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Holy Cross Cancer Blog

The Importance of Nutrient Dense Foods

  • Posted Nov 11, 2010
  • Maureen Mahoney

legumesThis month we are focusing on nutrient dense foods that are fairly easy to work into your diet. During cancer treatment it's essential to support your body's needs for protein, fat, carbohydrates, vitamins, minerals and fluid. Here are some easy to use guidelines that will be beneficial even you are not currently receiving treatment.

  • Protein is essential for many metabolic functions and is necessary for repair and growth, especially after surgery or invasive procedures. Protein foods are not only animal products. Legumes are an excellent source of protein, low in fat and high in fiber. They're easy to cook and have a longer refrigerator shelf life than meat, poultry or fish, which means you're spending less time cooking! Red meat, pork, dark meat poultry may contain high amounts of saturated fat and omega-6 fats; they also may have natural or added growth hormones that many spur growth rates of cancer cells.
  • Instead of refined sugars, choose fruits and lower glycemic sweeteners such as stevia and agave to satisfy cravings for sweets.
  • Stay hydrated by drinking plenty of water but also include 2 to 3 cups of green or white teas to provide additional antioxidants.
  • Limit saturated fats and shift to foods high in omega-3's and omega-9's such as fish, nuts, avocados, flax and olives. Avoid trans fats.
  • Milk that has added or contains natural growth hormones may spur growth rates of cancer cells. Milk also contains casein which can contribute to inflammation and decrease immunity. You can substitute milk with rice, oat or nut alternatives and in some cases soy.
  • Sustain your energy by eating plenty of whole grains. Complex carbohydrates with fiber provide a slow, sustained supply of fuel; examples are fruit, vegetables, grains, whole grain pasta, quinoa, brown rice and unsweetened high fiber cereal.
  • Get lots of cancer-fighting phytochemicals (plant based nutrients) in your diet by eating a rainbow of fruits and vegetables daily. The brighter the color, the more phytochemcials it contains

Direct to Consumer Genetic Testing

  • Posted Sep 28, 2010
  • Carol Brudenell

DNAThe phenomenon of Direct to Consumer testing (DTC) is relatively new and involves the offering and advertising of genetic testing to the public via the internet. The consumer is apprised of these services not only online but also through radio, newspaper and television advertising. The services offered range from testing for a single disease or constellation of diseases to the testing of the entire genome. The tests can assess the ancestry, disease predisposition, hereditary disease syndromes, genetic variations that affect drug metabolism, toxicity, and aid in drug selection, to name just a few. DTC Testing Concerns: The cost can vary from a few hundred to thousands of dollars and often the worth is questionable. Insurance does not cover these tests for the most part. The consumer may not understand the meaning or ramifications of the results. Some companies offer genetic counseling services to help interpret the results and provide recommendations based on the findings, some provide a list of counseling services in the community,  some offer a written report and others offer nothing other than the results. The test may yield results that contribute to a sense of safety when in fact the test did not address the main problem. An example of this is a case I read about where the company offered multisite 3 genetic testing for breast and ovarian cancer risk to a young woman who had a large family history of breast cancer and was not of Ashkenazi Jewish heritage This test identifies mutations that can be present in Jewish people from Eastern Europe and if present, indicates that this individual is at a greatly increased risk of breast and ovarian cancer. Unfortunately this test is not appropriate for a non-Jewish person and in order to completely rule out an increased risk for breast and ovarian cancer, she should have had a comprehensive analysis of these genes The test was negative and the person assumed she was not at any increased risk for the diseases in question. This testing also did not address the high risk of breast and ovarian caner for this young woman based on the large family history of breast cancer. Federal government oversight of genetic testing advertising and some of the products offered is non existent. This is a buyer-beware enterprise and poses problems for the health care industry in that the results of these tests often leave the health care provider to pick up the pieces and repair the damage done and that is dependent on whether the consumer even informs the health care provider of the independent testing. I am sure that DTC testing has some advantage in that it educates the public to the different possibilities just as does the pharmaceutical industry advertising of drugs. Unlike the latter, however, the genetic tests offered online, for the most part do not have to pass through the screening of the health care provider to be ordered as do many of the drugs. I am interested in hearing from you in regard to this issue and your opinion/experiences. If you are interested in exploring the topic further, click here and visit this website.


