Living with Breast Cancer

Conference for Women with Advanced Breas

3/18/2010 (7:37:55am)Tags: noneComments: (0)

Each spring, Living Beyond Breast Cancer (www.lbbc.org) sponsors a wonderful two day conference for women living with advanced breast cancer. Although I am not going this year, I have attended several times, and it is excellent. This is an opportunity to meet other women and to learn from many experts. The dates are May 1st and 2nd; it takes place just outside of Philadelphia. From Boston, this is an easy train trip, a possible drive, and an expensive flight. If you are considering attending and would prefer to fly, check out costs to fly to Baltimore and then rent a car. There is a huge difference in the fares. Note that there are travel grants available to help with the expense.

Here is their summary of the meeting:

Join us for the 4th Annual Conference for Women Living with Advanced Breast Cancer. Be inspired by speakers who have coped with cancer and find out what you want to know from our panel of experts. In our workshop sessions, experts will discuss medical treatments for bone, liver, lung and brain mets, clinical trials and cutting-edge therapies, and managing side-effects. Network and connect with other women and families.

Cancer and Language

3/17/2010 (7:46:21am)Tags: cancer language wordsComments: (0)

I love this essay from The New York Times by Dana Jennings. I have struggled for years with some of the language used in the cancer world. My most hated phrase is: "She failed treatment X." SHE did not fail! The treatment failed her. Although this common phrase is not intended to be critical, it sums up the usual "blame the victim" mentality. I also dislike all the war words, and have told my family that I will haunt them if my obituary (hopefully, a long, long time from now) says anything like "After a courageous battle....." 

Here it is:

MARCH 15, 2010, 4:47 PM

With Cancer, Let’s Face It: Words Are Inadequate

By DANA JENNINGS

James Steinberg

We’re all familiar with sentences like this one: Mr. Smith died yesterday after a long battle with

cancer. We think we know what it means, but we read it and hear it so often that it carries little

weight, bears no meaning. It’s one of the clichés of cancer.

It is easy shorthand. But it says more about the writer or speaker than it does about the

deceased. We like to say that people “fight” cancer because we wrestle fearfully with the notion of ever having the disease. We have turned cancer into one of our modern devils.

But after staggering through prostate cancer and its treatment — surgery, radiation and hormone therapy — the words “fight” and “battle” make me cringe and bristle.

I sometimes think of cancer as a long and difficult journey, a quest out of Tolkien, or a dark waltz — but never a battle. How can it be a battle when we patients are the actual battleground? We are caught in the middle, between our doctors and their potential tools of healing and the cell-devouring horde. We become a wasteland, at once infested by the black dust of cancer and damaged by the “friendly fire” of treatment. And ordinary language falls far short of explaining that keen sense of oblivion.

As a patient, it’s hard to articulate how being seriously ill feels. In a profound way, we are boiled down to our essential animal selves. We crave survival. We long for pain to end, for ice chips on parched lips, for the brush of a soft hand. It pays to have a positive outlook, I think, but that in no way translates to “fighting” cancer.

Cancer simply is. You can deny its presence in your body, cower at the thought or boldly state that you’re going to whup it. But the cancer does not care. You’re here, the cancer has arrived, and the disease is going to feed until your doctors destroy it or, at least, discourage it.

Then there’s the matter of bravery. We call cancer patients “brave,” perhaps, because the very word cancer makes most of us tremble in fear. But there is nothing brave about showing up for surgery or radiation sessions. Is a tree brave for still standing after its leaves shrivel and fall?

Bravery entails choice, and most patients have very little choice but to undergo treatment.

Which brings me to “victim.” I didn’t feel like a victim when I learned that I had cancer. Sure, I felt unlucky and sad and angry, but not like a victim. And I have no patience for the modern cult of victimology.

Victim implies an assailant, and there is no malice or intent with cancer. Some cells in my body mutinied, and I became a host organism — all of it completely organic and natural.

And what are we once treatment ends? Are we survivors? I don’t feel much like a survivor in the traditional (or even reality TV) sense. I didn’t crawl from a burning building or come homewhole from a tour of duty in Afghanistan. I’m just trying to lead a positive postcancer life, grateful that my surging Stage 3 cancer has been turned aside, pleased that I can realistically think about the future. I’m trying to complete the metamorphosis from brittle husk to being just me again.

