Tips for coping up with stressful times for cancer survivors

Feeling stressed? You are not alone!

Stress and anxiety are common once anyone is diagnosed with cancer. The feeling of hopelessness and fear always dwells heavily in people suffering from cancer.

Even when the treatment ends, the patients are still unable to recover from the trauma they once had and worry about the reoccurring of the disease, thereby oftentimes the constant struggle and anxiety leads to an unhealthy lifestyle.

Finding that you have cancer is an emotional and difficult journey and after the cancer diagnosis, people generally feel stressed, depressed and afraid. It’s a struggle for them to cope during these difficult times. Which is completely understandable as the disease is deadly and demands a lot of strength, courage and determination to fight against it.

Here are some life-changing tips for cancer survivors and advice from doctors and other survivors who once had the same experience as you are having now:

1. Accept your condition and try to control your fear

Fear of recurrence or coming back of the disease is the root cause of your entire problem including stress, anxiety and feeling of hopelessness. It is the most common emotional strain that each cancer patient goes through even after the completion of their treatment.

This fear always comes in the way of happiness and leading a healthy life. Accordingly. it is necessary to overcome this fear because nothing good would ever come out of it. It will only add to your problems and worries and worsen the situation even more.

So, don’t be so hard on yourself, you have already witnessed a massive challenge and even overpowered it. So you need to realise that you can get through this problem as well if you try a little hard and acknowledge yourself.

2. Seek support and don’t isolate yourself

Going through cancer is a difficult time and people often tend to isolate themself which eventually results in depression and anxiety. There are a lot of tools and help that are available to deal with the cancer survivors going through these hardships.

If you feel that you are not receiving enough care and treatment then voice out your concern. Let the others know that you are looking for support, care and companionship. There are a lot of people who care about you and your wellbeing, and you are immensely important to them. Keep that in mind that there are people who care and love you and they will continue to do so. Even after the treatment ends, don’t feel guilty/embarrassed to ask for help.

3. Stay connected to your family, and your loved ones

A cancer diagnosis affects the entire family and burdens them with stress, especially to the primary caretakers. It’s not just you who struggle and experience hardship, your family has also gone through it. Staying in touch with your family, friends and your loved ones who love, care and have faith in you is important.

If you can’t talk to them personally, then stay connected via Whatsapp, video chat, calls and other devices because these are the people who care about you. So, don’t feel ashamed or guilty to ask for help and be grateful to them. Together we can move mountains.

4. Express yourself, share your thoughts and fear

Conversation among your family and friends is understated but proves to be greatly beneficial for our mental health. Don’t hesitate or feel guilty about expressing and sharing your thoughts and fears. You can also perform other helpful activities like writing a journal, diary or blog to release stress and expressing your feelings.

If you don’t feel like writing then you can paint, draw, create crafts and other activities. You can also talk to other cancer survivors because they’ve also gone through the same difficulties as you. Sharing the same thoughts and hurdles can help you open up and help in understanding the situation you’re in currently.

5. Practice yoga and meditation

Yoga and meditation have a huge impact on your mind and body. Practising meditation and yoga helps to release stress and anxiety and reduce the risk of you having any other diseases. Regular practice of yoga and meditation boosts your mental health, increases attention and concentration and puts your mind at ease.

The correct time to do yoga and meditation is in the morning or early morning for at least 20 min per day. You should do meditation after practising yoga as it will calm and relax your whole body. The best yoga poses for enhancing your mental health are the following:

• The eagle pose
• The high lunge pose
• The tree pose

6. Maintain a healthy and normal lifestyle

Try to remain healthy and happier as possible. You know we want the best for you. Take your time to adjust with your daily life activities and work on your goal, priorities and lead a normal life. This can help in boosting your energy level and keeps you engaged so that negative thoughts do not cross your mind.

Eat diets full of green veggies and fruits to keep your body healthy and refreshing. Avoid Bad habits such as smoking, drinking alcohol, skipping your meals and keep yourself physically and mentally fit.

7. Get enough sleep

Lacking a considerable amount of sleep can lead to poor mental health. Enough sleep can overcome stress, lower the risk of other diseases and enhance your mood. Have a fixed bedtime and waking uptime. According to numerous studies, one should get 7-8 hours of sleep which allow the body to function properly.

8.Listen to your body & stay connected with your health provider

Monitor and take care of your body and don’t ignore any symptoms. Don’t hesitate to reach out to your caretaker if you have questions regarding your health and body. If you feel something isn’t right or when you notice something abnormal, contact your doctor right away. Keep your doctor daily updated about your physical and mental health.

Book an appointment with the Best Cancer Specialist at Oncoplus Hospital.

What is breast cancer in men and breast cancer symptoms?

Breast cancer in men is a rare type of cancer that develops in the breast tissue of a man. Cancer in the breast is commonly referred to as a disease that mainly targets women, but it does occur in men. Men also have breast tissue like women, which can develop into breast cancer as cells in almost any part of the body can become malignant and may spread into other areas. Cancer occurring in men is a rare case because it is related to the cells, glands or parts that store or produce milk. The chances of arising tumour cells in the breast in a man in his whole life are 1 out of 900.

Cancer in men is most commonly found in older men around the age of 50 to 60, though it can occur at any age. Men don’t realise that breast cancer can happen to them also, due to this reason cancer in men is not diagnosed at the right time until it becomes severe or reaches its later stage.

What are the symptoms of breast cancer in men?

The following include the signs and symptoms for breast cancer, if you experience any of these, at any age make sure to contact and get checked out by the doctor.:

• A pain-free lump or thickening of the skin in or around the breast/underarm.
• Changes in the shape or size of the breast or chest area
• Changes in the skin of your breasts such as dimpling, puckering and redness
• Changes in your nipples like scaling, redness or swelling in any part of the breast
• Nipple when it starts to invert or turn inward
• Discharge/leakage of blood or fluid from the nipple

How does breast cancer develop in men?

