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Cancer Nutrition 101: Top 5 patient and provider Q&A

JoAnna Hazard
Contributor

JoAnna is an Oncology Dietitian. She has 11 years of experience in medical nutrition therapy for cancer patients. Most recently, she is the head of nutrition services at cancer treatment centers of America, Philadelphia. 
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Can nutrition really make a difference in my outcomes as a cancer patient?
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Yes! We know that 80% of adults living with cancer will have some degree of malnutrition during their journey, and that 1 in 3 will have some type of nutrient deficiency. Malnutrition may lead to treatment interruptions or reductions in dose. Do you want to maintain your strength, stamina and restore health, all while completing treatment on time and with less symptoms and side effects? If yes, then focusing in on your nutrition now is crucial!
Girl Suffering from Symptoms of Viral Infection or Respiratory Illness Set, Severe Weakness, Sore Throat, Temperature, Cough, Chills, Runny Nose, Headache, Muscle Pain Vector Illustration Isolated on White Background.
As a person diagnosed with breast cancer, should I be avoiding soy?
doctor_md
Whole forms of soy food such as tofu, edamame and even soy milk have been shown to be beneficial for breast cancer at any stage. The estrogen like compounds in soy actually help to reduce your own (more powerful) estrogen, meaning less hormones in your body overall. Processed soy foods such as soy cheese, soy burgers, for example, are not included in this recommendation and should be avoided.
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Why is it important to have a cancer specific dietitian?
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In addition to the education required to become a dietitian, board certified oncology nutrition specialists have gone through at least 2000 hours of oncology specific training and have passed an exam to become credentialed. As of July 2020, there are currently only 806 board certified oncology nutrition specialists in the country. These professionals have the most up to date knowledge on varying cancer types, treatment regimes and how to best support your body during this hard time.
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What should I eat?
doctor_md
This is a very personal question that will be different for each person depending on their history, genetics and cancer type, among other things. There is no one perfect diet that fits everyone. Broadly, you should start focusing in on more fruits and vegetables because they are your main source of cancer fighting nutrition. Aim for 5-9 servings each day! Certain foods are better for certain cancer types, but big picture you can’t go wrong starting with this.
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What should I NOT eat?
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Again, this is dependent upon the person and cancer type. There are definitely some foods that no one should be consuming in any meaningful amounts. These include processed meats such as hot dogs, lunch meat, sausage and bacon. Another food, which shouldn’t shock you, is sugar. I’m not talking about natural sugars found in fruits and vegetables, but that overly processed white stuff that is everywhere! Sugar single handedly increases your risk for becoming overweight and diabetic, which in turn exponentially increases your risk for all cancer types.
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News

Patient Centered Breast Cancer Care Using Technology

Susan G. Komen Breast Cancer Foundation 4th annual patient navigation conference will be held at June 23, 2020. Our collaboration nurse Nancy Hacker, BSN, RN, OCN, CBCN, from Memorial Sloan Kettering Cancer Center, will give a talk with topic “Patient-Centered Care & Technology Continues To Amaze Us!”
Patient-centered care is the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient.  It includes listening to, informing and involving patients in their care.

The IOM (Institute of Medicine) defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” (1)
liyfe provides patient centered breast cancer care
Cancer care is complicated and highly situational. It requires a whole team (Medical Oncologist, Radiation Oncologist, Surgical Oncologist, nurse, patient navigator, therapist, dietitian, physiatrist, etc ) to coordinate with each other, work together in order to produce the best outcome.
However, there are many challenges, such as communication and patient compliance. Liyfe Clinic serves as the hub of each parties, facilitate the communication and patient education, the mission is to provide patient centered breast cancer care and produce the best outcome for each individual patient and patient family.
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News

Efficacy and Cost-Effectiveness of Breast Cancer Patient Navigation

At 2019 Susan G. Komen annual Patient Navigation Conference, Dr. Lily Tang, Associate Professor at Yale, CEO of Liyfe Clinic,  gave talk about “Sparing your heart from radiation — Deep Inspiration Breath Hold (DIBH) for left-sided breast cancer radiation therapy”. This presentation received a lot of positive feedbacks.
Dr. Lily Tang gave presentation at Susan G. Koman foundation
Dr. Lily Tang gave presentation at Susan G. Koman foundation
About 50% of patients with left-sided breast cancer will need whole breast Radiation Therapy. This means that heart is nearby and might get irradiated as well. Radiation induced cardiac disease is a proved clinical fact.
Dr. Lily Tang presents Deep Inspiration Breath Hold (DIBH)
Deep Inspiration Breath Hold (DIBH) is state-of-the-art technology to treat breast tissue while sparing the heart. Dr. Lily Tang is the first leading scientist who discovered this use case. She published paper at 2013, since then cancer centers in United States started to adopt this novel solution. Today, it has already become the standard treatment option in majority of the big cancer centers, and prevented tens of thousands of patients from radiation induced cardiac disease.
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knowledge

