Breast cancer patients can use antiperspirants during radiotherapy

Women undergoing daily radiation therapy for breast cancer are commonly told they should not use antiperspirant for fear that it could cause greater radiation damage to the skin, but a new study from the Perelman School of Medicine at the University of Pennsylvania shows that advice is not based on sound science.

While they found that about eight out of every 10 patients reported their doctors told them not to use antiperspirants and roughly the same number of doctors say they routinely make that recommendation, their study also showed there was no difference in the radiation skin dose absorbed by these patients with or without these deodorants. They published their findings in Radiotherapy and Oncology this month.

Going without antiperspirants entirely for a 3-6 week course of radiotherapy can have a negative impact on a patient’s quality-of-life,” said the study’s lead author Brian C. Baumann, MD, who recently completed his residency in Radiation Oncology at Penn and is a member of Penn’s Leonard Davis Institute of Health Economics. He is also currently an assistant professor of Radiation Oncology at Washington University in St. Louis. “Our study suggests that antiperspirants can be safely used during breast radiotherapy without risking increased skin side effects.”

The study tackled two key areas. First, it established that it’s still common practice for physicians to advise breast cancer patients to avoid antiperspirants during radiotherapy. Second, it debunked the myth that the use of these antiperspirants increases the amount of radiation the skin receives, thus causing more damage to the skin.

For the first part of the study, researchers utilized OncoLink, an online cancer service dedicated to patient and provider education that is run by Penn’s Radiation Oncology unit. They developed a survey to find out what percentage of providers still tell their patients not to use antiperspirants, and what percentage of patients say they received that advice. Of the 105 doctors and nurses who responded and said they regularly manage radiation dermatitis for their patients, 86 of them (82 percent) said they regularly tell patients not to use antiperspirants during their course of radiation treatment. On the patient side, 92 women responded who said they have received radiotherapy for breast cancer, 73 of whom (79 percent) say their healthcare providers advised them to avoid using deodorant for the duration of their treatment.

While the sample size of the survey is relatively small, the percentage of patients who received the advice to avoid antiperspirants and the percentage of providers who routinely offer this advice was very similar. We cannot make any conclusions about the exact prevalence of this recommendation, but we think the results strongly suggest that the recommendation remains popular,” Baumann said.

The advice persists despite a lack of scientific evidence. Trials have not shown antiperspirant use leads to higher skin side effects during breast radiation therapy, but those trials do not appear to have changed clinical practice. Baumann says that shows providers either do not know about these studies or they are skeptical of the results.

There can be a discrepancy between the ways we measure skin toxicity in clinical trials versus the problems patients report to their healthcare providers,” Baumann said. “The current skin toxicity scoring system has important limitations. It does not take pain or itching into account, for example, so it is possible that the studies may have missed a clinically meaningful effect because of the limitations of the measurement tool.” Researchers addressed that discrepancy in the second part of this study as they sought to find out if antiperspirants really do increase the surface dose of radiation on the skin. For this portion, researchers used optically stimulated luminescent dosimeters (OSLDs) – a common device for measuring the amount of surface radiation absorbed with each dose. They used three squares of paper: one with nothing on it, one with a thick coating of standard antiperspirant, and one with a thick coating of extra-strength antiperspirant. They placed the squares of paper in the beam’s path and measured the absorbed radiation dose with OSLDs.

We found no significant difference in surface dose with or without antiperspirant,” Baumann said.
Baumann’s team also moved the beam to four different angles, but found it did not lead to different results.
These antiperspirants also contain aluminum zirconium tetrachlorohydrex glycine, a common metal found in antiperspirants. The standard deodorants contain 15 percent of it, while the extra strength contains 25 percent.

We specifically wanted to know if the radiation could hit that metal and scatter, sending radiation off target and into other, healthy parts of the skin, but any difference in surface dose we found was within the margin of error,” Baumann said.

This study shows providers should be more liberal in letting patients use antiperspirants during radiation treatment, which may improve patient quality-of-life.”

Baumann et al. Avoiding antiperspirants during breast radiation therapy: Myth or sound advice? Radiother Oncol. 2017;S0167-8140(17)30432-2. doi: 10.1016/j.radonc.2017.06.021 [Abstract]

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Young adult cancer survivors struggle to get back to normal

Cancer survivors often talk about wanting to get back to normal, but a new study indicates many young adults who survived the disease struggle with attaining this goal two years after their initial diagnosis.

