Current Newsletter - October 2006

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=120 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfe1esnpes.jpg"> <div> <B>October 2006</B></div> <bR> <div> <A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B><U>Calendar</U></B></U></A><A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B> </B></U></A><B>  |   </B><A HREF="id60.htm" TARGET="_top" TITLE="Carers Group"><U><B><U>Carers Group</U></B></U></A><B>   |   </B><A HREF="id2.htm" TARGET="_top" TITLE="Group Guidelines"><U><B>Group Guidelines</B></U></A><B>   |  </B><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B> </B></U></A><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B><U>Library</U></B></U></A><B>   |   </B><A HREF="id4.htm" TARGET="_top" TITLE="Current Newsletters"><U><B><U>Current Newsletters</U></B></U></A><B>   |   </B><A HREF="id16.htm" TARGET="_top" TITLE="Archived Newsletters"><U><B><U>Archived Newsletters</U></B></U></A><B>   |   </B><B><U>Pamphlets</U></B><B>  |  </B><A HREF="index.htm" TARGET="_top" TITLE="Northern Beaches Prostate Cancer Support"><U><B><U>Hom</U></B></U></A><B><U>e</U></B></div> <div> </div> </td> </tr><tr> <td valign="top" height=360 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfc3.jpg"> <div> <B><U>NEWSLETTER</U></B></div> <div> No. 50 October, 2006</div> <div> Editor: Mark Tweeddale</div> <bR> <div> <B>1.     COMING EVENTS</B></div> <bR> <div> NOTE: Meetings are normally held at 6.30 pm on the first Tuesday of each month in the Palliative Care Cottage, Mona Vale Hospital<B> </B><I>(unless otherwise advertised)</I></div> <bR> <div> Tuesday 7 November  </div> <bR> <div> Associate Professor Susan Henshall, Head, Prostate Cancer Research Program, Garvan Institute of Medical Research: Prostate Cancer, </div> <div> Genetics and Gene Technology</div> <bR> <div> Professor Henshall leads a team of researchers at the Garvan Institute here in Sydney that is doing ground breaking work in Prostate Cancer - among other areas of medicine.  Her talk will cover some fascinating aspects of genetics, gene technology and other Prostate Cancer research at the Garvan. It promises to be an extremely interesting evening.</div> <bR> <div> Tuesday 5 December           </div> <bR> <div> Christmas Get-together </div> <div>                </div> <bR> <div> <B>2.     Report on our OCTOBER Meeting </B></div> <bR> <div> <B>2.1     "New Technology for Prostate Cancer" </B><B>Summary of the address by Assoc Professor Phillip Stricker, Prostate Cancer Centre, St Vincent's Hospital, Tuesday 3 October at 6.30 p.m.</B></div> <bR> <div> It was a great pleasure to welcome Associate Professor Phillip Stricker of the St Vincent's Clinic and Prostate Cancer Centre back to the Group. </div> <bR> <div> Prof Stricker listed the range of treatment options for a man when diagnosed with prostate cancer. They were:</div> <div> Surgery (radical prostatectomy)</div> <div> Robotic surgery</div> <div> Brachytherapy </div> <div> External Beam Radiotherapy (EBRT)</div> <div> High Intensity Focused Ultrasound (HIFU)</div> <div> Active surveillance</div> <bR> <div> <B>Surgery:</B>  Radical prostatectomy is still the most common treatment. Recent developments in manual surgery have enabled lower blood loss and hence fewer instances of blood transfusion being needed, and fewer complications such as blood clots. The hospital stay varies between 2 and 7 days, and catheters remain in place for 7 days in most cases. Mild incontinence occurs in around 3% of cases and severe incontinence in around 1%.</div> <bR> <div> A major recent development is the use of robotic surgery. This entails small "keyhole" incisions, with the surgeon sitting at a console and the surgery being undertaken by robotic instruments. The surgeon has a stereoscopic and magnified view of the operating field, and very fine manipulations can be undertaken. A short video clip was played, showing an example of this. (The term "robotic" is in fact not a good one, as it implies that the machine operates by itself, whereas it is a master-slave situation with the machine doing only what the surgeon instructs it to do.)