#cancer85years – CANSA research

ABC - Advocates for Breast Cancer - CANSAThrough its Type A programme, offering funding to established researchers at South African universities and research institutions, CANSA is currently funding a number of projects addressing breast cancer.

These projects span a wide range in terms of types of research and focus areas. Several projects are looking at breast cancer prevention in basic science studies. Dr Donita Africander of University of Stellenbosch is examining the chemo-preventative properties of bio-identical hormones; Prof Anna-Mart Engelbrecht of University of Stellenbosch is examining whether melatonin can prevent the onset of breast cancer in a mouse model; Prof Ann Louw of University of Stellenbosch is looking at the chemopreventive action of a Cyclopia extract in rat models of breast cancer; while Dr Annadie Krygsman of University of Stellenbosch is examining whether simple dietary modification by restriction of carbohydrate and/or omega-6 fatty acids can prevent breast cancer development in the urban South African context.

A number of other projects are looking at genetic aspects of breast cancer which could impact early diagnosis. Dr Adrienne Edkins of Rhodes University is conducting an analysis of stem-cell associated genes in breast cancer as biomarkers and predictors of cancer malignancy. Prof Lizette Jansen van Rensburg of University of Pretoria is looking at the role of DNA homologous recombination genes in breast/ovarian cancer susceptibility; Dr Ans Baeyens of WITS is examining genetic screening of triple negative and young breast cancer patients in South Africa; while Prof Fourie Joubertof University of Pretoria is conducting an investigation into genetic variation in South African breast cancer patients using genome sequencing.

We are also funding projects in the areas of clinical and public health research. Dr  Herbert Cubasch of WITS and Prof Jennifer Moodley of UCT are both conducting projects that will contribute to our understanding of delays in seeking care and accessing treatment in women with breast cancer in South Africa, and may have significant outcomes for healthcare delivery.

Compiled by
Dr Melissa Wallace, Head of Research
Lorraine Govender, National Advocacy Co – ordinator

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Buddies for life!

bhf circleBuddies For Life is a bi-monthly lifestyle magazine, published by Word for Word Media in association with the Breast Health Foundation, for breast cancer patients, their families and friends. It was launched in June 2011, and 22 issues have been published to date with many more to come.

The glossy print and online magazine aims to educate, encourage and provide support. An array of medical professionals and experts write supportive and educational articles for the magazine on topics such as treatment, health and wellness, diet, fitness, sexuality, new advances and psychological advice that will assist those affected by cancer to understand the disease and treatment.

The content is essential reading written in a style that simplifies terminology. Super Survivor is featured on the cover of every issue and the breast cancer survivor’s story is told. On the Chemo Couch is another platform for survivors to share their unique story.

In keeping with the aims of the Breast Health Foundation, each issue contains a section dedicated to the early detection and awareness of breast cancer.

Oncology Buddies, supported by CANSA, is a new section within the magazine catering for other cancer awareness, early detection and various support groups.

Buddies For Life is available in print at hospitals, private clinics, oncology practises, Buddies for lifemammography units, radiology centres and support groups. Medipost courier the distribution of the print magazines to all the various distribution points.

A digital version is also available on www.buddiesforlife.co.za and yearly subscriptions are offered.

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The Breast Health Foundation is one of the partner organisations in the Advocates for Breast Cancer (ABC)

Keeping cool in the tough times

Two-Coolers-RecipeIt is hard to imagine feeling hot and bothered in our chilly winter weather, but cancer treatment can play havoc with our normal body temperature.

And even if you are not feeling the heat, you can always do with a fruity vitamin boost!

Two Coolers
When you feel hot and bothered or sore try these to soothe and refresh.

Strawberry and Citrus Sorbet

Fresh juice of 2 big oranges
Fresh juice of 1 pink grapefruit
Fresh juice of 2 tangerines
Zest of 2 organic oranges, finely grated
10ozs (250g,2 cups) fresh strawberries or raspberries, cleaned
5 tablespoons maple syrup

Whizz together in a goblet blender or food processor. Pour into a shallow dish and freeze for 2-3 hours. Break into chunks and process again (using a sharp blade) until smooth and creamy. Return to the freezer for 30 minutes before serving. If you want to leave it longer in the freezer put it into little ice-lolly moulds at the final freeze and get them out as you feel the need.

