The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Cancer inspires a healthy diet Posted: Eating a well-thought out diet is playing a more central role in the overall care of cancer. CHEMOTHERAPY took its toll on Steven Satterfield. The co-owner and executive chef of Miller Union in Atlanta, US, lost his hair, his spunk, and his skin turned grayish-green. But Satterfield, a local and nationally acclaimed chef, battled back by turning to what he loves and understands well – the health benefits of eating nutrient-dense, fresh, and locally grown fruits and vegetables. Diagnosed in February 2012 with stage III testicular cancer, Satterfield underwent surgery and three rounds of chemotherapy – one week on, and two weeks off. By day six and seven during the on-weeks, Satterfield, known for boundless energy, was virtually bedridden. During chemotherapy, Satterfield gave in to weird cravings – like sudden urges for spicy Thai food. But he also satisfied his continuous yearning for carbs by filling up on vegetable-laden pasta dishes and a Gumbo z'Herbes, a green gumbo, traditionally served with greens – collards, kale, turnip greens and spinach. The way he nourished his body during his cancer journey helped him get through a tough time and paid off in health. Just one week after completing chemotherapy in June of last year, Satterfield returned to work at the restaurant full-time. During a recent afternoon, clad in jeans and plaid shirt, and sipping sparkling water, the chef said he believes his vegetable-and-fruit diet helped him bounce back fast. Satterfield is part of a growing number of cancer patients paying closer attention to nutrition every step of their journey. It's no longer considered "alternative" care, according to doctors. Instead, eating a well-thought out diet is playing a more central role in overall care. Shayna Komar, a registered dietitian who works at the Cancer Wellness centre at Piedmont Hospital in Atlanta, said healthy foods keep the body strong during treatment. Studies show people who are well nourished have shorter hospital stays after surgery compared to those who arrive at the hospital malnourished, she said. Healthy eating also helps wounds heal faster. On the flip side, patients with poor diets, including those who lose too much weight during chemotherapy sessions, may need to put their treatments on hold. Dr Omer Kucuk, professor of haematology-oncology and urology at the Winship Cancer Institute of Emory University, said patients today take more control over their health, researching information online and doing their homework. "They ask me what should I eat?" said Dr Kucuk. "And generally, the first thing I say is 'eat a healthy diet.' Eat eight to nine servings of fruits and vegetables a day, or at least five." But knowing the importance of healthy eating is just the first step. Dr Kucuk believes doctors need to help patients turn that knowledge into changes in diet. He said he makes good nutrition a priority, giving the subject just as much attention as discussing chemotherapy, radiation and treatment side effects. Dr Kucuk believes the vast majority of doctors still fall short in giving nutrition enough consideration when discussing care with patients. He said the anti-cancer properties of a diet full of fruits and vegetables can help prevent disease, as well as offer therapeutic benefits while a patient undergoes cancer treatments. He's seen first-hand how soy and tomatoes help minimise side effects from treatment. So, when a prostate cancer patient complains of losing muscle or feeling depressed, he doesn't immediately think of a pill to make them feel better. He encourages the patient to drink more soy milk – a protein and vitamin-rich drink. Of course, it's not always easy to eat a well-balanced diet during cancer treatments. It's common for cancer patients to experience side effects such as nausea or food might taste "off". Sometimes, food tastes too salty, and Komar suggests drizzling the food with agave nectar to help offset that. She encourages a colourful plate with lots of colour – reds and greens and yellows, like a rainbow. She also recommends lean protein such as chicken, fish, nuts, seeds and eggs. And she encourages five to six mini-meals throughout the day, which can be easier on the stomach. Satterfield has teamed up with Komar to teach a healthy cooking class revolving around fresh produce. The summer-time cooking demonstration included a zucchini dish with mint and garlic-chili oil, and a mix of purple and golden heirloom new potatoes with a lemon vinaigrette. Attendance for Satterfield's class quickly filled up, and healthy cooking classes at Piedmont's Cancer Wellness