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Summer ’13
No bones about it: Stay aware of risks to your bones from targeted treatments By Mary Brolley
Remarkable improvements in cancer treatments have allowed patients — even those with metastatic disease — to live longer. New targeted therapies like aromatase inhibitors and androgen deprivation agents are highly effective. Often used as adjuvant measures (to prevent recurrence), they’ve improved outcomes for breast and prostate cancer patients and generally have few side effects. But one of those side effects worries Beatrice Edwards, M.D., associate professor in General Internal Medicine. One of MD Anderson’s two geriatricians, Edwards specializes in the care of patients in active treatment who are 65 and older. An expert in bone health, Edwards says targeted therapies like tamoxifen, aromatase inhibitors and androgen deprivation increase patients’ risk of developing osteoporosis. This condition makes people more susceptible to serious fractures of the hip, spine and axial areas (wrist, ankle, etc.).
A troubling trend Edwards first noticed the problem when she was working at the Bone Health Center and the Lurie Comprehensive Cancer Center at Northwestern Memorial Hospital in Chicago. She saw a small group of women in their 50s who had suffered bone fractures (hip or vertebral fractures) after breast cancer treatment. She knew that most fractures of this type happen much later in a person’s life.
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Each of the women had been treated with chemotherapy and some with aromatase inhibitors, which work by blocking estrogen production.
To help protect your bones • Eat more protein and calcium-rich foods. • Ask your physician to check you for vitamin deficiencies.
In a 2011 paper in Clinical Cancer Research, Edwards and her colleagues detailed their findings about the serious adverse drug reactions caused by aromatase inhibitors. Her recent work, to be presented at the ASCO Breast Cancer Symposium in September 2013, reveals that women with breast cancer may suffer fractures at relatively “normal” bone mineral densities.
• Aim for 30 minutes of exercise a day. Include both weight-bearing and balance-improving (such as yoga or tai chi) exercises.
Beatrice Edwards, M.D.
Further research is needed to assess new imaging technologies that may identify those women at highest risk of fractures, she says.
The costs of osteoporosis The National Institutes of Health defines osteoporosis as “a systematic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk.” Osteoporotic fractures are far more common than heart attacks, breast cancer and strokes. And fractures — especially hip fractures — are a major cause of disability. One year after a hip fracture, 80% of patients cannot carry out at least one independent activity of daily living, like meal preparation, heavy housekeeping, climbing stairs, shopping, etc. Hip fractures are a major cause of nursing home admissions, and the mortality rate one year after the fracture is 20% to 30%.
So, though they’re quite effective, special care and monitoring are crucial when these targeted therapies are chosen as part of a treatment plan.
How to protect your bones Though many factors that influence a person’s risk for developing osteoporosis can’t be changed — heredity, gender, age and menopausal status, for example — diet and exercise interventions may reduce this risk from 15% to 30%. Edwards advises her patients to get checked for nutritional and vitamin deficiencies that may worsen the bone loss. And medications like isphosphonates and denosumab slow or stop the natural process of bone loss. Denosumab (Prolia®) has recently been approved for prevention of cancer treatment-induced bone loss, and bisphosphonates such as zoledronic acid (Reclast®), alendronate (Fosamax®) or risedronate (Actonel®) are also effective.
Exercise also plays a crucial role, Edwards says.
She encourages her patients to exercise daily, making sure to include both weight-bearing and balance-improving elements to their routine.
Why some targeted therapies can harm bones
The bottom line is that, as we age, bone health can make the difference between independence and disability.
Agents like aromatase inhibitors, tamoxifen and androgen deprivation shrink or kill tumors by blocking production of estrogen. But circulating estrogen is crucial to bone health.
And those who’ve faced cancer need to be especially vigilant.
So, added to the bone loss that occurs naturally with age, these therapies may damage patients’ bone mineral density. And because some types of chemotherapy induce premature menopause, women may face these problems at much younger ages than their peers.
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• Stop smoking and limit alcohol consumption.
“The changes to your bones that occur with aging don’t begin when you’re 70, they begin at 50,” Edwards says. “And cancer ages you before your time.” She believes that more research is needed to develop tools to measure patients’ bone health before they begin cancer treatment, so they can receive guidance about the best ways to protect their bones.
people profile ‘Poetic license’ helps recovery from head and neck cancer By Mary Brolley
All things considered, Susan Singer Kerschner is fortunate. Though she never thought she’d develop squamous cell carcinoma in her tonsil and endure weeks of grueling treatment followed by months of difficult recovery, she was able to weather the experience thanks to some extraordinary gifts. One was the support of family members in Houston who encouraged her to travel from Pennsylvania and stay with them while she was treated at MD Anderson. They drove her to appointment after appointment, handled her medications, bought special food she could swallow and offered endless comfort and encouragement. Susan also has a natural resilience, buoyed by a strong sense of humor. And there is her way with words. A poet, Kerschner used the literary form to express her feelings as she navigated the tricky path from sickness to health. Diagnosed in March 2010, Susan had her first surgery near her home in Reading, Pa. She came to MD Anderson in May of that year and underwent weeks of radiation, then another surgery.
