Living Well Oct./Sept. 2018 Edition

Cancer awareness

SEPTEMBER/OCTOBER 2018 A Publication of the

September/October 2018 ~ living well

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People in Missoula and western Montana want to feel good, look good and live well. Available at more than 150 newsstand locations throughout the area, Western Montana Living Well is well suited to more than 23,000 readers monthly who want health tips on fitness, nutrition, family, wellness, therapy and beauty.

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SEPTEMBER/OCTOBER 2018 VOL. 48

IN THIS ISSUE eye health cancer FACTS & figures

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ALSO IN THIS ISSUE

sunscreen cuts cancer riskS FOR KIDS

Page 7

COPING WITH THE SIDE EFFECTS OF TREATMENT

Page 9

the cost of cancer

Page 10

the jaydYn fred foundation Page 12 skipping chemo Page 14 taking care of appearance Page 16 opioids and cancer pain Page 17

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Facts & Figures 2018:

Rate of deaths from cancer continues decline From the American Cancer Society

The death rate from cancer in the US has declined steadily over the past 2 decades, according to annual statistics reporting from the American Cancer Society. As of 2015, the cancer death rate for men and women combined had fallen 26 percent from its peak in 1991. This decline translates to nearly 2.4 million deaths averted during this time period.

During the most recent decade of available data, the rate of new cancer diagnoses decreased by about 2% per year in men and stayed about the same in women.

“Cancer Statistics, 2018,” published in the American Cancer Society’s journal CA: A Cancer Journal for Clinicians, estimates the numbers of new cancer cases and deaths expected in the US this year. The estimates are some of the most widely quoted cancer statistics in the world. The information is also 4

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released in a companion report, Cancer Facts and Figures 2018,available on the interactive website, the Cancer Statistics Center. A total of 1,735,350 new cancer cases and 609,640 deaths from cancer are projected to occur in the US in 2018.

The drop in cancer mortality is mostly due to steady reductions in smoking and advances in early detection and treatment. “This new report reiterates where cancer control efforts have worked, particularly the impact of tobacco control,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society.

“A decline in consumption of cigarettes is credited with being the most important factor in the drop in cancer death rates. Strikingly though, tobacco remains by far the leading cause of cancer deaths today, responsible for nearly 3 in 10 cancer deaths.”

Major cancer types: Lung, breast, prostate, and colorectal cancer The overall drop in cancer death rates is largely due to decreasing death rates for lung, breast, prostate, and colorectal cancers.

• Lung cancer death rates declined 45% from 1990 to 2015 among men and 19% from 2002 to 2015 among women. From 2005 to 2014, the rates of new lung cancer cases dropped by 2.5% per year in men and 1.2% per year in women. The differences reflect historical patterns in tobacco use, where women began smoking in large numbers many years later than men, and were slower to quit.

• Breast cancer death rates declined 39% from 1989 to 2015 among women. The progress is attributed to improvements in early detection.

• Prostate cancer death rates declined 52% from 1993 to 2015 among men. Routine screening with the PSA blood test is no longer recommended because of concerns about high rates of over-diagnosis (finding cancers that would never need to be treated). Therefore, fewer cases of prostate cancer are now being detected.

• Colorectal cancer death rates declined 52% from 1970 to 2015 among men and women because of increased screening and improvements in treatment. However, between 2006 and 2015, the death rate among adults younger than 55 increased by 1% per year.

Cancer outcomes vary among racial/ ethnic groups The rates of new cancer cases and cancer deaths vary quite a bit among racial and ethnic groups, with rates generally highest among African Americans and lowest for Asian Americans. The cancer death rate in 2015 was 14% higher in blacks than in whites. That gap has narrowed from a peak of 33% in 1993.

However, the racial gap was much larger for those younger than 65 than it was for those 65 or older, likely in part due to universal health care access for seniors through Medicare.

Racial and ethnic disparities in the cancer burden are a reflection of several factors related to socioeconomic status. According to

the US Census Bureau, in 2016, 22% of blacks and 19% of Hispanics/Latinos lived below the poverty line, compared to 9% of whites and 10% of Asians.

