If you are going through chemotherapy or radiation treatment, then Kenny Perkins podcast “All Talk Oncology” is a must-listen for your personal health!
https://podcasts.apple.com/us/podcast/experience-power-nutrition-during-cancer-treatments/id1506594584?i=1000489683858
Chemotherapy is the cancer treatment most likely to weaken the immune system. Chemotherapy medicines target rapidly dividing cells, which cancer cells are — but so are many of the normal cells in your blood, bone marrow, mouth, intestinal tract, nose, nails, vagina, and hair. So chemotherapy affects them, too. Cancer cells are destroyed by chemotherapy because they can’t repair themselves very well. Your healthy cells typically can repair the damage from chemotherapy once treatment ends. (One notable exception is nerve cells in your hands and/or feet, which can be permanently damaged by certain chemotherapy medications — a condition known as peripheral neuropathy.)
As chemotherapy medicines damage the bone marrow, the marrow is less able to produce enough red blood cells, white blood cells, and platelets. Typically, the greatest impact is on white blood cells. When you don’t have enough white blood cells, your body is more vulnerable to infection.
Although most chemotherapy medications can have an impact on your immune system, how much of an impact depends on many factors, such as:
Some chemotherapy medicines are taken by mouth, in pill form, while others are given intravenously — through a vein in the chest, arm, or hand — at a hospital or clinic. If you’re having intravenous treatment, ask that it be given on the opposite side of the body from where you had your surgery. The injection site poses some risk of infection, and since breast cancer surgery usually removes lymph nodes, you definitely want to minimize that risk on the affected side of your body. (If you had cancer in both breasts, choose the side of the body that had less extensive surgery or fewer lymph nodes removed, if possible.)
The timing of different chemotherapy regimens varies. Typically, you would take the medication(s) for one day to several days, wait a couple of weeks to give the body time to recover, and then start the cycle again. Treatment can last for anywhere from 3 to 6 months. During that time, you would be considered to be immunocompromised — not as able to fight infection. After finishing chemotherapy treatment, it can take anywhere from about 21 to 28 days for your immune system to recover.
If chemotherapy is part of your treatment plan, you and your doctor should review the medications you’ll have and discuss potential effects on your immune system.
Before, during, and after chemotherapy, do your best to follow the common-sense ways to take care of your immune system, such as getting enough rest, eating a healthy diet, exercising, and reducing stress as much as you can. Some chemotherapy medicines can reduce your appetite and make you feel tired, so ask your doctor about ways to manage those side effects.
Before you start chemotherapy, your doctor should order a complete blood count (CBC) to check your baseline levels of different blood cells, including white blood cells. You’ll continue to have this blood test done periodically throughout your treatment. When your white blood cell count is lower than normal, you’re more prone to infection. Especially important is a type of white blood cell known as neutrophils, which are first responders to infection that can gobble up bacteria, fungi, and germs. Your test results will include an absolute neutrophil count, or ANC. Usually, your neutrophil levels start to drop about a week after your chemotherapy cycle begins, reach a low point in another week or so, and then slowly begin to climb again before your next cycle of treatment. Blood tests will help your doctor know if your neutrophil levels have bounced back enough in between treatments.
A normal neutrophil count is around 2,500-6,000. If yours is lower than that, and especially down to 1,000 or lower, your risk of infection is increased. If the count falls below 500, you have a condition called neutropenia, which greatly raises your risk of a serious infection.
Whatever your situation, it’s very important to follow specific steps for protecting yourself against infection and to promptly report any signs or symptoms of infection to your doctor. When your immune system is weak, an infection can worsen quickly and even turn life-threatening. If you have a fever higher than 100 and suspect infection but you can’t reach your doctor, seek emergency medical attention.
If your neutrophil levels don’t bounce back quickly enough between treatments or you develop neutropenia, your doctor may decide to:
If chemotherapy causes neutropenia accompanied by a fever, your doctor may prescribe medications called colony-stimulating factors (CSFs) or white blood cell growth factors to be given along with your remaining chemotherapy treatments. These medications can help the body produce more neutrophils and other types of white blood cells, which strengthens your ability to fight off infection. Examples include:
These are given as a series of shots in between treatment cycles. Although CSFs can reduce the risk of hospitalization due to infection, they can cause side effects such as aches in the bones, low-grade fever, and fatigue. Generally, CSFs are used in people who are on a chemotherapy regimen that more commonly causes neutropenia or for those who aren’t helped by an adjustment in the chemotherapy dose. Talk to your doctor to find out what is recommended for you.
