Dear 16-year-old me

BY GUEST BLOGGER | JULY 19, 2011

"Watch this video for me!

I love you guys!"

That's the email my 20-year-old brother sent to my entire family one Saturday afternoon in June. My baby brother, whose usual email content consists of football statistics or homework questions, shocked us all when the link he forwarded directed us to a video about melanoma.

Entitled "Dear 16-year-old me" the five-minute film, which features about a dozen real people (read: non-actors) sharing real stories, starts out light, splicing together a few members of the group offering advice to their former 16-year-old selves. From hair guidance to warnings about how the new Star Wars trilogy ruins everything, their recommendations make you laugh and contemplate what you'd want to tell your former self.

But then the PSA takes a sharp and somewhat unexpected turn, as it jumps from person to person revealing their physical scars and emotional stories of how melanoma affected their, or a loved one's, lives.

Created by The David Cornfield Melanoma Fund, the video explains that melanoma, the most dangerous form of skin cancer, is not only one of the most common cancers affecting young adults today, but also one that could easily be prevented and treated if caught early on. In fact, the 5-year survival rate for patients diagnosed with early-stage (stage 1) melanoma is greater than 90 percent. However, those diagnosed with stage 4 melanoma have a 5-year survival rate of about 15 to 20 percent, according to results from the 2008 American Joint Committee on Cancer Melanoma Staging Database. And with the National Cancer Institute predicting that more than 70,000 people will be diagnosed this year alone, it's easy to see why the members of the film encourage you, the viewer, to educate yourself, check yourself and share the video in efforts to spread awareness and prevent the deadly disease from spreading.

And with more than 2 million views on YouTube, the latter request is clearly being upheld.

Assuming that a majority of these views didn't arise from people searching for "melanoma" on YouTube, I was curious just how my not-exactly-news-savvy brother stumbled upon the Canadian organization's video. His response: "I was on Facebook, and it was on my newsfeed with the person describing it as 'never going in a tanning bed again.' So I watched it, because people close to me tan, at least occasionally."

"It was intense," he continues. "So I immediately wanted to spread the word to my close ones because I'd never want something like that to happen to y'all. So I sent the e-mail."

David Cornfield would be proud. David, the organization's namesake, was 32 when melanoma took its fatal blow. After years of battling the disease, which had gone away and then recurred, David told his wife that he "believed it was their duty to use his story to help others." And that's exactly what Sari, his wife, has done. Founded a short time after David's death, the Fund strives to uphold its mission to decrease melanoma incidence and improve prognosis through education, research and support. The rest of David's heartbreaking story can be found on the organization's website.

And as for me? After my thoughtful brother forwarded this onto me, I knew it was my turn to do my part. In addition to posting it on my personal Facebook and Twitter pages, I also messaged it out to the entire CURE staff and am now sending it out to all of you. So I hope you enjoy it and pass it on. You never know who it could end up saving. And remember, no one is immune to skin cancer. "All skin types, regardless of how much color you have to your skin, can get skin cancer," says Dr. Elizabeth Tanzi, of the Washington Institute of Dermatologic Laser Surgery in a July 18 Reuters Health article.

Taylor Walker, a graduate of the magazine journalism program at the University of Missouri-Columbia, is a summer editorial intern with CURE.

• Two new drugs approved, one pulled from the pipeline
• Cancer screening rates low
• A call for more pancreatic cancer research
• An introduction to cancer: From a father and his daughter
• The cushion of silence

The year of melanoma

BY GUEST BLOGGER | JUNE 20, 2011

CURE invited Wendy K. D. Selig, CEO of the Melanoma Research Alliance, to share her thoughts on the strides melanoma research has had this year, particularly from the news coming out of ASCO earlier this month.

"This clearly is the year of melanoma." These were the words of George Sledge, Jr., MD, president of the American Society of Clinical Oncology (ASCO), in a BusinessWeek interview, following news that made headlines regarding the latest exciting research results presented at ASCO's recent annual meeting.

We at the Melanoma Research Alliance (MRA) are obviously delighted with the reports, especially because the progress has energized the entire medical community to accelerate finding solutions to defeat this deadly disease.

While much more remains to be accomplished, the word out of the ASCO conference regarding metastatic melanoma is that patients and all those at risk for this deadly disease are now witnessing the launch of an era of unprecedented therapeutic opportunities. Until recently, patients with inoperable metastatic melanoma had very few treatment options. In fact, patients with disseminated stage 4 melanoma have a median life expectancy of less than one year.

