Environmental Risk Factors - Cancer Treatment Centers of America

Transcription

spring 2013
cfthrive.com
®
living
with
cancer
the big picture
Quality of life is key
one size does not fit all
Personalized cancer treatment
moves to the forefront
environmental
risk factors
Joe Mills
spring 2013
®
Features
6 Living with CanCer
26 the Big PiCture
in this issue
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View this entire issue at cfthrive.com
Cover photo by Bart Harris Photography
bartharris.com. special thanks to illinois Beach Resort
and Conference Center.
cfthrive.com
5
advocacy spotlight
Cancer schmancer
12
nutrition
Homegrown nutrition
16
ask the expert
Cooking Up Healthy Choices
20
Meet the Doctor
samuel Bieligk, MD, FACs
22
tips & trends
23
research today
One size Does not Fit All
31
naturopathic
Environmental risk Factors
36
innovation
Welcome relief: pain Management
is the Key to Living Well
38
ask the nurse
Tips for Caregivers: supporting patients
through Treatment
40
Mind-Body Connection
Moving Beyond survivor guilt
42
spiritual
Words to Live By
44
images of hope
46
inspiration
spring 2013 | cancer fighters thrive 3
welcome
a new Paradigm
Volume 8, Issue 19
EdITorIal STaFF
Maurie Markman, Md Editor-in-Chief
Tim Birdsall, Nd Medical Editor
diana Price Editor
lynne a. Kennedy Managing Editor
Sarah andrews Associate Editor
Bill Kelly Associate Editor
laura Malamud Associate Editor
Tiffany Payette Associate Editor
Katie ressler Associate Editor
Kristin Schaner Associate Editor
Julia Scherer Associate Editor
Megan Toth Associate Editor
Kari Young Creative Director
Christie Enochs Circulation Manager
Juli roos Production Manager
it wasn’t long ago that cancer was a word
more often whispered than said aloud. The
stigma of the disease kept people from discussing
it publicly, and the anticipated prognosis was
often assumed to be bleak. In recent years,
however, as advances in research have led to
more-effective treatments, patients are living
longer and speaking louder, and cancer is
increasingly considered a chronic condition that
can be effectively managed for many years.
In this issue of Cancer Fighters Thrive®, we
describe this new paradigm in which cancer is, in many cases, viewed as a chronic
adVErTISING SalES
Tracey Aaron
Arlington publishers representatives, inc.
(815) 356-8344
[email protected]
MaGazINE SuBSCrIPTIoNS or CoMMENTS
Lynne A. Kennedy (918) 286-5115
[email protected]
disease (“Living with Cancer”) and also how patients who live with cancer long
term benefit from an approach that emphasizes quality of life (“The Big Picture”).
As providers focus more on patients’ quality of life, pain management plays a
critical role, and we also include a feature devoted to that topic.
Several of the other articles included in this issue speak to topics related to living
with cancer long term; we offer features on the topic of “survivor guilt” as well
as environmental risk factors, garden-fresh nutrition, spiritual inspiration, and
caregiver tips.
EdITorIal Board
Syed abutalib, MD, Hematologic Oncologist, CTCA (Zion, IL);
lawrence altshuler, MD, Internist, CTCA (Tulsa, OK); Katherine
anderson, ND, National Director of Naturopathic Medicine, CTCA (Tulsa,
OK); Steve Bonner, President and CEO, CTCA (Schaumburg, IL); Sharon
day, RD, CSO, LDN, CNSC, Director of Nutrition, CTCA (Phoenix, AZ);
Susan Eckhardt, OT, Director of Oncology Rehab (Philadelphia, PA);
Michelle Moore, RN, BSN, Care Manager, CTCA (Zion, IL); daniel
Nader, DO, FCCP, National Director of Pulmonology, CTCA (Tulsa, OK);
Katherine Puckett, PhD, National Director of Mind-Body Medicine,
CTCA (Zion, IL); Jeffrey Sklar, DC, Director of Chiropractic Services
(Philadelphia, PA); amy Taub, MD, Dermatologist, Advanced Dermatology (Lincolnshire, IL); Jeffrey M. Weber, MD, Director of
Gastroenterology and Metabolism, CTCA (Phoenix, AZ).
PaTIENT PaNEl
As we do in each issue, we also deliver inspiring advocacy and physician profiles,
insight into cancer research topics, and many wonderful stories of cancer patients
and their families. Thank you for taking the time to read Cancer Fighters Thrive.
Enjoy the issue!
Maurie Markman, MD
Senior Vice President of Clinical Affairs
National Director of Medical Oncology
Cancer Treatment Centers of America
orDer your Free Print suBsCriPtion at CFthrive.CoM
information about treatment
if you or someone you love would like to learn more about treatment options at
Cancer Treatment Centers of America (CTCA), call a CTCA Oncology information specialist
at (800) 264-1255 or visit online at cancercenter.com/cfthrive.
4 cancer fighters thrive | spring 2013
audrey allen, Iva "Marie" Botchie, Sara Faccio, Janita Green,
Hugh King, George rader, Blas ruiz, anita Seever, liddell Smith,
Bryan Stordahl, ralph Tripp.
oPEraTIoNS
Heather Greaves, Loyalty Specialist, CTCA (Philadelphia, PA);
Janet Horn, Senior VP Communications, CTCA (Schaumburg, IL);
Steve Kroll, VP and General Counsel, CTCA (Schaumburg, IL);
Faith Williams, Loyalty Manager, CTCA (Philadelphia, PA).
Cancer Fighters Thrive® is published by OMNI Health Media for Cancer Treatment Centers of America (CTCA), which is solely responsible for its
content. All articles and materials contained in Cancer Fighters Thrive are intended to inform the reader about cancer and its treatment generally and
are not intended to endorse any particular provider of treatment or particular modality.
Each person who is the subject of an article contained in Cancer
Fighters Thrive is an actual person, and the medical results that they claim
to have achieved are their own opinions about their personal conditions.
The reader is cautioned against drawing any conclusions about effectiveness of any particular treatment or the chance of survivorship of any particular medical condition, whether treating at a CTCA facility or otherwise.
All readers are reminded that cancer is a complex disease and CTCA
makes no claims regarding its patients’ survivorship rates or as to the effectiveness of any of its treatment for any such conditions.
With respect to the clinical results claimed by any of the patients in
the articles contained in Cancer Fighters Thrive, no case is typical, and the
reader should not expect to experience these results. CTCA does not
endorse the products or services offered by any advertisers in this magazine.
cfthrive.com
© 2013 Rising Tide
cfthrive.com
advocacy spotlight
Advocacy Spotlight:
cancer schmancer
Young adults diagnosed with cancer create community
and advocate for their unique needs.
By Diana Price
A
ctor, producer, and advocate
In 2007 Drescher founded Cancer
survivor stories and opportunities for
diagnosis
Schmancer, a nonprofit organization
advocacy on its website, cancerschmancer.
with stage I uterine cancer
dedicated to prevention, early detection,
org, in an effort to educate women about
in 2000 came at the end of a long road of
and advocacy. Susan Holland, vice pres-
critical preventive health issues and to
misdiagnoses. After two years of symptoms
ident of Cancer Schmancer, says, “Cancer
motivate and empower patients to seek
that included cramping and bleeding
Schmancer seeks to transform patients
the best possible care. Drescher has also
between menstrual cycles, and frustrating
into medical consumers and to shift the
been actively advocating on behalf of
visits with eight different doctors, the
nation’s priority from exclusively search-
cancer patients in Washington, DC, where,
diagnosis finally delivered Fran an answer.
ing for a cure toward prevention and
Holland says, the organization is currently
And yet, though her search for a diagnosis
early detection.”
working to get a bipartisan carcinogen-
Fran
Drescher’s
was at an end, it was the beginning of an
entirely new journey.
In 2002 Drescher, an Emmy and Golden
To that end the organization has
would
based
education.
around
Fran
Vans—mobile
Globe nominee who starred in the long-
breast cancer detection units that serve
running CBS sitcom The Nanny (which
uninsured as well as underinsured
she also created and executive produced) as
areas—and, more recently, a Trash Cancer
well as in feature films, published a mem-
initiative aimed at educating consumers
oir, Cancer Schmancer, which described her
about possible carcinogens and toxins
journey to diagnosis. Compelled to tell her
in personal care products, cleaning
story in the hope that she could help other
products, and food. Holland says that
women get the answers they needed, she
more than 1,000 Trash Cancer parties
also felt called to do something more to in-
have been hosted around the country,
form and empower women. She knew that,
involving more than 10,000 people.
as her own case had illustrated, early detec-
“Trash Cancer teaches consumers how
tion of cancer was the key; she also knew
to detox their homes and become aware
that lack of information and misdiagnosis
of what we are putting in our mouths, on
often prevented women from being diag-
our skin, and using around us when we
nosed at an early stage. Fueled by her own
clean and garden,” she says.
experience, Drescher committed to using
In addition, Cancer Schmancer shares
her celebrity status to help get the word out.
information about prevention, inspiring
cfthrive.com
free-label bill through Congress that
developed an early-detection program
further
promote
consumer
For more information about
Cancer Schmancer, visit
cancerschmancer.org
Joe and Shelly Mills
cfthrive.com
cover story
living with
CanCer
By L Aurie Wertich
C
photos by Bart harris Photography
Special thanks to illinois Beach resort and conference center
cfthrive.com
ancer is not always a death
sentence. It can be a life
sentence—a call to live
life to the fullest even in the face of
disease. Just ask Joe Mills, a safety
manager for a small trucking
company in Bloomington, Illinois.
Joe was diagnosed with stage IV
cholangiocarcinoma (bile duct
liver cancer) in November 2011.
In the past year, he has undergone
chemotherapy and surgery—and
he has continued to work and enjoy
his life with his wife and family.
special feature
“I try to live as normal
a life as possible,” Joe
says. “I bike-ride every
chance I get. My wife
and I go for a lot of
walks and out to the
movies—anything we
can do to take the focus
off of illness.”
“I try to live as normal a life as possible,”
ship. Other cancers are considered incur-
new and innovative developments in
Joe says. “I bike-ride every chance I get.
able; there is treatment but no cure. Once
cancer treatment, patients can live a long
My wife and I go for a lot of walks and
upon a time, incurable cancers were re-
time with cancer—and with is the key
out to the movies—anything we can do to
ferred to as terminal but not now. There
word here. Patients with chronic cancer
take the focus off of illness.”
is a new term for these cancers: chronic.
are living with it, not dying from it.
Joe is one of a growing number of peo-
“The paradigm change is that we’re
ple who is living—and living well—in the
starting to look at cancer as a chronic
wake of an advanced cancer diagnosis. Yes,
illness as opposed to an acute illness,”
living well with
chronic cancer
you read that right: Joe is living well with
explains Simeon Jaggernauth, DO, a
“Chronic” may sound better than “ter-
cancer, fueled by a desire to be fully en-
medical oncologist at Cancer Treatment
minal,” but it’s still an enduring chal-
gaged in life and not about to let cancer
Centers of America® (CTCA) in Tulsa,
lenge. Chronic means “all the time.” In
get in the way.
Oklahoma. “It’s sort of like diabetes, hy-
other words, if you have chronic cancer,
pertension, AIDS, or hepatitis C. These
you will live with this cancer for the rest
Defining chronic cancer
are illnesses that people have and can be
of your life. That may sound like an or-
Some cancers are considered curable. Af-
treated for, but they’re not curable.”
deal, but there are an increasing number
In fact, a cancer can be considered in-
of tools to help patients manage for the
Lindsay rehm,
OcN,
with Jack
and PJ Donatucci
curable but quite treatable. Thanks to
remission
and rN,
move
forward
to survivor-
long term. Despite cancer and ongoing
ter successful treatment, patients go into
cfthrive.com
cover story
treatment, it is possible to live well with
ing chronic cancer is to maintain quality
the disease.
of life. Patients will live well if they are
“As people are living longer with
treated well,” explains Dr. Jaggernauth.
coping with chronic cancer
Living with chronic cancer is like running
cancer, we want to make sure they can
Treating patients well means shifting
maintain quality of life,” explains Tracy
the way in which we deliver the treat-
a marathon rather than a sprint. it’s
Whitworth, RN, a survivorship nurse at
ment. “This disease called cancer is
important to pace yourself, listen to your
CTCA® in Goodyear, Arizona. “We want
chronic,” Dr. Jaggernauth insists. “The
body, and take care of yourself. here are
to help patients not only contain and
way you treat a chronic disease is by giv-
some coping strategies for living long and
manage the disease but also live well with
ing chronic treatment.”
well in spite of cancer.
it. We want patients living life and creat-
This important recognition that cancer is appropriately viewed in an increas-
y Stay in charge and take an aggressive
role in your own health care.