The cause of breast cancer in men and women are similar. The breast of a man is similar to a girl’s breast before adolescence. During adolescence, women tend to produce more breast tissue along with fat but men naturally don’t.
Cancer always starts at the cellular level. Ordinarily, new and healthy cells are generated to replace the old ones. But due to disruption in the DNA as new cells are made, sometimes the cells grow out of control and begin to grow new cells abnormally which results in the formation of tumours, these can be either benign(non-cancerous) or malignant ( cancerous).

What are the risk factors of breast cancer?

The following are the risk factors of developing breast cancer in men. A risk factor that we all can control and protect ourselves.

• Being overWeight: Being overweight is a common risk factor for developing breast cancer. One of the main sources of estrogen in the body is fat tissue. Having more fat tissue means having a high level of estrogen in the body which ultimately leads to a higher risk of breast cancer.
• Diet: One should eat a healthy and more fat-free diet to prevent breast cancer as our diet and daily consumings is directly associated with the amount of fat in the body.
• Alcohol consumption: Latest research and studies have stated that a woman is at a higher risk for breast cancer if the alcohol consumption in the body is high.
• Exposure to estrogen: If you take drugs related to estrogen then you are likely to get breast cancer or you are at risk.

The risk factor you can’t control

• Older age: The main risk factor of getting breast cancer being a male is being old aged. Most breast cancers are found in men with an age 50 or older.
• Genetic mutations: Inherited changes or mutation to certain genes like BRCA1 and BRCA2, men with these changes in the genes have a high chance of getting breast cancer.
• Personal or family history of breast cancer: If you have already been diagnosed with breast cancer then, you are most likely to get it again either in the same breast or the other one or if your family members like mother, father, siblings (first-degree relative) have a link with breast cancer then you can have it.
• Liver disease: Having disease related to the liver such as hepatic cirrhosis or Klinefelter syndrome (having two X chromosomes rather than one) which increases the female hormone-like estrogen in the body.
• Radiation therapy: Having radiation therapy of the chest or around in childhood or adulthood can increase the chances of having this disease.

How is breast cancer in men diagnosed?

If your doctor has certain reasons to suspect for cancer, the following test and procedure you can follow:

• Clinical breast exam: Clinical breast exam is a physical exam done by the doctor or your healthcare provider. During a clinical breast exam, the doctor checks and feels the appearances of your breast for any lump or look at the differences in the size or shape of your breasts. They use his/her fingertip to examine it.
• Imaging tests: Next your doctor may order tests such as molecular breast imaging that uses radioactive tracers and a special camera to find cancer, mammography uses X-ray technology to produce the images of the breast. The images created are called mammograms. Occasionally, magnetic resonance imaging (MRI) and sonograms are also used.
• Breast biopsy: It is usually done when something suspicious is caught on any of the imaging tests. The procedure involves a minute part of the breast tissue to be sent to the pathological labs to determine whether it is malignant or benign. It is the most ultimate way to be diagnosed .
• Immunohistochemistry: It is a staining process that is performed on the breast tissue in order to ensure whether the cancer cells contain HER2 receptors and/or hormonal receptors( such as estrogen and progesterone) or not, Because if it does then the patient can be treated with medications that inhibit the level of estrogen and progesterone.

Breast cancer has five stages i.e from 0 to IV, stage 0 is invasive cancer which indicates that the abnormal cells are present but have not spread in the surrounding and stage IV is metastatic cancer which determines that cancer has spread in the surrounding and even the other parts of the body.

Once you are diagnosed with breast cancer, then your doctor will help to determine the stage of cancer on which you are and treatment will be suggested according to the stage of the disease.
These tests and procedures are used to stage breast cancer :

• Body scan or CT scan: Full body scans are imaging tests that take pictures of your whole body and help to scan cancer, their stages and other diseases early.
• Bone scan: It is an imaging test that safely scans the bones of your body by using a radioactive drug, radiopharmaceutical and is an efficient tool for finding cancer that has spread or about to spread in the bone. It can also help to determine how well is your working for cancer in the bones.
• Positron emission tomography (PET) scan:
  
  It is an imaging procedure that uses radioactive substances such as radiotracers to visualise and check the changes taking place on metabolic processes or other activities like blood flow, absorption and regional chemical composition.

Treatments for men with breast cancer

In order to receive the appropriate treatments and medications, you must measure your cancer stage, overall health and preferences. Treatment for men and women are generally the same. Breast cancer treatments often include surgery and other types of therapies and medication, if needed.

Surgery:

The surgeries are of two types

The first one is a mastectomy, in which your whole breast is removed including the areola and the nipples.

While the second one sentinel lymph node biopsy. This type of surgery involves analysing and removal of only the lymph nodes and tumour cells.

Radiation therapy or radiotherapy:

If your cancer is not treated or few cancerous cells are remaining even after the surgery, then this therapy will be your major treatment. Radiation therapy uses a beam of intense energy like X-ray and protons to kill the cancer cells.

Chemotherapy:

This uses medication to cure cancer by the vein in your arm or pill form or it can be both.

Book an appointment with the Best Cancer Specialist at Oncoplus Hospital.

Breast cancer is a cancer type that develops from breast cells. It emerges from the inner lining of the milk ducts or the lobules that render them with milk. The growth of the malignant tumor can spread to other body parts. The vast majority of breast cancer mostly occurs among females. It should be noted that the majority of cases of breast cancer examined until now are because of iodine absence in the breast cells. For females, about 20% of iodine is required and 70% in the thyroid, and the remaining 5% for the rest of the body.

When we talk about the importance of iodine in females, devouring a lot of salt isn’t the right step. As iodized salt is practically the world’s long source of plentiful iodine. When the iodine level reduces, the iodine receptors are blocked by an increased rate of fluoride, chlorine, and bromides present in the water, food, and the environment, resulting in breast cancer.

How effective is molecular iodine for breast cancer?

According to a recent study, researchers have found that molecular iodine determines how it helps to protect women from fibrocystic breast condition, and it’s proven how it attacks breast cancer. Historically, several studies have suggested iodine supplementation to improve breast health, but none of them focused on how it works on FBC cells. Researchers are working their way to recognize the specific MOA that made molecular iodine effective.