Earlier this year, the immunotherapeutic ipilimumab (now known as Yervoy), based on the first demonstration of improved survival in a randomized melanoma trial, received FDA approval. The advances continued with a report that vemurafenib, a so-called BRAF inhibitor that works by a completely different mechanism than ipilumumab, also confers improved overall survival in patients with advanced metastatic melanoma compared to standard chemotherapy.

Vemurafenib and ipilimumab represent two major kinds of drugs with activity against melanoma (signaling pathway inhibitors that target the tumor directly and immune-modulating drugs that work indirectly, respectively) for which there is now a growing, rich pipeline of clinical development.

These are significant milestones, providing platforms for further progress. Ongoing research is building upon these results by identifying mechanisms of drug resistance and biomarkers of treatment response, as well as investigating the value of combinatorial therapies. As the largest private funder of melanoma research, MRA is dedicated to remaining at the forefront of these, and other, critical avenues of research. We need to pursue new avenues because, despite the exciting advances that are benefiting patients today, not everyone responds to the new treatments, and too many people are seeing their cancers eventually return.

Combination treatment strategies supported by strong preclinical data are next in line and will benefit from recently updated FDA regulatory guidance in this area that will facilitate their development. Combination therapies will be critical for providing significant benefit to patients. This is one reason MRA applauds Genentech/Roche, makers of vemurafenib, and Bristol-Myers Squibb, makers of ipilimumab, for entering into an agreement to test these compounds in combination.

It is also noteworthy that these advances in melanoma, which have emanated from decades of scientific groundwork, have also revealed treatment paradigms applicable not only to melanoma but to many other forms of cancer as well.

Included in the $25 million to date the MRA is investing in cutting-edge translational science are projects investigating combination therapies such as BRAF inhibitors and immunotherapies as well as research to better understand the biological mechanisms of BRAF inhibitor resistance.

The recent findings and enthusiasm among researchers in the field motivate all of us at MRA and throughout the melanoma research community to redouble our efforts, so that, collaborating with all stakeholders, one day no one will have to suffer or die from melanoma.

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2011 Extraordinary Healer Award for Oncology Nursing Finalists Announced

BY GUEST BLOGGER | APRIL 11, 2011

Three nurse finalists and the patients and caregivers who nominated them are headed to Boston to celebrate the field of oncology nursing

Actress and breast cancer survivor, Cynthia Nixon, to act as Mistress of Ceremonies

DALLAS and THOUSAND OAKS, Calif. – April 11, 2011 – CURE magazine, the nation's largest magazine for people with cancer, has announced the three finalists for the 2011 Extraordinary Healer Award for oncology nursing. The contest, made possible with financial support from Amgen Oncology and Breakaway from Cancer®, invited patients and their families to submit a 400-1000 word essay describing the compassion, expertise and helpfulness a special oncology nurse exhibited toward them during their cancer journey.

This year's finalists include Marie Hayek from Columbus Community Hospital in Columbus, Texas, nominated by Martha Hastedt, also of Columbus; Robert Martinez from Bon Secours Cancer Institute in Mechanicsville, Va., nominated by Corinne Gray, also of Mechanicsville; and Rebecca Wojtecki from the Melodies Center for Childhood Cancer and Blood Disorders at Albany Medical Center in Albany, N.Y., nominated by Rita Stoddard, also of Albany.

"Each of this year's finalists represents very different experiences between nurses and their patients and caregivers," says Susan McClure, cancer survivor and publisher of CURE. "We have a nurse representing a small, rural community who works tirelessly to ensure that local patients can find assistance locally rather than having to travel for hours to receive care. Another decided to become an oncology nurse as a second career after retiring--he enrolled in nursing school with his daughter, graduated with her and now they work together at the same cancer center. In addition to these extraordinary examples, we have a young nurse who befriended a young adult patient and truly went above and beyond to help him finish college while undergoing treatment."

Each of the three nurse finalists and their essayists (plus one guest) will receive round-trip airfare and two-night accommodations in Boston, where they will be honored at a reception held in conjunction with the Oncology Nursing Society's 36th Annual Congress on April 28, 2011. This year's reception is expected to draw more than 800 oncology nurses.

Emmy, Grammy and Tony award-winning actress and breast cancer survivor, Cynthia Nixon, will act as the Mistress of Ceremonies. During the reception, the essayists will read their essay on-stage with their nurse standing beside them. Afterward, one of the finalist nurses will be presented with the 2011 Extraordinary Healer Award for Oncology Nursing and will also receive an all-expenses-paid spa trip for two.