For a change with added food value, try adding:

4ozs (100g, ½ cup) plain silken tofu
2 tablespoons more of maple syrup
2 teaspoons vanilla essence

Include frozen bananas at the final whizz stage before the second freeze.

Frozen Bananas

The simplest soother ever! Just peel ripe, firm and perfect bananas, wrap them individually in kitchen wrap/film and freeze overnight. Nibble on them whenever you fancy something cool and creamy. Don’t keep them in the freezer for too long, just do a few at a time.

If you can find sugar-free carob drops (try health food shops) melt them like chocolate in a ‘bain-marie’ (double saucepan) and dip your bananas in for an iron fortified, luxurious treat.

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

The DITTO project

ditto

The Ditto project is an initiative run by Reach for Recovery to provide indigent women access to a silicone prosthesis which helps to restore her self-image and confidence after the traumatic breast cancer diagnosis and surgery.

Surgery after a breast cancer diagnosis may involve part or all of a breast being removed (mastectomy). Having a mastectomy leads to a tier of decision making regarding whether to have surgical reconstruction, wear an external breast prosthesis, or not wear anything at all to replace the amputated breast.  External breast prosthesis may be the best option a woman has, especially if she cannot afford to undergo reconstructive surgery.  However, not all patients can afford the cost of a permanent prosthesis.

Reach for Recovery believes that all women who have had breast cancer surgery should have access to appropriate breast prostheses, regardless of whether they can pay for it or not. The reality is that many breast cancer patients in South Africa cannot even afford a bra, let alone a breast prosthesis. Reach for Recovery wants to help these women who come from low income groups to feel confident again after the traumatic diagnoses and surgery.  We believe that a breast prosthesis is an important step in her recovery, especially to those women from communities where a there is still a stigma attached to a cancer diagnoses.  A more natural appearance with a breast prosthesis, together with the emotional support that she can continue to receive from Reach for Recovery volunteers through support groups, will help her to return to her place of employment and continue to provide for her family.

Any breast cancer patient who can present a current Provincial Hospital Card qualifies for access to subsidised silicone prosthesis.  The patient is asked to make a donation of R80 towards the project (R160 in case of a bilateral).   However, no patient has ever been turned away because she could not afford to make a donation.  The prosthesis may be replaced after three years.

Unfortunately Reach for Recovery cannot provide the paying customer with an invoice to claim back from their medical aid as we do not have a Medical Practice Number.  However, we do offer as much support as possible in terms of general information on local and international manufacturers, suppliers etc.

The Ditto Project started in 2011.  Since then, a total of 3235 silicone prostheses costing more than R2 million were given to women who could not afford one.  Many women donated a small amount (R80) as a token of their gratitude, but we also supported women who could not afford any donation at all.

Apart from state patients, a growing number of women only have a Hospital Plan which does not cover breast prostheses. Pensioners are particularly hard hit.

We have also seen a steady increase in the number of women needing silicone prostheses since 2011:  from 475 in 2011 to 930 in 2015.  There is without doubt a growing need for this service.   Unfortunately a silicone prosthesis is guaranteed to last for only two years; therefore we are also experiencing women returning to Reach for Recovery to have their prostheses replaced.

The need for silicone prostheses for newly referred breast cancer patients plus the need for replacements impacts heavily on the funds that we use to subsidise these products. A needs analysis has shown that we would subsidise at least 1000 women with a new silicon breast prosthesis in the new financial year.  This includes women who would need a replacement.

We are extremely thankful to our donors who help us to ensure the sustainability of this project!

Reach to Recovery is one of the breast cancer organisations that is a part of ABC.

 

Reach for Recovery Logo (2)

Those dreaded side effects!

sideeffects

The chemotherapy drugs cannot distinguish between cancer cells and normal cells of the body and will attack other rapidly growing cells such as hair,skin, nails, lining of the digestive system and bone marrow (blood cell lines).

Therefore there are various side effects associated with the therapy and  because each drug acts in a slightly different way, the side effects will also differ between different drugs.

Thankfully, like all drugs (including Panado and Aspirin), not every side effect is experienced by every person, and some side effects are experienced to lesser degrees in some people.

