Yoga Improves Chronic Fatigue in Breast Cancer Survivors

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YOGA IMPROVES CHRONIC FATIGUE IN BREAST CANCER SURVIVORS

Breast cancer remains the most common serious cancer to afflict women, and the second most common cause of cancer-related death in women (second only to lung cancer).  In 2012, most patients with breast cancer will undergo surgery, chemotherapy, radiation therapy, and hormonal therapy as standard treatments for their cancer, and as many as 1 in 3 breast cancer survivors will go on to experience chronic fatigue after completing their extensive therapy for this common disease.

Many interventions have been proposed for chronic post-treatment fatigue in breast cancer survivors, but none of these interventions have been subjected to the scrutiny of high quality, prospective, randomized, controlled clinical research studies to validate their effectiveness.  However, a newly published prospective, randomized, controlled clinical research study suggests that lyengar yoga may be an effective intervention for chronic fatigue following breast cancer treatment.  This new study appears in the current issue of the journal Cancer.

Thirty-one female breast cancer survivors with chronic fatigue were randomized to one of two groups in this study.  Sixteen of these women were randomized to a yoga instruction group for 12 weeks (the “experimental” group), while the other 15 women were randomized to 12 weeks of health education classes (the “control” group).  At the end of the 12-week study period, and again 3 months later, the two groups of women were assessed for changes in fatigue levels (compared to baseline, at the time of their entry into the study); as well as changes in vigor, depressive symptoms, sleep quality, perceived stress levels, and physical performance status.

Following analysis of the data, the authors of this study concluded that 12 weeks of yoga training significantly improved the severity of chronic post-treatment fatigue in breast cancer survivors, when compared to 12 weeks of health education instruction.  (Importantly, this improvement in fatigue levels was maintained for at least 3 months after completion of 12 weeks of yoga classes.)  Additionally, the yoga group experienced significant improvements in physical vigor, when compared to the health education group of women.  At the same time, both groups of women reported improvements in depressive symptoms and perceived stress at the end of this clinical study, while no significant improvements in sleep quality or physical performance status were noted in either group of study participants.

This study is the first prospective, randomized, controlled clinical research study to show that a 12-week intervention with yoga training leads to significant and sustained improvements in chronic fatigue and physical vigor among women who have completed multidisciplinary therapy for breast cancer.  Based upon the findings of this small but important clinical study, breast cancer survivors who are struggling with post-treatment chronic fatigue might want to check out a yoga studio in their neighborhood!


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 




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Axillary Lymph Node Dissection for Breast Cancer May Not Be Necessary

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“A critical weekly review of important new research findings for health-conscious readers”



AXILLARY LYMPH NODE DISSECTION FOR BREAST CANCER MAY NOT BE NECESSARY

The management of breast cancer has undergone many advances since the radical mastectomy that first came into popularity in the United States in the late 19th century.  At that time, even early cancers of the breast were managed by surgically removing the entire breast, the underlying chest wall muscles, and all of the lymph nodes under the armpit (axilla).  It wasn’t until the 1970s that surgeons began to abandon radical mastectomy, in favor of the less disfiguring modified radical mastectomy, based upon emerging research data at the time.  By the 1980s, additional research data had confirmed that women who underwent lumpectomy plus radiation therapy experienced equivalent survival when compared to women who underwent mastectomy.  In the late 1990s, another major paradigm shift in the surgical management of breast cancer occurred with the rapid adoption of sentinel lymph node (SLN) biopsy, which had previously also revolutionized the surgical management of melanoma.  Following the successful application of SLN biopsy to breast cancer, the 60 to 70 percent of women with breast cancer who have normal axillary SLNs (i.e., no evidence of spread of breast cancer cells to the lymph nodes in the axilla) could now avoid undergoing complete axillary lymph node dissection (ALND), wherein about two-thirds of the armpit lymph nodes are surgically removed.  As the risk of arm swelling (lymphedema), numbness, and other long-term side effects associated with ALND are only one-tenth as common following SLN biopsy, the majority of women undergoing breast cancer surgery over the past decade have been able to avoid many of the chronic complications and side effects associated with the more radical surgical approaches used in the past.  However, between one-fourth and one-third of women diagnosed with breast cancer will still be found to have tumor cell in their SLNs, and most of these women have routinely been advised to undergo ALND to remove additional armpit lymph nodes.

