Cancer survivors not seeking help for depression

Source: www.dailyrx.com Author: staff Long-term treatment can affect how cancer survivors manage in the world. The fancy phrase for this is “psychosocial functioning.” A recent study looked at how head and neck cancer survivors get along after treatment. Depression is not uncommon among head and neck cancer survivors, researchers found in this new study. However, not many of the survivors in the study sought help for their depression with either antidepressants or therapy. Physicians could assist by screening for psychosocial problems because depression is very treatable, according to one expert. Allen M. Chen, MD, of the University of California, Davis, and now of the David Geffen School of Medicine at the University of California, Los Angeles, led this study. Dr. Chen and colleagues were looking at the rates of depression among head and neck cancer survivors who had received radiation therapy to treat the disease. “The treatment of head and neck cancer can lead to devastating impact on psychosocial functioning due to the many important structures located in the head and neck region," Tobenna Nwizu, MD, a solid tumor oncologist with the Taussig Cancer Institute at Cleveland Clinic, told dailyRx News. “Functions like speech, swallowing, taste and salivation can all be affected,” said Dr. Nwizu, who was not involved in this study. Treatment can also affect appearance, cause dry mouth and increase the risk of aspiration (sucking food into the airway), according to the authors. For this study, the researchers asked 211 head and neck cancer survivors to complete a [...]

SSRI Prevents Depression in Head, Neck Cancer

Source: MedPage TodayBy Salynn Boyles, Contributing WriterPublished: June 21, 2013  Prophylactic escitalopram cut the incidence of depression in head and neck cancer patients by more than 50% and improved quality of life, a clinical trial showed. Significantly fewer patients taking the antidepressant developed depression, when compared with those on placebo (10% vs 24.6%; stratified log-rank test, P=.04), according to a study in the June 20 issue of JAMA Otolaryngology Head and Neck Surgery. "Depression is very common among patients with this disease, but it is not easy to predict who will become depressed at the beginning of treatment," University of Nebraska Medical Center professor of head and neck oncology William Lydiatt, MD, told MedPage Today. "That's why the prevention paradigm may offer considerable benefit at an acceptable risk." As many as half of head and neck cancer patients develop clinical depression within months of their diagnosis and suicide rates are among the highest in patients with a medical illness, Lydiatt noted. "The burden of treatment is extensive and frequently includes dysphagia, disfigurement, voice alterations, mucositis, need for tracheostomy and feeding tubes, fatigue and depression," the researchers wrote. They chose the generic version of the popular SSRI Lexapro for the trial to give patients an affordable treatment option that's well tolerated in the elderly. The randomized, double-blind trial included 148 newly diagnosed head and neck cancer patients entering treatment who did not yet have a diagnosis of depression. The patients were stratified by sex, site of disease, stage, and primary modality of [...]

2013-06-21T14:10:07-07:00June, 2013|Oral Cancer News|

Cancer Patients’ Health Benefits From Physical Activity

Source: MedicalNewsToday.com According to an investigation published on bmj.com, cancer patients who have completed their primary cancer-related treatment, who engage in physical activity, can enhance their health. Earlier studies discovered that individuals with cancer anticipate to return to normal daily activities after completing their primary cancer-related treatment. However, these patients often find they experience lower physical activity, increased fatigue and a decrease in quality of life (QOL). Although, several health factors including QOL can be enhanced through engaging in exercise, according to studies. Investigators from the University of Hong Kong examined the results of 34 human trials that evaluated how exercise effects adult individuals with cancer. Each trial consisted of an average of 93 participants who had either suffered from prostate, breast, lung, colorectal, gynecologic or gastric cancer. The average age of the participants was 55 years. The trials included resistance, strength and aerobic training for a median duration of 13 weeks. Health improvements, such as BMI and body weight, blood sugar control, lower limb strength, fatigue, depression and QOL, were observed among participant's who received breast cancer treatment who engaged in a period of physical activity. Improvements, such as oxygen consumption, depression, BMI, body weight, handgrip strength and QOL, were also observed among patients who completed treatments for other types of cancer. Furthermore, variations in intensity and type of physical activity influenced the physical health of cancer patients and played a vital role in the effects of the exercise. Individuals with breast cancer found that resistance and aerobic exercise [...]

