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spring 2013 cfthrive.com ® living with cancer the big picture Quality of life is key one size does not fit all Personalized cancer treatment moves to the forefront environmental risk factors Joe Mills spring 2013 ® Features 6 Living with CanCer 26 the Big PiCture in this issue Want guaranteed delivery of Cancer Fighters Thrive® each quarter? Register for a complimentary subscription at cfthrive.com or call (918) 286-5115. Please provide us with your name and mailing address, and e-mail and/or phone number. View this entire issue at cfthrive.com Cover photo by Bart Harris Photography bartharris.com. special thanks to illinois Beach Resort and Conference Center. cfthrive.com 5 advocacy spotlight Cancer schmancer 12 nutrition Homegrown nutrition 16 ask the expert Cooking Up Healthy Choices 20 Meet the Doctor samuel Bieligk, MD, FACs 22 tips & trends 23 research today One size Does not Fit All 31 naturopathic Environmental risk Factors 36 innovation Welcome relief: pain Management is the Key to Living Well 38 ask the nurse Tips for Caregivers: supporting patients through Treatment 40 Mind-Body Connection Moving Beyond survivor guilt 42 spiritual Words to Live By 44 images of hope 46 inspiration spring 2013 | cancer fighters thrive 3 welcome a new Paradigm Volume 8, Issue 19 EdITorIal STaFF Maurie Markman, Md Editor-in-Chief Tim Birdsall, Nd Medical Editor diana Price Editor lynne a. Kennedy Managing Editor Sarah andrews Associate Editor Bill Kelly Associate Editor laura Malamud Associate Editor Tiffany Payette Associate Editor Katie ressler Associate Editor Kristin Schaner Associate Editor Julia Scherer Associate Editor Megan Toth Associate Editor Kari Young Creative Director Christie Enochs Circulation Manager Juli roos Production Manager it wasn’t long ago that cancer was a word more often whispered than said aloud. The stigma of the disease kept people from discussing it publicly, and the anticipated prognosis was often assumed to be bleak. In recent years, however, as advances in research have led to more-effective treatments, patients are living longer and speaking louder, and cancer is increasingly considered a chronic condition that can be effectively managed for many years. In this issue of Cancer Fighters Thrive®, we describe this new paradigm in which cancer is, in many cases, viewed as a chronic adVErTISING SalES Tracey Aaron Arlington publishers representatives, inc. (815) 356-8344 [email protected] MaGazINE SuBSCrIPTIoNS or CoMMENTS Lynne A. Kennedy (918) 286-5115 [email protected] disease (“Living with Cancer”) and also how patients who live with cancer long term benefit from an approach that emphasizes quality of life (“The Big Picture”). As providers focus more on patients’ quality of life, pain management plays a critical role, and we also include a feature devoted to that topic. Several of the other articles included in this issue speak to topics related to living with cancer long term; we offer features on the topic of “survivor guilt” as well as environmental risk factors, garden-fresh nutrition, spiritual inspiration, and caregiver tips. EdITorIal Board Syed abutalib, MD, Hematologic Oncologist, CTCA (Zion, IL); lawrence altshuler, MD, Internist, CTCA (Tulsa, OK); Katherine anderson, ND, National Director of Naturopathic Medicine, CTCA (Tulsa, OK); Steve Bonner, President and CEO, CTCA (Schaumburg, IL); Sharon day, RD, CSO, LDN, CNSC, Director of Nutrition, CTCA (Phoenix, AZ); Susan Eckhardt, OT, Director of Oncology Rehab (Philadelphia, PA); Michelle Moore, RN, BSN, Care Manager, CTCA (Zion, IL); daniel Nader, DO, FCCP, National Director of Pulmonology, CTCA (Tulsa, OK); Katherine Puckett, PhD, National Director of Mind-Body Medicine, CTCA (Zion, IL); Jeffrey Sklar, DC, Director of Chiropractic Services (Philadelphia, PA); amy Taub, MD, Dermatologist, Advanced Dermatology (Lincolnshire, IL); Jeffrey M. Weber, MD, Director of Gastroenterology and Metabolism, CTCA (Phoenix, AZ). PaTIENT PaNEl As we do in each issue, we also deliver inspiring advocacy and physician profiles, insight into cancer research topics, and many wonderful stories of cancer patients and their families. Thank you for taking the time to read Cancer Fighters Thrive. Enjoy the issue! Maurie Markman, MD Senior Vice President of Clinical Affairs National Director of Medical Oncology Cancer Treatment Centers of America orDer your Free Print suBsCriPtion at CFthrive.CoM information about treatment if you or someone you love would like to learn more about treatment options at Cancer Treatment Centers of America (CTCA), call a CTCA Oncology information specialist at (800) 264-1255 or visit online at cancercenter.com/cfthrive. 4 cancer fighters thrive | spring 2013 audrey allen, Iva "Marie" Botchie, Sara Faccio, Janita Green, Hugh King, George rader, Blas ruiz, anita Seever, liddell Smith, Bryan Stordahl, ralph Tripp. oPEraTIoNS Heather Greaves, Loyalty Specialist, CTCA (Philadelphia, PA); Janet Horn, Senior VP Communications, CTCA (Schaumburg, IL); Steve Kroll, VP and General Counsel, CTCA (Schaumburg, IL); Faith Williams, Loyalty Manager, CTCA (Philadelphia, PA). Cancer Fighters Thrive® is published by OMNI Health Media for Cancer Treatment Centers of America (CTCA), which is solely responsible for its content. All articles and materials contained in Cancer Fighters Thrive are intended to inform the reader about cancer and its treatment generally and are not intended to endorse any particular provider of treatment or particular modality. Each person who is the subject of an article contained in Cancer Fighters Thrive is an actual person, and the medical results that they claim to have achieved are their own opinions about their personal conditions. The reader is cautioned against drawing any conclusions about effectiveness of any particular treatment or the chance of survivorship of any particular medical condition, whether treating at a CTCA facility or otherwise. All readers are reminded that cancer is a complex disease and CTCA makes no claims regarding its patients’ survivorship rates or as to the effectiveness of any of its treatment for any such conditions. With respect to the clinical results claimed by any of the patients in the articles contained in Cancer Fighters Thrive, no case is typical, and the reader should not expect to experience these results. CTCA does not endorse the products or services offered by any advertisers in this magazine. cfthrive.com © 2013 Rising Tide cfthrive.com advocacy spotlight Advocacy Spotlight: cancer schmancer Young adults diagnosed with cancer create community and advocate for their unique needs. By Diana Price A ctor, producer, and advocate In 2007 Drescher founded Cancer survivor stories and opportunities for diagnosis Schmancer, a nonprofit organization advocacy on its website, cancerschmancer. with stage I uterine cancer dedicated to prevention, early detection, org, in an effort to educate women about in 2000 came at the end of a long road of and advocacy. Susan Holland, vice pres- critical preventive health issues and to misdiagnoses. After two years of symptoms ident of Cancer Schmancer, says, “Cancer motivate and empower patients to seek that included cramping and bleeding Schmancer seeks to transform patients the best possible care. Drescher has also between menstrual cycles, and frustrating into medical consumers and to shift the been actively advocating on behalf of visits with eight different doctors, the nation’s priority from exclusively search- cancer patients in Washington, DC, where, diagnosis finally delivered Fran an answer. ing for a cure toward prevention and Holland says, the organization is currently And yet, though her search for a diagnosis early detection.” working to get a bipartisan carcinogen- Fran Drescher’s was at an end, it was the beginning of an entirely new journey. In 2002 Drescher, an Emmy and Golden To that end the organization has would based education. around Fran Vans—mobile Globe nominee who starred in the long- breast cancer detection units that serve running CBS sitcom The Nanny (which uninsured as well as underinsured she also created and executive produced) as areas—and, more recently, a Trash Cancer well as in feature films, published a mem- initiative aimed at educating consumers oir, Cancer Schmancer, which described her about possible carcinogens and toxins journey to diagnosis. Compelled to tell her in personal care products, cleaning story in the hope that she could help other products, and food. Holland says that women get the answers they needed, she more than 1,000 Trash Cancer parties also felt called to do something more to in- have been hosted around the country, form and empower women. She knew that, involving more than 10,000 people. as her own case had illustrated, early detec- “Trash Cancer teaches consumers how tion of cancer was the key; she also knew to detox their homes and become aware that lack of information and misdiagnosis of what we are putting in our mouths, on often prevented women from being diag- our skin, and using around us when we nosed at an early stage. Fueled by her own clean and garden,” she says. experience, Drescher committed to using In addition, Cancer Schmancer shares her celebrity status to help get the word out. information about prevention, inspiring cfthrive.com free-label bill through Congress that developed an early-detection program further promote consumer For more information about Cancer Schmancer, visit cancerschmancer.org spring 2013 | cancer fighters thrive 5 Joe and Shelly Mills 6 cancer fighters thrive | spring 2013 cfthrive.com cover story living with CanCer By L Aurie Wertich C photos by Bart harris Photography Special thanks to illinois Beach resort and conference center cfthrive.com ancer is not always a death sentence. It can be a life sentence—a call to live life to the fullest even in the face of disease. Just ask Joe Mills, a safety manager for a small trucking company in Bloomington, Illinois. Joe was diagnosed with stage IV cholangiocarcinoma (bile duct liver cancer) in November 2011. In the past year, he has undergone chemotherapy and surgery—and he has continued to work and enjoy his life with his wife and family. spring 2013 | cancer fighters thrive 7 special feature “I try to live as normal a life as possible,” Joe says. “I bike-ride every chance I get. My wife and I go for a lot of walks and out to the movies—anything we can do to take the focus off of illness.” “I try to live as normal a life as possible,” ship. Other cancers are considered incur- new and innovative developments in Joe says. “I bike-ride every chance I get. able; there is treatment but no cure. Once cancer treatment, patients can live a long My wife and I go for a lot of walks and upon a time, incurable cancers were re- time with cancer—and with is the key out to the movies—anything we can do to ferred to as terminal but not now. There word here. Patients with chronic cancer take the focus off of illness.” is a new term for these cancers: chronic. are living with it, not dying from it. Joe is one of a growing number of peo- “The paradigm change is that we’re ple who is living—and living well—in the starting to look at cancer as a chronic wake of an advanced cancer diagnosis. Yes, illness as opposed to an acute illness,” living well with chronic cancer you read that right: Joe is living well with explains Simeon Jaggernauth, DO, a “Chronic” may sound better than “ter- cancer, fueled by a desire to be fully en- medical oncologist at Cancer Treatment minal,” but it’s still an enduring chal- gaged in life and not about to let cancer Centers of America® (CTCA) in Tulsa, lenge. Chronic means “all the time.” In get in the way. Oklahoma. “It’s sort of like diabetes, hy- other words, if you have chronic cancer, pertension, AIDS, or hepatitis C. These you will live with this cancer for the rest Defining chronic cancer are illnesses that people have and can be of your life. That may sound like an or- Some cancers are considered curable. Af- treated for, but they’re not curable.” deal, but there are an increasing number In fact, a cancer can be considered in- of tools to help patients manage for the Lindsay rehm, OcN, with Jack and PJ Donatucci curable but quite treatable. Thanks to remission and rN, move forward to survivor- long term. Despite cancer and ongoing ter successful treatment, patients go into 8 cancer fighters thrive | spring 2013 cfthrive.com cover story treatment, it is possible to live well with ing chronic cancer is to maintain quality the disease. of life. Patients will live well if they are “As people are living longer with treated well,” explains Dr. Jaggernauth. coping with chronic cancer Living with chronic cancer is like running cancer, we want to make sure they can Treating patients well means shifting maintain quality of life,” explains Tracy the way in which we deliver the treat- a marathon rather than a sprint. it’s Whitworth, RN, a survivorship nurse at ment. “This disease called cancer is important to pace yourself, listen to your CTCA® in Goodyear, Arizona. “We want chronic,” Dr. Jaggernauth insists. “The body, and take care of yourself. here are to help patients not only contain and way you treat a chronic disease is by giv- some coping strategies for living long and manage the disease but also live well with ing chronic treatment.” well in spite of cancer. it. We want patients living life and creat- This important recognition that cancer is appropriately viewed in an increas- y Stay in charge and take an aggressive role in your own health care. Whitworth’s role is to look at the big ing number of settings as a very serious y Ask questions. picture. She works to balance disease but chronic illness has led to the develop- management and quality of life. It’s her ment of strategies that consider the po- job to know her patients—really know tential impact of long-term side effects. them—so that she can help them strike Common long-term issues include per- the optimal balance between life and sistent fatigue and continuous numbness treatment. Whitworth examines work/life and tingling in hands and feet. ing memories.” balance issues, fatigue, pain, and much Investigators have begun to explore the more in assessing her patients. Then she use of the more frequent administration pulls out her “tool bag” and connects pa- of anticancer drugs at lower doses that tients to the appropriate resources. have the potential to maintain or even y Stay on top of your bone health. Ask your health care provider if you need a bone scan or Mri. y Be honest about side effects and how they affect your quality of life. Ask for help managing pain, fatigue, and other side effects. y take advantage of appropriate complementary medicine strategies, such as acupuncture, massage, and homeopathic medicine. “We