Things ARe Better for Me Already
I just did not understand how I could keep going every day. I briefly thought about signing up to go on disability because I was having so much pain every single day. I really did not know what else to do. One night, I was feeling sorry for myself when a commercial came on TV explaining that Chicago chiropractors can do so much for people who have chronic back trouble. I was a little leery. If pain killers weren’t going to help, how would a person...
I was taught the science of naturopathy and herbal medicine by Australia’s matriach of Wholistic Health, the late Dorothy Hall. From that foundation my model of Wholistic Naturology has evolved.
People need guidance in the use of complementary medicine, including botanicals. It is not as straight forward as you might think. Understanding herb-drug & drug-nutrient interactions requires a high degree of skill.
Knowledge of a patient’s surgical history is essential. For example patients with colostomies, ileostomies or shortened colons will have compromised nutrient absorption.
I have crafted this approach into a therapeutic model that is highly effective not only for helping cancer patients… but those with a diverse range of non cancer-related conditions.
My specialties are: Immune disorders, Colon Conditions, Allergies, Nutritional Medicine & Lifestyle Advice
1. Immune disorders – including but not limited to…
Despite recent developments in targeted therapies, the overall survival for metastatic NSCLC remains poor. The need for novel therapeutic options has led to the development of various new immunotherapeutic agents including anti-PD-1 and anti-PD-L1 antibodies, which appear to have a promising role in the treatment of the disease. Additionally, other immunotherapy options including CTLA-4 inhibitors and various vaccines are also currently being investigated as potential treatment options.
Lung cancer continues to be the leading cause of cancer related deaths worldwide. Approximately 80% of lung cancers are diagnosed as non-small cell lung cancer (NSCLC), which is further classified into three main histologies: adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. The treatment decisions for NSCLC are primarily dependent on the patient’s performance status, extent of disease, and histological subtype. Significant developments in the area of targeted therapies have changed the treatment paradigm for NSCLC. New drugs targeting EGFR, EML4-ALK, and ROS-1 mutations have provided considerable benefit and new therapeutic options for patients. Despite these advancements, the overall survival (OS) in patients with metastatic disease continues to be poor, and the majority of NSCLC patients are not candidates for these therapies.
There is significant need for novel and alternative therapeutic agents. With this in mind, various immunotherapeutic options have recently garnered significant attention and appear to hold a promising role in the treatment of NSCLC.
The importance of an intact immune system in controlling the growth of cancer cells has been recognized since the beginning of the 20th century. 1 Various studies have highlighted the role of the immune system in surveillance for elimination of preclinical cancers and the role of tumor-infiltrating lymphocytes as a prognostic tool. 2-4
Immunotherapy has had limited success in the treatment of solid tumors except in the treatment of melanoma and renal cell cancers. 5-8 This limitation has been thought to be the result of many factors including secretion of immunosuppressive cytokines and loss of major histocompatibility complex antigen expression. 9-11 Recent improvements in our understanding of the functioning of the immune system and its relation to tumor evasion have led to the development of novel agents that have promising results in the treatment of NSCLC. These agents include immune checkpoint inhibitors such as anti-PD-1 antibody, anti-PD-L1 antibody, and CTLA-4 inhibitors, as well as vaccines. This review will discuss these therapeutic options and the emerging data to support their role in the management of patients with lung cancer.
Tumors have various mechanisms by which they evade destruction by the immune system. One of these mechanisms is via the immune checkpoint pathway, which plays a key role in regulating T-cell responses. Under normal circumstances, the immune checkpoints are important in maintenance of self-tolerance by preventing autoimmunity and protecting the tissue from damage when the immune system is activated. 12 The expression of immune-checkpoint proteins can be manipulated by the tumor cells to develop resistance mechanisms. The two major inhibitory pathways involve the PD-1/ PD-L1 pathway and the CTLA-4 pathway.