The preclinical investigations have proven the MOA and the medical community a reason to revisit the historic research for hints on utilizing molecular iodine to cure and protect women.

What was the two different research?

Researchers conducted in vitro studies to observe the biochemical interaction on how the molecular iodine affects breast cancer cells and the cells from the fibrocystic breast tissue. Using an MCF10A, a human immortalized mammary epithelial cell line from the fibrocystic breast tissues of a 36-year-old female caucasian, the FBC study used molecular iodine at multiple doses and the growth or the production of the cells were measured. This followed by a gene expression analysis of major valid markers, that are accountable for cell growth and cell death. In this study also, primary human mammary epithelial cells were used from a healthy female donor.

This breast cancer study used the two most common breast cancer subtypes, using fixed breast cancer lines, MCF7 (luminal A subtype) and MDA-MB231 (triple-negative subtype). All of these cells were treated with molecular iodine at different concentrations to calculate the growth of the cells and their death. This is later followed by gene expression analysis of major valid molecular markers, that are primarily accountable for cell growth and death. Primary human mammary epithelial cells were utilized from a healthy female donor.

What are the results of Iodine effects on breast cancer?

The results from both of these studies indicate that molecular iodine has significant inhibitory effects on cell growth in both breast cancer and FBC. The new research results also showcase a rapid increase in cell death in breast cancer lines utilized in the study and from the cells of fibrocystic breast tissue.

In the FBC study, gene expression analysis using a quantitative RT-PCR established that cell cycle genes controlling the G1-S phase transition were up-regulated ( meaning an increase in the number of cellular components, such as RNA or protein).

There were so noticeable changes in Cyclin B expression levels that, again, indicated that cells were arrested before entry into cell division. The expression of nuclear hormone receptors PPAR-α and PPAR-γ was up-regulated. The BCL-2, inhibitor of cell death was more, while expression of caspase-3 was reduced, therefore indicating molecular iodine do incite cell death by activating caspase – a cysteine protease that plays a vital role in independent apoptosis.

While in the breast cancer cell line study, gene expression analysis using a quantitative RT-PCR also established that cell cycle genes controlling G1-S phase transition were majorly up-regulated. There were no changes noticed in Cyclin B expression levels, which further suggests that cells were arrested before entry into cell division.

Upregulation is seen in BLC-2, PPAR-α, and PPAR-γ with down-regulation of caspase-3 indicating molecular iodine causes cell death by activating the caspase-independent apoptosis pathway. The mesenchymal-epithelial transition or MET occurrence are recognized by molecular iodine treatment as shown by a sharp increase of GATA3 and E-cadherin and major down-regulation of vimentin in invasive MDA-MB231 cells.

The preclinical research allowed the researcher to under the mechanism that controls the tumor cells’ growth and showcases the significant cellular effects of molecular iodine on breast cancer cell lines. The results indicate a promising effect of molecular iodine on regulating breast cancer EMT differentiation program required for tumor initiation and metastasis.

More studies are to determine the possible impact of molecular iodine in the breast cancer subtypes using the in vitro 3D models. In conclusion, the preclinical data results suggest that administration of molecular iodine must improve the traditional therapies for the treatment of breast cancer and FBC.

The Takeaway

Although the use of iodine supplementation has long been used and recognized in clinics across the world, the treatment effects haven’t been successful. It’s mostly because of iodine supplements being either unstable or containing iodine salts, both of which have been said to be ineffective and contain severe harmful side effects.

Only molecular iodine is significantly effective in improving breast health consistently. Using molecular iodine regularly has shown to decrease the sensitivity of breast cells to the proliferative effects of estrogen, resulting in the normalization of breast tissue.

The complication or challenge with molecular iodine is its instability and oxidizing abilities, which prove ineffective to be useful for breast health. At present, we’ve only one formula of I2 that target breast cell is commercially available to all. It is made up of iodide and iodate salts that when exposed to gastric pH react to form molecular iodine.

FAQS on Molecular Iodine and Breast Cancer

Can iodine kill cancer cells?

To a certain extent, it can cause metastasis. Radioactive iodine, however, is an effective cancer treatment type effective for cancer of the thyroid gland. It’s effective as the radioactive iodine from the drink or capsule is soaked into your body and picked up by the thyroid cancer cells, even if it’s spread all across the body. The radiation causes the death of many cancer cells.

Does iodine help with cancer?

Yes! Iodine is required in the body for producing hydrochloric acid (HCL) and reducing HCL acids has been indicated in the development of these cancers. Iodine causes apoptosis (cancer cell death), removal of precancerous and virus-infected cells.

Can too much iodine cause cancer?

Yes, too much iodine can be harmful to the body. Taking high levels of iodine can lead to similar symptoms of iodine deficiency, including goiter (an enlarged thyroid gland). Increased levels of iodine intake can cause thyroid inflammation and thyroid cancer.

What are the symptoms of low iodine levels?

Here are some of the most common symptoms of iodine levels:

• dry skin
• puffy face
• muscle weakness
• increased sensitivity to cold
• constipation
• elevated blood cholesterol levels
• fatigue
• weight gain

Does iodine reduce breast cysts?

After a review of clinical studies, it’s been found that iodine replacement therapy, mostly for people with low levels of iodine, might enhance the tenderness associated with fibrocystic breast tissue. Women who taken iodine have met with very few side effects.

Book an appointment with the Best Cancer Specialist at Oncoplus Hospital.

Hiccups are an unexpectedly common symptom seen in patients having cancer, whether during cancer treatment or in the palliative care setting. Hiiccups causes these sounds due by involuntary clonic spasms of the diaphragm and intercostal muscles due to sudden closure of the glottis. In most cases, they are annoying and usually stop within a few minutes. However, some patients may experience continuing periods of greater than 24-48 hours, these are persistent/chronic/intractable hiccups that last more than 2 months, and up to 10% of the patients having advanced cancer deal with it. These are more common in men compared to women.

