Cancer survivor is still in the race

Lois Kyte was too sick the first time her friends and family took part in the Susan G. Komen Race for the Cure.
But as the sun shimmered off Lake Michigan on Sunday morning, she was there as "Team Lo Lo" joined a vast sea of pink and white along Lincoln Memorial Drive.
Kyte, whose nickname is Lo Lo, has walked the race at least six times. This year, 1 million people are expected to participate worldwide.
In Milwaukee, about 13,000 runners and walkers raised nearly $1 million, according to organizers. Local organizers had expected to raise $1.25 million, but they attributed the decline this year to the economy. Participation is still expected to be up slightly from 12,731 last year.
At the starting line, the serious runners in the 3.1-mile, 5K run took off like a shot. They are the exception. Only about 1,000 of the crowd of 13,000 participated in the timed race.
For the rest, the event is less a race and more a portrait of survival.
Of all of the runners, 1,000 were breast cancer survivors. That's a record, according to spokeswoman Mary Scheidler.
"That's what we like to see," Scheidler said. "We want that number to get bigger every year."
Pink race T-shirts signified those who have experienced breast cancer - currently, one in eight women in the United States is diagnosed with the disease.
Kyte, 69, of Brown Deer, the mother of six children, is a survivor. But it's been a struggle.
She has had cancer return four times since her initial diagnosis in 1998. On Sunday, she wore a pink scarf to cover her head because of recent radiation treatments.
Doctors found that the cancer had metastasized in her brain. She'll soon start chemotherapy.
"That was a blow," she said before the race. "But you almost always know that it's going to come back."
Team Lo Lo gathered under a tent sponsored by Laacke & Joys. When she arrived, Kyte, who is on medical leave as a teacher's aide at Stormonth School in Fox Point, was greeted by hugs and tears.
"This is a day to come together and support my mother for all that she has gone through," said Lynne Keckeisen, 44.
Team Lo Lo has other members who have been diagnosed with breast cancer. Friends have died from the disease.
Ironically, Kyte's physical battles have helped the team grow and lend help to the cause in other ways.
Members raised more than $4,500 this year.
Keckeisen's company, Allegra Printing & Imaging of Milwaukee, donated graphic and design work for placemats for breast cancer awareness month in October. The placemats will be distributed at McDonald's restaurants in southeastern Wisconsin.
Another daughter, Beth Kyte, has been a volunteer on the race committee for five years.
And for race day, Keckeisen's 14-year-old daughter, Emma, had her braces tightened with pink string.
Long after the runners sprinted away, Kyte, her husband, Dave, and another daughter, Suzanne, walked arm-and-arm as another son carried Team Lo Lo's sign.
She was, by her own, description, "weak and shaky."

What Foods Should Be Avoided During Chemo?

Q: Are there any foods that should be avoided during chemotherapy? And if so, why? Are there any foods I should eat more of?

— Donna, Maryland

A: Chemotherapy can decrease your body's ability to fight infections. This is particularly true when the white blood cell count is low, since white blood cells are what your body mobilizes to fight off an infection with germs such as bacteria. Different types of chemotherapy affect your infection-fighting capabilities to different degrees and for different durations. For example, patients who undergo high-dose chemotherapy followed by stem cell transplantation have a profoundly decreased ability to fight off infections, and this vulnerable period can last for weeks. On the other hand, patients receiving outpatient, standard-dose chemotherapy for common cancers such as colon cancer and breast cancer may have low white blood cell counts for only a few days and carry a fairly small risk of developing an infection.
You may be instructed to avoid certain foods, such as raw fish, raw shellfish, unwashed fruit, raw milk, and raw egg products, while you're receiving chemotherapy. These precautions are encouraged to limit the possibility that uncooked or unwashed products will lead to an infection that will be harder to fight off because of chemotherapy. Washed fruit and vegetables are generally safe, as are meat and eggs that have been appropriately cooked and stored.

