insomnia, constant nausea, weight loss, hair loss and a diminished sex life can all make a patient feel emotionally distraught.

Family and friends bear their pain too.

History of depression in yourself or your family.

Pessimistic view of life.

Living with a chronic disease like cancer.

Stressful events in your life.

Effects of some medications & chemotherapy.

Lack of support from family or friends.

Unrelieved physical symptoms (like pain).

Alcohol or drug abuse.

Unrelieved grief (not working through feelings of angry about how cancer and its treatment have affected your life).

Any persistent change in your mood, with the signs of depression listed above.

If you feel suicidal you must tell someone and get help. It is not safe to be on your own at these times.

I am told it is not unusual to have times when you feel very low after a diagnosis of cancer, and during or after treatment. Many people feel physically and emotionally exhausted from the treatment, and this can lower their mood. However, for some people affected by cancer their low mood may continue or get worse and they may need specialist help or treatment. Some people find that their sadness gives way to a situation where their mood is low most of the time for several weeks or more, and they are depressed.

Chemotherapy also affects patients because of a perceived burden of loss on family, friends and work. Patients may feel isolated from participating in family activities due to fatigue and medical appointments. Social life is also dramatically affected by chemotherapy due to fatigue and often shame. Therefore, some of the classical negative emotions during chemotherapy include anger, fear, anxiety, depression and isolation. The emotional distress from chemotherapy may come from a sense of not having any control over the matter.

Cognitive function and emotional health are strongly interconnected and chemotherapy can take a serious toll on both of them. In some cases, emotional distress can affect cognitive function, while in other cases, impaired cognition can alter judgment and emotional responses during cancer treatment.

The relationship between cancer and depression is complex.

Depression may be triggered by the diagnosis of cancer, other issues related to the cancer and its treatment, or the impact of the cancer on a person’s life. However, depression may occur by chance or be related to other difficult events, either in the past or in the present, which are nothing to do with cancer, such as the loss of a loved one.

Depression can develop slowly, making it very difficult for either you or your family to recognise when it started. In other cases it can seem to hit you suddenly – one day you wake up and realise that you feel hopeless and helpless and are engulfed in a ‘black cloud’ or, as Winston Churchill called it “black dog” of depression.

Depression can affect anyone at any age. It is extremely common – one in five (20%) people are affected by depression at some time in their lives. Depression is not a sign of personal failure or inability to cope. You can’t ‘pull yourself together’ or ‘snap out of it’. Depression can usually be successfully treated. The first step to feeling better is to admit the problem, then to get appropriate help.

Valerie Penny is a writer and poet - an American, living in Scotland who took early retirement for health reasons. Read her blog dealing with her journey through breast cancer at https://www.survivingbreastcancer.wordpress.com.

6

VISION, MAY 2015

Answering the questions

Art for cancer Kuns vir kanker

by Dr Bruce Campbell, a head and neck cancer surgeon at the Froedtert Cancer Centre

In 2014 PLWC hosted the first Art for Cancer auction. It was an enormous success. With artists like : Conrad Theys, Louis Jansen van Vuuren, Hennie Meyer, Ruan Huisamen, Shany van den Berg, dr Leonie Scholtz, Johan Coetzee, Theo Paul Vorster, Clare Menck, Cathy Layzell, Corné Weideman, Pierre Volschenk, Yvette Molenaar, Lize Beekman and others the standard was set high and guests enjoyed a homely lunch in the Oude Libertas Gallery with foodie expert Annalize Buchanan and her well renowned catering team, in the colourful company of artists. Entertainment guest Niel Rademan needed no intruduction and not a single person could have wished for a bigger surprise event.

Twenty years from now you will be more disappointed by the things you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. - Mark Twain Cancer physicians know when “The Questions” are coming. A casual conversation at a party or in the grocery store eventually turns to careers. The pleasant exchange is replaced with talk of life-changing illnesses and impossibly difficult decisions. The other person’s brow furrows, the head shakes, the face darkens. “How can you deal with that day after day?” they ask. “Isn’t it depressing? Why didn’t you pick something happier for a career?”

