FOR PATIENTS, SURVIVORS AND FRIENDS
Some Esophageal Cancer Treatments May Be More Effective in Women
A study of 366 patients with locally advanced esophageal cancer found that treating these tumors with chemotherapy and radiation before
surgery is more effective in women than in men. In women, 58 percent responded well to the treatments; in men, 47 percent had a good
response. The American Cancer Society estimates that about 13,360 men and 3,580 women will be diagnosed with esophageal cancer and
12,720 men and 2,970 women will die from the disease in 2017.
LEARN MORE IN THE OC TOBER 2017 THE ANNALS OF THORACIC SURGERY.
Access easy-to-read guidelines on
cancer treatment on the new Patient Guides
for Cancer app developed by the National
Comprehensive Cancer Network. Being familiar
with the guidelines can help you prepare for
conversations with your health care team.
Find nearby restaurants that meet your
dietary needs on HealthyOut. Put in your
location and the app will find restaurants near
you that offer options such as vegetarian,
paleo, gluten-sensitive, low-fat and heart-healthy menu items.
Build a tumor—and then blast it with
treatments—when you play Tumour Takedown,
a game developed by the Centre of the Cell
team at Queen Mary University of London. As
you play, the app explains how cancer forms
and how different types of treatments work to
slow or stop a tumor’s growth.
Q: Were you surprised that so few studies
asked breast cancer patients about long-term peripheral neuropathy?
A: Yes. When that study was conducted, every woman with a breast
cancer tumor over 1 centimeter was
treated with chemotherapy. Now we
have genomic tests and fewer women
get chemotherapy. But we have a
whole generation of women who
received taxane-based chemotherapy
for breast cancer without any evaluation of its long-term toxicity.
Q: Why do you think this is?
A: Someone has to invest the time and
money to do the research, and people
have to pay attention to what patients
are complaining about.
Q: Are some patients more likely
than others to develop peripheral
A: Our paper and other studies suggest
being older, being overweight or having
diabetes are associated with an increased
risk for peripheral neuropathy. These
people are more likely to have injured
nerves, and then a second toxic injury
[the chemotherapy] makes it worse.
Q: Why are most doctors unaware that
this is a potential long-term problem?
A: In survivorship care, there is a
bit of a “don’t ask, don’t tell” mentality. When patients come back to
see their doctor and they are two to
three years out, the focus is on the
cancer. Questions like “Are you having
fatigue? Are you having cognitive
problems? Are you having trouble
walking or dressing yourself because
of your neuropathy?” are not being
asked. There is less attention to
Q: Why are taxane-based chemotherapy
drugs more likely to cause this problem?
A: We don’t know. Basic scientists are
trying to figure out why and are also
working hard to develop drugs that would
mitigate this toxicity. Vinca alkaloids
used in lymphoma and oxaliplatin used
for colon cancer also cause nerve damage.
Drugs used to treat myeloma also cause
neuropathy. Taxanes seem to be worse,
and it is dose-related. But across the
board, there are a number of drugs that
are going to leave patients with problems.
Q: Should patients ask their doctors if
they have chemotherapy options that
might not cause peripheral neuropathy?
A: It would be good for patients to
have information about whether the
recommended treatment can cause
this side effect. Again, though, the
problem is that most of the doctors we
interviewed, and they are really superb
clinicians, were unaware of long-term
neuropathy issues. Raising awareness
about this is really the first step.
Q: What happens to patients who
A: The big problem is that we don’t
have any good interventions. There
was a terrific article about a randomized trial in which iced gloves and
socks were put on patients to reduce
neuropathy. We will need to study
this more to see if it is beneficial.
Since neuropathy doesn’t go away and
impacts quality of life, it would be
important to start a dialogue on how
we should be tailoring chemotherapy
for patients. We need to prevent
neuropathy if we can by considering
pre-existing risk factors for persistent
neuropathy as we select treatments.