Whitworth’s role is to look at the big
ing number of settings as a very serious
y Ask questions.
picture. She works to balance disease
but chronic illness has led to the develop-
management and quality of life. It’s her
ment of strategies that consider the po-
job to know her patients—really know
tential impact of long-term side effects.
them—so that she can help them strike
Common long-term issues include per-
the optimal balance between life and
sistent fatigue and continuous numbness
treatment. Whitworth examines work/life
and tingling in hands and feet.
ing memories.”
balance issues, fatigue, pain, and much
Investigators have begun to explore the
more in assessing her patients. Then she
use of the more frequent administration
pulls out her “tool bag” and connects pa-
of anticancer drugs at lower doses that
tients to the appropriate resources.
have the potential to maintain or even
y Stay on top of your bone health. Ask
your health care provider if you need
a bone scan or Mri.
y Be honest about side effects and how
they affect your quality of life. Ask
for help managing pain,
fatigue, and other side effects.
y take advantage of appropriate
complementary medicine strategies,
such as acupuncture, massage, and
homeopathic medicine.
“We really encourage patients to utilize
improve the effectiveness of therapy while
all of the wonderful complementary treat-
actually reducing side effects. For patients
ments we have here, such as naturopathic
whom doctors anticipate will be treated
medicine, nutrition therapy, mind-body
for long periods, for example a year or
medicine, acupuncture, and massage,”
longer, a “treatment holiday” may be used
y Keep a logbook of symptoms and
questions for follow-up visits.
Whitworth says. “The data support that
to permit the body to recover from the ef-
y Maintain consistent follow-up visits.
these are very helpful to keep everything
fects of cancer treatment.
in tune.”
Patty Marshall’s experience is an ex-
This balance—between treatment and
ample of the benefits of an approach that
quality of life—is the cornerstone of man-
focuses on the chronic nature of cancer
aging chronic cancer. “In a perfect world,
treatment. In May 2007 Patty was diag-
we want the treatment to obliterate the
nosed with stage IV breast cancer that
cancer but not affect quality of life,” Whit-
had spread to her bones. She decided
worth says. This may sound like a lofty
right then that cancer will not kill me.
goal, but it’s one that is more and more re-
Patty immediately started an innovative
alistic as cancer treatment changes.
weekly treatment program. The treat-
y Discuss your concerns with your
health care provider.
y Stay positive and surround yourself
with positive people.
y take impeccable care of yourself: eat
well, get plenty of rest, and make
time for the activities you love.
y engage in prayer, meditation, or
some sort of spiritual practice that
supports you.
ment not only controlled the cancer but
treating chronic cancer
also allowed her to maintain her normal
New developments in cancer treatment
routine.
have changed our ideas about the best
“I never did stop anything in my life.
way to treat cancer. “The goal of treat-
I volunteer at the church preschool on
cfthrive.com
cover story
Wednesdays, and I missed only one day
Preventing complications
says, it’s important to address it up front.
because my white count was low,” Patty
Despite advances in treatment, chronic can-
“Let’s not wait for a fracture to occur,” he
says. “Even through all 24 chemotherapy
cer can be rife with complications. “Patients
says. “Let’s be proactive and treat it with a
treatments, I have not been sick; I have not
are doing much better than before and liv-
more minimally invasive procedure.”
thrown up. I have maintained my life.”
ing longer,” says Richard Schmidt, MD,
Saying she didn’t stop anything is an
medical director of orthopedic oncology at
Be Your own advocate
understatement. In fact, her coping meth-
CTCA in Philadelphia, Pennsylvania. “The
Living with chronic cancer is not with-
od was to stay busy. Patty lives in Thayer,
spin-off of that is that because they are do-
out challenges. Whitworth asks patients:
Kansas, on a cattle ranch. Throughout her
ing better and living longer, they are devel-
“What is it that you want to do, and what
treatment she continued to ride horses,
oping metastatic sites to the bones.”
is stopping you?” Then she works to help
work, and garden—and she even took a
These bone metastases can cause pain
them address those challenges. She says
two-week vacation to a dude ranch in Col-
and even fractures, which can result in a
that it is imperative that patients discuss
orado. Stay busy doing what you love to do
spiral of complications. Dr. Schmidt says
their concerns with their health care team.
is her motto.
that in the face of metastatic cancer, it’s
“We’re here to help, but we can’t help if we
important to be proactive and prevent
don’t know what the issue is,” she explains.
fractures. One way to do this is through a
Dr. Schmidt echoes this sentiment and
“There are new technologies that have also
procedure called prophylactic stabilization
says that it is important for patients to pay
changed the way we treat cancer,” Dr. Jag-
of the femur, which involves putting a rod
attention and ask questions. “Patients re-
gernauth explains.
or pin into the thighbone to prevent it from
ally need to ask their health care provider:
breaking.
‘What is the status of my bone health? Are
treatment advances
These new technologies include targeted
agents, which are drugs designed to attack
The femur is one of the most common
my bones involved yet or not? Should I get
cancer cells while sparing healthy cells, and
sites for bone metastases, and a broken fe-
a bone scan?’ ” he says. “A lot of times we
immune therapy, which fights cancer by
mur can have devastating consequences,
focus on the primary lesion, and we tend
stimulating the immune system.
resulting in invasive surgery; a long, slow
to get outflanked a little bit. The patient
Melanoma, the deadliest form of skin
healing process; and loss of mobility. In
is complaining of bone pain, and no one
cancer, may soon be considered more of
contrast, a prophylactic stabilization can be
does an X-ray. If you have bone pain, insist
a chronic illness because of the impact on
performed through two or three small inci-
on getting an X-ray.”
the disease of targeted agents and immune
sions, and the rehabilitation from the pro-
therapy. “In the past few years, targeted
cedure is minimal.
coping with chronic cancer
agents have changed the way we treat mel-
Dr. Schmidt performs a lot of these pro-
Ultimately, the most important aspect of
anoma,” explains Dr. Jaggernauth. “People
cedures in an effort to help patients main-
living with chronic cancer may boil down
are living longer with the disease.”
tain quality of life and remain mobile and
to effective coping strategies. The most in-
What’s more, the way in which we deliver
independent. “From a holistic standpoint,
novative treatment approach and the best
treatment has changed. “There are lots of
it is important to keep patients active, mo-
supportive care can only do so much. If
different ways to administer medications
bile, and in charge of their own destiny,”
you’re mired in fear and stress, it’s going
now,” Whitworth explains. Oral chemother-
he explains.
to have an impact on your overall outlook
apy is sometimes less invasive, and there are
A patient who has bone pain or evidence
a lot of options available to help combat side
of disease progression might be a candi-
Joe says that though he has encoun-
effects. “We’re going to arm you—give you
date for the prophylactic procedure. When
tered fear and stress, his faith has provided
an arsenal of good stuff—to help minimize
a magnetic resonance imaging (MRI) scan
strength and refuge. “Before cancer came
or alleviate side effects,” Whitworth says.
indicates disease progression, Dr. Schmidt
along, I knew God in my head, but I didn’t
and quality of life.
cfthrive.com
cover story
“Cancer wants to steal joy and steal
life, but love will conquer it. So focus
on love, joy, and life.” —Joe Mills
really know him in my heart,” he says.
with friends and family. “A positive atti-
out cancer,” he explains. “I focus on what
“What has happened the most with this
tude is very important,” she insists. “Life
I want to achieve. Cancer wants to steal
cancer is the development of my faith. I
is precious. Enjoy every single minute of
joy and steal life, but love will conquer it.
know now that man is limited, medicine
it because none of us knows when we
So focus on love, joy, and life.”
is limited, but not God.”
could be taken out of here.”
Throughout his treatment Joe has had
Patty’s faith was instrumental in her
numerous conversations with God. “I
journey, also. “Put God first. If you let
realized I could focus on the disease or
God help you, you sure get along a whole
God,” he says. “I could focus on the ill-
lot better.”
ness or focus on living. I decided to focus
Joe uses an auto-racing analogy, ex-
on living. It is my faith in God that pro-
plaining that when drivers are going
vides strength, peace, joy, and comfort
through a high-speed turn, they’re look-
when fear tries to creep in.”
ing at marks on the pavement rather
Patty took a similar approach. She de-
than the wall that they don’t want to hit.
cided to stay busy and surround herself
“That’s how I live my life with or with-
cfthrive.com
No case is typical. You should not expect to
experience these results.
nutrition
Homegrown
Nutrition
Homegrown and farm-fresh herbs and veggies add flavor and
a nutritional boost to your meals. By Diana Price
photos by eric Green
cfthrive.com
ask the exPert
Cooking Up
Healthy Choices
Dietitians share their favorite healthy recipes.
cfthrive.com
nutrition
W
hen Larry Kessel, executive chef and
they come together to plan which herbs and vegetables they’ll
director of culinary services at Can-
grow, the team focuses on how the foods can help them create
cer Treatment Centers of America®
truly delicious dishes that highlight the produce. “We’re always
(CTCA) in Philadelphia, Pennsylva-
looking at how we can serve healthier, more nutritious food,”
nia, talks about incorporating fresh
Chef Kessel says, “and how we can eliminate unhealthy things
herbs and vegetables from the organic gardens at CTCA® into
in our recipes—butter, saturated fats, gluten, heavy sauces. We
the food he and his team offer patients, it’s hard not to notice the
like to use lots of herbs because it helps accentuate the flavor of
reverence in his descriptions. “As a chef, when you walk out in
the food and allows us not to have to rely on a lot of sodium and
the morning and the sun’s just coming up and there’s still dew
saturated fat—and it incorporates a great fresh flavor.”
on the ground and you see the herb garden—filled with basil,
The tasty results of Chef Kessel’s efforts to incorporate the
thyme, mint, chives, parsley, rosemary, peppers, tomatoes—and
fresh, homegrown produce include dishes like beef tenderloin
when you can pick fresh herbs and then go back in the kitchen
with chimichurri sauce and Maryland crab and corn vinaigrette
and cook with them, that’s the best.”
with yuzu and garden thyme, along with many other creative
And if you’ve ever popped a cherry tomato into your mouth
recipes and comfort food favorites. Though some of the cre-
straight from the plant, warm from the summer sun, or if you’ve
ative combinations may seem exotic, Chef Kessel says that fresh
tasted the difference that fresh basil makes in a pasta dish, or
herbs can be used in very simple ways to delicious effect, and
just-picked lettuce in a garden salad, you know the magic that
he encourages patients and caregivers to use fresh herbs when
Chef Kessel is describing. There is no doubt that food that comes
cooking at home. For instance, fresh basil can be pureed with
to the plate fresh from the field—or the windowsill herb garden
garlic, pine nuts (or walnuts), olive oil, and parmesan cheese to
or pots on the patio—offers a wealth of nutritional and taste
make pesto (great on pasta and as a sauce for chicken and fish);
benefits.
and many herbs can be added in vinaigrettes or marinades for
Chef Kessel says that the on-site garden at CTCA allows the
a quick punch of flavor.
culinary team to develop menus that provide patients with fla-
For those who want to grow their own fresh ingredients at
vorful, healthy meals based around seasonal ingredients. As
home, Chef Kessel says, there’s no need for major acreage—or
cfthrive.com
nutrition
Chef larry Kessel
time—to reap the rewards of flavorful
fresh herbs and veggies. Herbs especially
can be grown in pots on a patio or in
window boxes, as can lettuces and tomatoes. “Growing herbs is very simple,” he
says. “You can use planter boxes with
grow lights and grow from seed, or you
outside on a ledge, deck, or windowsill
recipes
and pick them as you need them—and
marYlanD craB anD corn vinaigrette with
once an herb garden starts to grow, it
Yuzu anD garDen thYme
takes off.” Once you start cooking with
Zest of 1 lemon
these ingredients, Chef Kessel says, you
1½ tablespoons fresh yuzu juice or fresh lemon juice
will never go back. “There’s nothing like
⅛ teaspoon freshly ground black pepper
the flavor that you get from fresh herbs
1 teaspoon chopped fresh thyme
as opposed to dry herbs.”
¼ cup extra virgin olive oil
can buy starter herbs and let them grow
Of course, if growing your own is not
Kosher or sea salt, to taste
practical, remember that most grocery
¼ pound grilled corn (removed from cob)
stores carry fresh herbs as do farmers’
¼ pound picked Maryland crab
markets. So, get your green thumb—or
1 teaspoon chopped fresh chives
your green grocer’s bag—in gear and
In a medium bowl, combine the lemon zest, yuzu juice, pepper, and thyme. Slowly
add some fresh herbs and veggies to your
whisk in the olive oil. Once all of the oil is whisked, season with a touch of kosher
next meal.
salt or sea salt. Then add the corn, crab, and chives. Adjust seasoning to taste.
Serve as a salad or as a sauce on grilled or pan-seared fish.
cfthrive.com
nutrition
Beef tenDerloin with
chimichurri sauce
Chimichurri Sauce
¾ cup olive oil
3 tablespoons sherry wine vinegar or red wine vinegar
3 tablespoons fresh lemon juice
3 cloves garlic, peeled
2 medium shallots, peeled and quartered
1 teaspoon fine sea salt
½ teaspoon fresh ground black pepper
½8 teaspoon dried crushed red pepper
3 cups (packed) stemmed fresh parsley
2 cups (packed) stemmed fresh cilantro
1 cup (packed) stemmed fresh mint
Beef Tenderloin
3½-pound beef tenderloin
2 tablespoons olive oil
Freshly ground black pepper, to taste
Kosher or sea salt, to taste
Note: Chef Kessel suggests using very little salt during the
cooking process. When the tenderloin is cooked, use a finishing salt like French sea salt or Himalayan pink salt sprinkled
on top.