Funds raised by this project help to fund the Cancer Buddy support services.

Art for Cancer/Kuns vir Kanker 2015 proudly announce the participation of some of South Africa's most profound, versatile and amazing artists who will donate works to go on auction on Sunday 1 November at Oude Libertas Gallery. Once again guests will enjoy a Sunday lunch with caterer Annalize Buchanan and decor specialist Flower Walker. Entertainment still to be announced.

These are legitimate questions. As a medical student many years ago, I enjoyed every rotation and wondered how I would ever be able to narrow down my choices and pick a specialty. Eventually, I decided that I was most content when I was in an operating room.

Even though I knew that I was going to be a surgeon, there were still dozens of directions where my career might head.

One day in 1980, I was in a small conference room in Chicago packed with medical students, residents, and surgeons who had gathered to hear a presentation by a visiting out-of-town surgeon.

He ran through his slide show, describing a procedure he had devised to restore voice for patients who had undergone removal of their voice boxes. It was a complex operation that involved the creation of tubes of lining tissues that shunted air from the trachea to the back of the throat allowing the person to speak.

This year all the works will be on exhibition in the gallery from the 22nd of October until the final event on the 1 November and will also be exhibited online .

Supporting artists who have already committed to contribute to this event are : Louis Jansen van Vuuren, Susan Grundlingh, Marié Stander, Ruan Huisamen, Clare Menck, Cathy Layzell, Strijdom van der Merwe, Lien Botha, Coral Fourie, Roelof Rossouw, Ian Hunter, Lize Beekman, Ann Marais, Lee Molenaar, Koos Bronkhorst, Willie Steyn, Marion Geiger, Anet Pienaar-Vosloo (photography/art), Jeanette Unit

It was interesting, but at my level of training, I was confused by the details and diagrams. I was years away from doing any type of surgery on my own. At some point during his talk, I probably checked my watch, wondering when the conference would be over.

Art lovers, collectors and enthusiasts we proudly invite you to a Sunday lunch in the company of artists and friends. A glamorous affair.

Then, the visiting surgeon flipped the controls and adjusted the volume on a 16-mm movie projector. The light flickered as the film moved past the bulb.

Sunday 1st November from 11:00 -15:00 Tickets (only 80) now available at R585 pp including Distell wines.

There, on the screen, was a man who had undergone a total removal of his voice box. The surgeon asked him a question and the patient responded by holding a vibrating device against his neck to create an artificial, machine-like sound that he shaped into words. He was understandable but his voice sounded synthetic.

All artworks on auction, directly from the artist.

For more information and to book your seat and ensure you are not disappointed, contact Liesl Moore admin@plwc.org.za or phone 021 5650039 during office hours. www.facebook.com/kunsvirkanker

The next scene was filmed after the same patient had undergone the voice restoring procedure. This time when he responded to the surgeon’s question, he brought his hand up to his neck and covered his stoma to redirect air from his lungs through the shunt and into his throat. He was able to talk! The sound was natural and fluent. I was enthralled by the patient’s outcome and can still remember his big smile at the end of the movie. The experienced physicians in the conference room asked questions about whether the procedure was practical or might cause more problems than it solved. I, on the other hand, thought that the procedure was amazing.

Look forward to seeing you there! that meeting steered me toward a career devoted to patients with head and neck cancer. I can trace my interest to that particular day.

I love my work even on the days I when I find my practice overwhelming. When someone outside of medicine scratches their head when I tell them what I do for a living, I explain how I felt when I heard that lecture many years ago. I describe the movie and the man’s huge grin. Over the years, I have seen more than a few of those grins on my own patients. It has, indeed, all been worthwhile.

I left the conference thinking, “I want to do something like that!”

Although the procedure described by the visiting surgeon never caught on (there are much simpler techniques widely used today),

7

VISION, MAY 2015

Dates to diarise

CONTACT DETAILS Cancer Buddies Johannesburg branch, and CanSurvive Cancer Support Groups - Parktown and Waterfall : 083 640 4949, cansurvive@icon.co.za

May 2015 23

CanSurvive Cancer Support Group, Netcare Waterfall City Hospital, Midrand, 09:00

28

Reach for Recovery, Cape Peninsula 10:00 Recurrence of Breast Cancer.