"As judges for this year's contest, we were tasked with selecting just three essays from more than 175 submissions," says Kathy LaTour, cancer survivor and editor-at-large of CURE. "And while it was a difficult task to narrow that pile down to three, each of this year's finalists exhibits a variety of characteristics that are truly extraordinary, and for that they deserve this recognition."

2011 marks the first year that Amgen Oncology and the Breakaway from Cancer initiative have sponsored the Extraordinary Healer Award, but the countless synergies between the two organizations' missions and the goal of the Extraordinary Healer Award are obvious. Founded in 2005 by Amgen, Breakaway from Cancer is a national initiative to increase awareness of important resources available to people affected by cancer – from prevention through survivorship.

"Oncology nurses are often the unsung heroes of cancer care. Those who have demonstrated exceptional devotion to meeting the needs of patients deserve to be recognized – that's why we at Amgen and Breakaway from Cancer are so pleased to sponsor the Extraordinary Healer Award," said Stuart Arbuckle, vice president and general manager, Amgen Oncology. "We commend the three finalists, who are testaments to the power of oncology nurses to make a lasting impact on patients and the families who depend on them."

This year's winning essay will appear in the Summer 2011 issue of CURE, and all three finalist essays will be featured on CURE's website, www.curetoday.com, beginning June 28, 2011. Additional information on the Extraordinary Healer Award for Oncology Nursing, including past finalist essays, pictures from last year's reception, and more, can be found online at www.curetoday.com/healeraward.

About CURE Magazine CURE magazine, a member of the US Oncology family – a division of McKesson Corporation, is a free, award-winning publication from Dallas-based CURE Media Group--the national source for cancer patient education. By combining science and humanity, CURE helps patients, survivors and caregivers navigate the cancer journey and understand their diagnosis and treatment, while providing tools to cope during and after cancer--ultimately helping them to live the life they aspire to live. US Oncology is a leading integrated oncology company uniting one of the largest community-based cancer treatment and research networks in America. Through the magazine, an annual resource guide for the newly diagnosed, books, and a new and interactive website, CURE provides a wealth of resources for everyone on the cancer journey.

About Breakaway from Cancer® Founded in 2005 by Amgen, Breakaway from Cancer® is Amgen's national initiative to increase awareness of important resources available to people affected by cancer – from prevention through survivorship. Through Breakaway from Cancer, Amgen has joined forces with four nonprofit partner organizations: Prevent Cancer Foundation, Cancer Support Community (formerly known as The Wellness Community), Patient Advocate Foundation, and National Coalition for Cancer Survivorship. These organizations offer a broad range of support services complementing those provided by a patient's team of healthcare professionals. For more information, please visit www.breakawayfromcancer.com.

About Amgen Amgen discovers, develops, manufactures and delivers innovative human therapeutics. A biotechnology pioneer since 1980, Amgen was one of the first companies to realize the new science's promise by bringing safe and effective medicines from lab, to manufacturing plant, to patient. Amgen therapeutics have changed the practice of medicine, helping millions of people around the world in the fight against cancer, kidney disease, rheumatoid arthritis, psoriasis, psoriatic arthritis and other serious illnesses. With a deep and broad pipeline of potential new medicines, Amgen remains committed to advancing science to dramatically improve people's lives. To learn more about our pioneering science and our vital medicines, visit www.amgen.com.

• Two new drugs approved, one pulled from the pipeline
• Cancer screening rates low
• A call for more pancreatic cancer research
• An introduction to cancer: From a father and his daughter
• The cushion of silence

Upcoming lung cancer webinar

BY GUEST BLOGGER | JANUARY 31, 2011

I just got an alert that the Lung Cancer Alliance and Legacy will be holding a panel to discuss the impact of lung cancer.

The moderated panel, which will feature several experts, will specifically discuss the impact on certain groups, including men, women, minorities and veterans. Other issues that will be discussed include challenges and opportunities in public health strategies about reducing lung cancer deaths.

The panel will be held February 2 from 9 a.m. to 11 a.m. in Washington, D.C. To find out more information, visit The Lung Cancer Alliance.

Also, you can watch the webinar online at www.lungcanceralliance.org/shadowswebcast. (The link will go live 10 minutes before the start of the program.) If you aren't able to watch on February 2, don't worry. The webinar will be available online for the month of February.

To learn more about the progress being made in treating lung cancer, check out Lung Overdue.

Lindsay Ray is the editorial assistant for CURE.

