Cancer Rehab Means a Better Quality of Life

By Jewel Johl, MD

The concept of rehabilitation has been widely accepted in cardiac and pulmonary care, and in recovery from traumatic and orthopedic injuries, but few understand how important this concept can be for cancer patients.  

Almost 70 percent of cancer patients report fatigue and overall de-conditioning during treatment.  Other complaints that many cancer patients have include muscle atrophy and decreased bone density, medication side effects, loss of stamina, balance problems and lymphedema.  Currently there are very few institutions and cancer centers that offer formal oncology rehabilitation services and these services are often omitted from cancer survivorship programs.

An oncology rehabilitation program should be designed to educate, support and empower patients who have, or have had cancer and to allow them optimal function and quality of life during and after their cancer treatments.  The National Comprehensive Cancer Network’s guidelines say “rehabilitation should begin with a cancer diagnosis and should continue even after cancer treatment ends.”

Oncology specific physical therapists can help patients overcome physical obstacles during treatment, and provide tools for independent participation in a plan to remain healthy and vibrant after cancer treatment. Patients who have lymphedema of any body part, restricted mobility, scar tissue formation after surgery, fatigue, de-conditioning or weakness, balance problems, difficulty walking, weight gain and decreased muscle mass can benefit from early intervention in an oncology rehabilitation program.  

At Diablo Valley Oncology, we have developed a state-of-the-art Physical Therapy and Lifestyle Center to meet the growing needs of cancer patients.  Our lead therapist, Alison Taba, is a licensed physical therapist with special training in oncology rehabilitation and lymphedema therapy.  Alison and our team of physical therapy specialists provide cancer rehabilitation services to patients who have been diagnosed with cancer, those undergoing cancer treatment and survivors of cancer to enable them to improve their quality of life and to help them successfully integrate back into society.  

In addition to physical therapy, our Lifestyle Center provides nutritional services by Tinrin Chew, RD, who specializes in providing oncology specific nutrition counseling for cancer patients.  Other services include group exercise classes and educational programs. Additional integrative health services will be incorporated in 2013.  

Our Physical Therapy and Lifestyle Center is the only one in the East Bay area and of the few in Northern California to provide cancer specific rehabilitation services.  Diablo Valley Physical Therapy & Lifestyle Center can be reached by calling 925-400-9570.

New Drug Brings Hope for Colon Cancer

By Jewel Johl, MD

March is colorectal cancer awareness month and a reminder to patients aged 50 and older to be screened either through occult blood test or colonoscopy. Screening for colorectal cancer can identify premalignant lesions and detect early stage cancer.

Approximately 150,000 new cases of large bowel cancer are diagnosed each year in the United States, of which 108,000 are colon cancers and the remainder rectal cancers. Annually, approximately 50,000 Americans die of colorectal cancer.  It is the second leading cause of cancer death, and accounts for approximately 9 percent of cancer deaths overall.

Several new drugs have been approved for metastatic colorectal cancer and have the potential to extend survival and improve patient quality of life.  Some of these drugs work in a unique, biological way.  While some are approved to be given in combination with chemotherapy, one is approved to be given by itself to patients who have advanced metastatic colorectal cancer and have run out of standard chemotherapy options.

While new drugs continue to give hope to colorectal cancer patients, early detection is still critically important to patient’s survival.  Screening for colorectal cancer can identify premalignant lesions and detect early stage cancer. There are several tests that are available for colorectal cancer screening. While stool occult blood test can detect cancer at an early stage, colonoscopy has the potential to prevent cancer by detecting polyps that can be removed prior to malignant transformation. Screening needs to start even earlier for patients with hereditary forms of colon cancer (HNPCC) or when a strong genetic predisposition is suspected.

Jewel Johl, M.D., a Medical Oncologist with Diablo Valley Oncology. One of his specialties is treating colorectal cancer.  He practices at the California Cancer and Research Institute in Pleasant Hill and at a satellite office in Brentwood.  For more information, call 925-677-5041.

