Therapy Made From Patient’s Immune System Shows Promise For Advanced Breast Cancer


“I’m one of the lucky ones,” says Judy Perkins, of the immunotherapy treatment she got. The experimental approach seems to have eradicated her metastatic breast cancer.”

Courtesy of Judy Perkins

Doctors at the National Institutes of Health say they’ve apparently completely eradicated cancer from a patient who had untreatable, advanced breast cancer.

The case is raising hopes about a new way to harness the immune system to fight some of the most common cancers. The methods and the patient’s experience are described Monday in a paper published in the journal Nature Medicine.

“We’re looking for a treatment — an immunotherapy — that can be broadly used in patients with common cancers,” says Dr. Steven Rosenberg, an oncologist and immunologist at the National Cancer Institute, who has been developing the approach.

Rosenberg’s team painstakingly analyzes the DNA in a sample of each patient’s cancer for mutations specific to their malignancies. Next, scientists sift through tumor tissue for immune system cells known as T cells that appear programmed to home in on those mutations.

But Rosenberg and others caution that the approach doesn’t work for everyone. In fact, it failed for two other breast cancer patients. Many more patients will have to be treated — and followed for much longer — to fully evaluate the treatment’s effectiveness, the scientists say.

Still, the treatment has helped seven of 45 patients with a variety of cancers, Rosenberg says. That’s a response rate of about 15 percent, and included patients with advanced cases of colon cancer, liver cancer and cervical cancer.

“Is it ready for prime time today? No,” Rosenberg says.”Can we do it in most patients today? No.”

But the treatment continues to be improved. “I think it’s the most promising treatment now being explored for solving the problem of the treatment of metastatic, common cancers,” he says.

The breast cancer patient helped by the treatment says it transformed her life.

“It’s amazing,” says Judy Perkins, 52, a retired engineer who lives in Port St. Lucie, Fla.

When Perkins was first diagnosed and treated for breast cancer in 2003, she thought she’d beaten the disease. “I thought I was done with it,” she says.

But about a decade later, she felt a new lump. Doctors discovered the cancer had already spread throughout her chest. Her prognosis was grim.

“I became a metastatic cancer patient,” says Perkins. “That was hard.”

Perkins went through round after round of chemotherapy. She tried every experimental treatment she could find. But the cancer kept spreading. Some of her tumors grew to the size of tennis balls.

Perkins received tumor infiltrating lymphocytes as treatment in 2015.

Courtesy of Stephanie Goff/NIH

“I had sort of essentially run out of arrows in my quiver,” she says. “While I would say I had some hope, I was also kind of like ready to quit, too.”

Then she heard about the experimental treatment at the NIH. It was designed to fight some of the most common cancers, including breast cancer.

“The excitement here is that we’re attacking the very mutations that are unique to that cancer — in that patient’s cancer and not in anybody else’s cancer. So it’s about as personalized a treatment as you can imagine,” Rosenberg says.

His team identified and then grew billions of T cells for Perkins in the lab and then infused them back into her body. They also gave her two drugs to help the cells do their job.

The treatment was grueling. Perkins says the hardest part was the side effects of a drug known as interleukin, which she received to help boost the effectiveness of the immune system cells. Interleukin causes severe flu-like symptoms, such as a high fever, intense malaise and uncontrollable shivering.

But the treatment apparently worked, Rosenberg reports. Perkins’ tumors soon disappeared. And, more than two years later, she remains cancer-free.

“All of her detectable disease has disappeared. It’s remarkable,” Rosenberg says.

Perkins is thrilled.

“I’m one of the lucky ones,” Perkins says. “We got the right T cells in the right place at the right time. And they went in and ate up all my cancer. And I’m cured. It’s freaking unreal.”

In an article accompanying the new paper, Laszlo Radvanyi, president and scientific director of the Ontario Institute for Cancer Research, calls the results “remarkable.”

The approach and other recent advances suggest scientists may be “at the cusp of a major revolution in finally realizing the elusive goal of being able to target the plethora of mutations in cancer through immunotherapy,” Radvanyi writes.

Other cancer researchers agree.

“When I saw this paper I thought: “Whoa! I mean, it’s very impressive,” says James Heath, president of the Institute for Systems Biology in Seattle.

“One of the most exciting breakthroughs in biomedicine over the past decade has been activating the immune system against various cancers. But they have not been successful in breast cancer. Metastatic breast cancer is basically a death sentence,” Heath says. “And this shows that you can reverse it. It’s a big deal.”

