Archives for April 2013

“Never give in, never give in, never, never, never…” Winston Churchill.

“…It is appointed unto men once to die…” Hebrews 9:27 (KJV)

The problem, in a nutshell, goes something like this: we feel pain, and we don’t like it. We die, and we don’t want to. We yearn for the eternal, but our bodies are mortal. Some might define our spirit as the thing that does the yearning. I also like to think of it as the thing that does the fighting.

Spirituality, then, might be the search for meaning in the face of some harsh realities. There are hard questions: What is our proper relationship with God? What is our place in the universe? Why do we suffer? What happens to the soul after the body dies? For millennia, people have assembled answers to these questions into a wide variety of faiths and philosophies.

The value of spirituality as a comfort to the very ill has long been recognized. But we’re learning that cancer patients, no matter how good or bad the prognosis, have profound spiritual needs. A few surprising facts from the medical literature:

1) Spirituality is important for the wellness of all cancer patients, at all stages of illness. _1,2

2) Strongly religious patients need more, not less, spiritual support. ₂

3) Community religious support, by itself, is rarely adequate to meet most patients’ needs. Medical chaplains, counselors, and other professionals are necessary for many (maybe most) patients. ₄

4) Healthcare professionals like nurses, practitioners, and physicians can provide effective spiritual support. ₄

How can a patient begin to address these issues? One can begin by developing an awareness of one’s own spiritual identity. For example, try answering the questions in the second paragraph. The effort can often inform the next step.

Since patients with well-developed religious identities find spirituality crucial to their coping, it may be beneficial for such patients to devote a little extra time for worship, meditation, or observance. None of us can afford to be complacent about the care of our fighting spirits.

References:

1. 1. Brady, et. Al. Psychooncology 8:417-428, 1999.
2. 2. Cotton, et. Al. Psychooncology 8:429-438, 1999.
3. 3. Balboni, et. Al. J Clin Oncol 25:555-560. 2007.
4. 4. Balboni, et. Al. J Clin Oncol 28:445-452. 2010.

Chemotherapy can cause many patients to have difficulty concentrating, remembering certain things, or  finishing brain-intensive tasks.  This is commonly called chemobrain. It can sometimes last for weeks, months, or years after treatment for cancer is completed. It’s often a very upsetting experience, even if it’s so slight that no one but the patient notices it.  It is not fully understood how or why chemobrain happens.  Is it caused by the cancer itself or the drugs given during chemotherapy (such as steroids or pain medication)? Is it the effect of chemotherapy on the blood? Is is due to the stress and emotional issues that cancer patients experience?  We have more questions than answers, unfortunately. We also don’t know how to prevent chemobrain from happening. Some patients respond to medications, but the results are very mixed.

If you think chemobrain is happening to you, try tracking the symptoms to see if anything in particular makes the problem worse. There are ways to cope with these memory changes without taking medication.  Some things to try include:

• Write things down-Use a detailed daily planner, make “to do” lists, and make lists of important information.  Sticky notes are very handy.
• Exercise your brain-Take a class to learn something new or do puzzles (such as crossword puzzles, Sudoku).
• Get enough rest/sleep.
• Exercise-Something as simple as a daily walk can improve your mood, make you more alert and can decrease tiredness.
• Eat a well-balanced diet.
• Set and follow a routine. 
• Focus on one task at a time.
• Ask for help when you need it!

Each individual is different and it is always helpful to speak with the nurse, nurse practitioner or doctor regarding your symptoms and what can be done to help.

More cancer patients are being cured than ever before because of early detection and improved treatments.  Survivorship begins the moment a person is diagnosed with cancer and lasts throughout his or her lifetime.  It is a unique journey for each person.  There is no right or wrong way to be a cancer survivor.  Many survivors experience a change in his or her life priorities, including relationships, family, career or lifestyle.  Some appreciate life more while others become more anxious and uncertain. 

Though going through cancer treatment can be difficult, many survivors find the time period after treatment to be the hardest part of the journey.  Appointments are less often, there is less contact with the oncology staff and sometimes more fears about recurrence surface.  Family and work relationships may be tested during this time.  Many wonder if they will ever feel “normal” again. 

Survivors still need regular appointments with the oncology staff, with an emphasis on survivors’ unique needs.  Treatment-related side-effects may linger.  There may be periodic tests needed for certain cancers (such as mammography, endoscopy, CT scans, or blood tests).  Establishing a healthy lifestyle becomes more important than ever, and survivors need support for weight loss, exercise, dietary changes, and smoking cessation.   Emotional and psychological support is also very important.  Some of this comes from maintaining a relationship with healthcare providers and learning the medical facts about one’s cancer.  But the value of cancer-specific support groups, behavioral health counselors, spiritual counseling, and community cannot be overstated.  Building relationships with others who have a cancer history can help during your survivorship. 

Remember, the survivorship journey starts at the time of diagnosis and lasts a lifetime.  This is your journey and you are never alone.

Obesity is an epidemic and a preventable illness. It is estimated that 1 in 3 adults and 1 in 5 children in the United States are obese. In a few years, obesity (NOT tobacco) will become the number one cause for many types of common cancers.

Obesity is defined as having too much body fat, as opposed to being overweight which refers to an excess of body weight. One way to determine obesity is to use the body mass index or BMI. To calculate the BMI:

Weight in pounds divided by (height in inches x height in inches) x 703

• Ideal BMI = 18-25
• Overweight = 25-30
• Obese = 30-40
• Morbidly obese = anything over 40.

Obesity is caused by taking in more calories than a body burns. The extra calories are then stored as fat. Contributing factors include taking in too many calories as well as not getting enough exercise each day.

Obesity results in a long-term energy imbalance that increases a person’s storage of fat and also circulating levels of fatty acids. These higher levels of fatty acids can cause resistance to insulin. Insulin is a hormone essential to regulating the body’s metabolism. Insulin resistance has been associated with the development of diabetes, heart disease, hypertension and certain cancers including breast, colon, prostate, kidney, liver and endometrial.

The association of obesity and cancer isn’t yet fully understood. So far, we know that:

-Fat tissue produces excess amounts of estrogen, high levels of which have been associated with an increased risk of breast and endometrial cancer.

-Elevated levels of insulin and insulin growth factor-1 in the blood of obese people causes increased cell division, which could eventually lead to cancer. Fat cells produce hormones called adipokines which stimulate cell growth. Also, the adipose tissue causes a state of chronic inflammation which lowers the body’s immune response and allows abnormal cells to grow and propagate.

Unfortunately, there is no one way to magically solve the obesity epidemic. Exercise and appropriate diet can slowly reverse the process. Hopefully, future research will give new insight why certain people are more prone to obesity and this will allow for development of new treatment options.  Until then, an ounce of prevention is definitely worth a pound of cure.