NFCR Writer Nicole Tartaglia, Author at NFCR

NFCR Writer Nicole Tartaglia

Healing the Wounds We Cannot See: Cancer and Adolescents

As cancer drug therapies continue to improve and oncology research gives patients more options, treatments and time, winning the war against cancer is a goal increasingly within reach. However, whether removing a tumor, limb, breast or node, or administering a groundbreaking new chemotherapy or targeted therapy—these represent the ability only of medicine to treat the physical implications of cancer. Whereas oncology social work stands in an important gap, seeking to address, assuage and heal the psychosocial and emotional impact of cancer for both patients and caregivers. In this article dedicated to the impact of oncology social work, we’ll explore the adolescent cancer community and how it is served by oncology social workers and the programs they offer.

Doubling Up

At present, there are over 500,000 adults affected by cancer in the state of New Jersey alone. Twenty five percent of these adults are raising one or more children under the age of 19. This means that for 125,000 parents with cancer, there are over 250,000 adolescents impacted, not including those who are in bereavement. And this is merely a fraction of the nation as whole. The facts are daunting and the need is profound. Families today have significant unmet psychosocial needs and few resources to turn to which address how a family unit navigates and survives cancer.

Deep Impact

Oncology social work is not talk therapy; rather, it is the place where oncology care meets the physical, emotional, social and spiritual needs of all people affected by cancer. Programs like the Cancer Support Community of Central New Jersey (CSCCNJ) provide services, free of charge, to patients and caregivers of all ages from diagnosis through bereavement. Their high school-based group for teens aims to help them to connect and to process as a means of coping with the already daunting demands of contemporary teenage life. Oncology social work recognizes that being a teenager is undoubtedly already an awkward, hormone-driven, pressure-filled and insecure time of life. When one adds cancer to the mix, isolation and cessation of communication become almost instantaneous foes.

Typically, teens do not find it easy to explain their lives with cancer to those without and consequently, why their friendships must change. Teens don’t relish conversations on why they can’t go to the dance, the movies or the game because mom, dad or sibling cannot be left alone or because chemo has made them too tired. Explaining to teenaged friends why you forgot to call or meet or connect because of brain fog caused by chemotherapy can be dismissed as an excuse or misunderstood by those on the outside as selfishness, melodramatic or uncaring, so teens can tend to simply shut down and shut out their inner circle, thereby, forfeiting much needed support. 

Healing—the Big Picture

Katherine Schaible, a licensed clinical social worker and program coordinator of CSCCNJ, believes that oncology social work centers and outreach programs are integral to surviving cancer whether you are a patient or caregiver. Oncology social work provides, “unique psycho-social intervention and relief to parents and empowers young adults to have the tools to positively influence them throughout their lives… Our aim is to fill their toolbox with how to identify feelings and how to have open communication with family and friends.” Because cancer has such a profoundly isolating effect, and because research proves that the morale and mental and emotional stability of those fighting cancer is critical to recovery, oncology social work programs like this ensure that no one fights cancer alone. Ms. Shaible adds that generalized “student support groups may not make it obvious to a teen dealing with cancer that they have a common plight with other group members.” 

In oncology social work groups, Ms. Schaible adds, “new friendships form and it’s a safe space where teens are empowered to ask questions,” and find connection within a community literally fighting for its life. Teens feel less isolated and more in control when they share experiences with others who can empathize. Within this framework, teens are taught how to deal with their emotional pain and find productive ways to grieve the loss of their pre-cancer lives and families. Great emphasis is placed on identifying and redefining personal goals, acknowledging the positives despite the pain and to see them thriving in their new and functional future.

Circling the Wagons

Oncology social work is an ideal resource for helping those teens affected by cancer as it assists in creating a community of care for them through outreach and education. Teens spend an average of 1,000 hours a year in school. Their “first responders”, that being their teachers, administrators and coaches, can receive guidance and even professional development from oncology social work initiatives to know better how to encourage and serve those students affected by cancer and guide them as they cope with everyday life.

Tangentially, oncology social work aims to serve parents and siblings so that they too can process and seek comfort and connection. Too often siblings of cancer patients take a back seat for obvious purposes to their sick brother or sister. Marriages and finances can be strained, plans for college must be rearranged. Oncology social work then becomes the vehicle for all members of affected families to have the resources to redirect, redefine and regroup with a view to finding their way forward.  

The impact of oncology social work is far reaching in its potential to change lives for the good. For adolescents it provides a platform for them to find community and regain a sense of normalcy. Being given the chance to process in a sympathetic environment, away from the clinical feel of a hospital or infusion center and in the company of peers, they are free to retake control of their futures by being given the tools to overcome their present challenges. Cancer may well be a long and dark chapter of their young lives, but through the assistance of oncology social workers and the programs they facilitate, they have the means and the method to step back into the light.

