5HDGWKHƓUVW person stories of people who are living with cancer, including personal diaries and honest, moving essays. cancerhealth.com/stories
Basics
Whether you’re newly diagnosed or a long-term survivor, check out our Basics section on cancer treatment, how to manage side effects and more. cancerhealth.com/basics
Science News
Learn about the latest treatment and prevention advances, cure research and conference news. cancerhealth.com/science-news
Cancer Health Digital
Scan the QR code (left) with your smartphone to check out the digital issue of Cancer Health online, or go to cancerhealth.com/digital to read past issues and the entire Smart + Strong digital library.
16 CULTIVATING A TRIPLE-POSITIVE OUTLOOK
Malkia Mann was diagnosed with triple-negative breast cancer. Her secret weapon: not letting it get her down. BY JENNIFER COOK
22 LET’S TALK ABOUT SEX
Cancer can change your sex life, but patients and survivors can take steps to improve their sexual well-being. BY LIZ
2 From the Editor
Why Not Me?
4 News
Start breast cancer screening at age 40? | reduce your risk factors | lymphoma & laughs with Hank Green | Gen X reality bites
6 Care & Treatment
Enhertu for HER2-ultralow breast cancer | telehealth palliative care | weight-loss drugs may prevent 10 types of cancer | “unprecedented” news for ALK-positive lung cancer
8 Voices
'DQ=HOOHURQFRQŴLFWLQJDGYLFH
10 A Leukemia Diary
Vietnam vet Bruce Wright has CLL.
HIGHLEYMAN
15 Basics Preventing liver cancer
26 Can Heal
A Fatal Inheritance author Lawrence Ingrassia on family loss and hope
28 Your Team
A go-to for precision medicine
29 Resources Liver cancer organizations
30 Solutions
Money tight? Send out an SOS.
32 Good Stuff Products that ease the mind
33 Reader Survey
Does cancer affect your intimacy?
Malkia Mann supports breast cancer survivors in San Francisco.
Why Not Me?
AS THE EDITOR OF CANCER HEALTH,
I have been asked, often privately and in hushed tones, whether my job can be depressing. It’s a convenient setup for me to extol the inspiring SHRSOHDQGVFLHQWLƓFDGYDQFHPHQWV ZHSURƓOHLQHDFKLVVXH$QG\HW,GR understand where the question comes from. We all face illness, pain and loss. 1RRQHOLYHVIRUHYHU6RPHƓQGWKHVH truths to be deeply upsetting. Others accept them while focusing on joy, beauty and hope. Some ask, “Why me?” Others, “Why not me?”
The features in our fall 2024 issue will motivate you to see life’s proverbial glass as half full. Lawrence Ingrassia lost his mother, two sisters, a brother and a nephew—most at young ages— to various cancers caused by what is now understood to be a rare genetic mutation. He documents both the heartbreaking loss and the lifesaving VFLHQWLƓFDFKLHYHPHQWVLQ A Fatal Inheritance. “Life brings us all sorts RIGLIƓFXOWWKLQJVDQGKDSS\WKLQJVŐ Ingrassia points out in our latest Can Heal column on page 26. “I do try to remind myself how fortunate I and my family have been.”
Malkia Mann, who has metastatic breast cancer and is featured on our cover, exudes an infectious lifeDIƓUPLQJDWWLWXGH7XUQWRSDJH to learn how her family, faith and a sisterhood of young survivors help boost her spirits.
Vietnam veteran Bruce Wright, a prostate cancer survivor living with chronic lymphocytic leukemia, uses his experience to advise others. “I love
it when I hear back from a veteran who has treatment success,” Wright shares in this issue’s Cancer Diary on page 10, adding that he’s helped over 100 veterans so far.
In our story about sexual health on page 22, Don Dizon, MD, and Annie Sprinkle, PhD, note that many patients and doctors don’t bring up sexual issues for fear of making one another uncomfortable. Thankfully, these advocates are sparking discussions and leading the way to wellness.
As these stories prove, it’s better to choose education, empowerment, health and hope.
Despite updated guidelines, many women prefer to wait until they’re 50. Here’s why.
Women at average risk for breast cancer should begin mammogram screening at age 40 instead of 50, according to updated guidelines issued earlier this year by the U.S. Preventive Services Task Force (USPSTF).
Previous guidelines were issued in 2016. Since then, the task force has reviewed more current medical data. It gave the updated recommendation a
A Second Opinion
Other breast cancer screening guidelines
• The American Cancer Society recommends that women ages 45 to 55 should receive mammograms every year, women 55 and older should do so every other year and women ages 40 to 44 should have the option to screen.
• The National Comprehensive Cancer Network recommends annual mammograms for averagerisk women ages 40 and older and suggests that women begin assessing their risk for breast cancer risk as early as age 25.
• The American College of Radiology recommends annual mammograms starting at age 40, earlier screening for women at higher risk and supplemental screening for those with dense breasts.
B grade, meaning there is “high FHUWDLQW\WKDWWKHQHWEHQHƓWLV moderate or there is moderate FHUWDLQW\WKDWWKHQHWEHQHƓWLV moderate to substantial.” USPSTF recommendations carry weight because the Affordable Care Act (ACA, or Obamacare) requires health insurance plans to cover preventive health care services that have received an A or B grade from the task force.
The updated guidelines spurred an ongoing discussion about whether too much breast cancer screening can be detrimental, especially because screening people at low risk may lead to false positives, unneeded biopsies and unnecessary treatment of slow-growing tumors that would have remained harmless—not to mention extra costs, time and anxiety.
A study published this summer in the Annals of Internal Medicine makes the case for educating women about the pros and cons of breast cancer screening instead of recommending that all women get mammograms starting at age 40.
The study, which included women ages 39 to 49, found that when participants were informed of the potential EHQHƓWVDQGKDUPVRI
mammograms, many preferred to GHOD\VFUHHQLQJ$WƓUVWRQO\ of the women surveyed said they wanted to wait until they turned 50 to get a mammogram, but once they were informed of the QXDQFHVRIVFUHHQLQJVDLG they preferred to wait until 50.
“They had rational, logical reasons for their preferences,” lead author of the study, Laura Scherer, PhD, a social psychologist at the University of Colorado School of Medicine, told STAT News. “Women who wanted to screen earlier, they had higher risk, like a family history, and were less concerned about the downsides.”
Reduce Your Risk Factors
40% of cancer cases are OLQNHGWRPRGLILDEOHFDXVHV
Four out of 10 cancer diagnoses and half of cancer deaths of adults 30 and older in the United States DUHOLQNHGWRPRGLƓDEOHULVN factors, according to a new study E\WKH$PHULFDQ&DQFHU6RFLHW\
Such factors include cigarette smoking, alcohol consumption, H[FHVVERG\ZHLJKWODFNRISK\VLFDO activity, consumption of red meat, exposure to ultraviolet radiation and infection with human papilloPDYLUXV +39 RUKHSDWLWLV%
Researchers found that smoking SOD\HGDQRXWVL]HUROHFRQWULEXWLQJ to 56% of all potentially preventDEOHFDQFHUVLQPHQ RXW of 368,600 cases) and 40% in ZRPHQ RI 6LPLlarly, 100% of cervical cancer cases
ZHUHOLQNHGWRPRGLƓDEOHULVN factors (in this case, HPV, which FDQEHSUHYHQWHGZLWKDYDFFLQH ,QDVWXG\E\WKH:RUOG+HDOWK 2UJDQL]DWLRQ :+2 GDWDIURP VKRZHGWKDWRIDGXOWV worldwide didn’t get the recommended daily amount of physical DFWLYLW\7KLVLVDLQFUHDVHIURP 7KH:+2UHFRPPHQGVWKDW adults exercise at moderate intensity for 150 minutes or at vigorous LQWHQVLW\IRUPLQXWHVSHUZHHN $ODFNRISK\VLFDODFWLYLW\LVOLQNHG to a greater risk for cancers—notaEO\EUHDVWDQGFRORQFDQFHUŋDV ZHOODVW\SHGLDEHWHVGHPHQWLD and cardiovascular events such as VWURNHVDQGKHDUWDWWDFNV
Hank Green
When popular YouTube math and science educator Hank Green was diagnosed with Hodgkin lymphoma last year at age 43, he shared the news with his fans, raising awareness about the treatable blood cancer. Educating people about cancer, you might think, is in his wheelhouse. Now he’s doing something new: a standup comedy special, Pissing Out Cancer, that, er, streams on Dropout. (The show’s title refers to the fact that chemotherapy breaks down tumor cells, which exit the body through urine.)
In the special—and in his many related YouTube posts—Green, who is now in remission, divulges the good, bad and weird aspects of having cancer. “It’s hard to make pain funny. It’s hard to make fatigue funny,” he acknowledged to STAT News. “This whole show has been about me, but actually, the whole show is about humans and the experience of being human: a weird jumble of cells that’s experiencing the universe.”
GEN X REALITY BITES LYMPHOMA & LAUGHS
Americans born between 1965 and 1980—known as Generation X—are more likely to be diagnosed with cancer compared to the baby boomers (born between 1946 to 1964) who preceded them, according to a new study by the National Cancer Institute (NCI).
The oldest Gen Xers will begin turning 60 next year. Despite decreases in certain cancers, notably lung and cervical cancers, in recent decades, other malignancies are on the rise in younger people. The study’s projections found increases in kidney, thyroid, colon and rectal cancer and in leukemia in men and women. The study also projected increases in ovarian, uterine and pancreatic cancers and non-Hodgkin lymphoma in women. In men, the study projected an increase in prostate cancer. However, the study did not turn up any answers as to why Gen Xers are seeing an increase. “Our study can’t speak to any particular cause,” lead study author Philip Rosenberg, PhD, a senior investigator at NCI, told NPR. “It gives you bootson-the-ground intelligence about what is happening. That’s where you go and look for clues about causes.”