The phrase “salvage radiation” is not used much anymore, but when one doctor said it in reference to my treatment, it made me feel less human and more like a “case.” It meant I needed radiation after surgery, because the cancer was more aggressive than expected — I needed to be “salvaged.”

I felt as if I had been plopped into some screwy sequel to “Raise the Titanic!” — time to raise the U.S.S. Jennings, lads. Or maybe I was going to get picked up by a scrap-metal truck and then get zapped at Frank’s Junkyard, laid out in the back seat of a 1960 Ford Fairlane.

And I’m still troubled by this sentence, which I’ve heard many times: “Well, at least it’s a good cancer.” It’s usually applied to cancers that are considered highly treatable, like those of the prostate and thyroid.

Most people mean well, but the idea of a good cancer makes no sense. At best, the words break meaninglessly over the patient. There are no good cancers, just as there are no good wars, no good earthquakes.

Words can just be inadequate. And as we stumble and trip toward trying to say the right and true thing, we often reach for the nearest rotted-out cliché for support. Better to say nothing,and offer the gift of your presence, than to utter bankrupt bromides.

Silences make us squirm. But when I was sickest, most numbed by my treatment, it was more than healing to bask in a friend’s compassionate silence, to receive and give a hug, to be sustained by a genuine smile.

Strangely enough, although cancer threatened my life it also exalted it, brought with it a bright and terrible clarity.

So, no, cancer isn’t a battle, a fight. It’s simply life — life raised to a higher power.

Exercise Benefits (Again)

3/16/2010 (7:52:41am)Tags: noneComments: (0)

I have written a number of times about the benefits of exercise and new studies continue to support this theme. Jennifer Wenzel, RN, PhD and colleagues from Johns Hopkins just reported this data about the benefits for breast and prostate cancer patients who exercised, moderately and regularly, throughout treatment. They found that these individuals had less fatigue, more vigor (love that word), and less psychological distress than their more sedentary colleagues. 

During my chemotherapy, I did continue to go to the gym almost every day. My routine certainly was less ambitious (not that it is ever all that ambitious), but I know I felt better for going. Maintaining my usual routine, the socialization, the sense that I still could move my body and have a little control--all were good. I well remember feeling a little self conscious about the scarf on my head, but certainly was not going to wear a hat or wig on the elliptical machine. In retrospect, a baseball hat with attached hair would have worked, too. On those mornings when I really did not want to get out of bed and go exercise, I didn't.

Here is a report of the study:

Exercise Intervention Improves Fatigue, Other

Outcomes in Cancer Patients

March 12, 2010 (Atlanta, Georgia) — Patients who exercised during cancer treatment experienced less fatigue, more vigor, and less emotional distress than those who were less active, according to the findings of a randomized trial evaluating an exercise intervention.

Jennifer Wenzel, PhD, RN, assistant professor at Johns Hopkins School of Nursing in Baltimore, Maryland, presented the findings here at the 16th International Conference on Cancer Nursing. The findings represent the completion of work initiated by Victoria Mock, PhD, also from Johns Hopkins, now deceased.

Of 620 eligible patients, 138 consented to be in the study; 73 were randomized to the exercise group and 65 were randomized to the usual-activity group. Patients had newly diagnosed nonmetastatic cancer and had no concurrent

health problems or disabilities that limited their ability to participate. At the time of study enrollment, they were not exercising more than 3 times (or 120 minutes) per week.

The mean age of the study participants was 60.2 years. Of the patients, 55.6% had prostate cancer and 32.5% had breast cancer. Patients were to receive treatment with chemotherapy and/or external-beam radiation therapy.

Participants in the exercise group received an individualized exercise prescription on the basis of their physical condition. Patients were asked to walk briskly for 10 minutes, increasing to 30 minutes, 5 days a week. The walking

intensity was designed to reach approximately 50% to 70% of maximum heart rate. The level of aerobic activity for walking, jogging, running, swimming, and biking was evaluated using the Physical Activity Questionnaire 5-activity

subscale (PAQFA) and calculated in METs/hour per week.

Of participants in the exercise group, 68% adhered to their exercise prescription; of those in the usual-activity group, 12% of exercised at a level greater than that assigned to the exercise group. A total of 68 patients in the exercise group and 58 patients in the usual-activity group completed the study. Increased aerobic exercise was significantly associated with less fatigue when measured with the Piper Fatigue Scale (P < .001), the Symptom Distress Scale (SDS) fatigue subscale (P < .005), and the Profile of Mood States (POMS) fatigue subscale (P < .02), after controlling for baseline outcome, age, and baseline and posttest PAQFA.