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Managing Anxiety & Depression in Cancer Patients

Cancer changes the entire landscape of a person’s life. Career plans, the future, the present; these are all called into question when a diagnosis arrives. Certainly it is expected for cancer patients to become sad or angry, anxious or overwhelmed, as they come to grips with the battle ahead. However, those who remain in a prolonged state of anxiety or depression should seek help. Since one in four cancer patients are diagnosed with clinical depression, it’s important that patients know how, where and when to get help. Managing anxiety and depression so that these do not become stumbling blocks to successfully surviving cancer is integral to the fight.

Know Your Foe
The signs and symptoms of depression vary by individual. The profundity of symptoms ranges from mild difficulty adjusting to living with cancer to those who encounter serious mental health problems such as debilitating anxiety and major depression.  The hallmarks of an individual’s ability to cope and assistance from which they’d benefit, depend on the seriousness of their distress and can be categorized as follows:

  • Normal adjustment. Those patients who cope well and learn quickly how to productively handle the challenges related to a cancer diagnosis. Patient adjustments come at different times including when they are diagnosed, after treatment, finish treatment, go into remission, suffer a recurrence and become a survivor.
  • Social or psychological distress. Those patients who exhibit initial trouble adjusting to the challenges of a life post diagnosis and managing the stress as a result. Professional help to develop adaptive coping skills is beneficial.
  • Adjustment disorder. These patients have difficulty making changes in their life which successfully allow them to manage stressful situations and includes depression, anxiety, emotional, social or behavioral issues and negatively impact overall quality of life. Professional help and medicine may be necessary to help this type of patient return to and maintain emotional equilibrium.
  • Anxiety disorder. Patients are extremely anxious as a result of stress such as cancer diagnosis and exhibit worry, fear and dread. The severity of symptoms affects the patient’s ability to lead normal productive lives and disorders can include generalized anxiety, panic disorder, agoraphobia, social anxiety, Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder. Treatments vary by diagnosis of particular anxiety disorder. Patients are encouraged to talk to their doctors to develop a plan which will cater to their specific needs be they psychological or pharmaceutical.

Risk Management
Cancer patients are encouraged to find ways of managing undo stress and mounting anxiety which can inhibit their ability to successfully handle an already difficult recovery. The impact of anxiety on recovery is biologically tangible. As per the National Academies of Science:

  • Stress hormones increase the production of free radicals which contributes to DNA damage and impaired immune function, thus hampering recovery.
  • Stress hormones increase systemic inflammation by increasing levels of inflammatory proteins (cytokines) which impair immune function and actually promote cancer growth.
  • Stress hormones make it more difficult for abnormal cells to die while also impeding DNA repair, a process which is vital to the body’s self-regulating anticancer mechanisms.
  • Stress hormones fuel the production of VEGF (vascular endothelial growth factor), a protein discovered by the National Foundation for Cancer Research’s long-supported scientist, Harold Dvorak, and other secretions which can promote tumor cell growth.

Help and Healing
Patients are encouraged to work with their doctors to find the courses of therapy which will most successfully and productively help them to manage anxiety, stress and depression so that they can concentrate on getting better. These can include but are not limited to:

  • Oncological Stress and anxiety are often the byproduct of physical limitations due to the cancer or its treatment. Taking advantage of physical therapy, occupational therapy, speech and language pathology and manual therapy, provide a wide range of tools to combat cancer-related side effects and alleviate those emotional byproducts that detract from a patient’s quality of life.
  • Spiritual support. Leaning on one’s personal faith can be a powerful tool in navigating a cancer diagnosis. Talking with clergy or spiritual counselors offers a natural, self-managed way to address anxiety and stress while gaining perspective on their cancer journey. 
  • Some patients experience profound depression or anxiety and must therefore include in their drug therapy protocols treatments such as anti-depressants. Patients who suffer from uncontrolled anxiety, fear and dread should discuss with their doctors which drugs can help them lessen those symptoms while at the same time not interfere with chemotherapy or oncology drugs they need to continue their journey toward being cancer free.

The stressors triggered by cancer are certainly in no short supply. However, patients who plan proactively and draw on the rich and diverse options readily available through their doctors, community and care team will find they have the choice to experience recovery in more productive ways. There is no one right way to manage recovery, however, mounting anxiety or depression should not to be ignored. Having cancer does not require patients to forfeit living their best life even while battling the disease.


