A breakthrough test may help people beat the odds against one of the deadliest cancers.
By the time most patients are diagnosed with pancreatic cancer, it has already spread, which is why most don’t survive.
This screening could change things.
“I don’t take no blood pressure pills, no kinda medicine or nothing, you know,” said pancreatic cancer survivor Henry Hall.
Working in his sweet potato field, 68-year-old Hall has the energy of a man half his age. Every harvest marks another year that he’s beaten the odds. “Been seven years, eight months, 15 days.”
That’s how long it’s been since Hall had surgery for pancreatic cancer. He knows just how lucky he is. “Probably one out of a million. I assumed that it just, you know, wasn’t my time.”
For all stages of pancreatic cancer combined, the one-year survival rate is just 20 percent. The five-year survival is only 4 percent.
“So there’s something about this disease that is inherently more aggressive than many of the other cancers,” Dr. Hong Jin Kim explained.
University of North Carolina researchers are investigating a specific form of a protein called palladin that shows up in pancreatic cancer tumors before the cancer starts to spread.
“That’s very exciting because what it tells us is that this increased palladin expression may actually be a marker for a very early stage in tumor development,” researcher Carol Otey said.
That protein, identified in a needle biopsy of the pancreas, could find cancers sooner. It’s early detection that could dramatically improve chances of survival.
“If we could do better at diagnosing it, we really could extend lives,” Otey said.
As for Hall, he plans to keep on doing what’s worked for him. “I’m gonna work on it ’till the Lord takes me home.”
Hall was able to survive his pancreatic cancer because, even though his tumor was large, they were able to remove it before the cancer spread.
Sitting has become our national pastime. Just about everything we do involves sitting: travel, TV, computers, electronic games, desk work, reading and dining. Being a couch potato is so easy these days that 70 percent of Americans don’t exercise enough for good health.
That’s why we’re in the fix we’re in. Sedentary living increases the risk of many chronic illnesses. Conditions such as obesity, diabetes, high blood pressure, heart failure and certain cancers are rising in epidemic proportions. The true culprit is physical inactivity in our country, some researchers say. And I’m inclined to agree.
Activity gene hypothesis
Scientists published a groundbreaking report in the Journal of Applied Physiology several years ago. Since then further evidence has strengthened the assertion that chronic illness occurs when we ignore our biological need for exercise.
Here’s how the reasoning goes: We’ve inherited genes from our Late Paleolithic ancestors that evolved to function in a physically active lifestyle. Our genetic makeup has changed little in the 10,000 years since humans were hunter-gatherers and physical activity was necessary for survival. But as labor-saving inventions have altered our world, the mismatch between lifestyle and exercise requirements has led to the onslaught of modern chronic illnesses. There are many examples.
Inactivity-related illnesses
Cancer
Breast cancer. Multiple studies have shown that lower levels of physical activity increase the risk of breast cancer, especially during the postmenopausal years.
Colon cancer. Lack of exercise is the risk factor most consistently associated with colon cancer. A 50 percent decrease in the rate of colon cancer was found in those with the highest levels of physical activity.
Pancreatic cancer. Walking less than 20 minutes a week was associated with twice the risk of pancreatic cancer compared to walking more the four hours a week.
Melanoma. Sedentary women had a 72 percent higher rate of melanoma skin cancer than those exercising five to seven days a week. In men the rate was 56 percent higher.
Cardiovascular disorders
Coronary artery disease. Inactivity raises LDL (bad) cholesterol levels, lowers HDL (good) cholesterol levels, and increases inflammatory substances in the blood that can lead to heart disease. Up to a third of heart disease deaths could be prevented with moderate exercise for 30 minutes five days a week, according to a study of Harvard nurses.
Congestive heart failure. Exercise can improve the overall function and exercise capacity of people afflicted with this disorder.
Hypertension. Blood pressure is substantially higher in sedentary people than in those who are more active.
Stroke. Exercise lowers blood pressure, controls weight, and reduces diabetes risk that can lead to stroke.
Other conditions
Type 2 diabetes. Body cells in inactive people become less sensitive to the effects of the hormone insulin. Since insulin normally lowers blood sugar levels, this lack of sensitivity may eventually lead to diabetes.
