Cancer and Chemotherapy

/ September 20th, 2010/ Posted in Health News / No Comments »

Cognitive Effects of Breast Cancer Tx Related to Age

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Point out that cognitive changes associated with chemotherapy are typically only seen in a subgroup of patients. This study represents an attempt to dissect out which patients are more susceptible to these effects.
Chemotherapy-related cognitive changes had significant associations with older age and lower baseline cognitive reserve, data from a case-control study of breast cancer patients showed.

Older patients with lower cognitive reserve who were treated with chemotherapy scored significantly lower on tests of processing speed than women treated only with tamoxifen (P=0.003) and a healthy control group (P<0.001), investigators reported in an article published online in the Journal of Clinical Oncology.

Chemotherapy also appeared to have a temporary adverse effect on verbal ability, which differed significantly from the tamoxifen-only and control groups at one month (P=0.01). Verbal ability improved, however, during two subsequent follow-up evaluations of patients who received chemotherapy.

The findings suggest that pretreatment factors, as well as various aspects of breast cancer and its therapy, have an impact on cognitive functioning, the researchers wrote.

“This study helps clarify two issues,” Tim A. Ahles, PhD, of Memorial Sloan-Kettering Cancer Center in New York, told MedPage Today. “The results indicate that only a subgroup of patients have long-term cognitive changes. Factors associated with long-term changes have been an area of interest to us and others.

“The second issue is that 20% to 30% of breast cancer patients appear to have lower-than-expected cognitive performance at diagnosis. This is higher than in the general population. We were curious to see whether that also predicted post-treatment cognitive changes, and our assessment of cognitive reserve sort of captures that.”

An exploratory analysis suggested that tamoxifen negatively affected certain aspects of cognitive function in patients who did not receive chemotherapy.

Cross-sectional and longitudinal studies have yielded evidence that breast cancer chemotherapy causes changes in cognitive function in a subgroup of patients. Similar studies have indicated that tamoxifen also contributes to cognitive decline, Ahles and colleagues wrote in the introduction to their findings.

Other data have shown lower-than-expected performance on neuropsychological tests in subgroups of breast cancer patients before treatment, suggesting that certain aspects of the cancer itself may affect cognitive function.

“Taken together, these findings suggest that there are multiple aspects of breast cancer and its treatment that may impact cognitive functioning in a subgroup of vulnerable individuals, which highlights the importance of identifying risk factors for cognitive decline,” the authors wrote.

Age has a well-established influence on cognitive decline, leading to speculation that older adults may have increased vulnerability to cognitive adverse effects of chemotherapy. However, prior studies have not examined possible interactions between age and cancer treatment and resulting effects on cognitive functioning.

Cognitive reserve, which constitutes an individual’s innate and developed cognitive capacity, may also play a role in a patient’s vulnerability to the cognitive effects of chemotherapy. Ahles and colleagues examined associations among age, pretreatment cognitive reserve, and post-treatment cognitive function. They defined cognitive reserve by scores on the Wide Range Achievement Test (WRAT-3).

The study involved patients with newly diagnosed breast cancer of stages 0 to 3A. The study population included 60 patients who received adjuvant chemotherapy and 72 patients who received adjuvant tamoxifen but no chemotherapy. The control group consisted of 45 healthy women who met inclusion criteria except for a diagnosis of breast cancer.

All study participants completed a battery of tests that assessed verbal ability, verbal memory, visual memory, working memory, processing speed, sorting, distractibility, reaction time, and self-reported depression. Breast cancer patients completed the tests before treatment and at three intervals after completing therapy. Women in the control group were tested on four occasions that approximated the time intervals for the patients.

The analysis showed significant interaction among group, age, and baseline WRAT-3 reading score (P<0.001). Older patients with lower baseline WRAT-3 scores and exposure to chemotherapy scored significantly lower on processing speed, averaging 0.15 less per 10-year increase in age and one standard deviation lower WRAT-3 score than the no-chemotherapy group and 0.23 less than the control group.

The authors found a significant group-by-time interaction (P=0.01) and a significant age-by-WRAT 3 interaction for verbal ability but not a significant three-way interaction.

Age significantly affected performance on the verbal memory, visual memory, working memory, and sorting assessments, and baseline WRAT-3 reading significantly influenced distractibility.

To examine the impact of tamoxifen, the authors compared results of 39 patients treated with the drug, 20 patients who received no endocrine therapy, and the healthy controls. The analysis showed a significant impact of tamoxifen on processing speed (P=0.036) and verbal memory (P=0.05).