Enhertu for HER2-Ultralow Breast Cancer
Enhertu (fam-trastuzumab deruxtecan), previously approved for the treatment of metastatic breast cancer with high or low HER2 expression, also works for women with ultralow HER2 levels.
Around 15% of breast cancer has a high level of HER2, a receptor for a protein that promotes cell growth. But some RISHRSOHWUDGLWLRQDOO\FODVVLƓHGDV HER2-negative actually have some HER2 receptors— a group now considered HER2-low—and around 25% have HER2-ultralow tumors.
Enhertu is an antibody-drug conjugate that uses a monoclonal antibody (purple in image) to deliver toxic chemotherapy (orange) directly to tumors. The DESTINY-Breast06 trial enrolled previously treated patients with hormone receptor–positive metastatic breast cancer who once would have
EHHQFODVVLƓHGDV+(5QHJDWLYH7KHVWXG\ included 713 people with HER2-low tumors (a score of +1 or +2) and 153 with HER2-ultralow tumors (0 but detectable).
Enhertu extended progression-free VXUYLYDOE\ƓYHPRQWKVFRPSDUHGZLWK standard chemotherapy (about 13 versus 8 months), reducing the risk of disease progression or death by 37% overall and by 22% in the HER2-ultralow group. Nine people with HER2-low tumors and four with HER2-ultralow tumors experienced complete remission.
These results “represent a potential shift in how we classify and treat metastatic breast cancer,” says lead investigator Giuseppe Curigliano, MD, PhD, of the University of Milan. “Enhertu could become a new standard of care” for patients with HER2-low and HER2-ultralow tumors.
Telehealth Palliative Care Helps People Living With Advanced Cancer
Virtual palliative care can be as effective as in-person care, according to a recent study. Oncology palliative care is intended to relieve symptoms and improve quality of life. It is not the same as hospice care, and it can help people at any stage of cancer. National guidelines recommend integrating palliative care from the time of
diagnosis for people with advanced cancer, but it is underutilized in part due to a shortage of trained providers.
This study included 1,250 adults at 22 U.S. cancer centers who were diagnosed with advanced non-small-cell lung cancer. They had palliative care sessions every four weeks conducted either via video or in person.
After six months, quality-of-life scores were equivalent in the two groups. They also did not differ VLJQLƓFDQWO\LQWHUPVRIGHSUHVsion or anxiety, coping skills, understanding treatment goals or perception of their prognosis.
The study started before the COVID-19 pandemic, and some
people were hesitant about telehealth due to unfamiliarity or discomfort with the technology. But many later did not want to go back to in-person visits, citing JUHDWHUFRQYHQLHQFHŴH[LEOH scheduling and less transportation time and cost. Telehealth can also facilitate involvement of family members and caregivers. But patients with auditory or YLVXDOLPSDLUPHQWPLJKWEHQHƓW more from in-person care.
“Telehealth has the potential to substantially reduce burden on patients, clinicians and health care resources while maintaining quality care,” says lead investigator Joseph Greer, PhD, of Massachusetts General Hospital.
WEIGHT-LOSS DRUGS MAY PREVENT 10 TYPES OF CANCER
People with type 2 diabetes who used glucagon-like peptide (GLP-1) receptor agonists—the drug class that includes Ozempic (semaglutide)—had a lower risk for multiple types of cancer, according to a recent study.
Overweight and obesity have been linked to at least 13 different cancers. GLP-1 analogs stimulate insulin production, regulate appetite and slow emptying of the stomach; they also have DQWLLQŴDPPDWRU\SURSHUWLHV2ULJLQDOO\GHYHORSHG WRWUHDWGLDEHWHVWKH\KDYHRWKHUEHQHƓWVLQFOXGing weight loss and reduced cardiovascular risk.
Researchers at Case Western Reserve University looked at electronic health records from over 60 health care organizations to compare the incidence of 13 obesity-associated malignancies among more than 1,650,000 people who were prescribed GLP-1 agonists or other diabetes medications between 2005 and 2018.
People who used GLP-1 agoQLVWVKDGDVLJQLƓFDQWO\ORZHUULVNIRU of the 13 malignancies compared with insulin recipients. For example, gallbladder cancer was reduced by 65%, liver cancer by 53%, ovarian cancer by 48% and colorectal cancer by 46%.
The magnitude of risk reduction was similar to that observed for bariatric surgery or intensive lifestyle interventions involving diet and exercise. However, */3DJRQLVWVGLGQRWVLJQLƓFDQWO\UHGXFHWKHULVN for any type of cancer when compared with metIRUPLQZKLFKDOVRKDVDQWLLQŴDPPDWRU\HIIHFWV and has been linked to lower cancer risk.
The potential cancer-preventive effects of GLP-1 agonists “warrant further long-term studies,” and the drugs also should be evaluated for secondary prevention to delay cancer recurrence, the study authors suggested.
“Unprecedented” Progression-Free Survival for ALK-Positive Lung Cancer
First-line treatment with Lorbrena (lorlatinib) delayed disease proJUHVVLRQDWƓYH\HDUVLQPRUH than half of people with ALKpositive metastatic non-small-cell lung cancer (NSCLC)—the longest progression-free survival ever reported for this type of cancer. Lorbrena is a next-generation targeted therapy that interferes with ALK, a protein that plays a role in cell growth. Around 5% of people with NSCLC have ALKpositive tumors. Lorbrena was granted accelerated approval in 2018 and full approval in 2021. The Phase III CROWN trial enrolled 296 patients with previ-
For more care and treatment news: cancerhealth.com/science-news
ously untreated Stage IIIb or IV ALK-positive NSCLC. They were randomly assigned to receive either oral Lorbrena once daily or the older ALK inhibitor Xalkori (crizotinib) twice daily.
In 2020, researchers reported that 78% of Lorbrena recipients were still alive without disease progression at one year, compared with 39% in the Xalkori group. Many participants were still doing well, so follow-up FRQWLQXHG$IWHUƓYH\HDUV progression-free survival rates were 60% versus 8%, respectively. The median progressionfree survival time was 9.1 months
in the Xalkori group but still has not been reached in the Lorbrena group. Lorbrena recipients had an 81% lower risk of disease progression or death and a 94% lower rate of disease progression in the brain. However, overall survival—the gold VWDQGDUGIRUFOLQLFDOEHQHƓWŋ has not yet been reported. These results “represent an unprecedented outcome for patients with advanced ALKpositive NSCLC and set a new benchmark for targeted therapies in cancer,” according to the study investigators.
Conflicting Treatment Advice
Blogger Dan Zeller shares his thoughts on the often opposing treatment guidance he has received during his ongoing experience with prostate cancer.
WHEN YOU’RE FIRST DIAGNOSED with cancer, no one tells you how PXFKFRQŴLFWLQJLQIRUPDWLRQDQG JXLGDQFH\RXZLOOHQFRXQWHUDQGKRZ we, as laypeople, will be put in the XQFRPIRUWDEOHSRVLWLRQRIKDYLQJWR VRUWWKURXJKWKHVHGLIIHUHQFHVZKHQ PDNLQJWUHDWPHQWGHFLVLRQV,I\RXōUH VRPHRQHOLNHPHŋ,VSHQWPXFKRI P\FDUHHULQGDWDGULYHQƓHOGVZKHUH PDQ\GHFLVLRQVZHUHEODFNDQGZKLWHŋ WKLVFDQEHHVSHFLDOO\IUXVWUDWLQJDQG DQ[LHW\LQGXFLQJ
My medical oncologist said she would start hormone therapy when my PSA reached 2.0 ng/mL; my urologist would start it when there were signs of metastases. On top of that, both specialists talked about the choice of mono versus combination therapies administered continuously or intermittently. Again, when the time comes, I’ll be expected to pick which expert’s approach I believe will be most effective. The easy solution would be to forgo any research and just do what the doctor says. But I have found that being an educated,
engaged patient has allowed me to have frank discussions with my doctors during which I can call out and better understand the differing approaches to my treatment. It also helped me understand that very little is blackand-white in cancer treatment.
The most important thing that I’ve learned throughout this 14-year cancer experience is that you should take the medical professionals’ advice, combine it with the knowledge you’ve acquired through your own research and make treatment decisions based on your goals
with the best information you have available at the time. Decide what is right for you, and, once you make that decision, don’t look back. Q
Dan Zeller has been blogging about his prostate cancer experiences since he was diagnosed in 2010. You can read more of his observations and insights on DansJourney.com.
A Leukemia Diary
Bruce Wright, 79, a Vietnam veteran who lives with his wife in Ladera Ranch, California, discovered in 2009 that he had both chronic lymphocytic leukemia (CLL) and prostate cancer.
April 1968
After I graduated from the U.S. Naval Academy in P\ƓUVWFRPPLVVLRQZDVRQWKH866Turner JoyDGHVWUR\HUWKDWFKRSSHGLQWR9LHWQDP,Q $SULO ZHZHQWLQWR'D1DQJ+DUERUDQG VSHQWDGD\DVKRUHZDONLQJDURXQGGLQLQJZLWK WKH0DULQHV:HGUDQNGLVWLOOHGZDWHUZKLFKZH ODWHUIRXQGKDG$JHQW2UDQJHLQLW:HGLGQōW NQRZDQ\WKLQJDERXWLWVGDQJHUV
August 2011 ,KDGEUDFK\WKHUDS\>LQWHUQDOUDGLDWLRQ@IRUWKH SURVWDWHFDQFHUŋLWZDVLQWKHJODQGRQO\ŋWKHGD\
after I retired. They implanted radioactive seeds in the prostate in an outpatient procedure. Recovery was six to nine months. It felt like I was peeing razor blades. But then the side effects went away. I currently get my PSA FKHFNHGDQG,ōPGRLQJƓQH
*RRJOHWROGPH,KDGƓYH\HDUVWROLYHZLWK
CLL. I was scared. At the time, the only treatment was chemotherapy. I joined a bulletin board group on the web and started getting information.
