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Progress Summer, 1998

Index

Facing Cancer with Style

Cancer Center Named Finalist in Quality Cup Competition

Research Roundup

Experts Offer “Eye-Opening” Look at Fatigue

A Gemstone of Support

Share Your Hope and Humor!

Current Events In Cancer

Get Involved in “The March”

M Personal Touch

 

Thanks . . .

to patients and staff for making March's National Nutrition Month a great success! In addition to the wonderful generosity of the Great Harvest Bread Co., contributors including Bio-Foods, Busch's Valuland, Ensure, Kroger and Noble World Wide Sales and Resource donated hundreds of nutritional food items given out to Cancer Center patients. Watch for more fun activities to come!
Martha DeRoeck, M.S., R.D. Cancer Center Nutrition Program

“It is comforting to know that your service is available and will be of help to others in need of information about current treatment options.”
Cancer Information Line
1-800-865-1125
Call 9 am to 4:30 pm, Monday through Friday.

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Facing Cancer with Style

When you look good, you feel better. That’s the simple idea behind a new program for women undergoing chemotherapy and radiation treatment at the University of Michigan Comprehensive Cancer Center.

The “Look Good, Feel Better” program offers simple tips and tools to help patients cope with often-traumatic treatment side effects such as hair loss, and regain a sense of self-confidence and control over their lives. The free program is sponsored nationally by the American Cancer Society, the Cosmetic, Toiletry and Fragrance Association Foundation, and the National Cosmetology Association.

Women of all ages attended the first group session at the U-M Cancer Center in April. Several trained cosmetologists helped women perform their own make-over using $200 worth of complimentary cosmetics and skin care products. They learned how to pencil in eyebrows, even out skin tone with foundation and blush, and emphasize lashless eyes with carefully applied eyeliner.

After their faces were picture perfect, cosmetologist Pam Hahn demonstrated creative techniques for disguising hair loss using wigs, turbans, scarves, hats and even old T-shirts. “Good for a bad no-hair day,” joked Hahn, who became a trainer for the program after both her husband and father were diagnosed with cancer.

“As a hairdresser, I see a lot of people in my chair who are going through treatment,” said Hahn. “This program gives me an opportunity to ‘give back’ to my wonderful clients and others. It’s been very rewarding and a lot of fun.”

Rebecca Roberts had just started chemo-therapy when she attended the first session. “Breast cancer and its treatment really affects how you feel about your femininity,” said Roberts, 38. “I’ve learned so much from this one session — and it’s a wonderful group of people.”

Laughter, camaraderie and exchanging of phone numbers proved the success of the first session to Lynn Dworzanin, M.S., R.N., C.S., the U-M nurse practitioner who was instrumental in organizing the Washtenaw community program in conjunction with the McAuley Cancer Center.

“I felt strongly about offering ‘Look Good, Feel Better’ to our patients,” said Dworzanin.

“Women who feel good about their looks demonstrate more self-confidence and empowerment,” continued Dworzanin. “These characteristics are intrinsic in helping women with cancer face the many challenges associated with their disease and treatment.”

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Cancer Center Named Finalist in Quality Cup Competition

The University of Michigan Comprehensive Cancer Center recently was honored at USA Today headquarters in Arlington, Va., for reaching the finalist level in the health category of the annual Rochester Institute of Technology (RIT) and USA Today Quality Cup Competition.

This national award recognizes teams making significant contributions to the improvement of quality products or services in an organization by applying principles of quality management.

“We’re very pleased to be one of only two finalists in the health category,” says Marcy Bohm Waldinger, M.H.S.A., administrative director of the U-M Cancer Center. “This award is a reflection of our faculty and staff’s dedication to providing our patients with the highest level of care in a welcoming and efficient environment.”

In preparation for opening a new outpatient facility in May 1997, the Cancer Center undertook a complete work redesign of the structure and process for diagnosis and treatment of cancer patients. Redesign concepts included the creation of six physician-lead teams organized by cancer type, improved convenience and comfort for patients receiving chemotherapy, and the creation of a clinic coordinator position to coordinate all scheduling and customer service training for staff.