• Why regulation matters ... but also flexibility
• For the Cure to a broken heart
• Two new drugs approved, one pulled from the pipeline
• Drug approved specifically for treating myelofibrosis
• Erbitux Approved for Metastatic Head and Neck Cancers

2010's Top 10 Cancer Stories

BY GUEST BLOGGER | JANUARY 4, 2011

CURE invited cancer advocate and breast cancer survivor Jody Schoger to share what she thought the Top 10 cancer stories of 2010 were. Her Top 10 list is below.

We're a society of list makers. We love categorizing everything we can get our minds around.

Not surprisingly, I started thinking about the "year in cancer" as 2010 drew to a close. The list I arrived at below is far from complete, but here goes.

1) Health Care Reform

Beginning in 2014--no one can be denied coverage due to a preexisting condition, including cancer. For the self-employed, people in transition, underemployed or in-between jobs, this is huge. Cancer still is a financial albatross, but this is a start. An unhealthy nation can't compete or prosper, regardless of your politics.

2) Komen Can't Cure

The slow burn on "pink madness" turned into a bonfire this year, undoubtedly sparked by the one of the worst promotions ever--Kentucky Fried Chicken's 'Bucket for the Cure.'

The sick of pink mood prevailed throughout social media, from laughs from Anna Rachnel (@ccchronicles) and her "Pink Boob Awards Gallery Relaunch" to some serious questions from advocate Alicia Staley in "Lawsuits for the Cure."

Beneath the laughs and the anger is frustration. The question became: is awareness enough? Getting a mammogram isn't necessarily a preventive measure but a diagnostic one. A vaccine is a preventative measure. Let's find one.

3) Breast Cancer Advances

This year we saw some interesting turn-arounds in breast cancer, including:

> Doctors now say that slowly progressive weight lifting does not increase a woman's risk for lymphadema and in fact, may lower it.

> Headlines from the San Antonio Breast Cancer Symposium (SABCS) about using the bone-building drug Zometa as part of adjunct therapy for stage 2 and stage 3 breast cancers literally contradicted themselves. The problem evolved from comparing two studies that were not alike. Also, an important fact was lost: a 29% survival benefit in women who were five years post-menopause. That's not mincemeat.

Good write-ups came from Sally Church (@maverickny) "Some additional thoughts on Zometa in early breast cancer" and CURE magazine's "Mixed Results for Zometa as a Breast Cancer Treatment" in the Winter 2011 issue.

> Mammography. Heavy sigh. Do you know why mammography is still paired with the word 'controversy'? Let's move past this. I haven't seen anyone post a convincing risk for 10 mammograms – the number of scans you'd have from ages 40 to 49 by keeping the base screening age at 40. Of all the tests that are abused in medicine, I hardly think it's the mammogram.

Other big stories in breast cancer:

> Biomarkers: Two ongoing studies, I-SPY 2 and TAILORx, involve molecular profiling to tailor specific treatments for a tumor. This is exciting. Finding the cancer isn't the problem, keeping the cancer from recurring is. These tests could show the way.

> Inflammatory breast cancer: one of the most intractable of all breast cancers. A new clinical trial (http://clinicaltrials.gov/ct2/show/NCT01036087?term=ueno&rank=2) compares chemotherapy regimens for women with newly diagnosed IBC. Principal investigator: Dr. Naoto Ueno (@teamoncology) at the University of Texas M.D. Anderson Cancer Center.

4) Lung Cancer Hits the Radar as a Women's Health Issue In 2010, simultaneous advances in medicine and advocacy helped move lung cancer, the most underfunded yet largest cancer killer in the US, into the public eye. From "Out of the Shadows," an excellent report from Brigham and Women's Hospital, we know that the incidence of lung cancer in women has increased six fold over the last 30 years. Adenocarcinoma, once rare, is now the most common type of lung cancer in women of all ages, particularly in young people who haven't smoked. A study published in the journal Lung Cancer showed CT scans reduced the death rate among 53,000 current and former heavy smokers by 20 percent compared with regular X-ray screening. The study looked at death rates in a different, smaller population of heavy smokers and estimated that those who received up to two CT scans would have between a 36% and 64% lower risk of dying, compared to those who went unscreened.

More from NIH: For Lung Cancer, A New Drug and a Way Forward (by Edward Winstead @edwardwinsted) and from Reuters: "More Signs Lung Cancer Screening Could Save Lives."

5) Patient-Centric Care

Patient-centric care, where your participation, your input, your questions and clear communication are not just encouraged but expected--is the new term for a practice excellent physicians have employed for years--taking your experience, wishes and preference into account when tailoring your treatment plan.

Here are two great examples:

Shared Decision Making, with Dr. Victor Montori at the Mayo Clinic, discusses how important clear communication is from both the patient's and the physician's perspective.