One day, I got a message from Terry Evans. He [mentioned] starting a CLL support group and asked if I was interested in joining. I said, “Yes, of course.” It was informal, in people’s living rooms. We would meet face-toface and share information, support each other. I started meeting other veterans who had CLL and helping them through the VA process so they could get beneƓWVWKH\KDGHDUQHGE\ serving our country.
2012–2013
January–August 2014
My VA doc tested me regularly. The CLL support group introduced us to specialists. My wife and I were on a journey to learn everything about CLL.
My VA doctor told me my spleen was getting bigger, white blood cell count up, red blood cells starting to go down. I was getting fatigued too. From the bulletin board group, I learned
That support group eventually became the CLL Society. It was founded by Dr. Brian .RIIPDQ,WZDVWKHƓUVWSODFHZKHUH,IRXQGUHDO grounded informative data to help me make a decision. I learned that there were new treatments coming down the pike, real 21st-century medicine.
that a well-known doctor, a CLL specialist, was putting on a forum in San Diego. That was Dr. Thomas Kipps. It was early in 2014. My wife and I went. She went up to him. He wasn’t taking new patients, but she asked if he would be so kind as to take me on. He said, “Have Bruce call my nurse and tell her he is my patient.”
By late summer, after a bone marrow biopsy, Dr. Kipps told me that I needed to get into treatment soon. I was in freefall—my bone marrow was 90% occluded by “bad” white blood cells. My red blood cell, white blood cell and platelet factory was about to shut down. He was going to try a new medicine, a third-generation monoclonal antibody.
September–December 2014
But my white blood cell count was so high that debris from the treatment, when the white blood cells are destroyed, would be toxic. We needed WRJHWP\ZKLWHEORRGFHOOFRXQWGRZQƓUVW7KH\ did apheresis—they take your blood out and run LWWKURXJKDFHQWULIXJH7KDWZDVƓYHKRXUVLQWKH chair, no drinking, can’t eat anything, no bathroom. My numbers shot back up again within a
From left: Bruce Wright near North Vietnam in 1971 and ’68. He flew F-4s in the war.
few days, so they had to repeat it. Four days later, they put me on that drug. That was September.
The monoclonal antibody had been studied with a chemotherapy drug, but my doctor wanted to see what it could do on its own because that was easier on the body. That was a six-month SURWRFRO ƓUVWZHHNO\WKHQHYHU\WZRZHHNVWKHQ PRQWKO\'XULQJWKHƓUVWLQIXVLRQZLWKLQPLQutes, I couldn’t breathe, so they stopped it. They ODWHUWLWUDWHGLWPRUHVORZO\DQGLWZDVƓQH,KDG no side effects from the treatment itself. He’s a wonderful doctor. I owe my life to him.
0\ZLIHDQG,HYHQZHQWRQDGD\3ULQFHVV cruise from Quebec to Fort Lauderdale in between PRQWKO\LQIXVLRQV,MXVWWRRNDQDQWLELRWLFSDFNHW with me in case I got an infection, since CLL compromises your immune system.
February 2015–July 2022 ,ƓQLVKHGWUHDWPHQWLQ)HEUXDU\RI,ZDV in remission. On our way home, my wife and I VWRSSHGDW0LJXHOōV&RFLQDRXUIDYRULWH0H[LFDQ UHVWDXUDQWXSE\3DORPDU,JREDFNWR'U.LSSV HYHU\VL[PRQWKV%HFDXVH\RXNQRZ&//DOZD\V FRPHVEDFN
I became a group facilitator with the CLL Society. ,JDYHWDONVLQ%RVWRQ1HZ2UOHDQV&OHYHODQG 3KLODGHOSKLD/RQJ,VODQG>1HZ<RUN@'HQYHU, recruited doctors too. I told anyone who contacted PHWKDW>LWōVQRWSRVVLEOHWR@HPDLOPHWRRPXFKRU
AGENT ORANGE AND CANCER
Agent Orange was a defoliant used by the U.S. military during the Vietnam War from 1962 to 1971. Exposure to the herbicide has been shown to increase
one’s risk for many cancers and other diseases. In 1991, Congress passed the Agent Orange Act, which maintains that anyone who “set foot” in Vietnam from 1962 through 1975 is assumed to have been exposed and should have all care paid for by the U.S.
call too much, or text too much. Empower yourself, NQRZ\RXUQXPEHUVQHYHUVWRSDVNLQJTXHVWLRQV
August 2022–January 2023
0\QXPEHUVZHUHXS'U.LSSVVWDUWHGPHRQWKH same six-month monoclonal antibody protocol, ZKLFKEURXJKWP\ZKLWHEORRGFHOOVWRQRUPDOOHYHOV After each infusion, my wife and I went to Miguel’s.
February 2023–September 2024
,IHHOJRRG,ōPDOPRVWVRDOLWWOHVORZHU0\ QXPEHUVDUHFRPLQJXSDJDLQEXWQRWOLNHEHIRUH VR'U.LSSVVD\V,ōPGRLQJ2.,ōPFKDLURIWKH &//6RFLHW\3DWLHQW$GYLVRU\%RDUGDVHQLRUVXSSRUW JURXSDGYLVHUUHVSRQVLEOHIRUJURXSVDQGD YHWHUDQVOLDLVRQ,ORYHLWZKHQ,KHDUEDFNIURPD YHWHUDQZKRKDVWUHDWPHQWVXFFHVV,GRP\KDSS\ GDQFH,ōYHKHOSHGYHWHUDQVUHFHLYHWKHLUMXVW FRPSHQVDWLRQIRUKDYLQJVHUYHGRXUFRXQWU\ ,ōPWKHFDUHJLYHUIRUP\ZLIHQRZZKRJHWVGLDO\VLVDWKRPHIRUNLGQH\IDLOXUH,KDYHKLJKEORRG SUHVVXUHSLORWōVQHFN IURPWKHYHUWHEUDHLQP\ QHFNWKDWDUHFRPSUHVVHGIURPŴ\LQJ DQGSLQFKHG QHUYHVLQP\OHIWDUPDQGKDQG,KDYHWLQQLWXVZHDU KHDULQJDLGV,KDYH376'DQGUHVLGXDOHIIHFWVIURP SURVWDWHFDQFHUWUHDWPHQW%XW\RXNQRZZHWRRN EDWWOHGDPDJH,FRXOGKDYHGLHGƓYHWLPHVLQ 9LHWQDP/LIHLVZRUNLQJRXW2.,KDYHQRWORVWP\ sense of humor or my religion. As the saying goes, I don’t let the old man in.
government. Those cancers include B-cell leukemias (including CLL), bladder cancer, Hodgkin lymphoma and non-Hodgkin lymphoma, multiple myeloma, prostate cancer, respiratory cancers (including lung cancer) and some soft tissue sarcomas.
IF YOU HAVE CLL, LET CALQUENCE
Not an actual patient.
Important Product Information
AND YOU CAN FOCUS ON THE THINGS YOU’RE LOVING.
CALQUENCE is a prescription oral treatment for adults with chronic lymphocytic leukemia or small lymphocytic lymphoma. May cause serious side effects including: serious infections, bleeding problems, decrease in blood cell count, new cancers, heart rhythm problems, and liver problems. Some may lead to GHDWK7HOO\RXUGRFWRULI\RXH[SHULHQFHLQIHFWLRQVVXFKDVŴXOLNHV\PSWRPV XQH[SHFWHGEOHHGLQJVXFK DVEORRGLQ\RXUVWRRORUXULQH KHDUWUK\WKPSUREOHPVVXFKDVIDVWRULUUHJXODUKHDUWEHDW RUOLYHUSUREOHPV such as stomach pain, dark urine or yellowing of your skin. Use sun protection when outside.
Please read Brief Summary of Prescribing Information on adjacent page.
You are encouraged to report the negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088
• CALQUENCE is a prescription medicine used to treat adults with: chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).
It is not known if CALQUENCE is safe and effective in children.
Before taking CALQUENCE, tell your healthcare provider about all of your medical conditions, including if you:
• have had recent surgery or plan to have surgery. Your healthcare provider may stop CALQUENCE for any planned medical, surgical, or dental procedure.
• have bleeding problems.
• have or had heart rhythm problems.
• have an infection.
• have or had liver problems, including hepatitis B virus (HBV) infection.
• are pregnant or plan to become pregnant. CALQUENCE may harm your unborn baby and cause problems during childbirth (dystocia).
° If you are able to become pregnant, your healthcare provider may do a pregnancy test before you start treatment with CALQUENCE
° Females who are able to become pregnant should use effective birth control (contraception) during treatment with CALQUENCE and for 1 week after the last dose of CALQUENCE.
• are breastfeeding or plan to breastfeed. It is not known if CALQUENCE passes into your breast milk. Do not breastfeed during treatment with CALQUENCE and for 2 weeks after your last dose of CALQUENCE.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking CALQUENCE with certain other medications may affect how CALQUENCE works and can cause side effects. Especially tell your healthcare provider if you take a blood thinner medicine.
How should I take CALQUENCE?
• Take CALQUENCE exactly as your healthcare provider tells you to take it.
• Do not change your dose or stop taking CALQUENCE unless your healthcare provider tells you to.
• Your healthcare provider may tell you to decrease your dose, temporarily stop, or completely stop taking CALQUENCE if you develop certain side effects.
• Do not switch (interchange) your CALQUENCE tablets with CALQUENCE capsules.
• Take CALQUENCE 2 times a day (about 12 hours apart).
• Take CALQUENCE with or without food.
• Swallow CALQUENCE tablets whole with a glass of water. Do not chew, crush, dissolve, or cut tablets.
• If you miss a dose of CALQUENCE, take it as soon as you remember. If it is more than 3 hours past your usual dosing time, skip the missed dose and take your next dose of CALQUENCE at your regularly scheduled time. Do not take an extra dose to make up for a missed dose.
