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Adjusting to Cancer's "New Normal"

Thought Control: Can Anything Take My Mind Off Cancer?

Comedy: Would a Few Laughs Help My Cancer?

Yes, Cancer Is Making Me Lose My Hair

When finding out someone was recently diagnosed with ovarian cancer, don't respond by telling them the disease is lethal and has no symptoms.

Ovarian Cancer: Please Don't Say It Is Lethal

I took a chance joining a cancer support group. Nearly seven years later, that chance is still bringing me much joy and comfort.

A Worthwhile Decision: Joining a Cancer Support Group

For patients with melanoma aged 75 and older, adjuvant (postsurgical), treatment with immune checkpoint inhibitors should be used with precaution, researchers have stated, citing relatively less efficacy and higher risk of toxicity when compared with younger patients. However, one expert who spoke with CURE® disputed these findings.

A team of German researchers whose findings were published in 

, compared 339 patients younger than 75 with 117 patients who were 75 and older, retrospectively analyzing immune-related side effects and outcomes for patients treated with immune checkpoint inhibitors Keytruda (pembrolizumab) or Opdivo (nivolumab) between Jan. 1, 2018 and Dec. 20, 2022.

Researchers reported that treatment was well-tolerated in both patient groups, with no significant difference in the overall occurrence of side effects.

Regarding notable mild to moderate side effects for patients 18 to 74 and 75 and older, respectively, rates of skin toxicity were 17.4% and 30%; rates of fatigue were 15.7% and 6.8%; rates of colitis (inflamed reaction in the colon) and diarrhea were 3.6% and 7.7%; and rates of nephritis (kidney inflammation)/elevated creatine kinase were 2.1% and 6.8%.

Furthermore, regarding disease-free survival, the median time between the start of immune checkpoint inhibitor therapy and the occurrence of disease metastasis was nine months among the older patients and 14 months among the group of younger patients.

“In terms of efficacy, it has to be noted that [disease-free survival] was significantly shorter in the elderly cohort,” researchers wrote. “There was also significantly more skin and nephrological toxicity and more cases of colitis/diarrhea. According to our results, adjuvant [immune checkpoint inhibitors [should be used with precaution in patients aged [at least] 75 years [old].”

Presurgical, Postsurgical Targeted Therapy Effective in Some Melanomas

But Dr. Siwen Hu-Lieskovan, Associate Professor of Medicine, and Director of Solid Tumor Immunotherapy at the Huntsman Cancer Institute, University of Utah, didn’t agree with the researchers’ conclusion, taking issue with the size of the study’s patient population.

“It's a relatively small cohort,” she said. “If you're going to explore toxicity in elderly patients in the general population, to have a little bit over 100 patients in this cohort, it's really a very small sample to look at. Especially when we're talking about toxicity to immunotherapy, it can be a very different set of symptoms, and different organs get involved. So when you lump everything together, it's really prone for sampling error.”

Immunotherapy — such as Keytruda or Opdivo — is a type of cancer treatment that helps a patient’s immune system fight cancer, as the National Cancer Institute explained. Both drugs are known as PD-1 inhibitors and they allow T cells, part of the body’s immune system, to kill cancer cells.

Such treatments, Hu-Lieskovan said, come with a wide range of unpredictable side effects.

“In general, the toxicity to immunotherapy is very unpredictable, in terms of which organ is going to be evolved and when,” she said. “So, a problem was managing toxicity to immunotherapy, and with anti-PD-1 therapy, it's actually a little better because only 10% to 20% of patients get severe toxicity. Most patients actually can tolerate the treatment pretty well with no problems or just mild problems. The toxicity to immunotherapy is ultimately immune in nature. So, the cells were trying to activate the anti-tumor immune response or reactivate it, but in the process, the immune cells start to attack the normal cells and in each individual patient, and we actually cannot predict which organ is going to be affected.”

Researchers reported that 57.3% of older patients prematurely discontinued treatment with immune checkpoint inhibitors, versus 32.1% of younger patients.

“[Older] patients are treated with [fewer] doses, and they discontinue their treatment much earlier than the younger patients,” said Hu-Lieskovan. “That could explain why this population had relapsed disease — not because of all these toxicities, or differences in terms of efficacy.”

