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Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Perceptions matter

People’s perception and expectations do affect their health care.

Palliative care physicians, at least in UK, are mainly based or linked to hospices.

In UK , hospices often provide terminal care to cancer patients. The hospice team provide a invaluable service in terms of minimising the patient’s suffering as the cancer takes its toll.

Palliative care physicians are an integral part of terminal care team. But they are often able to offer more than terminal care. Their significant expertise can be of immense help to patients in “early” part of cancer journey.

But the perception that a referral to palliative care team at hospice is bad news hinders some patients….

One option to overcome the stigma would be relocation of palliative care departments to cancer centres at hospitals so that the referral to palliative care team doesn’t have a negative connotation .

Please provide your thoughts at the BMJ site through rapid response link.

Reference

“Palliative care: relocation rather than rebranding is needed” published online by BMJ.

Access the article at: http://bmj.com/cgi/content/full/bmj.l1641

Toll-free link:

http://bmj.com/cgi/content/full/bmj.l1641?ijkey=gPzXvpIHI1jQwYi&keytype=ref

Can dietary supplements make you live longer?

A recent study published in Annals in Internal Medicine looked at the effects of dietary supplements on overall mortality risk.

“Use of dietary supplements was NOT associated with mortality benefits among U.S. adults.”

In fact, there was a suggestion of increased risk of cancer deaths from calcium supplements.

Reference: Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study. Ann Intern Med. [Epub ahead of print 9 April 2019] doi: 10.7326/M18-2478.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

What’s in a name?

awareness cancer design pink Photo by Miguel on Pexels.com

The word cancer is a dreaded one. Not without a good reason. Cancer is the number one killer. Even when someone has a good outcome, the cancer journey is torture. Emotional turmoil is immeasurably horrendous.

But many people would be surprised to hear that there exists a category of low risk cancers. “Low-risk Cancers are cancers which usually don’t kill; These Cancers are found either incidentally on scans performed for some other reasons or found as part of routine cancer screening.”

Because they are not deadly, Should the patients diagnosed with low-risk cancers be spared the dreaded label of cancer?

Should low-risk cancers be labelled something else and the word cancer used only for the “serious” high-risk cancers ?

Personally, I do not agree with renaming of the low risk cancers..Others disagree

Joint the debate at the BMJ.

Submit your views through rapid response

Reference: 
Should we rename low risk cancers? BMJ

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Is it a bad idea to use alternative therapy instead of conventional treatment for Cancer?

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Generally speaking Yes, it is a very bad idea.

Patients using alternative therapy exclusively  such as mistletoe therapy, vitamin therapy quite often come to harm.

For example, a well known Chinese actress shunned conventional chemotherapy for her lymphoma. Instead, Ms Xu Ting – a previously fit and well 26 year old – opted for traditional Chinese medicine methods for her lymphoma.

She underwent alternative therapies such as cupping, acupuncture, back stretching and a method called gua sha. Unfortunately traditional treatments didn’t help and she died from a potentially curable cancer. (1-3).

The misconceptions are certainly NOT confined to East. One of the prominent examples in the West is the fate of Dutch actress Sylvia Millecam.

She refused conventional treatment for her Breast Cancer and instead tried a wide range of so called alternative treatments – such as faith healing, salt therapy and magnetic field therapy. She unfortunately died of a potentially curable cancer. (4-6).

In addition to these well known anecdotal evidence, Studies have shown that alternative therapies can affect survival. Utilization of alternative therapies for curable cancer without any conventional therapy was associated with greater risk of death. (7-11).

However convincing the material you read on social media and wider internet, do NOT abandon conventional tretments. Always ask professional opinion about various things you have read and if not satisfied, ask second or third opinion.

 

How else cancer patients use complementary/ alternative therapy?

Although scientifically not universally validated, complementary medicine may help some cancer patients to cope better with their symptoms. Many patients do use acupuncture, hypnotherapy, massage, aromotherapy and group art therapy to deal with physical and psychological symptoms and side effetcs from conventional treatments.