COVID-19 Cancer Care 101: Top 10 patient and provider Q&A

Lily Tang Contributor

Dr. Tang is currently a medical physicist and faculty at Yale New Haven Hospital/Smilow Cancer Hospital. She was trained at the Harvard Medical School/Massachusetts General Hospital and at the University of California/San Diego. She held faculty appointments at the University of North Carolina/Chapel Hill, and at the Memorial Sloan Kettering Cancer Center. She has rich experience about cancer second opinion.She has extensive domain expertise in cancer care with 13 years of clinical experience.
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Are all cancer patients at risk? Or just those currently getting treatment?
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Patients with blood malignancies such as non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute myeloid leukemia, acute lymphoblastic leukemia and multiple myeloma are most at risk.

Those in active treatment for any type of cancer and those who’ve undergone bone marrow transplants are also at risk.
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Can patients and survivors get tested to see if they’re immunosuppressed?
answer
T here’s no easy blood test to check someone’s level of immune suppression, but being in active chemotherapy, having low white-cell or low lymphocyte counts and/or taking immune-suppressive agents (such as prednisone) are all associated with immune suppression and increased risk of infection.
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Should I cancel my treatment or follow-up appointments?
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C ancer patients with scheduled appointments should keep them, unless they’re experiencing coronavirus symptoms. If your hospital or clinic postpone your treatment, you can visit Liyfe Clinic to ask questions or telemedicine with your Oncologist.

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Can I see my Oncologist at home as part of normal treatment?
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Y es, you get some treatments through telemedicine. In fact, administration expands telemedicine for Medicare and encourages health plans to boost offerings during coronavirus pandemic. People will need to navigate this brave new health care system, especially for cancer patients, time is precious.

Your oncologists can use Skype, Zoom, Liyfe or any synchronized streaming services to deliver telemedicine, those tools are free.
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Should people still get screened for cancer during this pandemic?
answer
H ealth officials are urging everyone to stay home as much as possible to further reduce the risk of being exposed to COVID-19.

If you’re due for your screening to detect breast, colon, cervix, or lung cancer, but the health care facility postpones your appointment for the near future. You should seek alternative ways. Especially if you have symptoms that could be from cancer, you should contact your healthcare provider or visit Liyfe Clinic ASAP.

Chat With a Professional
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What should I do if I have symptoms?
answer
F or symptoms details, you can check out two websites: CDC
Heat map
Call your providers to see whether and how you can get tested in your area.

Go to authority online screening platform such as:
Purchase home test kits:
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What if a family member develops symptoms?
answer
I f someone in your household gets sick, have them sleep in a different room if you can. Wear gloves, masks, and separate meal kits. Make sure you wipe down areas with some sort of bleach wipes and keep washing your hands regularly. It’s also crucial not to bring a sick family member into your cancer treatment center.
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If I were due routine follow-up visits and not feeling ill? When a physical exam is important and telehealth is not a good option, should I be proactive and reschedule or should I keep my appointment as scheduled?
answer
F rom currently available data, almost all cancer patients are at higher risk of COVID-19 related mortality, and older people (men more than women) appear to be at higher risk of COVID-19 related mortality than younger people. Thus, efforts to reduce the risk of exposure of COVID-19 to all patients are needed, for example with reduction in the frequency of follow-up visits and replacing in-person visits with telephone or remote telemedicine (Skype, Zoom, Liyfe are some free ones) follow-up.

All asymptomatic routine follow-up patients may be rescheduled for three months or longer. The majority of patients who have recently completed chemo therapy or radiotherapy can safely have their follow-up extended by two to three months or more, with telemedicine as needed.

There are published data on nurse-led telephone follow-up and virtual PSA monitoring suggesting that prostate cancer patients can be monitored remotely unless symptomatic or with concerns for clinical progression.

