A Dietitian's Cancer Story Newsletter: Fall 2005

Fall 2005 Greetings from Diana Dyer, MS, RD, author of A Dietitian's Cancer Story During October 1995, ten years ago, I had an appointment with my oncologist for my first post-chemo check up. I asked him what I thought was a simple question, “Now that chemo is over, what can I do to help myself recover? His initial silence was both deafening and disheartening. I politely told him I would be back with a better answer than that as I left his office that day feeling very alone. His lack of an answer ultimately led me to write my book, A Dietitian’s Cancer Story, which I wrote to be exactly what I wish my own cancer center would have had available to hand me when I asked that “simple question”. I was looking for a short, motivational, and easy to read guide containing reliable information about nutrition and lifestyle changes that could help a cancer survivor potentially tip the scales in favor of both extension of life and improvement of the quality of life. Several years later, my oncologist shared with me his observation that “the oncology community didn’t even know there was a ballgame in town to have dropped the ball regarding the various concerns of cancer survivorship.” While many aspects of cancer survivorship receive more attention in 2005 compared to 1995, there is no standard of practice, and much more still needs to be done to optimize medical care and life after cancer. His earlier observation has recently been verified in an important new report just published, 10 years after I asked my original question. On November 7, 2005, The Institute of Medicine of the National Academies released its new report From Cancer Patient to Cancer Survivor: Lost in Transition. This report addresses the many issues facing adult cancer survivors once they have completed treatment, and yes, it does include recommendations for nutrition and lifestyle counseling among many other aspects of important follow-up care. I urge you to read this report (at least the summary) and ask your oncologist how survivorship concerns will be addressed at your cancer treatment facility. More can be read at the following web sites: http://www.iom.edu/report.asp?id=30869 http://www.canceradvocacy.org/news/iom.aspx This report is a direct result of grassroots efforts, with many cancer survivors speaking out to help pave the path so the recovery journey will be less difficult for those millions of cancer survivors still to follow. In this season of giving and thankfulness, I would like to thank all those survivors and health care professionals in the oncology community who shared their personal experience, gave their time, expertise, heart, advocacy, and service to develop this report. I also thank all of my readers who continue to be supportive for patients, friends, family, or colleagues with a cancer diagnosis. I could not help but smile with understanding as I recently heard one of Shirley Chisolm’s most notable quotations: “Service is the rent we pay for living on this earth.” How true, but please don’t think that service needs to be advocating at the national level. Emily Dickenson reminds us of the benefits from local service with her well-known poem: If I can stop one heart from breaking, I shall not live in vain. If I can ease one life the aching, Or cool one pain, Or help one fainting robin Unto his nest again, I shall not live in vain I send you all my best wishes for this holiday season and 2006 - may they be filled with hope, health, happiness, and service. Diana Dyer, MS, RD *************************** Newsletter Contents: I. Tidbits of Helpful Information II. Clinical Trials for Cancer Survivors III. Research Updates IV. Book Ordering Information *************************** I. Tidbits of Helpful Information A. It was with great sadness to hear of the passing of Steve Dunn, a long-term cancer survivor and advocate, who founded the very helpful web sitehttp://www.cancerguide.org. A friend told me about the following web sitehttp://www.gratefulness.org/candles/enter.cfm where I lit a candle in Steve’s honor. I now use this web site to light candles of hope for my friends who are experiencing the uncertainties of a cancer diagnosis and therapy. B. The Department of Health and Human Services (HHS) recently launched a new breast cancer site, http://www.hhs.gov/breastcancer/ , which helps patients understand their disease, its treatment, and gives them tools to help deal with the challenges that the disease creates in their lives. C. 30 manageable steps to take with the new “MyPyramid for a Healthier You!” Get