• People with lower socioeconomic status are more likely to smoke and be obese, partly because of targeted marketing to this population by tobacco companies and fast food chains. In addition, community factors often limit opportunities for physical activity and access to fresh fruits and vegetables.

• In 2016, 11% of blacks and 16% of Hispanics/Latinos were uninsured, compared to 6% of whites and 8% of Asians.

• Even when other factors are equal, studies show that racial and ethnic minorities tend to receive lower-quality health care than whites.

Cancer in children and adolescents Cancer is the second most common cause of death among children ages 1 to 14 years in the US, after accidents. In 2018, an estimated 10,590 children in this age group will be diagnosed with cancer and 1,180 will die from it. Leukemia accounts for almost a third (29%) of all childhood cancers, followed by brain and other nervous system tumors (26%).

Cancer incidence rates increased in children and adolescents by 0.6% per year since 1975. However, death rates have declined continuously. The 5-year relative survival rate for all cancer sites combined improved from 58% for children diagnosed during 1975 to 1977 to 83% for those diagnosed during 2007 to 2013.

Special section on ovarian cancer Each year, American Cancer Society researchers include a special section in Cancer Facts & Figures highlighting an issue of cancer research or care. This year, the topic is ovarian cancer. The report’s authors say improving the ability to detect ovarian cancer early is a research priority. Some key facts about ovarian cancer: • Women diagnosed with local-stage ovarian cancer have more than a 90% 5-year survival rate.

• About 4 out of 5 ovarian cancer patients are diagnosed with advanced disease that has spread throughout the abdominal cavity.

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• Ovarian cancer accounts for just 2.5% of all cancer cases in women, but 5% of cancer deaths because of the disease’s low survival rate.

• In 2018, there will be an estimated 22,240 new cases of ovarian cancer diagnosed and 14,070 deaths in the US. • The special section provides information about ovarian cancer risk factors, incidence and mortality rates and trends, early detection, and treatment that is primarily related to epithelial tumors, the most common subtype of ovarian cancer. Understanding of this subtype has evolved rapidly in recent years.

Other highlights from the report: • The overall estimate of 1,735,350 cases for 2018 equals more than 4,700 new cancer diagnoses each day.

• The lifetime probability of being diagnosed with cancer is 39.7% for men and 37.6% for women, which is a little more than 1 in 3.

• The most common cancers to be diagnosed in men are prostate, lung and colorectal cancers, which account for 42% of all cases, with prostate cancer alone accounting for

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living well ~ September/October 2018

almost 1 in 5 new diagnoses.

• The most common cancers to be diagnosed in women are breast, lung and colorectal cancers, which combined represent one-half of all cases; breast cancer alone accounts for 30% of all new cancer diagnoses in women.

• The most common causes of cancer death continue to be lung, prostate and colorectal cancers in men and lung, breast and colorectal cancers in women. These 4 cancers account for 45% of all cancer deaths, with 1 in 4 cancer deaths from lung cancer.

• Liver cancer incidence continues to increase rapidly in women, but appears to be stabilizing in men. People infected with hepatitis C virus (HCV) are at greater risk for liver cancer. All baby boomers (those born between 1945 and 1965) are recommended to be tested for HCV because 80% of HCVinfected people are in this age group.

“Cancer Statistics 2018” can be viewed at cacancerjournal.com, while “Cancer Facts & Figures 2018” is available at cancer.org/ statistics.

Using sunscreen in childhood cuts melanoma risk

By Mari A. Schaefer, The Philadelphia Inquirer (TNS)

Slather that sunscreen on your kids and don’t hold back. It could help save their lives.

A study out of Australia found that using sunscreen in childhood can reduce the risk of developing melanoma, the deadliest form of skin cancer, by 40 percent in young adults.

As with most cancers, the risk of melanoma increases with age. But according to the American Cancer Society, melanoma is one of the most common cancers in young adults (especially young women).

