Tag Archive for: Massachusetts General Hospital

Equity in Cancer Care: Accessing Lifestyle Medicine for All

 

How can ethical disparities toward equity in cancer survivorship be addressed? Expert Dr. Amy Comander from Massachusetts General Hospital discusses lifestyle medicine and methods and resources to help close disparities in optimal cancer care. 

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Enhancing Cancer Survivorship Through Wellness Strategies

Enhancing Cancer Survivorship Through Wellness Strategies

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

What Are the Benefits of Early Integration of Lifestyle Medicine?

What Are the Benefits of Early Integration of Lifestyle Medicine?

Transcript:

Lisa Hatfield:

Addressing ethical disparities in cancer survivorship is crucial for ensuring everyone has access to the best care possible. Is this a much bigger task than experts may realize? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program. 

Dr. Comander, how do you approach the ethical disparities in cancer survivorship interventions, and what steps do you advocate to ensure equitable access to lifestyle medicine and resources?

Dr. Amy Comander:

This is such an excellent question and definitely at top of mind all the time when I’m thinking about our lifestyle medicine program and the various offerings that we have at our hospital. How can we reach out to other communities that may not have access to these tools? For example, two summers ago, I collaborated with a colleague at a hospital in downtown Boston where they don’t really have as many survivorship resources for their patient population.

And we did some group education programs about lifestyle medicine. And I’ll just give you an example. We talked about exercise. And one of the women raised her hand and said, “In my neighborhood, I don’t feel comfortable going outside for a walk. So how am I really going to get this exercise in? I just can’t really walk around in my neighborhood.”

And I think learning from our patients about these concerns is so important. I will say that in that group setting, another woman raised her hand and said, “Well, I went to Target and bought these stretchy bands, and I learned how to do some of these exercises at home. And that’s what I do.” And that led to a really great conversation amongst the participants in the room.

So I do think this is really important. We do need to think about how can we bring these tools from lifestyle medicine to help all individuals facing a diagnosis of cancer. And certainly through the American College of Lifestyle Medicine, the organization that I’m very involved in, we do have an initiative called HEAL. Which is really focused on healthcare disparities and bringing tools from lifestyle medicine to all communities. So thank you so much for asking this important question.

Lisa Hatfield:

Okay. Thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

What Are the Benefits of Early Integration of Lifestyle Medicine?

 

How can early integration of lifestyle medicine benefit cancer patients? Expert Dr. Amy Comander from Massachusetts General Hospital discusses the importance of lifestyle medicine and the pillars of lifestyle medicine as part of oncology care. 

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Related Resources:

Enhancing Cancer Survivorship Through Wellness Strategies

Enhancing Cancer Survivorship Through Wellness Strategies

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

Equity in Cancer Care: Accessing Lifestyle Medicine for All

Equity in Cancer Care: Accessing Lifestyle Medicine for All

Transcript:

Lisa Hatfield:

The future of lifestyle medicine and cancer care holds immense potential for innovation. How do we harness the benefits early on? I’m connecting with a Harvard researcher to understand more in this Patient Empowerment Network RESTORE program. 

Dr. Comander, from your perspective, what are the key benefits of incorporating lifestyle medicine early in the cancer treatment continuum rather than solely focusing on survivorship?

Dr. Amy Comander:

When we think about individuals with cancer, who already have a very serious diagnosis, we want to help empower those individuals to improve their health to the best they can to help reduce the risk of other chronic diseases, reduce the risk of cancer recurrence potentially, and just feel better. And that’s why I think lifestyle medicine is so important and that these tools should be accessible to all individuals after a diagnosis of cancer.

And again, just focusing on learning about the importance of physical activity and nutrition and stress management and adequate sleep and social connection and avoiding risky substances. Again, it sounds overwhelming, and I usually tell my patients, just pick one thing that you want to start working on to help improve your health. And I will tell you, it’s amazing the progress that my patients have made. And I would say, like I think of a patient I saw the other day, she would tell you, “There’s no way in the world I ever wanted to get breast cancer.” It was definitely like the last thing on her list that she wanted.

But she did acknowledge that since her diagnosis, it was almost like a wake-up call, or a teachable moment that this is the time that I am now going to take charge of my health and be the healthiest version of me that I can. And I think that was really inspiring. And so I love hearing those kinds of comments from my patients once they have really taken charge and trying to improve their health behaviors in this way.

Lisa Hatfield:

Thank you. Dr. Comander, looking ahead, what innovations or advancements in lifestyle medicine do you anticipate will have the greatest impact on cancer care and survivorship in the coming years?

Dr. Amy Comander:

Well, there are so many exciting research studies coming out that are really further demonstrating the benefits of these lifestyle interventions for patients with a diagnosis of cancer. For example, so much research coming out about, learning about the mechanisms of the gut microbiome, or why exercise is important, or the benefits of achieving a healthy body weight, which I know is very complicated by the way.

So I think the more data we have to really demonstrate the importance of these tools for lifestyle medicine will really result in more widespread adoption of cancer centers around the United States, and around the world, really emphasizing that these tools need to be a key component of oncology care. And that’s certainly something I’m trying to do and I’m so grateful to partner with you to help spread this important message so we know that patients can learn about these tools to help take charge of their health as they’re going through cancer treatment.

Lisa Hatfield:

Well, you heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

Enhancing Cancer Survivorship Through Wellness Strategies

 

How can wellness strategies enhance cancer survivorship? Expert Dr. Amy Comander from Massachusetts General Hospital discusses research on lifestyle interventions, the role of nutrition and gut microbiome, and other impactful lifestyle interventions.

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Related Resources:

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

What Are the Benefits of Early Integration of Lifestyle Medicine?

What Are the Benefits of Early Integration of Lifestyle Medicine?

Equity in Cancer Care: Accessing Lifestyle Medicine for All

Equity in Cancer Care: Accessing Lifestyle Medicine for All

Transcript:

Lisa Hatfield:

Ensuring overall well-being during cancer treatment involves more than just addressing the illness itself. Wellness strategies are key but do they really optimize the health of cancer survivors? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program. 

Dr. Comander, what are some of the most effective wellness strategies you recommend for patients to incorporate during cancer treatment to support their overall well-being?

Dr. Amy Comander:

I’m really excited that over the past few years, we’re seeing more and more research demonstrating the important role of lifestyle interventions in terms of improving our patient’s outcome after a diagnosis of cancer. So I’m a breast oncologist, and of course there’s so much data in the field of breast oncology. But now we’re seeing so much data emerging with regard to individuals with prostate cancer or gynecologic cancers or hematologic malignancies, such as multiple myeloma.

So this is really an exciting time to be paying close attention to this field. So when you say, what are some of the most effective strategies? I have to pick my favorite exercise. This field of exercise oncology is really exciting, demonstrating that individuals who are able to engage in physical activity after their cancer diagnosis have improved quality of life, reduce cancer-related fatigue, and in many cases, improve outcome. And a lot of this data has certainly come from the field of breast oncology, but again, we are seeing it more and more in other types of cancers as well.

