How cancer care may be affected by depression, anxiety

A study by the Cancer Aging Research Group, which includes Upstate’s Ajeet Gajra, MD, examined the relationship between age, anxiety and depression in older adults with cancer.

Some facts:

More than half of all cancer diagnoses and almost three quarters of cancer deaths occur in patients older than 65.

Depression and anxiety are associated with poorer treatment outcomes, reduced ability to make treatment decisions, decreased adherence to lengthy treatment and longer hospital stays and suicide.

The study:

Researchers looked at data collected on 500 men and women age 65 and older who were about to start chemotherapy. The patients were recruited from outpatient oncology practices between November 2006 and November 2009. To assess their anxiety and depression levels, patients answered a 14-item validated tool survey called the Hospital Anxiety and Depression Scale.

The results: anxiety was apparent in 21 percent, and depression was apparent in 13 percent. Researchers compared those results with patient ages, genders, stages of cancer, education levels, social support and other medical problems.

Findings

–about depression:

People with an advanced stage of cancer were likely to have a higher level of depression.

Researchers found that depression was more likely in older patients who had multiple medical problems, poor social support and advanced cancer. They determined that screening or assessing such patients for depression is important. And, they suggest interventions that reduce loneliness and isolation could help.

–about anxiety:

As age increased, anxiety levels decreased. Some possible reasons why: Older adults 1. are more likely to take life on a day-by-day basis, 2. have learned to adapt to their strengths and weaknesses, 3. may have developed better emotional regulation and the ability to cope with life’s challenges, 4. are at a stage of life where they are focused on making peace with their lives, and 5. may benefit from a shortened time perspective, allowing them to concentrate on what matters at the moment.

–about anxiety and depression:

People who lack social support were likely to have higher levels of anxiety and depression.

People with multiple medical problems were likely to have higher levels of anxiety and depression.

At Upstate:

A dedicated social worker and a psychiatrist who specializes in oncology are available at the Upstate Cancer Center. Both of these people can help mediate problems associated with depression and anxiety.

In addition, the Cancer Center helps reduce the stress for patients by offering:

  • services for cancer care located within the same building;
  • multidisciplinary care that allows patients to meet with each member of their care team in a single afternoon; and
  • customized care, which means caregivers consider the social effects of various treatment regimens as they make recommendations.

Gajra impresses upon medical students and colleagues the importance of screening patients for depression and anxiety and treating them appropriately, since both can impact cancer treatment.

Posted in cancer, community, psychiatry, research | Leave a comment

PSA mystery solved at Upstate

Paul Kruger, who lives in Dexter, NY, works at Fort Drum, north and east of Watertown. He underwent five biopsies of his prostate before a physician at Upstate located the cancer that was causing his elevated prostate-specific antigen test.

Paul Kruger, who lives in Dexter, NY, works at Fort Drum, north and east of Watertown. He underwent five biopsies of his prostate before a physician at Upstate located the cancer that was causing his elevated prostate-specific antigen test.

By Susan Cole

The uncertainty and the waiting were the hardest parts of Paul Kruger’s battle with prostate cancer.

Kruger, 56. a heavy equipment mechanic at Fort Drum, knew an elevated prostate-specific antigen (PSA) level indicated trouble, but after five years of examinations and five painful biopsies, he was no closer to knowing why his level was so high. Then his wife, Nora read about the precision biopsies the urology team at Upstate University Hospital was using. The Krugers immediately booked an appointment.

Urologic oncologist, Srinivas Vourganti, MD, ordered a magnetic resonance imaging scan for Kruger, using a powerful 3 tesla machine. The MRI revealed areas of suspicion within the prostate and gave Vourganti some targets for the biopsy that would remove some cells for laboratory analysis. When the test results came back, Kruger learned that about a third of his prostate was taken over by cancer.

Hear an interview with Vourganti about the UroNav procedure

This red triangle is a 3-D image of Paul Kruger's prostate. The circular colored areas are areas of suspicion, as indicated by a magnetic resonance imaging scan. Using Upstate's UroNav fusion biopsy system, Srinivas Vourganti, MD, hones in on areas where cancer may be hiding. The cylinders show where the urologic oncologist removed tissue samples for biopsy. Cancer cells were found to occupy about a third of Kruger's prostate, in the green circular region.

This red triangle is a 3-D image of Paul Kruger’s prostate. The circular colored areas are areas of suspicion, as indicated by a magnetic resonance imaging scan. Using Upstate’s UroNav fusion biopsy system, Srinivas Vourganti, MD, hones in on areas where cancer may be hiding. The cylinders show where the urologic oncologist removed tissue samples for biopsy. Cancer cells were found to occupy about a third of Kruger’s prostate, in the green circular region.

