Animated Introduction to Cancer Biology
Receiving treatment for cancer often requires the nurse to frequently access your veins to draw blood, administer chemotherapy, or give intravenous fluids. The most common method is to insert a small metal or plastic needle under the skin into a vein in your hand or arm. Some people have veins that are difficult to find or that are very fragile, making visits to the doctor stressful because of worries that the nurse will not be able to get into the vein. In addition, some chemotherapy drugs are very irritating or must be given over many hours or days, with a risk that the drug can leak out of the vein and seep under your skin. To counteract these problems, special long-term vascular access devices have been developed to make it easier and safer for you to receive your treatment. These devices all have a special thin flexible catheter, or tube, that is placed under the skin and inserted into a large vein in your chest, leading to your heart. The catheter may be left in place for a number of months or years, until it is no longer needed.
In one type of device, the catheter is attached to an implantable port, a hollow round disk about the size of a quarter and a half-inch high. The disk is placed under the skin, usually on the chest wall, under the collarbone. To access the device, the nurse inserts a special needle through the skin into the port. Between treatments, the nurse must flush the device once a month to prevent it from clotting, but no other care is required. If you are “needle phobic,” ask your nurse about EMLA cream, which is a topical anesthetic. This medication can be applied to the skin directly over the port. The cream numbs the area, eliminating or reducing the pain of the needle stick. EMLA cream should be applied about 1 hour before your port is accessed. In another type of device, the catheter exits through the skin and is called an external catheter. Hickman catheters and PICC lines are examples of external catheters. The catheter may exit from the chest wall under the collarbone or on the arm. External catheters require frequent flushing and must be covered with a dressing. If you have an external catheter, your nurse will teach you how to take care of it. If you need a long-term catheter, your doctor will recommend the type that is best for you.
Long-term catheters can become infected and develop blood clots. Call your doctor immediately if you develop redness, swelling, discharge, or pain at the site of the port or where the catheter exits the skin, or if you develop swelling in the arm on the side of the catheter.
Term:
Topical anesthetic – A medication applied to the surface of the body (for example, the skin or mucous membranes) to numb the area.
Special long-term vascular access devices have been developed to make it easier and safer for you to receive your treatment
What are clinical trials?
Pete’s comment:
I felt initially that one of the advantages of getting treatment at a cancer center was the potential of participating in a clinical research study. Every day you hear about new drugs that may have a positive effect on cancer, and I felt that participating in a trial was a good opportunity to take advantage of the newest scientific research. When my treatment options included a clinical trial, I didn’t hesitate to participate.
Mary Ann’s comment:
I am presently enrolled in a clinical trial-my diagnosis fourth stage lung cancer. I was taken by surprise when my lung cancer returned after 2 years. This time I went immediately to MSKCC [Memorial Sloan-Kettering Cancer Center] for treatment.
Fortunately, I had a consultation there after my initial surgery and in a study of my cancer cells, it appeared that I carried a mutated gene on my cancer cells. I was asked if I would consider being part of a clinical trial team that was treating this type of cancer.
Not without some trepidation-I feared being given a placebo, but with my family urging me to take part in this-I decided that it was worth a try. I was also assured that there were no “blind” studies and that no one in the study would be given a placebo. I was also assured that if there was no sign of improvement in 6 weeks, I would be taken out of the trial and put on a more conventional form of chemotherapy.
As part of the clinical trial, I am carefully monitored. For the first few months, I was tested every 2 weeks-blood, urine, scans, EKG, etc. Progress was swift for me and within 6 weeks, a tiny growth on the tail of my pancreas (which was an unusual form of the lung cancer metastasis) had calcified and was no longer an issue. I am just past 6 months in the trial, and the growths in my lungs seem to have also shrunk to nothing.
When I began this trial, I thought back to my days in kindergarten-I was one of the children given the Salk vaccine for polio in that “clinical trial.” Months later, we were notified that I had indeed received the live vaccine. I felt heroic as a child-and I feel heroic now. Regardless of how this turns out in the long run, I feel as though it gives my life purpose and if it doesn’t work for me, it may be the building block for someone else in the future. In one irony of this, the medication I am on has helped my arthritis and literally cured my diabetes. My blood sugar has been normal-with no medication-since the trial began.
Who knows what other benefits may come from this trial?
Clinical trials are research studies designed to test new treatments on humans. Any kind of treatment may be studied-methods of administering radiation therapy, drugs (including chemotherapy), biologic agents, nutritional therapies, medical devices, or even behavioral therapies. Either a single new treatment or standard treatments combined in new ways may be studied.
New treatments are usually first developed in a laboratory and then tested on animals. If they seem to provide some benefit, they are tested in phases on humans to determine their safety and effectiveness.
• Phase I clinical trials are undertaken first, to determine the appropriate dose and schedule for the treatment, as well as its side effects.
• Phase II clinical trials test the treatment on patients with a particular type of cancer to determine effectiveness.