Researchers at the University of Sydney analyzed data collected from nearly 1,700 Australians, ages 18 to 40. They looked at those who were regular users of sunscreen in childhood and compared to those who rarely used the products. The results were published last week in JAMA Dermatology.

“The association of sun exposure and sunburn with melanoma risk, particularly in childhood, is well established and this study showed that regularly using sunscreen was protective against the harmful effects of sun exposure,” said Anne Cust, lead researcher and director of the Cancer Epidemiology and Prevention Research group at the University of Sydney’s School of Public Health.

Approximately two in three Australians will be diagnosed with some type of skin cancer by the time they are 70, according to the study.

It is estimated that in 2018, more than 91,000 people in the United States will be diagnosed with melanoma. In the last 10 years, rates for new cases of melanoma have been rising on average 1.5 percent each year,

according to the U.S. Centers for Disease Control and Prevention.

The Australian study was funded by the National Health and Medical Research Council (NHMRC), Cancer Council NSW, Cancer Council Victoria, Cancer Council Queensland, and the U.S. National Institutes of Health.

The CDC recommends these measures to avoid UV radiation: — Stay in the shade, especially during midday hours.

— Wear clothing that covers your arms and legs.

— Wear a hat with a wide brim to shade your face, head, ears, and neck.

— Wear sunglasses that wrap around and block both UVA and UVB rays.

—Use sunscreen with a sun protection factor (SPF) of 15 or higher, and both UVA and UVB (broad spectrum) protection.

— Avoid indoor tanning.

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What are the differences between cancers in adults and children?

From the American Cancer Society

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see Cancer Basics.

The types of cancers that develop in children are often different from the types that develop in adults.

Unlike many cancers in adults, childhood cancers are not strongly linked to lifestyle or environmental risk factors. Only a small number of childhood cancers are caused by DNA changes that are passed from parents to their child.

With some exceptions, childhood cancers tend to respond better to certain treatments..

Children might seem to do better with cancer treatments than adults because they usually do not have other health problems that can get worse with cancer treatment. On the other hand, children (especially very young children) are more likely to be affected by radiation therapy if it is needed as part of treatment.

Both chemo, radiation therapy, and other cancer treatments also can cause long-term side effects, so children who have had cancer will need careful follow-up for the rest of their 8

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lives.

In the United States, most children and teens with cancer are treated at a center that is a member of the Children’s Oncology Group (COG). All of these centers are associated with a university or children’s hospital. These centers offer the advantage of being treated by a team of specialists who know the differences between adult and childhood cancers, as well as the unique needs of children and teens with cancer and their families. This team usually includes pediatric oncologists (childhood cancer doctors), surgeons, radiation oncologists, pediatric oncology nurses, physician assistants (PAs), and nurse practitioners (NPs). As we have learned more about treating childhood cancer, it has become even more important that treatment be given by experts in this area.

These centers also have psychologists, social workers, child life specialists, nutritionists, rehabilitation and physical therapists, and educators who can support and educate the entire family.

Any time a child is diagnosed with cancer, it affects every family member and nearly every aspect of the family’s life.

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Cancer patients want more Information from doctors about cost

From the American Cancer Society

A study led by researchers from University of Michigan has found that many cancer patients would like more help from their health care providers in addressing costs of treatment. The study involved more than 3,000 people who answered a survey, including 2,502 women with early-stage breast cancer, 370 surgeons, 306 medical oncologists, and 169 radiation oncologists. The study was published online July 23, 2018 in Cancer, a peer-reviewed journal published by the American Cancer Society.

Cancer takes a financial toll on many patients, even if they have health insurance, due to outof-pocket costs and copays for treatment and other medications, and sometimes due to loss 10

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of work hours or gaps in employment. Previous studies have shown people with cancer have an increased rate of bankruptcy filings. Financial problems are linked to higher overall distress, lower health-related quality of life, and lower satisfaction with cancer care.