Participants who exercised throughout the study period had 7.5% more vigor on the POMS subscale (P < .001). With respect to quality of life, those who exercised had 3% less emotional distress on both the POMS total scale and the Medical Outcomes Study Short-Form Health Survey (MOS SF-36) emotional well-being subscale, compared with those who were less active (P = .021).

"A flexible, home-based exercise program has few risks and potential benefit that may be attainable for solid tumor patients, regardless of diagnosis," Dr. Wenzel said during the presentation. "Future intervention studies among patients receiving active cancer treatment should evaluate exercise guidelines specific to age or treatment type and, possibly, to cancer diagnosis."

According to Dr. Wenzel, interventions, including exercise, might need to be targeted to improve retention among study participants with less education and those from minority populations. "Lack of retention may prevent these already vulnerable groups from participating in an intervention that has many potential benefits," she told Medscape Oncology.

"Exercise interventions are receiving increasing attention and have been shown to have some benefit," said Mary Lou Siefert, DNSc, assistant professor at the William F. Connell School of Nursing at Boston College in Massachusetts. "I

would continue to suggest to my patients that short amounts of exercise, such as walking, are helpful," she told Medscape Oncology.

According to Dr. Siefert, the findings confirm those of other studies that have been published in the breast cancer literature. "This study evaluated 2 treatment types in 2 types of cancer," she said. "However, as the authors acknowledge, we really need to look at other cancers and populations as well," she said.

Choosing Your Doctors

3/15/2010 (7:37:20am)Tags: doctors medical team choicesComments: (0)

There are a number of different entrances into Breast Cancer World. You or your partner may first feel a lump. Your GYN or PCP may find something during an annual exam. A mammogram or breast MRI may indicate a suspicious area. However you get here, you will suddenly be faced with the important and difficult decision of choosing a doctor. If you have felt a lump, your first call will likely be to your current doctor. After that initial medical connection, you will be referred to a breast cancer specialist--probably a surgeon, but possibly a medical oncologist or a radiologist with expertise in breast cancer imaging and radiologically-guided biopsies.

This is not a medical emergency. It most certainly is a psychological emergency, and you are in crisis, but you do have a little time to slow down, consider your options, and make the best choices for your care. Clearly, step one is to have a definitive diagnosis. Mammograms and breast MRIs can raise the question, but they cannot answer it. The only way to know for sure whether a suspicious lump/area is malignant is to have a biopsy and for a pathologist to then examine the cells under a microscope. There are several kinds of possible biopsies for breast cancer, and your doctor will suggest what makes the most sense for your situation. One good website is ACS for a great deal of information about this process. 

If you have a definitive diagnosis of breast cancer, you need a surgeon. This can get tricky. It is probable that your GYN or PCP will have colleagues and traditional referral patterns;s/he likely will give you a name and suggest that you make an appointment with Surgeon X.  There are many general surgeons who do a great deal of breast surgery. There are also breast surgeons who have chosen to specialize in this field and devote 100% of their professional attention to breast cancer. My bias is probably obvious, but I believe that, for any medical problem, you want to find a doctor who deals with it every day. Ask. Talk both with your doctor and with any women whom you know (or know of) who have had breast surgery. Call the nearest NCI designated cancer center for names.

The most important thing about your surgeon is her/his technical skill. Many surgeons are also warm, engaging, and compassionate individuals. Certainly, the human chemistry matters, and it is best if you feel closely connected to your surgeon. Remember, however, that you really are hiring the surgeon's skills in the OR. You, hopefully, will only need her/him once or twice (e.g., if you need a second surgery for a full axillary node dissection or to achieve clean margins), and if you are confident that Surgeon Y is the very best available in your area, s/he's the one you want. Remember that breast surgeons do not usually do reconstruction. For that, you will need a plastic surgeon. Those of us in urban areas are often blessed with choices. In Boston, as well as in many other cities, there are a number of fabulous breast surgeons who combine the very best professional competence with very human sensitivity and care.