A small study randomizing lung cancer patients to symptom-based follow-up versus routine imaging found a survival benefit favoring symptom-based strategy. Whether telephone follow-ups can substitute in the short term for in-person visits is unknown.
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What to do if test positive with COVID-19?
answer
T he answer to this is complex and evolving. It will require physician discretion personalized to each patient. Ask oncologist to reassess the patient’s goals of care. Depends on the situation, cancelling or delaying cancer treatment might be necessary until the patient has recovered.
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knowledge

Cancer Second Opinion 101: Top 10 patient and provider Q&A

Lily Tang Contributor

Dr. Tang is currently a medical physicist and faculty at Yale New Haven Hospital/Smilow Cancer Hospital. She was trained at the Harvard Medical School/Massachusetts General Hospital and at the University of California/San Diego. She held faculty appointments at the University of North Carolina/Chapel Hill, and at the Memorial Sloan Kettering Cancer Center. She has rich experience about cancer second opinion.
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What is a second opinion?
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Because the diagnoses and treatment plans associated with cancer care are so complicated, it’s normal to experience confusion and doubt.

You might worry that your doctor has not found all the potential cancer, or that another doctor or hospital might propose a different treatment, or that a different doctor might know of some unconsidered treatment option. Therefore, you request a second opinion. Basically you simply ask a new doctor to either confirm the initial diagnosis and treatment plan, or provide an alternative.
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Will my original doctor feel offended if I want to get a second opinion?
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N o. As mentioned above, second opinions are routine in cancer care. Most doctors won’t feel offended. Everyone wants to make sure your diagnosis and treatment plan is the best for you. In the rare case where your initial doctor might feel it’s not necessary to get a second opinion, you can be firm and polite, and insist that your decision be respected. You don’t need your doctor’s permission. Above all, it’s important to have this conversation early.
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When I should seek a second opinion?
answer
Here are some scenarios:

1. When you want to explore all potential options.

2. When you want assurance that all your tumors were located.

3. Whenever you feel uncomfortable with your doctor, or your diagnosis, or with your treatment plan.

4. When your local cancer center is small. You want to know how a big center would treat your case.

5. When your health insurance requires it.

6. Whenever your cancer is rare, and your initial doctor is not experienced with that type of cancer.

7. When you simply want peace of mind.
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What questions should I ask the second opinion doctor?
answer
H ere are some questions:

1. Confirmation of diagnosis.

2. What treatment option would you recommend for MY situation?

3. Are there any new treatment options for MY case?

4. Am I eligible for a clinical trial?

5. What are the side effects of the treatment options?

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Are there any publications to support the importance of cancer second opinion?
answer
Yes. In the review mentioned earlier. Ruetters et al [1] summarized 13 medical papers on cancer second opinion. They found “Depending on the study, between 6.5% and 36% of patients search for a second opinion, due to a variety of reasons. Changes in diagnosis, treatment recommendations or prognosis as a result of the second opinion occurred in 12-69% of cases. In 43-82% of cases, the original diagnosis or treatment was verified. As a result, patient satisfaction was high, and the second opinion was deemed as helpful and reassuring in most cases.
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What is a good second opinion?
answer
Personalizing care and treatment options in a kind, ethical and scientific approach is the key to a first and second opinion.

An opinion without execution path would be useless. Therefore, a good second opinion should be a care package including below components:

1. Explain and review the first opinion with the patient.

2. Have a discussion about the patient wishes, intentions, and priorities in order to come up with a treatment plan that would offer the best outcome.

In some cases, the best plan and options will be provided to the patient based upon the latest clinical trials supporting the treatment decision.

3. Have followups with the patient treatments.
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Where can I find a second opinion?
answer
You can ask your initial doctor to recommend one. Some cancer centers may require you to do another set of exams in order to provide second opinion. Some don’t, and offer remote cancer second opinion. Such as, Memorial Sloan Kettering, Stanford, Mayo Clinic. However, the wait time is typically long and often it only provides a written report without patient interaction.

Liyfe Clinic also offers remote cancer second opinion care telemedicine package, which includes the components mentioned above. The turnaround time can be as fast as the 2 days.
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Can I google or go to social network to find similar diagnosis and compare the treatment option?
answer
T hat could be very dangerous. Although it’s convenient to search for information online, there is misinformation everywhere. The information you find may be inaccurate or not applicable to your situation.