To find participants for the current study, researchers searched the Surveillance, Epidemiology, and End Results (SEER) database provided by the National Cancer Institute (NCI). Questionnaires for the participants’ health care providers asked how often they discuss the financial burden of treatment with their patients, their level of awareness of the out-of-pocket costs of tests and treatments

they recommend, and how important they think it is to try to save their patients money.

Questionnaires for patients asked about financial and employment status changes since being diagnosed, how much cost-related help they received from their health care team, and whether they continue to have unmet financial needs. Researchers also evaluated whether age, race, and ethnicity played a factor.

Results showed providers and patients have different perceptions about how often these financial discussions are taking place.

Among the findings: providers • 50.9 percent of medical oncologists, 43.2 percent of radiation oncologists, and 15.6 percent of surgeons said that someone in their practice often or always discusses finances with patients.

• 40 percent of medical oncologists, 34.3 percent of radiation oncologists, and 27.3 percent of surgeons said they were very aware or quite aware of the out-of-pocket costs of the tests and treatments they recommend.

• 57 percent of medical oncologists, 55.8 percent of radiation oncologists, and 35.3 percent of surgeons said it was quite important or extremely important to save their patients money.

Among the findings: patients • 58.9 percent of black patients, 33.5 percent of Latina patients, 28.8 percent of Asian patients, and 27.1 percent of white patients reported having debt from treatment costs.

• Overall, 14 percent of patients reported lost income that totaled 10 percent or more of their household income.

• Overall, 17 percent of patients reported spending 10 percent or more of their household income on out-of-pocket medical expenses.

• 45.2 percent of black patients, 35.8 percent of Latina patients, 22.5 percent of Asian patients, and 21.5 percent of white patients reported cutting back on food spending to pay for cancer treatment. Some patients also reported having their utilities cut off, or even losing their homes.

• 49.7 percent of Latina patients, 48.9 percent of black patients, 35.2 percent of Asian patients, and 31.9 percent of white patients were at least somewhat worried about finances as a result of

cancer or its treatment. Of those being worried, 72.8 percent said they did not get at least some help from their health care providers.

• 31.1 percent of black patients, 30.3 percent of Latina patients, 25.4 percent of Asian patients, and 15.2 percent of white patients said they at least somewhat wanted to talk to their health care providers about the impact of breast cancer on their employment or finances. Of those, 55.4 percent reported they had not had a cost-related discussion with a health care provider.

Starting the conversation The study authors note that financial problems associated with cancer treatment continue to be common and emphasize the need for meaningful cost-related discussions between patients and providers. They suggest several approaches to address the problem, including training for health care providers about having effective conversations with patients about cancer costs in ways that are sensitive to cultural differences and needs. They also suggest using advanced interactive technology tools to evaluate patients’ financial concerns and alert providers to their needs.

The American Cancer Society recommends patients learn as much as possible about their cancer and cancer treatment before it starts, including any medical expenses and how their diagnosis may affect work and income. If this seems like too much to handle, patients can ask a friend or family member to help them track costs, and to go along to medical appointments and help with these discussions.

Some ways to bring up the subject of cost as cancer treatment is being planned include: • I’m worried about how much cancer treatment is going to cost me. Can we talk about it?

• Will my health insurance pay for this treatment? How much will I have to pay myself?

• I know this will be expensive. Where can I get an idea of the total cost of the treatment we’ve talked about?

Read more from the American Cancer Society about finding and paying for treatment, or call us at 1-800-227-2345.

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The Jadyn Fred Foundation helps with financial burden of childhood cancer, illness

By Rachel Crisp-Phillips

That and the simple goal is Executive the mission Director of statement of the Jadyn Fred the Jadyn Fred Foundation.

