What’s the Connection Between Heart Disease and Breast Cancer?

It may seem like the ultimate insult, but having survived breast cancer can put you at higher risk of additional health problems later in life. The National Cancer Institute reports that the average five-year survival rate for breast cancer is now about 90 percent, thanks to advanced treatment protocols. However, some patients who’ve had radiation treatment and chemotherapy may be at higher risk of developing cardiovascular disease in what’s called a late side effect of treatment for breast cancer. This means that the heart problem may not surface for months or years after the conclusion of treatment. According to a report in the journal EJC Supplements, an open access companion journal to the European Journal of Cancer, cardiovascular disease is already the leading cause of death “accounting for 30 to 50 percent of all deaths in most developed countries. Because of this high background rate, even a minor increase in risk of CVD [resulting from cancer treatment] will have an important impact on morbidity and mortality.”

According to a 2016 article in the Cleveland Clinic Journal of Medicine, ischemic heart disease (a reduction in blood supply to the heart) is the most common cause of death after radiation treatments. Valve disorders and diseases of the heart muscle and the pericardial sac that encases it are also common. A disruption to the electrical pulses that make the heart pump can also occur. “Overall, compared with nonirradiated patients, patients who have undergone chest radiotherapy have a 2 percent higher absolute risk of cardiac morbidity and death at five years and a 23 percent increased absolute risk after 20 years,” the article notes.

Anju Nohria, director of the cardio-oncology program at Brigham and Women/Dana-Farber Cancer Institute in Boston, says the problem stems from radiation’s ability to kill healthy cells that are located within the field of radiation being administered to a breast cancer tumor. Radiation “essentially destroys the cancer cells preferentially because they’re rapidly multiplying and therefore more susceptible. But [radiation can] also cause some damage to any healthy tissue” nearby. She says this is particularly true for patients having radiation treatments on the left breast, as the heart sits under that breast and is therefore closer to radiation beams in some cases. “If the tumor is on the left side but in your armpit, maybe you’re fine. But if it’s right over the heart, you have a higher risk,” of developing CVD later on because of that proximity to exposure, Nohria says.

In an effort to avoid exposing the heart as much as possible, many doctors now deliver radiation treatment while patients are lying prone, “meaning that they’re lying on their stomachs with their breasts hanging down." That way, the breast is sort of separated from the chest wall, and the heart is less in the radiation field.” Radiation is delivered from the underside of the table. Some doctors are also using “very sophisticated radiation techniques where they can map out the tumor and try to exclude the heart from the radiation field to the extent possible,” she says.

Even so, some patients will experience problems while others won’t, and the risk of developing cardiac problems after radiation treatment is dependent on a number of factors, including the location of the tumor and dose of radiation administered. “If you need a lot of radiation because you have a large tumor or it’s a particularly malignant tumor,” then the higher the dose the heart may receive, Nohria says. A patient’s age and preexisting cardiac risk factors like high blood pressure, high cholesterol and diabetes can also elevate risk. Smokers or people who already have heart disease are also at higher risk, “because in a way the heart has already sustained some damage and now you’re giving it an additional kick, so to speak.”

Certain chemotherapies including anthracycline drugs and certain drugs within the Herceptin family of HER2 agonists have also been linked with an increased rate of cardiovascular disease in some breast cancer patients, Nohria says. Adriamycin, an anthracycline chemotherapy, causes a “weakening of the heart muscle in 8 to 9 percent of women. In the majority of these cases, it happens within the first year of treatment,” she says. So if you’re taking this drug, expect your doctor to keep tabs on your cardiovascular health. “As we’ve begun to realize this [risk], we’re being more vigilant looking for it in the first year after treatment.” If this cardiac toxicity is noted early, “you can put people on heart medicines that help the heart recover in a certain proportion of patients.” But a change in cardiac health won’t always be obvious early on, she says. “Sometimes you’ll have an asymptomatic decline in your cardiac function – the squeezing of the heart muscle – and it only manifests when the person comes up with symptoms, which can be a several-year lag.”

With some of the HER2 agonist drugs, cardiac problems may actually be reversible in some patients, Nohria says. “If you stop the drug, there’s a high likelihood that your heart will get better. But in a few cases, like 30 percent, it doesn’t get better. For those people, you have to manage them with cardiac medications to try to prevent it from getting worse.” Combination therapies can present additional challenges to managing cardiac disease risks. Again, as with radiation, dosage makes a difference in whether a patient will develop cardiac issues after chemotherapy. “The higher the dose, the higher the likelihood that you’ll have a problem. For instance, if you have metastatic disease and you’ve had many, many doses of the drug, your risk is higher.” Similarly, “women over the age of 60, women with preexisting risk factors and women with preexisting heart disease” all have a higher risk of developing CVD after chemo. Patients who receive a combination of chemotherapy and radiation, particularly if it’s on the left side, “have a double whammy. Plus if you’re older and have a lot of risk factors, that sort of magnifies your risk because they’re additive,” Nohria says.

As more doctors have become aware of the connection between breast cancer treatments and heart health later in life, many are taking steps to reduce the risk, particularly in patients who have other risk factors for cardiovascular disease. In many patients, this means some prep work before therapy begins. “If you’re in a good medical center, before they start you on these things they should be getting a good cardiac history and trying to optimize your cardiac risk factors before starting you on these medications,” Nohria says. Breastcancer.org also recommends that, “no matter how old you are, it’s a good idea to ask your doctor about your personal risk of treatment-related heart problems and whether or not visiting a cardiologist before treatment starts is a good idea for you.” In addition to evaluating your baseline heart function and assessing your risk factors, “you also may want to ask your oncologist how your heart function will be monitored during treatment.”

A Cancer Conundrum: Too Many Drug Trials, Too Few Patients

With the arrival of two revolutionary treatment strategies, immunotherapy and personalized medicine, cancer researchers have found new hope — and a problem that is perhaps unprecedented in medical research. There are too many experimental cancer drugs in too many clinical trials, and not enough patients to test them on.

The logjam is caused partly by companies hoping to rush profitable new cancer drugs to market, and partly by the nature of these therapies, which can be spectacularly effective but only in select patients. In July, an expert panel of the Food and Drug Administration recommended approval of a groundbreaking new leukemia treatment, a type of immunotherapy. Companies are scrambling to develop other drugs based on using the immune system itself to attack cancers. Many of these experimental candidates in trials are quite similar. Yet each drug company wants to have its own proprietary version, seeing a potential windfall if it receives F.D.A. approval.

As a result, there are more than 1,000 immunotherapy trials underway, and the number keeps growing. “It’s hard to imagine we can support more than 1,000 studies,” said Dr. Daniel Chen, a vice president at Genentech, a biotechnology company. In a commentary in the journal Nature, he and Ira Mellman, also a vice president at the company, wrote that the proliferating trials “have outstripped our progress in understanding the basic underlying science.”