“Our primary goals were to be patient-focused, team-based and cost-effective,” says Waldinger. “Nearly one year after opening the facility, we continue to receive glowing feedback from patients, families, physicians, clinic staff and others.”

For the seventh annual Quality Cup competition, 176 nominations were received from Fortune 500 companies, government agencies, educational institutions, health care organizations and small businesses nationwide. Judging, including a site visit to each semi-finalist, was conducted by USA Today editorial staff, RIT professors, consultants, academics and industry quality experts.

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Research Roundup

Promising radioimmunotherapy results
A striking 100 percent of newly diagnosed, low-grade non-Hodgkin’s lymphoma patients responded to radiolabeled monoclonal antibody therapy as part of a clinical study at the University of Michigan Comprehensive Cancer Center. These preliminary results are based on 32 patients participating in a planned 60-patient study. Seventy-one percent of the 24 patients who had adequate follow-up for at least six months experienced complete remission or complete disappearance of their disease.

“It’s particularly encouraging that with a single therapeutic dose, patients were able to achieve ‘molecular’ remissions — a remission state which is believed to coincide with prolonged, durable responses to treatment,” says Mark Kaminski, M.D., associate professor of internal medicine at the U-M Cancer Center. “Molecular remissions are a rarity in patients treated with conventional chemotherapy.” Non-Hodgkin’s lymphoma affects the blood and lymph tissues. According to the National Cancer Institute, approximately 270,000 Americans are afflicted with non-Hodgkin’s lymphoma each year. Of that total, it is estimated that about 92,000 people have low-grade or transformed low-grade disease, an incurable form of non-Hodgkin’s lymphoma.

Exploring long-term effects of breast cancer treatment
Anne Schott, M.D., and colleagues are studying the long-term effects of breast cancer treatment and the risk of secondary cancers. “We hope to learn more about the problems breast cancer survivors face as a result of the surgery, chemotherapy and radiation that they may have received,” says Schott, a member of the Cancer Center’s breast care team and assistant professor of internal medicine.

As part of this National Cancer Institute-funded study, long-term survivors complete a questionnaire about their medical history, specific cancer treatments, and any long-lasting side effects, in particular lymphedema—painful arm swelling that may result from surgery and radiation. Information on pain, secondary cancers and menopause also is collected, and participants are given a physical examination.

Based on information that will be collected from approximately 200 long-term survivors, researchers will develop a standardized tool for assessing lymphedema that can be used in future studies to measure the effectiveness of lymphedema treatments. “It is important to know the long-term effects of breast cancer treatments in order to improve them, as well as to be able to counsel recently diagnosed women about the risks and benefits of treatment,” says Schott.

Improving quality of life for survivors and families
“Increasing numbers of children and adults are successfully being treated for cancer,” says Bernadine Cimprich, Ph.D., R.N., director of the Cancer Center’s Behavioral Oncology Program and assistant professor of nursing. “So it’s important to understand how we may best provide care and assistance to these long-term survivors.”

Cimprich, along with Mark Chesler, Ph.D., U-M professor of sociology, received a research award from the National Cancer Institute to study the quality of life and related service needs of long-term cancer survivors.

Chesler’s research focuses on discovering the psychological and social experiences of young and older survivors of childhood cancer, leukemias and lymphomas and their family members. “Cancer is a family disease, and it has an impact on all family members’ quality of life,” says Chesler. His work is a continuation of a study of 304 survivors of childhood cancer treated at the U-M C.S. Mott Children’s Hospital and their parents and siblings, and a 10-year follow up of 170 adult survivors of leukemia and lymphoma and their families.

Women living with a past diagnosis of breast cancer represent one of the largest groups of survivors in the United States. Cimprich’s research focuses on gaining an in-depth understanding of how breast cancer may affect quality of life including physical, psychological and social experiences of 150 long-term survivors of breast cancer who were diagnosed at younger, middle and older life stages.

“An important aim of this collaborative research is to discover how quality of life of cancer survivors and their family members may be affected across different life stages and disease conditions,” says Cimprich.“The research will identify the resultant needs or desires of survivors for medical, psychological and social support services.”

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Experts Offer “Eye-Opening” Look at Fatigue

Fighting cancer is a difficult process in the best of conditions, but very often severe fatigue becomes an overwhelming part of a patient’s daily life. Exhaustion, listlessness and an overwhelming need to sleep are common symptoms.