started! http://lancaster.unl.edu/food/ftnov-dec05.htm Great ideas for those New Year’s Resolutions! D. Please read and sign the petition for a "CHILDHOOD CANCER AWARENESS POSTAGE STAMP." http://www.thepetitionsite.com/takeaction/928701473 E. The American Institute for Cancer Research (AICR) has added a new feature to their web site. The AICR Nutrition Hotline can now be accessed most easily by going to http://www.aicr.org/hotline/ and clicking on “submit a question.” An email response from an AICR registered dietitian (RD) will be received within 3 working days. As in the past, questions can also be submitted by dialing 1-800-843-8114 from 9 to 5 EST Monday through Friday and asking for the Nutrition Hotline. F. I’ve highlighted http://www.CancerNutritionInfo.com in the past. This web site just keeps better and better. Much of the excellent content is available free of charge. However, the research analyses are the real strength of the web site’s content and are well worth the annual cost of $15.00. A free trial subscription is available. G. A helpful booklet called A Low-fat Dietary Guide to Aid in the Management of Skin Cancer by Homer S. Black, PhD and Suzanne Jaax, MS, RD can be downloaded and printed off from http://www.homersblack.com. Dr. Black conducted a clinical trial several years ago (N Engl J Med. 5;330(18):1272-5, 1994), which showed that following a 20% low-fat diet decreased the incidence of actinic keratoses (pre-malignant skin lesions) in people who had already had one occurrence of basal cell skin cancer. The control group (those people following their usual high fat diet) had nearly 5 times the number of these lesions develop during the two years of the study. Dr. Black does not know if a diet with higher fat content primarily coming from the healthful monounsaturated fats like those contained in olive oil will be as effective as this low fat diet (personal communication). However, the booklet is very helpful in teaching people how to calculate their approximate calorie needs, fat requirements when limiting intake to 20%, and the fat content of many foods.  *************************** II. Clinical Trials A. A second call for all long-term survivors of colorectal, prostate, and breast cancers to participate in the RENEW Study (Reach out to Enhance Wellness in Older Survivors) What: A diet and exercise program for long-term cancer survivors funded by National Institutes of Health - led by Dr. Wendy Demark-Wahnefried (Winner of the 2003 Komen Professor of Survivorship Award from the Susan G. Komen Breast Cancer Foundation) 1. At Duke University, Durham, NC 2. You do not need to have had cancer treatment at Duke 3. You will not need to travel to Duke 4. All materials will be mailed to you 5. Health counseling will be done by telephone Eligibility requirements: 1. Anyone with a diagnosis of colorectal, prostate, or breast cancer at least five (5) or more years ago. 2. At least age 65 3. Must be overweight Contact Information: 1. Call Denise Snyder at 1-877-239-1054 (toll-free) or, 2. Send Email to RENEW@geri.duke.edu This is an important and popular study. Call soon. B. Phase III Randomized Chemoprevention Study of Selenium in Participants with Previously Resected Stage I Non-small cell Lung Cancer (NSCLC) In this study, researchers are investigating the ability of selenium to prevent the development of secondary lung tumors in patients with surgically removed, early-stage NSCLC. Selenium is an essential dietary mineral that has been shown in animal studies to inhibit the growth of tumors. It is also associated with reduced cancer incidence in some animal populations. The following web site will review the study, give entry criteria, and study locations throughout the country. http://www.cancer.gov/clinicaltrials/ft-ECOG-5597 *************************** III. Research Updates A. Dietary Genistein Reduces Metastasis in a Post surgical Orthotopic Breast Cancer Model, SA Vantyghem et al., Cancer Research 65, 3396-3403, 2005. Metastatic spread, not primary tumor burden, is the leading cause of breast cancer deaths. A mouse model of breast cancer metastasis was developed where an implanted primary breast tumor was grown for 5 weeks and then was removed by surgical resection before systemic adjuvant treatment. Mice were then randomized into two diet groups: control soy-free diet versus genistein-supplemented diet. Five weeks later, metastatic burden was assessed. Genistein reduced the percent metastatic burden in the lungs by 10-fold. Conclusion: These results indicate that dietary intervention following cancer surgery can affect the outgrowth