Network Fall 2013

The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center

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Fall ’13

Catching a silent killer: Low-dose spiral CTs may find lung cancer earlier

By Mary Brolley

Lung cancer strikes fear into people’s hearts.

Although rates of tobacco use — the major cause of the disease — have plummeted since the 1970s, lung cancer is still the leading cause of cancer-related deaths for men and women in the United States and worldwide.

The American Cancer Society estimates that in 2013, 26% of cancer deaths in women and 28% of those in men will be due to lung cancer.

The disease takes a long time to develop, and it’s often detected in later stages, when it’s more difficult to treat.

But thanks to research conducted partly at MD Anderson, there’s now an effective screening method to catch lung cancer at an earlier stage.

“We knew that chest X-rays didn’t identify early stage lung cancer,” says Therese Bevers, M.D., professor in Clinical Cancer Prevention. “We needed another option.”

Luckily, evidence — some of it gathered at MD Anderson — was growing that low-dose spiral CT scans might be the answer.

Spiral CT scans effective with less radiation In the early 2000s, MD Anderson researchers began contributing data to the National Lung Screening Trial.

Involving more than 53,000 current and former heavy smokers aged 55 to 74, the trial compared the effects of two screening procedures for lung cancer — low-dose helical (or spiral) computed tomography (CT) and standard chest X-ray — on lung cancer mortality.

It found 20% fewer lung cancer deaths among participants screened with low-dose spiral CT. And due to increased detection of other dangerous conditions, the scans lowered death from all causes by more than 6%.

Because of these findings, the U.S. Preventive Task Force has issued a draft recommendation for the low-dose CT screenings for those who:

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Are 55 to 74 years old Have a 30-pack-year history of smoking (one pack a day for 30 years, two packs a day for 15 years, etc.)

• Smoke now or have quit within the last 15 years continued on page 2

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On the cusp of a breakthrough Could these tests someday be as routine as colonoscopies, Pap tests and mammograms?

Bevers thinks so. She remembers when MD Anderson patients and researchers were part of the massive lung screening trial. Its findings will be far-reaching, she says.

“These low-dose CT scans pick up not just smaller cancers, but other conditions that have effects on mortality, such as aortic aneurysms,” she says.

Anissa Lewis, program coordinator in Diagnostic Imaging, says MD Anderson does about 200 of the low-dose CT scans a year, but she expects those numbers to rise with increased screening requirements mandated by the Affordable Care Act. “There are other reasons people develop lung cancer — secondhand smoke, air quality, occupational hazards. But we’re starting with screening heavy smokers,” she says.

“Early detection is brand spanking new,” Lewis says. “Catching these lesions at stage 1 or 2 is remarkable.

Phenomenal.”

Though just two insurance companies currently cover the $250 procedure, the task force’s recommendation may convince more of them to do so. A soon-to-be-released cost benefit analysis will likely bolster wider acceptance and spur a willingness to pay for the scan.

Meanwhile, for current smokers or recent quitters (those who stopped smoking in the past year) who are screened, MD Anderson’s Tobacco Treatment Program has options to help them quit.

Still smoking? Get help to quit Maher Karam-Hage, M.D., associate professor in Behavioral Science, treats patients who come to the Cancer Prevention Center for the screening, then seek help to quit smoking.

“Ask smokers whether they want to quit, and 70% say yes,” he says. “Forty percent of them have tried at least once in the past year, but only 5% manage to quit on their own.”

“We can increase the quit rate greatly. With counseling and medications, 40%-50% of our patients quit and are still off cigarettes at 6 and 9 month follow-ups.”

To help smokers, MD Anderson offers smoking cessation programs for patients, employees and even the general public.

“We counsel smokers and help them quit,” Karam-Hage says. “We say, ‘It isn’t just about cancer. All smokers damage their lungs, their breathing, their cardiovascular health.’”

“Two-thirds of smokers will develop a disease. That’s a given,” he adds.

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“We offer them ways to quit.”

Want to quit smoking? Call the Tobacco Treatment Program at 713-792-7848 if you’re a patient or MD Anderson employee. Others may call 713-792-2265 to find out about participating in free clinical research studies.

people profile Austin singer: ‘Cancer’s made

me a better person’

By Mary Brolley

If cancer treatment is a journey, Christine Butterfield’s began with a wild ride.

Christine Butterfield with bandmate Michael Stevens

She was determined to focus on the positive.

“I concentrated on framing my chemo and radiation treatments as therapeutic,” she says.

First there was the headache from hell.

“It wouldn’t quit. And then I started vomiting,” Butterfield recalls. “I wanted to cut my head off.”

