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Posted: 15 Sep 2012 05:54 PM PDT

Looking at holistic healing for breast cancer.

BREAST cancer continues to plague us relentlessly. Despite the enormous amount of research done, modern medicine still cannot save many of those unlucky enough to have this modern-day disease, although some progress has been made. Now those with Stage 1 breast cancer can hope for over 90% chance of cure.

I am a proponent of holistic integrative medicine (combining the best of modern, natural and complementary medicine) and I believe the prevention and management of breast cancer can benefit much from this approach.

So what are the natural means that can help mitigate the problem? Let us explore several simple but important modifiable factors that can help make a difference.

The importance of adequate sleep

A recent study on 412 post-menopausal women with breast cancer showed that lack of sleep (six hours or less a night) is linked to more aggressive breast cancers, and higher risk of recurrence (reported in August 2012 issue of Breast Cancer Research and Treatment).

The conclusion could also be read as having adequate sleep (more than six hours) gives better prognosis.

Although this study was on postmenopausal women, it still underlines the possible important role of having adequate sleep for all women with breast cancer, and extrapolating it further, the possible impact on other cancers as well as in cancer prevention. Let us hope that studies on other cancers are also carried out.

The authors concluded that: "Effective intervention to increase duration of sleep and improve quality of sleep could be an under-appreciated avenue for reducing the risk of developing more aggressive breast cancers and recurrence."

In 2010, based on experimental and epidemiological work, the International Agency for Research on Cancer (IARC) concluded that work schedules that disturbed the circadian rhythm probably increase cancer risk.

The circadian rhythm regulates our wakefulness and sleep, controls numerous biological functions, and is disturbed in people who work at night or who have irregular working hours.

One hypothesis is that exposure to light during the night eliminates the nocturnal melatonin surge, disturbing the functioning of the biological clock genes that control cell proliferation, and/or the immune system.

Researchers in France had examined the effect of night work on the health of 3,000 women in a major study carried out between 2005 and 2008. They found that the risk of developing breast cancer was 30% higher in women who had worked nights compared to women who had never worked nights.

This increased risk was particularly marked in women who had worked nights for over four years, or in women whose working rhythm was less than three nights per week, because this led to more frequent disturbances between night and day rhythms.

The risk was highest for women who had worked at night prior to their first pregnancies. This has serious implications to our nurses and other female night-shift workers.

We already know that insufficient sleep is a risk factor for obesity, diabetes and heart disease. Sleep is the time that the body rests, recovers and repairs from the day's hectic work.

Each day, the body has to ensure thousands of metabolic processes run efficiently in the many organ systems. Much work is required to keep the body alive and healthy. With our unhealthy lifestyles, unhealthy diet and unhealthy environment, the body has much more work to do to keep the system going.

For example, each cell is bombarded by over 10,000 free radicals daily. There are toxic by-products of normal metabolism, as well as external toxins (including cigarettes and prescription drugs) which the body has to cope with.

Then there are the invading viruses, bacteria and parasites which are everywhere. Imagine how busy our defence/immune system must be.

During sleep, when there is no physical activity and eating (which consume most energy and produce most toxic by-products), the body's organ systems are able to recuperate and prepare for the following day's work. The only organs that do not rest as much are the heart and lungs, which have to continue working, although at slightly slower rates.

For some of us who dream often, the brain also remains active during sleep!

Now imagine if you are chronically deprived of adequate sleep. Even if each night, your deficit is only 5% in terms of total replenishment and recuperation of your defence/immune system, over months and years, the cumulative deficit will take a toll on your body.

If you understand the power of compound interest, then you will understand my warning.

I had a first-hand experience of the importance of adequate sleep about 20 years ago. I had just recovered from a bad bout of "flu" and was asked to lead the Muslim night prayers (qiyamulail). I only slept for two hours and was up preparing for, and leading the prayers from 2am onwards till morning. By 6am, I had the full-blown "flu" again.

So the next time you catch the "flu", make sure you have adequate sleep, drink plenty of water, and gets lots of tneder loving care!

Maintaining normal weight

Another study reported that women who are overweight or obese with hormone receptor-positive breast cancer (which means two-thirds of all breast cancers) have a higher risk of recurrence even though they received the best available cancer treatment.

Obesity is associated with about a 30% higher risk of recurrence and a nearly 50% higher risk of death despite the best cancer treatments.