of seeded tumor cells. My comments: This innovative study adds to some additional cell culture evidence that consumption of genistein (at least in this mouse model) may actually be beneficial in reducing the spread of breast cancer, a significant advance in the potential treatment of this disease. However, controversy continues regarding the consumption of soy foods and the isoflavone genistein (available as both a dietary supplement and also added to some foods) for women who have a history of or are at high risk for developing breast cancer. Much more research needs to be done to understand how much genistein, for how long, etc, etc, may produce this beneficial effect. (See below.) B. Mammalian lignans enterolactone and enterodiol, alone and in combination with the isoflavone genistein, do not promote the growth of MCF-7 xenografts in ovariectomized athymic nude mice, Power, KA, Saarinen, NM, Chen, JM, Thompson, LU, Int J Cancer. 2005 Sep 8; [published online, ahead of print] This study determined the effect of various dietary phytoestrogens (the mammalian lignans from flaxseed called enterolactone (ENL) and enterodiol (END) alone and in combination with the isoflavone genistein (GEN) from soybeans) on the growth of breast (MCF-7) tumors in ovariectomized nude mice. The mice with established estrogen sensitive breast tumors were all fed a basal diet and divided into 5 groups that received daily subcutaneous injections ENL, END, GEN, a mixture of these compounds (MIX), or vehicle as a negative control for 22 weeks. In the ENL- and END-treated mice, palpable tumors regressed significantly by 91 and 83%, respectively, resulting in final tumors that were similar to the negative control tumors. Tumor cell apoptosis (programmed cell death) was significantly enhanced by the lignans. In the GEN-treated mice, tumors initially regressed significantly by 64% but regression ceased following prolonged treatment, resulting in final tumors that were significantly larger compared to negative control, ENL-, and END-treated mice, in part by increasing tumor cell proliferation. The MIX treatment significantly regressed palpable tumors by 87% similar to negative control group, with no effects on tumor cell apoptosis or proliferation. Conclusions: the isoflavone GEN alone promoted the growth of established MCF-7 human breast cancer xenografts after prolonged treatment, while the mammalian lignans ENL and END did not. When these phytoestrogens were given in combination, no tumor growth-promoting effects were observed. My comments: This research shows why the controversy regarding the effects of genistein on breast cancer cells continues. However, the interesting aspect of this study is that the mixture of flaxseed lignans (available in the whole or ground seed) and the isolated soy isoflavone called genistein showed no tumor promoting activity for these implanted estrogen sensitive breast cancer cells. While it is important to understand this was not a diet study (the animals received all these phytoestrogens by injection), the mixture of the flaxseed and soy phytoestrogens showed tumor regression in this model. The benefits from combining foods (called food synergy) are receiving more and more attention in the research community. After all, this same model is used within the oncology community with multi-drug chemotherapy regimens and also combining types of therapy such as chemo and radiation. In any case, it is interesting for me to think about the results of this study in light of the fact that I have been combining soy foods with flaxseeds in my soy shake recipes for 10+ years without a recurrence of my estrogen positive breast cancer.  C. Tea and circulating estrogen levels in postmenopausal Chinese women in Singapore, Wu, AH et al, Carcinogenesis May 2005;26(5):976-80. This study investigated the relationship between tea intake and plasma estrogen and androstenedione (a hormone that is a precursor for testosterone) levels in healthy postmenopausal Chinese women in Singapore. Some limited evidence has suggested that green tea may decrease circulating sex-steroid hormones, whereas black tea may increase these hormones. In this group of 130 women, 84 were non or irregular (less than once a week) tea drinkers, 27 were regular (weekly/daily) green tea drinkers and 19 were regular (weekly/daily) black tea drinkers. Relative to plasma estrone levels in non- or irregular tea drinkers (29.5 pg/ml) the levels were 13% lower in regular green tea drinkers (25.8 pg/ml) and 19% higher in regular black tea drinkers (35.0 pg/ml). These differences in estrone levels were