Obesity. Sedentary people can lower their risk of many ailments by increasing physical activity, regardless of whether they are normal or overweight.
Alzheimer’s disease. Studies have shown that higher levels of exercise help minimize memory loss.
Arthritis. Physical activity can increase flexibility, muscle tone, cardiovascular conditioning, and general health in people with arthritis.
What minimum amount of exercise is needed for good health? Thirty minutes of moderate activity at least five days a week—and, for many people, sixty minutes a day may be even better. First consult your doctor if you’re unaccustomed to exercise. And make any changes gradually.
For more information: American College of Sports Medicine, www.acsm.org.
E-mail comments to doctor@practicalprevention.com. Dr. Smoots’ columns are not intended as a substitute for medical advice or treatment. Before adhering to any recommendations in this column consult your health care provider.
[caption id="attachment_1281" align="alignright" width="300" caption="Patricia Griecci Pancreatic Cancer Foundation"][/caption]
Look no further than that pup’s nonstop wagging tail or revel in a kitten’s soft rolling purr as it gets scratched behind its ears, and it’s clear — without the need for elaborate scientific evidence: pets bring a special companionship and joy to the lives of their owners. But our furry, four-legged friends can offer even more boons, keeping us active and involved in the world and boosting our health by bonding with and benefiting us, especially when we’re sick, maybe in the hospital and don’t even feel up to enjoying human company.
From autistic children to terminally ill cancer patients, pets can provide a calming presence when patients need it most. Their attention and affection can be downright therapeutic, some studies show, finding that having them around can lower blood pressure, slow heart rate, reduce depression and anxiety, decrease feelings of loneliness, and improve an individual’s perceived quality of health. Therapy involving interaction between patients and a trained pet, along with its human owner, reduces the anxiety of patients hospitalized for mood or psychotic disorders, an American Psychiatric Association study found. Pet ownership improves survival after heart attacks and reduces the mortality rate from coronary heart disease, another study showed.
Alzheimer’s patients, too, benefit from the presence of paws, with those with the disease and in institutions socializing better and displaying more serenity. Among Alzheimer’s patients attached to an animal companion, studies have found a lessening of outbursts, lower anxiety and fewer mood disorders.
Seniors, of course, often adore their dogs and cats, and studies show their health benefits from companionship. While their peers without pets slowed down and moved less, animal owners ages 65 to 80 proved more physically active — a key component in elder health, the American Psychological Association found in a study.
A number of hospitals have recognized the positive therapeutic effects that pets can have on patients and have developed programs that take advantage of these effects. For instance, in 1992, we initiated the P.O.O.C.H. (Pets Offer Ongoing Care and Healing) program. The volunteer pet-visitation program for patients seeks to provide comfort and solace by connecting animals with patients in our units for cardiology, HIV/AIDS, medical and surgical, pediatrics and rehabilitation, as well as the outpatient program at Cedars-Sinai‘s Samuel Oschin Comprehensive Cancer Center. Through this program a dog might stay with a patient anywhere from five minutes to an hour, bringing smiles, comfort and a welcomed diversion to the ailing. Thirty volunteers assist the program and many more are on a waiting list. One of our canine “volunteers,” Margie, a Boston terrier-French bulldog mix, even is a cancer survivor herself.
Even if you’re feeling well and not hospitalized, pets can potentially better your health, as there is increasing evidence that animal ownership provides measurable short-term psychological and physiological benefits, researchers in a Midwestern veterinary school say. They found that pets help their masters reduce their blood pressure and decrease other indicators of anxiety. Another study showed that dog and cat owners are less likely to need to see their physicians or to take heart or sleep medications.
Pets keep people moving and exercising, promoting overall health. Dog owners are 34 percent more likely to participate in the recommended minimum amount of exercise — 150 minutes of moderate to vigorous exercise — each week, a study in a peer-reviewed journal found. And if you look at that on a grand scale, it can really add up.
Downside to Puppy Love?