The second is a terrific application of theory in practice. I applaud the Palo Alto Medical Foundation for the 2006 creation of PAMF's Cancer Patient Advisory Council. The council does more than committee speak or fill blank pages with names on a roster, but has affected change in both survivor care and wellness programs.

6) Palliative & Hospice Care

When you are newly diagnosed or in treatment, palliative care and hospice services are the very last subjects in mind. As you heal from treatment and begin to value your life more and more, the task of addressing how you want it to end becomes--if not easier--more understandable. Just lifting the blinders and acknowledging the topic is a start.

This year a study showed that palliative care actually extended the lives of people with advanced lung cancer. Hospice and palliative care professionals even recommend becoming part of the patient's team when advanced disease is diagnosed. This way, difficult end-of-life decisions can be grappled with before the later effects of illness bring more distress to patients and their families.

My attitude about end-of-life treatment changed following the death of my mother. We can't control when we're born, but we can get directives in place that define how we want it to end. There's even a study under way, "Communication in Oncologist-Patient Encounters or C.O.P.E." that will help train professionals to help initiate end-of-life conversations with their patients.

7) The Power of ONE

Never discount the power of one. Here's what just a few women I've met this year have done to turn the tide:

> Suzanne Lindley, @rslindley, founder of YES: Beat Liver Tumors. If you don't know the story of the Texas housewife who took on Congress, please read, "Teaming Up Against Liver Cancers."

> Tami Boehmer (@TamiLB) author of Incredible Survivors, intimate portraits of people who are thriving despite a grim prognosis.

> Jennifer Windrum, (@jenniferwindrum) a one woman tornado of lung cancer building awareness with WTFLungCancer (@wtflungcancer)

> Britta Aragon, (@Britta_Aragon) founder of Cinco Vidas, for her work building awareness about toxins in make-up and skin care products.

8) The fastest growing cancer?

No, it isn't breast cancer. The fastest growing cancer is thyroid cancer. The disease has a large presence on social media thanks to advocates and writers, including Kairol Rosenthal and Katie Schwartz. These intelligent, passionate and funny women reach thousands. If you know of any women with thyroid cancer send them to "Dear Thryoid" (@dearthyroid) for information, support and community.

9) Adherence

Adherence is the ugly step-child of cancer care.

This year we found out that almost half of the women who were prescribed hormonal therapies for breast cancer failed to complete their course of therapy. Then a study released at SABCS in December revealed that only half of the study's 1.56 million women age 40 and older received a mammogram in any given year. Only 60 percent received more during a four-year period.

The potential for future health woes stemming from these studies is frightening. It's time for all of us to step out of our cancer clusters and advocate. Be bold. Ask your friends, did you get your mammogram this year? Your colonoscopy? When was the last time you had a physical?

Women CAN get basic screening at little or no cost. The CDC's National Breast and Cervical Cancer Early Detection Program http://www.cdc.gov/cancer/nbccedp/index.htm has provided free or low-cost screening for more than 20 years. Here's where to start: http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contactlist.asp.

Adherence is essential in every proactive health measure we make--from a healthy diet to exercise and stress reduction. Our ancestors didn't need a mobile ap to tell them to get up and feed the pigs or milk the cows. The sheer fact that they had animals to tend to made the aspect of choice irrelevant. Maybe we need to reclaim some of that spirit and stop thinking of exercise, as one example, as something we may or may not do. Maybe the choice will be which one, or, what's the most efficient exercise I can do today with limited time. Maybe our choice isn't what silly diet to try next but what foods will I pick to nourish my body today? And finally, perhaps the choice isn't taking the hormal therapy but selecting the most helpful coping strategy for the side effects. We need to help each other do better in every regard. Let's find ways to help each other succeed.

10) You are unique. So is your cancer. Personalized treatment will come.

Each child has her own unique genetic footprint. So does cancer. Our cancers are not alike. No one-size-fits-all protocol cures breast cancer, or lung cancer, or colon cancer, or leukemia. No one even agrees on what constitutes a "cure."

As researchers reach more deeply into cancer cells, following the wandering paths of enzymes and proteins, the whys and hows of recurrence and metastatic activity will begin to fall in place. Perhaps one day, maybe this year, a study result will become the stone that finally creates the avalanche needed to demolish cancer. My dream is to watch this avalanche pass by and around me in my lifetime.

Jody Schoger is a writer and cancer advocate living in The Woodlands, Texas. She explores women's cancer news, information and essays on her blog http://womenwcancer.blogspot.com. Follow her on Twitter: @jodyms.