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Brain Cancer Surgery: Thriving in Recovery

Brain cancer is a formidable adversary in the world of oncology. Against substantial odds, patients work with dedicated doctors to mount a counter offensive. The road to recovery is, to no one’s astonishment, arduous, as brain surgery exposes the very epicenter of our being, behavior, personality, motor skills and memory. Changes in how a patient thinks, remembers or interacts can demonstrate mild to profound changes vis-à-vis pre-operative (pre-op) norms. According to Johns Hopkins Medicine, the amount of time required for recovery varies by patient according to the procedure used to remove the brain tumor, the location of the tumor, areas of the brain affected by the surgery and the patient’s age and overall health. Depending on these factors, patients can anticipate a range of length and severity of post-op recovery.

Preparation: Doctors will work diligently to preserve patients’ cognitive abilities, motor skills and memories. “The whole goal of the surgery is to keep people whole, to keep them intact,” says Steven Brem, a neurosurgeon and co-director of the Brain Tumor Center at the Hospital of the University of Pennsylvania in Philadelphia. Talk with your doctor thoroughly about this and ask for specifics, contingencies and plan proactively to engage the right therapists, doctors and pharmaceutical therapies to cater to your individual needs. For example, damage or trauma to the occipital lobe will likely mean sight problems or vision on one side, whereas temporal lobe complications can include short-term memory loss, forgetting words and seizures.

Fatigue: Recovery is not and cannot be a race. Rather it is a slow, determined path. Patients report that after a neurosurgical procedure they notice a substantial lack of energy. In fact, fatigue is the number one side effect reported by patients. Doctors recommend that patients establish routines, write things down, take note of times of day when they have the most energy and then plan to make those times their most productive. Any accomplishment, though small, can provide a much needed boost in morale during recovery. Lastly, fatigue can be attributable to anemia. Check with your doctor about how to boost your dietary intake or if there is a medication you need to help manage anemia or its effects. 

Pain: There is to be expected a modicum of discomfort after any surgery. For those recovering from brain cancer surgery, discomfort or pain can manifest in a myriad of ways. The recovery time for a craniotomy ranges from 4-8 weeks and the sutures usually heal within 5 days. Patients can also anticipate discomfort caused by prolonged constipation (since the lower intestine is last among organs to reprise normal function after major surgery), headaches from the procedure or subsequent scar tissue and a raw throat. Post-surgery pain is best kept at bay by taking pain management medications as prescribed and speaking frankly with your caregivers and doctors about pain and pain management protocols.

Rehabilitation: Brain surgery, cancer-related or otherwise, may necessitate patients relearning how to do everyday tasks and can have a lasting impact or necessitate therapy. Full or partial recovery of such functions as speech, sight or gait takes time and/or effort.

  • After brain cancer surgery, many patients engage the assistance of physical, occupational and speech therapists. These specialized practitioners work with patients to give them their best quality of life. Physical therapists will assist patients in regaining mobility, establishing a fuller range of motion and decreasing pain. Occupational therapists will assist patients in modifying everyday tasks to suit their new levels of ability or affected ranges of motion to perform daily activities like, cooking, driving and working. Speech therapists do so much more than the obvious. Patients may need to relearn eating, swallowing, talking and they can help adjust how a patient verbally expresses themselves.
  • Neurological Complications. For seizures and headaches, patients are often prescribed medications to assist in a more productive recovery or manage symptoms. Anti-seizure medications are usually administered according to the frequency and severity of episodes.
  • Cognitive Remediation. As brain surgery can make it necessary for patients to learn differentiated ways to accomplish everyday tasks, cognitive remediation is a more frequently applied tactic to successful recovery and attaining better quality of life for post-op brain cancer patients. This therapeutic approach assists patient recovery by creating compensatory strategies in order to carry out important daily tasks. This is achieved by breaking tasks down into simple and logically sequenced steps while incorporating attention-enhancing activities. These stimulate internal brain functions and enhance retention, recall and help improve memory.

Changes in behavior, emotions and cognition following brain tumor surgery can be overwhelming and stressful. But with proper rehabilitation, a patient can achieve first-rate results and anticipate a good quality of life.



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World Cancer Day 2018: We Can, I Can


Each year, World Cancer Day (WCD) falls on February 4th. Since 2016, the theme of this global campaign has been “We Can, I Can.” The purpose is to get as many people as possible, all around the world, talking and thinking about cancer, with a view to educating the public on early detection and prevention, and influencing government and industry regarding matters of investment and research. World Cancer Day is an initiative which engages individuals, governments, corporations, research institutions, schools and universities on a global scale. Here we’ll give an overview of some of these resources, the scope of their impact and the involvement of the National Foundation for Cancer Research (NFCR) as it applies to WCD.