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Links

Chinese actress

1. https://www.independent.co.uk/news/people/xu-ting-death-cancer-actor-chose-alternative-medicine-over-chemotherapy-a7310786.html

2. https://www.bbc.co.uk/news/world-asia-china-37370201

3. https://www.theguardian.com/world/2016/sep/16/chinese-actor-xu-ting-dies-after-choosing-traditional-medicine-over-chemotherapy

Dutch actress

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1910656/

5. https://en.wikipedia.org/wiki/Sylvia_Millecam

6. https://www.theguardian.com/society/2004/mar/23/lifeandhealth.cancercare

Survival Risk

7. Cancer patients who use alternative medicine more than twice as likely to die.The Independent, August 15 2017

8. Cancer patients who rely on herbs, homeopathy or energy crystals over conventional treatment are two-and-a-half times more likely to die within five years of diagnosis.Mail Online, August 15 2017

9. Cancer patients who shun chemo for alternative therapies ‘are TWICE as likely to die’.The Sun, August 15 2017

10. Johnson SB, Park HS, Gross CP, Yu JB. Use of Alternative Medicine for Cancer and Its Impact on Survival.Journal of the National Cancer Institute. Published online August 10 2017

11. https://www.nhs.uk/news/cancer/alternative-cancer-therapies-may-increase-your-risk-death/

 

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Surprising Number of Americans Believe Alternative Therapies Can Cure Cancer

woman holding white laptop between women

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A recent National Cancer Opinion Survey found that a significant Number of Americans Believe Alternative Therapies Can Cure Cancer.

Nearly four in 10 Americans (39%) believe cancer can be cured solely through alternative therapies such as enzyme and oxygen therapy, diet, vitamins, and minerals.

Even many of the respondents with direct cancer experience—people who have or had cancer and family caregivers—believe cancer can be cured solely through alternative medicine.(22% and 38%, respectively).

The American survey also found that younger people are the group most likely to hold these views: 47% of people ages 18 to 37 and 44% of people ages 38 to 53.

It is counterintuitive that the generation with access to vast online information at the swipe of a finger holds such unscientific views. One wonders whether the social media is inadvertently promoting misinformation.

References

1.American Society of Clinical Oncology : Second National Cancer Opinion Survey.

 

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Can Turmeric control cancer ?

Turmeric powder

 

Turmeric is an orange coloured spice widely used in Indian dishes.

Turmeric has been used in Indian traditional medicine (Siddha and Ayurveda).

Turmeric has anti-inflammatory and anti-Cancer properties when tested in laboratories.

Remember – a potential to be beneficial (based on lab studies) is not the same as being proven to work in humans. Lot of substances which are promising in the laboratory eventually turn out to be useless in humans.

If you search PUBMED database- which is an online database of scientific papers- you will find hundreds of papers pertaining to medicinal use of turmeric and its key ingredients such as curcumin. But unfortunately among the many hundreds of published papers, there are very few human trials which have explored turmeric as a anti-cancer treatment.

Inspite of the positive anectodal reports on various internet sites, the available scientific evidence for use of turmeric as an anti-cancer treatment is very spare. ( references below).

Hence it is not worthwhile using turmeric as a cancer treatment.

If you do like Indian dishes, use turmeric as a spice in your normal diet.

But do stay away from the supplements which are sold with health claims.

 

ginger and turmeric powder

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References

The EssentialMedicinal Chemistry of Curcumin.Nelson KM, Dahlin JL, Bisson J, Graham J, Pauli GF, Walters MA. J Med Chem. 2017 Mar 9;60(5):1620-1637.

Phase I clinical trial of oralcurcumin: biomarkers of systemic activity and compliance.Sharma RA, Euden SA, Platton SL, Cooke DN, Shafayat A, Hewitt HR, Marczylo TH, Morgan B, Hemingway D, Plummer SM, Pirmohamed M, Gescher AJ, Steward WP. Clin Cancer Res. 2004 Oct 15;10(20):6847-54.

