Archive for the ‘Prostate Cancer’ category

Integrative Oncology

November 19th, 2012

Donna Karan and Keely Garfield
photo by Everett Meissner

Plato said, “The part can never be well unless the whole is well.” The team of doctors, technicians and staff at The Farber Center for Radiation Oncology take this maxim pretty seriously, and so not long ago they welcomed Donna Karan’s Urban Zen Integrative Therapy program (UZIT) into their midst, actualizing their faith in integrative medicine and the power of combined healthcare strategies towards optimal wellbeing. As the clinical coordinator for the UZIT program, I have witnessed the program’s astounding growth over these months. It continues to unfold and blossom in the perfectly tended soil of this medical oasis through the careful cultivation of everyone who has worked to give it life. This includes the UZIT volunteers and the patients themselves who have listened to their doctors’ urgings to try an UZIT session. For this, they are rewarded with a truly integrated healing experience in an environment of collaborative care.

What is an UZIT session? Generally scheduled right after radiation treatment, it provides one-on-one time with an integrative therapist and usually lasts approximately 30 to 45 minutes. Sessions combine gentle yoga, restorative yoga, breath awareness, meditation, aromatherapy, reiki and contemplative care to address a variety of symptoms including pain, anxiety, nausea, insomnia, constipation and exhaustion. Initially, most patients seek relief from stress and fatigue, wanting to feel more relaxed, and also have more energy. What they discover is a way to help themselves during and after cancer treatments as they go back to their lives with new and simple tools they can use daily. The techniques they learn help them to breath easier, deal with tension, and alleviate pain and discomfort. They begin to realize the importance of self-care and are empowered to make postive changes in their lifestyles beyond recovery. Indeed, they discover, as one great teacher put it, “The land of healing lies within, radiant with the happiness that is blindly sought in a thousand outer directions.”

How does it work? Essentially, our nervous systems are working overtime and the body cannot tell the difference between “good” stress and “bad” stress. Reacting to this or that, the body ratchets up the load of sugars, fats, and hormones such as cortisol we need to take action. We never get a chance to truly rest and recover. Most of us don’t get enough sleep and even when we do, true relaxation can be illusive. Integrative therapy is an invitation to practice active relaxation, amplifying the body’s own ability to repair and renew. Another outcome is the sense of power to be found in regaining control over our lives as we begin to see ourselves as participants in our healing journeys, cure or no.

On a typical day at Farber I can be found working with patients perhaps leading a chair-yoga sequence to boost energy, offering reiki to restore balance, using essential oils such as grapefruit or peppermint to assuage nausea or dizziness, meticulously folding blankets to create a restorative pose that will ease back pain, teaching someone how to stand in tree pose to help focus the mind, guiding another through a body-scan meditation or practicing simply for the joy of it! Being with my patients and holding the space for whatever needs to arise or fall away is vital.

A decade ago, I lived near-by The Farber Center and was caught up in the terrible events of 9/11 that ultimately precipitated my own journey back to life. To be on this turf again, now sharing all of the potent therapeutics that have helped me and that I so passionately believe in, feels like a miracle. My patients share my gratitude and awe for this work, and together we acknowledge the The Farber Center for Radiation Oncology for its leadership, compassion, and vision in creating a home for Urban Zen Integrative Therapy.

Many Bows,
Keely Garfield

Keely Garfield is a certified E-RYT 500 and an Urban Zen Integrative Therapist (UZIT). Having acquired her clinical training at Beth Israel Medical Center, Keely is currently the clinical coordinator for the UZIT program at The Farber Center for Radiation Oncology where she is also an UZIT therapist. Additionally, Keely holds a BA and an MFA in choreography,and her path has been shaped by her work as an acclaimed choreographer and dancer. Keely is also blessed by being the mother of two beautiful beings.

Marijuana linked to testicular cancer

September 10th, 2012

Scientists at the University of Southern California say they’ve detected a link between recreational marijuana use and a greater chance among young males of contracting a particularly dangerous form of testicular cancer called non-seminoma tumors, according to a small study published this month online in CANCER, a peer-reviewed journal of the American Cancer Society.

