As the calendar flipped to a new year, many of us made well-meaning promises to exercise more – and to really mean it this year. Chances are those promises will be forgotten before we’re used to writing 2014 on our checks.
Moving more is all about motivation. Looking better, feeling better, fitting into smaller jeans, running a race faster, keeping up with kids, increasing energy – all are common motivations, and good ones. An even better one: Regular exercise can reduce your risk of cancer and diabetes.
Making the commitment to enough exercise to reduce the risk of these diseases will barely cut into your schedule. Past studies suggest that even three 10-minute sessions of cycling with 10 to 20 second bursts of high-intensity sprints can reduce diabetes risk. The American Diabetes Association recommends moderate-intensity exercise – such as a brisk walk – 30 minutes a day, five days a week to minimize risk.
Researchers are still assessing the type and intensity of exercise most beneficial for cancer risk reduction, but it’s likely to be fairly modest based on the studies that are available. For example, for best reduction in breast cancer risk, women should exercise three to four hours per week – about 25 to 35 minutes per day, according to Leslie Bernstein, Ph.D., director of the Division of Etiology at City of Hope. The American Cancer Society recommends 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity activity weekly, preferably spread throughout the week.
Tips for getting started: » Continue Reading
Nearly 350 million people worldwide are coping with diabetes, and the disease is expected to be the seventh-leading cause of death by 2030. Aware of these grim statistics, researchers at City of Hope are committed to halting the global epidemic.
On the frontiers of epigenetic engineering
Art Riggs, Ph.D., chair of the Department of Diabetes and Metabolic Diseases Research, is focused on the possibilities within the field of epigenetics. A concept pioneered by Riggs, epigenetics refers to stable changes in gene expression, some of which can be passed on to future generations — but are not written into our genetic code.
Riggs is currently studying epigenetic engineering, the process of making epigenetic changes in stem or progenitor cells to impact how those cells differentiate, grow and mature. Riggs is collaborating with researchers throughout City of Hope’s Diabetes Research Center to find ways to use epigenetic engineering to increase the supply of beta cells for islet transplantation, and to improve regulatory T cells to reverse autoimmunity. » Continue Reading
Don’t panic. Start small. Increase gradually. Have fun. Eat real food. Listen to your body. Love your body.
Jeanette DePatie, a certified fitness instructor and personal trainer who goes by The Fat Chick, recently offered that advice via TweetChat to people considering their fitness goals for 2014.
Every year, many people vow to lose weight or start exercising more. These are worthy goals – as both have been linked with reduced risk of cancer and diabetes. However, many people give up these resolutions by mid-January, returning to the couch and the drive-thru.
It doesn’t have to be that way, DePatie says. Here’s some of the changes-for-the-long-term advice she and other participants shared in our recent TweetChat.
- It can be scary at first, but the key is to start GENTLY. You can always ramp up. Start with a few minutes and see. @fatchicksings
- Find an activity (or better yet, a few!) you enjoy & do them. (personally, I’m into urbanhikes, rollerblading & yoga) @foodie_fitness
- Good idea to make sure you have charged cell phone for walk. And walk short loops until you’re comfortable with your fitness level. @fatchicksings
- Set some goals and write them down. Then talk to loved ones about them & ask for support. It’s much easier to accomplish w/help. @rxwiki
- Getting fit does not have to be hard or expensive. You can also use a pedometer (like the one I got from COH) to count steps. @fatchicksings
- According to the National Weight Control Registry (the largest prospective investigation of long-term successful weight loss maintenance), 94 percent of participants increased their physical activity. The most common activity reported is walking. @cityofhope
- Opt for healthier food choices rather than substitutions (i.e. instead of sugar/fat substitutes, try using less of regular stuff). @foodie_fitness
- Change is more effective and works better when you start by liking yourself. @fatchicksings
- Spot reducing is a myth. You can use spot exercises to strength, but won’t make that spot smaller. @fatchicksings
- Key term here is LONG TERM. That’s what we want. These life changes are not just two weeks in January. @fatchicksings
For more tips, questions and answers, view the full chat here.