centre has doubled or even tripled in recent years, Komar said. Now 43, Satterfield has been cancer-free for one year. He is working on a cookbook he calls a "field guide to Southern produce", that will include a guide to shopping at farmer's markets and making the most of community-supported agriculture programmes, where buyers pre-pay to get boxes of whatever is fresh off local farms. Satterfield's obsession with the freshest seasonal produce continues to be the centrepiece at his restaurant, which has been featured in US magazines such Food & Wine. The menu includes a cucumber, tomato and blackberry salad along with a griddled pastured chicken with grilled squash, cherry tomatoes, feta cheese, mint and almonds. These days, he's on the go. He tries to either run before work or bike to work when the weather is nice. He continues to work on his book, and he's at his restaurant at least 10 hours a day. The chef often begins his day with a fruit smoothie made with banana, frozen organic berries and almond milk. From there, he fills up on generous helpings of in-season fruits and vegetables, and small amounts of protein, ie organic, humanely-raised chicken and fish. He snacks on peaches and almonds. But he still gives into cravings from time to time – whether it's fried food or ice cream. "I think it's all about balance," he said. "I try to make the most of my day by appreciating the amazing ingredients we get to work with... It's nice to be able to truly enjoy life and be thankful for what you have." – The Atlanta Journal-Constitution/McClatchy-Tribune Information Services |
| Posted: The presence of blood or red blood cells in the urine needs to be investigated promptly. THIS can be quite alarming if it occurs to you. The medical term for blood in the urine is haematuria. If you actually see blood in your urine, this is known as macroscopic haematuria. On the other hand, if it is detected by your doctor using laboratory tests, it is known as microscopic haematuria. This is usually carried out during a medical check-up, and the blood in the urine is incidentally picked up. Macroscopic or gross haematuria is more worrying as about one in five adults are subsequently found to have bladder cancer, as opposed to microscopic haematuria, where about one in 12 had bladder cancer. In fact, roughly 50% of those with visible blood in the urine will have an underlying cause identified. In microscopic haematuria, only about 10% will have an identifiable cause. However, not all red-coloured urine is caused by blood. There are certain medications, such as rifampicin for tuberculosis, as well as food like beetroot, which can cause reddish urine. Porphyria, a rare disease, can also make the urine appear dark red in colour. What are the causes? There are various causes of haematuria. It could be due to infection, stones, cancer, trauma, inflammation, or surgery affecting the urinary organs, which include the kidney, ureter (tube-like structure connecting the kidney and bladder), bladder and urethra (passage from the bladder to the external environment). Besides that, certain diseases like leukaemia, as well as medications like warfarin, can cause spontaneous bleeding. In men, enlargement of the prostate (benign prostate hyperplasia) is a common cause of blood in the urine. Glomerulonephritis, a disorder affecting the kidneys, may also lead to blood appearing in the urine. Surprisingly, strenuous exercise like long-distance running, rowing, swimming, cycling, football and boxing, have also been documented to give rise to haematuria, but this usually resolves spontaneously with rest. In other cases, despite extensive investigation, no cause can be found. This is termed idiopathic. What needs to be done? The doctor will first assess to ensure that not too much blood has been lost. If there is significant blood loss, a blood transfusion may be needed and further procedures to stop the bleed may be required. Otherwise, the doctor will take a full history, and this includes asking about smoking habits, exposure to industrial chemicals and any current medications. If there is burning pain around the penis or vagina when passing urine, it could be infection. Pain elsewhere in the abdomen or back could be due to stones. Painless gross haematuria is usually a sinister sign as it could be due to a tumour. Next would be a physical examination, which includes examination of the abdomen, the vagina for women, and rectum to assess the prostate in men. Following that, further investigations will be ordered, and this includes: 1. Urine – urine will be analysed under the microscope to confirm red blood cells, as well as to look for infection and cancer cells (urine cytology). For microscopic haematuria to be significant, there must be persistent detection of three or more red blood cells per high-power field in two out of three urine specimens examined under the microscope. Further tests will be needed only if there is persistent significant haematuria. 