This was New Year’s Eve of 2007, when Butterfield, then 32, was on vacation with her family in Breckenridge, Colo.

The splitting headache and nausea forced a trip to the nearest emergency room, but it didn’t have the necessary imaging equipment. She was advised to go to another hospital.

Winter storms had closed roads and grounded the medical helicopter, so she endured a harrowing ambulance ride. When she arrived, a CT scan showed a large mass on her right frontal lobe. The doctor advised her to see a neurologist in Denver.

Life after surgery, treatment For the most part, Butterfield has resumed her busy life.

She takes a daily dose of Accutane, and experiences a few side effects, such as dry skin and fatigue.

She’s also returned to her singing career, performing in Austin and beyond.

She wowed 500 guests at the Cancer Survivorship Conference in September, performing classics “I’ve Got Nothin’ but the Blues,” “As Time Goes By” and “Fly Me to The Moon.”

Her disarming sense of humor is always in evidence, even when reflecting on her cancer journey.

“The doctor in Denver said it looked like cancer, but that I needed a biopsy to find out,” Butterfield says. “He recommended I find a place where I had support. My family lives in Houston, and MD Anderson was the first hospital I thought of.”

“I used to dress up for all my appointments at MD Anderson,” she says. “I wanted them to try extra hard on me.”

A few days later, she and her husband Matt met Ganesh Rao, M.D., associate professor in Neurosurgery. Rao advised surgery to remove Butterfields’ tumor — an anaplastic astrocytoma — as soon as possible.

“Having cancer has been a struggle and a challenge. I told myself, ‘I’ll learn from this. I’ll allow it to make me a better person.’”

The couple drove home to Austin to prepare.

Their family and friends mobilized. Butterfield’s book club called an emergency meeting. No book was discussed, but concern and camaraderie were plentiful.

One friend gave each of the members a long-burning candle to light during Butterfield’s upcoming surgery.

“It was a tidal wave — an outpouring — of love and support, ” she says.

After the successful 11-hour surgery, Butterfield went through radiation and many rounds of chemotherapy.

Thinking of her then-toddler daughter Dylan kept her going during the difficult early days, Butterfield says.

“I’ve gotten a bit more relaxed.”

In the six years since her diagnosis, she’s gotten used to friends and acquaintances who don’t know what to say about the fact that she’s living with brain cancer.

“Here’s how I’m sometimes introduced at parties: ‘This is Christy… she’s superwoman’… then they whisper, ‘brain cancer,’” she laughs.

“It doesn’t bother me. If you’ve got the cancer card, you might as well use it.”

“Just live each day, enjoy each day.”

Christine Butterfield is a member of the Anderson Network patient matching program.

To join, call 713-792-2553 or 800-345-6324.

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doctor, doctor Focus on: Men and cancer risk One in two men will be diagnosed with cancer during his lifetime. And one in six will be diagnosed with prostate cancer, the second leading cause of cancer-related deaths in American men.

If you’re at average risk for colon cancer, you’ll need a colonoscopy every 10 years after that. If you have a family or personal history, you should get a colonoscopy at age 40.

We asked John Papadopoulos, M.D., about men’s cancer risks. An assistant professor of Urology, Papadopoulos works at the MD Anderson Regional Care Center in Katy. This article originally appeared in MD Anderson’s Cancerwise blog.

Most men should be screened for prostate cancer every year starting at age 50. If you’re African American or have a family history (brother, son, father) of prostate cancer, talk to your doctor about getting a digital rectal exam and PSA test to screen for prostate cancer every year starting at age 45.

Are there steps men can take to help avoid getting cancer?

Also, men ages 20 and older should practice testicular and skin awareness. Become familiar with your skin and testicles and report any changes to your doctor right away.

Yes. Here are some ways they can protect themselves:

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Avoid tobacco — even celebratory cigars — and limit alcohol to no more than two drinks per day.

How does a family history of cancer affect a man’s chances of developing cancer?

• Maintain a healthy weight and stay physically active each day.

For men, colon, prostate and pancreatic cancers can run in the family. Though it’s rare, male breast cancer can also run in the family.

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Maintain a healthy diet. Make fruits and vegetables the biggest part of every meal and go easy on the meat. Limit the amount of red meat you eat to 18 oz. a week and avoid processed meats like hot dogs and pepperoni.

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Wear sunscreen and practice sun safety.

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See a doctor regularly and get the screening exams you need. If you do have a chronic disease like cancer, diabetes or heart disease, the earlier we catch it, the easier it will be to treat.