Along with the midnight toast and the Times Square ball drop, New Year’s resolutions are an annual tradition at the changing of the year. But for many who’ve resolved to lead a healthier life in 2014 through mindful eating and regular exercising, sticking with these promises for the rest of year — and beyond — is another matter.
Drastic changes, like going on a diet that eliminates entire food categories or suddenly engaging in rigorous exercise routines, can backfire, according to Peggy Mancini, M.S., R.D., a clinical dietitian at City of Hope, and Jeanette DePatie, a certified fitness instructor who calls herself “The Fat Chick.” Not only are these changes difficult to stick with, they can be downright harmful, these experts say.
“Really long and intense workouts after being sedentary for a while … are a recipe for pain and injury. That is why the sports medicine guys are so busy in February,” DePatie says.
“Any diet that restricts a food group results in a loss of nutrients unique to that group. The lost weight is unlikely to be kept off if it’s not an eating plan you can stick with,” she says.
Instead, Mancini and DePatie offer these tips to resolution-makers so they can keep their promises for better health this year: » Continue Reading
Stem cell donations are usually an anonymous gift, with people who want to help others donating their lifesaving cells simply from the rightness and joy of being able to save another human being. The donor and the recipient almost never meet – except in special circumstances. On the morning of Jan. 1, 2014, at the 125th Rose Parade in Pasadena, Calif., those special circumstances were in place. Former City of Hope patient Ben Teller met the woman who saved him from Hodgkin lymphoma: Nancy Haag.
Teller had previously spoken of his journey through the disease and transplant process, but Haag’s experience has not been shared publicly. This is her story.
Nancy Haag was attending a community fair with her family near their Newport, R.I., home in 1995, when she saw a booth for the national bone marrow donor registry.
On an impulse, she signed up.
Unlike today’s method of swabbing the inside cheek of a prospective enrollee, organizers collected a sample of her blood that day. “I remember having that big wad of gauze on me, and thinking, ‘Oh, that’s cool. Who knows, maybe they’ll call me.’”
Seventeen years later, in August 2012, they did.
By that time, Haag was a 47-year-old preschool teacher and mother of six who was living in Coeur d’Alene, Idaho.
The call came during the “crazy-busy” week before her eldest daughter was getting married.
The Connecticut Be the Match office that had organized the Rhode Island donation drive nearly two decades before was calling to let her know she was a potential match, and to ask if she would undergo more thorough testing to confirm her compatibility. Haag learned only that the patient was a male in his early 20s, and had Hodgkin lymphoma.
“I just started thinking about the fact that my daughter and my son were about that age, and certainly, I would do whatever I needed to do for this young man to have a chance.”
Haag already knew about the ravages of Hodgkin lymphoma. When a dear friend and mother of a little boy in her preschool class was diagnosed with the disease years before, “I went through the journey with her,” Haag said. The friend survived chemotherapy and an autologous transplant, in which her stem cells were purified and infused back into her.
In the frenzied days before the wedding, Haag took time to have her doctor draw vials of her blood, then, meticulously following “really explicit directions,” she FedEx-ed her specimens back in a specially designed box packed with blocks of ice.
“I was still thinking they’re probably looking at 10 different people and there’s no way it will be me,” Haag recalled.
Cervical cancer was once one of the most-common causes of cancer death for women in the United States. Now, with better screening techniques, targeted treatments and vaccinations, the death rate has declined dramatically.
“The diagnosis and treatment of cervical cancers have changed markedly in the past 10 years,” said Robert J. Morgan, M.D., co-director of the gynecological cancers program at City of Hope. “The addition of chemotherapy to radiation in locally advanced cervical cancer in the early part of this century added significantly to the long-term, disease-free survivals in this illness.”
Discovering the connection between the human papillomavirus (HPV) and cervical cancer was also groundbreaking, allowing for vaccination to lower the risk of cancer. “This discovery has increased our understanding of the pathogenesis of this illness and has allowed the development of very effective vaccines that can prevent the illness from occurring,” Morgan said.
