Do You Have A Survivorship Care Plan?

When most breast cancer patients finish treatment, docs set up a schedule of regular visits for mammograms, blood work, and general physical monitoring.  In the best cases, they also help you develop a survivorship plan (SCP) to help navigate life as a whole after cancer.  The report, From Cancer Patient to Cancer Survivor: Lost in Translation, written in 2005, offers a blueprint for this transitional period.  In the introduction, the authors note:

Despite the increase in survivors...primary care physicians and other health care providers often are not extremely familiar with the consequences of cancer, and seldom receive explicit guidance from oncologists. Furthermore, the lack of clear evidence for what constitutes best practices in caring for patients with a history of cancer contributes to wide variation in care.

The report's recommendations acknowledge the the period after cancer treatment  should be seen as a "distinct phase of cancer care."   This means going beyond tests and helping patients deal with the fact that they have had cancer and are likely terrified that it will return.  Cancer care may last a lifetime.


Access to affordable health care is a constant in the group's recommendations, which is especially apt as we await the  U.S. Supreme Court's ruling on the Affordable Care Act.  If the act is struck down, require Congress to implement some of its aspects, such as allowing covering for people with preexisting conditions and eliminating lifetime caps on coverage.  Those who have gone through cancer treatment know that good healthcare is a lifesaver.  And the need for care does not stop when treatment ends—nor does the cost get any more reasonable.

Summer 2012: My Life Right Now

We drive up a rutted mountain road, going 15 miles an hour, feeling we are speeding as we dodge rocks and pines and locust trees full of pink blossoms. The road follows a small creek that rushes down the mountain, sliding over rocky beds and through lush grass. We stop to say hello to our nearest neighbors, two miles away.  And then we head here, to our wee cabin, settled in a mountain valley that ends in a 12,000-foot peak. 

It is our little piece of paradise.  From the cabin, we see mountains, trees, and meadow—not one house, not a sign of another human being.  My brother lives a quarter of a mile past us, but we cannot see his house, although we occasionally hear his dogs as they send bears up the trees and scare turkeys off into the meadow. I like the dogs and I love having my brother this close.

Our cabin is 480 square feet, one cozy room plus bath   The kitchen consists of antique cabinets and a skirted sink, something Laura Ingalls might relate to.  Except for the propane refrigerator and stove.

Our bedroom is tucked into a corner, with a four-poster walnut bed I bought at the Salvation Army in 1970, a few months before we were married—and it was an antique then.  Our living room and dining room are a hodgepodge of furniture from antique and junk shops and castoffs from our Iowa house and my parents’ home.  A wooden camping cooler my dad made is our coffee table and the desk is from our son’s room.  He refinished it sometime in the 80s.

We start the day with hot tea on the deck, then a hike, then breakfast on the deck.  Then Joe goes off to putter in the yard or cut down trees, or work in his little shop (aka shed) and I go inside to write or to putz around the cabin, rearranging this, moving that. At night, I have a hot magnesium drink as a nightcap and sit on the deck listening to the creek and watching the stars—you really can see billions and billions from here.

We have no light pollution because we have no lights. We are off the grid here, with solar power, propane gas, and well water.  Oh, and a compost toilet, which is far less nasty than you might think.  In fact, it is quite efficient and has no smell (as long as the fan is working).  Every week, though, we have to dump its drum, which makes our stay in paradise seem a little less idyllic.

Also on the downside is our Internet connection, which is dial-up and simply does not work.   Last year, satellite service came to the mountain but we have not yet signed on—we are waiting to see how it works, and reluctant to sign onto an expensive monthly contract for a place we live in for slightly more than three months. 

So the frequency of my blog posts drops every summer, as I simply don’t have the technology to effectively connect, and I have to wait until I go to town to do anything of any consequence online.  And my Facebook status updates get bunched together—several on one day, none for the rest of the week—for the same reason.

This is a beautiful place and it is ideal writing territory, so I am starting to work on my next book.  This location is not so great for communicating with the frequency with which we are all accustomed.  So my apologies for posting in bits and spurts.  Know that you are all on my mind as I relax and recharge.  And if you are heading north up I-25 between Trinidad and Walsenburg, Colorado, look to your left at the mountain looming there.  I am in its foothills.  Maybe writing.  Maybe staring at a pile of rocks called the East Spanish Peak.  

PHOTO:   This guy walked through the meadow across from out cabin the other day.  My husband Joe caught him, plus some early-morning rays.   NOTE:  And by "caught him" I meant on the camera.

More targeted therapy potential for TNBC: Protein RSK2

NEWS RELEASE

The Canadian Breast Cancer Foundation – BC/Yukon Region (CBCF) is thrilled to announce a game-changing discovery in triple-negative breast cancer (TNBC). This breakthrough points to one of the first personalized therapies for the treatment of TNBC and reports that RSK inhibition has the potential to block TNBC recurrence.

The breakthrough research of Canadian Breast Cancer Foundation – BC/Yukon Region’s (CBCF) Doctoral Breast Cancer Research Fellows Kristen Reipas and Dr. Anna Stratford will today be published in the highly recognized medical journal, Stem Cells.

