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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Cancer patients rarely demand unnecessary tests and treatments

Physicians often blame patient demands for contributing to high medical costs, however, a new study involving more than 5,000 patient-clinician visits indicates that cancer patients rarely push for unnecessary tests and treatments from their health care providers.

The study, conducted by Ezekiel Emanuel, MD, PhD and colleagues in the Abramson Cancer Center and the Perelman School of Medicine at the University of Pennsylvania and published in the inaugural issue of JAMA Oncology, examined a total of 5,050 patient-clinician encounters, and found that 440 (8.7 percent) of those included a patient demand or request for a medical intervention. Clinicians complied with 365 of the demands they deemed clinically appropriate. However, of the 50 demands requesting clinically inappropriate tests or treatments, clinicians only complied with seven (0.14 percent of the 5,050 encounters).

About half of the requests (49.1 percent) were for imaging studies, 13.6 percent were for laboratory tests such as tumor markers, and 5.2 percent were for genetic tests or chemosensitivity tests. Surprisingly, 15.5 percent of patient demands or requests were for palliative care interventions, such as pain medications and sleeping aides. Just 3.6 percent of patient demands or requests were for chemotherapy, and less than one percent for expensive proton beam therapy.

We decided to look specifically at cancer patients’ demands because oncology is a setting where there are life-and-death stakes for patients and the drugs and tests can get very expensive,” said senior author Emanuel, chair of the department of Medical Ethics and Health Policy at Penn. “However, we found, contrary to expectations, that patient demands are low and cannot be a key driver of increasing health care costs.”

The Penn Medicine team surveyed 60 clinicians — including 34 oncologists, 11 oncology fellows, and 15 nurse practitioners and physician assistants — immediately after patient encounters at three Philadelphia Hospitals (The Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital) between October 2013 and June 2014. The goals of the interviews were to determine frequency of patient requests or demands for tests and treatments, whether those requests were appropriate, whether they were granted and why.

The study also found that patients who had worse relationships with their physicians, and those on active therapy, were more likely to make demands or requests for tests or treatments.

We observed very few patient demands for inappropriate treatments, and it was even rarer that a physician complied with the demand,” said lead author Keerthi Gogineni, MD, MSHP, who was an instructor in Penn’s Abramson Cancer Center when the study was conducted and is now a faculty member at Emory University. “In this age of unregulated consumer medical information on the Internet, it’s encouraging to see that this hasn’t translated to cancer patients requesting inappropriate — and often costly — tests and treatments.”

Gogineni et al. Patient Demands and Requests for Cancer Tests and Treatments. JAMA Oncol. 2015;  doi:10.1001/jamaoncol.2014.197 [Article]

One-two punch catches cancer cells in vulnerable state

Timing may be decisive when it comes to overcoming cancer’s ability to evade treatment. By hitting breast cancer cells with a targeted therapeutic immediately after chemotherapy, researchers from Brigham and Women’s Hospital (BWH) were able to target cancer cells during a transitional stage when they were most vulnerable, killing cells and shrinking tumors in the lab and in pre-clinical models. The team reports its findings in Nature Communications.

We were studying the fundamentals of how resistance develops and looking to understand what drives relapse. What we found is a new paradigm for thinking about chemotherapy,” said senior author Shiladitya Sengupta, PhD, associate bioengineer at BWH.

Previous studies have examined cancer stem cells (CSCs) – small populations of cells within a tumor that are resistant to chemotherapy. Sengupta and his colleagues took breast cancer cells that did not have the markings of CSCs and exposed them to docetaxel, a common chemotherapy drug.

This confocal microscopy image depicts drug-tolerant cancer cells. By hitting breast cancer cells with a targeted therapeutic immediately after chemotherapy, researchers were able to target cancer cells during a transitional stage when they were most vulnerable. Credit: Aaron Goldman

The team found that after exposure to chemotherapy, the cells began developing physical markings usually seen in CSCs, including receptors on the cell surface to which specific proteins can bind. These “markers of stemness” suggested that the cells were transitioning into a different state, during which time they might be vulnerable to other cancer drugs.

To test this, the researchers treated the cells with a variety of targeted therapeutics immediately after chemotherapy. The researchers observed that two drugs each killed a large fraction of the cells that had begun transitioning: dasatinib, a drug that targets the Src Family Kinase (SFK) and RK20449, a new drug in pre-clinical testing that specifically targets one of the SFK proteins called Hck. The researchers confirmed these findings in a mammary carcinoma mouse model – treatment with dasatinib just a few days after administering two high doses of chemotherapy prevented tumor growth and increased survival rates. Treating cells simultaneously with docetaxal and dasatinib or administering dasatinib after a longer period of time did not produce the same effects. The researchers theorize that the cancer cells go through a temporary transition state, which means that administering the drugs in a very specific timeframe and sequence is important.