The authors suggest that the extra fat tissues cause hormonal changes and inflammation that induce the higher recurrence despite adequate medical therapy (reported in CANCER journal of the American Cancer Society). The study was done across the US and was supported by the US National Cancer Institute.

Those who are overweight/obese are already known to face a higher risk of hypertension, heart disease, stroke, diabetes, lung disease, joint disease, and many types of cancer (oesophagus, breast, uterine endometrium, colon, rectum, kidney, pancreas, thyroid, gallbladder, and possibly other cancer types).

However, in my opinion, the risk for cancer (and possibly other diseases too) is highly misunderstood and underestimated.

For breast cancer, the evidence now shows that obesity only increases the risk in post-menopausal women, but the offending weight gain could have started when the women were younger. Since cancer is a slow-growing phenomenon (by the time the earliest stage of cancer is detected, it has probably undergone many years of mutations and abnormal cell divisions), we only see the results of what began many years before.

Thus, although the added risk (due to obesity) is seen only after menopause (80% of breast cancers occur in post-menopausal women), the prevention should start much earlier.

Women should maintain normal weight when they are young to reduce breast cancer risk, and to improve their survival should they be unlucky to get breast cancer (the risk in Malaysia is one in 19).

Adequate exercise

A study of over 3,000 women (ages between 20-98) engaged in at least 10 hours of exercise per week showed they had about 30% lower risk of developing breast cancer. The benefit was strongest among postmenopausal women.

Other studies had shown that weight loss through regular exercise increases the benefit further, but weight gain can nullify some of the benefits obtained through exercise.

Physically active women who gain more than 5kg after menopause are still at a higher risk of developing breast cancer, though it is lower than for those who gain a similar amount of weight but do not exercise.

Obese women who exercise have about the same risk as normal weight women who do not exercise at all. The best is to maintain normal weight and do lots of exercise.

Healthy diet

Red meat and high-fat diets increase the risk of hypertension, heart disease, stroke, diabetes and several types of cancers (eg colon and prostate), but the link to breast cancer has not been proven.

Several studies have shown that breast cancer is less common in countries where the typical diet is low in total fat. However, studies in the US have not shown that eating a high fat diet increases the risk, nor eating less fat reduces it.

Although the benefits of a high fruits and veggies intake have not been established for breast cancer, studies have shown that such a diet is beneficial for cancers in general, and for many other health benefits.

Thus it is still recommended that we take a nutrient-dense diet rich in fruits and veggies, and limit red meats and unhealthy fats.

A recent study found that women with early stage breast cancer who were vitamin D deficient were more likely to have recurrence, and had a poorer prognosis.

Conference on holistic healing

If you want to know more about holistic healing for breast cancer, do attend this free conference to be held on Saturday, September 15, at the Sime Darby Convention Centre KL.

Speakers include medical doctors and other experts. It is organised by Cansurvive (www.cansurvive.org.my), a non-profit organisation that provides information, guidance and compassionate support for cancer patients, their families and friends.

For info and registration, please sms your name and email address to 012-3297566 or 0178812287; or email your name and mobile phone number to conference@cansurvive.org.my.

■ Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

A septic state

Posted: 15 Sep 2012 05:53 PM PDT

World Sepsis Day 2012 (Sept 13) is an attempt to raise awareness of this very deadly condition.

SEPSIS is one of the most common, least recognised illnesses in both the developed and developing world. Globally, 20 to 30 million patients are estimated to be affected every year.

In the developing world, sepsis accounts for 60 to 80% of lives lost per year in childhood, killing more than six million neonates and children yearly and is responsible for more than 100,000 cases of maternal sepsis.

Every hour, about 1,000 people die from sepsis worldwide.

Sepsis remains the primary cause of death from infection despite advances in modern medicine, including vaccines, antibiotics, and intensive care, with hospital mortality rates between 30 and 60%.

Sepsis, which is often misunderstood by the public as "blood-poisoning", is one of the leading causes of death around the world.

Sepsis occurs when the body's response to an infection injures its own tissues and organs. It may lead to shock, multiple organ failure, and death, especially if not recognised early and treated promptly. Between one third and one half of patients with sepsis die.