CanSurvive Head and Neck Support Group, Rivonia, Johannesburg.

Contact Kim Lucas 0828801218 or lct@global.co.za Cancer Buddies/People Living with Cancer, Cape Town: 076 775 6099, info@plwc.org.za, www.plwc.org.za

June 2015 4

CanSurvive Head and Neck Support Group, at Rehab Matters, 1 De la Rey Rd. Rivonia at 18h00

6

CHOC Ultimate Potjiekos Team Competition, Pirates Sports Club, Parkhurst. Contact Sophie Ndhlovu on 073 469 6289 or 011 486 1212 Entries close 1 June.

GVI Oncology /Cancer Buddies, Rondebosch Medical Centre Support Group. Contact: Linda Greeff 0825513310 linda.greeff@cancerbuddies.org.za GVI Cape Gate Support group: 10h00-12h00 in the Boardroom, Cape Gate Oncology Centre.| Contact: Caron Caron Majewski, 021 9443800

7

International Cancer Survivors Day

13

CanSurvive Cancer Support Group, Hazeldene Hall, Parktown 9:00

GVI Oncology Somerset West Group for advanced and metastatic cancers. Contact person: Nicolene Andrews 0218512255

23

CHOC Pamper day at Mowana Spa. Contact Sophie Ndhlovu on 073 469 6289 or 011 486 1212 CanSurvive Cancer Support Group, Netcare Waterfall City Hospital, Midrand, 09:00

Cancer.vive, Frieda Henning 082 335 49912, info@cancervive.co.za

27 27

Can-Sir, 021 761 6070, Ismail-Ian Fife, ismailianf@can-sir.org.za Support Group: 076 775 6099.

More Balls than Most: febe@pinkdrive.co.za, www.pinkdrive.co.za, 011 998 8022

Bosom Buddies, Hazeldene Hall, Parktown, 09:30 for 10h00

Prostate & Male Cancer Support Action Group, MediClinic Constantiaberg. Contact Can-Sir: 079 315 8627 or Linda Greeff 0825513310 linda.greeff@cancerbuddies.org.za

July 2015 2

CanSurvive Head and Neck Support Group, at Rehab Matters, 1 De la Rey Rd. Rivonia at 18h00

11

CanSurvive Cancer Support Group, Hazeldene Hall, Parktown 9:00

14

Reach for Recovery, Roodepoort Centre for the Aged, Robinson Street, Horizon14h00 Reach For Recovery, Johannesburg, 19 St John Road,

15

Wings of Hope Breast Cancer Support Group 011 432 8891, info@wingsofhope.co.za PinkDrive: febe@pinkdrive.co.za, www.pinkdrive.co.za, 011 998 8022 Bosom Buddies: 011 482 9492 or 0860 283 343, Netcare Rehab Hospital, Milpark. www.bosombuddies.org.za.

Houghton 13:30

18

Wings of Hope, German International School, Parktown, 09:30 for 10:00 - birthday.

21

Prostate & Male Cancer Support Group, Auditorium, Constantiaberg MediClinic, 18:00

25

CanSurvive Cancer Support Group, Netcare Waterfall City Hospital, Midrand, 09:00

30

Reach for Recovery, Cape Peninsula 10:00. Psychology and breast cancer

CHOC: Childhood Cancer Foundation SA; Head Office: 086 111 3500; headoffice@choc.org.za; www.choc.org.za CANSA National Office: Toll-free 0800 226622 CANSA Johannesburg Central: 011 648 0990, 19 St John Road, Houghton, www.cansa.org.za CANSA Pretoria: Contact Miemie du Plessis 012 361 4132 or 082 468 1521; Sr Ros Lorentz 012 329 3036 or 082 578 0578 Reach for Recovery (R4R) : Johannesburg Group, 011 487 2895.