One key challenge will be to make the treatment easier, faster, and affordable, Rosenberg says. “We’re working literally around the clock to try to improve the treatment.”

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For Some Hard-To-Find Tumors, Doctors See Promise In Artificial Intelligence


A team at Johns Hopkins Medicine in Baltimore is developing a tumor-detecting algorithm for detecting pancreatic cancer. But first, they have to train computers to distinguish between organs.

 

Artificial intelligence, which is bringing us everything from self-driving cars to personalized ads on the web, is also invading the world of medicine.

In radiology, this technology is increasingly helping doctors in their jobs. A computer program that assists doctors in diagnosing strokes garnered approval from the U.S. Food and Drug Administration earlier this year. Another that helps doctors diagnose broken wrists in X-ray images won FDA approval on May 24.

One particularly intriguing line of research seeks to train computers to diagnose one of the deadliest of all malignancies, pancreatic cancer, when the disease is still readily treatable.

That’s the vision of Dr. Elliot Fishman, a professor of radiology at Johns Hopkins Medicine in Baltimore. Artificial intelligence and radiology seem like a natural match, since so much of the task of reading images involves pattern recognition. It’s a dream that’s been decades in the making, Fishman says.

“When I started in radiology, they said, ‘OK, don’t worry about reading the chest X-rays because the computers will read them,’ ” Fishman says. “That was 35 years ago!”

Elliot Fishman says the goal of developing an artificial intelligence program is to spot pancreatic tumors early.

 

Computers still can’t perform the seemingly simple task of reading a chest X-ray, despite sky-high expectations and more than a little hype around the role of artificial intelligence. Fishman is undaunted as he turns this technology on pancreatic cancer.

And that disease is a huge challenge. Only 7 percent of patients given a pancreatic cancer diagnosis are alive five years later. One reason the disease is so deadly is that doctors usually diagnose it when it’s too late to remove the tumors with surgery. Fishman and his team want to change that, by training computers to recognize pancreatic cancer early. Working with Johns Hopkins computer science students and faculty, they are helping develop a tumor-detecting algorithm that could be built into CT scanner software.

Americans get 40 million CT scans of the abdomen every year, for everything from car accidents to back pain. Imagine if a computer program with expert abilities could look for pancreas tumors in all those scans.

“That’s the ultimate opportunity — to be able to diagnose it before you have any symptoms and at a stage where it’s even maybe too subtle for a radiologist to be able to detect it,” says Dr. Karen Horton, chair of the Johns Hopkins radiology department and Fishman’s collaborator on the project.

Karen Horton is chair of the Johns Hopkins radiology department and is collaborating with Fishman on The Felix Project.

The challenge lies in teaching a computer to detect what a well-trained doctor knows to look for.

“Elliot and I are very subspecialized so we’re really, really good,” Horton says matter-of-factly. “We see more pancreatic cancer than probably anyone in the world.”

She says if the computer algorithm could capture their collective knowledge about how to diagnose pancreatic cancer and give that expertise to the typical doctor, “you could be, I would argue, better than us, but certainly as good as us — which would mean better than most of the practicing radiologists.”

Even a program perfectly attuned to finding patterns can’t reliably recognize cancer if it hasn’t been trained on reliable starting material.

When it comes to developing AI, “sometimes people say, ‘oh just take a bunch of cases and put them in a computer and the computer will figure out what to do’,” Fishman says. “That’s nonsensical.”

The Felix Project at Johns Hopkins, as the pancreas effort is called, pours a huge amount of human time, labor and intellect into training computers to recognize the difference between a normal pancreas and one with a tumor.

Of all the internal organs to deal with, “the pancreas is the hardest,” Fishman says. “The kidney looks like a kidney, the liver’s a big thing.” On the other hand, he says, “The pancreas is a very soft organ, it sits way in the middle and the shape varies from patient to patient. Just finding the pancreas, even for radiologists, is at times a challenge.”

Eva Zinreich, a medical researcher, digitally paints a CT scan to help train the computer program. The process can take almost four hours for a single scan.

 

Eva Zinreich, a retired oncologist, is up for that challenge. She is one of a team of medical experts who spend their days poring over CT scans and teaching the computer how to recognize the pancreas, other organs, and then, tumors within the pancreas.

She sits at a computer workstation, wielding a digital paintbrush.

“I’ll show you in 3D because that’s the fun stuff, ok?” she says as she sets about coloring in the aorta and other blood vessels on a scan.