In terms of other wellness strategies, we’ve talked a lot about the important role of nutrition and thinking about some of those key concepts of what we consider an overall healthy diet, a predominance of fruits and vegetables, whole grains, limiting red meat, avoiding processed foods, and avoiding sugar-sweetened beverages and alcohol. So that’s kind of all part of a healthy diet that we think about. But more and more research is also demonstrating that diet can actually potentially influence outcome as well. And there’s a lot of research trying to understand the mechanisms of this.

And I think if your listeners are wondering, what’s an area where I can read more about this? I feel like the gut microbiome, learning more about that is really interesting. We know, for example, in the field of multiple myeloma research, or in the field of looking at immunotherapy drugs, a healthy, diverse gut microbiome, meaning those bacteria in your GI tract have favorable characteristics, and they’re very diverse and healthy, that is a reflection of the diet. Lots of healthy fruits and vegetables, fiber in the diet helps result in a healthy, diverse gut microbiome, which in emerging studies is showing that that is associated with an improved microbiome responsiveness to certain drugs, particularly immunotherapy.

So this is an exciting time. The field is evolving, but I’m excited to learn more as we continue to see these studies emerge.

Lisa Hatfield:

Thank you. And, Dr. Comander, how do you see lifestyle medicine contributing to optimizing the health of cancer survivors, particularly in reducing late effects and improving overall well-being?

Dr. Amy Comander:

I’m a strong advocate that these tools from lifestyle medicine should be a part of every patient’s cancer treatment. And these are pretty basic things when we think about, again, physical activity, encouraging exercise, following a healthy diet pattern, getting adequate sleep, social connection. Actually, let’s talk about social connection. I feel like that’s one when I first started getting to this field, I’m kind of like, yeah, social connection, that’s important.

But I will tell you, as I’ve been doing this more and more and working with groups of patients, focusing on providing education about diet and exercise and stress management and sleep and all of these important things that we’ve been talking about, I’ve noticed that the support from other individuals who truly get it, if you bring a group of patients together who are all going through treatment for multiple myeloma, or prostate cancer, or breast cancer, or whatever it may be, that support piece, talking to another person who’s facing the same challenge, who might want to meet you at the YMCA and go to that exercise class, or might be willing to text you, “Hey, how are you doing with those salads you’re trying to have for lunch each day?”

That accountability and support is such an important component of health. And I think we really learned during the pandemic how much social connection and support is so integral to our health. So I think in the field of oncology, the work this organization does, and so many others, that building up community, social connection, social support is really something we should invest more in to help improve the health and well-being of our patients with cancer.

Lisa Hatfield:

Absolutely agree. Thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

What are key lifestyle changes for cancer patients navigating treatment and recovery? Expert Dr. Amy Comander from Massachusetts General Hospital discusses survivorship care and lifestyle advice for coping with and recovering from cancer treatment.

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Related Resources:

Enhancing Cancer Survivorship Through Wellness Strategies

Enhancing Cancer Survivorship Through Wellness Strategies

What Are the Benefits of Early Integration of Lifestyle Medicine?

What Are the Benefits of Early Integration of Lifestyle Medicine?

Equity in Cancer Care: Accessing Lifestyle Medicine for All

Equity in Cancer Care: Accessing Lifestyle Medicine for All 

Transcript:

Lisa Hatfield:

Navigating cancer treatment and recovery is a journey that involves more than just medical care. Lifestyle choices play a crucial role too. What other factors play into this journey? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program. 

Dr. Comander, many patients often worry about secondary cancers. What are key lifestyle changes you recommend for cancer prevention and how do they differ from those recommended for post-cure recovery or post-treatment?

Dr. Amy Comander:

So an important component of survivorship care, which is care of the patient, certainly at the time of diagnosis and beyond, but in that follow-up phase as well, is screening for secondary cancers. And what does that mean? That means that a cancer that can develop after the diagnosis of the primary cancer. And I know to some listening that sounds really overwhelming. “You mean I can get another cancer?” But unfortunately, none of us have a crystal ball and that could happen. So what are strategies we can use to help reduce the risk of someone getting another cancer down the road?

And I first want to emphasize the importance of cancer screening. So we now have all these great tools for cancer screening; mammograms, breast MRIs, colonoscopy, pap smears, pelvic exams, CT scans for detection of lung cancer, and now we’re having these blood tests that we’re going to learn more about in the next few years. So there’s many screening strategies that are super important. So I encourage my patients to talk to their doctor. About making sure they’re staying on top of that because, my patients who I see in breast cancer follow-up, I always ask them, “When was your last colonoscopy?” And nobody loves getting that, but it’s really important as our major strategy for screening for colon cancer.

In terms of lifestyle recommendations, we know that a lot of the lifestyle recommendations that we talk about with our patients to improve their health during the survivorship phase of their care are also associated with a reduced risk of getting another type of cancer. So we know that physical activity is very beneficial to reduce the risk of many cancers, including breast cancer, colon cancer, and others. We know that being at a healthy body weight is really important in terms of thinking about risk for a future cancer. Again, a healthy diet with a focus of lots of whole grains, fruits, and vegetables is also so important.

So I think all the lifestyle strategies that we’ve really emphasized for cancer survivorship are also really important to optimize health, to reduce the risk of a secondary cancer and other chronic diseases, which I do have to mention, such as heart disease, stroke, type 2 diabetes. All of these things can happen too, because they can happen to all of us here. So we need to think about how can we optimize our health to reduce the risk of all of these potential conditions.

Lisa Hatfield:

Thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

How Can I Maintain a Healthy Diet During Ongoing Cancer Treatment?

How can cancer patients maintain a healthy diet during and after cancer treatment? Expert Dr. Amy Comander from Massachusetts General Hospital discusses common side effects of cancer treatment and advice for boosting nutrition during and after cancer treatment.

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How Does Cancer Treatment Impact Nutrition?How Does Cancer Treatment Impact Nutrition?

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Transcript:

Lisa Hatfield:

As a patient living with cancer where there’s no cure and treatment is ongoing, I’m constantly navigating the challenges of maintaining my health during treatment and avoiding unwanted side effects. Nutrition is a big part of that, but it’s not the whole picture. I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program.

Dr. Comander, how can patients manage treatment side effects that affect their appetite or ability to eat? And what role does hydration play in supporting cancer treatment and recovery?

Dr. Amy Comander:

We know that many individuals going through cancer treatment really have a poor appetite, often don’t feel like eating, and this can be due to a multitude of factors. Maybe it’s due to nausea from the medication, or other side effects from the chemotherapy agents or other medications that a patient’s taking. So this can really be a challenge. And I encourage a patient to really talk to his or her doctor about these concerns if really poor appetite is a major problem because, yeah, actually sometimes there’s strategies we can think about, sometimes there’s medications that can be helpful to boost the appetite, or sometimes it’s really thinking about introducing certain foods that may perhaps be appealing, such as making a smoothie.

Sometimes maybe you weren’t a smoothie person before going through cancer treatment, but now that might be a great way to get in some calories. Obviously you can put a lot of healthy things into a smoothie. So this is one strategy that some of my patients employ. But I certainly encourage someone listening to this to kind of talk to their doctor about this, if it’s a real problem like not being able to eat.