This milestone is especially notable during January, which Congress has deemed Cervical Cancer Awareness Month. Most people will acquire the HPV infection at some point in their lives, but their immune systems will usually eliminate the virus, Morgan said. The risk of developing cervical cancer, however, rises with exposure to the HPV strains that can cause the disease.
Preventive mammogram guidelines have long been a hot topic for debate.
Medical professionals and health care organizations are divided on how often a woman should be screened and at what age a woman should start preventive screening.
Health care organizations such as the American Cancer Society recommend annual mammograms for women beginning at age 40. The U.S. Preventive Services Task Force recommends that women be screened every two years starting at age 50.
A new study, however, found that women who had mammograms every 12 to 18 months lowered the risk that cancer would spread to the lymph nodes.
“[The new study] adds more power behind the fact that we do need screening mammograms starting at age 40 and every year,” said Laura Kruper, M.D., director of the Rita Cooper Finkel and J. William Finkel Women’s Health Center at City of Hope, in an interview with HealthDay.
The new year is fast approaching, and with nearly 70 percent of adult smokers wanting to kick the habit, many people are likely to make the resolution to give up cigarettes for good in 2014.
That’s great — tobacco is the leading cause of preventable illness and death in the United States and over half of smokers reaching middle age will die of a smoking-related illness. Further, it’s never too late to quit. Quitting smoking is beneficial at any age, and smokers who quit before age 35 have mortality rates similar to people who never smoked, according to the Centers for Disease Control and Prevention.
But quitting is easier said than done. Many smokers try to quit multiple times before succeeding, and less than 5 percent are able to quit cold turkey.
That’s not to say quitting is impossible. Just ask Brian Tiep, M.D., director of pulmonary rehabilitation and smoking cessation at City of Hope, and Rachel Dunham, M.S.N., nurse practitioner for smoking cessation and lung cancer screening.
Cancer will be defeated not in one enormous advance, experts agree, but in incremental advances. Those incremental advances often go unnoticed by the public at the time of their discovery, but in the years to come, they add up – to more life years, to greater survival rates, to more time spent with families and loved ones.
In 2014, patients will begin to see the benefits of many of those advances. Here, City of Hope’s physicians describe some of the recent scientific and medical developments they expect to benefit patients in the year ahead.
Breast cancer: A first-step therapy, now taken more seriously
Breast cancer remains a leading cancer killer of women (second only to lung cancer), but Joanne Mortimer, M.D., director of City of Hope’s Women’s Cancers Program, pointed to several studies that could begin to have a positive impact on treatment and survival.
The most significant recent development, she said, is the use of the monoclonal antibody pertuzumab as pretherapy (more formally known as neoadjuvant therapy) in HER2-positive breast cancer that has advanced locally. Such disease can be difficult to treat – and time is of the essence – so the Food and Drug Administration (FDA) earlier this year approved pertuzumab as neoadjuvant therapy when used along with the drugs Herceptin and docetaxel.
Such early treatment in high-risk patients is considered crucial to effectively fighting the disease.
“The results of this trial paved the way for using response to neoadjuvant chemotherapy as a surrogate for response and benefit to treatment of metastatic disease,” Mortimer said.
Other recent research suggests more effective therapies for women with metastatic disease. Mortimer pointed to a study that found neither mastectomy or lumpectomy and radiation were of benefit in treating the primary cancer, either initially or after response to systemic therapy.
“That suggests surgery may actually result in more rapid progression of metastatic disease,” she said. “In the absence of pain or local problems, mastectomy should not be performed outside of a clinical trial in this population.”
Cervical cancer: A notable drug advance and a simple, but powerful, test
Adding one drug to a treatment regimen can often have a significant difference; that appears to be the case with cervical cancer and the drug bevacizumab, which slows the growth of new blood vessels.
