DrJeremyGeffen

Cancer Support Groups and Survival

2007-09-06T14:20:00Z

Cancer treatment has come a long way in recent decades—with enormous gains in new chemotherapy and supportive care agents, evolving radiation therapy techniques, enhanced diagnostic imaging, as well as an emerging array of complementary therapies to improve quality of life.

Support groups of various kinds are among the most widely recognized complementary therapies that can enrich cancer care. Connection with others, especially sharing with others who are going through the cancer journey—either personally or as a loved one or caregiver—has been shown to be beneficial in numerous ways. A large and growing number of scientific studies have documented improvements in quality of life, sense of well-being, and purposeful living among participants in many different kinds of support groups and other psychosocial interventions.

The extent to which support and connection with others might impact survival in people with cancer has been a subject of great debate for many years. This debate was accelerated by a well-known 1989 study by Dr. David Spiegel at Stanford University, in which patients with metastatic breast cancer who participated in a weekly support group along with conventional treatment had both improved quality of life and significantly longer survival times than those who received conventional treatment alone. Since then, a number of additional studies have shown improvements in a variety of quality of life parameters among patients who participate in a variety of support programs, but with no conclusive evidence of longer survival.

Two recent studies shed further interesting light on this subject. The first, published in the Journal of Clinical Oncology in July 2007, reported on the impact of an in-hospital, psychotherapeutic support program for patients with a variety of gastrointestinal cancers who were undergoing surgery. Patients were randomly selected to receive standard treatment with or without psychotherapeutic support during their hospital stay. Results of a 10-year follow-up study showed that patients with localized or regional disease at the time of their surgery who were part of the psychotherapeutic support program had both improved quality of life and longer survival than similar patients who received standard care alone. This finding is intriguing and raises important questions about the potential benefits of support programs for patients with other types of cancer.

The second study, published in the online edition of the journal Cancer (also in July 2007) was led by Dr. Speigel himself in an effort to replicate the findings of his original study published in 1989. In this new study, patients with metastatic breast cancer were again randomly selected to receive conventional treatment with or without psychosocial therapies. After more that 10 years of follow-up study, Dr. Speigel found decreased levels of distress, anxiety, and pain among those who attended therapy, but no improvement in survival. However—quite remarkably—a significant survival advantage was found among a subgroup comprised of those patients who had estrogen-receptor negative breast cancers who also participated in the support program. These women had a median survival of almost 30 months, compared with just 9 months for those who did not participate in the support program.

There are at least two “take-home messages” from these recent studies. First, there may yet prove to be meaningful survival benefits from support groups and therapy programs for some patients. If so, further research will help clarify which patients might benefit the most. Second, evidence nonetheless continues to grow confirming clear improvements in quality of life for people with cancer from support groups and other psychosocial interventions, and all patients should explore them if interested. These programs are not only about adding “years to your life,” but adding “life to your years,” which is a worthy and valuable goal.

What Is “Integrative Oncology?”

2007-08-10T14:12:00Z

In earlier blogs I’ve discussed a growing trend that is occurring in medicine in general, and oncology in particular. With more than 80 percent of all people with cancer now using some form of complementary and alternative therapy, it is timely and illuminating to review how this trend has evolved, what “integrative oncology” means, and where this field is heading.

In 1971, famous New York Times reporter James Reston was accompanying President Richard Nixon on his groundbreaking trip to China. Reston developed acute appendicitis and underwent emergency surgery using acupuncture for anesthesia. The New York Times report of this created quite a sensation. For the first time, an ancient healing modality—long considered “quack medicine” by Western physicians—was acknowledged as having value.

This event launched what could be called the era of alternative medicine in the United States, which lasted throughout the 1970s and 1980s. During these two decades, millions of American’s began to explore a wide variety of nonconventional forms of medicine and healing modalities.

The 1990s ushered in what could be called the era of complementary and alternative medicine (CAM). These years brought an explosion of increasing CAM use among the general public, and especially patients with cancer. In 1999, Congress established the National Center for Complementary and Alternative Medicine (NCCAM). Its initial budget of $50 million grew to $122.7 million in 2006.