Common sense, of course, should tag along with enthusiasm for any endeavor, including pets’ roles in peoples’ lives. Our best companions, after all, also can carry illnesses that they can spread to us because they share our quarters. These zoonotic diseases include Camplylobacter infection resulting in diarrhea, Toxoplasmosis (a parasitic infection that affects cats and can cause developmental issues in fetuses), rabies, tapeworms and brucellosis (a bacterial disease). Because of advances in hygiene and veterinary medicine in this country, many of these conditions are more common in other parts of the planet, though if your pet travels with you, the possibilities of zoonotic infection increase.
With vaccination, proper sanitary awareness and knowledge of preventative measures, animal owners can limit their risk of zoonotic infections from pets. And, as the Centers for Disease Control and Prevention reported recently, pet owners — of course, please — should be sensible and thoroughly wash their hands with soap and water after coming into contact with animal saliva or feces. There’s little likelihood that any physician, parent or friend can or would want to curtail the hugs, and even kisses, that many owners (especially kids) lavish on their pets. But a word to the wise: your age or health status may affect your chances of contracting an illness from a pet. Those at higher risk include infants and children five or younger; others who should take extra care include organ transplant recipients and those with HIV/AIDS or under care for cancer.
Man’s best friends earned their title for a reason. So if you’re prone to anxiety, depression or loneliness, pet ownership may be an option to explore. Perhaps that old adage should be rephrased to: “A dog biscuit a day will keep the doctor away.”
How guilt, resentment, and other powerful caregiver feelings can raise your stress and sap your energy — and what you can do to avoid the damage.
Nobody would ever choose a smiley face as the perfect symbolic emoticon for a caregiver. Caregiving for an ailing loved one is just too stressful — often triggering damaging emotions that can not only undermine your good work but harm your health, as well. Here’s how to cope:
Caregiver emotion trap #1: Guilt
Guilt is virtually unavoidable as you try to “do it all.”
What causes guilt: Guilt stems from doing or saying what you believe is the wrong thing, not doing what you perceive to be enough, or otherwise not behaving in the “right” way, whether or not your perceptions are accurate. Caregivers often burden themselves with a long list of self-imposed “oughts,” “shoulds,” and “musts.” A few examples: I must avoid putting Mom in a nursing home. I ought to visit every day. I shouldn’t lose my temper with someone who has dementia.
5 Things That Probably Won’t Help You Live Longer
Risks of guilt: Caregiver guilt is an especially corrosive emotion because you’re beating yourself up over faults that are imagined, unavoidable — or simply human. That’s counterproductive at a time when you need to be your own best advocate.
What you can do: Lower your standards from ideal to real; aim for a B+ in the many aspects of your life rather than an across-the-board A+. When guilt nags, ask yourself what’s triggering it: A rigid “ought”? An unrealistic belief about your abilities? Above all, recognize that guilt is virtually unavoidable. Because your intentions are good but your time, resources, and skills are limited, you’re just plain going to feel guilty sometimes — so try to get comfortable with that gap between perfection and reality instead of beating yourself up over it.
Caregiver emotion trap #2: Resentment
This emotion is still so taboo that many caregivers are loathe to admit to it.
What causes resentment: Caregivers often feel put-upon and upset because of imagined slights by others,
including siblings and adult children who don’t do enough to help. Caregiver resentment is especially felt toward the person being cared for, when the caregiver’s life feels hijacked by responsibility and out of his or her own control.
Risks of resentment: Without enough support or noncaregiving outlets, feelings of being ignored, abandoned, or criticized can fester into anger and depression.
11 Warning Signs of Depression
What you can do: Simply naming this tricky emotion to a trusted confidante can bring some release. Try venting to a journal or anonymous blog. Know that resentment is a very natural and common response to long-term caregiving, especially if your work life, marriage, health, or outside activities are compromised as a result. Know, too, that you can feel this complicated emotion yet still be a good person and a good
caregiver.
Caregiver emotion trap #3: Anger
Some people outwardly show their anger more than others, but almost no one is never angry.
What causes anger: We get mad for reasons both direct (a balky loved one, an unfair criticism, one too many mishaps in a day) and indirect (lack of sleep, frustration over lack of control, pent-up disappointment).
Risks of anger: Chronic anger and hostility have been linked to high blood pressure, heart attack and heart disease, digestive-tract disorders, and headaches. Anger that builds up unexpressed can lead to depression or anxiety, while anger that explodes outward can jeopardize relationships and even harm others. Managing caregiver anger not only helps your well-being but makes you less likely to take out your fury on your loved one.