In terms of hydration, we know that is so important. Many of our treatments get metabolized by the liver or cleared by the kidneys. So it’s really important to stay well hydrated, especially in the summer months, if it’s really hot outside. So I always encourage my patients to have a trusty water bottle by their side at all times.

There’s so many fun water bottles out there, so I’m like, “Get one that you like. If it has to be pink, that’s great, whatever it is,” but have a water bottle with you at all times. Certainly think about water, other drinks with electrolytes, some people like Gatorade, whatever that might be, but it’s really important to be drinking throughout the day to stay hydrated, to keep yourself healthy as you’re going through cancer treatment.

Lisa Hatfield:

Okay, thank you. Dr. Comander, what strategies do you recommend for cancer patients to maintain adequate nutrition when experiencing treatment side effects such as nausea or taste changes? And additionally, are there specific foods or supplements that can help alleviate these side effects?

Dr. Amy Comander:

Right, so many patients when they’re going through chemotherapy, or receiving other treatments for their cancer, really note nausea, changes in taste, and have a really tough time finding what they want to eat during this time. And I will say, obviously, sometimes it’s playing around with the diet to find what things work and what things don’t work. And often that’s the first thing we might try. But if nausea is the primary issue, I will say we now have such an amazing array of anti-nausea medications that we can use for our patients going through chemotherapy.

And these are really game changers in the field of oncology. I can just see it even over my career how some of the newer medications we have, such as olanzapine(Zyprexa), to use for nausea, are really beneficial. So I think if you’re going through chemo and having a real hard time with nausea and that’s preventing you from eating, talk to your doctor. “What other anti-nausea medication can I consider taking so I can get nutrition into my body?”

Taste changes, it really is something that can evolve often during active chemotherapy treatment. Patients may experience that. It tends to get much better when you’re done with some of these drugs, such as cisplatin, for example, that can cause a lot of changes in taste. So that’s usually something that’s hopefully more of a short-term thing and will get better with time. In terms of specific foods or supplements, I really very much advocate that my patients get nutrition from whole foods with a focus on fruits and vegetables and whole grains. I’m not a big supplement person.

In fact, organizations such as the American Institute of Cancer Research really counsel patients not to focus on supplements as a major way to get nutrition into their body. Of course, there are some instances where supplements are needed. For example, a patient with anemia could have deficiency in iron or vitamin B12. Those are supplements that may be necessary to help boost those red blood cells. Or one of my patients, for example, a diagnosis of breast cancer, an aromatase inhibitor, where she may be experiencing a decline in bone density, she may need a vitamin D supplement because she lives in New England and doesn’t get enough sun exposure, which is how we get vitamin D.

So vitamin D, iron, B12, things like that sometimes are necessary, but there are a lot of supplements out there that people are encouraged to buy and spend a lot of money on, and I really would encourage you to shy away from that. That would be my recommendation.

Lisa Hatfield:

Okay, thank you. And a quick question for those patients who are on the flip side of the decrease in appetite. Sometimes patients going through cancer treatment are on high dose steroids, and they have the increase in appetite and they have certain cravings. Do you have any suggestions or recommendations for those patients?

Dr. Amy Comander:

Yes, we know that we use steroids a lot in oncology to help our patients manage nausea or other side effects related to their treatment. And you’re absolutely right, being on steroids can sometimes really rev up the appetite, make it hard to sleep at night, cause a whole wide array of other side effects. So certainly with my patients who have this problem, sometimes I try to cut down the steroids a little bit, see if we can get away with that to kind of minimize those adverse side effects from the steroids themselves.

But if someone really is having cravings, usually the steroids are used around chemo for just a few days. So I usually encourage them like, again, if you’re craving carbs, try to focus on some healthy carbs, again, focus on whole grains, try to avoid some of the potato chips and other stuff, which we know are not so good for us, but usually it’s a short-term thing, but maybe cutting down the steroids a little bit might be the first step if possible in collaboration with your oncology team.

 

Lisa Hatfield: Okay, thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

How Does Cancer Treatment Impact Nutrition?

 

What are the impacts of cancer treatment on nutrition? Expert Dr. Amy Comander from Massachusetts General Hospital discusses the impact of chemotherapy and nutrition advice for overcoming the impacts of cancer treatment.

Download Resource Guide

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How Do Wellness Practices Impact Cancer Care Outcomes?

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Transcript:

Lisa Hatfield:

As a patient living with cancer, I’m always thinking about how my treatments might impact my nutrition or vice versa in some cases. Do I need to increase or decrease anything? Should I change my dietary patterns? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE Program. 

Dr. Comander, can you give us a general overview of cancer treatment and its impact on nutrition?

Dr. Amy Comander:

Cancer treatment certainly has an impact on nutrition. And as I think about that, it kind of really depends where the patient is along his or her treatment journey. When we think about nutrition, certainly we know if an individual is going through active chemotherapy, often the taste buds change and things that used to be delicious don’t taste as good, and things that maybe a person didn’t like to eat all the time is the only thing he or she can tolerate, like a bagel. Nothing wrong with a bagel, but some of my patients tell me, “That’s all I can eat.”

But in general, when we think about a healthy approach to nutrition, I really counsel my patients on the benefits of a whole foods plant-predominant diet. Note I use the term plant-predominant. That just means it is so beneficial to consume a wide variety of fruits and vegetables and whole grains. Of course, it’s okay to incorporate a protein and maybe that’s a plant-based protein or maybe that’s fish or chicken, okay? But just thinking about the concept of half of the plate being full of fruits and vegetables is so important. And you might say, why is that so important?

Fruits and vegetables, the beautiful colors of various fruits and vegetables really reflect all those beneficial nutrients in the food that are also good for our gut microbiome, which is a term a lot of us hear now in the news, this term gut microbiome. And what does that really mean? Really refers to those microorganisms in our GI tract, gastrointestinal tract. And what’s really interesting is emerging research in some cancers is demonstrating that a healthy gut microbiome is really associated with how well certain treatments for cancer work.

So again, eating fruits and vegetables makes our gut microbiome healthy. And so this is so important for our health. Whole grains as well. Limiting red meat, limiting processed foods, limiting sugar-sweetened beverages. These are all the tips and tricks that I talk about with my patients. And if you want to really look this up and read about it and have a good understanding, again, the American Institute of Cancer Research and World Cancer Research Fund, on their website, they kind of have bullet points illustrating each of these points in terms of how we can approach a healthy diet after a cancer diagnosis.

Lisa Hatfield:

Okay, thank you so much for that information. A little shout out to a multiple myeloma doctor that I watch a lot, because that’s the type of cancer I have, her name is Dr. Urvi Shah, and she has done some research on that and recommends getting 30 different plant-based foods per week, not servings, but just the variety helps your gut microbiome. She’s done some research on that that I won’t go into here but, and it’s not that hard because we get to count all different kinds of lettuce in my salad, if I have romaine, spinach, and iceberg, there’s three right there. So thank you for those comments.

Dr. Amy Comander:

Yes, it’s a great tip to think about how can I get 30 different types of fruits and vegetables into my diet in a given week? And actually it’s kind of a fun challenge. So I love incorporating different types of lettuces into my salad. By the way, herbs count. So parsley, cilantro, things like that, those are plants. So it’s a fun game and it’s really a great way to make your gut microbiome happy and healthy.