Other food-related precautions have less to do with infection risk and more to do with what might taste good and sit well in your stomach. Some patients find that spicy foods are more irritating while they are on chemotherapy. If your chemotherapy gives you mouth sores, then acidic foods (such as citrus and tomatoes) are likely to be irritating until the mouth sores heal. Finally, the body's ability to metabolize certain chemotherapy drugs — that is, its ability to process and clear the drugs from the system — may be affected by grapefruit juice, so you may be advised not to drink it near the time of your treatment days.

It is best to try to eat a balanced diet and to maintain a normal weight during chemotherapy. While it is sometimes thought that cancer patients are bound to lose weight, patients who are receiving adjuvant chemotherapy — chemotherapy given after a cancer has been completely removed in order to decrease the chance that it will come back — often gain weight. It is not clear yet why this happens. Some patients may purposely overeat for fear of losing weight, and others may eat frequently to keep nausea at bay. Also, many chemotherapy treatments involve the use of steroid medications, and these drugs can increase appetite.

Should All Men Be Screened for Prostate Cancer?

Screening all men for prostate cancer using a currently available common blood test is not worthwhile, according to a new study.

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The study suggests that doctors need better tests before they can recommend large-scale screening, study co-author Dr. Mattias Johansson told Reuters Health. "In particular, tools that help distinguish rapidly growing and potentially lethal tumors from slow growing tumors are warranted in order to minimize overdiagnosis and overtreatment."

Johansson, from the International Agency for Research on Cancer in Lyon, France, and his colleagues looked at more than 500 men with prostate cancer and more than 1000 case without it with similar characteristics.
They found that prostate-specific antigen (PSA) - a common blood test used to detect the disease - could not reliably distinguish between slow-growing prostate cancers that were not likely to cause any harm, and those that were likely to become aggressive and deadly.

The authors did, however, find that a very low PSA level -- below 1.0 nanograms per milliliter of blood -- virtually rules out prostate cancer. Given that many men would have higher values, however, it would be unclear what to do with many results.

In an analysis accompanying the study in the BMJ, Dr. Jennifer Stark, from Harvard School of Public Health, Boston, and colleagues examined the benefits and harms of PSA screening and concluded that at present there is simply not enough data to support population-based screening.

Moreover, they note, further studies with more precise measures are needed to gauge the financial and psychological toll of false positive PSA results, overdiagnosis, and overtreatment of prostate cancer.

Before men undergo PSA screening, they should be fully informed of the benefits, harms, and uncertainty associated with the test, Dr. Stark and colleagues emphasize.

Prostate Cancer Guide for African-American Men and Their Families Now Available

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Publication Offers Facts and Guidance for Hardest-Hit Male Population and Features Personal Thoughts from Charlie Wilson, D.L. Hughley and Snoop Dogg SANTA MONICA, Calif.

A new guide, Straight Talk for African-American Men and their Families, is now available from the Prostate Cancer Foundation (PCF). It was produced in alliance with Charlie Wilson, famed R&B singer and recent prostate cancer survivor. African-American men are 1.6 times more likely to be diagnosed with prostate cancer and more than 2.4 times more likely to die from it than Caucasian men. The publication is being launched in conjunction with Charlie Wilson`s visit to the 10,000-member congregation of Los Angeles` Faith Central Bible Church in Inglewood this Sunday, September 20. He will be a featured speaker at the church`s 10:00 am service led by the congregation`s pastor, Bishop Kenneth C. Ulmer. In addition to being a cancer survivor, Wilson lost his father, Bishop Oscar W. Wilson to prostate cancer in June. 

"When I was diagnosed I was shocked to learn that prostate cancer is as common for men as breast cancer is for women. I was staggered to learn that the prospects are even worse for African-American men," explains Wilson. "I was lucky. Early detection and treatment saved my life. I have my wife, Mahin, to thank for insisting that I get screened." 

Since his diagnosis, Wilson has taken his message to all men, building awareness whenever he can. At every performance he talks to audiences about his experience with prostate cancer. He has also taken the awareness message to U.S. troops in the Middle East, having made two performance visits to Iraq, Afghanistan and Kuwait this year. 

"I`ve spent the majority of my life performing. It`s time for me to now be informing," says Wilson. "When Mahin and I learned that the PCF is giving hope to millions of men and their families by supporting research to discover new treatments and a cure for this disease, we knew we had to become involved and support their work." 