“I think there is a lot of exuberant rush to market,” said Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center. “And we are squandering our most precious resource — patients.” Take melanoma: There are more than 85,000 cases a year in the United States, according to Dr. Norman Sharpless, director of the Lineberger Comprehensive Cancer Center at the University of North Carolina, who was recently named director of the National Cancer Institute.

Most melanomas are cured by surgery, leaving about 10,000 patients who have had relapses and could be candidates for an experimental treatment. But nearly all will be treated by doctors outside of academic medical centers, who are not part of the clinical trials network and so do not offer patients experimental treatments. Companies therefore must compete for the few patients with relapsed melanoma who are at centers offering clinical trials.

Many end up struggling to find enough subjects to determine whether a treatment actually works — and if so, for whom. And these drugs often are not so different from one another. Immunotherapy drugs that attack a protein known as PD-1 are approved for treatment of lung cancer, renal cell cancer, bladder cancer and Hodgkin’s disease, noted Dr. Richard Pazdur, director of the F.D.A.’s Oncology Center of Excellence. Yet many pharmaceutical companies want their own anti-PD-1. Companies are hoping to combine immunotherapy drugs with other cancer drugs for added effect, and many do not want to have to rely on a competitor’s anti-PD-1 drug along with their own secondary drugs. So in new trials, additional anti-PD-1 drugs are being tested all over again against the same cancers — a me-too business strategy taken to multibillion-dollar extremes. “How many PD-1 antibodies does Planet Earth need?” wondered Dr. Roy Baynes, a senior vice president at Merck, which received approval for its first such drug in 2014.

Immunotherapy trials have proliferated so quickly that major medical centers are declining to furnish patients to them. The Yale Cancer Center participates in fewer than 10 percent of the immunotherapy trials it is asked to join. The problem is that many of the trials are uninteresting from a scientific view, said Dr. Roy Herbst, the center’s chief of medical oncology. The companies sponsoring these trials are not addressing new research questions, he said; they are trying to get proprietary drugs approved. If the struggle to find patients for immunotherapy trials is challenging, finding patients for another new type of cancer treatment can be next to impossible.

Socialization with Cancer Survivors Matters During Chemotherapy

A new study published by Network Science suggests that social interaction may be crucial for the success of chemotherapy in patients with cancer. The authors found that patients were more likely to achieve 5-year survival if they interacted with other patients during chemotherapy who also survived for 5 or more years.

On the other hand, patients had a slightly increased risk of mortality if they interacted with patients who died in less than 5 years, according to the study. “People model behavior based on what’s around them,” said lead author Jeff Lienert. “For example, you will often eat more when you’re dining with friends, even if you can’t see what they’re eating. When you’re bicycling, you will often perform better when you’re cycling with others, regardless of their performance.” The authors aimed to determine how social interaction affects patients undergoing chemotherapy.

One cancer is linked to highest suicide risk

Suicide is more common among cancer patients, but a new study suggests people suffering from lung cancer are at a higher risk than those who struggle with other forms of the disease.

For the study, researchers from Weill Cornell Medical College/New York Presbyterian Hospital analyzed information from a large patient database of 3,640,229 people, looking at suicide deaths for lung, prostate, breast and colorectal cancers individually. They found that over four decades, there were 6,661 suicides among cancer patients. When they compared suicides among cancer patients to the general population, the rate in patients with any kind of cancer was 60 percent higher.

"Cancer patients are under a lot of duress and stress when they're under treatment," said study author Dr. Jeffrey Port, a thoracic and cardiac surgeon at Weill Cornell Medical Center, told CBS News. When the scientists broke down the data on suicide by cancer type, they found dramatic differences. The suicide rate among lung cancer patients stood out: it was more than four times higher than the general population. They also found suicide rates were 40 percent higher than average among colorectal cancer patients, and 20 percent higher among those diagnosed with breast cancer or prostate cancer. Despite this, many doctors don't consider suicide risk in cancer patients, Port said. Patients may feel anxiety, depression or hopelessness after hearing stories from family members or friends who knew someone with the disease.

Port said doctors need to reassure their patients that every case is unique and that there are good treatments for early stage patients. "As lung cancer surgeons, we know the lung cancer diagnosis is a very serious diagnosis, but what's not out there is that patients with early stage disease are highly curable," said Port. What was most striking about the findings, Port said, is that 50 percent of suicides in lung cancer patients occurred in people who had what specialists consider highly treatable disease. "There's a disconnect about patients understanding their particular outcomes," he said. Suicide rates were also higher among Asians, men, older patients, those who were widowed, those who refused surgical treatment, and those with metastatic lung cancer , according to the study, which was presented at the American Thoracic Society 2017 International Conference, in Washington, D.C. Lung cancer (small cell and non-small cell types) is the second most common type among both men and women in the U.S. (not counting skin cancer, which was not included in the study).

The American Cancer Society estimates that in 2017, there will be about 222,500 new cases of lung cancer diagnosed and approximately 155,870 deaths from the disease. Lung cancer specialists don't tend to be well trained on the mental health side of patient care, said Port. "For us as a group it's striking that we're trained in medical school – we learn about the physical aspects of exam, but especially surgeons, we don't do a deeper dive into the psychosocial exams. It's pretty eye-opening that we should have to learn to ask patients, 'Are you sleeping, are you eating, how are your feeling about your diagnosis?' Doctors need to include these questions as part of the exam," said Port, adding that their care should be integrated with nurses and others who provide health care during cancer treatment.

One factor that may weigh heavily on the shoulders of patients: the consequences of lifelong health choices. "Eighty-five percent of our patients have traditionally been smokers and may have guilt about smoking all their life," Port said. But he also noted, "There's reason to be hopeful." "Each person's tumor is different genetically and we now have unique targeted therapies —immunotherapy — for early stage disease regardless of tumor type," he said. Dr. Joseph Weiner, an psychiatrist at Zucker Hillside Hospital, in Glen Oaks, New York, told CBS News that while the new study shows a correlation between lung cancer and suicide, other issues may come into play. "There may be other variables contributing that may be related to chemotherapies. And some people with lung cancer have changes in hormone secretions that may affect mood. A decrease in oxygen going to the brain may affect judgment and impulsivity, too," said Weiner.

Over much of Weiner's career he's worked with people who have had medical illnesses, including cancer. "I've gotten to see people suffer tremendously, emotionally. Some are unable to cope with a serious diagnosis and fall into depression, while others transcend their suffering and find hope even in the face of death," Weiner said. The way a doctor speaks to a cancer patient can have a big impact on that person's mental health and how he or she copes with the disease, said Weiner, whose wife died of lung cancer in 2015 almost a year after her diagnosis. He said she was a very strong person, but had some physicians who were better than others when it came to communication and compassion. "My wife asked her oncologist, 'Will I live long enough to watch my daughter graduate?' and the oncologist said, 'Now you're pushing it,'" said Weiner.