Lisa Hatfield:

Okay, thank you. Dr. Comander, what are some key nutritional guidelines for cancer patients during and after treatment?

Dr. Amy Comander:

It’s so important to think about guidelines for nutrition because we know out there on the internet, TikTok, Instagram, Facebook, there’s all kinds of people giving nutrition information. And for a cancer patient, it is very confusing and very overwhelming. That’s why I like to stick to the basics. What do research organizations such as the American Cancer Society, American Society of Clinical Oncology, AICR, American Institute of Cancer Research, what are we recommending?

And again, it’s thinking about a healthy diet pattern which includes an emphasis on whole foods, with fruits and vegetables and whole grains, limiting red meats, avoiding processed meats, limiting sugar-sweetened beverages, avoiding processed foods. If you go to the grocery store and you pick up something and it has 35 ingredients and you don’t understand what most of them are, you probably shouldn’t be eating it, okay?

So these are all some of the general themes that we think about when it comes to nutrition. I know it can be very scary and overwhelming, but just if you, again, think of your plate and if half of it is comprised of fruits and vegetables, a quarter is some type of whole grain, when I say whole grain, think about brown rice, whole wheat pasta, and some grains out there like quinoa and farro that maybe you’ve never tried but are really delicious and good for us.

And then a quarter of that plate, some type of protein source, whether that’s a plant-based protein or perhaps fish or chicken or something like that. But that’s really a great approach to thinking about nutrition. Another point I really need to emphasize is limiting alcohol. So, many people don’t really think much of having a glass of wine or two with their dinner each night, but unfortunately we know that for an individual with a diagnosis of cancer, especially if you’re on new medications or going through chemotherapy, in the best case scenario, alcohol really should be avoided or limited really to special occasions. 

Lisa Hatfield:

You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

How Can Wellness Interventions Aid Patients During and After Treatment?

How can wellness interventions aid cancer patients during and after treatment? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss benefits of different wellness practices, practical wellness strategies, and support resources.

Download Resource Guide

See More from RESTORE

Related Resources:

How Do Wellness Practices Impact Cancer Care Outcomes?

What Is Whole Person Care Exactly?

Why Is It Important to Address Whole Person Care?

Why Is It Important to Address Whole Person Care?

Transcript:

Lisa Hatfield:

How can wellness interventions help patients during and after cancer treatment? And what specific practices might help? I have many questions. I’m getting to the bottom of it in this Patient Empowerment Network RESTORE program.

Dr. Comander, how can wellness interventions help folks like myself during and after treatment? And while there seems to be only pros here, can you also speak to any risks of certain wellness practices during cancer treatment? And how can patients mitigate these risks?

Dr. Amy Comander:

Such an excellent question. And I do think it’s really important for us to focus on things that a patient can do after his or her diagnosis to take control of one’s health. We know there’s nothing scarier than getting a diagnosis of cancer and going through treatment for cancer. So we want to think about practical strategies that people can employ to feel better, tolerate their treatments better, and ultimately improve their health.

So let’s pick one of my favorites, which is exercise. I know for some people that word exercise sounds intimidating, scary. Maybe they’re not someone who ever really practiced exercise on a regular basis and so when their doctor or nurse practitioner or social worker is talking to them about this, they feel kind of intimidated. Well, I will say a new field emerging is actually called exercise oncology. It’s really fascinating. And we’re really learning about what is actually happening in the body when an individual exercises, what is going on at the cellular level that may actually be fighting the cancer.

And this is really interesting and exciting. And I love reading these scientific papers. But we’re not going to get into that right now. Let’s just talk about, when you talk about practical strategies, if you’re someone who really has not been active, just walking to the mailbox to get the mail. Try to do that each day. Maybe taking a walk in your dining room, a few laps around the dining room table, if you have one, just something basic like that, walking your dog, walking a friend’s dog. Like everyone has to start somewhere.

So when we talk to our patients about exercise, we just meet them where they are and help them get started with something. And I know this sounds very intimidating, but organizations such as the American Cancer Society, American College of Sports Medicine, and my organization, American Society of Clinical Oncology, strongly recommend that individuals going through cancer treatment engage in exercise. And so you just have to start somewhere. So why is this important? Exercise has been shown to help patients tolerate their treatment better, reduce side effects, reduce the need for dose reductions, improve the fatigue that is often associated with cancer, and in many cases, reduce risk of recurrence and improve the outcome. So there are so many reasons to do it.

You also ask about risks. And I can understand that many people are fearful of starting an exercise program if this is not something they’ve been doing on a regular basis. So I would encourage patients to talk to their doctor just to address any particular concerns. Certainly, let’s say an individual has cancer involving their bone and they’re worried that they might be at risk for a fall and a fracture. That’s something they should certainly talk about with their doctor.

As a breast oncologist, I care for many women who are concerned about risk for lymphedema. Lymphedema is swelling of the arm, perhaps on the side of the surgery. And my patients are often worried, will that get worse if she starts a strength training program? Actually, it will not, but that’s a good question for her doctor or her physical therapist. So I think it’s really important to think about exercise as the number one wellness intervention that we want to address. 

Lisa Hatfield:

Okay, thank you. And over to you, Nicole, what are some common wellness practices that cancer patients can adopt during treatment? And how can patients be empowered to take an active role in their wellness during and after cancer treatments?

Nicole Normandin Rueda:

Great question. So just like Dr. Comander said, so physical activity, starting somewhere is going to be of the utmost importance. Nutrition, balanced diet, making sure you’re hydrated, you are following all the recommendations from your medical team regarding what you consume, avoiding anything that you probably shouldn’t be consuming. Stress reduction techniques are all, mindfulness, meditation, deep breathing, the things that help you kind of get back to calm is really critical. We want to make sure patients are aware of their sleep. So the sleep cycle is one of those things that people often complain about, but aren’t really informed on how important it is to your actual overall well-being.

And so if that is an issue, we want to make sure that we are referring them to the appropriate specialist in order to help get that resolved. Social connections, again, huge. We want to make sure people understand that there are organizations and people out there that are here to just serve and help as much as we can. Maintaining the relationships, not just with their immediate family and friends, but also making new connections and new relationships with people that are going to support them throughout this journey is important.

For me as a social worker, empowering patients is what I do…it’s why I’m here. We want patients to have an active role in their wellness, both during and after treatment, because we know, as trained individuals, we know that that is going to overall have a positive impact in their quality of life, in their family’s experience throughout the cancer journey. And that’s important. This is a stressful time for a lot of people. So in order to do that, we always want to make sure we’re providing education and that is first and foremost going to come from the medical providers. Follow up to that would then be everything else, all the ancillary services.

So you have organizations, Patient Empowerment Network. We are very focused on providing evidence-based information in an easy to understand way. And so that is one of those organizations that, as a social worker, I would refer everybody to. But there are others that are doing fantastic things providing education on all sorts of topics, anything that you could possibly want. There are organizations that are doing it well. Now that’s the thing, we want to make sure that we are referring patients to get evidence-based, research-backed information for them to consume and digest at their own pace. Next would be advocacy. If you don’t have a strong advocate in your corner, or if you are not comfortable speaking up or asking questions, this is one of those things that is so incredibly important when it comes to empowering patients to really be involved in their care.