Supported by University of British Columbia (UBC) Associate Professor in the Faculty of Medicine, Dr. Sandra Dunn, trainees Ms. Reipas and Dr. Stratford have identified a protein critical to the survival of triple-negative breast cancer (TNBC) patients. This breakthrough research has the potential to cure TNBC by targeting a protein called RSK2, which eliminates TNBC cells completely. The study, published June 5, 2012 in Stem Cells medical journal, reports that RSK2 inhibitors have the ability to kill all of the cells including cancer stem cells which give rise to cancer recurrence. This cutting-edge discovery will potentially personalize the treatment of TNBC on an international scale.

"RSK2 inhibition provides a novel therapeutic avenue for TNBC and holds the promise of being one of the first targeted therapies for this challenging form of breast cancer," says Dr. Sandra Dunn, UBC.

TNBC is diagnosed in approximately 400,000 women worldwide and is considered the most difficult breast cancer subtype to treat due to lack of effective therapies. Dr. Dunn’s laboratory at the Child & Family Research Institute at BC Children’s Hospital led the project in collaboration with scientists from Breakthrough Breast Cancer UK and the University of Aukland NZ.

This project began four years ago when UBC Post Doctorate Fellow Dr. Stratford of the Child & Family Research Institute was awarded $214,000 by CBCF BC/Yukon to support her research on this project entitled “The regulation of the Y-box binding protein-1 (YB-1) by p90 ribosomal S6 kinase (RSK) in triple-negative breast cancer.”

In addition, a doctoral candidate in the Experimental Medicine Program at UBC, Kristen Reipas was awarded $35,000 in support of this research study, entitled “Targeting Y-box binding protein-1 eliminates tumor-initiating cells and reduces relapse in triple-negative breast cancer.”

The BC/Yukon Region of CBCF is proud to award the Breast Cancer Research Postgraduate Fellowships every year to the most qualified breast cancer research projects across the province. These awards are intended for qualified health care professionals, MD graduates or recent PhD graduates to provide assistance in launching a career as independent, social, clinical or basic science investigator in breast cancer research.

Canadian Breast Cancer Foundation – BC/Yukon Region

The BC/Yukon Region of CBCF was established in 1992 to make a difference in breast cancer research and breast health for the BC population. Every year CBCF, along with its donors, sponsors and partners, raises funds to support unique and innovative initiatives in prevention, early detection, treatment, research and emerging issues in the health care workforce.

Will biomarkers help ID women with TNBC who benefit from taxanes?

NEWS RELEASE

CHICAGO, June 2, 2012 /PRNewswire via COMTEX/ -- TLE3 Biomarker Over-expressed in HER2-positive, Hormone Receptor-positive, and Triple-negative Breast Cancers --

EGFR status May Facilitate Therapeutic Decision-making in Head and Neck Cancer --

In a poster presentation today, Gargi Basu, Ph.D., and colleagues at Caris Life Sciences, presented results from the first study providing a comprehensive review of transducin-like enhancer of split 3 (TLE3) expression in breast cancer subtypes. They described TLE3 as a transcriptional repressor that influences tumor growth and microtubule stability; its expression in epithelial tumor cells may reflect that these cells require the expression of TL3 to maintain their undifferentiated state. The expression of TLE3 is also associated with response to taxane therapy in patients with breast cancer.

Working with tumor cells collected from 978 breast cancer patients, the investigators employed two different technological platforms used in Caris Target Now -immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) - to gather information on four biomarkers: TLE3 (M-201), ER(1D5), PR(PgR636), and human epidermal growth factor receptor 2 (HER2)/neu (Polyclonal). IHC analysis of the four biomarkers was conducted at the protein level, and FISH was used to determine amplification of HER2/neu. Samples were then sub-classified as hormone receptor (HR)-positive (i.e., estrogen receptor [ER]-positive and/or progesterone receptor [PR]- positive), HER2-positive (either at the protein level or amplified by FISH), or triple-negative (i.e., lacking in ER, PR, and HER2/neu).

Overall, 351 (36%) of the patients were HR-positive, 150 (15%) were HER2-positive, and 477 (49%) were triple-negative. TLE3 was expressed in 82% of the HR-positive patients, 73% of the HER2-positive patients, and 61% of the triple-negative patients. To further investigate TLE3 expression in the patient subtypes, Dr. Basu and colleagues performed a pairwise Fisher's Exact Test between the various pairs; this analysis revealed that for all pairs, the ratios of TLE3-expressing individuals were significantly different. The largest difference was observed between the HR-positives and the triple-negatives (82% vs. 61%, respectively; p=2.509e-10), suggesting that the HR-positives have a higher likelihood of responding to taxane therapy. The HER2-positives, at 73%, had a ratio that was significantly higher than the triple-negatives and significantly lower than the HR-positives.

"We found TLE3 to be over-expressed in the majority of patients with HER2-positive and hormone receptor-positive breast cancer," Dr. Basu observed. "Interestingly, the comparatively low over-expression of TLE3 in the triple-negative subtype makes it especially important to identify those patients in this group who are most likely to respond to taxane therapy. If physicians are provided with such knowledge prior to starting therapy, their chances of selecting appropriate regimens for patients with these subtypes of breast cancer may be greatly improved."