What are the possible side effects of CALQUENCE?
CALQUENCE may cause serious side effects, including:
• Serious infections can happen during treatment with CALQUENCE and may lead to death. Your healthcare provider may prescribe certain medicines if you have an increased risk of getting infections. Tell your healthcare provider right away if you have any signs or symptoms of an infection, including fever, chills, or flu-like symptoms.
• Bleeding problems (hemorrhage) can happen during treatment with CALQUENCE and can be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs or symptoms of bleeding, including: blood in your stools or black stools (looks like tar), pink or brown urine, unexpected bleeding, or bleeding that is severe or you cannot control, vomit blood or vomit that looks like coffee grounds, cough up blood or blood clots, dizziness, weakness, confusion, changes in your speech, headache that lasts a long time, or bruising or red or purple skin marks.
• Decrease in blood cell counts. Decreased blood counts (white blood cells, platelets, and red blood cells) are common with CALQUENCE, but can also be severe. Your healthcare provider should do blood tests to check your blood counts regularly during treatment with CALQUENCE.
• Second primary cancers. New cancers have happened in people during treatment with CALQUENCE, including cancers of the skin or other organs. Your healthcare provider will check you for skin cancers during treatment with CALQUENCE. Use sun protection when you are outside in sunlight.
• Heart rhythm problems (cardiac arrhythmias) have happened in people treated with CALQUENCE, which may be serious or lead to death. Tell your healthcare provider if you have any of the following
signs or symptoms: fast or irregular heartbeat, dizziness, feeling faint, chest discomfort, or shortness of breath.
• Liver problems. Liver problems can happen during treatment with CALQUENCE, which may be severe or life-threatening, or lead to death. Contact your healthcare provider if you experience stomach pain or discomfort, urine of dark color or yellowing of your skin. Your healthcare provider will request tests to monitor your liver function during treatment with CALQUENCE.
The most common side effects of CALQUENCE include: headache, diarrhea, muscle and joint pain, upper respiratory tract infection, and bruising.
These are not all of the possible side effects of CALQUENCE. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I store CALQUENCE?
• Store CALQUENCE at room temperature between 68°F to 77°F (20°C to 25°C).
Keep CALQUENCE and all medicines out of the reach of children.
General information about the safe and effective use of CALQUENCE.
Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use CALQUENCE for a condition for which it was not prescribed. Do not give CALQUENCE to other people, even if they have the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for more information about CALQUENCE that is written for health professionals.
Viral hepatitis, fatty liver disease and heavy alcohol use are leading causes of liver cancer.
THE MOST COMMON TYPE of primary liver cancer, hepatocellular carcinoma (HCC), usually results from injury to the liver. The liver is also a common site of metastasis for cancers that originate elsewhere in the body. Liver cancer is the fastestgrowing cause of cancer death in the United States. HCC is often diagnosed late, when it is more GLIƓFXOWWRWUHDWEXWWKLVPDOLJnancy can be prevented.
Hepatitis B virus (HBV), hepatitis C virus (HCV), metabolic dysfunction-associated steatotic liver disease (MASLD), heavy alcohol consumption and expoVXUHWRWR[LQVFDQOHDGWRLQŴDPPDWLRQDQGƓEURVLVRUEXLOGXSRI scar tissue in the liver. Over time, this can progress to cirrhosis and liver cancer.
HBV and HCV are blood-borne viruses that can spread via drug injection equipment or personal items that come into contact with blood. They may also be transmitted sexually or from mother to child during pregnancy. The Centers for Disease Control and Prevention (CDC) recommends that all adults be screened for HBV and HCV at least once, regardless of their risk factors.
Fortunately, hepatitis B can be prevented with a vaccine, which is recommended for all infants at birth and for children, adolescents and adults who were not previously vaccinated. Hepatitis B can be treated with drugs that
control viral replication, but they seldom lead to a cure.
Conversely, there is no vaccine for hepatitis C, but almost everyone can be cured with directacting antivirals taken for two or three months.
MASLD and its more severe form, metabolic dysfunctionassociated steatohepatitis (MASH), result from fat accumulation in the liver, which can trigger LQŴDPPDWLRQDQGƓEURVLV7KH\ are linked to obesity and type 2 diabetes; management has relied on lifestyle changes such as weight loss and exercise. In March, the Food and Drug AdPLQLVWUDWLRQDSSURYHGWKHƓUVW MASH treatment, Rezdiffra (resmetirom), and many experimental drugs are in the pipeline.
Exposure to toxic substances can also trigger the development of cirrhosis and liver cancer. Alcohol consumption is the most common risk factor. The CDC recommends that women should have no more than one alcoholic drink per day and men should have no more than two. Other liver toxins include indusWULDOFKHPLFDOVDŴDWR[LQVIRXQG in mold and certain medications and herbal remedies. Smoking is another risk factor. Some studies suggest that coffee and aspirin may be protective.
Early-stage HCC often has no symptoms, so people at risk are advised to undergo routine screening. Antiviral treatment for
hepatitis B or C and management of MASLD can reduce the likelihood of liver cancer, but risk remains elevated for people who have developed cirrhosis.
The American Association for the Study of Liver Diseases (AASLD) recommends regular HCC screening for people with cirrhosis due to any cause. Monitoring is also advised for many middle-aged people with chronic hepatitis B, even if they do not yet have cirrhosis. AASLD recommends screening every six months using a combination of liver ultrasound scans and blood tests for alpha-fetoprotein, a tumor biomarker.
“Patients with chronic liver disease should be counseled to maintain a healthy weight, have a balanced diet, avoid tobacco and alcohol and achieve adequate control of comorbid conditions including components of the metabolic syndrome,” according to AASLD. “A healthy lifestyle KDVPXOWLSOHEHQHƓWVDQGPD\ decrease HCC risk.” Q
CULTIVATING A TRIPLE-POSITIVE OUTLOOK
Malkia Mann was diagnosed with triple-negative breast cancer at age 42.
Her secret weapon: not letting it get her down.
BY JENNIFER COOK
SOMETIMES IT’S A FLUKE WHEN A CANCER IS FOUND.
An exam for something else turns up, for example, a tumor that otherwise might not have been noticed until precious time has slipped away.
In 2020, during the COVID-19 pandemic, Malkia “Kia” Mann, who’s now 46, experienced bloody discharge from her left nipple. She was living in Northern California and juggling mom duties for her two daughters and son (then 21, 8 and 4), plus a demanding job with the Veterans Administration that involved a lot of travel and a side hustle as a custom baker of elaborate special-occasion cakes (her favorite creation: a shark birthday cake). “My stress relief would be to cook and bake,” Mann says with a characteristic laugh.
Malkia Mann stands in Golden Gate Park, future site of the BAYS Breast Cancer Memorial Garden.
Months earlier, she had noticed a clear nipple discharge from the same breast, but at the time, a mammogram and ultrasound were both clear. In November, she returned for another round of tests. is time, the diagnosis was a papilloma, a benign tumor in the milk ducts near the nipple. “ e general surgeon said, ‘ is is going to be easy. You’ll be in and out,’” Mann says. And then he added, “But let’s do an MRI just to make sure we didn’t miss anything.”
e MRI and a follow-up biopsy revealed that something had, indeed, been missed: Stage IIIC triple-negative breast cancer, hiding deep inside Mann’s dense breast
tissue. “If it wasn’t for them discovering the papilloma, they wouldn’t have found the tumor,” she says.
JOINING A CLINICAL TRIAL FOR TREATMENT
Triple-negative breast cancer, an aggressive type of invasive breast cancer, grows and spreads more quickly and has fewer treatment options than other types because it lacks receptors targeted by many available drugs. Mann’s oncologist recommended that she enroll in a study designed to determine the e ectiveness of a chemotherapy drug after surgery, so Mann had a chemo port implanted right before Christmas and had a lumpectomy on January 12, 2021, her oldest daughter’s 22nd birthday. (Unfortunately, the study showed that the drug did not make a di erence in recurrence or survival rates, Mann says.)
During this time, Mann also discovered Bay Area Young Survivors, or BAYS, a support group for women in the San Francisco Bay Area diagnosed with breast cancer under age 45. “ ey’ve become my extended family,” she says. “ ey’re so diverse, and everyone’s welcoming. I don’t know how I would have coped with some of these things if I was not in BAYS.” (See sidebar for more.)
In the late winter, Mann started six months of chemotherapy, followed by six weeks of radiation. Her youngest sister, Left: Mann in San Francisco’s Golden Gate Park; below: with her two daughters and son
who had just been laid o from her restaurant job in Los Angeles because of COVID-19, moved in, along with her son, for about six months so she could drive Mann to all her appointments, care for her after surgery and help with the kids, who were attending school online. Other family members also ew in to assist.
e help allowed Mann to soldier on through her treatments and to continue working for the VA. She took time o only for the placement of the port and the surgery itself. e pandemic shutdowns turned out to be a boon, as they allowed her to work from home and pause any work-related travel. In addition, her superiors were “pretty accommodating,” she says.
PAYING IT FORWARD
Malkia Mann’s tips for dealing with cancer.
• If you have dense breast tissue and insurance, press your doctor for an MRI, not just an ultrasound. “Advocate for yourself because it could save your life,” she says.
• Stay off Google, which can just make you depressed and anxious.
• When friends and family bombard you with advice, ƓQGDSROLWHZD\WRVD\ “Thanks, but I’m going to work with my medical team and do what’s best for me and my body because everything doesn’t work for everybody.”
Mann nished her treatments in the summer, but there was yet another health issue to contend with. An earlier PET scan had revealed a mass in her colon that her oncologist had recommended dealing with after her breast cancer was treated. As she was being readied for surgery, a prep nurse said to her, “I don’t know why, but God is telling me to pray with you.” e nurse read aloud her favorite scripture, Joshua 1:9 (“Have I not commanded you? Be strong and courageous. Do not be afraid. Do not be discouraged, for the Lord your God will be with you wherever you go”), and prayed, and Mann felt her nervousness oat away. e surgery went well, and the colon mass was found to be benign. Joshua 1:9 has become one of her go-to verses, with the words continuing to give her strength and ground her when she feels afraid.
