Heading Off Cancer Growth on the Cellular Level

Cancer cells are like all the cells in our body, in that they need certain basic building blocks – amino acids – in order to reproduce. There are 20 amino acids found in nature. The amino acid serine is often found in abundance in patients with certain types of breast cancer, lung cancer, and melanoma. The overproduction of this amino acid is often required for the rapid and unregulated growth characteristic of cancer.

Scientists at the Scripps Research Institute (TSRI) wondered if there was a way to take advantage of the relationship between cancer cell proliferation and serine. Amy GrayThey examined a large library of molecules -numbering 800,000 – to find an enzyme that inhibited serine production. After much research, the group found 408 contenders that could possibly work. This list was again narrowed down to a smaller set of seven, ending with one promising candidate. This molecule, 3-phosphoglycerate dehydrogenase (PHGDH), seemed to inhibit the first step in a cancer cell’s use of serine to reproduce itself.

Luke L. Lairson, assistant professor of chemistry at TSRI and principal investigator of cell biology at the California Institute for Biomedical Research remarked, “In addition to discovering an inhibitor that targets cancer metabolism, we also now have a tool to help answer interesting questions about serine metabolism.”

What does this mean for cancer patients in the future?

Discovering an enzyme that inhibits serine production means that a key process in cancer cell proliferation can be slowed down or even stopped.   Interfering with cancer cell metabolism could be a pathway to treatment. Potentially, adding the molecule PHGDH to cancer cells disturbs the basic need of cancer cells to divide and reproduce rapidly. Obviously this finding points to years of further research and drug development. But discovering this key relationship between serine over-production and a molecule that slows it down could be a model for new cancer treatments in the future.

 

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989988/

http://medicalxpress.com/news/2016-03-team-approach-curbing-cancer-cell.html

Shared Decision Making: Putting the Patient At The Center of Medical Care

“Tell me and I forget. Teach me and I remember. Involve me and I learn” – Benjamin Franklin

As gravity shifts away from health care providers as the sole keeper of medical information, the importance of sharing decisions, as opposed to clinicians making decisions on behalf of patients, has been increasingly recognized. Shared decision- making (SDM) is the conversation that happens between a patient and clinician to reach a healthcare choice together. Examples include decisions about surgery, medications, self-management, and screening and diagnostic tests. While the process commonly involves a clinician and patient, other members of the health care team or friends and family members may also be invited to participate. The clinician provides current, evidence-based information about treatment options, describing their risks and benefits; and the patient expresses his or her preferences and values. It is thus a communication approach that seeks to balance clinician expertise with patient preference.

Dr Mohsin Choudry describes shared decision-making as “a way of transforming the conversation between doctors and their patients so that the thoughts, concerns and especially the preferences of individuals are placed more equally alongside the clinician’s expertise, experience and skills.” Before physicians can really know what the proper treatment is for a patient, they must understand the particular needs of their patients. This approach recognises that clinicians and patients bring different but equally important forms of expertise to the decision-making process. The clinician’s expertise is based on knowledge of the disease, likely prognosis, tests and treatment; patients are experts on how a disease impacts their daily life, and their values and preferences. For some medical decisions, there is one clearly superior treatment path (for example, acute appendicitis necessitates surgery); but for many decisions there is more than one option in which attendant risks and benefits need to be assessed. In these cases the patient’s own priorities are important in reaching a treatment decision. Patients may hold a view that one treatment option fits their lifestyle better than another. This view may be different from the clinician’s.  Shared decision-making recognises a patient’s right to make these decisions, ensuring they are fully informed about the options they face. In its definition of shared decision-making, the Informed Medical Decisions Foundation ,  a non-profit that promotes evidence-based shared decision-making, describes the model as “honoring both the provider’s expert knowledge and the patient’s right to be fully informed of all care options and the potential harms and benefits. This process provides patients with the support they need to make the best individualized care decisions, while allowing providers to feel confident in the care they prescribe.”

