Long Term Cancer Survivors

Everybody wants to beat cancer and live a long time.  I’ve always been intrigued by long term cancer survivors.  What makes them do so well?  Sometimes they have a “good cancer”, one that is slow growing, or was discovered at an earlier stage.  Sometimes they have received a superior treatment.  And sometimes, especially with metastatic incurable cancer, the reasons aren’t so clear as to why they are doing well.  Perhaps patient factors like motivation are playing a part in allowing someone to beat the odds.

When I worked at CTCA I became intrigued by the long term survivors, those remarkable individuals who had been battling incurable cancer for a long time, and just kept plugging along.  What made them different??

The pyramids have been around for a long time... and will likely continue to be here for a very long time.

I came across a theory one day written by Dr. Richard Gott.  His theory had to do with estimating how long things will last, if you know how long they have been in existence already.  As Gott simply put it, “Things that have been around for a long time tend to stay around for a long time.”  Common sense, but he made mathematical formulas and was able to successfully calculate things like “how long will the Berlin wall continue to stand?”

Applying this theory to cancer, I figured that cancer patients who have already been fighting cancer for a long time would likely tend to continue successfully fighting cancer for a long while to come.

I decided to examine the records of our patients to see if this was true.  I analyzed hundred of cancer registry records of stage 4 incurable patients who were coming to CTCA for a consultation.  I looked at how long they had been fighting cancer before coming to CTCA, and then subsequently how long they survived after that point.  The results were dramatic.   Patients who had already been fighting their cancer for over 24 months tended to live an additional 10 months longer than those who had been fighting for less than 24  months.  The longer a patient had been fighting cancer, the longer he would continue to successfully fight.

Was there anything special about long term survivors?  Yes!  They were younger at diagnosis, more often female, tended to have an earlier stage at diagnosis, and had more breast cancer and less lung cancer.  Long term survivors were different in many ways, both obvious and unobvious.  Their cancer may have a better biology, they have been healthier and stronger, and they may have been more motivated to fight the cancer.

Cancer patients should not be discouraged if they are still early in their fight against cancer – even long term survivors were once short term survivors.  But hopefully this will give encouragement that you can “catch the wave”, in that the longer you fight, the better you will continue to do.

Please note that this principle is not intended to predict the survival of a single individual with cancer.  It is simply another variable in estimating prognosis for a group.

Live long and prosper.

My complete results are found in this article.

Posted in Fighting, Philosophy, Research, Statistics | 1 Comment

Will treatment help?

Many of the concerns about PSA screening for prostate cancer are based on the fact that some men are being diagnosed with very early and slow growing cancers that may not need any treatment.  You probably know that treatment doesn’t always help cancer.  In fact, there are 3 situations that can occur when you consider treating prostate cancer:

  1. The cancer is so early and so slow growing that treatment is not necessary, because the cancer will not cause problems during the person’s lifetime.
  2. The cancer will grow and will cause symptoms and/or death, and treatment is useful or necessary to prevent this from happening.
  3. The cancer is too advanced for the treatment to be helpful.

 

Only those in group 2 will benefit from treatment.  The big problem is that you cannot know which group you are in for sure!  You can only know statistically which group you are more likely to fall in.

Lets’s make a deal:

Will it be door #1, #2, or #3 ?

 

And that is one of the fundamental problems with watchful waiting.  If you tell someone that he is probably in group 1, i.e. probably doesn’t need treatment then he will ask “but what if I do?”  I think perhaps in some other cultures there is more of a laissez-faire attitude, but in America people are used to thinking that they can control their own destiny, and prevent that cancer from ever becoming a problem.  It’s the same thing about being in Group 3.  You cannot really know if you belong in the hopeless Group 3 until you at least attempt treatment.  Unexpected results occur all the time.  Certainly most people with cancer want to give themselves as much chance as they can.  Ultimately what we are left with is that everyone wants to believe that they are in group 2 — treatment will make a positive impact.  That’s why recommendations against screening and early treatment seem so hard to understand to many.


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Is PSA screening helpful or harmful?

