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In Honor of Breast Cancer Awareness Month, Give a Mammogram

Early detection is the key to surviving breast cancer.  Many women cannot afford the $100 average cost of a mammogram.  In honor of Breast Cancer Month, the National Breast Cancer Foundation is asking for donations to help fund their efforts to provide services for women who cannot afford them.

depression and cancer

You can make a donation here:

Your gift will support the National Mammography Program where NBCF partners with medical facilities across the country to provide free mammograms and diagnostic breast care services to under-served women.

Treating depression in Cancer Patients

 

treating depression in cancer patientsCecelia Gittleson writes in Memorial Sloan-Kettering‘s Cancer Center newsletter about the importance of diagnosing and treating depression in cancer patients.  She discusses sources of support for patients, survivors, and their caregivers.

Ms. Gittelson quotes a physician who specializes in the psychological treatment of people with breast cancer and their families on the importance of psychosocial support, “We’ve learned that depressed people generally do less well in the oncology setting,” explains Memorial Sloan-Kettering psychiatrist Mary Jane Massie. “This is probably due in part to the fact that because they feel bad — psychologically, physically, or both —they decide it isn’t useful to take their medications. And there can be a domino effect: They stop filling their prescriptions and may even start to miss medical appointments. But there is a lot of help available.”

I encourage anyone who is struggling with a cancer diagnosis, no matter which stage of treatment, to reach out to a mental health professionals.  Ms. Gittelson’s article and her recommendations for sources of support are here.

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

More Breast Cancer Treatments Hinted in Study – NYTimes.com

cancer treatment doctorSO many treatment advances have been made since my diagnosis of breast cancer in 2002.  We are going in the right direction in terms of finding a cure.  Please consider donating your time and/or resources to cancer research.

Here is an article published in the New York Times outlining current treatment strategies:

By GINA KOLATA
Published: September 23, 2012

In findings that are fundamentally reshaping the scientific understanding of breast cancer, researchers have identified four genetically distinct types of the cancer. And within those types, they found hallmark genetic changes that are driving many cancers.  These discoveries, published online on Sunday in the journal Nature, are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new ideas for more precise treatments aimed at genetic aberrations that now have no known treatment.

The study is the first comprehensive genetic analysis of breast cancer, which kills more than 35,000 women a year in the United States. The new paper, and several smaller recent studies, are electrifying the field.

“This is the road map for how we might cure breast cancer in the future,” said Dr. Matthew Ellis of Washington University, a researcher for the study.

Researchers and patient advocates caution that it will still take years to translate the new insights into transformative new treatments. Even within the four major types of breast cancer, individual tumors appear to be driven by their own sets of genetic changes. A wide variety of drugs will most likely need to be developed to tailor medicines to individual tumors.

“There are a lot of steps that turn basic science into clinically meaningful results,” said Karuna Jaggar, executive director of Breast Cancer Action, an advocacy group. “It is the ‘stay tuned’ story.”

The study is part of a large federal project, the Cancer Genome Atlas, to build maps of genetic changes in common cancers. Reports on similar studies of lung and colon cancer have been published recently. The breast cancer study was based on an analysis of tumors from 825 patients.

“There has never been a breast cancer genomics project on this scale,” said the atlas’s program director, Brad Ozenberger of the National Institutes of Health.

The investigators identified at least 40 genetic alterations that might be attacked by drugs. Many of them are already being developed for other types of cancer that have the same mutations. “We now have a good view of what goes wrong in breast cancer,” said Joe Gray, a genetic expert at Oregon Health & Science University, who was not involved in the study. “We haven’t had that before.”

The study focused on the most common types of breast cancer that are thought to arise in the milk duct. It concentrated on early breast cancers that had not yet spread to other parts of the body in order to find genetic changes that could be attacked, stopping a cancer before it metastasized.

The study’s biggest surprise involved a particularly deadly breast cancer whose tumor cells resemble basal cells of the skin and sweat glands, which are in the deepest layer of the skin. These breast cells form a scaffolding for milk duct cells. This type of cancer is often called triple negative and accounts for a small percentage of breast cancer.

But researchers found that this cancer was entirely different from the other types of breast cancer and much more resembles ovarian cancer and a type of lung cancer.

“It’s incredible,” said Dr. James Ingle of the Mayo Clinic, one of the study’s 348 authors, of the ovarian cancer connection. “It raises the possibility that there may be a common cause.”

There are immediate therapeutic implications. The study gives a biologic reason to try some routine treatments for ovarian cancer instead of a common class of drugs used in breast cancer known as anthracyclines. Anthracyclines, Dr. Ellis said, “are the drugs most breast cancer patients dread because they are associated with heart damage and leukemia.”

A new type of drug, PARP inhibitors, that seems to help squelch ovarian cancers, should also be tried in basal-like breast cancer, Dr. Ellis said.

