Breast Cancer Central

CYP2D6 Genotype, Antidepressant Use, and Tamoxifen Metabolism During Adjuvant Breast Cancer Treatment

In people with a specific genotype associated with their cancer, taking Paxil, and to a lesser extent Effexor, may alter the way tamoxifen works in their body.

Link: CYP2D6 Genotype, Antidepressant Use, and Tamoxifen Metabolism During Adjuvant Breast Cancer Treatment

Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy.

This study found that wenty years after the initial treatment, the impact of breast carcinoma on survivors' adjustment was minimal. However, the higher prevalence of PTSD symptoms in response to having had cancer is indicative of continuing psychologic sequelae long after treatment completion. Findings related to lymphedema and numbness and continued symptoms of PTSD suggest that the long-term psychologic and medical sequelae on adjustment may be underrecognized.

Link: Entrez PubMed.

Crawling Out of the Deep Hole of Cancer Depression

Increasingly, health care providers are realizing the many mental health issues involved in a cancer diagnosis. It starts with the adjustment of hearing a diagnosis and understanding what it means and continues through the grueling nature of most cancer treatments and the uncertainty and worry that the cancer will come back or spread.

“Cancer itself can cause people to become anxious or depressed. The treatments can contribute to mood changes, adjustment problems, even delirium in some cases, and so there’s a wide range of mental health issues that can affect patients,” said Michelle Riba, M.D., director of the PsychOncology Program at the U-M Comprehensive Cancer Center and professor of psychiatry at U-M Medical School.

Link: Crawling Out of the Deep Hole of Cancer Depression.

Distress Thermometer May Help Screen for Distress in Cancer...

The single-item distress thermometer (DT) compares favorably with longer measures used to screen cancer patients for distress, according to the results of a multicenter study published in the April 1 issue of Cancer.

"Based on evidence that psychologic distress often goes unrecognized although it is common among cancer patients, clinical practice guidelines recommend routine screening for distress," write Paul B. Jacobsen, PhD, from Moffitt Cancer Center in Tampa, Florida, and colleagues. Recognizing the need for a means to screen rapidly for distress in cancer patients, Roth and colleagues developed the single-item DT. Patients who complete this measure are asked to rate their distress using a scale with scores ranging from 0 ("no distress") to 10 ("extreme distress").

Link: Distress Thermometer May Help Screen for Distress in Cancer Patients.

Micrometastases common after breast cancer treatment

The majority of women with early-stage breast cancer have bone marrow micrometastases up to 4 years after diagnosis, new research suggests.

A study published in the International Journal of Cancer looked for transcripts of cytokeratin 19, a cancer marker, in the blood and bone marrow of 131 women with breast cancer, most of whom had node-negative T1 disease.

Link: Nursing Times News - daily online clinical news.

Care of Cancer Survivors

A cancer survivor is "anyone who has been diagnosed with cancer from the time of diagnosis through the balance of his or her life."1 Continued advances in cancer treatment have led to marked improvements in cure rates, resulting in almost 10 million U.S. cancer survivors.2 Nearly two thirds of all cancer patients survive for at least five years, and survival rates are much higher for many common types of cancer (Table 1).2,3 Cancer survivors are at increased risk for recurrence of the original cancer and development of second primary malignancies as a result of cancer therapy and other risk factors. Prolonged monitoring and treatment are warranted for long-term side effects of surgical, radiation, or cytotoxic therapy.

Approximately 70 percent of cancer patients have comorbid conditions,4 requiring a comprehensive approach to medical care.

Link: RedNova News - Health - Care of Cancer Survivors.

Sisters Network

A National African-American Breast Cancer Survivorship Organization.

Guidelines for Hormone Treatment of Women in the Menopausal Transition and Beyond

Recent communications regarding estrogen or estrogen progestin treatment and clinical cardioprotection, breast cancer risk and cerebral aging have produced considerable confusion and concerns among women, care-givers and the media. The actions of the United States' Food and Drug Administration (FDA) and other National Safety of Medicine Boards, such as the European Medicine Evaluation Agency (EMEA), in response to publication of data from the Women's Health Initiative (WHI)1-3 and the Million Women Study (MWS)4, have also raised concerns. The Executive Committee of the International Menopause Society (IMS) has considered position statements presented at the Fourth Workshop of the IMS, December 2003 and reviewed all presently available information from observational studies, randomized controlled trials (RCTs) and pre-clinical research

Provides a good review of the studies and recommendations, then proposes the following guidelines for treatment of perimenopausal women.

Link: RedNova News - Guidelines for Hormone Treatment of Women in the Menopausal Transition and Beyond.

HABITS (Hormonal Replacement Therapy After Breast Cancer - is It Safe?), a Randomized Comparison: Trial Stopped

Contrary to the conventional wisdom of the 199Os, the Women's Health Initiative Trial definitively demonstrated that, among postmenopausal women, the risks of HRT (increased risk of breast cancer, coronary artery disease, dementia and stroke) outweighed the benefits (relief of climateric symptoms, improved bone density). Limitations to this thought-provoking study include the non-blinded nature of the study design, lack of long-term time frame, lack of difference in overall survival data, lack of quality of life data and lack of sufficient power to perform meaningful subset analyzes (e.g. nodal status and stage of breast cancer). Nonetheless, the results of the HABITS trial represent the highest level of evidence- based data on the subject of HRT for breast cancer survivors. The results are congruent with experimental evidence that hormonal therapy enhances breast cancer cell growth and contributes to a growing body of evidence that helps guide our clinical decision- making.

Link: HABITS (Hormonal Replacement Therapy After Breast Cancer - is It Safe?), a Randomized Comparison: Trial Stopped.

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