Patients treated with tamoxifen performed significantly worse than the controls on processing speed (P=0.016), verbal memory (P=0.018), and verbal ability (P=0.023). Patients who did not receive tamoxifen did not differ significantly from the controls in any of the analyses.

Spotting the signs of breast cancer early helped save my life

Sep 20 2010 By Lisa Adams

IN white, high-heel white boots and a daring psychedelic mini skirt, Christine Kelly felt fabulous at a 1960s-themed fancy dress party to celebrate her 40th birthday.

But only a few months later, her world collapsed after she was diagnosed with breast cancer.

Now the Edinburgh mum-of-two has been chosen to speak about her fight with the devastating disease at an event tomorrow to mark the launch of Breast Cancer Awareness Month.

Landmarks across the capital, including Edinburgh Castle gatehouse, the Balmoral Hotel and the HBOS building on the Mound will be flooded with pink light.

It is a signal to Scots women that thinking pink and checking their breasts regularly could save their lives.

Christine said: “They say life begins at 40. For me, life suddenly changed at 40. I’d started a new job, the kids were at school, we had a lovely house and things were looking rosy.

“Then it all fell apart. The only reason I’m here today is because I spotted the signs early. If breast cancer is caught early, there is hope you can get through it and have the rest of your life to live.”

The statistics are frightening. Breast cancer affects one in nine women, so the chances are we will all know someone touched by the disease.

Scientists at the Breakthrough Breast Cancer Unit at the University of Edinburgh are leading the world in the fight against the disease.

More than 7000 Scottish women have signed up to join the Breakthrough Generations Study – an examination of the health and lifestyles of 100,000 women over the next 40 years, which aims to find the causes of breast cancer.

Health secretary Nicola Sturgeon said: “Breast cancer is the most common cancer among women in Scotland but modern treatments mean many more are surviving and going on to live healthy lives.

“Cancer services have developed and improved significantly in recent years, with state-of-the-art equipment and more doctors, nurses and other health professionals. Research is also vital and that’s why I am involved in the Breakthrough Generations Study.

“Hopefully, the knowledge gained through this survey, and others like it, will help to spare more mothers, daughters, grannies and best friends from the trauma of cancer.”

For Christine, it offers hope that her children Ashleigh, 21, and Nathan, 15, may one day live in a cancer-free world.

That’s why she has no fear of telling her story at tomorrow’s reception in front of more than 200 people, including other survivors as well as Sturgeon, scientists and charity representatives.

Christine said: “I am just about to turn 50, and want to celebrate by giving something back to those who made it all possible for me to have these years and many more to come. I’m determined to start my 50s as I would have liked to start my 40s.”

Christine, who is divorced, has raised more than 5000 for breast cancer charities and is planning a sponsored walk from Edinburgh to Glasgow to mark her 50th birthday in November.

But she recalls vividly how frightened she felt in the summer of 2001 when, after a holiday in France, she first felt a lump on her right breast.

Christine said: “It was Saturday night and I was massaging cream into my skin to keep my tan when I found a lump.

“I went to the doctor on Monday. At first, the doctor said I had lumpy breasts but I was certain that lump hadn’t been there before and I asked to be referred to the hospital. I had about six weeks to wait and got on with my life.”

The alarm bells started ringing after she was called back to the Western General Hospital in Edinburgh for a second mammogram. When a sample from the lump was taken to be analysed, Christine feared the worst.

She said: “I thought it must be time to accept some bad news. It was like an out-of-body experience. It felt like this was happening to somebody else.

“I’m very practical, so I thought we’d get through it. I had 101 questions after the doctor confirmed it was cancer.”

Telling her family was tough. She said: “How do you tell your mum you’ve got cancer? My daughter who was 12 at the time found it really difficult.

“She felt she couldn’t speak to me because she didn’t want to upset me. It took a long time and it was through the school that we finally got some counselling for her.

“I had a lovely book for my son which was written in child-friendly language. He was younger, so very accepting.”

Christine, who had no history of cancer in her family, had a grade-three aggressive tumour that was linked to hormone levels.

It had doubled in size in just a few weeks. At the end of September, after the tumour and the lymph nodes under her arm were removed, she heard her first good news. The cancer had not spread.

But chemotherapy transformed her from a fit young mum who went walking and running to a seriously ill woman with no hair who felt constantly on edge.

After six weeks of radiotherapy, Christine started feeling stronger. She took the drug tamoxifen for five years and, as she ticked each month off the calendar, slowly started to believe the cancer had gone for good.

Seven years on, she heard the magic statistics she’d been praying for – that she has the same chances of developing breast cancer as a woman of her age who had never had the disease.

But the experience had changed her. Christine said: “I see life differently. Before, I got stressed about the little things.