Even after you finish treatment, it is important to follow steps for protecting yourself against infection until your immune system returns to normal.
Source: Breastcancer.org
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Poor Nutrition Contributes to 1 in 5 Cancer Deaths; Experts Urge Counseling
The statistic is shocking: Severe malnutrition and weight loss play a role in at least one in five cancer deaths. Yet nutrition too often is an afterthought until someone’s already in trouble.
A move is on to change that, from hospitals that hire fancy gourmet chefs to the American Cancer Society’s dietitians-on-call phone service.
With cancer, you’ve got to “bring a lot more nutrients to each spoonful of food,” Certified Master Chef Jack Shoop is learning. A former restaurateur, he’s newly in charge of the kitchen at the Cancer Treatment Centers of America in Philadelphia.
Don’t underestimate the added temptation should the result resemble Bon Appetit: “The visual hardiness, and the actual heartiness, of these foods has to be understood for them to embrace it,” Shoop insists.
Tempting the palate is a huge hurdle: At diagnosis, up to a quarter of patients already have their appetite sapped, and most treatments can bring side effects that worsen the problem. Aside from the well-known nausea, vomiting and diarrhea, some cancers inhibit absorption of the nutrients patients force down. Not to mention strangely altered taste, mouth sores, dry mouth, difficulty swallowing and constipation.
Literally wasting away
About half of all cancer patients eventually suffer serious weight loss and malnutrition, a wasting syndrome called cachexia where they don’t just lose excess fat but vital muscle. A healthy person’s body adjusts when it doesn’t get enough calories, slowing metabolism to conserve nutrients. A cancer patient’s body doesn’t make that adjustment; metabolism even may speed up.
The National Cancer Institute estimates cachexia is the immediate cause of death for at least 20 percent of cancer patients, although advanced cancer might have eventually claimed many of them.
How much weight loss is too much? The institute defines patients as at-risk when they’ve lost more than 10 percent of their usual weight. Other research suggests that patients who lose more than 5 percent of their pre-cancer weight have a worse prognosis than people who can hang onto the pounds.
For their best shot at doing that, the American Cancer Society urges patients to ask to be assessed by a registered dietitian up front, right at diagnosis. While that’s common at designated cancer centers where dietitians work on-staff, it’s not routine elsewhere and surveys suggest just a third of patients have access to cancer nutritionists where they’re being treated.
“Patients who are well-nourished as they’re going through treatment have shorter hospital stays, are better able to tolerate treatment,” not to mention have better quality of life, says Colleen Doyle, nutrition chief at the society, which offers nutrition advice through its hot line at 1-800-ACS-2345.
Desperate patients often hunt their own nutrition advice on the Internet but can’t tell the good from the bad. The No. 1 Web-perpetuated myth: that sugar feeds tumor cells. Not true, says Maureen Huhmann, who chairs the American Dietetic Association’s oncology nutrition group. In fact, protein-packed milkshakes and smoothies can literally be lifesaving for some patients.
“I don’t want people to start losing weight because they cut foods out of their diet when they don’t really need to,” says Huhmann.
Then there are people overweight when diagnosed who delight at shedding pounds — until they learn they’re not just losing fat but muscle, too.
“You can be overweight and even obese and still be malnourished. It’s a dilemma,” says Carolyn Lammersfeld, the Cancer Treatment Centers’ nutrition director who works with Shoop, the chef, to help patients find palatable options.
Typically, a cancer patient needs as much as twice the protein of a healthy person and about 10 percent more calories. Some tumors bring bigger nutritional threats than others: Gastrointestinal and lung cancers tend to cause more weight loss than breast cancer.
Anti-nausea medications developed in the past decade bring relief to many patients, although they’re not always covered by insurance. Among options are a synthetic version of an ingredient from marijuana; cancer experts don’t promote smoking marijuana although some advocates claim it helps. Doctors also can prescribe appetite stimulants and, for worst cases, feeding tubes.
But eating by mouth is best, and dietitians can offer tips to help: Snacking throughout the day instead of trying to force down large meals can help, and high-fat or high-fiber foods make nausea last longer.