Combine the first eight ingredients of the chimichurri sauce in blender; blend until almost smooth.
Add one-quarter of the parsley, cilantro, and mint;
blend until incorporated. Add the remaining herbs
in three more additions, puréeing until almost
smooth after each addition.
Let beef stand 1 hour at room temperature. Preheat oven to 350°. Add oil to a sauté pan and bring
to high heat, add tenderloin, and sear each side until
browned. Finish in the oven until an instant-read
thermometer inserted into the thickest part of the
beef registers 135° for medium rare, about 40 minutes. Transfer to platter; cover loosely with foil and
let rest for 15 minutes. Thinly slice beef crosswise,
season with pepper and salt to taste, and serve with
chimichurri sauce.
cfthrive.com
ask the expert
Banana Flax
Granola Bars
summery
Bean salad
Matt Rinehart RD, CSO, LD
CTCA in Tulsa, Oklahoma
Sarah Possato, RD
CTCA in Zion, Illinois
These banana flax granola bars are a tasty, well-balanced snack.
I personally love this Summery Bean Salad because it is very
The rolled oats provide a good source of whole grain; the
fast and easy to put together as well as filling and delicious!
bananas provide potassium; the wheat germ, almonds, whole-
The avocado provides heart-healthy unsaturated fats, and the
grain oats, and egg provide protein; the cinnamon, flaxseeds,
strawberries provide the antioxidant vitamin C. Beans offer an
and wheat germ offer antioxidants; the ground flaxseed and
array of unique phytochemicals and antioxidants that are found
the wheat germ provide omega-3 fatty acids, which have anti-
in no other foods. For our patients at CTCA® who are trying
inflammatory benefits; and the almond milk is 50 percent more
to incorporate more plant-based protein sources, beans are a
fortified with calcium than cow’s milk. In addition, the bars
fantastic alternative—and they also contain detoxifying fiber,
are sweetened naturally with honey, and they offer improved
which helps keep the digestive tract functional.
blood sugar control compared with average granola bars due to
of the ingredients may have natural cancer-preventive benefits:
summery Bean salad
Dressing
fiber has been shown to reduce the risk of colorectal cancer, and
1 tablespoon extra virgin olive oil
ground flaxseed has in some cases shown anticancer benefits
1 tablespoon lemon juice or balsamic vinegar
with prostate, colon, and breast cancer. And as if that weren’t
Pinch of red pepper flakes
enough, these bars taste great!
1 tablespoon agave
the fiber and protein content and the cinnamon. Finally, several
Salt to taste
Banana Flax Granola Bars
1½ cups rolled oats
½ cup slivered almonds, crushed
2 tablespoons wheat germ
4 tablespoons ground flaxseeds
1 tablespoon cinnamon
½ cup carob chips
2 tablespoons honey
1 banana, mashed
1 egg
½ cup almond milk
Salad
Preheat oven to 350º. Mix all dry ingredients together. Add
Drizzle with dressing and mix together. Salad may be served
honey, banana, egg, and almond milk. Spread evenly in baking
cold or at room temperature.
dish lined with parchment paper. Bake for 25 to 30 minutes or
until browned.
1 cup strawberries, quartered
1 avocado, pitted, peeled, and diced
1 cup dry black beans, cooked until tender (will produce 2 cups)
or 2 cups canned black beans, rinsed
4 to 5 spring onions or scallions, ends trimmed, cut into
½-inch pieces
Mix dressing ingredients together; set aside. Combine
strawberries, avocado, beans, and onions in a large bowl.
Makes four 1-cup servings
Nutrition information per serving: calories 272; protein 9 g; carbohydrates 32 g;
total fat 12 g; saturated fat 1.5 g; dietary fiber 5 g; sodium 213 mg
Makes 10 servings
Nutrition information per serving: calories 193; protein 7 grams; carbohydrates
22 g; total fat 9 g; saturated fat 1.5 g; dietary fiber 4 g; sodium 29 milligrams
cfthrive.com
“ My breast cancer
diagnosis was the
heaviest weight
I’ve ever had to
bear.”
Karyn Marshall, DC
Breast Cancer Patient
Doctor of Chiropractic
World Champion
Weightlifter
ask the exPert
mixed Berry
CousCous
Danielle Bach, MS, RD, CSO
CTCA in Goodyear, Arizona
This is one of my favorite summertime recipes—the mint leaves
and the orange zest make it quite refreshing. Here at CTCA we
recommend that patients eat a cup of berries daily due to the
antioxidant content, which can help support the immune system,
and this recipe provides an easy way to get your daily berries. The
Greek yogurt is a great source of protein and probiotics, which
are “good” bacteria that help with gastrointestinal function. And
both the cinnamon and the fiber content from the berries help
with blood sugar management. Finally, this recipe is relatively
fast and easy, and it’s filling.
mixed Berry CousCous
1 cup instant couscous
2 cups apple and cranberry juice (no added sugar)
1 cinnamon stick
2 teaspoons orange zest
As a world-record-setting weight lifter, I was determined to
bring the tenacity that had served me so well in the gym to
my fight against breast cancer.
And as a chiropractor, I was especially impressed with
the approach at Cancer Treatment Centers of America®
(CTCA). It is called Patient Empowered Care®, and it means
I had a dedicated team of cancer experts who collaborated
on my treatment and worked with me to develop a detailed plan based on my specific needs. My team combined
advanced cancer treatments with supportive therapies like
acupuncture, nutritional counseling, and chiropractic care to
help ease the side effects of my treatment. I know it made
me a much better fighter.
Today, I’m busy training for fitness competitions again. And
I’m more certain than ever that CTCA® was the right
choice for me.
If you or a loved one has been diagnosed
with advanced-stage or complex cancer,
call 1-800-264-1255 or visit us at
cancercenter.com. Appointments
available now.
Atlanta • Chicago • Philadelphia • Phoenix • Tulsa
©2013 rising Tide
9 ounces raspberries
9 ounces blueberries
9 ounces strawberries, halved
7 ounces low-fat Greek yogurt or regular yogurt
2 tablespoons maple syrup
Fresh mint leaves, to garnish
Place the couscous in a bowl. Pour the juice into a saucepan
and add the cinnamon stick. Cover and bring to a boil. Remove
from heat and pour over couscous. Cover couscous mixture with
plastic wrap and let sit for about 5 minutes or until all the liquid
has been absorbed. Remove and discard the cinnamon stick.
Separate the grains of couscous with a fork, then gently fold in
the zest and most of the berries. Spoon the couscous mixture
into four serving bowls and sprinkle with the remaining berries.
Top with a generous dollop of yogurt and drizzle with the syrup.
Garnish with mint leaves and serve.
Makes 4 servings
Nutrition information per serving: calories 343; protein 9 g; carbohydrates
70 g; total fat 3 g; dietary fiber 7 g; sodium 35 mg
cfthrive.com
ask the expert
ToFu PumPkin PuddinG
Danielle Kennedy, RD, LDN
CTCA in Philadelphia,
Pennsylvania
I often recommend this tofu pumpkin pudding as a tasty treat
Providing loans to people living
with late-stage cancer
Are you experiencing
financial hardship?
for my patients because it’s easy on the digestive tract. The
ginger and subtle spice flavor help ease nausea, and the tofu
base provides nutrient density. It is simple to prepare and easy
to store, allowing patients to pull it out of the fridge for a quick
snack anytime. It gives the sense of a sweet treat without all of
the added sugar and fat, and it can be added to other foods to
provide extra calories and flavor.
ToFu PumPkin PuddinG
16-ounce can pumpkin
¾ cup granulated sugar
½ teaspoon salt
1 teaspoon ground cinnamon
½ teaspoon ground ginger
¼ teaspoon ground cloves
10-ounce package soft silken tofu, blended until smooth
Preheat oven to 425º. Cream together the pumpkin and the
sugar. Mix in the salt, spices, and tofu until thoroughly blended. Pour into a greased 8-by-8-inch pan. Bake for 15 minutes.
Lower the heat to 350º and bake for an additional 30 minutes
or until set.
Makes 9 servings
Nutrition information per serving: calories 108; protein 3 g; carbohydrates 23 g;
total fat 2 g; sodium 284 mg
If you have late stage cancer, a life insurance policy
and are experiencing financial hardship, our
Loans For Living program may be an option
for you. Call today to speak to one of
our experienced counselors.
1-866-459-1271
www.fifthseasonfinancial.com
meet the doctor
QA
meet the Doctor
&
samuel bieligk, md, facs
Surgical Oncologist
cancer treatment centers of America®
tulsa, Oklahoma
Samuel Bieligk, MD, FACS, is certified by the
why did you choose to specialize in
American Board of Surgery and is a Fellow of the
surgical oncology?
American College of Surgeons. After receiving a
When I was a general surgery resident at Tulane University Medical
bachelor’s degree in chemical engineering from the
School, I met a doctor who was pursuing a fellowship in surgical
University of Oklahoma, Dr. Bieligk earned a medical
oncology; I was very impressed with his knowledge of anatomy and
degree from the university’s medical school. He went
his technical abilities as a surgeon, and I was fascinated by the field of
on to complete a general surgery residency and a
surgical oncology. From that moment on, I felt like surgical oncology
research fellowship at Tulane University School of
would be my area of expertise.
Medicine in New Orleans and a surgical oncology
fellowship at Memorial Sloan-Kettering Cancer
why did you choose to practice medicine at ctca?
Center in New York City. Prior to joining CTCA®, Dr.
My decision was based on a combination of events. I received a
Bieligk served as medical director of surgical oncology
notification in the mail from a recruiter about coming by a booth to learn
at St. John’s Regional Medical Center in Joplin,
about CTCA at one of our medical meetings. I didn’t end up visiting the
Missouri. He has also served as an attending surgeon
booth, but once I got home I felt like I should give them a call, which I
at hospitals in Maryland and as an assistant professor
did, and then I traveled to Tulsa, Oklahoma, to visit the hospital.
in the departments of surgery at the University of
Maryland School of Medicine in Baltimore and the
After I lost my home and office in the tornado that hit Joplin, we worked
University of Texas Southwestern Medical Center
out of a trailer and a tent for a while before making the decision to
at Dallas. Dr. Bieligk has been published in many
move to Tulsa. The people at CTCA were very interested in my specialty
clinical periodicals, has contributed to multiple
because I could perform hyperthermic intraperitoneal chemotherapy
research projects and clinical research protocols, and
(HIPEC), and I felt comfortable there. It was a tough decision to leave,
has presented at numerous clinical conferences across
but it was the best decision for me personally and professionally.
the country. Dr. Bieligk is a member of the American
College of Surgeons, Society of Surgical Oncology, and
what do you like about ctca?
American Medical Association.
I like that I can walk 20 feet to meet with a medical oncologist about a
particular patient, I can meet with a gastroenterologist within 25 feet, I
cfthrive.com
meet the doctor
“Surgical oncology is changing in that we have an increasing
number of innovative technologies at our disposal.”
can consult with another surgeon with-
At CTCA the access to innovative
lives have been enhanced by surviving
in a few feet, and the radiation oncolo-
treatment is so much more robust than
this tragedy and the experiences that
gist is 100 yards away. This access to the
any other place I have worked. In my
followed.
multidisciplinary team facilitates my
previous employment and practice,
ability to make timely, informed patient
the ability to perform cutting-edge
what hobbies or interests do
management decisions, and I like that.
therapies was hindered by a lot of red
you pursue in your free time?
And there is a closeness with patients
tape and difficult hurdles, whereas here
I spend most of my free time with my
that is really nice.
the pathways to using these innovative
children. I like building things with my
technologies are much more clear—there
hands, and I recently built a tree house
how do you see the specialty
are fewer obstacles, and I can sense that
for my middle daughter. I also like
of surgical oncology
we will continue to pursue these new
attending football games, and my oldest
changing in the future?
treatments.
daughter and I attend University of
Surgical oncology is changing in that we
Oklahoma games.
have an increasing number of innovative
you and your family survived
technologies at our disposal: We use
the 2011 tornado in Joplin.
HIPEC, intraoperative radiation therapy
how did that experience
(IORT), and multiple modalities. I think
affect your oncology career
that surgical oncology will continue to
and you personally?
use these and other new technologies,
Certainly, every day we are much more
which are increasingly robust and more
thankful about almost everything. We
advanced. Laparoscopic surgery is
are so grateful to have a home, to be
another one of those innovative surgical
safe, and to know that we’re going to be
advances. All of these advanced strategies
fine from an employment standpoint—
really provide the patient with treatment
all those things you can take for granted.
opportunities that they’ve never been
We also appreciate our children and
offered before.
our faith more, and we find ourselves
grateful for the small things on a
regular basis. We definitely feel that our
cfthrive.com
For a free print subscription go to cfthrive.com
tips & trends
tips & trends
Managing Nausea
Ginger is a powerful
anti-nausea tool.
Try ginger tea or
ginger candies.
Need a ride?
Among the many considerations related to cancer
treatment, some cancer
patients face a practical—
and prohibitive—obstacle to getting the critical
treatment they need: transportation. Patients
who do not drive, do not have access to public transportation, do not have the financial resources to pay for transportation, or do not feel
well enough to get to treatment may not be able
to get the care they need. in these situations the
American cancer Society provides a valuable resource: its road to recovery Program matches
volunteer drivers, who donate their time and
the use of their cars, with patients who need to
be driven to treatment. For more information
call (800) 227-2345.
