network Spring

’09

Sharing hope, support and understanding with anyone diagnosed with cancer regardless of where treatment is or was received.

Two of three Americans are overweight or obese, putting them at higher risk for developing heart disease, type II diabetes and a host of cancers, according to the National Institutes of Health.

Should they get cancer, being overweight may worsen their prognosis or increase the likelihood of a recurrence.

Luckily, getting to a healthy weight may be simpler than is commonly thought.

“It’s about energy balance,” says Daniel Hughes, Ph.D., instructor in the Department of Behavioral Science at M. D. Anderson. “How much you take in compared to how active you are. My goal is to get more people more active for more of the time.”

He is a co-investigator on “Take Heart,” a pilot study researching behavioral interventions in cancer survivors with heart failure caused by treatment-induced cardiac toxicity.

This condition is an increasing concern, as more cancer survivors are living longer and, in some cases, suffering late effects of chemotherapy. Results of the study will benefit them, as well as the general public, Hughes says.

After getting a baseline measurement of each patient’s fitness level, researchers implement an individualized exercise program. Besides aerobic activity, Hughes encourages activities that build lean muscle.

“Approximately seventy percent of the calories you burn, you burn while at rest. With resistance training, patients can actually change their body composition and burn more calories at rest,” he says.

What you eat matters, too“We suggest a plant-based diet — mostly fruits,

vegetables and unrefined grains. And limiting sugars and fats,” says Wendy Demark-Wahnefried, Ph.D., professor in the Department of Behavioral Science.

She is the coauthor of a 2006 American Cancer Society report that concluded that obesity increases

the risk of several cancers. “Prostate, breast, endometrial, to name a few,” she says. “Losing weight reduces that risk.”

Social support may helpDemark-Wahnefried is the principal

investigator on a just-launched clinical trial exploring the effects of personalized diet and exercise advice combined with social support on women’s abilities to adopt and maintain a diet and exercise program.

She insists that eating well and exercising are not just about losing weight. “These interventions are designed to improve patients’ functionality and quality of life,” she says.

Hughes agrees. “The benefits of exercise are psychological as well as physical.”

Although most of the subjects in the exercise studies are not used to exercising, “After the session, most of them have that warm glow,” he says. “They say it wasn’t as hard as they thought it would be.”

Hughes advises patients to choose an activity they enjoy, take it easy at first, and look beyond the numbers on the scale. “Don’t weigh yourself too often,” he says. “A better gauge is how your clothes fit.”

He hopes that someday M. D. Anderson will have a diet and exercise assessment lab in each of its survivorship clinics to help the growing numbers of survivors live healthily and happily for many years.

Balanced: eating less, exercising more equal weight loss by Mary Brolley

The Anderson Network is a program of Volunteer Services at M. D. Anderson Cancer Center

As a cancer survivor, you might ask, “What do an antibiotic, an antidepressant, a spice and a wakefulness-promoting agent have to offer me?”

“Perhaps relief,” is the answer.

According to researchers at M. D. Anderson, some combination of four tried-and-true agents may work as interventions for treatment-related symptoms and side effects for patients with lung or head and neck cancers — especially if they are plagued by fatigue, pain, sleep disturbance, lack of appetite or drowsiness.

“Through a grant from the National Cancer Institute, we have the opportunity to test these agents in combination,” says Charles Cleeland, Ph.D., chair of the Department of Symptom Research at M. D. Anderson and principal investigator. “One of the problems with symptom research to date has been the lack of a strong evidence base. Now we have the funding to get good clinical trial information about a very accessible approach to symptoms.”

A constellation of symptomsThe clinical trials will continue the

work Cleeland and his team began several years ago with clinical investigators when they defined the specific symptoms patients with lung or head and neck cancers experience in response to treatment. (See Network fall 2007 on the M. D. Anderson Symptom Inventory for lung cancer and summer 2008 on the inventory for head and neck cancers, online at www.mdanderson.org/publications/network in “Archives.”)

“These patients start off with very few or no symptoms at diagnosis,” Cleeland says. “Then, from chemotherapy and radiation they develop a constellation of symptoms that we’ve learned are associated with aggressive cancer therapy. These can cause significant distress and are poorly controlled despite standard supportive care.

“One of the novel things about this study is the use of agents that are usually meant for another purpose

to treat these severe symptoms. We’ll analyze study results frequently and assign new patients to only the most successful treatments — a departure from classic randomized clinical trials.”

The four intervention agents are:

• Curcumin, the main ingredient in the yellow spice turmeric

• Minocycline (Minocin®), an antibiotic

• Modafinil (Provigil®) , a wakefulness-promoting agent originally developed to treat narcolepsy

• Bupropion (Wellbutrin®, Zyban®), an antidepressant

An interactive voice response system tracks the impact these interventions have over a period of time. A computer calls patients who use their telephone keypad to self-report the severity of their symptoms on a scale of 0-10, 0 being “not

present” and 10 being “as bad as you can imagine.”

By charting responses, Cleeland and his group can know that

treatment is successful if overall severity of symptoms is reduced.

Getting to the root of the matterGrowing scientific evidence suggests

that symptoms occur in clusters and that common biologic mechanisms, such as

inflammatory cytokines (signaling proteins), may cause or contribute to these clusters.

Cleeland’s group hopes that by investigating various combinations of these agents with broad

anti-inflammatory properties and low toxicity, they will be able to reduce the most severe symptoms caused by treatments: fatigue, pain, sleep disturbance, lack of appetite and drowsiness (in lung cancer patients) or difficulty swallowing (in head and neck cancer patients).