By treating with chemotherapy, we’re driving cells through a transition state and creating vulnerabilities,” said first author Aaron Goldman, PhD, a postdoctoral fellow in biomedical engineering at BWH. “This opens up the door: we can then try out different combinations and regimens to find the most effective way to kill the cells and inhibit tumor growth.

To make these observations, the researchers developed and leveraged three-dimensional “explants” – tissue derived from a patient’s tumor biopsy and grown in serum from that specific patient for research purposes. This model mimics the tumor’s microenvironment and preserves the tumor’s cellular diversity.

In a continuation of this work, Goldman is also using mathematical modeling to pursue the most effective dose of chemotherapy to induce the vulnerable transition state of the cancer cell demonstrated in this research.

Our goal is to build a regimen that will be efficacious for clinical trials,” said Goldman. “Once we understand specific timing, sequence of drug delivery and dosage better, it will be easier to translate these findings clinically.”

Goldman et al. Temporally sequenced anticancer drugs overcome adaptive resistance by targeting a vulnerable chemotherapy-induced phenotypic transition. 2015; Nature Comm. 6: 6139 doi:10.1038/ncomms7139 [Article]

Social network may improve care for cancer patients

Several chemotherapy patients at the UC Davis Comprehensive Cancer Center will be invited to use tablets with a unique social networking tool as part of their treatment plan. Researchers at the Betty Irene Moore School of Nursing at UC Davis hope to prove that mobile health technology improves the care experience for patients as well as the quality of care while also reducing cost.

The project is part of a two-year, $199,854 grant from the McKesson Foundation and its national Mobilizing for Health Initiative. Research on mobile health technology in cancer care is new, said Jill Joseph, the associate dean for research at the nursing school. Other cancer-related mobile applications are available, but are limited to education and awareness and don’t provide disease management tools or real-time communication.

We have ample evidence that cancer patients often receive fragmented care, experience significant distress, and may needlessly require care in emergency departments or inpatient settings, particularly during chemotherapy,” Joseph said. “Little research and development has focused on providing novel technologies to support cancer care coordination.

Participating patients will use a tablet device, such as a Google Nexus or iPad, to connect to their unique and private Personal Health Network that includes a nurse coordinator — who manages the their care — along with family, caregivers, clinicians and other desired partners. These people can connect with one another through real-time messaging, video and audio components as well as schedule appointments, assign tasks, store and track information and more.

A nurse coordinator is assigned to support each chemotherapy patient who uses the mobile application. This coordinator monitors the patient’s care plan, triages issues and communicates with caregivers. Unlike electronic health records and other information systems common in hospitals, the social networking platform allows patients, their families and caregivers to not only access information but communicate with another and make decisions about care and health management.

This is a new tool designed with the patient and family at the center of care,” said Katherine Kim, a recent doctoral graduate of the UC Davis nursing school who is now a visiting faculty member and project director.

For example, a chemotherapy patient might message her nurse coordinator that she’s not doing well that day, and feels nauseous and anxious. The nurse can then communicate with the patient to further assess the situation, communicate with other caregivers, and work with the patient to address the issues or take other steps such as reschedule appointments or review current medications.

Developed by private technology partner Tiatros, the social networking platform is different from other social media sites, like Facebook and LinkedIn, because it complies with health privacy laws and operates securely.

I’m excited about bringing nursing research into the Cancer Center. I’m especially excited for our patients to have an opportunity to be part of this project,” said Kerri Stuart, a nurse manager at the Cancer Center. “Learning you have cancer is overwhelming and the thought of chemotherapy is often terrifying. This is a tool that empowers patients and provides access to information when they need it, not just when the clinic is open.

Research team members will interview patients after they have used the program for six months to determine how their health, the delivery of care and their need for emergency or inpatient care was affected. The team includes nursing faculty from the School of Nursing as well as oncology nurses, social workers, and physicians from the UC Davis Comprehensive Cancer Center.

The study is the first funded project resulting from the development of the UC Davis Collaborative Cancer Care Research Group, a multidisciplinary team of experts who hope to develop technology-enabled solutions that improve the quality, accessibility and affordability of cancer care.