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Fatigue in Cancer Survivors: Maintaining the Light at the End of the Tunnel

No one gets through this battle alone. This forum is a location where interaction between individuals with oral cancer, friends and family members who are supporting those with cancer, survivors, care givers, and even interested members of the public, can meet to share experiences and ideas, ask questions, and hopefully find inspiration from those who have traveled this path before them. When I was going through treatment, I had so many questions. When was I going to get rid of all those sores in my mouth?

What about tasting things again? What about a treatment different than mine which I had heard about, and so many more questions. There was also the psychological aspect of it all, the depression, the burden it put on those around me both emotionally and physically, and the constant question…. When my wife needed to talk with someone about what she was going through, and make no mistake, even without the disease, those close to patients are under a significant burden, also needing their own kind of support and information, there was no forum for her to seek help.

Sometimes, only the voice and perspective of someone who has been there before you can give you the answer that you need. Doctors may provide you with their insights, but for all their knowledge and empathy with those they treat, they have not personally experienced the process. I finally found a voice, someone who had a similar cancer, one year before me.

That relationship, conducted primarily by emails, gave me so much hope and support. His insights showed me the light at the end of the tunnel, and from him I learned numerous little bits of useful information. Foods to try, tactics for dealing with swallowing, time frames to major landmarks in recovery…….

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Jason R. On Cancer, Lynch Syndrome and Soccer. Pioneering Oncologist Discusses Preventing Cancer. Pioneering Oncologist on Curing Cancer. Kevin C. Oeffinger on Tailoring Survivorship Care. Some studies have also included histologies other than SCLC. Direct comparison between these studies is difficult for a number of reasons which include the different eras in which they were conducted, different endpoints, and different study designs.

To complicate the picture further numerous trials of systemic therapies for extensive-stage SCLC allowed for the presence of brain metastases, but not all have evaluated CNS-specific endpoints. They fall into the broad categories of topoisomerase inhibitors etoposide, teniposide, doxorubicin, topotecan, irinotecan , platinum agents cisplatin, carboplatin , vinca alkaloids vincristine, vinorelbine , and alkylating agents cyclophosphamide, temozolomide. The role of immunotherapy such as pembrolizumab or nivolumab with ipilumimab is beginning to emerge for SCLC [ 92 , 93 ].

CNS responses have been seen across a range of treatment regimens, supporting potential efficacy in the target organ with no clear signal for superiority of one regimen over another. However, despite CNS responses in a substantial number of patients, OS remains dismal across numerous studies. The radiographic responses to systemic therapies are, however, heartening. They force us to push against the dogma that most systemically delivered agents are excluded from the nervous system.

This needs to be considered on both a histology-specific and therapy-specific basis. Our current understanding of the ability of specific therapeutic agents to cross into the healthy and the diseased CNS is limited.

Fatigue in Cancer Survivors: Maintaining the Light at the End of the Tunnel

This is in large part due to the practical limitation of performing pharmacokinetic PK studies on CNS tissue in living humans. The suboptimal outcomes which continue to be seen in patients with SCLC brain metastases warrant the need for further investigation. The robust radiographic response rates provide clear evidence for the biologic activity of our current treatment modalities.

Their limited effect, however, on improving survival support the need for additional advances. Ongoing efforts to limit the toxicity of radiotherapy may prove beneficial in this patient population as well as in other solid tumors. The ability of systemically administered treatments, including those traditionally thought to have limited CNS penetration, holds out even greater hope.

While there currently are no reliable prognostic or predictive molecular biomarkers in SCLC as our understanding of the disease evolves this will hopefully change.

Mauriel’s Story - Breast Cancer Survivor - Patient Testimonial

The study of SCLC brain metastases will continue to be limited by the paucity of tissue samples for this type of research. However, it should be noted that the neuropathologic work as well as imaging and therapeutic studies described above are beginning to shed light on how we may best address the problem of SCLC brain metastases.