“It used to be that the side effects of therapies were so horrible you sort of closed your eyes and treated,” Cleeland says. “Now doctors at M. D. Anderson have a sense that symptoms can be treated, and as our co-investigators, they want to help patients in a way that leaves them with less symptom burden.”

Someday cancer patients may hear: ‘For relief, take …’by Sandi Stromberg

3

Paying it forward:Survivor cheers othersby Mary Brolley

James Wiley studied the young couple on the Rotary House International hotel elevator. They looked worried, distracted — out of it.

“First time?” he asked gently.The couple acknowledged that they were indeed

visiting M. D. Anderson for the first time, then asked why he was there.

“For a check-up,” he said, then, sensing their interest, continued.

“Twenty-eight years ago I came here with no hope, with stage IV colon cancer.”

The couple brightened. Wiley told them that he was living proof that even those with the bleakest diagnoses must hold on to hope.

“You are in the best place you can be,” he assured them.

Since his remarkable recovery from cancer, Wiley and his wife Dean have reached out to encourage those in all stages of the cancer journey.

From despair to hopeIn 1980, Wiley was a 37-year-old chemist working

at a DuPont Corporation fibers-manufacturing plant in Chattanooga, Tenn. Afraid to confront the possibility that he was ill, and wishing to protect Dean, he ignored symptoms of colon cancer.

During cancer surgery in a Chattanooga hospital, his physicians discovered that it had metastasized to the liver. They thought that nothing could be done. Wiley had perhaps six months to live, they told the couple, and sent them home.

Then a friend of a friend recommended M. D. Anderson.

So the Wileys flew to Houston and met a team of medical professionals led by John Stroehlein, M.D., professor and chair ad interim of the Department of Gastroenterology, Hepatology and Nutrition. After a thorough diagnostic work-up, Stroehlein felt that liver surgery was an option for Wiley.

Such surgery was rarely performed in 1980 — just 10 percent of those with metastatic liver cancer qualified — so Wiley was a lucky man.

In the first year after surgery, Wiley and Dean returned to M. D. Anderson for frequent follow-up

visits. Though the travel to and from Houston was difficult, people rallied around to help.

Wiley is deeply grateful for the support that helped him survive and thrive: his faith, the care and concern of family, friends and coworkers, a supportive employer and the steadfast assistance of a loving partner.

In fact, Wiley believes that his cancer, or the journey through it, has enriched his life. It strengthened his faith and increased his love and respect for Dean. In the early years of their marriage, he admits he was “a bit of a chauvinist.”

“I thought I should take care of everything,” he muses. “But she amazed me after I got sick.”

Even in the early hours of the crisis, and despite his bleak prognosis, “I only saw her cry once,” he says. “She was focused. She took people to task. She had my back.”

To express his feelings about his cancer journey and miraculous recovery, Wiley has written a book about his experience.

“The Dawn Will Come” (available at www.amazon.com) also touches on Wiley’s impoverished childhood in rural Mississippi, the hard work and academic success that earned him scholarships to college, and his military service in Vietnam.

And though he credits others for his triumphs over adversity, the reader comes away with a genuine admiration for this thoughtful, gracious man.

People Profiles

John Stroehlein, M.D. (top right), with Dean and James Wiley

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Page 4 Briefs

Visit the Anderson Network Internet site at www.mdanderson.org/andersonnetwork

The Anderson Network is a program of Volunteer Services at M. D. Anderson Cancer Center.

Address changes should be sent to: Sandi Stromberg University of Texas M. D. Anderson Cancer Center Communications Office – Unit 700 6900 Fannin St. Houston, TX 77030-3800 Phone: 713-792-3457 Fax: 713-563-9735 E-mail: sfstromb@mdanderson.org

Articles and photos may be reprinted with permission.

Susan French, Executive Director, Volunteer Services Debbie Schultz, Assistant Director, Volunteer Services/ Anderson Network Sandi Stromberg, Writer/Editor, Network Kelley Moore, Graphic Design

Kenneth Woo, Chair, Anderson Network

© 2009 The University of Texas M. D. Anderson Cancer Center

network

If you’re looking for more information about cancer or cancer treatments and their effects, or if you want to connect with others experiencing similar situations, Anderson Network offers several online programs:

• Ask the Expert — www.mdanderson.org/asktheexpert/ — is a forum that features timely cancer topics and the chance to get your questions answered by M. D. Anderson cancer experts. Past discussions also are archived. The next topic will be Young Adult Cancer Survivorship, June 8-12.

• Cancer Survivor Message Board —www.mdanderrson.org/andersonnetwork/ —offers a place to ask questions, talk or just listen.

• Network newsletter — www.mdanderson.org/publications/network/ — is a quarterly publication with survivor stories, cancer news and other helpful information for cancer patients/survivors, caregivers and health care professionals.

• WarmNet — www.mdanderson.org/andersonnetwork/ — is a subscription listserv for cancer patients/survivors, caregivers, family members and friends

The Strength Within: Living With, Through and Beyond Cancer

Save the date for Anderson Network’s 21st annual patient and caregiver conference, Sept. 10-12, at the Houston Marriott Westchase, 2900 Briarpark Dr., featuring:

• Keynote speaker Hoda Kotb, “NBC Today” co-anchor and cancer survivor

• Martin Raber, M.D., clinical professor at M. D. Anderson and cancer survivor

• Charles Petty, Ph.D., humorist

For more information, visit our Internet site at www.mdanderson.org/patientconference, or call 713-792-2553 or 800-345-6324. Registration begins Monday, June 15.