</div> <bR> <div> The benefits are:</div> <div> less blood loss;</div> <div> shorter hospital stay;</div> <div> less post-operative pain (although modern surgery does not result in serious pain);</div> <div> faster return to normal activity</div> <div> less scarring (minimal benefit)</div> <div> quicker discharge from hospital and quicker recovery after that. </div> <bR> <div> The disadvantage is that the technique is in its early days, and experience with it is still being acquired. The quality of the surgery done by a surgeon who is highly experienced with the technique can equal that done manually (and may in future be better). It depends, as always, on the skill of the surgeon and the amount of his experience with robotic surgery. At present the results of skilled open surgeon may be better than those of a surgeon with limited experience of the robotic technique, but Prof Stricker, who was the first in NSW to use the technique, is impressed with the results.</div> <bR> <div> <I>Nerve Grafting:</I> This was once seen as the way to retain potency when nerves have to be resected. It entails removal of a nerve from the leg, and grafting it where the nerve was removed with the prostate. Unfortunately the results have been disappointing, even by the surgeon who developed the technique. </div> <bR> <div> One of the objectives in cancer surgery is that of "negative margins". When a cancer is removed and sent to the pathology laboratory, a report back that there are <I>negative margins</I> means that there is no cancer up to the edge of what's been done; that is, there is no cancer left behind. In Australia, the incidence of positive margins ranges between 5% and 40%. Very few centres in Australia handling higher numbers of cases have achieved better than 10%, including St Vincent's.  </div> <bR> <div> <B>High Dose Rate Brachytherapy:</B>   This is normally done in conjunction with External Beam Radiotherapy. Its benefit is that the radiation conforms very closely to the prostate, and so allows higher radiation doses than are possible with EBRT alone without excessive damage to nearby organs. This treatment is an alternative to surgery, but if unsuccessful cannot be followed up by salvage surgery.         </div> <bR> <div> <B>High Intensity Focused Ultrasound (HIFU):</B> This is a <I>very new</I> form of treatment (which is not yet covered by medical benefits, and so is expensive). An ultrasound probe is inserted into the rectum, and ultrasound is focused onto the prostate. The ultrasound causes vibrations which in turn generate heat concentrated at the focal region but not elsewhere. (This is similar in concept to focusing heat from the sun with a magnifying glass.) The zone treated is roughly cigar shaped, and each zone requires treatment for only about five seconds. Normally the aim is to treat the entire prostate, zone by zone, with the prostate being viewed simultaneously by ultrasound.</div> <bR> <div> The features of HIFU treatment are:</div> <div> there is no nuclear or X-ray radiation;</div> <div> there is minimal risk to neighbouring tissue;</div> <div> there is a very short hospital stay (e.g. day surgery);</div> <div> it may be done in one session, using a spinal anaesthetic;</div> <div> it can be repeated if necessary;</div> <div> other alternatives can be used later if the HIFU treatment is unsuccessful;</div> <div> it can be used if radiation treatment has failed;</div> <div> the effect on PSA is quite rapid (e.g. the PSA reaches its lowest point within 3 months compared with perhaps 24 months with</div> <div> brachytherapy).</div> <bR> <div> Like other treatments, it is not free from side effects. They include:</div> <div> prolonged urinary retention (necessitating use of a catheter) - 100% of cases;</div> <div> mild incontinence - 8%</div> <div> severe incontinence - less than 1%</div> <div> impotence - 20 - 70% (depending on the extent of the treatment)</div> <div> fistula between the bladder and the bowel - rare.</div> <bR> <div> For localised prostate cancer, HIFU is an emerging treatment particularly suitable for those patients who do not want to have surgery or radiation treatment.