Archive for September, 2009

Depression Increases Cancer Patients’ Risk of Dying

September 16, 2009

Depression Increases Cancer Patients’ Risk of Dying – this is the title of an article on the American Cancer Society website by David Sampson, Director, Medical & Scientific Communications. It relates to a study by Jillian Satin, MA, of the University of British Columbia (UBC) in Vancouver, Canada, and her colleagues who analyzed all of the studies to date they could identify related to the topic.
Jillian Satin says: “We found an increased risk of death in patients who report more depressive symptoms than others and also in patients who have been diagnosed with a depressive disorder compared to patients who have not.”
The article goes on to say: “The investigators note that the actual risk of death associated with depression in cancer patients is still small, so patients should not feel that they must maintain a positive attitude to beat their disease. Nevertheless, the study indicates that it is important for physicians to regularly screen cancer patients for depression and to provide appropriate treatments.”
As a cancer survivor with a history of undiagnosed depression, I know how important it was for me to be treated for depression when I was going through chemotherapy and thought my life was over. Fortunately I was able to work through depression and negative thinking with the help of a psychiatrist at UBC. She offered me drugs which I refused, and instead I opted for a course in Cognitive Behavioral Therapy (CBT). Along with other tools, I was able to turn my life around and regain my health. I still have bouts of depression from time to time, but they are short lived compared to the bouts I had before CBT.

I know people with cancer who say they don’t believe in positive thinking, and health care providers who say patients should not have to “think positive”. I agree that pretending to be positive when you’re feeling stressed or depressed is not a wise thing to do. However, I believe I would have died long ago if I hadn’t managed to convert my negative thinking and depression into positive thinking and hope, so that I would live to see my children grow up.

The key is to do the work to get rid of negative thoughts and depression. CBT has been proven to be an effective way to control depression, but it takes a willingness to work on it and requires an element of support, as it is very difficult to do this alone.

I know how hard it is to be in the depths of depression; I’ve been there, with thoughts of being so miserable I wanted my life to end. Usually what happened to break that cycle was for me to find something else to focus on, and force myself to put time and effort into getting busy with that. Gradually I could feel myself in a bit of an upward spiral and with sheer determination I would climb up out of the deep, dark, pit where I had previously seen myself trapped. It was helpful to find something to work towards and to think about besides the bottom of that pit.

When I hear people say “I don’t believe in positive thinking” it makes me cringe, because I would not want to go back to that state where I was such a negative thinker. My life has improved 100% since I learned to see things in a different light and focus on positive thoughts every day.

I ask the question “What do you want more of in your life?” If the answer is love, peace, and joy, then I encourage people to do what it takes to reach out for those things which bring happiness.

Cancer is a cruel disease, but it can also teach us some valuable lessons. My experience has taught me to live one day at a time, and to pay attention to the good things in life. I have many positive emotions which feel so much better than the negative emotions I used to spend time with. Now when those negative emotions appear, I am able to process them and let them go, so they can be replaced with love, compassion, and forgiveness for me as well as for others.

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Yoga program helps people with cancer

September 8, 2009

Yoga Thrive is a program designed to help people recover from cancer; participants are “calmer, more limber and stronger than before” says writer Hayley Mick in the Globe and Mail recently. Yoga Thrive instructors are specially trained with regard to cancer and will modify stretches to accommodate people who have had surgery, etc.

Exercise is good for people recovering from cancer, even in the early stages of treatment as long as they’re careful not to overdo it. Yoga will provide the added benefit of the mind-body connection so that people are more in tune with listening to the body if it is saying “No”. Gentle yoga exercise includes deep breathing to promote relaxation, which is a valuable tool in cancer recovery.

Hopefully the Yoga program will produce a similar effect to the dragon boat movement started in 1996 in Vancouver, BC by Dr. Don MacKenzie and a team of energetic breast cancer survivors. Abreast in a Boat (AIAB) was created to show that it’s still possible to exercise after breast cancer surgery. It has been a huge success and women all over the world find enrichment in their lives because of it. Dragon boating provides people with physical exercise, a support group, camaraderie, entertainment, travel, a purpose in life, and much more.

It’s no wonder that recurrence of cancer is reduced when people get together to exercise. Physical exercise alone reduces recurrence; add to that the interaction of people in a similar situation, and the emotional, psychosocial, and spiritual benefits increase as well. I hope the Yoga program catches on and that more people will benefit from learning to control cancer and raise their quality of life.

Cancer does not have to be a death sentence. Just ask the members of Abreast in a Boat and they will tell you their lives have been enriched following a diagnosis of cancer. If it is diagnosed early enough, cancer can be a wake up call and provide an opportunity to make the most of each day.

Clinical breast exam controversy

September 4, 2009

A recent study discusses the “controversy about whether adding clinical breast examination (CBE) to mammography improves the accuracy of breast screening.” The study was published online on August 31, 2009 in the Journal of the National Cancer Institute.
The study of women in the Ontario Breast Screening Program (OBSP) discusses the rise in false positives when women have a clinical breast exam at the same time as the mammography exam. The conclusion of the study is that “women should be informed of the benefits and risks of having a CBE in addition to mammography for breast screening.”
This is an interesting study with a worthwhile conclusion. My concern with any controversy is that it adds to the confusion felt by some women, who may throw up their hands and stay away from screening altogether. I hope this won’t be the case as I believe that women, and men, should be tuned in to the importance of the early detection of cancer.

I understand the fear that women experience when they’re recalled for follow up after a mammogram or when a lump is found on a clinical exam. I was diagnosed with advanced breast cancer in 1986 because screening mammography was not available and my doctor refused to order a mammogram. This resulted in a greater load on the health care system than if it had been detected earlier since it involved surgery, chemotherapy, and longer follow up. There was also a much larger fear factor for my self and my family than if the cancer had been found sooner.

I think we need to do more to help women get through “false positives” without fear and anxiety. The point remains that it’s better to find cancer earlier than later, and to reassure women that it’s better to go through a false positive diagnostic process than to take a chance on letting an unfound cancer grow larger.

There are a couple of basic issues which contribute to false positive mammograms. As a mammographer, I have explained to many women about the challenges of reading mammograms. Breast tissue is formed in branches like grapes so that if the branches are on top of each other in the images, then it’s difficult to tell what’s there; women may be asked to return for further X-rays, either coned, a different angle, or ultrasound. This does not mean there is something wrong with the tissue, but that the radiologist needs more information to make an accurate diagnosis. Similarly, looking at images of dense breast tissue is more challenging as it’s like looking through a tree full of leaves in the summer. As women age, the dense tissue turns to fat and mammograms are much easier to read as they are more like looking through a tree in the winter.

If women are educated to know that the early stages of a mammography work up are a matter of gathering information, then it will relieve some anxiety. False positives from CBE’s are usually from feeling a lump or thickening. Since 80% of breast lumps are benign, it makes sense that they can be viewed calmly if they can be viewed as probable cysts or normal breast lumps, not cancerous growths.

Breast self examinations (BSE) are often not recommended due to the fear factor of false positives, and I hope that CBE’s will not be viewed in the same light. Mammograms are the gold standard in the detection of breast cancer; however, they are not perfect and I believe it’s in everyone’s best interest to continue to do both monthly BSE’s and annual CBE’s with a health professional.