“If there’s one thing on my wish list for the future, it would be education to encourage all women to check their breasts regularly and if they notice any changes to consult their GP.”

The risk of breast cancer increases with age. Over-50s get an invitation for free screening every three years, which you should take. For more help, call 08080 100 200 or see breakthrough.org.uk.consult

Pediatric Cancer:Curing the Beast

Do you know how many children will die in 2010? Do you know their names? Some of you do.

“Our dear precious Sam has won the prize. He is celebrating in Heaven with Jesus and other family members that have passed on before him. We had told Sam all week this past week that we would be with him soon….in just the blink of an eye. How I cannot wait for that day! Everything feels so different. We knew this was coming 4 weeks ago when Sam was sent home in hospice care. Even knowing in our hearts that this would happen never prepares you for when it actually happens. Mike and I were holding Sam and he died in our arms and went straight to the arms of Jesus. He put up such a fight and never stopped fighting until the very end,” Sam’s Mom.

What would you do if you had taken your child to the doctor for flu-like symptoms and found it was so much more than the flu?

Peyton’s parents remember, “Our entire world stopped. We awoke to a phone call from our doctor saying we needed to pack a bag and take our daughter up to All Children’s Hospital immediately. Once in the doctor’s office at ACH, we were told that yes, she did have Leukemia. They gave her some local anesthesia and we sang some songs while I had to hold her down so they could do a bone marrow and spinal test. She was a trooper throughout, but we found out later that the Leukemia had invaded her body so much that the doctor was unable to get enough bone marrow to test.”

After immediate admission to the hospital, Peyton got an IV and morphine was administered every 15 minutes. Peyton’s dad said, “It may seem odd, but I had heard so much about morphine, I was actually leery of it. But it helped out with her pain, and made her silly. She got 2 blood transfusions. Her white blood cell count was high, but her red blood cell and platelet counts were low. Thanks to the morphine, she slept.”

The Pediatric Cancer Research Foundation (PCRF) is a non-profit organization founded in 1982 to improve the care, quality of life and survival rate of children with malignant diseases.

Since its inception, PCRF has raised over $22 million to fund cuttingedge research that leads to medically sound treatment protocol for childhood cancers. Much progress has been made. For instance, childhood leukemia, once almost certainly fatal, now has a 70% survival rate. But the battle is far from over – cancer continues to afflict more children under the age of 18 each year than any other disease.

Due to the dedication of volunteers supporting PCRF, 80% of every dollar raised goes directly to research. PCRF is privately supported through donations from individuals, charitable foundations and businesses that recognize the urgent need to improve treatment and cure childhood cancers. The foundation raises funds through gifts from individuals, special giving programs, events, corporate sponshoships, grants and the sale of holiday cards drawn by children fighting cancer.

According to the PCRF website, they currently are funding grants for research in the areas of stem cell transplantation, stem cell biology, molecular oncology, and molecular and cellular genetics. PCRF supported over $1.2 million in research work in 2009.

There are some optimistic moments in the research and treatment of childhood cancers every time a child survives.

“At age 2, Sierra was diagnosed with PNET (primitive neuro ectodermal tumor). She received high dose chemotherapy and stem cell rescue in May 1996. A very healthy Sierra now loves any sport, especially Little League, and physical education is her favorite subject in school! Sierra’s mother notes that “Sierra is tough! She has recently become very open about her cancer and she shared about her brain tumor and scar at her Share Day at school.”

“Eleven years ago, 4 year old Jack was diagnosed with acute lymhoblastic leukemia and immediately began treatment with aggressive chemotherapy for three years. Jack’s mom had been volunteering at PCRF prior to his diagnosis. Today Jack is a healthy and active freshman in high school, enjoying a life of soccer, football, fishing, surfing, boogie boarding and loves playing electric and acoustic guitar.” Now living like a typical teenager, his life as a young child was anything but.

There are thousands of stories about childhood cancers; there will be about 12,000 stories of cancer diagnosis this year. There will be about 4,000 stories of pediatric cancer related deaths; 11 stories a day.

September has been set aside as Childhood Cancer Awareness Month spotlighting the types of cancer that largely affect children, survivorship issues, and – importantly – to help raise funds for research groups working towards a cure.

The voices of the children cry out for a cure! The parents, brothers, sisters, grandparents, aunts, uncles, cousins and friends of those children carrying the burden of fighting these terrible childhood cancers also cry out for a cure.

Pediatric Cancer needs to be brought out into the daylight where it can receive the attention it deserves as the ugly beast stealing our children before they have the chance to explore life. Research is essential in the discovery of Pediatric Cancer treatments, essential in saving the lives of these children.


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