</div> <bR> <div> <B>Photodynamic Therapy:   </B> A treatment which at present is still being experimented with is the use of drugs that become active when exposed to light, and which then kill cancer cells. The drug is administered, and then a strong light is introduced to the prostate. At present this treatment is entirely experimental.</div> <bR> <div> <B>Imaging Techniques:  </B> If it were possible to detect precisely where the cancer is located (e.g. totally within the prostate, or spread locally, or present in small metastases elsewhere), it would greatly help in selecting the appropriate treatment options. Unfortunately that is generally not possible at present with either the full body bone scan or X-rays. However, two approaches which are showing promise are:</div> <div> Positron Emission Tomography (PET) with intravenous radioactive choline;</div> <div> Magnetic Resonance Imaging (MRI) using Ultra Small Particles of Iron Oxide (USPIO) as a contrast medium.</div> <div> Neither of these techniques is available in Australia at present.</div> <bR> <div> <B>To Treat or Not to Treat: That is the Question …. :  </B>There are three main questions that are considered when deciding whether the cancer should be treated. They are:</div> <div> Is the prostate cancer life-threatening?</div> <div> How old is the patient and does he have any other illnesses or conditions?</div> <div> What treatments are available and what are the benefits and risks of each?</div> <bR> <div> <B>Selection of the Treatment:   </B>Factors that influence the decision include:</div> <div> the nature of the tumour;</div> <div> the prostate;</div> <div> local factors (e.g. obesity, previous surgery in the region);</div> <div> the geographical location (someone in a distant location may find it difficult attend frequently for treatment;</div> <div> the type of patient </div> <div> his sexual and urinary priorities</div> <div> is he a worrier? </div> <div> Is he someone who wants to be involved in the decision, or someone who takes the view "<I>the doctor knows best</I>"?</div> <div> does he simply "<I>want it out</I>"?</div> <div> is he afraid of surgery?</div> <div> is he the "pragmatic" type?</div> <div> does he "<I>believe he will live for ever</I>"?</div> <div> is he willing to take a risk (a "punter") or is he conservative?</div> <div> does he prefer natural therapy?</div> <div> the patient's previous experience of some form of cancer (personally or in the family etc.);</div> <div> family history of cancer </div> <div> cultural background;</div> <div> financial factors</div> <bR> <div> In the case of the patient who wants only natural therapy, and for those who are looking for what they personally can do to complement their medical treatment, there are a number of possibilities. For example, the growth of the cancer <I>may</I> be slowed by a diet with:</div> <div> very low calorie intake;</div> <div> very low fat content;</div> <div> supplements of </div> <div> selenium </div> <div> lycopene (e.g. tomato sauce or paste)</div> <div> pomegranate juice (around 250 ml per day)</div> <bR> <div> <B>Multidisciplinary Teams - the Coming Trend:  </B>It is becoming more common for patients to be treated by a multidisciplinary team, instead of being referred from one individual specialist to another. Such teams, which meet regularly to review patients' treatment and progress, may comprise:</div> <div> urologists</div> <div> radio-oncologists</div> <div> medical oncologists</div> <div> dieticians</div> <div> psychologists</div> <div> research unit</div> <div> clinical trials coordinator </div> <div> etc</div> <bR> <div> (HMT and JC)</div> <bR> <bR> <div> <B>3.     Reports on meetings held elsewhere</B></div> <bR> <div> <B>3.1     </B><I><B>"Prostate Cancer Clinical Trials"</B></I><B> Summary of the address by Dr Gavin Marx, medical oncologist, at the meeting of the SAH Prostate Cancer Support Group at Jacaranda Lodge, Sydney Adventist Hospital, Monday 28 August at 7.00 pm</B></div> <bR> <div> <B>Why Trials are Important</B>: Dr Marx opened his presentation by explaining that most of the best cancer treatments today are based on what has been learnt from clinical trials. Clinical trials may have various aims. These include improvement of:</div> <div> Treatment</div> <div> Prevention methods</div> <div> Early screening</div> <div> Diagnosis</div> <div> Quality of life</div> <bR> <div> A lot of progress has been made with trials over the last two to three years, and particularly in the last twelve months. The focus has been on patients with prostate cancer that was "hormone refractory". Such patients have limited treatment options at present.