A new report from the United States Preventive Services Task Force suggests that regular PSA cancer screening for prostate cancer can cause more suffering than good.  The reasoning is that many men who are diagnosed with prostate cancer in this way have minor cancers that would not have been a health threat during their lifetimes.

But, for many men this PSA screening undoubtedly has saved their lives!  Today I saw Mr. Jackson (name changed) who is undergoing intensity modulated radiation therapy (IMRT) for his prostate cancer.  He told me, “I hear that these PSA tests can cause harm.”  Translation: What am I doing here?  Am I doing the right thing?

I replied to Mr. Jackson that he is a perfect example of how PSA screening is successful!  He is in his early 50’s, African American, and was found to have a PSA of 6 during his yearly physical.  A biopsy showed a Gleason 7 cancer in 3 out of 12 cores with perineural invasion.  He is now undergoing treatment with short term hormonal therapy (Lupron) + high dose radiation.   If he did not have treatment, the cancer would probably have spread and caused death by his late 50’s, 60’s or 70’s.  But because the cancer was caught relatively early through screening his cure rate is probably around 80 – 90%.  I think it is obvious that some men are helped with PSA screening.

An article in the New York Times describes the situation further .

Dr. Kelly

Posted in Prostate, Radiation, Screening, Testing | Tagged | Leave a comment

People Helping People, by David Haas

Going through cancer is a horrible experience, especially for people with no support system. No one wants to go through such trying times by themselves. That is why there are special support groups that are designed to help cancer survivors, patients in remission, people who are still going through cancer treatments, and their families cope with their condition.

There are cancer support groups for many different kinds of cancers. Whether one is going through skin cancer, colon cancer, or even a rare disease such as mesothelioma, there are people ready to help the healing process. The group discussions can range from talking about a person’s day to how to increase the life expectancy of certain diseases.
There are a few reasons why a support group or a cancer survivor network is very important.

It helps patients explain their feelings

Cancer patients find it hard to explain how they feel to ordinary people, even if they are loved ones. However, talking with people who are going through the same thing helps patients to evaluate their feelings and relay their feelings, helping them to process their complex thoughts and emotions. This type of release actually helps reduce stress and anxiety, making the immune system stronger to fight the disease.

Patients can receive advice

The people in cancer survivor networks have experienced the pains and stress associated with cancer and cancer treatment. As a result, many of them have important advice for other cancer patients. Patients may not receive this type of advice in other settings.  Also, it is much easier to receive advice and commentary from these people because they are going through or have gone through the same thing that you are going through.

Exchanging advice and ideas is a great way for patients to feel more comfortable about their condition. It is almost like the advice helps patients feel more confident and secure to face treatment and recovery.

Cancer survivors can help other patients

Cancer survivor networks and support groups are not only for cancer patients. Many cancer survivors still want to be connected to people who are going through the same thing they went through. In fact, many networks encourage cancer survivors to stay connected to help new cancer patients feel comfortable with their condition.

Conclusion

Cancer survivor networks do not have to be in person. There are plenty of support groups online as well. Patients who are homebound will find the online cancer survivor networks useful. However, attending in-person meetings have a more personal tone and feeling, compared to online meetings.

Here are some great support networks online:

Inspire.com

Caring Bridge

Daily Strength

Guest blog post by: David Haas

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Helping rectal side effects from prostate cancer radiation

With modern radiation therapies such as IMRT the radiation beams are very focused on the prostate gland.  However, there is still a patch of rectum directly behind the prostate gland that will get hit with a very high dose of radiation therapy.  A larger portion of the rectum will also receive low to moderate doses of radiation.  This can cause symptoms such as a sensation that you need to have a bowel movement, looseness, diarrhea, constipation, mucous or blood in the bowel movements, leakage, and hemorrhoid irritation.   Fortunately, these side effects will get much better and usually go away within a few months of finishing therapy.

If you are experiencing these symptoms, there are plenty of over-the-counter remedies that can help.

One combination I suggest for bowel irregularity or mild diarrhea is:

Activia Yogurt   +    Metamucil   +/-   Imodium-AD

Activia yogurt provides healthy bacteria that your digestive tract needs to ensure proper functioning.  If you don’t like yogurt, you can also get these probiotic bacteria supplements from health food stores.  These are usually kept refrigerated.

