Cancer Health Fall 2022 by Smart + Strong

A SMART+STRONGCANCERHEALTH.COMPUBLICATIONFALL2022$3.99 A MISSIONNEW From doctor to patient to research champion BreastLowMBCUpdates:CancerandHER2 MakingFoodTasteGoodAgainCanmRNACureCancer? ClinicalVirtualEasierTrials Living a Full Life With MyelomaMultiple forBooksKids Kelly Shanahan, MD

INFORMATION

IMPORTANT SAFETY

Granted FDA BREAKTHROUGH STATUS and approved for adults with metastatic breast cancer (mBC) who received a prior treatment for HER2+ mBC or have breast cancer that has come back within 6 months of completing treatment for their early-stage breast cancer

What is the most important information I should know about ENHERTU? /XQJSUREOHPVWKDWPD\EHVHYHUHOLIHWKUHDWHQLQJRUWKDWPD\OHDGWRGHDWK If you develop lung problems your healthcare provider may treat you with corticosteroid medicines. Tell your healthcare provider right away if you get any of the following signs and symptoms: Cough • Trouble breathing or shortness of breath • Fever Other new or worsening breathing symptoms (e.g., chest tightness, wheezing) see additional Important Safety Information and a Brief Summary of full Prescribing Information, including Boxed WARNINGS, on following pages. an actual patient.

•

ENHERTU was compared to Kadcyla® (ado-trastuzumab emtansine) in a clinical trial of 524 people who: Had HER2+ breast cancer that had spread to other parts of their body or could not be removed by surgery, and

•

• Had received a prior treatment for HER2+ metastatic breast cancer that came back during or within 6 months of treatment after surgery In this trial, 261 people were treated with ENHERTU and 263 were treated with Kadcyla. Find out more about ENHERTU by speaking to your healthcare provider, and by visiting ENHERTU.com/learnmore

*Median progression-free survival (mPFS) was not reached with ENHERTU at the time it was assessed, and mPFS for people taking Kadcyla was about 7 months. Median progression-free survival is the length of time from the start of treatment that half of the people in the trial had gone without disease progression. When more than half of the people had lived without disease progression, mPFS has not been reached.

ENHERTU REDUCED THE RISK OF PEOPLE’S CANCER PROGRESSING, or of them dying, by 72% compared to Kadcyla*

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What is ENHERTU? ENHERTU is a prescription medicine used in adults to treat human epidermal growth factor receptor 2 (HER2)-positive: • Breast cancer that cannot be removed by surgery or that has spread to other parts of the body (metastatic), and who have received a prior anti-HER2 breast cancer treatment: for metastatic disease, or have breast cancer that has come back during or within 6 months of completing treatment for their early-stage breast cancer. ,WLVQRWNQRZQLI(1+(578LVVDIHDQGH̆HFWLYHLQFKLOGUHQ

ENHERTU is a prescription medicine used in adults to treat human epidermal growth factor receptor 2 (HER2)-positive: • Breast cancer that cannot be removed by surgery or that has spread to other parts of the body (metastatic), and who have received a prior anti-HER2 breast cancer treatment: for metastatic disease, or have breast cancer that has come back during or within 6 months of completing treatment for their earlystage breast cancer.

Your healthcare provider will check your heart function before starting treatment with ENHERTU. Tell your healthcare provider right away if you get any of the following signs and symptoms:

It is not known if ENHERTU is safe and H̆HFWLYHLQFKLOGUHQ You are encouraged to report negative VLGHH̆HFWVRISUHVFULSWLRQGUXJVWRWKH FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. Please see a Brief Summary of IXOO3UHVFULELQJ,QIRUPDWLRQ LQFOXGLQJ%R[HG:$51,1*6 RQIROORZLQJSDJHV

Your healthcare provider will FKHFN\RXIRUWKHVHVLGHH̆HFWV during your treatment with (1+(578<RXUKHDOWKFDUH SURYLGHUPD\UHGXFH\RXUGRVH delay treatment or completely stop treatment with ENHERTU if you KDYHVHYHUHVLGHH̆HFWV +DUPWR\RXUXQERUQEDE\Tell your healthcare provider right away if you become pregnant or think you might be pregnant during treatment with ENHERTU.

• Hair loss • Constipation • Low levels of blood potassium • Decreased appetite • Diarrhea • Pain in muscles and bones

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• Cough • Trouble breathing or shortness of breath • Fever • Other new or worsening breathing symptoms (e.g., chest tightness, wheezing)

• Headache • Stomach-area (abdominal) pain ENHERTU may cause fertility problems

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• If you miss a planned dose of ENHERTU, call your healthcare provider right away to schedule an appointment. Do not wait until the next planned treatment cycle.

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ENHERTU® is a registered trademark of Daiichi Sankyo Company, Limited. Other brands listed are the trademark of their respective owners and are not trademarks or registered trademarks of Daiichi Sankyo or AstraZeneca.

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Tell your healthcare provider about all the medicines you take, including prescription and over-thecounter medicines, vitamins, and herbal supplements. How will I receive ENHERTU?

• Have signs or symptoms of an infection.

What is the most important information I should know about ENHERTU® ENHERTUderuxtecan-nxki)?(fam-trastuzumabcancauseseriousside

Lung problems that may be VHYHUHOLIHWKUHDWHQLQJRUWKDW

• Your healthcare provider may slow down or temporarily stop your infusion of ENHERTU if you have an infusionrelated reaction, or permanently stop ENHERTU if you have severe infusion reactions.

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• Irregular heartbeat • Sudden weight gain • Dizziness or feeling light-headed Loss of consciousness

• Your healthcare provider will decide how many treatments you need.

• Your healthcare provider will give medicines before your infusion to help prevent nausea and vomiting.

Important Safety Information

• Males who have female partners that are able to become pregnant should use H̆HFWLYHELUWKFRQWUROFRQWUDFHSWLRQ during treatment with ENHERTU and for at least 4 months after the last dose.

The most common side H̆HFWVRI(1+(578ZKHQ used in people with breast FDQFHULQFOXGH • Nausea • Low white blood cell counts • Low red blood cell counts • Increased liver function tests • Feeling tired • Vomiting • Low platelet counts

• New or worsening shortness of breath • Coughing • Feeling tired • Swelling of your ankles or legs

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:KDWDUHWKHSRVVLEOHVLGHH̆HFWV of ENHERTUENHERTU?can cause VHULRXVVLGHH̆HFWV6HH³:KDWLV the most important information I should know about ENHERTU?”

• Infections of the respiratory tract

• If you are able to become pregnant, your healthcare provider should do a pregnancy test before you start treatment with ENHERTU.

• You will receive ENHERTU into your vein through an intravenous (IV) line by your healthcare provider.

• Have or have had any heart problems.

Low white blood cell counts are common with ENHERTU and can sometimes be severe. Your healthcare provider will check your white blood cell counts before starting ENHERTU and before starting each dose. Tell your healthcare provider right away if you develop any signs or symptoms of an infection or have fever or chills during treatment with ENHERTU.

• Females who are able to become SUHJQDQWVKRXOGXVHH̆HFWLYHELUWK control (contraception) during treatment with ENHERTU and for at least 7 months after the last dose.

• Are breastfeeding or plan to breastfeed. It is not known if ENHERTU passes into your breast milk. Do not breastfeed during treatment with ENHERTU and for 7 months after the last dose.

If you develop lung problems your healthcare provider may treat you with corticosteroid medicines. Tell your healthcare provider right away if you get any of the following signs and symptoms:

Low white blood cell count

H̆HFWVRI(1+(578&DOO\RXUGRFWRU IRUPHGLFDODGYLFHDERXWVLGHH̆HFWV <RXPD\UHSRUWVLGHH̆HFWVWR'DLLFKL Sankyo at 1-877-437-7763 or to FDA at 1-800-FDA-1088. What is ENHERTU?

• Have lung or breathing problems.

• ENHERTU is given 1 time every three weeks (21-day treatment cycle).

• stomach cancer called gastric or gastroesophageal junction (GEJ) adenocarcinoma that has spread to areas near your stomach (locally advanced) or that has spread to other parts of your body (metastatic), and who have received a prior trastuzumab-based regimen. It is not known if ENHERTU is safe and effective in children.

• are breastfeeding or plan to breastfeed. It is not known if ENHERTU passes into your breast milk. Do not breastfeed during treatment with ENHERTU and for 7 months after the last dose.

ENHERTU is a prescription medicine used in adults to treat human epidermal growth factor receptor 2 (HER2)-positive:

• ENHERTU is given 1 time every three weeks (21-day treatment cycle).

Active Ingredient: fam-trastuzumab deruxtecan-nxki.

•• for metastatic disease, or •• have breast cancer that has come back during or within 6 months of completing treatment for their early-stage breast cancer.

• have lung or breathing problems.

What is the most important information I should know about

• Your healthcare provider will decide how many treatments you need.

The most common side effects of ENHERTU, when used in people with stomach cancer, include: • low red blood cell counts • diarrhea

Inactive Ingredients: L-histidine, L-histidine hydrochloride monohydrate, polysorbate 80, and sucrose.

Manufactured by: Daiichi Sankyo, Inc., Basking Ridge, NJ 07920 U.S. License No. 2128

• Your healthcare provider will give you medicines before your infusion to help prevent nausea and vomiting.

• Low white blood cell count (neutropenia). Low white blood cell counts are common with ENHERTU and can sometimes be severe. Your healthcare provider will check your white blood cell counts before starting ENHERTU and before starting each dose. Tell your healthcare provider right away if you develop any signs or symptoms of an infection or have fever or chills during treatment with ENHERTU.

• Your healthcare provider may slow down or temporarily stop your infusion of ENHERTU if you have an infusion-related reaction, or permanently stop ENHERTU if you have severe infusion reactions.

•• fever •• other new or worsening breathing symptoms (e.g., chest tightness, wheezing)

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. How will I receive ENHERTU?

••

Your healthcare provider will check you for these side effects during your treatment with ENHERTU. Your healthcare provider may reduce your dose, delay treatment or completely stop treatment with ENHERTU if you have severe side effects

• low platelet counts • vomiting • nausea • constipation

••

• Lung problems that may be severe, life-threatening or that may lead to death. If you develop lung problems your healthcare provider may treat you with corticosteroid medicines. Tell your healthcare provider right away if you get any of the following signs and symptoms: •• cough •• trouble breathing or shortness of breath

• Harm to your unborn baby. Tell your healthcare provider right away if you become pregnant or think you might be pregnant during treatment with ENHERTU.