Many people being treated for cancer worry about experiencing side effects related to the digestive system—especially nausea. the good news
is that not everyone experiences nausea, and, for those who do, there are
many creative options for managing the condition. in addition to taking the
medications that may be prescribed by a doctor, the following are tips for
managing nausea.
• Try ginger products. Ginger is a powerful anti-nausea tool. try ginger
tea or ginger candies. Flavored ginger ale (ginger “beer”) is also an option.
• Other helpful foods. Peppermint tea, queasy “pops” or “drops,” and cola
syrup can also help relieve nausea. every patient is different, so be open
to trying multiple nausea remedies to find something that works for you.
• Avoid strong food odors. Sometimes food odors themselves can be
enough to make you feel sick or vomit. try cold foods more often.
• Eat bland and low-fat foods. Bananas, mashed potatoes, rice, toast,
oatmeal, applesauce, crackers, and other bland foods can be soothing to
the stomach and are less likely to cause vomiting.
• Relax. try to eat your meals in a calm environment. Distract yourself
with peaceful music, a favorite film, or good company.
CleaNiNg for a ReasoN
if you’re going through cancer treatment,
chances are the last thing you have time
and energy for is cleaning your home.
And yet a clean home environment
can make a real difference in your
outlook. For a welcome relief
from difficult physical chores,
consider cleaning for a reason, a
texas-based nonprofit organization
that partners with maid services in
communities across the united
States and canada to provide
female cancer patients with free,
professional cleaning services.
For more information visit
cleaningforareason.org.
cfthrive.com
research today
reSeArch
tODAy
one size Does not fit all
Personalized cancer treatment moves forward.
By kari Bohlke, scD
it’S A POPuLAr terM these days:
to respond to a targeted drug called Zel-
innovation in colorectal cancer care
personalized medicine. But what does
boraf® (vemurafenib).
The development of new, personalized
it actually mean? In the case of cancer,
• For women with early-stage, estrogen
cancer treatments starts with innovative
personalized treatment involves using
receptor–positive breast cancer, the On-
cancer researchers. Edward H. Lin, MD,
the specific characteristics of the cancer
cotype DX® test provides information
a medical oncologist and researcher
and the patient to guide treatment deci-
about risk of recurrence and need for
at Seattle Cancer Care Alliance and
sions. The goal is to identify in advance
chemotherapy.
the Fred Hutchinson Cancer Research
the treatments that are most likely to
Research in personalized cancer care
Center, specializes in the treatment of
be effective for a given individual. Al-
is challenging—cancers can be driven by
gastrointestinal cancers and is studying
though this idea is not a new one, our
multiple, complex biological pathways—
new and more-effective ways to treat
ability to achieve it is growing as re-
but progress is clearly being made. And
colorectal
searchers identify new biological path-
when tests are available to guide treatment
interested in the role of cancer stem
ways that contribute to cancer growth
decisions, patients can benefit no matter
cells in cancer growth and resistance to
and new drugs that target these path-
what the test result. If you learn that you
treatment. “It’s an emerging field,” he
ways.
are not a candidate for a particular treat-
explains. “These are cells that may have
ment, for example, you can avoid the side
escaped chemotherapy, and a higher
here are a few examples:
effects and the cost of that treatment and
number of these cells predicts worse
• Roughly 5 percent of non–small cell
focus your attention on other approaches
outcomes for the patient.”
lung cancers contain an abnormal ver-
that are more likely to be effective.
cancer.
He’s
particularly
A treatment that Dr. Lin is studying
sion of a gene known as ALK. Patients
These tests do not replace a discussion
involves a combination of two drugs
who test positive for this genetic change
of treatment options with your physician,
that are taken orally (by mouth):
tend to benefit from a targeted drug
but they do allow for a more informed
Xeloda® (capecitabine) and Celebrex®
known as Xalkori® (crizotinib).
discussion. Factors other than test re-
(celecoxib). Xeloda is a chemotherapy
• Melanomas that test positive for a par-
sults—such as your individual needs or
drug, and Celebrex is a nonsteroidal
ticular mutation in the BRAF gene tend
preferences—can also be considered.
anti-inflammatory drug (NSAID) that is
cfthrive.com
research today
Researchers can’t take all of the credit for advances in
cancer treatment. The patients who participate in clinical
studies and who try new approaches to treatment are a
key part of the process.
“I was so sick,” she recalls. By this
time Dr. Lin had moved from Texas
to Washington State, but Gail was
determined to take charge of her own
care: “I got on the Internet and looked
for his name because I remembered
that he was doing something different.”
commonly used for such conditions as
the Other Part of the equation
She traveled to Seattle to see him and
arthritis. Interestingly, the combination
Researchers can’t take all of the credit
repeated the treatment with Xeloda and
of these two drugs improved colorectal
for advances in cancer treatment. The
Celebrex that she’d received earlier in
cancer outcomes by targeting cancer
patients who participate in clinical
the course of the disease. She was free of
stem cells in some of his patients.
studies and who try new approaches to
detectable cancer at the time she began
treatment are a key part of the process.
this treatment—and remains so.
“We’ve already treated more than 100
patients,” says Dr. Lin. The result so far:
Gail Shugart, of Alpine, Texas, has
Gail understands that the combination
promising response rates and survival
been treated for metastatic colorectal
of Xeloda and Celebrex is still under
among people with advanced colorectal
cancer by Dr. Lin. Although Gail’s
study, but she feels good about working
cancer. As an added benefit, the addition
story does not prove that Xeloda and
with someone who is actively researching
of Celebrex to Xeloda reduces one of the
Celebrex provide a benefit—definitive
the topic. “He’s an independent thinker,”
frequent side effects of Xeloda: hand-foot
information about the safety and the
she says of Dr. Lin, “and he just wants to
syndrome, a condition that involves red-
efficacy of this treatment requires final
save lives.”
ness and swelling in the hands and the
results from large studies—it does
feet.
illustrate some of the challenges and
What it’s All About
decisions that a person confronting the
Ultimately, personalized cancer care
limits of standard treatments must face.
is about the person. When asked what
To further evaluate the combination
of Xeloda and Celebrex, Dr. Lin is
conducting a phase II clinical trial with
When Gail was first diagnosed with
motivates him, Dr. Lin responds, “It’s
funding from the Gateway for Cancer
colon cancer in the fall of 2004, the
just really gratifying. My family has
Research,
organization
cancer had already spread to her liver.
been touched with colon cancer, and I’ve
that funds innovative, patient-centered
“I was 59,” she says. “I didn’t really pay
seen a lot of patients over the years. It’s
cancer research on both conventional
attention to some of the signs.” She
certainly these patients who inspire me
and complementary cancer therapies.
received conventional treatments such as
to do what I do today.”
“We’re using the Gateway funding to
surgery and intravenous chemotherapy
Organizations such as Gateway that
prospectively prove that you can induce
and was also treated with Xeloda and
fund innovative cancer research share
complete remission in patients with
Celebrex by Dr. Lin, who was then at the
this focus: the organization’s research
colon cancer,” says Dr. Lin. The study
MD Anderson Cancer Center. Together
mission is to support patient-centered
will compare Xeloda and Celebrex with
these treatments eliminated all signs of
research that improves cancer treatment
standard chemotherapy among patients
cancer.
outcomes and restores the cancer
a
nonprofit
with metastatic colorectal cancer that
In spite of this good response to initial
has responded to initial chemotherapy.
treatment, the cancer later returned—
The study will also explore whether
twice—in one of her lungs. Surgeons
For more information about
certain biologic markers can predict
were able to remove the lung metastases,
Gateway-funded clinical trials, visit:
which patients are likely to respond to
but Gail found that she couldn’t tolerate
demandcurestoday.org/cancer-research.
the novel treatment.
the additional intravenous medications.
patients’ quality of life.
cfthrive.com
At CTCA, we fight breast cancer with advanced medical
treatments that help patients experience a better quality of
life. Learn more about our breast cancer treatment program.
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Andrea Bateman 1-800-749-7116, [email protected]
special feature
THe Big
PiCTURe
Quality of life is key.
By Laurie Wertich
L
ife doesn’t stop in the face of a cancer
diagnosis—in fact, it often gets busier.
There are doctor appointments, scans, and
treatments—on top of work, carpools,
laundry, meals, household maintenance, and so much
more. It is a juggling act that would challenge even the
most proficient multitasker.
So, how can cancer patients juggle all of these
challenges? The answer boils down to one thing: quality
of life.
Quality of life
Quality of life refers to an individual’s overall wellbeing—the emotional, social, and physical aspects
of life and how they may be impacted over time by a
disease or daily stressors.
The fundamental key to surviving and thriving with
cancer is maintaining a good quality of life. Focusing
only on treating cancer can leave patients feeling sick,
tired, and unable to perform the activities they have to
do or love doing.
Christopher M. Stephenson, DO, an osteopathic
physician and hospitalist at Cancer Treatment Centers
photos by Bart harris
cfthrive.com
Left to right: Audrey ridolfi; chris M. Stephenson, DO;
Mary thyme, rN; Awilda Lafonne, PA
cfthrive.com
special feature
works to resolve any concerns and regularly communicates with the patient’s entire CTCA care team to ensure immediate and continual symptom management
throughout treatment and beyond.
“The goal of the Quality of Life
Center is to provide comprehensive,
hopeful solutions, including medical
and integrative therapies and services,
to enhance the physical and emotional
well-being of our oncology patients at
all phases of their care,” Dr. Stephenson
explains. “Upon entering treatment, the
patient is viewed as a survivor, and all
resources are focused on improving his
tom Lay; chris M. Stephenson, DO; Sara Mortenson
or her quality of life.”
of America® (CTCA) in Zion, Illinois,
This does not happen by accident; rather,
explains that when patients experience
it is an intentional, well-researched, and
the whole patient
symptoms such as pain or fatigue, it can
targeted approach that has resulted in the
Cancer is just one piece of the puzzle.
not only affect their ability to perform
creation of special clinics designed to focus
Many patients diagnosed with cancer are
activities of daily living but also interfere
on the wants and the needs of patients.
living with other chronic conditions—
The Quality of Life Centers at CTCA
referred to as comorbidities—such as
offer a unique, innovative approach to
diabetes, heart disease, osteoporosis,
helping patients navigate cancer and
obesity,
addressed properly or controlled or
maintain the best quality of life possible.
commonly experience many symptoms
managed, then we’re not going to have
The clinics are an integral component
as a result of cancer treatment, the most
compliance with treatment, and we’re not
of each hospital and provide a central
common of them being fatigue, pain,
going to have success—leading to greatly
location for addressing and managing
neuropathy, nausea, anxiety, depression,
diminished outcomes,” Dr. Stephenson
symptoms as well as coordinating
and sexual dysfunction.
says.
treatment.
with treatment and even the response to
that treatment.
“If one of those issues is not being
and
many
more.
Patients
The Quality of Life Center is a place,
“There are different patients who are
putting Quality of
life first
outside of regular oncologic care, where
candidates for different therapies,” explains
patients can address any issues that might
Dr. Stephenson. “These therapies have to be
At CTCA® cancer treatment and quality
interfere with their daily living. The spe-
monitored and modulated for the specific
of life go hand in hand, with doctors and
cially trained medical professionals work-
condition of the patient.”
patients working together through all
ing with patients oversee the big picture
For example, patients with severe
stages of treatment and follow-up care.
and treat the patient as a whole. The team
cardiac disease may not be candidates for
Mistie Bickford and her mother, Kim, often exercise together.
cfthrive.com
special feature
some medications used to treat cancer.
the management of their comorbidities,”
effective to take during treatment and
Patients with diabetes may need extra
Dr. Stephenson says.
with the specific diagnosis.
support with controlling blood sugar
The care management team tracks the
If a patient has a prior cardiovascular
because some cancer treatments can
data, so that if a patient has level-4 pain
condition, physicians in the Quality
affect blood sugar control.
(on a scale of 0 to 10) in June and that
of Life Center use preventive strategies
pain jumps to a level 7 in July, the issue
to ensure that the patient does not
will be addressed.
encounter heart issues during surgery.
“Each one of our hospitals has an
oncology-mindful,
internal
medicine
care approach that addresses the core
“What sets us apart is how we manage
For example, they’ll optimize their heart
issues that are unique to each patient,
and measure these things,” says Dr.
and blood pressure medications, and
the specific treatments for the disease,
Stephenson. “If the patient’s pain level is
they’ll also prescribe the appropriate
and the comorbidities affecting that
too high, the nurse will tell the doctor. If
pain medications to relieve and prevent
particular patient,” Dr. Stephenson says.
he or she needs assistance in managing
pain because a pain response could place
The bottom line is that the physicians
the pain, the patient is referred to the
extra stress on the heart.
and the nurses in the Quality of Life
Quality of Life Center, where I will do
Pain management is one of the most
Centers have a vitally important job: to
everything within my power to bring
critical factors to maintaining a good
know and understand each individual
relief to the patient. This is unique. No
quality of life. “Pain interferes with ev-
patient so that they can help proactively
one else is doing this.”
erything,” Dr. Stephenson explains. “It is
a significant health issue that affects all
manage any side effects or health issues
an ounce of prevention
other issues in a patient. How can one
Measuring and tracking symptoms is only
truly enjoy life if he or she is always in
assessing Quality of life
the starting point. The Quality of Life
pain? Many clinicians consider it the
All care team members at CTCA
Center is about action, specifically pre-
fifth vital sign.”
continually work to monitor and assess
ventive action. More often than not, the
patients’ quality of life. CTCA has
best defense is a good offense.
that may arise during treatment.