Sepsis causes more deaths than prostate cancer, breast cancer and HIV/AIDS combined. Experts in the field believe it is actually responsible for the majority of the mortality associated with HIV/AIDS, malaria, pneumonia and other infections acquired in the community, in healthcare settings, and by traumatic injury.

Patients surviving sepsis have double the risk of death in the following five years compared with hospitalised controls, and suffer from physical, cognitive and affective health problems.

The incidence of sepsis is increasing dramatically despite the advantages of modern medicine. The reasons for this are diverse, but include an ageing population, increasing use of high-risk interventions in all age groups, and the development of drug-resistant and more virulent varieties of infections.

Hospitalisations for sepsis have more than doubled over the last 10 years and have overtaken those for myocardial infarction in the US. International and national surveys indicate that 20 to 40% of septic patients who require treatment in the intensive care unit developed sepsis outside the hospital.

Delayed diagnosis

Sepsis is often diagnosed too late because the clinical symptoms and laboratory signs that are currently used for the diagnosis of sepsis, like raised temperature, increased pulse or breathing rate, or white blood cell count, are unspecific.

In children, the signs and symptoms may be subtle, and deterioration may be rapid. Sepsis is under-recognised and poorly understood due to confusion about its definition among patients and healthcare providers, inadequate diagnostic tools, inconsistent application of standardised clinical guidelines to treat sepsis, and lack of documentation of sepsis as a cause of death on death certificates.

Despite the fact that a patient with sepsis is around five times more likely to die than a patient who has suffered a heart attack or stroke, the disease is still not recognised or afforded the same sense of urgency as these critical care conditions.

If a patient were to stumble into an emergency room clutching the chest and barely able to walk, he or she would be treated immediately. Yet symptoms of sepsis are less widely appreciated and therefore present a more deadly threat.

In the midst of a global, economic crisis that sees governments introducing spending cuts and harsh austerity measures, ignoring one of the most deadly diseases will lead to continued, huge and avoidable healthcare costs.

A medical emergency

If diagnosed and treated in the first hour following presentation, a patient has more than an 80% survival rate. After the sixth hour, the patient only has a 30% survival rate.

It is crucially important that the early symptoms of sepsis are recognised by both the public and the healthcare sector and treatment accessed, where possible, within the first hour – the "Golden Hour". If it is, then the risk of death from sepsis is halved.

The challenge is ensuring that the signs and symptoms of sepsis are recognised from the outset. These include rapid heart rate, difficulty in breathing, rapid breathing, low blood pressure, change in behaviour (confusion, drowsiness), fever or hypothermia and changes in skin colour, amongst others.

Similarly, the recognition of these warning signs should not only occur amongst in-hospital staff, but also amongst all healthcare professionals the patient may encounter beforehand, such as general practitioners, family doctors, community nurses and paramedics.

Rapid initiation of simple, timely interventions including antimicrobials, intravenous fluids and targeted treatment to restore the circulation can halve the risk of dying.

Patients with suspected sepsis should be referred immediately to an appropriate facility. Early sepsis treatment is cost effective and hospital and intensive care bed days can be reduced.

Awareness is the number one cure for sepsis

Raising recognition of the disease and increasing the number of patients treated in the "Golden Hour" is the single biggest attempt we can make to save lives.

The Global Sepsis Alliance (GSA) and its members that include the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), the World Federation of Intensive and Critical Care Societies (WFPICCS), the World Federation of Critical Care Nurses (WFCCN), the International Federation for Emergency Medicine (IFEM), the International Sepsis Forum (ISF) and the Sepsis Alliance (SA) have joined together to issue a call of action to bring the tragedy of sepsis mortality to the attention of health policymakers at a national, regional and global level.

In order to do this, they are asking everyone to support the first World Sepsis Day, which took place on September 13, 2012.

Treating sepsis in the "Golden Hour" is a real opportunity to reduce the drastic numbers of people who are still dying or are seriously affected by sepsis.

However, the key to treatment within this crucial time period comes through awareness. Only a global approach to tackling sepsis and reinforcing recognition at every level will drive the initiative to reduce the amount of deaths in every country.

n Adapted from 'Sepsis Factsheet and Saving Lives: Treating Sepsis in the Golden Hour' by World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM).

A target to aim for

Posted: 15 Sep 2012 05:51 PM PDT

Exploring the paradigm shift in the treatment of lung cancer.

