Thursday, June 14, 2018

The 15 Worst Things You Can Say When Someone Has Breast Cancer


By Rachel Swalin

Think before you speak
When you find out someone has breast cancer, it can be hard to know what to say. Even if you have the best of intentions, it's easy to blurt out something that's less-than-helpful. "People don't mean to be insensitive," says Alyson Moadel, PhD, director of the psychosocial oncology program at Albert Einstein College of Medicine in the Bronx, New York. "The news just scares them, and they don't know the right thing to say." While not every person will object to all of the following phrases, it's probably best to err on the side of caution and try to avoid these.

"My sister/mother/friend had breast cancer."

"Everyone's got a cancer story," says Dennis Citrin, MD, PhD, author of Knowledge is Power: What Every Woman Should Know About Breast Cancer. While hearing your friend's diagnosis may seem like a good time to share the hardships of others, you have to realize all breast cancer patients aren't alike. "There can be subtle differences between the types of breast cancer that one person's experience may have no relevance for another," Dr. Citrin says. Every individual breast cancer patient will have her own unique struggles to face, so avoid relating the negatives, or even positives, of someone else's condition.

"Are you going to lose your hair?"

Most women view hair as a link to femininity, and the idea you might lose it can be very hard to bear. Even for a patient who's already thinning up top, best not to make a comment related to hair at all. "We all want to be told we look good," says Melanie Young, breast cancer survivor and author of Getting Things Off My Chest: A Survivor's Guide to Staying Fearless and Fabulous in the Face of Breast Cancer. If you notice your friend is looking particularly nice one day, make it a point to let her know. Another good bet: invite her to test out some new makeup with you and turn it into a fun day of pampering.
"Will you lose your breasts?"
 Having a mastectomy is not necessary in many cases, so don't assume it's the norm for every breast cancer patient. "The new paradigm of treatment isn't focused on immediately sending patients to the surgeon," Dr. Citrin says. Most doctors will biopsy the tumor before determining the best course of action. Emerging research indicates that 10-year survival rates are equal among bilateral mastectomy and lumpectomy with radiation patients, so you may begin hearing of fewer women having both breasts removed. Bottom line: She may not yet know whether or not she needs a mastectomy, so safer not to bring it up. On the flip side, you shouldn't try to make a mastectomy out to be positive either. "I had people tell me, 'I wish my boob job was covered by insurance,'" Young says. "But do you wish you had cancer?" 

"Do you think hormone therapy or weight gain caused it?"
Like any type of cancer, there are many breast cancer risk factors that have been discovered from looking at patterns across large populations of women. But no one can say for sure what causes any individual's specific case. Sometimes DNA is damaged and cancer gets a start for no reason at all. "A lot of people feel anxiety when someone they know is diagnosed with breast cancer, so they try to explain it away," says Marisa Weiss, MD, a breast cancer survivor and director of breast radiation oncology at Lankenau Medical Center near Philadelphia and founder of Breastcancer.org. Try to avoid a "what if" line of questioning. 

"Are you sure you want to try that treatment?"

When breast cancer patients are first diagnosed, some family members feel like they need to take control of the situation, Moadel says. That includes trying to make decisions when it comes to how they should take their medications or what treatments might be best. This is one area where the breast cancer patient really needs to call the shots. "Cancer doesn't mean she'll want to stop doing the things most meaningful for her," Dr. Weiss says. No matter what treatment lies ahead for your loved one, keep in mind she ultimately know the best path for herself.

"You don't look sick."

Other people might try to downplay a loved one's condition, Moadel says. Making things out to be fine, however, isn't as uplifting as you'd think. Whether you're dealing with early stage or relapsed/recurrent breast cancer, it's still a scary thing. "Treating their illness like a minor ailment doesn't touch on how they're truly feeling," Moadel says. A person could be battling it for years to come, so you can't just push those fears aside. When a loved one is open to discussing their illness, don't be afraid to share the sadness with them and offer support when needed.

Saying nothing at all
After a breast cancer diagnosis, it's not uncommon for some people to completely avoid the topic or stop visiting all together, Moadel says. Hearing the words can be so shocking you might not know what to say at first. Start by asking what you can do to help. "The best supporters are the ones who can listen and respond to what the patient needs," Moadel says. Just showing you can be there to help a loved one cope is what matters most.