Next, she colors the pancreas yellow.

“You see that shaded area?” she asks. “That’s the tumor,” and she proceeds to color it red.

Zinreich digitally paints the pancreas (yellow) and a tumor (red) in a CT scan.

 

It will take her almost four hours just to mark up this single scan. Four medical experts have been working full-time for well over a year on this project. They’ve done this painstaking work on scans from about 1,000 healthy people, and their tally of pancreatic cancer images is now approaching 1,000 as well, Fishman says.

They are feeding their annotated scans into the project’s computer program and gradually teaching it to recognize the same signs of a tumor that radiologists now pick out of the scans.

At another workstation in the lab, radiologist Linda Chu is trying to make the computer system even more adept than Elliot Fishman and Karen Horton are at recognizing pancreas cancers. She’s developing ways for the computer to look for patterns in the scan that the human eye can’t pick out. It’s interpreting textures in the images, rather than shapes and shading.

Chu says she’s making tentative progress. For example, she’s been training the software to identify subtle clues that distinguish between a benign cyst and cancer.

“We don’t truly understand what the computer is seeing, but clearly the computer is able to see something in the images that us humans cannot comprehend at this point,” Chu says.

But this is also part of the challenge of AI — if the computer highlights something that a human expert can’t see, and it’s not clear how it arrived at that conclusion, can you trust it?

“That’s what makes the research interesting!” Chu says.

Computer science students from the Johns Hopkins University main campus are key to developing the software that’s learning how to read and interpret the images that flow from Fishman’s lab.

The Lustgarten Foundation, which is focused on pancreatic cancer, has provided nearly $4 million over two years to fund the Felix Project. Horton says if it’s successful, all the information they collected on healthy people can be used as a starting point to study tumors elsewhere in the body.

“You could have Felix kidney, Felix liver, Felix lung, Felix, heart,” she says. And they could all go together into the scanner software.

The project is named after the “Felix Felicis” good-luck potion, from the Harry Potter books. And, absent an effective magic spell, the laborious process is a reminder that success in bringing artificial intelligence to medicine will not be as simple as dumping piles of data into a computer and trusting that an algorithm will sort it all out.

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Recent Study Shows How Sunscreen Causes Cancer, Not the Sun


Did you know that despite the invention of sunscreen, cases of skin cancers are on the rise every year? Elizabeth Plourde, Ph.D., is a California-based scientist who has shown that malignant melanoma and all other skin cancers increased significantly with ubiquitous sunscreen use over a 30-year period. Sunscreens contain chemicals that are known carcinogens and endocrine-disrupting chemicals (EDC).

So why so much faith in sunscreen? What’s going on here? Sunscreen is a product we’ve been sold that we cannot live without. But just think about what we did for the thousands of years before it’s invention. The sun has been a source of life since the beginning of human existence and has many benefits to the human body.

The Sun Doesn’t Harm Us

Firstly, the sun doesn’t harm us. It only nourishes us. There’s even really good science to prove this. One of the latest major studies was published by the Karolinska Institute in Sweden in 2014.

They conducted a study that found women who avoided lying out in the sun were actually TWICE as likely to die compared to those who make sunbathing a daily ritual.

This wasn’t a small study either. It looked at 30,000 women for a period of 20 years!

The A’s And B’s Of Sun Rays

We often hear about the different types of sun rays, so here’s the low down.

Ultraviolet B rays (UVB) are the primary cause of sunburn and non-melanoma skin cancers such as squamous cell carcinoma. The chemicals that form a product’s sun protection factor are aimed at blocking those UVB rays.

Ultraviolet A rays (UVA) penetrate deeper into the skin and are harder to block. Scientists know less about the dangers of UVA radiation and this could potentially be very dangerous. The general consensus now is that whilst UVA ray damage is much less obvious than UVB, it is probably a lot more serious!!

False Sense Of Security

A sunscreen lotion’s SPF rating has little to do with the product’s ability to shield the skin from UVA rays (this is because UVA and UVB protection do not harmonize). High-SPF products suppress sunburn from UVB but not other types of sun damage. Therefore they tend to lull users into staying in the sun longer and overexposing themselves to both UVA and UVB rays.

Since people think they are ‘protected’ they tend to extend their time in the sun well past the point when users of low-SPF products or natural oils head indoors. As a result, while the users of conventional sunscreen may get less UVB-inflicted sunburns as unprotected sunbathers, they are more likely to absorb more damaging UVA radiation (which studies are still inconclusive as to cancer-causing effects).