• Phase III clinical trials are conducted on patients with a particular type of cancer to compare the effectiveness of the new treatment with that of the standard treatment. Half the patients in the study get the new treatment and half get the standard treatment. Patients enrolled in a Phase III clinical trial are randomly assigned to be in one of these groups. You cannot select the treatment you want.
Participating in a clinical trial is not being a “guinea pig.” The studies are designed thoughtfully and are based on information previously learned about the new treatment. To protect the safety of patients, the U.S. Food and Drug Administration (FDA) strictly regulates and monitors how clinical trials are conducted. The study must undergo internal review at the hospital the doctor is affiliated with, and it must be approved and monitored by an Institutional Review Board (IRB). In addition, for each study, very specific eligibility criteria describe who can be treated in the study; these criteria consist of a list of conditions that must be met for someone to enroll in a clinical trial. Finally, a clinical trial requires a consent form, a written document signed by patients to indicate that they have been informed about a treatment, as well as the associated risks and benefits, and that they agree to receive the treatment. The form describes the purpose of the study, the treatment the participants will receive, the possible side effects, the risks and benefits, and the financial costs. Before receiving any treatment, you must sign this consent form, indicating that you understand the study and you agree to participate in it.
Participating in a clinical trial gives you the opportunity to receive new treatments before they are available to other people. You receive care by a leading doctor affiliated with a major cancer center, and you are closely monitored throughout your treatment. You also contribute to progress in medical science. Just remember that the treatment given in a clinical trial is not yet proven to be more effective than the standard treatment you might otherwise receive, and you could even have unexpected side effects. Furthermore, you may have to spend more time receiving treatment, having the required diagnostic tests, and seeing the doctor. In addition, the financial cost to you may be greater. Your health insurance might not cover some aspects of the care, and you might have to pay for transportation or housing if the treatment is not close to home.
Although most cancer clinical trials are designed to test new treatments for cancer, an increasing number of trials are designed to test new methods of managing the symptoms experienced by people with cancer. If you are interested in finding out more about clinical trials, an excellent source of information is Taking Part in Clinical Trials: What Cancer Patients Need to Know, a booklet available from the Cancer Information Service of the National Cancer Institute.
Term:
Eligibility criteria – A list of conditions that must be met for someone to enroll in a clinical trial.
Consent form – A written document signed by patients to indicate that they have been informed about a treatment, as well as the associated risks and benefits, and that they agree to receive the treatment; also referred to as informed consent.
To protect patients, the U.S. Food and Drug Administration strictly regulates and monitors clinical trials.
What are complementary and alternative treatments?
Complementary and alternative medicine (CAM) includes a wide variety of approaches to improving health and treating disease that the traditional medical community does not recognize as standard or conventional. When used in addition to conventional methods of treatment, they are referred to as complementary; when used instead of conventional methods of treatment, they are referred to as alternative.
Complementary and alternative therapies may be categorized in many different ways.
The National Center for Complementary and Alternative Medicine (NCCAM) divides them into five domains:
1. Whole medical systems of theory and practice: These are practices used by different cultures in various parts of the world to stimulate or support the body’s ability to heal itself or restore the yin-yang balance and flow of qi. Examples include homeopathic medicine, naturopathic medicine, traditional Chinese medicine (e.g., acupuncture), and Ayurveda.
2. Mind–body medicine: These techniques help the mind enhance body functions and reduce symptoms. Examples include meditation, guided imagery, hypnosis, prayer, and creative therapies.
3. Biologically based practices: These use substances found in nature such as herbs, foods, vitamins, and other biologic products (e.g., shark cartilage).
4. Manipulative and body-based practices: These techniques involve the manipulation or movement of the body, such as those used by chiropractors and massage therapists.
5. Energy medicine: These techniques manipulate energy fields within or outside the body. Examples include therapeutic touch, the use of magnets, or Reiki (a technique of placing hands lightly on the body or just above it to heal the spirit and thus the body).
The practice of complementary and alternative therapies is rapidly increasing, partly due to our increasing understanding of them. The body of scientific knowledge about specific complementary and alternative therapies, how they work, and what effects they have on the body is constantly growing. To disseminate authoritative information about complementary and alternative therapies and to scientifically study their safety and effectiveness, the U.S. government founded the National Center for Complementary and Alternative Medicine as part of the National Institutes of Health.
However, the increased use of such therapies also reflects the desperation of many people with cancer, resulting in a willingness to try anything and everything they feel might help them. Complementary and alternative therapies are not regulated in the same way as traditional medications and medical devices. Many treatments and products offer no evidence of effectiveness, and, in fact, some may even be harmful to you. If you are considering unconventional therapies, get as much accurate information as you can about them. Discuss your thoughts with your doctor, and inform him or her of your intentions. Many of these therapies can be used safely with the traditional treatments you are receiving. Others, however, can interfere with your treatment, cause serious side effects when combined with your treatment, or may even be harmful to you.
Term:
Acupuncture – A technique of inserting thin needles into the body at specific locations with the goal of restoring the normal flow of energy in the body; often used to treat pain or other symptoms.
If you are considering unconventional therapies, get as much accurate information as you can about them, and speak with your doctor before you begin.