In his Philadelphia hospital cafeteria, Shoop gives taste tests to introduce patients to healthful foods they may never have tried: Quinoa, a grain with the same amino acids of meat, or Arctic char, a salmon-like fish but less fatty.
Doing his own butchering allows Shoop to make stocks and sauces with the bones to add even more protein to meat dishes. Garnish with mushrooms, he advises, for a bit more.
And he teaches caregivers how to add 400 extra calories and 20 grams of protein to a simple smoothie, milkshake or oatmeal — using whole milk or yogurt, some protein powder, and grinding up fruits, nuts and flax seed.
“If you’re not getting answers, keep searching,” says Lammersfeld. “People need to know that weight loss and not being able to eat is not a good thing during cancer treatment.”
updated 5/18/2009 6:36:10 PM ET
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Bispecific antibodies, as the name suggests, simultaneously target 2 or more tumor antigens on the same or separate cells to disrupt cancer development or progression. Others engage and tether cancer cells and immune cells together to increase cancer-cell destruction.
No matter the strategy researchers take, however, interest in these bioengineered antibodies has been rekindled by the striking success seen in the treatment of some cancers with immunotherapy — notably, checkpoint inhibitors and chimeric antigen receptor T-cell (CAR-T) therapy — in the past few years.
“Bispecific antibodies were stalled for a bit, but in this new era of immunotherapy, there’s definitely renewed interest,” said Nikhil Munshi, MD, a medical oncologist at Dana Farber Cancer Institute and director of basic and correlative science at the Jerome Lipper Multiple Myeloma Center in Boston, Massachusetts. “And, we have newer, more modern methodologies that have propelled the field forward.”
An estimated 50 clinical trials using bispecific antibodies for various malignancies are now underway, while biotechnology companies and academic labs purportedly have hundreds of different products in development and awaiting testing.1
Still, the US Food and Drug Administration (FDA) has approved only 1 bispecific antibody with a cancer indication so far, underscoring the need for further research, before these targeted biologics can emerge as viable and less costly alternatives to other types of immunotherapy that are highly tailored to an individual’s cancer.
In July 2017, the FDA approved Amgen’s bispecific antibody, blinatumomab (Blincyto) for acute lymphoblastic leukemia (ALL) in adults and children with advanced disease.2 Blinatumomab targets and binds 2 proteins, one, CD19, that is found on the surface of B-lineage cells and the other, CD3, that is found on T cells — essentially bringing the 2 in close enough proximity that T cells better recognize leukemic cells to kill them.
Other investigators are using similar tacks in creating these dual-targeting agents.
Researchers at The Ohio State University Comprehensive Cancer Center in Columbus, for example, used an approach comparable to blinatumomab in a humanized mouse model for multiple myeloma, according to Ilan Zipkin, PhD, a vice president at the Parker Institute for Cancer Immunotherapy in San Francisco, California. But the investigators extended the approved drug’s approach, he says, by tethering a common tumor antigen in this cancer, CS1, to a receptor, NKG2D, expressed on several types of immune system cells that kill.
Dr Zipkin wrote in an email that the Ohio researchers “are showing activity with a bispecific that promotes several different cell types to kill the myeloma cells,” including, importantly, natural killer cells. Results of that study were among those highlighted at the American Association for Cancer Research Annual Meeting in Chicago, Illinois, earlier this year.3
In multiple myeloma, CS1 is considered a well-defined antigen, which investigators already are targeting with CAR-T therapy, according to Dr Munshi. “But this group put it together with NKG2D, an interesting molecule, which is scientifically intriguing,” he says. “They showed a good response.”
Nevertheless, for this and other bispecific antibodies to work best in patients, Dr Munshi said there is a prerequisite: a functional immune system must be present. CAR-T therapy has a clear advantage over bispecific antibodies right now, he explained, because “you can overcome some of the immune-suppressive environment” that occurs. Still, given the prohibitive costs of CAR-T’s customized approach, Dr Munshi and others believe bispecific antibodies could provide an economical alternative for patients in the future, broadening access to treatment.
Michael Verneris, MD, director of bone marrow transplant and cellular therapy at Children’s Hospital in Denver, Colorado, also sees an evolving role for these next-generation designer antibodies. Although the need for intact immunity and a lack of persistent therapeutic effect pose barriers right now, he says, bispecific antibodies have considerable upside, as well.
