Archives for 2013

Breast Radiation Causes Heart Disease – For Very, Very Few

Breast Radiation Causes Heart Disease – For Very, Very Few

Breast radiation remains necessary for women with early stage breast cancer if they wish to avoid mastectomy. Like all cancer treatments, there are potential side-effects–most of which are minor. A small minority of patients receiving such treatment may be at higher risk for heart disease.

Overall, the risk of heart disease for most patients is very low since radiation treatments are designed to completely (or mostly) avoid the heart. But a report from the New England Journal of Medicine showed an undeniable increase in the risk of heart disease in 2,168 patients receiving breast radiation. How high was the risk? About half a percent for those receiving the highest radiation dose to the heart.  Estimating the total dose given to the heart is one of the problems with the NEJM study. The other? The cases dated from 1958 to 2001, and included a large number of patients treated without modern targeting techniques such as multidimensional targeting and breath hold.

It’s estimated that contemporary radiation techniques deliver less than 2 Gy of radiation (a very small amount)  to the heart -which is far less than that given to most of women in the NEJM study treated before the 1980s.

What’s the bottom line? If the risk of recurrence is significant, the benefits of radiation still heavily outweigh the potential risk of heart disease, especially given modern radiation techniques.

Read more about it here:

http://www.ascopost.com/issues/october-15,-2013/breast-cancer-radiotherapy-and-cardiotoxicity-what-is-the-true-risk.aspx

http://www.ncbi.nlm.nih.gov/pubmed/?term=N+Engl+J+Med+368%3A987-998%2C+2013

Congratulations!

Congratulations!

We are proud of our affiliation with the National Cancer Institute in bringing breakthrough treatments to patients throughout Northeast Wisconsin.

In recognition for his enrollment of patients to NCI sponsored clinical trials, congratulations to David Groteluschen, MD for receiving the Silver Certificate of Excellence.

nci

Colorectal Cancer: Being Physically Active is Better

Colorectal Cancer: Being Physically Active is Better

A study published recently in the Journal of Clinical Oncology in March of this year and sponsored by the American Cancer Society has reported that patients with localized colorectal (large bowel ) cancer had improved overall survival with increased physical activity; whereas a more sedentary lifestyle was associated with reduced survival.

In this study, participants completed detailed questionnaires regarding their physical activities and leisure time before and after being diagnosed with cancer of the colon or rectum. There were 3 categories of activity -walking less than 1 hr/wk, walking 1 to less than 2.5 hrs/wk and 2.5 hrs or more walking/week. Leisure time categories were sitting less than 3 hrs/day, 3 to less than 6 hrs/day and 6 or more hours/day. Patients were followed over an extended period of time (up to 16.1 years).

In patients with the highest activity level, there was a 42% reduced risk of death from all causes. In patients who reported sitting for 6 or more hours/day, there was a 62% increased risk of dying from complications related to colorectal cancer.

The authors acknowledged certain limitations of the study, but concluded that physicians should consider counseling colorectal cancer survivors to adopt a physically active life style aiming to achieve 2.5 hrs or more of moderate intensity activity per week, such as walking, and to avoid prolonged sitting.

I have to admit that in my practice, I need to be more proactive in talking to my patients about the benefits of physical activity and better understand the obstacles to a less sedentary lifestyle.

Gender Differences in Grief

Gender Differences in Grief

It is no surprise that men and women are profoundly different in a variety of ways and one of these key differences is the area of grief. It can be helpful to understand how gender differences play a part in how we grieve, whether we are the person grieving or if it a family member or friend.

Women frequently express that they feel their male counterparts are not grieving or supportive; often men say that they do not know how to best support their female loved ones, or how to handle the emotion and pain that stems from grief.

Men tend to be more comfortable attending to life changes by taking on new roles and responsibilities that result from the death of a loved one. Learning new non-traditional roles such as cooking, cleaning or becoming a single parent can be a distraction from their grief.  Males often view social relationships as more of a time to share activities than emotions. So often they state that they know the story in their head and they don’t need to retell it. They tend to want to “fix it” and will rely on their own resources—often keeping feelings and emotions to themselves.

Women, on the other hand, tend to be more emotional and will work on their grief by talking about it. They will tell their story over and over again because they say it helps them process and work through their grief. Women confide in friends, outwardly express their feelings and emotions, and “feel” their way through grief.