WORLDWIDE, lung cancer is the most common and deadly form of cancer; it accounts for 1.6 million new cancer cases annually.

Approximately 1.38 million people die from lung cancer, and it is a gargantuan myth that it is a smokers-only disease, confined to men.

Evidence reveals that more and more non-smokers are included in this morbid statistic. And women are more susceptible to developing lung cancer.

In Malaysia, more than 80% of women who developed adenocarcinoma (the most common lung cancer subtype) are never smokers.

There are no conclusive indications why this is so, but it is strongly suspected that genetics and environment play a large role.

The current prevalence of lung cancer in Malaysia is around 18 per 100,000 of the population. With almost 3,000 new patients diagnosed each year, there is a possibility that lung cancer is still on the rise.

Screening for lung cancer

According to Datuk Dr Mohamed Ibrahim Abdul Wahid, consultant clinical oncologist and president of the Malaysian Oncological Society and the Asian & Pacific Federation of Organisation for Cancer Research and Control, cancer cells can progress rapidly, even in the early stages. As such, early diagnosis is the key to treatment.

"Right now, there are no proper methods to screen for lung cancer. There are blood tests which test for lung cancer tumour markers, but these are primarily used as a guide for patients who have cancer; after giving treatment, if the markers go down, doctors knows that the treatment is working. But if it goes up instead, doctors will know that something has gone wrong," remarked Dr Ibrahim.

"One of the biggest problems with tumour markers is that they can give a lot of false positives, and can lead to unnecessary stress and worry."

He added: "It's not just the false positives that these test kits can generate, there are also a lot of false negatives; that is why they should never be used as a screening tool."

Similarly, genetic screening or genetic profiling is not a viable method of screening for lung cancer. What it does is show whether you are at risk, but this does not mean that you will develop lung cancer.

Early detection

Catching lung cancer in the early stages means a higher chance for doctors to save the patient. The biggest problem with lung cancer is that the only way to detect it is with CT or PET scans. There are low dose CT scan alternatives, but as a screening tool, it is not acceptable as it also exposes the patient to radiation, and it's not cheap.

"One of the ways of diagnosing lung cancer is to look at the history of the patient and examine the patient. This should be followed by a CT scan and bronchoscopy. If the tumour is in a deeper part of the lung, then doctors may need to do a CT-guided bronchoscopy.

"It is not enough to check from the CT scan, as a biopsy is needed to confirm the type of tumour, and also to find if it is primary or secondary cancer. Lung cancer means it originates from the lungs, but if the cancer is from other parts of the body and has spread to the lungs, then the doctor planning treatment will need to take this into account," explained Dr Ibrahim.

Under the radar

Consultant oncologist Dr Kevin Hew noted that lung cancer has a tendency to stay hidden until the very last minute.

"For many patients, the lack of symptoms is often why they do not realise that they have lung cancer, and by the time symptoms start appearing, the cancer is already in its advanced stages.

"Lung cancer is basically divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC consists of several other types, of which adenocarcinoma has the highest number of patients compared to other NSCLC types," he added.

Dr Hew opined that part of the reason is because of the improved filters used by cigarette companies.

"Smokers need to inhale more deeply in order to get the same 'kick', and this deeper inhalation leads to carcinogens in cigarette smoke being introduced into the deeper parts of the lungs.

"Previously, most lung cancers presented in the upper airways, which trigger coughing or breathing difficulties in patients who then get treatment earlier (earlier diagnosis of lung cancer). But with adenocarcinoma, it is usually diagnosed late because it is 'silent' in the earlier stages of the cancer," he explained.

Treatment in stages

For the earlier stages of cancer, the treatment of choice is often surgery. This option is usually open for patients with Stage 1, Stage 2 and Stage 3A cancer. Patients are not given other targeted therapy drugs in case of cancer recurrence; there is a possibility that the cancer may become immune to the effects of the drug, thus rendering it useless for future use with the same patient.

Of course, it is not as straightforward as simple surgery. Depending on the size and location of the tumour, some patients may need to undergo a few cycles of chemotherapy prior to surgery.

But when it comes to late stage cancer, whatever treatment given is not so much to cure the cancer, but more towards controlling it. This typically means that the treatment given is to delay progression.

The issue in treatment is: should they get standard chemotherapy and then immediately get targeted therapy? Should they get targeted therapy with chemotherapy?

