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George Valentine needs something from his elected representatives in Congress: securing predictable annual out-of-pocket costs under Medicare Part D’s prescription drug plan.

Advocates for Change: George's Story

The PAN Foundation today opened a new patient assistance program for people living with carcinoid syndrome.

The PAN Foundation Opens New Carcinoid Syndrome Patient Assistance Fund

The use of aerobic exercise demonstrated improved self-reported cognitive function and its impact on quality of life for woman initiating chemotherapy for breast cancer; however, this intervention did not result in significant differences in objective cognitive function postintervention after chemotherapy completion.

According to study findings published in 

, “When considered alongside existing evidence, improved self‐reported cognitive function adds further weight to the call to action on making exercise assessment, prescription and referral a medical standard of care,” study authors wrote.

After 12 to 24 weeks of the intervention, four out of six self-reported cognitive function outcomes showed significant differences favoring the aerobic exercise group. These improvements included perceived cognitive impairment, perceived cognitive ability, overall (i.e., total) perceived cognitive function and associated quality of life. This suggests that regular aerobic exercise is influential in preserving or improving these self-reported cognitive function and quality of life outcomes, as mentioned in the study. No significant differences between groups were found for measured cognitive ability outcomes during postintervention after accounting for multiple tests.

“These results do not support the hypothesis that exercise improves cognitive performance in key domains affected by chemotherapy (e.g., verbal/visual memory, attention, working memory, processing speed, executive function and psychomotor performance),” study authors wrote. “However, the intervention resulted in greater improvements in self‐reported cognitive function and its impact on [quality of life] for the [exercise intervention] group compared to the [usual care] group.”

Furthermore, as reported by patients, side effects were not attributable to the exercise intervention.

The exercise intervention involved progressive aerobic training during chemotherapy, initially supervised in-person but switched to unsupervised sessions due to COVID-19 restrictions, with remote support via email, text and phone calls. The intervention lasted 12 to 24 weeks, matching the chemotherapy regimen. Patients received three personalized sessions weekly, targeting specific heart rate and power output zones.

Sessions lasted 20 to 40 minutes and were led by certified exercise professionals. Patients used treadmills, stationary bikes and ellipticals and were encouraged to vary their exercise modes to prevent injuries. Heart rate monitors tracked exercise intensity, and if chemotherapy side effects hindered reaching target zones, patients were advised to exercise at a manageable perceived exertion level.

The usual care group served as a wait-list control condition, which involved no active treatment and followed the standard care protocol at the participating site. Participants in the usual care group were advised to continue their normal exercise routine without any restrictions.

Once chemotherapy was completed, the usual care group received the same exercise program as the exercise group, although the duration was limited to 12 weeks. Exercise prescriptions for patients were tailored based on their results from the post-chemotherapy cardiopulmonary exercise test (CPET).

Of note, patients who were limited in their ability to reach their target heart rate zone by the side effects of chemotherapy were encouraged to work at the rating of perceived exertion associated with heart rate zone via the 6 to 20 Borg scale.

The Borg scale measures exertion on a range from 6 (no exertion) to 20 (maximum effort). A rating between 12 and 14 usually indicates a moderate or somewhat hard level of intensity.

A total of 57 patients were analyzed, ages from 29 to 70, with stage 2 breast cancer. The exercise intervention group consisted of 28 patients and the usual care group consisted of 29 patients. In addition, the exercise group had a mean attendance of 33.8 supervised sessions out of an average of 43.3 prescribed total sessions.

The most common exclusion criteria were starting chemotherapy and engaging in moderate- to vigorous-intensity aerobic exercise for 150 or more minutes per week in the three months before enrollment.

“Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE): A randomized controlled trial” by Dr. Jennifer Brunet, et al., 

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Aerobic exercise during chemotherapy for breast cancer improved self-reported cognitive function and quality of life, but not objective cognitive performance. The intervention involved progressive aerobic training, initially supervised and later unsupervised due to COVID-19, with remote support. Patients exercised three times weekly, targeting specific heart rate zones, using treadmills, bikes, and ellipticals. The usual care group, serving as a control, received the exercise program post-chemotherapy. The study involved 57 patients, ages 29 to 70, with stage 2 breast cancer, highlighting the potential benefits of exercise in this context.

Aerobic exercise improved self-reported cognitive function in women undergoing chemotherapy for breast cancer but had no effect on objective cognitive function.