Foundation, As children a Missoula are often non-profit covered for organization most of their that provides individual financial medical assistance to expenses, it’s children with the day-tospecial medical day necessities needs. that frequently With become a gratitude born struggle. With from tragedy, no children’s the foundation hospital in provided photo was created Montana, the Monte meets young fans at March’s fundraiser at Paul’s Pancake Parlor in Missoula. in honor cost of travel of Jadyn Fred, a young girl who was taken to and from the treatment facility, including by an incredibly rare form of cancer called food and lodging for both patient and caregiver, pancreatoblastoma. Born to Britt and Alecia becomes considerable. Furthermore, some Fred, she was diagnosed at age three and caregivers encounter the necessity to quit their by age six had succumbed to the disease jobs in order to be available to support and despite a strong spirit and numerous medical transport their ailing children. interventions.

The foundation’s belief that everyone needs Since its creation in 2001, the Jadyn Fred help once in a while grew from an outpouring Foundation has distributed $849,000 to over of community support experienced by the Fred 877 families in Montana. These funds assist in family as Jadyn went through her own treatment covering the many additional costs associated process. Their positive experiences in the with treating serious medical conditions in a hospital, along with the resilience and strength child. of their daughter, inspired them to carry on When a child is ill, other unexpected a spirit of generosity after the young child’s financial burdens pile up constantly alongside passing. Her kind and caring ways are emulated the medical expenses. Aid is most often needed in the purpose of the Jadyn Fred Foundation. for additional costs incurred from long-distance Anyone can apply for assistance through travel to healthcare facilities, as well as medical the foundation. The distribution of funds is bills and prescriptions not covered by insurance. determined by necessity, and families with “A lot of families, even though they have children currently in ongoing cancer treatment insurance and Medicaid, still have a lot more take top priority. However, funds are also given expenses,” said Lynn Fred, Jadyn’s grandfather to assist children with major medical needs 12

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who do not have cancer, as well as children with special needs who require long-term care more so than surgery or major medical procedures.

The dollars that are distributed by the foundation are raised throughout the year by a combination of grant-writing, donation collecting, and special fundraising events. Anyone is welcome to help sponsor or volunteer during these functions.

The foundation’s biggest event of the year is the Jadyn Fred Foundation Benefit Dinner and Golf Scramble event each July. The two-day benefit kicks off with a charity auction followed by a golf tournament the next day.

The next big event for the foundation will be their annual Jadyn Fred Foundation Christmas Party, held every December. This holiday celebration invites anyone to volunteer to purchase Christmas gifts for ill children who might otherwise receive nothing. The gifts are then handed out by Santa during the festive gathering.

“We had about 156 people last year for Christmas, and they all received gifts. Some of them wouldn’t have a Christmas unless we had

those sponsors,” said Fred.

In March, the foundation holds a Paul’s Pancake Fundraiser where a portion of a day’s sales are donated to the charity. Monte from the University of Montana Grizzlies makes an appearance, and a raffle is also featured.

Moving forward, the Jadyn Fred Foundation plans to continue their trajectory of helping an increasing number children every year. “Just to give an example,” said Fred, “in 2003 we helped four families and in 2017 we helped 132 families.”

With twelve knowledgeable and respected community members on the foundation’s board to help guide operations, and strong community support, the Jadyn Fred Foundation plans to continue touching lives through financial support for as long as possible.

“We’re always looking for different adventures to go into,” said Fred.

For more information on the organization, or to make a donation, contact The Jadyn Fred Foundation at 406-370-2159 or visit jadynfred.org.

Living Well September/October 2018 ~ living well

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Study: more breast cancer patients can safely skip chemotherapy From the American Cancer Society

A federally funded study has found that many women with the most common type of early stage breast cancer likely do not need chemotherapy after surgery. The study was presented June 3, 2018 at the American Society of Clinical Oncology meeting in Chicago, and simultaneously published in the New England Journal of Medicine. It is likely to change the way many newly diagnosed breast cancer patients are treated.

“With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70% of patients who are diagnosed with the most common form of breast cancer,” said Kathy Albain, MD, a co-author of the study. “For countless women and their doctors, the days of 14

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uncertainty are over.”