For more news on cancer updates, research and education, don’t forget to 

Citing toxicities and lack of efficacy, some are calling for caution when treating older patients with melanoma with immune checkpoint inhibitors. 

Tumor

Researchers Urge Caution of Immunotherapy in Older Patients with Melanoma

For a Black woman, a diagnosis of breast cancer is a death sentence. Statistically, black women are 41% more likely to die from breast cancer, according to the American Cancer Society. For me, the diagnosis was a rebirth — a reality check that gave me a whole new perspective on who I was, who I could be, and the role I believed I could play in the world.

I was in my early 20s, having the time of my life. I was pursuing my dream as an aspiring comedian. I became well connected in a city I love, I was in love. I worked my way into the life I dreamed of in NYC.

My father passed away in 2004, and his death shook me to my core, I felt alone. My mother was living, she and I have had a rocky relationship for years.

This was the perfect time for me to go for it —make a name for myself and move to Los Angeles. This is also the year I found out I had breast cancer. I was staying at the Roosevelt Hotel, having the time of my life! Hanging with celebrities, hitting the parties and brunching in the midafternoon. Everything was going my way... I knew about breast cancer, of course, and had heard about the toll that it takes on black women. But I never thought it would happen to me.

I was lounging at the pool, sipping on a margarita and I rubbed my breast, adjusted my bikini top and felt a bump; I immediately started to feel all round my breast and it was clear: there was a bump, for sure. I couldn’t believe it and kept feeling all around while I was trying to look like I was enjoying myself. But there was a bump insidemy breast.

When the party stopped at the pool, I went inside my room and checked again, and I noticed it was red maybe from the touching. I called my radiologist the following day. But being from the East Coast, my doctors were in New York. He asked,“when can you fly back to New York?” I said ASAP! I was familiar with radiologists because in the 9th grade, I had a surgery to remove a benign mass and was told and taught to give self-exams.

Once I arrived at the airport, my world started to shrink slowly, for whatever reason (other than a lump being on my breast) I knew something was wrong; I knew I was up against something but just didn't know the magnitude. The feeling I had was just to get to the next day.

After getting my mammogram, the radiologist wanted more images and then a sonogram, all done inside the office, the same day. I was flat on the table and Isaid, "Can we biopsy the lump?” He was totally against the thought. I was told I was too young.But I wanted to do it and I pushed and wouldn't take no for an answer. So we did the biopsy. 

My boyfriend and I went to lunch and while we were sitting there eating, the cell rang, and it was the doctor's office. "Hello" the first thing Isaid was, "I have cancer?!" "Yes, you do."

When the words sunk in for the moment,I felt all the normal emotions: fear, anger, denial. At first, I wanted to run away from the diagnosis. I wanted to fly back to LA and forget but I couldn't because the doctor was a friend of my boyfriend, and we were directed immediately to meet with an oncologist.

We were told the oncologist was waiting for us. At that moment I knew this was serious — more serious than I could ever imagine. There was a car on hand, and we jumped in car and drove to the oncologist.At this point, I was numb. I didn't have any thoughts; I was just along for the ride. I wanted the oncologist to tell me that the radiologist was wrong and there was a big mistake. I wanted to jump on the next flight and call my friends once I landed and tell them it was a close call but I'm alright.

When we arrived and I was walking through the office to meet with the doctor, I witnessed chairs with machines hooked to them.The rooms were private and looked cold and isolated. It was no place for a 29-year-old who was full of life, waiting to get a big break on stage making people laugh. I did not want to be there for any reason.

The doctor's actual office was cluttered with awards and family photos, degree after degree on the wall. We started talking, and he was asking me about my background while looking over the stack of paper in front of him. I couldn't believe that in such a short time all this paperwork about me was with him. My boyfriend was right by my side and the doctor became quiet reading my chart, flipping the papers, everything the radiologist sent over.

He looked up at me and he said, "If you don't do chemo you are cooked."There was silence in the room. I didn't know what “cooked” really meant but it didn't sound good.

In that moment, I straightened up and mustered up all the confidence I had, and I told this man who has never met me before and really didn't know anything about me, I didn't care what he was reading. I am a child of God and I do believe that the holy spirit came over me so to this award-winning, 10,000-degrees-having doctorI said, "Only God knows my expiration date." I Looked over to my boyfriend and I said I'm ready to go.