The choice of a medical oncologist is, perhaps, even more important. This is a relationship that will continue for years, if not for the rest of your life. You absolutely want to be cared for by a doctor whom you trust, respect, and like. While breast cancer surgery is pretty straight-forward with rather limited choices (wide excision or mastectomy with or without reconstruction), there may be a range of possibilities for your systemic care. Following surgery and the final pathology report, you will need to consult with a medical oncologist. Even if the recommendation is no systemic treatment, it is a doctor with this training who should help you make this decision. Again, talk to everyone you know about their experience with their oncologist. Call the nearest NCI designated cancer center. It is very important to identify a medical oncologist who is completely up to date on all the newest research and trials as well as someone who practices at a center/hospital/office that is comfortable for you. Many people travel a long distance for an opinion with an expert at a large Cancer Center, and then have the treatment itself with a medical oncologist close to home.

When you are meeting with a medical oncologist for the first time, in addition to all your questions about your cancer and proposed treatments, take a few moments to consider her/his style and environment. Does she listen to you? Is she respectful of you and whomever is accompanying you? How can you reach her between appointments? Does she correspond by email with her patients? Is there a specific time of day that she is usually available for phone calls? Look at the staff in the office, too. Are they friendly, efficient, respectful? Is everyone's privacy being protected? Is the space itself comfortable and welcoming?

Again, we are so blessed in Boston to have several great academic medical centers and many fine doctors. Many women, with whom I work, consult with two or three oncologists, at two or three institutions, before making a doctor decision. I tell them that the medicine in any of Boston's big hospitals will be the same, but the cultures are different. Without placing any value judgments, I assure them that they will feel most comfortable at one or another place. Pay attention to the pit of your stomach. Of course, you will be anxious during these first meetings, but how long the anxiety persists, how well cared-for you feel, and how comfortable you become during the discussions are important. You will know when you have found the right doctor. Remember that you are the consumer, that you have choices, and that your single goal is receiving the very best medical care for your unique situation.

After Cancer Short Video

3/14/2010 (4:15:14pm)Tags: after cancer survivorship issuesComments: (0)

This is an excellent short video about after treatment issues. Lidia Shapira, MD, who is interviewed in this ASCO piece, is a wonderful medical oncologist at MGH.

http://www.cancer.net/patient/Multimedia/Cancer.Net+Videos

Oncotype Tests Not Well Explained

3/13/2010 (7:33:18am)Tags: oncotype oncotype DX cancer gene recurrence genomic testing riskComments: (0)

Some of you are aware of the Oncotype DX test that is often used to help determine which women with early breast cancer would benefit from chemotherapy. It has been in use for a little more than five years and was initially only offered to women who had ER/PR positive (hormone positive), node negative disease. Over the course of a few years, it was expanded to sometimes include women who had positive node(s).

We have known for a long time that chemotherapy is often given to women who don't need it and/or who won't benefit from it. Determining the risk/benefit ratio and trying to better understand whose cancer is at higher risk for recurrence is a major challenge. A major direction of all cancer research is better targeting therapies and understanding who should get/who needs what treatment. As it stands now, for every 100 women with breast cancer who are given adjuvant chemotherapy, only a minority (depending on the stage and type, that number can vary from 3 or 4 to 20 or more) will benefit from it. The catch, of course, is that it is impossible to select those women at risk, and the reality of recurrent/metastatic breast cancer (meaning, not a local recurrence) is a disease that cannot be cured. Very high stakes.

I actually first learned of this test five years ago when my second breast cancer was diagnosed. For a range of specific reasons, including the fact that there was no way to know whether any axillary lymph nodes were involved because I had had an axillary node dissection 12 years earlier--voila, there were no nodes to be tested, I did have the Oncotype DX test done. The results returned in an intermediate risk range which confirmed the value of chemotherapy.

Here is a summary from Medpage about understanding these test results and then a link to find out more about the test itself:

 

Cancer Gene Test Results Often Not Well Explained

By Charles Bankhead, Staff Writer, MedPage Today

Review

Discussions of genetic test results for breast cancer recurrence risk frequently miss the mark for patient comprehension, according to a survey of women with early-stage breast cancer.

A third of the survey respondents said they did not fully understand discussions with healthcare providers about results of genomic testing. The findings underscore the need to improve communication with patients about risk and treatment decision-making, investigators reported online in Cancer.

"Most women had high perceived understanding of what they discussed with physicians regarding their test results," Janice P. Tzeng, of the University of North Carolina in Chapel Hill, and colleagues wrote in conclusion. "However, a significant number of women did not fully understand discussions about their genomic-based recurrence risk, which presents the need to continue developing optimal ways to communicate and ensure both perceived and actual comprehension of genomic-based information.