2012-02-03T10:35:20-07:00February, 2012|Oral Cancer News|

Many Head and Neck Cancer Survivors Face Eating Problems

Source: HealthDay News Persistent pain, eating problems and depression are the most common problems experienced by long-term survivors of head and neck cancer, a new study finds. In the study, published in the Jan. 16 online issue of the journal Archives of Otolaryngology -- Head & Neck Surgery, researchers looked at 337 people who were diagnosed with head and neck cancer from 1995 to 2004 and survived at least five years. More than 50 percent of the survivors had problems eating because of poor throat functioning, 28.5 percent had symptoms of depression and more than 17 percent had substantial pain, the researchers found. However, when the long-term survivors were compared to age-matched people in the general population, their average general health was similar, Dr. Gerry Funk, of the University of Iowa Hospitals and Clinics in Iowa City, and colleagues explained in a journal news release. The investigators also found that pain and diet in the first year after cancer treatment were the strongest independent predictors of five-year, health-related quality-of-life outcomes. Problems with mouth and throat function in head and neck cancer survivors can be due to factors such as neuromuscular changes, anatomic deficits after surgery, pain and dental problems, the researchers noted. "Early interventions addressing eating issues, swallowing problems and pain management will be a crucial component in improving this patient population's long-term quality of life, especially in those who are functioning poorly one year after diagnosis," the study authors concluded. This story was also covered in a narrative form [...]

2012-01-18T13:54:28-07:00January, 2012|Oral Cancer News|

Prescription Drug Prices Will Soon Be More Affordable

Source: Stamford Advocate The cost of prescription medicines used by millions of people every day is about to plummet. The next 14 months will bring generic versions of seven of the world's 20 best-selling drugs, including the top two: cholesterol fighter Lipitor and blood thinner Plavix. The magnitude of this wave of expiring drugs patents is unprecedented. Between now and 2016, blockbusters with about $255 billion in global annual sales are set to go off patent, notes EvaluatePharma Ltd., a London research firm. Generic competition will decimate sales of the brand-name drugs and slash the cost to patients and companies that provide health benefits. Top drugs getting generic competition by September 2012 are taken by millions every day: Lipitor alone is taken by about 4.3 million Americans and Plavix by 1.4 million. Generic versions of big-selling drugs for blood pressure, asthma, diabetes, depression, high triglycerides, HIV and bipolar disorder also are coming by then. The flood of generics will continue for the next decade or so, as about 120 brand-name prescription drugs lose market exclusivity, according to prescription benefit manager Medco Health Solutions Inc. "My estimation is at least 15 percent of the population is currently using one of the drugs whose patents will expire in 2011 or 2012," says Joel Owerbach, chief pharmacy officer for Excellus Blue Cross Blue Shield, which serves most of upstate New York. Those patients, along with businesses and taxpayers who help pay for prescription drugs through corporate and government prescription plans, collectively will save [...]

Lower survival rate for head and neck cancer patients who suffer from stress and depression

Source: Medical News Today Studies have shown that stress can affect the immune system and weaken the body's defense against infection and disease. In cancer patients this stress can also affect a tumor's ability to grow and spread. However, the biological mechanisms that underlie such associations are not well understood. Now, researchers at Fox Chase Cancer Center find that poor psychosocial functioning is associated with greater vascular endothelial growth factor (VEGF) expression - a signaling protein that not only stimulates tumor growth, but is also associated with shorter disease-free survival in head and neck cancer patients. "There is research showing that high VEGF expression in other cancers, such as ovarian, is associated with psychosocial factors," says Carolyn Fang, Ph.D., Co-Leader of the Cancer Prevention and Control Program at Fox Chase, who presented the study at the 32nd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine on Thursday, April 28th. "This information coupled with what we already know about VEGF promoting tumor aggressiveness and poorer prognosis in head and neck cancer patients, certainly gave us a reason to look at this biomarker." VEGF not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines - a category of signaling molecules used extensively in intercellular communication. In the current study, Fang and colleagues looked at 37 newly diagnosed, pre-surgical head and neck cancer patients, to see if psychosocial functioning, such as perceived stress and depressive factors, was associated with VEGF, a [...]

In cancer survival, ‘mind matters,’ says expert

Source: www.medscape.com Author: staff Social support and psychologic/psychiatric interventions can improve survival in cancer but are "overlooked" in the treatment of the disease, argues a psychiatrist in an essay published in the February 2 issue of the Journal of the American Medical Association. "A patient's personal mental management of the stresses associated with cancer" is a "natural ally" in the battle with this disease, writes David Spiegel, MD, from the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine in Palo Alto, California. "It is plausible that interventions providing emotional and social support at the end of life have a positive influence on physiological stress-response systems that affect survival," he writes, suggesting a mechanism of action. But another expert in the field of behavioral medicine noted that there is very little evidence of such survival benefit. "Social support almost certainly makes people feel better, which is hugely important, and I wouldn't be surprised if it did improve survival," said Richard Sloan, PhD, from the Division of Behavioral Medicine at the Columbia University Medical Center in New York City. But, he added, there is no strong body of evidence that treatments and services addressing social or emotional issues improve survival in the field of cancer. For instance, "I know of no study in cancer patients that shows that reducing depression improves survival," he said. "We should treat depression because it makes patients miserable, not because we think it may improve survival," he added. Dr. Sloan's great concern about [...]