“We have a very aggressive pain management protocol in place at CTCA. If
implemented a new assessment protocol
“We try to prevent complications be-
you are in so much pain all the time, you
that nurses use every time they see a
fore they arise,” Dr. Stephenson explains.
are not going to want to comply with
patient. “Essentially, we are having
The only way to do this is to know exactly
your treatment plan,” Dr. Stephenson
our nurses measure things that impair
what is going on with each patient.
says. “If patients have pain, we are go-
our patients’ well-being,” explains Dr.
For example, if a patient has diabetes,
Stephenson. “We are measuring the
the physicians in the Quality of Life
things that patients tell us are important
Center take a proactive strategy to
to improve their quality of life during and
managing both the diabetes and the
communication is key
after the cancer is treated.”
cancer. Dr. Stephenson explains that they
Addressing
This nurse assessment includes nine
will use long-acting and short-acting
a main key to cancer treatment. The
symptoms that nurses ask patients about
insulin to counteract the negative effects
innovative
every time they visit the clinic: pain,
that can occur as a result of some cancer
at CTCA is a good starting point
anxiety, depression, numbness/tingling,
treatments. What’s more, all patients
and can open the door to effective
fatigue, nausea/vomiting, appetite changes,
have access to nutrition and naturopathic
communication between the patient and
constipation, and diarrhea. “After 14
oncology providers at CTCA hospitals,
the team physicians.
months of analysis and research, we came
who will help the patient determine what
up with these key predictors of symptom
to eat to maintain an ideal weight and
important for patients to be open about
management that will affect compliance
blood sugar during cancer treatment
their symptoms. “If you are empowered
with the entire oncologic therapy plan and
and what natural therapies are safe and
to speak with your doctor about these
cfthrive.com
ing to do something about it before they
leave.”
Dr.
quality-of-life
nurse
Stephenson
issues
assessment
says
that
is
tool
it
is
special feature
issues, you will feel more comfortable
with your doctor and your treatment, and
you will have a better clinical response,”
he insists.
“We listen to our patients,” Dr.
Stephenson says. “Then, having heard
them, we solve the problems with them
and give them strategies for managing
their symptoms to improve their overall
quality of life.”
Dr. Stephenson with members of the care team
™
With Coram, patients benefit from a broad
range of specialty infusion services, including:
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cfthrive.com
naturopathic
environmental
risk factors
By Laurie Wertich
W
How do lifestyle
factors and
exposure to
environmental
substances
affect our
cancer risk?
hat causes cancer? It’s the million-dollar
exposure to that substance can increase the risk of cancer.
question—and if you pay attention to
The term environmental risk factor usually brings to mind
the messages in the media, the answer is:
things like chemicals and radiation, and these things are indeed
everything. But that isn’t really the case.
risk factors; however, there are many other factors that fall
There are indeed some environmental risk factors for
within that category, as well. In fact, the greatest risk factors
cancer—meaning exposure to substances that could increase
we face in the United States are not exposures to radiation or
the risk of developing cancer—but there are also a lot of
chemicals in the environment around us but, rather, our own
unproven claims about factors that increase the risk of cancer.
dietary and lifestyle choices—most of which can be modified.
The trick is learning to discern fact from fiction. The best way
“From a public health point of view, environmental risk factors
to protect ourselves from cancer: information and lifestyle
are not just things that you are exposed to in the environment
modification.
around you or the things you eat, drink, or put on your skin.
They are the sum total of those factors, plus other behavioral
what is an environmental risk factor?
and lifestyle factors that expose your body to carcinogens and
Environmental risk factors for cancer are things in your
affect how your body responds to those carcinogens,” explains
environment that may increase the risk of developing cancer.
Robert Wascher, MD, FACS, surgical oncologist at Cancer
Carcinogens are materials that are known to cause cancer.
Treatment Centers of America® (CTCA) in Goodyear, Arizona,
When a substance is referred to as a “known cancer risk factor”
and author of A Cancer Prevention Guide for the Human Race
or a “known carcinogen,” it means that science has proven that
(Dog Ear Publishing, 2010; $14.99).
cfthrive.com
naturopathic
AvOiDiNG exPOSure tO
eNvirONMeNtAL riSK FActOrS
There are plenty of steps you can take to limit your exposure
to environmental risk factors.
• Avoid tobacco. the best advice is to abstain from all
tobacco products, including cigarettes. if you live with
a smoker, have him or her smoke outside; install an
air filtration system in the home and wash clothes
frequently, especially before holding a baby because
clothing can carry the toxic compounds.
• Maintain a healthy body weight and get three to four
hours of moderate physical activity per week.
• Minimize alcohol intake, which for most adults means
no more than one or two alcoholic beverages per day
(and preferably less).
• Cook meats at low temperatures to avoid charring.
• Minimize your intake of meat and other animal
products and increase your intake of whole grains and
fresh fruits and vegetables.
“TobACCo IS
bY fAR THe
GReATeST CAuSe
of CANCeR CASeS
AND DeATH.”
lifestyle factors
“When you take that broader view, tobacco in all of its forms is
still the greatest environmental risk factor for cancer, whether
you use it yourself or are exposed to it by others,” Dr. Wascher
notes. “At least one-third of all cancer deaths are directly or
indirectly related to tobacco exposure.”
The next biggest category, which also accounts for one-third
of cancer deaths, is a group of lifestyle factors lumped together:
obesity, alcohol intake, physical inactivity, and dietary exposure
to food-related carcinogens. In other words, when you look at
• Comply with cancer screening guidelines and
recommended vaccinations.
these two main categories of cancer risk factors, 60 percent of
• Avoid electromagnetic fields (EMFs). in the home two
of the biggest sources of eMFs are hairdryers and electric
blankets.
these lifestyle factors.
• Clean house. remove shoes before entering the house
and dust, vacuum, and mop frequently to cut down on
chemicals that can accumulate in dust.
cancer diagnoses could be avoided through modification of
These environmental factors are modifiable, but what about
the other 40 percent? Are there other cancer risk factors that we
might be able to avoid? Maybe—and some of them are more
modifiable than others.
identifying risk factors
• Use natural or homemade cleaning products. Most
cleaning products are loaded with chemicals, and
manufacturers are not required to disclose ingredients
on the label. read labels carefully and buy products that
disclose their ingredients.
“There are a number of compounds in the air, water supply,
• Get a radon detector. if you have particularly high levels
of radon in your home, you may want to seek the services
of a radon specialist. you may benefit from sealing
off your basement and installing a radon remediation
system. Sometimes these things are even covered by
homeowner’s insurance.
cases and cancer-associated deaths, but it’s hard to accurately
• Avoid BPA. BPA is found in plastic, canned foods, and
even on receipts.
and food supply that carry potential risk,” explains Dr.
Wascher. “Some of these environmental factors are still not
well understood. However, occupational exposure to known
carcinogens probably accounts for two to five percent of cancer
measure environmental exposure to carcinogens outside of
certain work environments.”
There’s the catch: how do we measure exposure and assess
risk when we aren’t sure what we’re even measuring? In the
scientific community, randomized controlled clinical trials
are the gold standard—meaning that one group is given some
sort of intervention (like exposure to a type of medication) and
cfthrive.com
naturopathic
environmental factors that are beyond
debate.
AIR PolluTIoN
• Tobacco Tobacco use, particularly
cigarette smoking, has been linked to
almost every type of cancer, especially
lung cancer. “Tobacco is by far the greatest cause of cancer cases and death,” Dr.
Wascher says. According to Shelly Smekens, ND, naturopathic resident at CTCA®
in Zion, Illinois, the risk is high for both
smokers and nonsmokers exposed to secondhand smoke.
• Radon Radon is a colorless, odorless
gas that develops as a result of uranium
decay. It is present in some level almost
everywhere in the world, but some places
have higher levels of radon, particularly
areas with cold winters and in buildings with basements where the gas can
accumulate. “After cigarette smoking,
radon is the second-highest modifiable
another is not, and then the two groups
ferently to carcinogens. “In any discus-
risk factor for lung cancer, which is still
are compared. But environmental
sion about environmental carcinogens
the number one cause of cancer death
exposure to potential carcinogens does
and environmental cancer risk, you have
in the United States,” explains Smekens.
not happen in a controlled environment
to say something about the fact that not
Dr. Wascher notes, “Radon gas exposure
like that.
all of us are going to respond in the same
probably accounts for five to eight per-
“With regard to a lot of environmental
way,” explains Dr. Wascher. “There ap-
cent of all lung cancer cases.”
exposures, we don’t have a natural
pears to be an underlying genetic com-
• aiR polluTion “Particulate air pol-
control group because often everyone
ponent involved in our individual risk of
lution, especially exhaust from diesel
is exposed to them,” explains Connie
actually developing cancer in response
engines, has been linked to lung cancer,”
Engel, science and education manager
to being exposed to many known car-
Dr. Wascher says. “Individuals who live
for the Breast Cancer Fund, a national
cinogens. We’re all different, and we
in heavily polluted areas therefore appear
nonprofit organization dedicated to
all have a different genetic makeup.”
to have higher rates of lung cancer.”
• chaRRed food Heterocyclic amines,
preventing breast cancer by eliminating
or HCAs, are carcinogenic chemical com-
radiation linked to the disease. “We
confirmed environmental
risk factors
can’t control who is exposed, and we
Scientists like data. Data provide great-
temperature. Grilled and heavily charred
certainly can’t do a randomized study
er certainty, and with greater certainty
meats have been linked to colorectal,
and randomly assign people to things
we can make better recommendations.
pancreatic, stomach, and breast cancers.
that we think are hurting them.”
Identifying true carcinogens is poten-
• dieTaRy choices “Diets rich in
tially complicated, but there are some
red meat and other animal products are
exposure to toxic chemicals and
What’s more, individuals respond difcfthrive.com
pounds created by cooking meat at a high
naturopathic
cONtrOverSiAL
PrOveN
There are ongoing studies in these areas.
These are proven cancer risk factors.
AciDic WAter
tOBAccO
FLuOriDAteD WAter
rADON
SuGAr
OBeSity
DeODOrANtS AND ANtiPerSPirANtS
MeAt-rich DietS
BreASt iMPLANtS
DietS LOW iN WhOLe GrAiNS
WeAriNG A BrA
DietS LOW iN FreSh FruitS AND
veGetABLeS
PhySicAL iNActivity
ALcOhOL
iNFectiONS With certAiN viruSeS AND
BActeriA
Air POLLutiON
chArreD Or heAviLy GriLLeD MeAtS
SOMe cheMicALS
Robert A. Wascher, MD, FACS, A Cancer Prevention Guide for the Human Race (Indianapolis: Dog Ear Publishing, 2010).
also associated with an increased cancer
the management of cancer, but many of
chemicals because there are a lot of
risk,” says Dr. Wascher, “and particularly
these scans are being done for less-than-
variables,” Dr. Wascher says.
cancer of the esophagus, stomach, pan-
solid critical reasons,” Dr. Wascher says.
The challenge comes in proving beyond
creas, colon, and rectum. Diets that are
He recommends prudent use of these
a shadow of a doubt that certain chemicals
low in whole grains and fresh fruits and
scans—and the use of ultrasound or mag-
pose a risk. The scientific community
vegetables also increase the risk of these
netic resonance imaging when possible
needs solid facts to rule against a
same cancers.”
and appropriate, instead of CT scans.
chemical, but the available scientific data
• RadiaTion Exposure to radiation can
• poweR lines Smekens explains that
is often not black-and-white. Engel says
increase the risk of cancer. “For most of
electromagnetic fields (EMFs) have been
that if you look at the full body of data—
us, that is probably not a huge deal be-
associated with leukemia, brain tumors,
which includes both human and animal
cause we didn’t live downwind of Cher-
and breast cancer. “There have been
studies—there is biologically plausible
nobyl,” explains Dr. Wascher. “But an
some occupational studies on people who
concern regarding certain chemicals.
area of increasing concern is medical X-
worked on power lines that showed small
She lists several chemicals of concern,
ray exposure. In fact, recent conservative
but real increases in leukemia and brain
including
estimates suggest that one to two percent
cancer,” she says. An association has also
phthalates and bisphenol A (BPA).
of all new cancer cases may be linked to
been found between housing proximity
“You don’t have that much to lose by
medical X-rays and to CT [computed to-
to power lines and increased incidence of
avoiding these chemicals, and you have
mography] scans in particular.” Many of
childhood leukemia.
everything to gain,” Engel insists.
to medical treatment, but sometimes X-
what about chemicals?