••

• have signs or symptoms of an infection.

• have or have had any heart problems.

• You will receive ENHERTU into your vein through an intravenous (IV) line by your healthcare provider.

• increased liver function tests • diarrhea • feeling tired • pain in muscles and bones • vomiting • infections of the respiratory tract • low platelet counts • headache • hair loss • stomach-area (abdominal) pain

• decreased appetite • fever • increased liver function tests • hair loss

ENHERTU® is a registered trademark of Daiichi Sankyo Company, Ltd.

• low white blood cell counts • low levels of blood potassium

•• Males who have female partners that are able to become pregnant should use effective birth control (contraception) during treatment with ENHERTU and for at least 4 months after the last dose.

• breast cancer that cannot be removed by surgery or that has spread to other parts of the body (metastatic), and who have received a prior anti-HER2 breast cancer treatment:

Marketed by: Daiichi Sankyo, Inc., Basking Ridge, NJ 07920 and AstraZeneca Pharmaceuticals LP, Wilmington, DE 19850

Before you receive ENHERTU, tell your healthcare provider about all of your medical conditions, including if you:

• low red blood cell counts • decreased appetite

This Medication Guide has been approved by the U.S. Food and Drug Administration.Revised:05/2022

What are the possible side effects of ENHERTU?

Medication Guide ENHERTU® (en-HER-too) (fam-trastuzumab deruxtecan-nxki) for injection

•• If you are able to become pregnant, your healthcare provider should do a pregnancy test before you start treatment with ENHERTU.

See “What are the possible side effects of ENHERTU?” for more information about side effects.

•• Females who are able to become pregnant should use effective birth control (contraception) during treatment with ENHERTU and for at least 7 months after the last dose.

The most common side effects of ENHERTU, when used in people with breast cancer, include: • nausea • constipation • low white blood cell counts • low levels of blood potassium

What is ENHERTU?

ENHERTU can cause serious side effects. See “What is the most important information I should know about ENHERTU?”

For more information, call 1-877-437-7763 or go to https://www.ENHERTU.com

• feeling ENHERTUtiredmay cause fertility problems in males, which may affect the ability to father children. Talk to your healthcare provider if you have concerns about fertility. These are not all of the possible side effects of ENHERTU. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. General information about the safe and effective use of ENHERTU. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or healthcare provider for information about ENHERTU that is written for healthcare professionals. What are the ingredients in ENHERTU?

ENHERTUENHERTU?can cause serious side effects, including:

• Heart problems that may affect your heart’s ability to pump blood. Your healthcare provider will check your heart function before starting treatment with ENHERTU. Tell your healthcare provider right away if you get any of the following signs and symptoms:••neworworsening shortness •• irregular heartbeat of breath •• sudden weight gain coughing •• dizziness or feeling feeling tired light-headed swelling of your ankles or legs •• loss of consciousness

• If you miss a planned dose of ENHERTU, call your healthcare provider right away to schedule an appointment. Do not wait until the next planned treatment cycle.

NewsScience Learn about the treatmentlatest advances, cure research and conference news. cancerhealth.com/science-news Cancer Health Digital Scan the QR

us | abortion access affects cancer patients | say yes to ﬂat

newly diagnosed or a survivor,long-termcheck out our Basics

The technology used to create effective COVID-19 vaccines may also help ﬁght cancer. LIZ HIGHLEYMAN inhibitor cancer cells spread during cannabis reduces like chests Don S. Dizon, MD, says sexual health is possible after cancer. Myeloma Law moved to Maryland with her new wife and teen daughter. With cancer is sorry for your loss. role of oncologist taste about wellness plan. who living with you’re section treatment, how to effects more. cancerhealth.com/basics code (left) Health online, go to cancerhealth.com/digital past issues entire Strong library. metastaticchampionsShanahanbreastcancerresearch.

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shrinks lung tumors | breast

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good again 33 Reader Survey Tell us

E xclusively on Cancer Health.com Cancer Health Stories Read the ﬁrstperson stories of people

When ob-gyn Kelly Shanahan was diagnosed with metastatic breast cancer in 2013, she found a new mission. JENNIFER COOK 22 THE mRNA REVOLUTION

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pain for cancer patients 8 News Stars: Just

with issuethetosmartphoneyourcheckoutdigitalof Cancer

on cancer

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16 THE MAKING OF AN ADVOCATE

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29 Resources Websites on exercise and cancer 30 Good Stuff Books for children, cards for cancer patients and mindfulness for you 32 Solutions Making food

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12 Basics Updates on liver cancer treatment 14 A Multiple

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EDITORIAL INTERN Jilleen Barrett ART DIRECTOR Doriot Kim ART PRODUCTION MANAGER Michael Halliday ADVISORY BOARD Dena Battle; Jamie Ennis Boyd; Catherine Guthrie; Timothy Henrich, MD; Carl June, MD; Leigh Leibel, MSc; Yung Lie, PhD; Gilberto Lopes, MD; Jennifer L. McQuade, MD; Amelie Ramirez, DPH; Hope Rugo, MD; Kelly Shanahan, MD; Carla Tardif

4 CancerHealth FALL 2022 cancerhealth.com FROM THE EDITOR

“WE DESERVE BETTER,” declares caregiverscancer—andcouldbreastlikeShe’sinadvocatephysician-turned-KellyShanahan,MD,ourcoverstory(page16).speakingaboutpeople,her,livingwithmetastaticcancer.Thesentimentapplytoanyonewithtotheactivists,andresearchers

The Supreme Court’s ruling to strike down Roe v. Wade landed women’s reproductive health care in national headlines, but nearly 1 in 1,000 pregnant women are diagnosed with cancer each year, so abortion access also affects cancer patients (page 8). More women who have mastectomies, according to a recent survey, are opting for flat closures—but they often must deal with pushback from their doctors (page 9). In related news (page 6), the Food and Drug Administration OK’d a breast cancer treatment for those with low HER2 levels.

MANAGING EDITOR Jennifer Morton SCIENCE EDITOR Liz Highleyman

SMART + STRONG PRESIDENT AND COO Ian E. Anderson EDITORIAL DIRECTOR Oriol R. Gutierrez Jr. CHIEF TECHNOLOGY OFFICER Christian Evans VICE INTEGRATEDPRESIDENT,SALES Diane Anderson INTEGRATED ADVERTISING MANAGER Jonathan Gaskell INTEGRATED COORDINATORADVERTISING Sarah Pursell SALES OFFICE sales@cancerhealth.com212-938-2051

fighting for them—but as this issue of Cancer Health highlights, the statement is notably apt for women.

Twitter:trents@cancerhealth.comEditor-in-Chief@trentonstraube

CDM PUBLISHING, LLC CHIEF EXECUTIVE OFFICER Jeremy Grayzel CONTROLLER Joel Kaplan Cancer Health (ISSN 2688-6200) Issue No. 19. Copyright © 2022 CDM Publishing, LLC. All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted, in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the written permission of the publisher. Smart + Strong® and Cancer Health™ are registered trademarks of CDM Publishing, LLC. Cancer Health is BPA audited.

As the new editor-in-chief of Cancer Health, I am honored to amplify the stories of survivors, families, advocates and health care providers. I’m also thankful to have my predecessor, Bob Barnett, helping out as editor-at-large.

ISTOCK(ILLUSTRATION)CUELLAR;JOHNNIE(STRAUBE)

FEEDBACK Email: info@cancerhealth.com

I’m among them, though having basal-cell skin cancer (and a resulting scar above my nose) seems a minor inconvenience compared with the experience of many others, such as my father, who is now recovering from non-Hodgkin lymphoma, and Her Hope

EDITOR-IN-CHIEF Trent Straube

my little sister, who died of leukemia at age 22. Indeed, cancer touches us all.

TRENT STRAUBE

BULK SUBSCRIPTIONS order.cancerhealth.com subs@cancerhealth.comor

Finally, I’m excited about covering advancements in research, care and treatment. For example, can messenger RNA (mRNA), the technology used to create COVID-19 vaccines, also help fight cancer? Read our science feature, “The mRNA Revolution” (page 22), to find out.

Breast cancer is the most prevalent cancer among women, followed by uterine and thyroid cancers; among men, prostate, melanoma of the skin and colorectal cancers top the list based on the latest data (page 9).

As of January 1 of this year, 18 million Americans are cancer survivors.

EDITOR-AT-LARGE Bob Barnett NEWS WRITERS Sukanya Charuchandra; Laura Schmidt COPY CHIEF Joe Mejía

IN THE SEARCH FOR A CURE, THEY KNOW EXACTLY WHERE THEY STAND. ON THE SHOULDERS OF GIANTS. For 75 years, Damon Runyon has provided funding to scientists who bet their careers on high-risk, high-reward hypotheses, concepts, and strategies. In this time, Damon Runyon scientists have advanced cancer research exponentially – because each one builds upon the achievements of those who came before. As we celebrate this milestone of scientiﬁc achievement, we honor the scientists who have contributed to this legacy and continue to carry it forward. With them, we look to the future. To learn more, visit damonrunyon.org Gordon J. Freeman, PhD Damon Runyon’79–’81Fellow Villani,Alexandra-ChloéPhD Current Damon RunyonRachleff Innovator

COVID

6 CancerHealth FALL 2022 cancerhealth.com

Breast cancer is classified by the type of receptors on tumors. Around 15% of patients have a high level of HER2, a receptor for a protein that promotes cell growth. But some 60% of people who were traditionally classified as HER2-negative actually have some HER2 receptors, a group now defined as HER2-low.