Men say that they limit their expression of emotion because they may not want to appear weak. Women report frustration with men demonstrating little emotion and not wanting to talk about the person who died. Women may view this as cold and think that the man is not grieving. Men often feel the expectation to be strong and so may be given or may accept little social support. Society has traditionally taught little boys not to cry while   comforting little girls who do. Hopefully as we educate more, this message is changing. These conflicting gender messages can carry through one’s entire life and may cause misunderstandings between males and females who are grieving. This can lead to frustration, anger, and feeling isolated in one’s grief for both genders.

Men are generally “inward” thinkers; they think of the “situation” not the emotional responses. This does not make them less emotional, or less responsive to those around them; they just have a different method of looking at the emotional response.  The woman in grief is traditionally looking for support. She will look to those that can understand and listen to her express her emotions. She is not looking to “FIX” anything, but to regain her perspective and understand some purpose in her grief. Both men and women need support in grief. They need to hear from others their emotions are normal, their responses to the emotions are normal, and that they will be able to live and love again.

It is critical to stress that whether you are a male or female dealing with a loss of a loved one, if you are unwilling to express grief in any form at all, you will likely face serious consequences during your future journey. It is a make-or-break choice for those of us who lose someone and are willing to express our grief fully, in whatever way we are comfortable. Not to express our grief is to potentially set ourselves up for a lifetime of illness, bitterness, anger, and lack of connection to life.

When we look at gender differences in grief, what is important to remember is that neither way is right or wrong, just different. Both genders can learn from the other.  If we learn to understand and accept one another’s differences, we can learn to support one another without trying to change them. Grief is a very personal and individual experiencewith everyone navigating through this journey in his or her own way. The hope is that those walking this journey can experience comforting support along the way.

Green Bay Oncology Recognized as Unity Guardian Angel

Green Bay Oncology Recognized as Unity Guardian Angel

Unity, leaders in hospice and palliative care, announced on October 14th, 2013, the selection of Green Bay Oncology as the 2013 Unity Guardian Angel award winner for its contributions to the organization. Green Bay Oncology was honored during a recent presentaion to President, Dr. David Groteluschen and Chief Operating Officer, Jenifer Kolar.

“Green Bay Oncology is proud to accept the Guardian Angel award. End of life care for patients and their loved ones is an essential component of quality medical care. Throughout the years, Unity has and continues to provide exceptional hospice and palliative care in northeast Wisconsin. We greatly value our relationship with Unity, and look forward to continued collaboration in the service of our Community,” said Dr. David Groteluschen, President of Green Bay Oncology.

Each year, since 1997, Unity has recognized as Guardian Angels an individual or group of individuals who have supported Unity’s patients and families through collaboration, monetary donations or the gift of time, knowledge and skills.

“Green Bay Oncology has a long history as the region’s largest group of cancer specialists who bring the world’s latest treatments to their patients,” said Alisa Gerke, Unity’s Executive Director. “We are grateful to them for their expertise and willingness to collaborate for the best patient outcomes possible.”

Green Bay Oncology shares the distinction as a Unity Guardian Angel with other noted community members and organizations. Past honorees include:  Cellcom, Kay Ferguson, Paul Koch, MD; Sue and the late Michael Mietzel, Dr. Bill and Sandy Schneider, Bill and Marge Galvin, James McGovern, MD; Carol Bush, Cornerstone Foundation, AXA Advisors/Voyageur Group, Howard and the late DeLane Hansen, Rick and Ginny Baer, Jack and Engrid Meng, Elaine Le Duc, Merrill Lynch, and Schreiber Foods.

About Green Bay Oncology

Our mission at Green Bay Oncology is to provide the best oncology care in the Midwest.  By building empathetic, caring relationships, we will enhance the physical, psychological, and social well being of our patients, our employees and the community we serve.  We embrace even the most difficult of cases because we are determined to partner with patients and their families, our employees and the community, to relentlessly battle cancer.

About Unity

Unity is a not-for-profit provider of palliative, hospice care and grief support in 12 counties in Northeast Wisconsin and has offices in the Green Bay area, Marinette, Shawano and Sturgeon Bay. A continuation of the former Bellin Hospice program founded in 1977, Unity is a partnership of Bellin Health, St. Mary’s Hospital Medical Center and St. Vincent Hospital. Unity is a member of the National Hospice and Palliative Care Organization (NHPCO). For more information call (920) 338-1111 or visit www.unityhospice.org.