He said his wife was a strong person and didn't let it get in her way of focusing on her dream. But Weiner said a better alternative would have been to say, "I can't promise, but I can promise we'll try as hard as we can." For patients struggling with depression and suicide risk, words can have a powerful affect, he noted. Support can make a difference. "One of the destructive things a clinician can say is that there's nothing more we can do for you. There's always something we can do for you, whether it's pain management, symptom control, holding a hand, giving a hug, connecting with a chaplain or mental health provider, or discussing medication for depression and anxiety. It's not just the application of chemotherapy.

It's about the provision of humanity," he said. Most of all, he said doctors treating lung cancer and other cancer patients can provide hope. "Hope is broad. None of us live forever. What are we hoping for? Are we hoping to be loved? Are we hoping to leave a legacy for our lives? To see someone get married? Are we hoping to demonstrate to our loved ones that we can approach a life circumstance with great dignity? Are we looking to thank people? Are we looking to ask for forgiveness? I'm talking about hope as a process of how you want to live your life. Focusing on the day rather than the medical outcome."

Preventing Hair Loss From Chemotherapy

For many women, one of the first and scariest thoughts when diagnosed with breast cancer is not about the loss of their breast, but about losing their hair. A 2010 survey found that nearly half of breast cancer patients feel that hair loss is the most traumatic side effect of chemotherapy, with some experiencing less distress over losing their breast than their hair. And 8 percent of the women polled would choose to forego chemotherapy because it meant losing their hair. It's not hard to understand why hair loss can be so emotionally devastating. For many women, hair is an important part of their identity and sexuality, and losing it diminishes their sense of self. Hair loss can also take away your privacy – since it's such a very visible and constant reminder that you're sick with cancer. Unfortunately, until recently, most American women did not know about nor have access to a treatment that helps prevent chemotherapy-induced hair loss. Cold caps have been used in Europe for more than 40 years, and in 2015, a newer scalp cooling technology, called DigniCap, was Food and Drug Administration-cleared for use in the U.S. Two studies published recently in the Journal of the American Medical Association found that approximately half the women who used this scalp cooling device were able to keep more than 50 percent of their hair while undergoing chemotherapy. The news was even better for women receiving taxane-based chemotherapy (Taxol, Taxotere and Abraxane), with two-thirds of women able to preserve more than half their hair. According to hair experts, that 50-percent mark is important because hair loss isn't noticeable to other people until more than half of it is lost.

How Scalp Cooling Prevents Hair Loss

The hair-making cells, called hair follicles, are very sensitive to chemotherapy. Cold caps and scalp cooling systems keep the scalp cold, which narrows the blood vessels, reducing the amount of the chemotherapy medicine that reaches the hair follicles. It also decreases the activity of the hair follicles, slowing down cell division and making the follicles less affected by the chemo treatment. To be effective, cold caps need to be worn for a period of time before, during and after a chemotherapy treatment. It's also important for a cap to be tightly fitted to ensure it's coming in contact with the entire scalp.

Weighing Your Options

There are two different types of devices used for preventing hair loss: cold caps and scalp cooling systems. Cold caps are similar to ice packs and are kept in a special refrigerator before they're used. Because they thaw during a chemotherapy session, they have to be replaced with a new cap every half hour. It's difficult to change the caps on your own while having an infusion, so another person is usually needed to help with the process. Both the caps and fridges are usually rented by the patient. The cost depends on the number of chemotherapy sessions needed and how many months of treatment is involved. A typical cost for these caps is about $500 per month. Depending on your insurance plan, the cost of renting the cap may be covered. There are also charitable programs that provide financial assistance to women who can't afford to pay for a cold cap. Scalp cooling systems are a newer computer-controlled cap device attached to a small refrigeration machine that circulates coolant throughout the chemotherapy session, eliminating the need to change caps during the treatment. As mentioned earlier, DigniCap has been FDA cleared; another, the Orbis Paxman System, is pending FDA clearance. These systems are owned by a limited number of cancer treatment centers around the country and offered at a cost to patients receiving chemotherapy. Patients are usually charged between $1,500 and $3,000, which may or may not be covered by insurance.

Results and Side Effects

The results of scalp cooling treatments vary and, for some women, they are not that effective. An important factor is the type of chemotherapy and the dosage you're taking. Studies have found that women who are given only taxane chemotherapy have far better results than those who get only anthracycline-based chemotherapy (Adriamycin, Ellience and daunorubicin). Hair type may also impact hair loss. There is some evidence that women with thicker hair may not respond as well to scalp cooling as those with thinner hair. This may be because thicker hair prevents the scalp from getting as cold as it needs to be for the treatment to be effective. It's essential that the caps be tightly fitted and cover the entire scalp. If not, hair loss can occur in the areas where the cap is not close enough to the scalp. There can also be some discomfort when using both cold caps and scalp cooling systems. Reactions can include cold-induced headaches, chills and neck and shoulder pain. Additionally, there are some concerns about the risk that the caps prevent the chemotherapy from fully killing off the cancer cells that might be in the scalp, and therefore put women at risk for a future cancer. However, many studies in Europe where it's been used for decades have not found any increased risk of cancer in the scalp after the use of the caps, and the FDA considers such cases extremely rare. If chemotherapy is part of your treatment plan and preventing hair loss is important to you, make sure to discuss the options with your physician before chemo begins. Ask about the effects that your chemo regimen and hair type might have on the results, as well as whether a scalp cooling system is available at your treatment center and their success rate in preventing hair loss. And make sure to find out whether your insurance covers any of the costs so you're not stuck having to pay unexpected bills. If hair preservation is not possible or the right choice for you, but you feel that hair is important to preserve some sense of normalcy, there are wonderfully styled wigs that are far more natural looking and comfortable than in the past. Many are available at a low cost, but high-quality human hair wigs can be pricey. Some women find scarves and turbans work best for them and can get very creative with their design, while others discover a sense of empowerment and beauty in baring their bald head.

Chemo Brain is Real!

Breast cancer survivors report substantially more cognitive difficulties as much as 6 months after chemotherapy compared with age-matched controls, according to new research. The result, from a study of 581 breast cancer patients recruited from community practices across the United States, adds to evidence from other studies which show that cognitive difficulties after chemotherapy, colloquially known as chemofog or chemo brain, are a real problem for breast cancer survivors, the authors write. 