Many side effects may be unpleasant, but are not harmful. Some side effects may get worse and some may get better with each cycle of treatment. Others may develop during the course of the treatment.

Some side effects need to be treated and some can be managed by anticipating them and controlling them in advance which lessens their effect.

Some side effects are more serious and it is important to contact your doctor if you are worried.

The good news is that cancer cells divide more rapidly than normal cells and are therefore more likely to be killed by chemotherapy.

More good news is that normal cells are also more able to recover than cancer cells and therefore most side effects are not permanent and will reverse once the treatment is finished.

Blood cell counts are done each time a new cycle of chemotherapy is started. This is usually done the day before the next treatment or very early on the same morning of the treatment. Sometimes a blood test will be done mid-cycle depending on the patient or the combination of drugs used.

The most common side effects and some of the agents that cause them:

Nausea/Vomiting (FEC, AC> CMF, Xeloda)

Drugs that help prevent against nausea are given before the combinations that cause this. Medication is also given to take home for a few days after treatment too. Different drugs work for different people and it may be necessary to try more than one antiemetic before you get relief.  It is important not to give up – if the prescribed antiemetic is not effective, work with your doctor and nurse to find the one that works best for you.

Diarrhoea/ Constipation (all, but especially Xeloda, Vinorelbine)

The irritation of the lining of the bowel may lead to diarrhoea. This can often be managed with dietry changes but may require medication. Drinking lots of fluids is important to help replace losses.

Chemotherapy may cause some people to become constipated.  Others may become constipated because they are less active than before, because of diet changes, or from pain medication they may be taking.

Mouth sores and ulcers (all)

The cells lining the mouth may be affected and the mouth may be sensitive or develop small ulcers. Sometimes changes or loss of taste can occur which recovers once treatment is completed.

Lower blood cell counts (FEC,AC, CMF, Gemcitabine,Vinorelbine,)

This occurs because the chemotherapy drugs affect the bone marrow. The bone marrow makes white blood cells, red blood cells and platelets. The levels of these blood cell counts are checked regularly during treatment.

Low white cell counts (FEC, AC, CMF)– white blood cells help fight infection. If you have a severe infection and your white cell count is very low, it could be life threatening and may require hospitilisation. It is important to contact your treating doctor if your temperature goes above 38degC.

Low red cell counts (FEC,AC, CMF,Taxol, Gemcitabine)– red blood cells carry oxygen to the cells. If the count goes down you may become anaemic which will result in you feeling tired and breathless. If severe, you may need a blood transfusion.

Low platelets (Gemcitabine)– platelets help blood to clot. If the count goes down you may bruise easily.

Tiredness/Fatigue (all)

Fatigue is a common side-effect of chemotherapy and can range from mild lethargy to feeling completely wiped out.  It is not always due to a low red cell count (anaemia). It can be a deep tiredness that does not get better from sleep and tends to be worse at the beginning and end of a treatment cycle but may persist for 6 months to a year after treatment.

Hair loss (FEC,AC) Hair thinning (CMF,Taxol, Vinorelbine)

Some chemotherapy combinations (such as AC, FEC, CAF) make all hair fall out both on the head and the rest of the body.

Other combinations cause some hair to fall out so the hair thins out.

This can be upsetting but it is temporary- the hair will begin to grow back a few weeks after treatment has stopped. It may grow back different in colour or texture though.

Skin and nail changes (Taxol, Xeloda, Vinorelbine)

Skin may become dry and sensitive to sunlight and some drugs even cause rashes. Nails may also become brittle or discoloured.

Hand-foot  Syndrome (Xeloda)

The earliest symptoms of Hand-foot Syndrome is a painful sensitivity of the hands and feet. It may progress from sensitivity to redness and swelling on the palms of the hands and soles of the feet.  The redness looks like sunburn and it may blister and in severe cases form sores.  The affected skin can also become dry and peel.  It is important to advise your doctor or nurse about any Hand-foot Syndrome symptoms, even if they are mild, as treating early can help prevent severe cases.

Eye problems (all)

Sore eyes, “gritty” eyes, watery eyes, infection in eyes(conjunctivitis), and blurred vision may occur in some people to varying degrees during their treatment.