Philippe Autier, a scientist formerly with the International Agency for Research on Cancer and part of the World Health Organization, has conducted numerous studies on sunbathers and believes that high-SPF products spur “profound changes in sun behavior” that may account for the increased melanoma risk found in some studies. We can now spend the whole day at the beach without having to retreat to cover.

More Chemicals Than You Bargained For

High SPF products require higher concentrations of sun-filtering chemicals than low SPF sunscreens or natural oils. Some of these ingredients may pose health risks when they penetrate the skin. They have been linked to tissue damage, potential hormone disruption and may trigger allergic skin reactions.

If studies showed that high SPF products were better at reducing skin damage and skin cancer risk, then perhaps this extra chemical exposure might be justified. But since they don’t offer any benefit, then choosing alternative sunscreens really start to look a whole lot more appealing.

Natural Sun Protection

When we are outside the light that comes into our eyes sends signals to the pituitary gland which triggers hormones to be released for skin protection.

The more we try to fool nature with chemicals the more cancer and other sickness shows up. Often the stress surrounding these health concerns is more detrimental than the issue itself. Health is simple and always has been.

At least let kids go out and play in the sun to develop enough Vitamin D before slathering all those chemicals on them.

Enjoy the life-giving amazing sun rays you are so blessed to have! Build a tan slowly, be smart and you will live a long healthy happy life.

 

Do Cellphones Cause Cancer?


The question of whether cellphones can cause cancer became a popular one after the dramatic increase in cell phone use since the 1990s. Scientists’ main concern is that cell phones can increase the risk of brain tumors or other tumors in the head and neck area – and as of now, there doesn’t seem to be a clear answer.

Cell phones give off a form of energy known as radiofrequency (RF) waves. They are at the low-energy end of the electromagnetic spectrum – as opposed to the higher-energy end where X-rays exist – and they emit a type of non-ionizing radiation. In contrast to ionizing radiation, this type does not cause cancer by damaging DNA in cells, but there is still a concern that it could cause biological effects that result in some cancers.

However, the only consistently recognizable biological effect of RF energy is heat. The closer the phone is to the head, the greater the expected exposure is. If RF radiation is absorbed in large enough amounts by materials containing water, such as food, fluids, and body tissues, it produces this heat that can lead to burns and tissue damage. Still, it is unclear whether RF waves could result in cancer in some circumstances.

An iPhone.

Many factors affect the amount of RF energy a person is exposed to, such as the amount of time spent on the phone, the model of the phone, and if a hands-free device or speaker is being used. The distance and path to the nearest cell phone tower also play a role. The farther a way a person is from the tower, the more energy is required to get a good signal on the phone. The same is true of areas where many people are using their phones and excess energy is required to get a good signal.

RF radiation is so common in the environment that there is no way to completely avoid it. Most phone manufacturers post information about the amount of RF energy absorbed from the phone into the user’s body, called the specific absorption rate (SAR), on their website or user manual. Different phones have different SARs, so customers can reduce RF energy exposure by researching different models when shopping for a phone. The highest SAR in the U.S. is 1.6 watts/kg, but actual SAR values may vary based on certain factors.

Studies have been conducted to find a possible link between cell phone use and the development of tumors. They are fairly limited, however, due to low numbers of study participants and risk of recall bias. Recall bias can occur when individuals who develop brain tumors are more predisposed to recall heavier cell phone use than those who do not, despite lack of true difference. Also, tumors can take decades to develop, and given that cell phones have only been in use for about 20 years, these studies are unable to follow people for very long periods of time. Additionally, cell phone use is constantly changing.

Outside of direct studies on cell phone use, brain cancer incidence and death rates have changed little in the past decade, making it even more difficult to pinpoint if cell phone use plays a role in tumor development.

For all book lovers please visit my friend’s website.
URL: http://www.romancewithbooks.com

Do Cellphones Cause Cancer?


The question of whether cellphones can cause cancer became a popular one after the dramatic increase in cell phone use since the 1990s. Scientists’ main concern is that cell phones can increase the risk of brain tumors or other tumors in the head and neck area – and as of now, there doesn’t seem to be a clear answer.

Cell phones give off a form of energy known as radiofrequency (RF) waves. They are at the low-energy end of the electromagnetic spectrum – as opposed to the higher-energy end where X-rays exist – and they emit a type of non-ionizing radiation. In contrast to ionizing radiation, this type does not cause cancer by damaging DNA in cells, but there is still a concern that it could cause biological effects that result in some cancers.