Programmed cell death-1(PD-1) is one of the pathways that inhibits tumor-specific T cells. PD-1 is a member of the B7-CD28 superfamily, and is a cell surface receptor with two known ligands: PD-L1(B7-H1) and PD-L2(B7-DC). 13 It is an inhibitory receptor, and mediates immunosuppression. 14 PD-1 is expressed on activated CD4+ and CD8+ T cells, natural killer T cells, B cells, activated monocytes, and activated dendritic cells. 13,15,16
Binding of the PD-1 receptor with its PD-L1 ligand causes T-cell inhibition and downregulation of T-cell response. 17 PD-1 overexpression has been observed in patients with NSCLC, 18 and an increase in PD-L1 positive tumor cells have been noted in tumor tissue as compared to normal lung parenchyma. 19
Blocking the binding of PD-1 to its PD-L1 ligand can potentially restore the function of chronically exhausted tumor-specific T cells and augment the T-cell response. 20
A phase I dose-escalation trial of a fully human IgG4-blocking monoclonal antibody against PD-1, nivolumab, administered once every 2 weeks, evaluated its efficacy in patients with previously treated solid tumors including NSCLC. 14 Patients with melanoma, NSCLC, renal cell cancer, castrationresistant prostate cancer, or colorectal cancer were enrolled.
Lung cancer is the leading cancer killer in both men and women in the U.S. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women. 1
An estimated 158,040 Americans are expected to die from lung cancer in 2015, accounting for approximately 27 percent of all cancer deaths. 2
The number of deaths caused by lung cancer has increased approximately 3.5 percent between 1999 and 2012 from 152,156 to 157,499. The number of deaths among men has plateaued but the number is still rising among women. In 2012, there were 86,740 deaths due to lung cancer in men and 70,759 in women. 1
The age-adjusted death rate for lung cancer is higher for men (56.1 per 100,000 persons) than for women (36.4 per 100,000 persons). It also is higher for blacks (48.3 per 100,000 persons) compared to whites (45.6 per 100,000 persons). Black men have a far higher age-adjusted lung cancer death rate than white men, while black and white women have similar rates. 1
Prevalence and Incidence
Approximately 402,326 Americans living today have been diagnosed with lung cancer at some point in their lives. 3
During 2015, an estimated 221,200 new cases of lung cancer were expected to be diagnosed, representing about 13 percent of all cancer diagnoses. 2
The majority of living lung cancer patients have been diagnosed within the last five years. Lung cancer is mostly a disease of the elderly. In 2011, 82 percent of those living with lung cancer were 60 years of age or older. 3
In 2011, Kentucky had the highest age-adjusted lung cancer incidence rates in both men (112.2 per 100,000) and women (79.3 per 100,000). Utah had the lowest age-adjusted cancer incidence rates in both men and women (34.5 per 100,000 and 25.0 per 100,000, respectively). 4 These state-specific rates were parallel to smoking prevalence rates.