Reference:
[1] Ruetters D, Keinki C, Schroth S, Liebl P, Huebner,Is there evidence for a better health care for cancer patients after a second opinion? A systematic review . J Cancer Res Clin Oncol., 2016, Jul; 142(7):1521-8.
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knowledge

Radiation 101: Top 10 patient and provider Q&A

Shea Liu Contributor

Dr. Shea Liu is currently medical physicist and assistant professor working at Memorial Sloan Kettering Cancer Center. Dr. Liu has solid clinical skills as well as rich research experience on a wide variety of radiotherapy treatments. He obtained his PhD in Optics at University College Dublin, Ireland, and did postdoctoral research on health informatics and machine learning in radiation oncology at Washington University St. Louis. His medical physics resident experience at Stanford University pushed him further to become the expert in this field.
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What is radiation therapy?
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A   type of cancer treatment that is used to shrink tumors and stop the growth of cancer cells. Radiotherapy is very effective in treating some types of cancer that in fact, nearly two-thirds of patients will receive radiation therapy, according to American Society for Radiation Oncology (ASTRO).

Radiotherapy can be used as a stand-alone treatment, and often it is used in combination with surgery, chemotherapy, targeted therapy, etc. For example, prostate and larynx cancer are often treated with radiotherapy alone, while a woman with breast cancer may be treated with surgery, radiation therapy and chemotherapy.
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Why radiation?
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Radiation therapy is often used to cure cancer, and sometimes also to reduce the symptoms, and therefore improve a patient’s quality of life. For instance, it can shrink a lung tumor that is causing shortness of breath. It will also reduce the risk that cancer will return after surgery or chemotherapy to control the growth of remaining cancer cells.
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How is radiation delivered?
answer
D epending on the location, size and type of cancer, you may receive one or a combination of techniques. There are 2 primary types of delivery:

1) External beam radiation: using high-energy specialized machine to deliver the prescribed dose directly at the cancerous cells.

2) Brachytherapy:implanting radioactive material into the body at the local treated site.
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Does radiation therapy hurt?
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I t does not hurt while being treated, and you will not become radioactive from the treatments either.
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Is radiation safe?
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R adiation has been used successfully to treat patients for more than 100 years. In that time, many advances have been made to ensure that radiation therapy is safe and effective. The prescribed dose is delivered precisely to the tumor while sparing healthy tissue around it and minimize side effects. For example, for breast cancer patients, to avoid introducing radiation dose into the lung and heart, a set of treatment beam angles were carefully chosen for each patient.
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What to expect for a complete course of radiation therapy?
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G enerally, a patient will go through: referral, consultation, simulation, treatment planning, treatment delivery, and follow-ups.
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What are the types of radiation therapy equipment?
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T he type of equipment used will depend on the location, size and type of cancer. Here is a list of some common types of radiation therapy:

1. Three-dimensional conformal radiation therapy (3D-CRT)

This is a technique where beams of radiation used in treatment are shaped to match the tumor and are delivered accurately from several directions.

2. Intensity modulated radiation therapy (IMRT)

A form of 3D CRT in which the physician designated specific doses of radiation that the tumor and normal surrounding tissues receive. It allows radiation to be more exactly shaped to fit the tumor.

3. Proton therapy

A type of radiation therapy that uses high-energy protons rather than photons (x-rays) to treat certain types of cancer. The physical characteristics of the proton therapy beam may allow doctors to more effectively reduce the radiation dose to nearby healthy tissue. Most commonly used in the treatment of pediatric, CNS and intraocular cancers.

4. Stereotactic Body Radiotherapy (SBRT) or Stereotactic Radiosurgery (SRS)

A specialized form of radiation therapy that focuses high-power energy on a small area of the body. Despite its name, radiosurgery is a treatment, not a surgical procedure. Radiosurgery generally implies a single high dose or just a few high dose treatments.

5. Brachytherapy

Radioactive material is placed into or close to the tumor. In this way large prescribed doses can damage the cancer cells and it allows minimal radiation exposure to normal tissue. Radioactive sources used are normally thin wires, ribbons, capsules or seeds. These can be either permanently or temporarily placed in the body
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Are there side effects, and what are they?
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S ome patients experience few side effects from radiation therapy or even non. Others, side effects may occur because the radiation used to destroy cancer cells can also damage healthy cells and tissues located near the treatment area.

The occurrence and probability of side effects depend on the type and location of radiation therapy, and of course depend on individual patient. Common side effects include: skin reactions, fatigue, diarrhea, fatigue, hair loss, mouth and throat changes, nausea and vomiting, sexuality and fertility in men and women, etc2. Side effects may last for several weeks after the final day of treatment, or even longer.
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Who is the radiotherapy team?
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T he radiation therapy team includes:

Radiation oncologists (physicians)

Dosimetrists (treatment planning)

Physicists (quality assurance and machine calibration)

Therapists (treatment delivery)

Nurse

Social workers

Receptionists