The longitudinal study is among the first seeking to understand the social functioning among adolescents and young adults who have had cancer.

The research is important to help these young survivors better reintegrate into society,” said study co-author Brad Zebrack, a professor of social work at the University of Michigan.

Researchers collected data from 215 cancer patients aged 14 to 39 years who visited five medical facilities nationwide between March 2008 and April 2010. Patients completed a self-report measure of social functioning within the first four months of diagnosis, and again at 12 months and 24 months later. They also answered questions about their social interactions with family and friends, psychological needs and mental health.

Thirty-two percent of the survivors reported consistently low social functioning over time – and some had been off treatment. Zebrack and colleagues say this could stem from the transition from treatment to off-treatment survivorship, a time fraught with new challenges to a cancer survivor, including the negative impact on finances, body image, work plans, relationship with spouse/significant other and plans for having children.

In addition, those reporting low scores on social functioning also had high levels of distress, possibly reflecting an impaired ability to reintegrate into social activities due to the effects of cancer, the study showed.

This finding highlights the need to screen, identify and respond to the needs of high-risk adult-young adolescent patients at the time of diagnosis and then monitor them over time,” said Zebrack, an expert with the U-M Institute for Healthcare Policy & Innovation. “They are likely the ones most in need of help in managing work, school and potentially problematic relationships with family members and friends.”

Current research indicates that young adult cancer patients benefit from support programs that put them in touch with other young adult cancer survivors.

They do not find being in a support group with ‘people my grandma’s age’ to be all that helpful,” said Olga Husson, the study’s lead author and a researcher at Radboud University Medical Center in the Netherlands.

The study’s other authors were Christine Aguilar of the University of Texas Health Science Center, Brandon Hayes-Lattin of the Oregon Health and Science University and Steve Cole of HopeLab Foundation.

The study appears online in the journal Cancer.

Husson et al. Cancer in adolescents and young adults: Who remains at risk of poor social functioning over time? Cancer. 2017;123(14):2743-2751. doi: 10.1002/cncr.30656 [Abstract]

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A Survivor’s Guide to Managing the Side Effects of Mesothelioma

When a patient is diagnosed with cancer, he or she must deal with a lot of variables. Choosing a treatment type, and committing to its completion is a job in itself. The treatment often has side effects that patients must deal with on top of the cancer. Doctors and researchers are finding new ways to treat the health effects as successful treatments continue to rise in number. Patients have many medical and palliative choices in today’s care environment.

Try Brain Puzzles

One of the first tips for coping is maintaining a mental balance. Chemotherapy and associated treatments leave a fuzzy mind behind. Patients might forget about things that are normally simple in nature. Use puzzles to keep up with a clear mind. By exercising the brain, these mental side effects can be fought off. As the patient moves forward with other treatments, the mind can still use the puzzles as a way to jog the brain and create new, neural pathways.

Managing Immunotherapy with Medications

According to the U.S. News and World Report, immunotherapy is the wave of the future. By using the body’s own resources, cancer cells can be killed off in record numbers. An unwanted effect from this cancer treatment, however, is inflammation. This reaction is normal. It can get out of hand with immunotherapy pills so doctors normally suggest counter solutions in the form of other medications.

Increase your Calorie Count

When patients have mesothelioma and treatment is ongoing, they may experience a lack of appetite. The American Lung Association suggests that excess calories in the form of good fats must be added to any consumed foods. Drizzle olive oil on a meal so that the patient consumes enough calories to avoid weight loss. Good fats improve the body’s cardiovascular system with cholesterol-fighting power. The extra calories can be used to maintain a healthy weight as treatment continues.

Avoid Infections with Hygienic Solutions

Sores and infections are common during any cancer treatment. Patients must take care of their health as much as possible. Use baking soda every day and rinse out the mouth with some water. This substance fights off germs at the molecular level. Aside from this suggestion, patients should wash their hands and keep their feet covered when they are outdoors. Any infections will impede the success of a medical program.

Breathe Deeply

Mesothelioma patients deal with lung-tissue problems so basic breathing can be problematic. Patients should try to breathe in deeply with a relaxed tone to their muscles. Doctors might suggest breathing techniques that are specific to a patient’s situation. Solid breathing will improve the lung’s flexibility as mesothelioma is being eradicated from the patients’ bodies.