The year 2000 heralded the emerging era of integrative medicine and oncology, with the formation of the Consortium of Academic Health Centers for Integrative Medicine. “Integrative oncology” refers to the safe and effective use of CAM therapies, along with conventional care, for people with cancer. By definition, it strives to address the mental, emotional, and spiritual needs and concerns of patients and families, as well as their physical needs. In 2002 the first integrative oncology journal, Integrative Cancer Therapies, was published, and in 2003, the Society for Integrative Oncology was inaugurated. The first integrative oncology textbook, Integrative Oncology: Principles and Practice, was published in 2006. More than 60 percent of U.S. medical schools are now offering curricula related in some way to integrative medicine.

In recent years, some of the country’s most prestigious cancer centers—including the National Cancer Institute, Memorial Sloan Kettering Cancer Center, and MD Anderson Cancer Center—have developed integrative oncology programs. They are offering a widening array of services to patients and families, and are conducting important research on the benefits of CAM therapies in cancer.

Clearly, integrative oncology is a growing trend that represents the future of cancer care. It is inspiring and exciting to see how research in this field is leading to more holistic, compassionate, “integrative” care for the whole person, not just the disease. The Seven Levels of Healing® program, and many other resources on the Caring4Cancer website, provide leading-edge information and guidance about how to address healing on all levels for you and your loved ones.

Enjoy the Summer Sun Safely

2007-07-06T12:31:00Z

With summer here again, it’s a good time to review the importance of protecting yourself and loved ones from the sun’s harmful rays, particularly if you (or they) are undergoing cancer treatment.

As most people are now aware, ultraviolet (UV) rays from the sun can cause a variety of skin cancers—the most common form of cancer in the United States. In fact, one in five Americans and one in three Caucasians will develop skin cancer in the course of their lives. The good news is that more than 90 percent of all skin cancers are preventable, and with early detection and proper treatment, the survival rate for people with skin cancer is approximately 99 percent.

The American Cancer Society emphasizes the importance of protecting your skin from the sun. Here are some simple things you can do to minimize harmful overexposure. Seek shade whenever you are outdoors, especially during the hottest time of day. Cover yourself as much as possible with clothing. Wear long-sleeved shirts and pants, hats, and sunglasses that are designed to block UV rays. Most important, use frequent applications of an effective sunscreen, with a sun protective factor (SPF) of 30 or greater, especially when you are at the beach or outdoors for long periods of time.

Many people think that having a suntan will help protect them from the sun’s damage, but this is not true. Exposure to the sun causes some skin cells to produce a pigment called melanin, which darkens the skin’s color. A tan is actually a sign that the skin has been damaged. For many people, repeating this kind of damage will eventually cause wrinkles, blotches, sagging tissue, and can even lead to skin cancer.

Certain cancer treatments can increase the skin’s sensitivity to sunlight, a condition called photosensitivity. Patients with photosensitivity burn more easily when they are exposed to the sun, even for short periods of time. So, cancer patients should be especially cautious when spending time outside. Chemotherapy-related photosensitivity is temporary and usually subsides when treatment ends.

Radiation therapy, on the other hand, can cause changes to the skin that increase the risk of sunburn and skin cancer indefinitely. Cancer patients who have undergone radiation therapy should continue to be careful about sun exposure to the areas of skin that received radiation, even if their radiation therapy occurred years ago.

The journey through cancer, while often extremely challenging, can also be an opportunity to focus on the simple pleasures of life. Spending time outdoors, in nature, is certainly—for many people—one of life’s great joys. By taking the simple precautions listed above, you and your loved ones can enjoy the summer sunshine safely.

Cancer-Related Fatigue – What You Can Do to Help Yourself

2007-07-05T12:29:00Z

Fatigue is the most common adverse symptom among people with cancer and is often one of the most distressing as well. Studies show that up to 60 percent of all patients experience fatigue that adversely affects their physical, mental, and emotional well-being. In one study of more than 1,000 patients, the percentage who complained of fatigue (58 percent) was more than double the percentage who complained about pain (22 percent) or nausea and vomiting (18 percent). It is also now clear that symptoms of fatigue can persist for months, or even years, after cancer treatment has been completed.