Many factors can contribute to cancer fatigue — emotional stress, depression, anxiety, and changes in sleeping and eating patterns. Chemotherapy and its side effects can lead to anemia (a decreased number of red blood cells), which is a common cause of fatigue.

“Too often, fatigue is accepted as an inevitable part of treatment by both patients and health care professionals,” says Shon Dwyer, patient health educator at the University of Michigan Comprehensive Cancer Center. “This doesn’t have to be the case. There are ways cancer patients can feel more focused, alert and awake.”

All of the eye-opening facts recently were presented at a free Cancer AnswerNight offered by the University of Michigan Comprehensive Cancer Center and sponsored in part by Ortho Biotech. A panel of experts lead by moderator Denise R. Reinke, R.N., B.S.N., O.C.N., taught patients how to fight fatigue using restorative activities, nutrition, exercise and daily planning.

Here are some highlights of what the experts had to say:

Bernadine Cimprich, Ph.D., R.N., C.S. Director of Cancer Center Behavioral Oncology Program and Assistant Professor of Nursing

• We all have a limited capacity for directed attention — the ability to focus and concentrate.
• Attentional fatigue is real. It creeps up on you and it persists. Think of ways to restore your mental energy, as well as your physical energy.
• Research has found that “restorative activities,” such as gardening, enjoying nature, bird watching, listening to music, community involvement and walking or biking yield significant improvement in mental energy.

Martha DeRoeck, M.S., R.D. Cancer Center Nutritionist

• Delegate — use your time and energy to plan meals and write out a grocery list, then enlist someone to do the shopping for you.
• Steer clear of complicated menus.
• Drink six to eight glasses of water per day — most patients do not drink enough.
• Eat a wide variety of foods — that's the key to good nutrition.

Sheila Crowley, M.S., R.N., C.S., O.C.N. Doctoral Student, U-M School of Nursing

• Only 20 percent of the adult population exercises at a level needed for good health.
• Exercise won’t prevent fatigue, but it will help reduce it over time.
• Many patients find that a combination of resting and exercise helps to alleviate fatigue — resting alone is usually not enough.
• A moderate level of exercise can be done while undergoing treatment. Don’t wait until treatment is over, when it is much harder to recover.

Viola Wittersheim, Cancer Patient

• Cancer fatigue is a matter of survival, it is very real.
• Listen to your body. Cooperate with your body. It takes time to recover. Be patient.
• Creative expression can be very important to healing.
• I made several “therapy quilts,” which gave my mind a distraction, a place to rest.
• Delegate to loved ones and friends.
• I thank my No. 1 care giver, my husband, for doing all the things I had no energy to do. He even did windows.
• Strive to have a positive attitude.

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A Gemstone of Support

The Patient Education Resource Center (PERC) offers free information on survivorship issues, support services, treatment options and community services referrals. The PERC is open to the public and staffed by a team of dedicated volunteers, many of whom are cancer survivors. Emily Hollenberg has volunteered at the Center since it opened its doors. She is a registered nurse, wife, mother of two, gourmet cook and a four-year survivor of breast cancer. Recently, Emily spoke with Maxine Solvay, the Cancer Center’s Promotion Coordinator about her cancer journey and her involvement with the PERC.

Q. What type of cancer did you have and when were you diagnosed?
A. Cancer always comes as a surprise — my sister was diagnosed in 1984 with breast cancer at age 40. I remember helping her work through it. Somehow, though you know you have a first-degree relative with breast cancer, you just put it out of your mind and say, “someone else, but not me.” I did all the right things — mammograms and check-ups — but then life comes and taps you on the shoulder anyway. In 1994, I was diagnosed with stage-two breast cancer with lymph node involvement and began a course of lumpectomy, chemotherapy and radiation. I was working full time when I was diagnosed and throughout my treatments. I was then the vice president of nursing at Oakwood Hospital in Dearborn.