The uncertainty over, he shifted his focus to cope with a cancer diagnosis. “All the waiting, not knowing and not understanding is what is hard,” he said. “Every time I went through another biopsy, I thought, ‘When are they going to find it?’ “

After Vourganti explained his options, Kruger decided to have his prostate surgically removed in a minimally invasive operation last June. Vourganti said the operation was a success. “Mr. Kruger’s tumor was well away from the erectile nerves, so I was able to perform a bilateral nerve-sparing surgery, “ he described.

Six months after the surgery, Kruger is cancer-free and back to his normal routine, keeping the snow plows running at Fort Drum.

He said he is grateful that his Upstate team worked so quickly and effectively to remove his cancer.

“We’ve had family members with cancer, and it was a death sentence, “ Kruger said. “To come to Upstate and meet Dr. Vourganti and have all my questions finally answered and my cancer gone? It’s amazing.”

What’s the PSA?

The PSA test measures the blood level of prostate-specific antigen, a protein that is produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he had prostate cancer. However, there are additional reasons for having an elevated PSA level, and some men who have prostate cancer do not have elevated PSA.

Posted in community, surgery, urology | Leave a comment

Are you at risk for oral cancer?

Protect yourself Oral cancer frequently begins as a painless lesion in your mouth. Therefore, experts recommend you carefully examine your mouth on a regular basis for red or white spots, lumps or anything that looks abnormal.   Stand in front of a mirror. Using gauze for grip, lift your tongue so you can see beneath and in back of your mouth. Pull your cheeks away from your teeth to get a good look.   See your dentist or doctor if you find something unusual. “If it’s affecting your life, and it lasts longer than two weeks, then it requires professional evaluation,” advises oral surgeon Terrence Thines, a professor in Upstate University Hospital’s division of dentistry.

Protect yourself — Oral cancer frequently begins as a painless lesion in your mouth. Therefore, experts recommend you carefully examine your mouth on a regular basis for red or white spots, lumps or anything that looks abnormal.
Stand in front of a mirror. Using gauze for grip, lift your tongue so you can see beneath and in back of your mouth. Pull your cheeks away from your teeth to get a good look. See your dentist or doctor if you find something unusual. “If it’s affecting your life, and it lasts longer than two weeks, then it requires professional evaluation,” advises oral surgeon Terrence Thines, a professor in Upstate University Hospital’s division of dentistry.

Most of the people with oral cancers whom Terrence Thines cares for are in their fifth or sixth decades of life. But lately, the oral surgeon from Upstate’s division of dentistry is seeing younger patients with the same type of disease.

Many are infected with the human papilloma virus, or HPV. Infection with certain types of HPV, easily spread from one person to another during skin-to-skin contact, can cause some forms of cancer. Thines said research so far has not connected the increase in oral cancers directly to HPV, but some experts believe the rise is related to an increase in oral sex.

Hear an interview with Thines

Tobacco and alcohol use are among the strongest risk factors for oral and oropharyngeal cancers. Smokers are many times more likely than nonsmokers to develop these cancers, says the American Cancer Society, which adds that seven out of 10 patients with oral cancer are heavy drinkers. Combining the two vices ups the risk even more. “According to some studies, the risk of these cancers in heavy drinkers and smokers may be as much as 100 times more than the risk of these cancers in people who don’t smoke or drink,” the society says.

Thines said oropharyngeal cancers – cancers from the lips to the back of the throat – represent up to 4 percent of all cancer diagnoses. The death rate from oral cancer is on the decline, probably due to better diagnosis and better prevention strategies. “You have a good prognosis if the cancer is detected and treated early,” he said.

Depending on the location and type of cancer cells, surgery is likely to be the first step in treatment. That may be followed by radiation and/or chemotherapy. Surgery may be disfiguring. “That’s one of the reasons we promote early detection,” Thines said, explaining that the earlier oral cancers are detected, the smaller they are likely to be and the less tissue that has to be removed.

 Hear an interview with Thines

 

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Exceptional surgical suite allows for MRI during operations

Director of pediatric neurosurgery, Zulma Tovar-Spinoza, MD, reviews the patient’s magnetic resonance images prior to beginning surgery.

Director of pediatric neurosurgery, Zulma Tovar-Spinoza, MD, reviews the patient’s magnetic resonance images prior to beginning surgery.