 

Metamucil contains psyllium, which is a form of soluble fiber that can dissolve in liquids.  It comes in a powder form that you mix with water, or as snacks like these apple crisp wafers.  If you don’t like metamucil you can also get soluble fiber from beans, oatmeal, and fruit such as apples, bananas, pears and peaches.  Metamucil is a great regulator; it can help both constipation and mild diarrhea.  You need to consume a lot of liquid with metamucil.  It may also reduce irritation of the bowel, which can be useful if your rectum is irritated from radiation!

Imodium-AD is an anti-diarrhea medication.  If you are having frequent, loose bowel movements, then adding some of this can help slow it down.  You may only require a small amount, such as 1/2 tablet or 1 tablet per day.    You can take Imodium up to 4 times per day, but adjust the dose to the least amount required.

If you are having constipation do not use Imodium!  Using Activia + Metamucial + plenty of fluid may be sufficient.  If you need some extra help, try using Senokot-S, 1 – 2 tablets twice daily.  For severe constipation, try Miralax.

Hemorrhoid irritation is also common during radiation.  You can use a simple ointment like aquaphor, or an over-the-counter remedy such as Anusol-HC / Anucort-HC which will also contain hydrocortisone steroid.

A little blood in the bowels is common during radiation, usually from hemorrhoids or rectal irritation.  Tell your doctor if you are having bleeding.  If it is unusual you may be recommended to have a screening colonoscopy once you have recovered from the radiation.

Some radiation oncologists recommend going on a low-fiber diet (meat, potatoes, white rice, etc) while you are undergoing prostate or pelvic radiation.  I do not.  I think it is best to eat a healthy diet which also includes fruit, vegetables, and beans.   If necessary, this diet can be adjusted as you are undergoing the treatment.

 

Posted in Alt Med, Prostate, Radiation, Resources, Symptoms | 2 Comments

Seven ways a radiation oncologist ensures the right spot is being treated!

Mistakes are a no-no in radiation therapy.  We take them as seriously as a pilot of a passenger jet plane would.  It has been estimated that less than 1 out of every 1,000 radiation therapy cancer treatments may have a minor set-up error, which fortunately is usually of little consequence.  We minimize these errors by following a detailed process.  First we meet with the patient, and prescribe a radiation dose if we think it will help.  Next, we do our own mapping scan of that part of the body, and blend in other scans that might show the tumor better.  We draw lines around all the tumors on the computer and add some extra treatment safety margins.  The dosimetrist then determines where all the radiation beams will enter, the physicist does a mock treatment on a plastic model, and we sign off on their work.  Each day after a patient is treated we approve a check-film that was taken of the part of the body being treated.  We visit with the patient once a week to check tumor size, skin reactions, and other side effects.  We can even ask for a dose reconstruction which shows a scan of the patient with the actual dosages of radiation superimposed.  It definitely takes a qualified team to ensure everyone gets the right treatment.  I’ll explain each if these steps in a little more detail: 

1. Prescription

The radiation oncologist must meet with each patient, and see if he has a cancer type and stage that would benefit from having radiation treatment.  He prescribes a daily radiation dose, and the number of days of treatment.

2. Mapping

An “immobilization device” is created that will keep the patient in the same position every treatment, and limit his movement during the treatment.  It is basically a cushion or a plastic mask that molds to your body.  A simulation CT scan is taken through the part of the body we will be treating. If there are any other scans that show the tumor better, such as an MRI or PET scan then these are blended in with the CT.  Sometimes markers are placed in the tumor.

3. Drawing

The radiation oncologist sits down at a computer and circles the tumor(s) on every CT slice.  He will add some additional safety margins around this in case some microscopic amounts of cancer have spread a little ways outside the tumor.  Also, we add extra safety margin if the tumor will move during breathing.

4. Technical Work

The dosimetrist figures out where the radiation beams will enter the body and how strong each beam will be, to cause the least damage to health organs. A treatment plan is created for the patient, which is a set of computer instructions that tells the radiation machine how to perform the treatment.  The physicist then takes the plan and runs it on a plastic dummy with radiation detectors inside, and he verifies the correct daily dose is being given.  The radiation oncologist signs off on this work.