And I can tell you firsthand, my mom was my dad’s biggest advocate. It was kind of embarrassing at times, but in hindsight, thank goodness, because had she not been so ferocious and asked so many questions, there’s a lot of things that we wouldn’t have known as a family going through a cancer diagnosis. So that’s really important. And I know working with medical teams, they want somebody to ask questions, they want to be able to provide as much information as they can. That’s a good backbone for people to understand, that their medical teams are going to want to make sure that they walk out of the room feeling like they have the information they need. 

And so we want to make sure that we are providing as much information, as many resources as we can. And then it is up to the patient and their care partners or their family members to then take that and run with it. But we want to be able to make sure that we’re giving them what they need in order to ask the right questions at the right time to the right people. And if they have the resources that they need to go and make it happen.

Lisa Hatfield:

Okay, thank you so much, Nicole. You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

How Do Wellness Practices Impact Cancer Care Outcomes?

What are the impacts of wellness practices on cancer care outcomes? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss the field of lifestyle medicine, the six pillars of lifestyle medicine, research results, and wellness resources for cancer patients. 

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Transcript:

Lisa Hatfield:

How do wellness practices impact cancer care outcomes? I’m getting to the bottom of it in this RESTORE Program. Dr. Comander, you have a strong interest in cancer survivorship, lifestyle medicine, and improving outcomes of patients facing cancer. Can you speak to the impact of wellness practices on cancer treatment outcomes and what are we learning?

Dr. Amy Comander:

So I’ve gotten very interested in the field of lifestyle medicine over the past few years. And I think it’s really important to define what that is to those who are just learning about that term for the first time. So lifestyle medicine refers to the therapeutic use of evidence-based lifestyle interventions to prevent and treat chronic diseases. In addition, those who are trained in lifestyle medicine work to empower the patient to adopt these tools and make effective behavior changes. 

The six pillars of lifestyle medicine include physical activity, attention to diet, social connection, avoidance of risky substances, stress management, and adequate sleep. These are so important for the care of our patients with cancer from the time of diagnosis and beyond. And at our hospital we’ve developed a program where we provide individualized consultations to counsel our patients on each of these pillars to help them optimize their health and well-being, and in many cases, outcome from cancer. There are emerging studies demonstrating the important role of these lifestyle behaviors for improving outcome for our patients.

As a breast oncologist, I can tell you that there are significant studies demonstrating that individuals with a diagnosis of breast cancer who are able to exercise, whether that’s during treatment or after completion of primary treatment, actually have a lower risk of recurrence and improved outcome from their breast cancer. This is very powerful data, and we’re actually seeing this in other cancer types as well. So it’s very important that we in the oncology field provide our patients with these tools so they can engage in these six pillars of lifestyle medicine to improve their health and well-being.

Lisa Hatfield:

Okay, thank you for that. One quick follow-up question, and then I have a question for Nicole. So if a patient does not have a lifestyle medicine specialist, I guess that’s how I think of you, who, what is the resource, like at a local community center, could they ask the social worker there to help me out with these additional aspects of my cancer treatment? Who would they go to for those questions?

Dr. Amy Comander:  

Such an excellent question, and I know I’m fortunate that we have this wonderful program that we started. I would say that in terms of exercise, if you have access to a YMCA, many YMCAs have a program called the  LIVESTRONG Program, which is a free exercise program for cancer survivors, and many individuals take advantage of that, and that’s a great resource. If you can’t access a YMCA, thankfully, due to technology like this, we now have the opportunity to offer all kinds of exercise programs on YouTube or through an entity called the Maple Tree Cancer Alliance. There’s so many options potentially available online for somebody who wants to take on an exercise program. I’ll pick another important pillar of lifestyle medicine, nutrition.

One, we know there’s so much information out there on the internet, but one organization that does a very good job on conveying important evidence-based nutrition information is the American Institute of Cancer Research, AICR. So I often refer my patients to that site where they can read articles about nutrition, check out recipes, and, again, it’s very evidence-based and based on research that I trust, and so I think that’s a great resource for individuals who might not have access to an oncology-registered dietician at their hospital.

Lisa Hatfield:

Okay, thank you. And Nicole, are there specific wellness practices that have been shown to improve treatment outcomes for patients facing a cancer diagnosis?

Nicole Normandin Rueda:

Yeah, absolutely. So research has shown that adopting certain wellness practices can significantly improve your quality of life and potentially enhance treatment outcomes. Patients that have physical activity, and what that looks like is different for every patient. So regular exercise can mean a lot of different things. At the end of the day, from my perspective, the importance is that you’re moving your body. So if you start with just stretching, yoga, things to get your body start to start moving, it’s better than absolutely nothing, and then you work your way up to as much as you can endure. That’s key, I think, just like Dr. Comander just said.

Second, we have nutrition. So the balanced diet is difficult for everybody, but whenever it comes to a cancer diagnosis, you really want to take into consideration whatever your doctor’s recommending, and that’s specific to your treatment potentially. But as well as just making sure that you are nourishing your body, getting enough water, staying hydrated, all of the basics.

Next, I know that mindfulness and stress reduction techniques are huge. These practices, including like meditation, yoga, just deep breathing exercises to help kind of reduce that stress level, improve your overall clarity and mental health is really important. We want patients to stay as cool, calm, and collected as they can be. And so even just taking some deep breaths in through your nose, out through your mouth, these things are critical. And then I think another big one is the psychological side of things.

So psychosocial is one of those words that doesn’t mean anything to a lot of people, but to those of us who are trained, we understand that psychosocial means everything around you, everything that interacts with you is impacted by this cancer diagnosis. So we want to make sure we are connecting patients with all of the support groups that we can possibly think of. If that’s what they’re looking for. We also want to take into consideration the cultural situation. So if that means that you really don’t want to sit in a room with others, but you want to just read a blog from somebody like an empowerment lead or something like that, that can also be helpful.

And that is what patients are looking for now is easy access to information that is evidence-based, of course, but also that is just testimonial, somebody that’s been there and can guide them through what it’s like to, yeah, it is okay to talk to others, and it is okay to ask for help when you need it. So we really want to encourage that as much as possible. And obviously we want to foster a sense of community. We want everybody to understand you’re not alone. And there’s organizations out there doing fantastic things. Patient Empowerment Network is one of them, but there’s also so many others that are just doing fantastic things to support patients in every aspect of their cancer diagnosis.

Lisa Hatfield:

Thank you, Nicole. You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

Dr. Amy Comander: Why Is It Important for You to Empower Patients?

Why is it important to empower patients? Expert Dr. Amy Comander from Massachusetts General Hospital shares a quote that she uses to help patients with goals for their cancer care. 