Compared to targeted therapy, chemotherapy usually works on a broader spectrum. Where targeted therapy only addresses specific molecules in cancer cells, chemotherapy has a much broader approach; while it can be effective, it does tend to cause unwanted side-effects.

Since chemotherapy is designed to stop or slow the growth of cancer cells, it frequently damages healthy cells. This often leads to side effects like nausea, vomiting, and hair loss.

These side effects are usually not permanent and your body can recover once the chemotherapy is stopped.

Because of the physically demanding aspect of chemotherapy, it cannot be given continuously over a long period of time. At best, it is given for around seven to eight cycles, as it will affect the patient's bone marrow (which takes a long time to recover).

Of course, this is not to say that standard chemotherapy is being phased out. Instead, it is also evolving with time. In the past, the use of a one-size-fits-all approach was the only available means to fight cancer. Sadly, this was highly inefficient, but many improvements have been made through the years.

Targeted therapy

Things are beginning to change for the better; targeted therapy is slowly changing the way cancers are treated. In lung cancer, it gives patients with advanced Stage 3B and Stage 4 NSCLC a chance of a better quality of life.

This methodology relies on new breakthroughs in the understanding of cell biology at the genetic and molecular level.

Cancer cells radically alter the signalling networks of normal cells that regulate cellular activities controlling cell division and survival. Targeted therapy represents a means to interrupt this signalling network.

It is becoming the choice for first-line treatment as it is highly effective and have minimal side effects.

This is crucial, especially for the treatment of advanced Stage 3B and Stage 4 NSCLC, where patients are often not capable of enduring the stress placed on their bodies by chemotherapy.

"The discovery of the EGFR mutation was of great import. When the class of oral drugs known as EGFR-TKI was used four years ago in EGFR mutation positive patients, the results were very encouraging," Dr Hew said.

"The advantage of using EGFR-TKIs is that it is effective, with manageable side effects. The patient can endure long term usage of the drug. This effectively converts lung cancer from a disease with a very short life span into a chronic illness where the patient lives with the disease for a longer period of time.

"For patients who develop lung cancer because of EGFR mutation, the effective method of treatment is the use of EGFR-TKIs to block or inhibit the signals used by the cancer cells; this deprives the cancer cells of their means of proliferation, thus causing it to die off. These drugs are mainly used for advanced stages of NSCLC (Stage 3B or Stage 4).

"It is important to note that in the advanced stages of lung cancer, any treatment options that are available are meant to manage or control the cancer, and not cure it," stressed Dr Hew.

Dr Ibrahim was quick to stress that targeted therapy is not recommended for use in the earlier stages of cancer. This is due to the possibility of the cancer recurring, and if this happens, there is the possibility that the cancer may develop immunity towards the drugs used against it during the earlier stage.

"Patients with EGFR mutation positive Stage 3B and Stage 4 NSCLC who are in the advanced and inoperable stages could have the choice of selecting targeted therapy as first-line treatment. Currently, this option is only available for patients who are EGFR mutation positive."

The beauty of this treatment is that it allows lung cancer patients to sustain a reasonably good quality of life throughout the time that they are receiving the drug as they do not need to suffer the rigours of chemotherapy.

"At this point, looking at averages, we have moved the survival rate from three months to around one year. This means that while there are patients who only survive a few months, there are also some who survive for a few years. It is currently still beyond the capability of modern medicine to cure. The best that can be done is to control the cancer or its symptoms and improve the quality of life for the patient," shared Dr Ibrahim.

Like many targeted therapies, EGFR-TKIs come at a price. But it is worth noting that this oral treatment brings hope to advanced NSCLC patients. Survival rates have improved, and equally important, the quality of life for patients has also improved.

Both Dr Ibrahim and Dr Hew noted that this is a fantastic development, and sees this as a delivery on the promise of targeted therapy and advanced medicine.

"Most patients with EGFR mutation who received EGFR-TKIs have had some benefit. It is effective in controlling the cancer from progression. By testing for EGFR mutation, doctors will be able to make a more informed treatment choice for the patients.

"Conversely, if a patient is EGFR mutation negative, then EGFR-TKIs are not likely to demonstrate any efficacy. This spares the patients from wasting time and resources for taking a drug that is not going to help them."

Kredit: www.thestar.com.my

Isnin, 17 September 2012

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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