Phlebitis (FEC, AC, CMF, Vinorelbine,)

Damage to the lining of the veins used in some chemotherapies can result in discomfort or burning sensation in the veins. This may last for some weeks. If venous access is difficult a port (a cannula inserted under a general anaesthetic)into a large vein in the chest) may be advised. If the vein is burning or painful during chemotherapy, please alert the chemotherapy sister.

Peripheral neuropathy (Taxol, Vinorelbine)

This is experienced as a numbness or tingling sensation in fingers or toes. In more severe cases it may be painful. It is most commonly seen in diabetics and in those who have had multiple courses as it tends to be cumulative. It may persist for a few months after completing treatment.

Allergic reactions (Taxol)

If this occurs, it usually happens with the first dose. If it occurs it will happen in the chemo room and not later at home. It is usually prevented by and easily treated with antihistamines and steroids.

Liver changes (Gemcitabine, Vinorelbine,Xeloda)

In many cases this is only noticed on the blood tests and goes unnoticed by the patient. It will go back to normal after treatment. In the cases of breast cancer that has already spread to the liver, the liver function may be affected by the cancer itself and may actually improve on chemotherapy.

Menstrual irregularity and infertility (all)

When women receive chemotherapy it can damage the ovaries and reduce the amount of hormones they produce, resulting in short-or long-term infertility (inability to fall pregnant).  The effects of ‘chemo’ on your hormones may result in:

♦          Menstrual periods becoming irregular or stopping completely

♦          Menopause-like symptoms, e.g. hot flushes and itching burning, or dryness

of vaginal tissues

♦          Vaginal infections are more likely

Menstrual function can start again up to 2 years after chemotherapy. The onset of menopause may also be brought earlier and fertility may be impaired. If a woman may want a baby after chemotherapy, it is a good idea to discuss this with the doctor before starting chemotherapy.

Remember that, chemotherapy is not a safe method of contraception and a safe contraceptive is very important during chemotherapy as the drugs would be extremely harmful to the foetus.

Cardiac failure (FEC, AC, CAF, Xeloda)

In very rare instances some chemotherapy can lead to heart failure. If your doctor thinks you are at risk a cardiac function test will be done before starting chemotherapy.

There are many other possible side effects of chemotherapy, many of which are extremely rare or mild and therefore not covered here but can be discussed individually with your doctor if you have concerns.

Frequently asked Questions:

“So just how bad am I going to feel?”

This is impossible to predict.  Everybody is different.  Many people can continue working during chemo, but may find they need to take a day or 2 off after chemo before going back to work.  Remember your experience will be different from the lady sitting next to you in the chemo room, so don’t panic if you find you are having a harder time than she (or an easier time!).  Tell your doctor.  Often something can be done to make the next time better.  Some things  you may have to grin and bear.

“What about other medicines, drugs and supplements during chemotherapy?”

It is important to discuss this with your specialist any other drugs your are taking or additional drugs you would like to take.  This includes vitamins or dietary supplements, vaccines or immunizations, immune boosters and herbal medicines.  They may interfere with the effectivity of your chemotherapy treatment.  Whatever boosts you may boost your cancer cells too!!

Blog written by Ronelle Lovric http://www.capebreastcare.org

 

 

Chemo Q & A

http://www.thewhyfoundation.org/cancer-answers/cancer-treatments/what-does-chemotherapy-look-like/
Original colour photograph by Mary Elizabeth Gentle from the article by writer, Allison W. Gryphon, Stage 3a Breast Cancer Survivor: “What Does Chemo Look Like?”

 

How often is the chemotherapy given and how long does it take?

This is decided by:

  • the type of cancer.
  • the goal of the treatment — i.e. either curative or to relieve symptoms.
  • the different chemotherapy drugs.
  • how your body copes with the chemotherapy.

It can be given daily, weekly or monthly and given in cycles where treatment is alternated with rest periods. Just make sure that you stick to the schedule so that you can get the best results.

Can I take other medication?

It depends what you are taking. Make sure that you give your oncologist a list of any prescription drugs or over-the-counter medication you are taking so you can get the best advice for your specific situation. e.g. vitamins, allergy pills, indigestion aids, pills for colds and flu, aspirin, pain killers and any minerals or herbal supplements.