• Why regulation matters ... but also flexibility
• For the Cure to a broken heart
• Two new drugs approved, one pulled from the pipeline
• Drug approved specifically for treating myelofibrosis
• Erbitux Approved for Metastatic Head and Neck Cancers

Pelotonia riders cycle for research

BY GUEST BLOGGER | AUGUST 17, 2010

Audrey Rabalais, a senior journalism major at Ohio University, is a summer editorial intern with CURE.

Although cyclist and cancer survivor Lance Armstrong does his most renowned riding in France, he received a warm welcome when he pedaled into Athens last year: Athens, Ohio, to be clear. Armstrong was the spokesman for the inaugural Pelotonia bicycle tour, a 180-mile ride that raised $4.5 million in 2009 for cancer research at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James).

The grassroots bicycle tour was the brainchild of Michael Caligiuri, MD, director of the OSUCCC and CEO of The James. Looking for sources of funding for the cancer center, Caligiuri was inspired by the Pan-Mass Challenge, a cycling event that raises money for the Dana-Farber Cancer Institute in Boston. The Pelotonia was then created, the name stemming from peloton, the term for the main group of riders in a cycling race.

Unlike runners, cyclists aim to stay as close as possible to one another, as this reduces wind resistance and makes travel more efficient. Although the Pelotonia is not a race, the idea of working as an efficient team applies to the goal of curing cancer – 100 percent of every dollar raised by teams and individuals in the Pelotonia goes toward cancer research.

Last year's ride drew 2,265 cyclists from 31 states. This year, there are over 4000 registered entries for the Pelotonia website. The 2010 route will be the same as last year, beginning at Ohio State University's Chemical Abstracts building and, for those who ride the entire route, finishing outside Ohio University's Convocation Center on the first day. Riders then spend the night in Athens and ride back to Columbus the following day.

I happened to be in Athens during the race last year, as I was a Resident Assistant in the Convocation Center which, in addition to being a basketball arena, houses a circular residence hall. The hype surrounding the arrival of the riders was tangible, as tents and a band stand were set up earlier in the day. Some of the riders stayed in the dorms overnight and the parking garage was filled with well-used road bikes. In a town with just one main road, an event like this is exciting, especially when the cause is an incredibly worth one.

The money raised from last year is currently funding research for pancreatic cancer prevention, triple-negative breast cancer therapies, a new leukemia drug, and the role of heredity in cancer development. If as much or more money is raised this year, who knows what new research is on the horizon for the cancer center.

This year's race is August 20 to the 22nd, and it's not too late to sign up! In addition to helping fund cancer research, wouldn't it be great to say that you rode with Lance Armstrong?

• Two new drugs approved, one pulled from the pipeline
• Cancer screening rates low
• A call for more pancreatic cancer research
• An introduction to cancer: From a father and his daughter
• The cushion of silence

New exercise guidelines for cancer survivors

BY GUEST BLOGGER | JUNE 6, 2010

Survivors may soon get their very own exercise prescription, following new guidelines presented today at the American Society of Clinical Oncology's annual meeting.

Prior guidelines aren't specific enough, said Kathryn Schmitz, PhD, of the University of Pennsylvania School of Medicine, during a session on physical activity in cancer survivors. Plus, scientific evidence about cancer and exercise has grown greatly in the past few decades, as has the number of cancer survivors, which has jumped from two million to 12 million since the 1970s. Considering the increasing number of exercise programs for patients and survivors that are popping up all around the world, Schmitz said better guidance was needed not only for fitness instructors but also for physicians who need to get past the idea that patients shouldn't push themselves during treatment.

Schmitz headed up a panel of experts brought together by the American College of Sports Medicine to develop new recommendations for exercise during and after cancer treatment. Published studies in five cancer types--breast, prostate, hematologic, colon, and gynecologic--were used to develop the recommendations.

Although Schmitz noted there are circumstances in which a patient or survivor should receive a medical assessment before starting an exercise program, she said it shouldn't be the norm. In fact, the panel concluded that in order to reduce barriers to starting an exercise program, requiring medical assessment for all survivors is not recommended. "We chose to do this because we felt that the small risk in a small body of patients was probably less than the amount of risk that is induced by telling people that they shouldn't exercise until they're cleared," she said during the session, adding that the risk of inactivity for the large majority of patients at low risk for problems is probably greater than the small risk of putting someone in harm's way.