August 2015

Reach for Recovery (R4R) : West Rand Group. Contact Sandra on 011 953 3188 or 078 848 7343.

1

Bosom Buddies, Hazeldene Hall, Parktown, 09:30 for 10h00

Reach for Recovery (R4R) Pretoria Group: 082 212 9933

6

CanSurvive Head and Neck Support Group, at Rehab Matters, 1 De la Rey Rd. Rivonia at 18h00

Reach for recovery, Cape Peninsula, 021 689 5347 or 0833061941 CANSA ofďŹ ces at 37A Main Road, MOWBRAY starting at 10:00

8

CanSurvive Cancer Support Group, Hazeldene Hall, Parktown 9:00 Prostate & Male Cancer Support Group, Auditorium, Constantiaberg MediClinic, 18:00

Reach for Recovery: Durban, Marika Wade, 072 248 0008, swade@telkomsa.net

18 22

CanSurvive Cancer Support Group, Netcare Waterfall City Hospital, Midrand, 09:00

27

Reach for Recovery, Cape Peninsula 10:00. Does deodorant cause breast cancer?

Reach for Recovery: Harare, Zimbabwe contact 707659.

Breast Best Friend Zimbabwe, e-mail bbfzim@gmailcom Cancer Centre - Harare: 60 Livingstone Avenue, Harare Tel: 707673 / 705522 / 707444 Fax: 732676 E-mail: cancer@mweb.co.zw www.cancerhre.co.zw

8

VISION, MAY 2015 drome, PTSD, obesity and weight loss associated with cancer.

News in brief

There’s a litany of potential applications for cannabinoids as therapeutics – epilepsy, pain management and cancer-associated weight loss being the most accepted. The underlying idea of Kalytera is to modify cannabinoids, or the molecules that regulate the endocannabinoid system, to get rid of the psychoactive properties of the drugs.

ASCO cancer treatment and survivorship Care Plans

That way, the therapeutic’s focus is primarily on the condition itself.

Kalytera’s candidates are still preclinical for osteoporosis, PraderWilli and obesity, but it’s nearing phase 2 trials for cancer-associated weight loss.

ASCO has developed two types of forms to help people diagnosed with cancer keep track of the treatment they received and medical care they may need in the future: a Cancer Treatment Plan and a Survivorship Care Plan.

The startup’s chaired by Israeli organic chemist Raphael Mechoulam, who is credited by some as the “Grandfather of Marijuana.” He was, after all, the first scientist to isolate THC as a compound back in the 1960s – back when the NIH was saying that “marijuana is not an American problem,” Vocativ writes in a profile on the scientist.

The ASCO Cancer Treatment Plan is a form that provides a convenient way to store information about your cancer, cancer treatment, and follow-up care. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime.

Muscle-building supplements linked to testicular cancer

Using the treatment plan, your current oncologist can enter the chemotherapy dose you received, the specific drugs that were used, the number of treatment cycles that were completed, surgeries done, and any additional treatment that was given, such as radiation therapy or hormonal therapy.

Men who use muscle-building supplements (MBSs) that contain creatine or androstenedione may have up to 65% increased risk of developing testicular cancer, according to a case-control study published online in March in the British Journal of Cancer.

ASCO also offers a form called a Survivorship Care Plan. It contains important information about the given treatment, the need for future check-ups and cancer tests, the potential long-term late effects of the treatment you received, and ideas for improving your health.

This risk increased even more among men who began using MBSs before age 25, who used various kinds of MBSs, or who used them for a long duration.

These forms are not intended to provide a complete medical record.

And, no single treatment or survivorship care plan is appropriate for all patients due to the complexity of cancer care. Talk with your doctor for more information about your individual treatment and follow-up care. The ASCO Cancer Treatment Plan and Survivorship Care Plan should be used with the guidance of your doctor.

The study is the first to look at the epidemiologic associations between MBSs and testicular cancer, the researchers note.