really encourage patients to utilize improve the effectiveness of therapy while all of the wonderful complementary treat- actually reducing side effects. For patients ments we have here, such as naturopathic whom doctors anticipate will be treated medicine, nutrition therapy, mind-body for long periods, for example a year or medicine, acupuncture, and massage,” longer, a “treatment holiday” may be used y Keep a logbook of symptoms and questions for follow-up visits. Whitworth says. “The data support that to permit the body to recover from the ef- y Maintain consistent follow-up visits. these are very helpful to keep everything fects of cancer treatment. in tune.” Patty Marshall’s experience is an ex- This balance—between treatment and ample of the benefits of an approach that quality of life—is the cornerstone of man- focuses on the chronic nature of cancer aging chronic cancer. “In a perfect world, treatment. In May 2007 Patty was diag- we want the treatment to obliterate the nosed with stage IV breast cancer that cancer but not affect quality of life,” Whit- had spread to her bones. She decided worth says. This may sound like a lofty right then that cancer will not kill me. goal, but it’s one that is more and more re- Patty immediately started an innovative alistic as cancer treatment changes. weekly treatment program. The treat- y Discuss your concerns with your health care provider. y Stay positive and surround yourself with positive people. y take impeccable care of yourself: eat well, get plenty of rest, and make time for the activities you love. y engage in prayer, meditation, or some sort of spiritual practice that supports you. ment not only controlled the cancer but treating chronic cancer also allowed her to maintain her normal New developments in cancer treatment routine. have changed our ideas about the best “I never did stop anything in my life. way to treat cancer. “The goal of treat- I volunteer at the church preschool on cfthrive.com spring 2013 | cancer fighters thrive 9 cover story Wednesdays, and I missed only one day Preventing complications says, it’s important to address it up front. because my white count was low,” Patty Despite advances in treatment, chronic can- “Let’s not wait for a fracture to occur,” he says. “Even through all 24 chemotherapy cer can be rife with complications. “Patients says. “Let’s be proactive and treat it with a treatments, I have not been sick; I have not are doing much better than before and liv- more minimally invasive procedure.” thrown up. I have maintained my life.” ing longer,” says Richard Schmidt, MD, Saying she didn’t stop anything is an medical director of orthopedic oncology at Be Your own advocate understatement. In fact, her coping meth- CTCA in Philadelphia, Pennsylvania. “The Living with chronic cancer is not with- od was to stay busy. Patty lives in Thayer, spin-off of that is that because they are do- out challenges. Whitworth asks patients: Kansas, on a cattle ranch. Throughout her ing better and living longer, they are devel- “What is it that you want to do, and what treatment she continued to ride horses, oping metastatic sites to the bones.” is stopping you?” Then she works to help work, and garden—and she even took a These bone metastases can cause pain them address those challenges. She says two-week vacation to a dude ranch in Col- and even fractures, which can result in a that it is imperative that patients discuss orado. Stay busy doing what you love to do spiral of complications. Dr. Schmidt says their concerns with their health care team. is her motto. that in the face of metastatic cancer, it’s “We’re here to help, but we can’t help if we important to be proactive and prevent don’t know what the issue is,” she explains. fractures. One way to do this is through a Dr. Schmidt echoes this sentiment and “There are new technologies that have also procedure called prophylactic stabilization says that it is important for patients to pay changed the way we treat cancer,” Dr. Jag- of the femur, which involves putting a rod attention and ask questions. “Patients re- gernauth explains. or pin into the thighbone to prevent it from ally need to ask their health care provider: breaking. ‘What is the status of my bone health? Are treatment advances These new technologies include targeted agents, which are drugs designed to attack The femur is one of the most common my bones involved yet or not? Should I get cancer cells while sparing healthy cells, and sites for bone metastases, and a broken fe- a bone scan?’ ” he says. “A lot of times we immune therapy, which fights cancer by mur can have devastating consequences, focus on the primary lesion, and we tend stimulating the immune system. resulting in invasive surgery; a long, slow to get outflanked a little bit. The patient Melanoma, the deadliest form of skin healing process; and loss of mobility. In is complaining of bone pain, and no one cancer, may soon be considered more of contrast, a prophylactic stabilization can be does an X-ray. If you have bone pain, insist a chronic illness because of the impact on performed through two or three small inci- on getting an X-ray.” the disease of targeted agents and immune sions, and the rehabilitation from the pro- therapy. “In the past few years, targeted cedure is minimal. coping with chronic cancer agents have changed the way we treat mel- Dr. Schmidt performs a lot of these pro- Ultimately, the most important aspect of anoma,” explains Dr. Jaggernauth. “People cedures in an effort to help patients main- living with chronic cancer may boil down are living longer with the disease.” tain quality of life and remain mobile and to effective coping strategies. The most in- What’s more, the way in which we deliver independent. “From a holistic standpoint, novative treatment approach and the best treatment has changed. “There are lots of it is important to keep patients active, mo- supportive care can only do so much. If different ways to administer medications bile, and in charge of their own destiny,” you’re mired in fear and stress, it’s going now,” Whitworth explains. Oral chemother- he explains. to have an impact on your overall outlook apy is sometimes less invasive, and there are A patient who has bone pain or evidence a lot of options available to help combat side of disease progression might be a candi- Joe says that though he has encoun- effects. “We’re going to arm you—give you date for the prophylactic procedure. When tered fear and stress, his faith has provided an arsenal of good stuff—to help minimize a magnetic resonance imaging (MRI) scan strength and refuge. “Before cancer came or alleviate side effects,” Whitworth says. indicates disease progression, Dr. Schmidt along, I knew God in my head, but I didn’t 10 cancer fighters thrive | spring 2013 and quality of life. cfthrive.com cover story “Cancer wants to steal joy and steal life, but love will conquer it. So focus on love, joy, and life.” —Joe Mills really know him in my heart,” he says. with friends and family. “A positive atti- out cancer,” he explains. “I focus on what “What has happened the most with this tude is very important,” she insists. “Life I want to achieve. Cancer wants to steal cancer is the development of my faith. I is precious. Enjoy every single minute of joy and steal life, but love will conquer it. know now that man is limited, medicine it because none of us knows when we So focus on love, joy, and life.” is limited, but not God.” could be taken out of here.” Throughout his treatment Joe has had Patty’s faith was instrumental in her numerous conversations with God. “I journey, also. “Put God first. If you let realized I could focus on the disease or God help you, you sure get along a whole God,” he says. “I could focus on the ill- lot better.” ness or focus on living. I decided to focus Joe uses an auto-racing analogy, ex- on living. It is my faith in God that pro- plaining that when drivers are going vides strength, peace, joy, and comfort through a high-speed turn, they’re look- when fear tries to creep in.” ing at marks on the pavement rather Patty took a similar approach. She de- than the wall that they don’t want to hit. cided to stay busy and surround herself “That’s how I live my life with or with- cfthrive.com No case is typical. You should not expect to experience these results. spring 2013 | cancer fighters thrive 11 nutrition Homegrown Nutrition Homegrown and farm-fresh herbs and veggies add flavor and a nutritional boost to your meals. By Diana Price photos by eric Green 12 cancer fighters thrive | spring 2013 cfthrive.com ask the exPert Cooking Up Healthy Choices Dietitians share their favorite healthy recipes. 16 cancer fighters thrive | spring 2013 cfthrive.com nutrition W hen Larry Kessel, executive chef and they come together to plan which herbs and vegetables they’ll director of culinary services at Can- grow, the team focuses on how the foods can help them create cer Treatment Centers of America® truly delicious dishes that highlight the produce. “We’re always (CTCA) in Philadelphia, Pennsylva- looking at how we can serve healthier, more nutritious food,” nia, talks about incorporating fresh Chef Kessel says, “and how we can eliminate unhealthy things herbs and vegetables from the organic gardens at CTCA® into in our recipes—butter, saturated fats, gluten, heavy sauces. We the food he and his team offer patients, it’s hard not to notice the like to use lots of herbs because it helps accentuate the flavor of reverence in his descriptions. “As a chef, when you walk out in the food and allows us not to have to rely on a lot of sodium and the morning and the sun’s just coming up and there’s still dew saturated fat—and it incorporates a great fresh flavor.” on the ground and you see the herb garden—filled with basil, The tasty results of Chef Kessel’s efforts to incorporate the thyme, mint, chives, parsley, rosemary, peppers, tomatoes—and fresh, homegrown produce include dishes like beef tenderloin when you can pick fresh herbs and then go back in the kitchen with chimichurri sauce and Maryland crab and corn vinaigrette and cook with them, that’s the best.” with yuzu and garden thyme, along with many other creative And if you’ve ever popped a cherry tomato into your mouth recipes and comfort food favorites. Though some of the cre- straight from the plant, warm from the summer sun, or if you’ve ative combinations may seem exotic, Chef Kessel says that fresh tasted the difference that fresh basil makes in a pasta dish, or herbs can be used in very simple ways to delicious effect, and just-picked lettuce in a garden salad, you know the magic that he encourages patients and caregivers to use fresh herbs when Chef Kessel is describing. There is no doubt that food that comes cooking at home. For instance, fresh basil can be pureed with to the plate fresh from the field—or the windowsill herb garden garlic, pine nuts (or walnuts), olive oil, and parmesan cheese to or pots on the patio—offers a wealth of nutritional and taste make pesto (great on pasta and as a sauce for chicken and fish); benefits. and many herbs can be added in vinaigrettes or marinades for Chef Kessel says that the on-site garden at CTCA allows the a quick punch of flavor. culinary team to develop menus that provide patients with fla- For those who want to grow their own fresh ingredients at vorful, healthy meals based around seasonal ingredients. As home, Chef Kessel says, there’s no need for major acreage—or cfthrive.com spring 2013 | cancer fighters thrive 13 nutrition Chef larry Kessel time—to reap the rewards of flavorful fresh herbs and veggies. Herbs especially can be grown in pots on a patio or in window boxes, as can lettuces and tomatoes. “Growing herbs is very simple,” he says. “You can use planter boxes with grow lights and grow from seed, or you outside on a ledge, deck, or windowsill recipes and pick them as you need them—and marYlanD craB anD corn vinaigrette with once an herb garden starts to grow, it Yuzu anD garDen thYme takes off.” Once you start cooking with Zest of 1 lemon these ingredients, Chef Kessel says, you 1½ tablespoons fresh yuzu juice or fresh lemon juice will never go back. “There’s nothing like ⅛ teaspoon freshly ground black pepper the flavor that you get from fresh herbs 1 teaspoon chopped fresh thyme as opposed to dry herbs.” ¼ cup extra virgin olive oil can buy starter herbs and let them grow Of course, if growing your own is not Kosher or sea salt, to taste practical, remember that most grocery ¼ pound grilled corn (removed from cob) stores carry fresh herbs as do farmers’ ¼ pound picked Maryland crab markets. So, get your green thumb—or 1 teaspoon chopped fresh chives your green grocer’s bag—in gear and In a medium bowl, combine the lemon zest, yuzu juice, pepper, and thyme. Slowly add some fresh herbs and veggies to your whisk in the olive oil. Once all of the oil is whisked, season with a touch of kosher next meal. salt or sea salt. Then add the corn, crab, and chives. Adjust seasoning to taste. Serve as a salad or as a sauce on grilled or pan-seared fish. 14 cancer fighters thrive | spring 2013 cfthrive.com nutrition Beef tenDerloin with chimichurri sauce Chimichurri Sauce ¾ cup olive oil 3 tablespoons sherry wine vinegar or red wine vinegar 3 tablespoons fresh lemon juice 3 cloves garlic, peeled 2 medium shallots, peeled and quartered 1 teaspoon fine sea salt ½ teaspoon fresh ground black pepper ½8 teaspoon dried crushed red pepper 3 cups (packed) stemmed fresh parsley 2 cups (packed) stemmed fresh cilantro 1 cup (packed) stemmed fresh mint Beef Tenderloin 3½-pound beef tenderloin 2 tablespoons olive oil Freshly ground black pepper, to taste Kosher or sea salt, to taste Note: Chef Kessel suggests using very little salt during the cooking process. When the tenderloin is cooked, use a finishing salt like French sea salt or Himalayan pink salt sprinkled on top. Combine the first eight ingredients of the chimichurri sauce in blender; blend until almost smooth. Add one-quarter of the parsley, cilantro, and mint; blend until incorporated. Add the remaining herbs in three more additions, puréeing until almost smooth after each addition. Let beef stand 1 hour at room temperature. Preheat oven to 350°. Add oil to a sauté pan and bring to high heat, add tenderloin, and sear each side until browned. Finish in the oven until an instant-read thermometer inserted into the thickest part of the beef registers 135° for medium rare, about 40 minutes. Transfer to platter; cover loosely with foil and let rest for 15 minutes. Thinly slice beef crosswise, season with pepper and salt to taste, and serve with chimichurri sauce. cfthrive.com spring 2013 | cancer fighters thrive 15 ask the expert Banana Flax Granola Bars summery Bean salad Matt Rinehart RD, CSO, LD CTCA in Tulsa, Oklahoma Sarah Possato, RD CTCA in Zion, Illinois These banana flax granola bars are a tasty, well-balanced snack. I personally love this Summery Bean Salad because it is very The rolled oats provide a good source of whole grain; the fast and easy to put together as well as filling and delicious! bananas provide potassium; the wheat germ, almonds, whole- The avocado provides heart-healthy unsaturated fats, and the grain oats, and egg provide protein; the cinnamon, flaxseeds, strawberries provide the antioxidant vitamin C. Beans offer an and wheat germ offer antioxidants; the ground flaxseed and array of unique phytochemicals and antioxidants that are found the wheat germ provide omega-3 fatty acids, which have anti- in no other foods. For our patients at CTCA® who are trying inflammatory benefits; and the almond milk is 50 percent more to incorporate more plant-based protein sources, beans are a fortified with calcium than cow’s milk. In addition, the bars fantastic alternative—and they also contain detoxifying fiber, are sweetened naturally with honey, and they offer improved which helps keep the digestive tract functional. blood sugar control compared with average granola bars due to of the ingredients may have natural cancer-preventive benefits: summery Bean salad Dressing fiber has been shown to reduce the risk of colorectal cancer, and 1 tablespoon extra virgin olive oil ground flaxseed has in some cases shown anticancer benefits 1 tablespoon lemon juice or balsamic vinegar with prostate, colon, and breast cancer. And as if that weren’t Pinch of red pepper flakes enough, these bars taste great! 