The first and most important guideline, Schmitz said, is that patients and survivors must avoid inactivity. They must continue their normal activities during and after treatment, and resume daily life as soon as possible after surgery. Other specific recommendations include:

> Over the course of one month, it's safe to build sedentary patients up to 150 minutes of moderate-intensity aerobic exercise per week
> It's safe for patients undergoing stem cell transplant to exercise every day, but these patients should reduce intensity and progression of intensity because of the effects on the immune system
> For patients suffering from weight loss, resistance training can help build strength
> For those with prostate, hematologic, and colon cancers, twice-weekly resistance training is recommended: one exercise for each major muscle group for eight to 10 repetitions, and one to three sets per exercise
> Women with breast and gynecologic cancers should start with a supervised resistance training program given the risk for lymphedema
> Given side effects such as incontinence and sexual dysfunction, floor exercises should be added to an exercise routine for men with prostate cancer
> Colon cancer patients with an ostomy should avoid excessive intra-abdominal pressures

The full guidelines will be published in the July 1 issue of the journal Medicine and Science in Sports and Exercise, and are expected to be made available on the ACSM website at www.acsm.org.

Check out CURE's 2010 Cancer Resource Guide to learn more about exercise and recovery, including where to find a cancer-certified trainer or a cancer exercise program near you.

Melissa Weber is the former managing editor of CURE and is covering the annual meeting of the American Society of Clinical Oncology.

• Sentinel nodes: A convergence of knowledge from different trials
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• Attention oncologists: talk to your patients about treatment costs

Unraveling the complexities of myeloma therapy

BY GUEST BLOGGER | DECEMBER 14, 2009

Diane Gambill, PhD, is CURE's senior scientific advisor and chief scientific officer for Physician's Education Resource and Cancer Information Group.

For years, debates over the right way to deliver therapies for cancer have included questions on whether to give one drug up front or two (or more), and whether to save your "best" drug for later if your disease returns. For myeloma, the emerging picture is that three drugs are better than two, and two are better than one such that using all your best drugs up front might be best. At this year's American Society of Hematology meeting, a plenary session paper showed that if a proven three-drug regimen is followed with additional therapy, termed maintenance therapy, patients do even better.

The study, conducted by Dr. Maria Mateos and colleagues in Spain, included 260 newly diagnosed patients who were at least 65 years old. The trial compared induction (or initial) therapy with Velcade/melphalan/prednisone (VMP) to Velcade/thalidomide/prednisone (VTP). One aim of the trial was to figure out whether you really need a type of drug called an anthracycline, so the comparator arm replaced the anthracycline melphalan with thalidomide, an immunomodulatory agent. One notable part of the design of this study was the use of Velcade on a weekly rather than twice-weekly schedule. The investigators wanted to know if by reducing the dose, they could reduce the overall adverse event profile without compromising efficacy.

The response rates were very similar between the two regimens in this part of the trial (80 percent versus 81 percent). VMP was associated with more hematologic toxicities, and VTP was associated with more cardiac toxicities. There was less Velcade-related peripheral neuropathy with the weekly schedule than you would expect to see with the twice-weekly schedule.

Once induction therapy was completed, patients in each arm were randomized to receive maintenance with either Velcade/prednisone (VP) or Velcade/thalidomide (VT). Adding maintenance therapy to the induction regimen increased the complete response rate, and the toxicity added by the extended therapy was low. The use of VT following either induction regimen improved progression-free survival by a statistically significant length of time compared to VP (not reached versus 33 months); however, this improvement did not translate into an increase in overall survival. Further, VMP followed by VT was found to be better than VTP followed by VP, which means the anthracycline (melphalan) component of induction therapy is important to keep.

The main take-home messages from this study are that a less intense regimen with follow-up maintenance therapy is safe and effective. These results reinforce the notion that duration of therapy is an important factor in getting the best results--if you can receive all of your planned therapy without dose reductions or skipping doses, your myeloma is more likely to respond--and that maintenance therapy adds to the benefit.

• Why regulation matters ... but also flexibility
• More trail mix
• When the cancer comes back
• Two new drugs approved, one pulled from the pipeline
• Emerging treatment option for myeloma presented at hematology meeting

Advocates question the experts

BY GUEST BLOGGER | DECEMBER 12, 2009

Every year, CURE invites one advocate who is attending the San Antonio Breast Cancer Symposium to serve as a guest blogger. This year readers will be hearing from Bev Parker, PhD, a 24-year breast cancer survivor who is attending the symposium for the seventh year.

For advocates, a significant highlight of the symposium is always the evening "Hot Topics" sessions, now in their 12th year. Hot Topics is sponsored by the Alamo Breast Cancer Foundation, which this year awarded scholarships to 34 advocates to participate in the symposium. Slots to attend are highly sought after, and advocates may only apply every five years. (For more information, visit www.alamobreastcancer.org .)