So, what can a person with cancer do to relieve their fatigue? To begin, it is critical to speak with your physician about possible medical causes, such as anemia, which is very common among people with cancer and can be effectively treated with medication. Your doctor will also want to evaluate you for other potential contributing medical or psychosocial causes of fatigue. Once these have been properly assessed, there are a number of positive, effective things you can do to help yourself.

First, exercise is one of the simplest and most effective ways of dealing with fatigue. Numerous studies have demonstrated that many kinds of exercise are indeed both safe and effective at alleviating the symptoms of fatigue that are so common among people with cancer. Physical exercise can be undertaken in many forms and to varying degrees. Even low-intensity activities, such as taking a walk or gentle stretching, can help relieve fatigue. For people with more active routines and abilities, moderate-intensity activities, such as swimming, jogging, lifting weights, cycling, or yoga exercises, can be even more effective. Exercise not only relieves symptoms of fatigue, but can help reduce stress and anxiety, and improve overall mood and sleep patterns.

A variety of psychosocial interventions have also been shown to be of benefit in relieving symptoms of fatigue. Like exercise, these interventions come in many different forms, such as support groups, meditation and relaxation programs, and guided imagery exercises. Additional options include hypnosis, individual counseling sessions, stress-management training, behavioral-modification programs, or structured health-education classes. The key point is to proactively address not only the physical aspects of fatigue, but also the mental and emotional challenges that so commonly accompany it.

A third arena in which you can take action to help your fatigue relates to diet and nutrition. An important simple step is to drink plenty of water and stay well hydrated. Next, ensure that you are getting adequate and appropriate nutrition for your age, body type, medical condition, and overall circumstance. Eat more fruit, vegetables, whole grains, salads, and fish, and start cutting back on sugar, alcohol, processed foods, and red meat. Many people experience improvement in their energy level and mood simply by increasing their water intake appropriately (up to 8 glasses of pure water every day) and adopting a healthier diet.

Be sure to discuss your questions about fatigue, and what can be done to alleviate it, with your physician. Visit the Nutrition and the Wellbeing sections of Caring4Cancer to learn more.

My Journal Private

2007-06-11T03:20:09Z

This is the default My Journal Private post.

My Journal Friends

2007-06-11T03:20:09Z

This is the default My Journal Friends post.

My Story

2007-06-11T03:20:09Z

This is the default My Story post.

The Power of Healing Circles

2007-06-01T13:58:15Z

Healing circles are a wonderful way to come together in support of someone who has been diagnosed with cancer. Some people call them prayer circles or friendship circles. Such a gathering of friends and family can take many forms. Simply gathering together, and meditating or playing beautiful music, or sharing poems and stories can be enormously healing for everyone involved. The important point is that everyone comes with the intention to support the health of someone they love.

Often such gatherings result in people spontaneously organizing a team to bring food, help with transportation, or provide support in whatever form is needed. The assistance can be as varied as the people involved, according to their time, skills, and availability. It might include sending cards, being available for last-minute requests for help, sending e-mails, making phone calls, sharing special music or poems, running errands, help with other household tasks, or simply providing companionship.

Even if some of the individuals in the healing circle don't know each other, what they do have in common is love and concern for the person they are choosing to support. The gathering can be healing and energizing for everyone, and result in lasting bonds and friendships. The networks that are formed often go on to provide support for other people who may or may not even be involved in the original group.

As Albert Einstein famously said, "Strange is our situation here upon earth. Each of us comes for a short visit, not knowing why, yet sometimes seeming to divine a purpose. From the standpoint of daily life, however, there is one thing we do know: that we are here for the sake of each other… and also for the countless unknown souls with whose fate we are connected by a bond of sympathy." This bond of sympathy reflects the spirit and intention of healing circles, and is what creates their great power, effectiveness, and meaning. It also reflects the universal human impulse to gather together in times of illness that is an instinctual part of our common humanity-and has been since ancient times.

Time Management and the Parable of the Mayonnaise Jar

2007-05-09T15:24:32Z

For many people who are navigating the journey through cancer, it is more important than ever to set priorities and manage time well. This can be very challenging, however, because cancer treatment can leave you with many new tasks, including frequent treatments, tests, and doctor appointments, and less energy to accomplish everything. Being diagnosed with cancer can inspire people to re-examine their priorities. Especially now, it is worthwhile to assess the purpose of your life and your most important goals.