</div> <bR> <div> (<I>Hormone Refractory</I>: When the potentially curative treatments such as surgery and radiotherapy have not been successful, or if the cancer has recurred years later, the next treatment is usually hormone therapy with either Zoladex or Lucrin. This switches off production of testosterone by the testes, reducing the testosterone level in the blood to around 5% of the normal level. In most cases this stops the cancer for some years. When the PSA starts to rise again, often the next treatment is to block the remaining 5% of the testosterone from entering the cancer. When this additional treatment is no longer effective, the disease is described as "hormone refractory".)</div> <bR> <div> Dr Marx explained that trials are research studies that aim to find better ways to a) prevent, b) detect or c) treat cancer. Treatments today are the result of trials conducted five years ago or longer. Patient safety is protected in a number of ways. Before a trial is approved, it must be passed by both an independent scientific committee and an independent ethics committee. These committees ensure that the proposed trial has scientific merit and that the patients are being given full information to enable them to give "informed consent". During the trial, the progress is monitored by an independent review board and a data safety and review board so that if dangers are discovered along the way the trial can be stopped.</div> <bR> <div> Any new treatment undergoes three phases of trial. </div> <bR> <div> <I>Phase I:</I> The treatment is given to 15 - 30 people to confirm the safe dosage, how it can best be given, and to gain an understanding of the effects on the body.</div> <bR> <div> <I>Phase II:</I> The treatment is given to fewer than 100 people to determine whether it does what it is intended to do, and to get a clearer understanding of how it affects the body.</div> <bR> <div> <I>Phase III:</I> The aim is to determine whether the treatment is better than the current standard treatment. The patients in the trial are divided into two equal groups. One group receives the new treatment, and the other receives standard treatment. (A placebo is given to this second group only if the standard treatment would be to do nothing.) To avoid the patients receiving the new treatment getting a better standard of care, or taking better care of themselves, than those not receiving the new treatment, rigorous trials are conducted in a "double blind" manner, that is neither the patient nor the treating doctor know which patients are receiving the new treatment and which are not.</div> <bR> <div> The benefits of taking part in a trial include:</div> <div> as an absolute minimum, patients receive the standard treatment for their stage of the cancer;</div> <div> there is the opportunity of being treated with the very newest treatment which, if effective, is unlikely to be generally available for a</div> <div> further 5 to 10 years; as a result of being very closely monitored, patients on trials on the whole do better than those not on trials, </div> <div> even if they are not receiving the new treatment; even if a patient is in the group that does not receive the new treatment, their</div> <div> participation is helping the research, and thus helping others.</div> <bR> <div> In Australia, fewer than 10% of cancer patients are on trials. Typical reasons include:</div> <div> not knowing about trials;</div> <div> not having access to trials;</div> <div> no appropriate trial occurring at the time;</div> <div> suspicion or fear of research;</div> <div> logistical difficulties - distance, frequency of visits, number of tests to be undergone etc.</div> <bR> <div> Difficulties faced in conducting trials so as to get clear results include:</div> <div> difficulties in defining objective measures of the response (e.g. survival time is relatively easy, but quality of life is difficult); </div> <div> the highly varied nature of the patients (age, fitness, health, grading of their cancers, etc.)