Legislative Watch
Maine and Kentucky Make Strides in Reducing Colorectal Cancer

When Maine Governor John Baldacci signed a bill titled An Act Relating to Insurance Coverage for Colorectal Cancer Early Detection on March 26, Maine became the 24th state to mandate insurance coverage for colorectal cancer screening. Less than a month later, Kentucky Governor Steve Beshear signed a similar bill that provides colorectal cancer screening to uninsured and underinsured individuals.

Late last year, Rep. Ed Mazurek (D-Maine) introduced the bill, which overwhelmingly passed Maine’s House and Senate in March. The state law mandates screening coverage for individuals who have symptoms of colon cancer, are at high risk for the disease, or are over 50. Maine already mandates screening coverage for breast and cervical cancers.

“This is one of those bills that make you feel good when it’s accomplished,” says Mazurek, who has received positive feedback from the community and members of Maine’s Congress. “This bill [will] save lives.”

Kentucky’s Colon Cancer Screening Act establishes a program headed by the state’s Department of Public Health to provide screening services to people ages 50 to 64 as well as highrisk individuals without insurance.

Nearly half of the United States has laws that require the coverage, and Medicare provides annual fecal occult blood tests at no cost to people over 50, in addition to regular flexible sigmoidoscopy and colonoscopy screenings.

Currently, only 60 percent of Maine residents who should be screened for colon cancer take advantage of it, making colon cancer the second most common cause of cancer death in the state. And in Kentucky, the mortality rate for colorectal cancer is 18 percent higher than the national average.

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The Place to Be
Planet Cancer's Young Adult Re-Orientation

Planet Cancer’s re-orientation events give young adult cancer patients and survivors the opportunity to learn, have fun, and network. The event, held on September 19-21, targets 25- to 40-year-olds and will be held at The Crossings, a spa retreat in Austin, Texas. Registration and a $50 refundable deposit are due by August 19. Find details at www.planetcancer.org or call 512-452-9010.

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People Report [expanded for the web]
Kennedy Diagnosed With Malignant Brain Tumor

	A seizure led to a brain tumor diagnosis for Sen. Edward Kennedy Photo courtesy of The Office of Sen. Edward Kennedy

Sen. Edward Kennedy (D-Massachusetts), 76, was diagnosed with glioma, a malignant brain tumor, after suffering a seizure in mid-May. The tumor, located in the front left lobe, may impact Kennedy’s speech and motor abilities. First elected in 1962, he is serving his eighth term in office and is the second-longest serving senator currently in Congress.

Academy Award-winning director Sydney Pollack, 73, died of cancer May 26. Pollack, who directed, produced, and acted in many well-known films, including Out of Africa, Tootsie, and most recently Michael Clayton, was undergoing treatment after being diagnosed in late 2007. Doctors were unable to determine where the cancer originated.

Dirty Dancing star Patrick Swayze was diagnosed with pancreatic cancer in January and has been receiving chemotherapy and the experimental drug, vatalanib, at Stanford University Cancer Center in Palo Alto, California. Swayze’s physician said in a statement that the 55-year-old actor has a limited amount of disease and has responded well to treatment.

Swayze, 55, completed filming an A&E pilot last December called The Beast, which may become a new drama series on the network next season. He also stars in the independent film Powder Blue, expected to be released this year.

Canadian blues and jazz icon Jeff Healey died of metastatic cancer March 2 at age 41. After a rare form of childhood cancer called retinoblastoma left Healey blind as a baby, he taught himself how to play the guitar. Healey died just weeks before the release of his tenth album, Mess of Blues.

Cynthia Nixon, who played Miranda on HBO’s Sex and the City, disclosed in April that she was diagnosed with breast cancer in 2006 while starring in the off-Broadway show The Prime of Miss Jean Brodie. Nixon, 42, successfully completed treatment and is now a spokesperson for Susan G. Komen for the Cure.

Diagnosed with a recurrence of Hodgkin’s disease in April, Sen. Arlen Specter (R-Pennsylvania), 78, says it won’t stop him from running for re-election in 2010. First diagnosed in 2005, Specter recently published Never Give In: Battling Cancer in the Senate in which he details his six months of treatment while working full time in the Senate.