1 tablespoon agave the fiber and protein content and the cinnamon. Finally, several Salt to taste Banana Flax Granola Bars 1½ cups rolled oats ½ cup slivered almonds, crushed 2 tablespoons wheat germ 4 tablespoons ground flaxseeds 1 tablespoon cinnamon ½ cup carob chips 2 tablespoons honey 1 banana, mashed 1 egg ½ cup almond milk Salad Preheat oven to 350º. Mix all dry ingredients together. Add Drizzle with dressing and mix together. Salad may be served honey, banana, egg, and almond milk. Spread evenly in baking cold or at room temperature. dish lined with parchment paper. Bake for 25 to 30 minutes or until browned. 1 cup strawberries, quartered 1 avocado, pitted, peeled, and diced 1 cup dry black beans, cooked until tender (will produce 2 cups) or 2 cups canned black beans, rinsed 4 to 5 spring onions or scallions, ends trimmed, cut into ½-inch pieces Mix dressing ingredients together; set aside. Combine strawberries, avocado, beans, and onions in a large bowl. Makes four 1-cup servings Nutrition information per serving: calories 272; protein 9 g; carbohydrates 32 g; total fat 12 g; saturated fat 1.5 g; dietary fiber 5 g; sodium 213 mg Makes 10 servings Nutrition information per serving: calories 193; protein 7 grams; carbohydrates 22 g; total fat 9 g; saturated fat 1.5 g; dietary fiber 4 g; sodium 29 milligrams cfthrive.com spring 2013 | cancer fighters thrive 17 “ My breast cancer diagnosis was the heaviest weight I’ve ever had to bear.” Karyn Marshall, DC Breast Cancer Patient Doctor of Chiropractic World Champion Weightlifter ask the exPert mixed Berry CousCous Danielle Bach, MS, RD, CSO CTCA in Goodyear, Arizona This is one of my favorite summertime recipes—the mint leaves and the orange zest make it quite refreshing. Here at CTCA we recommend that patients eat a cup of berries daily due to the antioxidant content, which can help support the immune system, and this recipe provides an easy way to get your daily berries. The Greek yogurt is a great source of protein and probiotics, which are “good” bacteria that help with gastrointestinal function. And both the cinnamon and the fiber content from the berries help with blood sugar management. Finally, this recipe is relatively fast and easy, and it’s filling. mixed Berry CousCous 1 cup instant couscous 2 cups apple and cranberry juice (no added sugar) 1 cinnamon stick 2 teaspoons orange zest As a world-record-setting weight lifter, I was determined to bring the tenacity that had served me so well in the gym to my fight against breast cancer. And as a chiropractor, I was especially impressed with the approach at Cancer Treatment Centers of America® (CTCA). It is called Patient Empowered Care®, and it means I had a dedicated team of cancer experts who collaborated on my treatment and worked with me to develop a detailed plan based on my specific needs. My team combined advanced cancer treatments with supportive therapies like acupuncture, nutritional counseling, and chiropractic care to help ease the side effects of my treatment. I know it made me a much better fighter. Today, I’m busy training for fitness competitions again. And I’m more certain than ever that CTCA® was the right choice for me. If you or a loved one has been diagnosed with advanced-stage or complex cancer, call 1-800-264-1255 or visit us at cancercenter.com. Appointments available now. Atlanta • Chicago • Philadelphia • Phoenix • Tulsa ©2013 rising Tide 18 cancer fighters thrive | spring 2013 9 ounces raspberries 9 ounces blueberries 9 ounces strawberries, halved 7 ounces low-fat Greek yogurt or regular yogurt 2 tablespoons maple syrup Fresh mint leaves, to garnish Place the couscous in a bowl. Pour the juice into a saucepan and add the cinnamon stick. Cover and bring to a boil. Remove from heat and pour over couscous. Cover couscous mixture with plastic wrap and let sit for about 5 minutes or until all the liquid has been absorbed. Remove and discard the cinnamon stick. Separate the grains of couscous with a fork, then gently fold in the zest and most of the berries. Spoon the couscous mixture into four serving bowls and sprinkle with the remaining berries. Top with a generous dollop of yogurt and drizzle with the syrup. Garnish with mint leaves and serve. Makes 4 servings Nutrition information per serving: calories 343; protein 9 g; carbohydrates 70 g; total fat 3 g; dietary fiber 7 g; sodium 35 mg cfthrive.com ask the expert ToFu PumPkin PuddinG Danielle Kennedy, RD, LDN CTCA in Philadelphia, Pennsylvania I often recommend this tofu pumpkin pudding as a tasty treat Providing loans to people living with late-stage cancer Are you experiencing financial hardship? for my patients because it’s easy on the digestive tract. The ginger and subtle spice flavor help ease nausea, and the tofu base provides nutrient density. It is simple to prepare and easy to store, allowing patients to pull it out of the fridge for a quick snack anytime. It gives the sense of a sweet treat without all of the added sugar and fat, and it can be added to other foods to provide extra calories and flavor. ToFu PumPkin PuddinG 16-ounce can pumpkin ¾ cup granulated sugar ½ teaspoon salt 1 teaspoon ground cinnamon ½ teaspoon ground ginger ¼ teaspoon ground cloves 10-ounce package soft silken tofu, blended until smooth Preheat oven to 425º. Cream together the pumpkin and the sugar. Mix in the salt, spices, and tofu until thoroughly blended. Pour into a greased 8-by-8-inch pan. Bake for 15 minutes. Lower the heat to 350º and bake for an additional 30 minutes or until set. Makes 9 servings Nutrition information per serving: calories 108; protein 3 g; carbohydrates 23 g; total fat 2 g; sodium 284 mg If you have late stage cancer, a life insurance policy and are experiencing financial hardship, our Loans For Living program may be an option for you. Call today to speak to one of our experienced counselors. 1-866-459-1271 www.fifthseasonfinancial.com meet the doctor QA meet the Doctor & samuel bieligk, md, facs Surgical Oncologist cancer treatment centers of America® tulsa, Oklahoma Samuel Bieligk, MD, FACS, is certified by the why did you choose to specialize in American Board of Surgery and is a Fellow of the surgical oncology? American College of Surgeons. After receiving a When I was a general surgery resident at Tulane University Medical bachelor’s degree in chemical engineering from the School, I met a doctor who was pursuing a fellowship in surgical University of Oklahoma, Dr. Bieligk earned a medical oncology; I was very impressed with his knowledge of anatomy and degree from the university’s medical school. He went his technical abilities as a surgeon, and I was fascinated by the field of on to complete a general surgery residency and a surgical oncology. From that moment on, I felt like surgical oncology research fellowship at Tulane University School of would be my area of expertise. Medicine in New Orleans and a surgical oncology fellowship at Memorial Sloan-Kettering Cancer why did you choose to practice medicine at ctca? Center in New York City. Prior to joining CTCA®, Dr. My decision was based on a combination of events. I received a Bieligk served as medical director of surgical oncology notification in the mail from a recruiter about coming by a booth to learn at St. John’s Regional Medical Center in Joplin, about CTCA at one of our medical meetings. I didn’t end up visiting the Missouri. He has also served as an attending surgeon booth, but once I got home I felt like I should give them a call, which I at hospitals in Maryland and as an assistant professor did, and then I traveled to Tulsa, Oklahoma, to visit the hospital. in the departments of surgery at the University of Maryland School of Medicine in Baltimore and the After I lost my home and office in the tornado that hit Joplin, we worked University of Texas Southwestern Medical Center out of a trailer and a tent for a while before making the decision to at Dallas. Dr. Bieligk has been published in many move to Tulsa. The people at CTCA were very interested in my specialty clinical periodicals, has contributed to multiple because I could perform hyperthermic intraperitoneal chemotherapy research projects and clinical research protocols, and (HIPEC), and I felt comfortable there. It was a tough decision to leave, has presented at numerous clinical conferences across but it was the best decision for me personally and professionally. the country. Dr. Bieligk is a member of the American College of Surgeons, Society of Surgical Oncology, and what do you like about ctca? American Medical Association. I like that I can walk 20 feet to meet with a medical oncologist about a particular patient, I can meet with a gastroenterologist within 25 feet, I 20 cancer fighters thrive | spring 2013 cfthrive.com meet the doctor “Surgical oncology is changing in that we have an increasing number of innovative technologies at our disposal.” can consult with another surgeon with- At CTCA the access to innovative lives have been enhanced by surviving in a few feet, and the radiation oncolo- treatment is so much more robust than this tragedy and the experiences that gist is 100 yards away. This access to the any other place I have worked. In my followed. multidisciplinary team facilitates my previous employment and practice, ability to make timely, informed patient the ability to perform cutting-edge what hobbies or interests do management decisions, and I like that. therapies was hindered by a lot of red you pursue in your free time? And there is a closeness with patients tape and difficult hurdles, whereas here I spend most of my free time with my that is really nice. the pathways to using these innovative children. I like building things with my technologies are much more clear—there hands, and I recently built a tree house how do you see the specialty are fewer obstacles, and I can sense that for my middle daughter. I also like of surgical oncology we will continue to pursue these new attending football games, and my oldest changing in the future? treatments. daughter and I attend University of Surgical oncology is changing in that we Oklahoma games. have an increasing number of innovative you and your family survived technologies at our disposal: We use the 2011 tornado in Joplin. HIPEC, intraoperative radiation therapy how did that experience (IORT), and multiple modalities. I think affect your oncology career that surgical oncology will continue to and you personally? use these and other new technologies, Certainly, every day we are much more which are increasingly robust and more thankful about almost everything. We advanced. Laparoscopic surgery is are so grateful to have a home, to be another one of those innovative surgical safe, and to know that we’re going to be advances. All of these advanced strategies fine from an employment standpoint— really provide the patient with treatment all those things you can take for granted. opportunities that they’ve never been We also appreciate our children and offered before. our faith more, and we find ourselves grateful for the small things on a regular basis. We definitely feel that our cfthrive.com For a free print subscription go to cfthrive.com spring 2013 | cancer fighters thrive 21 tips & trends tips & trends Managing Nausea Ginger is a powerful anti-nausea tool. Try ginger tea or ginger candies. Need a ride? Among the many considerations related to cancer treatment, some cancer patients face a practical— and prohibitive—obstacle to getting the critical treatment they need: transportation. Patients who do not drive, do not have access to public transportation, do not have the financial resources to pay for transportation, or do not feel well enough to get to treatment may not be able to get the care they need. in these situations the American cancer Society provides a valuable resource: its road to recovery Program matches volunteer drivers, who donate their time and the use of their cars, with patients who need to be driven to treatment. For more information call (800) 227-2345. 