However, the only consistently recognizable biological effect of RF energy is heat. The closer the phone is to the head, the greater the expected exposure is. If RF radiation is absorbed in large enough amounts by materials containing water, such as food, fluids, and body tissues, it produces this heat that can lead to burns and tissue damage. Still, it is unclear whether RF waves could result in cancer in some circumstances.

An iPhone.

Many factors affect the amount of RF energy a person is exposed to, such as the amount of time spent on the phone, the model of the phone, and if a hands-free device or speaker is being used. The distance and path to the nearest cell phone tower also play a role. The farther a way a person is from the tower, the more energy is required to get a good signal on the phone. The same is true of areas where many people are using their phones and excess energy is required to get a good signal.

RF radiation is so common in the environment that there is no way to completely avoid it. Most phone manufacturers post information about the amount of RF energy absorbed from the phone into the user’s body, called the specific absorption rate (SAR), on their website or user manual. Different phones have different SARs, so customers can reduce RF energy exposure by researching different models when shopping for a phone. The highest SAR in the U.S. is 1.6 watts/kg, but actual SAR values may vary based on certain factors.

Studies have been conducted to find a possible link between cell phone use and the development of tumors. They are fairly limited, however, due to low numbers of study participants and risk of recall bias. Recall bias can occur when individuals who develop brain tumors are more predisposed to recall heavier cell phone use than those who do not, despite lack of true difference. Also, tumors can take decades to develop, and given that cell phones have only been in use for about 20 years, these studies are unable to follow people for very long periods of time. Additionally, cell phone use is constantly changing.

Outside of direct studies on cell phone use, brain cancer incidence and death rates have changed little in the past decade, making it even more difficult to pinpoint if cell phone use plays a role in tumor development.

Source:http://www.dana-farber.org

 

For all book lovers please visit my friend’s website.
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Ten Things to Know About Young Women with Breast Cancer


Women who develop breast cancer when they’re relatively young – under age 45 – face a variety of issues unique to their stage of life. Questions about how the disease may affect their careers, relationships, sexual functioning, and ability to have and raise children often become pressing in the aftermath of a diagnosis.

Because breast cancer is relatively rare in young women – the average age at which the disease is diagnosed in the United States is 61 – there has been little research focused on young women, and such research is needed, ranging from the biology of the disease in younger patients to the particular challenges they encounter. To begin to fill in that gap, we launched the Young Women’s Breast Cancer Study in 2006, the first multi-institutional effort to track the medical and psychosocial issues faced by a large group of young women with breast cancer in the U.S.

The study enrolled more than 1,300 women across the country. Participants were surveyed at the time of their diagnosis and treatment, and continue to be surveyed post-treatment about issues such as fertility concerns, sexual functioning, body image, genetic testing, treatment decisions, and family planning. Participants were also asked to provide blood and tissue samples for analyses to better understand the biology of breast cancer in young women.

Meredith Faggen, MD, delivers care to Joyce White, a young woman with breast cancer.

Data collected by the study have significantly increased our understanding of the nature of the disease in younger women and how it impacts their lives. Research based on the data may help change not only the way breast cancer is treated in these patients, but also the support services they receive.

Here are some of the most intriguing findings to date from studies using the Young Women’s Breast Cancer Study data.*

  • A substantial portion of young women with hormone receptor-positive breast cancer had high grade, more aggressive tumors.
  • A higher percentage of breast tumors in young women were HER2-positive versus those in older women. The HER2 protein spurs cancer cell growth and is a target for some drugs.
  • There was no association between the age at which participants were last pregnant, or were ever pregnant, and the molecular subtype of cancer they developed.
  • Participants sought care in a timely fashion. The median period between detecting a suspicious breast lump, or other symptom, and seeking care from a physician was only two weeks.
  • Genetic testing rates are increasing. Seventy-seven percent of participants diagnosed with breast cancer in 2006 agreed to be tested for mutations in the BRCA genes, which increase the risk of future breast and/or ovarian cancer. By 2013, that figure had risen to 95 percent.
  • An increasing percentage of young women with cancer in one breast are choosing to have the unaffected breast removed. The vast majority of study participants who chose this option said they did so to decrease the chance of developing cancer in the second breast, but many believe it will improve their survival. Research has shown that for women with breast cancer on one side, having the other breast removed does not improve survival.
  • Thirty-eight percent of participants said that, prior to their diagnosis, they’d been interested in having children. At the time of diagnosis, twenty-six percent indicated such an interest. Although the percentage declined in succeeding years, it remained in the 25 percent range for the first three or four years after diagnosis.
  • 11 percent of participants had taken steps to preserve their fertility by freezing embryos, freezing eggs, or other techniques.
  • Other studies have sought to gauge young women’s fertility following breast cancer treatment, using menstrual periods as a marker of their ability to have children. Among patients under 30, 87 percent continued to have periods, as did 64 percent of those aged 36-40. All patients not treated with chemotherapy continued to have periods in the initial years after diagnosis, as did 60 percent of those who did receive chemotherapy.
  • Of the participants who tried to get pregnant following treatment, the vast majority succeeded.