The Trial Assigning IndividuaLized Options for Treatment (TAILORx) study involved more than 10,000 women with hormone receptor (HR)positive, HER2-negative breast cancer that had not spread to lymph nodes. The women’s tumors were tested with Oncotype DX, the brand-name of a gene expression test that can help predict if some early stage (stage 1 or 2) breast cancers are likely to come back after initial treatment.

The test looks at a set of 21 genes in cancer cells from tumor biopsy samples to get a “recurrence score” between 0 and 100. The higher the score, the greater the chance the cancer will come back.

Previous studies have found that women with scores of 10 or lower did not need chemotherapy,

while women with scores higher than 25 did benefit from chemotherapy. But for the large group of women with intermediate scores (11 to 25) and their doctors, the need for chemotherapy has been less clear.

Most women in the mid-range can avoid chemo.

The new study looked at the 6,711 women from the trial who fell in the mid-range of 11 to 25. The goal of the study was to find out if these women could safely skip the chemotherapy.

Following surgery, the women were randomly assigned to receive chemotherapy followed by hormone therapy, or hormone therapy alone. The study was intended to measure invasive diseasefree survival, the proportion of women who had not died, or had their cancer return, or developed a new cancer. Results were very similar between the two groups.

• Five years after treatment, the rate of invasive disease-free survival was 93.1% for those who had chemo and 92.8% for those who did not.

• Nine years after treatment, the rate of invasive disease-free survival was 84.3% for those who had chemo and 83.3% for those who did not.

Rates of overall survival were also very similar between the 2 groups.

• Five years after treatment, the rate of overall survival was 98.1% for those who had chemo and 98.0% for those who did not.

• Nine years after treatment, the rate of overall survival was 93.8% for those who had chemo and 93.9% for those who did not.

“Until now, we’ve been able to recommend treatment for women with these cancers at high and low risk of recurrence, but women at intermediate risk have been uncertain about the appropriate strategy to take,” said Jeffrey Abrams, MD, a coauthor of the study. “These findings, showing no benefit from receiving chemotherapy plus hormone therapy for most patients in this intermediate-risk group, will go a long way to support oncologists and patients in decisions about the best course of treatment.”

Age as a factor Chemotherapy did appear to have some benefit

in women who were age 50 or younger with a recurrence score of 16 to 25. For this age group, there were 2% fewer cases of cancer returning for recurrence scores between 16 to 20, and 7% fewer cases for scores between 21 to 25.

The authors conclude that the new findings suggest chemotherapy may be avoided in about 70% of women with HR-positive, HER2-negative, node-negative breast cancer. They say this applies to women who are: • older than age 50 and with a recurrence score of 11–25 • any age with a recurrence score of 0–10 • age 50 years or younger with a recurrence score of 11–15 The findings suggest that chemotherapy may be considered for the remaining 30% of women with HR-positive, HER2-negative, node-negative breast cancer – those who are: • any age with a recurrence score of 26–100 • age 50 years or younger with a recurrence score of 16–25

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September/October 2018 ~ living well

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Cancer Cancer treatment treatment side side effects: effects: Changes Changes in in taste taste and and smell smell

Cancer and its treatment can change your Cancer and its treatment can change child’s senses of taste and smell.

Theseyour changes child’s senses of taste and smell.

These may make foods taste bitter or metallic changes and can may make foods taste bitter or metallic andtips can affect your child’s appetite. Here are some affect your child’s appetite.

Here are some tips that may help you get your child to eat: that may help you get your child to eat: • Serve foods cold or at room temperature.

• Serve foods cold or at room temperature.

This can decrease the foods’ tastes and smells, This canthem decrease the tastes and smells, making easier tofoods’ tolerate. making them easier to tolerate.

• To reduce smells • To reduce smells - Cover drinks, and have your child drink - Cover drinks, and have your child drink through a straw. through a straw.

- Choose foods that don’t need to be - Choose foods that don’t need to be cooked. cooked.

- Don’t cook foods with strong odors Don’t cook with strong odors when- your child is foods around. when- your child is around.

Avoid eating in rooms that are stuffy or Avoid eating in rooms that are stuffy or too warm. too warm.

