FOR PATIENTS, SURVIVORS AND FRIENDS
Avoid unneeded medical care with the new
app from Choosing Wisely, a program developed
by the American Board of Internal Medicine and
Consumer Reports. The app provides guidance
on medical tests and procedures and includes
questions to ask your doctor about cancer tests,
scans and treatments.
Help cancer researchers decode cancer
genomes by downloading DreamLab, an
app that allows you to lend your phone’s
processing power to the Garvan Institute of
Medical Research in Australia. Decide how
much power you want to contribute (check
with your provider about potential charges)
—then let your phone go to work.
Got stress? The Cancer Distress Coach app
was created by the Duke Cancer Institute to help
cancer patients and caregivers gain coping skills
and build a network of support. For the first
two months you use the app, you will be part of
a clinical trial that will help Duke researchers
evaluate how well Cancer Distress Coach works.
up when in the cancer center. It can also
include feeling angry, sad, almost empty,
or not being able to experience emotions
properly. Another symptom is avoiding
things that remind you of the trauma. In
cancer, this plays out with people avoiding having scans or not going to surveillance appointments that are necessary
for their care. PTSD is generally a mix
of symptoms from all of these areas.
Q: Did the study’s findings surprise you?
A: It was surprising to me that at six
months from their diagnosis so many
patients— 20 percent—met the criteria
Q: How can doctors better help
A: One symptom of PTSD is not being
able to recall details of important conversations. Doctors need to be aware of
that, because patients who have PTSD or
are at risk for PTSD may not be retaining information the way they should and
will need to have information about their
prognosis or their treatments repeated
multiple times. Oncologists also need to
do a better job of letting patients know
that treatments can be very difficult or
traumatic, and that if they are having a
hard time emotionally, their doctor can
help them manage that.
Q: Are some patients more at risk of
developing PTSD than others?
A: There are some well-understood
risk factors for PTSD in the cancer
setting. These include a previous
history of trauma or PTSD, having a
lower socioeconomic status or financial problems, and being a younger
cancer patient. Having less social
support, needing to be hospitalized
and having invasive treatments are
also correlated with more PTSD risk.
Q: Could some people who think they
have chemobrain actually have PTSD?
A: I think there is good biological
data that chemotherapy has an effect
on cognition. Animal studies show
chemotherapy agents affect the
growth of hippocampal brain cells,
which are involved in memory and
cognition, and I find it hard to believe
that it doesn’t happen in humans, too.
But it also is well-established that the
stress hormone cortisol, which is [not
regulated properly] in people with
PTSD, can separately affect the hippocampal brain cells. I think there is
a parallel mechanism that plays out.
Q: What should patients who think they
have PTSD do?
A: It is important for people to see
a good therapist. I see patients in
the cancer center. For some cancer
patients, this is a safe space to talk
about their emotions. For others,
the cancer center is not a safe space
because it is where they experienced
the trauma and they prefer to see a
therapist outside of the cancer center.
In terms of medication, there are
drugs that can be helpful, especially
if there is depression or anxiety
accompanying the PTSD.
Q: Can the trauma associated with
cancer affect family members, too?
A: When people have experienced
the difficult death of a loved one,
that stress can lead to PTSD. Family
members who accompany loved ones
to treatments are not likely to get
PTSD unless their loved one had a
near-death experience. PTSD is the
result of a significant emotional event
that occurs in which you were helpless when experiencing it.
Study Shows How Metastatic Tumor Microenvironment Changes
Using biopsies of high-grade serous ovarian cancer metastases, researchers were able to show how the cells and the proteins that
surround the tumor—its microenvironment—change as metastases develop and progress. In addition, the researchers identified 22
genes in the microenvironment associated with shorter overall survival in ovarian and 12 other cancers. According to the researchers,
their findings suggest it may be possible to develop drugs that treat cancer by altering the tumor microenvironment.
LEARN MORE IN THE MARCH 2018 CANCER DISCOVERY.