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Transcript:

Dr. Amy Comander:  

I love this question because as an oncologist, I love to empower my patients to take charge of their care and do everything they can to live a healthy life. And I often will think of a question, and this is actually related to one of my favorite running stars, Des Linden. I have to give a shoutout. I live in Boston. She won the Boston Marathon in 2018, and she’s famous for this quote, “Think about your why.” What is your why with any goal that you’re trying to achieve?

And so I will ask my patients that question, like, “What is important to you? What is your why?” And that might be being around to spend as much time as possible with their grandchildren, or that may be losing 10 pounds to fit into a dress for an upcoming wedding. Every person is going to have a different goal or a different why. And I really try to connect with my patients to understand what that goal is for them and what is important to them. And that helps them feel empowered to take charge of their health and achieve that goal.

What Is Whole Person Care Exactly?

Whole person care is a key part of cancer treatment, but what does it mean exactly? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss the meaning, aspects, and benefits of whole person care for cancer patients.

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Transcript:

Lisa Hatfield:

We hear about the importance of wellness during and after cancer treatment. Some refer to it as whole person care or lifestyle medicine, but what is it really? I’m getting to the bottom of it in this Patient Empowerment Network RESTORE Program. 

Dr. Comander, can you explain the concept of whole person care in the context of cancer treatment, and why are these concepts or strategies important for patients and care partners to understand?

Dr. Amy Comander:

Thank you for that excellent question. As an oncologist, I really focus on providing care for the whole patient or really taking what we also refer to as a patient-centered approach, certainly taking into account my patient’s diagnosis, the stage of the cancer, and the appropriate treatments, but also how can I best address all the other needs my patient is facing, whether that’s transportation to appointments, her goals when it comes to her treatment plan, her neighborhood she lives in and how easy it is for her to get to appointments and get outside to get exercise, and really thinking about all of these needs and integrating them as I formulate a treatment plan and also bringing in other members of our team to address the needs that my patient may face so we can really take care of the whole patient. So I’m so glad that you asked about that.

Lisa Hatfield:

Thank you. Nicole, can you share what the meaning of a whole person care is for you as a social worker? As you interact with patients, how do you explain it to them?

Nicole Normandin Rueda:

Sure. So whole person care means you’re addressing not just the physical aspects of cancer, but also the emotional, social, psychological, and spiritual dimensions of the patient’s experience. 

The approach recognizes that cancer affects every aspect of a patient’s life and that effective care must go beyond just the traditional medical treatments. It also includes everything from nutrition, physical activity, counseling. It’s very personalized to the patient, meaning we take the time to get to know the patient, figure out how we can help tailor the interventions that we’re going to suggest to their specific needs, including everything that we need to consider, such as their personal, cultural, or social context. And finally, it’s holistic. So we’re addressing emotional, psychological, social challenges that may arise.

In addition to just being diagnosed with cancer, everything else that’s compounded whenever that happens to somebody, we want to make sure that we are addressing as much of that as possible. So whenever I’m interacting with patients, I’m the social worker that comes in and really just gets to explain all of this from A to Z, that we are, as a team, we’re going to take a comprehensive approach that treats them as individuals, rather as just focusing on treating the disease.

I emphasize that we’re looking at their overall well-being, helping them manage their day-to-day life, as well as everything else that comes with a cancer diagnosis, their side effects, the emotional stress, the financial issues that may come about, the change in roles, the cultural things that may come up. All of these things will be addressed in some way or another, depending on what the needs of the patient are.

Lisa Hatfield:

You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

What Questions Should You Ask About a Proposed Thyroid Cancer Treatment Plan?

What Questions Should You Ask About a Proposed Thyroid Cancer Treatment Plan? from Patient Empowerment Network on Vimeo.

What questions should you ask about a proposed thyroid cancer treatment plan? Dr. Wirth provides guidance on self-advocacy, seeking a second opinion, and discussing essential molecular testing for identifying targetable gene alterations.

Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.

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Transcript:

Katherine:

What questions should patients ask about their proposed treatment plan? 

Dr. Wirth:

So, Katherine your questions are so spot on, and these are the kinds of questions that we get asked in clinic all the time. And I could say one thing that I think, I don’t know if medical students still are in this, but I learned this in medical school. If a patient says to you, “What would you say to me if I were your mother?”  

You’re not supposed to answer that question because of course you’re going to have your biases. But I realize people ask me that question all the time. And so, it’s a good question, so I should answer it because it’s a good question. But I think that I would simply encourage people to not be shy. Their doctors care deeply about them. Their doctors are pressed for time, but their doctors are always going to be happy to stop and answer every single question that the patient has. And the most basic questions are the best ones, but sometimes they’re also the hardest question to ask. But coming with a list of the important questions is very helpful. Bringing along a family member or friend and having them have their list of questions is also very helpful.  

But writing down especially the hard questions can help you ask the question because it can be hard to say, “How long might this drug help me live?” Asking about how long I might live can be really hard to say, but if you’ve got it written down there, it’s a little bit easier to say. Or if it’s hard for you to get those words out, hand your doctor over your notebook, and your doctor can look at the questions and help answer the questions.

So, I just would encourage people to think in advance about what the questions are that they want to make sure that they cover and jot them down. And don’t be shy. Don’t be shy about saying, “Do you think it would be worthwhile for me to get a second opinion? And if so, who do you recommend?” And most doctors are perfectly content with somebody asking if they think a second opinion would be a good idea.  

And I’ve always said if I were diagnosed with cancer, I would want to have a second opinion just to be sure that what my favorite doctor was saying to me really sounded right. So, don’t be shy about asking for second opinions. With thyroid cancer I also think now it’s so important that we’re doing the molecular diagnostics of the tumors for patients to identify those patients that have targetable gene alterations. And it is still a relatively new thing in oncology to do molecular diagnostics for thyroid cancer as well as other solid tumors. And so, it is something that is not always recommended or offered to patients. But that’s something that patients with thyroid cancer should absolutely ask their doctors about. 

What Are the Benefits of Thyroid Cancer Clinical Trial Participation?

What Are the Benefits of Thyroid Cancer Clinical Trial Participation? from Patient Empowerment Network on Vimeo.

What are the benefits of thyroid cancer clinical trial participation? Dr. Lori Wirth discusses how clinical trials provide access to promising new treatments, offering patients additional options, and the potential for significant advancements in managing their disease.

Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.

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Transcript:

Katherine:

Dr. Wirth, what would you say to patients who are hesitant to participate in a clinical trial? 

Dr. Wirth:

Oh, boy. So, that’s such an important question. 

Katherine:

Yeah.  

Dr. Wirth:

And I think that the natural reluctance to put oneself into an uncertain setting like a clinical trial is completely understandable.  

But a couple of things that I would say is first of all there is a lot of really deep work that goes into identifying new agents that have promise in the preclinical setting from laboratories either within the pharmaceutical industry or within academics. The amount of smarts that goes into development new drugs as well as early testing to ensure safety and that there’s a real signal of activity, that amount of work that’s done before a clinical trial is launched is really quite significant. So, when we’re bringing a new drug into clinical trials, we already know that there’s a very good likelihood that that drug is going to have good activity.  

Katherine:

Okay.  