“These are modular, relatively small molecules that can be quick to produce,” he said. “If ‘A’ and ‘B’ don’t work, you can keep on mixing and matching until you can create whatever you want.” One obvious advantage to patients is that if complications arise, they can be addressed quickly, he said.
“The great hope is that these will be in the deck of options for patients,” as an integral part of a multipronged strategy against cancer, Dr Verneris said.
Although no bispecific monoclonal antibodies in the first-line setting exist yet, he is confident that clinical trials in patients with early-stage cancers eventually will take place, when chemotherapy damage to their immune systems is not so extensive.
Dr Verneris said he has watched unlikely strategies in immuno-oncology gradually unfold successfully before, and the same could happen with bispecific antibodies. “It’s been hugely gratifying to see some of these ideas come raging forward.”
References
Susan Jenks
August 22, 2018
Click here for full article: Cancer Therapy Advisor
By Nikki Ross
06/25/2018
As if chemotherapy isn’t hard enough on its own, patients who undergo this course of cancer treatment also have the added struggle of maintaining a nutritious diet.
Now these patients have access to a nutritional supplement specifically designed to give them the nutrients they need when they find it hard to keep down their meals.
“This is the baby we have been working on for two years,” said Dr. Peter Acs, founder and chief medical officer for Nutronco.
The goal for the supplement, Poweronco, is to improve nutrition, rebuild muscle, support the immune system, decrease inflammation and overall to help with chemotherapy side effects. The product was developed and produced by the emerging nutrition company Nutronco.
“It bothered me to see patients struggle to find a nutritional product that they could keep down,” said Acs, who also is a board-certified hematologist and oncologist.
“I had been wanting to do something like this for years and now it’s here.”
Poweronco is a chocolate flavored powder that chemotherapy patients can mix in six to eight ounces of water once or twice a day.
It costs $99.99 for a one month supply which equals $3.75 per serving. It can be purchased on Nutronco’s website. They are hoping to soon have it available in nutritional stores.
“This is something that they can drink easily because it dissolves nicely in the water,” said Hayes Milani, CFO of Nutronco.
“It’s filling but we also always recommend taking it with a healthy diet.”
Milani and Acs stress that Poweronco is not an alternative treatment though it does help patients tolerate their chemotherapy treatment better then those who don’t take it.
“The main thing for patients undergoing chemotherapy is to eat well and maintaining weighing during treatment,” said Padmaja Sai, hematologist and oncologist at Florida Hospital. “If they are not really getting enough nutrients through their diet then we recommend patients take some nutritional supplements.”
There are several factors that contribute to nutritional deterioration in chemotherapy patients.
The treatment causes cells to stop multiplying in the body, even the good ones.
Patients who undergo chemotherapy may be subject to bed rest and, according to Acs, patients on bed rest lose 10 percent of muscle mass per week.
“Fifty to 80 percent of cancer patients have nutritional issues,” Aces said.
“Forty percent of cancer patients die from malnutrition or cachexia.”
The supplement contains ingredients that help to combat the negative side effects of chemotherapy treatment. It has nucleotides that boost the immune system, help with healing and decreases the chance of infection.
It also contains probiotics that help with the development and stability of the good bacteria in the body, strengthens the immune system and prevents the chemotherapy side effect of diarrhea.
“I don’t see anything wrong with it as long as it ties into everything else we mentioned maintaining a healthy lifestyle, organic diet, no smoking and limited alcohol intake,” Sai said. “As far as I know there is no other nutritional supplement that caters to chemotherapy patients.”
Prebiotics also have been added to the supplement to give good bacteria the surface to grow. Ginger and other ingredients are also there to reduce nausea. It also includes protein. “Many oncologists will be skeptical,” said Dr. Michael Epitropoulos, oncologist, chiropractic and natural medicine physician.
“They have checked for a reaction between the ingredients and the chemotherapy and found that it will not harm treatment like other supplements.”
Acs said his main goal in developing this supplement is to help chemotherapy patients have a more positive outcome. “This is to help them take some control over their nutrition,” Acs said. “And to help them fight against cancer.”
For information on Nutronco and their products, visit nutronco.com.
To contact Dr. Peter Acs, call 352-672-4403.
To contact Hayes Milani, call 352-278-2526.
To contact Dr. Michael Epitropoulos, call 386-274-2520.