Source:http://www.dana-farber.org

 

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Brother’s Stem Cells Make Remission Possible for Pediatric Leukemia Patient


How do you repay someone who has given you the gift of life? Eight-year-old Emma Duffin of Enfield, Connecticut, started by giving a kiss and cuddle to her brother, Alexander, who donated his bone marrow stem cells to Emma to reboot her immune system and send her rare form of leukemia into remission.

Emma’s journey to a stem cell transplant began in April 2014, when her usual energetic demeanor began to change. “Emma was very vibrant, very active, and she did not like to rest,” says her father, Brian Duffin. But suddenly his go-go daughter was exhausted all the time. She was diagnosed with strep throat, then foot-and-mouth disease, but neither medication nor time brought any improvement.

During yet another trip to the emergency room, a blood draw revealed Emma had an alarmingly low level of hemoglobin – a 3 instead of the normal range for a juvenile of 11 or higher.

“For an adult, such low levels would have been fatal,” Brian says. Emma was rushed to Connecticut Children’s Medical Center (CCMC), where she was diagnosed a few days later with acute undifferentiated leukemia.

Most leukemias fall into two types: acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML). Each type is treated with a distinct protocol. Acute undifferentiated leukemia is a subset of the disease that shows markers of both types.

“As a result, part of the leukemia is often resistant to one protocol or the other,” explains Steven Margossian, MD, PhD, a senior physician of pediatric hematology and oncology at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. “In this circumstance, the best approach is often a bone marrow stem cell transplant. The bone marrow is the factory where leukemia cells are made. By using strong chemotherapy to destroy the existing bone marrow cells, you can then replace those with normal, healthy cells from a donor as closely matched to the patient as possible.”

In Emma’s case, Alexander ended up being her perfect match.

Emma’s oncologist at CCMC trained under Dr. Margossian and referred the family to her mentor.

“When your doctor tells you the number one pediatric stem cell transplant hospital in the world is only 90 minutes from your house, you don’t question it,” says Allyson Duffin, Emma’s mom.

After Emma completed three rounds of chemotherapy at CCMC, the Duffin family traveled to Boston to prepare for “zero day”: the day Dr. Margossian would perform the stem cell transplant. Prior to the transplant, Emma had one last round of high-dose chemotherapy and radiation – a typical pre-transplant treatment called conditioning therapy – to wipe out any remaining malignant stem cells. Then, on zero day, Margossian’s team harvested and processed Alexander’s stem cells and prepared Emma for the infusion. Brian had the privilege of pushing the button that began the infusion, transferring this gift of life from his son to his daughter.

Emma remained at Boston Children’s Hospital for about a month until engraftment, or the point at which the new stem cells produce enough neutrophils, a specific kind of white blood cell, to provide protection against bacterial infection.

“She was still energetic during that time; she has a zest for life that is unquestionable,” Brian says.

On Halloween, Emma dressed as Elsa and enjoyed “reverse trick-or-treating,” as doctors and nurses brought candy to her on their rounds.

Still, the month of recovery had its challenges. The conditioning therapy often causes the onset of mucositis, an extremely painful inflammation of the mucous membranes that line the digestive tract. Emma’s case was especially severe; she had to be fed through a nasal tube.

“For 95 percent of stem cell patients, the pain of mucositis is what they remember the most about their transplant,” Margossian says.

Emma also endured graft-versus-host disease (GVHD), another expected side effect of a stem cell transplant in which the donor’s white blood cells (the “graft”) attack the host’s cells, which can cause skin rashes and irritate the digestive system and liver.

“Emma’s nurses were very proactive about it,” Allyson says. “They gave her Benadryl and used every lotion known to man to soothe her skin.”