Now, a newly published clinical research study from the American College of Surgeons Oncology Group has, once again, dramatically shifted the paradigm of breast cancer management.  This clinical research study, which I was privileged to participate in when I was a Surgical Oncology Fellow at the John Wayne Cancer Institute, enrolled 891 women newly diagnosed with breast cancer, and with early metastatic cancer involving one or more of their axillary SLNs.  These women were evenly randomized into two groups.  One group underwent the standard therapy of ALND, while the other half of these patient volunteers were observed, without further surgery, following SLN biopsy.  The results of this pioneering breast cancer research study appear in the current issue of the Journal of the American Medical Association.

After an average duration of patient follow-up of more than 6 years, this pivotal clinical study has confirmed what many of us oncologists have long suspected.  In women with evidence of microscopic spread of breast cancer to one or more axillary SLNs, there was no difference in overall survival whether or not they went on to undergo ALND, as long as they underwent otherwise standard therapy for lymph-node-positive breast cancer (including lumpectomy, radiation therapy to the breast, and chemotherapy).

I cannot overstate the potential impact of the findings of this important clinical study.  However, while some have heralded the findings of this study as breaking important new ground, in fact that ground was broken by the very same pioneering prospective clinical research study (the National Surgical Adjuvant Breast and Bowel Project’s NSABP B-04 study, which began in 1971) that originally led surgeons to abandon radical mastectomy.  Within this older large prospective clinical study was an important subgroup of 586 women with palpably enlarged axillary lymph nodes (and which actually indicated a more advanced stage of lymph node involvement than the women who participated in the more modern American College of Surgeons Oncology Group study).  Like all of the women who participated in the NSABP B-04 study, these 586 breast cancer patients with enlarged armpit lymph nodes were randomized to undergo radical mastectomy with radical ALND versus mastectomy alone (and no lymph node surgery at all ) combined with radiation therapy.  After an average follow-up of 25 years, there wasabsolutely no difference in survival between the women who underwent radical lymph node surgery combined with radical mastectomy versus those women who underwent simple mastectomy alone (and no lymph node surgery) followed by radiation therapy.

Thus, the newly reported findings of this pivotal American College of Surgeons Oncology Group clinical study only further validates the findings of the nearly 40 year-old NSABP B-04 study, and should put to rest, once and for all, the decades-old debate about the role of surgery in the management of the axillary lymph nodes in patients with newly diagnosed breast cancer.  At a minimum, surgeons should now advise their breast cancer patients that there is now 40 years worth of high-level clinical research data showing that the surgical removal of most or all of the armpit lymph nodes (ALND) does not improve survival in women who otherwise undergo standard breast cancer treatment that includes lumpectomy (or mastectomy), chemotherapy, and radiation therapy.

I predict that the findings of these two landmark breast cancer surgical studies will, together, once again revolutionize the surgical management of breast cancer, and will further reduce the adverse impact of surgery on hundreds of thousands of women around the world each year.  Indeed, this latest revolution in the management of breast cancer has already started at major cancer centers in the United States, where women are already being advised that the finding of early spread of breast cancer cells to their axillary SLNs no longer mandates “completion ALND,” as long as these patients undergo standard chemotherapy and radiation therapy following lumpectomy and SLN biopsy.


For a complete discussion of evidence-based approaches to cancer risk and cancer prevention, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!


On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity




Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author




For a different perspective on Dr. Wascher, please click on the following YouTube link: Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.