In appreciation for his outreach and support, the PCF named one of its recent Creativity Research Awards after Wilson. It was granted to Adam Dicker, MD, PhD, at Thomas Jefferson University. Dr. Dicker is testing a new theory of metastasis that may result in the development of a new therapeutic strategy to stop the spread of prostate cancer cells throughout the body. 

"We are very fortunate to have Charlie bring this crucial message to the African-American community, a part of our population that bears a disproportionate burden for prostate cancer," said Jonathan W. Simons, president and CEO of the PCF. "As a survivor with a family history of prostate cancer, he talks from experience and speaks from the heart." 

In addition to providing facts and guidance on prostate cancer for African-Americans, the new Straight Talk guide also features personal thoughts from Wilson`s fellow entertainers, D.L. Hughley and Snoop Dogg. A copy of the guide can be ordered for delivery by mail or downloaded online at www.pcf.org/charliewilson. 

About the Prostate Cancer Foundation The Prostate Cancer Foundation is the world`s largest philanthropic source of support for prostate cancer research focused on discovering better treatments and a cure for prostate cancer. Founded in 1993, the PCF has raised more than $370 million and provided funding to more than 1,500 research projects at nearly 200 institutions worldwide. The PCF also advocates for greater awareness of prostate cancer and more governmental research funds. PCF advocacy has helped produce a 20-fold increase in government funding for prostate cancer since 1994. More information about prostate cancer and the PCF can be found at www.pcf.org.

HER2 Testing May be Underutilized in Breast Cancer

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Cancer therapies are increasingly being tailored to fit the genetic profile of the patient, but new research suggests that human epidermal growth-factor receptor (HER)2 gene testing may be underused. A literature review found only scant information about the actual use of HER2 testing in clinical practice, suggesting that there are "important variations in testing practices and key gaps in knowledge about those practices."
The review was published online September 14 in Cancer.
It concludes that a large percentage of breast cancer patients who might benefit from trastuzumab (Herceptin) treatment appear not to be receiving it. Up to 66% of women eligible for HER2 testing had no documentation of a test in their health-insurance records, and up to 20% of patients receiving trastuzumab were not tested or had no documentation of a positive test.
The researchers also note that 20% of HER2 test results might be incorrect.

There are important knowledge gaps regarding the real-world use of HER2 testing and trastuzumab.

