Cancer touches the lives of most Americans at one point or another. The American Cancer Society projects that 2017 will bring nearly 1.7 million new diagnoses of the disease, and more than 600,000 deaths. Fortunately, modern medicine can read some of cancer’s earliest warning signals, tailor treatments to patients’ needs, and reduce their pain and stress along the way. Here, we look at genetic testing to predict the likelihood of cancer; holistic health practices for those dealing with its effects; and the use of medical marijuana by cancer patients.
in the genes
Heredity is behind our most distinctive characteristics, from hair color to body type. Sometimes, however, it’s also the harbinger of bad news such as cancer. In the past, doctors could diagnose this serious condition only after it had taken hold in the body, which presented a setback to successful treatment. Now, however, they can look for mutations in our DNA that signal cancer risk early on, and create advance plans to deal with it.
Doctors use two main types of genetic testing to learn about a patient’s cancer ‘picture,’ says Erin Linnenbringer, Ph.D., an instructor in surgery at Washington University’s Siteman Cancer Center. The first is germline genetic testing, which is done on a blood sample and helps determine if the patient’s DNA carries a mutation that increases the risk of certain cancers. The second is tumor (or ‘somatic’) genetic testing, which is done on biopsied tumor tissue. It’s used to create a prognosis and help doctors choose the best treatments, Linnenbringer says. “It may help them decide which type of chemotherapy drug to use, or whether radiation is necessary,” she notes.
Linnenbringer says germline testing is used most often to look for risk of breast, ovarian and colorectal cancers, but it also can identify risk of more rare cancers. “Germline testing is most effective for cancer screening when an otherwise healthy person has the same mutation as an affected family member,” Linnenbringer notes. And tumor genetic testing can be used for certain types of lung cancer, breast cancer, melanoma and leukemia, she says.
all in the family
People with a family history of cancer should ask a primary care doctor for a referral to a genetic counselor for possible germline testing, Linnenbringer says. And those who already have a cancer diagnosis should ask what type of testing may be appropriate for them. “A counselor can educate the patient about testing options, discuss benefits and limitations, and support the person through the decisionmaking and results process,” she notes.
Germline testing can’t determine if tumors are already present, or when they might develop. It only can confirm that a genetic tendency for the disease exists, says Suzanne Mahon, DNSc, RN, a SLUCare advanced practice nurse, who counsels families about cancer risk at Saint Louis University Cancer Center. “We know that about 10 percent of cancers have a genetic predisposition,” she says. “The goal is to determine whether the family has a hereditary risk. If we can identify that, we can do more aggressive screening and possibly recommend preventive surgery.”
Mahon adds that testing for cancer’s likelihood isn’t always as straightforward as it may seem. It’s possible, for example, to screen for a cancer the patient seems likely to get, but then have nothing show up on his or her test results. It’s also possible for some family members to inherit a cancer risk, but not others. “Say there’s a young woman who tells her gynecologist about a family history of cancer,” Mahon explains. “She doesn’t have a gynecological or breast cancer diagnosis herself, but she’s worried about risk. The doctor orders genetic testing, but no mutation is detected. Her family members may think they’re safe, but it doesn’t mean they don’t have the hereditary risk. They should be tested, too.”
Mahon says genetic testing is a complex process, but it can do a lot of good and help the patient make better health choices. “It also can save a lot in treatment costs,” she notes. “And you can’t put a price on the relief it brings when you can prove that the patient hasn’t inherited a cancer risk.”
the whole patient
These days, dealing with cancer isn’t just about treating or removing tumors. It’s about caring for body, mind and spirit to ensure the patient is as mentally and physically supported as possible, doctors say.
Michelle Smith, D.C., manager of integrative medicine and therapy services for Mercy St. Louis, says cancer patients can access many ‘holistic’ services that address mind and body simultaneously. She is a chiropractor and acupuncturist who works to reduce stress, pain, nausea, anxiety and other symptoms experienced by those in treatment, so they can approach the process more positively. Mercy’s Integrated Medicine Department offers many services, including yoga, fitness, acupuncture, ‘healing touch’ body-energy therapy, ‘guided imagery’ visualization, aromatherapy, reflexology, nutrition and counseling to help patients progress more comfortably through treatment.
According to information published by the Cleveland Clinic, physical exercise and relaxation techniques like those used in yoga can lessen cancer treatment’s mental and physical side effects, including fatigue, poor sleep and depression. This may be because the physical activity helps regulate cortisol, the body’s stress hormone, which also has been linked to worse cancer outcomes when elevated.
movement and touch
“Yoga, massage, healing touch and meditation definitely help with relaxation, centering yourself and improving your outlook,” Smith says. “Techniques like these also empower patients to have some say in their own care plan. They’re not able to choose what drugs they will be given or the amount of chemotherapy they’ll receive. But this is something they can pick, and giving them some control in health care decisions is good for their mental well-being. They can tell us, ‘Massage helps my pain, but healing touch doesn’t.’ That helps providers decide which tools should be part of each person’s treatment plan.”
Smith says touch and relaxation techniques like yoga and massage also are beneficial because they can be used no matter what kind of cancer treatment the patient is receiving. “They are all safe, and there are no conflicts with medications,” she says. “They can help the patient achieve connection and calm from a body, mind and spiritual perspective.”
marijuana: magic medicine?
Marijuana for medical use is not currently legal in Missouri, but it’s on the health care community’s radar, as several states have passed laws allowing it in the last year. Its use is not without risks, but some health care providers believe it should be legalized in a purified, standardized form to help patients with conditions like cancer.
According to information published by the National Institutes of Health, marijuana (hemp, or cannabis sativa) has been shown in some cases to ease cancer patients’ pain and reduce the nausea and vomiting caused by medications. The problem with legalizing it, according to NIH, is threefold: 1.) Marijuana use can cause significant health problems, including neurological and cognitive impairment; 2.) The composition, safety and use of the drug are hard to regulate; and 3.) The public may assume marijuana is safe if it’s being used by patients.
on the docket
Rep. Jim Neely (R-Cameron), a physician, has been working to get a medical marijuana bill through the Missouri legislature in recent years. He lost a daughter to cancer in 2015, and has said he feels strongly about making medical marijuana available to patients who could benefit from it. His proposed bill would expand Missouri’s existing ‘Right to Try’ law to include medical marijuana. The law currently allows terminally ill patients to try some drugs that haven’t yet gained FDA approval.
Doctors say more research is needed to determine if marijuana can be used in a safe and effective manner for patients with conditions like cancer. “The limited research available suggests that medical marijuana may help with chemotherapy-related nausea in patients who don’t respond to recommended anti-nausea regimens,” says Dr. John Buettner, medical director of clinical ethics at St. Luke’s Hospital. “If medical marijuana became legal in Missouri, all health care providers would need to carefully review the risks and benefits before recommending it to patients.”