Victoria Cortessis, one of the study’s authors and an assistant professor of preventive medicine at the Keck School of Medicine of USC in Los Angeles and her colleagues analyzed the self-reported recreational drug use of 163 young men who had been diagnosed with testicular cancer. Among those patients who acknowledged indulging in pot, just over half (51 percent) told medical researchers they puffed or ingested cannabis more than once per week.

The team then compared the illegal drug histories of 163 men ages 18 to 35 who were diagnosed with testicular cancer between 1986 and 1991 with the lifestyle habits of 292 healthy men of the same age and ethnicity. Inside the data, they saw that men who had used marijuana recreationally were twice as likely to develop mixed-germ-cell tumors, including the deadlier non-seminona tumors.

It’s not clear how marijuana may increase testicular cancer risk. The active ingredient in marijuana, THC, binds to cannabinoid receptors in the body, which are present in the brain as well as the gonads. THC may impair testicular health by disrupting the signals of the compounds that normally bind to cannbinoid receptors, the researchers said.

There are those that disagree with the findings pointing out that the rates of testicular cancer in California didn’t increase in the 1960s and 1970s when pot use went up. Also arguing that If there was a true cause and effect relationship you would see a increase in testicular cancer rates associated with greater use of cannabis.

This study is in contrast to a recenter study that showed marijuana helped with cancer. Clearly more research needs to be done. Madrid Study

The recommendation is that if you are using marijuana medicinally, you should understand all the risks and benefits. Talk to your doctor.

How To Prevent Cancer

August 15th, 2012

The data out there is that as many as 70% of known causes of cancers are avoidable and related to lifestyle. Of course, your first line of defense is to avoid tobacco products. But here are a few more tips that you might not know about.

1. Lose 10 lbs. Acccording to the American Cancer Society, being overweight or obese accounts for 20% of all cancer deaths among women and 14% among men. Did you know that even if you’re not technically overweight, gaining just 10 pounds after the age of 30 increases your risk of developing breast, pancreatic, and cervical, among other cancers.

2. Marinate your meat. Processed, charred, and well-done meats can contain cancer-causing heterocyclic amines, which form when meat is seared at high temperatures, and polycyclic aromatic hydrocarbons, which get into food when it’s charcoal broiled. If you do grill, add rosemary and thyme to your favorite marinade and soak meat for at least an hour before cooking. The antioxidant-rich spices can cut HCAs by as much as 87%, according to research at Kansas State University.

3. Walk it off. Moderate exercise such as brisk walking 2 hours a week cuts risk of breast cancer 18%. Regular workouts may lower your risks by helping you burn fat, which otherwise produces its own estrogen, a known contributor to breast cancer.

4. Get immunized. Cancer prevention includes protection from certain viral infections. Talk to your doctor about immunization against: Hepatitis B. Hepatitis B can increase the risk of developing liver cancer. The hepatitis B vaccine is routinely given to infants. It’s also recommended for certain high-risk adults — such as adults who are sexually active but not in a mutually monogamous relationship, men who have sex with men, and health care or public safety workers who might be exposed to infected blood or body fluids.
Human papillomavirus (HPV). HPV is a sexually transmitted virus that can lead to cervical cancer. The HPV vaccine is available to both men and women age 26 or younger who didn’t have the vaccine as an adolescent.

5. Avoid carcinogens in cosmetics. Use EWG’s Skin Deep Cosmetics Database to find products free of chemicals known or suspected to cause cancer. When you’re shopping, don’t buy products that list ingredients with “PEG” or “-eth” in their name (chemicals often tainted with contaminants linked to cancer).

6. Eat a plant based diet. The best diet for preventing or fighting cancer is a predominantly plant-based diet that includes a variety of vegetables, fruits, and whole grains. A plant-based diet means eating mostly foods that come from plants: vegetables, fruits, nuts, grains, and beans.