Dr. Wirth:

The other reason for patients to think about participating in clinical trials is when patients have metastatic disease in the solid tumor setting whether it’s colorectal cancer or breast cancer, unfortunately most of our treatments don’t work so well that there’s a chance of cure. However, if we can’t cure a cancer, the next best thing is to knock it back and hold it at bay for as long as possible so that people can feel well but also live as long as possible.

However, if we don’t have a drug that can work so well that can cure cancer completely many cancers ultimately are going to escape the control, and we’re going to need new therapies for those patients. When patients participate in a clinical trial that’s just giving them a whole other treatment option. And so, to have more options available gives more chances that there’s going to be a real homerun or a real success in terms of treatment.  

So, I would much rather have my patient have three options of treatment rather than two options of treatment. And we can always turn to the drugs that we have that are already FDA approved as long as somebody’s well enough to receive cancer treatment. If there’s a promising clinical trial of a new agent that’s only available in a clinical trial, and if we use that earlier in the course of the disease, that gives us more options for down the road. 

Thyroid Cancer Research and Treatment Highlights

Thyroid Cancer Research and Treatment Highlights from Patient Empowerment Network on Vimeo.

What are the latest thyroid cancer research and treatment highlights? Dr. Lori Wirth discusses recent advancements, including successful clinical trials with newer therapies, and ongoing research into the latest targeted treatments for advanced thyroid cancer.

Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.

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Transcript:

Katherine:

Dr. Wirth, what are your research areas of focus? 

Dr. Wirth:

Here at Mass General in Boston we focus on clinical trials looking at new therapies for patients with advanced thyroid cancer including iodine refractory thyroid cancer, anaplastic thyroid cancer, medullary thyroid cancer.  

We also have a big program in studying in the laboratory what makes thyroid cancers tick in order to try to come up with new angles for new drug therapies based on preclinical work that’s being done.  

Katherine:

Okay. In terms of thyroid cancer are there research developments that are showing a lot of promise that you’re excited about? 

Dr. Wirth:

And so, Katherine, I’m so glad you’re asking that question because we’ve actually had some really big successes in clinical trials for patients with thyroid cancer recently. One of the big successes was a study called COSMIC-311 which looked at the drug cabozantinib (Cabometyx) in patients with iodine refractory thyroid cancer who had progressed on the first-line therapy.  

Most commonly that’s lenvatinib (Lenvima), but you can have other first-line therapies as well. And that study was a randomized Phase III study that was done in an international setting and showed that cabozantinib had very good activity in the second line following progression on first-line therapy.

So, we now have treatments lined up for patients for the first line, but then also we have good treatment for patients who’ve progressed on the first-line therapy and need further treatment. So, that was one major success. Another major success recently was the LIBRETTO-531 trial. So, that was a randomized Phase III trial also done internationally in patients with progressive RET-mutated medullary thyroid cancer.  

And that study randomized patients to receive either the RET specific therapy selpercatinib compared to a multikinase inhibitor either cabozantinib or vandetanib (Caprelsa). And the LIBRETTO-531 study showed that selpercatinib is much better than the older standard of care therapies in terms of response rates, durability of response. And we’re even seeing that it looks like there’s a signal where the overall survival is longer with serpercatinib compared to the older standard of care therapies.

So, whenever we have a strongly positive Phase II trial in oncology it’s a big win. And those are two examples of big wins recently. Another study that I would highlight has come out of Germany looking at the combination of pembrolizumab which is an immunotherapy drug in combination with lenvatinib the multikinase inhibitor in patients with anaplastic thyroid cancer.  

And it was a relatively small study. It was a Phase II trial, but this Phase II trial in Germany showed very good activity with this combination of pembrolizumab (Keytruda) and lenvatinib in people with anaplastic thyroid cancer. So, that is very promising for the future for those patients as well. 

Katherine:

Dr. Wirth, is there anything you’d like to add about the evolution of thyroid cancer care? Are you excited about anything that we haven’t already talked about? 

Dr. Wirth:

I am so excited about our recent evolution in thyroid cancer care where we’ve gone from only having old fashioned IV chemotherapy which really doesn’t work very well in thyroid cancer to having really effective multikinase inhibitors for thyroid cancer patients. And now we even have gene specific targeted therapies that work even better in certain specific situations. And so, this evolution over the last 10 years has really changed the landscape of therapies available to our patients. And we now have drugs for almost all of our patients with thyroid cancer.  

They have a good likelihood of working really well for a really long period of time. And that’s changed in my lifetime, taking care of people with thyroid cancer. And the progress that we’ve seen in the last 10 years is really only accelerating before our very eyes. One of the targets that we didn’t talk about earlier is the BRAF V600E mutation.

And I just want to talk about that very briefly because that’s actually the most common potentially targetable gene alteration in thyroid cancer. But thyroid cancer patients share that gene mutation with other cancers as well including melanoma, a subset of people with lung cancer, a subset of people with colorectal cancer as well. There are a lot of new drugs that are being studied in clinical trials targeting that BRAF V600E mutation and other cousins within that pathway of gene alterations that drive cancers.  

And so there is a very active industry that is working on developing the next best therapy for all of these targets that we’ve talked about, NTRK, RET, BRAF mutations, immunotherapy approaches to people with all different types of solid tumors. And those kinds of clinical trials are being done now in advanced thyroid cancer.

Whereas 15 years ago it was really difficult to get a trial up and running for people with thyroid cancer because it was seen as such a rare cancer, kind of a niche cancer where there’s not a lot of money to be made in developing drugs compared to the numbers of women with breast cancer or numbers of people with lung cancer.  

It’s a different story now. There’s a lot of active drug development specifically for people with thyroid cancer. 

Understanding Targeted Thyroid Cancer Treatment Approaches

Understanding Targeted Thyroid Cancer Treatment Approaches from Patient Empowerment Network on Vimeo.

What are targeted thyroid cancer treatment approaches? Dr. Wirth explains standard options like multikinase inhibitors, newer gene-specific treatments, patient suitability for targeted therapies, and common side effects.

Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.

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Transcript:

Katherine:

Thank you. Dr. Wirth, what are the targeted treatment approaches for treating thyroid cancer?  

Dr. Wirth:

Yes, so we do have new options for treating iodine-refractory thyroid cancer, also anaplastic thyroid cancer, and then the medullary thyroid cancer.  

So, the first group of drugs that were studied starting a decade ago and have become standard of care options for these patients are the multikinase inhibitors, which are targeted therapies. But the drugs target multiple kinases not just one kinase, so we call them multikinase inhibitors. Lenvatinib (Lenvima) is the multikinase inhibitor that’s used most often in iodine refractory thyroid cancer.

But we have other multikinase inhibitors as well. Cabozantinib (Cabometyx) is a drug that’s available now for second-line therapy in iodine refractory thyroid cancer. That’s a multikinase inhibitor. And then for medullary thyroid cancer multikinase inhibitors were studied about 10 years ago as well. 

And cabozantinib (Cabometyx) and vandetanib (Caprelsa)  are both multikinase inhibitors that have good activity and were FDA-approved for the treatments of medullary thyroid cancer. But one of the things that’s been so exciting in the last five to eight years is that we now know that a large portion of all of these various thyroid cancers are driven by specific gene mutations.

