Wednesday, May 31, 2017

When News Triggers That Old Fear

By now most people have heard that Olivia Newton-John's breast cancer has returned this time in her lower back. (USA Today) It has been 25 years since her initial diagnosis. Breast cancer metastasizes and it is not unusual for women to be disease free for five, ten, fifteen years and have the disease return. There is a organization METAvivor whose focus is to do just that and to support women who are living with disease. 

Did you know that Ovarian Cancer can recur - months and years later? I know women who have dealt with single recurrences and some with multiple recurrences. Some women are in constant treatment just like those with metastatic breast cancer.

Yes, there are new drugs being developed to treat the recurrences and target specific mutations but just like with breast cancer, more research is needed. But being diagnosed with a disease that can recur at any time brings along with it other issues to deal with too.

My first reaction to hearing about Olivia Newton-John was sadness and then the fear took hold. I could feel that strange tightening in the pit of my stomach. And then my thoughts took off to a place that I try very hard to keep in check. Damn. I could recur at any time.

I've been really tired lately.  ( Could be my allergies.)
My lower back started hurting a few days ago. ( Could be bending to pick up my grandsons.)
My digestive system still isn't right since the stomach bug I had two weeks ago. ( Could just be it is taking that long to clear up.) 

I take a deep breath. And then another and finally slowly get hold of myself.  I know that my gyn onc will see me in a few months for my regular check-up. I know that if these symptoms continue for two more weeks I can always give her a call and see her early. Alright I have a plan. Once I have a plan I am good.

Being disease free is not being worry free. That is a side effect that can come on at any time.
How do you handle your fears of recurrence?  

Every Day is a Blessing!

Friday, May 26, 2017

2017 Annual Retreat on Cancer Research Public Forum Highlights

I was pleased to have the opportunity to attend yesterday's Public Forum segment of the 2017 Annual Retreat on Cancer Research in New Jersey presented by the Rutgers Cancer Institute of New Jersey (RCINJ) and the New Jersey Commission on Cancer Research. This years Forum topic was Precision Medicine. The Event took place at the Rutgers College Avenue Student Center.

After an introduction and welcome by Shridar Ganesan, MD, PhD (RCINJ),  Dr. Kim Hershfield spoke on The Promise and Practice of Precision Oncology. After a short review of the structure of the cell and DNA, she described how oncogenes and tumor suppressor genes work. In the past, treatments were based on the organ where the cancer was found and the cancer's histology. Today knowledge of a tumor's gene mutations can lead to the use of a targeted therapy. Knowledge of the mutations that can cause a cancer has increased in the past few years and researchers like those at RCINJ are working to understand the impact of those mutations and develop targeted therapies for them.

Another avenue of recent study is the use of a  liquid biopsy. With a liquid biopsy, a blood sample is examined for circulating DNA from a cancer tumor.

As Dr. Hershfield mentioned Precision Medicine is at the "toddler" stage.  But every day researchers are looking to develop new treatments, test combination therapies, understand and reduce side effects, understand pathways, all with the goal of providing the best treatments for cancer patients.

The second speaker was Hetal Vig, MS a genetics counselor from RCINJ who spoke on Capturing the Spectrum of Hereditary Cancers: A Moving Target in the Setting of Targeted Therapy. Cancer may develop due to mutations that are germline ( hereditary) or sporadic. When examining a patient's family history it is important that both the maternal and paternal sides of the family are examined.

As an example, Ms Vig mentioned how BRCA mutations increase a person's risk for breast, ovarian and pancreatic cancers. Every person has two of each gene. When you have a germline mutation the mutation comes from the egg or sperm. If you are born with a BRCA mutation in one gene and over time you should develop a BRCA mutation in the second gene you can develop cancer. When you have a sporadic cancer  you are born with no mutations in either gene but over time for some reason both your genes develop a BRCA mutation which can lead to cancer. So there are less steps to go through when you start out with a hereditary mutation to develop cancer. And it also explains why most sporadic cancers develop later in life since it takes more time for the mutations to occur.

Ms Vig also talked about incidental findings on genetic testing results. A framework needs to be developed regarding how to share those findings with patients. Interpreting the complex genetic test results many patients receive should be done by a trained genetic counselor.  (I agree 100%.)

The final speaker of the morning, Dr Eric Singer , RCINJ spoke on Ethical Issues in Precision Oncology. Dr Singer's talk began with a discussion of clinical trial design and informed consent. Do patients really know that the trial they are taking part in is for research and may not offer them any benefit? Dr Singer also mentioned incidental findings and how those findings should be shared with patients. Dr Singer mentioned that is is important that health care providers protect patients from misinformation.

He also stressed the need for oncologists to know their patient's goals. Part of the discussion could include the cost the patient will have to bear when taking new expensive targeted therapies.The patient / health care provider discussion could include: Will the treatment extend survival? Will the treatment have toxic side effects? What patient reported outcomes have other patients provided? Is the decision to use the treatment performance-based or value-based?

I was happy to see in each of the presentations the patient being central to the treatment decision. 

After the Forum I took some time to view the posters outside the Multi-purpose room. Here is one of particular interest to those with ovarian cancer.

Impact of Body Mass Index on Ovarian Cancer Survival Varies by Stage
Elisa Banderas et al
This study looked at the impact of obesity on ovarian cancer survival
It included over 1100 women with epithelial ovarian cancer diagnosed between 2000-2013 at Kaiser Permanente Northern California. "There was no evidence of an association between BMI( body mass index) on overall or ovarian cancer-specific survival" but they found a strong association by stage.
Conclusion: "Associations of obesity with ovarian cancer survival differ by stage, with decreased survival among those with localized disease and increased survival among those with late-stage disease. "

I look forward to next year's Retreat.

Every Day is a Blessing! Thankful for the doctors, researchers and staff throughout the state of NJ who are striving to understand cancer and make their patient's lives better. 

Tuesday, May 9, 2017

Public Forum - 2017 Annual Retreat on Cancer Research in NJ

The Annual Retreat on Cancer Research in New Jersey is hosted by the Rutgers Cancer Institute of NJ and the New Jersey Commission on Cancer Research. The event includes poster sessions and mini-symposium on research by expert NJ researchers.

The day also includes a Public Forum. I have been lucky to have attended a few of the public sessions over the past few years. Last year's public forum topic was Survivorship. This year, the topic is Precision Medicine.

The topics of discussion will be:
The Promise and Practice of Precision Oncology
Capturing the Spectrum of Hereditary Cancers: A Moving Target in the Setting of Targeted Therapy
Ethical Issues in Precision Oncology.

This years event will take place on May 25, 2017  (8:30-10:00 am) at the Rutgers College Avenue Student Center.

Registration is free.
Please register on the following website:

I've already registered for the event. How many of my fellow advocates and survivors will join me?

 See you on the 25th!

Every Day is a Blessing!