Chemicals, Healthy Families, a national
rays and scans are overused. “When prop-
“It’s a fuzzy area when you start talking
coalition of organizations and individuals
erly used, CT scans are very important in
about environmental pollutants and
working to raise awareness about toxic
these scans are important and necessary
endocrine
disruptors
like
Lindsay Dahl, deputy director of Safer
cfthrive.com
naturopathic
JuSt SAy NO tO
cheMicALS
The jury may still be out on some
chemicals, but there are certain ones
that are worth avoiding. It can’t hurt,
and it might help.
• Phthalates. Phthalates are endocrine disruptors with a possible link to
breast cancer. Phthalates are used in
building materials, personal care products, detergents, surfactants, children’s
toys, pharmaceuticals, and more.
• BPa. Bisphenol A is an endocrine
disruptor that has been linked to thyroid
dysfunction as well as several different
types of cancer. the united States has
banned the use of BPA in baby bottles,
whereas other countries have banned
its use entirely. BPA is used in the lining
of cans and has been shown to leach
into canned food. Most receipts are also
coated in BPA.
• Formaldehyde. Formaldehyde has
been classified as a known human carcinogen. it is used in building materials,
furniture, cabinets, countertops, cleaners, and more.
• tCe. trichloroethylene is an industrial
solvent and is used in rug cleaners,
adhesives, paint removers, and spot
removers. the most common exposure
to tce is through contaminated drinking water. evidence continues to pile up
against tce, and research is ongoing.
• FragranCe. Synthetic fragrances
are common in personal care products
and cleaning products. Fragrance is
tricky: When a product lists “fragrance”
as an ingredient, that one ingredient
may include dozens of chemicals. Because you don’t know which chemicals
are included, it’s best to avoid the product altogether.
cfthrive.com
chemicals in homes, workplaces, and
ten years of when they removed lead
products, says that peer-reviewed science
from gasoline.”
has shown some strong links between
cancer and some chemicals. “Two of
Prevention is key
the best examples are formaldehyde
There are a variety of environmental
and
she
risk factors linked to cancer, but there
says. Formaldehyde is a known human
is no need to live in fear. It’s impossible
carcinogen and a common indoor
to avoid all exposure to potential
air pollutant. It can be found in
carcinogens, but it pays to know what is
building materials, furniture, cabinets,
in your environment and to do your best
countertops, cleaners, and more. TCE
to protect yourself against potential risk
is used in rug cleaners, adhesives, paint
factors.
trichloroethylene
(TCE),”
removers, and spot removers. It is highly
“Even if you’re conservative and throw
toxic and can contaminate the water
out the wacky stuff and accept the known
supply. There have been reported cancer
limitations of the science and the data,”
clusters next to manufacturing facilities
says Dr. Wascher, “at least 60 percent
that use these chemicals.
of all new cancer cases are tied to one
Engel says that even low doses of some
or more modifiable lifestyle or other
compounds can be cause for concern,
environmental risk factors, and many
especially when the exposure happens at
of the types of cancers that are linked to
vulnerable periods of development such
preventable risk factors are, in fact, the
as during infancy, before and during
cancers that cause the greatest number of
puberty, and during pregnancy and
cancer-related deaths.”
lactation. “We think of this as a public
health issue,” she says. “And we think it
is important to give people tools to make
informed decisions.”
But how do you make informed
decisions about chemicals when there is
so much conflicting data?
“There are so many things to worry
about that you could drive yourself
nuts,” admits Dahl, but she is quick to
point out that the news is not all bad.
“Prevention is hard to quantify, but we
know that it works. For example, lead
levels in the blood plummeted within
innovation
welcome
reLieF
Pain Management is
the Key to living Well
By Kari Bohlke, ScD
E
veryone has likely heard one
talking with an exPert
“If pain goes unrelieved, it denies that
of the following at some point:
“Pain is one of the most common
individual comfort and greatly affects
“Keep a stiff upper lip.” “Grin
symptoms
cancer,”
daily activities. What I tell patients in the
and bear it.” “Play through the
explains Raed Rahman, DO, director of
clinic is that most people are multi-taskers:
pain.” When it comes to cancer, however,
pain management at Cancer Treatment
they can do many tasks at one time. But
these suggestions do not apply. Untreated
Centers of America® (CTCA) in Zion,
when patients have severe pain, or pain
pain can interfere with virtually every
Illinois. Pain can result from the cancer
for many months, they can become uni-
aspect of life, from the ability to sleep to
itself or from treatments such as
taskers: they’re focused only on the pain
the ability to enjoy the company of family
chemotherapy, radiation therapy, and
and may need help with a lot of common
and friends. Talking openly with health
surgery.
daily tasks.”
associated
with
care providers about pain can ensure
“One of the barriers to adequate pain
appropriate care at the right time. Pain
relief,” says Dr. Rahman, “is that some
manY oPtions for
management is an important part of
patients believe that pain is something
Pain management
cancer care, and many treatment centers
that they have to live with.” The
“You can manage pain in the human body
have providers who specialize in this area.
consequences of this can be far-reaching:
in a lot of ways,” continues Dr. Rahman,
cfthrive.com
innovation
pointing to such options as medication,
a scale of 0 to 10), it’s helpful for the
that a pain medication strategy can
physical therapy, acupuncture, massage
doctor to have information about what
be developed with a patient’s daily
therapy, chiropractic care, mind-body
the pain feels like, whether it’s constant
activities in mind. “I don’t prescribe
support, and pastoral care. Depending
or intermittent, and what factors make it
these medications to patients so that
on the situation, procedures that treat
better or worse. Words that can describe
they sleep all day or can’t function,” says
the cancer or that block nerves from
different types of pain include sharp,
Dr. Rahman. “That’s not the purpose.
sending pain messages can also provide
dull, throbbing, burning, and shooting.
The purpose is for the patient to take the
medication when needed and to function
relief. The key to finding what’s right for a
given individual is a comprehensive pain
Pain meDications
at home, to function at work, and to live
evaluation. “The pain can be physical,
Although medications are not the
their life.”
psychological, or psychosocial. You need
only way to manage pain, they are
For certain types of pain, a doctor
an idea of exactly where the pain is
effective and important options for
may recommend a different type of
coming from or what’s making it worse.”
many people. Pain medications come
medication. The tingling and burning
An important goal of pain management
in a range of strengths, from over-the-
that can accompany nerve damage, for
(and of care at CTCA® in general) is to
counter remedies such as ibuprofen and
example, may respond to treatment with
treat the entire person. In some cases
acetaminophen to strong prescription
an antidepressant or antiepileptic drug.
this may involve using more than one
drugs such as oxycodone and morphine.
Similarly, pain caused by swelling may
approach to pain management. Use of
If a physician approves over-the-counter
respond to medications that reduce the
pain medication in combination with a
medications that provide adequate relief,
swelling, such as an anti-inflammatory.
nonpharmaceutical treatment such as
these may be all that is needed. If more-
relaxation, for example, may result in
severe or persistent pain is an issue,
holistic care ProviDes hoPe
better pain control and overall wellness
however, a doctor may suggest stronger
“In most patients cancer pain can be
than either approach alone. Recognizing
drugs. Use of these medications to treat
successfully controlled with appropriate
and treating common problems such as
pain, says Dr. Rahman, can help a patient
techniques and safe drugs,” concludes Dr.
depression and anxiety can also change
maximize quality of life and ability to
Rahman. “Working with a pain manage-
the perception of pain.
function.
ment specialist, patients don’t have to live
For patients who experience pain,
If strong pain medications are needed,
with pain. The overall approach to pain
the right place to start is a discussion
experts in pain management can develop
management should be comprehensive in
with a primary care provider. “Usually,
a treatment plan that fits a patient’s short-
nature and involve a holistic plan that in-
due in part to the existing patient/
and long-term needs. In some cases it
cludes using one or more of the methods
physician relationship,” says Dr. Rahman,
may be necessary to try more than one
discussed earlier.”
“the primary care provider knows the
type of medication to find the one that
The goal is not only to ensure that pa-
patient better than anyone else and
works best. “When you look at the basic
tients feel better but also to allow them
can implement basic pain management
chemistry of these pain medications,”
to function better and to live the life they
strategies.” But
strategies
says Dr. Rahman, “they’re like brothers
want to lead. An individualized and com-
aren’t successful, a referral to a pain
and sisters; they have a lot of similarities
prehensive approach to pain management
management specialist may be beneficial.
but minor differences.” So, if the first
can help achieve this goal.
When undergoing a pain assessment, a
medication isn’t adequate or produces
patient will likely need to answer several
intolerable side effects, there is likely
questions about the nature of the pain. In
another drug or treatment approach that
addition to the location and the severity
may work well.
if
these
of pain (which is often measured on
cfthrive.com
Reference
Pain Control. NIH Publication No. 12-6287. National
Cancer Institute website. Available at: http://www.cancer.
gov/cancertopics/coping/paincontrol.pdf. Accessed November
12, 2012.
It’s also important to keep in mind
ask the nurse
QA
&
tiPs for caregivers:
suPPorting Patients
through treatment
By Theresa Rodriguez, RN, BSN
Cancer Treatment Centers of America® (CTCA)
how can caregivers best
and pet therapy also help many patients
what Questions might a
support patients’ physical
relax and feel better, thereby increasing
caregiver ask the loved one’s
needs during treatment?
coping skills. I would encourage you
care team to be best prepared
Treatment for cancer is a journey,
as a caregiver to celebrate the good
to support the patient during
and patients will certainly experience
times with your loved one—especially
treatment?
changes to their bodies throughout their
days of high energy or milestones in
The road to healing is a difficult one
care. Caregivers can be supportive of
treatment. Remain positive, prayerful,
that will pose many challenges to all
patients’ physical needs by encouraging
and encouraging during the down times.
dimensions of a patient’s life—physical,
movement, by practicing tolerance, and
Know that treatment is a journey.
emotional, and spiritual. Know that
through understanding that the patient
each member of a care team is an expert
may experience physical limitations.
what are some common
in his or her respective field and has
Simply knowing what resources the
challenges that caregivers
a wealth of knowledge and advice to
hospital offers patients, such as physical
face as they support patients
offer from professional experience.
and rehabilitative therapy, is a wonderful
during this time?
Caregivers should ask the care team
first step. CTCA® has personnel who
Caregivers need support, too, as seeing
members what the common challenges
can guide patients in these areas; it also
their loved one face cancer poses many
tend to be and how to prevent or work
has an on-site fitness center for gentle
challenges—physically, emotionally,
through them. For example, a caregiver
exercise, which encourages strength and
and financially. Caregivers may need
may ask a dietitian, “What foods do you
cardiovascular health—both of which aid
to take unexpected time off from work
recommend I prepare if my loved one’s
in healing.
to support or travel with the patient.
appetite is affected by treatment?” Or one
They may be called on to work more,
might ask a naturopathic doctor, “Which
how can caregivers best
or begin employment, to help offset the
supplements are the most important to
support patients emotionally
cost of care. They may need counseling
take if my loved one is not able to ingest
during treatment?
support themselves as they work through
them all?”
Many patients describe cancer treatment
new feelings. CTCA has services to aid
as an emotional roller coaster. CTCA
caregivers in all of these areas, including
what steps can caregivers
offers counseling and spiritual support
support groups and assistance in
take to ensure their own
via the mind-body medicine and pastoral
completing Family and Medical Leave
wellness during this time?
care departments, in addition to staffing
Act paperwork.
Being there for someone 100 percent of
a professional psychologist if needed.
the time can be draining and leave the
Reiki as well as laughter, music, dance,
caregiver feeling helpless, so knowing
cfthrive.com
that services are available—both in the
care of someone with cancer can be
Theresa Rodriguez, RN, has been a
hospital and in one’s home commu-
absorbing, so take advantage of those
nurse with Cancer Treatment Centers
nity—is important. The services of the
who desperately want to help you—they
of America® at Midwestern Regional
counseling and pastoral care departments
are out there and waiting! Take time
Medical Center in Zion, Illinois, since
at CTCA are available for caregivers, too. I
for yourself and know that respite is a
2006. Rodriguez graduated from
have heard hundreds of stories of patients’
natural need. As your loved one feels
Franklin and Marshall College in
neighbors and church members coming
better, increase the frequency or duration
Lancaster, Pennsylvania, with a double
together. For any caregiver it is impor-
of your breaks. And remember: you don’t
undergraduate degree in biology and
tant to realize that breaks are okay—as
have to be physically present for your
Spanish. She worked as a lab technician
is accepting the assistance of the myriad
loved one to know that you’re there for
for Abbott Laboratories for several
friends and family members who natu-
him or her.
years and taught high school science
rally want to step in for a caregiver during
before obtaining her RN from College of
that time.
Lake County in Grayslake, Illinois. She
received her BSN from Olivet Nazarene
any other tips you would
University in Bourbonnais, Illinois, and
offer to caregivers who want
is currently on track to receive her MSN
to support their loved ones
from Chamberlain College of Nursing in
during cancer treatment?
Arlington, Virginia, in the spring of 2013.
My advice is to heed the following
statement: You are not alone. Taking
cfthrive.com
mind-body connection
Moving Beyond survivor guilt
By Laurie Wertich
“Tell me, what is it you plan to do
with your one wild and precious life?”
—Mary Oliver
C
me? This is a normal response to such an
of guilt and sadness. Why did I survive
overwhelming diagnosis. Why did I get this
when others did not? Why was I so lucky?
disease? Why am I sick when others are not?
