Shorter radiation is better

Sometimes editing takes out all the important information. This took  a lot of digging to find out what the hell it was talking about.

I first came across this article which says higher dose shorter radiation is better that the traditional radiation given to breast cancer patients. This makes sense because the damage from radiation is cumulative meaning that it gets worse and worse after each treatment. Other side effects such as fatigue are also lessened from the shorter course of treatment.

Well that is nice to know but how much shorter is it? I couldn't tell but did go find the referenced article, Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported Outcomes in a Large Multicenter Cohort, on JAMA Oncology. You got that?

How's this instead?

"Randomized trials have established that hypofractionated regimens of radiotherapy to the whole breast can provide long-term disease control that is equivalent to the excellent outcomes of more protracted conventional fractionation schedules in selected patients undergoing lumpectomy for breast cancer. Hypofractionation might also result in lower rates of late toxic effects than conventional fractionation. Although the American Society for Radiation Oncology has issued consensus guidelines to identify patients in whom hypofractionation is appropriate and endorsed consideration of hypofractionation in its Choosing Wisely campaign, uptake of hypofractionated regimens has demonstrated considerable variability worldwide and has been relatively slow within the United States."

Okay, what if I tell you this:

"Traditionally, women undergoing lumpectomy for breast cancer were treated with 5-6 weeks of daily radiation after surgery. "Hypofractionated" regimens are shorter courses of radiation, in which a slightly larger dose of radiation is given per day, allowing radiation to be delivered in a shorter period of time, most commonly in 3-4 weeks."

Finally, I get to the truth and find that 2 weeks less, slightly higher dose radiation offers fewer side effects? Why couldn't they say that first?

I have a bad case of 'Icouldntcareless'

I have a new ailment and it is  a close relative to 'Apathy' and 'Screwitall', and its called 'Icoudntcareless'. Its symptoms border on fatigue and ennui and require lots of time with your feet up to recover from recent stresses.

Sometimes you get too much thrown at you to deal with and the best treatment is to ignore it all. That' s what I'm doing. The other day I blogged about blocking out life. I am continuing in that mode and taking things a step further.

My schedule for the next few days has lots of things on it but I am not going to do anything I don't have to. I finally caught up on some much needed sleep, I think. But I might need to get another 10 hours tonight (seriously). The knee doctor gave me a fancy new brace and wants me to try PT and then come back in 6-8 weeks. The good thing is I can do PT at my gym instead of going to a separate place with lots more appointments.

The fibromyalgia support group was okay, not great. It has potential but there is one woman in it who wants to be the center of attention and dominates all conversations. The other woman who attended did not speak unless directly addressed. A nice combination. I will try it a few more times and then decide but am leaning against it. I need to get over my current 'Icouldntcareless' before making any decisions.

Maybe I am turning into a cynic or something.

A Cancer Diagnosis is More Important

Today's Ask Amy column upset me and made me think. You can read it below or here as published in the Boston Globe.

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Q. My sister (in her early 40s) was diagnosed with cancer. They caught it early, so it’s still at an early stage. We in the family all found out about this a few weeks ago.

I have messaged her and her husband a few times since then to chitchat, but never asked them about the cancer.
I feel like if they want to talk about it or need my help, I will be there. It is understood by everyone in my family that we will help each other if asked.
My sister and I haven’t spoken for a week, and I found out from my other sister that my brother-in-law called me rude and not supportive because I didn’t offer to help.
I have two young children, and the younger one was constantly sick. I also work full time and am dealing with a dying father-in-law.
I don’t have the memory capacity or time to follow up on them all the time. Was I being rude? Hurt

A. You were being rude, and you ARE being rude.

Even if yours is a family that considers illness to be a private matter — your sister has cancer. It is incomprehensible that you would learn of this, initiate contact with your sister to “chitchat,” and then never mention it.
Your sister and her husband also did not bring it up, but they knew you had an awareness of their situation and were no doubt expecting you to at least inquire.
You say you can’t be supportive because your sister’s cancer is trumped by other family issues. This is even more baffling, because if you have experience dealing with illness, surely you realize that the comfort doesn’t come from offers of “help,” but from having people at least acknowledge the challenging situation illness presents.
In the course of your messaging, what does it cost you to type: “Oh, Sis, I heard about your cancer. Thank goodness it was caught early. I’m thinking of you. . .”?
All of your reasons for not doing this come off as justifications after the fact. You should apologize and offer some sisterly support.

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I agree with Amy here. If someone is diagnosed with cancer, it should be recognized by family members. I have had too many people run for the hills at the word cancer. I never wanted to be buried in phone calls about my medical issues but it is nice if family members recognize it.

Obviously the letter writer is a bit self centered and she has a bit too much going on in her life to think of anyone else. But seriously? Your sister had cancer and you blew it off.

This is just too perky for me

My gag reflex is kicking in. This woman has metastatic breast cancer and is successfully being treated by Ibrance according to her perky oncologist. It isn't news, it feels like an Ibrance commercial.

 

I have the urge to barf. I'm sorry but its true. And yes its that really expensive new treatment.

And my inner marketing person says this kind of news article is really a type of advertising. I am not saying that anyone in the video did anything wrong. But marketing comes in all forms. And Pfizer is making big bucks on Ibrance.

You can read that article here. Okay, my inner witchy cynic is showing this morning. Maybe I need a nap or something.