"One of the main goals of our study, which was the largest prospective, longitudinal study in the community to date, was to help us understand more about the cognitive complaints that patients often report during their cancer treatments and to better understand the trajectory of those cognitive problems," lead author Michelle C. Janelsins, PhD, from the James P. Wilmot Cancer Institute, University of Rochester Medical Center, New York, told Medscape Medical News. "We found that a significant percentage of our breast cancer patients, 45.2%, reported that they had clinically meaningful changes in their cognitive function from before treatment to after treatment, compared with only 10% of healthy controls," Dr Janelsins said. "That's a lot of people who are complaining of problems. And after 6 months, although there was some rebound, still 36.5% of breast cancer patients were complaining of problems with cognitive function, compared with 13.6% in the control group," she added.

The study was published in the February issue of the Journal of Clinical Oncology. For the study, 581 patients with breast cancer and 364 age-matched noncancer controls completed the Functional Assessment of Cancer Therapy — Cognitive Function (FACT-Cog) before and after chemotherapy, and again 6 months after the course of chemotherapy had ended. Controls were family members, friends of patients, or unrelated, and obtained from the National Cancer Institute Community Oncology Research Program (NCORP) research database, Dr Janelsins explained.

"The FACT-Cog is a validated measure of patient-reported outcomes that was developed specifically to assess cognitive challenges identified by patients with cancer," she noted. The mean age of study participants was 53 years, and 48% of breast cancer patients received anthracycline-based chemotherapy regimens. Before any chemotherapy, FACT-Cog scores were lower in patients with breast cancer compared with controls (P < .001). Older age (P = .009), black race (P = 0.34), lower reading ability, higher anxiety, and higher depressive symptoms (all P < .001) were predictive of lower FACT-Cog scores at baseline. Education, however, was not predictive (P = .809). Significantly greater cognitive complaints, as shown by declines in the FACT-Cog score as well as four subscales (perceived cognitive impairment [PCI], perceived cognitive abilities [PCA], and impact on quality of life [QOL]), were reported by breast cancer patients compared with controls before, immediately after, and 6 months after chemotherapy (P < .001) at all time points.

This study has several strengths, Patricia A. Ganz, MD, professor of medicine and public health at UCLA Schools of Medicine and Public Health, Los Angeles, California, told Medscape Medical News. In addition to its large sample size and control group, the use of self-reported perceptions of cognitive decline could also be considered a strength, commented Dr Ganz, who coauthored an accompanying editorial. "This is a large trial, where they also did neuropsychological testing, although those results were not reported in this paper," Dr Ganz said. "The issue is, how much does self-reported difficulty with cognition relate to test-associated changes? The tests, by and large, that are used in these settings are pretty crude in the sense that they are designed to pick up big changes, whereas these patients may have much more subtle changes, and as a result, self-report may actually be more sensitive at detecting these changes," she said.

"For instance, the neuropsychologist will tell you that you have to have more than a one or two standard deviation difference to say somebody is impaired, but I think what patients are really aware of is that they can perceive a difference. It's just not big enough in magnitude to be detected on these tests," Dr Ganz said. "The other thing that we find is that the norms for a lot of these tests are based on the general population who have an IQ of 100, whereas at least in the breast cancer patients we have tested, some have IQs of 110, 120, so they are brighter and may still appear in the normal range, but they are not perceiving their mental functioning as being normal," she said. Both Dr Janelsins and Dr Ganz agree that the findings from this and other studies should reassure breast cancer survivors who experience symptoms of cognitive impairment after chemotherapy that what they are experiencing is, indeed, real.

"This is one of the largest studies to be conducted to date in a nationwide setting and is really validating concerns that patients have — that this is a real problem and it needs respect. Patients should be aware this is a possible side effect of cancer treatment, and if they are having any concerns about their cognition they should bring them up with their provider and not just brush them off as an aging effect. These are real problems," Dr Janelsins emphasized. The study results reinforce the perception that something is going on with these women, Dr Ganz agreed.

"Women will come in and say 'I can't think straight,' or 'It's really hard for me to concentrate,' or 'I'm having trouble finding words. I used to be able to start to work at my computer and I'd know what I was doing, but now I forget within a few minutes why I am sitting there,'" she said. "Those are the kinds of things patients who have had cancer treatments often complain of. Many patients are able to go back to work, but continued to be troubled by these problems, but others are unable to. I remember one patient who was legal counsel for a big corporation. She just couldn't go back to work," Dr Ganz said.

Cancer rates set to increase six times faster in women than men

Cancer rates will increase nearly six times faster in women than in men over the next 20 years, with obesity partly to blame, experts predict. As several of the obesity-related cancer types only affect women, the growing number of people of both sexes who are severely overweight is likely to have a greater effect on incidence of the disease among women, according to the analysis by Cancer Research UK. Cases of ovarian, cervical and oral cancers are predicted to rise the most. Rates will rise by around 0.5% for men and 3% for women, meaning an estimated 4.5 million women and 4.8 million men will be diagnosed with cancer by 2035.

That equates to projected UK cancer rates increasing by approximately 0.5% for men and 3% for women. The figures were released on the same day as the National Institute for Health and Care Excellence (Nice) announced that it was recommending that the breast cancer drug palbociclib should not be routinely funded on the NHS in England. Charities decried the decision by the drugs watchdog, stressing the importance of developing and supporting more treatments to help women to survive, but they also urged women to change their lifestyles to minimise their risk. Cancer Research UK’s chief executive Sir Harpal Kumar said: “These new figures reveal the huge challenge we continue to face, both in the UK and worldwide.

Research is at the heart of finding ways to reduce cancer’s burden and ensure more people survive, particularly for hard-to-treat cancers where the outlook for patients is still bleak. We need to keep working hard to reduce the devastating impact cancer can have on so many families. “The latest figures show that more than 8 million people die from cancer each year across the world. More people die from cancer than Aids, malaria and tuberculosis put together.

With more investment into research, we hope to make big improvements over the next 20 years in diagnosing the disease earlier and improving and developing treatments so that by 2034, three in four people will survive their disease.” Smoking is another factor behind the projected growth of cancer cases among women, which will mean the gap between the number of women and men with the disease narrows. Widespread smoking among women happened later than men and lighting up continues to have a big effect on the number of cancer cases diagnosed each year, says Cancer Research UK. Sarah Toule, head of health information at the World Cancer Research Fund, said lack of exercise and alcohol consumption were also driving the predicted increase in the UK cancer rate for women.