Donna Karan at The Farber Center

July 12th, 2012

photo credit: Everett Meissner

Dr. Marnee Spierer, Donna Karan, Dr. Leonard Farber photo credit: Everett Meissner

For those of you who missed our newsletter, we were happy to have Donna Karan pay a visit to The Farber Center this past month to get an update on her integrative therapy program in our center. Donna Karen had a vision of health care. She imagined a healthcare system where the patient is treated, not just the disease. She imagined a system where eastern healing techniques, yoga therapy, essential oil therapy, and nutrition are used in combination with western medicine in a holistic approach to patient care.

In 2009, the Urban Zen Foundation launched a new program designed to meet this vision: The Urban Zen Integrative Therapy (UZIT) Program is a 500-hour advanced program focused on integrating multiple therapies into patient care. This UZIT program now spends its time at The Farber Center for Radiation Oncology. As you may have read in the last news letter from Keely, the UZIT program has been warmly received by our patients. For the patients it means that they are rewarded with a truly integrated healing experience in an environment of collaborative care.

The UZIT program at The Farber Center has been running for almost a year now, and we were happy to welcome Donna Karan to The Farber Center to see the integrative practice at work. Donna spent time meeting with Dr. Marnee Spierer, Dr. Leonard Farber and a few of our patients to discuss the program. She spent a long time talking to each patient about their experience and story and how the UZIT program has helped them.

Donna with patients Hollie and Marcel photo credit: Everett Meissner

Donna with Patient Kristina photo credit: Everett Meissner

Our goal at The Farber Center is to expand the program so every patient can see an integrative therapist every day of their treatment. To read more about her visit or learn about the program click here: www.urbanzen.org

If you missed the last newsletter you can read it here: Newsletter

Dr. Timothy Chen joins The Farber Center

February 9th, 2012

Dr. Timothy Chen

We would like to welcome Dr. Chen to The Farber Center family. Dr. Timothy H. Chen, MD, is a board-certified Radiation Oncologist. After receiving his undergraduate degree from Taipei Medical College’s School of Medical Technology in Taiwan, Dr. Chen went on to complete his medical degree and then completed his residency at SUNY Health Science Center at Syracuse. Dr. Chen served as Chief Resident of the Department of Radiation Oncology at The New York Hospital Cornell Medical Center.

Dr. Chen holds special interest in the treatment of gynecologic malignancy, lung cancer, central nervous system malignancy, prostate implant, stereotactic radiosurgery, and brachytherapy (seed implantation). His passion for the field of medicine is further evidenced by his appointments as assistant professor at the SUNY Health Science Center at Stony Brook and instructor in Human Anatomy, Pathology at New York Methodist Hospital’s School of Radiation Therapy Technology.

In addition, Dr. Chen is an active member of various professional associations including: the American Society of Therapeutic Radiology and Oncology, American College of Radiation Oncology, American Medical Association, and American Cancer Society. Dr. Chen is also president at the American Cancer Society Asian Initiative. Dr. Chen is fluent in Mandarin and Taiwanese. He currently lives in New Jersey with his wife Laura, and two kids Krista age 13 and Joshua age 9.

We have also featured Dr. Chen in our new monthly newsletter click here: FARBER NEWSLETTER

Knowing your family history can save lives

January 23rd, 2012

Lynch Syndrome International

Did you know that one out of every 35 patients that get colon cancer, also has Lynch Syndrome. Lynch Syndrome is a hereditary disorder caused by a mutation in a mismatch repair gene in which affected individuals have a higher than normal chance of developing colorectal cancer, endometrial cancer, and various other types of aggressive cancers, often at a young age.

Lynch syndrome has no gender, ethnic or cultural preference. It targets families, predisposing them to cancer at a younger than average age. Children of a Lynch syndrome parent possess a 50% risk of acquiring a mutation. During their lifetimes, those diagnosed face up to an 80% risk of contracting colon cancer and, women have up to a 60% risk of contracting endometrial cancers. An increased risk exists of contracting a myriad of other cancers. Lynch syndrome cancers are extremely aggressive and don’t have the extended “dwell time” (time tumors live and exist in the body until becoming cancerous) as other cancers, thus the reason it is very important to obtain regular surveillance testing.