22 cancer fighters thrive | spring 2013 Many people being treated for cancer worry about experiencing side effects related to the digestive system—especially nausea. the good news is that not everyone experiences nausea, and, for those who do, there are many creative options for managing the condition. in addition to taking the medications that may be prescribed by a doctor, the following are tips for managing nausea. • Try ginger products. Ginger is a powerful anti-nausea tool. try ginger tea or ginger candies. Flavored ginger ale (ginger “beer”) is also an option. • Other helpful foods. Peppermint tea, queasy “pops” or “drops,” and cola syrup can also help relieve nausea. every patient is different, so be open to trying multiple nausea remedies to find something that works for you. • Avoid strong food odors. Sometimes food odors themselves can be enough to make you feel sick or vomit. try cold foods more often. • Eat bland and low-fat foods. Bananas, mashed potatoes, rice, toast, oatmeal, applesauce, crackers, and other bland foods can be soothing to the stomach and are less likely to cause vomiting. • Relax. try to eat your meals in a calm environment. Distract yourself with peaceful music, a favorite film, or good company. CleaNiNg for a ReasoN if you’re going through cancer treatment, chances are the last thing you have time and energy for is cleaning your home. And yet a clean home environment can make a real difference in your outlook. For a welcome relief from difficult physical chores, consider cleaning for a reason, a texas-based nonprofit organization that partners with maid services in communities across the united States and canada to provide female cancer patients with free, professional cleaning services. For more information visit cleaningforareason.org. cfthrive.com research today reSeArch tODAy one size Does not fit all Personalized cancer treatment moves forward. By kari Bohlke, scD it’S A POPuLAr terM these days: to respond to a targeted drug called Zel- innovation in colorectal cancer care personalized medicine. But what does boraf® (vemurafenib). The development of new, personalized it actually mean? In the case of cancer, • For women with early-stage, estrogen cancer treatments starts with innovative personalized treatment involves using receptor–positive breast cancer, the On- cancer researchers. Edward H. Lin, MD, the specific characteristics of the cancer cotype DX® test provides information a medical oncologist and researcher and the patient to guide treatment deci- about risk of recurrence and need for at Seattle Cancer Care Alliance and sions. The goal is to identify in advance chemotherapy. the Fred Hutchinson Cancer Research the treatments that are most likely to Research in personalized cancer care Center, specializes in the treatment of be effective for a given individual. Al- is challenging—cancers can be driven by gastrointestinal cancers and is studying though this idea is not a new one, our multiple, complex biological pathways— new and more-effective ways to treat ability to achieve it is growing as re- but progress is clearly being made. And colorectal searchers identify new biological path- when tests are available to guide treatment interested in the role of cancer stem ways that contribute to cancer growth decisions, patients can benefit no matter cells in cancer growth and resistance to and new drugs that target these path- what the test result. If you learn that you treatment. “It’s an emerging field,” he ways. are not a candidate for a particular treat- explains. “These are cells that may have ment, for example, you can avoid the side escaped chemotherapy, and a higher here are a few examples: effects and the cost of that treatment and number of these cells predicts worse • Roughly 5 percent of non–small cell focus your attention on other approaches outcomes for the patient.” lung cancers contain an abnormal ver- that are more likely to be effective. cancer. He’s particularly A treatment that Dr. Lin is studying sion of a gene known as ALK. Patients These tests do not replace a discussion involves a combination of two drugs who test positive for this genetic change of treatment options with your physician, that are taken orally (by mouth): tend to benefit from a targeted drug but they do allow for a more informed Xeloda® (capecitabine) and Celebrex® known as Xalkori® (crizotinib). discussion. Factors other than test re- (celecoxib). Xeloda is a chemotherapy • Melanomas that test positive for a par- sults—such as your individual needs or drug, and Celebrex is a nonsteroidal ticular mutation in the BRAF gene tend preferences—can also be considered. anti-inflammatory drug (NSAID) that is cfthrive.com spring 2013 | cancer fighters thrive 23 research today Researchers can’t take all of the credit for advances in cancer treatment. The patients who participate in clinical studies and who try new approaches to treatment are a key part of the process. “I was so sick,” she recalls. By this time Dr. Lin had moved from Texas to Washington State, but Gail was determined to take charge of her own care: “I got on the Internet and looked for his name because I remembered that he was doing something different.” commonly used for such conditions as the Other Part of the equation She traveled to Seattle to see him and arthritis. Interestingly, the combination Researchers can’t take all of the credit repeated the treatment with Xeloda and of these two drugs improved colorectal for advances in cancer treatment. The Celebrex that she’d received earlier in cancer outcomes by targeting cancer patients who participate in clinical the course of the disease. She was free of stem cells in some of his patients. studies and who try new approaches to detectable cancer at the time she began treatment are a key part of the process. this treatment—and remains so. “We’ve already treated more than 100 patients,” says Dr. Lin. The result so far: Gail Shugart, of Alpine, Texas, has Gail understands that the combination promising response rates and survival been treated for metastatic colorectal of Xeloda and Celebrex is still under among people with advanced colorectal cancer by Dr. Lin. Although Gail’s study, but she feels good about working cancer. As an added benefit, the addition story does not prove that Xeloda and with someone who is actively researching of Celebrex to Xeloda reduces one of the Celebrex provide a benefit—definitive the topic. “He’s an independent thinker,” frequent side effects of Xeloda: hand-foot information about the safety and the she says of Dr. Lin, “and he just wants to syndrome, a condition that involves red- efficacy of this treatment requires final save lives.” ness and swelling in the hands and the results from large studies—it does feet. illustrate some of the challenges and What it’s All About decisions that a person confronting the Ultimately, personalized cancer care limits of standard treatments must face. is about the person. When asked what To further evaluate the combination of Xeloda and Celebrex, Dr. Lin is conducting a phase II clinical trial with When Gail was first diagnosed with motivates him, Dr. Lin responds, “It’s funding from the Gateway for Cancer colon cancer in the fall of 2004, the just really gratifying. My family has Research, organization cancer had already spread to her liver. been touched with colon cancer, and I’ve that funds innovative, patient-centered “I was 59,” she says. “I didn’t really pay seen a lot of patients over the years. It’s cancer research on both conventional attention to some of the signs.” She certainly these patients who inspire me and complementary cancer therapies. received conventional treatments such as to do what I do today.” “We’re using the Gateway funding to surgery and intravenous chemotherapy Organizations such as Gateway that prospectively prove that you can induce and was also treated with Xeloda and fund innovative cancer research share complete remission in patients with Celebrex by Dr. Lin, who was then at the this focus: the organization’s research colon cancer,” says Dr. Lin. The study MD Anderson Cancer Center. Together mission is to support patient-centered will compare Xeloda and Celebrex with these treatments eliminated all signs of research that improves cancer treatment standard chemotherapy among patients cancer. outcomes and restores the cancer a nonprofit with metastatic colorectal cancer that In spite of this good response to initial has responded to initial chemotherapy. treatment, the cancer later returned— The study will also explore whether twice—in one of her lungs. Surgeons For more information about certain biologic markers can predict were able to remove the lung metastases, Gateway-funded clinical trials, visit: which patients are likely to respond to but Gail found that she couldn’t tolerate demandcurestoday.org/cancer-research. the novel treatment. the additional intravenous medications. 24 cancer fighters thrive | spring 2013 patients’ quality of life. cfthrive.com At CTCA, we fight breast cancer with advanced medical treatments that help patients experience a better quality of life. Learn more about our breast cancer treatment program. BCW Alaskan Cruise KEYNOTE SPEAKERS July 12–19, 2013 Sailing out of Seattle, Washington to Ketchikan, Juneau, Skagway and Victoria, British Columbia on the Celebrity Solstice Reverend Dr. Michael Barry, Director Pastoral Care Sharon Day, RD, CSO, CNSC Director of Nutrition Beginning at $1,329* Interior P/P *Includes port charges and fees. Celebrity reserves the right to impose a fuel supplement on all guests at up to $10 per person per day if the price of West Texas Intermediate fuel exceeds $65 per barrel. Rates are per person, based on double occupancy and are subject to availability. Restrictions apply. Ship’s registry: Malta Call Great Southern Travel today Andrea Bateman 1-800-749-7116, [email protected] special feature THe Big PiCTURe Quality of life is key. By Laurie Wertich L ife doesn’t stop in the face of a cancer diagnosis—in fact, it often gets busier. There are doctor appointments, scans, and treatments—on top of work, carpools, laundry, meals, household maintenance, and so much more. It is a juggling act that would challenge even the most proficient multitasker. So, how can cancer patients juggle all of these challenges? The answer boils down to one thing: quality of life. Quality of life Quality of life refers to an individual’s overall wellbeing—the emotional, social, and physical aspects of life and how they may be impacted over time by a disease or daily stressors. The fundamental key to surviving and thriving with cancer is maintaining a good quality of life. Focusing only on treating cancer can leave patients feeling sick, tired, and unable to perform the activities they have to do or love doing. Christopher M. Stephenson, DO, an osteopathic physician and hospitalist at Cancer Treatment Centers 26 cancer fighters thrive | spring 2013 photos by Bart harris cfthrive.com Left to right: Audrey ridolfi; chris M. Stephenson, DO; Mary thyme, rN; Awilda Lafonne, PA cfthrive.com spring 2013 | cancer fighters thrive 27 special feature works to resolve any concerns and regularly communicates with the patient’s entire CTCA care team to ensure immediate and continual symptom management throughout treatment and beyond. “The goal of the Quality of Life Center is to provide comprehensive, hopeful solutions, including medical and integrative therapies and services, to enhance the physical and emotional well-being of our oncology patients at all phases of their care,” Dr. Stephenson explains. “Upon entering treatment, the patient is viewed as a survivor, and all resources are focused on improving his tom Lay; chris M. Stephenson, DO; Sara Mortenson or her quality of life.” of America® (CTCA) in Zion, Illinois, This does not happen by accident; rather, explains that when patients experience it is an intentional, well-researched, and the whole patient symptoms such as pain or fatigue, it can targeted approach that has resulted in the Cancer is just one piece of the puzzle. not only affect their ability to perform creation of special clinics designed to focus Many patients diagnosed with cancer are activities of daily living but also interfere on the wants and the needs of patients. living with other chronic conditions— The Quality of Life Centers at CTCA referred to as comorbidities—such as offer a unique, innovative approach to diabetes, heart disease, osteoporosis, helping patients navigate cancer and obesity, addressed properly or controlled or maintain the best quality of life possible. commonly experience many symptoms managed, then we’re not going to have The clinics are an integral component as a result of cancer treatment, the most compliance with treatment, and we’re not of each hospital and provide a central common of them being fatigue, pain, going to have success—leading to greatly location for addressing and managing neuropathy, nausea, anxiety, depression, diminished outcomes,” Dr. Stephenson symptoms as well as coordinating and sexual dysfunction. says. treatment. with treatment and even the response to that treatment. “If one of those issues is not being and many more. Patients The Quality of Life Center is a place, “There are different patients who are putting Quality of life first outside of regular oncologic care, where candidates for different therapies,” explains patients can address any issues that might Dr. Stephenson. “These therapies have to be At CTCA® cancer treatment and quality interfere with their daily living. The spe- monitored and modulated for the specific of life go hand in hand, with doctors and cially trained medical professionals work- condition of the patient.” patients working together through all ing with patients oversee the big picture For example, patients with severe stages of treatment and follow-up care. and treat the patient as a whole. The team cardiac disease may not be candidates for Mistie Bickford and her mother, Kim, often exercise together. 