The most advanced imaging options available are part of Upstate’s newest surgical suite, which allows patients to undergo magnetic resonance imaging during an operation.

The clarity of the 3-tesla MRI is ideal for conditions that involve the brain, spine and musculoskeletal system, including brain tumors, epilepsy and cancer. Its powerful imaging capabilities provide exceptional detail.

Surgeons are able to immediately verify the complete removal of tumors, verify the placement of probes and minimize the impact to healthy tissues. This helps improve patient outcomes.

Hear an interview about the new suite

This 3-D computerized image shows the inside of the patient's brain and the 3.1-millimeter opening -- a bit larger than the tip of a pen -- for the laser.

This 3-D computerized image shows the inside of the patient’s brain and the 3.1-millimeter opening — a bit larger than the tip of a pen — for the laser.

Using a laser and MRI guidance, Tovar-Spinoza will remove a tumor through a melting process called ablation.

Using a laser and MRI guidance, Tovar-Spinoza will remove a tumor through a melting process called ablation.

Once the neurosurgeon secures the laser in the patient's brain, the door to the MRI suite opens, and the patient -- still under anesthesia  -- is moved into the scanner.

Once the neurosurgeon secures the laser in the patient’s brain, the door to the MRI suite opens, and the patient — still under anesthesia — is moved into the scanner.

MRI technologists help position the patient in the scanner.

MRI technologists help position the patient in the scanner.

Tovar-Spinoza reviews the intraoperative scans to verify the tumor removal is complete.

Tovar-Spinoza reviews the intraoperative scans to verify the tumor removal is complete.

Hear an interview about the new suite

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Battling breast cancer by knocking on doors

She Matters advocate Martha Chavis-Bonner helps her neighbor, Edward Moody, sign his wife up for a mammogram at the Patricia J. Numann Center for Breast, Endocrine and Plastic Surgery at the Upstate Specialty Services Center. Moody's wife, says Chavis-Bonner, is typical of many African American women: "so busy working and taking care of her family that she doesn't take time for her own health."

She Matters advocate Martha Chavis-Bonner helps her neighbor, Edward Moody, sign his wife up for a mammogram at the Patricia J. Numann Center for Breast, Endocrine and Plastic Surgery at the Upstate Specialty Services Center. Moody’s wife, says Chavis-Bonner, is typical of many African American women: “so busy working and taking care of her family that she doesn’t take time for her own health.”

Lisa Bigelow says her father’s mindset was that he could avoid cancer simply by not getting tested for the disease. She believes early detection is the best protection – and she is helping to spread that word.

“Both my parents died of cancer. I wish they were still here. That’s why I’m involved,” Bigelow says. She is part of a team of resident health advocates that is raising awareness of breast cancer in their community.

Armed with tenants’ lists, sign up sheets, and flash cards with cancer facts, the team goes door to door at Syracuse’s Pioneer Homes, a public housing complex with 1,194 residents.

Their goal is to get women age 40 and older from Pioneer Homes and the neighboring community to have annual mammograms, and to deepen their understanding of breast cancer prevention, diagnosis, treatment and survival, which often depends on early detection.

So far, the resident health advocates — Bigelow, Martha Chavis-Bonner, Lawrence Diamond-Walls and Mary Harris — have enrolled more than 200 women in the “She Matters” breast cancer program, and 70 have had mammograms so far. (As a male, Diamond-Walls talks with men about male breast cancer and encourages them to get the women in their lives to get mammograms.)

Hear an interview about “She Matters”

What’s the process? The team works with Upstate staff to host educational sessions at the community room at Pioneer Homes, which are followed by mammogram “parties” at the Upstate Harrison Specialty Services Center. Reminder calls are made, and referral sheets are given to attendees so they can recommend friends and neighbors.

Statistics, personal experiences, and training and services from Upstate and the Onondaga County Health Department have prepared the team to do its health outreach work. The team completed a resident health advocate education program, designed and taught by Upstate staff and other local health experts. A $50,000 grant from the Susan G. Komen Foundation pays for the program.

The statistics are daunting. Nationally, African American women are more likely than all other ethnic groups to die of breast cancer. In Syracuse, more than 160 women are diagnosed with breast cancer each year, and the incidence of breast cancer is higher in Onondaga County than in the US as a whole. (In Onondaga County 132 women per 100,000 will develop breast cancer in a year. Nationally, the number is 124 per 100,000.)

