Supportive care: An update from San Antonio

The day prior to the official beginning of the San Antonio Breast Cancer Symposium was dedicated to a series of lectures and panel discussions aimed at both the public and professionals.The topics ranged the gamut of highly technical molecular analysis of cancer to the area of symptom management on breast cancer and cancer therapies. The symptom management conference was very well attended – highlighting the growing attention that this area is receiving even though it has always been a principal concern of the patient. Dr. Kathryn Schmitz reviewed a randomized trial of physical therapy and conditioning to prevent the worsening of lymphedema symptoms after breast surgery. It has previously been suggested that the dogma of avoiding arm exertion is unfounded – and this was verified by Dr. Schmitz's study. In fact, in patients who had more than six nodes removed, there was even a suggestion of improvement of lymphedema. She concluded that formal protocols of graduated measured exercise and resistance training under professional supervision should be widely implemented and covered by insurance. I reviewed our previous work in the area of botanical agents for both breast cancer therapy and symptom management. Herbal agents have been used for centuries and numerous anti-cancer compounds have been isolated from these sources. However, multiple components in botanical extract may work in concert, so laboratory studies were conducted to identify promising herbal compounds were followed by early phase safety trials. One herb, Ban Zhi Lian, which showed preclinical activity, was tested in a phase 1 trial and demonstrated reasonable tolerability with mild bloating and diarrhea observed. Future studies are planned to test enough patients to examine the effectiveness of this agent. Dr. Michael Rabow reviewed the basics of pain control in cancer patients – an area that is becoming increasingly specialized but still relies on narcotic-type analgesics. Careful attention to side effects of narcotics better allows patients to meet pain needs and maintain their usual activities. Adjunctive medications can augment the pain reduction, and much research is being focused on newer alternatives. Finally, Dr, Michelle Melisko presented some background on a scalp-cooling approach to minimize hair loss during chemotherapy. This strategy has been shown to be effective to some extent in about half of patients, less so in patients who had longer (six months) duration of chemotherapy. A prospective study is ongoing at UCSF and Wake Forest to better characterize its effectiveness and feasibility with specific chemotherapy regimens. Such data may lead to coverage by insurance companies. This session on supportive care was well received, but points to the slow progress in this very important domain. As more funding, both governmental and non-profit, is aimed at this area, it will hopefully accelerate future developments.