“It is concerning that rates are predicted to rise so sharply in women, especially as so many cancer cases could be prevented,” she said. “For example, about two in five breast cancer cases in the UK could be prevented if women maintained a healthy weight, were more physically active and didn’t drink alcohol – that’s around 20,000 fewer cases a year. Other cancers that could be reduced by women having a healthier lifestyle include womb and ovary.” Professor Kevin Fenton, the director of health and wellbeing at Public Health England, said: “The top things we can all do to prevent and reduce the risk of cancer are quitting smoking, maintaining a healthy weight, being physically active and attending cancer screening when invited.”

In draft guidance explaining its reasoning for its advice on palbociclib, which is made by Pfizer, the drug watchdog said that a full course of treatment costs £79,560. Although Nice found that the drug stalled the growth of the cancer for an extra 10 months on average “it was still not enough to make palbociclib cost effective at its current price”. The watchdog estimates that around 5,500 people in England – out of 45,000 new diagnoses of breast cancer each year – would be eligible for treatment with palbociclib. Baroness Delyth Morgan, chief executive at Breast Cancer Now, said: “This is the clearest illustration to date that the drug appraisal system is totally unfit for purpose in assessing first-in-class breast cancer medicines. “Palbociclib could benefit a large proportion of metastatic breast cancer patients and may even be the closest thing these women would have to a cure in their lifetime.” She urged Pfizer to reconsider its decision not to offer the NHS a discount on the list price and said the pharmaceutical giant must work with Nice to ensure the drug can be made widely available to women as soon as possible.

The Institute of Cancer Research (ICR), with its partner The Royal Marsden NHS Foundation Trust, led a major clinical trial of palbociclib. Dr Nicholas Turner, team leader in Molecular Oncology at ICR and consultant medical oncologist at The Royal Marsden, said: “Palbociclib is one of the most important advances in treating the most common type of breast cancer in 20 years. “If the manufacturer, Nice, and NHS England can find a way of making this treatment available for patients, they will substantially improve the lives of patients with breast cancer.” In December, Nice turned down another breast cancer drug, Kadcyla, made by Roche Pharmaceuticals, on financial grounds, triggering an outcry from patients’ groups who say it prolongs the lives of people who are seriously ill with the disease. At present there are an estimated 7.4 million men and 6.7 million women being diagnosed with cancer worldwide each year. The disease is the leading cause of death globally, accounting for an estimated 8.2m deaths in 2012 and approximately 15% of all deaths.

Lymphedema and Breast Cancer: When Is Risk Greatest?

The time course for developing lymphedema depends on the type of breast cancer treatment, but the risk peaks between 24 and 36 months post therapy, regardless of treatment type, according to new research. Receipt of radiation therapy (RT) is also a key to the timing. "Lymphedema develops earlier in patients who receive radiation, especially those receiving regional lymph node radiation," said the study's lead author, Susan McDuff, MD, PhD, a resident in radiation oncology at the Massachusetts General Hospital (MGH) Cancer Center in Boston.

Lymphedema can be "an incredibly morbid" complication following treatment for breast cancer and is an ongoing source of anxiety for survivors, she said here at the American Society for Radiation Oncology (ASTRO) 2016 Annual Meeting. To help patients know when they may be "out of the woods," Dr McDuff and colleagues undertook a cohort study to determine whether there is a period when patients are at greatest risk. First, they looked at cumulative incidence.

The team analyzed the records of 1495 patients seen between 2005 and 2016 in a prospective lymphedema screening program at MGH. The time it took to reach 5% cumulative incidence by treatment group was 32 months for surgery alone and 15 months for RT (P = .02) However, a further look at the data revealed that patients who received regional lymph node radiation (RLNR) reached the 5% cumulative incidence in only 6 months vs 37 months for those who received local RT (P < .0001). There was a median follow-up of 3.9 years and a cumulative lymphedema incidence of 11.4% in the study population. Nearly three quarters (73%) of the patients received RT as a component of their treatment. To pinpoint risk over time, the researchers looked at the percentage of patients in various treatment groups who were diagnosed with lymphedema in each year during the first 5 years post therapy. This was done by plotting the annual hazard rate for the treatment groups. All patients received some mix of axillary surgery and RT.

The groups were as follows: no axillary surgery (n = 180); sentinel lymph node biopsy (SLNB) plus or minus local RT (n = 899); SLNB plus regional lymph node radiation (RLNR) (n = 46); and axillary lymph node dissection (ALND) plus or minus local RT (n = 132); and ALND plus RLNR (n = 264). "The timing of the risk appears to be the most significant within the first 2 to 3 years after treatment," summarized Dr McDuff.


The new study addresses an important clinical question, said Abram Recht, MD, professor of radiation oncology at Harvard Medical School in Boston, who acted as an adviser to the study authors. "If you are going to do surveillance, how long do you have to do it?" he commented to Medscape Medical News. "You can expect that most patients who undergo sentinel lymph node biopsy with or without local RT, which is the largest treatment group, may not need active monitoring past 2 years," he concluded. "The period of the greatest risk is the first 3 years," said Dr Recht, echoing Dr McDuff. "If lymphedema hasn't developed by 5 years, then it probably won't happen," he added. The new results are an argument for "personalizing" a lymphedema monitoring program, said Dr McDuff, adding that more follow-up is needed for high-risk groups.

The goal is early identification and intervention. Shannon MacDonald, MD, associate professor of radiation oncology at Harvard, who acted as discussant of the study, said that the hope with monitoring is "that an earlier intervention for lymphedema would improve outcome." Dr MacDonald told Medscape Medical News that the new study results will also "allow patients to have some alleviation of anxiety as to when to expect lymphedema if it occurs," she said. The findings could also influence "when clinicians have patients come in for monitoring," Dr MacDonald added. This "very large" study makes a "meaningful contribution" to clinical knowledge, in part because there are "limited" data on timing, she said. Lymphedema is less common than in the past, owing to improvements in surgical management, but inaccuracy of measurements has plagued estimates of the incidence of lymphedema, Dr MacDonald said.

The new MGH study used a perometer, a tool that employs infrared technology to objectively measure the limb, which is "more likely to be accurate than a tape measure or other modalities," she said. The perometer was used to perform prospective arm volume measurements of the study patients preoperatively and then postoperatively and in follow-ups at regular intervals. Lymphedema was defined as a >10% relative volume increase occurring >3 months postoperatively. The treatments for lymphedema in the cohort included compression sleeves (88%), manual decompression (52%), and physical therapy–directed exercise (89%). "Patients worry a lot about lymphedema" concluded Dr Recht. "It's a really hard thing in survivorship," agreed Dr McDuff.

Cold cap can combat hair loss from chemo for breast cancer

A cooling cap that prevents hair loss during chemotherapy has come through its clinical trials and can make a huge difference to the quality of life of patients, Dr. Paula Klein, medical director, Breast Cancer Clinical Trials, Mount Sinai Health System in New York told NY1.