New Drugs in Oncology 2012

By: Michelle Taymuree, PharmD, MBA

The Food and Drug Administration believes Americans should have access to safe and effective drug therapies as early as possible and in 2012 approved 35 novel medicines that can now be used by physicians across the country. Of these 35 novel drugs, 15 were particularly notable for their significant contributions to the health and quality of life of patients. Of the 15 drugs, 8 were specifically targeted to cancer treatment or cancer related treatment and 5 of the 8 drugs can be taken orally.

• Erivedge is the first FDA approved drug for late-stage (metastatic) basal cell cancer, the most common form of skin cancer. Erivedge can be taken orally.
• Xtandi was approved to treat men with late-stage (metastatic) castration-resistant prostate cancer that has spread or recurred, even after medical or surgical therapy to minimize the prostate tumor growth hormone, testosterone. Xtandi can be taken orally.
• Jakafi is the first drug to be approved for patients with myelofibrosis. Myelofibrosis is a rare disease in which the bone marrow is replaced by scar tissue, forcing blood cells to be made in the liver or spleen rather than in the bone marrow. This causes enlarged spleens, pain, anemia, fatigue and other symptoms. This is the first drug approved to decrease patients’ symptoms. Jakafi can be taken orally.
• Voraxaze was approved to lower the toxic levels of the chemotherapy drug, methotrexate. Methotrexate is a commonly used cancer chemotherapy drug normally eliminated from the body by the kidneys. Patients receiving high doses of methotrexate may, however, develop kidney failure. Voraxaze lowers the toxin levels to the kidney.
• Erwinaze is the first treatment for patients with acute lymphoblastic leukemia (ALL) who have developed an allergy to E. coli-derived asparaginase and pegaspargase drugs.
• Stivarga is the latest colorectal cancer treatment to demonstrate an ability to extend patients’ lives and was the second drug FDA approved for patients with colorectal cancer within two months. Zaltrap was the first. Stivarga can be taken orally.
• Perjeta was approved for patients with late-stage (metastatic) breast cancer. Perjeta is a new anti-HER2 therapy, and was approved to slow disease progression in patients with HER2-positive metastatic breast cancer, when used in combination with two other cancer drugs.
• Bosulif was approved for patients diagnosed with Chronic Myelogenous Leukemia (CML). CML is a blood and bone marrow disease that usually affects older adults. Most people with CML have a genetic defect, called the Philadelphia chromosome, which causes the bone marrow to make an enzyme called tyrosine kinase. This enzyme triggers the development of too many abnormal and unhealthy white blood cells, interfering with their ability to fight infection. Bosulif works by blocking the signal of the tyrosine kinase that causes the abnormal and unhealthy white bloods cells to grow. Bosulif can be taken orally.

Michelle Taymuree, Pharm.D, MBA is Director of Pharmacy with Diablo Valley Oncology at the California Cancer and Research Institute in Pleasant Hill. The practice specializes in comprehensive, cutting edge treatment of all forms of cancer and blood disorders. They provide private suites for outpatient infusion and Michelle counsels patients on their medications. She can be reached at 925-677-5041.

January is Cervical Cancer Awareness Month

By Gigi Chen, MD

As with any cancer, prevention and early detection is crucial. With increasing use of the PAP test (a screening looking for any changes to the cervix) the number of cervical cancer cases has decreased in American women by 70%. From 1992 to 2003 the number of deaths from cervical cancer in American women was on a steady decline, and has since plateaued. Cervical cancer tends to occur during a woman’s mid-life with most cases occurring before the age of 50 and more than 20% of cervical cancer cases occurring in women over the age of 65.

Though screenings are being performed to help prevent cervical cancer there are risk factors that aid in the development of the disease. HPV is the primary cause of the disease. Certain types of HPV are called high-risk types because they are strongly linked to cancers, including cancer of the cervix, vulva, and vagina in women, penile cancer in men, and anal and oral cancer in both men and women. Infection with HPV is common, and in most people the body is able to clear the infection on its own. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection can lead to the development of cervical cancer. Though HPV can be spread during sex, sex doesn't have to occur for the infection to spread. All that is needed to pass HPV from one person to another is skin-to-skin contact with an area of the body infected with HPV. There is currently no cure for HPV infection, however, there are ways to treat the warts and abnormal cell growth that HPV causes.