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Obesity, Diabetes and Breast Cancer Recurrence Risk

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


OBESITY, DIABETES AND BREAST CANCER RECURRENCE RISK

 

Obesity and diabetes have both been linked to an increased risk of certain types of cancer (including breast cancer), as discussed in detail in my new book, A Cancer Prevention Guide for the Human Race.  (The single greatest risk factor for adult-onset diabetes is obesity.)

Not only have obesity and diabetes been strongly linked to an increased risk of developing cancer, but these two chronic illnesses, which have become epidemic in our modern culture, also appear to increase the risk of breast cancer recurrence, and death due to recurrent breast cancer.  Two newly published clinical research studies, which appear in the current issue of the Journal of Clinical Oncology, reveal just how strongly obesity and diabetes impact the incidence of breast cancer recurrence, and death due to breast cancer, among women who have previously been diagnosed with this common form of cancer.

In the first study, the impact of obesity on breast cancer recurrence, and the risk of death due to breast cancer, was assessed among 18,967 women with a previous diagnosis of breast cancer in Denmark.   Using body mass index (BMI) scores, which indicate whether a person is obese or not, the findings of this study were quite concerning.  (A BMI between 18.5 and 24.9 indicates a healthy weight, while a BMI of 25 to 29.9 indicates that a person is overweight, and a BMI of 30 or more indicates obesity.)

In this very large public health study with long-term follow-up, female breast cancer survivors with a BMI of 30 or more (when compared to women with a BMI below 25) were, stage-for-stage, 46 percent more likely to be diagnosed with metastatic breast cancer within 10 years of their original diagnosis, and 38 percent more likely to die of metastatic breast cancer within 30 years of their original breast cancer diagnosis.

In the second study, 604 women with a prior diagnosis of breast cancer were evaluated with a blood test that measures insulin secretion levels (serum C-peptide).  Fasting C-peptide levels were measured in these breast cancer survivors 3 years after their initial cancer diagnosis, and this group of research volunteers was then followed for about a decade.  In this study, a 1nanogram per milliliter (ng/mL) increase in serum C-peptide levels, even among women without diabetes, was associated with a 31 percent increase in the risk of death from any cause over the duration of this study.  This same miniscule 1 ng/mL increase in C-peptide blood levels was also associated with a 35 percent increase in the risk of death specifically due to breast cancer.  (The increased risk of death associated with rising C-peptide levels among women with diabetes was even higher.)  Thus, this study is one of the first ever to show that rising levels of insulin secretion in women either with or without diabetes is associated with a significantly higher risk of death due to recurrent breast cancer.

Taken together, the findings of these two very important clinical studies add to the findings of previous studies that have linked both obesity and diabetes with an increased likelihood of breast cancer recurrence and death due to recurrent breast cancer.  These, and other, clinical studies also continue to show that the chemotherapy and hormonal therapy that is routinely given following the diagnosis of breast cancer appears to be less effective in obese women and in diabetic women, when compared to women without either of these chronic illnesses.  The findings of these studies also mirror cancer risk and cancer prevention studies that have linked breast cancer risk with both obesity and diabetes.

If you have a history of breast cancer, and you are significantly overweight, then it is essential that you discuss a prudent weight loss program with your doctor, including a healthy diet and a regimen of regular aerobic exercise (as discussed in my new book).  Likewise, if you have diabetes, both weight loss interventions and tight control of your diabetes are essential for reducing your risk of breast cancer recurrence, and your overall risk of premature death from cancer and other serious illnesses associated with diabetes.

 

For a complete discussion of the role of obesity, diabetes, diet, and exercise in cancer prevention, and other important evidence-based approaches to cancer prevention, order your copy of my new book, A Cancer Prevention Guide for the Human Race, now!  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

 

GIVE  THE  GIFT  OF  HEALTH  THIS  HOLIDAY  SEASON!  For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores! 

 

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.comTop 100 Bestseller’s List” for Kindle e-books!  On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people had logged onto Weekly Health Update in 2010!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.