</div> <div> the wide variety of other medical conditions of the patients (e.g. if a patient eventually dies, is the death due to the cancer, or another</div> <div> medical condition?)</div> <bR> <div> The results of a trial are not released until the trial is complete. They are published first in conferences and peer-reviewed international journals and the results are not made public until that has happened and the results have been exposed to peer review by other specialists in the field. (By the time an advance is announced in the popular press, it has almost certainly been known by specialists for several years!)</div> <bR> <div> Because scientific understanding of cancer cells and their growth has improved so much in recent years, numerous avenues of research have opened up aimed at blocking those growth mechanisms. Future possibilities are very exciting.</div> <bR> <div> Trials designed for hormone-refractory patients currently running include:</div> <bR> <div> <I>Denosumab</I>: a human monoclonal antibody that aims to delay the development of secondaries in the bones. This trial is recruiting participants right now. It is open to hormone refractory patients who do not have secondaries in their bones. (There is to be a second trial for those with bony secondaries, with the aim of slowing their growth.)</div> <bR> <div> <I>Taxotere plus PI-88</I>: a variation on an earlier trial which used Taxotere plus thalidomide. This trial aims to provide an improved attack on secondaries by combining the cancer-destructive action of Taxotere with PI-88 which inhibits formation of blood vessels needed by the cancer to grow. The treatment aims to improve the quality of life, and to extend survival of hormone refractory patients. </div> <bR> <div> In question time, the following information emerged.</div> <div> Most medical oncologists would know about these trials and could advise patients about their suitability and how to become involved. </div> <div> So the message is: <I>"Ask your specialist about trials!"</I>.</div> <div> Great advances are being made, and as time passes there are more options for treatment. </div> <div> Like all medications, Taxotere has side effects, which were outlined. The extent of these tends to increase with successive doses, and </div> <div> may define the limit to the treatment.</div> <bR> <div> (HMT & Pam Sandoe)</div> <bR> <bR> <div> <I><B>APCC Conference: </B></I><B>4 & 5 October, Garvan Institute</B></div> <bR> <div> The Australian Prostate Cancer Collaboration (APCC) conference is a forum for researchers studying prostate cancer to exchange information about their progress. Twenty six talks were presented. Much of the material was too technical for me, but I found many points interesting. They include the following (with the names of the speakers shown in brackets).</div> <bR> <div> <I>There is growing recognition of the importance of multidisciplinary care of prostate cancer patients because of both the physical and the "psychosocial" impacts (Dr Mariko Carey), and an experimental approach was described that aimed to reduce the psychosocial needs of patients at the Peter MacCallum Institute, Melbourne. So far there have been few studies of the effectiveness of psychosocial interventions, and those that have been done mostly had inadequate methods. But it is clear that there is a need for ongoing support in addition to that provided by clinicians.</I></div> <div> A new study is being planned to assess the nature of the psychological stress experienced by carers of prostate cancer patients (Ms Megan Ferguson, Psychology-Oncology Research Unit).</div> <div> <I>While there is growing recognition of the benefits of multidisciplinary care, it is not clear what form this should take (Dr Kris Rasiah, Visiting Scientist, Garvan Institute). For example, would it be "one-stop" clinics, multiple selected consultations, or perhaps multidisciplinary team meetings or case conferences? (The last of these appears to be the developing NSW approach).