By explicitly recognising a patient’s right to make decisions about their care, SDM can help ensure that care is truly patient-centered. In Making Shared Decision-Making A Reality: No Decision About Me Without Me, the authors recommend that shared decision-making in the context of a clinical consultation should:

  • support patients to articulate their understanding of their condition and of what they hope treatment (or self-management support) will achieve;
  • inform patients about their condition, about the treatment or support options available, and about the benefits and risks of each;
  • ensure that patients and clinicians arrive at a decision based on mutual understanding of this information;
  • record and implement the decision reached.Screen Shot 2015-10-29 at 4.43.27 AM

The most important attribute of patient-centered care is the active engagement of patients in decisions about their care.
“No decision about me, without me” can only be realised by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone. This has been endorsed by the Salzburg Statement on Shared Decision Making, authored by 58 representatives from 18 countries, which states that clinicians have an ethical imperative to share important decisions with patients. Clinical encounters should always include a two-way flow of information, allowing patients to ask questions, explain their circumstances and express their preferences. Clinicians must provide high quality information, tailored to the patient’s needs and they should allow patients sufficient time to consider their options. Similarly, in Shared Decision Making: A Model for Clinical Practice, the authors argue that achieving shared decision-making depends on building a good relationship in the clinical encounter so that patients, carers and clinicians work together, in equal partnership, to make decisions and agree a care plan. According to the Mayo Clinic Shared Decision Making National Resource Center, this model involves “developing a partnership based on empathy, exchanging information about the available options, deliberating while considering the potential consequences of each one, and making a decision by consensus.” Good communication can help to build rapport, respect and trust between patients and health professionals and it is especially important when decisions are being made about treatment.

Decision Aids

One of the most important requirements for decision-making is information. There are a number of tools available to support the process such as information sheets, DVDs, interactive websites, cates plots or options grids. Decision aids that are based on research evidence are designed to show information about different options and help patients reach an informed choice. The Mayo Clinic has been developing its own decision aids since 2005 and distributing them free of charge to other health care providers. For instance, Mayo’s Diabetes Medication Choice Decision Aid helps patients choose among the six medications commonly used to treat type-2 diabetes. Patients choose the issues that are most important to them, for example, blood sugar control or method of administration —and then work with their physicians to make comparisons among the drugs, based on the chosen criterion.

Discussing their options and preferences with health professionals enables patients to understand their choices better and feel they have made a decision which is right for them. Research studies have found that people who take part in decisions have better health outcomes (such as controlled high blood pressure) and are more likely to stick to a treatment plan, than those who do not.  A 2012 Cochrane review of 86 randomized trials found that patients who use decision aids improve their knowledge of their treatment options, have more accurate expectations of the potential benefits and risks, reach choices that accord with their values, and more actively participate in decision making. Instead of elective surgery, patients using decision aids opt for conservative options more often than those not using decision aids.

Barriers to Shared Decision-Making

Barriers to shared decision-making include poor communication, for example doctors using medical terminology which is incomprehensible to patients; lack of information and low health literacy levels. It is worth noting that not everyone wants to be involved in shared decision making with their doctors; and not every doctor wants to take the time. Some patients come from cultural backgrounds that lack a tradition of individuals making autonomous decisions. Some health professionals may think they are engaged in shared decision-making even when they are not.

Shared Decision-Making – An Ethical Imperative

With this proviso in mind, it is nevertheless clear that the tide is turning toward more active patient participation in decisions about health care. Research has shown that when patients know they have options for the best treatment, screening test, or diagnostic procedure, most of them will want to participate with their clinicians in making the choice. A systematic review of patient preferences for shared decision making indicates 71% of patients in studies after 2000 preferred sharing decision roles, compared to 50% of studies before 2000.  The most important reason for practising shared decision-making is that it is the right thing to do. The Salzburg Statement goes so far as to say it is an ethical imperative and failure to facilitate shared decision-making in the clinical encounter should be taken as evidence of poor quality care. Evidence for the benefits of shared decision-making is mounting. Providing patients with current, evidence-based information, relevant decision aids and giving them time to explore their options and work through their concerns, will help patients choose a treatment route which best suits their needs and preferences, and ultimately lead to better health outcomes for all.

ePatient 101 Course – Thoughts and Opinions

Having trouble navigating the healthcare industry? Overwhelmed with all the decisions you need to make? Buried in all of the information? If you answered yes to any of those questions, then the ePatient 101 Course could be just what you’re looking for. ePatient 101 was created by Intake.me to empower patients, caregivers, or patient advocates in all of their health matters. Being an “ePatient” means becoming empowered, educated, and engaged in your disease.