All told, she spent six months in Houston.
For her recovery, she credits her supportive family and her “brilliant doctors,” Randal Weber, M.D., chair of Head and Neck Surgery, David Rosenthal, M.D., professor in Radiation Oncology, and Rony Dev, O.D., assistant professor in Palliative Care and Rehabilitation Medicine, as well as their dedicated support teams.
Help from unexpected places Her fellow patients also offered humor and solace. Three years later, Susan clearly recalls the camaraderie in even the most fleeting encounters with them. “While waiting in line, another patient once asked me, ‘What are you in for?’ ” she says.
Excerpt from Kerschner’s poem “Simple Things:” The medical pronouncement you are now free to go turbulence has subsided preparing me for the next six months before poking and prodding restarts
“I’ll never forget him or his kindness. He told me, ‘It’s doable.’ ” She pauses, then laughs. “It wasn’t, but I’m still glad he said it.” She also found comfort from talking to other survivors through the Anderson Network. Susan didn’t plan to write her book of poems, “The Shoulders of Country Roads: My Journey From Head and Neck Cancer.” But she found MD Anderson “a wonderful place to write.” “Waiting to see a doctor or to receive treatment was difficult,” she says. “So I ended up writing a lot in waiting rooms.” She also wrote at night, in bed, when she found she couldn’t sleep. “It was cathartic, soothing,” she says. Kerschner’s book is divided into five sections, with four of the chapter headings in common medical shorthand (“Fx” for fracture, “Dx” for diagnosis, “Tx” for treatment and “Rx” for prescriptions). All the poems are vignettes of her journey from the beginning to the end of her illness. The book, “The Shoulders of Country Roads: My Journey From Head and Neck Cancer,” is available from Amazon.com. Back in Pennsylvania, Susan Kerschner is a human resources manager at Boscov’s, the largest family-owned department store chain in the country.
“A man overheard what I’d said about my cancer. He told me he’d had the same kind of cancer and the same treatment.
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doctor, doctor Cancer treatment: Radiation therapy explained Shalin Shah, M.D., is the center medical director at MD Anderson’s Regional Care Center in Sugar Land. His research concerns how diet, exercise and other integrative medicine strategies may improve the cure rates and side effects of treatment in cancer patients. This article originally appeared in MD Anderson’s Cancerwise blog. Regardless of where radiation fits into your cancer treatment plan, you may have questions about what you’ll experience during the therapy.
Here are a few things you should know.
How radiation works Receiving radiation is similar to receiving very strong X-rays. Advances in the therapy allow us to pinpoint cancerous cells with amazing accuracy. The goal of radiation is to kill the cancerous cells to both shrink a tumor and to prevent it from growing and spreading. We try to avoid normal tissue at the same time.
Common radiation myths Patients often ask if radiation will make them glow in the dark. The answer is no. And if you receive external radiation therapy or even some types of internal radiation, you won’t be radioactive or a hazard to anyone else.
Radiation side effects: What to expect Most patients have side effects during radiation, but these may often be managed with simple measures. Side effects vary from patient to patient and depend on where on the body radiation is delivered.
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Shalin Shah, M.D.
After a few treatments, patients may experience skin reddening, similar to a sunburn, at the point where the radiation was delivered. The skin may feel a little dry and even itchy, and some patients experience minor peeling. Patients who need radiation in their abdomen or stomach may get diarrhea, though this can be managed with dietary changes and over-the-counter medication. Hair loss is uncommon during radiation treatment, unless the brain is being treated. During radiation therapy, some patients experience changes in taste and smell, and find that some foods they normally enjoy don’t taste the same. Most patients gradually regain their normal sense of taste and smell after therapy. In addition, patients being treated for head and neck cancers may experience dry mouth syndrome. I always advise them to drink water and juice frequently to help with this. Another common side effect of radiation treatment is fatigue, which can continue for a couple of months after treatments are complete. While there’s no surefire cure for fatigue, it’s best to prepare to experience some drowsiness and make simple lifestyle changes to help manage it. These changes include getting mild exercise, drinking plenty of fluids and taking time to rest. Cancer can be exhausting, and patients need to take care of themselves and let others help them as much as possible. Maintaining a healthy, balanced diet may also help boost energy levels.
Every patient is unique Like all aspects of cancer care, response to radiation therapy differs from patient to patient. So make sure you discuss anything you experience with your physician. We can often recommend ways to minimize discomfort during this step toward survivorship.