Get the Word Out
Of the nearly nine million people globally who die from cancer each year, over four million of those pass before the age of 69. It’s believed that multitudes of these deaths, especially, could be prevented, or lifespans significantly prolonged, but for the lack of early detection through routine and proper screenings. In view of these statistics, World Cancer Day was launched by the Swiss-based Union for International Cancer Control, its partners, networks and members, of which NFCR is proud to be one.  Its theme of “We Can, I Can,” which began in 2016 and culminates in 2018, encompasses a paradigm—a vision/belief/motivating fundamental—that the global burden of cancer can be tremendously lightened, and groups and individuals can take action to bring about such a reality.

We Can, I Can
As the theme suggests, World Cancer Day and its components are suitable to the many and the one. The framework, We Can, includes topics and messages such as prevention, creating healthy working, schooling and living environments within communities, playing a part in helping those affected to successfully return to work through corporate or business programs, and supporting and creating changes in policy that can support the cancer community and improve access to care.

Similarly, the framework, I Can, suggests of individuals ways to make their voices heard, ask for support, receive guidance on making healthy life choices and learn about the importance of early detection. For those within the cancer community, I Can entails provision of support, help to return to work, and access to engaged communities, care-providers and loved ones.

Money Matters
Investment in controlling cancer figures prominently among the goals of World Cancer Day. And as a charity whose primary function is the provision of funding to impactful oncology research—“Research for a Cure”—NFCR is especially attuned to this element of today’s “We Can, I Can” call-to-action.

Regardless of the type, cancer research is significantly underfunded vis-à-vis the work it’s being asked to do, the drug therapies it’s being asked to develop and the tremendous patient population with which it’s being asked to keep pace. World Cancer Day places particular importance on making the case for investing in cancer research and control. This means making an impact not only in the labs, but in the government and halls of justice as well.

You Matter!
Take time today to get involved in World Cancer Day. Every individual matters. Each dollar makes a difference. No effort is too small, particularly with so many around the world today striving together to fight cancer.

Today especially: We Can, I Can!

Here are a few suggestions:

  • Committing to a lifestyle decision known to mitigate against cancer risk
  • Offering love and hope to a cancer survivor
  • Scheduling a cancer screening
  • Engaging an elected government official, encouraging support to cancer research funding
  • Contributing to NFCR or another reputable cancer-fighting organization associated with World Cancer Day
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Antioxidants: Body Balance

A 2017 epidemiological study published in Frontiers in Oncology suggests that a diet rich in antioxidants like carotenoids and vitamin C can help to prevent breast cancer and lung cancer. Antioxidants have had their fair share of press in recent years and numerous studies have been done trying to pinpoint their perceived benefits. The good news is that those benefits are plentiful and getting enough of these powerhouse elements into one’s diet is easy as their sources are bountiful and delicious. But what are antioxidants? What do they accomplish in our bodies and how do these functions translate into cancer prevention?

That’s Radical

Mention of antioxidants is usually in tandem with the term “free radicals.” Free radicals are highly reactive chemicals that have the potential and ability to harm cells. Their initial purpose is to aid in the metabolic processes, like digestion and converting food into energy. But when too many free radicals are produced, they can become a dangerous enemy.

Left unchecked, free radicals are capable of destroying enzymes, protein molecules and even complete cells. They can multiply by process of a chain reaction the byproducts of which are able to damage cell structures so profoundly that they compromise the immune system and even DNA codes are altered in a process called oxidation where they combine and react chemically with other molecules with which they were never meant to combine. Similar to a rusty nail in the rain, if the body’s cells go unprotected, impending and progressive damage occurs called “oxidative stress.”  Free radicals accelerate the aging process by breaking down collagen, creating an aged appearance in the cells of our skin, eyes, tissue, joints, heart and brain. Since they react with oxygen, they lower the oxygen supply to cells and fuel systemic inflammation leaving our immune systems vulnerable.

What Antioxidants Do

Antioxidants include beta-carotene and other carotenoids such as lycopene, vitamins A, C, and E, and other natural and manufactured substances. They protect cells from damage because they inhibit oxidation in our bodies and are specifically used to counteract the deterioration of stored food products. In short, antioxidants are the anti-free radicals, keeping the latter from having the opportunity to interact with those molecules with which they were never meant to combine. In this way antioxidants help slow the aging process, reduce inflammation and boost our immune systems. All of these benefits lessen the oxidative stress on the body.

Key to Cancer Prevention?

There have been studies which have shown that antioxidant supplements like vitamins A, C, E, folic acid and beta-carotene can help reduce the risk for certain illnesses related to oxidative stress and that these include types of cancer. A 1993 clinical trial from China found what they termed “significantly reduced” stomach cancer mortality rates in those participants who took beta-carotene, vitamin E and selenium over five-years. However, just as readily as there are studies to support the cancer counter activity of antioxidants, you will find studies that prove they can do more harm than good.