• Be patient with yourself and embrace your emotions. You’re going to be on an emotional roller coaster, and it’s OK.
• No matter what stage you’re at, be encouraged. Even if you have a diagnosis of metastatic disease, it’s not the end. With today’s technology, research and medications, people are living longer.
GETTING A PROGNOSIS—AND PALLIATIVE CARE
e following summer, Mann was ready to have her port removed. She’d had it for more than a year, and it was a constant reminder of the cancer she had now put behind her. Plus, it had to be ushed out every six to eight weeks. So in July 2022, she asked her oncologist whether it could
be taken out. Her doctor agreed, but rst, Mann had to have a PET scan. As it turned out, she received the PET scan report at home through the hospital’s patient portal even before her doctors read it. e news was devastating. “I saw it said ‘metastatic,’ and I know what that means. It said [the cancer] was in my lungs and in a mammary node under my sternum,” she says. “I was in shock. My whole world turned upside down. I had been doing so well, getting back to working out and working and starting my life again.”
Her cancer doctor referred her to another oncologist at Stanford Medicine, one whom other BAYS members had seen, for a consultation. e new specialist asked Mann whether her doctor had given her a prognosis and, if not, whether she wanted one. Curious, Mann said yes. “She basically said, ‘For triple-negative, we’re seeing a one- to two-year survival rate,’” Mann says. She was devastated again. Suddenly, “I had a time limit on me.” Further, the doctor referred Mann for palliative care, which she associated with end of life. “So that was like a double whammy.”
But when the palliative care social worker called, she explained that the care wasn’t just about end of life. It would also provide help with pain management, emotional support and help with caregivers and children as well as other resources. Mann listened and accepted the services, which have been extremely helpful; she’s thankful she didn’t close her mind to the assistance.
THE SERENDIPITY OF MEDICAL RETIREMENT
After working through and beyond her two diagnoses, Mann decided in December 2022 to leave her job at the VA. A scan had revealed disease progression, and she wanted to focus full-time on her health and her family. She researched her options and learned that she could
medically retire and receive her full retirement bene ts, even though she had worked at the VA for 17 years instead of the requisite 20. “I was scared at rst because I thought, How am I gonna pay my bills?” she says. “But I was just like, I don’t know what’s gonna happen, but God, I’m gonna trust you, and I’m gonna start this paperwork.”
She left on medical leave in February 2023. Colleagues donated roughly 300 hours of sick leave they otherwise would have lost, which carried her to nearly May. Her o cial medical retirement date was June 3, which meant there would be a two- or three-month gap in her rent payments, so she went to the leasing o ce to explain her situation. A couple of days later, the sta texted her to say that the owner, a breast cancer survivor, wanted to reduce her rent by $600 a month—not just temporarily but as long as Mann lived in the apartment. “I started crying. I couldn’t believe it,” she says. But it all seemed to be part of a larger plan for her to be exactly where she was.
It’s now been more than a year since she retired, which she feels was the right decision. Today, Mann tells people that she’s a “professional patient—that’s what I do for a living.” She hangs out with friends, former colleagues and family members who are also retired and sometimes travels with them. She’s been to Jamaica, Martha’s Vineyard (which she’d always wanted to visit) and Spain, where she
had such a great time that she decided to “utilize this time and live life and spend time with my children. And when I feel the urge to travel, I’ll travel.”
But there have been more setbacks. While at home with her kids after a trip to the Bahamas, she was getting ready to attend a metastatic breast cancer retreat and had a seizure. When she woke up on the oor, her eldest daughter was beside her calling for help. e cause of the seizure: 25 brain lesions. When her radiologist showed them to her on a screen in her hospital room, “I didn’t get sad. I had a sense of relief,” she says. “I felt a sense of gratitude because I had been traveling all over the world, literally. e week before, I was snorkeling in the Bahamas with my kids. I was in the Florida swamps looking at alligators. I was on a plane, a cruise. And I just kept thinking—because I was a ticking time bomb and didn’t know it—what if that seizure happened while I was snorkeling or I was at home by myself? Or driving? I had been literally 20 or 30 minutes from being in my car.
“So I was telling my family and my doctors, I am meant to still be here. Every time I think about it, I still get so emotional, and, like, I’m smiling. Because I know—and I have a very strong faith—if it wasn’t meant for me to be here, it would have happened somewhere else. So I couldn’t feel sad. I don’t—and I still don’t.” Q
THE BAYS BREAST CANCER MEMORIAL GARDEN
In October 2023, the Bay Area Young Survivors (BAYS), a nonSURƓWVXSSRUW group for people diagnosed with breast cancer before age 45, had a 20th anniversary soiree to raise money for the organization and to help fund the Bay Area Young Survivors Breast Cancer Memorial Garden in San Francisco’s Golden
Gate Park. The garden will honor more than 100 BAYS members and the thousands of people who die of metastatic breast cancer each year. Long delayed due to escalating costs, construction is slated to commence in September. Mann, who is on the BAYS board and handles intake for and represents the metastatic breast cancer
members of BAYS, admires the passion and hard work of the members, all of whom are volunteers who have worked on the garden. “I’m proud to be part of an organization that celebrates [these women]. I feel like I have a bunch of new sisters!” she says.
Renderings of the Golden Gate Park garden
Committed to Making a Di erence in the Lives of Oncology Patients
The HealthWell Foundation is honored to be included in the White House Cancer Moonshot initiative and to further our commitment to support oncology patients who cannot a ord their often lifesaving medications. HealthWell was recognized for its e orts in the White House Cancer Moonshot Fact Sheet, published Wednesday, September 13, 2023. The Cancer Moonshot initiative is mobilizing e orts nationally to prevent more than four million cancer deaths by 2047 and to improve the experience of people who are touched by cancer. The goal is to “end cancer as we know it.”
Since 2004, as part of the over $4.1 billion in total patient grant awards across over 90 disease areas, HealthWell has awarded over $2 billion in medication copayment and insurance premium assistance across 39 oncology funds through more than 485,000 grants to over 334,000 underinsured patients. In addition, we have assisted more than 500 oncology patients seeking behavioral health services with over $300,000 in awards through more than 675 grants through our Cancer-Related Behavioral Health Fund to help with out-of-pocket treatment-related costs for prescription drugs, counseling services, psychotherapy, and transportation.
Our vision is to ensure that no patient goes without health care because they cannot a ord it. When health insurance is not enough, we fill the gap by assisting with copays, premiums, deductibles and out-of-pocket expenses for essential treatments and medications.
Do you work with oncology patients who need assistance with their medication copayment or insurance premium costs? HealthWell may be able to help. To learn more about our program and the oncology funds we cover, visit our Disease Funds page at:
www.HealthWellFoundation.org/disease-funds
Website: www.HealthWellFoundation.org
Facebook: Facebook.com/healthwellfoundation
Instagram: @HealthWellFoundation
Linkedin: healthwell-foundation
ONCOLOGY FUND PORTFOLIO
Acute Myeloid Leukemia
B-Cell Lymphoma – Medicare Access
Bladder and Urothelial Cancer – Medicare Access
Bone Metastases - Medicare Access
Breakthrough Cancer Pain – Medicare Access
Breast Cancer – Medicare Access
Cancer-Related Behavioral Health
Carcinoid Tumors and Associated Symptoms
Carcinoid Tumors and Associated Symptoms –Medicare Access
Chemotherapy Induced Anemia
Chemotherapy Induced Anemia/Neutropenia
Chemotherapy Induced Nausea or Vomiting –Medicare Access
Chemotherapy Induced Neutropenia –Medicare Access
Chronic Lymphocytic Leukemia
Chronic Myeloid Leukemia
Chronic Myeloid Leukemia – Medicare Access
Colorectal Carcinoma – Medicare Access
Cutaneous T-Cell Lymphoma
Gastric Cancer – Medicare Access
Glioblastoma Multiforme/Anaplastic Astrocytoma
Head and Neck Cancer – Medicare Access
Hepatocellular Carcinoma – Medicare Access
Hodgkin’s Lymphoma
Lymphoma Travel Fund
Mantle Cell Lymphoma
Melanoma
Melanoma – Medicare Access
Multiple Myeloma – Medicare Access
Myelodysplastic Syndromes – Medicare Access
Non-Hodgkin’s Lymphoma – Medicare Access
Non-Small Cell Lung Cancer
Non-Small Cell Lung Cancer – Medicare Access
Ovarian Cancer – Medicare Access
Pancreatic Cancer – Medicare Access
Prostate Cancer – Medicare Access
Renal Cell Carcinoma – Medicare Access
Small Cell Lung Cancer – Medicare Access
Squamous Cell Cancer of the Skin – Medicare Access
Waldenstrom Macroglobulinemia
Wilms’ Tumor
If you or someone you know is in need of financial assistance to help with oncology treatments, scan the QR code for a list of diseases covered, or call 800-675-8416 9 a.m. – 5 p.m. Monday – Friday ET to speak with a HealthWell representative.
A cancer diagnosis can change your sex life, but patience, experimentation and communication can help you get back on track.
BY LIZ HIGHLEYMAN
SEXUALITY IS AN IMPORTANT PART OF life that contributes to overall well-being. Getting a cancer diagnosis, undergoing treatment and becoming a survivor can a ect sexual desire and function. Surgery, radiation and chemotherapy not only alter the body, but they can also change how patients—and their partners—feel about their bodies and about sex.
“Sexuality is not synonymous with sexual activity. It covers intimacy, desire, arousal, orgasm and satisfaction,” says Don Dizon, MD, director of the Pelvic Malignancies Program and the Sexual Health First Responders Clinic at Brown University Health Cancer Center. “When it functions normally, we don’t think about it, but when something negatively a ects who we are sexually and how we experience pleasure, it can be quite distressing.”