 Unity+1tag_RGB

Living Long and Well with Cancer: Can Exercise Help?

Living Long and Well with Cancer: Can Exercise Help?

A century ago, when illness struck, patients were sent to bed, isolated and ‘let’ of blood.  Fortunately, sanatoriums and leeches have been done away with, but the concept of bed rest or inactivity is still one that has been debated until just recently.

Historically, there have been concerns that exercise could make cancer spread or cause the cancer to return. It has also been felt that exercise may cause treatment side-effects to worsen, leading to more fatigue, more pain.

Research in exercise and cancer has changed our attitudes towards activity and illness. In 2011, cancer experts joined with exercise experts to review the current research.  These experts clearly found that cancer survivors (including those undergoing treatment) can experience a multitude of benefits from exercise.

The National Cancer Institute reviewed over 45 studies. Virtually all of the studies showed that exercise decreased the risk of cancer-related death as well as death from other causes.  In other words, exercise made it less likely that cancer survivors would die from a recurrence of their cancer.  Exercise was found to improve blood sugar levels, decrease inflammation, and increase the number of immune system cells thought to attack cancer cells. Contrary to early concerns, patients reported feeling less fatigue, less nausea and pain, and a better quality of life. 

What can you do?

It’s actually quite simple.  Moderate activity–every day for about 20 minutes–can make a difference.  In a majority of the studies reviewed, walking was the main form of exercise.  However, household activities such as gardening, cleaning, raking, and so on, count toward your 20 minutes per day.  Gentle weights twice a week, as well as stretching throughout the week, are also recommended.

Check out your local YMCA.  Many local YMCAs have ‘LIVESTRONG at the YMCA’ programs available.  This is a research-based physical activity and well-being program designed to help adult cancer survivors reclaim their total health. Participants work with Y staff trained in supportive cancer care.  The Green Bay LIVESTRONG at the YMCA contact information is: livestrong@greenbayymca.org. Or contact Stacy Ryan, Member Experience Director at 920-436-1231

Of course, before beginning an exercise program talk to your provider.  There may be some restrictions you should be aware of given the site of cancer.  Just get moving!

Electronic Cigarette Devices

Electronic Cigarette Devices

The roots of the modern cigarette go back to the 9th century when the Mayans and Aztecs used tobacco in religious ceremonies.   It was not until 1880 a cigarette machine was invented and cigarettes were manufactured in mass numbers. At that time cigarettes became available to many more people. 

We did not have what we call evidence-based practice at that time.  Therefore many medical and non-medical practices were passed down through generations and never proven to cure an illness.  It was not until the late 1800s that the Food and Drug Administration started regulating products to protect public health.

Had the modern cigarette become available to the public in 1900, cigarettes as we know them may not be on the market because of the proven negative health impacts associated with them, although, many of those effects do not show up until years later.  Evidence-based testing may have kept them off the market. Keeping that in mind, it is very easy to see why medical experts in tobacco cessation, including those here at Green Bay Oncology, do not support the use of electronic cigarette devices at this time.  There is no evidence that we will not be dealing with negative health effects from the electronic cigarette twenty years from now.

What we do know about electronic cigarettes…

  1. Nicotine content varies widely across brands (some contain as much or more than a traditional cigarette and others contain no nicotine at all)
  2. Nicotine alone has health effects as well, including high addiction rates (addiction to the chemicals), fast heart beat, nausea, vomiting, increased blood sugar, constricting blood vessels, hardening of arteries and even overdose.  Nicotine replacement therapies contain nicotine but are effective in treating tobacco addiction while avoiding other toxic chemicals.
  3. Evidence about safety and efficacy is lacking and poor quality
  4. Electronic cigarettes do not contain tar
  5. These devices are widely accessible to people of all ages including adolescents
  6. A recent Italian study showed that the electronic cigarette may be as effective as a other tobacco cessation treatments
  7. Tobacco companies are selling the devices
  8. Many other countries have banned the use of electronic cigarette devices

What we do not know…

  1. The chemical – both heavy metal and carcinogen – content of electronic cigarettes
  2. Whether these devices serve as a gateway “drug” for adolescents that later transition to tobacco products
  3. How, if at all, will these products impact tobacco cessation efforts?
  4. What are the long term effects of the ingredients within the device(s)?
  5. Are there roles in healthcare to utilize the positive effects of nicotine alone?