Carotenoids, an antioxidant group including beta-carotene, lycopene, lutein and zeaxanthin, are highly bioavailable in many of the foods we eat. Whereas these elements have helped with the lessening of oxidation and address other damaging effects such as blue light’s effect on the eyes, excess consumption or supplementation of these in the systems of those predisposed to or with lung cancer or mesothelioma has shown to yield adverse events.

For better or worse, the hunt for concretized proof continues as to whether or not antioxidants or, more specifically, supplements thereof, can impede the proliferation of cancer cells. Information from recent clinical trials is less clear as, in recent years, large-scale and randomized studies have reached only inconsistent conclusions. What is known is that the intake of foods already rich in antioxidants, consumed according to current dietary recommendations, does suppress free radicals. This suppression keeps the levels of inflammation lower, slows aging in the skin, eyes, tissue, joints, heart and brain, allows the immune system to function more optimally and keeps the body more consistently oxidized and refreshed.

NFCR Tie-in

Former National Foundation for Cancer Research (NFCR)-sponsored researcher, Dr. Helmut Sies, is a physician, scientist and a pioneer in redox biology. He is a leader in the study of carotenoids in plants and how they protect the skin and other organs from free radicals. In 1985, Dr. Sies first coined the term “oxidative stress” in a landmark paper. In 1989, he discovered that lycopene—the carotenoid antioxidant found in tomatoes and carrots—exhibits the highest antioxidant activity and singlet oxygen quenching ability of all dietary carotenoids. Lycopene has strong skin cancer prevention effects. Its antioxidation effects are greatest when tomatoes are processed as in a paste or sauce and combined with oil for the best bioavailability.  Dr. Sies’ research also illustrated how flavonoids (found in cocoa products) can prevent skin damage caused by ultraviolet radiation, improve blood vessel function and reduce cardiovascular risk.

In 2013, Dr. Helmut Sies was awarded the Linus Pauling Institute Prize for Health Research, an honor that recognizes excellence in research relating to the roles of vitamins, essential minerals and phytochemicals in promoting health, and preventing or treating disease.  The National Foundation for Cancer Research is proud to have sponsored the research program of Dr. Sies and his team from 1983 to 2016.


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Cervical Cancer Prevention & Awareness

January is Cervical Cancer Awareness Month, and the National Foundation for Cancer Research (NFCR) joins others in raising awareness of and informing of steps toward preventing the disease—one of the most detectable and treatable cancers, if vigilance is observed.  Here is information and a set of best practices.

Risk Factors: More than 12,000 women in the U.S. will be diagnosed each year with cervical cancer, and nearly 4,000 will die. Ninety-nine percent of the cases are caused by the human papillomavirus (HPV). It is estimated that nearly 70% of cervical cancer cases can be attributed to two types of the virus, HPV-16 and HPV-18, which are often referred to as high-risk types of HPV.

Protect: HPV is contracted by having sexual contact with someone who has the virus, which can cause genital warts or develop into cervical cancer. Other risk factors associated with cervical cancer include having many sexual partners, smoking, taking birth control pills and engaging in early sexual contact.

Prevention: Cervical cancer develops over time and is, therefore, one of the more preventable cancers. Prevention is routine, easily accessible and includes:

  • Having a regular PAP test at your gynecologist’s office. This test should be done every three years from ages 21 to 30. If these test results remain normal throughout a patient’s early years, risk of cervical cancer developing is low.
  • Having an HPV test. This should be done beginning at age 30 or in response to an irregular PAP test.
  • According to the Centers for Disease Control and Prevention (CDC), after age 30, if both the PAP test and HPV test comes back normal, you can ask your doctor to wait 5 years before your next set of tests. But still complete routine yearly check-ups.
  • Getting the HPV vaccine. This is administered in a series of two or three injections between the ages of 9 and 26, and is recommended by the CDC to be administered to both boys and girls at around age 11 or 12. The vaccine prevents the most common forms of HPV attributable to cervical, vulvar or vaginal cancer from developing.
  • Prudently considering birth control usage. Women who use oral birth control pills have an increased risk of developing cervical cancer.  This risk drops significantly and swiftly once the pill is stopped. Taking oral contraceptives for more than a period of five years has been associated with doubling the risk of developing cervical cancer.

Early Detection: If detected early, cervical cancer has an exceptionally high survival rate. The 5-year survival rate for women diagnosed early as with invasive cervical cancer is 91%. And, fortunately, approximately 46% of women with cervical cancer are, indeed, diagnosed early. In cases where cervical cancer has already spread to surrounding tissues, organs and/or lymph nodes, the 5-year survival rate is markedly reduced to 57%.