Tumor

Aerobic Exercise May Improve Self-Reported Cognitive Function in Breast Cancer

If you have been diagnosed with cancer, you know just how much it turns your whole life upside down. Heck, it turns the lives of everyone who loves you upside down and spins you around in a circle until you are so dizzy you just want to vomit. Some of us 

 vomit, but once you come up for air, or at least when I did, I felt like I needed to learn how to live again.

How do you live when you are constantly trying to figure out how not to die?

I was diagnosed with stage 4 colon cancer in early February 2023. I was 37 years old, and cancer was the very last thing on my mind. What even is an oncologist? The word wasn't a part of my vocabulary.

That year, it seemed like all the spring holidays came early. Graciously, my mom hosted the family on these days. At each one, I would show up with a sad smile and try to get through the day without crying. On those occasions, in the back of my mind, and I'm sure everyone else's in attendance, was the same persistent question: Would this be my last fill-in-the-blank?My last Easter, my last Mother’s Day, my last birthday… Always pervasively circulating in my mind would be this thought: Will I be around for this next year? And in typical Eeyore fashion (Yes, that Eeyore, the sad donkey from Winnie the Pooh), I would internalize the “probably going to rain” mentality and just assume I would not.

We took hundreds of pictures where I dutifully smiled. My kids were rotated through the line so each could have a picture with Mom. I smiled with my sister, mom, dad, husband and anyone else fortunate enough to be around. Every time we would get together, we would take what felt like 100s of pictures.

By the time Thanksgiving and Christmas came around, I wasn't so grim. It helped that my tumors were responsive to chemo and I was scheduled for surgery to hopefully remove what remained.

Yes, these hopeful circumstances related to my disease helped my overall attitude, but what I found helped the most was that during that dark year, I had surrounded myself with other survivors. These were people who inspired me. They were living with metastatic cancer, yet still doing all the things. They were running marathons, hiking mountains, taking once-in-a-lifetime trips, getting married, learning new skills and embracing old skills. They had found a way to 

. Not just live the day-to-day grind like so many of us have for years, but authentically live in the face of dim prognoses and unimaginable darkness. They inspire, advocate and wake up every day embracing life.

In the face of cancer, those who come before me have shown me how to live each day knowing it could very well be their last. It's cliche, but it's true.

None of us are given a timeline or know when we will no longer be a citizen of this world.

Do I still think about dying? Every. single. day. But I also live in the present now and embrace the time given to me.

To all the survivors out there living life to the fullest, thank you for showing me the light, how to genuinely smile again and how to live life while actively trying not to die.

This story was written and submitted by Lauryn Cooney. The article reflects the views of Cooney and not of CURE®. This is also not supposed to be intended as medical advice.

A cancer diagnosis profoundly disrupts life, prompting existential reflections on mortality and the challenge of living fully amidst uncertainty. Lauryn Cooney, diagnosed with stage 4 colon cancer at 37, shares her journey from despair to hope, influenced by the resilience of fellow survivors. Initially overwhelmed by the prospect of impending loss, Cooney found solace and inspiration in a community of individuals living vibrantly despite metastatic cancer. This narrative underscores the importance of embracing life, finding joy in the present, and drawing strength from others facing similar battles.

With stage 4 colon cancer, I still think about death, but I’ve learned how to live in the present to enjoy each day I have.  

How I Truly Learned to Live With Stage 4 Colon Cancer

For patients with metastatic triple-negative breast cancer, clinical activity with Trodelvy (sacituzumab govitecan) stays consistent, researchers found.

Enhertu (trastuzumab deruxtecan) in a subgroup with HER2-low disease also continued to demonstrate promising clinical activity after administration of Trodelvy, suggesting the use of sequential antibody-drug conjugates in this population.

As clinical trials may not accurately represent the patient population, a real-world study from 2021 to 2023 was conducted that allows the data to be more applicable to patients.

“It is always important, even if we get the results from the clinical trials, to do real-world studies to see if the clinical benefit or the benefit from the drug is the same in the real-world population or not,” said Dr. Arya Roy, a breast medical oncology and assistant professor at The Ohio State Comprehensive Cancer Center, in an interview with CURE®.

, the objective response rate (ORR) in patients with metastatic triple-negative breast cancer was 27.8% and the median progression-free survival (PFS) was 4.8 months. In patients with HER2-low metastatic triple-negative breast cancer who received Enhertu after Trodelvy, the ORR to Enhertu was 34.8% and the median PFS was 7.0 months.