5. Checking the Daily Set-Up

Each day, the radiation therapist gets the patient set up on the machine, and runs the treatment plan.  A check film is created before each treatment, which is a scan of the part of the body being treated.  This check film should line up perfectly with the simulation CT scan.  The radiation oncologist reviews these check films every day.

6. The Weekly Check

Once a week, the radiation oncologist meets with the patient while he is undergoing therapy.  He looks for radiation skin reactions, he can sometimes monitor if the tumor is shrinking, and he looks to see if the treatment is proceeding as expected.

7. Adaption

Some treatment machines can record the dose that is actually given to the body and the tumor during a treatment session.  We can also monitor if the tumor grows or shrinks or there is weight loss during a course of radiation, and we can adjust the radiation treatment plan to compensate for this.

In Conclusion

Since the radiation beam is invisible and cannot be felt, it can sometimes be a leap of faith for patients to believe that we are radiating the right spot at the right dose.  However this is a process that we do over and over with a dedicated team with several layers of quality assurance and safety checks built in.   Modern radiation technologies such as IMRT are also associated with a lower error rate than older radiation methods.

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A naturopathic doctor can help you fight cancer

Naturopathic doctors with an ND degree have gone to a 4 year medical school, much like MD’s and DO’s.  Their training emphasizes the body’s own role in promoting optimal health and natural and holistic solutions for illnesses.  I believe that naturopathic medicine can offer a valuable addition to conventional cancer therapies to help the treatment success, reduce the side effects, or reduce the chances of having a recurrence of the cancer in the future.  Sometimes, when there are no conventional options available, natural therapies may be the only treatment possibility.

In the Tulsa community I’ve worked with two naturopathic doctors with extensive cancer experience.  I believe that any Northeastern Oklahoma cancer patients who are looking for an extra edge in fighting their cancer would be wise to consider a consultation with either of these two fine doctors, Dr. Kellman or Dr. Leu:

Dr. Michael Leu, ND

407 W ‘A’ Street, Jenks OK 74037
PH: 918-298-9300      www.DrLeu.com

Dr. Leu’s “Pathways to Wellness” is a clinic that works on the principles of Naturopathic Medicine. This means Dr. Leu’s treatments involve treating the whole body in a more natural way.  What makes our practice unique, is that Dr. Leu understands the pros and cons of both the conventional and natural approaches to health challenges. Being a registered pharmacist for over 25 years, and a naturopathic physician for over 9 years, Dr. Leu has a grasp of which therapy is in the best interest of your long-term health goals.

Dr. Daniel Kellman, ND, FABNO, Tulsa Naturopathic Group, LLC

Specializing in Integrative Oncology–supportive therapies for cancer patients to reduce side effects of chemotherapy, radiation, surgery and to improve the anti-cancer effect by implementing prevention strategies.  Also seeing patients with a variety of health issues such as arthritis, fatigue, digestive problems, skin issues, chronic pain or just general wellness visits.

Call 918-813-9729 to schedule an appointment
Website:   www.tulsanaturopathicgroup.com

Dr. Daniel Kellman works full time as a Staff Naturopathic Doctor at a cancer hospital in Tulsa. He also decided to start seeing patients privately after years of requests. His hours of availability are as follows:

Saturdays:  9 a.m. to 3 p.m.
Tuesdays:   6 p.m. to 8 p.m.

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A War of Vital Importance

Sun Tzu said:
The art of war is of vital importance to the State.  It is a matter of life and death, a road either to safety or to ruin. Hence it is a subject of inquiry that can on no account be neglected. AOW 1:1-2

Cancer is one of the ultimate confrontations that any person can have.    Cancer arises from within us, yet represents an enemy that is totally alien and hostile and can produce no physical good whatsoever.  It is a battle that if not won, will result in death.  It is a battle that if lost, will not even benefit the enemy (cancer), for it too will die when the body dies.