Lung cancer is the most common cancer worldwide, accounting for 1.8 million new cases and 1.6 million deaths in 2012. 5
The National Institutes of Health estimate that cancer care cost the U.S. an overall $124.6 billion in 2010, $12.1 billion of which is due to lung cancer. Lost productivity due to early death from cancer lead to an additional $134.8 billion in 2005, $36.1 billion of which was caused by lung cancer. 6
More men are diagnosed with lung cancer each year, but more women live with the disease. The rate of new cases in 2011 showed that men develop lung cancer more often than women (64.8 and 48.6 per 100,000, respectively). 3
The rate of new lung cancer cases (incidence) over the past 37 years has dropped for men (28 percent decrease), while it has risen for women (98 percent increase). In 1975, rates were low for women, but rising for both men and women. In 1984, the rate of new cases for men peaked (102.1 per 100,000) and then began declining. The rate of new cases for women increased further, did not peak until 1998 (52.9 per 100,000), and has now started to decline.3
Blacks are more likely to develop and die from lung cancer than persons of any other racial or ethnic group. The age-adjusted lung cancer incidence rate among black men is approximately 32 percent higher than for white men, even though their overall exposure to cigarette smoke, the primary risk factor for lung cancer, is lower. 3, 7
The lung cancer incidence rate for black women is roughly equal to that of white women, despite the fact that they smoke fewer cigarettes. 3, 7
The lung cancer five-year survival rate (17.8 percent) is lower than many other leading cancer sites, such as the colon (65.4 percent), breast (90.5 percent) and prostate (99.6 percent). 3
The five-year survival rate for lung cancer is 54 percent for cases detected when the disease is still localized (within the lungs). However, only 15 percent of lung cancer cases are diagnosed at an early stage. For distant tumors (spread to other organs) the five-year survival rate is only 4 percent. 3
More than half of people with lung cancer die within one year of being diagnosed. 3
Smoking-Attributable Lung Cancer
Smoking, a main cause of small cell and non-small cell lung cancer, contributes to 80 percent and 90 percent of lung cancer deaths in women and men, respectively. Men who smoke are 23 times more likely to develop lung cancer. Women are 13 times more likely, compared to never smokers. 8
Between 2005 and 2010, an average of 130,659 Americans (74,300 men and 56,359 women) died of smoking-attributable lung cancer each year. Exposure to secondhand smoke causes approximately 7,330 lung cancer deaths among nonsmokers every year. 9
Nonsmokers have a 20 to 30 percent greater chance of developing lung cancer if they are exposed to secondhand smoke at home or work. 10
It has been estimated that active smoking is responsible for close to 90 percent of lung cancer cases; radon causes 10 percent, occupational exposures to carcinogens account for approximately 9 to 15 percent and outdoor air pollution 1 to 2 percent. Because of the interactions between exposures, the combined attributable risk for lung cancer can exceed 100 percent. 11
Exposure to radon is estimated to be the second-leading cause of lung cancer, accounting for an estimated 21,000 lung cancer deaths each year (range of 8,000 to 45,000). Radon is a tasteless, colorless and odorless gas that is produced by decaying uranium and occurs naturally in soil and rock. The majority of these deaths occur among smokers since there is a greater risk for lung cancer when smokers also are exposed to radon. 12
Lung cancer can also be caused by occupational exposures, including asbestos, uranium and coke (an important fuel in the manufacture of iron in smelters, blast furnaces and foundries). The combination of asbestos exposure and smoking greatly increases the risk of developing lung cancer. 13
Nonsmoking asbestos workers are five times more likely to develop lung cancer than nonsmokers not exposed to asbestos; if they also smoke, the risk factor jumps to 50 or higher. 11 Environmental exposures also can increase the risk of lung cancer death. 14
U.S. National Institutes of Health. National Cancer Institute. State Cancer Profiles ;web tool, accessed October 6, 2014.
World Health Organization. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Lung Cancer. Accessed November 10, 2014.
U.S. National Institutes of Health. National Cancer Institute. Cancer Trends Progress Report – 2011/2012 Update. Costs of Cancer Care.
Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 2010. Analysis by the American Lung Association, Research and Program Services Division using SPSS software.
The Health Consequences of Smoking: A Report of the U.S. Surgeon General, 2004.
We rely on the support of others to provide our program free of charge to cancer survivors. It costs approximately $600 for each participant to complete the 101 Days Back to Life program. This includes 28 personal training sessions, a consult with a nutritional expert and access to the gym and trainer during the program. There are many different ways to give including a one-time donation, becoming a monthly partner, or sponsoring one participant.
One-time donation: No matter the dollar amount, Survivor Fitness is thankful to receive your help and support.
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Become a Monthly Partner: By signing up to become a monthly partner you’re making a commitment to help survivors truly regain their health. The amount per month is up to you or you can choose to donate $50 per month and support one survivor per year. If you’re interested in becoming a monthly partner, please email email@example.com.