A Placebo-Controlled Double-Blinded Randomized Pilot Study of Combination Phytotherapy in Biochemically Recurrent Prostate Cancer.van Die MD, Williams SG, Emery J, Bone KM, Taylor JM, Lusk E, Pirotta MV. Prostate. 2017 May;77(7):765-775.

Efficacy and Safety of Curcumin in Treatment of Intestinal Adenomas in Patients With Familial Adenomatous Polyposis.Cruz-Correa M, Hylind LM, Marrero JH, Zahurak ML, Murray-Stewart T, Casero RA Jr, Montgomery EA, Iacobuzio-Donahue C, Brosens LA, Offerhaus GJ, Umar A, Rodriguez LM, Giardiello FM. Gastroenterology. 2018 Sep;155(3):668-673.

Effect on prostatic specific antigen by a short time treatment with a Curcuma extract: A real life experience and implications for prostate biopsy.Fabiani A, Morosetti C, Filosa A, Principi E, Lepri L, Maurelli V, Fioretti F, Servi L. Arch Ital Urol Androl. 2018 Jun 30;90(2):107-111.

Pharmacodynamic and pharmacokinetic study of oral Curcuma extract in patients with colorectal cancer.Sharma RA, McLelland HR, Hill KA, Ireson CR, Euden SA, Manson MM, Pirmohamed M, Marnett LJ, Gescher AJ, Steward WP. Clin Cancer Res. 2001 Jul;7(7):1894.

Consumption of the putative chemopreventive agent curcumin by cancer patients: assessment of curcumin levels in the colorectum and their pharmacodynamic consequences.Garcea G, Berry DP, Jones DJ, Singh R, Dennison AR, Farmer PB, Sharma RA, Steward WP, Gescher AJ. Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):120-5.

A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer–the U.K. NCRN Pomi-T study.Thomas R, Williams M, Sharma H, Chaudry A, Bellamy P. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6

Consumption of the putative chemopreventive agent curcumin by cancer patients: assessment of curcumin levels in the colorectum and their pharmacodynamic consequences.Garcea G, Berry DP, Jones DJ, Singh R, Dennison AR, Farmer PB, Sharma RA, Steward WP, Gescher AJ. Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):120-5.

A phase I/II study of gemcitabine-based chemotherapy plus curcumin for patients with gemcitabine-resistant pancreatic cancer.Kanai M, Yoshimura K, Asada M, Imaizumi A, Suzuki C, Matsumoto S, Nishimura T, Mori Y, Masui T, Kawaguchi Y, Yanagihara K, Yazumi S, Chiba T, Guha S, Aggarwal BB. Cancer Chemother Pharmacol. 2011 Jul;68(1):157.

Phytosome complex of curcumin as complementary therapy of advanced pancreatic cancer improves safety and efficacy of gemcitabine: Results of a prospective phase II trial.Pastorelli D, Fabricio ASC, Giovanis P, D’Ippolito S, Fiduccia P, Soldà C, Buda A, Sperti C, Bardini R, Da Dalt G, Rainato G, Gion M, Ursini F. Pharmacol Res. 2018 Jun;132:72-79.

Monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, and curcumin: a randomized, double-blind placebo-controlled cross-over 4g study and an open-label 8g extension study.Golombick T, Diamond TH, Manoharan A, Ramakrishna R. Am J Hematol. 2012 May;87(5):455-60.

 

Image credit: Simon A. Eugster. Turmeric (Curcuma longa):fresh rhizome and powder.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Are Vitamin and Food supplements safe and helpful?

 

medical tablets pharmacy cure

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A British man recently ended up needing a liver transplant after taking green tea capsules. (1).(2).

Many people do not realise that supplements can be useless or even harmful. 

Firstly, Dietary supplements may not always be helpful. Even though the Public Health team in England recommend vItamin D supplements, a large study published recently  – found that Vitamin D supplements do NOT prevent fractures or falls in General population. (3) (4).