One such happy patient was Donna Tookes, a patient who was treated with the cap during her breast cancer therapy and had been resigned to hair loss. She told the station, “I accepted it.” In fact, she did not have to. Thanks to her participation in a trial of the Dignicap from Dignitana headed by Klein, she didn't lose any hair at all. The cap “literally freezes the scalp so that it shuts down blood vessels,” Klein told NY1. “Less chemotherapy is delivered to the scalp.”

The cap Klein used pumps coolant through it. The patient's hair is wet and this keeps the temperature of scalp and hair near freezing during therapy. This constricts the blood vessels in the region, and thus reduces the amount of anti-cancer drugs that reach hair follicles. The scalp-cooling technique has been in use for years in Europe, but is only now gaining FDA approval and greater use in the U.S. There had been fears that sparing the scalp from treatment might allow cancer to spread to that area. But clinical evidence from Europe has now suggested that this is not the case.

“In Europe they do not show a significant increase in scalp metastases,” said Klein. The cooling system which chills the hair and scalp to just above freezing during therapy received the agency's okay for a multicenter clinical trial in 2015. “Some of today’s most powerful, lifesaving chemotherapy treatments still cause complete hair loss, a side effect that many women consider to be emotionally devastating,” Dr. Hope S. Rugo, principal investigator for the study and Director of Breast Oncology and Clinical Trials Education at the UCSF Helen Diller Family Comprehensive Cancer Center noted in a 2015 statement about the trials.

In the Mt. Sinai trials about seven out of 10 early-stage breast cancer patients kept at least half their hair without any negative events linked to the cooling cap. The FDA approval is, for the present, limited to early-stage breast cancer, but Klein stated that she thinks it will eventually find more widespread use. “I am extremely excited to finally be able to offer patients scalp cooling during chemotherapy, which allows them to retain normalcy and privacy in their lives,” she stressed.

For patients, the loss of hair is among the most important chemo side effects, according to a 2008 article published in the journal Psycho-Oncology by Julie Lemieux, Elizabeth Maunsell and Louise Provencher. They found that “chemotherapy-induced hair loss is considered to be the most important side effect of chemotherapy, frequently ranking among the first three for breast cancer patients, and can lead to refusal of chemotherapy. Secondly, it is described by breast cancer women as causing distress and as being traumatizing. Thirdly, there might be an impact on body image, although not all studies reported this association.”

Young breast cancer survivor: Chemo Friday, back to work Saturday

It was just an ordinary September day, a year ago, and Tylithia Burks was home from her night shift as a nuclear pharmacist, vegging out on the couch. Somebody on TV was talking about breast self-examination. Even though she was only 33, not knowing of any family history of the disease, Burks decided self-examination was a good idea. She found a lump.

"Had I not done the exam, I would never have found it," she says now. "It could have been six months or a year." What happened after that discovery offers a look at the new face of breast-cancer treatment. Instead of immediate surgery, Burks embarked on a 16-round course of chemotherapy to reduce the size of the tumor. And instead of feeling sorry for herself, Burks went indoor skydiving at iFLY and posed for a set of glamour shots.

Over the five months, the chemo shrank the tumor from 3 centimeters to 4 millimeters. Burks worked her night shift at Triad Isotopes through the whole thing. Some nights, it was hard. "My co-workers knew," Burks says, "and they looked out for me." Enter Dr. Tejal Patel, Burks' doctor and a breast medical oncologist at the Houston Methodist Cancer Center. She doesn't think patients need to put their lives on pause for cancer. "There's not a lot out there about patients who do wonderfully," she says. "We can control the side effects, and it doesn't have to take away your life." For Burks, who is naturally bright-eyed and ebullient, keeping her life as routine as possible was the goal. "The thing is, prior to starting, I told myself I wanted to work and do other normal things, not just have cancer," she says. "I did it for normalcy." 

If she had chemo on a Friday, she was back to work on Saturday night. Burks also drew on her network of friends and fellow church members - she had people to take her to chemo, people to get food to her, people to pray for her. Burks' mother died of lung cancer in March 2008. "She tried to be private and keep it to herself," she says. "I'm very private, but this was not a time to do that." Because chemo can play havoc with a woman's reproductive organs, Burks' friends ran a GoFundMe crowd-funding campaign to raise money to freeze her eggs.

Burks, who is single, likes to joke that her children are on ice for now. She had her mastectomy in April and her reconstructive surgery in September. No cancer was found in her lymph nodes, and she has about a 15 percent chance of recurrence. She does not have the BRCA mutations that can be a signal for cancer. "Everyone has life happen to them," Burks says. "If you let it take you down, what are you living for?" Breast cancer in young women is relatively uncommon.

According to the Centers for Disease Control, only about 11 percent of new breast cancers are discovered in women younger than 45. Patel, who likes to point out that there are now 15.5 million survivors of breast cancer, says the new supportive treatments that make chemo more bearable work for patients at any age. "That's my goal," she says, "not to have to live in a bubble, but to work, go to church and go shopping." But care has to be ongoing, says Patel, because anxiety can surface, along with hot flashes and nerve pain. Fatigue, sexual dysfunction and, of course, financial worries can afflict survivors. Burks, who grew up in Killeen, the daughter of a career Army father, sees unusual symmetry between her cancer and her mother's.

Both were diagnosed in September. Her mother died in March; she finished chemo in March. She is looking forward to getting a tattoo of two ribbons: one white, for lung cancer; and one pink, for breast cancer. Right now, in memory of her Korean mother, she has a small tattoo of the Korean character for strength on the back of her neck. Burks is upbeat. "It's not the end of the world. You can beat it and have a normal life," she says. "Don't let it change you."

New technology may help women with breast cancer forego chemotherapy

For women who are diagnosed with breast cancer every year in the U.S., a leading cause of cancer death among Hispanic women, one of the toughest choices to make is what type of treatment to choose. 

A new test, called MammaPrint, is making it possible so women could forego chemotherapy. Such was the case for 46-year-old Zaida Vazquez when she was diagnosed with breast cancer this May. Breast cancer is the most commonly diagnosed cancer. Among Hispanic women, breast cancer will be the leading cause of cancer death this year (16 percent), followed by cancers of the lung (13 percent) and colorectum (9 percent), according to the American Cancer Society. Vasquez had surgery in July and then opted for chemotherapy – but stopped midway because she said it made her feel terrible.

Her days were ridden with nausea and exhaustion. That was when her oncologist, Dr. Mayra Rivera, suggested forgoing chemotherapy based on her MammaPrint results that analyzed 70 genes associated with a breast tumor’s chance of metastasizing. “MammaPrint gives me a biology footprint of the tumor,” said Dr. Rivera of Puerto Rico. “And, with patients like Zaida in the early stages of their breast cancer, also known as low risk, this test would benefit more women like her.” MammaPrint is among a growing number of tests attracting interest in the medical world because it lets women know if they could avoid chemotherapy with little risk that they’ll relapse. The tests examine a woman’s genes to determine whether the cancer has a chance of spreading. The tests and MammaPrint gained stature last month when a study exploring its effectiveness was published in The New England Journal of Medicine.