"Everything will be OK."

Being reassured is confusing because a lot of cancer patients still have a year of treatment in front of them," Dr. Weiss says. And each stage of breast cancer comes with different forms of treatment. For example, a stage I patient may have the lump removed and some radiation while stage III might require chemotherapy or surgery, according to the American Cancer Society. Not many breast cancer patients want to be told what to do either, so avoid statements like "Be positive" that come off as commands. "It's easy for you to say. You don't have to worry about feeling ill all day or the bills," Young says. Not every patient's journey will be smooth, so it's important to show you accept your loved one's condition and the treatment she's about to face.

"What stage are you?"

If you're a close friend or family member, wanting to know the stage of a patient's breast cancer is understandable. When you haven't known someone as long, like a co-worker or neighbor, it's best not to ask. With this phrase, you have to consider the underlying meaning behind the question. "What the patient really hears is, 'How close are you to death?'" Moadel says. It depends on the person, but not all people with breast cancer will want to talk about how far their condition has progressed. In that case, focus on the present and ask how their day is going instead.


"It must run in your family."

Though some breast cancer is tied to genetics, it's not always clear-cut. According to the National Cancer Institute, mutations in the BRCA1 and BRCA2 account for about 5 to 10% of all breast cancers. So calling out someone's condition as a "family thing" is insensitive and may not be accurate. It also gives your friend more cause to worry about the other members of her family tree. "When they are told they have breast cancer, women immediately think about their own daughters," Moadel says. 

"That's terrible news."

When you first hear someone has breast cancer, there's no denying it can be jarring. Your knee-jerk reaction might be to start talking about how awful it is. Thing is, statements like that make the news all about you, not the patient. "To have someone speak to you as if you're a goner and going to suffer is the worst," Moadel says. Even something as simple as "Oh my God" can crush a patient's spirit. Instead say "I'm sorry" and let the person know you'll be there for support. "Sometimes saying less in that first disclosure is best as long as you stay present," Moadel says.


"Wasn't your treatment supposed to work?"

When a person's cancer goes into remission, that doesn't mean she's cured. In fact, about 20% of breast cancer survivors who've undergone at least 5 years of treatment to prevent recurrence do end up relapsing within 10 years. There have been many breakthroughs with treatment for breast cancer, but it's difficult for doctors to guarantee one method will completely get rid of cancer. "With oncology there's no degree of certainty," Dr. Citrin says. "Part of a breast cancer patient's fear is tied to not knowing what the future holds." Instead of questioning where things went wrong, trust that your loved one's medical team knows the best plan to tackle the next stage of treatment.

"Just let me know what you need."

Breast cancer patients already have so much to think about. This comment puts more stress on them to find some way you can help. "I didn't know what I'd need until I was in the middle of it," Young says. Though it's perfectly fine to say she can count on you for help, keep the lines of communication open as time passes, Young says. Even better: take initiative. Next time you're at the grocery store, call her up and ask if there's anything you can get for her.

"Why haven't I heard from you?"

Managing treatment and figuring out how to pay medical bills can be overwhelming. It doesn't help when a patient gets bombarded for an update on her situation. "You just don't want to say the same thing over and over and spend time answering emails," Young says. After a loved one's been diagnosed, understand she may need time to get a handle on her life now that breast cancer is in the picture. After a few months, plan a time to treat her to coffee or dinner so you two can catch up.

"It could be a worse cancer."

Breast cancer may not progress as fast as, say, pancreatic cancer, but that doesn't mean it's any less serious. "I once had someone tell me, 'Your breasts are ornaments. It could be something internal,'" Young says. Breast cancer is still life-threatening, and at the end of the day, no cancer is worse than another. Say something like "I'm glad they caught it" or "You're in my prayers" instead.