Symptoms: Any of the following could be symptoms of cervical cancer. Consider reporting these to your doctor, especially if experiencing many of these below signs.

  • Light bleeding or spotting between or just following periods
  • Heavier or longer than normal menstrual bleeding
  • Bleeding after intercourse, douching or a pelvic examination
  • Persistent or unexplained pain in the pelvic and/or back
  • An increase in vaginal discharge
  • Painful sexual intercourse or during urination
  • Bleeding after menopause

Cervical cancer is a beatable foe for those women who adopt a strategy of prevention and early detection. Beyond that, women owe it to themselves to live long, active, healthy lives without the fear of the disease.

The NFCR has long been associated with cervical cancer discoveries. For example, Dr. Harold F. Dvorak, a former NFCR-sponsored scientist and the inaugural winner of the Foundation’s Albert Szent-Györgyi Prize for Progress in Cancer Research, discovered the vascular endothelial cell growth factor (VEGF). Avastin is among the class of VEGF-targeting oncology drugs which have come onto the market since Dr. Dvorak’s seminal discovery in 1983 that cancer cells secrete the protein.

Among recent findings is a summer 2017 report on Phase III clinical trials showing that Avastin and chemotherapy extended survival for women with cervical cancer. The combined therapy had already in 2014 been approved by the Food and Drug Administration to treat patients with persistent, recurrent or metastatic cases of the disease.


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Struggles of Survivorship: Part 2 – Psycho-Social Implications

depressed manThe mental status of cancer survivors can be fragile and destabilized. Psycho-social complications often arise, such as fear of recurrent illness, financial hardship, anxiety, difficulty handling the end of treatment, fatigue, lasting “brain fog”, broken relationships and even post-traumatic stress disorder. In order to navigate this myriad of challenging issues which are just some of the factors that fuel a wide range of depression symptoms, it’s vital that survivors and their circle of support be aware of what the risks are and what to look for.

A Matter of the Mind

 According to a recent cancer survivorship initiative, of those patients who’ve survived cancer, 60% have physical or psychological needs left unmet, 30% have issues maintaining close relationships and 90% suffer some type of financial hardship, just to name a few common challenges. Chief among psycho-social factors include some of the following symptoms which are spread over various cancer types:

  • Fatigue: The toll that cancer and its treatment take on the body leaves many patients complaining of tiredness years after their treatments have ended.
  • “Damocles Syndrome:” Named for the mythological figure who was positioned with a sword dangling over his head, preventing him from enjoying a feast laid before him. Many cancer survivors live overshadowed by the ghost of cancer and thus they retreat from making major life decisions, feeling too frightened to engage and falling into deeper fear and sadness.
  • At the other end of the spectrum is survivor’s guilt. Real bonds are developed in chemotherapy infusion centers and therapy groups, yet the fact sadly remains, not everyone survives. Patients who do can sometimes harbor guilt that they reached remission when others did not, thereby triggering a reversal of their previous “Why me?” at diagnosis to a “Why not me?” now that they’ve survived.
  • Fear of recurrence can be terrifying to survivors. Many patients become paralyzed by fear prior to returning for routine tests or scans fearing their cancer may have returned. These bouts of terror can, in some, lead to avoidance of doctor’s appointments and missing opportunities to thwart any potential metastases. Conversely, patients risk missing receipt of a renewed clean bill of health and the peace of mind such a diagnosis can bring.
  • General depression: Survivors experience depression for diverse reasons. Frequently, over the course of cancer treatments, the bodies they once knew are changed irrevocably and the implications of missing or altered limbs, changes in speech, cognitive ability, sight, hearing or general mobility can dim the good news of remission.

Helping to Heal

Healing is best done before, during and after treatment so that patients can maintain some semblance of equilibrium during their trying set of circumstances. Patients generally tend to under-report symptoms and so having a medical and support team surrounding them throughout the process allows for more timely and consistent detection of abnormal behavior or symptoms of depression.  This team can include family, friends and other trusted loved ones or acquaintances; cancer support groups; health care team members; faith-based groups and clergy; counselors and therapists; and other cancer survivors.


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Struggles of Survivorship: Part 1 – Pain

woman with pain in chestIt is estimated that by the year 2030, deaths due to cancer will drop dramatically and life expectancy after diagnosis will have significantly increased. Whereas this is encouraging news and proof positive that the practice of oncology and the drugs used to treat cancer have become progressively more effective, there are other factors to consider. Increased survival rates translate to more individuals living longer as survivors and the implications thereof. When one survives cancer and, hopefully, receives the seal of remission, the journey does not end; rather patients remain impacted in real and lasting ways. In many cases, cancer survivors suffer chronic pain and it is vital that they plan how best to proceed when pain threatens to overwhelm.