"Finally," they wrote, "women with intermediate and high genomic-based recurrence risks deserve special attention, as they are more likely to suffer from worry about recurrence and distress regarding their result."

The findings came from a survey and medical-record review of 77 women with early-stage breast cancer. All the women had estrogen receptor-positive tumors and zero to three involved lymph nodes. They were evaluated by means of the Oncotype DX genomic test from 2004 to 2009. Complete data were available for 68 of the patients.

Half of the patients had test results indicating a low risk of recurrence, and another 37% had results indicating an intermediate risk. A quarter of the patients recalled having anxiety about their test results.

The authors found that 71% of the respondents accurately recalled the recurrence risk indicated by their test results. Two-thirds thought that they understood much of what they were told about the test results, leaving a third of the study group with incomplete or inadequate understanding of their results. When asked whether they would have the genomic test again, 96% of respondents said they would, and 95% said they would recommend the test to other women in the same situation.

Additionally, 95% of the women said the test results helped them better understand their treatment options' chances of success, 71% believed their test results were accurate, and 76% found the test useful because it could determine with certainty whether they had a high risk of recurrence. "Overall, results suggest that women are satisfied with genomic testing, given that they would recommend the test to other women and would have the test if they had to decide again," the authors wrote. "They also saw many benefits and few concerns about genomic testing."

Primary source: Cancer

Source reference:

Tzeng JP, et al "Women's experiences with genomic testing for breast cancer recurrence risk" Cancer 2010;

 

To learn more about the test itself:

http://tinyurl.com/yj7gwqe

 

 

Support Groups

3/12/2010 (10:12:11am)Tags: noneComments: (0)

Many of you know that I am a major fan of support groups. I strongly believe that the right group can be the best help for someone living through breast cancer. It can be difficult to find the "right group." Given the high incidence of breast cancer, one would think that there would practically be groups on every street corner. Instead, there are relatively few, and the options diminish when you try to match schedules and geography. I facilitate five support groups at BIDMC: one for women who are newly diagnosed or going through adjuvant treatment, two for women who have completed treatment, one for women with Stage IV/metastatic disease, and one for women with GYN cancers. If any of this might interest you, please contact me. My standard description of my groups is this: "We talk about all the hard things, but we also laugh a lot. And are always there for each other."

How do you find a group near you? You can ask your doctor or nurse (and, frankly, the nurse is more likely to know). If there is an oncology social worker in your treating facility, she certainly will know. You can call a local hospital or cancer center, ask for the social work department, and ask there. You can call your local American Cancer Society; they try to maintain current lists of nearby groups. You can look online. You can contact the Association of Oncology Social Work at www.aosw.org and ask for the name of someone near you.

When you do make a call of inquiry, in addition to asking about times and location and fees (usually there are none for cancer support groups; ours are all free), there are two important questions to include:

1. Who facilitates the group? You want an experienced and competent group leader. Although some other kinds of groups work fine as peer support, I think that is risky for cancer support groups.

2. Who comes to the group? Some groups, like mine, are structured for women at specific points in the experience. Others are open to anyone with a diagnosis. There are people who strongly argue for both types. My opinion is that it is better to be with others in a comparable situation. A woman living with Stage IV breast cancer and a woman who was diagnosed last week with early breast cancer will not be able to be as much help to one another or find as much personal help as each would like.

Here is a summary from ASCO's Cancer Net about groups:

 

Key Points:

Support groups can help people with cancer gain emotional and educational support throughout their cancer experience.

Many types of support groups are available, and many resources are available to help you find one that is best for your situation.

Having cancer can be one of the most stressful experiences of a person's life. Support groups can help many people cope with the emotional aspects of cancer by providing a safe place to share experiences and learn from others who are facing similar situations.

Reasons to join a support group

Hearing the news of your cancer diagnosis usually triggers a strong emotional response. While some people experience shock, anger, and disbelief, others may feel intense sadness, fear, and a sense of loss. A person may also feel lonely and isolated, as even the most supportive family and friends cannot understand exactly how it feels to have cancer.

Support groups offer the chance for people to talk about their experiences with others living with cancer.