The parable of the "Mayonnaise Jar" is a story about priorities that is often told in time management seminars, with many variations. It is a metaphor that can help you remember to set your priorities and create time for what matters to you most. When your life seems almost too much to handle, when 24 hours in a day are not enough, remember the "Mayonnaise Jar."

A professor stands before his philosophy class and picks up a large, empty mayonnaise jar. On the table beside the jar are separate containers of golf balls, pebbles, sand, and water. The professor fills the jar with golf balls, and asks the students, "is the jar full?" Half the class says, "yes." But half say, "no, there is still space between the golf balls." The professor then pours the pebbles into the mayonnaise jar and shakes it lightly so the pebbles settle into the open areas between the golf balls. Again he asks the students, "is the jar full?" Once again, half the class says, "yes." But half say "no, there is still space between the pebbles." The professor now pours sand into the mayonnaise jar and shakes it lightly so that the sand fills up the remaining spaces between the pebbles. He again asks the students, "Is the jar full?" This time, most of the students agree, "yes, the jar is full." But a few insightful ones say, "no, there is still some space between the grains of sand."

The professor smiles. He then pours a significant amount of water into the already apparently full mayonnaise jar, filling all the invisible empty spaces between the golf balls, pebbles, and sand. The students laugh. Now he doesn't have to ask if the jar is full. Instead he says:

"Pay attention to the things that are most important to your happiness. Play with your children. Spend time with your parents. Visit with grandparents. Take time to exercise, eat well, and rest, too. Spend time in nature. Hold hands with your spouse. Take time for yourself.

"Take care of the golf balls first. If you put in the big stuff first—the stuff that really matters—the small stuff will find a way to fit in. And if it doesn't, it is just sand, anyway."

Whether you have cancer or care for someone who does, I encourage you to take time to list your most important priorities, discuss them with your loved ones, and agree to fit the most important things into your life first, one day at a time. For more on "Life Assessment" during cancer, see Level 6 of The Seven Levels of Healing at Caring4Cancer.com

Risks of Herbs and Supplements in Cancer Treatment

2007-04-26T16:38:49Z

Millions of people use a variety of herbs and supplements in their quest for health-including, as many studies show, a significant percentage of people with cancer. Unfortunately, and for various reasons, patients often don't tell their oncologists about it. This can be a serious mistake.

Many people assume that herbs and supplements are "natural" and therefore "safe," which is sometimes true. But there are many situations-particularly for patients receiving chemotherapy-where this assumption can actually be dangerous.

Why is this? Some herbs and supplements can interfere in a variety of ways with the metabolism of chemotherapy and other drugs. For example, garlic, fish oils, evening primrose oil, and gingko all have anticoagulant, that is blood-thinning, effects. St. John's Wort, an over-the-counter herbal remedy used by many people for symptoms of depression, can affect the metabolism of hormones, antibiotics, and chemotherapeutic agents. Echinacea is a widely used herbal immune system stimulant that can interfere with corticosteroids and monoclonal antibody treatments. Studies have also shown that betacarotene supplements can actually increase the risk of lung and prostate cancer in smokers.

These are just a few well-documented examples of how herbs and supplements can be risky when used concurrently with conventional cancer treatments. The "take-home message" is to talk with your physician if you are considering using any herbs or supplements at all, especially while you are undergoing treatment for cancer. Doctors are increasingly becoming aware of the importance of these issues, and are learning how to support patients and families in making informed choices about herbs, supplements, and other complementary and alternative (CAM) therapies. Raising your questions openly is important for both you and the medical team that is providing your care. Don't be bashful about getting your questions answered so you can feel confident and comfortable about all aspects of your care.

A cancer “wake up call”

2007-03-14T14:20:54Z

The recent news of Elizabeth Edwards' and Tony Snow’s cancer recurrences was heart-wrenching and touched many people. Jonathan Alter’s Newsweek Magazine cover story, "My Life With Cancer" (April 9, 2007), is also very poignant and inspiring. All three individuals eloquently illustrate and describe many of the issues and challenges encountered on the cancer journey—concerns which are familiar to anyone dealing with cancer. In many ways, their stories are a big "wake-up call" for our country.