Over the course of the COVID-19 pandemic, people with cancer have heard conflicting messages about their risk. People with active cancer—especially blood cancers like leukemia or lymphoma—and those receiving certain types of cancer treatment are more likely to have worse COVID outcomes. What’s more, they may not respond as well to COVID vaccines, especially if they are taking medications that damage antibody-producing B cells. But this does not appear to be the case for cancer survivors. Researchers at UTHealth Houston used electronic health records to assess the association between COVID outcomes and cancer in 300,000 adults seen at nearly 8,000 hospitals and clinics during the first year of the pandemic, before vaccines wereOverall,available.cancer patients had a higher risk for COVID hospitalization and death than people never diagnosed with cancer. Breaking this down, people with a recent diagnosis were 10% more likely to be hospi talized and had a 17% increased risk of death. Those who received chemotherapy or radiation within the past three months also had higher mortality. But cancer survivors, people diagnosed with cancer more than a year ago and those who were not on active treatment did not have worse outcomes compared with the general population. People with recently diagnosed cancer and those on treatment can reduce their risk for poor COVID outcomes by getting the recommended vaccines and boosters and, if they do not respond well, taking Evusheld for preexposure prophylaxis. Risk for Cancer Survivors

The Phase III DESTINY-Breast04 trial included 557 previously treated women with HER2-low metastatic breast cancer. They were randomly assigned to receive Enhertu or their physician’s choice of chemotherapy. Antibody-drug conjugates like Enhertu use monoclonal antibodies to deliver toxic chemotherapy drugs directly toAmongtumors.women with hormonereceptor-positive, HER2-low tumors, the median overall survival time was 23.9 months in the Enhertu group versus 17.5 months in the chemotherapy group. Enhertu reduced the risk of disease progression by 49% and the risk of death by 36%. The presentation earned a standing ovation, and some experts say the results are “practice“Ourchanging.”studyshows that trastuzumab deruxtecan may be a new and highly effective targeted therapy option available for this newly defined patient population,” says investigator Shanu Modi, MD, of Memorial Sloan Kettering Cancer Center. The results could also be relevant for people with other types of HER2-low cancer.

The antibody-drug conjugate Enhertu levelsprovedexpression,breastforderuxtecan),(fam-trastuzumabapprovedin2019thetreatmentofmetastaticcancerwithhighHER2hasnowbeenap-forpeoplewithlowHER2aswell.

HER2-LOW BREAST CANCER

CARE & TREATMENT BY LIZ HIGHLEYMAN

MEDICAL CANNABIS REDUCES PAIN FOR CANCER PATIENTS

Gil Bar-Sela, MD, of Ha’Emek Medical Center in Israel, and colleagues recruited oncologists who were able to issue medical cannabis licenses to their patients. The patients completed anonymous questionnaires about pain and other symptoms and side effects before starting cannabis and again at several points during the next six months. The researchers found that pain measures improved significantly, and other cancer-related symptoms also decreased. What’s more, patients were able to reduce their use of other painkillers. In fact, nearly half stopped all pain medications after using cannabis for six months.

EXPERIMENTAL KRAS INHIBITOR SHRINKS LUNG TUMORS

Cannabis may be an alternative to opioid pain relievers for people with cancer-related pain, according to a recent study. Pain is among the leading reasons for reduced quality of life among people undergoing cancer treatment. Many patients are interested in trying medical cannabis, but research on its benefits remains limited.

PROJECT;LITERACYGENETICOFCOURTESYILLUSTRATION)(DNA ISTOCKOTHERS:ALL For more care and treatment news: cancerhealth.com/science-news

Breast Cancer Cells Spread During Sleep

Circulating tumor cells (CTCs) are more likely to be active at night in women with breast cancer, recent research shows. These cells can seep into the bloodstream, travel to other parts of the body and grow into a new tumor, a process known as metastasis. The body’s circadian rhythms have long been thought to play a role in cancer. Nicola Aceto, PhD, of the Swiss Federal Institute of Technology, and colleagues first observed tumors in mice, finding that CTC levels varied based on when their blood was drawn. The researchers then studied 30 women hospitalized with breast cancer, collecting blood samples at 4 a.m. and again at 10 a.m. Almost 80% of detected CTCs were in samples taken very early in the morning, when the women had been resting. Turning back to mice, which are nocturnal, they found that CTC levels were up to 88 times higher during the resting period. This study shows that “tumors wake up when patients are sleeping,” Aceto told Nature. —Laura Schmidt

After three decades of unsuccessful attempts, researchers have finally cracked the KRAS code, leading to the development of promising new targeted therapies. The KRAS gene makes proteins that regulate cell growth, and KRAS mutations can allow cancer to grow out of control. One experimental KRAS inhibitor, adagrasib, targets a specific mutation known as KRAS G12C, which is found in about 13% of non-small-cell lung cancer (NSCLC) tumors. The first drug targeting the same mutation, Lumakras (sotorasib), was approved last year. In the Phase II KRYSTAL-1 study, 112 patients with this mutation who had previously received both chemotherapy and checkpoint inhibitor immunotherapy were treated with adagrasib pills twice daily. After about a year of follow-up, the overall response rate (tumor shrinkage) was 43%. What’s more, the drug also shrank tumors that had spread to the brain. The median progressionfree survival time was 6.5 months, and the median overall survival time was 12.6“Thesemonths.data highlight that inhibiting KRAS-G12C can lead to clinically meaningful benefits to NSCLC patients with this form of lung cancer,” says Pasi Jänne, MD, PhD, of Dana-Farber Cancer Institute in Boston. Adagrasib has also shown activity against other malignancies with the KRAS-G12C mutation, including colorectal, pancreatic and biliary tract cancers.

Nearly 1 in 1,000 pregnant women are diagnosed with cancer each year. What’s more, some cancers must be treated immediately to save the mother, and some treatments may be harmful to the developing fetus. What to do? It’s a harrowing decision made all the more complicated by the Supreme Court ruling that overturned Roe v. Wade and allows states and Congress to ban abortions. Indeed, oncologists could possibly risk prison time if treating their cancer patients terminates a pregnancy. Without taking a position on the court’s ruling, the American Cancer Society and the American Cancer Society Cancer Action Network urge states to ensure that people with cancer have access to immediate care, that they have the right to preserve fertility before starting treatment and that cancer screenings and early diagnoses remain accessible and affordable. “Every patient,” the nonproﬁts write, “should be able to increase their likelihood to survive cancer by having the option to start cancer therapy immediately, regardless of pregnancy status.”

Get more cancer news: cancerhealth.com/news

• Currently starring in the TV series The Old Man, Jeff Bridges faced an unexpected challenge after being treated for non-Hodgkin lymphoma in 2020. “My chemo stripped me of all my immune system, so then I got COVID on top of that, and it wiped me out. That made my cancer look like nothing,” he recently told Entertainment Weekly, adding that his cancer is in remission and he is “feeling good.”

Abortion Access Affects Cancer Patients

Fame doesn’t prevent cancer. But celebrities who share their cancer stories can help educate, raise awareness and reduce stigma. These boldfaced names are some recent examples:

• In June, country music icon Toby Keith posted the following message on social media: “Last fall I was diagnosed with stomach cancer. I’ve spent the last 6 months receiving chemo, radiation and surgery. So far, so good. I need time to breathe, recover and relax.… But I will see the fans sooner than later.” About a month later, “Team Toby” warned fans about impostors professing to be the singer, posting false health updates and requesting money.

STARS: JUST LIKE US

8 CancerHealth FALL 2022 cancerhealth.com

• Jared Kushner, the son-inlaw of former President Donald Trump and a senior White House adviser in that administration, revealed in a memoir that he was diagnosed with thyroid cancer in October 2019 and had surgery to remove part of the gland. “This was a personal problem,” he wrote in the book, “and not for public consumption.”

• Good Morning America coanchor Robin Roberts shared her breast cancer diagnosis in 2007. Today, she’s cancer-free, but now her partner, Amber Laign, battles the same illness. “She and I have been together almost 17 years and have helped each other through our challenges, like my journey with cancer,” Roberts said in one of her regular video posts. “It’s my turn now to be there for her like she was for me.”

From left: Toby Keith, RobertsRobinandJeffBridges

NEWS BY TRENT STRAUBE

18 MILLION cancerhealth.com FALL2022 CancerHealth 9

Luckily, remote technologies, such as virtual meetings, may increase enrollment. A recent survey of nearly 1,200 cancer patients and survivors found that 80% were willing to use remote technologies to enroll in clinical trials. In fact, those who said they wouldn’t attend in-person appointments claimed they’d be more likely to participate if they could do so remotely. “Expanding who is able to enroll in trials through these tools could have a signiﬁcant positive impact on the number and diversity of patients enrolled in trials,” said Devon Adams, a senior analyst and emerging science expert at the American Cancer Society Cancer Action Network, which conducted the survey. What’s more, he added, “the [COVID-19] pandemic necessitated mass adoption of remote technologies, and patients’ positive experiences with those tools is increasingly reﬂected in their willingness to use technology in trials.”

A growing number of women are opting for flat closures after their mastectomies (as opposed to having breast reconstruction) and are satisfied with their decision, according to a survey in the Annals of Surgical Oncology. But many women facing breast cancer surgery are not given the option of “going flat” or are met with pushback from their surgeons. In some cases, The Washington Post reported, doctors left extra skin on patients against their wishes—just in case they changed their minds. To counter this outdated attitude, the advocacy group Flat Closure NOW aims to normalize the procedure and encourages women with flat closures to support one another and speak out.That’s the number of cancer survivors in the United States as of January 1, 2022, according to a new report on cancer prevalence from the American Cancer Society and the National Cancer Institute. Produced every three years, the report found that 67% of survivors are 65 or older, that the growing population of survivors is increasingly diverse and that more resources are needed to reduce disparities for communities of color. The most common cancers among men are prostate (3,523,230), melanoma of the skin (760,640) and colorectal (726,450). Among women, they are breast (4,055,770), uterine (891,560) and thyroid (823,800).

For clinical trials to determine whether drugs and medical procedures are safe and effective for all potential users, regardless of age, race and ethnicity, the trials must include a diverse cross-section of participants. But joining a clinical trial often requires traveling and taking time off for in-person appointments, which poses a challenge for many folks.

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Easier Clinical Trials

SAY YES TO FLAT CHESTS

issues, evaluation and peopledersexualtreatmentstheforandgen-minoritizedremainunexplored. We need to be aware of our own implicit biases when it comes to care of the whole patient. Our efforts to prolong the survival of people with cancer need to address the issue of what that life can—and will—look like. To avoid conversations around sexuality after cancer robs people of the opportunity to fully participate in a domain that deﬁnes us as human beings.