When Pain Remains

For survivors of cancer, pain is not solely a result of tissue damage caused by their disease. It is often the byproduct of treatment-related toxic or trauma-related damage to nerves. This damage results in long-lasting pain or even late-onset neuropathy. Pain is not always immediate and can persist after treatment or may manifest several months or even years after the end of treatment. Quite often this type of chronic pain is one of a number of symptoms including fatigue, anxiety, depression and sleep disturbance and have a negative impact on survivors’ physically and interpersonally.  To combat the effects of pain, the following options represent some of the options to be used in pursuit of relief:

  • Opioids: These drug therapies are certainly an option. However, when applied in the survivorship setting its use is often discouraged due to long-term side effects, including the development of opiate-induced hyperalgesia, as well as the obvious risk of abuse and addiction. 
  • Opioid alternatives: Physicians are now using nonsteroidal anti-inflammatory and other drugs normally used to treat other disorders. These include anticonvulsants to ease neuropathic pain, bisphosphonates for bone pain and sometimes for bone mineral loss, and antidepressants which can help with neuropathic pain, as well.
  • Gene therapy represents a potentially useful, new approach but it requires careful selection of a therapeutic gene which won’t cause any further complications to the survivor.  See your oncologist and ask for the most up-to-date information.
  • Some patients can benefit from secondary treatments, which include nerve blocks, trigger point injections, spinal cord stimulators or implanted intrathecal pumps. These applications go directly to the sources of pain effectively turning them off and bringing relief. Nerve and tissue damage are a possibility, along with infection or bleeding as these are slightly invasive procedures, however, they’ve proved useful in restoring a better quality of life. Consult your physician and have them explain the risks and benefits.
  • For those hoping to avoid a glut of drug therapies, some good results have been seen, for example with back pain at surgical sites, using stretching and training exercises to ease survivors pain along with basic nonsteroidal anti-inflammatory drugs like ibuprofen and an occasional muscle relaxant. Walking regularly paired with some more gentle training exercises appear to, in many cases, ease bone pain.
  • Survivors should be encouraged to actively participate in the plan of care for their pain management, including non-pharmacologic therapies to help them focus on specific and attainable outcomes such as improved functional capacities, restorative sleep, social activities, mood and coping. These may help to reduce pain to a tolerable level and allow patients to feel they have some control over their own destinies. To be in constant pain is a depersonalizing experience, therefore the more patients can have a voice or an avenue for self-determination or actualization, the better off they’ll likely be.

Pain is a difficult, often isolating experience, therefore it is incumbent upon the physician and/or pain management specialist to help the cancer survivor get past the discomfort as best possible.


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Thoughtfully Yours: Holiday Gifts for Cancer Patients

gifts under a Christmas treeChestnuts roasting, songs, laughter and festive family meals are the hallmark of nearly every holiday now at hand. It’s worthwhile to consider viewing this time of year as a chance to purposely choose to celebrate the things we have and the love we share—in spite of cancer.

As you celebrate the Holidays, and if you have a loved one battling cancer, it may be with trepidation that you choose a gift to give. To help assuage your anxiety, take a peek at our list of gifts for those in your life who battle cancer and who embody the spirit of this hopeful season of life, love, family, and possibility.


  • Give! – Recently I had the opportunity to participate in a workplace Secret Santa exchange. As luck would have it, I would play Kris Kringle to a co-worker who is a cancer survivor. Her desire was not for trinkets or perfume, chocolate or coffee. Rather, she asked that I contribute the allotted spending limit to her preferred cancer charity in her name! I did just that, and created a beautiful certificate, had it laminated presented it to her with a big bow. So ask if there is a charitable organization which is important to your loved one to which you can give. It may be the most meaningful gift you can offer.
  • Soothe: Dry skin and lips are a side effect of chemotherapy, so unscented lotions and lip balms are a great choice and will avoid triggering any nausea due to chemotherapy altered senses of smell.
  • Nourish: Rather than offering sweets or candy, offer a gift card to their preferred grocery store so that they can choose the things they know will make healthy, tolerable and comforting meals. As a bonus, offer to shop and cook with them to spend quality time if they would like.
  • Entertain: Under normal circumstances, we all like a good cry, however, those undergoing cancer treatment don’t need their heartstrings tugged upon under already strenuous circumstances. If you choose audiobooks, movies or music, choose those light-hearted themes and storylines that lift spirits and provide entertainment and diversion. Laughter is a powerful medicine.
  • Cultivate: In lieu of fresh flowers or plants, since these may contain spores or develop mold as they die, offer paper origami flowers or even a fresh fruit bouquet which is beautiful, healthy and delicious. 
  • Inspire: Instead of choosing a get-well card, which may only serve to remind the patient of their sickness at a time where they’d prefer to be in a festive mind frame, choose instead a beautiful card with a blank inside. Write an inspirational verse, a favorite quote or just a note of love and support from the heart. Take care to keep the tone of the note uplifting. What a lovely way to give your cancer warrior a reminder of support.
  • Color: Many patients enjoy using adult coloring books filled with beautiful scenes into which they can disappear. A book and a good set of colored pencils can provide much needed diversion all while producing beautiful art.