The doctor quickly started explaining his position. He wanted me to know that I was in trouble and needed to take care of myself immediately. He gave us his directions and we expressed our concerns. After our talk, we said thank you and walked out of the office. Driving down the street there was silence in the car. My hand was on the seat and my boyfriend's hand was on the side of his seat and I felt warmth, he put his hand on top of mind but didn't say a word. Tears started to flow from my eyes down my cheek — I couldn't help it. I couldn't stop my tears from flowing and I said my voice cracking "I don't want to die ''

The biggest concern is that I was moved to the west coast. I couldn't care for myself on the west coast with no one. My boyfriend and I were on rocky ground, loving one another and not knowing what's going on with us before this happened. I moved to LA to become a star, not to get diagnosed with cancer at the age of 29! This was a nightmare!

The oncologist was clear that I needed to move fast if I was going to do the chemo treatment. I asked if I could return to LA and get my thoughts together. The answer was yes, try to make up your mind within 30 days.

I packed my bags and headed back to LA; I was in such a state I don't remember boarding the plane. I don't remember how I got from the airport to the hotel. I made a hair appointment subconsciously anticipating some type of treatment and I wouldn't have to do my hair. I was so scared about what chemo would do to me emotionally, physically, mentally. I had my girlfriend braid my hair. 

As I was leaving the shop, I saw a sign and this sign spoke to me as my father would have spoken to me. It was a sign from my father that I only would have understood. My father worked for General Motors and there was the GM logo and under the logo it read "Take care of your car like you take care of you." That was the sign. I had to do chemo! I wasn't crazy about cars or anything like that. It was the "Take care of you." That was it.

In a manner I would later learn is typical of Black women who are diagnosed with breast cancer, I hoped that God and faith would see me through. But once I decided to do the treatment, I was unstoppable. (I DIDN'T want to die) I was so scared that I couldn’t focus on the cancer, I was focused on getting the cancer out of my body. I made a choice: my choice I wanted to live, and this is what I focused on.

I didn’t run away from the cancer; I ran toward it. When it was time for my radiation treatment, which was located in the basement of Mount Sinai, I saw a picture in the “New York Times” of a group of women dressed in pink, marching for breast cancer awareness. I felt numb, angry, love and safe — all these emotions in a matter of seconds. This is when the first time I asked God,“Why me?” 

I wrote in the “New York Times” “PinkChoseMe” (one word). I looked at it and I felt strong, I felt like I could beat it. There was a woman in the waiting room, she was with her husband, and he had cancer and wasn’t in good shape. I would read the newspaper to her, and she would tell me about her plants in Greece and how she missed them, but she needed to be with her dying husband. Our conversations saved each other. She needed to talk about something other than her reality and me listening and reading to her took me out of my reality. But what I also learned about cancer and how it was affecting women all over the world.

That was the moment the nonprofit, PinkChoseMe, was createdto support young women of color and women living with breast cancer in underserved communities.

Through that process, I was reborn. I learned how to advocate for myself with doctors. I learned how to walk into a room full of powerful people and engage them as equals. I learned how to experience true joy instead of smiling through my pain. And I learned what it meant to truly take care of myself from the inside out.

I also learned about the factors that drive the vastly poorer outcomes for black women who are diagnosed with breast cancer.For example, a smaller percentage of Black women with breast cancer attend follow-up appointments compared to White women. Usually when we receive our diagnosis, we are sent home to manage by ourselves without any further support. My diagnosis led me to get more deeply in touch with my culture and think critically about the lessons we are taught about our bodies, our culture patterns, and our power.

I refused to put my head in the sand and gave up, I held my head high, was diagnosed twice after my first diagnosis.but I am still here and I'm not going anywhere.

This post was written and submitted by Tiffany Jones. The article reflects the views of Tiffany Jones and not of CURE®. This is also not supposed to be intended as medical advice.

After being diagnosed with breast cancer, I learned more about the disparities that Black women with the disease face. 

My Cancer Diagnosis Connected Me With My Culture

I loved the month of June. As a young girl, June meant that school was out, and summer fun was to be had. Our pool was always filled with family and friends. My mom was always the perfect hostess.

My beloved mom passed away from metastatic breast cancer that had only been diagnosed the month before. She was only 37 years old. I was just 12.

