Who is the Cancer Caregiver? The Unsung Hero

Who is the Cancer Caregiver? The Unsung Hero

The cancer caregiver serves a critical role on the journey to recovery. Often times it's a family member who takes care of the patient. Read how Jacqueline helped her father through Stage 3 Prostate Cancer. 

“First thing I want to do is get the right steps and know the best options to treat my father,” she said. 

But her caregiver duties had an even more difficult task. She needed to maintain a cool composure despite deep worries. 

“The second thing going through my mind was…how to calm my father down in order to decrease his stress and anxiety.” 

As the cancer patient, Baba became depressed. He faced a double layer of confusion because of the language barrier. He needed more time to comprehend his diagnosis. 

“So my role was to calm him down,” Jacqueline said. “Decrease the effect of the news and just keep him positive.”

 The cancer caregiver tried to paint a more upbeat picture.

”Prostate cancer is not as deadly as pancreatic cancer,” Jacqueline explained to Baba. “And prostate cancer grows slow. And we will operate the next day. And the recovery is better unlike other cancers.” 

Under the grave situation, Jacqueline became a fortress against emotional turmoil. She needed to tone down the fear and sadness expressed by family members. 

“Sometimes the stress of the family members is higher than the patient,” said Jacqueline. 

“They don’t understand the situation and how it should be handled. So sometimes the family members cause the patient to be stressed, because they become overreactive.” 

What is integrative medicine? Podcast explores nutrition and holistic cancer therapies

What is integrative medicine? Podcast explores nutrition and holistic cancer therapies

A nutritionist has launched a platform sharing expertise on food and the fight against cancer. Jason Bosley-Smith is founder and host of ONCancer Health. The online resource offers podcast interviews and content from clinicians and academics working in nutrition and cancer. Topics involve evidence-based studies with a focus on exploring cutting-edge, holistic therapies.

A proponent of integrative medicine, Bosley-Smith teaches at the Maryland University of Integrative Health. Patients are no longer satisfied with one-size-fits-all guidelines. Instead, they desire customizable herbal, exercise, and nutritional remedies, according to Bosley-Smith.

“There’s been somewhat of a paradigm shift toward functional and complementary medicine. In the healthcare system, some traditional dietary recommendations have become a bit antiquated,” he said to SmartBridge Health.

A licensed nutritionist, Bosley-Smith said his interest in nutrition, health, and specifically cancer, stemmed from personal experiences. His grandfather died from colorectal cancer. Later, a childhood friend entered hospice care because of skin cancer. The friend was a 36-year-old mother of two young children.

What's the difference between active surveillance and watchful waiting when treating prostate cancer?

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Prostate cancer often grows slowly and should not be treated unless it is likely to cause a patient harm during his lifetime.  Based on the traits of a patient's prostate cancer, his overall health and medical condition, a game plan which avoids surgery and radiation may be best.  

Active surveillance is where the patient and physician defer surgery or radiation right away, and instead track the cancer's status.  With active surveillance, you and your doctor will follow clues from routine PSA tests, DREs (Digital Rectal Exams), biopsies and imaging (i.e., MRI) to determine if the cancer is growing or getting more aggressive.  If that happens, then you and your doctor will work out the next steps.  

Active surveillance is best for men with small, low-risk tumors without symptoms.  It is also good for men who are at a higher risk from surgery or radiation.  Action is taken only if the cancer changes or grows.  Active surveillance may require you to have multiple biopsies to track cancer growth.  

Watchful waiting is a less aggressive form of monitoring prostate cancer without treating it.  It does not involve regular biopsies or other frequent testing.  Watchful waiting is best used for men with prostate cancer who do not want or cannot have treatment therapies, especially those men with other life-threatening medical conditions. 

The main benefit of watchful waiting is that it avoids many treatment and surveillance-related risks and side effects.  However, with this approach the cancer could grow and spread between follow-up visits and ultimately make it harder to treat.  Patients should talk with their doctors about which method is best.  

Why should I get a prostate cancer screening?

Why should I get a prostate cancer screening?

It's time for men to break the stigma. Dr. Kelvin Moses, Urologist at Vanderbilt University, shares why it's important to talk about prostate cancer screening with the men in your life. 

"That’s very important because men in general and certainly black men... are maybe afraid. Prostate function deals with sexual function and urinary function and maybe not everybody is comfortable talking about that..."

Watch the VIDEO to hear ways to help men start the conversation on prostate health

What should I eat if I have cancer?

What should I eat if I have cancer?

A common question patients have is what they can do from a dietary standpoint upon being diagnosed with cancer. While most cancer-treated is focused on doctor prescribed regimens (chemotherapy, hormonal therapy, radiation, surgery), there are many studies that have focused on nutrition. Are there "good" foods to eat from a cancer standpoint? 

Should I use marijuana as part of my cancer treatment?