Gift-giving to the cancer community is about personal touches. It’s important to remember patients can benefit from even the simplest opportunity to let their hearts be light during this season of celebration. With a little creativity and a lot of love, anyone can be part of making this special time of year festive, full of laughter and joy for our loved ones battling cancer.  


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Pancreatic Cancer: What You Need to Know

We will today take an in-depth look at pancreatic cancer.

The Who

According to Johns Hopkins University, this year, “an estimated 53,070 adults (27,670 men and 25,400 women) in the United States will be diagnosed with pancreatic cancer. It is estimated that 41,780 deaths (21,450 men and 20,330 women) from this disease will occur.” Those most profoundly at risk for pancreatic cancer are those over the age of 50, making up almost 80% of those diagnosed. Ethnicity is also a factor. Persons of African-American descent are more likely to be diagnosed. This tendency is largely attributed to higher rates of smoking, diabetes, and obesity in this demographic, and because those who smoke or have diabetes are at increased risk for pancreatic cancer overall. Gene mutations like BRCA-2 or those from Ashkenazi Jewish heritage carry higher risks as well. In the past, men were more likely than women to develop pancreatic cancer, as this was linked most closely to tobacco use, however, as the usage gap has waned, so too has the proportion of diagnoses. At present, pancreatic cancer is the fourth largest cause of death for both men and women in the U.S.

Early Detection Not Prioritized

Presently there are still no reliable testing mechanisms for early detection of this disease. On the whole, government funding of research for this testing is very low, at around 2 percent of National Cancer Institute funding. The Pancreatic Cancer Action Network (PANCAN) terms this disparity “a trickle of federal funding for a river of need,” and offers a comprehensive look at why survival rates have stayed stagnant in the single digits for so long. In comparison to some other cancers, the average dollar amount of basic research grants for pancreatic cancer was found by the Network to be 18 to 29 percent less than those for lung, colon, breast, and prostate cancers. If caught early, when tumors can be successfully removed, the 5-year survival rate is 27%. However, if cancer cells have metastasized to surrounding tissues, organs or infiltrated the lymphatic system, the 5-year survival rate drastically decreases to a mere 11%. If the cancer has spread to a distant part of the body, the 1-year survival rate decreases to 15% and the 5-year survival rate dwindles to a grim 2%.

Any Good News?

Thankfully, progress is being made. Oncologists today are much more familiar with the types of changes in pancreatic cell DNA that typically signal or enable the growth of cancer. Research is being aggressively pursued to develop new tests to detect abnormalities with greater accuracy and efficiency. Genetic testing is also available to those who may be genetically predisposed to pancreatic cancer. Currently, the genetic marker CA19-9 is the best available tumor marker, but is only 80% accurate in identifying patients with pancreatic cancer. Since CA19-9 is not ultra-precise in its ability to identify early and potentially curable cases of pancreatic cancer, several other markers have been studied, including SPAN-1, CA-50, DUPAN-2, elastase-1, tissue polypeptide antigen and tissue polypeptide-specific antigen. But these markers, though helpful, have not performed nearly as well as the CA19-9.

On the Horizon

Dr. Daniel Von Hoff, a National Foundation for Cancer Research-sponsored researcher, has had a major role in the development of two recent FDA-approved regimens for pancreatic cancer: a combination of nab-paclitaxel and gemcitabine as a 1st line therapy, and a combination of liposomal irinotecan and 5-FU for patients who are refractory to gemcitabine. Dr. Von Hoff and his team are also working tirelessly to develop mechanisms to attack and defeat so-called “undruggable” targets within tumors. And they are also using a single cell-based sequencing technique to quantitatively determine cell groups and their signaling pathways in the stroma or ‘scar tissue’ surrounding patient’s pancreatic tumors—largely thought to determine the aggressiveness of the cancer and its drug resistance. Patients will be treated in a Phase I clinical trial with therapies that may be tailored to their tumor based on the results of single-cell sequencing.



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