• Try using plastic flatware and glass cups • plates Try using plastic flatware and glass cups and if your child has a metallic taste in andmouth plates while if youreating. child has a metallic taste in his his mouth while eating.

• Try foods or drinks that are different from • Try foods or drinks that are different from ones your child usually eats. Children seem ones your child usually eats. Children seem 16

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the American Cancer Society to like saltyFrom foods, such as chips, pretzels, and to like salty foods, such as chips, pretzels, and crackers. (Remember, if your child is getting crackers.sodium (Remember, if your child isbut getting steroids may be a problem, there steroids sodium may be a problem, but are low sodium varieties of many snackthere foods.) are low sodium varieties of many snack foods.)

• Freeze fruits such as cantaloupe, grapes, • Freeze fruits such as cantaloupe, grapes, oranges, and watermelon, or buy frozen oranges, andand watermelon, or buy blueberries strawberries and frozen eat them as blueberries and strawberries and eat them as frozen treats. frozen treats.

• Offer fresh vegetables. They may be more • Offer fresh vegetables. They may be more appealing than canned or frozen ones. appealing than canned or frozen ones.

• Try marinating meats to make them more • Try marinating meats to make them more tender. tender.

• If red meats taste strange, try other • If red meats taste strange, try other protein-rich foods such as chicken, fish, eggs, protein-rich or cheese. foods such as chicken, fish, eggs, or• cheese.

Blend fresh fruits into shakes, smoothies, • Blend fresh fruits into shakes, smoothies, ice cream, or yogurt. ice• cream, or yogurt.

Keep your child’s mouth clean by regular • Keep your child’s mouth clean by regular rinsing and brushing, which can help foods rinsing and taste better.brushing, which can help foods taste better.

Living With Cancer:

Opioids and cancer pain How to use opioids safely Are you talking with your health care provider about taking an opioid for cancer pain? Opioid painkillers are highly addictive, and they are not safe for some people. Your medical history, family history and personal history of substance use help determine whether opioids are safe for you to try. Now is the time to plan for safe use, storage and disposal of these medications. Practicing caution can mean the difference between life and death.

Treating acute lymphocytic leukemia Acute lymphocytic leukemia is a cancer of the blood and bone marrow. It’s the most common type of cancer in children, and treatment results in a good chance for a cure.

Acute lymphocytic leukemia also can occur in adults, though the chance of a cure is reduced greatly. There are several types of treatment for

From the American Cancer Society

this blood and bone marrow cancer, including chemotherapy, targeted therapy, radiation and bone marrow transplant. Learn more about these treatment options and the four phases of treatment for acute lymphocytic leukemia.

Embryonal tumors Embryonal tumors of the central nervous system are cancerous tumors that start in fetal cells in the brain. Embryonal tumors can occur at any age, but they occur most often in babies and young children. Signs and symptoms of embryonal tumors vary, depending on the type of tumor; location; severity; and other factors, such as pressure buildup within the brain. Symptoms may include headache, nausea, vomiting, unusual tiredness, dizziness, double vision, unsteady walk or seizures. Learn more about the diagnosis and treatment of embryonal tumors.

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Managing your cancer fatigue From the American Cancer Society

From the Mayo Clinic 1. Protect your routine. Fewer disruptions mean less energy-zapping stress.

2. Play to your energy. What time are you at your best? Plan activities then.

3. Increase your physical activity. The research is clear that moving is medicine. So make it a priority.

4. Make a good night’s sleep your priority.

Leave time for more hours of rest if you need them.

5. Prioritize daily goals. Get energized as you cross things off your list.

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6. Put chairs in every room. Mini-rests while brushing teeth or prepping food keep energy levels steady.

7. Add some healthy distraction. Dive into a good book or music to escape fatigue while conserving energy.

8. Be careful about online activity. Make sure social media and searching are helping you feel supported, not anxious.

9. Listen to your body. Take heart that fatigue is a normal part of the process and always rest when you need to.

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