Group members can share feelings and experiences that seem too strange or too difficult to share with family and friends. The group experience can create a sense of belonging that helps each person feel less alone and more understood. Sharing feelings and fears with others who understand may also help reduce stress.

In addition to sharing their feelings and experiences, support group members discuss practical information, such as what to expect during treatment, how to manage treatment side effects and pain, and how to communicate with health care providers and family members. Exchanging information and advice may help achieve a sense of control and can reduce feelings of helplessness.

Many studies have shown that support groups can help people with cancer feel less depressed and anxious and more hopeful. Although support groups are not for everyone, people who benefit from support groups may find themselves better able to handle their emotions.

 

PTSD and Cancer

3/11/2010 (6:28:40am)Tags: noneComments: (3)

I have written before in this blog and at length in my book, A Commonsense Guide to Life After Breast Cancer, about the prevalence of PTSD (Post Traumatic Stress Syndrome) in women who have had cancer. Although this label is more commonly applied to soldiers coming home from war, accident or natural disaster victims, or people who have experienced other disasters, I have always felt it was often relevant post cancer. Certainly, being diagnosed with a potentially life-threatening illness and experiencing a range of difficult, often painful, sometimes disfiguring, always frightening, treatments and being left with a changed life view qualifies for this term. I think I also like the concept because it defines the issue as being stimulated by an event, circumstances, something beyond our control. When, in contrast, we think about depression (also common, of course), it can seem more self-focused.

Here is a quote about risk factors for PTSD from ASCO's Cancer Net and then a link to read more:

Risk factors

It is not clear why some people with cancer develop PTSD while others do not. Some factors may make a person more likely to develop the disorder, including a younger age. Another study shows that survivors of childhood cancer, especially those who had longer and more intensive treatments, have an increased risk of PTSD.

PTSD also seems to be more common for:

People who have had PTSD or other mental health conditions before being diagnosed with cancer

Women from minority groups

People with high levels of overall stress

People who use avoidance strategies as a way to cope with stress, such as using drugs or alcohol

People with less formal education

People with low or no income

Single people

 

Factors that may make a person less likely to develop PTSD include getting strong support from family and friends, being given correct information about the stage of the cancer (where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body), and having good relationships with members of the health care team.

Please remember that PTSD is highly treatable. If you see yourself in any of this, it is important to contact a mental health provider, ideally someone who is familiar with cancer and its treatment. A few sessions will make a big difference.

 

http://www.cancer.net/patient/Survivorship/About+Survivorship

 

Underweight and Increased Risk

3/10/2010 (7:22:28am)Tags: underweight low weight recurrenceComments: (1)

The headline of this study jumped out at me: "Being underweight increases breast cancer recurrence and death." For years, we have been hearing about the importance of weight maintenance, the dangers of obesity both for breast cancer and many other health issues. To be fair, this study from Dong Young-Noh and colleagues at the University of Seoul, published in Journal of Clinical Oncology, carefully differentiates underweight from low normal weight. It also is a first study to look at the impact of very low weights on survival, and we don't know whether this will hold up under further scrutiny.

It is also interesting to me that this study, contradicting the usual thoughts, is from Asia. Remember the recent study from China about the possible advantage of eating a lot of soy? That, too, was in direct opposition to the usual recommendations. Once again, we will just have to wait and see as other researchers explore the question. In the meantime, maybe we can feel slightly less guilty about the occasional brownie.

What it does do, immediately, is remind me of all the contradictions and uncertainties re how we can best care for ourselves after completing treatment. It all seems to come down to Eat right, Exercise, Get enough sleep, Don't smoke, and Wear your seatbelt. Beyond that, we just hope we are lucky.

Here it is:

 

Oncology

Being underweight increases breast cancer recurrence and death

By Liz Scherer

22 December 2009

J Clin Oncol 20 09; 27: 5899–5905

MedWire News: Underweight breast cancer patients are at increased risk for poor overall survival and shorter time to recurrence, report researchers.

The relevance of body mass index (BMI) as a prognostic factor in breast cancer remains controversial, state Dong-Young Noh, from the Seoul National University College of Medicine in Korea, and colleagues.

Even less clear is the impact of underweight, which “in contrast to the considerable body of work on obesity and breast cancer outcome” has not been adequately addressed, write the researchers in the Journal of Clinical Oncology.