Research suggests that as many as 90% of people with breast, gynecological or prostate cancers experience diculties with sexual desire or function. For women, the most frequently reported problems include vaginal dryness or atrophy and pain during intercourse (dyspareunia). For men, erectile dysfunction is a common problem. People of any gender may experience loss of sexual desire (libido) and di culty reaching orgasm.
Treatment for breast, cervical, ovarian or prostate cancers may involve removal of the ovaries or testes or use of hormone therapy to slow the growth of tumors with estrogen, progesterone or androgen (male hormone) receptors. is can put younger women into sudden menopause and can cause numerous side e ects for postmenopausal women and men as well. In an e ort to prevent cancer recurrence,
such treatment may last for years.
But sexual problems are not only a concern for people with cancers that a ect the reproductive system. Surgery or radiation for any type of cancer in the pelvic region can lead to scarring and damage to organs, nerves and blood vessels that play a role in sexual function. Treatment for anal cancer can impact the sex lives of gay men and others who enjoy anal sex. Some people with bladder or colorectal cancer will need an ostomy bag to collect urine or feces. One bright spot, however, is that the recent trend toward active surveillance, less invasive surgery, more targeted radiation therapy and lower medication doses can lessen negative outcomes.
Beyond the direct physical e ects, cancer and its treatment can also take an emotional toll. Chemotherapy, other cancer medications and radiation can cause side e ects such as fatigue, nausea and pain that can leave people uninterested in sex. Hair loss or weight changes due to chemotherapy or removal of a breast can lead to self-consciousness or a poor body image. And simply facing cancer can trigger stress, insomnia, anxiety and depression, all of which can kill the mood.
Sprinkle was diagnosed with early breast cancer about 20 years ago and had lumpectomies, radiation and chemotherapy, which caused “instant menopause.” Years later, when she got scans after a car accident, doctors found signs of lung cancer, and she underwent surgery again. In characteristic fashion, Sprinkle and her partner, University of California Santa Cruz art professor Beth Stephens, PhD, made cancer a theme of their art.
Cancer patients and survivors can take steps to improve their sexual desire and function before, during and after treatment. Patience, experimentation and communication are keys to a better sex life.
Often, the cancer experience brings couples closer together, but sometimes it can drive them apart. Partners might have a hard time understanding a lack of sexual interest and may need time to adapt to changes in appearance and function. Some partners may withdraw emotionally or fear that sex will cause harm. What’s more, changing roles—for example, when a spouse becomes a caregiver—can a ect sexual relationships. Single people may have concerns about when to bring up cancer while dating, and they may be hesitant to start new relationships if their prognosis is uncertain.
“Sometimes cancer can make a relationship stronger. My partner was so loving and supportive, I fell more in love. But for some, it’s a deal-breaker,” says Annie Sprinkle, PhD, a former adult lm star and current performance artist who holds a doctorate in human sexuality. “Cancer is going to change you. You have to accept that, and your partner has to accept it.”
For women, estrogen replacement therapy may improve menopausal symptoms, but this is often not possible for those with hormone-driven cancers. Estrogen creams or vaginal rings can relieve dryness and irritation without increasing the risk for cancer progression or recurrence. A recent study showed that Addyi ( ibanserin), a drug that helps balance neurotransmitters in the brain, improved sexual desire, arousal and satisfaction for women with breast cancer. Modern breast surgery techniques are less likely to cause lasting changes in mobility and sensation. Most women have reconstructive surgery after breast removal, but going at is also an option.
For men, decisions about testosterone replacement therapy to revive a agging libido can be a balancing act between managing symptoms and minimizing the risk of cancer recurrence. For some men, drugs like Viagra (sildena l) or Cialis (tadala l) are e ective for treating erectile dysfunction. Penile injections, in atable implants or vacuum pumps may also be an option. Some experts recommend “erectile rehabilitation,” or regular use of
Above: Don Dizon; Annie Sprinkle; top: Sprinkle and her partner, Beth Stephens, shaved their heads during chemotherapy.
medications and vacuum pumps to achieve an erection even when sex is not desired.
For everyone, eating a balanced diet, getting enough exercise, maintaining a healthy weight and getting adequate sleep contribute to overall quality of life, including sexual well-being. Studies have shown that aerobic exercise, pelvic oor exercises, yoga and meditation can help improve libido and sexual function. Exercises that strengthen the pelvic muscles, in particular, can reduce pain during intercourse, prevent urine leakage during sex and lead to rmer erections.
Time and patience can go a long way. Some sexual symptoms are likely to improve after treatment is completed. Nerves and blood vessels injured by surgery or radiation can sometimes repair themselves, but this can take months or even years. Give yourself time to heal before resuming vaginal or anal sex. Due to a waning libido, sex may not be as spontaneous as it used to be. You might need to plan ahead for when you have more energy or to give erectile dysfunction meds time to work. Adapting to physical and emotional changes can be a prolonged process for both the person with cancer and their partner.
achieve orgasm without ejaculation. If intercourse is not possible, explore other ways to maintain intimacy. Your sex life may be di erent than it was before cancer, but it can still be pleasurable.
“Sometimes people have too narrow a de nition of sex,” says Sprinkle. “Get out of the idea that sex is only about intercourse. Find what turns you on. If nothing does, at least have sensual pleasure, like massage or cuddling. Anything can be sex if it gives you pleasure or you nd it sensual or erotic. Your sex life can become your pleasure life.”
Open communication is among the most important factors, both between partners and between people with cancer and their health care providers. Talk to your partner about how you’re feeling physically, mentally and emotionally. Discuss what you want out of your sex lives and how to satisfy both of you. If this is di cult, a marriage or couples counselor or sex therapist might be able to help.
THERE’S NO RIGHT WAY—THERE’S JUST WHAT WORKS FOR YOU.
“I like to say, the only answer to any question about sex is, ‘It depends.’ at’s spot-on when it comes to sex and cancer,” Sprinkle says. “Parts of your body might be numb or nervy or have scar tissue, or you can’t have weight on top of you. Forget everything and do it your way. ere’s no right way—there’s just what works for you.”
Experimentation is key. Before resuming sex with a partner, it might be helpful to explore your own body and its changing sensations to gure out what feels good—or doesn’t—now. Tune in to novel sensations, and try new positions that might be more comfortable. Some people may choose to wear sexy clothing to hold a breast prosthesis in place or cover a chemo port or ostomy bag. Lubricants can relieve vaginal dryness—many di erent types are available. Likewise, there’s a wide variety of vibrators and other sex toys to try. Men who are unable to have an erection can usually still experience sexual sensations and learn to
Early in your journey, have frank discussions with your care team—doctors, nurses, mental health therapists and social workers—about how cancer and its treatment could a ect your sexual well-being and how to prevent or ameliorate problems. Some cancer centers have sexual health specialists and o er sexual rehabilitation programs. Forewarned is forearmed.
Unfortunately, a majority of cancer patients report that they did not receive adequate sexual health information before, during or after treatment. In part, this is due to a stereotype that older people are not interested in sex. Finding appropriate information can be especially challenging for gay, lesbian, bisexual and transgender people. For their part, most oncologists say they never received training in managing sexual problems. Patients often say they don’t want to make their doctors uncomfortable, while doctors say they don’t want to make their patients uncomfortable. Don’t be afraid to make the rst move.
“Sexuality does not have to be another part of one’s life ‘lost’ to cancer,” says Dizon. “To avoid conversations around sexuality after cancer robs people of the opportunity to fully participate in a domain that de nes us as human beings.” Q
Genetics, Grief and Hope
After losing his mom, two sisters, a brother and a nephew to various cancers, Lawrence Ingrassia wrote A Fatal Inheritance. Here, he shares some healing insights.
NOT LONG AGO, MAINSTREAM
science was skeptical that cancer could be hereditary. Malignancies, it was widely believed, were caused by viruses, environmental toxins and carcinogens. Indeed, those factors do often lead to cancer, but thanks to discoveries in genetics beginning in the 1990s, we now understand, for instance, that certain genes work to regulate cell division and suppress tumor growth. Mutations in those genes, which can be hereditary, increase the risk for cancer. Perhaps the best-known examples are BRCA1 and BRCA2, the so-called breast cancer genes. (Everyone has these genes, but only a small proportion have the mutations that cause cancer.)
emotional tale.
We spoke with Ingrassia for this installment of our Can Heal column—that OLIHDIƓUPLQJGHFODUDWLRQ is right there in the title of our magazine: Cancer Heal th—and we discussed grief, caregiving, genetic testing and hope.
From top: the Ingrassia family in 1960; the book cover
There’s also Li-Fraumeni syndrome, affecting the p53 gene. It’s a much rarer disorder and one of the subjects of Lawrence Ingrassia’s book A Fatal Inheritance: How a Family Misfortune Revealed a Deadly Medical Mystery Ingrassia, a journalist who worked at The Los Angeles Times and The Wall Street Journal, lost his mother (she was 42), two sisters (at ages 24 and 32), a brother (69) and a nephew (39) to various cancers resulting from the syndrome.
As Ingrassia writes in his book: “The story of Li-Fraumeni syndrome and, more broadly, of cancer research isn’t one story, but two. It is both a heartbreaking story of family loss and an inspiring story RIVFLHQWLƓFDFKLHYHPHQWŐ,QGHHGKHGRFXPHQWV not only the story of his family and others but also of the researchers. It makes for an educational and
People with Li-Fraumeni syndrome have a 50% chance of passing it on to their children. There’s now a genetic test for it. In 2015, at age 63, you got the test as part of a clinical trial designed to study the psychological effects of testing positive. However, you tested negative, which wasn’t a surprise, since most people with the condition develop cancers at younger ages and you’d enjoyed a healthy cancer-free life. Do you recommend folks get tested if they think their family is at risk? Deciding whether to get tested—and then deciding, if you’re positive, whether to have children—is really personal for all sorts of reasons. My recommendation is to at least consider getting tested because knowledge can be power, and you can make informed decisions. If you learn you have it, then you can get screened for cancers, because early detection is the best way to beat these cancers and prolong your life. And then you can get your children tested and screened. Just waiting for stuff to happen is a strategy that you can regret.