After Emma was released from the hospital, she remained in quarantine at home for nine months, allowing her fragile immune system to gradually rebuild itself without unnecessary exposure to germs in indoor public places. She entertained plenty of visitors on her front porch, relished rides around town with her family, and enjoyed the occasional meal on the outside patio at her favorite restaurant.

When Emma’s quarantine restrictions were lifted on June 1, 2015, “she celebrated by doing anything and everything,” Brian says with a laugh. “She shopped, she visited friends, she ate inside at her favorite restaurant – and she was excited to go back to school.”

Today, Emma remains healthy. “You would never know she had been so sick,” Allyson says. Now 11, Emma is in a dance troupe and involved in acting. She plays trumpet in her school band. And yes, she and Alexander are back to the usual sibling antics.

“Kids often bounce back more easily, physically and psychologically, because they are more resilient,” Margossian said. “Emma is spunky, and her energetic attitude went a long way in positively influencing her recovery.”

Source:http://www.dana-farber.org

 

For all book lovers please visit my friend’s website.
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The Truth About Melanoma and Skin Cancer: Facts and Common Myths


Often caused by excessive exposure to ultraviolet (UV) rays in sunlight, melanoma accounts for only 4 to 5 percent of skin cancer cases, but is responsible for most skin cancer-related deaths. As with many forms of cancer, melanoma is often misunderstood, and myths persist.

When detected and treated in its earliest stages, however, melanoma is often curable. The key is to avoid overexposure to UV rays – by limiting time outdoors during the peak hours of sunlight and wearing sun-protective clothing and sunscreen – and to be on the lookout for changes in moles and other blemishes that can be an early sign of the disease.

Jennifer Y. Lin, MD, of Dana-Farber Cancer Institute’s Melanoma Treatment Program, sets the record straight on five of the most common myths about melanoma.

Myth 1: A diagnosis of melanoma means that I have months to live.

There are four stages of melanoma — five if you include a form known as melanoma in situ, an early form of the disease that affects only the top layer of skin. Stage 1 melanomas, which are less than one millimeter thick and almost always have not spread beyond their original site, have an excellent prognosis and are generally cured by surgery. The depth of the original melanoma is critical to determining how it will be treated and how people with it are likely to fare. Although more melanomas are being diagnosed, the largest portion are made up of Stage 1 melanomas. Before worrying about the worst outcomes, speak with your doctor about what stage melanoma you have.

Myth 2: There is no difference between SPF 30 and SPF 100 sunscreen.

Although the baseline protection from SPF 30 and SPF 100 is not vastly different, the higher number provides longer coverage. (SPF stands for sun protection factor, or the amount of ultraviolet radiation the skin can absorb without burning while the sunscreen is on.)

If it normally takes you 10 minutes in the sun to burn, an SPF 30 sunscreen protects you for 300 minutes. An SPF 100 should, in theory, provide 1,000 minutes of coverage. If you are sweating and active, the sunscreen can rub off and should therefore be reapplied every two hours. When you are using a high SPF, there is a smaller likelihood of having a “missed spot.” A good way to know that you are applying enough sunscreen is to use the measurement of a shot glass of sunscreen for exposed sites.

Myth 3: If it is a cloudy day, I do not need to wear sunscreen.

About 80 percent of ultraviolet radiation reaches the earth even through clouds. Use a moisturizer with sunscreen daily, especially for areas that have high exposure, such as your face.

Myth 4: If I am low in vitamin D levels, I must get some sun exposure.

Although the skin is the most efficient site of vitamin D production, adequate amounts can be obtained from your diet and from supplements. Vitamin D helps you absorb calcium and build strong bones, so we frequently recommend supplements that include vitamin D and calcium.

Myth 5: If I have dark skin, I can’t burn and won’t get melanoma.

Even people with dark skin can burn if they’re exposed to the sun long enough. Although melanoma is much more rare in individuals of darker skin, it can occur. We recommend that darker-skinned individuals inspect their hands and feet once a month.

Source: Dana-Farber Cancer Institute.

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Study reveals that many oncologists recommend medical marijuana clinically despite not feeling sufficiently knowledgeable to do so


  • Researchers identified a discrepancy between oncologists’ self-reported knowledge base and their clinical practices and beliefs regarding medical marijuana.
  • They conclude that critical gaps exist in research, education, and policy regarding medical marijuana.

While a wide majority of oncologists do not feel informed enough about medical marijuana’s utility to make clinical recommendations, most do in fact conduct discussions on medical marijuana in the clinic and nearly half recommend it to their patients, say researchers who surveyed a population-based sample of medical oncologists.

