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Can lifestyle changes improve outcomes in breast cancer? Results of clinical trial may encourage adoption of healthy behaviors They’ll kick up their exercise a notch, learn how to shop for and prepare healthy meals, and practice stress reduction techniques. All under the watchful eye of trained coaches. Perhaps most important, they’ll do these things with others in the same boat. “They” will be 120 breast cancer patients recruited from MD Anderson’s Nellie B. Connally Breast Center and Department of Radiation Oncology to test the premise that comprehensive integrative oncology, including certain lifestyle and behavior changes, may strengthen the body’s defenses against cancer. In an ambitious clinical trial set to begin this summer, researchers will explore whether improving patients’ diet and nutrition, levels of physical activity, stress management and social engagement can help them avoid a recurrence and increase survival. Leading the trial is Lorenzo Cohen, Ph.D., professor in the departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program. A control group will receive the standard of care without the lifestyle interventions. Both groups will be monitored regularly for immune function, endocrine function, insulin and glucose metabolism, and more.
A cancer cell doesn’t grow in a vacuum Though we all have premalignant cells in our bodies, not all of them grow or become malignant. The tumor microenvironment — the environment surrounding the cells, including immune cells, blood vessels, proteins and other molecules — plays an important part in whether cancer cells survive and multiply, get killed by the system or undergo spontaneous death. Funded by the Servan-Schreiber/Cohen Anticancer Fund, the trial will explore several components as part of the comprehensive integrative oncology intervention:
• dietary coaching to help reach or maintain a healthy weight and focus on eating an anti- cancer diet, • supporting daily physical activity, • providing practical tools for managing stress, and • fostering social connection and mindfulness in all aspects of life. Cohen worked closely with the late David Servan-Schreiber, M.D., Ph.D., to design the trial. Servan-Schreiber, who died in July 2011 of a brain cancer recurrence, was a physician, neuroscientist and author of the New York Times bestseller “Anticancer — A New Way of Life.” He was also an adjunct professor in the section of Integrative Medicine in MD Anderson’s Department of General Oncology. Although the study will be conducted only at MD Anderson, positive results might set an example for other cancer centers around the world.
Coaching new behaviors The study is designed to take advantage of patients’ daily visits to the Radiation Treatment Center. Three times a week, they’ll attend sessions. A once-a-week group class will teach cooking skills and foster sharing among study members. When radiation therapy ends, participants will have weekly meetings with their coaches over the computer. They’ll be monitored carefully and will keep track of their progress throughout the trial on a web-based portal. “This lifestyle coaching will be incorporated into participants’ radiation therapy treatment,” Cohen says. “It’s a teachable moment, because they’re at MD Anderson every day during this time.”
Scan this QR code with your smartphone to watch Dr. Cohen explain the trial, or visit www.mdanderson.org/network.
people profile Friendship sustains anal cancer patient during intensive treatment Mary Elizabeth “Ebba” Dunn of Wetumpka, Ala., begins her cancer story in low-key fashion. “I had some funny blood work,” she says. Because of this, her doctor kept putting off a scheduled minor surgery, she says. The longtime church organist and mother of four daughters explains that when she did convince her doctor to go ahead with a surgery to remove her hemorrhoids, he found a growth that he sent in for a biopsy. Although he said he didn’t think it was anything to worry about, he called three days later to say she had anal cancer, specifically a squamous cell carcinoma. Anal cancer is fairly rare — much less common than cancers of the colon or rectum — but rates of the disease are rising. Fewer than 6,000 cases were diagnosed in the United States in 2011. The average age at diagnosis is early 60s, and it’s somewhat more common in women than men. If caught early, it’s highly treatable. Dunn knew exactly where she wanted to have treatment. Her close friend Eleanor “Tee” Couch, who’s lived in Houston for many years, works at MD Anderson. Couch, program coordinator in the Public Education Office, invited Dunn and her husband, Beau, to stay at her house when they came into town for their first appointment. The couple met Dunn’s physicians: Cathy Eng, M.D., associate professor in the Department of Gastrointestinal Medical Oncology, and Christopher Crane, M.D., professor in the Department of Radiation Oncology. Crane designed an individualized protocol for her: a sixweek concurrent course of chemotherapy and radiation. “He told us that one treatment type would enhance the other,” Dunn says. This meant that the couple would need to stay in Houston for six weeks. When they told Couch they’d rent a hotel room or apartment, “She wouldn’t hear of it,” Dunn recalls.
A friend’s home provides respite It was an intensive treatment, consisting of radiation every weekday morning and a six-hour infusion of chemotherapy on Mondays, followed by wearing a bag of chemo for the rest of the week. Dunn never felt nauseated, but did consult with a dietitian to help with gastrointestinal side effects caused by the chemotherapy. And even though she says slyly, “It’s hotter than Wetumpka,” Dunn enjoyed her stay in Houston.
Photo: Elizabeth Puckett
Ebba Dunn has been the organist at Trinity Episcopal Church of Wetumpka, Ala., since 1971.