Though doing these things might not ensure you won’t get cancer, a healthy lifestyle puts you in fighting shape if you do.

What cancer screening exams do men need?

And when should most men start screening?

Most men need both a prostate exam (digital rectal exam and PSA test) and a colonoscopy starting at age 50. This is the appropriate age for screening if you don’t have a family history (father, son, brother) of prostate or colon cancer and you’re not African American, which can make you more likely to develop these cancers.

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John Papadopoulos, M.D.

You’re at greater risk for an inherited cancer if one or more close blood relatives were diagnosed before age 50 or if they’ve had two or more different cancers. You’re also at increased risk if close blood relatives had the same type of cancer, a rare cancer or a BRCA mutation.

Why are some groups advising men not to get PSA testing?

Not all prostate cancer is deadly. Research has shown that widespread PSA screening for prostate cancer may lead to detection of non-lethal forms of the disease, which can cause worry and lead to aggressive and unnecessary treatment.

Before getting PSA testing, men should talk to their doctors about the risks and benefits. And if screening shows you have prostate cancer, talk to your doctor about whether it’s appropriate to treat it. Only aggressive forms of prostate cancer should be treated.

Keep up with the latest cancer news — and patient perspectives — at www.cancerwise.org.

research briefs Improving sun protection practices for children of melanoma survivors Children of melanoma survivors are more likely to wear hats and reapply sunscreen after receiving a specialized multimedia informational program. The findings were published in the journal of Cancer Epidemiology, Biomarkers and Prevention, a publication of the American Association for Cancer Research.

Led by MD Anderson behavioral science researchers Ellen Gritz, Ph.D., and Mary Tripp, Ph.D., the randomized trial tested whether a sun protection program for melanoma survivors and their children was more effective than standard educational materials available to the general public.

In the United States, more than 76,000 new cases of melanoma, the deadliest form of skin cancer, will be diagnosed this year. “Similar to tobacco education, sun protection education is also critical, especially in the early stages of life, ” Tripp says.

Because of inherited and behavioral factors, children of melanoma survivors have nearly double the risk of developing the disease.

Melanoma survivors completed telephone interviews at baseline and at one month and four months after intervention.

Overall, the intervention increased sunscreen reapplication and the use of wide-brimmed hats in the children. The greatest effect on sunscreen behavior was in survivors who had children younger than 8 years old.

Noting that few interventions directed to parents have increased children’s protective hat-wearing behavior, Tripp called the study “a valuable starting point for future research.”

Once bevacizumab was approved for recurrent glioblastoma, some physicians began giving it as frontline therapy. But there was no data to support this use.

“From a patient care and regulatory standpoint, we felt it was important to conduct the trial,” Gilbert says.

Results showed that the drug failed to increase overall survival — or statistically significant progression-free survival — in newly diagnosed patients.

However, Gilbert stresses that the study still found the drug had some use in managing the disease.

Bevacizumab fails newly diagnosed glioblastoma patients

“Bevacizumab has the same benefit whether given early or late, and, because of the risk of extra toxicity upfront, its use can be reserved as a later treatment for most patients,” he says.

Mark Gilbert, M.D., professor in Neuro-Oncology, led the first Phase III, randomized, double-blind study on the use of bevacizumab (Avastin) in glioblastoma.

To learn more about MD Anderson research, visit www.mdanderson.org/newsroom or the Cancer Frontline blog at www2.mdanderson. org/cancerfrontline.

The trial’s findings were highlighted at the 2013 annual meeting of the American Society of Clinical Oncologists.

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Anxious? Depressed? You’re not alone. Psychiatrist advises cancer

patients, caregivers to seek help

By Mary Brolley

After the shock of a cancer diagnosis and while weathering treatment, most patients focus solely on beating the disease and returning to health.

But emotional health must be considered, too.

Beyond the stress of treatment, there may be financial or family pressures and a sense of loss of control. It’s no wonder that many cancer patients experience anxiety and depression.

“Clinicians treating cancer patients expect them to have some level of emotional distress,” says Seema Thekdi, M.D., assistant professor in Psychiatry. “It’s completely normal.”

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Fortunately, a combination of lifestyle changes, psychotherapy and medication may help patients manage anxiety and depression, she says.

Emotional distress may involve:

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sadness and feelings of loss,

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worry and fear,

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insomnia and fatigue,

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body image and self-esteem issues,

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relationship stress,

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appetite issues,

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changes in sexual functioning, or

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substance use or abuse.

Depression may also involve feelings of sadness or loss of pleasure in activities formerly enjoyed, emptiness, tearfulness, irritability, hopelessness or anger.

they don’t want to take antidepressant or antianxiety medications.