These high-profile cases graphically illustrate the vulnerability we all face in an era in which one in three Americans will be diagnosed with cancer at some point in their lives. The recent barrage of media attention about cancer is fueling a much wider awareness about cancer and everything that goes along with it. As a medical oncologist who has guided thousands of people and their loved ones through the tumultuous journey through cancer, I think this "wake-up call" is very good news. It is good that we are talking about these profound issues of life, death, and cancer care. These discussions can point us to a deeper meaning and purpose in life and hopefully—greater research, education, communication, and support—will improve the quality of care for all patients and families.

This is a core part of Caring4Cancer’s mission and a central tenet of The Seven Levels of Healing. If you haven’t read Alter’s article, you can find it here. Edwards, Snow, and Alter are courageously serving us all in their willingness to speak publicly about the challenges they are facing. They also reflect the same quiet courage of millions of equally heroic, but less well-known, patients and families throughout this country and elsewhere—and the physicians, nurses, and other health care professionals who care for them. We at Caring4Cancer salute everyone on the cancer journey, and hope to be of service and support at every step along the way.

Why So Many People with Cancer Use CAM

2007-03-14T14:20:29Z

Numerous studies in medical literature show that up to 80 percent of all cancer patients use some form of complementary and alternative medicine (CAM) during the course of their illness. So, if you or a loved one with cancer are exploring CAM therapies, know that you are not alone! In fact, millions of people spend billions of dollars out-of-pocket for CAM therapies and services each year.

Why is this occurring? For numerous reasons.

To begin, despite the extraordinary advances in the diagnosis and treatment of cancer that have occurred in recent years, many patients still face great challenges and uncertainty in dealing with their illness. They want to do everything they can to help themselves to feel better and live longer.

In this context, cancer patients use CAM therapies to:

Try to improve their survival
Reduce side effects from their treatment
Alleviate mental, emotional, and spiritual pain and anxiety
Improve their quality of life

Some patients also use CAM therapies in response to pressure from family, friends, and co-workers. This social pressure can sometimes be intense and unhelpful, especially when numerous well-intentioned people make conflicting recommendations.

Still other patients use CAM therapies because of television, magazine, or direct mail marketing by a huge herb, vitamin, and supplement industry. This advertising can play on peoples' fears, especially in difficult or challenging circumstances such as dealing with cancer.

Another reason for the increasing use of CAM therapies is related to the United States' changing demographics. Specifically, millions of baby boomers are now entering their 50s and 60s. Many are developing cancer, and they have higher demands and expectations about all aspects of their care than did their parents, who were part of the WWII generation. We are now in an era where doctors and cancer centers increasingly recognize patients as "consumers," and even market their ancillary CAM services and activities to attract patients.

Many of these trends are actually quite positive, especially when informed patients use CAM therapies in a safe and effective manner, and with the knowledge and support of their medical team. It is important, however, that you not feel pressured into using any therapies, especially unproven ones or without the knowledge of your physician.

Visit the "Your Wellbeing" section of www.Caring4Cancer.com to learn more. Sign up to receive The Seven Levels of Healing e-newsletters, which provide additional guidance and information on a regular basis (see the e-newsletter "Sign Up Now" page on the website). And, feel free to post any questions or comments you may have on The Seven Levels of Healing message board.

CAM and Cancer—Emerging Scientific Evidence of Benefits

2007-03-14T14:19:29Z

Hi everyone. I recently returned from CAM Expo East in New York City, where I spoke on a keynote panel entitled "Integrative Oncology." CAM Expo East is one of the country's major annual conferences dedicated to the exploration of complementary and alternative approaches to health.

The conference was a wonderful experience, with practitioners and experts in the field attending from all over the country. It was inspiring to see how far integrative oncology—which combines safe and effective complementary and alternative (CAM) therapies with conventional cancer care—has come in attaining credibility in mainstream medicine. This is largely because of many strong, scientific studies that document the safety and benefits of a wide variety of CAM modalities, particularly for people with cancer.

Today—in the future—I'll be discussing some of the most important and exciting developments in this field, and how they can make a difference for you and your loved ones as you navigate the journey through cancer.

In preparation for the CAM Expo, I did an extensive review of the scientific literature on the benefits of various CAM therapies for people with cancer. I was impressed by the number and quality of studies already published in this arena. A large number of additional studies are also under way at such prestigious institutions as MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, the National Cancer Institute, and many others.