Patients and other consumers may use ASCO’s Treatment and Survivorship Care Plan templates without seeking permission from ASCO. They can be downloaded from http://www.cancer.net/survivorship/follow-care-after-cancer-treatment/asco-cancer-treatment-and-survivorship-care-plans

"Although no population survey data exist to suggest just what percentage of young people use MBSs, we do know that the MBS business rakes in billions of dollars," Dr Zheng commented in an interview.

Young people, in particular, use MBSs, and the number of users is increasing, according to senior author Tong Zhang Zheng, MB, ScD, who led the study at Yale University before joining the Brown University School of Public Health as a professor of epidemiology.

An international consortium is working to build an understanding about the unclear etiology of testicular cancer.

Refining cannabinoids for therapeutic use

Brachytherapy improves survival for inoperable early stage endometrial cancer

Los Angeles startup Kalytera Therapeutics is taking the high out of the THC – refining cannabinoids so they can have broader therapeutic applications in conditions like osteoporosis, Prader-Willi syn-

Women who have early stage endometrial cancer and are inoperable tend to live longer if they have been treated with brachytherapy with or without external beam radiation, according to new research presented at the 3rd ESTRO Forum in Barcelona, Spain.

Tollfree service for cancer patients

Brachytherapy is a type of internal radiotherapy that involves putting a radioactive source close to, or in the tumour. Although it has been used historically to treat inoperable endometrial cancer, there are no guidelines based on randomised evidence to support this approach. Dr Sahaja Acharya told the conference: "To our knowledge, this is the first population-based study to compare outcomes for patients who received brachytherapy, with or without external beam radiation, to those who did not receive brachytherapy and were treated with external beam radiation alone."

PLWC Cancer Buddies now has a tollfree number - it is

0800 033 337 All cancer patients now have access to free cancer support and can ask any questions about cancer and treatment of cancer; the emotional issues related to the cancer journey; questions about side effects of treatment; assistance with accessing resources like wigs, prosthesis, home nursing and hospice. Problems relating to access to treatment or services delivery issues can also be reported .

Dr Acharya, a resident physician in the Radiation Oncology Department of Washington University in Saint Louis, USA, and her

9

VISION, MAY 2015 colleagues analysed data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) for 460 women in the USA who had been treated with radiation therapy between 1998 and 2011 for inoperable stage 1 endometrial cancer.

Don't die from embarrassment An article on www.healthworkscollective.com tells how, in his memoir On Writing, Stephen King writes of his mother's 1971 trip to Minnesota for her sister's funeral. On the plane, she begins to bleed. She's long since entered menopause, but she simply tells herself that she's having one last period. She acquires a tampon and mentions nothing.

Usually, early stage endometrial cancer can be removed surgically and has a good prognosis. However, sometimes it is inoperable and this can be for a number of reasons, including if the patient has a number of other medical problems that would make an operation risky or if they are very overweight or obese. In these cases radiotherapy is the only remaining treatment option and the average survival time is around three years.

The researchers found that brachytherapy was associated with a better overall survival: death from any cause was 13% lower, with 60% of women who had been treated with brachytherapy alive three years after treatment compared to 47% of women who had been treated with external beam radiation alone. They then matched women who received brachytherapy to those who did not receive brachytherapy based on age, grade and year of diagnosis.

After adjusting for these factors, they found that the survival benefit persisted in favour of those who received brachytherapy. http://www.medicalnewstoday.com/releases/293057.php?tw

Pepsi removes controversial sweetener from Diet Pepsi After sales of Diet Pepsi fell by more than five percent last year, PepsiCo is removing the controversial artificial sweetener aspartame from their product and replacing it with sucralose.

Sucralose is a popular artificial sweetener, usually sold under the brand name Splenda. It's not poisonous; it doesn't cause cancer, and it isn't a pesticide. Sucralose does not break down in the body, and it doesn't release chlorine into your system.