Effects of prolonged hiccups on the patient having cancer

Prolonged or persistent may have undesirable effects. These may include:

• fatigue/tiredness
• Reduction in fluid and food intake
• Emotional anxiety and distress
• Lack of sleep
• Irritation
• Deduction in cognitive function
• Problems in aspiration
• Weight loss
• Diminish the quality of life
• For a mesothelioma patient, hiccups can be painful.

Plausible causes of persistent hiccups

• Many conditions are thought to be the cause of this problem including low levels of calcium, sodium, and potassium, alcohol intake, sudden strokes, head injuries, and many more but the exact cause is still not verified.
• Many doctors say that this can also be due to the intake of medications as many of them are used in the treatment and also during chemotherapy. Of these medications.
• It is said that the most frequent cause of prolonged/experienced hiccups is dexamethasone.
• Definite chemotherapy drugs used during the treatment – In people with cancer sometimes, these drugs might cause side effects.
• Changes in temperature
• Other drugs, including anti-nausea medicines, steroids, and antibiotics.
• Nerve and minor brain injuries.
• If your kidneys are not functioning properly
• The cancer is pressuring your diaphragm

Treatments for mild hiccups

There are no medical treatments for treating hiccups as these are temporary and get away easily without treatment. Many old and home remedies for hiccups are said to be efficient but may not work on the patient having persistent hiccups, these remedies include:

• Holding the breath
• Gargling
• Acupuncture
• Rubbing the pharynx with cotton
• Breathing into a paper bag
• Biting a lemon
• Digital rectal massage
• Taking a deep breath and holding it for a few second and then reeling it slowly may also help

Treatments for persistent hiccups

Other treatments include Chlorpromazine, Chlorpromazine is a dimethylamine derivative of phenothiazine. It acts peripherally by dopamine antagonism in the hypothalamus. It is the only medication approved for the treatment of hiccups by the US Food and Drug Administration, and for many years it has been in use.

Unfortunately, it doesn’t apply to everyone and has adverse reactions like confusion, hypotension, tiredness, nausea, urinary retention, and excessive sleep even in a single dose.

Baclofen is also an effective drug for people suffering from persistent hiccups and has initiation of baclofen resulted in the proper resolution of hiccups in 6 out of 10 patients and showed remarkable improvement in 2 patients. It is suggested to take an amount of 5gm-20gm of baclofen, three times a day.

Gabapentin is also a medication that has shown significant improvement and the hiccups were relieved by oral gabapentin. Baclofen is a gamma-aminobutyric acid (GABA) analog that activates an inhibitory neurotransmitter is thought to help in blocking the hiccup stimulus. It is recommended to take 100 mg of gabapentin three to four times a day.

Nifedipine, a calcium channel blocker, may play a role in reversing the abnormal depolarization in the hiccup reflex arc.1 It has been reported to put an end to persistent hiccups but tends to induce hypotension, which may be especially severe in volume contracted patients or those receiving opioids. A daily dose of 30 to 60 mg of this drug had a significant effect on patients’ hiccups and even stopped the hiccups in 24 hours.

FAQS on Hiccups in Cancer Patients?

What helps hiccups in cancer patients?

Your doctors would be the best expert to help treat the hiccups directly based on your condition. The most common medication for treating hiccups in cancer patients would be the anti-sickness drug metoclopramide (Maxolon) or a sedative such as haloperidol or chlorpromazine.

What causes hiccups in cancer patients?

Hiccups occur mostly due to irritation of the nerve that controls the diaphragm which can have different reasons behind it. Those might be due to a certain chemotherapy drug used for treating cancer. Other medications that can or cannot be used for cancer-related problems, such as steroids, antibiotics, or anti-nausea medicines.

Which medicine is best for hiccups?

Medications that are effective in treating long-term hiccups are the following:

• Baclofen
• Metoclopramide
• Chlorpromazine

Can hiccups be a side effect of chemo?

Hiccups are one of the side effects of chemotherapy. Intractable hiccups severely affect a person’s resting and eating habits while reducing their quality of life.

What to take to stop hiccups?

Here are some effective tips for curing hiccups-

• Drink water very quickly
• Tell someone beforehand to frighten you
• Gargle with water
• Bite on a lemon
• Pull hard on your tongue
• Use smelling salts

What drug causes hiccups?

Here are some of the most common drugs that set our triggering hiccups:

• Barbiturates (methohexital)
• Antibiotics (azithromycin)
• Phenothiazines (perphenazine)
• Opioids (hydrocodone) Alcohol
• Benzodiazepines – midazolam, lormetazepam, and lorazepam
• Steroids – dexamethasone, methylprednisolone, oxandrolone, and progesterone

Can hiccups be a sign of something serious?

Yes, hiccups can be a sign of serious illness. Make an immediate appointment to see the doctor if your hiccups last more than 48 hours or if the hiccups turn so bothering that they can cause problems with eating, sleeping, or breathing.

Are hiccups a sign of death?

Hiccups can happen if a person nears death if they have an underlying health condition or taking a specific medication. Hiccups are a major complication of severe illness due to the effects of treatment medication.

Why does Sugar stop hiccups?

Sugar is a distraction technique that’s effective in treating hiccups, mostly mild ones. Take a spoonful of sugar and let it dissolve on your tongue or tickle the roof of your mouth with a Q-tip or stick your finger in your ears to stimulate branches of the vagus nerve. The overload on other vagus endings will get rid of hiccups.

Do hiccups go away when you sleep?

Yes! The hiccups have a significant tendency to fade away at sleep onset.

Book an appointment with the Best Cancer Specialist at Oncoplus Hospital.

Myeloid Leukaemia (AML) is a rare but intense type of cancer of myeloid cells (white blood cells responsible for strengthening our immune system and fighting infection). The new standard of care for acute myeloid leukaemia is being tested all around the world for effective treatment of its patients.

The latest results from the VIALE-A phase III clinical trial from this summer revealed a 34% decrease in the death risk, by cementing a drug combination that’s been tested around the work. Phase III was a large multicenter clinical trial that was created to establish whether the combination of “Venetoclax ” and “azacitidine” is superior to azacitidine alone. It was a confirmatory study for the patients diagnosed with AML that we’re unable to tolerate intensive chemotherapy.