2. Blood – a blood test (haemoglobin) will be done to ensure that not too much blood has been lost, as well as to confirm that there are no problems with the clotting of blood (coagulation profile and platelets level). 3. Imaging – an ultrasound, and if necessary, a computerised tomography (CT) scan or intravenous urogram (IVU) will be done to obtain images of the urinary tract/organs to look for stones, tumours or other abnormalities. 4. Flexible cystoscope – this is a soft, tube-like instrument, which has a camera at one end. It is inserted through the urethra into the bladder to enable the doctor to have a look at the bladder. It is done under local anaesthesia, where gels containing medication (lignocaine) are inserted into the urethra to numb the area. It is a quick procedure, usually taking less than 10 minutes. If all these tests are normal and microscopic haematuria still persists, a renal biopsy may be needed if there is also protein detected in the urine and the function of the kidney is impaired. In this procedure, a small piece of kidney tissue is removed via a needle, guided by ultrasound or CT scan, to be examined under the microscope. This is to detect diseases of the kidney. How is it treated? This would depend on the cause. If there is gross blood in the urine, a catheter may be inserted into the bladder to irrigate the bladder and wash out the blood and clots. Approximately 80% of haematuria resolves by itself. If the bleeding persists, a cystoscopy may be done under anaesthesia to remove blood clots and "burn" (diathermise) the areas in the bladder that are bleeding. If it is due to the prostate, a resection of the prostate may need to be done. Likewise, if it is tumour in the bladder, resection of the tumour needs to be done. If it is due to infection, a course of antibiotics will usually solve the problem. Medications that may affect blood-clotting need to be stopped, and if there is a medical disorder affecting the clotting of blood, this will need to be treated with blood products (like platelets and fresh frozen plasma). If it is due to a tumour or injury to the kidney, removal of the kidney (nephrectomy) or angioembolisation (occluding the blood vessel, which is bleeding, with substances such as coils) may be required. Any blood in the urine which is visible to the naked eye needs to be investigated. Persistent, significant microscopic haematuria (as defined earlier on) should be investigated as well. The main worry is an underlying cancer. A urologist is the specialist who will be the best person to consult with regarding this matter. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article. |
| Posted: An oral targeted therapy proven to extend overall survival in patients with advanced colorectal cancer is now available in Malaysia. IT has been estimated that one in 33 Malaysians is at risk of developing colorectal cancer, making it the second most common form of cancer affecting Malaysians today. Colorectal cancer is the world's third-most common cancer, with an estimated 1.23 million people diagnosed in 2008. The global incidence is found to be higher in men by 1.4 times compared to women. Colorectal cancer occurs when small growths known as polyps turn cancerous. These small growths come from the cells lining the colon and rectum. Polyps begin as benign (non-cancerous) growths, and may gradually enlarge and develop into cancer over a prolonged period of time. It is difficult to identify which polyps would eventually become cancerous; hence it is recommended that polyps should be removed immediately when they are detected. For most individuals, colorectal cancer begins in the inner lining of the colon or rectum and progresses into a tumour over several years. Colorectal cancer often has no symptoms in the early stages; the severity of the cancer is measured by the stage of the disease and the spread of the cancer to other parts of the body. About 50-60% of colorectal cancer patients will develop metastases, the process of cancerous cells spreading to distant tissues. Once colorectal cancer spreads to other parts of the body, the patient's survival rate dramatically declines. When colorectal cancer is at the metastatic stage, the prognosis is very poor, with an estimated survival rate of less than 10%. Treatment for metastatic colorectal cancer varies, from surgery, chemotherapy, radiotherapy