With so much cancer in your family, it’s surprising you never made the genetic connection. Our dad was a research chemist, and our supposition was that he had brought home chemicals on his clothes, tiny particles we ingested and that later
manifested itself as cancer. Of course, there really are a lot of chemical carcinogens, so that’s logical. And once you convince yourself of something, it’s hard to actually think of alternatives.
You’ve been a caregiver many times over. What advice do you have for a person whose loved one was just diagnosed with cancer?
DECIDING WHETHER TO GET TESTED IS PERSONAL.
First of all, it’s OK to be afraid and angry, but it’s important to show your support in whatever way they need. Different people need different things. My youngest sister, who died at 24, said she didn’t want to see us crying. That was hard. But if anyone had to cry, you went out of the room. With everything she was going through, that would have been too much for her because that would have been putting the sadness back on her. You could ask the person: “Can I do some research for you?” “Can I go to your doctor appointments with you and take notes?” That can be helpful. Also remember that there are many, many cancer survivors out there. Indeed, the progress in many types of cancer is dramatic in so many ways, and yet people go into it thinking, This is a death sentence. But it isn’t necessarily—you can live quite a long life. That’s the thing to tell people: You can get through this. It’s not going to be easy, but there are a lot of cancer survivors, so talk to other people. You aren’t alone. There are support groups and associations, all sorts of information. As I mentioned in the book, Facebook support groups are important, especially if you have a rare condition. Until Facebook came along, there might be one or two families in an entire city, and you would feel alone. But now, you can go online and there’s emotional support but also advice.
You mentioned in the book that after your sister died, you began looking at family photos at Christmas. Is this a ritual you hold on to?
I still do it. Looking at old family photos can remind you of what you lost but also of what you had. It is an enduring thing—these memories you’ll always have. Seeing my mother beaming at us as children— you don’t get that unless you look at that photo. Seeing me and my siblings in various settings, like in the kitchen sharing food or at weddings or dancing and talking together with friends. Life is a real tapestry, truly. And the photographs help capture that. They can EHUHLQIRUFLQJDQGOLIHDIƓUPLQJ,ōG encourage people to do that. Yes, you might have some tears, but I think you’ll come out of it feeling deeply moved as well.
Lawrence Ingrassia
I do try to remind myself how fortunate I and my family have been. You can’t ask, “Why me?” about the bad things without asking, “Why me?” about the good things. I also try to remind myself: Yes, cancer has devastated my family, but other families have other WKLQJV/LIHEULQJVXVDOOVRUWVRIGLIƓFXOWWKLQJVDQG happy things, and you have to recognize that.
$Q\ƓQDOZRUGVRIDGYLFH"
For me, it has been helpful to embrace grief. Among my most vivid and intense memories are those times I spent with my sisters and brother during WKHLUFDQFHUWUHDWPHQWVDQGƓQDOGD\V,QHYHUIHOW closer to them. Decades later, in my mind’s eye, I can still recall so many details—sitting next to them, holding their hands. Recalling these things, not letting go, helps keep them alive in my memories.
$OVR,ƓQGLWOLIHDIƓUPLQJWRUHPHPEHUWKHODVW JHVWXUHRIP\\RXQJHVWVLVWHU,QKHUƓQDOGD\VVKH DUUDQJHGIRUGHOLYHU\ŋDIWHUVKHGLHGŋRIŴRZHULQJ plants to me, my brother and sister, some good friends and even her oncologist with a one-word message: “Forward!” Even as her time was cut short, she wanted us to keep going. I think that is true of all our loved ones who die. They want us to be happy and live full lives. Q
A Go-To for Precision Medicine
An interview with Matthew Reiss, PhD, manager of precision medicine and navigation at GO2 for Lung Cancer, who notes: “Cancer is not one disease but several separate diseases.”
What are GO2 for Lung Cancer and LungMATCH?
GO2 for Lung Cancer is a nonSURƓWWKDWVXSSRUWVSHRSOHZLWK lung cancer through multiple avenues. LungMATCH is part of that. It’s a one-on-one converVDWLRQZLWKLQGLYLGXDOVZKRFDUH DERXW\RX\RXUQHHGVDQG\RXU TXHVWLRQVDQGZKRWDNHWKH WLPHWRPDNHVXUHWKDW\RXKDYH WKHDQVZHUVDQGLQIRUPDWLRQ WKDW\RXQHHG:HIRFXVRQ WKUHHSLOODUV ELRPDUNHUDQDO\VLVFOLQLFDOWULDOPDWFKLQJDQG SUHFLVLRQPHGLFLQH:HWDON WKURXJKDSHUVRQōVELRPDUNHU UHSRUWDQGPDNHVXUHWKH\ XQGHUVWDQGLWDQGZKHWKHUWKH results mean they’re eligible IRUWDUJHWHGWKHUDS\
What is precision medicine? &DQFHULVQRWRQHGLVHDVHEXW VHYHUDOVHSDUDWHGLVHDVHVWKDW each have their unique genetic FRPSRQHQWVWKDWPDNHHDFK
LQGLYLGXDOUHVSRQGGLIIHUHQWO\ WRGLIIHUHQWWUHDWPHQWVDVZHOO as to the cancer itself. There are FHUWDLQJHQHVZLWKLQDWXPRU WKDWGULYHWKHFDQFHUWRFRQWLQXH JURZLQJ$QGIRUVRPHRIWKRVH JHQHVWKHUHDUHGUXJVWKDW VSHFLƓFDOO\WDUJHWWKHP7KLV approach treats the cancer cells
3UHFLVLRQPHGLFLQHXVXDOO\ VWDUWVZLWKDJHQRPLFSURƓOH an analysis of a tumor’s genetic PDNHXS>WRVHHZKHWKHUWKH person’s cancer has gene variaWLRQVWKDWFDQEHWUHDWHGZLWK WDUJHWHGWKHUDS\@:HZDQWWR get people not only the most effective treatment but also a treatment that suits their lifestyle.
How would you describe your role at the organization?
What makes GO2 for Lung Cancer different from a patient’s health care team? :RQGHUIXOUHVRXUFHVDUHDYDLOable through health care teams. %XWZHDUHQRWERXQGE\D 15- to 20-minute appointment ZLQGRZ,ōYHWDONHGWRSHRSOH on the phone for 10 minutes EHFDXVHWKH\ZHUHMXVWORRNLQJ IRUVRPHEDVLFLQIRUPDWLRQ$QG ,ōYHWDONHGWRSHRSOHIRUDQKRXU or multiple times over the course RIPRQWKV:HZLOOJREDFNDQG IRUWKZLWKLQGLYLGXDOVDQGDQVZHU SUHWW\PXFKDQ\TXHVWLRQ$QG all LungMATCH services are free. ,IVRPHRQHōVLQWHUHVWHGDJUHDW SODFHWRVWDUWZRXOGEHRXUHPDLO HelpLine, support@go2.org, or by calling 800-298-2436.
What inspires your work?
Matthew Reiss helps educate people about biomarkers.
,PDNHVXUHWKDWSHRSOHKDYH WKHHGXFDWLRQWKH\QHHGDVZHOO as the resources WRXQGHUVWDQG ZKDWWUHDWPHQWV are available WRWKHP$QG I may match
WKHPZLWKFOLQLFDOWULDOVLI WKH\ōUHLQWHUHVWHGLQWKDW%XW WKHQZHJREH\RQGWKDW 7KHUHōVDGLYLVLRQFDOOHG3DWLHQW Services that really specializes LQWKHVXSSRUWDQGJXLGDQFH WKDWLQGLYLGXDOVQHHGRXWVLGH of the treatments.
,KDGDQRSSRUWXQLW\WRIXOƓOOWKLV UROHIRUVRPHRQH,FDUHGDERXW ,OHDUQHGWKDWLWōVUHDOO\GLIƓFXOWWR navigate all the information out there. Going through that proFHVVZDVH\HRSHQLQJEXWDOVR UHDOO\UHZDUGLQJ,IHOWOLNH,ZDV DEOHWRFRQWULEXWHWRPDNLQJVXUH WKH\KDGDOOWKHLQIRUPDWLRQLQ IURQWRIWKHPDQGFRXOGZHLJK ZKDWōVLPSRUWDQWWRWKHP6R LWZDVUHDOO\H[FLWLQJIRUPHWR FRPHDFURVVWKLVSRVLWLRQZKHQ ,ZDVMREVHDUFKLQJEHFDXVHLW WDNHVWKHKXPDQDVSHFWRIPHGLFLQHWKDW,ōYHDOZD\VORYHGDQG SXWVLWWRJHWKHUZLWKWKHVFLHQFH WKDW,ƓQGUHDOO\LQWHUHVWLQJQ
Who’s on your team? cancerhealth.com/team
5HVRXUFHVIRU/LYHU&DQFHU
7+(/,9(5,67+(/$5*(6762/,'25*$1,17+(%2'<
It removes toxins from the blood, maintains healthy sugar and fat levels and performs numerous other vital functions. People with liver diseases, such as hepatitis B, hepatitis C and fatty liver disease, are at increased risk for the most common type of liver cancer, hepatocellular carcinoma. What’s more, heavy alcohol use can cause cirrhosis, or scarring of the liver, the main risk factor for liver cancer. The following websites offer current research, support and more for people with liver cancer.