Most of the women enrolled in She Matters have health insurance, reports project manager Linda Veit. Those who don’t are referred to the health department’s cancer service. Through that service, the uninsured women (five so far) receive a host of cancer screenings — colorectal, pap and clinical breast exams. Then, they return to Upstate for mammograms.

Harris says being a community health advocate means being there for the women in She Matters. “We’ll be your support system,” she promises. “We’re here if you feel nervous. We’re here if you need help.”

Plans include extending the She Matters program to other Syracuse Housing Authority residences. To find out more about the program, call She Matters at 315-464-6303 or 315-217-5825.

Hear an interview about “She Matters”

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Upstate researcher focuses on what a protein can teach about cancer

Fruit fly ovaries are made up of subunits called germanium, which house germline stem cells, as shown in green above. Germline cells are the sex cells that pass along genes to the next generation.

Fruit fly ovaries are made up of subunits called germanium, which house germline stem cells, as shown in green above. Germline cells are the sex cells that pass along genes to the next generation.

An Upstate scientist who conducts research in fruit flies is hopeful that her work will help our understanding of cancer and other diseases. Fruit flies are often used in research because their genome is similar to that of humans.

Francesca Pignoni, PhD, recently received a $161,000 grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to support her research. She is an associate professor of ophthalmology, biochemistry and molecular biology; and neuroscience and physiology.

She is studying the function of a protein that was discovered in her laboratory in Upstate. The protein allows fruit flies to keep stem cells within its ovary where they divide to ensure the passage of genetic material to the next generation through reproduction. Cancer is one disease that can be explored through this research.

Pignoni says that he protein appears to play an important role in a type of molecular communication known as BMP signaling. BMP signaling is a major regulator of a cell’s fate – including its ability to grow an multiply and to form more specialized cells. The BMP molecule is the same in the fruit fly as in the human, where it has been linked to colon cancer, breast cancer, lung cancer and some diseases of the bone. When the newly discovered protein is added in excess, the stem cells develop into tumors. Learning more about how the protein works at a cellular level can lead to a better understanding of how BMP dysfunction causes cancer.

“We clearly show in the flies that the level of this protein needs to be regulated in order for the stem cells to be under control,” said Darin Dolezal, an MD/PhD student assigned to Pignoni’s lab. “The proliferation of stem cells has to do with the growth of cancers. What we don’t know is whether this protein does, as well.”

Dolezal admits that as a boy growing up on Long Island, then attending Cornell University and aiming for a career in the medical sciences, he never imagined he would study ovaries in fruit flies. It’s not because he is interested in insect biology. Rather, he wants to determine if this protein can lead to a better way to diagnose or treat cancer.

“There are things that we can learn in the fruit fly ovaries that can directly translate into human clinical medicine. We’ll figure it out in flies and then maybe move into more complex organisms and try to understand it there,” said Dolezal.

Pignoni said she wants to understand if the protein helps cells receive or interpret only the BMP signal, or if it is part of a more general biologic process that impacts multiple signaling systems.

“In the latter case, its dysfunction would profoundly affect the ability of cells to communicate with each other,” she said. Either way, determining how the protein works at a cellular level could help explain how dysfunction of BMP, and perhaps other signaling pathways, causes cancer and other human disorders.

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Physicians Practice features stroke care, shoulder implants, urethroplasty, more

PhysPractMarch2015The March issue of Physicians Practice features stories from Upstate about stroke care, a new shoulder implant and urethroplasty. The stories are aimed at medical professionals, but anyone is welcome to browse.

Physicians Practice is a publication that is distributed to physicians throughout Upstate’s 17-county service area, stretching from the Canadian border to the Pennsylvania border.

 

Posted in orthopedic, stroke, surgery, urology | Leave a comment

Have you seen the winter issue of Cancer Care?

cancercarewinter2015Upstate’s winter issue of Cancer Care features on its cover Heather Gangemi, a young woman who remains vigilant with her health in adulthood because of her cancer diagnosis in childhood.

Also in this issue, readers will get a look at the new neurosurgical suite, which allows patients to undergo magnetic resonance imaging before surgeons close incisions. We will introduce you to two patients who wrote books about their cancer experiences, and a man whose elevated PSA mystery was solved at Upstate.

Our experts tackle questions on the risks of oral cancer, avoiding nausea, getting a good night’s rest, and deciding on the appropriate treatment for advanced lung cancer.

For a free subscription to Cancer Care, send an email to magazine@upstate.edu with “Cancer Care” in the subject line. Provide your name and mailing address. In the meantime, you can read an electronic version of this issue.