Secondly, Dietary supplements can be harmful. For example , a cancer prevention trial involving 35,533 North-American men reported that  “Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men”. (JAMA 2011; 306: 1549).  Another cancer prevention trial in Finland involving 29,133 male smokers unexpectedly found a “higher incidence of lung cancer among the men who received beta carotene dietary supplements”. (NEJM 1994;330:1029 )

On the other hand, Vitamin are essential nutrients. Vitamin deficiency can be severely harmful to health. Vitamin D deficiency is common in colder parts of northern hemisphere. Vitamin D supplements are used in treatment and prevention of osteoporosis (5). Vitamin B12 deficiency is common in Vegans and Vitamin B12 supplements are used. (6).

So there is no clear cut answer ….

Always consider the possibility that “dietary supplements may actually have harmful as well as possible beneficial effects”. 

yellow health medicine wellness

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References: 

  1. BBC News – Are supplements safe and do they work? https://www.bbc.com/news/health-45992725
  1. Daily mail: Green tea supplements may cause liver damage, warns EU watchdog. https://www.dailymail.co.uk/health/article-5629791/How-healthy-healthy-EU-warns-green-tea-supplements.html
  1. Public Health England recommends vitamin D supplements in autumn and winter.  BMJ 354 doi:10.1136/bmj.i4061
  1. Guardian : Vitamin D supplements don’t help bone health, major study concludes. https://www.theguardian.com/society/2018/oct/04/vitamin-d-supplements-dont-help-bone-health-major-study-concludes
  1. Vitamin B12 and Health: http://www.lnds.nhs.uk/Library/Vitamin_B12_and_HealthOct2018LNDS123.pdf
  1. National Osteoporosis Guideline Group: https://www.sheffield.ac.uk/NOGG/mainrecommendations.html

Can Vitamin D control prostate cancer?

Vitamin D is also known as the “sunshine vitamin” because it’s produced in your skin in response to sunlight. Vitamin D is critical for bone health and general health.

sunlight

Low levels of vitamin D in blood have been linked to cancer and other diseases.

But taking Vitamin D supplements to control an existing prostate cancer is controversial.

vitamin D

In  the lab, Vitamin D can stop prostate cancer cells growing and spreading.

One human trial suggested better outcome when high strength vitamin D is combined with standard chemotherapy.  But a second trial involving prostate cancer patients showed an unexpected and unexplained increase in death rate in patients taking Vitamin D with chemotherapy.

So the answer is “no” – Vitamin D cannot be used to control prostate cancer.

Related Links:

1. Sung V. 1,25-Dihydroxyvitamin D3 decreases human prostate cancer cell adhesion and migration. Mol Cell Endocrinol. 2000;164:133–143.

2. Moffatt KA. Growth inhibitory effects of 1α, 25-dihydroxyvitamin D3 are mediated by increased levels of p21 in the prostatic carcinoma cell line ALVA-31. Cancer Res. 2001;61:7122–7129.

3. Double-blinded randomized study of high-dose calcitriol plus docetaxel compared with placebo plus docetaxel in androgen-independent prostate cancer: a report from the ASCENT Investigators. J Clin Oncol. 2007 Feb 20;25(6):669-74.

4. Another Clinical Trial Failure – Ascent-2 https://malecare.org/another-clinical-trial-failure-ascent-2/

5. Randomized, open-label phase III trial of docetaxel plus high-dose calcitriol versus docetaxel plus prednisone for patients with castration-resistant prostate cancer. J Clin Oncol. 2011 Jun 1;29(16):2191-8.

 

 

 

Can Pomegranate fruit control prostate cancer?

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Some lab studies have indicated that pomegranate fruit is active against prostate cancer. Unfortunately, three separate patient studies have shown only minor activity  in the form of “slowing down of PSA rise”

So “Eat fresh fruit or Drink fresh juice” if you relish it like any other fruit or juice. If there is any effect on prostate cancer, it would be unexpected bonus. But don’t compel yourself to eat or drink it for therapeutic benefit !

