Qigong Reduces Depression for Breast Cancer Patients

English: Chinese characters 氣功 for Qigong, Qi ...
English: Chinese characters 氣功 for Qigong, Qi gong, Chi Kung (Photo credit: Wikipedia)

Summary: Qigong improves symptoms of depression and overall quality of life. The positive effects of the intervention for patients receiving radiation therapy for breast cancer may be most noticeable after treatment.

What is Qigong? Here’s what the National Qigong Association has to say: Qigong (chew-gong) is made of 2 words (chee, or life force that flows through all things in the universe and gong (pronounced gung) or skill that is cultivated through steady practice). Qigong is the integration of physical postures, breathing techniques, and focused intentions.

The Study: 96 women with breast cancer undergoing radiation therapy were randomized to either a qigong group or a control group. The research was conducted at Fudan Universtiy Shanghai Cancer Center (Shanghai, China), in collaboration with faculty from University of Texas MD Anderson Cancer Center (USA). Women were excluded from the study if they self-reported prior regular qigong or tai chi practice in the prior year. The qigong program involved five 40-minute qigong classes each week during the 5-6 week course of radiation therapy. 78% attended at least half of the sessions.

Results: Regardless of whether patients did qigong or not, their scores for depression improved. However, the symptoms of depression improved more in the qigong group (than in the control group). But the significant differences didn’t emerge until 1 and 3 months after radiation therapy was complete.

My take: Interesting, but bias and patient expectations were not controlled in the study. Could it be that the qigong practitioners anticipated a positive effect from the intervention? Are the results applicable to a non-Chinese population? To me, this study does not offer high level evidence that the intervention reduces depression. Still, qigong is generally considered safe, and might be considered among other mind-body techniques as a part of an integrated management strategy for patients with breast cancer. I practice it, and you may want to, too.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page. Thanks!

Breast Cancer: Surgery Delays Longer Than 6 Weeks Decrease Survival in Young Women

signs of a breast tumour
Signs of a breast tumour (Photo credit: Wikipedia)

A study looked back at just under 9,000 women diagnosed between 1997 and 2006 and included in the California Cancer Registry, part of the US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program. Time to delay was defined as the number of weeks between breast cancer diagnosis (by biopsy) and treatment aimed at cure (lumpectomy or mastectomy, for example). The group examined was composed of women under 40.

Key Findings: The 5-year survival among women treated surgically that had a treatment delay time more than 6 weeks was 80%, compared with 90% for dose with a delay time less than 2 weeks.

Looking by race, African-Americans and Latinas were more likely to have delays (15%) compared to non-Hispanic whites. As well, delays were more common among the uninsured (18%) compared to those with private insurance (9.5%). Not surprisingly then, women with low socioeconomic status were more likely to be delayed (17.5% versus 8%).

My take: Previous studies have had mixed results. Many of those studies did not focus solely on the younger population, a higher-risk group in general. It is important for us to avoid delays before and after a breast cancer diagnosis to maximize survival odds for young women. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page. Thanks!

Smith EC, et al: JAMA Surg. April 24, 2013 (early release online).

Musings: Investigators versus Discovers

English: Albert Einstein Français : Portrait d...
English: Albert Einstein Français : Portrait d’Albert Einstein (Photo credit: Wikipedia)

Emil “Tom” Frei III, MD died recently and my mind wends back to a speech he gave at the American Association for Cancer Research (AACR)/American Society of Clinical Oncology (ASCO) meeting. In his keynote address, Dr. Frei describes two types of clinical cancer researchers: “Investigators” and “Discoverers.” Investigators proceed in a very orderly fashion, are esteemed by their peers, typically succeed (at least in answering the often rather ordinary question being addressed by their work), but produce, at most, single-step advances and don’t create new paradigms. In contradistinction, discoverers follow a path of inquiry that often seems disordered, tend not to be esteemed by their peers, often fail, but on occasions where they do succeed, produce multistep advances and create new paradigms. Dr. Frei’s point was that we would be better off being more supportive of the work of discoverers. What say you?

In the medical arena, discoverers have linked bacterial infection (Helicobactor pylori) to peptic ulcer disease. In breast cancer, few believed  that a drug targeting an antibody would revolutionize how we treat (with the targeted agent trastazumab (Herceptin)) some aggressive cancers. With respect to the latter, even the drug company that developed the drug was not particularly supportive of the concept and its stubborn progenitor (Dr. Denny Slamon). Of course, it was especially enjoyable to see Herceptin take the world by storm and for others to jump on board to claim partial credit for developing it!

I thank Larry Weisenthal, MD, PhD for reminding me of Frei’s observations. I’m Dr. Michael Hunter.

Smoking Linked to Shorter Disease-free Survival in Stage III Colon Cancer

Light a cigaretteOne more reason to toss the cigarettes: According to an analysis from Fred Hutchinson Cancer Research Center in Seattle, patients with Stage III colon cancer who ever smoked had a significantly shorter disease-free survival compared with never-smokers. This increase in risk was particularly apparent for those whose tumors had a particular subtype of colon cancer (so-called BRAF wild-type or KRAS mutant).