To make a donation, please click the ‘donate’ button below after selecting your donation of choice or you can mail donations to P.O. Box 41434 Nashville, TN 37204. If you’d like additional information or if you’re interested in becoming a monthly partner, please email firstname.lastname@example.org or call 615-720-1116.
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When Christopher Gordon first felt the pea-sized lump under his armpit, he decided to ignore it. It was 2006, he was just 35 and, as far as he was concerned, in rude good health.
But as he would discover over the following years, a life can be hijacked, halted even, by something as apparently innocuous as a tiny swelling.
Diagnosed with melanoma, one of the deadliest of skin cancers, he underwent surgery to remove the tumour, followed by three months of radiation in his native New Zealand. That was only the beginning of a long and arduous journey that would take him far from home in an effort to save his life.
Six months after those first treatments, a CT scan revealed more lumps in his abdomen and in his back. Those tumours were growing quickly.
‘It was like a bombshell when they told me that the cancer had metastasised,’ he recalls. The bad news continued. The flight attendant spent six months travelling back and forth to Los Angeles to participate in a promising drug trial but his tumours did not respond.
Then he was told of another drug trial in Melbourne and, in late 2008, he met University of Melbourne Professor Grant McArthur and Lorenzo Galli Chair in Melanoma and Skin Cancers at the Department of Oncology at Peter MacCallum Cancer Centre. This time fortune would favour the brave New Zealander.
Professor McArthur belongs to a band of medical pioneers which is revolutionising the way treatment is being delivered to patients. Dubbed ‘precision medicine’ or ‘individualised medicine’, it works on the premise that every person is as unique on the inside as they are on the outside.
Treatments are tailored to each patient, taking into account their individual variability in genes, environment and lifestyle. This approach harnesses the expertise of leaders in the fields of medicine, genetics, mathematics, pathology and technology. It represents teamwork at its best and it would take some time for Christopher to fully understand he was standing with innovators on the frontier of medicine.
The story of the drug that would save his life began years ago at Plexxikon, a small biotech company in San Francisco. Its work centred on a gene called a BRAF, which helps regulate cell growth. After discovering that a mutated form of the gene was present in nearly half of all advanced melanoma cancers, researchers developed a drug that could turn off the mutant program caused by that mutated gene.
Professor McArthur’s laboratory in Melbourne was among the first centres in the world to conduct clinical trials of the anti-BRAF drug. Patients’ responses to the drug were dramatic and the treatment is now a standard throughout the world.
The possibilities in the field have fired Professor McArthur and the multi-disciplinary experts who support his clinical work.
‘You have to establish the technology in healthcare systems to enable clinicians to look at gene mutations,’ Professor McArthur says. ‘It’s a clear example of the paradigm of personalised medicine where you profile an individual’s cancer, looking at all the unique features in the DNA, and then link that to a therapy.’
The treatment has significantly improved the prognosis for patients with advanced melanoma. Where the average survival rate was once nine months, it has now been extended to more than two years.
An estimated 1400 Australians die from melanoma each year and about 40 per cent of them have the BRAF mutation. ‘This means that 500 to 600 people now benefit from this treatment,’ says Professor McArthur. ‘What is also important is that we are now rapidly identifying all the genes that are mutated or that change in cancers and are getting detailed catalogues of these.
‘There are major efforts happening in ovarian, lung, acute myeloid leukaemia as well as other cancers. These are world-leading efforts to develop personalised medicine approaches for patients with these type of cancers.’
This new approach marks quite a departure from the old. ‘The old approach was to develop cancer treatments in an empirical way, to look for drugs that could kill cancer cells, to test those drugs across all cancers and observe whether they work or not,’ says Professor McArthur.
‘Now cancer treatments can turn off precise individual proteins in the cancer cell and you can screen patients for changes in their DNA sequence that tell whether or not these drugs will work.’
The team is not resting on its laurels. ‘In many ways, the BRAF story was like picking low-hanging fruit,’ he explains. ‘The real challenge is to be able to personalise treatment based on rare events that are occurring in patient cancer genomes.