Another risk factor for cervical cancer is smoking. Women who smoke are almost twice and likely to develop cervical cancer than those women who do not smoke. Also, women who are HIV+ or have AIDS are also more likely to develop the disease due to their damaged immune system and therefore have a higher chance of contracting HPV. Other risk factors include family history, and taking oral contraceptives for an extended period of time, early onset of sexual activity and multiple sexual partners.

In order to prevent the disease here are some basic recommendations:

• Get vaccinated against HPV
• All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (although it may be used as a part of follow-up for an abnormal Pap test).
• Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This should continue until age 65.
• Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.

Please remember, these are basic guidelines for helping to prevent cervical cancer. Always consult your physician for more detailed information.

Dr. Chen is board certified in medical oncology and hematology and practices with Diablo Valley Oncology, located at the California Cancer and Research Institute in Pleasant Hill. She treats all forms of cancer and blood disorders and has a special interest in lung and gynecologic cancer. 

San Antonio Breast Cancer Conference Update

By: Dr. Tiffany Svhan

At the San Antonio Breast Cancer Symposium today, results of the international ATLAS trial were presented. This trial included nearly 7000 women with hormone-sensitive early stage breast cancer.  The presenter, Dr. C. Davies from the United Kingdom, discussed the results of 5 years of adjuvant tamoxifen versus 10 years.  Women who took tamoxifen for 10 years rather than 5 had a nearly 3% reduction in the risk of death.  While modest, the benefit appears to be real and meaningful.  This data may be most important in premenopausal women, as postmenopausal women tend to switch to aromatase inhibitors after 5 years of tamoxifen.  This data may lead to a significant change in how we treat young women with early stage breast cancer.

Read the New York Times Article on Tamoxifen here.

Being a Caregiver is a Challenging Job

By: Michelle Rooney, NP

Caring for a loved one who is diagnosed with cancer is tough physically, mentally and emotionally. What defines a caregiver? Caregivers are family members, friends and loved ones who provide full and part time support for a cancer patient. They do this through preparing food, running errands, helping with doctors appointments and treatment, coordinating care, cleaning, and offering emotional support for not only the patient but for the other people involved in their treatment. The opportunities to care for someone suffering from cancer, in any capacity, are endless.

Being a caregiver is a challenging job. We want to share with you some helpful tips and resources for taking care of yourself, and being better prepared to care for those you love. Remember, everyone’s situation is individual and unique, so some of these may not apply to you.

Be open and communicate. Communication is key, not only your loved one, but with their healthcare team, other caregivers, and people who are connected to the cancer patient. It can take time to figure out communication styles that work best for you, but keeping everyone up to date on the care of your loved one and their needs will provide you more help and understanding from those around you. One effective and efficient method that is becoming more widely used is to create a blog or webpage for your loved one.  Most of these sites are free and easy to setup and manage. Carepages and CaringBridge are two popular sites to blog on.

Be HIPAA compliant. Often as a loved one’s health declines, they need more help. If you are the primary caretaker, or someone who is helping with doctors visits, treatment, medication or other medical support, it is important the patient has signed paperwork allowing you access to their medical information (HIPAA). Having this release will allow you to be in exams with the patient, to help by taking notes, and if necessary, communicate with the medical team. You will be enabled as the patient’s advocate; having the ability to ask questions they may forget or feel too overwhelmed to ask, have treatment options explained, communicate with others what prognosis and plans are in place, and comfort the patient. This HIPAA form is usually signed during the registration process but can be updated at anytime.

Stay organized. This is easier for some individuals than others, but the effort is worth it. Take notes as you would for your own care. Keep track of medications, vitals, labs and other tests, which can help everyone understand the illness and the treatment. Keeping all of the information organized is also helpful when you need help from other caregivers. Having all of the information accessible makes an easy transition for other people to help give medications, take the patient to appointments and adjust to their needs.