and other alternative targeted therapies. The particular choice of treatment chosen for metastatic colorectal cancer differs from patient to patient, depending on factors such as the size, location, and number of metastatic tumours; the patient's age, etc. "The majority of colon cancer patients discover the disease only in its later stages, when the five-year survival rate is less than 10%," said consultant clinical oncologist Datuk Dr Mohamed Ibrahim Wahid. "Treatment options for advanced colorectal cancer patients with metastatic disease are limited, especially after standard approaches have been exhausted. "A treatment option such as regorafenib (Stivarga) will surely be welcome, as it can give patients more precious time to spend with their loved ones, with the added advantage of it being oral, unlike the intravenous administration of other available therapies." Stivarga or regorafenib is an oral multikinase inhibitor, which acts on multiple pathways involved in cancer progression, and is the first single agent of its kind to demonstrate significant survival benefit in patients with metastatic colorectal cancer. As an oral monotherapy agent, regorafenib offers improved convenience for patients by eliminating the need for, and cost associated with, IV infusion therapies. The drug inhibits a number of protein kinases (enzymes which act to transfer chemical signals) involved in cancer progression. With a different mode of action and multiple targets of inhibition, the drug may provide an important treatment advancement for those patients with metastatic colorectal cancer who have no further approved options. The approval of the drug in Malaysia brings new hope to advanced colorectal cancer patients who have previously been treated with standard therapies. Regorafenib is the first oral targeted therapy that has been proven to extend survival, provide tumour control and keep the cancer from progressing. The approval of the drug is based on positive results from a global landmark Phase III CORRECT (COloRectal cancer treated with Regorafenib or plaCebo after failure of standard Therapy) trial, which involved 760 patients, 15% of whom were from Asia. The CORRECT study demonstrated that treatment with regorafenib, plus best supportive care, significantly improved both overall survival and progression-free survival, compared to placebo in patients with metastatic colorectal cancer whose disease had progressed after approved standard therapies. "The CORRECT study has demonstrated regorafenib's ability to improve tumour control and the survival of a large number of patients who previously had no treatment options. "This is an important advance in the treatment of advanced colorectal cancer," said Australian medical oncologist Dr Peter Gibbs. According to Thomas Steffen, managing director for Bayer Co (Malaysia) Sdn Bhd, "The approval of Stivarga recognises the potential benefits it brings to colorectal cancer patients who need more treatment options and time with their loved ones." He added, "Today's announcement is an important milestone for Bayer in our ongoing effort to develop novel therapies for unmet medical needs, particularly in the area of oncology." The drug was approved for use by the Malaysian Health Ministry in June, for the treatment of advanced colorectal cancer with metastatic disease. It has also been approved for this indication in several other countries, including the US, Canada, Japan and Singapore. References: 1. Grothey A, Van Custem E, Sobrero A, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicenter, randomized, placebo-controlled, phase 3 trial. Lancet 2013:381:303-312. 2. Ministry of Health Malaysia. National Cancer Registry Report: Malaysia Cancer Statistics-Data and Figure 2007. 3. Ministry of Health. Health Facts 2012 4. WHO GLOBOCON 2008. Colorectal cancer on the rise. New Straits Times, 30/09/12. Avalable at http://www.nst.com.my/nation/general/colorectal-cancer-on-the-rise-1.150298. Accessed 25/08/13 5. GLOBOCAN 2008 Fast Stats. Malaysia. Available at http://globocan.iarc.fr/factsheet.asp. Accessed 23/09/13 6. Wilkes, G.M. Metastatic Colorectal Cancer: Management Challenges and Opportunities. Oncology Nurse Edition, 2011. 25(7). Available at www.cancernetwork.com/colorectal-cancer/content/article/10165/1902212?pageNumber=1. Retrieved 29/07/13 7. http://www.medicinenet.com/colon_cancer/article.htm 8. American Cancer Society. Colorectal Cancer. 2010 Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf Accessed Jan 2013 9. http://www.cancer.gov/cancertopics/pdq/treatment/colon/HealthProfessional/page9#Section_369. Retrieved 14 August 2013 |
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