</I></div> <div> In the case of breast cancer, the benefits of the multidisciplinary approach have been: a) the treatment each patient receives is more likely to be evidence-based rather than a particular consultant's habit; b) it is likely to be more conservative - less radical; c) improved survival as a result of using adjuvant chemotherapy and hormone therapy along with surgery/ radiotherapy; d) there has been a reduced time between diagnosis and starting treatment due to follow-up by the nurse coordinator; and e) many other qualitative benefits. (Dr Kris Rasiah).</div> <div> <I>A survey of prostate cancer patients identified the potential side effects that would be of most concern to them (Dr Madeline King, Centre for Health Economics Research and Evaluation). The most serious were (in order): severe urinary leakage, severe urinary blockage, bowel</I><I><B> </B></I><I>symptoms. Next came: severe fatigue, moodiness, hot flushes. Others were of lower concern.</I></div> <div> Good progress is being made in various fundamental research studies into early detection of prostate cancer, how it grows, and future approaches to its treatment. (various speakers).</div> <div> <I>Complementary methods from which prostate cancer patients may gain benefit include: a diet low in animal fats and high in lycopenes (e.g. from tomato products) and soy protein; supplementary selenium, vitamin D, calcium and fish oils (Dr Manish Patel, University of Sydney).</I></div> <bR> <div> A study of the men diagnosed with prostate cancer between October 2000 and October 2002 found that 90% at diagnosis had localised disease (T1a to T2b), or whom most (42%) had T1c (Mr David Smith, Cancer Council NSW). About half of the men (47%) had moderate to low Gleason scores (6 or less), while 16% had high Gleason scores (8 - 10). Over half (55%) had radical prostatectomy as their initial treatment, 20% had external beam radiotherapy with or without adjuvant hormone treatment, and 11% chose Active Surveillance. Eight percent had hormone therapy alone, and 5% had brachytherapy. Factors that influenced the choice included age, stage of the cancer, Gleason score and PSA.</div> <div> <I>Salvage therapy (i.e. treatment when the initial treatment has not totally removed the cancer e.g. external beam radiotherapy following</I></div> <div> <I>surgery) is associated with a percentage of major complications, expense, and poor outcomes (Dr Mark Emberton, Institute of Urology </I></div> <div> <I>and  Nephrology, London). However, the alternative of relying on hormone therapy has counter-balancing limitations: limited tolerability </I></div> <div> <I>of its side effects; finite duration of effectiveness; long term harm (e.g. osteoporosis). There is a trend toward less invasive salvag</I><I>e</I></div> <div> <I>treatment. </I></div> <div> <I>Such treatments under development include HIFU (heating), cryotherapy (freezing), photodynamic therapy, radiofrequency heating, etc. </I></div> <div> Because there is a shortage of hard evidence about which first treatment option is best for each patient, it is not possible to make the </div> <div> decision with confidence (Mr John Ramsay, Prostate Cancer Foundation of Australia). In fact, making that decision can be the most </div> <div> stressful time of all for a prostate cancer patient.</div> <div> <I>Delays between the initial suspicion of a problem (e.g. by a GP) to firm diagnosis of prostate cancer (e.g. by a urologist) appears to </I></div> <div> <I>increase the risk of a poorer outcome for younger men (Dr Carole Pinnock, Principal Research Scientist, Repatriation General Hospital).</I></div> <div> How patients view Support Groups depends greatly on the view of their medical specialist(s) (A/Prof Suzanne Stegings, Psycho-Oncology</div> <div> Research Unit, Queensland). A survey of 36 clinicians from across Australia found that while they rated peer-support of patients </div> <div> positively, between those Groups and clinicians.   (HMT)</div> <bR> <bR> <div> <B>GENERAL NEWS </B><B>FROM THE Prostate Cancer Foundation of Australia</B></div> <bR> <div> <B>4.1.1.</B>   <B>A REMINDER:  November is </B><I><B>"</B></I><I><B>M</B></I><I><B>ovember".