28 cancer fighters thrive | spring 2013 cfthrive.com special feature some medications used to treat cancer. the management of their comorbidities,” effective to take during treatment and Patients with diabetes may need extra Dr. Stephenson says. with the specific diagnosis. support with controlling blood sugar The care management team tracks the If a patient has a prior cardiovascular because some cancer treatments can data, so that if a patient has level-4 pain condition, physicians in the Quality affect blood sugar control. (on a scale of 0 to 10) in June and that of Life Center use preventive strategies pain jumps to a level 7 in July, the issue to ensure that the patient does not will be addressed. encounter heart issues during surgery. “Each one of our hospitals has an oncology-mindful, internal medicine care approach that addresses the core “What sets us apart is how we manage For example, they’ll optimize their heart issues that are unique to each patient, and measure these things,” says Dr. and blood pressure medications, and the specific treatments for the disease, Stephenson. “If the patient’s pain level is they’ll also prescribe the appropriate and the comorbidities affecting that too high, the nurse will tell the doctor. If pain medications to relieve and prevent particular patient,” Dr. Stephenson says. he or she needs assistance in managing pain because a pain response could place The bottom line is that the physicians the pain, the patient is referred to the extra stress on the heart. and the nurses in the Quality of Life Quality of Life Center, where I will do Pain management is one of the most Centers have a vitally important job: to everything within my power to bring critical factors to maintaining a good know and understand each individual relief to the patient. This is unique. No quality of life. “Pain interferes with ev- patient so that they can help proactively one else is doing this.” erything,” Dr. Stephenson explains. “It is a significant health issue that affects all manage any side effects or health issues an ounce of prevention other issues in a patient. How can one Measuring and tracking symptoms is only truly enjoy life if he or she is always in assessing Quality of life the starting point. The Quality of Life pain? Many clinicians consider it the All care team members at CTCA Center is about action, specifically pre- fifth vital sign.” continually work to monitor and assess ventive action. More often than not, the patients’ quality of life. CTCA has best defense is a good offense. that may arise during treatment. “We have a very aggressive pain management protocol in place at CTCA. If implemented a new assessment protocol “We try to prevent complications be- you are in so much pain all the time, you that nurses use every time they see a fore they arise,” Dr. Stephenson explains. are not going to want to comply with patient. “Essentially, we are having The only way to do this is to know exactly your treatment plan,” Dr. Stephenson our nurses measure things that impair what is going on with each patient. says. “If patients have pain, we are go- our patients’ well-being,” explains Dr. For example, if a patient has diabetes, Stephenson. “We are measuring the the physicians in the Quality of Life things that patients tell us are important Center take a proactive strategy to to improve their quality of life during and managing both the diabetes and the communication is key after the cancer is treated.” cancer. Dr. Stephenson explains that they Addressing This nurse assessment includes nine will use long-acting and short-acting a main key to cancer treatment. The symptoms that nurses ask patients about insulin to counteract the negative effects innovative every time they visit the clinic: pain, that can occur as a result of some cancer at CTCA is a good starting point anxiety, depression, numbness/tingling, treatments. What’s more, all patients and can open the door to effective fatigue, nausea/vomiting, appetite changes, have access to nutrition and naturopathic communication between the patient and constipation, and diarrhea. “After 14 oncology providers at CTCA hospitals, the team physicians. months of analysis and research, we came who will help the patient determine what up with these key predictors of symptom to eat to maintain an ideal weight and important for patients to be open about management that will affect compliance blood sugar during cancer treatment their symptoms. “If you are empowered with the entire oncologic therapy plan and and what natural therapies are safe and to speak with your doctor about these cfthrive.com For a free print subscription go to cfthrive.com ing to do something about it before they leave.” Dr. quality-of-life nurse Stephenson issues assessment says that is tool it is spring 2013 | cancer fighters thrive 29 special feature issues, you will feel more comfortable with your doctor and your treatment, and you will have a better clinical response,” he insists. “We listen to our patients,” Dr. Stephenson says. “Then, having heard them, we solve the problems with them and give them strategies for managing their symptoms to improve their overall quality of life.” Dr. Stephenson with members of the care team ™ With Coram, patients benefit from a broad range of specialty infusion services, including: TPN and tube feeding Anti-infective services Patient-controlled analgesia 24/7 access to clinicians Personal support and advocacy Clinical and compliance monitoring With more than 85 branch locations nationwide, including over 65 infusion suites, we offer both national presence and comprehensive local coverage. Our experienced clinicians are known for providing an exceptional level of personalized care to thousands of home and infusion suite patients every day, including those with complex therapy needs. CASEDirect 800.423.1411 coramhc.com © 2012 Coram LLC 30 cancer fighters thrive | spring 2013 cfthrive.com naturopathic environmental risk factors By Laurie Wertich W How do lifestyle factors and exposure to environmental substances affect our cancer risk? hat causes cancer? It’s the million-dollar exposure to that substance can increase the risk of cancer. question—and if you pay attention to The term environmental risk factor usually brings to mind the messages in the media, the answer is: things like chemicals and radiation, and these things are indeed everything. But that isn’t really the case. risk factors; however, there are many other factors that fall There are indeed some environmental risk factors for within that category, as well. In fact, the greatest risk factors cancer—meaning exposure to substances that could increase we face in the United States are not exposures to radiation or the risk of developing cancer—but there are also a lot of chemicals in the environment around us but, rather, our own unproven claims about factors that increase the risk of cancer. dietary and lifestyle choices—most of which can be modified. The trick is learning to discern fact from fiction. The best way “From a public health point of view, environmental risk factors to protect ourselves from cancer: information and lifestyle are not just things that you are exposed to in the environment modification. around you or the things you eat, drink, or put on your skin. They are the sum total of those factors, plus other behavioral what is an environmental risk factor? and lifestyle factors that expose your body to carcinogens and Environmental risk factors for cancer are things in your affect how your body responds to those carcinogens,” explains environment that may increase the risk of developing cancer. Robert Wascher, MD, FACS, surgical oncologist at Cancer Carcinogens are materials that are known to cause cancer. Treatment Centers of America® (CTCA) in Goodyear, Arizona, When a substance is referred to as a “known cancer risk factor” and author of A Cancer Prevention Guide for the Human Race or a “known carcinogen,” it means that science has proven that (Dog Ear Publishing, 2010; $14.99). cfthrive.com spring 2013 | cancer fighters thrive 31 naturopathic AvOiDiNG exPOSure tO eNvirONMeNtAL riSK FActOrS There are plenty of steps you can take to limit your exposure to environmental risk factors. • Avoid tobacco. the best advice is to abstain from all tobacco products, including cigarettes. if you live with a smoker, have him or her smoke outside; install an air filtration system in the home and wash clothes frequently, especially before holding a baby because clothing can carry the toxic compounds. • Maintain a healthy body weight and get three to four hours of moderate physical activity per week. • Minimize alcohol intake, which for most adults means no more than one or two alcoholic beverages per day (and preferably less). • Cook meats at low temperatures to avoid charring. • Minimize your intake of meat and other animal products and increase your intake of whole grains and fresh fruits and vegetables. “TobACCo IS bY fAR THe GReATeST CAuSe of CANCeR CASeS AND DeATH.” lifestyle factors “When you take that broader view, tobacco in all of its forms is still the greatest environmental risk factor for cancer, whether you use it yourself or are exposed to it by others,” Dr. Wascher notes. “At least one-third of all cancer deaths are directly or indirectly related to tobacco exposure.” The next biggest category, which also accounts for one-third of cancer deaths, is a group of lifestyle factors lumped together: obesity, alcohol intake, physical inactivity, and dietary exposure to food-related carcinogens. In other words, when you look at • Comply with cancer screening guidelines and recommended vaccinations. these two main categories of cancer risk factors, 60 percent of • Avoid electromagnetic fields (EMFs). in the home two of the biggest sources of eMFs are hairdryers and electric blankets. these lifestyle factors. • Clean house. remove shoes before entering the house and dust, vacuum, and mop frequently to cut down on chemicals that can accumulate in dust. cancer diagnoses could be avoided through modification of These environmental factors are modifiable, but what about the other 40 percent? Are there other cancer risk factors that we might be able to avoid? Maybe—and some of them are more modifiable than others. identifying risk factors • Use natural or homemade cleaning products. Most cleaning products are loaded with chemicals, and manufacturers are not required to disclose ingredients on the label. read labels carefully and buy products that disclose their ingredients. “There are a number of compounds in the air, water supply, • Get a radon detector. if you have particularly high levels of radon in your home, you may want to seek the services of a radon specialist. you may benefit from sealing off your basement and installing a radon remediation system. Sometimes these things are even covered by homeowner’s insurance. cases and cancer-associated deaths, but it’s hard to accurately • Avoid BPA. BPA is found in plastic, canned foods, and even on receipts. 32 cancer fighters thrive | spring 2013 and food supply that carry potential risk,” explains Dr. Wascher. “Some of these environmental factors are still not well understood. However, occupational exposure to known carcinogens probably accounts for two to five percent of cancer measure environmental exposure to carcinogens outside of certain work environments.” There’s the catch: how do we measure exposure and assess risk when we aren’t sure what we’re even measuring? In the scientific community, randomized controlled clinical trials are the gold standard—meaning that one group is given some sort of intervention (like exposure to a type of medication) and cfthrive.com naturopathic environmental factors that are beyond debate. AIR PolluTIoN • Tobacco Tobacco use, particularly cigarette smoking, has been linked to almost every type of cancer, especially lung cancer. “Tobacco is by far the greatest cause of cancer cases and death,” Dr. Wascher says. According to Shelly Smekens, ND, naturopathic resident at CTCA® in Zion, Illinois, the risk is high for both smokers and nonsmokers exposed to secondhand smoke. • Radon Radon is a colorless, odorless gas that develops as a result of uranium decay. It is present in some level almost everywhere in the world, but some places have higher levels of radon, particularly areas with cold winters and in buildings with basements where the gas can accumulate. “After cigarette smoking, radon is the second-highest modifiable another is not, and then the two groups ferently to carcinogens. “In any discus- risk factor for lung cancer, which is still are compared. But environmental sion about environmental carcinogens the number one cause of cancer death exposure to potential carcinogens does and environmental cancer risk, you have in the United States,” explains Smekens. not happen in a controlled environment to say something about the fact that not Dr. Wascher notes, “Radon gas exposure like that. all of us are going to respond in the same probably accounts for five to eight per- “With regard to a lot of environmental way,” explains Dr. Wascher. “There ap- cent of all lung cancer cases.” exposures, we don’t have a natural pears to be an underlying genetic com- • aiR polluTion “Particulate air pol- control group because often everyone ponent involved in our individual risk of lution, especially exhaust from diesel is exposed to them,” explains Connie actually developing cancer in response engines, has been linked to lung cancer,” Engel, science and education manager to being exposed to many known car- Dr. Wascher says. “Individuals who live for the Breast Cancer Fund, a national cinogens. We’re all different, and we in heavily polluted areas therefore appear nonprofit organization dedicated to all have a different genetic makeup.” to have higher rates of lung cancer.” • chaRRed food Heterocyclic amines, preventing breast cancer by eliminating or HCAs, are carcinogenic chemical com- radiation linked to the disease. “We confirmed environmental risk factors can’t control who is exposed, and we Scientists like data. Data provide great- temperature. Grilled and heavily charred certainly can’t do a randomized study er certainty, and with greater certainty meats have been linked to colorectal, and randomly assign people to things we can make better recommendations. pancreatic, stomach, and breast cancers. that we think are hurting them.” Identifying true carcinogens is poten- • dieTaRy choices “Diets rich in tially complicated, but there are some red meat and other animal products are exposure to toxic chemicals and What’s more, individuals respond difcfthrive.com pounds created by cooking meat at a high spring 2013 | cancer fighters thrive 33 naturopathic cONtrOverSiAL PrOveN There are ongoing studies in these areas. These are proven cancer risk factors. AciDic WAter tOBAccO FLuOriDAteD WAter rADON SuGAr OBeSity DeODOrANtS AND ANtiPerSPirANtS MeAt-rich DietS BreASt iMPLANtS DietS LOW iN WhOLe GrAiNS WeAriNG A BrA DietS LOW iN FreSh FruitS AND veGetABLeS PhySicAL iNActivity ALcOhOL iNFectiONS With certAiN viruSeS AND BActeriA Air POLLutiON chArreD Or heAviLy GriLLeD MeAtS SOMe cheMicALS Robert A. Wascher, MD, FACS, A Cancer Prevention Guide for the Human Race (Indianapolis: Dog Ear Publishing, 2010). also associated with an increased cancer the management of cancer, but many of chemicals because there are a lot of risk,” says Dr. Wascher, “and particularly these scans are being done for less-than- variables,” Dr. Wascher says. cancer of the esophagus, stomach, pan- solid critical reasons,” Dr. Wascher says. The challenge comes in proving beyond creas, colon, and rectum. Diets that are He recommends prudent use of these a shadow of a doubt that certain chemicals low in whole grains and fresh fruits and scans—and the use of ultrasound or mag- pose a risk. The scientific community vegetables also increase the risk of these netic resonance imaging when possible needs solid facts to rule against a same cancers.” and appropriate, instead of CT scans. chemical, but the available scientific data • RadiaTion Exposure to radiation can • poweR lines Smekens explains that is often not black-and-white. Engel says increase the risk of cancer. “For most of electromagnetic fields (EMFs) have been that if you look at the full body of data— us, that is probably not a huge deal be- associated with leukemia, brain tumors, which includes both human and animal cause we didn’t live downwind of Cher- and breast cancer. “There have been studies—there is biologically plausible nobyl,” explains Dr. Wascher. “But an some occupational studies on people who concern regarding certain chemicals. area of increasing concern is medical X- worked on power lines that showed small She lists several chemicals of concern, ray exposure. In fact, recent conservative but real increases in leukemia