MammaPrint was used in the study, called MINDACT, which analyzed 6,693 breast cancer patients across 112 centers in Europe with newly diagnosed early-stage breast cancer. J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society, said these types of tests are not new. Lichtenfeld said that in the late 90s, there was a substantial amount of tests being developed that looked into the tumor tissue to predict how it would behave over time. Similar to MammaPrint’s approach was Oncotype DX, which took off but only analyzed 21 genes.

MammaPrint looks into the activity of 70 genes. MammaPrint is lesser known and used less often, but has become more popular the past few years. Still, it’s stirred discussion in the medical community because the tests are not 100 percent accurate and could falsely tell a woman she doesn’t need chemotherapy when she actually does. Others, however, believe it will spare thousands of women with early-stage breast cancer the painful – and expensive – experience of going through chemotherapy. The Journal of Medicine article said the MammaPrint clinical trial offers probabilities and not necessarily concrete guidance.

“The reality is that there haven’t been real life trials over an extended period of time to show that these tests work the way they are supposed to work,” Lichtenfeld said. The first author of the MINDACT study said it’s worth noting that this is the first clinical trial of its kind. “There hasn’t been another clinical trial wherein diagnostic tests were evaluated like this, that looked into the biology of the disease, for as long as we did,” said Dr. Laura van ’t Veer, chief research officer of the study. Of the European countries involved in the study, Spain was one of the most active in the trial coming in at about 700 participants.

In centers in Barcelona and Madrid, MammaPrint is already being used frequently. “Everyone can agree that avoiding chemotherapy is the end goal but one thing to look at is tumor tissue and the history of a woman and the treatment she got but it’s quite another thing to use forward-looking studies to try to determine the accuracy,” Lichtenfeld added. Rivera says the new test offers more options to breast cancer patients at low risk who might be hesitant to undergo chemotherapy.

“We are moving toward finding out more about tumors in breast cancers that will help patients make a decision more objectively about next steps,” Rivera said. Vazquez says she doesn’t regret her decision even if at first her family was on the fence. But after finding out she was at low risk post-surgery, she’s thankful there was another medical option.

Test Tells Breast Cancer Patients Who Can Safely Skip Chemo

by MARILYNN MARCHIONE, THE ASSOCIATED PRESS

Many women with early-stage breast cancer can skip chemotherapy without hurting their odds of beating the disease — good news from a major study that shows the value of a gene-activity test to gauge each patient's risk.

The test accurately identified a group of women whose cancers are so likely to respond to hormone-blocking drugs that adding chemo would do little if any good while exposing them to side effects and other health risks. In the study, women who skipped chemo based on the test had less than a 1 percent chance of cancer recurring far away, such as the liver or lungs, within the next five years.

"You can't do better than that," said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York.

An independent expert, Dr. Clifford Hudis of New York's Memorial Sloan Kettering Cancer Center, agreed.

"There is really no chance that chemotherapy could make that number better," he said. Using the gene test "lets us focus our chemotherapy more on the higher-risk patients who do benefit" and spare others the ordeal.

The study was sponsored by the National Cancer Institute. Results were published online Monday by the New England Journal of Medicine and discussed at the European Cancer Congress in Vienna.

The study involved the most common type of breast cancer — early stage, without spread to lymph nodes; hormone-positive, meaning the tumor's growth is fueled by estrogen or progesterone; and not the type that the drug Herceptin targets. Each year, more than 100,000 women in the United States alone are diagnosed with this.

The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo, to help kill any stray cancer cells that may have spread beyond the breast and could seed a new cancer later. Doctors know that most of these women don't need chemo but there are no great ways to tell who can safely skip it.

A California company, Genomic Health Inc., has sold a test called Oncotype DX since 2004 to help gauge this risk. The test measures the activity of genes that control cell growth, and others that indicate a likely response to hormone therapy treatment.

Past studies have looked at how women classified as low, intermediate or high risk by the test have fared. The new study is the first to assign women treatments based on their scores and track recurrence rates.

Of the 10,253 women in the study, 16 percent were classified as low risk, 67 percent as intermediate and 17 percent as high risk for recurrence by the test. The high-risk group was given chemotherapy and hormone-blocking drugs. Women in the middle group were randomly assigned to get hormone therapy alone or to add chemo. Results on these groups are not yet ready — the study is continuing.

But independent monitors recommended the results on the low-risk group be released, because it was clear that adding chemo would not improve their fate.

After five years, about 99 percent had not relapsed, and 98 percent were alive. About 94 percent were free of any invasive cancer, including new cancers at other sites or in the opposite breast.

"These patients who had low risk scores by Oncotype did extraordinarily well at five years," said Dr. Hope Rugo, a breast cancer specialist at the University of California, San Francisco, with no role in the study. "There is no chance that for these patients, that chemotherapy would have any benefit."

Dr. Karen Beckerman, a New York City obstetrician diagnosed with breast cancer in 2011, said she was advised to have chemo but feared complications. A doctor suggested the gene test and she scored very low for recurrence risk.

"I was convinced that there was no indication for chemotherapy. I was thrilled not to have to have it," and has been fine since then, she said.

Mary Lou Smith, a breast cancer survivor and advocate who helped design the trial for ECOG, the Eastern Cooperative Oncology Group, which ran it, said she thought women "would be thrilled" to skip chemo.

"Patients love the idea of a test" to help reduce uncertainty about treatment, she said. "I've had chemotherapy. It's not pretty."

The test costs $4,175, which Medicare and many insurers cover. Others besides Oncotype DX also are on the market, and Hudis said he hopes the new study will encourage more, to compete on price and accuracy.

"The future is bright" for gene tests to more precisely guide treatment, he said.

Ovarian Cancer: Why Don't More Doctors Use This Life-Extending Technique?

American Council on Science and Health

In America this year, over 21,000 new cases of ovarian cancer are expected, and over 14,000 deaths. 

Once ovarian cancer has spread within the peritoneal cavity or to other organs, long-range survival is rare. However, shorter-term benefits can be obtained via several different chemotherapy regimens and one, essentially abdominal chemotherapy, has been very promising.

So why isn't it used more?

Clinical trials dating back almost 20 years have consistently demonstrated a survival advantage in advanced ovarian cancer treated with this IP/IV (intraperitoneal/intravenous) chemotherapy, as compared with standard IV only chemotherapy. 