The symptoms of cancer will vary between patients. If a patient discovers an unusual issue, speaking to the doctor must be the first step. There might be a reasonable answer for the issue, or further evaluations may be in order. Prioritize every aspect of a healthy lifestyle so that cancer treatment is not a future option.

Virgil Anderson

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Red onions pack a cancer-fighting punch, study reveals

The next time you walk down the produce aisle of your grocery store, you may want to reach for red onions if you are looking to fight off cancer. In the first study to examine how effective Ontario-grown onions are at killing cancer cells, University of Guelph researchers have found that not all onions are created equal.

Engineering professor Suresh Neethirajan and PhD student Abdulmonem Murayyan tested five onion types grown in Ontario and discovered the Ruby Ring onion variety came out on top. Onions as a superfood are still not well known. But they contain one of the highest concentrations of quercetin, a type of flavonoid, and Ontario onions boasts particularly high levels of the compound compared to some parts of the world.

The Guelph study revealed that the red onion not only has high levels of quercetin, but also high amounts of anthocyanin, which enriches the scavenging properties of quercetin molecules, said Murayyan, study’s lead author.

Anthocyanin is instrumental in providing colour to fruits and vegetables so it makes sense that the red onions, which are darkest in colour, would have the most cancer-fighting power.

Published recently in Food Research International, the study involved placing colon cancer cells in direct contact with quercetin extracted from the five different onion varieties.

We found onions are excellent at killing cancer cells,” said Murayyan. “Onions activate pathways that encourage cancer cells to undergo cell death. They promote an unfavourable environment for cancer cells and they disrupt communication between cancer cells, which inhibits growth.”

The researchers have also recently determined onions are effective at killing breast cancer cells. “The next step will be to test the vegetable’s cancer-fighting powers in human trials,” said Murayyan.

These findings follow a recent study by the researchers on new extraction technique that eliminates the use of chemicals, making the quercetin found in onions more suitable for consumption. Other extraction methods use solvents that can leave a toxic residue which is then ingested in food, said Neethirajan.

This new method that we tested to be effective only uses super-heated water in a pressurized container,” he said. “Developing a chemical-free extraction method is important because it means we can use onion’s cancer-fighting properties in nutraceuticals and in pill form.”

While we can currently include this superfood in salads and on burgers as a preventative measure, the researchers expect onion extract will eventually be added to food products such as juice or baked goods and be sold in pill form as a type of natural cancer treatment.

Murayyan et al. Antiproliferative activity of Ontario grown onions against colorectal adenocarcinoma cells. Food Res Int. 2017;96:12-18. doi: 10.1016/j.foodres.2017.03.017 [Abstract]

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Balance, gait negatively impacted after chemotherapy treatment

A single chemotherapy treatment can result in a significant negative impact on walking gait and balance, putting patients at an increasing risk for falls, according to a new study involving breast cancer patients conducted by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James). Up to 60 percent of patients experience chemotherapy-induced peripheral neuropathy (CIPN), nerve damage that impacts feeling in the hands or feet; however, when and to what extent this damage impacts functional abilities has been largely unknown.

This new study is the first to objectively measure the functional abilities of cancer patients during and after taxane-based chemotherapy. Researchers followed 33 patients with stage I-III breast cancer, assessing functional performance (standing balance and gait) and patient-reported outcomes at five timepoints spanning before treatment began up to three months post-treatment completion.

Researchers observed a 28 percent increase in side-to-side sway (medial-lateral) after just one chemotherapy treatment. That increased to 48 percent with cumulative chemotherapy exposure. Patients also demonstrated a 5 percent reduction in walking speed after three cycles of chemotherapy.

This is not simply a quality of life concern – CIPN can impact a patient’s ability to receive treatment at all, limiting the potential for a cure. For patients who have great difficulty with neuropathy, we often have to modify their treatment regimen to make it tolerable – sometimes the therapy has to be ceased entirely,” says Maryam Lustberg, MD, MPH, senior author of the study and director of breast cancer survivorship services at the OSUCCC – James. “We need to make these treatments more tolerable to patients so they can get the full benefit of the treatments.”

Lustberg and her colleagues report that taxane exposure is also associated with worsened sensory symptoms and poorer postural control. There was also an association between patients’ balance and self-reported sensory symptoms.

Significant Clinical Problem

CIPN leads to pain, falls and difficulty walking as well as performing activities of daily living. Although symptoms can improve with time, up to 30 percent of patients have persistent symptoms that last at least six months.