$ƦƞƫƢƜƚƧ&ƚƧƜƞƫ6ƨƜƢƞƭƲ cancer.org
Visit this site for a wealth of information about liver cancer during and after treatment, including resources such as downloadable PDFs to help patients cope with their diagnosis, understand treatment options and stay well beyond treatment. Take advantage of its 24/7 cancer helpline and patient/caregiver support program.
$ƦƞƫƢƜƚƧ/ƢƯƞƫ)ƨƮƧƝƚƭƢƨƧ liverfoundation.org
ALF’s Liver Resource Center offers educational materials on diet and health, fatty liver disease, hepatitis and other risk factors for liver cancer. Dozens of Wellness Webinars cover topics such as liver disease prevention, disease managePHQWDQGƓWQHVV
&ƚƧƜƞƫ+ƨƩƞ1ƞƭưƨƫƤ cancerhopenetwork.org
7KLVQRQSURƓWSURYLGHVIUHH FRQƓGHQWLDORQHRQRQHVXSSRUW to people with cancer and their families. The organization matches cancer patients or
Discover more resources: cancerhealth.com/resources
their relatives with trained volunteers who have undergone and recovered from a similar cancer experience. Its website offers free materials and resources for caregivers, health care professionals and support groups in Spanish and English.
&ƞƧƭƞƫƬƟƨƫ'ƢƬƞƚƬƞ&ƨƧƭƫƨƥ
cdc.gov
The CDC regularly updates its site with new statistics and studies about liver cancer and diseases that can cause it, such as hepatitis B and C virus. Read and download fact sheets, posters and many other federal resources on risk factors, symptoms, treatment and recovery.
*ƥƨƛƚƥ/ƢƯƞƫ,ƧƬƭƢƭƮƭƞ globalliver.org
Raising awareness, supporting liver cancer patients and advocating for research are just a few of this organization’s goals. Its online resource center links users to dozens of PDFs and videos on basic liver health, liver cancers, fatty liver disease, pediatric liver diseases and more.
+ƞƩƚƭƢƭƢƬ%)ƨƮƧƝƚƭƢƨƧ hepb.org
The Hepatitis B Foundation offers various resources on hep B, one of the most common causes of liver cancer. Its website features up-to-date fact sheets, opportunities for clinical trials and the B Heppy podcast.
1ƚƭƢƨƧƚƥ&ƚƧƜƞƫ,ƧƬƭƢƭƮƭƞ cancer.gov
This site offers statistics, treatments, ongoing research and more, including pages devoted to liver cancer. Browse symptoms, staging, risk factors and VFUHHQLQJRSWLRQVRUƓQGDQ NCI-designated cancer center near you.
8ƧƢƭƞƝ1ƞƭưƨƫƤƟƨƫ 2ƫƠƚƧ6ơƚƫƢƧƠ unos.org
Liver transplant is a treatment option for some people with liver cancer. UNOS manages the national transplant waiting list, matches donors to recipients and prioritizes equitable liver allocation. Its website highlights essential information and news on liver transplants.
Money Tight? Send Out an SOS
How to minimize the financial burden of a cancer diagnosis
WORRIES ABOUT THE COST OF CANCER CARE AND TREATMENT
can send your stress levels soaring. But you can get assistance from many different sources. Follow the steps below to tap into programs
Triage Center is a great place to EHJLQ7KHQDWLRQDOQRQSURƓW hosts free in-person and online conference series two to three times each year that explore “underdiscussed topics that impact a family’s income, such as employment rights, disability insurance and paid leave for caregivers,” says Triage’s CEO, Joanna Fawzy Doran Esq. “Our goal is to give people information on how to access help now while DOVRDGGUHVVLQJWKHXQGHUO\LQJFDXVHVRIƓQDQcial hardship so that moving forward, people don’t continue to experience these problems.” TriageCancer.org features numerous videos, webinars and a Cancer Finances Toolkit that helps those newly diagnosed with cancer—as well as treatment veterans—navigate a host of key LVVXHVWKDWFDQDIIHFWWKHLUƓQDQFLDOZHOOEHLQJ
Apply for Funding
“Financial grants from organizations like the HealthWell Foundation can help people with cancer by closing the gap between what their insurance covers and what they must pay out-of-pocket,” notes HealthWell’s FKLHIGHYHORSPHQWRIƓFHU$ODQ.OHLQ “Patients, their caregivers and providers also can visit our website to sign up for Real-Time Fund Alerts that let you monitor the status of
our funds and get a text, email or call if the status of a fund changes.” Cancer Care, Cancer )LQDQFHVDQG)DPLO\5HDFKRIIHUƓQDQFLDODLG as well as information about clinical trials, employment issues and paying for long-term care, while the Cancer Financial Assistance Coalition provides access to a database of helpful organizations. Each has its own rules and eligibility requirements and must be contacted individually.
Pay Your Family Caregiver
Cancer may compromise your ability to care for yourself. But if \RXPHHWVSHFLƓFVWDWHHOLJLELOLW\ requirements, you may qualify for Medicaid. The government-assisted health insurance program allows you to pay a friend or family member to be your caregiver. 3URJUDPQDPHVDQGVSHFLƓFGHWDLOVPD\GLIIHU by state, but all cut eligible cancer patients a PXFKQHHGHGƓQDQFLDOEUHDN
Get Paid if You Can’t Work
Government programs such as Supplemental Social Security, Social Security Disability Insurance, Medicare and Medicaid can help if cancer prevents you from earning a living. Plus, disability insurance and government aid can replace lost wages. One caveat: The programs need time to SURFHVVDSSOLFDWLRQVVRƓOHWKHSDSHUZRUN$6$3
AUTUMN OF SOLACE
Products that ease the mind during and after treatment include chemo-friendly clothes and comfy headphones.
Sleep disorders are common in people with cancer. Ditch uncomfortable plastic headphones for Perytong Headband Headphones ($19.99, Amazon) WKDWVLWŴDW around your head and double as a soothing sleep mask. Available LQRYHUDGR]HQFRORUV these wireless headphones work not just while you’re lying down but also while you’re getting the physical activity recommended for cancer patients. The Bluetooth headphones offer up to 10 hours of listening time and block ambient noise.
A good book can quiet the mind, but sometimes we don’t feel like holding a book and ŴLSSLQJWKURXJKSDJHV&RQVLGHU buying an Audible subscription ($15 to $150) for yourself or a ORYHGRQH&KRRVHEHWZHHQRQH to 12 months of credits for access to more than 800,000 downloadable audiobooks, including bestsellers and new releases. Take Audible’s online TXL]WRƓQGWKH perfect book to embark on your literary escape.
After losing a friend to cancer, makeup artist Karissa Bodnar founded Thrive Causemetics, a vegan beauty brand that empowers women DQGZRUNVZLWKPRUHWKDQQRQSURƓWSDUWQHUVZRUOGZLGH supporting people with cancer, survivors of domestic violence and more. Dry lips caused by chemotherapy or radiation can be frustrating to manage. Thrive’s Exfoliating Lip Scrub ($24) gently removes dry ŴDNHVDQGPRLVWXUL]HVZLWKQDWXUDORLOVZKLOH the Pout Hero Liquid Balm Lip Treatment ($26) will nourish and restore chapped lips. Use them in combination for an intensive overnight lip mask.
“I have used this journey to learn more about myself than I ever knew,” Nicole Lawson-Wilson, MBA, writes in her breast cancer memoir, Epiphany: Don’t Waste Your Cancer. The slim volume is packed with insights that this mom, wife and businesswoman gained while she confronted surgery, chemo, setbacks and triumphs. “I had to learn to feel JRRGDERXWEHLQJŴDZHGŐVKH writes. “In reality, the imperfect, ŴDZHGLQFLVLRQV,KDYHDOORZHG to be seen have drawn more positive attention than my version of wanting to be perfect ever could.”
Chemotherapy is often administered via intravenous infusions, which requires easy access to catheter lines. Inspired by his own cancer journey, Chemo Cozy cocreator Greg Hamilton designed accessible and comfortable clothing to help patients of all ages have a better treatment experience. The clothing line’s Polar Fleece Jacket ($69.99, various colors) has specially located zipper openings that allow universal access to ports, catheter lines, feed tubes and more without requiring folks to disrobe.
SEX AND CANCER
Cancer and its treatments can affect your sexual health—including fertility issues for men and women— in a variety of ways. Take our survey and let Cancer Health know about your sexual wellness.
What type(s) of cancer do you have?
How would you rate your overall sexual health?
TExcellent TGood
TFair TPoor
How comfortable are you discussing sexual health topics with your health care provider?
TVery comfortable
TSomewhat comfortable
TNot at all comfortable
Have you ever had a health care provider who was uncomfortable discussing sexual health topics with you?
TYes TNo
Have you experienced any pain or discomfort during sex since your diagnosis?
TYes TNo
Have you experienced any changes in sexual desire or libido since your diagnosis?
TYes TNo
Have you experienced any issues with sexual satisfaction since your diagnosis?
TYes TNo
How much has your cancer diagnosis affected your sexual health and relationships?
TSevere impact TModerate impact
TMild impact TNo impact
Did you discuss fertility preservation options with your health care provider after your cancer diagnosis?
TYes TNo TNot applicable
How would you rate the information and support you have received from your cancer health care team regarding your sexual health?
TExcellent TGood
TFair TPoor
TI haven’t received any information or support.
What year were you born?
What is your gender?
TMale TFemale
TTransgender TOther
What is your current level of education?
TSome high school THigh school graduate
TSome college TBachelor’s degree or higher
What is your annual income?
TLess than $15,000 T$15,000–$34,999
T$35,000–$49,999 T$50,000–$74,999
T$75,000–$99,999 T$100,000 or more
What is your ethnicity? (Check all that apply.)
TAmerican Indian/Alaska Native
TArab/Middle Eastern TAsian
TBlack/African American THispanic/Latino
T1DWLYH+DZDLLDQ3DFLƓF,VODQGHUTWhite
TOther ___________________________
What is your ZIP code?
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.
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.