It's manufactured from sugar, but it's approximately 600 times sweeter than sugar, so very little is needed. Most sucralose passes through your digestive system without being absorbed. The small amount that's absorbed leaves the body through the urine. http://www.nbcnews.com/nightly-news/video/diet-pepsi-to-ditchaspartame-for-splenda-434078275857

It isn't until two years later that her doctor finally catches a very advanced case of uterine cancer. It will kill her within a year. King observes that his mother Ruth, a religious and old-fashioned woman, actually died of embarrassment. improvement in their prostatitis.

Source: Dentistry, 2015; 05(03); doi: 10.45172/2161-1122.1000284

Honey: Such a good wound-healer that surgeons are urged to use it Surgeons are being urged to apply honey to the patient’s wounds after surgery. A new study suggests that it is one of the most effective methods for fast wound-healing, and may be every bit as good as antibiotics.

Wounds that are treated with honey regularly – either hourly or daily, depending on the severity of the wound – usually become sterile within three to 10 days. It’s especially effective for treating wounds that become infected or fail to close or heal. Researchers at the North West Wales NHS Trust in Bangor say it can also help heal wounds left by laparoscopic, or ‘keyhole’, surgery to remove cancers.

Honey came out top of a review of 18 studies that looked at different wound-healing therapies, including maggots. Some of the papers were prepared more than 60 years ago, around the time when research into honey stopped with the introduction of antibiotics.

Lead researcher Dr Fasal Rauf Khan commented: “It can be used to sterilise infected wounds, speed up healing and impede tumours, particularly in keyhole surgery.”

Source: International Journal of Clinical Practice, 2007; 61: 1705-7

Reverse prostate problems by treating gum disease

Early cancer detection: "Physicians and patients need a good database"

Treating gum disease can reduce inflammation in the body, and it could be a way of reversing arthritis and heart disease. And a new study demonstrates that it’s an effective way to treat prostate inflammation, or prostatitis.

Whether it is a mammogram, colonoscopy or a skin cancer screening – after a certain age, we are subject to various early cancer detection screenings. Yet many of us don’t know that these screening tests are also associated with risks. This is something that Dr. Sylvia Sänger from the University Medical Centre Hamburg-Eppendorf discovered in a study.

With prostatitis, the prostate gland becomes inflamed, and urination can be difficult or painful. It can heal in time, but drugs such as antibiotics, painkillers and anti-inflammatories are commonly prescribed to help treat it.

But researchers from Case Western Reserve University have successfully treated the problem by reducing gum disease and inflammation.

In a study of 27 men with prostatitis, all had moderate to severe gum disease. During the eight-week study period, they were treated for gum disease, but not for their prostatitis, and yet 21 of the 27 men had lower levels of PSA (an inflammation marker of the prostate gland) afterwards. Those with the highest levels of inflammation benefited the most, and their symptoms improved or disappeared altogether. Just six of the men said there had been no

In an interview with MEDICA.de, Dr. Sänger talks about the reasons for this lack of knowledge, further study results and the point of different early detection methods.

She says: "Every physician is obligated to educate his patients on examination or treatment methods – this also applies to early detection. He should introduce all options to the patient and explain their benefits and risks. Only then is it possible to ponder the purpose of a screening test for the respective patient together. This approach however, is still not practiced by all physicians.

"Many people trust their doctor and rely on his/her recommendation.

If the physician therefore recommends a screening test, the patient

10

VISION, MAY 2015 usually undergoes the exam – 84 percent of study participants confirmed this.

Wings of Hope pampering patients

"It is good and important for the physician to be the first contact in this type of situation. Yet both physicians and patients need a good database to decide together which exam makes sense on an individual basis. People are also required to change their way of thinking in this case. As a patient, I cannot just hand off my responsibility in the waiting room like a coat and expect the doctor to tell me what I should do. This is not how joint decision-making works.

"Cancer screening makes sense especially when there is personal risk.

If my mother has been diagnosed with breast cancer for instance, I would definitely want to get a mammogram and take advantage of this exam. However, the physician should still educate me on the risk factors. Early cancer detection tests make sense on an individual basis. Whether they make sense for the general population however, is something we as a society need to determine on a regular basis."

Wings of Hope were invited to assist at the Olivedale Hospital's oncology centre on the 4 May with the chemo pamper day.