What you can do: Rather than trying to avoid anger, learn to express it in healthy ways. Simple deep- breathing exercises
can channel mounting anger into a calmer state, for example. Talk yourself down with soothing chants: It’s okay. Let it go.
Ask yourself if there’s a constructive solution to situations that make you angry: Is a compromise possible? Would being more assertive (which is different from anger) help you feel a sense of control? Laughing at absurdities and idiotic behavior can provide a healthier biological release than snapping.
Caregiver emotion trap #4: Worry
A little goes a long way, but sometimes we can’t turn off the fretting.
What causes worry: Good intentions, love, and wanting the best for your loved ones are the wellsprings of worry. Focusing intensely on the what-ifs provides a perverse kind of comfort to the brain: If we’re worrying, we’re engaged. Of course, that ultimately triggers more worry and upset because it’s engagement without accomplishing anything.
Risks of worry: Being concerned is harmless. Overworry and obsessing, however, can disrupt sleep, cause headaches and stomach aches, and lead to mindless eating or undereating.
What you can do: If you notice worrying thoughts interfering with getting through the day or sleeping at night, force a break to the cycle. Try setting a timer and resolving to focus on something else when the five minutes is up. Then flip negative thoughts to their productive side: How can you help? Who can you call? Are there possible solutions? And don’t be shy about seeking out a trained counselor to help you express and redirect obsessive ruminations more constructively.
Caregiver emotion trap #5: Loneliness
Your world can shrink almost before you realize what’s happened.
What causes loneliness: Friends may back away out of uncertainty or a belief they aren’t wanted. Intense time demands lead you to drop out of outside activities. If you’re dealing with dementia, the loss of your
loved one’s former level of companionship is another keenly[1] felt social loss adding to isolation.
Risks of loneliness: Your very brain is altered: People with large, rich social networks have different brain structures, new research finds. Loneliness seems to curb willpower and the ability to persevere, and it can lead to overeating, smoking, and overuse of alcohol. Lonely people also have more cortisol, the stress hormone. And social isolation is a risk factor for dementia.
What you can do: Expand your social circles, real and virtual. Arrange respite help, so you can add at least one outside activity, such as one you’ve dropped. Take the initiative to reach out to old friends and invite them over if you can’t get out easily. Consider joining a support group related to caregiving or your loved one’s illness. In online forums, you can find kinship with those who know just what you’re going through.
Caregiver emotion trap #6: Grief
Don’t think this one applies yet? Think again.
What causes grief: Although most people link grief with death, anticipatory grief is a similar emotion felt by caregivers who are coping with a loved one’s long-term chronic illness, especially when there are clear losses of ability (as in dementia) or when the diagnosis is almost certainly terminal.
Risks of grief: “Long good-byes” can trigger guilt as well as sadness if one mistakenly believes that it’s inappropriate to grieve someone still alive. Mourning the loss of a beloved companion is also a risk factor for depression.
What you can do: Know that your feelings are normal and as painful as “real” (postmortem) grief. Allow yourself to feel sadness and express it to your loved one as well as to supportive others; pasting on a happy face belies the truth and can be frustrating to the person who knows he or she is ill or dying. Make time for yourself so that you’re living a life outside of caregiving that will support you both now and later.
Caregiver emotion trap #7: Defensiveness
Protecting yourself is good — to a point.
What causes defensiveness: When you’re doing so much, it’s only natural to bristle at suggestions that there might be different or better approaches. Especially if you’re feeling stressed, insecure, or unsure, hearing comments or criticisms by others, or reading information that’s contrary to your views, can inspire a knee- jerk response of self-protection: “I’m right; that’s wrong!”
Risks of defensiveness: While nobody knows your loved one and your situation as well as you do, being overly defensive can make you closed-minded. Y ou risk losing out on real help. Y ou may be so close to the situation that you can’t see the forest for the trees, for example; a social worker or friend may have a perspective that points to what really might be a better way.