Q. How did your cancer journey change your life?
A. I rethought my life and quit my job. I realized I was working 70 hours a week, and my kids were looking quite old (16 and 18). You look back and there are things you regret — I had never made Christmas cookies. During that first year, I bought cookie cutters and threw myself into baking. It was reaffirming, but then I got bored. I knew I wanted to go back to work, but I didn’t want to work 70 hours a week. For however long I have — whether a short bit of time or an eternity — I want to have time to be with my family. My life now is dedicated to building memories for my family and for myself. I work 20 hours a week, and I volunteer at jobs that are important to me.

Q. How did you become involved with the PERC?
A. Even before it opened, I saw an ad in the paper and I called. One of the things that struck me when I was going through treatment is that people don’t have information. I believe if you know what you are doing and you have good information and support, you can tolerate almost anything. I like to give information to people and not just information on their illness, but how they are going to get on with their life. And they love to see you. When I say, “I’m a cancer survivor” patients are surprised that I look so well. I tell people I use to have “no hair days,” but it doesn’t last forever.

Q. What keeps you coming back to the PERC?
A. I feel good about what I am doing. It’s very rewarding. I consider myself lucky because I had a lot of support. When I see people in the waiting room with no family and no insurance, I realize that the whole experience of cancer and cancer treatment is just awful for them. So anything I can do to make someone feel better is a reward. I think in the whole scheme of cancer treatment, you need the doctors, nurses, social workers and everyone else, but somewhere along the line you need some low-profile person telling you, “You can do this.”

Q. How would you describe the PERC?
A. I think the center is a gemstone. I wish we could get more patients to come into the resource center. We are more than information. We are heart, humor and hope. We give out medical and inspirational materials, and we also give out a lot of hugs. I think people like this because there is a distancing that occurs when you tell someone you have cancer. It’s almost as if people think hugging someone with cancer would hurt them, or they’d catch cancer. People think they have to be cautious. There is a lot of isolation — you’re not feeling good about how you look or how you feel, and suddenly people are distancing themselves from you. In the PERC, the message we give is that we care about you, we’re interested in you and we want to help you.

You’ll find Emily in the PERC every Friday from 9 a.m. to 1 p.m. To volunteer in the PERC call (734) 936-9947. For information on other volunteer opportunities in the Cancer Center, call volunteer services at (734) 936-4327.

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Share Your Hope and Humor!

The U-M Comprehensive Cancer Center's Web site has a new section entitled 'Share the Hope and Humor.' It is for patients, survivors and loved-ones to share the inspirational messages that have helped them on their cancer journey. Please send poems, short stories, inspirational quotes and humorous items to Maxine Solvay, U-M Cancer Center, 427 Med-Inn, 1500 E. Medical Center Dr., Ann Arbor, MI, 48019-0843 or Email: msolvay@umich.edu Trademarked and copyrighted material can only be used with written permission of the publisher. Materials will become the possession of the Progress editor and cannot be returned.


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Current Events In Cancer

What is the Breast Cancer Prevention Trial?
The Breast Cancer Prevention Trial is a clinical trial designed to see if the drug tamoxifen can prevent breast cancer in women who are at an increased risk of developing the disease. The National Cancer Institute-funded study began recruiting participants in April 1992 and closed enrollment in September 1997; 13,388 women ages 35 and older are enrolled at more than 300 centers across the United States and Canada, including the University of Michigan Comprehensive Cancer Center.

What is tamoxifen?
Tamoxifen is a drug, taken by mouth as a pill. It has been used for 25 years to treat patients with advanced breast cancer. Since 1985, it has also been recommended in the U.S. for adjuvant — or additional — therapy, following surgery and/or radiation for early-stage breast cancer. Tamoxifen works against breast cancer, in part, by interfering with the activity of estrogen, a female hormone that promotes the growth of breast cancer cells. In treatment, the drug slows or stops the growth of these cells.

Why was tamoxifen tested to prevent breast cancer?
Research has shown that taking tamoxifen as adjuvant therapy for breast cancer not only helps prevent the original breast cancer from returning but also helps to prevent the development of new cancers in the opposite breast. Researchers believed that tamoxifen might have a similar beneficial effect for women at increased risk of breast cancer. While tamoxifen acts against the effects of estrogen in breast tissue, it acts like estrogen in other body systems. Tamoxifen’s estrogen-like effects include the lowering of blood cholesterol and the slowing of bone loss.