and brain including estimates suggest that one to two percent cancer,” she says. An association has also phthalates and bisphenol A (BPA). of all new cancer cases may be linked to been found between housing proximity “You don’t have that much to lose by medical X-rays and to CT [computed to- to power lines and increased incidence of avoiding these chemicals, and you have mography] scans in particular.” Many of childhood leukemia. everything to gain,” Engel insists. to medical treatment, but sometimes X- what about chemicals? Chemicals, Healthy Families, a national rays and scans are overused. “When prop- “It’s a fuzzy area when you start talking coalition of organizations and individuals erly used, CT scans are very important in about environmental pollutants and working to raise awareness about toxic these scans are important and necessary 34 cancer fighters thrive | spring 2013 endocrine disruptors like Lindsay Dahl, deputy director of Safer cfthrive.com naturopathic JuSt SAy NO tO cheMicALS The jury may still be out on some chemicals, but there are certain ones that are worth avoiding. It can’t hurt, and it might help. • Phthalates. Phthalates are endocrine disruptors with a possible link to breast cancer. Phthalates are used in building materials, personal care products, detergents, surfactants, children’s toys, pharmaceuticals, and more. • BPa. Bisphenol A is an endocrine disruptor that has been linked to thyroid dysfunction as well as several different types of cancer. the united States has banned the use of BPA in baby bottles, whereas other countries have banned its use entirely. BPA is used in the lining of cans and has been shown to leach into canned food. Most receipts are also coated in BPA. • Formaldehyde. Formaldehyde has been classified as a known human carcinogen. it is used in building materials, furniture, cabinets, countertops, cleaners, and more. • tCe. trichloroethylene is an industrial solvent and is used in rug cleaners, adhesives, paint removers, and spot removers. the most common exposure to tce is through contaminated drinking water. evidence continues to pile up against tce, and research is ongoing. • FragranCe. Synthetic fragrances are common in personal care products and cleaning products. Fragrance is tricky: When a product lists “fragrance” as an ingredient, that one ingredient may include dozens of chemicals. Because you don’t know which chemicals are included, it’s best to avoid the product altogether. cfthrive.com chemicals in homes, workplaces, and ten years of when they removed lead products, says that peer-reviewed science from gasoline.” has shown some strong links between cancer and some chemicals. “Two of Prevention is key the best examples are formaldehyde There are a variety of environmental and she risk factors linked to cancer, but there says. Formaldehyde is a known human is no need to live in fear. It’s impossible carcinogen and a common indoor to avoid all exposure to potential air pollutant. It can be found in carcinogens, but it pays to know what is building materials, furniture, cabinets, in your environment and to do your best countertops, cleaners, and more. TCE to protect yourself against potential risk is used in rug cleaners, adhesives, paint factors. trichloroethylene (TCE),” removers, and spot removers. It is highly “Even if you’re conservative and throw toxic and can contaminate the water out the wacky stuff and accept the known supply. There have been reported cancer limitations of the science and the data,” clusters next to manufacturing facilities says Dr. Wascher, “at least 60 percent that use these chemicals. of all new cancer cases are tied to one Engel says that even low doses of some or more modifiable lifestyle or other compounds can be cause for concern, environmental risk factors, and many especially when the exposure happens at of the types of cancers that are linked to vulnerable periods of development such preventable risk factors are, in fact, the as during infancy, before and during cancers that cause the greatest number of puberty, and during pregnancy and cancer-related deaths.” lactation. “We think of this as a public health issue,” she says. “And we think it is important to give people tools to make informed decisions.” But how do you make informed decisions about chemicals when there is so much conflicting data? “There are so many things to worry about that you could drive yourself nuts,” admits Dahl, but she is quick to point out that the news is not all bad. “Prevention is hard to quantify, but we know that it works. For example, lead levels in the blood plummeted within spring 2013 | cancer fighters thrive 35 innovation welcome reLieF Pain Management is the Key to living Well By Kari Bohlke, ScD E veryone has likely heard one talking with an exPert “If pain goes unrelieved, it denies that of the following at some point: “Pain is one of the most common individual comfort and greatly affects “Keep a stiff upper lip.” “Grin symptoms cancer,” daily activities. What I tell patients in the and bear it.” “Play through the explains Raed Rahman, DO, director of clinic is that most people are multi-taskers: pain.” When it comes to cancer, however, pain management at Cancer Treatment they can do many tasks at one time. But these suggestions do not apply. Untreated Centers of America® (CTCA) in Zion, when patients have severe pain, or pain pain can interfere with virtually every Illinois. Pain can result from the cancer for many months, they can become uni- aspect of life, from the ability to sleep to itself or from treatments such as taskers: they’re focused only on the pain the ability to enjoy the company of family chemotherapy, radiation therapy, and and may need help with a lot of common and friends. Talking openly with health surgery. daily tasks.” associated with care providers about pain can ensure “One of the barriers to adequate pain appropriate care at the right time. Pain relief,” says Dr. Rahman, “is that some manY oPtions for management is an important part of patients believe that pain is something Pain management cancer care, and many treatment centers that they have to live with.” The “You can manage pain in the human body have providers who specialize in this area. consequences of this can be far-reaching: in a lot of ways,” continues Dr. Rahman, 36 cancer fighters thrive | spring 2013 cfthrive.com innovation pointing to such options as medication, a scale of 0 to 10), it’s helpful for the that a pain medication strategy can physical therapy, acupuncture, massage doctor to have information about what be developed with a patient’s daily therapy, chiropractic care, mind-body the pain feels like, whether it’s constant activities in mind. “I don’t prescribe support, and pastoral care. Depending or intermittent, and what factors make it these medications to patients so that on the situation, procedures that treat better or worse. Words that can describe they sleep all day or can’t function,” says the cancer or that block nerves from different types of pain include sharp, Dr. Rahman. “That’s not the purpose. sending pain messages can also provide dull, throbbing, burning, and shooting. The purpose is for the patient to take the medication when needed and to function relief. The key to finding what’s right for a given individual is a comprehensive pain Pain meDications at home, to function at work, and to live evaluation. “The pain can be physical, Although medications are not the their life.” psychological, or psychosocial. You need only way to manage pain, they are For certain types of pain, a doctor an idea of exactly where the pain is effective and important options for may recommend a different type of coming from or what’s making it worse.” many people. Pain medications come medication. The tingling and burning An important goal of pain management in a range of strengths, from over-the- that can accompany nerve damage, for (and of care at CTCA® in general) is to counter remedies such as ibuprofen and example, may respond to treatment with treat the entire person. In some cases acetaminophen to strong prescription an antidepressant or antiepileptic drug. this may involve using more than one drugs such as oxycodone and morphine. Similarly, pain caused by swelling may approach to pain management. Use of If a physician approves over-the-counter respond to medications that reduce the pain medication in combination with a medications that provide adequate relief, swelling, such as an anti-inflammatory. nonpharmaceutical treatment such as these may be all that is needed. If more- relaxation, for example, may result in severe or persistent pain is an issue, holistic care ProviDes hoPe better pain control and overall wellness however, a doctor may suggest stronger “In most patients cancer pain can be than either approach alone. Recognizing drugs. Use of these medications to treat successfully controlled with appropriate and treating common problems such as pain, says Dr. Rahman, can help a patient techniques and safe drugs,” concludes Dr. depression and anxiety can also change maximize quality of life and ability to Rahman. “Working with a pain manage- the perception of pain. function. ment specialist, patients don’t have to live For patients who experience pain, If strong pain medications are needed, with pain. The overall approach to pain the right place to start is a discussion experts in pain management can develop management should be comprehensive in with a primary care provider. “Usually, a treatment plan that fits a patient’s short- nature and involve a holistic plan that in- due in part to the existing patient/ and long-term needs. In some cases it cludes using one or more of the methods physician relationship,” says Dr. Rahman, may be necessary to try more than one discussed earlier.” “the primary care provider knows the type of medication to find the one that The goal is not only to ensure that pa- patient better than anyone else and works best. “When you look at the basic tients feel better but also to allow them can implement basic pain management chemistry of these pain medications,” to function better and to live the life they strategies.” But strategies says Dr. Rahman, “they’re like brothers want to lead. An individualized and com- aren’t successful, a referral to a pain and sisters; they have a lot of similarities prehensive approach to pain management management specialist may be beneficial. but minor differences.” So, if the first can help achieve this goal. When undergoing a pain assessment, a medication isn’t adequate or produces patient will likely need to answer several intolerable side effects, there is likely questions about the nature of the pain. In another drug or treatment approach that addition to the location and the severity may work well. if these of pain (which is often measured on cfthrive.com Reference Pain Control. NIH Publication No. 12-6287. National Cancer Institute website. Available at: http://www.cancer. gov/cancertopics/coping/paincontrol.pdf. Accessed November 12, 2012. It’s also important to keep in mind For a free print subscription go to cfthrive.com spring 2013 | cancer fighters thrive 37 ask the nurse QA & tiPs for caregivers: suPPorting Patients through treatment By Theresa Rodriguez, RN, BSN Cancer Treatment Centers of America® (CTCA) how can caregivers best and pet therapy also help many patients what Questions might a support patients’ physical relax and feel better, thereby increasing caregiver ask the loved one’s needs during treatment? coping skills. I would encourage you care team to be best prepared Treatment for cancer is a journey, as a caregiver to celebrate the good to support the patient during and patients will certainly experience times with your loved one—especially treatment? changes to their bodies throughout their days of high energy or milestones in The road to healing is a difficult one care. Caregivers can be supportive of treatment. Remain positive, prayerful, that will pose many challenges to all patients’ physical needs by encouraging and encouraging during the down times. dimensions of a patient’s life—physical, movement, by practicing tolerance, and Know that treatment is a journey. emotional, and spiritual. Know that through understanding that the patient each member of a care team is an expert may experience physical limitations. what are some common in his or her respective field and has Simply knowing what resources the challenges that caregivers a wealth of knowledge and advice to hospital offers patients, such as physical face as they support patients offer from professional experience. and rehabilitative therapy, is a wonderful during this time? Caregivers should ask the care team first step. CTCA® has personnel who Caregivers need support, too, as seeing members what the common challenges can guide patients in these areas; it also their loved one face cancer poses many tend to be and how to prevent or work has an on-site fitness center for gentle challenges—physically, emotionally, through them. For example, a caregiver exercise, which encourages strength and and financially. Caregivers may need may ask a dietitian, “What foods do you cardiovascular health—both of which aid to take unexpected time off from work recommend I prepare if my loved one’s in healing. to support or travel with the patient. appetite is affected by treatment?” Or one They may be called on to work more, might ask a naturopathic doctor, “Which how can caregivers best or begin employment, to help offset the supplements are the most important to support patients emotionally cost of care. They may need counseling take if my loved one is not able to ingest during treatment? support themselves as they work through them all?” Many patients describe cancer treatment new feelings. CTCA has services to aid as an emotional roller coaster. CTCA caregivers in all of these areas, including what steps can caregivers offers counseling and spiritual support support groups and assistance in take to ensure their own via the mind-body medicine and pastoral completing Family and Medical Leave wellness during this time? care departments, in addition to staffing Act paperwork. Being there for someone 100 percent of a professional psychologist if needed. the time can be draining and leave the Reiki as well as laughter, music, dance, caregiver feeling helpless, so knowing 38 cancer fighters thrive | spring 2013 cfthrive.com that services are available—both in the care of someone with cancer can be Theresa Rodriguez, RN, has been a hospital and in one’s home commu- absorbing, so take advantage of those nurse with Cancer Treatment Centers nity—is important. The services of the who desperately want to help you—they of America® at Midwestern Regional counseling and pastoral care departments are out there and waiting! Take time Medical Center