What you can do: Try not to take everything you hear personally. Instead of immediately getting cross or discarding others’ input, vow to pause long enough to consider it. Remember the big picture. Is there merit in a new idea, or not? What you’re hearing as a criticism of you might be a well-intentioned attempt to help your loved one. You may decide things are fine as is, and that’s great. But if you start from a point of calm and confidence, the focus becomes (as it should be) your loved one, not you.
Caring.com was created to help you care for your aging parents, grandparents, and other loved ones. As the leading destination for eldercare resources on the Internet, our mission is to give you the information and services you need to make better decisions, save time, and feel more supported. Caring.com provides the practical information, personal support, expert advice, and easy-to-use tools you need during this challenging time.
[caption id="" align="alignright" width="200" caption="Guide to Cancer Research"][/caption]
This has been a remarkable year for pancreatic neuroendocrine cancer research. Two drugs have recently been approved to treat pancreatic neuroendocrine tumors: sunitinib (Sutent) and everolimus (Afinitor). Findings from the clinical trials that led to the approval of these drugs were presented at the 2011 ASCO Annual Meeting. And, as you will read in this section, there were also recent reports further discussing the role of gemcitabine (Gemzar) to treat adenocarcinoma of the pancreas, the most common type of pancreatic cancer. This drug is being studied alone as well as in combination with other anti-cancer drugs and radiation. The management of pancreatic cancer is evolving at a rapid pace. Patients and doctors have many reasons to remain hopeful that current treatment methods will improve in the coming years.
Al B. Benson III, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Sunitinib is Highly Effective Against Advanced Pancreatic Tumors
Treatment with the anti-cancer drug sunitinib more than doubled the time that patients with advanced pancreatic neuroendocrine tumors (NETs) experienced no spread or growth in their cancer compared with patients who received a placebo (an inactive drug). Additionally, patients who received sunitinib lived six months longer than those in the placebo group. These findings were updated results of a clinical trial and confirmed earlier positive results. Patients who received a placebo in the study were offered the opportunity to receive sunitinib once the study was completed. The most common side effects in patients who took sunitinib were fewer white blood cells, high blood pressure, and hand-foot syndrome. Hand-foot syndrome is a condition marked by pain, swelling, numbness, tingling, or redness of the hands or feet.
WHAT PATIENTS NEED TO KNOW
Earlier this year, the Food and Drug Administration (FDA) approved sunitinib to treat patients with progressive pancreatic NETs that cannot be removed by surgery or that have spread to other parts of the body. This type of cancer is rare, and has few treatment options. Sunitinib is a type of targeted anti-cancer drug called a multikinase inhibitor, which blocks a protein that signals cancer cells to grow. Overall, the results of this trial are very positive and important. These data confirm the benefits of sunitinib and its ability to control cancer. Doctors now have another viable option to offer their patients with advanced pancreatic NETs.
A large clinical trial showed that the targeted anti-cancer drug everolimus lengthened the time patients with advanced pancreatic NETs were free from cancer growth or spread. The trial, called RADIANT-3, was instrumental in the drug receiving FDA approval to treat this type of cancer— the first such approval in nearly 30 years. Researchers also wanted to see what impact, if any, the use of a somatostatin analog would have in this patient group. Somatostatin analogs can inhibit the growth of cells, including cancer cells, and have been used for some time in the treatment of pancreatic cancer. Some patients in this trial received either a somatostatin analog at the same time as everolimus or at some point earlier in their treatment. In patients who received a somatostatin analog plus everolimus, their tumors did not grow or spread for 11.4 months (versus 3.9 months for those receiving a somatostatin analog and a placebo). Patients who did not receive a somatostatin analog and received everolimus alone were free from tumor growth or spread for 10.8 months (versus 4.6 months for patients not receiving a somatostatin analog and receiving a placebo).
WHAT PATIENTS NEED TO KNOW
Everolimus is a targeted anti-cancer drug called an mTOR inhibitor, which blocks the signaling pathway that is active in certain tumors. It stops cancer cells from dividing and may also prevent the growth of blood vessels that tumors need to survive. The results of this trial indicate that everolimus is effective whether or not patients had previously received a somatostatin analog. And if they did, when they received it (either before or during treatment with everolimus) made no difference. Patients will now have access to a treatment that has been proven to delay tumor growth and reduce the risk of cancer spread.