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Prevention
Birth Control Pill Prevents 200,000 Ovarian Cancers

Researchers estimate that the widespread use of oral contraceptive pills over the past several decades has significantly decreased the incidence of ovarian cancer—preventing 200,000 cases and 100,000 deaths worldwide over the past 50 years. The report, published in January in the Lancet, noted the prevention numbers could substantially increase as the birth control method becomes more available in low-income households and developing countries, ultimately preventing about 30,000 cases globally each year.

While it has been known that birth control pills confer protection against ovarian cancer, it wasn’t known by how much. Researchers found that long-term use (about 15 years) of the pill can cut the risk of ovarian cancer by about half.

More specifically, the group examined 45 epidemiological studies involving ovarian cancer and oral contraceptives in more than 100,000 women with or without ovarian cancer. Women taking the pill for less than five years lowered their risk by 22 percent, while women taking the pill for five to nine years lowered their risk by 36 percent, and 10 to 14 years of use cut the risk by 44 percent.

Women who took the pill for 15 years or more decreased their risk by 58 percent. Researchers note that oral contraception may cause a slight increase in breast and cervical cancer risk, though not to the extent of hormone replacement therapy in postmenopausal women. However, the risk of breast and cervical cancer is small and disappears after stopping birth control use, whereas the ovarian cancer protection benefit continues even after a woman stops taking the pill—up to nearly 30 years.

However, the researchers do not advocate widespread use of the pill as chemoprevention against ovarian cancer, and women should weigh their individual risks with the benefits.

The hormones in oral contraceptives are the key to ovulation suppression, which is believed to be the factor that reduces ovarian cancer risk. And while the dose of hormones in contraceptive pills has been significantly reduced since the 1960s, it appears the varying hormone levels had no effect on the risk reduction since risk was consistent from the ’60s through the ’80s.

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House Call
Q&A: Hormone Replacement Therapy

Q: If I stop taking hormone replacement therapy, does the risk of breast cancer persist?

A: There has been a lot of discussion in the medical community over the past several years regarding the benefits and risks of using hormone replacement therapy (HRT) with estrogen and progestin, sometimes referred to as combined HRT, to reduce the symptoms of menopause.

In 2002, researchers reported evidence of significant harm—including an increase in breast cancer cases—in a study of women who used combined HRT. News of the study, called the Women’s Health Initiative, led many women to stop taking HRT, and an analysis released last year found that in 2003, there were 14,000 fewer breast cancer diagnoses than in 2002, a drop of nearly 7 percent.

Not everyone agreed that the decline in new invasive breast cancer cases was solely because of fewer hormone prescriptions. The decrease appeared so quickly that other factors, including fewer women getting annual mammograms, may have had an impact. If women weren’t getting screened, breast cancer couldn’t be diagnosed in the first place, but the actual percentage drop in screening did not appear to account for most of the reduction in breast cancer cases.

Now, a new analysis of what happened to women in the Women’s Health Initiative trial suggests no similar sudden decline in breast cancer cases in those who stopped HRT in 2002. The analysis, which appeared in a March issue of the Journal of the American Medical Association, showed that within three years of stopping the 2002 trial, the risk of breast cancer slightly increased while the benefits of combined HRT—lower risk of colon cancer and hip fractures—dissipated. The authors concede that further follow-up and research are needed.

So, does this mean stopping HRT doesn’t account for the decrease in breast cancers, and the decline was due entirely to other explanations, like screening? Probably not.

Further follow-up in the coming years is needed before we can say for certain how the new, more conservative recommendations regarding HRT treatments will impact the number of newly diagnosed breast cancers. What we will most likely find is that all of these factors are important.

For women struggling with the symptoms of menopause, the message remains the same: If you are a woman age 40 or over and at average risk, use HRT with caution, at the lowest effective dose for the shortest time in consultation with your health care professional, and have a mammogram and clinical breast examination every year.

—Len Lichtenfeld, MD, is deputy medical officer for the American Cancer Society.