Researchers say the study provides initial support for the feasibility and potential utility of implementing objective measures of physical function into the oncology clinic.

Cancer survivors are at a significant increased risk for falls, and the incidence rate of falling after chemotherapy is a serious concern for survivors’ long-term quality of life,” adds Lustberg. “Our study provides new insights on how taxane-based chemotherapy can impact fundamental aspects of patient function. These new insights can help us develop better strategies to help patients combat these challenges and, in some cases, choose a different therapy to treat the disease but with reduced side effects.”

The OSUCCC – James is expanding this research to assess CIPN in colorectal cancer patients receiving taxane-based chemotherapy.

Integrating Gait, Balance Testing Into Clinical Practice

Study co-author Ajit Chaudhari, PhD, associate professor of physical therapy, orthopedics, mechanical engineering and biomedical engineering at The Ohio State University Wexner Medical Center says the study was an important first step in achieving better long-term outcomes after cancer and provides a new tool for integrating gait and balance screening into clinical care.

We have created an easy-to-use clinical tool that has strong potential to quickly help clinicians identify patients – very early on – who are developing a chemotherapy reaction that impacts gait and balance,” says Chaudhari. “It’s no longer good enough for someone to just ‘survive’ cancer because many patients have decades of life ahead of them. It is critical to do everything we can to make the rest of their lives as productive and enjoyable as they want it to be.

Monfort et al. Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients. Breast Cancer Res Treat. 2017; doi: 10.1007/s10549-017-4230-8 [Abstract]

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Are wealthier people more likely to receive a diagnosis of cancer?

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CREDIT The Dartmouth Institute

Do wealthier people receive too much medical care? In a Perspective article recently published in the New England Journal of Medicine, H. Gilbert Welch, MD, and Elliott Fisher, MD, of The Dartmouth Institute for Health Policy and Clinical Practice examine the association between income level and cancer diagnosis.

Using data from the Surveillance, Epidemiology, and End Results (SEER) program, Welch and Fisher examined incidence and mortality trends for four types of cancers: breast cancer, prostate cancer, thyroid cancer and melanoma. They chose these specific cancers because the likelihood of diagnosis is sensitive to the intensity with which physicians look for these cancers – the combined effect of factors, including the frequency of screening and diagnostic exams, the ability of exams to detect small irregularities, and the threshold used to label results as abnormal. As Welch and Fisher note, these factors can have a dramatic effect on the apparent amount of disease. In simple terms, the harder doctors look for these cancers, the more they find.

Using 2000 U.S. census data, Welch and Fisher compared incidence and mortality of the four cancers in high- vs. low-income counties (median incomes greater than $75,000 and less than $40,000, respectively). Among their findings:

  • High-income counties have recorded a much greater increase in the incidence of these four cancers than low-income counties.
  • The combined death rate from the four cancers is similar in high- and low-income counties, which Welch and Fisher say suggests that the underlying burden of disease is actually similar in high- and low-income counties.
  • Mortality from these cancers hasn’t been increasing (as one might expect given the increase in diagnosis), but rather decreasing-due largely to improved treatments for breast and prostate cancer.

What accounts for the higher incidence of cancer in high-income counties? Welch and Fisher say there could be several contributing factors: affluent people may expect and demand more testing. Also, health systems serving relatively wealthy and healthy populations may see offering more testing “as a good way to produce more patients and increase business.”

If we want to move toward more sustainable and affordable health care systems, we’re going to have to understand what’s driving the overutilization of care and develop better ways to address it,” Fisher said.

Among the remedies Welch and Fisher suggest are moving toward alternative payment models, such as accountable care organizations, that move us away from the traditional fee-for-service model; reducing, or at least disclosing, financial conflicts of interest (such as doctors who receive payments from breast and prostate care centers); and promoting a more nuanced and balanced view of medical care.”Doctors and other health care professionals tend to overstate the role of medical testing in promoting health – particularly in people who aren’t sick,” Welch said. “A healthy diet, regular exercise, and a sense of purpose are very often the best tools people, at every income level, have to maintain good health.

Welch and Fisher. Income and Cancer Overdiagnosis – When Too Much Care Is Harmful. N Engl J Med. 2017;376(23):2208-2209. doi: 10.1056/NEJMp1615069 [Abstract]

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Using a genetic signature to overcome chemotherapy-resistant lung cancer

Patients with non-small cell lung cancer (NSCLC) often respond to standard chemotherapy, only to develop drug resistance later, and with fatal consequences. But what if doctors could identify those at greatest risk of relapse and provide a therapy to overcome or avoid it?