</B></I></div> <bR> <div> <FONT SIZE="3" COLOR="#000000" FACE="Tahoma" >The countdown has begun for this next big fun charity event, starting on November 1. For information go to:  </FONT><A HREF="http://www.movember.com.au" TARGET="_top" TITLE="http://www.movember.com.au"><U><U>www.</U></U></A><A HREF="http://www.movember.com.au" TARGET="_top" TITLE="http://www.movember.com.au"><U><B><U>m</U></B></U></A><A HREF="http://www.movember.com.au" TARGET="_top" TITLE="http://www.movember.com.au"><U><U>ovember.com.au</U></U></A></div> <bR> <div> <B>4.1.2.   Group Affiliation with the PCFA</B></div> <bR> <div> At the October meeting, a representation of approximately 45 members agreed unanimously that our Northern Beaches Support Group should affiliate with the PCFA, and an application form has been forwarded to the Foundation.</div> <bR> <div> <B>4.1.3.   Support and Advocacy Committee (SAC), NSW</B></div> <bR> <div> Minutes of the SAC Teleconference held on Thursday, 21 September, are available from the Group Library.</div> <bR> <div> <B>From the Cancer Council</B></div> <bR> <div> The Cancer Council NSW will be running a <I>free General Cancer Support Group Facilitator Training Workshop</I> at its headquarters in</div> <div> Woolloomooloo on Saturday 18 November, 2006, from 9.00am - 4.30pm. For further information and for applications, contact </div> <div> Kim Pearce at the Council:  </div> <div> <B>Phone: 9334 1846;  E-mail:  </B><FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:kimp@nswcc.org.au" TARGET="_top" TITLE="mailto:kimp@nswcc.org.au"><U><B><U>kimp@nswcc.org.au</U></B></U></A></FONT></div> <bR> <div> The Council will also be running a <I>Consumer Advocacy Training Course</I> in Sydney on 20 - 21 April, 2007. For further information </div> <div> and for applications, contact Kelly Williams at the Council: </div> <div> <B>Phone:   9334 1748;    Mob: 0402 203 277  E-mail:  </B><FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:kwilliams@nswcc.org.au" TARGET="_top" TITLE="mailto:kwilliams@nswcc.org.au"><U><B><U>kwilliams@nswcc.org.au</U></B></U></A></FONT></div> <bR> <bR> <div> <B>4.3     COMMONWEALTH CARELINK CENTRE</B></div> <bR> <div> Information about our Group and what it offers is available on the Commonwealth Carelink Centre database. Please refer any of your friends or family who are looking for information about us to the Centre's website: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.commcarelink.health.gov.au" TARGET="_top" TITLE="http://www.commcarelink.health.gov.au"><U><B><U>www.commcarelink.health.gov.au</U></B></U></A></FONT><B> </B></div> <bR> <div> <B>PUBLICATIONS RECEIVED</B><B>  </B>(Copies of all of the following are available for borrowing from our Lending Library.)</div> <bR> <div> <I>Cancer Support News.</I> The Cancer Council, NSW. Issue 4, October, 2006.</div> <div> <I>Volunteer Voice.</I> The Cancer Council, NSW. Spring Edition, September, 2006.</div> <div> <I>Local News.</I> The Cancer Council, NSW. Spring Edition, September, 2006.</div> <div> <I>Newsletter 24.</I> Cancer Voices, NSW. September, 2006.</div> <div> <I>Update.</I> The Newsletter of Prostate Research Campaign, UK. Issue No 25,  Spring, 2006. This includes items on robotic surgery </div> <div> and a new test, based on molecular markers in the blood-stream, to replace PSA testing.</div> <bR> <div> <B>4.5     CONTACT NUMBERS</B></div> <bR> <div> Program Co-ordinator: <B>Dr Peter Moore</B>,  Northern Beaches Palliative Care, Tel 9998 0222 </div> <div> Group Leader:  <B>John Conroy</B>  Tel 9918 9358, <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:conroyjs@bigpond.com" TARGET="_top" TITLE="mailto:conroyjs@bigpond.com"><U><U>conroyjs@bigpond.com</U></U></A></FONT></div> <div> <B>Jo-Ann Steeves</B> ; <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:steeves@pacific.net.au" TARGET="_top" TITLE="mailto:steeves@pacific.net.au"><U><U>steeves@pacific.net.au</U></U></A></FONT>  or leave a message at Palliative Care: 9998 0222</div> <div> Newsletter Editor: <B>Mark Tweeddale</B>, Tel 9440 8184, <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:hmarktw@bigpond.net.au" TARGET="_top" TITLE="mailto:hmarktw@bigpond.net.au"><U><U>hmarktw@bigpond.net.au</U></U></A></FONT> </div> <bR> <div> NSW Cancer Cancer Council Support Helpline Tel  13 11 20 </div> <div> