6 ways to avoid nausea during cancer treatment

Good nutrition is an important component of cancer care, helping patients maintain strength and weight so they can better handle their treatments. Chemotherapy and radiation therapy may cause unpleasant side effects for some patients.

Maria Erdman, a registered dietitian nutritionist at the Upstate Cancer Center, shares advice for dealing with nausea and vomiting. Erdman recommends:

* eating frequent small portions every few hours throughout the day.

* avoiding foods or restaurants with strong or unpleasant odors.

* eating foods that are not greasy, fried, or very spicy.

* drinking only sips of fluids as necessary throughout your meal.

* for an especially queasy stomach, eat dry crackers or toast to help it settle before eating other foods.

* take all prescribed anti-nausea medicines as prescribed.

All of these recommendations are generalized – find what works for you.

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Cancer as a child means she keeps vigilant watch as an adult

Heather Gangemi, 32, of North Syracuse survived Hodgkin’s lymphoma, which was diagnosed when she was 14. She spoke at the ribbon cutting for the new Upstate Cancer Center in July.

Heather Gangemi, 32, of North Syracuse survived Hodgkin’s lymphoma, which was diagnosed when she was 14. She spoke at the ribbon cutting for the new Upstate Cancer Center in July.

She worries about freckles. She gets concerned if her sleep habits are off. When she felt a lump in her breast, it ruined her weekend.

As a pediatric cancer survivor who is now 32, Heather Gangemi is on high alert.

She was diagnosed with Hodgkin’s lymphoma at the age of 14. Her lymph nodes swelled to the size of golf balls. Normally they should be the size of peas, which enlarge to the size of marbles during sickness. What she hoped would be a bad case of allergies or a cold turned out to be cancer.

“Up until the moment the oncologist told me that I had cancer, cancer never entered my mind. I would have never guessed that cancer would happen to a healthy kid like me,” Gangemi said during the ribbon cutting for the new Upstate Cancer Center last summer.

Heather Gangemi at age 14.

Heather Gangemi at age 14.

She received four months of chemotherapy and a month of radiation therapy at Upstate University Hospital before she was considered in remission. She remembers nurses and doctors who made her feel beautiful when she was bald, who helped her participate in making health care decisions even as a young teen.

At first her appointments were every three months, then every six. Now she has checkups every year. Today she has lived more than half of her life as a cancer survivor.

“I live a normal life, but I spend quite a bit of time worrying about my health. I’ve had shadows on x-rays that should be nothing, and thankfully turned out to be nothing, but are scary just the same,” she said.

Complications from childhood cancers and their treatments may occur many years later, so experts recommend survivors be carefully monitored for the rest of their lives. “The specific late effects that a person who was treated for childhood cancer might experience depend on the type and location of his or her cancer, the type of treatment he or seen received, and patient-related factors, such as age at diagnosis,” the American Cancer Society points out on its website.

Cancer had a huge impact on her life, and when it came time for college, Gangemi knew science would be in her future somehow. She had a desire to work in the field of oncology. She briefly thought about medical school. Then she looked into radiation technology. Neither seemed right for her. “I don’t think I would have been able to handle it. I think I would have gotten too invested in every single patient.”

So Gangemi found her passion at Bristol-Myers Squibb in East Syracuse. There, she assists the division that manufactures oncology medications.

 

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Volunteers dispense comfort in cancer center

Linda Bigsby distributes drinks and snacks in the infusion area of the Upstate Cancer Center. Adults interested in volunteering in the center can call 1-315-464-5180. Volunteers are needed daytime from Monday to Friday, to assist patients in the infusion areas and to staff a “Comfort Cart.”

Linda Bigsby distributes drinks and snacks in the infusion area of the Upstate Cancer Center. Adults interested in volunteering in the center can call 1-315-464-5180. Volunteers are needed daytime from Monday to Friday, to assist patients in the infusion areas and to staff a “Comfort Cart.”

The gesture may seem small, but for the cancer patient who feels chilly during infusion, the offer of a warm blanket provides much more than creature comfort.

“I do the simplest of things, but people are so appreciative,” says Linda Bigsby of Camillus, a volunteer assigned to the Upstate Cancer Center.

After retiring from a career as a nurse, Bigsby found time to give back to her community. She has volunteered the past five years at Upstate University Hospital. She started in the pediatric intensive care unit and then transferred into oncology.

“I liked it immediately,” she said. “I love the constant interaction. You almost become friends with the patients. You end up spending time talking with them, looking at photographs, hearing about their lives.”

Bigsby offers snacks if a patient is hungry, magazines if he or she wants to read, companionship if he or she is alone. She says she has learned to tell when people wish to be left alone, and when they want company.

Bigsby and the other volunteers from the cancer center are going through the American Cancer Society’s Cancer Resource Volunteer program so they are familiar with the resources available from the society. That way, as the volunteers get to know patients, they will be able to suggest appropriate programs and services that might be helpful, along with the creature comforts the provide.

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Cancer documentary to preview at Upstate

Ken.BurnsGet an early look at clips from the upcoming television event, “The Story of Cancer: The Emperor of All Maladies” from 6 to 8 p.m. Wednesday, March 25.

The Upstate Cancer Center, in partnership with WCNY Public Media, presents the free preview event. Parking is also free in the open lot on East Adams Street across from the center.

Physicians and staff from the cancer center will make presentations during the event. Attendees will learn about their risk of cancer and the newest treatments available.

“The Story of Cancer” is a six-hour documentary based on “The Emperor of All Maladies: A Biography of Cancer.” The film was directed by filmmakers Barak Goodman and produced by Ken Burns, who recently oversaw production of “The Roosevelts.”

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How to get your mind off a cancer diagnosis long enough to get a good night’s sleep

Kaushal Nanavati, MD

Kaushal Nanavati, MD

Q & A with Kaushal Nanavati, MD

“Most people who are depressed or anxious are troubled about a past that we cannot go back to change or a future that may not even come to fruition. In that process, we miss out on living the present moment. When you are worrying about your diagnosis, that worry is about a future that may or may not be. So to calm your mind, here are several techniques you can use.

“The first is to practice deep breathing. When you go to bed, lay down comfortably. Then take a slow deep breath in through your nose. As you do, expand your stomach like a balloon. Then breathe out slowly through your mouth, deflating that balloon. Some people like to chant “AUM” when breathing out. Others may have something else that they focus on. The point is to focus on the breath. When your mind starts to wander, just come back to focus on your breath and continue breathing. You can do it for 5 to 10 minutes or longer if you wish. This will help to calm your mind.

“Another technique is to write all the stresses in your life at the present moment on a piece of paper. Then on a separate piece of paper, make two columns. One column can be labeled “Things I can do something about,” and the other can be labeled, “Things I cannot control.” Take all of your stresses and sort them into the two columns.

“The things you can do something about become your list of action items. Take one item at a time, and make a plan to complete it. Once done, use a marker to cross it off your list. As you see this list shrinking, you know you are actively living and taking care of the stresses in your life.

“The other side of the page is filled with things that you can’t directly control. Whenever your mind goes to that side, bring it back to your action item list and pick a stressor to resolve.

“None of us are guaranteed tomorrow. The life we live is lived today. However, when told you have cancer, suddenly this label threatens the plans you may have made and makes us more concerned about things that we feel are unfinished, or regret words that have been spoken or not said.

“You don’t need to receive a diagnosis to start closing those loops. The time is now, and you are the answer. Create contentment and peace in your life each day, and start being more selfish. Selfish is good when it is self-care, self-love, and self-respect.”

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Chemotherapy — or not? For older patients with advanced lung cancer, the answer is not simple

Non small cell lung cancer is a leading cause of cancer-related death in the United States. Almost half (47 percent) of patients with lung cancer are age 70 or older. While the incidence of and death rate from lung cancer have improved in people age 50 and younger, that is not the case for those age 70 and older, says Ajeet Gajra, MD, above, who reviewed treatment options for the Journal of Clinical Oncology.

Non small cell lung cancer is a leading cause of cancer-related death in the United States. Almost half (47 percent) of patients with lung cancer are age 70 or older. While the incidence of and death rate from lung cancer have improved in people age 50 and younger, that is not the case for those age 70 and older, says Ajeet Gajra, MD, above, who reviewed treatment options for the Journal of Clinical Oncology. Photo by Susan Kahn.

Treatment for lung cancer can include surgery, radiation and/or chemotherapy, and what works for one patient may not be so successful in another. That’s particularly true among older patients.

“Care for older patients is much more complex,” says Ajeet Gajra, MD, a medical oncologist and cancer researcher at Upstate.

People age 70 and older are likely to have additional medical problems and may be taking medication. They may have cognitive deficits, undiagnosed psychological issues and/or inadequate social support.

“Most important perhaps, they have limitations in physical function. They experience more side effects from treatments. We cannot treat them in the same way that we treat younger patients.”

Gajra was asked by the Journal of Clinical Oncology to outline the treatment options for lung cancer in older patients to keep physicians informed. His work was published last year.

Is chemotherapy worthwhile? Gajra cited studies that show chemotherapy can add several weeks to the lives of patients over age 70 with advanced lung cancer. However, side effects of many of the medications used to treat cancer may be more severe in older patients.

Some older patients may prefer to preserve quality of life over prolonging life, he points out.

One drug or two? Doctors may prescribe chemotherapy that includes a single medication or a combination. Gajra found research showing the benefits of both treatments. He opposes a blanket recommendation for all older patients. “The elderly are heterogeneous: some are functional, some are not; some have excellent organ function, others do not,” he writes.

Which drugs?

A monoclonal antibody called bevacizumab is commonly prescribed because doctors believe it can add a couple of months to the lifespan of patients with metastatic lung cancer. But after focusing on patients age 70 and older in four unrelated studies, Gajra says the drug’s benefits are not so clear and may not add to survival.

Erlotinib – which slows the growth of cancer cells — can lengthen survival in older patients, but with more severe side effects. Patients over age 65 reported more rashes, fatigue and dehydration than younger patients. “A prescription for erlotinib should be preceded by a realistic discussion of adverse effects,” Gajra advises.

What about after surgery? Patients who have surgery may receive chemotherapy afterward. Which drug, how much and for how long have to be considered for each individual patient.

Chemotherapy containing the drug, cisplatin works for relatively healthy older adults, but its benefit has not been shown in patients age 80 and older “and should be undertaken with extra caution,” Gajra writes. He also notes that chemotherapy containing the drug, carboplatin may provide modest benefit to some patients.

What about during radiation? Some doctors prescribe chemotherapy to be taken while a patient undergoes radiation therapy for cancer that is still confined to the chest. While some studies have shown no improvement in survival or quality of life by adding chemotherapy to radiation, others have shown improved outcomes, but with significant side effects.

Gajra says some older patients may benefit from chemotherapy with radiation, but he urges doctors use caution with this type of therapy – and consider the patient’s overall health and nutritional state.

See Gajra’s journal article

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14 questions to ask about clinical trials

The National Cancer Institute says the answers to these questions can help you decide whether to participate in a clinical trial. Ask your health care provider:

  • Why is this trial being done?
  • Why do the doctors who designed the trial believe that the treatments being studied may be better than the standard treatment? Why may it not be better?
  • How long will I be in the trial?
  • What kinds of tests and treatments are involved?
  • What are the possible side effects or risks of the new treatment?
  • What are the possible benefits?
  • How will we know if the treatment is working?
  • Will I have to pay for any of the treatments or tests?
  • What costs will my health insurance cover?
  • How could the trial affect my daily life?
  • How often will I have to come to the hospital or clinic?
  • Will I have to travel long distances to take part?
  • What are my other treatment choices?
  • How does the treatment I would receive in this trial compare with the other treatment choices?
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Two patients wrote books about their cancer experiences

Author David Lankes, PhD, center, with his oncology nurses, from left to right, Carolyn Stafford, Heidi See, Cyndy Carr and Kevin O'Keefe.

Author David Lankes, PhD, center, with his oncology nurses, from left to right, Carolyn Stafford, Heidi See, Cyndy Carr and Kevin O’Keefe.

Professor sought to be boring

 Excerpt “Here is the hardest lesson I learned in chemotherapy. I was not battling cancer. The chemo was battling cancer. Battling is the wrong metaphor. I didn’t feel like I was on the front line of some war. No, I was the home front. Once the battle was endorsed, I was the one at home sacrificing to support the war effort: taking the rations and reductions as part of my duty in the fight. The chemo was storming the barricades.   “The key, I came to see, in beating cancer through chemo is not fighting, but acceptance. You must accept the drugs, and you must accept that the drugs are going to progressively take from you as much, or so it seems, as the cancer. You must accept that your legs will ache and weaken; that your breathing will constrict; that your bowels will constipate; that you will lose energy. You must accept that for the drugs to do their work – the true battle – you must accept a lack of control.”   --from “The Boring Patient,” by R. David Lankes


Excerpt
“Here is the hardest lesson I learned in chemotherapy. I was not battling cancer. The chemo was battling cancer. Battling is the wrong metaphor. I didn’t feel like I was on the front line of some war. No, I was the home front. Once the battle was endorsed, I was the one at home sacrificing to support the war effort: taking the rations and reductions as part of my duty in the fight. The chemo was storming the barricades.”

Publishing a book called “The Boring Patient” was Syracuse University professor R. David Lankes’ way of summing up his experience with Hodgkin’s lymphoma, a cancer that starts in the white blood cells.

He was diagnosed in 2010 after doctors first thought he had bronchitis, then trans ischemic attacks and then a seizure disorder. Lankes, a professor in SU’s School of Information Studies, underwent chemotherapy and a bone marrow transplant and writes candidly about the ordeal in 17 chapters. Doctors and nurses go unnamed as Lankes tells it like it was.

He chronicles his thoughts and feelings (often wryly) as well as his treatment details. Lankes said he decided not to wallow in negative thoughts and to instead adopt a cheery outlook, even on days when he had to fake it. That helped. He also aimed to be the boring patient. He did not want to be interesting because that meant complications that would draw more attention and demand more treatment. He just wanted to quickly and quietly go through his treatment and have it be successful.

So far, the cancer has not recurred.

Hear an interview with Lankes about his book

She chronicled her year with breast cancer

Excerpt "Somewhere between smores over the pit and campfire breakfast, I noticed a hard lump on the side of my right breast. I'm a side sleeper and it became an obvious pain when I would roll a certain way."

Excerpt
“Somewhere between smores over the pit and campfire breakfast, I noticed a hard lump on the side of my right breast. I’m a side sleeper and it became an obvious pain when I would roll a certain way.”

Shelly Straub of Cicero shares the story, and photos, of her diagnosis and treatment for breast cancer in a book she calls, “A Tale of Two Boobies: One Year with Cancer.”

Her diagnosis came in October 2013, followed by a double mastectomy and reconstructive surgery, chemotherapy and radiation. “It was one year of hell,” she said. “It was difficult. It was very hard to get through. Everything in my life changed.”

Because the experience seemed so surreal, Straub wanted to write a book in order to remember her story. She included graphic photos – and a parental advisory on the book cover – in order to be instructional. Also included are her monthly calendars, which show the activities of everyday life (Thanksgiving, the start of winter) mixed with medical appointments (biopsy results, surgery for port installation.)

Hear an interview with Straub about her book

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Facts about four gynecologic cancers

Although all involve organs of the female genital tract, each of these four gynecologic cancers have unique symptoms and treatments, says Rinki Agarwal, MD, an Upstate gynecologic oncologist. An early assessment by a Gynecologic Oncologist is likely to improve outcomes.

Cervical

Cancer of the cervix is usually diagnosed in midlife. Most women with cervical cancer are infected with HPV (human papilloma virus). A vaccine, now available for girls and boys, has good efficacy and proven safety.

Symptoms

Cervical cancers may have no symptoms and may be detected by routine gynecological exams, especially at early stages. Symptoms may include abnormal vaginal bleeding, unusual vaginal discharge or pain during intercourse.

Treatment

Regular pelvic exams can uncover pre-cancerous conditions. Surgery, radiation and/or chemotherapy are options for treatment. Surgery is less effective in later stages.

Ovarian

Ovarian cancer is considered a silent disease as the symptoms are usually subtle. It does not have good screening tests available and is frequently diagnosed at an advanced stage.