VOICES BY DON S. DIZON, MD 10 CancerHealth FALL 2022 cancerhealth.com DIZONS.DONOFCOURTESY

a scale from anxiety to conﬁdence—inﬂuenced by health, medications and treatmentrelated side effects but also by society’s and one’s own view of sexuality growing up and the views of intimate partners. We have a long way to go. Much of the work on sexuality after cancer emphasizes the heterosexual experience; the

Sexuality: A Human Right

Brown University professor of medicine and surgery Don S. Dizon, MD, runs a sexuality clinic for people with cancer at the Lifespan Cancer Institute.

Sexual health after cancer is possible, says Don S. Dizon. clinic for with cancer at the Cancer Institute.

Sexuality is not synonymous with sexual activity. It covers intimacy, desire, arousal, orgasm and satisfaction. When it functions normally, we don’t think about it, but when something negatively affects who we are sexually and how we experience pleasure, it can be quite distressing. Patients often come to me with a loss of desire, but sitting with someone can help delineate the complexity of the issue, including lack of arousal, pain with penetration or inability to accept one’s changed body image. It is important for clinicians to give voice to these concerns— and for people to feel free to seek help. Just as we address quality of life, we should strive for a better sexual life for all people with cancer. Not everyone wants to be sexually active, but for those who do, we have a responsibility to address it. While the ﬁeld of sexual health treatments is young, there are options. For women who have pain with penetration, aqueous lidocaine, a dilute solution, is efﬁcacious. For those with vaginal dryness and atrophy, vaginal moisturizers are a mainstay; but if these are not effective, vaginal estrogen is safe, even for people with

thatcancermodelKatz,function.moreViagra),focusesbreasthormone-receptor-positivecancer.Formen,treatmentmainlyonPDE5inhibitors(e.g.,butmalesexualityiscomplicatedthanerectileMycolleagueAnneRN,andIdevelopedaofmalesexualhealthafter(theKatz-Dizonmodel)envisionsmalesexualityon

I ONCE MET A WOMAN, YEARS OUT FROM HER BREAST cancer diagnosis, who recalled with honesty what it was like to lose her breast, go through chemotherapy and radiation and take endocrine therapy. She didn’t have anyone to turn to and discuss what it did to her sexuality and sense of self, what a tough time she was having in her marriage, how her sexuality was changing in ways she couldn’t fully understand, how her body was not responding to touch as before. When she brought up these very private issues to her oncologist, she was dumbfounded by the response: “At least you’re alive.” She never asked again. She and her husband separated and, ultimately, divorced.

Sexuality does not have to be another part of one’s life “lost” to cancer. That was true of the woman whose marriage fell apart due to cancer. The reason she came to see me after years was that she had started a new relationship. Helping her rediscover her sexuality and sensuality helped bring that part of her life back. ■

If it matters to you, it matters to us. . She’s a healthcare professional, adept writer, mother, and metastatic breast cancer survivor. When Thomasina first started her journey, she needed the individual attention that only a social worker could provide. She needed the financial assistance to help pay for multiple medications and doctor’s visits. She needed the motivation and tenacity to help others like her. She needed CancerCare. We’re still here for Thomasina, and we are here for you too. Thomasina FinancialCarePetCareSurvivorCarePersonalCareEmotionalCareEducationalCare 800-813-HOPE (4673) | WWW.CANCERCARE.ORG

Liver Cancer Treatment options for advanced HCC include a combination of the checkpoint inhibitor Tecentriq (atezolizumab) plus Avastin (bevacizumab) or targeted therapy using Nexavar or Lenvima (lenvatinib). Additional options for second-line therapy include the targeted drugs Cabometyx (cabozantinib), Cyramza (ramucirumab) and Stivarga (regorafenib) and the checkpoint inhibitors Keytruda (pembrolizumab) and Opdivo (nivolumab), with or without Yervoy (ipilimumab).

ISTOCK BASICS BY LIZ HIGHLEYMAN 12 CancerHealth FALL 2022 cancerhealth.com Learn more cancer basics: cancerhealth.com/basics

WHILE MANY CANCER TYPES are decreasing, liver cancer is on the rise. New cases have more than tripled in the United States since 1980, according to the American Cancer Society. Liver cancer mortality has also increased, making it the sixth leading cause of cancer death.

Over years or decades, chronic hepatitis B or C, fatty liver disease, heavy alcohol consumption and other causes of liver injury can lead to serious complications, including cirrhosis and hepatocellular carcinoma (HCC), the most common type of primary liver cancer. The liver is also a common site of metastasis, or cancer that spreads from elsewhere in the body.

The recent approval of several new medications has changed the treatment landscape.

Targeted therapies can stop working, and immunotherapy doesn’t work for everyone. Your treatment plan may include a combination of surgery, radiation and medications. A liver transplant may be possible in some cases, but donor livers are in short supply. Liver cancer treatment continues to evolve, and several new therapies are under study. Ask your doctor whether a clinical trial might be a good option for you. ■

Around 41,300 Americans will be diagnosed with liver cancer and about 30,500 will die from it this year. Men are over twice as likely as women to be diagnosed with liver cancer. In the United States, this type of cancer is more common among Asians and Pacific Islanders due to a high prevalence of hepatitis B. Early liver cancer often has no symptoms, making it difficult to catch at a more treatable stage. For this reason, people with cirrhosis are advised to undergo regular liver cancer monitoring. Treatment for hepatocellular carcinoma depends on how advanced it is, including the size and number of tumors, whether the cancer has spread to other parts of the body and liver function status. Treatment Options In some cases, small liver tumors can be surgically removed (resection). Unlike other organs, a substantial portion of the liver can be removed and it will regenerate. Limited tumors may be treated with local therapies, including destroying the cancer with microwaves or radio waves (radiofrequency ablation), injection of alcohol into the tumor (percutaneous ethanol injection) or blocking the hepatic artery, the liver’s main blood supply (embolization).

Standard first-line treatment

Traditional chemotherapy is not very effective against HCC, but targeted therapy and immunotherapy offer more promise for advanced or metastatic disease. The Food and Drug Administration approved the first targeted therapy for HCC, Nexavar (sorafenib), in 2007. That was about the only option for a decade, but then several approvals came in quick succession, changing the treatment landscape. Most targeted therapies for HCC interfere with angiogenesis, or the development of blood vessels that supply tumors. Checkpoint inhibitor immunotherapy unleashes T cells to destroy tumors.

Stand

Patients can help accelerate research by sharing their data and unique experiences.

Photo By Matt Sayles Up To Cancer is a division of the Entertainment Industry Foundation (EIF), a 501(c)(3) charitable organization. sign movement at

Uzo Aduba Stand Up To Cancer Ambassador

StandUpToCancer.org/CountMeIn

When patients stand together with researchers, they can unlock new discoveries and treatments.

People with all types of cancer may be eligible to join Stand Up To Cancer, Count Me In and more than 7,500 patients who have already participated in this mission to accelerate the pace of cancer research.

Right now, most clinical information is not regularly shared with the researchers who are trying to uncover new information about cancer every day, but you can help change that.

JOIN THEACCELERATEMOVEMENTTOCANCERRESEARCH Find out more and

up to join the

I saw a doctor who specializes in medical cannabis. My oncologist said it was OK. I worked with an in-house physician at a dispensary who recommended tinctures with THC and CBD, with certain terpenes, and a translingual one to help me sleep. It really helped. It reduced nausea so I could eat, lowered pain so I could sleep.

Lilia Law, an information technology manager, lives in Gaithersburg, Maryland, with her wife and daughter. She has multiple myeloma. Lilia Law, relaxing on the Chesapeake Bay. Right: On her 36th birthday, with her future wife, Keisha (left), and Jasmindaughter,(right).

August 2019 The in-house lab test result at the nephrologist was 10.2. They sent me to the emergency room. I called up my girlfriend. At the hospital, they found cancerous cells in my kidneys; an oncologist/ hematologist told me it might be a blood cancer. Things moved fast. Two days after a bone marrow biopsy, he told me they found multiple myeloma. He’s making small talk. I’m like, Dude! Blood cancer? I didn’t even learn until much later that this kind of cancer is more common in Black people.

October 2019

I toured the infusion ﬂoor where I would start chemo the next day—twice a week for six months.

April–May 2019 I visited my mom in Texas; she has colon cancer. Flying back, I felt sick. Over the next few weeks, I had nausea, bad migraines. I thought I had irritable bowel syndrome, so I saw a gastroenterologist, who didn’t see anything except some immune factors that I should look into. But I let it go. My legs started feeling weak; they even gave out so I slid down the stairs to the loft. A general practitioner did a metabolic panel. He was really concerned about the levels of creatine in my kidneys. For women, levels over 1.2 are abnormal; mine were 2.5. Over the next three weeks, the levels went up to 4, a sign of acute kidney failure, and then 8. He helped me get in to see a nephrologist.

November–December 2019

A MyelomaMultipleDiary

14 CancerHealth FALL 2022 cancerhealth.com DIARY AS TOLD TO BOB BARNETT

I’M 38. I WORK OUT, EAT A HEALTHY DIET. My dad is African American, and my mom is from Mexico. In 2016, I donated one of my kidneys to my mom. In 2018, I moved from Houston with my daughter to be close to the woman who would become my wife.

I was diagnosed with end-stage renal failure. My creatine levels were 11.6. My nephrologist told me I could do peritoneal dialysis, which is easier [than hemodialysis]. I went into the hospital to have a tube

My 36th birthday was October 5. I was always tired. My body ached. I had fevers, heat radiating throughout my body. I would just lie down, sleep. I was on prednisone, which kept me up at night. I had nausea. My weight dropped from 135 to 115.

I was shaking hands with the nurses, tears just ﬂowing. My daughter! Who would take care of her? I was told there was no cure but my cancer was highly treatable. Sounds good, I guess? I ﬂew to Houston to tell my daughter. It was her 15th birthday. It was so hard for her. She was about to move in with me in Maryland, become a high school freshman. I knew it would be tough, but we would get through. I wound up doing chemo for a year. The cancer had affected my kidneys. With treatment, they believed, my kidney function would come back. I didn’t want dialysis. I saw my mom go through that.