‘The challenge is how we deal with gene mutations that are unique to 1 per cent of the population … We need to identify these needles in the haystack. We then need to learn how these certain mutations might benefit from certain treatment approaches.’
A critical element in this new world of precision medicine is genomics. This is where the work of University of Melbourne Associate Professor Clara Gaff, Executive Director of Melbourne Genomics Health Alliance at the Walter and Eliza Hall Institute, comes in to play.
While genetics is the study of one particular gene, genomics is the study of the complete genome, the full set of DNA, which gives doctors a better chance of finding gene changes associated with a disease or condition.
‘Knowing the genetic make-up of a person or a cancer can assist the clinician to make decisions about the patient’s management based on that knowledge,’ she explains. ‘Doctors used to rely on information about the structure of the body, tissues and cells.
Genetic and genomic tests offer more precise information about the cause of a condition or a cancer. The more precise the knowledge a clinician has, the more precise the diagnosis or treatment can be.
Unlocking the mysteries of genomics is a formidable challenge. ‘There are about 3 billion base pairs in the human genome,’ says Associate Professor Gaff. ‘A common analogy used is that our genomic information is the equivalent of 1000 copies of War and Peace.’
Not all the information can be interpreted. ‘For now we understand some facets of the genome,’ she adds. ‘Big data sets are being used to better understand the significance of changes across the genome.’
It is estimated that 60 gigabits of storage is required to hold the data of one patient. Melbourne Genomics estimates that over the next three years an allocation in excess of 100 terabits could be required.
Providing this technological framework is another piece of the precision medicine puzzle. Dr Doug Boyle, Director of the Research Information Technology Unit at the University of Melbourne, is the brains behind key infrastructure that has been developed to access patient data across Australia so it can then be used by researchers to push back medical boundaries.
He calls the technology GRHANITE, the GeneRic Health Network Information Technology for the Enterprise. One of its greatest innovations is its ability to record-link without any identity exposure.
There are an estimated 7300 general practice surgeries around Australia and until the advent of GRHANITE, little or no GP patient data has been able to be captured for record-linked research purposes.
So far, 650 of those practices have been linked with GRHANITE for the first time. This, says Dr Boyle, allows researchers to look at the whole care journey that patients have undertaken.
‘Anecdotally 95 per cent of all healthcare happens in the community and yet, because of the difficulty of accessing such data, very little research is conducted using it. Our ability to open up the vast amount of information that is primary care is hugely exciting.’
It has been estimated that with proper integrated data analytics, healthcare costs could be reduced by as much as 30 per cent. A 10 per cent reduction would result in a cost saving of $1.5 billion in Victoria alone.
As medical research advances, it will be increasingly common for the diagnosis, planning, pre-operative preparation, operation and post-operative care to be tailored to the individual. ‘Working as a multi-disciplinary team optimises a patient’s care,’ says David Story, Chair of Anaesthesia at the University of Melbourne.
‘It allows a team to look at a patient’s care from different perspectives. The aim of precision medicine in anaesthesia is to identify an individual’s risk factors and to optimise care, taking those risks into consideration.’
Professor Story says diabetes is an obvious example of a risk factor. One in four patients admitted to many hospitals has diabetes and half are undiagnosed before admission.
Precision medicine is an excellent strategy and philosophy. It’s an excellent way forward.
‘We need to look at individual patients every time we take care of them.’
Christopher Gordon’s medical journey has not been easy but it has been successful. Once he was taking eight BRAF inhibitor pills twice a day, and almost three times as many to counter side effects.
When chronic inflammation of the eyes forced him off the trial, he was gutted. ‘I had always told myself that one day this might happen.’
However, an alternative treatment without the same side effects, and which he continues to take, was found for him. ‘The medical team has been incredible and saying goodbye to them has been bittersweet. I will miss them.’