“Anywhere you went, you saw people who were in treatment. That helped a lot,” she says. “There weren’t a lot of people staring at you, saying, ‘Oh, poor you.’ ” Dunn looked forward to returning to Couch’s comfortable home in the evenings after treatment. Beau often cooked for the trio. “I did a lot of reading,” Dunn says. “And we got to watch the Alabama Crimson Tide play on the weekends. I went to church and tried to be as active as I could.” More than a year later, she’s active in her church and community, takes a regular exercise class, and works as an extra in movies filmed in the area. She’s grateful for her health and for her supportive family and friends — especially her generous friend Couch. “Tee was a lifesaver, really,” she says.
Ebba Dunn is a member of Anderson Network, a program of the Department of Volunteer Services that matches cancer patients with survivors who’ve had the same disease and treatment. To join, call 800-345-6324 or go to www.mdanderson.org/ andersonnetwork.
research briefs Everolimus prolongs progression-free survival for patients with neuroendocrine tumors Combination treatment with everolimus and octreotide has shown to improve progression-free survival for patients with advanced neuroendocrine tumors and a history of carcinoid syndrome, according to MD Anderson researchers. Results of an international, randomized, placebo-controlled Phase III study were published recently in the journal Lancet. Neuroendocrine tumors, also known as carcinoids, are uncommon tumors arising from various primary sites. They form in the hormone-producing cells of the body’s neuroendocrine system, which is composed of cells that are a cross between traditional endocrine cells and nerve cells. Frequently, carcinoids spread to the liver, causing a variety of symptoms termed carcinoid syndrome. Everolimus is a kinase inhibitor that treats cancer by stopping cancer cells from reproducing and by decreasing their blood supply. The treatment combination of everolimus and octreotide led to a clinically meaningful five-month delay in tumor growth, compared to octreotide alone. There are no FDA-approved drugs for control of neuroendocrine tumors, says lead author James Yao, M.D., associate professor in the Department of Gastrointestinal Medical Oncology. “This research offers a promising option where there were few previously.”
Acupuncture can prevent radiation-induced chronic dry mouth A new study shows that, when given at the same time as radiation therapy, acupuncture may reduce the debilitating side effect xerostomia (chronic dry mouth). The study, published in the journal Cancer, reported findings from the first randomized, controlled trial of acupuncture for the prevention of this side effect. Characterized by reduced salivary flow, xerostomia commonly affects patients receiving radiation therapy for head and neck cancer. Most current treatments offer limited benefit, says study author Lorenzo Cohen, Ph.D., professor in the departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program. Cohen and colleagues examined 86 patients with nasopharyngeal carcinoma treated at Fudan University Shanghai Cancer Center in Shanghai, China. A type of head and neck cancer, nasopharyngeal carcinoma forms in the upper part of the pharynx behind the throat. In the study, 40 patients were randomized to radiation with acupuncture and 46 to radiation without acupuncture. Results were based on data derived from two self-report questionnaires, as well as the measurement of saliva flow. Further research is planned.
Anderson Network News: Help, support for young adults with cancer Being diagnosed with cancer in your late teens, 20s or 30s presents a whole different set of issues than those faced by older or younger survivors. It can seem like a lonely world where no one understands what you’re going through. Programs like Cancer180, the Cancer Survivor Message Board, WarmNet, the Adolescent and Young Adult Program, and the Cancer180 and Young Cancer Connection Facebook pages provide support and connection to other young adults affected by cancer. To learn more, check out: • www.mdanderson.org/andersonnetwork • www.cancer180.org • www.mdanderson.org/aya • www.facebook.com/cancer180 To learn more about MD Anderson research, • www.facebook.com/youngcancerconnection
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network The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center. Address changes should be sent to: Mary Brolley The University of Texas MD Anderson Cancer Center Communications Office – Unit 700 6900 Fannin St. Houston, TX 77030-3800 Phone: 713-792-0658 Fax: 713-563-9735 Email: firstname.lastname@example.org Articles and photos may be reprinted with permission. Susan French, Executive Director, Volunteer Services Debbie Schultz, Assistant Director, Volunteer Services/ Anderson Network Sara McIntosh, Chair, Anderson Network Mary Brolley, Writer/Editor, Network Gini Reed, Graphic Design © 2012 The University of Texas MD Anderson Cancer Center
Institute created to speed up cancer drug development A major new research institute at MD Anderson will blend the best attributes of academic research and the biotech industry to identify and test new cancer targets, convert scientific knowledge into new cancer drugs and advance these drugs through innovative clinical trials. Researchers will also investigate complementary diagnostics for cancer patients via multidisciplinary collaboration. The new Institute for Applied Cancer Science will be led by Giulio Draetta, M.D., Ph.D., and Lynda Chin, M.D. Its goal — building an “expressway” for speedier drug development — would be impossible without the strength of MD Anderson’s 18,000-member workforce, notes Ronald DePinho, M.D., president. “It’s a great day for cancer patients and a dark day for cancer,” DePinho said at the institute’s announcement in late November.
Lynda Chin, M.D.
Giulio Draetta, M.D., Ph.D.
Read more Network content at www.mdanderson.org/network Ronald DePinho, M.D.
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