The course is laid out in four key components:

  • The course itself with tips and advice from experts and patients
  • Exercises to form your own ePatient toolkit
  • Technological tools to help organize your information on the intake.me platform
  • Patient chat community for support and troubleshooting

This format allows you to have the confidence and strength to be able to best advocate for yourself. This course has received rave reviews and you can read some of those below. Oh, and did I mention it’s free to all!

“What’s great about the virtual learning environment is that it allows you to combine video, audio and other multimedia content from multiple sources into one, easy-to-access place. Users get carefully curated content that feels fresh and that they can complete at their own pace.

“The benefit of the eLearning environment is that its able to meet you where you are… you can do it anytime, anywhere, and you don’t need to spend a lot of time or money to gain valuable tools and insight on topics that can greatly impact your health and the health of those around you.”
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Coming Soon!
“We are excited to partner with the Patient Empowerment Network because our missions align perfectly: we’re all passionate about empowering patients throughout their healthcare journey. With the folks at Patient Empowerment Network, we’re able to provide our first disease-specific courses, starting with CLL 101 (Chronic lymphocytic leukemia), and we look forward to co-creating more courses through our partnership in the future.” – Darla Brown, intake.me founder

[lead]Join us on Fri 3/18 1 PM ET/10 AM PT for an Empowered #patientchat on Twitter (@power4patients) with our friends @intakeme[/lead]
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Tweetchats: What Are They? How Can I Participate?

A Tweetchat or a Twitter Chat is a live event where a group of Twitter users come together to discuss a predetermined topic. To sift through all of the world’s tweets a designated hashtag (#) is used for each tweet contributed to the conversation. Each chat has a set start time, time limit, and a host that moderates.

The moderator asks questions to prompt responses from the participants and helps get the conversation going/moving along. Cues are usually used such as T1, T2, and T3 for topics or Q1, Q2, and Q3 for questions 1 through 3 to provide context and clarity to both questions and responses. To participate in the chat, all you have to do is include the hashtag in your tweet. Websites such as tchat.io can help by filtering out all other tweets so you can focus on discussing one topic and it automatically adds the hashtag to your tweets.

Now that you understand the basics, you might wonder why you should participate. This type of platform allows you connect with a larger group of patients or experts who understand and know first hand what you are going through. In addition to the social connection benefits, tweetchats can be educational. You can learn about different treatment options, clinical trials, etc. You can find a list of all the different healthcare tweetchats here.

References:

http://www.forbes.com/sites/stevecooper/2013/09/30/the-ultimate-guide-to-hosting-a-tweet-chat/#28c902e364b3

https://blog.bufferapp.com/twitter-chat-101

Lung Cancer Clinical Trial Awareness

Interview with Jennifer C. King, PhD, Director, Science and Research, Lung Cancer Alliance

 

Jennifer King

Jennifer King

The Lung Cancer Alliance (LCA) is the oldest and leading non-profit organization dedicated to saving lives and advancing research in the field of lung cancer. LCA advocates for research funding and reimbursement to patients for treatment for lung cancer. They offer nationwide educational campaigns to educate and support lung cancer patients, families and caregivers. LCA’s website contains a great deal of information about the biology of lung cancer, types of lung cancer, lung cancer research, lung cancer treatments including managing side effects, clinical trials for lung cancer and treatment centers.lung cancer helpline

LCA also offers a great deal of support for lung cancer patients and families. They have a HelpLine, a “Phone Buddy” program, a “Guides” program for families and caregivers and a “LCA Unite” mobile app for iPhone and Android:  that helps connect patients to one another, offers 24/7 support via live chat and offers local resources, including support groups and treatment centers.

Jennifer C. King, PhD is the Director of Science and Research for the Lung Cancer Alliance. Jennifer is responsible for leading scientific and research initiatives that improve the lives of lung cancer patients and those at risk for lung cancer

I talked with Jennifer about her role at LCA and what her perspectives were on clinical trial awareness and patient participation.

Jennifer explained that LCA is focused on patient support, information and referral services for lung cancer patients and caregivers. Located in Washington DC, they work with policy-makers to help promote awareness and increase survivorship for lung cancer. Jennifer is working on increasing the LCA research portfolio, building an in-house research staff, partnering with other organizations and the LCA Screening Centers of Excellence. Historically, LCA has not funded research directly but has worked extensively with other organizations to that end, including the development of the first ever Lung Cancer Research Program within the Department of Defense.