Promising Early Results for Treating Inoperable Pancreatic Cancer
The standard treatment for advanced adenocarcinoma of the pancreas is gemcitabine. In a recent trial, gemcitabine combined with an anti-cancer drug treatment called S-1, was better at controlling tumor growth and spread than gemcitabine alone in patients whose pancreatic cancer could not be surgically removed. S-1 is an experimental combination of the drugs tegafur, gimeracil, and oteracil not yet available in the U.S. (this study was performed in Japan). The combined S-1/gemcitabine treatment shrank tumors in nearly 30% of patients—more than three times better than gemcitabine alone, which controlled tumors in just fewer than 7% of patients. Additionally, patients who took the S-1/gemcitabine combination lived about five months longer than those who took gemcitabine alone. The drugs were well tolerated by the study participants. In another trial, of the same S-1/gemcitabine combination, patients lived almost five months longer when they received the combination compared to gemcitabine alone. After one year, 22% more patients were alive in the group that received the S-1/gemcitabine combination than in the group who received only gemcitabine. Even though the number of patients in this trial was very small, the positive results hold promise that the combination will become another standard approach for inoperable pancreatic cancer if it becomes available here.
WHAT PATIENTS NEED TO KNOW
Gemcitabine is a chemotherapy drug called an antimetabolite, which stops cells from growing and causes cancer cells to die. Gemcitabine is currently used to treat pancreatic, breast, ovarian, and lung cancers. Past studies showed that the addition of other anti-cancer drugs to gemcitabine did not help patients live significantly longer. However, the results of these two trials suggest the opposite. Researchers believe that this combination therapy may become an initial standard treatment for inoperable pancreatic cancer.
Experimental Regimen After Surgery in Pancreatic Cancer
More than 60% of patients with pancreatic cancer who received an experimental drug sequence were cancer-free after one year. The clinical trial included patients who already had undergone surgery. They then received chemotherapy with gemcitabine and cisplatin. Next, patients whose cancer did not grow or spread received chemotherapy and radiation with gemcitabine. Finally, patients received weekly gemcitabine as a maintenance treatment—meaning it was used long-term to prevent cancer from coming back. Among all patients the median time of survival was 33.6 months. The side effects from this treatment approach were manageable, and the more serious side effects were blood related.
WHAT PATIENTS NEED TO KNOW
Even after surgery, fewer than 20% of patients with pancreatic cancer are still alive after five years. The cancer may return to its original site or spread to other areas in the body. Experts believe an approach that combines more than one method of post-surgery adjuvant treatment is needed in pancreatic cancer patients. Adjuvant means additional cancer treatment given after the first treatment to lower the risk that the cancer will return. Although this clinical trial studied only a few patients, the encouraging results support an adjuvant treatment approach in pancreatic cancer.
Chemotherapy After Surgery in Ampullary Cancer
A large clinical trial studied patients with a specific type of cancer called ampullary cancer—a rare cancer similar to pancreatic and bile duct cancers. Data from this trial showed a benefit to using additional chemotherapy in patients with clean surgical margins, which are the edges or borders of the tissue removed in cancer surgery. The margin is called “clean” when no cancer cells are found at the edge of the tissue. This suggests that all of the cancer has been removed. After surgery, ampullary cancer patients received either an anti-cancer treatment called 5-FU/FA (a combination of 5-fluorouracil and folinic acid), gemcitabine, or no treatment. They were then monitored by doctors. Patients who received chemotherapy and had their tumor completely removed did better than those who received no treatment.
WHAT PATIENTS NEED TO KNOW
Ampullary cancer is the second most common cancer in patients with tumors in the pancreas that can be surgically removed. However, only about one-half of all patients who undergo surgery for this type of cancer are alive five years later, and no standard adjuvant treatment exists. Researchers are looking for better treatments for patients with this type of cancer. In this study, there was no difference in survival between patients who received 5-FU/FA and those who took gemcitabine. However, these results are nevertheless encouraging. The results suggest that adjuvant chemotherapy is helpful in certain patients. The results also give researchers more information to offer prognoses for their patients in the future. The role of adjuvant therapy in ampullary cancer remains unclear, and more research is planned to study treatments in patients with this type of cancer.
February 19th, 2012 | 
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