The two-hour Hot Topics sessions are held during three evenings following the daily presentations. Several well-known individuals who hold MD and/or PhD degrees participate on a panel of experts. Each day features a different panel and each person on the panel gives a 10 to 15 minute overview of what he or she found most interesting during the day.

Afterward, advocates are encouraged to ask questions, to which the panel members respond. We advocates are free to pose those questions we might feel too "dumb" to ask in open sessions. In turn, the experts often remark that Hot Topics sessions are the high point of the symposium for them. Here are a few of the interesting off-hand comments made by a few of the panel members:

>"We ask one [research] question and get two more" (Hyman Muss, MD).

>We don't know "how long is long enough on an AI [aromatase inhibitor]" (Judy Garber, MD).

>"Pharmacogenomics is the wave of the future" (Peter Ravdin, MD, PhD).

>"The bone is the first site of recurrence in a third of patients." (Julie Gralow, MD).

>"It's hard to wait to get the results of clinical trials." (Steven Shak, MD).

Advocates have been brought into the scientific process more and more in recent years. We have talents, skills, and experience to offer, and we use them on grant review committees, institutional review boards, government committees, etc... In addition, one of our most valuable contributions is putting a "face" on the disease of breast cancer. We represent therapies that worked and are here to join with scientists and others to push for newer and better therapies that were not available for those who didn't make it, but will be for those who follow.

More tomorrow!

To read more articles from CURE's coverage of SABCS 2009, visit sabcs2009.curetoday.com.

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• A call for more pancreatic cancer research
• An introduction to cancer: From a father and his daughter
• The cushion of silence

Trial tests new drugs, male breast cancer detailed

BY GUEST BLOGGER | DECEMBER 11, 2009

Every year, CURE invites one advocate who is attending the San Antonio Breast Cancer Symposium to serve as a guest blogger. This year readers will be hearing from Bev Parker, PhD, a 24-year breast cancer survivor who is attending the symposium for the seventh year.

Breast cancer advocates at the San Antonio symposium have many opportunities to be involved and to learn. Two of my favorites today were the I-SPY 2 trial and posters on male breast cancer.

Laura Esserman, MD, of the University of California at San Francisco, is the dedicated principal investigator of I-SPY 2, and Jane Perlmutter, PhD, is the tireless champion of advocate involvement (among many others spending countless hours on the trial). These two individuals hosted a breakfast today to educate interested advocates. I-SPY 2 features a random, adaptive, neoadjuvant design that involves testing investigational drugs in women whose locally advanced breast cancer is at high risk of recurrence.

Prior to surgery, these women will undergo standard chemotherapy, and as many as 80 percent will also be given investigational drugs. Tissue from the surgery will rapidly identify the drugs that increase the chance that no cancer remains (referred to as "pathological complete response").

Many drugs will be tried (among the first, a PARP inhibitor) and each will be tested on 20 to 120 patients, based on biomarker profiles. Patients will be followed for three to five years. This trial design allows for learning while doing, enables earlier drug approval, and drastically reduces costs.

The trial will be conducted throughout the country with about 15 open sites by May 2010. The drugs that increase the chance that women will have a pathological complete response will go into phase 3 testing. One exciting part is that advocates have been involved at every step along the way.

Male breast cancer comprises about 1 percent of breast cancer cases diagnosed each year in the U.S. Of the more than 1,000 posters presented this year at the symposium, five featured male breast cancer. One study was conducted in each of the following countries: Canada, Germany, Sweden, the U.K., and the U.S.

Below are some of the study conclusions, alphabetical by country:
>Most men were prescribed adjuvant endocrine therapy, usually tamoxifen. Despite increased use of endocrine therapy, overall survival has not changed significantly over time.
>Luminal A is the most common type of male breast cancer. It shows a significant improved outcome compared with basal-like tumors.

>No difference exists in the distribution of stage at diagnosis between male and female breast cancer.

>Subtle differences exist between male and female breast cancer regarding hormone receptor profiles.

>Men and women may share common risk factors for breast cancer. The biology of male breast cancer resembles the late onset and ER-positive type of female breast cancer.

Mortality rates for breast cancer have improved over time, but progress for men lagged behind that for women.

More tomorrow!

To read more articles from CURE's coverage of SABCS 2009, visit sabcs2009.curetoday.com.

• Why regulation matters ... but also flexibility
• More trail mix
• When the cancer comes back
• Two new drugs approved, one pulled from the pipeline
• Emerging treatment option for myeloma presented at hematology meeting