As Courtney DiNardo, MD, MSCE, Clinical Researcher in the Department of Leukaemia explained that most of the patients with AML are over the age of 65, which is an age where standard chemotherapies are not an ideal option. It has an increasing rate of toxicity and proves less effective. The main intentions of the phases III VIALE-A trail were to have better overall survival (OS) rate. Fortunately, the study was successful in showcasing it.

The response rate was 66% high, which explained that the majority of the people responded better with the regimen of “venetoclax” and “azacitidine”. The overall survival rate improved significantly in patients that have taken this combination. Even the timing of the response, people who studied and went into remission were excessively higher.

The majority of people who received venetoclax and azacitidine together achieved a diminution of severity of AML within the first cycle of the treatment. Or it was several months faster than the prior existing standard of care.

The new medication is completely different and live-changing in the treatment of cancer, especially AML. It’s the first confirmatory, phase II study that’s evident in showing something better from the previous standard of care, from azacitidine or a low dose of chemotherapy. The new treatment has proved that the drug combination has upgraded the outcomes in both remission rates and OS.

What makes this approach of treatment better than the rest?

There’s been numerous research and study done over the past few decades to improve the outcomes of people with AML. And various other treatments have tried treating the disease but the result has been elusive. AML has remained to be the most common kind of leukaemia in the world with a 5-year survival rate of 28%.

The combination of venetoclax, a first-in-class medicine added with azacitidine showed a great deal of improvement in older patients with AML. Backed with intensive research evidence and real-time effectiveness, this approach suggested being a potent drug combination.

What’s Venetoclax and Azacitidine?

Venetoclax is effective in treating adults with chronic lymphocytic leukaemia or small lymphocytic lymphoma. This medication targets the B-cell lymphoma-2 (BCL-2) protein that prevents some blood cancer cells from dying naturally from the process of apoptosis. It selectively binds to the BCL-2 protein and hinders it from coming in contact with cancer cells, which helps to restore apoptosis.

While Azacitidine is a chemotherapy drug that functions by allowing the bone marrow to grow normal blood cells, decrease the requirement for blood transfusions and kill abnormal blood cells. It’s placed in a class of medications, known as demethylating agents that are designed to target aberrations of DNA methylation patterns linked with cancer onset and progression.

How was VIALE-A clinical trial done?

In the double-blind, placebo-controlled, phase III VIALE-A clinical trial, about 433 people who haven’t received any treatment beforehand with AML and ineligible for intensive chemotherapy were randomized to take either a combination of venetoclax (n=286) arm or azacitidine in combination with a placebo arm (n=145).

The final results expected were primarily the overall survival (OS) rate and complete remission rate along with incomplete hematologic recovery in the United States, China, Japan, the European Union, and EU countries. While the secondary results were complete remission (CR) and CR with partial hematologic recovery (CR + CRH).

According to the researchers, people assigned with venetoclax and azacitidine arm combination in the VIALE-A trial have a median survival rate of 14.7 months against 9.6 months for people with the placebo arm.

Moreover, about 66.4% of people who received venetoclax plus azacitidine achieved CR+CRi against 28.3% for the azacitidine plus placebo group.

The safety of the procedure was mostly consistent among the patients with previous studies of venetoclax and azacitidine combination. The most adverse complication of the combined medication was the following:

• • Hematologic and gastrointestinal nature (40%)
  • Thrombocytopenia (46%)
  • Nausea (44%)
  • Constipation (43%)
  • Diarrhea (41%)
  • Febrile Neutropenia (42%)
  • Neutropenia (42%)

The most common and severe reactions happened with less than 10% of patients given venetoclax and azacitidine are febrile neutropenia (30%) and pneumonia (17%).

Tumour lysis syndrome (TLS) was recognized during ramp-up in three patients in the venetoclax arm, but none in the placebo arm. As we all know, TLS is a severe complication of venetoclax due to the fast breakdown of cancer cells, often causing kidney failure, death, dialysis, and death.

Complications caused in the trial, however, were temporary, biochemical changes resolved with uricosuric agents and calcium supplements without treatment interruption.

What are the complications of the venetoclax + azacitidine regimen?

The biggest problem associated with the venetoclax and azacitidine regimen is its toxicity. It’s quite concerning according to the researchers. There’s already more myelosuppression due to lower white blood cell count due to this regimen. If you have neutropenia and neutropenia-related fever, then you must inform your doctors or physicians. But the toxicity is possible to be reduced at its lowest by the physicians.

The management of patients is the key importance when given the combination of the medication. Historically, patience with azacitidine alone didn’t go into remission until the fourth or sixth cycle of therapy. So researchers didn’t do routinely early bone marrows and required no major interventions and kept the patients on cycle due to their low blood counts when they still had leukaemia.

The combination, however, is different as the vast majority of patients go into remission within the first cycle, meaning it’s important to do bone marrow in the first cycle itself. Older patients with AML often have multiple medical conditions at the same time so physicians have to modify the treatment regimen down. Instead of the standard 4 weeks, physicians spread the 21-day regimen over 5 weeks. Doctors have to stop the therapy in between and wait for a week or two for counts to recover, then modify the treatment accordingly.

Monitoring guidelines are developed as a part of the study and available to help the physicians with the management of AML patients acquiring the venetoclax and azacitidine regimen. This drug combination is an incredibly effective regimen that’s well-tolerable if the patients are appropriately managed.

What’s to look for in AML cure?

The drug has turned into becoming standard care for older patients with AML, all over the USA. The FDA has also approved the regimen use in 2018, after the phase, I study that gave impressive response rates and the possibility of improvements to overall survival (OS).

After racing the phase III VIALE-A study, the results of the drug combination, this newfound regimen has rapidly adopted the standards of care across the world. There’s still a clinical implication, not just in US citizens but globally. But, this regimen is seen as a practice-changing new therapy globally where the complications can be reduced.

This regime is still an improved standard of care that’s not the same as eliminating the disease. We still need additional research for a new standard of care for AML. This regimen is not helpful for the majority of patients with AML.