Many Junes later, as I aged, the pain of the loss of my mother had dissipated and I learned to love June again. It marched summertime in after a cold New England winter. Our toddler daughter loved the garden and its treasures.

In the winter of 1998, we were thrilled to learn that we would be expecting a baby boy in the early fall. I loved being pregnant and treated my body like a temple to give our son a healthy start on life. I worked out before my husband and daughter even woke in the morning. Healthy foods, no alcohol and naps — lots of naps.

I was plagued with fatigue that I never felt before, even during my previous pregnancy with my daughter. My doctor, my friends and family told me not to worry; I was a young, active woman with a very active 4-year-old and a husband that traveled extensively for business.

“Just rest when you need to,” I was told.

I was doing exactly that when I discovered a lump in my left breast. “What the heck is that?” I thought. “Breathe. It must be a milk duct,” I told myself. “Yeah, that’s it ... an enlarged gland or milk duct. It must be.” After all I was five months pregnant.

It was a Monday, and I had a scheduled OB-GYN appointment on Friday. I kept telling myself the lump I felt was nothing. I repeated that at least a million times before my appointment.

I almost didn’t tell my doctor about the lump. But at the last minute said, “Would you mind humoring me and feeling this thing on my breast?”

He said that I needed to get this checked out by a surgeon immediately. Like today. The surgeon agreed to see me as the last patient on that busy Friday.

“Mommy why are you crying?” “Kimberly, you have a malignancy.”

The doctor’s plans were to operate within 10 days to remove the lump and lymph nodes under my left arm. It would be under general anesthesia and my OB-GYN would be present.

After surgery, I awoke to the news that the entire lump was removed and that there were clear margins. Eleven lymph nodes were negative. It was promising news.

Back at home I suddenly awoke to pain, sharp pain every few minutes. I was in labor. Back to the hospital we raced.

For three days I tried to hold him in, as I was only five months along. “It’s time to push, Kim!” And then he was born, small, but healthy. His birthday was June 24.

On the day we checked him out of NICU, I walked into the adjoining cancer center to plan out my chemo for the first six months of my baby’s life, to be followed by a bilateral mastectomy.

Our family settled into a life around chemo, appointments, hope and prayer.

And then I found a lump in my neck. I was 37 — the same age that my mother was when she died. I now had stage 4 metastatic breast cancer and I slipped into “living to die.” Every holiday, birthday and other yearly occasion, became a question of, “Is this the last one I’ll enjoy?”

But the truth was that I wasn’t enjoying things. I was just surviving until the next occasion without enjoying the many days that I should have been living.

Until I had an epiphany. Actually, it was a spiritual awakening.

While praying for more days to live, I realized that I needed to live the days that I had. I wanted to just live to the fullest as much as I could and let God handle the rest and to free myself of the burden of always fighting and to slow down and just enjoy the day that was guaranteed to me ... today.

Today is June 16, 2024. My son, the preemie, will turn 26 in a couple of weeks.

I have endured two more metastases to my mediastinum and left lung. I have been in remission and am finally off of the chemo I was on for over 23 years. I opened a meditation studio in 2016 to teach others the lifestyle of gratitude in all circumstances and being fully present and engaging in life each day.

I really love June — and I plan on being around for many more.

This post was written and submitted by Kim Green. The article reflects the views of Green and not of CURE®. This is also not supposed to be intended as medical advice.

I spent a lot of time after my metastatic breast cancer diagnosis worrying of each experience would be my last. Then I had an epiphany.

The Moment I Pivoted After Cancer

Despite significant treatment advances in the past few decades, approximately 50% of cancers remain undetected until late in the cancer’s stage, when prognosis is poor and treatment is often less effective in extending survivorship.

Research shows that nearly half of deaths and 42% of healthy years lost among people with cancer could be attributed to preventable risk factors.

 If we pair treatment advances with more effective screening and early detection approaches, we may be able to change these statistics, particularly for cancers that are considered most deadly. Cancer has touched my life in many ways: as a physician and as a caregiver for close family and friends diagnosed with cancer. In each of these experiences, I’ve seen first-hand the impact of timely detection and intervention on one’s prognosis and treatment outcome.

I also recognize that to achieve early detection across cancer types, numerous challenges must be overcome – from better understanding critical care gaps, translating valuable insights into screening technologies, and working with community organizations to better reach underserved populations.

Stephanie J. Hammonds

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