Emergency Preparedness for People with Cancer

Flooded Street.jpgIn the past few weeks, devastating hurricanes and earthquakes have forced people out of their homes and away from their cancer care facilities, highlighting a need for better education and preparedness surrounding the medical consequences of natural disasters. Emergency situations such as a hurricane, earthquake, blizzard, flood, or blackout, are unpreventable and can drive a city into disarray in a matter of hours – but the more preemptive thinking and planning that people do prior to a catastrophic event, the better equipped they will be to respond. This is especially true for people with cancer, who must be particularly cautious during such times, as they are often more susceptible to infection or injury.

Follow these 5 tips to help minimize the harm that a natural disaster or public emergency can cause to your personal health:

Travel with Caution
Since extreme weather can cause travel delays both on roads and throughout public transportation, be sure to allow extra time to make it to your appointment safely. You may also want to consider staying in a hotel near the hospital to avoid hazardous commuting conditions before and after your appointment, especially if you’ll be in and out of the facility more than once within a few days. Some programs, such as the American Cancer Society Hope Lodge in Manhattan and Extended Stay America’s Hotel Keys of Hope help to alleviate the financial burden of traveling away from home to receive treatment by offering guest rooms for people undergoing cancer care. If you are uncertain about travel conditions, call Weill Cornell Medicine and NewYork-Presbyterian’s (WCM/NYP) emergency hotline at 212-746-9262.

Stay in Touch
If you are due for an infusion or injection during an episode of severe weather or other emergency, contact your doctor to discuss the risks versus benefits of finding a safe way to get to WCM/NYP’s treatment center, finding an alternative temporary treatment center, or possibly delaying treatment. In case you do need to seek treatment at an alternative facility, reach out to your insurance provider for help, and bring your insurance card with you to any clinical visits.

Know Your Info
Be aware of your exact diagnosis and disease stage, as well as where you are in the chemotherapy or radiation treatment cycle (if applicable). If you are a participant in a clinical trial, know the trial number, principal investigator (PI), and treatments involved. Should you forget any details pertaining to your medical records, you can easily consult Weill Cornell Connect, WCM/NYP’s secure online health connection that allows you to communicate with your doctor, access test results, request prescription refills, and manage appointments – anywhere, anytime.

Power Through Outages
Power outages frequently accompany extreme weather conditions, and it is vital to prepare accordingly. In the event that you cannot charge your mobile devices or access the Internet, you will want to have physical backup of important medical information, so record the names and dosages of all the medications you take, and keep copies of prescription slips that contain your health care providers’ names and contact information. Also note that some medications that require refrigeration may lose potency in temperature variation. In the event of a blackout, they should be replaced as soon as possible.

Pack the Essentials
Keep a first aid kit including basic essentials like extra bandages and gauze compresses, antiseptic wipes and ointments, over-the-counter pain relief medicines, and 3-4 days’ supply of any oral medications you may be required to take. Medication in its original container may be subject to contamination if exposed to flood water and is best stored in a sealable bag (Ziploc, for example) ahead of a natural disaster. Look to replace any medication that does not appear dry.

In general, but especially after severe inclement weather, be sure to communicate with your cancer care team if anything out of the ordinary happened (such as running out of medication or receiving treatment at an alternative facility) during the emergency episode so that they can update your medical records.

All of the physician practices at WCM/NYP have coverage 24 hours a day, 7 days a week, but even in the rare event that the outpatient center is closed, the emergency department will likely be open. In the case of a medical emergency, dial 212-472-2222 or 911.

Wishing everyone a safe fall and winter season!

Liquid Biopsies in Prostate Cancer: Ready for Prime Time?

Beltran and Lab
(From L to R) Dr. Himisha Beltran, Dr. Raymond Pastore and Dr. Bishoy Faltas

Recent studies in advanced prostate cancer have identified emerging treatment targets and mechanisms of treatment resistance. At the 2017 European Society of Medical Oncology (ESMO) Annual Meeting, Dr. Himisha Beltran chaired and moderated a session evaluating the use of liquid biopsies – blood tests used to glean information about tumors – as a useful clinical tool for prostate cancer management.

While there are no formal guidelines on who, when, how and what to test for in prostate cancer, Dr. Beltran’s expertise provided important guidance to the global oncology community on this topic, as the prospect that a blood test might reveal many insights about the cancer and the tumor makeup has led oncologists to feel excited. Several steps are still needed for broad clinical implementation.

As tumors grow, some of their cells may enter into the bloodstream. These cells are known as circulating tumor cells (CTCs) and travel throughout the body along with fragments of tumor cell DNA known as circulating tumor DNA (ctDNA). Compared with traditional biopsies which extract tissue directly from the tumor, liquid biopsies offer a less invasive way for doctors to detect molecular biomarkers and learn more about what’s going on with someone’s cancer. Liquid biopsies can also better capture tumor heterogeneity, as CTCs and ctDNA can provide a window into the entire tumor (and metastatic sites), compared with a traditional biopsy in which typically only one part of the tumor is sampled. Thus, with a simple blood test, doctors can potentially access a more comprehensive view of an individual’s cancer, which can then help them determine the best treatment for that person. Blood testing can also be more easily repeated throughout the course of treatment in order to monitor disease changes in response to therapy, so liquid biopsy offers ways to detect treatment resistance and resistance mutations early on and throughout the course of the disease.