Future research sources on the identity of patients with AML that aren’t likely to respond with the combination of venetoclax and azacitidine regimen. Hopefully, it works on people with certain gene mutations that have proved to respond poorly to the regimen.

In the care of TP53 mutations (TP53 is a gene that helps to cease the tumor growth. It acts and is known as a tumor suppressor), effective TP52-treatment to azacitidine and venetoclax that responds safely is still being worked upon.

Book an appointment with the Best Cancer Specialist at Oncoplus Hospital.

Coping with a cancer diagnosis: Emotional & psychosocial effects

A cancer diagnosis is a life-changing event in anyone’s life. It is a destructive disease-causing vita psychological problems among the patients and their family and friends. Psychological agony is a significant and continuing problem for those suffering from cancer who are heavily affected by the time of diagnosis, in the first year after the diagnosis, and commonly during their treatment.

Their mental health needs should be handled with care, but are often ignored as they are not always properly recognized and understood. In the past ten years, there has been a growth in implementing and spreading screening methods for the psychological outcomes of cancer, including depression, anxiety, post-traumatic stress, isolation, hopelessness, distress, and demoralization. Also, guidelines and agencies dedicated to the management of the psychological consequences have been developed and supported by several scientific cancer associations.

Physiological consequences of cancer

By just hearing the word “cancer” said the doctor can have a major effect on a person’s mental and physical health, and relationships with our loved ones. While treating the physical consequences, patients should not ignore the emotional issues related to cancer. One can improve their life by learning more about cancer which may help to make the disease seem less frightening and mysterious.

A patient’s financial, psychological, and social situation may all change due to cancer and its treatment. Here are some of the most common mental effects on a cancer patient:

• Reduction in the performance and functional activity, poor memory, and concentration, disrupting sexual activity are important in influencing the physiological response of cancer patients.
• The loss in the stability of one’s emotional position( e.g. anxiety, fears, sadness, and worries), the reduction in self-esteem, the need for dependence on others, and feeling hopelessness is often experienced by the patients. The change of certainty about the future is also an example of emotional effects during this illness. This also includes the changing whole set of personal values, about our importance, questioning the meaning of one’s own life and existence.
• Social intercourse and skills, communication between the family, and close relationships are also affected by cancer.
• Feeling of sadness, loneliness, abandonment, panic, problems in returning to work, or even hiding their medical condition from others are common issues related to cancer patients.
• The most common effects of this diagnosis are mental disorders including major and minor depression, stress and adjustment-related issues, anxiety disorders, emotional distress, sexual disorders, and demoralization syndrome.

All of these aspects may be shown in the different phases of the disease from diagnosis to treatment or medical care. Patients tend to adopt variable emotional, cognitive, and behavior toward the disease.

Consequences of physiological problems and disorder

Psychological distress and disorders have magnificent negative effects on the patients and even on their families and loved ones.

• Cancer patients experience huge levels of cancer-related disorders which may heavily affect their health, quality of life, and the chance of survival in a negative way.
• Distress involves a range of feelings from endangered to sad to depression, anxiety, isolation, hopelessness, and panic. But importantly, general severe distress has an impact on cancer evolution.
• This type of distress results in disruption of the hypothalamic-pituitary-adrenal axis and activating the sympathetic nervous system that has a devastating impact on the cardiovascular immune and the endocrine systems.
• These disturb the biological activities such as catecholamine production, changes in circadian cortisol levels, cellular immune suppression, activation of proinflammatory cytokines, and regulation of leukocyte and tumor cell gene expression, that can promote cancer growth and spread of cancerous cells in a different part of the body.
• An increased rate of suicide is also associated with cancer.

TLS usually develops within a few hours to 2-3 days after the start of the chemotherapy. The mortality rate of patients suffering from tumor lysis syndrome is less the 20%

Care and Treatment

Attend support groups

A good social support network has always been associated with an increased and improved quality of life for those patients who are suffering from cancer and undergoing treatment and its distress. Knowing about cancer can make the patient feel less scared and more empowered. Nearly all studies have shown an improvement in physiology for cancer, attending support groups. Social groups help patients in reducing their pain and anxiety.

Routine screening

Screening should be part of care and clinical practice guidelines, these were developed a few years ago and are extremely helpful to clinicians in providing wide-ranging care for cancer patients and their families.

Converse with your doctor

The patient should try to talk openly with the doctors, one of the main reasons why the doctors are unable to distinguish between the general sadness and the severe distress as the patient doesn’t talk openly to the doctors or their caretakers. One-third of cancer patients experience severe distress but about 5-6% can get through it. There is no shame in sharing the problems openly and asking what you need and lack.

Proper healthy diet

Patients should be provided with a healthy and nutritious diet, these improve the physical condition of their body exercise, when possible is important. Studies show that this helps to keep the mind calm, improving memory and concentration, and strengthens the body. This also allows the patient to spend time with others.

Express your feelings

It’s okay to feel a certain way at a point in your life. But it’s also healthy and common to express how you feel to your loved ones. Don’t fear expressing strong feelings like anger or sadness, let go of them as much as possible. Talk about your feelings to a close member of your family or friends, or with other cancer survivors and support groups. If you still find it difficult to discuss your condition with others, express your feelings by thinking about why you feel them or write them down.

Quit blaming yourself or plead guilty

You are strong and brave. Don’t let any condition weaken your spirit and question your mental health. Most cancer patients tend to blame themselves for getting cancer. Although it’s completely incorrect, even scientists don’t know how a person gets cancer and how someone else doesn’t. All bodies are different and cancer can happen to anyone, from a triathlete to a programmer. It’s not up to us.

Dominate the positive, over the negative

It’s always easy to come across a negative when a condition worsens or you are under a problem. It might sound cliche, but life has both dark and light moments. Try to look for the good part of all things even in a bad time or be hopeful rather than thinking the worst. How we perceive the world, the world also becomes the same for us. So try to focus your energy on getting better, and staying healthy as much as possible. Express love to your loved ones for being there with you in misery and fortune. When you start to think of the good, you’ll get many reasons to be happy about in life.