LYNCH CANCERS LIFETIME RISKS
Colon Cancer – Up to 80% General Population 2%
Endometrial Cancer – Up to 60% General Population 1%
Stomach – Up to 13% General Population – 1%
Ovarian – Up to 12% General Population 1%

The only known method of accurately diagnosing Lynch syndrome is through genetic testing. If the family medical history indicates three family members, two of which are directly related to a third, and who each sustained Lynch cancers (Colorectal Cancer, Endometrial Cancer, Gastric Cancer, Ovarian Cancer, Hepatobiliary Cancer, Pancreatic Cancer, Ureter Cancer, Renal Pelvic Cancer, Skin Cancer (Muir Torre) and Brain Cancer. genetic testing should be discussed with one’s physician.

Once Lynch syndrome has been diagnosed, a highly targeted screening and medical management program is essential and may be lifesaving. During routine surveillance screening, tumors may be discovered and are more easily removed or treated before becoming life threatening. To learn more about Lynch Syndrome go here: Lynch Syndrome International

Give this new year

January 18th, 2012

Have you ever wondered if there was an easier way to raise money for a friend or loved one in need. As we all know even those who have medical insurance, the out-of-pocket expenses can be daunting. Unfortunately, most sites are set up to help you raise monies for existing non-profit organizations, but I did find a great site called Give Forward. The site started in 2008 and has helped to raise over $5million for out-of-pocket medical expenses. They have over 10,000 users and completed over 5,000 fundraisers.

GiveForward provides personalized fundraising webpages to users, the majority of whom are looking for help for themselves or someone close to them for expenses like co-pays, travel to treatment and making ends meet in the face of a devastating illness. GiveForward funds its service by deducting a 7% fee from donations, which covers credit-card processing fees and the company’s own expenses.

Take a look, its easy to set up:GiveForward

A few of their current fundraisers

What to do when the hair is gone

October 24th, 2011

Follea Wig


Hair loss is one of the most common side effects of chemotherapy. Some people prefer to let their baldness run its course untreated and unhidden. For others, losing their hair makes them feel raw, and exposed. What is most important to know is that what ever your choice, you should know that some insurance companies will reimburse women for the purchase of a medical cranial hair prosthesis (wig).
Most insurance companies will require a prescription from your physician or oncologist for a medical cranial hair prosthesis. Many of the companies will not cover wigs and it will be important to have the correct wording (medical cranial hair prosthesis) in the prescription in order to get reimbursement.
It is also suggested that you obtain a letter of medical necessity from your physician, oncologist, or dermatologist. This will be an explanation of the need for the medical cranial hair prosthesis and the medical cause for the loss of hair. It will also be necessary to provide a paid receipt for the medical cranial hair prosthesis for the insurance company.
Information necessary for insurance reimbursement:
A prescription for a medical cranial hair prosthesis from your physician
A letter of medical necessity from your physician
A paid receipt for the medical cranial hair prosthesis
A confirmation of prosthetic coverage from the insurance company

Since a wig is not everyone’s choice below are some wig options and alternatives:

www.caringandcomfort.com
A unique option is to use your hair or donated hair to make your own wig. You can send just one head of hair (one ponytail) and they will match the color and texture to provide the rest needed to complete the wig. (About 3 heads of hair are used to make each wig.)

www.follea.com
A great choice for women is the Gripper-2 Cool which features a hand-tied lace top, with small open lace-front. They chose to incorporate a soft-lined, close-wefted back that passes the “hairdryer test”. That is, if you blow a hairdryer (or a strong wind) on the back of your head, you don’t see the wefts. In order to accomplish this they have almost doubled the density in the back top and side sections just below the crown, in comparison to the original Gripper Cool. The advantages of this design include allowing more air to pass through to the scalp, to keep the wearer cool, as well as letting the style lay closer to the back of the head. It also vastly reduces the risk of hair inverting through the cap compared to an all hand-tied back.follea gripper
In NYC you can get them from:

Michelle Duncan
380 Lenox Avenue Ste 3A
New York, NY 10027
917-733-4160
www.charlesduncanbeaute.com

http://www.y-me.org
The Y-Me National Breast Cancer Organization provides wigs, prostheses and mastectomy bras to women whose budget just won’t stretch to cover the cost of those items. Contact them to find out where the closest affiliate office is located that has a Wig Bank. The NBCO offices often have salons where women can try on items before taking them home.

http://andrewdisimonewigs.com
American Cancer Society volunteer and NYC veteran hairstylist, Andrew DiSimone offers the largest selection of all hand tied wigs in New York City and complementary 24 hour drop off wig servicing at his NYC hair salon for as long as you need to wear it. Wigs by Andrew Disimone are revolutionary hair systems with graft technology – not old style weft design. Each hair loss system is essentially a stocking thin layer of skin or lace with human or synthetic hair tied to it one at a time! They have an easy on/off design that allows your own hair to grow underneath. No tapes or bond to hold them on, and they fit incredibly well. A custom mold of your head can be made, plus you can request any hair texture, color and length up to 20″.

http://www.4women.com/
BeauBeau® head scarves are designed specifically for hair loss due to chemotherapy, alopecia or other medical conditions. They’re unique, fashionable and versatile!

Choose head scarves from Soft rayon, delicate silk, workout fabrics, headwarmers – lined with exquisitely soft cotton. Their chic cancer scarves focus on uniqueness over mass production, creating beautiful cancer headwear to compliment your wardrobe from casual to elegant.

http://www.forzieri.com
For luxury head scarves from designers like Missoni and Cavalli this site is great.

http://www.headcovers.com
This site was created by a breast cancer survivor and has some great sleep caps and hats.

Integrative therapy at The Farber Center

October 17th, 2011

We have partnered with Urben Zen to provide Integrative therapy to all our Farber Center patients on treatment. What is an integrative therapy session? There are specific yoga therapies, Reiki therapy, and Oil therapy that deal with different aspects of the symptoms of all diseases. Urben Zen has designed the following yoga therapies to assit with the symptoms of pain, anxiety, nausea, insomnia, constipation and exhaustion. These therapies will now be provided at The Farber Center for Radiation Oncology:

IN-BED MOVEMENTS
Helps to relieve anxiety, improve circultion, minimize constipation, and decrease insomnia
RESTORATIVE PROCESS
Enhances circulation, digestion and respiration
BREATH AWARENESS
Assists in dealing with pain, anxiety, nausea, insomnia and constipation
BODY SCANNING
Meditation assists in minimizing pain and releasing anxiety

What is Reiki?
Reiki treats the whole person- emotionally, physically, & spiritually- creating many beneficial effects that include relaxation and feelings for peace, security and well-being.

What is Essential Oil Therapy?
Essential oil therapy promotes a general sense of well being by promoting relaxation to relieve stress and anxiety as well as assisting to minimize insomnia, nausea, and pain.

The voice of the patient should be listened to and heard. Please take a moment to watch this video to learn why Urban Zen was inspired to make healthcare and well-being an initiative of great.

And when your cancer treatment is over The Farber Center for Radiation Oncology has joined forces with Urban Zen’s integrative therapy program (UZIT) and created OHE (optimal healing environment) classes to create a place/space where you can explore the issues that brought you treatment and to do what you can to prevent you or your loved ones from going through it again.

The 4-week integrative program is targeted to EMPOWER the cancer patent to get the best treatment of mind, body and sprit.

Program:
Initial consultation: with one of our physicians to review the overall scope of the program, the concept of functional medicine, heart disease, diabetes, obesity, “knowing your numbers,” and introduction of “Daily Health Log.” There are no out of pocket expenses for Farber Center patients.

Week 1: Nutrition/Zen*
Discuss various dietary options and specific guidelines for CA patients, esp related to preventing recurrences. Dieting,Supplements, Juicing, Fiber, etc.

