Treating Wife’s Stress May Be Indirect Care For Men With Prostate Cancer

ScienceDaily (Mar. 31, 2008) — When a couple is dealing with cancer, a partner’s psychological distress might drag down the well-being of either person, according to a new study of 168 married couples.

“Whether it is my own or my partner’s, psychological distress may impact my quality of life,” said lead researcher Youngmee Kim, director of Family Studies at the American Cancer Society’s Behavioral Research Center in Atlanta.

The physical health of husbands seemed to be especially vulnerable to the poor emotional well-being of their wives.

“We found an interesting pattern. The psychological distress of the female partner seemed to have the greatest effect — whether the woman was the breast cancer survivor or the caregiver of a man with prostate cancer. If the female has higher level of psychological distress, the male partner will have higher level of psychosomatic problems,” Kim said.

The study appears in the April issue of the Annals of Behavioral Medicine.

All of the couples in the study were male-female pairs. In all cases, one of the partners had received a breast or prostate cancer diagnosis about two years before participating in American Cancer Society surveys, from which the new study data were drawn.

In the survey, husbands with wives under high stress rarely reported psychological or emotional problems.

“Men tend not to say that psychological stress associated with cancer diagnosis and treatment is a problem, but they tend to somatize those stresses, reporting headaches, backaches. Maybe men are not conditioned or socialized to express those touchy feelings. They tend to show those feelings — let them come out — through their body,” Kim said.

Kim and her colleagues said their study could be a starting point for identifying groups of people who might benefit from programs designed to improve coping skills or reduce stress.

In particular, helping women manage psychological stress might improve the mental and physical health of both partners dealing with cancer, Kim said.

“Often in clinical practice, we only pay attention to the patient or survivor – try to improve their distress. But beyond focusing on the patient — in addition to treating the survivor’s stress — we need to include or pay attention to caregiving wives. That will impact the patient. It’s indirect care,” Kim said.

“People are starting to understand that some cancers can be seen as a couples’ disease,” said Frank Penedo, associate professor in the Division of Bio-behavioral Oncology and Cancer Control at the University of Miami Miller School of Medicine.

“The males’ perception of how well they function physically in some ways depends on the support they get from their partner,” Penedo said.

When a man has a stressed-out wife, reports from the men suggest it is their physical health, not emotional well-being, that is likely to suffer, he said.

Adapted from materials provided by Center For The Advancement Of Health.

Nonprotruding Colorectal Growths May Harbor Cancer

Most colorectal cancers are thought to arise from polypoid adenomas – growths that protrude from the mucous membrane in the colon or rectum. A study from the Veterans Affairs (VA) Health Care System in Palo Alto, CA, published in the March 5 Journal of the American Medical Association adds to a growing body of evidence that nonpolypoid colorectal neoplasms (NP-CRNs) – abnormalities that can appear either flat or depressed relative to the surrounding membrane – can also contain precancerous or cancerous cells. Previous studies established the existence of NP-CRNs in Japan, but their prevalence and importance in other parts of the world has remained unclear.

In the VA study, gastroenterologists and pathologists who were trained in a special exchange program with Japanese cancer centers examined 1,819 patients at the Palo Alto VA hospital undergoing colonoscopy for screening, surveillance (for people at high risk of colorectal cancer), or symptoms of colorectal neoplasms. Patients underwent biopsy, removal of polyps or NP-CRNs, or surgery as needed.

The investigators found NP-CRNs in 170 patients (9.35 percent of those examined). Although these lesions were less common than colorectal polyps, they were more likely to contain precancerous or cancerous cells, accounting for only about 15 percent of identified neoplasms but 54 percent of superficial carcinomas. “Nonpolypoid morphology was strongly associated with findings of in situ or submucosal invasive carcinoma,” stated the authors.

NP-CRNs missed during colonoscopy may help explain the occurrence of interval colorectal cancers – cancers that arise between scheduled screening colonoscopies in patients who appear not to have any precancerous polyps – explains Dr. David Lieberman from Oregon Health and Science University in an accompanying editorial.

The existence of NP-CRNs will have important implications for colorectal cancer screening in the United States, continued Dr. Lieberman. “The finding that NP-CRNs have high rates of serious pathology suggests that effective screening programs will need to accurately identify patients who harbor these lesions.”

Source: NCI Cancer Bulletin. March 18, 2008

Ottawa moves to rid Internet of cancer-cure scams

DAWN WALTON

March 13, 2008

CALGARY — Ottawa has cracked down on dozens of Canadian-based Internet scams promising cancer cures or treatments that do nothing more than con people out of their money and potentially harm their health.