Banner image: A summer’s day at Manly Beach, Sydney, Australia. Picture: Sacha Fernandez/ Flickr
The body’s reaction to chemotherapy, radiation, or targeted treatments depends on a number of factors such as length of treatment, dosage prescribed, and a person’s health history. Most side effects are short term, but some can last throughout your treatment and even for some time afterward. Although side effects can be uncomfortable or painful, doctors now have many ways to reduce and even prevent side effects from treatment.
The following are possible side effects you may experience and resources to help you manage:
People with cancer are at risk for developing blood clots for various reasons, but steps can be taken to prevent and treat blood clots.
Cancer that starts in or spreads to the bones can lead to bone pain and an increase in risk for complications, including weakening of the bone, fractures, and high calcium levels in the blood. Cancer treatments may also affect your bones.
Side effects from cancer treatment may include tooth decay and other mouth issues, including dry mouth and mouth sores. It’s important to address any dental concerns you have, especially before beginning treatment, but also during and after with both your treating physician and dentist.
Defined as two or more loose bowel movements per day, diarrhea may be caused by some types of chemotherapy and radiation to certain areas of the body. There are many things you can do to help control diarrhea.
People with cancer who have undergone lymph node removal and/or radiation as part of their treatment are at risk for developing lymphedema, a painful swelling that happens when your body’s lymphatic fluid is unable to circulate properly and builds up in your soft tissues instead.
If you are experiencing pain as a result of your cancer or its treatment, you should know that managing this pain is an important part of your overall care and should be brought to the attention of your physician. They may find it helpful to provide a referral to a pain management specialist.
Lung cancer survival rates are a measure of how many people remain alive with lung cancer after a certain amount of time. For example, a 5-year survival rate of 40% for a condition, would mean that 40% of people, or 40 out of 100 people, would be alive after 5 years. When talking about lung cancer, physicians often use the term median survival as well. Median survival is the amount of time at which 50% of people with a condition will have died, and 50% are still alive.
Lung cancer survival rates are statistics and don’t necessarily give an accurate estimate of how long an individual will survive with a certain disease. There are many factors that affect lung cancer survival rates, including general health, sex, race, and treatments used. Smoking cessation is demonstrated to improve survival in patients with early stage non-small cell lung cancer and in some patients with small cell lung cancer.
Not everyone living with lung cancer is interested in hearing statistics about survival rates. Some people want to know what they can expect (statistically that is) with their particular type of lung cancer, whereas others find numbers about survival rates to be discouraging. It is important for loved ones to be sensitive to this, and honor the wishes of their loved one with cancer. That said, even if you aren’t interested in statistics there are things you can do to raise your odds.
Check out this article to see things (other than surgery, chemotherapy, and radiation therapy) that have been found to increase survival in well-researched studies.
Overall Survival Rates by Lung Cancer Type
Small Cell Lung Cancer – The overall 5-year survival rate for small cell lung cancer (limited and extensive) is only about 6%.
Non-Small Cell Lung Cancer – The overall 5-year survival rate for non-small cell lung cancer (all stages combined) is roughly 18%.
BAC (Bronchioloalveolar Carcinoma) – The survival rate with BAC is significantly better than with other forms of non-small cell lung cancer, especially when it is caught early and only one tumor is present. In one study, those who were diagnosed with BAC and had tumors less than 3 centimeters in diameter, had a 5-year survival rate of 100% with surgery. The 5-year survival rate for people with more advanced stages of the disease varies considerably.
Survival Rates by Lung Cancer Stage
As mentioned above, survival rates do not reflect differences in individuals. In addition, keep in mind that not everyone with a particular stage of lung cancer has the same prognosis. Staging lung cancer can help guide treatment, but there is a wide spectrum of cancers within each stage.
Small Cell Lung Cancer – The overall 5-year survival rate for both stages of small cell lung cancer (limited stage plus extensive stage) is only about 6%. Without treatment, the average life expectancy for extensive disease is 2 to 4 months, and with treatment is 6 to 12 months.