Who participated in the prevention trial?
Women at increased risk for developing breast cancer participated in the study. These included women 60 years of age and older who qualified to participate based on age alone, and women between the ages of 35 and 59 with an increased risk of breast cancer equivalent to or greater than that of a 60-year-old woman. At age 60, about 17 of every 1,000 women are expected to develop breast cancer within five years. Participants were randomized (selected by chance) to receive either tamoxifen or a placebo. In a process known as “double blinding,” neither the participant nor her physician knew which pill she was receiving. This allowed researchers to see what the true benefits and side effects of tamoxifen are without the influence of other factors.

What are the initial results of the prevention trial?
Women on the trial have been followed for about four years. Results show 45 percent fewer diagnoses of invasive breast cancer in women who were randomized to take tamoxifen compared to women who were randomized to take the placebo (85 cases in the tamoxifen group versus 154 cases in the placebo group). Women on tamoxifen also had fewer diagnoses of non-invasive breast cancer. Eight women have died of breast cancer, three women in the tamoxifen group and five women in the placebo group. Tamoxifen did increase the women’s chances of three rare but serious health problems. There were 33 cases of endometrial cancer (cancer of the lining of the uterus) in the tamoxifen group versus 14 cases in the placebo group; 17 cases of pulmonary embolism (blood clot in the lung) in the tamoxifen group versus 6 cases in the placebo group; and 30 cases of deep vein thrombosis (blood clots in major veins) in the tamoxifen group versus 19 cases in the placebo group.

Why was the study “unblinded?”
Participants and their physicians were informed what pills the participants had been taking when the National Cancer Institute, the National Surgical Adjuvant Breast and Bowel Project and an independent committee assessed the data, which showed clear evidence of a reduction of breast cancer incidence in the tamoxifen group. It was agreed that any additional information that could be gained from continuing the study in its current form did not outweigh the benefits of making the treatment available to the participants in the placebo group and other women at an increased risk of breast cancer.

Should women at increased risk of breast cancer take tamoxifen?
As with any medical intervention, the decision to take tamoxifen is an individual one in which the benefits and risks of the therapy must be considered. The balance of these benefits and risks will vary depending on a woman’s health history and how she weighs the benefits and risks. Therefore, even if a woman is at increased risk of breast cancer, tamoxifen therapy may not be appropriate for her. Women who are considering tamoxifen therapy should see their health care provider.

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Get Involved in “The March”

On Sept. 26, individuals across the nation will pause to recognize the impact of cancer on our society. A grassroots campaign called “THE MARCH: Coming Together to Conquer Cancer” has been organized to make cancer — its treatment and cure — a national priority.

The campaign kick-off will be held on the Mall in Washington, D.C., where survivors and their families, physicians, researchers and elected officials will come together for a candlelighting ceremony and rally. The goal is to raise awareness that cancer is everyone’s problem and demand greater funding for cancer research and increased access to quality care for all people with cancer.

The University of Michigan Comprehensive Cancer Center is planning several exciting events in conjunction with national activities, including a Survivors’ March on the U-M Football Stadium during the Michigan State University game. For more information, please call (800) 742-2300, ext. 9268.

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M Personal Touch

Breast surgery and other cancer treatments may alter a woman’s appearance and leave her emotionally shaken. M Personal Touch, a division of the U-M Health System, offers a program to meet the special physical and emotional needs of women confronted with a diagnosis of breast cancer.

Services include:

• Personalized consultation with a registered nurse who is a certified prosthetic fitter with special training to help women decide which post-breast surgery products suit their body type, surgery and lifestyle.
• A comprehensive line of post-breast surgery products. A breast surgery exercise tape is also available to help increase one’s energy and regain arm and shoulder mobility.
• Information regarding nutrition, diet and community support groups.

Services and products available through M Personal Touch help restore a woman’s appearance and renew her self-confidence. This program is committed to helping women with special needs pursue the lifestyle they choose. For more information or to schedule an appointment for a personalized fitting, please call (734) 973-2400.

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Editor

Max S. Wicha, M.D.
Director, U-M Cancer Center

Maria White
Director, Marketing Communications

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