March–July 2022 The ﬁrst month was the most difﬁcult. I felt depressed, was moody and angry sometimes. I had survivor’s remorse, felt bad for that 19-year-old. Someone gave a life so you can have a life. I’m relying on my wife again. I don’t like to feel weak; I like to push through. But I am learning to be patient with myself. It’s OK to ask for help. I’m in a much better place now. I was on like 14 different meds, now down to three or four a few times a day. My side effects are more tolerable. Woo-hoo! I know multiple myeloma is a marathon, not a sprint. My myeloma numbers started to rise in April, so I’m back on maintenance oral chemotherapy, but it shouldn’t interfere with my kidney.

January–May 2021 I was in remission! I was home, recovering. In May, I started maintenance oral chemo to prevent a relapse. My hair grew back, now ﬁne and straight. But I was going to need a new kidney. The plan was to rest for a year, then get on the kidney donor list.

I didn’t want to be a burden on my girlfriend. I felt some guilt. It’s so much, let alone for someone I had just met a couple of years before, when I was healthy. Maybe she was putting on a brave face. We got into couples therapy to make sure we were solid. In hindsight, it was all in my head. My multiple myeloma numbers were low enough that I could stop chemo. I was referred for a bone marrow transplant. I got a second and a third opinion, and they all recommended the same thing. My insurance accepted it. I started the medical workup. They injected me with a medicine that ampliﬁes stem cells, which are harvested and frozen to be put back in your body. My girlfriend took me and my daughter out to celebrate my birthday. I wanted salsa lessons. I grew up around salsa because of my mother. I walk in, and they’re playing this song I grew up listening to. I’m dancing already—it’s my jam, right? Then I see all my family there, friends from Houston, her family. After salsa lessons, she gets down on one knee, pulls the ring out. I say, “OMG, yes!”

Cancer is daunting. But you don’t know how strong you are, how much of a badass you are, until you go through it. I bought a house, got married, have a business. I never let any of this stop me. If anything, I have bigger goals now. This too shall pass. Why not get through it by laughing? For more ﬁrst-person essays, go to: cancerhealth.com/stories took me about four months to be back to

September–October 2020

LAWLILIAOFCOURTESYOTHERS)(ALLISTOCK;(PAPER) inserted in my stomach, and they trained me to connect it to a machine at home, eight hours a night.

cancerhealth.com FALL 2022 CancerHealth 15

February 2022 I got the call on Valentine’s Day. They had a donor, a 19-year-old who died in a car accident. We drove to Baltimore the next morning. I hadn’t eaten anything, so they gowned me up. The kidney arrived around 2 p.m. I got a new kidney. I was taken off the chemo to avoid any damage to the new kidney.

November 2020 We signed off on a new house on November 3, got married on November 13. It was the middle of COVID, so it was just my daughter, my mom and my brother in my mother-in-law’s living room—an intimate wedding. It was everything. The next day, my wife drove me to the hospital with my mother. Because of COVID, no one could spend time with me. A bone marrow transplant is super rough on your body. I went into early menopause due to the high-dose IV chemotherapy. And when stem cells multiply, bone marrow increases, but bones don’t stretch, so it’s super painful. I had migraines, throwing up, fevers, infections. My thick curly hair fell out; my face was swollen. The nurses became my family. Even water was difﬁcult to swallow. I was there 17 days. December 2020 I was super underweight, around 114. My wife made smoothies. I drank through a straw. I took a threemonth disability leave. It took me about four months to be back to myself.

Kelly Shanahan, with her daughter, Hunter Turney, and dogs, Gryffindor (left) and Scoopy (right)

When ob-gyn Kelly Shanahan was diagnosed with metastatic breast cancer in 2013, her passion and expertise fueled a new mission.

BY JENNIFER COOK

So in November 2013, on her 53rd birthday, she had both MRI and PET scans, “and lo and behold, I had metastases in every bone in my body.” She had already broken a vertebra—hence her back pain—and her thigh bone was perilously close to breaking. The day after she was diagnosed with metastatic breast cancer (MBC), she recalls, “was the last day I picked up a scalpel, the last day I did surgery.” Six days later, she had a titanium rod inserted in her thigh to keep her leg from breaking.

But doctoring was not to remain Shanahan’s profession; cancer saw to that. She was diagnosed with Stage II breast cancer in 2008 after a mammogram revealed a malignancy in one of her “fibrocystic, lumpy-bumpy breasts,” she says. The diagnosis didn’t shock her, as she has a strong family history of breast cancer—her mother and two aunts as well as other relatives had been diagnosed with the disease.

“The oncologist told me, ‘We don’t need any follow-up. Just report any symptoms.’ Well, five years later, I developed back pain. I sneezed while walking up the stairs and thought I’d pulled a muscle,” she recalls. But it didn’t get better, and an oncologist colleague convinced her that, given her cancer history, she should get scans.

Within hours of her diagnosis, Shanahan was in her oncologist’s office to discuss her prognosis and treatments. She had discovered that the median life expectancy for people with MBC was not quite three years then, maybe not enough time to see her daughter graduate from high school or help her move into her first college dorm, Shanahan recalls now, with a catch in her voice. But her oncologist imparted a crucial message, saying, “I know you know the statistics. You are not a statistic.” That reinforced her resolve to confront the cancer head-on.

“I’ve never been average, ever in my entire life, and, you know, I’m not going to start now,” she recalls thinking.

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f you’re fortunate, work is more than what you do.

To prevent recurrence, Shanahan went on an aromatase inhibitor. But she developed “really bad arthritis-type side effects” in her hands, so she went off it within a year.

It’s your calling. That’s how Kelly Shanahan, MD, 61, felt about delivering babies and performing gynecological surgery as an ob-gyn in South Lake Tahoe, California. She moved there in 1994 to join an ob-gyn practice; in short order, she got married, had a daughter (in 1998) and built a thriving solo practice.

Shanahan opted for a bilateral mastectomy, implant reconstruction and four months of IV chemotherapy. South Lake Tahoe doesn’t have any oncology services or radiation therapy, so if she’d opted for a lumpectomy and radiation, it would have meant seven weeks of long drives for a few minutes of radiation. Being a busy mom influenced her decision; she would drive her 9-year-old to soccer practice, among other activities, and was the primary family breadwinner (her husband is a general contractor, but, as a doctor, she was earning more). “I was back in my office seeing patients within two weeks of surgery,” she says. “I scheduled chemo at the end of the week, so I felt crappy over the weekend, and I was back seeing patients on Monday. I was like, I’m putting cancer behind me. It’s just a bump in the road.” Her practice and family life thrived.

Life-extending targeted therapies known as CDK4/6 inhibitors had not yet been approved, and, although she might have been a candidate for a clinical trial, Shanahan didn’t relish the idea of frequent seven- to eight-hour round-trip drives to San Francisco during winter in snow country, with a painful rod in her leg. Plus, her oncologist claimed it was a last resort she didn’t need. (She now regrets thisSodecision.)shedida “very, very unconventional combination IV chemo—two drugs at a time, two different sets of drugs over 14 months”—followed by a different aromatase. The regimen was successful but left Shanahan with permanent neuropathy in her feet and hands. The numbness made it unsafe for her to continue to see patients. “I might not be able to feel their breast lump,” she explains, “and I might not be able to catch a baby.” In early 2016, she quit practicing medicine.

BREAST CANCER, ROUND TWO

But when she and a radiologist reviewed her previous film, she was surprised to learn that a colleague had missed the cancer on a mammogram two years earlier.

Clockwise from top left: Kelly Shanahan with her oncologist, UCSF’s Hope Rugo, MD, an MBC expert; Duke University oncologist Nicole Kuderer, MD, Kelly Shanahan, Julia Maués and Christine Hodgdon at the first GRASP session in 2019; daughter Hunter Turney, musician Ed Sheeran and Kelly Shanahan at a Do It For The Love foundation event in 2015

Shanahan volunteered for METAvivor—an organization that funds MBC research, raises awareness and supports people with the disease—and became a board member in 2019. She started attending professional meetings, including the international San Antonio Breast Cancer Symposium and the annual meeting of the American Society of Clinical Oncology (ASCO), the world’s largest cancer conference. “I’d just walk up to researchers at the end of their talks and ask them questions,” she recalls. She was finding her voice as a cancer research advocate. She joined Twitter to tweet out conference news. At one ASCO meeting, she walked up to Tatiana Prowell, MD, an oncologist at the Johns Hopkins Kimmel Comprehensive Cancer Center who serves as a breast cancer scientific liaison to the Food and Drug Administration (FDA). They started working together, and Shanahan became an important impetus in the FDA’s push for decentralized clinical trials—“bringing the trial to the people,” she says. When people with cancer can get lab work or imaging tests done locally, for example, it lowers a barrier to participation in clinical trials and can increase the pool—especially among diverse, underrepresented groups—which can help fill studies faster and speed results (see “Easier Clinical Trials,” page 9).

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“Advocacy keeps me occupied, gives me a purpose,” says Shanahan. “I feel as fulfilled as I did as a physician.”

South Lake Tahoe “didn’t have a breast cancer support group until another breast cancer patient and I started one,” she says. She found Facebook groups, attended patient conferences, connected with others who had MBC and volunteered with advocacy organizations. “I found my circle of people,” she says.

Shanahan’s daughter headed off to college. With an empty nest and her doctoring days over, Shanahan felt adrift.

FROM DOCTOR TO ADVOCATE

Hodgdon concurs. “It’s hard to be an advocate because it’s a lot of losses—physical losses as well as losing friends—and not a lot of wins. But Kelly has been able to channel everything she learned as a doctor to be a really, really successful advocate. She’s helped drive positive change in clinical trial design and research projects.” And she’s done it with almost no financial support.

Shanahan became a mentor for GRASP (Guiding Researchers and Advocates to Scientific Partnerships), an organization started by Julia Maués and Christine Hodgdon, two friends who both have MBC, to connect advocates and cancer researchers. While being a doctor helps open some advocacy doors for Shanahan, Maués says, “when she ‘gets in’ she makes the other side realize that she’s there as a patient, with experience in living with MBC, not as an ob-gyn. Her knowledge, passion and personal connection have elevated her as one of the main voices in MBC research advocacy.”

“Most of us who do advocacy, we’re not paid,” Shanahan says. She was fortunate to have received good advice early in her career to get not only life insurance but also longterm disability insurance, “and that pays the bills.” In her first year of conference attendance, she spent $10,000 out of her own pocket. She’s gotten small travel grants for Kelly Shanahan and her daughter are planning a adventuretravelsoon.

