When to ask for help: Talking about symptoms is first step in treating them

Larry Stone asked for help with symptoms related to his cancer treatment.

Larry Stone asked for help with symptoms related to his cancer treatment.

Larry Stone joined a clinical trial in fall 2009 to test a medication that offered the possibility of prolonging the effectiveness of the hormone therapy he was taking to stave off prostate cancer. When he started to experience mild numbness in his hands and feet later that spring, he didn’t think too much about it. But by June, pain and swelling sent him to the hospital overnight.

His hospital stay relieved his pain somewhat, but it prompted him to ask his oncology team a question: “Is there a specialist I can see?”

That simple question triggered a referral to the University of Michigan Comprehensive Cancer Center’s Symptom Management and Supportive Care Clinic. Stone met with Susan Urba, M.D. — the clinic’s leader — as well as pharmacist Emily Mackler, Pharm.D. Together, the team mapped out a program to reduce Stone’s discomfort.

“That was the start of a great relationship,” Stone said.

Read more about symptom management in the University of Michigan Comprehensive Cancer Center’s patient publication, Thrive. Or, if you are a U-M patient, call 1-877-907-0859 to make an appointment with the U-M Symptom Management and Supportive Care Clinic.

 

New trends in breast reconstruction

Women making a decision about breast cancer surgery should include a plastic surgeon in that discussion. Several options for breast reconstruction give women choices, with each choice carrying its own risks and benefits.

Pink ribbon

October is Breast Cancer Awareness Month.

“The decision tree is complicated. A plastic surgeon ultimately has to walk through the choices with patients and help them consider which option is best for their individual situation and preferences,” says Adeyiza Momoh, M.D., assistant professor of plastic surgery at the U-M Medical School.

As more younger women at high risk of breast cancer choose to have their breasts removed before cancer develops, a procedure called a DIEP (Deep Inferior Epigastric Perforator) flap has become increasingly popular. The technique involves transplanting tissue from the woman’s abdomen into her chest. But unlike traditional tissue reconstruction, called a pedicled TRAM flap, where the entire rectus muscle was included with the flap, a DIEP flap involves a complex approach to dissecting out the small blood vessels and leaving the muscle behind. The blood vessels are then reconnected to blood vessels in the chest.

The technique preserves the abdominal muscle function and typically has fewer abdominal complications. Continue reading

U-M pharmacists, doctors collaborate to ensure patients get drugs they need, despite shortages

After Shawn Burr became a patient at the University of Michigan Comprehensive Cancer Center, his doctor asked an unusual question: Would he be able to bring his own chemotherapy drug?

The Cancer Center — like many institutions throughout the country — was facing a daunting shortage of cytarabine, a generic chemotherapy drug that is instrumental in treating acute myeloid leukemia, the form of cancer Burr has. Two of the three companies that make cytarabine had run into manufacturing problems: One couldn’t obtain the raw materials necessary; the other had to recall batches because of quality concerns. The third company couldn’t keep up with the resulting demand.

And so, when it became clear to Sherry DeLoach, a pharmacist who coordinates drug purchasing for the U-M Health System, that stocks were running low, she notified the oncology pharmacists. They, in turn, met with the doctors whose patients use cytarabine to develop a strategy to ensure that every patient who needed the drug received it. One piece of this plan, among many others, was to ask newly referred patients if they could obtain the drug from their current health-care provider.

U-M would have provided Burr with the drug regardless of his answer. But Burr’s care team at St. Joseph Mercy Port Huron Hospital was able to lend U-M enough cytarabine to accommodate his treatment.

“It’s a pretty hopeless feeling,” Burr said. “Usually, you think health care is all about money, but when it comes to generics, there’s not a lot you can do if drug companies decide they aren’t going to make a drug anymore. There needs to be some policy put in place to protect patients.”

Read the rest of this story

Visit Thrive, the U-M Comprehensive Cancer Center’s patient publication at mCancer.org/thrive.

Bone deep: Learn how to keep bones strong, even if cancer treatment increases osteoporosis risk

The results of Susan McDonald’s bone mineral density screening were troubling. Bone density had decreased 3 percent in her spine and 3.6 percent in her hips since a scan done two years earlier. Given her history of breast cancer and the potential that related treatments might further sap her bones’ strength, McDonald needed a plan to improve her bone health.

Her oncologist, Catherine Van Poznak, M.D., outlined some options to address the thinning in her bones, which in the case of her hips had progressed to a precursor of osteoporosis called osteopenia. McDonald, a 72-year-old Ann Arbor resident, decided to make a concerted effort to increase her walks from 20 minutes to 30 minutes per day, covering about a mile-and-a-half to a mile-and-three-quarters during each outing.

Two years later, McDonald’s bone mineral density was much improved.

“I’m a small, fine-boned woman who’s likely to get in trouble with bone problems,” McDonald said. “But they were talking about osteopenia in my hips two years ago; they’re not saying that anymore.”

Bone health may be of particular concern for people with a history of cancer, said Van Poznak, a University of Michigan Comprehensive Cancer Center oncologist who specializes in breast cancer’s relationship to bone. People with breast or prostate cancer who undergo treatments that block specific hormones may be at higher risk of thinning bones. Also, certain chemotherapy drugs used to treat these or other cancers may induce ovarian failure in younger women, causing bones to thin as a result of early menopause and estrogen deprivation. In addition, steroids may also accelerate bone loss in both men and women.

Although cancer treatment may increase the likelihood of developing osteoporosis — which may lead to painful bone fractures — many options are available to prevent it, Van Poznak said. The key is to talk to your doctor early to develop a plan of action. Here are six steps you can take to improve your bone health. Continue reading