in Zion, Illinois, since at CTCA are available for caregivers, too. I for yourself and know that respite is a 2006. Rodriguez graduated from have heard hundreds of stories of patients’ natural need. As your loved one feels Franklin and Marshall College in neighbors and church members coming better, increase the frequency or duration Lancaster, Pennsylvania, with a double together. For any caregiver it is impor- of your breaks. And remember: you don’t undergraduate degree in biology and tant to realize that breaks are okay—as have to be physically present for your Spanish. She worked as a lab technician is accepting the assistance of the myriad loved one to know that you’re there for for Abbott Laboratories for several friends and family members who natu- him or her. years and taught high school science rally want to step in for a caregiver during before obtaining her RN from College of that time. Lake County in Grayslake, Illinois. She received her BSN from Olivet Nazarene any other tips you would University in Bourbonnais, Illinois, and offer to caregivers who want is currently on track to receive her MSN to support their loved ones from Chamberlain College of Nursing in during cancer treatment? Arlington, Virginia, in the spring of 2013. My advice is to heed the following statement: You are not alone. Taking cfthrive.com spring 2013 | cancer fighters thrive 39 mind-body connection Moving Beyond survivor guilt By Laurie Wertich “Tell me, what is it you plan to do with your one wild and precious life?” —Mary Oliver C me? This is a normal response to such an of guilt and sadness. Why did I survive overwhelming diagnosis. Why did I get this when others did not? Why was I so lucky? disease? Why am I sick when others are not? Why do I have to endure this treatment? WHaT is sURvivoR gUilT? ancer survivorship can be Though generally unanswerable, it is a Survivor guilt is common among survivors accompanied by a unique completely reasonable question. of traumatic events—such as war, natural set of emotions—joy, grief, In the shift from diagnosis to treatment disasters, accidents, and even acute or long- fear, relief, deep gratitude, a and on to recovery, the primary question term illnesses such as cancer. Survivor guilt heightened sense of purpose, and an over- changes. More often than not, most can- refers to the sense of guilt or responsibility whelming sense of responsibility to live life cer patients move pretty quickly from Why that can occur when one person survives a to the fullest. me? to What’s next? What do I need to do to traumatic event that others did not. And, But there is another nagging feeling that survive? How can I best care for myself dur- yes, cancer can be a traumatic event. can sneak into the mix: guilt. Survivorship ing treatment? What will I do with my pre- is such a blessing, yet in spite of that bless- cious life after treatment? “Not all of our patients experience cancer as a traumatic event,” explains Rhonda Col- Here’s where it gets interesting: in the ley, MS, LPT, LMFT, a mind-body therapist face of survivorship, many patients find at Cancer Treatment Centers of America® themselves also circling back around to (CTCA) in Tulsa, Oklahoma. “But even if WHy Me? that first question as they move beyond they aren’t traumatized, they can still ex- The first question that many people ask diagnosis to treatment and recovery, only perience survivor guilt, which means basi- in the face of a cancer diagnosis is Why this time Why me? carries with it a twinge cally feeling guilty that they got through this ing, we often find ourselves reflecting on those who have not been as fortunate. 40 cancer fighters thrive | spring 2013 cfthrive.com mind-body connection other patient survive or, worse, that they Colley encourages patients to examine Colley works with a lot of survivors who should have been the one to pass away. their feelings of guilt by journaling, talk- are experiencing some level of guilt. “We call Some survivors will get stuck in a vicious ing to a therapist, or participating in a it ‘imagined guilt’ or ‘survivor guilt,’” she cycle of “if only”: If only I had told her about support group. “I like to get patients con- says. “Sometimes patients feel responsible the special vitamins I was taking. If only I nected to groups because that can help in part for the passing of fellow patients.” had encouraged him to try acupuncture. If give them a constant sense of balance,” only I had worked harder to build hope in she explains. treatment journey relatively unscathed.” This may not make sense to someone who has not walked the cancer path, sat that person. What’s more, Colley says that one of with fellow patients in the waiting room, “Some people experience no survivor the most effective ways to move beyond compared diagnoses and treatment plans, guilt, and others are overwhelmed by it,” survivor guilt is to look ahead and try and given and received encouragement Colley explains. “Many times it’s some- to bring something good out of the ex- throughout the journey. But to a cancer thing that may be operating at a deeper perience. “What could a survivor do that survivor, it makes perfect sense, and it is level, and the person is not even aware that would be productive and fruitful going another part of the cancer journey that they have it.” forward?” she asks. must be processed. Survivorship presents an opportunity CoPiNg WiTH sURvivoR gUilT to leave regrets behind and reprioritize Though some refer to survivor guilt as making drastic changes, but sometimes it There is a sense of implied comparison imagined guilt, that’s not to say it isn’t real. can be as simple as planting a tree in hon- that occurs among people who have en- “We do not invalidate anyone’s feelings. or of a fellow patient who did not survive. dured similar ordeals. It’s only natural to Feelings are very real,” explains Colley. compare type and stage of cancer, treat- “The feeling of guilt is real, but the foun- THis Too sHall Pass ment plans, nutrition plans, and more. It’s dation of it is imagined.” The good news is that survivor WHo exPeRieNCes sURvivoR gUilT? life in a new way. Sometimes this means what we do—we find common ground, es- With that in mind, often the first step guilt typically fades with time. It pecially in the face of cancer—because we in coping with survivor guilt is to examine is important to acknowledge and need one another. the foundation of the guilt. A mind-body accept the feelings of guilt—and “We have an amazing support commu- therapist can be instrumental in this pro- allow yourself to move beyond nity at CTCA®,” Colley says. “Our patients cess. “I really encourage patients to talk to them. You deserve to survive seek each other out in the cafeteria and the us about their feelings regarding other pa- and thrive and enjoy your waiting rooms. They gravitate toward one tients,” Colley says. “Sometimes it is a big one wild and pre- another. But because of that tight bond, help just to verbalize the feelings.” cious life. they might be more inclined to feel a sense Colley says that she asks patients to be willing to hear feedback: “We mirror back of survivor guilt.” Colley explains that CTCA patients to them what we are hearing them say— form deep connections. “They may have which is that they are experiencing some- the same type and stage of cancer, and then thing that is understandable but unfound- they go through treatment and one has a ed.” She says that it is important to exam- different outcome.” ine the feelings and understand that they Sometimes in these cases, but not al- are real—but unrealistic. “We ask them to ways, survivor guilt ensues. Some patients really think about how they arrived at this develop a sense of guilt or responsibility— conclusion that they should have been able believing that they should have helped the to help this other person survive.” cfthrive.com For a free print subscription go to cfthrive.com spring 2013 | cancer fighters thrive 41 spiritual Words to Live By Patients and caregivers find strength in inspirational quotes and scripture. By Diana Price If someone were to ask you to share words that have brought you comfort during difficult times, what would you offer up? Would it be a verse of scripture that has provided spiritual comfort and reaffirmed your faith? A humorous quote? Lyrics from a song? Maybe you’d choose a significant poem or a saying passed down through your family lore. Whatever your choice, the words would no doubt carry special meaning for you because they speak to your personal experience and connect you to the thing you go to for comfort—whether it’s faith, literature, art, or family; those words provide a touchstone for your soul. Cancer patients and caregivers often turn to inspiring and comforting quotes and scripture as they come to terms with a diagnosis and undergo treatment. Chip Gordon, MDiv, director of pastoral care at Cancer Treatment Centers of America® (CTCA) in Newnan, Georgia, says that in his experience this practice provides powerful spiritual support, and he encourages patients to find a quote or verse that speaks to them: “The verse or quote that a patient chooses serves as 42 cancer fighters thrive | spring 2013 an ‘Ebenezer’ in his or her life. The word Ebenezer comes from the Hebrew word that means ‘stone of help.’ That’s exactly what these verses or quotes do: they help patients as they continue on their journey with cancer.” The choice of words is, of course, highly personal and reflects the myriad personalities and spiritual lives of cancer patients and their loved ones. Rev. Gordon says that a favorite verse of his, which he shares with many patients, comes from Jeremiah 29:11: “For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.” The quote is especially meaningful, he says, because “At CTCA we are committed to giving our patients hope. This verse exemplifies what we are all about while pointing our patients to the hope they can have during the journey.” Recently via the CTCA® Facebook page, employees, patients and caregivers shared some of the words that have provided support through their personal journeys. Here are their words of wisdom: cfthrive.com spiritual “ScArS . . . Are tAttOOS With Better StOrieS.” —Debbie Waken “FAith iS KNOWiNG everythiNG thAt yOu hOPe FOr WiLL cOMe true.” —Jenny Lincke Mitchell “there iS StiLL SOMe GOOD iN the WOrLD— FiND it!” —Kelly Wikiera “WiSh it; DreAM it; DO it.” —Gary Hackney “PeAce i LeAve With yOu, My PeAce i Give uNtO yOu; NOt AS the WOrLD Giveth, Give i uNtO yOu. A Foundation of Hope At several ctcA hospitals, inspiring quotes and scripture verses Let NOt yOur heArt Be trOuBLeD, Neither Let are literally incorporated into the foundation of the buildings. it Be AFrAiD.” (JOhN 14:27) During the hospitals’ Blessing ceremony, patients, caregivers, —Mary Griffin Newton and staff have the opportunity to inscribe words that have special meaning to them on the foundation of the new building before final “NO ONe crieS WheN cANcer DieS, SAD teArS FALL NeverMOre. flooring and finishes are incorporated. rev. Gordon, who participated in the “Grounded in hope” Blessing cONDitiON: reMiSSiON, SuBMiSSiON tO teStiNG, ceremony at ctcA in Newnan, Georgia, says the experience was i’LL FiNALLy cLOSe thAt DOOr. extremely moving: “to see patients standing in the lobby of our NO MOre FeAr WheN cANcer cLeAr My DAyS unfinished center, excited about the opening in Georgia and hopeful WiLL Be FOrever MOre. about where they were in their healing, showed me what a huge NO MOre LOSS NOW i’M the BOSS, ONce AGAiN part our spiritual emphasis has on our patients.” thiS eAGLe WiLL SOAr.” —Robbie Robinson As participants shared words of inspiration and healing with one another and with all of the patients who would enter the center in the future, there was a sense of optimism and hope. “For “My MOM FOuGht LuNG cANcer FOr 11 yeArS. many patients,” rev. Gordon says, “it was a new beginning, as they She Never cOMPLAiNeD. NOt ONce. her experienced healing from the pain they had experienced in the FAvOrite SAyiNG WAS ‘it cOuLD ALWAyS Be past.” WOrSe!’” —Elizabeth Palmer Crumb One scripture verse in particular that rev. Gordon saw inscribed that day stood out: “But those who hope in the Lord will renew their strength. they will soar on wings like eagles; they will run “veriLy, ALONG With every hArDShiP iS reLieF.” and not grow weary, they will walk and not be faint.” (isaiah 40:31) —Nor Aini Ali “cANcer iS A WOrD, NOt A LiFe SeNteNce!” —Deborah Ayres Fichter cfthrive.com spring 2013 | cancer fighters thrive 43 images of hope Stories of travel Patients and their families make time to relax, bond, and widen their horizons. 1. JOAN DicKeNS “My friends Joe, ellie, and Jean with me and my dad on a rhine river cruise in 2010. My Dad was 96 and is still going strong in 2012!” 2. JOhN JuBAS John and his wife, Anita, pose with daughter, Maren, at a Penn State university football game. Maren is a junior at Penn State. ➊ 3. WALt reiFFer Walt and his wife, cyndi, at rehoboth Beach, Delaware. 4. ANNe BOuDWiN “this is me and my husband, claude, in Bermuda. We cruised there (our ship is behind us) from Boston. in the picture we’re on a charter boat returning from our snorkeling excursion. it was awesome!” ❷ ➌ 44 cancer fighters thrive | spring 2013 ❹ No case is typical. You should not expect to experience these results. cfthrive.com images mages of hope hope ❺ ❻ 5. JAN PeDerSON Jan and her husband, Bruce, pose in israel with the Dome of the rock in the distance. ❼ ❽ ➒ ❽ 6. JODy KeiM “this is a photo i took in San Diego, california. it is the sun setting on my treatment for stage iv breast cancer and the beginning of my new life.” 7. SANDrA DeAN Sandra and her husband, roy, pose at Boomtown casino in Biloxi, Mississippi. 