ADVOCATES FOR BREAST CANCER_what is chemo_what does chemo look like_south africaBlack and white photograph of a chemotherapy drip/cancer treatment - via The Why Foundation: "What Does Chemo Look Like?"

 

 

 

 

 

 

 

 

 

~ original colour photographs by Mary Elizabeth Gentle from “What Does Chemo Look Like?” by Allison W. Gryphon ~

How will I know if the chemotherapy is working?

When necessary, you will be sent for examinations and tests which will help your oncologist determine how effective the treatment has been. Please ask your oncologist to explain these tests to you.

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Important questions to ask before you start:

When you are having treatment, it is sometimes difficult to know what to ask about — so here are some ideas to get you started:

  • Why should I receive chemotherapy?
  • What are the benefits of chemotherapy?
  • What are the associated risks of chemotherapy?
  • Are there any other methods of treatment available for my specific cancer?
  • What is the standard of treatment for my type of cancer?
  • Are there any ongoing clinical trials for my type of cancer?


Ask these questions about your TREATMENT SCHEDULE:

  • How many chemotherapy treatments must I get?
  • Which chemotherapy drugs/agents will I receive?
  • How will the chemotherapy be administered?
  • Where will the chemotherapy be given?
  • How long will each chemotherapy treatment take?

Ask these questions about the SIDE EFFECTS of chemotherapy:

  • What are the possible side effects of my chemotherapy?
  • When will the side effects start?
  • What side effects usually occur with my type of cancer?
  • Are there any side effects that need to be reported immediately?
  • What can I do to minimise the side effects?

To ask any more questions – or answer other users’ questions – join us on Twitter here or Facebook here!

TAKEAWAY:

A must-read by THE WHY FOUNDATION:

What Does Chemo Look Like? 

 

 

What about radiotherapy?

 

When a patient is diagnosed with cancer, it is usually a turning point in their life. Few forget the initial shock and disbelief after the diagnosis, as well as the fear and the feeling of helplessness that is experienced. In between all these emotions there are usually further tests that must be done and an urgency to start treatment – and to start experiencing the haven of care and empathy that is the oncology unit.

robin

Treatment of cancer can be labelled curative (when the treatment is aimed at  the remission of the cancer and the healing of the patient is possible ) or palliative (when the treatment is aimed at ensuring symptom control and focuses on improving quality of life of the patient ) cure is not possible patients can live long and well before they pass on.

The oncology team will decide on the best possible treatment for you, depending on the type of cancer and the stage it is in. We talked about this coordination of care in this post and about the teams who will take care of you in this one.

One of the ways in which your cancer may be treated is though radiotherapy. This is the use of high-energy x-ray beams that can penetrate tissue, causing cell damage and cell death and reducing the cancer growth.

Normal cells are also influenced by radiation, but most of them recover from the effect of radiation. Normal tissue still needs to be protected from radiation as far as possible so the total amount of radiation is limited to the dosage normal tissue can tolerate.

Every patient’s treatment is planned individually with the use of highly sophisticated 3-D computer technology. Normal tissue is protected from radiation beams when possible and the newer radiation machines have built-in  shielding that is very sensitive and effectively protects the patients sensitive organs.

The aim of radiotherapy is to kill cancer cells with as little risk as possible to normal cells.  Radiotherapy can be used in the treatment of different kinds of cancer in nearly any part of the body.

Radiation, like surgery, is a local treatment. It influences only the tissue in the specific area of the body that is being radiated.

Radiation is often used in combination with surgery to treat cancer. Radiation can be given before surgery to shrink a cancer mass, this may enable them to remove all cancer tissue by using less extensive surgical methods. Radiotherapy can also be given after surgery to reduce the chances of regrowth of any remaining cancer cells.

In some cases radiation is used in combination with chemotherapy. The radiation can be given before, during or after chemotherapy. Combination therapy is tailored carefully to suit each individual patient’s needs according to the type of cancer, the location and the disease stage.

Where a cure isn’t a realistic option anymore, radiation is often used to shrink cancer masses and in doing so to relieve pressure, pain and other symptoms associated with uncontrolled cancer growth. This treatment is known as palliation (symptom relief). Most cancer patients find that they can lead a better quality of life after radiation for problematic symptoms.

 

Next week we will explain what to expect when you go for your radiotherapy treatment.