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“I did not choose to get breast cancer, and I certainly did not choose to get metastatic breast cancer,” she says. “But every day, I get to choose how I deal with it. And I choose to deal with it with sarcasm and to live my life to the fullest. I always say, ‘I am living with breast cancer.’ And when I get that tilted head, pitying ‘How are you?’ my answer is a very perky, ‘Not dead yet!’ which makes a lot of people uncomfortable—I don’t really care. “I will continue to try to make a difference, to fight for research funding and for laws for health equity. I will continue to remind people that those of us living with metastatic breast cancer and the 44,000 of us who die from it every year in the U.S., we deserve better,” she says. “And hopefully, I’ll leave this world a slightly better place than when I entered it.” ■

cancerhealth.com 2022 conferences and recently received a small honorarium for a virtual cancer presentation. “It pays for the coffee shop bills and the occasional bottle of wine,” she says, “but not much more than that.”

FALL

When Shanahan is asked about how advocacy can move the needle for people with MBC, the first item she mentions is MBC-focused research. Despite the huge levels of funding for breast cancer research, “only 5% to 10% goes toward research that will help people who are actually dying of breast cancer,” she says. “I’m incredibly proud that in 2020, in the midst of the COVID pandemic, METAvivor raised $4.4 million in new research funding, while very large, very pink organizations chose not to fund new research.” In 2021, METAvivor raised over $5 million. Next is bringing the patient voice into the conversation with researchers. “I’ve been a research advocate on projects where they’re proposing a clinical trial and they want to do all these biopsies. And I’m like, ‘Why? Would you let somebody stick a needle in your liver every week?’” With scientists doing basic research, she’ll say, “This sounds like super cool science, but how’s this gonna help a human being?” Then there’s legislation. METAvivor members advocate for MBC with their elected representatives in Washington, DC. One bill, introduced in the House of Representatives in May 2021, that Shanahan hopes to see passed is the Metastatic Breast Cancer Access to Care Act, which would eliminate the current five-month waiting period for Social Security Disability Insurance benefits and the additional 24-month waiting period for Medicare coverage for people with MBC. She herself would have benefited from such a law. “I was self-employed, so I didn’t have some big group insurance plan,” she says. “If I hadn’t had some savings, if I hadn’t had a long-term disability policy, I don’t know what we would have done.”

ANYONE CAN BE AN ADVOCATE Kelly Shanahan believes there’s a place for everyone in advocacy. “The first time you ask your doctor, ‘Why are you recommending this?’ you are being an advocate for yourself,” she says. You just have to think about what comes naturally to you and what you like doing. “If you were that person who ran for town council, legislative advocacy can be your place. If you are always asking why and you’re interested in figuring things out, research advocacy might be right. Are you a computer geek? Many organizations could use some help with web design. If you are the PTA mom or dad and you did all the fundraisers, there’s a place for you in raising money for all sorts of things—support, research and more.”

CancerHealth 21

WHAT PEOPLE WITH MBC NEED

“I’m doing great now,” she says. Currently, she’s planning travel, planning to see people, planning to do things because, “you know, you can’t take it with you,” she says. She recently returned from a longdelayed trip to Europe with a friend with MBC; her husband encouraged her to make it happen. Next, she wants to go to the Galapagos Islands with her daughter.

Shanahan has outlived the statistics: It’s been almost nine years since her MBC diagnosis. For six of those years, she was stable, with no evidence of active disease, on the aromatase inhibitor. That changed last year, when her mother died of COVID on the East Coast and Shanahan had no chance to say goodbye in person—her oncologist strongly advised against travel. The stress, she believes, suppressed her immune system and reactivated her tumors. She went on a CDK4/6 inhibitor along with an estrogen blocker. This time, she had a liquid biopsy and knows her mutations.

DEFYING THE ODDS

Many people ﬁrst heard about messenger RNA (mRNA) when it was used to create highly eﬀective COVID-19 vaccines in 2020. But the technology is hardly new, having been tweaked and optimized by multiple research teams over the past few decades.

It refers to a method for giving cells the instructions to make speciﬁc proteins (see “What Is mRNA?” page 25). As such, mRNA might help prevent infections ranging from inﬂuenza to HIV and treat diseases as diverse as heart disease and multiple sclerosis. But tackling cancer won’t be as easy as taming a respiratory virus.

BY LIZ HIGHLEYMAN

The main application of mRNA technology in oncology is cancer vaccines, which aim to teach the immune system to recognize and attack malignant cells. BioNTech and Moderna, the other COVID vaccine powerhouse, have a pipeline of candidates, as do the German biopharmaceutical company CureVac and several smaller start-ups. Early studies of mRNA vaccines for cancer led to a mix of successes and setbacks. Some good early results involved so-called hot tumors, like melanoma, that have many mutations and attract T cells. BioNTech’s promising melanoma vaccine (BNT111), for example, has advanced to Phase II trials. But researchers hope to treat a broader range of cancers, known as cold tumors, that do not respond as well to immunotherapy. Fortunately, an inﬂux of funding for COVID vaccines has given mRNA cancer research a shot in the arm.

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The technology used to create COVID-19 vaccines may also help fight cancer.

Indeed, BioNTech cofounders Ugur Sahin, MD, PhD, and Özlem Türeci, MD, PhD, a husband-andwife team who met when they were in training as oncologists, have been working on mRNA technology for cancer immunotherapy for more than 20 years. While BioNTech is best known for its successful COVID vaccine (developed in partnership with Pﬁzer), Sahin told STAT News, “We don’t consider ourselves a messenger RNA company. We consider ourselves an immunotherapy company.”

mRNA FOR CANCER VACCINES

A key advance in immunotherapy has been the advent of PD-1 checkpoint inhibitors, monoclonal antibodies that block immune-dampening proteins on T cells. Some tumors can hijack these receptors to turn off T-cell activity; checkpoint inhibitors release the brakes. But these drugs don’t work for everyone, and they are less effective against cold tumors that don’t easily attract T cells. Combining checkpoint blockers with mRNA vaccines could have the effect of letting up on the brakes and stepping on the accelerator at the same time. Some mRNA vaccine candidates contain the code for shared cancer antigens that are frequently expressed on particular types of tumors. Researchers at Duke University, for example, are working on an mRNA vaccine that targets mutations that commonly arise in people with HER2-positive advanced breast cancer. But personalized vaccines that target neoantigens—unique antigens that

cancerhealth.com FALL 2022 CancerHealth 23 ISTOCK

arise as cancer cells mutate—may hold more promise.

One challenge to overcome with cancer vaccines is that, unlike viruses, malignant cells arise from normal human cells, so they may not look “foreign” enough to arouse the immune system.

As Balachandran reported at this year’s American Society of Clinical Oncology (ASCO) annual meeting in June, eight of 16 participants in a Phase I trial who received the individually tailored mRNA vaccines had activated T cells that recognized their cancer. These patients showed delayed recurrence, suggesting that the T cells activated Strands RNAmessengerof(mRNA)

Vinod Balachandran, MD, of Memorial Sloan Kettering Cancer Center (MSKCC) in New York City, and colleagues are working on personalized mRNA vaccines for hard-totreat pancreatic cancer. Their approach involves sequencing a surgically removed tumor and selecting the neoantigens that are most likely to elicit a robust immune response. Tumor samples are sent to BioNTech in Germany to create customized vaccines for each patient (a product dubbed autogene cevumeran, also known as BNT122). Meanwhile, the patients receive the checkpoint inhibitor Tecentriq (atezolizumab). When the vaccine is injected, immune dendritic cells make the neoantigen proteins and train T cells to recognize and attack tumors that express them.

Moderna’s leading mRNA cancer vaccine candidate, dubbed mRNA-4157, can contain up to three dozen different neoantigens. In a small Phase I trial presented at the 2019 ASCO meeting, the vaccine plus the checkpoint inhibitor Keytruda (pembrolizumab) shrank tumors in one third of patients. mRNA-4157 has now advanced to Phase II Anotherstudies.Moderna candidate, mRNA-5671, which targets tumors with common KRAS mutations, is in Phase I. Further back in preclinical development, mRNA-4359 contains code for PD-L1 (the binding partner of the PD-1 checkpoint protein) and IDO (an enzyme that suppresses T-cell activity). The company plans to test it in people with advanced melanoma and non-small-cell lung cancer.

The mRNA technology can also be used to improve response to CAR-T therapy, which currently works better against blood cancers than solid tumors. BioNTech is studying a CAR T-cell product (BNT211) that targets claudin 6, a molecule highly expressed on several types of tumors, plus an mRNA vaccine (CARVac) intended to help the engineered T cells thrive. A small study presented at this year’s American Association for Cancer Research meeting showed that 43% of people treated with the combination experienced tumor shrinkage. While personalized cancer vaccines—like custom-made CAR-T therapy—may be highly effective, they are labor intensive and costly, thereby limiting their use. Off-theshelf mRNA vaccines could offer wider access.

BIONTECHOFCOURTESY 24 CancerHealth FALL 2022 cancerhealth.com by the vaccines are doing their job. Researchers are also studying whether this approach can reduce the risk of colorectal cancer recurrence in people who have undergone surgery and completed chemotherapy. In such patients, the persistent presence of circulating tumor DNA is a warning sign that the cancer could come back. Up to 20 neoantigens from each patient’s resected tumor are selected and used to create a customized mRNA vaccine. The first participant in a Phase II trial was treated last“mRNAOctober.vaccines can be rapidly generated and readily personalized, enabling new innovative vaccine strategies for cancer patients,” says study investigator Scott Kopetz, MD, PhD, of MD Anderson Cancer Center.

Robert Bradley, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, and Omar Abdel-Wahab, MD, of MSKCC, who met when they were Damon Runyon Cancer Research Foundation fellows, have shown that two drugs that disrupt mRNA production can make tumors sprout more neoantigens, making them easier for A laboratory worker receives patient tumor samples at BioNTech’s facility in Germany. The samples are used to create personalized mRNA vaccines that specifically target each patient’s cancer.

Beyond vaccines, mRNA technology can also be used to treat cancer in other ways. One approach being explored aims to stimulate immune responses by inserting code for immune-modulating cytokines directly into tumors, which can turn cold tumors hot. BioNTech’s BNT131 contains code for interleukin 12 (IL-12), interferon-alpha and other immune-boosting proteins. Similarly, Moderna’s mRNA-2752 encodes the pro-inflammatory cytokines IL-23 and IL-36 as well as OX40L, a molecule that enhances the activity of various types of immune cells.