In this study they explored the association between breast cancer and being underweight (BMI <18.5 kg/m2) or overweight (BMI ≥25 kg/m2) using national data on 24,698 Korean breast cancer patients. An additional evaluation that focused solely on body weight and breast cancer recurrence was conducted using information from 4335 breast cancer patients from a single database.

In the first analysis, underweight patients had significantly lower odds of overall survival and breast cancer-specific survival compared with normal-weight patients, at a hazard ratio of 1.48 after adjusting for known prognostic factors. This association remained across increasing stages of disease. Conversely, overweight patients did not have a significantly increased risk for death compared with normal-weight patients.

In the second analysis, being underweight was associated with significantly greater odds of local breast cancer recurrence and distant metastasis compared with being of normal weight, at odds ratios of 1.93 and 5.13, respectively. This association was not seen in overweight or obese women.

“Underweight should be considered as a high-risk factor for death and recurrence after breast cancer surgery,” say the researchers.

They conclude that the findings have important implications, not only for devising a tailored treatment approach, but also for “methodology of research on the association between BMI and breast cancer prognosis.” The team adds that underweight should be classified separately from normal weight to avoid false-negative conclusions.

 

Sex and Wellbutrin

3/9/2010 (2:53:23pm)Tags: sex libido wellbutrinComments: (0)

Hope that this title grabbed your attention!

I have written before about dimished libido and other sexual issues that are so common for women during and after breast cancer treatment. Some of the problems are directly related to menopause and the diminished estrogen and vaginal dryness that accompany this stage of life. Some of the problems are more associated with psychological concerns and changed body image, and some of the problems may be related to couples' patterns and communication and general level of satisfaction and intimacy.

This recent small study looked at the impact of the anti-depressant Buproprion (Wellbutrin) on HSDD (hypoactive sexual desire disorder--translated, that means "diminished or no interest in sex". Through the years, I have listened to many hilarious conversations in support groups where women talked about their absent libido and made lists of all the things they would prefer to do rather than have sex. When the list includes things like mop the kitchen floor or go to the dentist, you know there is trouble. Here's a report of the study (and, as an aside, I am fascinated that this study is from Iran):

Buproprion Shows Benefits for Women With

Hypoactive Sexual Desire Disorder

www.medscape.com

By Amy Norton

NEW YORK (Reuters Health) Feb 25 - The antidepressant bupropion (Wellbutrin) may hold promise for improving symptoms in younger women with hypoactive sexual desire disorder (HSDD), a small study suggests.

In the new study, Iranian researchers found that bupropion sustained-release (Wellbutrin SR) generally boosted sex drive among 116 women with HSDD who took the drug for 12 weeks.

Compared with 116 women given a placebo, their scores on the Brief Index of Sexual Functioning for Women (BISFW) were twice as high, according to findings published in BJU International.

As it stands, there is no treatment for HSDD widely accepted by women, according to the researchers on the new study, led by Dr. Mohammad Reza Safarinejad of Shahid Beheshti University in Tehran. In Europe, a testosterone patch (Intrinsa) is approved for treating HSDD in postmenopausal women. It is not approved in the U.S.

Dr. Safarinejad told Reuters Health by email that studies have shown bupropion SR to improve sexual function in women who are having sexual side effects from selective serotonin reuptake inhibitors (SSRIs). For the current study, Dr. Safarinejad and colleagues randomly assigned 232 women between the ages of 20 and 40 to take either bupropion SR or a placebo every day for 12 weeks. All of the women had been diagnosed with HSDD and were free of depression or other major health problems.

At the outset, both groups of women had similar scores on the Brief Index of Sexual Functioning for Women (BISF-W) - - just under 16, on average. The average score for healthy women with a regular partner is 33.6, Dr. Safarinejad said. After 12 weeks, that score improved to 33.9 among women in the antidepressant group, versus 16.9 in the placebo group.

The most common side effects linked to bupropion included headache (affecting 9 percent of the group), insomnia and dry mouth (each affecting 7 percent), and nausea and muscle aches (each affecting 6 percent).

While the findings suggest that bupropion improves low sex drive, this is the first study to test the antidepressant in premenopausal women with HSDD. "Further studies are needed" to help researchers understand the role of bupropion in HSDD, Dr. Safarinejad noted.

Exactly why bupropion might improve sexual function is unclear. One theory attributes the effects to enhanced dopamine and norepinephrine activity.

Reuters Health Information © 2010

From Reuters Health Information

 

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