Tuesday, June 12, 2018

Good News: Not All Women With Breast Cancer Need Chemo

Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major international study that is expected to quickly change medical treatment.
“We can spare thousands and thousands of women from getting toxic treatment that really wouldn’t benefit them,” said Dr. Ingrid A. Mayer, from Vanderbilt University Medical Center, an author of the study. “This is very powerful. It really changes the standard of care.”
The study found that gene tests on tumor samples were able to identify women who could safely skip chemotherapy and take only a drug that blocks the hormone estrogen or stops the body from making it. The hormone-blocking drug tamoxifen and related medicines, called endocrine therapy, have become an essential part of treatment for most women because they lower the risks of recurrence, new breast tumors and death from the disease.
“I think this is a very significant advance,” said Dr. Larry Norton, of Memorial Sloan Kettering Cancer Center in New York. He is not an author of the study, but his hospital participated. “I’ll be able to look people in the eye and say, ‘We analyzed your tumor, you have a really good prognosis and you actually don’t need chemotherapy.’ That’s a nice thing to be able to say to somebody.”
Continue reading the main stor
This year, about 260,000 new cases of breast cancer are expected in women in the United States, and 41,000 deaths. Globally, the most recent figures are from 2012, when there were 1.7 million new cases and more than half-a-million deaths.
Chemotherapy can save lives, but has serious risks that make it important to avoid treatment if it is not needed. In addition to the hair loss and nausea that patients dread, chemo can cause heart and nerve damage, leave patients vulnerable to infection and increase the risk of leukemia later in life. TAILORx is part of a wider effort to fine-tune treatments and spare patients from harsh side effects whenever possible.
Endocrine therapy also has side effects, which can include hot flashes and other symptoms of menopause, weight gain and pain in joints and muscles. Tamoxifen can increase the risk of cancer of the uterus.
Patients affected by the new findings include women who, like most in the study, have early-stage breast tumors measuring one to five centimeters that have not spread to lymph nodes; are sensitive to estrogen; test negative for a protein called HER2; and have a score of 11 to 25 on a widely used test that gauges the activity of a panel of genes involved in cancer recurrence.
The gene test, called Oncotype DX Breast Cancer Assay, is the focus of the study. Other gene assays exist, but this one is the most widely used in the United States. It is performed on tumor samples after surgery, to help determine whether chemo would help. The test is generally done for early-stage disease, not more advanced tumors that clearly need chemo because they have spread to lymph nodes or beyond.
The test, available since 2004, gives scores from 0 to 100. It costs about $3,000, and insurance usually covers it. Previous research has shown that scores 10 and under do not call for chemotherapy, and scores over 25 do.
But most women who are eligible for the test have scores from 11 to 25, which are considered intermediate.
“This has been one of the large unanswered questions in breast cancer management in recent times, what to do with patients with intermediate scores,” Dr. Norton said. “What to do has been totally unknown.” He added, “A lot of patients in that range are getting chemo.”

Phizer Receives Priority For New Breasr Cancer Drug

By Terry Chrisomalis
Summary

Priority Review On The Way
Pfizer obtains priority review for talazoparib in treating patients with germline BRCA-mutated breast cancer, with FDA decision date by December 2018.
Treatment with talazoparib in BRCA-mutated breast cancer reduced the risk of disease progression by 46%.
If talazoparib is approved by the FDA it will have to go up against other competing drugs for the same indication such as Lynparza, Zejula, and Rubraca.
Pfizer's acquisition of Medivation also gave it Xtandi, which produced alliance revenues of $590 million in 2017.
Pfizer is expecting an FDA decision date for an expanded label on Xtandi in non-metastatic castration resistant prostate cancer by July.
Recently, Pfizer (PFE) announced that it had received priority review for its breast cancer drug talazoparib. This priority review will allow the drug to gain approval sometime near the end of the year, which is a huge positive. There will be a host of competitors that will not make it an easy market to get into. However, Pfizer hasn't done all that bad since its acquisition of Medivation which gave it talazoparib. That's why I believe Pfizer is a buy. 
With the FDA priority review for talazoparib, it will speed up the approval process. The FDA decision for approval is now expected by December of 2018. The reason for the acceptance of the NDA filing and for the priority review designation being given was because of positive results from the EMBRACA trial. This phase 3 study recruited a total of 431 patients with an inherited BRCA mutation and locally advanced or metastatic triple negative breast cancer (TNBC) or hormone receptor-positive (HR+)/HER2-breast cancer. The study met its primary endpoint of progression-free survival (PFS). The trial was set up to test talazoparib versus standard of care chemotherapy. It was noted that patients treated with talazoparib had a median PFS of 8.6 months, compared to only 5.6 months for those treated with chemotherapy. This means that treatment with talazoparib resulted in a 46% reduction in the risk of disease progression. Now, I'm happy to say that I like the results from this study. Why are these results so significant? That's because this trial tested talazoparib versus investigator's choice of chemotherapy. That means those patients on the chemo were given whatever chemotherapy their investigator deemed would be most sufficient. Despite the ability investigator's choice of chemotherapy, talazoparib still performed better in PFS. Another impressive observation was that talazoparib was able to allow a greater proportion of the patients to achieve a partial or complete response rate (objective response rate - ORR) of 62.6%. On the other hand, chemotherapy only saw an ORR of 27.2%. Along with the NDA that was just accepted by the FDA for priority review, the EMA has also already accepted the application for talazoparib.