Helpful Tools for Improving Nutrition During Cancer Treatment

  • Posted Jul 15, 2010
  • Maureen Mahoney

ist1_3450899-healthful-eatingMaintaining adequate nutrition is a crucial part of your cancer treatment. Eating a variety of foods daily from all food groups will help you obtain the nutrients you need to maintain your strength, feel better during your treatment, and/or heal any post-operative wounds. However, you may have difficulty consuming some foods either due to the cancer itself or to the side effects of the treatment. Therefore, you may need to make some changes to improve your food intake based on your symptoms. Keeping a food journal can take the confusion out of how many calories and how much protein you take in each day. Nausea and Vomiting: Eat slowly and take small bites or sips. Eat dry foods like toast and crackers, especially after waking in the morning, and even before getting out of bed. Eat smaller portions of food that are low in fat since they are easier to digest and move through the the stomach faster, but eat more often to make up for your calorie and protein needs. Limit overly sweet or spicy foods. Do not lie down flat for at least 2 hours after eating. Resting should be done sitting down or if necessary to recline, make sure your head is at least 4 inches higher than your feet. Wear loose fitting clothing and breathe fresh cool air to help relieve symptoms. Taste Alterations: Tart foods enhance flavors. Try orange juice, pickles, lemons, limes or tomato juice (avoid this if you have a sore mouth or throat). If meats are not appealing, try marinating meats in fruit juice, sweet wine or Italian dressing. Try meat alternatives such as eggs, cheese, tofu, vegetarian meat substitutes, yogurt and nuts. Serve foods chilled or at room temperature. Loss of Appetite: Avoid drinking fluids with meals. Fluids can produce an early feeling of fulness; limit fluids to 1/2 cup at meals and drink other liquids 2 hours before the meal. Eat several small meals and snacks throughout the day. Keep nutritious snacks available at all times, even when on-the-go. Leftovers make good snacks. Eat a snack before going to bed. Avoid foods that may be gas forming such as salads, cabbage, broccoli, beans and carbonated beverages. Avoid foods with strong odors. Choose cold or room temperature foods and create plenty of ventilation. Create a pleasant environment; if desired spend the mealtime with family and/or friends. Eat when hungry, even if it's not mealtime. Make every mouthful count! Eat mostly high protein, high calorie foods. To add calories an protein easily, mix powdered milk into foods and beverages or drink supplements such as Ensure or Boost. There are many other challenges that patients deal with every day. If you have specific questions and would like to speak to a Registered Dietitian, please comment on this entry or call Maureen Mahoney, R.D. at the Bienes Cancer Center at 954-771-8000 x1528.


Non-Small Cell Lung & Small Cell Lung Cancer Research Trials

  • Posted Apr 27, 2010
  • Carol Brudenell

lungsHoly Cross Hospital is building a large portfolio of clinical trials for Lung Cancer to make available the latest in therapy for both Non-Small Cell Lung and Small Cell Lung Cancer patients.  You can access the trials on our web siteand below is the press release that tells you all about our latest Phase 1 trial for Non-Small Cell Lung Cancer.

Holy Cross Hospital Leads in Cancer Research By Enrolling First Patient in International Clinical Trial

Hospital seeks participants with non-small cell lung cancer who have exhausted all other treatment options

 FORT LAUDERDALE, Fla. The Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital has enrolled the first patient in what will be the worldwide clinical trial of a new treatment for patients with non-small cell lung cancer (NSCLC) who have exhausted all other options for treatment.