In a recent study, scientists found that breast cancer patients with decreased muscle mass may have a significantly higher risk of death compared to patients without it. This study, titled “Association of Muscle and Adiposity Measured by Computed Tomography with Survival in Patients With Nonmetastatic Breast Cancer” was published in JAMA Oncology on April 5, 2018*. They examined 3,241 women from Kaiser Permanente of Northern California and Dana Farber Cancer Institute of Harvard Medical School between January 2000 and December 2013. Very importantly, these patients did not have metastatic cancer but rather were diagnosed with stage II or stage III breast cancer that are potentially curable. According to their results, muscle characteristics appear to be important predictors of survival for those who have breast cancer. Patients who had decreased muscle mass were 41 percent less likely to have survived than those who did not. Patients with the highest amount of body fat were also linked to an increased mortality risk. Patients who had both were 89 percent more likely to have died. At Nutronco we have been emphasizing the utmost importance of nutrition and especially protein intake to help rebuild and maintain muscle mass in cancer patients. This is the largest study to date of patients with nonmetastatic breast cancer, and it demonstrated that decreased muscle mass (sarcopenia) is underrecognized, highly prevalent, and is associated with a significant increased risk of death. The authors of the study concluded that we should consider interventions to improve muscle mass such as protein supplementation. Our PowerOnco supplement provides high quality pure protein with high amount of branched chain amino acids, especially leucine, that has been shown to be the most powerful booster of muscle mass.
*Caan BJ, Cespedes Feliciano EM, Prado CM et al. Association of Muscle and Adiposity Measured by Computed Tomography with Survival in Patients With Nonmetastatic Breast Cancer. JAMA Oncol 2018 Apr 5.
Peter Acs, MD, PhD – Medical Oncologist
Updated 7:00 PM ET, Thursday June 21, 2018
Cancer cells are very different from normal cells. These differences typically allow them to escape from under control and grow wildly. Not only do they grow uncontrollably, but they are aggressive and become invasive. Normal cells will mature into specialized cell types with specific functions, whereas cancer cells do the opposite: they become less and less specialized as they lose control and become more aggressive. The way we describe how much they differ from normal cells is called: grade. A cancer that is low grade resembles more to its normal counterpart than a high grade disease (for more information see blog: What is Tumor Grade?). In addition to cancer cells’ ability to multiply without control, they are also able to ignore signals that normally tell cells to stop dividing or to die. Cancer cells may produce and secrete growth factors and other hormones that will stimulate normal cells to act in favor of the cancer, like forming blood vessels. Another important feature of cancer cells is that they may change in ways that help them evade the immune system and become “invisible” to the body’s natural ability to remove abnormal cells. Luckily, some of these features we can use in the fight against cancer. The rapid growth of cancer cells is the reason why we can use chemotherapy that typically targets dividing cells and due to the hormone dependence of some cancers, we can use hormonal manipulation.
Peter Acs, MD, PhD – Medical Oncologist
Updated 11:20 AM ET, Monday May 28, 2018
According to several research studies cancer cells are metabolically different from normal cells. It was initially suggested over 60 years ago, by Noble laureate Otto Warburg, that the most prominent feature of tumor cell metabolism (the so-called Warburg effect) is the cancer cells’ strong dependence on sugar. Warburg proposed that cellular respiration must be irreversibly injured in cancer cells. Although the concept has been refined, aerobic glycolysis (use of sugar for energy) is still considered to be a hallmark of cancer. This opens up novel therapeutic strategies exploiting this potential Achilles heel of cancer. This so-called “ketogenic diet”, that is high in fat and low in carbohydrates, is considered to have beneficial effects by forcing cells to utilize fatty acids as their primary energy source. There is increasing amount of evidence implying that the ketogenic diet is an effective adjuvant cancer therapy. Most cancer cells lack the enzymes necessary to metabolize fat or protein and they depend on sugar. Sugar does not cause cancer, but if we restrict carbohydrates, the main source of glucose, we make it difficult for cancer cells to divide and they may starve to death. Recently, a group of scientists in Belgium found a direct link between sugar intake and cancer. Besides providing a clear warning to cancer patients to reduce sugar consumption, they identified a mechanism by which high sugar activates the aggressiveness of cancer. According to the lead author, there are some recent clinical trials which indicate that low sugar diet is beneficial for recovery of patients with cancer especially for those that undergo chemotherapy.
Peter Acs, MD, PhD – Medical Oncologist
Updated 7:00 PM ET, Mon March 26, 2018