8. PeG trAcey “My husband, Steve, and i pause for a rest after a day of touring the ruins in tulum, Mexico, in July 1994.” ➓ 9. iNGriD reitANO ingrid poses with friends Gretchen Biancone-Goff and Dawn Krempecki at Old Faithful geyser in yellowstone National Park. 10. PhiLLiP MOOre iii “cancer fighters can have leisure moments. During my bout with cancer, i have continued my quest for adventure. Adventure has taken me to hawaii, Arizona, Germany, colorado, and Georgia.” cfthrive.com spring 2013 | cancer fighters thrive 45 inspiration do great By Nicole Haran i never knew anyone with cancer un- with friends, I turned back to see one of phrase as much as I did throughout the til last year, when three of us were my pals crying into her hands as others year. diagnosed: my aunt, my father-in- consoled her. Someone once told me that None of it was easy. Buckets of tears law, and me. My aunt was the first to get having cancer is like being at your own were shed, but I have no doubt that ev- the news. Many months went by and I did funeral. At that moment that is exactly erything was made better by the positivity not call, write, or visit. how I felt. around me. My father-in-law (her brother) was di- Others had no difficulty “overlooking” “You will do great” is one of those agnosed soon thereafter. Feeling scared the diagnosis, keeping the status quo. In phrases we say to our kids thousands of and at a loss for words, I kept my distance, fact, they became chronically upbeat. My times in a lifetime. We say it because it rarely called, and, despite his positive at- brother, for instance, hadn’t seemed so means I believe in you. We say it because titude, felt somber around him. We never happy and optimistic to me in years. My it means All you can do is your best. We told our children about their aunt or cancer diagnosis brought out the best in say it because we know that to succeed in grandfather. him. I attached myself to my husband’s getting through tough spots we must to Three months later I was diagnosed confidence. When I spoke to people who some degree create our own reality. with stage III breast cancer. After my di- behaved as though I would someday be agnosis I learned that my father’s mother well, I felt stronger, happier, and healthier. and sister both died of breast cancer be- My surgeon and oncologist were so fore I was born. I was never told. positive that my husband and I named Determined to keep things as normal as them the “sunshine sisters.” Friends who possible for our kids, I instructed friends made me laugh so hard it hurt while I and family to “act regular, even positive” healed from my bilateral mastectomy at all times around me and the children. were rock stars in my eyes. I knew how There were several people in my life who much I would need them in the days to were so fearful and sad about my diag- come, and I was right: laughing helped nosis that it soon was apparent that they with everything. could not “play along” by acting positive. The fear of chemo and radiation di- I could see it in their eyes and hear it in minished when a wonderful family friend their voices; my diagnosis prevented them told me I would “do great” through it all. from being supportive to me. Their heavi- She is a nurse at a cancer center, and she ness scared me half to death. I began to told me I was going to “do great.” I de- avoid them, the look on their faces, and cided to believe her. Do great became my the stories they told me. Once when I was mantra, and all the people who could leaving a restaurant after a nice lunch “play positive” in my life clung to that 46 cancer fighters thrive | spring 2013 To learn how Nicole Haran is using her Do great mantra to help others, visit dogreatcampaign.com. The campaign urges everyone who has been touched by cancer to see the video on the website, share it with others, and write their own Do great message. cfthrive.com ® BRIEF SUMMARY OF PRESCRIBING INFORMATION INDICATIONS AND USAGE SANCUSO® (Granisetron Transdermal System) is indicated for the prevention of nausea and vomiting in patients receiving moderately and/or highly emetogenic chemotherapy regimens of up to 5 consecutive days duration. DOSAGE AND ADMINISTRATION The transdermal system (patch) should be applied to clean, dry, intact healthy skin on the upper outer arm. SANCUSO should not be placed on skin that is red, irritated or damaged. Each patch is packed in a pouch and should be applied directly after the pouch has been opened. The patch should not be cut into pieces. Adults Apply a single patch to the upper outer arm a minimum of 24 hours before chemotherapy. The patch may be applied up to a maximum of 48 hours before chemotherapy as appropriate. Remove the patch a minimum of 24 hours after completion of chemotherapy. The patch can be worn for up to 7 days depending on the duration of the chemotherapy regimen. DOSAGE FORMS AND STRENGTHS SANCUSO is a 52 cm2 patch containing 34.3 mg of granisetron. The patch releases 3.1 mg of granisetron per 24 hours for up to 7 days. CONTRAINDICATIONS SANCUSO is contraindicated in patients with known hypersensitivity to granisetron or to any of the components of the patch. WARNINGS AND PRECAUTIONS Gastrointestinal The use of granisetron in patients may mask a progressive ileus and/or gastric distention caused by the underlying condition. Skin Reactions In clinical trials with SANCUSO, application site reactions were reported which were generally mild in intensity and did not lead to discontinuation of use. The incidence of reactions was comparable with placebo. If severe reactions, or a generalized skin reaction occur (e.g. allergic rash, including erythematous, macular, papular rash or pruritus), the patch must be removed. Exposure to Sunlight Granisetron may be affected by direct natural or artificial sunlight. Patients must be advised to cover the patch application site, e.g. with clothing, if there is a risk of exposure to sunlight throughout the period of wear and for 10 days following its removal because of a potential skin reaction. ADVERSE REACTIONS Clinical Trials Experience The safety of SANCUSO was evaluated in a total of 404 patients undergoing chemotherapy who participated in two double-blind, comparator studies with patch treatment durations of up to 7 days. The control groups included a total of 406 patients who received a daily dose of 2 mg oral granisetron, for 1 to 5 days. Adverse reactions considered by the investigators as drug-related occurred in 8.7% (35/404) of patients receiving SANCUSO and 7.1% (29/406) of patients receiving oral granisetron. The most common adverse reaction was constipation that occurred in 5.4% of patients in the SANCUSO group and 3.0% of patients in the oral granisetron group. Table 1 lists the treatment emergent adverse reactions that occurred in at least 3% of patients treated with SANCUSO or oral granisetron. Table 1: Incidence of Adverse Reactions in Double-Blind, Active Comparator Controlled Studies in Cancer Patients Receiving Chemotherapy (Events ≥ 3% in either group) Body System Preferred Term SANCUSO TDS N=404 (%) Oral granisetron N=406 (%) 5.4 3.0 0.7 3.0 Gastrointestinal disorders Constipation Nervous system disorders Headache DRUG INTERACTIONS Granisetron does not induce or inhibit the cytochrome P-450 drug-metabolizing enzyme system in vitro. There have been no definitive drug-drug-interaction studies to examine pharmacokinetic or pharmacodynamic interaction with other drugs. However, in humans, granisetron hydrochloride injection has been safely administered with drugs representing benzodiazepines, neuroleptics and anti-ulcer medications commonly prescribed with antiemetic treatments. Granisetron hydrochloride injection also does not appear to interact with emetogenic cancer therapies. In agreement with these data, no clinically relevant drug interactions have been reported in clinical studies with SANCUSO. Because granisetron is metabolized by hepatic cytochrome P-450 drug-metabolizing enzymes (CYP1A1 and CYP3A4), inducers or inhibitors of these enzymes may change the clearance and hence, the half-life of granisetron. In addition, the activity of the cytochrome P-450 subfamily 3A4 (involved in the metabolism of some of the main narcotic analgesic agents) is not modified by granisetron hydrochloride in vitro. In in vitro human microsomal studies, ketoconazole inhibited ring oxidation of granisetron hydrochloride. However, the clinical significance of in vivo pharmacokinetic interactions with ketoconazole is not known. In a human pharmacokinetic study, hepatic enzyme induction with phenobarbital resulted in a 25% increase in total plasma clearance of intravenous granisetron hydrochloride. The clinical significance of this change is not known. USE IN SPECIFIC POPULATIONS Pregnancy Pregnancy Category B Reproduction studies with granisetron hydrochloride have been performed in pregnant rats at intravenous doses up to 9 mg/kg/day (54 mg/m2/day, about 24 times the recommended human dose delivered by the SANCUSO patch, based on body surface area) and oral doses up to 125 mg/m2/day (750 mg/m2/day, about 326 times the recommended human dose with SANCUSO based on body surface area). Reproduction studies have been performed in pregnant rabbits at intravenous doses up to 3 mg/kg/day (36 mg/m2/day, about 16 times the human dose with SANCUSO based on body surface area) and at oral doses up to 32 mg/kg/day (384 mg/m2/day, about 167 times the human dose with SANCUSO based on body surface area). These studies did not reveal any evidence of impaired fertility or harm to the fetus due to granisetron. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, SANCUSO should be used during pregnancy only if clearly needed. Nursing Mothers It is not known whether granisetron is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when SANCUSO is administered to a nursing woman. Pediatric Use Safety and effectiveness of SANCUSO in pediatric patients under 18 years of age have not been established. Geriatric Use Clinical studies of SANCUSO did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, cautious treatment selection for an elderly patient is prudent because of the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Renal Failure or Hepatically-Impaired Patients Although no studies have been performed to investigate the pharmacokinetics of SANCUSO in patients with renal or hepatic impairment, pharmacokinetic information is available for intravenous granisetron. OVERDOSAGE There is no specific antidote for granisetron overdosage. In the case of overdosage, symptomatic treatment should be given. Overdosage of up to 38.5 mg of granisetron hydrochloride, as a single intravenous injection, has been reported without symptoms or only the occurrence of a slight headache. In clinical trials there were no reported cases of overdosage with SANCUSO. HOW SUPPLIED/STORAGE AND HANDLING SANCUSO (Granisetron Transdermal System) is supplied as a 52 cm2 patch containing 34.3 mg of granisetron. Each patch is printed on one side with the words “Granisetron 3.1 mg/24 hours”. Each patch is packaged in a separate sealed foil-lined plastic pouch. SANCUSO is available in packages of 1 (NDC 42747-726-01) patch. Store at 20˚-25˚C (68˚-77˚F); excursions permitted between 15˚-30˚C (59˚-86˚F). [see USP Controlled Room Temperature]. SANCUSO should be stored in the original packaging. PATIENT COUNSELING INFORMATION See FDA-approved patient labeling. Gastrointestinal Because the use of granisetron may mask a progressive ileus and/or gastric distention caused by the underlying condition, patients should be instructed to tell their physician if they have pain or swelling in their abdomen. Skin Reactions Patients should be instructed to remove the patch if they have a severe skin reaction, or a generalized skin reaction (e.g. allergic rash, including erythematous, macular, papular rash or pruritus). When patients remove the patch, they should be instructed to peel it off gently. Exposure to Sunlight Granisetron may be degraded by direct sunlight or exposure to sunlamps. In addition, an in vitro study using Chinese hamster ovary cells suggests that granisetron has the potential for photogenotoxicity. Patients must be advised to cover the patch application site, e.g. with clothing, if there is a risk of exposure to sunlight or sunlamps throughout the period of wear and for 10 days following its removal. FDA-Approved Patient Labeling Rx Only Manufactured by: Aveva Drug Delivery Systems Inc., Miramar FL 33025 Manufactured for: ProStrakan Inc., Bridgewater NJ 08807 Copyright ©2012, ProStrakan Inc. All rights reserved. SANCUSO and ProStrakan are trademarks owned by the ProStrakan group of companies Revised: 02/2012 Cancer Fighters Thrive® 10109 E. 79th Street Tulsa, oK 74133 SANCUSO® (Granisetron Transdermal System): A recommendation from leading treatment guidelines1,2 When preparing for chemotherapy, be armed & ready For nausea and vomiting One patch. One application. 5 days of coverage.3,4 Visit www.sancuso.com to learn more and to download a moneysaving copay card. Please refer to the sunlight warning in the important safety information below. Important safety information SANCUSO® (Granisetron Transdermal System) is indicated for the prevention of nausea and vomiting in patients receiving moderately and/or highly emetogenic chemotherapy regimens of up to 5 consecutive days duration.4 Do not use SANCUSO if you are allergic to granisetron or any of the other ingredients in SANCUSO.4 Tell your healthcare professional if you are pregnant, if you plan to become pregnant, or you are breastfeeding.4 Tell your healthcare professional if you have pain or swelling in stomach area (abdomen), or if you are allergic to medical adhesive tape, adhesive dressings, or other skin patches.4 Tell your healthcare professional about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Other medicines may affect how SANCUSO works. SANCUSO may also affect how your other medicines work.4 The medicine in SANCUSO (granisetron) may not work well and/or may affect your skin if exposed to direct sunlight and the light from sunlamps or tanning beds. While wearing the patch keep it covered with clothing if you will be in sunlight or near a sunlamp, including tanning beds. Keep the skin where SANCUSO was applied covered for another 10 days after the patch is taken off to protect from exposure to direct sunlight.4 You may see mild redness on the skin where the patch is removed. This redness should go away within three days. If redness continues, tell your healthcare professional. The most common side effect of SANCUSO is constipation.4 Tell your healthcare professional if you have any side effect that bothers you or that does not go away. This is not the only possible side effect of SANCUSO.4 For more information, ask your healthcare professional or pharmacist. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. References: 1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Antiemesis. V.1.2012. http://www.nccn.org/professionals/physician_ gls/pdf/antiemesis.pdf. Accessed December 13, 2011. 2. Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2011;29(31):4189-4198. 3. Boccia RV, Gordan LN, Clark G, Howell JD, Grunberg SM; on behalf of the Sancuso Study Group. Efficacy and tolerability of transdermal granisetron for the control of chemotherapy-induced nausea and vomiting associated with moderately and highly emetogenic multi-day chemotherapy: a randomized, double-blind, phase III study. Support Care Cancer. 2011;19(10):1609-1617. 4. SANCUSO [package insert]. Bridgewater, NJ: ProStrakan, Inc; 2012. ONLY ® 1-800-SANCUSO www.sancuso.com SANCUSO is a registered trademark of ProStrakan, Inc. ©2012 ProStrakan, Inc. All rights reserved. Printed in U.S.A. SAN-2012-006R1 July 2012 48 cancer fighters thrive | spring 2013 Please see brief summary of Prescribing Information on adjacent page. Keeps them covered cfthrive.com