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Chemotherapy for Breast Cancer & Memory Loss

 

Welcome to Weekly Health Update



“A critical weekly review of important new research findings for health-conscious readers” 

CHEMOTHERAPY FOR BREAST CANCER & MEMORY LOSS

“Chemo Brain” is a term often used by breast cancer patients to describe the decreased memory, and other cognitive dysfunctions, associated with chemotherapy for this common form of cancer.  However, there has been very little prospective, objective clinical research into this phenomenon.  Furthermore, what little research that has been done in this area, to date, has primarily focused upon subjective self-assessments, by breast cancer patients, of their own level of cognitive function following chemotherapy.  Moreover, until recently, the complaints of breast cancer patients regarding their self-perceived memory loss following chemotherapy were often dismissed by many physicians. 

Now, a newly published prospective clinical research study from the M.D. Anderson Cancer Center suggests that physicians may have vastly underestimated the frequency, severity, and duration of cognitive dysfunction following standard breast cancer chemotherapy.  This clinical study, which appears in the current issue of the journal Cancer, prospectively enrolled 42 women with newly diagnosed breast cancer.  All of these women then underwent standardized neuropsychological evaluation before, during, and after chemotherapy.  Importantly, this study not only tested these breast cancer patients in the early period after they completed their chemotherapy, but also one year after their chemotherapy had ended.  The findings from this small study strikingly illustrate just how common, and how enduring, memory loss and other forms of cognitive dysfunction are following chemotherapy for breast cancer.

Prior to beginning chemotherapy, 21 percent of these patients had some detectable degree of cognitive dysfunction.  By the end of their chemotherapy treatments, a whopping 65 percent of these 42 patients displayed measurable declines in memory function, organizational ability, and cognitive processing speed.  One year later, 61 percent of these women continued to display measurable declines in cognitive function.  Worse yet, among this group of women with persistent cognitive dysfunction one year after completion of their chemotherapy, 71 percent continued to display progressively worsening of cognitive function when compared to their level of function immediately after finishing chemotherapy.  Finally, the remaining 29 percent of this group of women with long-term evidence of cognitive dysfunction actually displayed a delayed-onset of cognitive decline when they were tested one year after chemotherapy (i.e., when compared to the results of their neuropsychological testing immediately after chemotherapy).

Although this clinical research study enrolled a small cohort of patients, its prospective nature, and its use of validated neuropsychological tests, make it a powerful research study for its size.  The findings of this study also fit well with previous laboratory research studies that have shown both acute and delayed changes in the actual structure of the brains of animals treated, proportionately, with the same chemotherapy drugs commonly used to treat breast cancer in humans.  Whether or not the significant declines in cognitive function that were observed, one year after chemotherapy in the 61 percent of women who participated in this study, will eventually stabilize, improve or worsen is unknown at this time.  Longer follow-up of these 42 breast cancer patients will have to be performed to answer this important question.  However, this small prospective study clearly indicates that the majority of women who undergo standard chemotherapy for breast cancer appear to experience significant and prolonged declines in their level of cognitive function, including memory loss, decreased organizational skills, and a general slowing of their cognitive processing speed, and that these adverse changes persist for at least a year after completion of chemotherapy.

The findings of this study should spur additional research into the precise cause(s) of this chemotherapy-associated impairment in cognitive function, as well as strategies to reduce the severity and duration of these adverse health effects following chemotherapy for breast cancer.  Meanwhile, it is important for me to stress that chemotherapy unquestionably extends survival, and saves lives, among women who are appropriately advised to undergo such treatment for breast cancer.  In my opinion, no patient should read this column, and then go on to refuse chemotherapy that has been appropriately recommended because of the findings of this clinical research study.  

 

To learn more about the prevention, screening, diagnosis and treatment of breast cancer, look for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in the summer of this year.



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would like to take this opportunity to thank the nearly 120,000 new and returning readers who visited our premier global health information website last month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. 


In view of the extreme devastation and human misery brought about in Haiti and Chile by the recent earthquakes, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in those countries to assist the injured, the ill, and the homeless.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti 


 

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