Be in Incharge of things

Just because you’ve got cancer doesn’t mean you are helpless. You can completely control and take charge of your life like you did before. Stay involved in your health care, try to learn about the medicines, keep up with your appointments and make good lifestyle changes to turn things better accordingly. Scheduling your day daily is a power move, it gives you a great sense of control. Not just physically, controlling your thoughts can help. Although you can’t control every thought, try not to think about the worse or fearful ones, instead try to look up for the positive things like someones’ birthday, anniversary, next picnic, or a good book.

Don’t pretend, feel free to feel down

Don’t try too hard to follow the rules as well. Staying positive and thinking for the best is an ideal way to live but it’s completely normal to feel sad or gloomy once in a while. Have freedom over your feelings.

Decide when you want to discuss cancer

Cancer is still very unknown to people and often they tend to talk to you about your conditions. It can be overwhelming and tiring to discuss cancer so frequently with every relative or well-wisher you meet. Even when the loved ones mean well, you must let them know what and how you feel about the subject. If you don’t want to discuss them, politely express to them that you are not comfortable talking about them.

Rely on a long-lost hobby

Hobbies are always fun to explore. Bring back your old hobbies such as woodworking, reading, art & crafts, paintings, photography, or watching movies, listening to music, or dancing all night. Look for things to enjoy with kids in your family, take your mind off on a fun and interactive tasks.

Enjoy Solitude

Relaxing by yourself or doing an activity that helps you unwind and enjoy silence can be a great escape from the chaos that comes with cancer. Try to do relaxing activities such as meditation, exercises, guided imagery, and others to help your body and mind relax and release stress.

Stay Active

Don’t just lie on your bed all day. That won’t help with anything in life. Getting out of your house and going for a little jog, or doing exercise or gentle yoga can keep you fit and active.

Book an appointment with the Best Cancer Specialist at Oncoplus Hospital.

Guide to Tumor lysis syndrome: Vital things to know

What is tumor lysis syndrome?

Tumor lysis syndrome ( TLS ) refers to the condition of metabolic disturbance which occurs when a large number of tumor cells or neoplastic cells are killed briskly within a short period, leading to the release of intracellular components in the blood. This syndrome is characterized by the quick development of hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, with acute kidney injury and is hazardous.

TLS is common in people having blood-related cancer and lymphoma( lymphatic cancer). It initially rises through chemotherapy. Risk factors include tumors with rapid cell growth and movement, hematologic cancers like acute leukemia, or tumors with a high sensitivity to chemotherapy.

Patients with high levels of lactate dehydrogenase (greater than 1,000 U/L) and people with damaged renal function are also at risk. Various chemotherapy agents like cisplatin, etoposide, cytarabine, and paclitaxel are also connected with this syndrome.

How does it develop?

Not all cancer patients have an equal rate of developing this syndrome. TLS is most likely to happen when blood disorders and cancer are treated with chemotherapy. In highly reproducing cancer acute leukemia, few cells die before the treatment as it’s the end of their life cycle.

If a huge amount of these cells lyse and die, TLS may grow before the beginning of the treatment. However, a huge amount of intracellular substances are released in the bloodstream as most of the neoplastic cells in the bone marrow and bloodstream of patients suffering from acute leukemia are destroyed through chemotherapy.

These cells get destroyed and die, a large amount of phosphate and potassium are released including purine nucleic acids.

Patients with huge “tumor burdens” (number of cancer cells in the body) or have rapidly dividing cells that respond well with treatment are at high risk. These include:

• Leukaemia
• Non-Hodgkin lymphoma
• Tumors like hepatoblastoma and neuroblastoma
• Myeloproliferative diseases or neoplasm
• Cancer that causes the ill function of the kidney before the treatment start

Other risks

• Intrathecal chemotherapy ( injection of chemotherapy, given directly into the fluid-filled space around the brain and spinal cord).
• Chemoembolization ( soothing treatment for tumors found in the liver).
• Radiation therapy (uses a beam of huge and intense energy to kill cancer cells)
• Corticosteroid therapy
• Hormonal and biological therapy

TLS usually develops within a few hours to 2-3 days after the start of the chemotherapy. The mortality rate of patients suffering from tumor lysis syndrome is less the 20%

What are the symptoms?

The symptoms of these syndromes may be lenient at first, but become hazardous over time due to the mixing of several substances in your systemic circulation. Symptoms of TLS include:

• Nausea, vomiting
• Weakness and fatigue
• Numbness, seizure, and tingling
• Muscle cramping and joint pain
• Hallucinations and confusion
• Decreased, dark urine

If TLS left untreated, it eventually leads to severe outcomes, these include:

• Seizures
• Abnormal heart rate
• Loss of muscle control
• Even death

Hyperkalemia, Hyperphosphatemia, Hypocalcemia and hyperuricemia

Generally, the first sign of TLS is hyperkalemia and the most dangerous component of this syndrome as potassium tends to leave the cell before they rupture. Hyperkalemia is defined as a medical condition of the body when it has too much potassium in the blood. Potassium is an important nutrient and helps in building nerves, muscles, and the heart.

Mild hyperkalemia is usually asymptomatic but chronic ones can cause a threat to life, cardiac arrhythmias, muscle weakness, or paralysis. This electrolyte can cause lethal dysrhythmias and damage normal cardiac functions. The kidneys aren’t able to excrete enough potassium to remunerate for the hyperkalemia as it is submerged by excess potassium.

Hyperphosphatemia is known as having a high level of phosphate in the blood released from the cancerous cells, phosphate is an electrolyte i.e. electrically charged substance that has phosphorus in it. The kidneys try to get rid of the excess amount of phosphorus in the bloodstream by increasing urine output and decreasing the amount of phosphorus reabsorption, but in the end, it reaches its limits where they can no longer payback, and phosphorus piles up in the blood. Generally, Hyperphosphatemia develops 1-2 days after the treatment.

As phosphate levels increase, phosphate ions (negatively charged) merge with calcium ions (positively charged) eventually leading to decreased serum calcium level. A condition where the body has really less than enough calcium is known as Hypocalcemia. It is also a sign of TLS. These calcium-phosphate complexes cause tubular obstruction and acute renal damage.