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History, hope combine in cancer biography

By Leslie Kohman, MD

maladiesDid you know that cancer has been described in Egyptian mummies?

Or that chemotherapy was developed to treat childhood leukemia, and its use in adult cancers is a much later development?

Or how the National Cancer Institute has had intermittent periods of congressional underfunding since its inception in 1937, very similar to what we are experiencing now?

Or that the American Cancer Society started with a volunteer “Women’s Field Army” that took to the streets in the 1930s to raise awareness and funds?

Or that until recently, cancer was a shameful secret that people did not discuss openly?

All these and many more fascinating anecdotes are described in the Emperor of All Maladies: A Biography of Cancer, written by Siddhartha Mukherjee, MD, a young medical oncologist at one of the major teaching hospitals in Boston.

Since President Richard Nixon signed the National Cancer Act in 1971, which became known as the beginning of the “War on Cancer,” cancer treatments, investigations and publicity have steadily increased. Countless people have dedicated their lives to learning about cancer and how to treat it, to the great benefit of innumerable patients. Nonetheless, we have not won this war yet, and the science of cancer is so complex that it may not be possible.

Mukherjee skillfully combines history, biography and science with moving stories about patients, those who have survived cancer and those who have not. He has written a fascinating book at a level accessible to the general reader as well as those with a more medical or scientific bent. He describes human conflict, failure and triumph in masterly fashion.

He also describes his own personal development as a physician as he enters with his patients into the world of cancer.

I highly recommend this extraordinary story of history and hope to anyone who has been touched by cancer or is curious about it (that is all of us!) and I look forward with great anticipation to the upcoming Ken Burns film inspired by this book, to be shown on PBS March 30, 31 and April 1, 2015.

Ken.BurnsSAVE THE DATE: Get 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 the WCNY television station, 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.”

###

Leslie Kohman, MD, is the medical director of the Upstate Cancer Center. Hear an interview with her about the history of cancer. 

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Do results from research on children’s cancers ever shed light on cancers that adults experience?

A Syracuse woman submitted this question to “Upstate Answers,” and Amy Caruso Brown, MD, assistant professor in pediatrics and the Center for Bioethics and Humanities at Upstate, provides an enlightening answer:

(If you’ve got a general medical/science question you would like to see answered in this space, please send it to whatsup@upstate.edu)

Brown’s response:

“Yes! Definitely! There are a few ways to think about this question.

“First, around the world, thousands of researchers are studying cancer cells in their laboratories. Some study particular mechanisms that play a role in cancer development – for instance, changes in genes that cause cells to grow out of control – while others study how cancer cells respond to drugs, in test tubes or in lab animals, like mice.

“Most researchers perform experiments on several different types of cancer cells, including both pediatric and adult cancers, and cancer researchers at all levels talk to each other and exchange ideas and information. A discovery initially found in cancer cells from pediatric leukemia patients, for instance, may turn out to help us understand and better treat colon or breast cancer, which are extremely rare in children but common in adults.

“I recently worked on a protocol for a study of a new drug, a type of tyrosine kinase inhibitor, that was invented by a pediatric oncologist but also seems promising for treating some adult cancers. Since it has never been tested in humans, the first clinical trial of this new drug will be in adult patients.

“Secondly, adult patients sometimes get cancers that we would consider “pediatric” because they are much more likely to occur in childhood, and so most of what we know about how best to treat these adults comes from research done with children. We now know that young adults, particularly those with acute lymphoid leukemia (ALL), have better outcomes when they are treated with pediatric chemotherapy protocols and, in some cases, by pediatric oncologists.

“The Children’s Oncology Group is a consortium of more than 200 pediatric cancer programs (including Upstate) that supports about 85 ongoing clinical trials. Their study of the best treatment for a specific type of ALL called high-risk pre-B is currently open to patients up to age 30. ALL is the most common type of childhood cancer, but about a third of ALL patients are adults.

“Finally, outcomes for children with cancer have improved dramatically over the past 40 years, and much of that progress is due to the collaboration between pediatric oncologists and researchers around the world, through the Children’s Oncology Group and similar European research groups.

“The majority of children, adolescents and young adults with cancer – 60 percent – are enrolled in clinical trials, meaning that data on the treatment they received and how they responded is collected, analyzed and used to guide future treatment options. In contrast, fewer than 5 percent of adults with cancer participate in clinical trials.

“Many adult oncologists see the pediatric approach to research as one to emulate in order to more systematically improve outcomes for adults with cancer.”

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