“[Trodelvy] gives an option to patients who don’t have any targetable mutations or who don't have any immune markers where we could use immunotherapy. So, I would say that Trodelvy is definitely a good drug, especially for triple-negative breast cancer patients, where we don't have a lot of options,” Roy said.

Severe or worse side effects were seen in 50.9% of patients. These consisted of neutropenia in 35.7% of patients, anemia in 27%, vomiting in 16.5%, fatigue in 8.7% and diarrhea in 7%. Reductions in dose size and discontinuation of treatment because of side effects were required in 51.3% and 13.2% of patients, respectively. Three patients received Enhertu after discontinuing Trodelvy because of severe side effects such as fatigue, anemia and diarrhea, which did not occur after starting Enhertu. The rate of any severity of side effects was 97.3%.

“In the clinical trial also, [neutropenia] was the most common side effect that we saw, and in our real-world study as well, but it is manageable because we have drugs called G-CSF, or granulocyte colony-stimulating factors, which are specific drugs that are given to increase the number of white [blood] cells in your body.

Keytruda Plus Radiation Therapy Shows Promis for Patients With Breast Cancer

Among 115 patients, the median age during initiation of Trodelvy was 60 years and all patients were female. A total of 61 patients had primary refractory disease and the median number of previous therapies in the metastatic setting was two. The intensity of the median relative dose was 92%.

In addition, the most common organs affected by metastases were bone (55.7%), lung (53.9%), liver (50.4%) and brain (21.7%). During the time of Trodelvy initiation, four patients received local therapy to the brain, and others had stable brain metastasis.

“So, there are several challenges still, because one thing is, triple active breast cancer is a very aggressive phenotype. So even if we have all these drugs, if the patient is not eligible to get immunotherapy, then that is actually a major limiting factor, because we are taking one line of treatment completely out. So then the patients will have limited options,” Dr. Roy said.

“Real-World Clinical Outcomes With Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer” by Dr. Sabah Alaklabi, et al., 

Trodelvy (sacituzumab govitecan) maintains consistent clinical activity in metastatic triple-negative breast cancer, with an objective response rate (ORR) of 27.8% and median progression-free survival (PFS) of 4.8 months. Enhertu (trastuzumab deruxtecan) shows promise in HER2-low patients post-Trodelvy, with a 34.8% ORR and 7.0 months PFS. Real-world studies highlight the importance of evaluating clinical benefits outside trials. Side effects, notably neutropenia, are common but manageable. The study underscores the limited treatment options for patients ineligible for immunotherapy.

Trodelvy shows effectiveness in real-world breast cancer treatment, even after receiving Enhertu therapy.

Trodelvy Is Effective in Real-World Patients With Breast Cancer Subset

Continuous advances in treatment for patients with relapsed or refractory multiple myeloma emphasize the need for patients and their doctors to work together during treatment decision-making.

Considering factors such as disease-free survival may be important for patients. However, quality of life and family circumstances should also be carefully thought out before treatment decisions are made, said Dr. Henry Fung during an interview with CURE®.

Fung is the chair of the Department of Bone Marrow Transplant and Cellular Therapies and director of the Multiple Myeloma Programs at Fox Chase Cancer Center in Philadelphia.

He recently sat down with CURE® to discuss available treatment options for patients with relapsed or refractory multiple myeloma, why collective treatment decisions are crucial and advice for patients, regardless of the status of their journey.

CURE®: For patients with relapsed or refractory multiple myeloma, what are some of the traditional treatments they may receive?

There are many treatment options for patients with relapsed or refractory multiple myeloma. Unfortunately, all patients will [experience] relapse with multiple myeloma. We still consider multiple myeloma an incurable disease, but it’s also not uncommon for patients to be disease-free or in remission beyond seven to eight years. We’ve had patients go beyond 15 years and are still disease-free, so maybe this is potentially curable, but we don’t have enough data to declare that yet.

The first treatment includes the anti-CD38 monoclonal antibody, which should be included in every single salvage regimen nowadays and also has recently become the standard of care for frontline treatment.

Then, we have three different immunomodulating agents: [Thalomid (thalidomide)], [Pomalyst (pomalidomide)] and [Revlimid (lenalidomide)].

The combination [of treatments] that we will use will depend on whether patients are refractory to the last treatment. Also, the toxicity profile [is important], and that will determine the treatment for patients.

Having said that, these [treatments] are also evolving very rapidly. Now we have two CAR-T cell therapies and three bispecific antibodies.

