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Linking weight and cancer recurrence

Keeping the weight down appears to be a good idea for breast cancer survivors, though doctors haven't been sure why. Now researchers at Duke are studying the connection between weight gain and a higher risk of cancer recurrence.

"With some treatments, like chemotherapy, you'd think you would lose weight. But that's not the case. We're finding that during therapy, your metabolism is down and your activity is down, so you're at greater risk to gain weight, " explained Wendy Demark, Ph.D., who studies nutrition's effect on patients at the Duke Comprehensive Cancer Center. The Duke study, she says, is trying to determine whether regular, moderate exercise during therapy wards off weight gain and thus reduces recurrence of breast cancer.

The study is in the pilot stage now, with researchers monitoring two groups of women to see, first, if it's reasonable to ask women to exercise while they're undergoing treatment, and then, whether exercise is effective. It'll be about a year before enough data can be gathered to see if the study should continue.

In the meantime, friends and relatives can make a difference in cancer patients' health. Instead of dropping off a fat-laden casserole, prepare a meal or dish of vegetables. A fruit basket makes a perfect gift, Demark says, since it's easy to arrange, provides fiber and nutrients and also satisfies a sweet tooth. In addition to being lower in calories and fat, fruits and vegetables have been shown to have a protective effect against cancer on their own, she said. Layer of skills ease stress

Between job strain and the extra stress of raising children, working women could use some help handling life's demands. That help could be an extra layer of coping skills.

"Working women with children at home have higher stress, as we've seen from consistently higher levels, around the clock, of stress hormones. That's a significant problem in this country today because more than 70 percent of working women have children in the home," says Dr. Redford Williams, chief of Duke's division of behavioral medicine. "An added layer of life skills could be helpful – learning to be more assertive with a partner to get better shared responsibility, to deal with negative emotions, to express needs better."

Williams, whose stress research led him to develop life management workshops, advocates practicing a set of life skills to better cope with job demands and negative emotions, and to build stronger relationships.

He outlines the skills as learning to identify, evaluate and manage negative emotions. "It's important to learn how to act effectively when their evaluation of negative emotions -- like anger -- tell them action is called for," Williams explains. "When the negative emotion arises from the situation rather than another person's behavior, problem solving's needed. When behavior's the issue, assertion is called for to get the other person to stop treating you that way."

Communication skills play a large part in coping with daily life, he says. Learning to speak and listen more effectively can help establish better, stronger relationships, which in turn "will help you cope better, empathize with others, and help reduce your reaction to others' behavior."

Computer joins anti-cancer arsenal

There's another weapon in the fight against cancer – the personal computer.

Now, without leaving the home or the office, women can find out about their risk for developing a gynecological, or reproductive, cancer and how to reduce that risk. All they have to do is surf over to the Women's Cancer Network web site.

"Reproductive cancer -- cancer of the ovaries, uterus or cervix -- strikes more than 80,000 women each year," said Dr. Andrew Berchuck of Duke's gynecologic oncology division. As one of the physician/researchers involved in the web project, Berchuck wrote the section on endometrial cancers, which are diagnosed in some 33,000 women annually. "By putting together this web site, we hope to increase the number of patients whose cancers are caught in the earliest stages, or even in precancerous stages, when there's the best chance for treatment and cure."

Besides getting information on risk factors and symptoms, women can find out their personal risk level for reproductive cancer. In about 10 minutes, site visitors can type in some basic medical and family history, then receive an immediate, confidential assessment of their individual risk.

The site gives information on the role of a gynecological oncologist, and information on ovarian, endometrial, cervical and breast cancer. Women can scan basic facts, symptoms, risk factors, treatment options and other information. The site posts the latest news from national media on reproductive cancer and provides links to other sources, including how to find cancer treatment specialists in their area.

"It's easy access for women that gives them good basic information without their having to make an appointment or leave their desk," Berchuck said.

HERS heart protection

There should be no question that hormone replacement therapy (HRT) is the way to go for many women if results from the nation's first randomized trial of HRT for women with heart disease match doctors' prior observations. So say researchers at Duke who are involved in the soon-to-be-completed Heart and Estrogen/Progestin Replacement Study (HERS), a clinical trial with more than 2,700 women at 18 sites, including Duke.

HRT is thought to help protect against heart disease in post-menopausal women, as well as to lower the risk of osteoporosis. HERS is tracking the incidence of heart disease, breast and endometrial cancer in participants, all of whom have known coronary disease, have had a heart attack, bypass or other cardiac interventions.

Preliminary data points to some increased risk for women with coronary artery disease who take HRT, but that risk will be weighed against the benefits documented after analysis of all the information, says Dr. Kristin Newby, a cardiologist at Duke. There's about a two to threefold risk of blood clots in the legs and of smaller clots that can break off, then travel to the lungs, "but the risk is pretty small – still only about one in 5,000-10,000." And that, she says, is for women with coronary disease, who would be at higher risk than women without heart problems.