statistically significant (P = 0.03) in spite of adjusting for age, body mass index, intake of soy, and other covariates. A similar pattern of differences between tea intake, and plasma levels of estradiol (P = 0.08) and androstenedione (P = 0.14) were found. Larger studies are needed to confirm these results and to better understand the potentially differing effect of black and green tea on circulating estrogen levels and ultimately on the risk of breast cancer. My comments: This is a small observational study that has shown differences in hormone levels of potential interest to those studying reasons why there is a lower incidence of breast cancer in Asian countries. It was most interesting to see the increased hormone levels in women who consumed black versus green tea. I continue to carry my own green tea when traveling, as it is still the unusual restaurant, airline, or conference that has it available. D. Antioxidant vitamin and mineral supplementation and prostate cancer prevention in the SU.VI.MAX trial, Meyer, F et al, Int J Cancer. 2005 Aug 20;116(2):182-6 The Supplementation en Vitamines et Mineraux Antioxydants (SU.VI.MAX) study is a randomized, double-blind, placebo-controlled primary prevention trial evaluating antioxidant supplementation on the risk of cardiovascular disease and cancer. A total of 13,017 French adults (7876 women aged 35-60 years and 5141 men aged 45-60 years) were included. All participants took a single daily capsule of a combination of 120 mg of ascorbic acid, 30 mg of vitamin E, 6 mg of beta-carotene, 100 micrograms of selenium, and 20 mg of zinc, or a placebo and were followed for 8 years. Overall, there was a moderate non-significant reduction in prostate cancer rate associated with the supplementation. However, the most notable results were the striking differences seen between men who had a normal PSA versus those who started the study with levels higher than 3. Among men with normal PSA, there was a statistically significant 48% reduction in the rate of prostate cancer for men receiving the supplements. In men with higher PSA levels at baseline, the supplementation was associated with a 54% increased incidence of prostate cancer. My comments: Whew, talk about controversy and complexity. Nothing is ever simple when it involves cancer and antioxidants. The increase in prostate cancer with the antioxidant supplementation was only of borderline statistical significance, but I would highly recommend knowing your baseline PSA prior to taking antioxidants hoping to prevent prostate cancer. In addition, I always recommend having your diet reviewed by a registered dietitian (RD) for individualized advice in order to optimize the healthfulness of your diet to reduce the risk of or treat all diseases for which you may be at high risk. Finally, always discuss the introduction or use of all dietary supplements with both your doctor and RD to help evaluate the pros and cons based on current research. *************************** IV - Both editions of A Dietitian's Cancer Story (English version ISBN 096672383X) and Historia De Cáncer De Una Dietista (Spanish version ISBN 0966723821) can be ordered from any bookstore, library, Amazon.com, and directly from the American Institute for Cancer Research (AICR) by calling 1-800-843-8114 or going to AICR’s web site <http://www.aicr.org>. Discounts for orders of 10 or more copies are available for both editions by calling AICR at 1-800-843-8114 - asking to speak to Candis Navarette. Many cancer centers, health care professional offices, and places of worship have ordered books in larger quantities to have available to give as educational and support information or to resell. Bookstores and libraries may order directly from the book wholesalers Ingram or Baker & Taylor. Personally autographed copies of A Dietitian's Cancer Story are now readily available through Nicola's Books in Ann Arbor, Michigan. It's easy to order the book directly from this full service independent bookstore at their web site,http://www.nicolasbooks.com which has a space to indicate how you would like the book inscribed. They will happily mail the book anywhere in the world. *************************** I send my best wishes to all of you for health, healing, and hope! Diana -- Diana Grant Dyer, MS, RD - Author A Dietitian's Cancer Story (English and Spanish translation) Available from AICR (call 1-800-843-8114) "Information and inspiration for cancer survivors" Proceeds donated to the Diana Dyer Cancer Survivors' Nutrition and Cancer Research Endowment at the American Institute for Cancer Research (AICR)