Why do I have to endure this treatment?
WHaT is sURvivoR gUilT?
ancer survivorship can be
Though generally unanswerable, it is a
Survivor guilt is common among survivors
accompanied by a unique
completely reasonable question.
of traumatic events—such as war, natural
set of emotions—joy, grief,
In the shift from diagnosis to treatment
disasters, accidents, and even acute or long-
fear, relief, deep gratitude, a
and on to recovery, the primary question
term illnesses such as cancer. Survivor guilt
heightened sense of purpose, and an over-
changes. More often than not, most can-
refers to the sense of guilt or responsibility
whelming sense of responsibility to live life
cer patients move pretty quickly from Why
that can occur when one person survives a
to the fullest.
me? to What’s next? What do I need to do to
traumatic event that others did not. And,
But there is another nagging feeling that
survive? How can I best care for myself dur-
yes, cancer can be a traumatic event.
can sneak into the mix: guilt. Survivorship
ing treatment? What will I do with my pre-
is such a blessing, yet in spite of that bless-
cious life after treatment?
“Not all of our patients experience cancer
as a traumatic event,” explains Rhonda Col-
Here’s where it gets interesting: in the
ley, MS, LPT, LMFT, a mind-body therapist
face of survivorship, many patients find
at Cancer Treatment Centers of America®
themselves also circling back around to
(CTCA) in Tulsa, Oklahoma. “But even if
WHy Me?
that first question as they move beyond
they aren’t traumatized, they can still ex-
The first question that many people ask
diagnosis to treatment and recovery, only
perience survivor guilt, which means basi-
in the face of a cancer diagnosis is Why
this time Why me? carries with it a twinge
cally feeling guilty that they got through this
ing, we often find ourselves reflecting on
those who have not been as fortunate.
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mind-body connection
other patient survive or, worse, that they
Colley encourages patients to examine
Colley works with a lot of survivors who
should have been the one to pass away.
their feelings of guilt by journaling, talk-
are experiencing some level of guilt. “We call
Some survivors will get stuck in a vicious
ing to a therapist, or participating in a
it ‘imagined guilt’ or ‘survivor guilt,’” she
cycle of “if only”: If only I had told her about
support group. “I like to get patients con-
says. “Sometimes patients feel responsible
the special vitamins I was taking. If only I
nected to groups because that can help
in part for the passing of fellow patients.”
had encouraged him to try acupuncture. If
give them a constant sense of balance,”
only I had worked harder to build hope in
she explains.
treatment journey relatively unscathed.”
This may not make sense to someone
who has not walked the cancer path, sat
that person.
What’s more, Colley says that one of
with fellow patients in the waiting room,
“Some people experience no survivor
the most effective ways to move beyond
compared diagnoses and treatment plans,
guilt, and others are overwhelmed by it,”
survivor guilt is to look ahead and try
and given and received encouragement
Colley explains. “Many times it’s some-
to bring something good out of the ex-
throughout the journey. But to a cancer
thing that may be operating at a deeper
perience. “What could a survivor do that
survivor, it makes perfect sense, and it is
level, and the person is not even aware that
would be productive and fruitful going
another part of the cancer journey that
they have it.”
forward?” she asks.
must be processed.
Survivorship presents an opportunity
CoPiNg WiTH
sURvivoR gUilT
to leave regrets behind and reprioritize
Though some refer to survivor guilt as
making drastic changes, but sometimes it
There is a sense of implied comparison
imagined guilt, that’s not to say it isn’t real.
can be as simple as planting a tree in hon-
that occurs among people who have en-
“We do not invalidate anyone’s feelings.
or of a fellow patient who did not survive.
dured similar ordeals. It’s only natural to
Feelings are very real,” explains Colley.
compare type and stage of cancer, treat-
“The feeling of guilt is real, but the foun-
THis Too sHall Pass
ment plans, nutrition plans, and more. It’s
dation of it is imagined.”
The good news is that survivor
WHo exPeRieNCes
sURvivoR gUilT?
life in a new way. Sometimes this means
what we do—we find common ground, es-
With that in mind, often the first step
guilt typically fades with time. It
pecially in the face of cancer—because we
in coping with survivor guilt is to examine
is important to acknowledge and
need one another.
the foundation of the guilt. A mind-body
accept the feelings of guilt—and
“We have an amazing support commu-
therapist can be instrumental in this pro-
allow yourself to move beyond
nity at CTCA®,” Colley says. “Our patients
cess. “I really encourage patients to talk to
them. You deserve to survive
seek each other out in the cafeteria and the
us about their feelings regarding other pa-
and thrive and enjoy your
waiting rooms. They gravitate toward one
tients,” Colley says. “Sometimes it is a big
one wild and pre-
another. But because of that tight bond,
help just to verbalize the feelings.”
cious life.
they might be more inclined to feel a sense
Colley says that she asks patients to be
willing to hear feedback: “We mirror back
of survivor guilt.”
Colley explains that CTCA patients
to them what we are hearing them say—
form deep connections. “They may have
which is that they are experiencing some-
the same type and stage of cancer, and then
thing that is understandable but unfound-
they go through treatment and one has a
ed.” She says that it is important to exam-
different outcome.”
ine the feelings and understand that they
Sometimes in these cases, but not al-
are real—but unrealistic. “We ask them to
ways, survivor guilt ensues. Some patients
really think about how they arrived at this
develop a sense of guilt or responsibility—
conclusion that they should have been able
believing that they should have helped the
to help this other person survive.”
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spiritual
Words to Live By
Patients and caregivers find strength in inspirational quotes and scripture.
By Diana Price
If
someone were to ask you to share words that
have brought you comfort during difficult times,
what would you offer up? Would it be a verse of
scripture that has provided spiritual comfort and reaffirmed
your faith? A humorous quote? Lyrics from a song? Maybe
you’d choose a significant poem or a saying passed down
through your family lore. Whatever your choice, the words
would no doubt carry special meaning for you because they
speak to your personal experience and connect you to the
thing you go to for comfort—whether it’s faith, literature, art,
or family; those words provide a touchstone for your soul.
Cancer patients and caregivers often turn to inspiring
and comforting quotes and scripture as they come to terms
with a diagnosis and undergo treatment. Chip Gordon,
MDiv, director of pastoral care at Cancer Treatment Centers
of America® (CTCA) in Newnan, Georgia, says that in his
experience this practice provides powerful spiritual support,
and he encourages patients to find a quote or verse that speaks
to them: “The verse or quote that a patient chooses serves as
an ‘Ebenezer’ in his or her life. The word Ebenezer comes from
the Hebrew word that means ‘stone of help.’ That’s exactly
what these verses or quotes do: they help patients as they
continue on their journey with cancer.”
The choice of words is, of course, highly personal and
reflects the myriad personalities and spiritual lives of cancer
patients and their loved ones. Rev. Gordon says that a favorite
verse of his, which he shares with many patients, comes
from Jeremiah 29:11: “For I know the plans I have for you,”
declares the Lord, “plans to prosper you and not to harm you,
plans to give you hope and a future.” The quote is especially
meaningful, he says, because “At CTCA we are committed to
giving our patients hope. This verse exemplifies what we are
all about while pointing our patients to the hope they can
have during the journey.”
Recently via the CTCA® Facebook page, employees,
patients and caregivers shared some of the words that have
provided support through their personal journeys. Here are
their words of wisdom:
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spiritual
“ScArS . . . Are tAttOOS With Better StOrieS.”
—Debbie Waken
“FAith iS KNOWiNG everythiNG thAt yOu hOPe
FOr WiLL cOMe true.”
—Jenny Lincke Mitchell
“there iS StiLL SOMe GOOD iN the WOrLD—
FiND it!”
—Kelly Wikiera
“WiSh it; DreAM it; DO it.”
—Gary Hackney
“PeAce i LeAve With yOu, My PeAce i Give uNtO
yOu; NOt AS the WOrLD Giveth, Give i uNtO yOu.
A Foundation of Hope
At several ctcA hospitals, inspiring quotes and scripture verses
Let NOt yOur heArt Be trOuBLeD, Neither Let
are literally incorporated into the foundation of the buildings.
it Be AFrAiD.” (JOhN 14:27)
During the hospitals’ Blessing ceremony, patients, caregivers,
—Mary Griffin Newton
and staff have the opportunity to inscribe words that have special
meaning to them on the foundation of the new building before final
“NO ONe crieS WheN cANcer DieS, SAD teArS
FALL NeverMOre.
flooring and finishes are incorporated.
rev. Gordon, who participated in the “Grounded in hope” Blessing
cONDitiON: reMiSSiON, SuBMiSSiON tO teStiNG,
ceremony at ctcA in Newnan, Georgia, says the experience was
i’LL FiNALLy cLOSe thAt DOOr.
extremely moving: “to see patients standing in the lobby of our
NO MOre FeAr WheN cANcer cLeAr My DAyS
unfinished center, excited about the opening in Georgia and hopeful
WiLL Be FOrever MOre.
about where they were in their healing, showed me what a huge
NO MOre LOSS NOW i’M the BOSS, ONce AGAiN
part our spiritual emphasis has on our patients.”
thiS eAGLe WiLL SOAr.”
—Robbie Robinson
As participants shared words of inspiration and healing with
one another and with all of the patients who would enter the
center in the future, there was a sense of optimism and hope. “For
“My MOM FOuGht LuNG cANcer FOr 11 yeArS.
many patients,” rev. Gordon says, “it was a new beginning, as they
She Never cOMPLAiNeD. NOt ONce. her
experienced healing from the pain they had experienced in the
FAvOrite SAyiNG WAS ‘it cOuLD ALWAyS Be
past.”
WOrSe!’”
—Elizabeth Palmer Crumb
One scripture verse in particular that rev. Gordon saw inscribed
that day stood out: “But those who hope in the Lord will renew
their strength. they will soar on wings like eagles; they will run
“veriLy, ALONG With every hArDShiP iS reLieF.”
and not grow weary, they will walk and not be faint.” (isaiah 40:31)
—Nor Aini Ali
“cANcer iS A WOrD, NOt A LiFe SeNteNce!”
—Deborah Ayres Fichter
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images of hope
Stories of travel
Patients and their families make time to relax, bond, and
widen their horizons.
1. JOAN DicKeNS
“My friends Joe, ellie, and Jean
with me and my dad on a rhine
river cruise in 2010. My Dad
was 96 and is still going strong
in 2012!”
2. JOhN JuBAS
John and his wife, Anita, pose
with daughter, Maren, at a
Penn State university football
game. Maren is a junior at
Penn State.
➊
3. WALt reiFFer
Walt and his wife, cyndi, at
rehoboth Beach, Delaware.
4. ANNe BOuDWiN
“this is me and my husband,
claude, in Bermuda. We
cruised there (our ship is behind us) from Boston. in the
picture we’re on a charter boat
returning from our snorkeling
excursion. it was awesome!”
❷
➌
❹
No case is typical. You should
not expect to experience
these results.
cfthrive.com
images
mages of hope
hope
❺
❻
5. JAN PeDerSON
Jan and her husband, Bruce, pose in israel
with the Dome of the rock in the distance.
❼
❽
➒
❽
6. JODy KeiM
“this is a photo i took in San Diego,
california. it is the sun setting on my
treatment for stage iv breast cancer and
the beginning of my new life.”
7. SANDrA DeAN
Sandra and her husband, roy, pose at
Boomtown casino in Biloxi, Mississippi.
8. PeG trAcey
“My husband, Steve, and i pause for a rest
after a day of touring the ruins in tulum,
Mexico, in July 1994.”
➓
9. iNGriD reitANO
ingrid poses with friends Gretchen
Biancone-Goff and Dawn Krempecki
at Old Faithful geyser in yellowstone
National Park.
10. PhiLLiP MOOre iii
“cancer fighters can have leisure
moments. During my bout with cancer, i
have continued my quest for adventure.
Adventure has taken me to hawaii,
Arizona, Germany, colorado, and Georgia.”
cfthrive.com
inspiration
do great
By Nicole Haran
i
never knew anyone with cancer un-
with friends, I turned back to see one of
phrase as much as I did throughout the
til last year, when three of us were
my pals crying into her hands as others
year.
diagnosed: my aunt, my father-in-
consoled her. Someone once told me that
None of it was easy. Buckets of tears
law, and me. My aunt was the first to get
having cancer is like being at your own
were shed, but I have no doubt that ev-
the news. Many months went by and I did
funeral. At that moment that is exactly
erything was made better by the positivity
not call, write, or visit.
how I felt.
around me.