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Marijuana as Medicine

Marijuana has been used in herbal remedies for centuries. There are two main biologically active components in marijuana: tetrahydrocannabinol (THC) and cannabidiol (CBD). A number of studies of marijuana found that the active components can be helpful in treating a number of cancer-related symptoms, including nausea and vomiting from chemotherapy, neuropathic pain (pain caused by damaged nerves), poor appetite, pain relief, anxiety and insomnia.

There are two chemically-pure drugs based on marijuana compounds that have been approved by the US Food and Drug Administration (FDA) for medical use.

  • Dronabinol (Marinol®) is a gelatin capsule containing delta-9-tetrahydrocannabinol (THC) that is approved by the FDA to treat nausea and vomiting caused by cancer chemotherapy as well as weight loss and poor appetite in patients with AIDS.
  • Nabilone (Cesamet®) is a synthetic cannabinoid that acts much like THC. It can be taken by mouth to treat nausea and vomiting caused by cancer chemotherapy when other drugs have not worked.

Side Effects

Like many other drugs, the prescription cannabinoids, dronabinol and nabilone, can cause side effects and complications. Some people have trouble with increased heart rate, decreased blood pressure, dizziness or lightheadedness. These drugs can cause drowsiness as well as mood changes or a feeling of being “high” that some people find uncomfortable. They can also worsen pre-existing mental illnesses. Patients have also reported problems with dry mouth and trouble with recent memory. People who have had emotional illnesses, paranoia, or hallucinations may find their symptoms are worse when taking cannabinoid drugs.

Marijuana Today

In addition to the two FDA-approved medications mentioned above, recreational use of marijuana is prevalent in cancer populations, particularly now that over half of the states have legalized its use. 

As of January 8, 2018, 30 states and Washington DC have legalized marijuana in one form or another (either only medical-use or both medical and recreational use). See the State Marijuana Laws in 2018 Map.

Meanwhile, a recent study found that where marijuana or its derivatives are legal, up to 25% of cancer patients engage in its use. However, as of date, the FDA has not approved the use of botanical marijuana to treat any medical condition. The FDA states more research and conclusive evidence are needed. 

Talk to your doctor about what you should expect when taking one of the FDA-approved drugs or if you are considering using recreational marijuana. It’s a good idea to have someone with you when you first start taking one of these drugs and after any dose changes.

References:

 

Post right hemi-colectomy. Refused chemo. Now discovered residual cancer in fatty tissue next to anastomosis. How do you treat this?

The patient underwent hemicolectomy without chemotherapy and had a locoregional, anastomotic recurrence.  

First, for proper staging, a PET CT should be performed. This is not an uncommon location for recurrence in patients who haven't undergone chemotherapy, though data is limited.

Repeat surgical resection, if the cancer is in fact localized to the are near anastomosis, should be the next step, along with evaluations by medical and radiation oncology who will coordinate care with the surgeon.

Chemotherapy, and possibly radiation therapy, should be strongly considered either before or after surgery.

What is the best treatment for adenocarcinoma of the lung?

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When considering treatment options for non-small cell lung cancer like adenocarcinoma, we evaluate the patient’s stage (I-IV) and if appropriate, molecular profile. Staging is dependent on the size, location, and number of lymph nodes involved in the lung cancer. Types of treatments include radiation therapy, surgery, and systemic therapy (which is further divided into chemotherapy, targeted therapy, and immunotherapy).

Stage IA lung cancers can be managed surgically if the patient is able to undergo an operation, and if the tumor is in a location that is surgically accessible. Radiation treatment alone may also be used.

For stage IB, II, and IIIA patients, surgery, radiation alone or with chemotherapy may also be used. These decisions depend on lymph nodes involved by the cancer, how healthy the patient is, and if the surgery had clean resection margins (meaning there was no cancer at the edges of the tumor).

Stage II and III patients with cancer that has spread to the lymph nodes also benefit from immunotherapy postoperatively.

Stage IIIB lung adenocarcinoma is treated with chemotherapy, radiation, and followed with an immunotherapy called durvalumab.

In patients with Stage IV, metastatic lung adenocarcinoma, we must first consider the performance status of the patient to ensure that our treatments will not cause undue harm. Surgery is rarely used in Stage IV lung cancer, and only if there are very few locations of metastasis in an otherwise healthy patient. Molecular testing including EGFR, ALK, ROS1, BRAF mutations and PD-L1 percentage are standard of care in this group of patients. In patients with cancers that harbor the aforementioned mutations, targeted, oral therapies are used. Chemotherapy and immunotherapy can be considered when the tumor develops resistance to these treatments. If PD-L1 status is greater than 50%, immunotherapy, namely pembrolizumab, is appropriate first line therapy. In the absence of mutations or high PD-L1 levels, chemotherapy, with or without immunotherapy, is front line treatment. Immunotherapy, other types of chemotherapy, and clinical trials represent options after chemotherapy.

Special considerations must also be taken for patients who have lung cancer that has metastasized to their brain. These cancers are treated with surgery and radiation, though some will have responses to chemotherapy or targeted therapy. We are not certain how effective immunotherapy is in patients with brain metastasis from lung cancer, but studies are ongoing.