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Childhood Cancer [web exclusive]
Childhood Cancer Survivors at Increased Risk for Heart Problems

A new analysis from the Childhood Cancer Survivor Study (CCSS) found that survivors have a five- to 10-fold increase in the risk of heart disease in early adulthood when compared with their healthy siblings. In early June, researchers from the University of Minnesota presented their findings at the annual meeting of the American Society of Clinical Oncology in Chicago, noting the while the risk was still small, were concerned that survivors may not be adequately monitored for heart problems after treatment.

Initiated in 1993, the CCSS includes data from more than 14,000 childhood cancer survivors diagnosed under age 21 between 1970 and 1986 and about 4,000 sibling controls, making it the largest study of childhood cancer survivors.

Survivors self-reported heart conditions, which showed a 10 times greater risk for atherosclerosis (hardening of the arteries); 5.7 times greater risk for congestive heart failure; 4.9 times greater risk for myocardial infarction (heart attack); 6.3 times greater risk for pericardial disease and 4.8 times greater risk for valvular disease.

Incidence of heart disease 30 years after diagnosis was 4 percent for congestive heart failure, 2 percent for atherosclerosis, and 1 percent for heart attack. Cases of pericardial disease and valvular heart disease reached 3 and 4 percent, respectively, totaling 1,030 total cardiac events in the survivor group.

“Proportionately these numbers are relatively low, but yet notably excessive when compared to the sibling control group,” said lead researcher Daniel Mulrooney, MD, during his presentation of the results at the annual meeting of the American Society of Clinical Oncology. Dr. Mulrooney, assistant professor of pediatrics at the Masonic Cancer Center, University of Minnesota, noted a third of the survivors studied were under 40.

Survivors treated with heart-damaging chemotherapies, such as anthracyclines, and radiation therapy to the chest were at a higher risk compared with survivors who didn’t receive these treatments.

Previous CCSS results have found survivors at increased risk of secondary cancers, infertility, and kidney failure. Because of the arrival of targeted therapies and improvements in radiation therapy, it is believed the risk of many of these long-term and late effects is lower in survivors diagnosed in the past 20 years.

The importance of studies examining the long-term and late effects of childhood cancer treatments has grown, especially as the five-year survival rate for childhood cancers reaches about 80 percent today and there are more survivors of childhood cancers alive now than at any other time, with about 300,000 in the United States alone. The CCSS studies have led to an increase in long-term planning and monitoring of survivors’ health and working toward preventing such damaging effects.

For more information about the Childhood Cancer Survivor Study, visit the National Cancer Institute.

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Destination [web exclusive]
Kokolulu Cancer Retreat Center on the Big Island of Hawaii

Kokolulu Cancer Retreat Center (www.cancer-retreats.org; 808-889-9893) on the Big Island of Hawaii offers holistic alternative therapies and ancient Chinese healing energy techniques in a remote, peaceful environment. The center offers group and individual retreats for cancer survivors who have finished treatment.

The staff works with each participant to design programs tailored to their unique needs. Co-founded by Karin Whitney Cooke, RN, and Lulu (Lew) Whitney, MEd, Kokolulu, the program uses an integrated form of health care that addresses mind, body, spirit, nature, and community through guided imagery, meditation, psychological counseling, spiritual development, and exercise.

In addition to sessions and activities held on location, ranging from ancient Chinese practices like qigong, massage, Reiki, and acupuncture to simple relaxation treatments with pedicures, salt scrubs, and ocean bathing, the retreat includes travel to other sacred healing sites on the island.

The staff is a blend of qualified professionals trained in holistic therapies and the field of integrative healing. With a combined expertise in complementary and alternative medicine, psychology, and nutrition, the Kokolulu staff provides participants with professional, take-home information they can use to continue the healing process long after leaving the retreat.

The cost of a one-week retreat for either a group or individual setting is $2950, and participants are encouraged to bring a guest to join them for an additional $650. The cost of the retreat includes accommodations, meals, and travel on the island. There is also an option for extending the retreat stay.

Upcoming Group Retreat Dates:
July 21-25
September 29-October 3
December 1-5

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On the Web [web exclusive]
www.cancer.net

The American Society of Clinical Oncology, a professional organization of oncologists, has launched Cancer.Net, formerly People Living With Cancer, a comprehensive website providing reliable and up-to-date information for cancer patients.