In summary, right now there is not enough evidence-based information on electronic cigarette devices to make sound medical decisions to argue for or against using these products.

 

Diffuse B-cell large cell lymphoma: Beware of the double hit

Diffuse B-cell large cell lymphoma: Beware of the double hit

Lymphomas are cancers of lymph cells (lymphocytes). B-lymphocytes play an important role in the immune system and are involved in producing antibodies against viruses and bacteria during an infection.

When B-lymphocytes become malignant, they can form slower growing tumors (low grade lymphomas) or faster growing tumors (high grade lymphomas).

Diffuse large B-cell lymphoma is one of the most common form of high grade lymphomas. Standard treatment consists of a monoclonal antibody called rituximab and  four other agents (Adriamycin, vincristine, cyclophosphamide, prednisone). This combination is known as R-CHOP – and can cure up to two-thirds of patients with B-cell large cell lymphomas.

But what about patients who don’t seem to benefit from R-CHOP? We’re starting to understand important biological differences in some of these more difficult cases. In a large international study of lymphoma patients receiving R-CHOP, some of the patients responding poorly to treatment were found to have abnormal gene activity. Specifically, patients whose cancer cells expressed both MYC and BCL-2 did not do nearly as well as the rest of the study group. only 30% of these patients were still alive at 5 years.

The authors concluded that staining of lymphoma tissue for MYC and BCL2 is a useful tool to help assess prognosis of patients  with B-cell large cell lymphoma and help identify patients who potentially could benefit from novel therapies.

This is a very active area of research and I am hopeful that we will have exciting breakthroughs in the future.

Stand Up For Your Health

Stand Up For Your Health

This is not just a “catchy” slogan but is actually a fact. There is a growing body of evidence that has shown that sitting for long periods of time can be extremely bad for your health, almost as much as smoking. Periods of prolonged sitting is being studied by researchers to be linked to multiple health problems such as diabetes, high blood pressure, heart disease and cancer. Prolonged sitting increases inflammation, insulin resistance, and obesity.

How can this happen? Not only is sitting lousy at burning calories but it has been shown to suppress the production of an enzyme called lipoprotein lipase which is essential for turning bad cholesterol into good. Sitting has also been linked to insulin resistance and, therefore, trouble metabolizing sugar.

Unfortunately, our work environment has significantly contributed to the time most people spend sitting each day. Most jobs have removed physical activity in our lives and most of us spend our time at work sitting at desks with very little movement throughout the day. Watching television at home and computers only add to the number of hours spent sitting.

One study of men in the Netherlands reported that occupational sitting for 6-8 hours per day increased the risk for colon cancer. Other studies found that women who sat for long periods were also at a higher risk for developing endometrial cancer than were those who did not, regardless of whether the women participated in moderate to vigorous physical activity. A U.S. study found that women who sat for 6 hours or more per day had a 28% higher risk for Non-Hodgkin lymphoma than did women who sat for less than 3 hours per day.

In fact, exercise alone does not overcome the increased risks of prolonged sitting. The American Cancer Society published a study in 2010 in which mortality rates during the 14 year follow-up period were lower for participants who exercised regularly than for those who did not. However, study participants who sat for 8 hours or more per day had higher mortality rates than those who sat for less than 3 hours per day. In other words, physical exercise seems to reduce but not eliminate the negative effects of sitting.

How can we change our habit of prolonged sitting? Very easily! We need to get in the habit of learning to stand at work and at home more and spend less time on our bottoms. We need to take breaks, even 1 to 2 minute breaks every hour can lead to improved health. Some people have carried this to extreme measures such as putting a treadmill at their desks and spend time walking instead of sitting. Learning to take the stairs and getting up to talk to co-workers instead of calling or e-mailing will get us moving more in the workplace. Try pacing when on the phone or schedule walking meetings are other suggestions.

Remember to be creative; get up and just don’t sit there. Stand up for your health.

Mayo Cancer Expert Joins Green Bay Oncology

Mayo Cancer Expert Joins Green Bay Oncology

Green Bay Oncology is pleased to announce the addition of Brian Burnette, M.D. An experienced hemotologist and oncologist, Dr. Burnette has been involved in numerous studies, is well published and lectures internationally on cancer-related topics.