Breast Cancer in the Prime of Life Early Nutritional Intervention Recommended for Cancer Patients House Call: How to Deal with Painhttps://openworks.mdanderson.org/oncolog/1182/thumbnail.jp

Gonzales, Manny

Stuyck, Karen

English

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University of Texas MD Anderson Cancer Center OpenWorks @ MD Anderson OncoLog MD Anderson's Report to Physicians (All issues) OncoLog MD Anderson's Report to Physicians 6-2006 OncoLog Volume 51, Number 06, June 2006 Karen Stuyck The University of Texas MD Anderson Cancer Center Manny Gonzales The University of Texas MD Anderson Cancer Center Follow this and additional works at: https://openworks.mdanderson.org/oncolog  Part of the History of Science, Technology, and Medicine Commons, and the Oncology Commons Recommended Citation Stuyck, Karen and Gonzales, Manny, "OncoLog Volume 51, Number 06, June 2006" (2006). OncoLog MD Anderson's Report to Physicians (All issues). 188. https://openworks.mdanderson.org/oncolog/188 This Newsletter is brought to you for free and open access by the OncoLog MD Anderson's Report to Physicians at OpenWorks @ MD Anderson. It has been accepted for inclusion in OncoLog MD Anderson's Report to Physicians (All issues) by an authorized administrator of OpenWorks @ MD Anderson. For more information, please contact rml-help@mdanderson.org.   OncoLog • June 2006    3alone, Ms. Broxson said, relating thestory of a young woman with a one-year-old child who attended a support groupfor breast cancer patients. Everyonein the group was much older than she,and while they were welcoming to her,the woman felt she had “nothing incommon with what they were goingthrough.” As a result, she never wentback to the support group. Breast cancer, Ms. Broxson said,“is an interruption of the usual lifestages.” Often, young patients haveconsidered themselves healthy theirwhole lives. They might have youngchildren or were planning to havechildren. Breast cancer throws awrench into their life plans. These women appear to have amore intense fear of their cancerrecurring than older breast cancerpatients do, Ms. Broxson said. Theywonder if they will be alive to see theirchildren grow up or whether they willhave enough stamina to raise them.They also often worry about how to telltheir young children about their illnessand how to communicate to their familyhow they are feeling and the adjust-ments that must be made. Helping them to cope with theiranxiety, learn more about their illnessand the latest treatments, and findsocial support with other young breastcancer patients is part of treating thewhole patient, Ms. Broxson said.Support programsTo address the concerns of theseyounger women, M. D. Anderson hasdeveloped a number of new initiatives. Young BreastCancer Survivors Program was createdin January 2005 to provide educationalresources for women under the age of 45with breast cancer and to research theneeds of these women. The program wasa surprise 50th birthday present from to his wife, who was diagnosedwith breast cancer when she was 45years old, as a tribute to her courage infighting her own breast cancer and herdesire to educate others. “For young women who may havemore than half of their lives ahead ofthem, breast cancer causes a big detourin their lives,” said Ms. . “Thereare so many unknown issues that affectthem: whether they’ll be able to havechildren, the side effects of radiationand chemotherapy that may bring onearly menopause, and how the illnesswill affect them psychologically.” said she wants the Young BreastCancer Survivors Program to providethese young women with the mostrecent medical information as wellas allow survivors to share ideas aboutrelated issues such as mental healthand nutrition. The program will sponsor its firstworkshop for young breast cancersurvivors as part of the AndersonNetwork’s “Living Fully With andBeyond Cancer” conference in September2006. Topics will include nutrition andweight management during and afterbreast cancer, mindfulness techniques asa way to control stress and anxiety, andsexuality and loss of sexual desire afterbreast cancer. In addition to providing patients withcurrent information about the disease, theYoung Breast Cancer Survivors Programwill educate healthcare providers aboutthe needs of breast cancer patients underthe age of 45. Further information about supportfor young breast cancer survivors isavailable through the Houston chapterof the Young Survival Coalition(www.youngsurvival.org) and theWeb site for the Young Breast Cancer Survivors Program(www.mdanderson.org/departments/yngbreastsrv). ●Young women with breast cancermay be eligible for these clinical trials.For more information and a morecomplete listing of available trials,visit www.mdanderson.org or callthe M. D. Anderson Information Lineat (800) 392-1611 or (713) 792-3245.For premenopausal women• Phase III trial of LHRH analogadministration during chemotherapyto reduce ovarian failure followingstandard adjuvant chemotherapyin early-stage, hormone-receptor-negative breast cancer (SWOGS0230).Physician: Ana Maria Gonzalez-Angulo, M.D.• Phase III trial evaluating the roleof ovarian function suppressionand the role of exemestane asadjuvant therapies for premeno-pausal women with endocrine-responsive breast cancer (SWOG)(2004-0453). Physician: Marjorie C.Green, M.D.For pregnant women• Multimodality treatment of primarybreast cancer occurring concomitantwith pregnancy (ID01-193). Physi-cian: Richard Theriault, D.O.Other• An open-label phase I study ofhumanized milk fat globule-1antibody in patients with locallyadvanced or metastatic breastcancer (TOPCAT) (2004-0106).Physician: Nuhad K. Ibrahim, M.D.