 Lung cancer accounts for the most cancer-related deaths in both men and women in the United States. Approximately 87 percent of all lung cancers are non-small cell, a disease in which malignant cells form in the tissues of the lung.  Despite medical advances, the five year survival rate for patients diagnosed in any stage of NSCLC is just 15 percent and only 2 percent for those patients whose disease has metastasized and spread outside the lung.  Holy Cross Hospital, which collaborates with Massachusetts General Hospital Cancer Center in Boston to expand oncology services to South Florida residents, is participating in the FDA study of the new investigational drug PF-02341066 that selectively targets cancer-causing genes present in some NSCLC patients.  “Depending on the patient’s age, stage of the disease and overall health, treatments for non-small cell lung cancer can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of these.  In our investigation of this new drug, we are working with patients for whom these standard of care treatments have not been able to stop the growth of their disease,” said Dr. Martin Gutierrez, medical director of the Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital. Eligible patients for the study can be male or female, must be at least 18 years of age and have a proven diagnosis of NSCLC that showed progression after at least one but no more than two chemotherapy regimens.  Patients accepted into the study receive the drug orally on a continuous schedule. Holy Cross Hospital is participating in both Phase One and Phase Two of the trial which is officially titled “Open-Label, Randomized Study of the Safety, Efficacy, and Pharmacokinetics of Erlotinib with or without PF-02341066 in Patients with Advanced Non-Small Cell Adenocarcinoma of the Lung.”  The Holy Cross Hospital Cancer Center offers disease specific care in all oncology sub-specialties including medical, surgical and radiation oncology.  The Cancer Center also offers research trials that span from early drug development through the later Phase 3 stages for multiple types of cancer. Those interested in enrolling in the study or learning more should call the Michael and Dianne Bienes Comprehensive Cancer Center research office at 954-267-7704 or visit www.holycrosscancer.com.


The Antioxidant Controversy

  • Posted Apr 26, 2010
  • Maureen Mahoney

antioxidantsMany  cancer experts believe that science doesn't yet fully support antioxidant use during cancer treatment. According to the American Institute for Cancer Research (AIRC), the current evidence supports both views on antioxidants - that they could interfere with treatment and protect healthy cells and reduce side effects.  Cancer experts seem to be split into two camps on the antioxidant issue. Radiation and some chemotherapy agents work by generating free radicals that kill rapidly dividing cancer cells. Since antioxidants scavenge free radicals, the thinking is that they may interfere with these cancer treatments. The other side of the argument is that oxidation supports the growth of malignant cells, which may conflict with treatment. Thus, antioxidants may counter the harmful effects of oxidation in the malignancy process, boost the effects of the cancer therapy, and protect patients form the therapy's toxic side effects. Several randomized clinical trials found that the concurrent administration of antioxidants with chemotherapy or radiation therapy reduces treatment related side effects; some data indicate antioxidants may protect healthy cells (as well as tumor cells) from oxidative damage generated by cancer therapy; and other data suggest that antioxidants can protect normal tissues from chemotherapy or radiation-induced damage without decreasing tumor control. Still many oncology experts discourage the use of supplemental antioxidants because of the possibility of tumor protection and reduced survival. There is more evidence needed in order to provide approval or disapproval of antioxidant supplementation. While the controversy continues on supplementation, there shouldn't be any when it comes to antioxidants found in whole food sources. Food sources of antioxidants are very unlikely to reach levels sufficiently high enough to interfere with treatment. Experts from many oncology centers including, Yale-Griffin Prevention Research Center, UCLA Center for Integrative Oncology, Naval Medical Center in San Diego, promote a whole food diet eating at least 3 to 4 fresh fruits and vegetables each day. Diets rich in phytochemicals, vitamins and minerals can help control tumor growth by reducing inflammation and controlling the rate of cell division.  Below are some of the nutrition guidelines promoted by many clinical nutrition specialists for patients facing cancer therapy:

  • Get lots of cancer-fighting phytochemicals in your diet by eating a rainbow of fruits and vegetables daily. The brighter the color, the more phytochemicals it contains.
  • Sustain your energy by eating plenty of whole grains. Complex carbohydrates with  fiber provide a slow, sustained supply of fuel.
  • For protein, include legumes, fish and omega-3 eggs. Reduce red meats and pork which contains saturated fat and natural or added growth hormones.
  • Drink milk from rice, oat, soy or nuts.
  • Instead of refined sugars, choose fruits and lower glycemic sweeteners such as agave and stevia.
  • Limit total fat intake and shift to foods high in omega-3's and omega-9's such as fish, nuts, avocados, flax and olives.
  • Stay hydrated throughout the day with water and occasionally white or green tea.
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Holy Cross Current Lung Cancer Clinical Trial List

  • Posted Nov 02, 2009
  • Carol Brudenell

lungsThis is an incredibly exciting time in our cancer center. Under Dr. Martin Gutierrez’ leadership our clinical research program is soaring to new heights. We have now opened numerous clinical trials for our enhanced lung cancer program. You will begin to see print ads, direct mailings and also hear ads on the radio to educate people about what new treatment options are available to certain cancer patients. Listed below is a few of the trials in the Holy Cross Hospital Lung Clinical Trial List:

  • A Phase III Randomized Trial Of Adjuvant Chemotherapy With Or Without Bevacizumab For Patients With Completely Resected Stage Ib (> 4 Cm) – IIIa Non-Small Cell Lung Cancer (NSCLC)
  • The Impact Of Ethnic Origin On Patients Being Treated Second Line With Pemetrexed – An Observational Study
  • Phase III Comparison Of Thoracic Radiotherapy Regimens In Patients With Limited Small Cell Lung Cancer Also Receiving Cisplatin And Etoposide
  • A Phase II, Randomized, Open Label Study Of Figitumumab Plus Cisplatin (Or Carboplatin) And Etoposide, Versus Cisplatin And Etoposide Alone, As First Line Treatment In Patients With Extensive-Stage Disease Small Cell Lung Cancer
  • Phase 1/2, Open-Label, Randomized Study of the Safety, Efficacy, and Pharmacokinetics of Erlotinib with or without PF-02341066 in Patients with Advanced Non-Small Cell Adenocarcinoma of the Lung
  • Phase II, open-label single arm study of the efficacy and safety of PF 02341066 in patients with advanced non-small cell lung cancer (NSCLC) harboring a translocation or inversion involving the anaplastic lymphoma kinase (ALK) gene locus
  • Phase III, Randomized, Open-Label Study of the Efficacy and Safety of PF-02341066 versus Standard of Care Chemotherapy (Pemetrexed or Docetaxel) in Patients with Advanced Non-Small Cell Lung Cancer (NSCLC) Harboring a Translocation or Inversion Event Involving the Anaplastic Lymphoma Kinase (ALK) Gene Locus
  • Phase II Trial of Preoperative Chemotherapy and Bevacizumab in Patients with Stage IB (>4 cm), II, or Select Stage III Non-Small Cell Lung Cancer
  • Phase II trial for Stage IIIB/IV Non-Small Lung Cancer (NSCLC) with three arm chemotherapy study for Poor Performance Status patients
  • Phase 1b/II Study to Determine the Recommended Dose, Safety, and Preliminary Efficacy of Belinostat (PXD 101), a Histone Deacytylase Inhibitor, in Combination with Carboplatin, Paclitaxel, and Bevicizumzb (BelcaP-B) in Patients with Untreated Non-small Cell Lung Cancer (NSCLC)

This brings a whole new array of options for patients to be treated. If you are interested in learning more please call me at 954-267-7704. If you know of a patient who may be eligible for one of these trials please call our lung cancer program line at 954-351-LUNG (5864) to schedule an appointment to see Dr. Gutierrez. More next month.