Bear in mind that the pomegranate juice or fruit can interfere with some other medications. And I will also state the obvious that “pomegranate is not an approved cancer treatment”.

Links for further reading:

1. Daily Mail. Pomegranate juice ‘can help fight prostate cancer’. http://www.dailymail.co.uk/news/article-393368/Pomegranate-juice-help-fight-prostate-cancer.html

2. Guardian: Consider the pomegranate.  https://www.theguardian.com/lifeandstyle/wordofmouth/2011/feb/01/consider-pomegranate

3.Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res. Jul 1 2006;12(13):4018-4026.

4. A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer.Prostate Cancer Prostatic Dis. 2013 Mar;16(1):50-5.

5. A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer—the U.K. NCRN Pomi-T study. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6.

6. Is pomegranate juice a potential perpetrator of clinical drug-drug interactions? Review of the in vitro, preclinical and clinical evidence. Eur J Drug Metab Pharmacokinet. 2013 Dec;38(4):223-9. doi: 10.1007/s13318-013-0137-x.

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What causes prostate cancer?

The short answer is “bad luck“.

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The fact is that we do not know the exact cause of prostate cancer in most patients .

So, at present, we have to say it’s “bad luck” if one develops prostate cancer.

Many things have be shown to be associated with increased risk of prostate cancer.

father son

Sometimes prostate cancer runs in the family and abnormal genes are passed from one generation to other. So it’s “bad luck” if you have inherited the abnormal genes. One cannot change their genes.

Western men are at increased risk compared to the Asians.  Afro-Caribbean men are at much higher risk of developing prostate cancer compared to Caucasians.

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Many other factors such as bad diet, obesity, unhealthy life style, smoking, hormones, & inflammation have been suggested as possible risk actors but none of the them have been conclusively proven as the cause of prostate cancer.

 

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How to communicate that the disease is mild even though symptoms are disabling?

women s white long sleeved top

Beth McHugh makes a strong argument for doctors “not to explicitly discuss disease severity scale”.

But

(1) A valid informed consent would then become difficult

(2) Not discussing severity, is not a practical option for patients with certain illness.

My BMJ eLetter on this topic…

Risk categorisation will continue to be the norm in future as genomic data leads to personalised medicine.

England’s 100 000 Genomes Project

Living with cancer…

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A cancer diagnosis turns your life upside down. But “Living with cancer” should not bring your professional life to a cliff edge.

Continuing to offer your professional knowledge and expertise not only helps you financially but also boosts your self esteem. But working full time is not an option nor feasible for many cancer patients.

Asteriid,a unique charity, launched by David Shutts, aims to help millions of people living with cancer.

Read the inspiring story of David Shutts at BBC website.

How do you get work when your cancer won’t go away?“.

BBC TV news also featured the pioneering Charity Astriid on its Morning bulletin on 11th May 2018.

To know more about Astriid, please visit: https://www.astriid.org.uk/s/ 

www.sundar.blog

 

stetchscope pen laptop

Hi,

This blog will be a commentary on health related news with particular focus on clinical studies involving the cancers I treat. (my profile: https://sundar.uk ).

Disclaimers first:

  1. This blog cannot provide personal medical advice. Medicine is incredibly complex and nothing is absolute, and everything depends on individual circumstances. So always consult your own oncologist.
  2. Remember modern medicine is ever changing and the “only thing that is permanent is change itself”. That’s why new evidence sometimes completely contradicts conventional wisdom and practice.  Don’t be surprised if scientific studies contradict each other.
  3. To avoid anyone inadvertently disclosing personal or confidential information, comments will be disabled.
  4. The views expressed here are strictly personal and the views do not in any way whatsoever reflect the views or policies of the many professional organisations I am associated with.

Sundar

www.sundar.blog