Neoplastic cells also release purine nucleic acid. Usually, purines are metabolized to hypoxanthine, converted to xanthine, and then to uric acid by the enzyme xanthine. An excess amount of purines are released rapidly in the blood during this syndrome. The kidneys are unable to excrete the overwhelming amount and results in hyperuricemia and uric acid formation in the kidneys. Hyperuricemia is seen 48 to 72 hours after the beginning of chemotherapy.

Due to these circumstances, the kidneys are submerged by excess phosphorus, potassium, uric acid crystals, and calcium phosphate precipitate leading to acute renal failure. The kidney tries to compensate for the increased electrolyte and uric acid by increasing the urine output, but can’t, due to uric acid nephropathy and volume depletion.

Lab work is carried out every 6 hours for the first 24 hours after chemotherapy started if a patient is in danger due to tumor lysis syndrome.

Diagnosis

Clinical signs, lab tests, and symptoms are used in diagnosing the tumor lysis syndrome.

The Cairo-bishop grading system, used in classifying and grading TLS, states lab anomalies in serum uric acid, phosphorus, potassium levels 25% increased over baseline, and serum calcium levels were decreased by 25% from baseline.

This system contemplates lab value alters that occur in patients from 3 days before to 7 days after the beginning of chemotherapy. The lab irregularity organized by the system is categorized based on cardiac dysrhythmias, seizures, severity including age-adjusted serum creatinine.
Tumor lysis syndrome is generally diagnosed by:

• Complete blood cell count
• Phosphorus and calcium test
• Urinalysis
• The uric acid level in the blood
• Creatinine level

Quick identification key

One can recover from this life-threatening problem of cancer treatment if they are promptly able to recognize the signs and symptoms of tumor lysis syndrome and take preventive measures.

Prevention and treatment of TLS

To help prevent TLS, the following steps you should be taken:

• Before the beginning of treatment, your healthcare will determine whether you have the risk of developing this syndrome. This is based on the type of cancer.
• Lab tests, checking conditions like poor kidney function, heart disease, or hypertension
• Medications like Allopurinol ( Lopurin, Zyloprim (Aloprim) should be taken, to reduce or stop the amount of uric acid and rasburicase (Elitek, Fasturtec) for breaking down the uric acid.
• The level of electrolyte should be balanced
• Level of calcium and potassium

Allopurinol

It stops the conversion of xanthine to uric acid and hypoxanthine to xanthine by inhibiting xanthine oxidase. Ideally, it starts 1-2 days before the starting of chemotherapy.

Monitors patients for any fever, allergies, or skin rash including nausea, vomiting, and chills. Common unfavorable results from the intake of allopurinol headache and drowsiness.

Allopurinol therapy is done before chemotherapy as it helps to prevent excess uric acid. It has no effect on patients suffering from hyperuricemia and it increases the level of xanthine that could damage the kidney.

It is never operated with capecitabine because allopurinol may deteriorate its effectiveness.

Rasburicase

Rasburicase is a drug that cures hyperuricemia, changes uric acid to allantoin. allantoin is more soluble than uric acid in urine. This drug decreases the level of uric acid and manages the amount of serum potassium, calcium, phosphate, and creatinine.

Also, it works quickly and takes 4-5 hours to show effectiveness. Patients should be well hydrated before taking this drug. Patients with large tumor burdens tend to take longer therapy (up to seven days or twice/day) while for other patients it is effective in 1-2 days.

Pay attention to the patient taking rasburicase while sending lab specimens for the uric acid level test. To maintain approx uric results, the blood samples must be kept on ice after being taken. Poorly ensured samples will give false results because any uric acid of the sample being reduced by rasburicase at room temperature.

Patients receiving this drug should not be supplied with allopurinol as it can interfere in the work of rasburicase and may decrease its effectiveness. Rasburicase should never be given to patients suffering from glucose-6-phosphate dehydrogenase deficiency due to the risk of critical hemolysis.

Stop giving this drug to the patient if it shows a sign of hypersensitivity. Signs of hypersensitivity reactions include bronchospasm, urticaria, dyspnea, chest discomfort, hypoxia, and hypotension. The most common unfavorable reactions of patients related to one dose of this drug infusion are headache, vomiting, and fever. But eventually results in urticaria pruritus, dyspnea, increased liver enzymes, and chest and back pain with increased or repeated dosing.

Healing the complications of TLS

• Patients with TLS should be provided with enough water and stay well hydrated before the treatments.
• IV calcium should not be delivered to patients with hyperphosphatemia, because it increases calcium phosphate precipitation.
• Hyperphosphatemia control is managed with phosphate binders such as aluminum hydroxide given in limited dosages to avoid aluminum toxicity. Other phosphate binders having calcium, such as calcium carbonate or calcium acetate may be used instead.
• Ensuring the sign and symptoms of hypomagnesemia from sodium sulfonate and hypocalcemia using sorbitol also the patient’s 12-lead ECG should also be monitored and maintained as it plays a role in indicating and accessing cardiac rate and rhythm for dysrhythmias.
• Patients having symptomatic hyperkalemia should be accessed with iv regular insulin and dextrose for redistributing potassium, within the cell.
• Patients not responding to these measures should be accessed to a renal replacement, such as hemodialysis, to manage renal failure and electrolyte anomalies.

Quick identification key

One can recover from this life-threatening problem of cancer treatment if they are promptly able to recognize the signs and symptoms of tumor lysis syndrome and take preventive measures.

Cautious of these medications!

A list of medication, patients suffering from TLS must avoid or there would worsen the effects of this syndrome:

• Acetylsalicylic acid,(aspirin)
• Medication containing potassium and phosphorus
• Beta-blockers
• Mannitol
• Some antibiotics
• Heparin
• Bisphosphonates
• Potassium-sparing diuretics
• Nephrotoxic agents such as aminoglycosides and nonsteroidal anti-inflammatory drugs

Book an appointment with the Best Cancer Specialist at Oncoplus Hospital.