OTHER mRNA APPROACHES

Cancer vaccines deliver instructions for either tumorassociated antigens frequently found on a particular type of tumor, allowing for off-theshelf vaccines, or antigens specific to an individual’s tumor (known as neoantigens), which can be used to create personalized vaccines. mRNA is best thought of as a production platform. Instead of developing each new vaccine from scratch, scientists only need to plug in a different piece of code. This enables the rapid production of new vaccines to target emerging virus variants or evolving cancer cells. What’s more, mRNA vaccines can contain code for multiple targets, which is harder to accomplish with old-school vaccines. But mRNA is not a panacea. The molecules are unstable and fall apart easily. Injected mRNA deteriorates rapidly in the body—not such a drawback for virus vaccines but a problem when dealing with chronic diseases like cancer. One solution may be self-amplifying mRNAs that include code for RNA replication machinery, enabling them to copy themselves.

IsWhatmRNA?

China’s Lion TCR, for example, is using mRNA to give T cells receptors that recognize hepatitis B antigens on liver cancer tumors. Other researchers are using mRNA to modify CAR T cells so they can recognize tumor antigens. And mRNA that encodes tumor-associated antigens can be used to increase antigen presentation by dendritic cells, which activate T cells. On the prevention front, mRNA vaccines could potentially be used to reduce the risk of infection with cancercausing viruses. Highly effective vaccines for human papillomavirus (which causes cervical, anal and oral cancer) and hepatitis B virus (which causes liver cancer) are already available, but hepatitis C virus has proved more elusive. Moderna recently launched a trial of an experimental vaccine for Epstein-Barr virus, which causes lymphoma and throat cancer. More speculatively, researchers at Oregon State University are working on a prophylactic mRNA skin cancer vaccine that increases production of an enzyme that acts as an antioxidant to prevent skin cell damage from ultraviolet radiation.Muchof this may seem like science fiction today, but the advent of mRNA technology opens up a whole new world of possibilities. ■ Messenger RNA (ribonucleic acid) is a piece of genetic code that tells cells how to make proteins. The human genetic blueprint exists in the cell nucleus as double-stranded DNA. In a process known as transcription, a section of this code is copied to an intermediary form, a segment of singlestranded RNA that acts as a template for protein production. This mRNA uses cellular machinery called ribosomes to string together building blocks to form new proteins, a process called coronavirusspikeblueprintsforproteins.thatuseVaccinestranslation.andtherapeuticssyntheticmRNAmoleculesencodethedesiredCOVID-19vaccines,example,delivermRNAformakingtheproteintheSARS-CoV-2usestoentercells.

ISTOCK cancerhealth.com FALL 2022 CancerHealth 25 T cells to spot and possibly more susceptible to checkpointmRNAinhibitors.canbe used as an editing tool to alter immune cells in the laboratory to make them better cancer fighters.

Translation mRNA Protein Transcription DNA

Friends and family wanted us to celebrate after my husband’s surgery. But cancer was a poltergeist living in our house. have been expected. Cancer was not some temporary inconvenience that had disrupted our weekend plans. The diagnosis irretrievably altered our lives. The future that we had envisioned for ourselves was wiped clear in that emergency room, leaving a void of uncertainty.Whatweexperienced in those days after the diagnosis was grief. And we were right to grieve what had been lost. When a loved one dies, grief is expected and acknowledged. It is customary to say, “I am sorry for your loss.” But when someone is diagnosed with a catastrophic illness, we would never consider saying, “I’m sorry for your loss.” Instead, we resort to toxically positive comments like, “You’ve got this!” and “Be strong.”

I AM SORRY FOR YOUR LOSS….

Read more articles about kidney cancer: cancerhealth.com/kidney

LIFE WITH CANCER BY DENA BATTLE BATTLEDENAOFCOURTESY 26 CancerHealth FALL 2022 cancerhealth.com

Society’s failure to acknowledge grief caused by cancer makes it harder for people to move forward and find the strength and resilience that they need. It drags out the process, as patients and caregivers question their normal reaction to trauma and loss.

More than 1.6 million Americans will be diagnosed with cancer this year, and 400,000 people in the world will face the same diagnosis that my husband faced: kidney Experiencescancer.willvary, treatments and management will be different and the outcomes will not all be the same. But the grief and uncertainty brought on by cancer will be felt by all.

In 2009, my husband, Chris, went to the emergency room for suspected appendicitis. But the CT scan didn’t show appendicitis; it showed a massive tumor on his kidney. Nothing could have prepared me for hearing that my seemingly healthy 40-year-old husband had cancer. The diagnosis was earth-shattering.Followingarushed surgery, the medical establishment proclaimed my husband “cured” and encouraged us to celebrate. Friends and family who sustained us in the initial weeks disbanded, content that the crisis was over. But Chris and I did not feel relieved. During the year following his diagnosis, we remained clouded by doubt and uncertainty. Cancer was a poltergeist living in our house, constantly disrupting any return to normalcy. To the people closest to us, our response seemed excessive and worrisome—and that made us feel even more isolated andManyalone.years later, after my husband’s diagnosis and eventual death from cancer, I had a revelation. Reading books about grief and resilience made me realize that our reaction to his initial diagnosis was not misguided. It was exactly what should

To everyone who needs to hear these words today: I am sorry for your loss. You are not alone. ■ Dena Battle is the president and cofounder of KCCure, a kidney cancer advocacy organization (KCCure.org), which originally published a version of this essay. It is republished with permission. Dena Battle

Finding a new normal after a cancer diagnosis is possible. But before we can redraw, revise and reimagine a new and different future, we first must accept that the old normal is no more.

Permission to Grieve

To learn more about bladder cancer and the Bladder Cancer Advocacy Network, please visit bcan.org or call 1-888-901-2226.

include information about: • Prevention • Diagnosis • Treatment • Survivorship • Caregiving • Clinical trials Help

Bladder cancer is among the most commonly diagnosed cancers in the United States, let one of the least known and understood. Yet in 2022, more than 81,000 people will be diagnosed with the disease and more than 17,000 will not survive it. The Bladder Cancer Advocacy Network (BCAN) is a community of patients, caregivers, survivors, advocates, medical and research professionals united in support of people touched by bladder cancer. Each year, we provide thousands of patients, caregivers and the medical community with the educational resources and support services they need to navigate their journeys. Additionally, since 2009, BCAN has funded more than $6 million in bladder cancer research.

BCAN’s free-of-charge bladder cancer resources us defeat bladder cancer by joining us in a 2022 Walk to End Bladder Cancer. Visit bcanwalk.org for details.

A tumor could be growing into a bony region, causing significant discomfort, or into the spinal cord, causing paralysis, or into the brain, where many types of chemotherapy can’t enter. In cases such as these, radiation therapy in a palliative care setting can help alleviate the burden of cancer at these sites, improving quality of life, reducing pain and helping the patient function.regain

The intersection of patient care, science, technology and innovation keeps me invigorated. I greatly value the relationship with patients I form as part of the oncology team. These patients entrust you, literally, with their lives. I’m so grateful that I have the privilege to help patients, to help make the journey feel safer and more secure and to ease their emotional burden. ■

What is radiation therapy? Radiation therapy, or radiotherapy, is the use of various forms of high-energy X-rays to treat cancer and other diseases. It works by damaging the genetic material within cancer cells. Contemporary radiation therapy optimizes delivery to the tumor and minimizes the dose to the nearby normal anatomy.

Gopal K. Bajaj, MD, is a radiation oncologist at Inova Schar Cancer Institute in Fairfax, Virginia.

Approximately 60% of patients with a cancer diagnosis will receive radiation therapy at some point during their treatment. Radiation is often used in the postoperative setting to help improve local control of the cancer, minimize the chance of recurrence and improve survival. It’s also used in place of surgery in certain scenarios where surgery may not be feasible or may be disabling. And it’s often used with chemotherapy for curative purposes for many types of cancer, such as lung and prostate cancers, various types of brain tumors and head and neck cancers.

In most cases, the side effects are limited to the area being radiated. If we’re radiating the lung or the chest, for example, it’s common that patients may get some esophagitis [inflammation that can damage the esophagus]. If we’re radiating the breast, patients may have skin changes or discomfort around the breast area. A few side effects are systemic, similar to chemotherapy, such as fatigue as well as feeling weak. Even if bone marrow is radiated, though, most patients are not at substantial risk for immune suppression. What inspires you in your work?

How often is radiation therapy part of cancer care?

The most common type is external beam radiation from linear accelerators, equipment that allows us to deliver computerized radiation therapy tailored to each patient’s anatomy, prior to each treatment. What are common side effects?

What is the oncologist’sradiationrole?

INSTITUTECANCERSCHARINOVA

Radiation Oncologist saysisRadiationcommon,Bajaj.

The radiation oncologist is the clinical leader of the radiation oncology team. The involvement starts with an initial patient consultation to determine if radiation is needed and, if so, the safest and most effective type. During radiotherapy, the radiation oncologist oversees the patient’s clinical care and toxicity management and continues to follow the patient in the post-therapy surveillance period, both for early and late toxicity management and as part of a multidisciplinary team to monitor tumor control.

When is radiationpalliativetherapyused?

How is typicallyradiationadministered?

Who’s on your team? cancerhealth.com/team

28 CancerHealth FALL 2022 cancerhealth.com YOUR TEAM BY ABBY SAJID

ONLY)PURPOSESILLUSTRATIVEFORUSED(MODELISTOCK cancerhealth.com FALL 2022 CancerHealth 29

FOR ANYONE LIVING WITH CANCER, EXERCISE IS A POWERFUL tool to improve physical function, decrease fatigue, enhance mood and maintain quality of life. These websites provide expert guidance so that you can improve your fitness appropriately and safely.