My father-in-law (her brother) was di-
Others had no difficulty “overlooking”
“You will do great” is one of those
agnosed soon thereafter. Feeling scared
the diagnosis, keeping the status quo. In
phrases we say to our kids thousands of
and at a loss for words, I kept my distance,
fact, they became chronically upbeat. My
times in a lifetime. We say it because it
rarely called, and, despite his positive at-
brother, for instance, hadn’t seemed so
means I believe in you. We say it because
titude, felt somber around him. We never
happy and optimistic to me in years. My
it means All you can do is your best. We
told our children about their aunt or
cancer diagnosis brought out the best in
say it because we know that to succeed in
grandfather.
him. I attached myself to my husband’s
getting through tough spots we must to
Three months later I was diagnosed
confidence. When I spoke to people who
some degree create our own reality.
with stage III breast cancer. After my di-
behaved as though I would someday be
agnosis I learned that my father’s mother
well, I felt stronger, happier, and healthier.
and sister both died of breast cancer be-
My surgeon and oncologist were so
fore I was born. I was never told.
positive that my husband and I named
Determined to keep things as normal as
them the “sunshine sisters.” Friends who
possible for our kids, I instructed friends
made me laugh so hard it hurt while I
and family to “act regular, even positive”
healed from my bilateral mastectomy
at all times around me and the children.
were rock stars in my eyes. I knew how
There were several people in my life who
much I would need them in the days to
were so fearful and sad about my diag-
come, and I was right: laughing helped
nosis that it soon was apparent that they
with everything.
could not “play along” by acting positive.
The fear of chemo and radiation di-
I could see it in their eyes and hear it in
minished when a wonderful family friend
their voices; my diagnosis prevented them
told me I would “do great” through it all.
from being supportive to me. Their heavi-
She is a nurse at a cancer center, and she
ness scared me half to death. I began to
told me I was going to “do great.” I de-
avoid them, the look on their faces, and
cided to believe her. Do great became my
the stories they told me. Once when I was
mantra, and all the people who could
leaving a restaurant after a nice lunch
“play positive” in my life clung to that
To learn how Nicole Haran is using her
Do great mantra to help others, visit
dogreatcampaign.com. The campaign
urges everyone who has been touched by
cancer to see the video on the website,
share it with others, and write their own
Do great message.
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®
BRIEF SUMMARY OF PRESCRIBING INFORMATION
INDICATIONS AND USAGE
SANCUSO® (Granisetron Transdermal System) is indicated for the prevention of nausea and vomiting in patients
receiving moderately and/or highly emetogenic chemotherapy regimens of up to 5 consecutive days duration.
DOSAGE AND ADMINISTRATION
The transdermal system (patch) should be applied to clean, dry, intact healthy skin on the upper outer arm.
SANCUSO should not be placed on skin that is red, irritated or damaged. Each patch is packed in a pouch and
should be applied directly after the pouch has been opened. The patch should not be cut into pieces.
Adults
Apply a single patch to the upper outer arm a minimum of 24 hours before chemotherapy. The patch may be
applied up to a maximum of 48 hours before chemotherapy as appropriate. Remove the patch a minimum of
24 hours after completion of chemotherapy. The patch can be worn for up to 7 days depending on the duration
of the chemotherapy regimen.
DOSAGE FORMS AND STRENGTHS
SANCUSO is a 52 cm2 patch containing 34.3 mg of granisetron. The patch releases 3.1 mg of granisetron per
24 hours for up to 7 days.
CONTRAINDICATIONS
SANCUSO is contraindicated in patients with known hypersensitivity to granisetron or to any of the components
of the patch.
WARNINGS AND PRECAUTIONS
Gastrointestinal
The use of granisetron in patients may mask a progressive ileus and/or gastric distention caused by the
underlying condition.
Skin Reactions
In clinical trials with SANCUSO, application site reactions were reported which were generally mild in intensity
and did not lead to discontinuation of use. The incidence of reactions was comparable with placebo. If severe
reactions, or a generalized skin reaction occur (e.g. allergic rash, including erythematous, macular, papular rash
or pruritus), the patch must be removed.
Exposure to Sunlight
Granisetron may be affected by direct natural or artificial sunlight. Patients must be advised to cover the patch
application site, e.g. with clothing, if there is a risk of exposure to sunlight throughout the period of wear and
for 10 days following its removal because of a potential skin reaction.
ADVERSE REACTIONS
Clinical Trials Experience
The safety of SANCUSO was evaluated in a total of 404 patients undergoing chemotherapy who participated
in two double-blind, comparator studies with patch treatment durations of up to 7 days. The control groups
included a total of 406 patients who received a daily dose of 2 mg oral granisetron, for 1 to 5 days.
Adverse reactions considered by the investigators as drug-related occurred in 8.7% (35/404) of patients
receiving SANCUSO and 7.1% (29/406) of patients receiving oral granisetron. The most common adverse
reaction was constipation that occurred in 5.4% of patients in the SANCUSO group and 3.0% of patients in the
oral granisetron group.
Table 1 lists the treatment emergent adverse reactions that occurred in at least 3% of patients treated with
SANCUSO or oral granisetron.
Table 1: Incidence of Adverse Reactions in Double-Blind, Active Comparator Controlled Studies in
Cancer Patients Receiving Chemotherapy (Events ≥ 3% in either group)
Body System
Preferred Term
SANCUSO TDS
N=404
(%)
Oral granisetron
N=406
(%)
5.4
3.0
0.7
3.0
Gastrointestinal disorders
Constipation
Nervous system disorders
Headache
DRUG INTERACTIONS
Granisetron does not induce or inhibit the cytochrome P-450 drug-metabolizing enzyme system in vitro. There
have been no definitive drug-drug-interaction studies to examine pharmacokinetic or pharmacodynamic
interaction with other drugs. However, in humans, granisetron hydrochloride injection has been safely
administered with drugs representing benzodiazepines, neuroleptics and anti-ulcer medications commonly
prescribed with antiemetic treatments. Granisetron hydrochloride injection also does not appear to interact with
emetogenic cancer therapies. In agreement with these data, no clinically relevant drug interactions have been
reported in clinical studies with SANCUSO.
Because granisetron is metabolized by hepatic cytochrome P-450 drug-metabolizing enzymes (CYP1A1
and CYP3A4), inducers or inhibitors of these enzymes may change the clearance and hence, the half-life of
granisetron. In addition, the activity of the cytochrome P-450 subfamily 3A4 (involved in the metabolism of
some of the main narcotic analgesic agents) is not modified by granisetron hydrochloride in vitro. In in vitro
human microsomal studies, ketoconazole inhibited ring oxidation of granisetron hydrochloride. However,
the clinical significance of in vivo pharmacokinetic interactions with ketoconazole is not known. In a human
pharmacokinetic study, hepatic enzyme induction with phenobarbital resulted in a 25% increase in total plasma
clearance of intravenous granisetron hydrochloride. The clinical significance of this change is not known.
USE IN SPECIFIC POPULATIONS
Pregnancy
Pregnancy Category B
Reproduction studies with granisetron hydrochloride have been performed in pregnant rats at intravenous
doses up to 9 mg/kg/day (54 mg/m2/day, about 24 times the recommended human dose delivered by the
SANCUSO patch, based on body surface area) and oral doses up to 125 mg/m2/day
(750 mg/m2/day, about 326 times the recommended human dose with SANCUSO based on body surface area).
Reproduction studies have been performed in pregnant rabbits at intravenous doses up to 3 mg/kg/day (36
mg/m2/day, about 16 times the human dose with SANCUSO based on body surface area) and at oral doses up
to 32 mg/kg/day (384 mg/m2/day, about 167 times the human dose with SANCUSO based on body surface
area). These studies did not reveal any evidence of impaired fertility or harm to the fetus due to granisetron.
There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction
studies are not always predictive of human response, SANCUSO should be used during pregnancy only if
clearly needed.
Nursing Mothers
It is not known whether granisetron is excreted in human milk. Because many drugs are excreted in human
milk, caution should be exercised when SANCUSO is administered to a nursing woman.
Pediatric Use
Safety and effectiveness of SANCUSO in pediatric patients under 18 years of age have not been established.
Geriatric Use
Clinical studies of SANCUSO did not include sufficient numbers of subjects aged 65 and over to determine
whether they respond differently from younger subjects. Other reported clinical experience has not identified
differences in responses between the elderly and younger patients. In general, cautious treatment selection for
an elderly patient is prudent because of the greater frequency of decreased hepatic, renal, or cardiac function,
and of concomitant disease or other drug therapy.
Renal Failure or Hepatically-Impaired Patients
Although no studies have been performed to investigate the pharmacokinetics of SANCUSO in patients with
renal or hepatic impairment, pharmacokinetic information is available for intravenous granisetron.
OVERDOSAGE
There is no specific antidote for granisetron overdosage. In the case of overdosage, symptomatic treatment
should be given. Overdosage of up to 38.5 mg of granisetron hydrochloride, as a single intravenous injection,
has been reported without symptoms or only the occurrence of a slight headache. In clinical trials there were
no reported cases of overdosage with SANCUSO.
HOW SUPPLIED/STORAGE AND HANDLING
SANCUSO (Granisetron Transdermal System) is supplied as a 52 cm2 patch containing 34.3 mg of granisetron.
Each patch is printed on one side with the words “Granisetron 3.1 mg/24 hours”.
Each patch is packaged in a separate sealed foil-lined plastic pouch.
SANCUSO is available in packages of 1 (NDC 42747-726-01) patch.
Store at 20˚-25˚C (68˚-77˚F); excursions permitted between 15˚-30˚C (59˚-86˚F). [see USP Controlled Room
Temperature].
SANCUSO should be stored in the original packaging.
PATIENT COUNSELING INFORMATION
See FDA-approved patient labeling.
Gastrointestinal
Because the use of granisetron may mask a progressive ileus and/or gastric distention caused by the
underlying condition, patients should be instructed to tell their physician if they have pain or swelling in their
abdomen.
Skin Reactions
Patients should be instructed to remove the patch if they have a severe skin reaction, or a generalized skin
reaction (e.g. allergic rash, including erythematous, macular, papular rash or pruritus). When patients remove
the patch, they should be instructed to peel it off gently.
Exposure to Sunlight
Granisetron may be degraded by direct sunlight or exposure to sunlamps. In addition, an in vitro
study using Chinese hamster ovary cells suggests that granisetron has the potential for photogenotoxicity.
Patients must be advised to cover the patch application site, e.g. with clothing, if there is a risk of exposure to
sunlight or sunlamps throughout the period of wear and for 10 days following its removal.
FDA-Approved Patient Labeling
Rx Only
Manufactured by:
Aveva Drug Delivery Systems Inc.,
Miramar FL 33025
Manufactured for:
ProStrakan Inc.,
Bridgewater
NJ 08807
Copyright ©2012, ProStrakan Inc. All rights reserved.
SANCUSO and ProStrakan are trademarks owned by the ProStrakan group of companies
Revised: 02/2012
Cancer Fighters Thrive®
10109 E. 79th Street
Tulsa, oK 74133
SANCUSO® (Granisetron Transdermal System):
A recommendation from
leading treatment guidelines1,2
When preparing for chemotherapy, be
armed
&
ready
For nausea and vomiting
One patch.
One application.
5 days of coverage.3,4
Visit www.sancuso.com to learn
more and to download a moneysaving copay card.
Please refer to the sunlight warning in
the important safety information below.
Important safety information
SANCUSO® (Granisetron Transdermal System) is indicated for the prevention of nausea and vomiting in patients receiving moderately and/or highly emetogenic chemotherapy regimens of up to
5 consecutive days duration.4 Do not use SANCUSO if you are allergic to granisetron or any of the other ingredients in SANCUSO.4 Tell your healthcare professional if you are pregnant, if you plan
to become pregnant, or you are breastfeeding.4 Tell your healthcare professional if you have pain or swelling in stomach area (abdomen), or if you are allergic to medical adhesive tape, adhesive
dressings, or other skin patches.4 Tell your healthcare professional about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Other
medicines may affect how SANCUSO works. SANCUSO may also affect how your other medicines work.4 The medicine in SANCUSO (granisetron) may not work well and/or may affect your skin if
exposed to direct sunlight and the light from sunlamps or tanning beds. While wearing the patch keep it covered with clothing if you will be in sunlight or near a sunlamp, including tanning beds.
Keep the skin where SANCUSO was applied covered for another 10 days after the patch is taken off to protect from exposure to direct sunlight.4 You may see mild redness on the skin where the
patch is removed. This redness should go away within three days. If redness continues, tell your healthcare professional. The most common side effect of SANCUSO is constipation.4 Tell your
healthcare professional if you have any side effect that bothers you or that does not go away. This is not the only possible side effect of SANCUSO.4 For more information, ask your healthcare
professional or pharmacist.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
References:
1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Antiemesis. V.1.2012. http://www.nccn.org/professionals/physician_
gls/pdf/antiemesis.pdf. Accessed December 13, 2011. 2. Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology Clinical
Practice Guideline Update. J Clin Oncol. 2011;29(31):4189-4198. 3. Boccia RV, Gordan LN, Clark G, Howell JD, Grunberg SM; on behalf of the Sancuso Study
Group. Efficacy and tolerability of transdermal granisetron for the control of chemotherapy-induced nausea and vomiting associated with moderately and highly
emetogenic multi-day chemotherapy: a randomized, double-blind, phase III study. Support Care Cancer. 2011;19(10):1609-1617. 4. SANCUSO [package insert].
Bridgewater, NJ: ProStrakan, Inc; 2012.
ONLY
®
1-800-SANCUSO
www.sancuso.com
SANCUSO is a registered trademark of ProStrakan, Inc.
©2012 ProStrakan, Inc.
All rights reserved. Printed in U.S.A. SAN-2012-006R1 July 2012
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Environmental Risk Factors - Cancer Treatment Centers of America

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