Researchers at UT Southwestern Medical Center believe they have an answer: a 35-gene signature that identifies tumor cells most likely to develop resistance to treatment. The study, published today in Cell Reports, points to a new pharmacologic approach to target chemo-resistant lung cancer and even prevent development of such resistance in the first place.

Cancer relapse after chemotherapy poses a major obstacle to treating lung cancer, and resistance to chemotherapy is a big cause of that treatment failure,” said study co-author Dr. John Minna, a Professor and Director of in the Hamon Center for Therapeutic Oncology Research at UT Southwestern. “These findings provide new insights into why resistance develops and how to overcome it.

Dr. Minna, with additional appointments in Pharmacology and Internal Medicine, also holds the Sarah M. and Charles E. Seay Distinguished Chair in Cancer Research and the Max L. Thomas Distinguished Chair in Molecular Pulmonary Oncology. Investigators studied mouse and cellular models of NSCLC, a type of lung cancer that the American Cancer Society estimates accounts for 85 percent of all lung cancer cases in the United States.

Previous studies have shown that up to 70 percent of those cancers develop resistance to standard therapy, such as the platinum-taxane two-drug combo that is often given,” said study senior author Dr. Elisabeth D. Martinez, Assistant Professor of Pharmacology and in the Hamon Center. Both she and Dr. Minna are also members of UTSW’s Harold C. Simmons Comprehensive Cancer Center.

Using long-term on/off drug cycles, lead author and former postdoctoral researcher Dr. Maithili Dalvi developed a series of cellular models of progressive tumor resistance to standard chemotherapy that ranged from very sensitive to highly insensitive. Next, the researchers identified genes commonly altered during the development of resistance across multiple cell line and mouse models and identified a 35-gene signature that indicated a higher genetic likelihood of chemotherapy resistance.

It’s like a fingerprint for resistance,” Dr. Martinez said, adding that it was predictive in both cells and mouse models.

Next, they compared this resistance biomarker using genetic profiles from human tumors in their National Cancer Institute (NCI) lung cancer Specialized Programs of Research Excellence (SPORE) database at UT MD Anderson Cancer Center in Houston. The database contained information on patient outcomes and those who had been treated with the two-drug chemotherapy. The genetic fingerprint for resistance correlated with cancer relapse in NSCLC patients in the database, she said.

Researchers discovered that as cancer cells developed greater resistance to chemotherapy, they progressively made higher amounts of enzymes called JumonjiC lysine demethylases. Dr. Martinez said these enzymes facilitate resistance by changing the expression of – or turning on and off – genes.
Cancer cells use these enzymes to change, or reprogram, gene expression in order to survive the toxic stress of the chemotherapy. By changing the expression of genes, the tumor cells can adapt and survive the toxins,” she said.

Investigators then tested two potential drugs, both JumonjiC inhibitors. One of them, JIB-04, was found by UT Southwestern researchers in the Martinez lab during a small-molecule screen conducted at the National Center for Advancing Translational Sciences’ Chemical Genomics Center in Bethesda, Maryland.

I believe this is the first report of NSCLC tumors taking advantage of multiple JumonjiC enzymes to reprogram gene expression in order to survive chemotoxic stress. In addition, and this is the most fascinating part: Dr. Dalvi found that greater chemotherapy resistance defines a new susceptibility to the JumonjiC inhibitors,” she said. “The cancer cells develop a new Achilles’ heel that we can hit.”

Because the chemo-resistant cancer cells are dependent on JumonjiC enzymes for survival, inhibiting those enzymes returns cancer cells to mortality and vulnerability to cell death, she explained.
We think these JumonjiC inhibitors have the potential to be used either to treat tumors once they become resistant to standard therapies, or to prevent resistance altogether,” she said. “In our experiments these inhibitors appear to be much more potent in killing cancer cells than normal cells.”

Later, researchers tested whether the Jumonji inhibitors JIB-04 or GSK-J4 prevented chemotherapy resistance. This strategy succeeded in cell cultures and partially prevented resistance in animal models, Dr. Martinez said.

Dalvi et al. Taxane-Platin-Resistant Lung Cancers Co-develop Hypersensitivity to JumonjiC Demethylase Inhibitors.Cell Reports, 2017;19:1669–1684 [Article]

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