In a military battle, your death can be for a higher purpose, that of your country or your beliefs.  In fighting cancer, the “purpose” is harder to see.  You are fighting a senseless growth that has overtaken your body mindlessly, with the eventual outcome of disabling and killing yourself and itself along with you.  But, the battle becomes the way.  It is the way to salvation or to death.  Even if a patient decides not to take any treatment, he is still dealing with that cancer every day for the rest of his life.

If the battle does not always result in cure, it can still be necessary for most people to hope and fight.  The I Ching says, “Joyful in difficulty, the people forget about their death”.  Fighting is a way to try to continue holding on to what you have.  It is an attempt to bring control to a situation that may initially seem out of control.

Cancer is one of the most feared illnesses, due to a few reasons.  Firstly, cancer and the treatments themselves can cause pain, weakness, suffering, and malnutrition.  Secondly, many people feel that they have a lack of knowledge or a lack of control in fighting the cancer.  But, most importantly, the third reason is that a cancer diagnosis signals that there is a countdown timer on our life, on our existence, on all we know and love.  It is like a sand hourglass whose every falling grain of sand is like a cancer cell forming in our body.  It is an existential alarm clock that has started to ring.  Most people manage to not think too much about dying one day.  Or, they may have rationalized death as being part of the circle of life, or they know through their religion that they will go to a better place.  But, ultimately for most people, they will be in full panic mode when they receive a terminal diagnosis.   Even worse is when they are told that it will come at a certain time, such as “less that 3 months”, or “in 12 months”.

Hope in cancer patients means that firstly there will be little pain and suffering.  But far more importantly, hope means that there will be a reprieve on the death sentence.  We hope to die in old age, when we believe we have lived a long, good, and productive life, and even then hopefully death will come silently in the middle of the night without any warning.

For those who fight cancer, life can take on the vibrant hue of life being experienced on a daily basis.  Life may become lived much more in the moment; every day can become a blessing of its own.

For those who beat cancer, it is as if they have been reborn.

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Hello world!

So begins my blog about the “art” of fighting cancer.  Some of you may wonder what in the world this means.  It means looking beyond the conventional science of fighting cancer: exploring innovative combinations of treatment, doing personalized adaptation of treatment,  and adding nutritional and alternative therapies.  It means looking into the philosophy and strategy of what is being done, not just following a treatment recipe.

There are many diseases that can usually be cured simply.  A broken leg is casted or a metal brace or an artificial hip is surgically placed.  An infection like pneumonia can usually be successfully treated with prescription antibiotics.  For cataracts, the lens of the eye is removed and an artificial lens is inserted.  For all of these conditions, simple science and simple rules can be used to treat these conditions because the treatment itself is relatively straightforward, effective, and safe.

This is not the case with cancer.  Consider cancer of the pancreas.  If you strictly follow the scientific rules for treating this condition, also known as “the standard of care”, there is only a 5% cure rate.  Obviously, science has not yet provided the answer for successfully treating this condition.  If you want to try to improve on these odds, it may be necessary to be a little creative and go beyond the simple rules.  Art comes into play when a patient’s situation is analyzed to see how it is different from the average case, the whole person is looked at in addition to just the cancer, different treatments are combined together in creative ways, the cancer is targeted more expertly.  These are all things that go beyond the simple rules.

In my blog, I will sometimes make use of Sun Tzu’s Art of War book.  Sun Tzu was a general in ancient China, approximately 2500 hundred years ago.   His victories on the battlefield inspired him to write the Art of War.  His book is much more than just a description of tactical maneuvers; instead it focuses more on the philosophy of war for managing conflicts and winning battles.  It has been adopted by politicians and businessmen for dealing with rivals.  Throughout the blog there will be quotations from The Art of War, and I will try to apply them to better help you understand and manage cancer.

While heading the profit of my counsel, avail yourself also of any helpful circumstances over and beyond the ordinary rules. AOW 1:16

I hope that my blog can be of help to cancer patients, their families, and interested doctors and other health care workers who deal with cancer.  I’ll try to keep the jargon simple, but this site is probably best for those with a curious nature.

- Doug Kelly, MD

Posted in AOW, Intro | 1 Comment