Blocking out life

Sometimes I feel I need to ignore life and the rest of the world and focus on my ever growing list of ailments. Its not that I want to, its that sometimes my body insists on being the focus. Like the past few days. And probably the next few days.

I have many other things I would like to do but I have to focus on my health. I will fit in other 'stuff' around my health crap. And it really is crap right now.

I have a feeling I did some damage to my knee, how much I will learn more on Wednesday. It hasn't been contributing basic things like flexibility and stability to the rest of my body for the past few days. This means I can't go to the gym. Actually I don't dare go to the gym. But I really want to go. I think exercise will help me deal with stress. And I have blood work this week as well as two other doctor appointments. Right now I am getting blood work done every two weeks.

I also broke down and succumbed to pressure from my new therapist to try the new fibromyalgia support group. I did point out that I do have multiple ailments and fibromyalgia is one of the less challenging ones to me at this point. I mean its there. It causes me pain, fatigue, and, my favorite, insomnia. It isn't progressively causing damage to my body or lurking in the background, threatening to recur like some of the others.

I was told that the fibromyalgia group should help provide 'coping' strategies. I agreed to go once to see if these 'coping' strategies are really covered and potentially show any benefit for me. But my cynical self doubts that.

I am just stressed, anxious, in pain, tired, and a few other things so life isn't as much fun right now. Call me a cranky cynic right now.

MAINT REQ'D

Yesterday I went to a mini college reunion about 1 1/2 hours away. My husband was supposed to come with me but woke up not feeling well so I went by myself. I do not usually travel much these days by myself because of my health issues and the need for naps and all that.

I drove our 1.5 year old Corolla and took the scenic route because there was a 10 mile back up on the interstate. I ended up driving home, leaving around 830pm. It took about 1/2 an hour to get back to the highway. Once I get on the highway, the road was finally empty and it should have been a quick hour home. I hit the left lane as usual and was able to go a consistent 70 or so, also as usual.

Then this shows up on the dashboard:

I did not have a good feeling. I instantly tried to call my normally-helpful-former-mechanic-turned-mechanical-engineer brother who had the nerve not to answer his phone. Where was he ignoring my calls when I needed him? Then I tried to call, and woke up, my husband for advice. I pulled off at the next exit and there was a Dunkin Donuts right there that was still open. I pulled into their parking lot as I spoke with my husband. He was telling me to check the oil, look at the temperature, and otherwise open the hood and look at the stuff there like I knew what was going on. (I knew it would be dirty and full of strange things.)

My question was why would a nicely running car which was relatively new all of a sudden have a little warning light? Especially 60 miles from home, by myself, at night? My first thought was not to open the hood but instead to open the owners manual. There I find the answer to my stress - basically it was due for service. As it didn't say MAINT REQ'D SOON I was off the hook.

My husband was happy to go back to sleep. I was happy to get back on the road. But I really could have skipped that little episode. I have enough stress in my life without car issues too. Thanks.

Another 'Upside' to Breast Cancer Treatment

Its not enough that breast cancer treatment consists of slashing, poisoning and burning. These leave a physical and emotional toll that can include additional ailments, including new cancers. One of them is nice rare one without much available research and a high mortality rate - angiosarcoma. Please read and enjoy the following:

"Physicians have long noticed that breast cancer patients who have had surgery or radiation therapy have an heightened risk of developing angiosarcoma, a rare type of cancer that originates in the lining of the blood vessels.

Now, researchers at Loyola University Health System in Maywood, Ill., have focused in on a finding that could be a possible precursor to angiosarcoma. With further research this finding could lead to more definitive markers that could predict those who are most likely to develop the disease. Angiosarcoma is a malignant, rapidly growing, highly invasive type of cancer that has a high mortality rate.

In a case study published in the Journal of the American Academy of Dermatology, researchers at Loyola identified what at first appeared to be only a tiny bruise on the right breast of a 63-year-old woman. Four years prior the woman had had a lumpectomy in the breast and radiation therapy for cancer. She had also had chemotherapy and hormone therapy. 

“Normally, when you see a benign-appearing vascular lesion, you probably would pass it up,” said Dr. Joshua Mandrell, a dermatologist who co-authored the report. “But given her history, we biopsied it and it did show that it was an atypical vascular lesion.”

Atypical vascular lesions are abnormal vascular growths that are thought to form in response to trauma, such as that caused by surgery and radiation therapy, according to the study. The lesions are so rare that few medical professionals are aware of their existence. There are also no well defined prognosis factors or treatment guidelines for them.

“Atypical vascular lesions are not completely benign blood vessel growths and are not angiosarcoma. They are right in the middle. They are atypical enough that we suggest in our study that they warrant treatment,” Mandrell said. “The thought is that they could potentially become angiosarcomas.”

How lovely is that? When I searched on cancer.org's website for angiosarcoma, this is what I found:

"This form of cancer starts in cells that line blood vessels or lymph vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication of previous radiation treatments. This is an extremely rare complication of breast radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur in the arms of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see the section "How is breast cancer treated?") These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas. See Sarcoma: Adult Soft Tissue Cancer."

That was all that was listed. And when I went to the link for sarcoma, it was not even mentioned. Nice.

I can't wait. I had radiation and have lymphedema. I'll just add this to my list of crap to look out for. And if its related to cancer, it is all crap.