Exercise RESOURCESBY LAURA SCHMIDT

Discover more resources: cancerhealth.com/resources

American Cancer Society cancer.org

The patient information website run by the American Society of Clinical Oncology, the world’s largest cancer organization, provides expert-written articles on many aspects of fitness. Learn how exercise can reduce the side effects of surgery and treatment, such as fatigue or neuropathy, and improve balance. There are articles about exercise and specific cancers (including prostate, breast and lung), how to start and commit to an exercise program and how to get exercise support. Search under “Exercise.” Cancer TrainingExerciseInstitute thecancerspecialist.com/ user-directory A global leader in oncology exercise since 1995, the Cancer Exercise Training Institute has trained over 15,000 cancer exercise specialists in 50 countries. An easy-to-use global directory helps people locate oncologycertified exercise trainers for their specific needs. The institute also offers a free resource library, which it regularly expands. American College of Sports Medicine acsm.org With more than 50,000 members and certified professionals from 90 countries, the American College of Sports Medicine (ACSM) aims to inspire everyone to be active. The organization recently updated its physical activity guidelines for people with cancer and offers downloadable PDFs, infographics and articles covering, for example, different types of training (strength, aerobic, resistance, etc.) and exercise for cancer prevention and treatment. Search under “Cancer.” MD Anderson Cancer Center mdanderson.org Run by a major cancer research center, MD Anderson Cancer Center answers the why of adding physical activity to your daily routine and offers a sample five-day exercise plan that includes moderate activities, such as aerobic dance classes, bicycling and fast-paced walking. The center suggests gradually building up stamina and offers ways you can stay motivated and achieve the benefits of exercise, including maintaining a healthy weight and supporting healthy digestion. Search under “Physical Activity.” Moving Through Cancer exerciseismedicine.org/eim-inaction/moving-through-cancer/ Moving Through Cancer, run by ACSM, applies evidencebased science and clinical resources to educate people with cancer, their families, health care providers and survivors about the benefits of regular physical activity. Its easily searchable database and directory allow professionals and patients to find trained professionals and programs in their areas—whether in a medical setting, a community-based facility or at home.

The American Cancer Society offers a range of information about exercise before, during and after treatment. These include benefits of regular exercise, such as improved muscle strength, stamina, better sleep and increased appetite. Whether your goal is to become active before treatment or to build strength during recovery, the website provides evidencebased physical activity recommendations for people affected by cancer and offers helpful exercise tips. Search under “Exercise.” American Society of Clinical Oncology cancer.net

Find more products to make life easier: cancerhealth.com/good-stuff

AUTUMN OF CALM

Author Chelsey Gomez survived Hodgkin lymphoma twice—when her daughter was 3 years old and again when she was 4—so she knows how scary it is to talk to kids about cancer. That’s why she wrote Chemotherapy 101 for Kids! An Easy to Understand Guide for Children, a colorful illustrated book series for kids ages 3 to 9. The books are a great resource for children to understand what’s happening with a family member chemo—orundergoingforachildwithcancer.

Former Buddhist monk Andy Puddicombe was already cofounder of the popular guided mindfulness and meditation app Headspace when he was diagnosed with testicular cancer in 2013. Mindfulness meditation helped him cope with the physical, mental and emotional impact of cancer. Research has shown that the practice can help people living with cancer feel calmer, get better sleep, have more energy and experience less physical pain. For $69.99 a year or $12.99 a month, Headspace meditations.beginner-friendlyoffersspace.com)(head-over500

It’s not easy to get the sleep you need when you’re getting cancer treatment, especially when you’re taking chemotherapy medications that interfere with your sleep/wake cycles. With its noisereducing, moisturizing silk that doubles as a headband for nightly skincare routines, the Washable Silk Sleep Mask ($48) by Lunya will help get you to sleep fast no matter the time of day.

Washable Silk Lunya will get you to SCHMIDT

Mindfulness on your phone, gifts that soothe, a book for children, greeting cards that feel right and a necklace that gives back

30 CancerHealth FALL 2022 cancerhealth.com

Em & Friends makes greeting and empathy cards for real shewithdiagnosedDowellerWhenhardincrediblyandgoodlife—thetimesthetimes.found-EmilyMc-wascancer,wasn’t

satisfied with the greetingavailablecards, so she wrote and illustrated her own. Ten years later, she has collaborated with many talented artists to create hundreds of cards, including ones for cancer, empathy and sympathy as well as for mental health ($5 each). “Please let me be the first to punch the next person who tells you everything happens for a reason,” reads one. Another: “No card can make this better. But I’m giving you one anyway.” Beautifully illustrated boxed card sets, journals, sticker packs and more are also available for all occasions. Layered necklaces offer minimalist, effortless style. The Kendra Scott Multi-StrandEmilie Necklace in Rose Quartz ($58; kendrascott.com) also supports breast cancer research. Half of the proceeds up to $150,000 are donated to the Kendra Scott’s Breast Cancer Research Foundation research grant, in honor of Scott’s friend Holley Rothell Kitchen, who died of metastatic breast cancer. The grant currently supports Baylor College of Medicine’s Suzanne A.W. Fuqua, PhD, whose research focuses on metastatic breast cancer. The necklace is also available in silver, gold or rose gold to complement any outfit.

GOOD STUFF BY LAURA

FIND US AT A SMART + STRONG PUBLICATION Award-winning consumer health care information • A daily resource for people living with and affected by cancer • Clear, comprehensive prevention and treatment information • News, personal stories, blogs, cancer-speciﬁc resources and more • Sign up online to receive free treatment and lifestyle email newsletters Follow us on: CancerHealth.com TM

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Solution: Spice it up. Try hot sauce and spices such as cayenne or cumin. Salting your food at the table will help bring flavors forward so you can taste them again. Don’t stop until flavors show up.

Problem: Foods and water have a metallic or bitter taste.

LimeAppleStrawberry,FreshandJuice. This Jacobs,survivorfromrecipe,cancerHollyeisassimple as it gets: Add 2 ½ cups of fresh strawberries (stems removed, cut in half), 1 apple (peeled and cored and cut into large pieces), the juice of 1 lime and 1 cup of water to a blender. Makes one serving.

Solution: Try adding a sweetener such as maple syrup, acids such as lemon or lime or your favorite vinegar to foods on the plate. And squeezing a little lemon or lime into a glass of water cuts through metallic taste to help you hydrated.stay

Problem: Foods taste overly sweet or overly salty.

TASTE CHANGES, A COMMON SIDE EFFECT FOR PEOPLE WHO RECEIVE CHEMOTHERAPY AS A cancer treatment, can make it challenging to consume enough food to maintain weight and muscle mass. These changes can linger up to a year after treatment is complete. But with a few simple kitchen tricks, you can return to enjoying food again. Try these tips and recipes from Cook for Your Life (cookforyourlife.org), a Fred Hutch nutrition and culinary website geared toward people touched by cancer that features recipes for people at high risk of developing cancer, people undergoing treatment and people supporting those in survivorship. Recipes are used with permission—©2022 Cook for Your Life, a 501(c)(3) nonprofit organization.

Making Food Taste Good Again

Solution: Lemon or lime juice or vinegar can help balance overly sweet tastes, and lemon or lime juice can also help with overly salty tastes. In addition, miso, with its rich umami flavor, makes many foods taste better.

Problem: Foods taste bland, “like cardboard.”

Miso Lime Sauce. This recipe is excellent with crunchy steamed vegetables, poultry or tofu. In a small saucepan, sugarsherry,tablespoonswhitetablespoonstogetherwhisk2miso,2dry1teaspoonand1teaspoon soy sauce. Then whisk in 1 to 2 tablespoons of freshly squeezed lime juice—a teaspoon at a time to taste. Heat through until it almost boils; if the sauce is stiff, add a little water. Spoon the sauce over food. Eat immediately!

32 CancerHealth FALL 2022 cancerhealth.com

Southern Spiced Popcorn. Pop ½ cup of popcorn kernels with 3 medium-highcoconutspoonstable-ofoiloverheat in a covered large saucepot; shake continuously until the popping slows down. Remove from heat, empty into a bowl and sprinkle with 1 teaspoon kosher salt, ½ teaspoon cayenne pepper, ½ teaspoon Old Bay seasoning and ½ teaspoon smoked paprika. Makes 8 servings. Cancer treatments, especially chemotherapy, can make some foods taste metallic, bitter, sweet, salty or bland. These kitchen tricks can help.

SOLUTIONS BY COOK FOR YOUR LIFE

ISTOCK SURVEY Whether you are in treatment or in recovery or are a long-term survivor, it’s a good idea to talk with your doctor about how to take care of your physical, emotional, social and spiritual needs. Take our survey and let Cancer Health know how you promote wellness in your life. How often do you exercise? ❑ Every day ❑ Several times a week ❑ Once a week ❑ I don’t exercise regularly. Do you maintain a healthy and balanced diet? ❑ Yes ❑ No Do you get enough sleep each night? ❑ Yes ❑ No Do you smoke cigarettes? ❑ Yes ❑ No How often do you drink alcohol? ❑ Frequently ❑ Rarely ❑ Occasionally ❑ I don’t drink alcohol. Do you regularly take time to unwind and relax? ❑ Yes ❑ No How often do you feel stressed? ❑ Frequently ❑ Occasionally ❑ Rarely Do you find healthy ways to manage your stress? ❑ Yes ❑ No Do you have a good support network? ❑ Yes ❑ No Do you participate in any support groups? ❑ Yes ❑ No Do you get any wellness support from your health care team? ❑ Yes ❑ No Do you regularly find ways to stimulate and challenge yourself mentally? ❑ Yes ❑ No Do you have a faith or spiritual practice that is important to you? ❑ Yes ❑ No What year were you born? What is your gender? ❑ Male ❑ Female ❑ Transgender ❑ Other What is your current level of education? ❑ Some high school ❑ High school graduate ❑ Some college ❑ Bachelor’s degree or higher What is your annual household income? ❑ Less than $15,000 ❑ $15,000–$34,999 ❑ $35,000–$49,999 ❑ $50,000–$74,999 ❑ $75,000–$99,999 ❑ $100,000 or more What is your ethnicity? (Check all that apply.) ❑ American Indian/Alaska Native ❑ Arab/Middle Eastern ❑ Asian ❑ Black/African American ❑ Hispanic/Latino ❑ Native Hawaiian/Pacific Islander ❑ White ❑ Other ___________________________ What is your ZIP code? YOUR WELLNESS PLAN Scan this QR code with your smartphone to take this survey at cancerhealth.com/surveys. Or email a photo of your completed survey to website@cancerhealth.com.