Keep up with the latest cancer news — and patient perspectives — at www.cancerwise.org.
research briefs MET protein levels show promise as biomarker for aggressive colon cancer MET protein levels correlate strongly with epithelial-mesenchymal transition (EMT) phenotype, a treatment-resistant type of colorectal cancer. These levels may be used as a surrogate biomarker, according to new MD Anderson research. The study results, which compared MET protein expression with protein/gene expression of EMT markers and evaluated impact on survival, were released in June at the annual meeting of the American Society of Clinical Oncology. The study provides another piece of the puzzle of personalized cancer diagnosis and treatment. This approach will be applied to other colorectal cancer subtypes, with the hope of defining other simple and readily available biomarkers. “If we can identify and group cancers with similar behaviors, we’ll be closer to identifying vulnerabilities and optimal therapies for each subset,” says Scott Kopetz, M.D., Ph.D., associate professor in Gastrointestinal Medical Oncology and senior author on the study.
Ibrutinib has ‘unprecedented’ impact on mantle cell lymphoma In a major international study led by MD Anderson researchers, the targeted therapy ibrutinib continues to show remarkable promise for treating relapsed or refractory mantle cell lymphoma (MCL). The most recent interim findings of the 18-center Phase II study were published in June in the New England Journal of Medicine. The ongoing trial of oral ibrutinib in patients with heavily treated relapsed or refractory MCL has maintained a response rate as high as 70% — better than any other single agent ever tested in the challenging disease — with milder side effects than other treatments. MCL is a rare and aggressive B-cell subtype of non-Hodgkin lymphoma that, according to the Leukemia and Lymphoma Society, accounts for 6% of non-Hodgkin cases. Despite high response rates to initial highly toxic combination-drug chemotherapy, patients often relapse.
The B-cell receptor pathway is critical in B-cell lymphoma, and Bruton’s tyrosine kinase (BTK) is an essential component of this pathway. Ibrutinib targets the BTK molecule, causing cell death and decreasing cellular migration and adhesion in malignant B-cells. “This oral inhibitor of the Bruton’s tyrosine kinase in the B-cell receptor pathway is the most important breakthrough to date in the treatment of mantle cell lymphoma,” says Michael Wang, M.D., associate professor in Lymphoma and Myeloma and Stem Cell Transplantation and Cellular Therapy. Wang is lead author on the trial. “Ibrutinib is an oral drug, taken once a day, and its side effects are not severe. Yet it can achieve more than previous combination chemotherapy approaches. Our results constitute excellent news for our patients and patients around the world,” he says.
To learn more about MD Anderson research, visit www.mdanderson.org/newsroom or the Cancer Frontline blog at www2.mdanderson. org/cancerfrontline. 5
‘Emperor of All Maladies’ author headlines Cancer Survivorship Conference Sept. 27-28
Cancer researcher and oncologist Siddhartha Mukherjee, M.D., Ph.D., is fascinated with the human struggle to understand and control cancer. His 2010 book, “The Emperor of All Maladies,” traces the people, politics and circumstances that have marked improvements in cancer treatment and research since the early part of the last century. Also a tale of Mukherjee’s “coming of age” as an oncologist, “The Emperor of All Maladies” won the Pulitzer Prize in 2011 for general nonfiction and was named to Oprah’s Top 10 Books of 2010. Mukherjee will headline the 25th annual Anderson Network Cancer Survivorship Conference Sept. 27-28 at the Omni Westside, 13210 Katy Freeway, in Houston. The conference is open to all who want to learn more about the issues cancer survivors face, meet and share with other survivors, take wellness classes and have fun. Thanks to MD Anderson, sponsors and individual donors, the cost of the conference is just $60 for early registrants, which includes all meals, activities and self-parking. Registration is available online until Sept. 16. After that, participants pay $70 at the door on the day of the conference. The conference includes nearly two dozen informative breakout sessions:
Academic Affairs and professor in Neurosurgery, and Newsham is associate director of research planning and development in Genitourinary Medical Oncology. Austin-based singer and brain cancer survivor Christine Butterfield will entertain at the banquet on Sept. 27.
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Treatment-related cognitive issues
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Bone health in cancer survivors
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Fertility in young adult survivors
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Fatigue and sleep disorders related to treatment
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Updates in neuropathy treatment
The popular medical panel will present an overview of their research and answer questions from the audience. It includes Ronald DePinho, M.D., president of MD Anderson; Jeffrey Gershenwald, M.D., professor in Surgical Oncology; and Michael Keating, M.D., professor in Leukemia. Other keynote speakers are Oliver Bogler, Ph.D., and Irene Newsham, Ph.D., married MD Anderson researchers and breast cancer survivors. Bogler is senior vice president for
The Anderson Network, an organization with support and educational services for patients/survivors, their families and caregivers, is a program of Volunteer Services.