Robert J. Morgan M.D., co-director of the Gynecological Oncology/Peritoneal Malignancy Program at City of Hope, explained a recent study evaluating the role of the drug in addition to chemotherapy in metastatic carcinoma of the uterine cervix. “The addition of bevacizumab to chemotherapy resulted in a survival benefit from 13.3 months to an improved 17 months with very acceptable toxicity,” Morgan said.
“This is the first study that has resulted in a meaningful survival benefit for recurrent cervical cancer compared to the ‘standard’ chemotherapy of cisplatin and paclitaxel,” he added.
But cervical cancer must be detected before it can be treated and, for many parts of the world, that detection remains a significant hurdle. Recent findings could begin to change the outlook.
“In India, a study was carried out that used a simple method of identifying potential cervical cancers in areas that are too poor to have access to pap smear technology,” Morgan said. The method? The application of vinegar.
“Using trained observers and using acetic acid (vinegar) on the cervix, many early cervical cancers were identified,” Morgan said. “It is estimated that the mortality rate of this illness can be slashed by up to one third by this simple technique. “
He added: “It is still though important, particularly in this country, that women obtain regular gynecologic care and also that pre-teens and teenagers obtain the HPV vaccine.”
Endometrial (uterine) cancer: Understanding molecular changes
To fight a disease, doctors need to understand it.
“One problem with uterine and all gynecologic cancer is that we have not had a good understanding of how molecular changes in combination with histology may be beneficial in directing treatments,” said Morgan, also a professor and associate director for medical education in the Department of Medical Oncology & Therapeutics Research at City of Hope.
One recent study has improved that understanding considerably, giving researchers new avenues to explore. Morgan points to a large study using the Cancer Genome Atlas that analyzed molecular characteristics of 373 endometrial cancers, including low-grade endometrioid cancers, high-grade endometrioid cancers and papillary serous cancers. Researchers were able to identify four new categories of endometrial cancer based on the molecular characterizations of the tumors.
“This may well lead to treatment decisions based on molecular markers in addition to histological markers and allow better treatment with targeted agents,” Morgan said. “For example, one subset of high-grade endometrioid tumors had p53 mutations similar to papillary serous tumors, and the supposition is made that these may respond better to treatments designed for serous tumors.”
For women with endometrial cancer – and the doctors treating them – that kind of research-based guidance will be crucial to better outcomes.
Lung cancer: The benefit of precision therapies
In treating lung cancer, think “precision.”
Karen L. Reckamp, M.D. M.S., co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope, said physicians are increasingly using information on the genomics of lung tumors. With this information, they can better block cancer growth and improve outcomes by providing precision therapy for patients.
“In addition, we are beginning to understand the impact of activating the immune system to enhance the attack on tumor cells,” Reckamp said. “We may see a day when a patient’s own immune system can be directed against lung cancer.”
Meanwhile, Dan J. Raz, M.D., co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope, is emphasizing the importance of screening.
“Lung cancer screening is recommended by the U.S. Preventive Services Task Force,” he said. “Widespread adoption of lung cancer screening with low-dose radiation CT scanning has the potential to dramatically reduce death from lung cancer and turn lung cancer into a disease that is detected at an early stage a majority of the time.”
Ovarian cancer: Improved treatments on the way
The treatment of ovarian cancer is becoming both more effective and more complex.
“There are problems with the current standard treatments of ovarian cancer, including the fact that our treatments are similar despite differences in histology and grading of the tumors,” acknowledged Morgan. He cites a lack of research in smaller subsets of ovarian cancer and a lack of effective alternative therapies, despite the development of many targeted agents in the past decade.
But several developments suggest room for improvement in the coming year. For starters, a new drug, salumetinib, is showing promise against low-grade ovarian tumors that have been very difficult to treat. Further, Morgan added: “More agents directed at specific genomic mutations should result in improved treatments in the next few years.”
He also said that treatments could become easier on the patients themselves, pointing to new research on weekly schedules of the chemotherapy drugs carboplatin and taxol that suggests the regimen is just as effective, but less toxic than more traditional regimens.