The full text of the interview can be found at: http://tinyurl.com/lcxjsff

Patients were made comfortable and treated with presents and snacks. The Wings, represented by Jenny Aspinal and Christel Klima, explained about cancer support and actively provided support to the chemotherapy patients.This service was highly appreciated by both, staff and patients.

Organic nanoparticles, more lethal to tumors Radiotherapy used in cancer treatment is a promising treatment method, albeit rather indiscriminate. Indeed, it affects neighbouring healthy tissues and tumours alike. Researchers have thus been exploring the possibilities of using various radio-sensitizers; these nanoscale entities focus the destructive effects of radiotherapy more specifically on tumour cells. In a study published in EPJ D, physicists have now shown that the production of low-energy electrons by radio-sensitizers made of carbon nanostructures hinges on a key physical mechanism referred to as plasmons - collective excitations of so-called valence electrons; a phenomenon already documented in rare metal sensitizers. This reseach was conducted by Alexey Verkhovtsev, affiliated with the MBN Research Center in Frankfurt, Germany and A.F. Ioffe Physical-Technical Institute in St Petersburg, Russia and an international team.

Nanoparticle radio-sensitizers are nanoscale compounds, typically composed of rare metals such as coated gold, platinum, or gadolinium. Alternatives sensitizers could be made of carbon-based nanostructures, such as fullerenes or nanotubes, provided they are biocompatible and non-toxic. Previous studies have revealed that gold and platinum nanoparticles produce a large number of electrons via the plasmon excitation mechanism. In the case of a carbon nanoparticle, this phenomenon yields electrons with higher energy than pure metals, thus inducing greater biological damage. http://www.medicalnewstoday.com/releases/294119.php?tw

Revealing kidney cancer's secret An international team of scientists, led by UC Davis nephrologist Robert Weiss, have used a sophisticated combination of proteomics and metabolomics to show how renal cell carcinoma (RCC) repro-

DISCLAIMER: This newsletter is for information purposes only and is not intended to replace the advice of a medical professional. Items contained in Vision may have been obtained from various news sources and been edited for use here. Where possible a point of contact is provided. Readers should conduct their own research into any person, company, product or service. Please consult your doctor for personal medical advice before taking any action that may impact on your health. The information and opinions expressed in this publication are not recommendations and the views expressed are not necessarily those of People Living With Cancer, Cancer Buddies, CanSurvive or those of the Editor.

grams its metabolism and evades the immune system. In addition, the study found that cancer grade has a major impact on this reprogramming. These results, published in the journal Cancer Research, point to new therapeutic options for this particularly deadly cancer.

"The mortality for someone with highly metastatic RCC is somewhere in the 90 percent range," said Weiss, professor of nephrology and internal medicine at UC Davis and chief of nephrology at the VA Northern California Health System in Sacramento. "We now know this cancer is actually reprogramming its environment to minimise the immune response." http://www.medicalnewstoday.com/releases/293996.php?tw

Moderate exercise may make cancer treatments more effective Kansas State University kinesiology research offers encouraging information for cancer patients: A brisk walk or a slow jog on a regular basis may be the key to improved cancer treatments.

Brad Behnke, associate professor of exercise physiology, and collaborators have shown that moderate exercise on a regular basis enhances tumour oxygenation, which may improve treatments in cancer patients. Now Behnke is using an American Cancer Society grant to study moderate exercise as a way to make radiation treatments more effective, especially for difficult-to-treat tumours.

"If we can increase the efficacy of radiation treatment, then the patient's prognosis is enhanced," Behnke said. "An intervention like exercise has almost universally positive side effects versus other treatments that can have deleterious side effects. Exercise is a type of therapy that benefits multiple systems in the body, and may permanently alter the environment within the tumour."

The National Cancer Institute at the National Institutes of Health recommends exercise for cancer patients and cancer survivors, but little research shows what happens within the tumours during such exercise. Behnke and collaborators have published their exercise and cancer research in the Journal of the National Cancer Institute.

11