Friday, March 20, 2015

Using Viruses to Cure Cancer - Getting The Word Out

On March 6th, just two weeks ago, an HBO television program called Vice aired a documentary about how viruses, some of which used to kill human beings in large numbers, are now being utilized to treat and actually cure cancer.  Major cancer research centers such as The Mayo Clinic in Minnesota, MD Anderson Cancer Center in Houston, Texas and The University of Pennsylvania in Philadelphia, are conducting groundbreaking trials with cancer patients using genetically modified viruses such as the common cold virus, the measles virus and the HIV virus. According to the physicians involved in these trials, we are on the verge of a major breakthrough in cancer treatment. As the maker of this documentary states, it is important to get the word out about this so that these technologies can be fast tracked and be made available to anyone who needs them.

Dr. John Bell at the Center for Innovative Cancer Research in Ottawa, Canada, is credited with being the first to discover that viruses can actually attack cancer cells without harming the healthy cells around them.  One of the most successful series of ongoing trials has been happening at The Children's Hospital of Philadelphia under the auspices of Dr. Carl June. Dr. June and his colleagues have for about the last four years, been using the HIV virus to treat leukemia in children whose cancer had progressed to the point where other standard cancer therapies were no longer of any use. In these trials, genetically engineered HIV is being used to reprogram the t-cells in the patients' bodies, so that the patients' immune systems can tell the difference between the cancer cells and normals cells, and begin to attack the cancer cells. In this documentary, Dr. June informs us that so far, thirty-nine children have participated, and ninety percent have experienced complete remission with no remaining trace of their cancer. Most seem to be staying in remission for several years. He goes on to tell us that this particular treatment is "probably going to be available and FDA approved in 2016", and that using modified viruses to treat cancer represents "a true paradigm shift".

There are about 300 kinds of cancer. Which viruses attack which cancers most effectively? There is still a lot of research that needs to happen to answer this question. At the Mayo Clinic, they are reengineering the measles virus, and then using it to treat bone cancers.  At MD Anderson, they are treating glioblastomas or brain cancers with a modified common cold virus and patients who had no hope are going into remission.

View the entire VICE documentary here:

Friday, March 13, 2015

Treating Posttraumatic Stress in BRCA Survivors

In an earlier post, I described how breast cancer survivors are often the victims of posttraumatic stress, and frequently display many of the signs and symptoms that are associated with that psychological diagnosis. Things like heightened anxiety, hypervigilance, a change in outlook on life, negative beliefs and expectations about herself or her body, and a change in risk-taking behaviors may be present not just during treatment, but also after treatment has ended.

Now I am going to describe how psychodynamic psychotherapy can help with the disturbing PTSD symptoms that survivors may be experiencing. In addition to discussing problematic symptoms and how the survivor is coping with them, the psychotherapist will work on understanding and appreciating the significance to the client of not only having had breast cancer, but also of each of the treatment interventions to which she was exposed. Today's mainstream cancer treatments, i.e. surgery, radiation, and chemotherapy all act as powerful triggers of complex emotions and earlier traumatic experiences. It is crucial to understand how each breast cancer patient mentally engaged with each of them. Every woman’s breast cancer journey is unique, and is a function of not just her encounters with her medical providers, medical interventions and our health care system, but also of her earlier life experiences. How we engage with the present is always influenced by what we experienced in the past.

It is vital that the psychotherapist assist the client in uncovering and comprehending the psychological meaning to her of what she has been through. For example, what did each treatment modality symbolize to this particular client? Did the chemotherapy represent something positive that was going to destroy cancer cells and restore health, or did it feel like an evil intruder that was wreaking havoc throughout her body? Did the accompanying loss of hair, a well-known side-effect of chemotherapy cause the patient to feel less attractive to her spouse or to potential romantic/sexual partners? Was it experienced as the destruction of an important symbol of femininity? Did it feel like a potent connection to an early attachment figure was destroyed?  Perhaps an early caregiver who expressed love by fixing and combing her hair? Did it have both of these meanings as well as others?

How did all of the physiological and cognitive effects of the treatments (fatigue, nausea, memory loss, loss of mental sharpness etc.) affect things like self-esteem, perception of a benign world, sense of bodily vulnerability, or the person’s sense of their future possibilities?

In order to effectively treat symptoms like depression, anxiety and insomnia over the long term, it is often crucial that psychological meanings be patiently explored, in the context of a safe, psychotherapeutic relationship in which trust and mutual respect have been established and are being carefully nurtured.

Sunday, March 08, 2015

Posttraumatic Stress – A Frequent Consequence of Breast Cancer Diagnosis and Treatment

Given the limited state of our current medical knowledge, a diagnosis of breast cancer followed by extensive cancer treatment usually constitutes a prolonged trauma. Therefore when breast cancer survivors appear in psychotherapists' offices, they are likely to be suffering from some degree of post-traumatic stress even if their reasons for seeking treatment seem to be unrelated to their cancer experiences.

Patients, their families and their medical providers may be unaware that it is not unusual for survivors to continue to experience things like irritability, difficulty concentrating, trouble getting a good night's sleep or heightened anxiety for some time after breast cancer treatment has ended. An increased sense of vulnerability is also a very common aftereffect of cancer treatment even when the cancer was caught at an early stage, and patients are told at the end of their treatment that they are cancer-free.

Survivors may display ways of coping that are typical for persons who have experienced trauma. They may for example, become hypervigilant with respect to cancer. Every time they have a new ache or pain that does not have an obvious cause, they may begin to think that the cancer has returned and experience acute emotional distress. Similarly every time they hear that a food, a product or something else in the environment may be correlated with an increased risk of cancer, they may immediately try to avoid that substance. This is of course, a common and reasonable way that humans try to increase their sense of control and decrease their level of free-floating anxiety. However in today’s news/media environment, research study results are often reported without the media outlet taking the time to determine which of the studies have been well designed and which are merely preliminary or speculative. One media outlet after another may pick up and report the same story without ever investigating the actual significance of a study’s results, yielding to the pressure of our twenty-four hour news cycle. It is easy to see how a person who is trying to reduce her exposure to environmental toxins can end up feeling more stressed and overwhelmed.

Posttraumatic stress symptoms are often part of “the new normal”, a phrase that has been adopted by oncologists to describe how their patients are different after cancer treatment from how they were before cancer treatment. These symptoms often make up a significant part of “the new normal” and they can linger for a long time. Fortunately psychotherapists now know a lot about how to identify and treat them, so that survivors can obtain relief and an increased sense of control over their lives.