Symptoms

Bloating, pelvic or abdominal pain, trouble eating or feeling full quickly and feeling the need to urinate urgently or often can be symptoms of ovarian cancer – along with fatigue, pain during intercourse, upset stomach or heartburn, constipation, back pain and menstrual changes. Because early detection can dramatically improve survival rates, seek medical care for these symptoms if they persist daily for more than a couple weeks.

Treatment

Ovarian cancer responds well to treatment, which usually includes a combination of surgery and chemotherapy.

Uterine

Also called endometrial cancer, this affects the lining of the uterus. It is diagnosed through a tissue biopsy and/or imaging studies.

Symptoms

This cancer is almost always caught early, because the early symptoms — irregular/ heavy vaginal bleeding or discharge and pelvic pain — send women to their gynecologists.

Treatment

Surgery is the main treatment, but a variety of radiation therapies and chemotherapies are also options for treatment. Hormones may also be prescribed.

Vulvar

Most cancers of the vulva are squamous cell carcinomas, which is a skin cancer, and this disease is more commonly seen in an older population. A vulvar cancer may be related to an infection with the human papilloma virus. The HPV vaccine may provide protection against vulvar cancer.

Symptoms

Itching, pain or burning, thickening of the skin or an open sore on the vulva that lasts for a month or more could signal vulvar cancer. Also be concerned if an area on the vulva looks different from normal — lighter or darker, red or pink. Wart-like bumps may be suspicious, too.

Treatment

Pre-cancerous conditions are likely to be discovered during regular pelvic exams. If cancer is diagnosed, patients and doctors may choose surgery, radiation and/or chemotherapy, depending on how the stage of the cancer.

Need help finding a gynecologist? Contact Upstate Connect at 1-800-464-8668.

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Music adds to the healing environment

Pianist Sydney Fina, 14, and the North Syracuse Junior High School performed at the Upstate Cancer Center in December.

Pianist Sydney Fina, 14, and the North Syracuse Junior High School performed at the Upstate Cancer Center in December. If you would like to perform, volunteers can apply to perform at the Upstate Cancer Center by contacting Matt Capogreco at capogrem@upstate.edu or 1-315-464-3605. Be prepared to share a video or audio clip that demonstrates the type of music you wish to perform.

Daylight and sunshine pour into the Upstate Cancer Center lobby through walls made of windows. For musicians who perform there, “it’s definitely inspiring,” says music program coordinator, Victoria Krukowski.

Victoria Krukowski, who plays the clarinet, is the music program coordinator for the Upstate Cancer Center. Here are five songs she would enjoy performing: * "Give Me the Simple Life," by Rube Bloom & Harry Ruby * "Send in the Clowns," by Stephen Sondheim * “Imagine,” by John Lennon * “You Are the Sunshine of My Life,” by Stevie Wonder * “The Entertainer,” by Scott Joplin

Victoria Krukowski, who plays the clarinet, is the music program coordinator for the Upstate Cancer Center. Here are five songs she would enjoy performing:
* “Give Me the Simple Life,” by Rube Bloom & Harry Ruby
* “Send in the Clowns,” by Stephen Sondheim
* “Imagine,” by John Lennon
* “You Are the Sunshine of My Life,” by Stevie Wonder
* “The Entertainer,” by Scott Joplin

Visit the center weekdays between 10 a.m. and 4 p.m. — when most appointments are scheduled — and you are liable to hear music from a cello, a harp, a string quartet, a piano, or a singer. Krukowski seeks upbeat performers from a variety of genres who are willing to play music appropriate to healing — softly. Sound travels up the glass to be heard in waiting rooms above the lobby.

“It’s amazing how much it adds to the environment,” she says.

Krukowski, who plays the clarinet, performed with the Syracuse Symphony Orchestra for 14 years and now performs with Symphoria. As music program coordinator at the cancer center, she selects and schedules performers.

She is not looking for elevator music, but she does not want anything too loud that would overwhelm the senses.

Tunes that are upbeat and familiar are good choices, including Broadway favorites, ‘60s and ‘70s songs that appeal to lots of people, Mozart and Bach. Beatles tunes are always a hit. “People seem to like tunes that they know,” she says.

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