And many of those gene mutations lead to expression of abnormal proteins that make the cancer a cancer cell. And in many circumstances, those abnormal proteins driving the cancer cell growth are now targetable with gene-specific therapies. So, there’s been a lot of progress made recently in that area of the work that we do, which has really led to some great successes.  

So, the first example of a really great success was in targeting the TRK protein, TRK. And that is aberrantly expressed in a subset of the iodine refractory differentiated thyroid cancers by virtue of a gene alteration called a fusion. So, you can see NTRK1 or NTRK 3 fusions driving a subset of iodine refractory differentiated thyroid cancer.

And there are now a couple of drugs that target TRK very potently and specifically including larotrectinib (Vitrakvi) that was studied in multiple different types of tumors all driven by NTRK fusions, including a fairly large cohort of patients with iodine refractory differentiated thyroid cancer. And in the thyroid cancer patients, we saw really high responses with larotrectinib, which is an oral drug taken by mouth at home every day.  

And not only did we see very high response rates, but we also are seeing very durable responses where patients can remain on larotrectinib month after month after month or even for years with a significant regression of their thyroid cancer. Sometimes people even will have a complete response on larotrectinib. And they can tolerate larotrectinib well for the most part for a very long period of time. So, that’s a targeted therapy success story for patients with NTRK fusion-positive thyroid cancer. Another example is targeting RET fusions and RET mutations. So, we see RET fusions in iodine refractory differentiated thyroid cancer in a portion of them.  

We also occasionally see RET fusions driving anaplastic thyroid cancer. And then more than half of patients with medullary thyroid cancers will have RET mutations. And so, the gene mutation is slightly different than a gene fusion, but the end result is very similar so that RET is overactive in these cancers and now is druggable with RET-specific inhibitors. The one that’s been studied the most in thyroid cancer is selpercatinib (Retevmo). And similar to larotrectinib and NTRK driven thyroid cancers serlpercatinib and RET-driven thyroid cancers has great activity, very high response rates, very durable responses. And again, it’s taken at home every day by mouth, and it’s really very well-tolerated overall.  

Katherine:

Well which patients are a good fit for a targeted treatment approach? 

Dr. Wirth:

So, the patients that are a good fit are patients first of all who need a systemic therapy.  

So, for example, if a patient has had a thyroid nodule that’s not all that big, a biopsy shows it’s thyroid cancer, and the patient has a complete resection of that disease and may or may not have gotten treated with radioactive iodine. 

But if they’re disease free they don’t need any further therapy. And a lot of patients are in that category which is the best-case scenario. But when patients have persistent disease that eventually is going to grow over time, then we do genotyping of the tumor or molecular diagnostics. It’s the same thing, different phrases. But then we’ll extract the DNA from the cancer cells to see what types of targetable gene alterations might be present driving that thyroid cancer. In patients who are found to have an NTRK fusion, a drug like larotrectinib is an option.  

If we see a RET fusion, then a RET specific therapy might be an option. So, you need to have some disease that needs a systemic therapy, and then the target needs to be present as well.  

Katherine:

What are the common side effects for a targeted approach? 

Dr. Wirth:

So, the side effects are a little bit different flavor for the different drugs. So, larotrectinib, for example, is a potent and specific TRK inhibitor. And TRK is expressed in the development of the nervous system as well as the maintenance in full grown people of the nervous system. So, you can have on target TRK related side effects involving the nervous system from when patients are on larotrectinib.  

So, we can, for example, see a little bit of dizziness or gait unsteadiness which is a direct result of inhibiting TRK. Or sometimes patients will develop kind of an unusual pain syndrome where when they’re getting close to the time that they’re supposed to take their next does of Larotrectinib when the amount of drug in the body is beginning to wane, then some patients will develop pain like joint pain for example, pain from arthritis but it seems to be exacerbated.

And then when they take their next dose of larotrectinib the pain goes away as well. So, there’s some impact on pain control that we can see as a side effect of larotrectinib. Fatigue I think is the other probably most common side effect which probably also is an on-target side effect from larotrectinib.  

Katherine:

Yeah.  

Dr. Wirth:

There can be some inflammation in the liver which we can see in blood tests, so we have to monitor blood tests for that kind of inflammation, which is uncommon but can be seen and sometimes will require some dose reductions in order to not have to worry about liver injury in a particular patient. 

What Are Initial Thyroid Cancer Treatment Approaches?

What Are Initial Thyroid Cancer Treatment Approaches? from Patient Empowerment Network on Vimeo.

What are initial thyroid cancer treatment approaches? Dr. Lori Wirth explains why surgery is the primary treatment, when radioactive iodine is appropriate, and the need for lifelong thyroid hormone replacement after thyroidectomy.

Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.

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Transcript:

Katherine:

So, what are the main treatment classes for each type? 

Dr. Wirth:

So, surgery is always considered a mainstay for any type of thyroid cancer whenever possible. Often patients will present with a lump in their neck that is noticed either by themselves or on physical examination and is noticeable before the cancer has spread to other parts of the body. And that’s definitely the best-case scenario. If those cancers can be completely resected by surgery with either a hemithyroidectomy or a total thyroidectomy, then there’s a reasonably good chance of cure in many cases.  

So, surgery is first and foremost the treatment that we think about. Then for the subtypes of thyroid cancer that arise from the regular thyroid cells namely papillary thyroid cancer, follicular thyroid cancer, oncocytic, and high grade.  

Those patients will often also be treated after surgery with radioactive iodine.  

The normal thyroid tissue takes up iodine from the blood in order to make thyroid hormone. And we can make iodine radioactive, give that to a patient, and it can sometimes be taken up by the thyroid cancer cells just like normal thyroid cells would take up normal iodine from the blood. And if those cells take up radioactive iodine, then they’re killed off by the radioactive iodine. We know, however, that anaplastic thyroid cancers don’t take up radioactive iodine.  

So, we don’t use radioactive iodine ever in anaplastic thyroid cancers. And then also in medullary thyroid cancers, because they’re really a completely different cell altogether, those cancers are not treated with radioactive iodine as well.   

Katherine:

Okay.  

Dr. Wirth:

So, most patients will need to have surgery. Many patients will also be treated with radioactive iodine. And for many, many patients with thyroid cancer, that’s all the treatment that they need, and they’re done.

There are, however, patients who will have more aggressive thyroid cancer or thyroid cancer that’s already metastasized to other parts of the body. And if those cancers don’t respond to radioactive iodine, then we consider them radioactive iodine resistant or refractory. And then we have other treatments in the arsenal for those cases.  

Katherine:

This may seem like a very simple question to you. But once the thyroid has been removed, doesn’t the patient then have to take some sort of supplement for the rest of their lives? 

Dr. Wirth:

Yes, exactly. So, the job of the thyroid gland mostly is to make thyroid hormone. And thyroid hormone is one of the things that governs the body’s metabolism. So, if you take away the thyroid gland, then without the thyroid hormone replacement patients will become hypothyroid. And eventually it can be so severe that people can be quite, quite, quite ill. So, anyone who’s had a complete thyroidectomy will need treatment with thyroid hormone replacement for the rest of their lives.