Ask for help. Not only should you rely on the support of the patient’s friends and family, but of your own. Battling cancer is a community effort and you need people to talk to as well, so talk to friends, family or a professional when you are feeling overwhelmed, depressed, or having trouble meeting the needs of yourself and your loved one.

Take breaks and take care of yourself. As a primary caretaker, spending time doing something for yourself can feel strange and selfish.  But, you must make time to take care of yourself so that you are physically and mentally strong for your loved one.  Doing something you enjoy, whether it be exercise, cooking, reading or sleeping will be rejuvenating and refreshing.  You will be healthier and happier, and your loved one will benefit from renewed energy.

These are just a few tips and resources to help caregiving go a little easier. There are many more aspects of caretaking that were not listed and many that will be unique to your situation. If you have any questions, or feel you need support please contact the Cancer Support Community. We have a local chapter in Walnut Creek: 3276 McNutt Ave  Walnut Creek, CA 94597 - (925) 933-0107.

November is Lung Cancer Awareness Month

By Gigi Chen, MD

Lung cancer accounts for about 14% of all cancer diagnosis, however, it is responsible for almost 29% of all cancer deaths. Lung cancer is the leading cause of cancer death for both men and women in U.S. In 2012, an estimated 226,200 new cases of lung cancer will be diagnosed. The incidence and death have been decreasing for men, but had been rising for women until around the year 2000 when they began to level off. The major cause of lung cancer is smoking, which is responsible for 85% to 90% of lung cancer. Other risk factors include environmental and occupational exposures such as asbestos, radon, air pollution, radiation and second hand tobacco.

More than 95% of lung cancer consists of one of the four major types: squamous, adenocarcinoma, large cell, or small cell cancer. Squamous, adenocarcinoma and large cell are together called non-small cell lung cancer. Adenocarcinoma comprises of 50% of lung cancer in US. The most common symptoms patients experience are decreased appetite, fatigue, weakness and cough.

Currently, most patients with lung cancer are diagnosed at an advanced stage. There has been recent promising data in the area of lung cancer screening. The National Lung Cancer Screening trial enrolled 53,000 current or former heavy smokers and showed that screening high risk patients with low dose CT decreased mortality from lung cancer by 20% compared to chest X ray. High risk patients are either current or former smokers with 30 pack year smoking history, aged 55 to 74 years. The International Early Lung Cancer Action Program (I-ELCAP) assessed whether annual screening with low dose CT can increase early detection in patients at risk for lung cancer. They found that if lung cancer is detected in stage I and promptly removed, the 10 year survival is 92%. These trials suggest that early screening can decrease the risk of death from lung cancer in high risk patients.

Treatment of lung cancer requires a collaborative effort between patients and their medical oncologist, thoracic surgeons and radiation oncologist. Treatment strategies for non-small cell lung cancer can include surgery, chemotherapy or radiation or a combination of these methods. Whereas treatment for small cell lung cancer typically involves chemotherapy or combined chemotherapy and radiation.

There have a number of new and exciting drugs in lung cancer that can target cancer at a molecular level. Erlotinib is an oral drug that works effectively in patients with EGFR mutation, which can be found in up to 50% of Asian patients and about 10% Caucasian patients. Another example is Crizotinib, which is effective in patients with tumor express EML4-ALK rearrangement, which occurs in about 10,000 patients in US. Bevacizumab and Cetuximab which are monoclonal antibodies can be used in conjunction with chemotherapy in newly diagnosed non-small cell lung cancer. Understanding lung cancer genomics and biology will enable development of medicines that are more effective and have fewer side effects. 

Dr. Chen is board certified in medical oncology and hematology and practices with Diablo Valley Oncology, located at the California Cancer and Research Institute in Pleasant Hill. She treats all forms of cancer and blood disorders and has a special interest in lung and gynecologic cancer.  

November is National Lung Cancer Awareness Month and the California Cancer and Research Institute has arranged to offer complimentary consultants for screening during the week of November 12-16.

To learn more about this lung cancer awareness program, please call 925-826-1900.