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Through art, you can express your emotions about the cancer journey and connect with others who are touched by the illness. Share your art in CURE® magazine’s online gallery between Jan. 10 and Feb. 10 and it may be selected for inclusion in the magazine’s 2020 calendar. To participate in the calendar contest, submit a photo and description of your art to https://www.curetoday.com/gallery!
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Depression and Cancer
November 11, 2019
Beloved Jeopardy game show host, Alex Trebek, was diagnosed with pancreatic cancer earlier this year. Public personalities are usually very private about their health struggles, so it was surprising to learn of Trebek’s diagnosis. By divulging details about his treatment and the progression of his disease on television, viewers were invited to enter into his experience.
In an interview with Good Morning America’s Robin Roberts, Mr. Trebek talked candidly about his diagnosis and also revealed his struggle with feelings of depression. Speaking to Ms. Roberts, he stated “I’ve had kidney stones, I’ve had ruptured discs, so I’m used to dealing with pain, but what I’m not used to dealing with is the surges that come on suddenly of deep, deep sadness — and it brings tears to my eyes.”
During the interview, Trebek also spoke about his battle with disease-related depression as he discussed chemotherapy treatment and the effects he experienced. As he spoke with Ms. Roberts, he said, “Chemo affects people in different ways and people have to understand that and there’s nothing wrong with saying, hey, I’m really depressed today and I have no idea why. Why am I crying today?”
Depression is one of the most common side effects of cancer and may begin anytime during or after treatment. No one knows exactly why depression is so prevalent in the lives of those with cancer, but it is thought that feelings of deep sadness may stem from rapid changes brought about during or after a cancer diagnosis.
Feelings of sadness are normal and affect everyone to some degree. These feelings can occur at different times and for different reasons, but when feelings of sadness won’t go away, they may indicate the beginning stages of depression. Breastcancer.org states in one article that depression is more than just feeling down in the dumps or sad for a few days. Feelings of depression don't go away and can interfere with your everyday life. The site also ntoes that more than 20 million people in the United States deal with depression each year.
Cancer as a Social Disease
November 12, 2019
Maybe it's because I also lecture on cancer survivorship, and on sexual health after cancer, but I've come to realize that I am rarely treating only the one with cancer—I am also treating that patient's loved ones because I've come to understand that cancer is a social disease. It's part of what makes this profession so special. We not only meet people at their most vulnerable, we meet those important to her. And we get to know everyone. If we are fortunate, these relationships span years, and we get to really understand patients as people—sharing in their joys and celebrations and their sorrows. I've seen women with ovarian cancer attend their children's weddings and meet their first grandchild. I've seen young women with breast cancer marry and have families. I've treated women born around the same time as me, and I've met their kids, who are around the same age as my own. I've watched their kids grow, as I and my patients grow gray. I wish it happened often, but sadly, it doesn't. And to me, it's hard because when a patient dies, not only does that special relationship cease, so do the relationships that I've built with that patient's circle. I've said goodbye to many people after their loved ones have died, and it can almost feel like they've walked into another world—one where I no longer fit.
I wondered if this was something others also experienced, and whether my colleagues also found themselves thinking about the families and friends that came in to our lives because of one person's cancer, and left once that person had died. I decided to talk with Dr. Aditya Bardia about it. Aditya is a friend and colleague I met when I was at Massachusetts General Hospital. He is also an accomplished clinical researcher who serves as the Director of Precision Medicine at the MGH Center for Breast Cancer. His work focuses on integrating precision diagnostics and therapeutics, including the clinical application of circulating tumor cells and DNA as "liquid biopsy," to significantly improve the outcomes of men and women treated for, and living with, breast cancer. Recently, his work on the antibody drug conjugate (ADC), sacituzumab govitecan, was published in the New England Journal of Medicine. More than this, Aditya is also an incredibly kind clinician—thoughtful, deliberate, and empathic. His dual roles in drug development and early trials and as a busy clinician made him the perfect person to ask about this.
"For me, not seeing a patient's family or friends after they've died is tough," he stated. "Over the years, I establish a deep bond with the patient and their families. It's something forged through the times I've helped them cope at their most vulnerable, the times weve laughed and shared significant life events, and those times when we worked through cancer treatments not working. The patient and caregivers essentially become like a part of an extended family."
That made sense to me. I remember in my early days as an attending, I had met a young woman with an aggressive breast cancer. She had come in with her family. I got to know all of them pretty well—even learning that the kids were from a prior marriage. For a while we would see each other during 3-month checkups. They barely felt like medical visits because we would just tell stories about our lives and laugh. Then she developed metastatic disease. She restarted treatment and our visits became more somber. Despite our best efforts, she didn't respond to treatment and died a few months after her diagnosis. I still remember that her husband came back to see me a week after her funeral. He just needed to talk— he felt like a lifeline had been cut. He explained how the cancer center had been his only other family during that period and that he hadn't realized how much those visits meant to him. We talked for a while that day, even discussing starting a group for men whose wives had died of cancer. But life got busy and I didnt hear from him again, but that didnt mean I stopped thinking about him.
I had felt an obligation to take care of him, but I didnt know how to. I asked Aditya about it as well. "I do think we have an obligation as providers—and as extended family members-- to support the patients family after someone we cared for dies. Its such a difficult and challenging time. What that means might range from sending a sympathy support card, to making a phone call, to attending the funeral, or even making a personal visit. I have done all of these in one form or another and feel it not only helps the family members but it helps me as well. I think cancer centers can do more, especially since we know that families are as important as the person with cancer. Whether that is formal programs to support caregivers or after care programs after a loved one dies, these are needs that should be met. At the end of the day, it is about doing what we can to heal the patient, and that includes their families."
I agree as well, and we are starting to see those voices in programs. At Lifespan Cancer Institute we have formed Patient and Family Advisory Councils to help steer patient—centered care. Their input will become essential to identifying and meeting the needs of caregivers and spouses throughout the cancer trajectory. We just need to ensure that access continues for caregivers and families, even after the patient him- or herself has died.
What is the JUUL?
Medically reviewed by Andy Tan, MPH, PhD
August 7, 2019
JUUL is a brand of electronic cigarette, or e-cigarette, that enables users to inhale vapor infused with nicotine, flavorings, and other compounds. Introduced in 2015, JUULs work much as other e-cigarettes do, but because they’re small and sleek — resembling a USB flash drive — and come in a variety of flavors, critics have charged that they’ve been specifically targeted to young people.
Research by the Centers for Disease Control and Prevention shows them to be the most popular brand of e-cigarette on the market.
Because they deliver a hit of nicotine — an addictive drug that provides a pleasurable sensation — without the cancer-causing tar found in tobacco products, JUULs (pronounced “jewels”) have been touted as a safer alternative to smoking. Juul Labs, Inc., the maker of JUULs, defines its mission as “improving the lives of one billion adult smokers by eliminating cigarettes.”
Research shows, however, that not only do most e-cigarette users continue to smoke traditional cigarettes, but that e-cigarette use can actually make young people more likely to take up smoking, according to the American Lung Association.
JUULs consist of a battery-powered vaporizer that connects to a cartridge, or “pod,” filled with liquid containing nicotine salts, flavorings, and other substances such as glycerol, propylene glycol, and benzoic acid. One of the features that distinguishes JUULs from similar products is their small size — easily enclosed in the palm of the hand — compact design, and relatively small plume of vapor. They initially gained notoriety for the high nicotine content in their pods, although other manufacturers have largely caught up, research by investigators at Stanford University has shown.