Micro RNAs may explain why African-Amercan and Caucasian Women React Differently to the Same Treatment

NEW RELEASE

Chicago, IL (PRWEB) June 02, 2012

Researchers and doctors at the North Shore-LIJ Health System and the Feinstein Institute for Medical Research have discovered a potential explanation for why breast cancer is not experienced the same way with African American and Caucasian patients. This data will be presented at the 2012 American Society of Clinical Oncology (ASCO) Annual Meeting to be held from Friday through Tuesday (June 1-5) in Chicago, IL.

Breast cancer is more common in Caucasian women than in African American women; however, African American women experience a more aggressive form of breast cancer that occurs almost a decade earlier than Caucasian women. Because of this, African American women have a lower breast cancer survival rate than Caucasian women. To explore the reasons why, researchers and doctors at the North Shore-LIJ Health System and the Feinstein Institute for Medical Research conducted a study to determine 1) why the expression of a genetic marker embedded in deoxyribonucleic acid (DNA), called microRNA, differs between African American and Caucasian women, and 2) if variation in microRNAs may explain the observed survival difference between African American and Caucasian women.

In this study, microRNA profiles from the blood of 32 female patients were collected before removal of breast tumors. The mean age of the patients was 50 years, ranging from age 31 to 68, and 10 of the patients had stage III triple-negative breast cancer (five were African American and five were Caucasian), 10 patients had stage III estrogen-receptor or progesterone-receptor positive breast cancer (five were African American and five were Caucasian), and 12 patients were controls (six were African American and six were Caucasian). Triple-negative breast cancer refers to any breast cancer that does not express three receptors known to advance most breast cancers; estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2 (HER2). Although triple-negative breast cancer is estrogen-receptor negative, progesterone-receptor negative and HER2 negative, and the most successful treatments for breast cancer target these receptors, triple-negative breast cancer typically responds to chemotherapy.

The study found that, 1) female Caucasian patients who had triple-negative breast cancer overexpressed 20 microRNAs (15 times higher than the controls), and none of the microRNAs these patients had were found in any of the African American patients, 2) female African American breast cancer patients overexpressed only six microRNAs (15 times higher than the controls), and none of these microRNAs were detected in Caucasian patients who had triple-negative breast cancer, and 3) four microRNAs in African American patients and eight microRNAs in Caucasian patients were not previously reported in association with breast cancer, which suggests that they may be connected to how the patient reacts to cancer.

“The striking difference in the patterns of microRNA expression between African American and Caucasian breast cancer patients may provide insight into answering why, when receiving similar treatments, outcomes are different between African Americans and Caucasians,” said Iuliana Shapira, MD, director of the Cancer Genetics Program at the North Shore-LIJ Health System’s Monter Cancer Center. “Breast cancer patients who have the most devastating outcome may carry the microRNAs that promote cancer. What we saw in this study is that Caucasian women may carry microRNAs that protect against cancer while African American women do not express those microRNAs. The lack of expressing these microRNAs in African Americans could be the cause of poor outcomes seen in these women. Methods to increase microRNAs in the blood before surgery for cancer, such as giving chemotherapy before surgery for cancer, may improve survival rates in African American women with triple-negative breast cancer.”

About The Feinstein Institute for Medical Research
Headquartered in Manhasset, NY, The Feinstein Institute for Medical Research is home to international scientific leaders in cancer research, Parkinson's disease, Alzheimer’s disease, psychiatric disorders, rheumatoid arthritis, lupus, sepsis, inflammatory bowel disease, human genetics, pulmonary hypertension, leukemia, neuroimmunology, and medicinal chemistry. The Feinstein Institute, part of the North Shore-LIJ Health System, ranks in the top 5th percentile of all National Institutes of Health grants awarded to research centers. For more information visithttp://www.FeinsteinInstitute.org.

Seeing Hope for Patients with Metastatic Breast Cancer

Medpage Today published an interview with  Dr. Carey Anders of the University of North Carolina in Chapel Hill.  Dr. Anders has written a great deal about triple negative breast cancer.  In this piece, she talks about targeted therapies for TNBC and her hope for the future of treatment for metastatic breast cancer.  My favorite part of the interview comes at the end, when she talks about being an oncologist and how she sees her relationship with her patients: 

I'm always struck when people outside of the hospital or even within the hospital find out that I'm an oncologist. They kind of get a sad look on their face and say, "Oh, that must be so hard," and I promptly reply that it's a very positive profession. On most days -- of course, we have our sad days -- but on most days it's a very hopeful profession and a happy profession. We have such wonderful relationships with our patients and families and are working with them in a very poignant time in their life.

I'm very enthusiastic about what we have on the horizon in breast cancer. We're learning so much more in the laboratory about what makes the cancer cells work. And over time that will translate to targeted therapies with the goal of really helping prolong survival, but not making patients experience the side effects in the process. So I'm very enthusiastic.

You can read the transcript or watch the video at Medpage Today.