Phase I Clinical Trials Program

  • Posted Sep 21, 2009
  • Carol Brudenell

clinical-trials-imageCurrently our practice has a large selection of Phase II and III clinical trials through the Community Clinical Oncology Program (CCOP), Gynecologic Oncology Group (GOG) and Pharmaceutical companies. We are audited regularly by both the cooperative research groups (National Cancer Center funded) and the pharmaceutical company monitors. Our results are consistently good to excellent. We are poised to expand on our success by adding a Phase I program to increase access to treatment trials for our patients with locally advanced or metastatic disease. At present, when these patients have exhausted standard of care treatment, they have to leave their family and local support systems to travel outside the county, and often the state, to find cutting edge care. The Michael and Dianne Bienes Comprehensive Cancer Center has the vision and clinical expertise to establish a Phase I program that will help cancer patients, with no other treatment options, to stay in the community for treatment and supportive care. In preparation for opening our Phase I program, we are consulting with a firm from Pennsylvania this week. This company will audit our facilities and phase I preparation to date and tell us what else we can do to make our program state of the art and ready to open. In November, we will be ready to go live with a Phase I study for Non-Small Cell Lung Cancer (NSCLC). Through relationships with the Sarah Cannon Research Institute and other contract research organizations, we have a pipeline of Phase I trials that will open over the next year. Stay tuned to our new website for the Phase I trials as they open. It would be remiss not to mention our greatest asset in this effort, Dr. Martin Gutierrez, the Medical Director of the Bienes Cancer Center and principal investigator for our phase I program. He is an experienced phase I investigator who came to us a year ago from the National Cancer Institute in Bethesda, Maryland. He wrote, opened and conducted 12 phase I studies with various compounds in collaboration with an international team. He will be writing some of phase I trials here as well. We are very excited to be able to offer this program to you along with our other trials that address most of the cancers. Click here to read more about phase I trials and any current trials, many of which are open here at Holy Cross. See you next month and feel free to call me at 954-267-7704 if you want more details about any of our clinical trials.


Holy Cross Lung Cancer Program

  • Posted Sep 01, 2009
  • Carol Brudenell

lungsWe are especially excited in the cancer center about the October launch of our new program for patients with lung cancer. Dr. Martin Gutierrez, our Medical Director and specialist in the treatment of lung cancer will be launching this program next month with ten clinical trials and a team of practitioners to meet every medical and psychosocial need of patients challenged with lung cancer. These particular trials will treat both non-small cell and small cell lung cancer. The various clinical studies combine standard of care with radiation or antiangiogenic agents (drugs that prevent blood vessel formation that feed tumors) or novel new agents that are targeted to interrupt specific pathways that cause lung cancer cells to multiply. Non-small cell lung cancer accounts for about 85% of lung cancers while the remaining 15% is largely due to small cell cancer. Non-small cell lung cancer is the most frequently diagnosed cancer and the most common fatal malignancy in the United States. It is responsible for nearly 30% of all cancer related deaths. * The lung cancer program has several trials of particular interest that combat non-small cell cancer using a targeted oral drug. It is a small molecule inhibitor of the c-met pathway. When the c-met pathway is activated it leads to accelerated growth of cancer cells. The c-met inhibitor molecule blocks activation of the pathway and prevents tumor growth. This drug and other targeted therapies are often called personalized therapies because they are usually more effective in persons with a specific genetic make-up. We are looking forward to sharing more with you about these clinical trials and our Lung Cancer Program in the near future. For more information about our Lung Cancer Program and new therapies occurring now, please call me any time at 954-267-7704. *Jemel, A. et al, Cancer Statistics, 2008. CA Cancer J CLin 58:71-96, 2008.


Medical & Surgical Options for BRCA Positive People

  • Posted Jul 23, 2009
  • Carol Brudenell

Earlier this year, we talked about the BRCA testing for women at high risk for breast and ovarian cancer.  Although only 5-10 % of persons having BRCA analysis actually test positive, this is usually devastating for these few people. They have many decisions to make and it can be a painful process. The screening options that are recommended are:

  1. Monthly breast self exam

  2. Semi annual clinical breast examination by the same health care provider

  3. Semi annual mammograms alternating with breast MRI

  4. Annual transvaginal ultrasounds (to visualize the ovaries)

  5. Some physicians exam the blood annually for a protein that is often elevated in persons with ovarian cancer (CA-125)

Some BRCA positive people choose medical or surgical options:

  1. Tamoxifen (an estrogen inhibitor) decreases breast cancer risk by 49%

  2. Bilateral mastectomy reduces risk by 90%

  3. Removal of the ovaries reduces the risk of ovarian cancer by 96% and breast cancer by 53%

  4. Oral contraceptives have been shown to lower ovarian cancer risk by 54%

These are difficult choices for many patients who are BRCA positive but it has also been my experience that women (in particular) who test negative but have a strong family history of breast cancer often do not hesitate to choose more intense screening and even bilateral mastectomies and removal of their ovaries.   Many of our patients are young with small children or grandchildren and life is precious.  It is their firm belief that being at very high risk for breast or ovarian cancer is an unacceptable reality.  They are aggressive in screening and having surgery to reduce the risk.

 

What would you do if you were faced with these realities?  I thought I knew before

I met some of these women. Let me know your thoughts.


Pages

Below is a commentary from Maureen G. Mann, MS, MBA, FACHE, Executive Director of the Michael and Dianne Bienes Cancer Center at Holy Cross Hospital, urging lawmakers to oppose House Bill 169. 

"...I am a very involved volunteer with the American Cancer Society...so this particular bill causes me great concern. Please see the notes below and VOTE NO when this bill comes to the floor...


Oppose House Bill 169
Nicotine Products & Nicotine Dispensing Device

Background
Originally, the intent of HB 169 was to prohibit the sale of nicotine products and nicotine dispensing devices (e-cigarettes) to minors. However, added amendment language would strip local governments of their ability to regulate all tobacco products and e-cigarettes, overturn existing ordinances, and block future opportunities to protect kids in the retail environment. For example, many of the product placement ordinances we currently have in Florida go beyond the minimum standards set by the US Food and Drug Administration (FDA), requiring that ALL tobacco products are placed behind the counter at retail stores, not just cigarettes and smokeless tobacco. With the preemption language, the bill now does more harm than good in the fight to keep Florida’s children tobacco free.


Key Points
Many of the ordinances we currently have in Florida deal with product placement, requiring that all tobacco, not just cigarettes and smokeless tobacco, are placed behind the counter at retail stores. They are stronger than the minimum standards required by the FDA and are all meant to keep tobacco
products out of the hands of children.

In-store tobacco displays serve to increase product availability, visibility and brand awareness and stimulate trial and purchase of products.1 Product placement laws limit youth access to tobacco via illegal sales and shoplifting.
Proponents for preemption claim that we need a uniform state law that covers all businesses rather than a patchwork of local ordinances. The fact is retailers are used to complying with a variety of local laws, including zoning, traffic restrictions, health regulations and even alcohol sales. Tobacco regulations
are no different than other regulations that vary from jurisdiction to jurisdiction.        
Local governments are more flexible and responsive than state government in effectively dealing with emerging problems and finding innovative solutions. Local governments are closer to the community and have been more effective than the state or federal government in addressing the problem of
tobacco use.

My Position
State laws should serve as a minimum standard for a policy objective while allowing communities to enact stronger ordinances to protect their youth and residents in the most appropriate manner. The American Cancer Society Cancer Action Network, American Lung Association, American Heart Association, Campaign for Tobacco-Free Kids and our partners ask that you oppose HB 169 and prevent the dismantlement of effective local tobacco ordinances around the state."


 


About the Center

The Michael & Dianne Bienes Comprehensive Cancer Center in Fort Lauderdale, Florida is the Cancer Care Leader in Broward County. Dedicated to providing patients with precise diagnosis, the latest and most advanced treatment and aftercare options, we offer a multidisciplinary approach to care, a compassionate and spiritual healing environment, and an affiliation with the National Cancer Institute. We are also working together with Massachusetts General Hospital Cancer Center to provide South Florida residents with rapid access to specialized cancer care and genetics counseling.

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