Basal-like cancers are most prevalent in younger women, in African-Americans and in women with breast cancer genes BRCA1 and BRCA2.

Two other types of breast cancer, accounting for most cases of the disease, arise from the luminal cells that line milk ducts. These cancers have proteins on their surfaces that grab estrogen, fueling their growth. Just about everyone with estrogen-fueled cancer gets the same treatment. Some do well. Others do not.

The genetic analysis divided these cancers into two distinct types. Patients with luminal A cancer had good prognoses while those with luminal B did not, suggesting that perhaps patients with the first kind of tumor might do well with just hormonal therapy to block estrogen from spurring their cancers while those with the second kind might do better with chemotherapy in addition to hormonal therapy.

In some cases, genetic aberrations were so strongly associated with one or the other luminal subtype that they appeared to be the actual cause of the cancer, said Dr. Charles Perou of the University of North Carolina, who is the lead author of the study. And he called that “a stunning finding.”

“We are really getting at the roots of these cancers,” he said.

After basal-like cancers, and luminal A and B cancers, the fourth type of breast cancer is what the researchers called HER2-enriched. Breast cancers often have extra copies of a gene, HER2, that drives their growth. A drug, Herceptin, can block the gene and has changed the prognosis for these patients from one of the worst in breast cancer to one of the best.

Yet although Herceptin is approved for every breast cancer patient whose tumor makes too much HER2, the new analysis finds that not all of these tumors are alike. The HER2-enriched should respond readily to Herceptin; the other type might not.

The only way to know is to do a clinical trial, and one is already being planned. Herceptin is expensive and can occasionally damage the heart. “We absolutely only want to give it to patients who can benefit,” Dr. Perou said.

For now, despite the tantalizing possibilities, patients will have to wait for clinical trials to see whether drugs that block the genetic aberrations can stop the cancers. And it could be a vast undertaking to get all the drug testing done. Because there are so many different ways a breast cancer cell can go awry, there may have to be dozens of drug studies, each focusing on a different genetic change.

One of Dr. Ellis’s patients, Elizabeth Stark, 48, has a basal-type breast cancer. She has gone through three rounds of chemotherapy, surgery and radiation over the past four years. Her disease is stable now and Dr. Stark, a biochemist at Pfizer, says she knows it will take time for the explosion of genetic data to produce new treatments that might help her.

“In 10 years it will be different,” she said, adding emphatically, “I know I will be here in 10 years.”

Mental Health Therapy and Cancer

Cancer-2Mental health counseling and therapy can obviously be helpful when dealing with the anxiety and depression a patient may experience after first hearing a cancer diagnosis, but counseling can be essential later also, after the initial shock is gone.  Some patients handle the initial crisis stage quite well, but then struggle emotionally once treatment is completed.

When I was a cancer patient, I had a large red X on my calendar that showed me The Last Day Of Treatment.  It was almost always the first topic of conversation with fellow cancer patients.  We each asked of the other, “How many more rounds of chemo do you have?” or “When is your last day of radiation?”, etc., as we all eagerly looked forward to that last day.

As the last day came and went, I began to feel better physically, a little stronger each day. Psychologically, however, I began to experience some surprising new anxiety.  During treatment, my fears where assuaged with thoughts of “I am fighting this!” and “My doctors and nurses are doing everything they possibly can to help cure me.”  Once I was no longer seeing a medical professional weekly, I began to feel much more alone with my cancer.

Lidia Schapira, MD, medical oncologist at Massachusetts General Hospital, describes a patient’s coping with the end of active cancer treatment as follows:

Typically, there is a surge in anxiety and worry over the possibility that the cancer will return once active treatment is completed. Often, people feel they are not doing enough to actively fight the cancer.  People often want to know what signs to look for to detect a cancer recurrence (return) as early as possible and recognize the long-term side effects of treatment. 

If you are in treatment now, or know someone in treatment, remember the transition from cancer patient to cancer survivor can be a difficult one.  Some common symptoms of anxiety during this transition are:

  • worry about recurrence
  • worry about finances
  • thinking about dying young, before you expected
  • loss of ability to plan for the future
  • poor body image or self esteem
  • thoughts of “why me?”
  • blaming self and feeling “deserving” of the cancer
  • anger over the losses of time for treatment
  • fear of the long-term side effects of the treatments
  • fear of ongoing fatigue and weakness
  • inability to handle social situations
Mental health counseling or therapy can be beneficial during this critical time of transition.  One of the goals of the therapy will be to help the patient recognize, process, and reframe the anxiety-producing thoughts above.  The therapist can help the patient learn to work through the anxiety of transitioning into survivorship, and learn to celebrate the joys of the present.
Remember, the fight is not over once the treatment ends.  For some patients, an equally difficult struggle remains.  Mental health counseling can help ease this struggle.