The study, published today in the Journal of ClinicalOncology, is the first nationally-representative survey of medical oncologists to examine attitudes, knowledge and practices regarding the agent since medical marijuana became legal on the state level in the U.S. Medical marijuana refers to the non-pharmaceutical cannabis products that healthcare providers recommend for therapeutic purposes. A significant proportion of medical marijuana products are whole-plant marijuana, which contains hundreds of active ingredients with complicated synergistic and inhibitory interactions. By contrast, cannabinoid pharmaceuticals, which are available with a prescription through a pharmacy, contain no more than a couple of active ingredients. While considerable research has gone into the development of cannabinoid pharmaceuticals, much less has been completed on medical marijuana’s utility in cancer and other diseases. The researchers speculate that the immature scientific evidence base poses challenges for oncologists.

“In this study, we identified a concerning discrepancy: although 80% of the oncologists we surveyed discussed medical marijuana with patients and nearly half recommended use of the agent clinically, less than 30% of the total sample actually consider themselves knowledgeable enough to make such recommendations,” said Ilana Braun, MD, chief of Dana-Farber Cancer Institute’s Division of Adult Psychosocial Oncology. “We can think of few other instances in which physicians would offer clinical advice about a topic on which they do not feel knowledgeable. We suspect that this is at least partly due to the uncomfortable spot in which oncologists find themselves.  Medical marijuana is legal in over half the states, with cancer as a qualifying condition in the vast majority of laws, yet the scientific evidence base supporting use of medical marijuana in oncology remains thin.”

The mailed survey queried medical oncologists’ attitudes toward medical marijuana’s efficacy and safety in comparison with standard treatments; their practices regarding medical marijuana, including holding discussions with patients and recommending medical marijuana clinically; and whether they considered themselves sufficiently informed regarding medical marijuana’s utility in oncology. Responses indicated significant differences in attitudes and practices based on non-clinical factors, for instance regional location in the U.S.

“Ensuring that physicians have a sufficient knowledge on which to base their medical recommendations is essential to providing high quality care, according to Eric G. Campbell, PhD, formerly a professor of medicine at the Massachusetts General Hospital, now a professor at the University of Colorado School of Medicine. “Our study suggests that there is clearly room for improvement when it comes to medical marijuana.”

To date, no randomized clinical trials have examined whole-plant medical marijuana’s effects in cancer patients, so oncologists are limited to relying on lower quality evidence, research on pharmaceutical cannabinoids or research on medical marijuana’s use in treating diseases other than cancer.

Of note, additional findings of the current study suggest that nearly two-thirds of oncologists believe medical marijuana to be an effective adjunct to standard pain treatment, and equally or more effective than the standard therapies for symptoms like nausea or lack of appetite, common side effects of cancer treatments such as chemotherapy.

Source:http://www.dana-farber.org

 

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Antidepressants for the treatment of depression in people with cancer.


BACKGROUND: Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results.

OBJECTIVES: To assess the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage).

SEARCH METHODS: We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 6), MEDLINE Ovid (1946 to June week 4 2017), Embase Ovid (1980 to 2017 week 27) and PsycINFO Ovid (1987 to July week 4 2017). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials.

SELECTION CRITERIA: We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis).

DATA COLLECTION AND ANALYSIS: Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into Review Manager 5 using a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by Cochrane.

MAIN RESULTS: We retrieved a total of 10 studies (885 participants), seven of which contributed to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update we included one additional unpublished study. These new data contributed to the secondary analysis, while the results of the primary analysis remained unchanged.For acute-phase treatment response (6 to 12 weeks), we found no difference between antidepressants as a class and placebo on symptoms of depression measured both as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants; very low certainty evidence) and as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants; very low certainty evidence). No trials reported data on follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, showing no difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants; very low certainty evidence). No clear evidence of a beneficial effect of antidepressants versus either placebo or other antidepressants emerged from our analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low certainty evidence). In terms of dropouts due to any cause, we found no difference between antidepressants as a class compared with placebo (RR 0.85, 95% CI 0.52 to 1.38, seven RCTs, 479 participants; very low certainty evidence), and between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the certainty (quality) of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity.

AUTHORS’ CONCLUSIONS: Despite the impact of depression on people with cancer, the available studies were very few and of low quality. This review found very low certainty evidence for the effects of these drugs compared with placebo. On the basis of these results, clear implications for practice cannot be deduced. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent to prescribe may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. To better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.

 

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