2011-02-06T09:15:28-07:00February, 2011|Oral Cancer News|

Depression not an “invariable complication” of cancer

Source: www.medscape.com Author: Nick Mulcahy Depression — the most extensively studied mood complication associated with cancer — is "less common in patients with cancer than previously thought," according to the authors of a new meta-analysis. "Substantial uncertainty exists about prevalence of mood disorders in patients with cancer, including those in oncological, hematological, and palliative-care settings," write the authors, led by Alex Mitchell, MRCPsych, from the Department of Cancer Studies and Molecular Medicine at the Leicester Royal Infirmary and Leicestershire Partnership Trust, in the United Kingdom. For instance, reviews of depression in palliative-care cancer settings have shown prevalences between 1% and 69%, say the authors. However, the meta-analysis found that depression affects only about 16% of patients in oncological, hematological, and palliative-care settings. This rate is "modest," and suggests that "depression is not an invariable complication of cancer," write the authors. The analysis was published online January 19 in the Lancet Oncology. But depression is only one problem. "Some combination of mood disorders" occurs in 30% to 40% of cancer patients in these 3 hospital settings, the authors report. The study's take-away message is that clinicians should remain "vigilant for mood complications, not just depression," suggest Dr. Mitchell and colleagues. They also recommend that clinicians use simplified screening tools to look out for "distress, activities of daily living, quality of life, unmet needs, and desire for help." Herein lies the great challenge, suggested an expert not involved with the meta-analysis — namely, how to proceed in the cancer clinic with patients [...]

The fog that follows chemotherapy

Source: nytimes.com Author: Jane E. Brody As more people with cancer survive and try to return to their former lives, a side effect of chemotherapy is getting more and more attention. Its name is apt, if unappealing: chemo brain. Nearly every chemotherapy patient experiences short-term problems with memory and concentration. But about 15 percent suffer prolonged effects of what is known medically as chemotherapy-induced cognitive impairment. The symptoms are remarkably consistent: a mental fogginess that may include problems with memory, word retrieval, concentration, processing numbers, following instructions, multitasking and setting priorities. In those affected — and doctors at this point have no way of predicting who might be — it is as if the cognitive portion of the brain were barely functioning. Symptoms are most apparent to high-functioning individuals used to juggling the demands of complex jobs or demanding home lives, or both. The chemo brain phenomenon was described two years ago in The New York Times by Jane Gross, who noted that after years of medical denial, “there is now widespread acknowledgment that patients with cognitive symptoms are not imagining things.” Some therapists have attributed the symptoms of chemo brain to anxiety, depression, stress, fatigue and fear rather than direct effects of chemotherapy on the brain and hormone balance. Yet when such factors dissipate, the symptoms may not. Recent studies that took other influences into account and analyzed how patients’ brains worked before and after cancer treatment have shown that cognitive effects of chemotherapy are real and, for some, [...]

Evidence-Based Recommendations for Cancer Fatigue, Anorexia, Depression, and Dyspnea

Source: Journal of Clinical Oncology, Vol 26, No 23 (August 10), 2008: pp. 3886-3895 Authors: Sydney M. Dy et al. Purpose: The experience of patients with cancer often involves symptoms of fatigue, anorexia, depression, and dyspnea. Methods: We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Results: For fatigue, providers should screen patients at the initial visit, for newly identified advanced cancer, and at chemotherapy visits; assess for depression and insomnia in newly identified fatigue; and follow up after treatment for fatigue or a secondary cause. For anorexia, providers should screen at the initial visit for cancer affecting the oropharynx or gastrointestinal tract or advanced cancer, evaluate for associated symptoms, treat underlying causes, provide nutritional counseling for patients undergoing treatment that may affect nutritional intake, and follow up patients given appetite stimulants. For depression, providers should screen newly diagnosed patients, those started on chemotherapy or radiotherapy, those with newly identified advanced disease, and those expressing a desire for hastened death; document a treatment plan in diagnosed patients; and follow up response after treatment. For general dyspnea, providers should evaluate for causes of new or worsening dyspnea, treat or symptomatically manage underlying causes, follow up to evaluate treatment effectiveness, and offer opioids in advanced cancer when other treatments are unsuccessful. For dyspnea and malignant pleural effusions, providers should offer thoracentesis, follow up after thoracentesis, and offer pleurodesis [...]

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