An exhaustive summary of these studies would fill a large book. One clear nugget I can share with you today, however, relates to four very commonly used CAM therapies: acupuncture, massage, yoga, and mind-body interventions, such as guided imagery, meditation, and relaxation. Numerous studies in the medical literature now demonstrate unequivocal benefits from these modalities for people with cancer. Some of the most well-known and well-documented benefits include improvements in anxiety, depression, insomnia, fatigue, and pain. Acupuncture and massage have also specifically been proven effective in reducing treatment-related nausea and vomiting. These findings are good news for many patients who are searching for meaningful options to enhance their well-being and promote deeper levels of healing.

To learn more, visit the "Your Wellbeing" section of www.Caring4Cancer.com. You can also sign up to receive The Seven Levels of Healing e-newsletters, which provide additional helpful ideas, suggestions, and information (see the e-newsletter "Sign Up Now" page on the website). If you have any questions or comments, please post them on The Seven Levels of Healing message board. I look forward to hearing from you!

Cancer and the Internet

2007-03-05T15:51:37Z

Welcome to my blog. I'm honored to have this opportunity to share some thoughts and insights about navigating the "journey through cancer" as skillfully and effectively as possible. This is, of course, a complex process, and it requires heart and courage as well as knowledge and good medical care. At Caring4Cancer, we are proud to bring leading-edge information, guidance, support, and practical solutions about all aspects of the journey for patients, family members, and caregivers.

Today I thought I'd share some thoughts and insights about the Internet, and what an incredible tool it has become for anyone dealing with illness, and especially cancer. To begin, here are some interesting statistics:

In 2004 approximately 120 million Americans were using the Internet.
Up to 80 percent (nearly 100 million) used the Internet to find health information.
Currently, more than 5 million Americans go online to search for health information each day.
More than half report that the Internet improved the way they receive health information.

People with cancer—their family members, loved ones, and friends—among the most active users of the Internet. Their numbers are significant and growing. Recent studies reveal that:

There are more than 10 million Americans alive today who have been
diagnosed with cancer.
Each year more than 1.4 million people in the United States are diagnosed with cancer.
Approximately 30 percent to 40 percent of cancer patients use the Internet directly
(i.e., themselves).
An additional 15 percent to 20 percent of patients use it indirectly (i.e., have
information retrieved for them by a spouse, child, or friend).

Use of the Internet will undoubtedly continue in the coming years. In this context, it is important to mention some challenges that patients with cancer and their loved ones often encounter with the Internet.

To begin, the amount of information about cancer available online is staggering, and much of it is unreliable. It can also be very disorganized and difficult to understand. Patients and families must have trust and confidence in the information they are finding on the Internet. They must also have assistance in sorting through what information is relevant for their unique situation and what is not.

That's where Caring4Cancer comes in: all of its information is reviewed by leading experts in oncology, is fully up-to-date, and completely reliable. It is clearly organized, and can be specifically tailored to each individual's circumstance. Furthermore, it addresses the needs, questions, and concerns of loved ones and caregivers as well as patients.

In addition to providing important health-related information, the Internet is becoming widely used as a resource for connection with others and emotional support—for people dealing with cancer. Online support groups, message boards, and chat rooms are now widespread.

They have some distinct advantages over more traditional cancer support groups and forums. They can be accessed from home, 24 hours a day, and allow participation to be completely anonymous. They allow people from different walks of life and in different parts of the country (or world) to easily connect and share stories, information, and support. Communicating online also eliminates any visual distractions that can arise from age, gender, or social status. Connection with other people dealing with a particular type of cancer can also be facilitated.

Meaningful research on the benefits of online groups and support programs is growing. A number of published studies document their benefits and potential to help people feel connected, empowered, and better informed, and to live more effectively with their disease.

I encourage you to join the Online Community at Caring4Cancer. Explore the numerous opportunities to find important information, support, and connection with others. Learn about The Seven Levels of Healing and how they can transform your cancer journey. Visit the Seven Levels message board and share your stories, knowledge, and questions. Sign up to receive our free e-newsletters, and use these wonderful resources to maximize your care.

With warmest wishes,

Jeremy Geffen, MD, FACP