Meanwhile, ongoing research into the PARP inhibitor olaparib suggests that it may improve treatment of hereditary ovarian cancers when used in the maintenance setting and that the angiogenesis inhibitor cediranib could improve survival in recurrent ovarian cancer.
More research is needed on these drugs before they can be used routinely, but the potential is promising.
Drugs aren’t the only option. “At City of Hope, we are collaborating in a T cell study investigating whether immune therapy may be beneficial in specific subsets of ovarian cancer patients,” Morgan said. “This is based on new knowledge of the immune system and how it plays a role in ovarian cancer.”
Pancreatic cancer: A novel approach to improve survivability
Pancreatic cancer’s lethal reputation comes from its stealth. As Gagandeep Singh, M.D., interim chair of the Department of Surgery at City of Hope, described the disease: “Fifty percent of pancreatic cancer is diagnosed at Stage IV, i.e., after it has spread, giving it a very bleak outlook.”
On the positive side, he noted, 50 percent of patients do not have metastatic disease. “While only 10 percent are operable at the time of diagnosis, the remaining 35 to 40 percent are considered locally advanced,” he said. “We strive to make these 40 percent operable, too, by a combination of neoadjuvant chemotherapy with radiotherapy followed by aggressive surgery or just aggressive surgery up front.”
Singh is optimistic about the future, especially as it relates to improvements in a procedure known as the Whipple, which involves the removal of the head of the pancreas along with the bile duct and the upper part of the intestine. During the surgery, tissue from the intestine is used to reconstruct the bile system, intestine and pancreas.
“We have been able to harness the advantage of the robot to do robotic-assisted Whipples by inserting hand-simulated instruments through tiny holes and then conducting the operation through these keyhole incisions,” Singh said. “The magnification, coupled with ease of use of these robotic instruments, adds to better and more radical clearance of the cancer.”
But choosing the right institution is crucial. “This is what is key – making sure those patients that have nonmetastatic pancreatic cancer go to the right institution at the right time to improve their survivability,” Singh said.
Prostate cancer: Using fluorescents to target disease
Timothy Wilson, M.D., the Pauline & Martin Collins Family Chair in Urology at City of Hope and director of the Prostate Cancer Program, has high hopes for doctors increasing ability to see precisely where cancerous cells stop and non-diseased cells begin. The key is fluorescence.
“The concept is the fluorescent label antibody against an antigen that sits on prostate cells, cancerous or not,” Wilson said. “You inject the fluorescent label antibody into the patient; it then targets and locates the prostate cell. And then during surgery, while doing it robotically, a switch is flipped that lights up that fluorescent label antibody so you see prostate tissue.”
He added: “This helps make sure we get all the cancer out or will help us see prostate cancer cells in lymph nodes.”
City of Hope plans to begin a clinical trial of that technique within months. It’s also exploring how to improve active surveillance, also known as “watchful waiting,” in men who have prostate cancer but who may not need immediate treatment. One method uses magnetic resonance imaging assessment of the prostate; another uses biomarkers.
Wilson referred specifically to the promise of a biomarker study by Steven Smith, Ph.D., professor of molecular science, urology and urologic oncology, that could help determine which men should stay on active surveillance and which men should receive treatment.
Radiation oncology: Getting a clear picture
For Jeffrey Wong, M.D., chair of City of Hope’s Department of Radiation Oncology, the future is looking not only brighter, but much clearer.
“There are two exciting trends for the field with the integration of imaging in radiation oncology,” he said. One involves what’s known as SBRT, for stereotactic body radiation therapy. This type of therapy uses very precise, very concentrated beams of radiation directed directly at the tumor. The other trend to watch uses ultrafocused sound with magnetic resonance imaging.
“For patients who refuse surgery or are medically unable to have surgery, SBRT can be used for lung patients with a 90 percent effectiveness in controlling the cancer,” Wong said.
As for magnetic resonance-guided focused ultrasound, or MRgFUS, it’s currently being evaluated by the Food and Drug Administration and is being tested to ablate prostate cancer, Wong said.
City of Hope’s Vicky Hoffman contributed to this report.