Monday, June 11, 2018

Some Antidepressants Interfere With Hormone-Therapy Drugs

Some Antidepressants Interact with Tamoxifen

Several Antidepressants Cancel Out the Anti-Estrogen Effects of Hormone Therapy

By Pam Stephan, About.com Guide

About.com Health's Disease and Condition content is reviewed by the Medical Review Board
See More About:hormone therapy tamoxifen prevent recurrence

Tamoxifen is a hormone therapy drug taken by many premenopausal women after completing their initial treatments for estrogen-sensitive breast cancer. To treat the side effects of Tamoxifen and to help with depression, doctors often prescribe antidepressants. However, research shows that some of these drugs can cancel out the benefits of Tamoxifen, and should be avoided.

Once a young woman is past surgery, chemotherapy and radiation therapy, she may need to take Tamoxifen for five years to block estrogen receptors in breast tissue and prevent a recurrence of the cancer. In some cases, Tamoxifen may be given to women at high risk for breast cancer as an effort to forestall or prevent the development of a breast tumor.

The side effects of Tamoxifen often include menopausal symptoms, such as hot flashes, low libido, vaginal dryness and osteoporosis. In rare cases, some women experience endometrial cancer, cataracts and circulatory problems. In addition, many women who have been treated with chemotherapy for estrogen-receptor positive breast cancer develop some depression during or after primary treatment. You may not develop these problems, but you should be aware of them and discuss these side effects with your doctor if these appear.

Here is a table of antidepressants that may affect the benefits of tamoxifen in women with estrogen-receptor positive breast cancer.

Antidepressants And How They Interact With Tamoxifen

Antidepressant Drug Interaction with Tamoxifen Safety Range
Paxil (paroxetine)

Prozac (fluoxetine)

Prevents antiestrogen benefit Avoid Use
Cymbalta (duloxetine)

Wellbutrin (bupropion)

Zoloft (sertraline)

Medium interefence with antiestrogen benefit
Note: Studies confirm that Zoloft inteferes with Tamoxifen.

Increases Risk
Saint John's Wort
(hypericum) Modest inhibition of antiestrogen benefit Increased Risk
Celexa (citalopram)

Lexapro (escitalopram)

Pristiq (desvenlafaxine)

Remeron (mirtazapine)

Mild interaction
Note: Pristiq and Remeron have not been well-studied for interaction with Tamoxifen.

Slight Risk
Black Cohosh
(actaea) May enhance the antiestrogen benefit
Note: There are just a few studies for interaction with Tamoxifen.

Slight Risk
Effexor (venlafaxine)

Almost no interaction with Tamoxifen Best Choice
Sources:
Black Cohosh. Kligler, B. Albert Einstein College of Medicine, New York. Am Fam Physician. 2003 Jul 1;68(1):114-116.

Interactions between tamoxifen and antidepressants via cytochrome P450. Desmarais JE, et al. Journal of Clinical Psychiatry (Dec. 2009): Vol. 70, No. 12, pp. 1688-97.

Tamoxifen treatment and new-onset depression in breast cancer patients. Lee KC, Ray GT, Hunkeler EM, Finley PR. Psychosomatics. 2007 May-Jun;48(3):205-10.