In 2006, a large study known as GOG-172 (Gynecologic Oncology Group) demonstrated a 16-month improvement in median overall survival. A new study just published in the Journal of Clinical Oncology confirms the superiority of the combined IP/IV approach. But data collected from six National Comprehensive Cancer Centers Hospitals showed that the combination approach is only being utilized by slightly less than half of patients who are candidates for it.

The study was performed by a multi-center group of researchers led by Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston, and was also published in the Journal of Clinical Oncology. They examined IP/IV chemotherapy use in all patients (823) diagnosed between 2003 and 2012, and evaluated overall survival and treatment-related toxicities in a sample (402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias.

They determined that the use of IP/IV chemotherapy increased, (most likely)  as a result of the 2006 publication of the GOG-172 study, from 0% in 2003 to 50% in 2008, and plateaued thereafter; 43 percent of patients received modified IP/IV regimens at treatment initiation. IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%), compared with IV chemotherapy.

The authors concluded that although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.

An article in the New York Times by Denise Grady on this study and topic speculated on some possible reasons why this beneficial treatment method is being under-utilized: “Experts suggest a variety of reasons that the treatment is so underused: It is harder to administer than intravenous therapy, and some doctors may still doubt its benefits or think it is too toxic. Some may also see it as a drain on their income, because it is time-consuming and uses generic drugs on which oncologists make little money.”

Those possible rationales for not giving late-stage ovarian cancer patients state-of-the-art treatment are quite simply unacceptable. Another word of advice from the Times/Grady article is this: “Patients have to be more proactive and forceful. They should ask if their doctor uses the IP/IV treatment, and if he or she does not, they should seek another doctor.”

Treatment allows patients to keep hair during chemotherapy

Read the story here http://bit.ly/1EpXRSE

Lymphedema Challenge

Actress and Academy Award winner, Kathy Bates recently kicked off theLymphatic Education & Research Network's Face of Lymphedema Challege. She proclaimed, "I'm Kathy Bates. I had a double mastectomy 2 years ago and as a result I have lymphedema in both arms. I didn't have a clue what would be involved after surgery and it was hard to find a doctor who would help me deal with, not only the physical effects, but the psychological effects as well. Struggling alone with lymphedema can feel like a punishment for having cancer. That's why I hope to bring awareness."

It's great to have such a high profile spokesperson help to bring awareness and hopefully a cure to lymphedema. Take the Face of Lymphedema Challege: http://lymphaticnetwork.org/get-involved/face-of-lymphedema-challenge/

Winter Tips for Lymphedema Patients

With the arctic blast in full swing, we thought we would share some tips for our friends with lymphedema!

1. Be very careful of ice. Remember you can’t always see ice, it can be what they call black ice, a very fine coat. Walk on surfaces very carefully. You don’t want to  fall.

2. Dress appropriately. Keep your limbs comfortably warm but not  too warm or too tight. Remember that you can swell in wintertime as  well.

3. Always wear appropriate footwear. Make sure you have  worn and broken in your boots, sneakers or your winter wear before you  tread out. Awkward foot gear can cause falls.

4. Moisturize! Remember in wintertime skin can be extremely dry with the heater blowing.

5. Make sure if you happen to get your  garments or socks wet, change them as soon as possible to avoid skin irritations or fungal infections.

6. Wear mittens instead of gloves. They provide more warmth and gloves can also become tight on the fingers if you swell.

7. Keep a winter lymphedema survival kit in your car.  Try to carry extra medications, bandages, extra blanket, batteries,  flashlights, etc with you in case you are stranded somewhere.

Nominate Women in Cancer Treatment to Receive Free Wigs

5 more days to enter Wigs for Wonderful Women! bit.ly/1xzBvt9 

Read what the daughter of our client said about our work in creating a customized wig for her mom while she was going through chemotherapy treatment:

"THE BEST! Words can not describe the expierience we had with Ricky and Kristen. Hearing the words cancer and chemo are devastating. The first thing my mother thought about was loosing her hair. As her daughter I did the research and Ricky Knowels kept on coming up. So we traveled to Houston. WOW, what a great decision!! In 2 days Ricky ordered, colored, and cut a beautiful new wig. He spent so much time talking and listening. And Kristen, well what can I say, the patience of a Saint. always talking about the health side, what to look out for, how to manage expectations...so much that the Dr never covered!!!

I am filled with Gratitude that we have Ricky and Kristen in our lives they are truly ANGELS!!!" - Debra

10 Tips for While Going Through Cancer

10 Tips for While Going Through Cancer

1. Adopt a fighting spirit.
2. It's okay to discourage false cheerfulness and to share how you're feeling.
3. Seek support from your family and friends.
4. As a member of your health care team, learn about your disease and ask questions.
5. Be an active participant in your treatment and recovery efforts.
6. Make positive changes in your lifestyle that will improve your outcomes, such as quitting smoking, incorporating exercise and getting good nutrition.
7. Find something to laugh about each day. Good humor is healthy for the body and soul.
8. For safety's sake, when not feeling your best, ask for transportation assistance to your medical appointments.
9. Participation in a support group can help you learn from others.
10. Pay attention to how you are feeling and get plenty of rest, good nutrition, and take time for personal care.

Enter Our Free Contest for a Chance to Win Wigs!

A Houston-Area woman with any type of cancer can enter by writing about her personal journey with cancer, or a friend or family member of a Houston-Area woman with cancer can share how their loved one inspires them. 

All stories must be submitted by 11:59 pm on Sunday, November 2, 2014. 

Stories can be submitted via email to kristen@hairandwellness.com, or by US mail to: Ricky Knowles Hair and Wellness 4141 Southwest Freeway, Suite 315 Houston, TX 77027 

Contestants will have a chance to win several great prizes, including: 

The grand prize of a completely customized human hair wig, beautifully designed and styled by world-renowned hair duplication master stylist, Ricky Knowles. 

Two (2) - second place winners will receive a completely customized synthetic hair wig, beautifully designed and styled by world-renowned hair duplication master stylist, Ricky knowles. 

Ten (10) - third place winners will receive a beautiful pre-tied head scarf and Neuma travel size shampoo, conditioner and organic scalp treatment. 

Grand prize, second and third place winners will be announced Friday, November 7th at 
www.facebook.com/RickyKnowlesHairAndWellness. 

Grand prize, second place and third place winners will be chosen by an independent judge. 

Every contestant will be automatically entered into a special weekly drawing for a chance to win a beautiful pre-tied head scarf. 

The weekly drawings will be announced every Friday on www.facebook.com/RickyKnowlesHairAndWellness from Friday, November 7th through Friday December 19th for a total of 7 weekly winners. 

For more information about the contest, visit: http://www.hairandwellness.com/winwigs.html