Do patients have a say in what treatment or treatment combination they receive for their relapsed or refractory multiple myeloma?

Yes, we always give them the option while we’re [deciding on treatment]. We need to get patients’ informed consent and [understand] what the goal of therapy is for each patient.

Then, based on our expertise, [we list] what is best for [the patient]. [We ask] what they think and the alternative options. The goal of therapy is different for everyone. There are patients who say, “I want to at least play nine-hole golf. Otherwise, I don’t want to live anymore.” So, everyone’s goals are different: family goals are different and patient goals are different.

[Factors are considered, such as] whether they need pain medication, whether it’s worth continuing treatment, if they can be disease-free, if it’s important to reach remission or if they can just live as long as possible.

KRd56 Versus KRd27 Shows Similar Effectiveness, Safety in R/R Multiple Myeloma

For CAR-T cell therapy, it’s a one-time treatment, and if it works well, patients can be disease-free for a few years or more than that. [Patients] may live for three years or five years, but in between, one can play 18-hole golf, and the other has to come to see us every week.

Some patients want potentially fewer side effects. The CAR-T cell therapy is more intensive and has more side effects. [Some patients might say,] “I don’t want to take the risk, I don’t want to do that. I love the nurses and doctors so much.” So, they’ll come to the office. So, there are many considerations.

What advice would you offer to patients with relapsed or refractory multiple myeloma?

I think it’s very important for patients with newly diagnosed multiple myeloma or [patients] at any [point] of disease progression should connect with a myeloma center for multiple myeloma. [These centers] have the expertise and support for them and [they can] work with their local doctors together in order to get the best treatment.

Everyone should have a second opinion. As we said there are many [treatment] options. It’s good that [patients may] respect and trust their doctor, but now there are many different treatment options to choose from. All patients deserve the best, not just to live. They all deserve the best treatment, not just to [have good] responses to or reach remission or make them live longer. Because there are different options, the goal of therapy should be discussed, [considering] what patients think is best for them, their family and their circumstances.

This transcription was edited for clarity and conciseness.

For more news on cancer updates, research, and education, don’t forget to 

Advancements in treating relapsed or refractory multiple myeloma necessitate collaborative decision-making between patients and physicians, considering both clinical outcomes and personal circumstances. While multiple myeloma remains incurable, long-term remission is possible with evolving treatments like anti-CD38 monoclonal antibodies, immunomodulating agents, CAR-T cell therapies, and bispecific antibodies. Patients should be actively involved in treatment choices, aligning therapy goals with personal and family priorities. Seeking care from specialized myeloma centers and obtaining second opinions are crucial for optimizing treatment strategies and ensuring the best possible outcomes.

Patients with relapsed or refractory multiple myeloma should consider quality of life with survival when choosing the most suitable treatment option.

QOL a Crucial Consideration During R/R Myeloma Treatment Decision-Making

The time to testosterone recovery in patients with prostate cancer depends on factors including length of androgen deprivation therapy (ADT), testosterone levels before treatment and age.

included 1,444 patients with prostate cancer from five trials. Among the overall patient population, researchers treated 115 with ADT for four months, treated 880 for six months, treated 353 for 18 months, treated 36 for 28 months and treated 60 for 36 months. Of note, patients who received ADT for longer periods had more aggressive prostate cancer, senior study author Dr. Amar Kishan explained to CURE®.

Kishan is a radiation oncologist and the executive vice chair for the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA and the UCLA Jonsson Comprehensive Cancer Center in Los Angeles.

“What we wanted to look at is whether we could identify two things. The first is patterns and predictors of recovering testosterone,” he said. “The second is whether there is any association between how long it takes to recover testosterone and the ultimate cure rates or outcomes.”

Testosterone Recovery in Patients With Prostate Cancer

Testosterone recovery in prostate cancer patients post-ADT is influenced by treatment duration, baseline testosterone levels, and age. A study involving 1,444 patients revealed that longer ADT duration correlates with more aggressive cancer. Younger patients and those with higher baseline testosterone recover faster. Recovery typically takes around six months, but can extend beyond 18 months. ADT side effects include low libido, hot flashes, and mood changes. Patients are advised against hastening recovery unnaturally and should consult doctors for managing side effects through lifestyle changes or medications.

Patients with prostate cancer may differ in time to testosterone recovery, depending on the length of treatment and age, but takes six months on average.

The PAN Foundation

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