Red Blood Cells

There is an emerging role for molecular testing in advanced prostate cancer since this information can better inform treatment decisions involving targeted therapies, such as PARP inhibitors, platinum-based chemotherapy, and immunotherapies. Liquid biopsies such as ctDNA may provide information about the genomic alterations present in the cancer, which can be used to help predict how people might respond to certain therapies.

Through liquid biopsies, physicians and researchers can also better detect signs of therapy resistance that may be emerging. For example, if a patient has a gene amplification or mutation detected in ctDNA that involves the androgen receptor (AR) gene, or AR splice variants expressed in CTCs, this may indicate that potent AR-targeted therapies may be less likely to work. This is because the cancer cells may develop various ways to reactivate androgen receptor signaling by acquiring extra copies of the AR gene (gene amplification), activating AR mutations, and/or AR splice variants (such as the AR-V7 variant), all of which result in downstream over-activity of the AR-pathway. Knowing this information up front may spare people from the side effects from a treatment likely to be ineffective. Current research is focused on developing more effective AR pathway inhibitors in this setting. CTCs may also identify other features of the cancer such as localization of the AR in response to taxanes as observed in the TAXYNERGY trial, tumor heterogeneity, and expression of emerging therapeutic targets.

Through a grant from the Prostate Cancer Foundation (PCF), Dr. Beltran and colleagues at WCM are working as part of an international consortium to develop, validate, and implement a ctDNA platform for prostate cancer. This targeted genomic sequencing test, called PCF SELECT, identifies tumor mutations in ctDNA from metastatic prostate cancer patients to guide treatment selection based on precision medicine. It is currently undergoing centralized development, and the long-term goal is that this ctDNA test will be widely used by the clinical prostate cancer community for precision medicine applications.

While liquid biopsies do have promise for these indications and can help guide decisions on the most appropriate treatments for prostate cancer patients, it is important that both patients and clinicians understand the advantages and limitations of available and emerging technologies. Undergoing treatment at a center of excellence that contributes to research on emerging trends allows individuals the opportunity to be among the first to access cutting-edge technologies that may benefit them.

 

New Research from Weill Cornell Medicine (WCM) Sheds Light on the Prevalence of Heart Attack and Stroke in Diagnosed Cancer Patients

Cancer cells produce substances that “thicken” the blood, so men and women with cancer have a significantly higher risk of developing blood clots. A manifestation of blood clots can be cardiovascular events such as heart attack and stroke. The latest research found that six months after diagnosis, people with cancer had a higher rate of heart attack or stroke.

New research from Weill Cornell Medicine (WCM), published in the Journal of the American College of Cardiology, found that patients newly diagnosed with cancer are more than twice as likely to suffer from arterial thromboembolism – a sudden interruption of blood flow to an organ or body part due to a clot that has come from another part of the body – as cancer-free patients. The types of cancers studied include breast, lung, prostate, colorectal, bladder, pancreatic and gastric cancer.

Dr. Babak B. Navi, neurologist at Weill Cornell Medicine, and his team evaluated the risk of heart attack and stroke in patients age 66 or older with new cancer diagnoses compared with people who did not have cancer. Results showed that six months after diagnosis, people with cancer had a higher rate of heart attack or stroke (4.7%) due to blood clots than people without cancer (2.2%). After the first six months, the differences in risk got smaller. One year after diagnosis, the risks were about the same in people with and without cancer. Dr. Babak Navi and his team also discovered that more advanced stages of cancer were associated with higher risk.

This research is an outgrowth of the data that Dr. Babak Navi presented at last year’s International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC)  about the risk of heart attacks and stroke in women with breast cancer. Results showed that women diagnosed with breast cancer have a higher risk of a heart attack or stroke in the first year after diagnosis compared to similar women without breast cancer.

Through the latest research, we now know the risk of clotting goes beyond breast cancer and is a risk factor for many different forms of cancer. Further research is needed in order to develop optimal strategies to prevent arterial thromboembolism in patients with cancer.

Weill Cornell Medicine

“People with cancer are known to be at increased risk of blood clots and this risk is believed to vary according to cancer type, stage of disease, and treatment modality. We also know that patients with cancer are more likely to have cardiovascular events which may be induced by tumor or its treatment,” says Dr. Scott Tagawa, medical oncologist and Director of the Weill Cornell Medicine Genitourinary (GU) Oncology Program. “This research further underscores the need to conduct clinical trials to determine the best prevention methods and treatment of thrombosis in patients with cancer.”

Mark your calendars to learn more about the cancer clotting connection at this year’s World Thrombosis Day event.

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