The Competition Bureau said yesterday that it has found Internet fraudsters and has forced 92 per cent of the dubious websites to either modify or remove their unproven claims. The bureau is still working on getting the remainder to comply, but said enforcement action could be elevated to include fines or criminal charges.

Describing the swindling of cancer patients as among the most “despicable forms of fraud,” the bureau also launched Project False Hope yesterday, which aims to teach people how to avoid online scams.

“They are targeting the most vulnerable people,” said Andrea Rosen, acting deputy commissioner of the Competition Bureau, which has previously taken aim at suspicious weight loss and diabetes claims found online. “We’re trying to pick the worst of the groups.”

Source & full article:  Globe & Mail, March 13, 2008

ALTTO Trial Seeks to Define Best Therapy for HER2 Breast Cancer

A major clinical trial to determine the best treatment for early-stage breast cancer testing positive for the HER2 protein is now enrolling women in North America, researchers from the Mayo Clinic and NCI announced last week at the NCI Science Writers’ Seminar in New York City. The international trial, known as the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) study, will recruit 8,000 women with HER2-positive breast cancer in 50 countries across 6 continents and may set the standard of care for women with this aggressive type of breast cancer.

About 20 to 25 percent of breast cancers are studded with the HER2 protein, also known as human epidermal growth factor receptor 2. HER2 is involved in transmitting growth signals from external growth factors to a cell’s nucleus. In some types of cancer, this growth signaling pathway leads to increased tumor cell proliferation, suppression of programmed cell death (apoptosis), enhanced motility, and increased tumor angiogenesis. HER2-positive breast cancer tends to be more aggressive, less responsive to standard treatments, and more likely to recur than breast cancer that does not contain HER2.

Patients with HER2-positive breast cancer may benefit from treatments that target this protein, and two targeted drugs, trastuzumab (Herceptin) and lapatinib (Tykerb), have been approved by the Food and Drug Administration to treat patients with HER2-positive tumors. While both of these agents target HER2, they do so in different ways. Trastuzumab, which is approved as a first-line treatment for metastatic disease or adjuvantly for early-stage breast cancer, is a monoclonal antibody that attaches to HER2-positive cancer cells and prevents the protein from receiving growth signals. It may also help a patient’s immune system mount a response against the tumor. Lapatinib belongs to a class of drugs called small molecule inhibitors; its small size allows it to permeate the cancer cell and interrupt the HER2 signaling pathway from inside. Currently, lapatinib is only approved for the treatment of metastatic HER2-positve breast cancer. This study will be the first major trial of adjuvant lapatinib for early-stage breast cancer.

Approval of trastuzumab for treatment of early-stage, HER2-positive breast cancer in 2006 greatly improved outcomes for women with this disease, and researchers hope that the ALTTO trial will further extend the benefits of adjuvant therapy targeting HER2. In this trial, women who have undergone surgery to remove their tumors will be randomly assigned to receive lapatinib or trastuzumab alone, lapatinib administered after trastuzumab, or the two drugs administered together.

“The primary questions this trial is intended to answer are: Does lapatinib work better than trastuzumab or are they equivalent in terms of disease-free survival? Or might the combination of the two be better than either single drug alone?” says Dr. Edith Perez of the Mayo Clinic in Jacksonville, FL, and the North American coordinator for the trial. “We know that trastuzumab is a fantastic drug, but we’re still not curing all women with this type of cancer. This trial is an important step toward curing more patients with breast cancer.”

In addition to the targeted therapies being tested, all patients must have completed at least four cycles of anthracycline-based chemotherapy before randomization; patients for whom chemotherapy with a taxane is indicated will be treated with the drug paclitaxel (Taxol) along with their assigned targeted therapy.

“Adjuvant chemotherapy is very important for the treatment of HER2-positive breast cancer and is a required part of this study,” says Dr. Perez.

The ALTTO trial is the first global initiative in which two large, academic breast cancer research networks covering different parts of the world – The Breast Cancer Intergroup of North America (TBCI), based in the U.S., and the Breast International Group (BIG) in Brussels, Belgium – have jointly developed a study in which all care and data collection are standardized, regardless of where patients are treated.

“We hope that this model of international collaboration is one which we can build upon in the future,” says Dr. Jo Anne Zujewski, a senior investigator in the Clinical Investigations Branch in NCI’s Cancer Therapy Evaluation Program.

Source: NCI Cancer Bulletin. March 4, 2008