• Gemcitabine and R115777 combina-tion therapy for metastatic breastcancer (2003-0992). Physician:Banu Arun, M.D.• A randomized, double-blind, two-period, placebo-controlled crossovertrial of sustained-release methyl-phenidate in the treatment of fatiguein breast cancer patients. (ID00-372).Physician: Carmelita P. Escalante,M.D.• Mini-allogenic peripheral bloodprogenitor cell transplantation forrecurrent or metastatic breast cancer(DM97-268). Physician: Naoto Ueno,M.D., Ph.D.• A randomized phase III study ofconventional breast irradiation vs.partial breast irradiation for womenwith stage 0, I, or II breast cancer(RTOG0413). Physician: Eric Strom,M.D.• Neoadjuvant Herceptin for ductalcarcinoma in situ of the breast (2004-0701). Physician: Henry Kuerer, M.D.• Phase I/II study of trastuzumab incombination with RAD001 in patientswith HER-2-overexpressing, PTEN-deficient metastatic breast cancerprogressing on trastuzumab-basedtherapy (2004-0471). Physician:Francisco Esteva, M.D. ●PROTOCOLS4    OncoLog • June 2006by Manny GonzalesThe relationship betweennutrition and cancer is notyet fully understood, butresearchers do know thatwell-nourished patients have a betterprognosis. For many patients withcancer, however, the onset of cachexiawill ultimately make it difficult toavoid weight loss. Therefore, earlyintervention may be the key toeffective nutritional support.Traditionally, nutritional support hasbeen recommended after a patient haslost at least 10% of his or her bodyweight, but experts now recommendintervening much sooner. Egidio DelFabbro, M.D., assistant professor inthe Department of Palliative Careand Rehabilitation Medicine at TheUniversity of Texas M. D. AndersonCancer Center, pointed out that studieshave shown that patients with a 5% ormore loss in body weight have decreasedsurvival rates and an inability to toleratechemotherapy. “We think that there’senough evidence that a patient is notgoing to be able to tolerate chemo-therapy as well; there are more sideeffects and decreased survival,” he said.“Over the last few years, there’s been arealization that not only is 5% too muchweight loss, but even less than that maybe problematic,” Dr. Del Fabbro said.Carefully designed nutritionalguidelines should be provided topatients with cancer as early as possibleto help avoid the loss of fat and muscleassociated with cachexia. Dr. Del Fabbro,who is the director of M. D. Anderson’sCachexia Clinic, encourages patients toeat foods that they like, but he and hiscolleagues also pay close attention toprotein, fat, and carbohydrate composi-tion. Protein is especially importantbecause someone with insufficientprotein intake will not be able tomaintain and rebuild the muscle thatis lost with cachexia.Nicki Lowenstein, a manager inthe Department of Clinical Nutrition,believes that patients should speakto a doctor and a dietician as soon aspossible after the diagnosis, even beforeany weight loss is evident. “From adietician’s perspective, it’s great if youcan get them really early in the diagnosis,because they’re very open to makingchanges to their diet that might bebeneficial,” said Ms. Lowenstein.Registered dieticians at M. D.Anderson meet with patients andencourage them to maintain theirweight in a healthy manner. “Now,we’re looking at the issue as more of abalance—what they can eat, what theywill eat, and what they should eat,” Ms.Lowenstein said. “There are still someclinicians who will say, ‘Eat whateveryou want because you’re going tohave a difficult time eating,’ butthe general consensus amongnutrition professionals is to try tosteer patients in the direction ofthings that will support theirbody’s immune system andtheir body’s good health togive them the best physicaledge possible in fightingthe disease.”Because the nutritionalneeds of people withcancer differ from thoseof the general population,dieticians educate theirpatients on the specifics oftheir changing nutritionalneeds and how best tointroduce changes to theirdiets. “Some patients arediagnosed and become veryproactive, going into warriormode. They arm themselveswith all that they can, anddiet is one of those things.And we encourage patientsto take every advantage theycan that’s not detrimental,”said Ms. Lowenstein.Changes in diet shouldbe made gradually to allowthe body time to adjust, and patientsshould avoid radical changes in dietaltogether. A dietician can work withpatients who want to introduce certainchanges and help them evaluate thealternatives. “It’s not unusual for a patientto get diagnosed and decide that this isthe time in his or her life to becomevegetarian, and that’s not always the bestidea, because obviously, when you excludea big food group, like meat, you’reexcluding one of the best sourcesof protein,” said Ms. Lowenstein.The use of appetite stimulants ormeal replacement drinks, such as Boostor Ensure, should also beconsidered to help patientsachieve adequate nutritionalintake. Doctors should raisethe issue of nutritionalsupplements with theirpatients as well becausemany patients may alreadybe taking them at thetime of diagnosis.Studies have shownthat patients with a 5% or moloss in body weight have decsurvival rates and an inability tolerate chemotherapy, points Dr. Del Fabbro.Nicki Lowenstein,clinical nutritionmanager, encouragesdoctors to talk withcancer patients aboutnutrition soon afterdiagnosis.EarlyNutritionalInterventionRecommendedfor CancerPatients

OncoLog Volume 51, Number 06, June 2006

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OncoLog Volume 51, Number 06, June 2006

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