My take: This report adds to a small number looking at the effects of smoking on colon cancer outcomes. We need more research to confirm and better understand the association between smoking and survival outcomes among those with colon cancer, especially by cancer subtype. Still, the research presented is quite suggestive of a link between colon cancer outcomes and smoking cigarettes. And so the usual advice: If you smoke, stop. If you don’t, don’t start. And if you quit, congratulations. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page. Thanks!

The Gossip Test & Francis Crick

Francis Crick in his office. Behind him is a m...
             Francis Crick in his office. (Photo credit: Wikipedia)

Did you know?

Francis Crick joined James Watson, Rosalind Franklin,  New Zealand-born physicist Maurice Wilkins, and others to discover the structure of DNA. But did you know that after earning a degree in physics from University College in London, Crick had his pathway remarkably altered by the breakout of World War II. Instead of proceeding to a graduate degree in physics, he took a civilian job at the British Admiralty Research Laboratory. There he helped develop radar and magnetic mines. One of these mine designs was effective against German minesweepers. After the war, he was intellectually restless and decided to change careers. Here’s what he said about how he chose the next chapter of his life:

“I had discovered the gossip test – what you are really interested in is what you gossip about. Without hesitation, I applied it to my recent conversations. Quickly I narrowed down my interests to two main areas: the borderline between the living and the nonliving, and the workings of the brain.” (Francis Crick, in his book What Mad Pursuit)

In 1953, he and Watson published their findings on the double-helix structure for DNA in the British scientific weekly Nature. And the rest is history. And now you know.

I’m Dr. Michael Hunter.

Genomic Analysis Lends Insight to Prostate Cancer

Gleason grade Lower grades are associated with...
Gleason grade Lower grades are associated with small, closely packed glands. Cells spread out and lose glandular architecture as grade increases. Gleason score is calculated from grade as described in the text. (Photo credit: Wikipedia)

Under the headline “Cool!” researchers at Mayo Clinic (USA) used next-generation gene analysis to determine that some of the more aggressive prostate cancer tumors have similar genetic origins. This may help in predicting who will have progression of cancer.

Background: This study is the first of its kind: It used next-generation genomic sequencing in adjacent Gleason patterns, allowing us to correlate genome changes and what we see under the microscope (grade). The standard method for evaluating prostate biopsy tissue is a numeric system called Gleason grading. A pathologist looks at the tumor under the microscope, and gives it a Gleason score based on the pattern of its cells. As many prostate cancer samples have more than one pattern, the two most prominent patterns are added together to give a Gleason score. The highest Gleason scores represent the most aggressive, potentially life-threatening cancer.

The study: The study looked at Gleason score 7 tumors, a score linked to a higher risk of progression (compared to low grade tumors, many of which don’t need any treatment). The tumors all appeared to have a common genetiv origin. These DNA changes in the aggressive cancers were also seen in lower Gleason pattern tumors, suggesting that the gene analysis could identify which cancers might be aggressive (before the pathologist could by looking under the microscope). In fact, the Gleason pattern 3 tumors had more gene alterations in common with its corresponding Gleason pattern 4 tumor (than they did when compared to Gleason pattern 3 tumors from other patients).

My take: This is just what the doctor ordered. Many prostate cancers never needed to be diagnosed! And yet 10s of thousands die every year of the disease. So how do we know which cancers to ignore and which to treat? We need more guidance, and this study points the way to a future when care can be far more individualized than it is today.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page. Thanks!

Estrogen Receptor Negative Breast Cancer: Can Coffee Reduce Risk?

cups of coffee panoramic

Recent research demonstrates that coffee consumption may reduce your risk of cancer; more specifically, this study (published in the open access journal Breast Cancer Research) shows that drinking coffee specifically reduces the risk of cancer not driven by “female” hormones, or estrogen-receptor (ER)-negative breast cancer.

The study: Swedish researchers compared lifestyle factors and coffee consumption among women with breast cancer, and age-matched women without the disease. Several lifestyle factors influenced risk, including age at menopause, exercise, weight, education, and a family history of breast cancer. Coffee drinkers had a lower incidence of breast cancer than women who rarely drank coffee. But when  adjusted for factors such as age, the protective effect of coffee on breast cancer were only measurable for ER-neagative breast cancer.


Results: The authors compared lifestyle factors and coffee consumption between women with breast cancer and age-matched women without. They found that coffee drinkers had a lower incidence of breast cancer than women who rarely drank coffee. However they also found that several lifestyle factors affected breast cancer rates, such as age. Once they had adjusted their data to account for these other factors they found that the protective effect of coffee on breast cancer was only measurable for ER-negative breast cancer.
My take: There are often conflicting results regarding the beneficial effects of coffee. This study is helpful in that it broke out the coffee effect by the type of breast cancer (ER positive versus ER negative). Now we have the suggestion that coffee may lower the risk of ER-negative breast cancer. Oh, and it tastes good too! (Full disclosure: I live in the Seattle area.) It seemed that the more the coffee, the lower the risk. But take heed: Once you get up to 4+ cups, you may introduce other problems such as cardiac ones.
The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page. Thanks!