Refining our existing therapeutic modalities such as WBRT to limit their toxicity will be an impactful advance. In addition to the promise of hippocampal avoidance, further tailoring of the radiation fields informed by neuroimaging studies could improve efficacy while decreasing toxicity. Systemic therapies actively targeting SCLC brain metastases are also of interest. Potential targets include components of the angiogenic pathway such as SUR1 or a host of potential immunotherapeutic targets. Parceling out the answers to CNS-specific questions from large therapeutic trials which include patients with brain metastases may provide us with important insights and adequate safety and efficacy signals to justify moving forward with brain metastases-specific trials.

Finally, the prevention of brain metastases in the SCLC patient population would be an important advance. The targeting of chemokines and adhesion molecules may play a role in achieving this goal. While improvements in survival for patients with SCLC brain metastases have been limited, the groundwork for important advances is present.

Kumthekar has received honoraria for serving as a consultant for Abbvie and Angiochem. All other authors have nothing to disclose. National Center for Biotechnology Information , U. Journal List Oncotarget v. Published online Jul Rimas V. Lukas , 1 Vinai Gondi , 2 David O.

“There is Light at the End of the Tunnel”: Three-time Cancer Survivor Ed Yakacki’s Story

Kamson , 3 Priya Kumthekar , 1 and Ravi Salgia 4. David O. Author information Article notes Copyright and License information Disclaimer. Correspondence to: Rimas V. Lukas, gro. Received May 18; Accepted Jul 3. This is an open-access article distributed under the terms of the Creative Commons Attribution License 3. This article has been cited by other articles in PMC.

Giuliana Rancic: Finding the Light at the End of the Tunnel

Design A comprehensive review of the literature covering epidemiology, pathophysiology, imaging characteristics, prognosis, and therapeutic management of SCLC brain metastases was performed. Results SCLC brain metastases continue to have a poor prognosis. Conclusions A clearer understanding of SCLC brain metastases will help lay the framework for studies which will hopefully translate into meaningful therapeutic options for these patients.

Keywords: brain metastases, chemotherapy, pathophysiology, radiation therapy, small cell lung cancer.

Mari-Anna Stålnacke

Epidemiology Lung cancer metastases to the brain affect more patients than any other solid tumor metastases in the U. Pathophysiology SCLC is a tumor which arises from pulmonary neuroendocrine cells as well as other potential candidate cells such as alveolar type 2 cells [ 10 ]. Neuro-anatomic localization SCLC is more likely to be associated with multiple brain metastases as opposed to single brain metastases.

Open in a separate window. Nuclear imaging Positron emission tomography PET uses radiotracers to visualize metabolic activity in vivo. Surgery Due to the frequent multi-metastatic picture in SCLC surgery does not typically have a role in the management of this disease. Radiotherapy Because brain metastases are a frequent problem in patients with SCLC [ 64 ], and the burden of brain metastases can impact on quality and length of survival, several prospective trials have examined the use of prophylactic cranial irradiation PCI in SCLC patients who present without brain metastases.

Future Oncol. Treatment of brain metastases. J Clin Oncol.

Fatigue in Cancer Survivors: Maintaining the Light at the End of the Tunnel

Brain metastases: an overview. CNS Oncol. Treatment of brain metastases in the modern genomic era. Pharmacol Ther. Brain metastases in non-small-cell lung cancer. Clin Lung Cancer. Brain metastases in non-small-cell lung cancer: better outcomes through current therapies and utilization of molecularly targeted approaches. Systemic Therapies in the Treatment of non-small cell lung cancer brain metastases.

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Small cell lung cancer: can recent advances in biology and molecular biology be translated into improved outcomes? J Thorac Oncol. Prognostic role of patient gender in limited-disease small-cell lung cancer treated with chemo radiotherapy. Strahlenther Onkol. Factors affecting the risk of brain metastasis in small cell lung cancer with surgery: is prophylactic cranial irradiation necessary for stage I—III disease?

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Expression-profiling of angiogenesis related genes in brain metastases of lung cancer and melanoma. Tumor Biol.

Inhibition of SUR1 decreases the vascular permeability of cerebral metastases. Int J Mol Sci. Isogeneic comparison of primary and metastatic lung cancer identifies CX3CR1 as a molecular determinant of site-specific metastatic diffusion. Oncol Rep. Formation of neurosensory organ by epithelial cell slithering. Current status of chemokines in the adult CNS. Prog Neurobiol.