If these feelings last longer than two weeks, it may signal major depression, Thekdi says. If patients self-medicate with alcohol or drugs to deal with anxiety or depression, that’s also a warning sign.

“When patients come into our center, I reassure them that they don’t have to take medications to control these symptoms.”

Cancer patients at increased risk for anxiety or depression may have a history of depression; an advanced stage or difficult prognosis; loss of function or disfigurement caused by the disease; or persistent cancer-related symptoms.

Emotional consequences of cancer Physician and pain-care specialist Russell Portenoy, M.D., found in a 1994 study that during treatment, an overwhelming percentage of cancer patients experienced lack of energy, worrying, feelings of sadness, and pain.

After treatment, there’s still a lot to worry about. Patients may wonder: Will I recover? Will my cancer recur? What does my future look like?

Because these concerns often surface or intensify after treatment, the Psychiatry Service at MD Anderson sees patients for a full year after treatment ends. Composed of psychiatrists and psychiatric advanced practice nurses, the service helps patients deal with the emotional consequences of cancer.

“There are lifestyle changes that may help just as much — getting more exercise, meditating or doing yoga, for example.”

Seema Thekdi, M.D. And there’s psychotherapy, which involves individual counseling with a mental health professional who might be a psychiatrist, psychologist, social work counselor or marriage and family therapist.

“Asking for help with anxiety and depression is not a sign of weakness. It’s a sign of strength,” Thekdi says. “It’s an important part of total care.”

“Many can’t process the experience emotionally during treatment. And afterward, there may be less reassurance — due to decreased contact with their care team, for example — that they’re going to be okay,” says Thekdi.

Patients usually find her department’s services in one of three ways, she says. Some patients ask to speak to a therapist or counselor. Or a member of the care team, noting that a patient is especially depressed or anxious, will refer the patient to Psychiatry.

And sometimes, when taking a patient’s history, a clinician will notice that he or she already takes an antidepressant or antianxiety medication. This may make it more likely that he or she will be referred for psychiatric follow up.

Lifestyle changes, counseling can help Thekdi says patients should seek help for their anxiety and depression if symptoms interfere with their ability to function.

Some, she says, don’t reach out with these concerns because

Alone or together with any of the other options, there are a variety of medications to treat anxiety and depression.

What’s important, Thekdi says, is for those in distress to seek help.

That goes for spouses and caregivers of cancer patients, too. Research has shown that they, too, are at increased risk for depression and anxiety after their loved one’s cancer treatment, compared to the general population.

Thekdi emphasizes that because cancer survivors are living longer, treating their emotional distress is critical.

“Emotional health is so important,” she says. “I have a very low threshold for thinking counseling or other interventions might help.”

“Asking for help is not a sign of weakness. It’s a sign of strength,” she adds. “It’s an important part of total care.”

“Share these concerns with your doctor or medical team.

Don’t wait to be asked about it.”

For more resources on dealing with anxiety and depression during cancer treatment, call askMDAnderson at 1-877-632-6789.

MD Anderson patients may request a referral to the Psychiatry Service from their primary oncology team.

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network The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center.

Address changes should be sent to: Mary Brolley The University of Texas MD Anderson Cancer Center 1400 Pressler St. - Unit 1486 Houston, TX 77030-3722 Phone: 713-792-0658 Fax: 713-745-1875 Email: mbrolley@mdanderson.org Articles and photos may be reprinted with permission.

Susan French, Executive Director, Volunteer Services Debbie Schultz, Assistant Director, Volunteer Services/ Anderson Network Frank McCreary, Chair, Anderson Network Mary Brolley, Writer/Editor, Network Gini Reed, Graphic Design © 2013 The University of Texas MD Anderson Cancer Center

Anderson Network’s One-on-One Support/ Matching program needs your help Would you consider providing one-on-one support for a patient or caregiver with the same or similar diagnosis, treatment or experience?

If so, call the Anderson Network at 713-792-2553 or 800-345-6324, and learn how to become a member of our one-on-one patient matching program.

Especially needed are those who have experienced:

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Small cell lung cancer

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Cholangiocarcinoma

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Advanced lung cancer

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Ovarian cancer

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Head and neck cancers

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Cancer of unknown primary

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Liver cancer

We’re also looking for those who speak languages other than English, especially Spanish.

Your story and willingness to listen could make the difference in another person’s ability to cope with their diagnosis and treatment. The Anderson Network motto is: “Sometimes the best help comes from someone who’s been there.”

www.mdanderson.org/andersonnetwork 8