With an easy-to-remember web address, Cancer.Net provides quick access to all the information and tools from PLWC, says editor-in-chief Diane Blum, who also serves as executive director of the nonprofit CancerCare.

In addition to a new name and website, Cancer.Net also offers new features, including the Advocacy and Policy section and quick links, such as “Newly Diagnosed: First Steps to Take” and “Survivorship: Next Steps to Take,” which guide patients and survivors through the site, highlighting sections, articles, and podcasts.

A 150-member editorial board develops and reviews all content, which includes updated sections on cancer types and cancer-related syndromes, as well as Spanish translations.

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Bookshelf
The Light Within: The Extraordinary Friendship of a Doctor and Patient Brought Together by Cancer

By Lois M. Ramondetta, MD & Deborah Rose Sills
William Morrow, 2008

A friendship between two women—a gynecologic oncologist and her patient—is the heart of The Light Within.

Lois Ramondetta, MD, of M.D. Anderson Cancer Center in Houston, and Deborah Rose Sills met in 1998, when Sills refused to drink the required bowel cleanser before abdominal surgery that would determine if her ovarian cancer had returned. Dr. Lois—as Sills called her—showed up with arms crossed, declaring there would be no surgery if Sills did not drink up.

After surgery, Sills, joyful that there was no sign the cancer had returned, grew to enjoy the funny, smart doctor who had studied both biology and Sills’ own discipline, religious studies. Before Sills left the hospital, the two had formed an intellectual and spiritual bond that would result in a great friendship and ongoing discussion about the relationship between patient and physician in the face of terminal illness.

Over the following years, Sills and Dr. Ramondetta developed a friendship rooted in the joy and pain of living life while facing death. When the cancer did recur, Sills returned to Houston from her home in Santa Barbara, California, for an experimental bone marrow transplant. Sills struggled to raise her adolescent daughter, Abby, in the midst of her own dying, while Dr. Ramondetta struggled to raise her young daughter, Jessica, while working 90-hour weeks and dealing with the deaths of her patients.

While the book explores aspects of death, including that of Sills, it is mostly about life, perfectly illustrated in one of her last requests—that the book not end with her death, but the birth of Dr. Ramondetta’s second child, Leila Rose. In their friendship the two women found a safe harbor where they could explore the issues of life and death that surrounded them—an exploration they left for us in The Light Within.

—Kathy LaTour

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The Advocate
John Perkins—A Sense of Duty

	John Perkins cared for his sister, Stephanie, after returning from service in Iraq.

After a successful bout with acute lymphocytic leukemia in 2000, Stephanie Perkins, 29, of Walla Walla, Washington, and her family knew what it would take to battle the recurrence that appeared in 2007. A stem cell transplant was the best option for cure, so Stephanie’s family members were tested to find a match, including her little brother, a soldier stationed in Iraq. Working with military officials, Army Spc. John Perkins, 27, was able to quickly fly to Washington to see if he was a match to Stephanie.

After testing, John returned to Iraq, but several weeks later, he came home permanently to help care for Stephanie. After the initial plan of rotating caregiving duties between family members fell through, John became his sister’s full-time caregiver, helping her through treatment, severe side effects, and recovery.

“It was hard for him to leave his fellow soldiers in Iraq,” says Stephanie, who received treatment in Seattle. “It was harder still to be alone with me five hours away from any other family.”

Through it all, she says, John was upbeat and inspiring. “I really don’t know how he did it.”

“It wasn’t easy,” John says with a laugh, “but at the same time it wasn’t too bad, coming from the war zone. It might have seemed overwhelming, but I was used to it.”

Now officially out of the military, John says Stephanie’s battle with leukemia had a lasting impression on him. After a blood infection left her with a clot in her lungs, Stephanie was in intensive care for a week. John stayed with her at the hospital, hoping for the best, and carefully watching the revolving teams of medical professionals take care of her. “It inspired me to become a respiratory therapist,” says John, who is currently taking classes toward the accreditation.

Do you know a patient, survivor, or caregiver we should highlight in The Advocate? If so, e-mail your nomination to editor@curetoday.com.

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