To see the conference agenda or to register, go to www.mdanderson.org/patientconference or call 713-792-2553 in Houston, 800-345-6324 toll free.
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Conference Facts
Conference Registration
Registration deadline:
Cancer Survivorship Conference Omni Houston Hotel Westside • Sept. 27-28, 2013
Monday, Sept. 16
Registration online:
www.mdanderson.org/ patientconference
Please complete one registration form per person (you may copy additional forms) and return to:
Scholarships:
Cancer Survivorship Conference Conference Management Unit – 1381 UT MD Anderson Cancer Center P.O. Box 301439 Houston, TX 77230
Conference location:
Please note: All sections must be completed for the registration to be processed.
A limited number of scholarships are available for patients and caregivers. To obtain an application, go to www. mdanderson.org/patientconference or call the Anderson Network at 800-3456324 or 713-792-2553. Omni Houston Hotel Westside, 13210 Katy Freeway, Houston, Texas 77079
Hotel rates:
Name: Last _____________________________ First________________________________ Address:_____________________________________________________________________
The hotel is offering a group room rate of $99 for reservations made by Sept. 13.
City:___________________________________________
For reservations and directions, call 800-THE-OMNI (800-843-6664).
Zip:___________________ _ Daytime phone:______________________________________
Be sure to mention that you want The University of Texas MD Anderson group rate.
Parking:
Self-parking is available at no charge. Valet parking is at your own expense.
Photography
By registering, I understand that MD Anderson will be photographing and/or recording the Survivorship Conference and that as a participant in the conference, my image or voice may be included in the photos and/or recordings made by or for MD Anderson. By registering for and/or participating in the conference (1) I irrevocably give permission to MD Anderson to have photographs and audio or audiovisual recordings taken or made of me in connection with the conference activities (the “Media Materials”) and to use, copy, distribute, display, exhibit, and release the Media Materials in connection with any of its business, educational, professional, or fundraising activities; (2) I release MD Anderson and The University of Texas System and their Board of Regents, officers, agents, and employees from any and all liability in connection with the Media Materials; and (3) I waive all rights, interest, or claims for payment or other compensation in connection with any use, copying, distribution, display, exhibition, or release of the Media Materials.
For additional conference information, call the Anderson Network at 800-345-6324 or 713-792-2553, or visit www.mdanderson.org/patientconference.
State:______________________
Email address: (for confirmation only)____________________________________________
Registration fee: Registration is $60 until Sept. 16. After that, participants must register
at the conference for a late registration fee of $70. Conference fee covers all activities and meals, including self-parking, Friday night banquet, Saturday luncheon and coffee breaks throughout the conference. I will attend/need: The banquet on Friday night
q yes
q no
Vegetarian meals
q yes
q no
Breakout sessions: If you’re able to go online, consult the conference agenda at www.
mdanderson.org/patientconference. Choose the number of the breakout session you would like to attend in each cluster on Friday and Saturday and list by number here: Friday, Cluster 1 _________________________ Friday, Cluster 2_______________________ Friday, Cluster 3 _________________________ Saturday, Cluster 4____________________
Payment information: The registration fee for the conference is $60, which covers only
a minimal amount of the cost of the conference. The price is kept low due to the generosity of MD Anderson, corporations and individuals. Please make checks payable to UT MD Anderson Cancer Center. If you are paying by credit card, check one: q VISA
q MasterCard
q American Express
Card number: _________________________________________ Exp. date: _____________ Authorized signature: __________________________________________________________ Those paying by credit card may fax the registration form to 713-794-1724, but an authorized signature must accompany the form.
If you require a wheelchair, oxygen, etc., please bring your own equipment to the conference. For the protection of patients undergoing treatment, children under 16 years of age are not allowed.
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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 Communications Office – Unit 700 6900 Fannin St. Houston, TX 77030-3800 Phone: 713-792-0658 Fax: 713-563-9735 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 Scott Merville, Contributing Writer Gini Reed, Graphic Design © 2013 The University of Texas MD Anderson Cancer Center
Join the Healthy Bites challenge
Maintaining a healthy diet is often easier said than done. That’s why MD Anderson started a nutrition program called Healthy Bites. When you join, we’ll ask you to complete one nutrition challenge each month in 2013. An added bonus – each challenge supports a cancer prevention nutrition message. You’ll also get new tools, recipes and tips to help you complete each month’s challenge. Join today! Just sign up for our newsletter, Focused on Health, to receive challenges directly to your inbox. It’s not too late to become a Healthy Bites champ!
www.mdanderson.org/healthybites
The Anderson Network needs survivors of lung, head and neck, gastric and liver cancers to lend phone support to others. Please call 713-792-2553 or 800-345-6324. 8