"Our review of the literature suggests that there are important knowledge gaps regarding the real-world use of HER2 testing and trastuzumab," study author Elena Elkin, PhD, a researcher at Memorial Sloan-Kettering Cancer Center in New York City, said in a statement.
"Filling these gaps may help optimize limited healthcare resources and improve care for women with breast cancer," she added.
Genomic testing continues to evolve and can add significant prognostic and predictive information to standard parameters for breast cancer patients, as previously reported by Medscape Oncology.
HER2 testing was developed to identify patients with breast cancers that overexpress HER2, which occurs in 20% to 30% of cases. Trastuzumab, a humanized monoclonal antibody, binds strongly and selectively to the extracellular portion of HER2, and is highly effective in women with breast cancers that overexpress the HER2 gene, the authors explain.
Testing for HER2 is now recommended for all patients with invasive breast cancer, and the US Food and Drug Administration has approved 3 types of tests for this purpose: immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and, most recently, chromogen in situ hybridization (CISH).
But despite the proven efficacy of trastuzumab in patients with HER2-positive breast cancer, the authors point out that there is still uncertainty regarding the best approach to selecting patients for treatment. There is also uncertainty about the most appropriate and efficient testing strategy and the reliability and interpretation of test results.
The goal of this study was to evaluate what is currently known about the use and cost-effectiveness of HER2 testing in clinical practice in the United States, the authors explain.
The researchers, led by Kathryn A. Phillips, PhD, professor of health economics and health services research at the University of California-San Francisco, conducted a literature review and examined available evidence about the percentage of eligible patients tested for HER2, the test methods used, concordance of test results between community and central/reference laboratories, the use of trastuzumab by HER2 test result, and the cost-effectiveness of testing strategies.
Limited Information Available About HER2 Testing
Overall, they found that there was very little information about the use of HER2 testing in routine clinical practice. "The limited evidence available suggests that there are important variations in testing practices and key gaps in knowledge about those practices," the authors write.
The studies also tended to include selected populations, used outdated information, and were frequently not published in peer-reviewed journals.
Of the studies that assessed the percentage of patients tested for HER2, 1 reported that 52% of metastatic breast cancer patients at a single facility received testing in 1999/2000. Another study reported testing in 32% of Medicare enrollees with newly diagnosed breast cancer in 2005; among these women, 93% received only IHC, 0.3% received only FISH, and 6% received both tests.
Possible Inappropriate Use of Trastuzumab
The authors also identified 1 study that demonstrated the potentially inappropriate use of trastuzumab. About 12% to 20% of the women enrolled in a large health plan who received trastuzumab had not been tested or did not have conclusive evidence of a positive test. In that example, an estimated 8% of the patients who received trastuzumab underexpressed HER2, 4% had not been tested at all, and the details were unknown for 8% because the physician did not provide the record.
The researchers were unable to find any studies that examined laboratory concordance in routine practice. However, several studies did assess concordance in conjunction with enrollment in clinical trials, and an American Society of Clinical Oncology/College of American Pathologists guideline review of these studies found that approximately 20% of IHC tests performed by community laboratories are incorrect, based on comparison with central or reference laboratory results.
Of 621 studies that were reviewed, 4 contained information about the cost-effectiveness of HER2 testing or trastuzumab treatment in the United States. However, only 1 paper examined HER2 testing strategies in an American population by analyzing 7 possible test-treat strategies, and there were no studies that analyzed testing strategies in the adjuvant setting.
There were also no studies that assessed the way testing use has changed since 2005, when indications for HER2 testing were expanded.
"Our findings regarding HER2 testing illustrate both the challenges and the opportunities in building an evidence base to support effective and efficient decision making about emerging testing technologies in cancer care," they conclude. "HER2 testing provides an example of a test that is clinically beneficial but that faces quality and implementation challenges, and such challenges will increasingly become relevant as more new testing technologies and targeted therapies emerge."
This study was funded by 2 grants to Dr. Phillips from the National Cancer Institute and a grant from the Blue Shield Foundation of California (unrestricted). Dr. Philips and coauthor Jennifer S. Haas, MD, MSPH, from Brigham and Women's Hospital in Boston, Massachusetts, report having received an unrestricted grant from the Aetna Foundation to examine the use of HER2 testing and gene-expression profiling for breast cancer. Dr. Haas also reports receiving a research grant from Pfizer for unrelated work.

Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study

Background

Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests.

Methods

We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR), pudendal somatosensory evoked potentials (PEPs), motor evoked potential (MEPs) and sympathetic skin responses (SSRs). The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. .Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test.

Results

59.6 % of patients operated reported sexual dysfunction, while this complication occurred in 16.4 % in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function.

Conclusions

Patients operated showed severe sexual dysfunction. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

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Depression can affect cancer survival: researchers

VANCOUVER, British Columbia (Reuters) - Depression can affect the likelihood of surviving cancer, but no clear association even how quickly the cancer progresses, according to a report released Monday.

Mortality rates are almost 40 percent higher for cancer patients diagnosed with major or minor depression, according to researchers at the University of British Columbia, which polled more than two dozen international clinical studies.

"We found an increased risk of death in patients who report more depressive symptoms than others, and also in patients who have been diagnosed with depressive disorder compared with patients who do not have," Jillian Raso, principal investigator of the report said.

The report was published in the online edition of the Journal of the American Cancer Society Cancer.

Eighty-five percent of cancer patients consider their state of mind affects how quickly the disease progresses, but Canadian researchers said that belief is not really supported by the few studies that looked at him.

The researchers admitted they were surprised by the lack of clear link between depression and cancer progression, and warned that it may be because very few clinical studies have been done on the subject.

(Reporting by Allan Dowd, editing by Rob Wilson)