Week 2: Movement/Zen*
Explore physical activity with emphasis on yoga

Week 3: Mind/Body/Zen*
Tools for stress reduction and empowerment

Week 4: Guest Lectures/Zen*
Nutrition, Stress Reduction, Adrenal Fatigue,Inflammation, Immunity,

*Zen: each week will include guided meditation and yoga practice with therapist from the Urban Zen integrative therapy program. The UZIT program is a 12 month program that includes training in yoga therapy, essential oil therapy, Reiki, nutrition, and contemplative care giving to addresses the key patient symptoms of PANIC- pain, anxiety, nausea, insomnia, constipation, and exhaustion.

To find out more about the program or to register for our October 18th class please contact The Farber Center at 212 300-0663

FALL SCHEDULE

5 Day Prostate Cancer Treatment

September 26th, 2011

When you are researching prostate cancer there are a lot of treatment options out there and I highlighted them in a previous blog. What I would like to highlight today is a 5 day course of treatment.

What is a 5 day course of treatment? It is a five-day, non-invasive treatment for prostate cancer (called “stereotactic body radiation therapy” or “SBRT”). SBRT is a specialized form of IMRT (intensity modulated radiation therapy) that delivers high doses of radiation over a period of five days. Instead of giving small doses of radiation each day for several weeks, SBRT involves delivery of very focused beams of high-dose radiation. Several beams are aimed at the tumor from different angles. When for other cancers it is delivered in a single fraction it is known as stereotactic body radiosurgery. Like other forms of external radiation, these treatments are painless.

Currently there are nuances determined by which machine you are treated on. Cyberknife is one machine, another is Elekta Infinity which is what we have here at The Farber Center.

TOTAL TREATMENT TIME: 45 minutes on CyberKnife vs. 20 minutes on Elekta Infinity.

TREATMENT PLANNING: Both CyberKnife and Elekta Inifinity use Monte Carlo based dose calculations. Unlike other planning software programs that use theory models to calculate dose, Monte Carlo is statistical planning and the most accurate. Because Elekta Infinity utilizes a multileaf collumater, which can change shape instantaneously we can mimic the shape of the prostate as seen from different beam angles better, compared to the circular aperture in a CyberKnife system. This will reduce the normal tissue being irradiated from various gantry angles. Thus we can achieve better DVH (Dose Volume Histogram) with LINAC based prostate SRT compared to CyberKnife.

TARGETING THE PROSTATE: None of these machines can track the motion of the prostate throughout treatment AND adjust delivery accordingly. The CyberKnife System uses invasively implanted fiducials as reference points to identify the exact location of the prostate. Patients will wait approximately one week after insertion of the fiducials before CyberKnife treatment planning can begin to ensure that fiducial movement has stabilized.

At The Farber Center for Radiation Oncology we have a completely non-invasive approach to targeting the prostate. We use a RadiaDyne balloon. The balloon acts primarily as an immobilizer reducing the daily variations in location of the prostate, and allowing the rectum and prostate to be positioned in a more predictable and reproducible location during the treatment course. Because of the decreased probability of the prostate moving out of the treatment fields, smaller treatment margins around the prostate may be used. This will have the effect of lowering the radiation dose to the normal tissue surrounding the prostate and lowering the incidence of potential side effects to normal tissues. We also take a second Cone Beam CT Scan in the middle of treatment to verify the position of the prostate. This together with the placement of the RadiaDyne ballon ensures consistency in the location and motion of the prostate during the course of treatment. Due to the fact that we can complete a entire treatment including setup and imaging in under 20 minutes, the amount of prostate motion documented from studies (Both, et al) is kept at a clinical minimum.

KEY POINTS with Elekta Infinity:
5 Day Treatment
No need for surgical procedure
No Hormones
Better bladder DVH
Higher Rate of Erectile Function Preservation
CBCT to see prostate/rectum interface

In my opinion, the most important factors in selecting the right team are the reputation, training and experience of the radiation oncologists and their support staff (physicists, dosimetrists, therapists, nurses, etc.) in treating prostate cancer using SBRT.