Social Security Benefits and Breast Cancer


According to the American Cancer Society, breast cancer is the second most common cancer among women in the United States. That being said, breast cancer affects everyone differently—including men. Depending how advanced an individual’s breast cancer is, will determine the limitations that he or she will face.

Breast cancer and breast cancer treatments can cause serious side effects that may limit an individual’s ability to work and earn a living. As a result, loss of income and lack of health insurance can cause significant financial distress. If you have been diagnosed with breast cancer and can no longer work, you may be eligible for Social Security Disability benefits. 

The following information will provide you with a brief overview of the disability benefit program and will help you prepare to begin the application process. 

Social Security Disability Technical Requirements
The Social Security Administration—or SSA—governs two separate programs that offer disability benefits. To be considered eligible for either program, applicants must meet the SSA’s definition of disability. This means that you have a health condition or disability that is expected to keep you from participating in Substantial Gainful Activity (SGA) for at least one year. In 2013, SGA is $1,040 per month. In addition to these basic requirements, each of the two disability programs has their own set of qualifying criteria. 

SSDI- The first program—Social Security Disability Insurance—is funded by income taxes paid by workers all over the country. Therefore, eligibility for this program is determined, in part, by an applicant’s work history and the amount of taxes they’ve paid. To simplify this, the SSA assigns “work credits” to each quarter a worker pays taxes. Then, they require a certain amount of work credits to qualify for SSDI. Learn more about work credits and SSDI, here: http://www.disability-benefits-help.org/glossary/work-credits.

SSI- The second program that offers disability benefits is the Supplemental Security Income program—or SSI. SSI is a needs-based program. This means that, for an applicant to qualify, he or she cannot exceed certain financial limits. SSI does not take work credits into account—therefore this program is a good option for individuals who may not have enough work credits to qualify for SSDI.  Learn more about SSI, here: http://www.disability-benefits-help.org/ssi/qualify-for-ssi.

It is important to note that once an applicant is awarded benefits from either program, they may also become eligible for Medicare or Medicaid. In some cases, applicants may be able to qualify for both SSI and SSDI benefits. 

Social Security Disability Medical Requirements
To gauge the severity of an applicant’s condition, the SSA consults what is referred to as the “blue book”. The blue book is essentially a list of disabling conditions as well as specific qualifying criteria for each. The cancer listings in the SSA’s blue book are all quite similar to one another. If you have been diagnosed with breast cancer, and the cancer has spread to other areas of the body, recurs after treatment, or is inflammatory, you will likely be considered eligible under the breast cancer listing. 

If you do not meet these requirements, but your symptoms or treatments make it impossible for you to keep working, you may still be able to qualify for benefits under a medical vocational allowance. Essentially, this means that even though you don’t meet the blue book listing, the SSA recognizes that breast cancer makes it impossible for you to work.  

Compassionate Allowance
Because breast cancer affects everyone differently, the SSA recognizes that individuals with advanced stage breast cancer cannot be expected to wait the standard processing times to receive disability benefits. For this reason, they have added advanced stage breast cancer to the list of compassionate allowances (CAL). 

The CAL program allows individuals with serious conditions to be approved for disability benefits in as little as ten days. The SSA states that if you have stage four breast cancer or if your breast cancer is inoperable, you may qualify for expedited processing through the CAL program. It is important to note that you do not need to fill out additional paperwork to qualify for the compassionate allowance program—the SSA will determine whether or not your condition matches CAL standards and will expedite your claim accordingly. 

Preparing to Apply for Social Security Disability Benefits 
Prior to beginning the application procedures, it is extremely important that you collect medical documentation to support your claim. The SSA will use this documentation to determine whether or not you meet their requirements. Medical documentation should include records of your diagnosis, your treatments, your response to treatments, lab results, hospitalizations, and even personal notes from your doctor. In addition to these records you should also have copies of financial and work related records. 

Once you are ready to begin, you can submit your initial application online or in person at your local Social Security office. It is important to remember that many initial applications are denied. If you find yourself in this situation, do not panic. You are allowed to appeal this decision. 

Keep in mind that Social Security Disability benefits are available to help you. It’s important that you don’t give up—no matter how difficult the process may seem. Once you are awarded benefits you can focus on your health, not your finances.