LCA currently offers patients information on finding clinical trials by working with the Lung Cancer Clinical Trial Matching Service powered by EmergingMed. This service allows patients to work with a Clinical Trial Navigator who creates a list of appropriate trials and then emails or mails them directly to the patient.

LCA also offers information on clinical trials and questions to ask when considering a clinical trial. They also have a brochure, Understanding Lung Cancer Clinical Trials that can be printed or downloaded.

I asked Jennifer how patients and patient advocacy groups can do their part to help promote awareness about clinical trials and she replied, “Talk about it! Everyone needs to be talking about it and helping to spread the word. Patients need to talk about trials with their medical team early in their treatment discussions. Providers need to offer trials to patients. Patients need to know what questions to ask. Doctors need to have the information to answer patient questions.”

Jennifer emphasized that caregivers are a critical audience. She added, “Caregivers are often the ones going online and doing the research.” These caregivers need support and information also. Patient advocacy groups need to include them actively in the discussion and offer them the information they need.

I asked Jennifer what information, support or program she thought was the most effective in succeeding in increasing patient awareness in trials. King answered that it was critical to have diverse programs and types of support and information in order to reach different groups of people. “There are many different demographics within the lung cancer patient population. It takes a lot of different programs to reach everyone. So many of our programs interplay with each other and having different ways to reach different audiences is really critical.”

If you are a lung cancer patient or the caregiver, family member or loved one of a lung cancer patient, please visit the Lung Cancer Alliance website. They have a great deal of useful and helpful information available. And please reach out to those in your lung cancer community who are not so tech-savvy and help them, so that they can take advantage of all the resources available. Less tech-savvy patients and caregivers are also encouraged to call LCA’s HelpLine where they can speak to someone directly who can answer questions and provide support.

Clinical Trials

 

 

Frederique’s Lung Cancer Story

This post was originally published on MyLifeLine.org. MyLifeLine.org Cancer Foundation connects MyLifeLine logocancer patients and caregivers to their community of family and friends for social and emotional support. We provide unique communication and stress reducing tools that allow patients and caregivers to share their journey and focus on healing. To learn more, visit MyLifeLine.org and check out the MyLifeLine.org blog.

Frederique was with her son when she started speaking strangely; she wasn’t finishing her sentences and her words weren’t making sense. She didn’t realize it was happening but her son was alarmed and contacted his dad and emergency medical services. The next day, Frederique learned she had tumors in her lung and brain. Her diagnosis was  Stage IV  lung cancer which had metastasized in the brain.

“We fear cancer so much as a society that when you find you have it, you just have to face it,” Frederique recalled upon learning her diagnosis. “The fear was gone.”

Two rounds of chemotherapy, two gamma knife sessions and three rounds of radiation were part of her treatment process over the two years she has been diagnosed , and she is now looking into a clinical trial.

Although she doesn’t know if she will ever be cancer-free, Frederique chooses to look at her cancer journey as an adventure, see the joy in her experiences and live a normal life. She does power yoga, exercises through hikes and walks, and even traveled to France, all while living with cancer.

“There is a disconnect with this diagnosis and how my body is doing. I really do live a normal life,” Frederique explained.

Frederique MLLEarly on, she created what she calls a “healing circle” to help her and her family throughout her cancer experience. She used MyLifeLine.org to share her story and coordinate volunteers.

“I think the technology is amazing. It helps me not only to receive support but also to give hope around me. Staying vibrant and positive throughout such a challenge seems to be inspiring for people. I am delighted that my experience can be of service that way,” she said.

Frederique’s advice for others facing a cancer diagnosis is to find a way to relieve the fear. “Cancer is such a fearful event, especially stage IV,” Frederique explained. “Find a way to ­not be scared of the disease. In my opinion, fear is detrimental to the healing process.” She keeps the fear at bay by meditating and connecting with the energy around her (yoga, chi gong, reiki), but she explained that anybody can find their own way of relieving the fear.

“I could live this journey in total fear and be in a dark mood all of the time, but then I would lose precious time. Yes, I have days where I am scared or sad but most of the time I prefer to live in joy,” Frederique said.

Thanks to the cancer, Frederique rediscovered herself, deepened her connections to others and shifted to a new understanding of the world. “I’ve never been happier, to be honest. I’m where I’m supposed to be now,” she reflected.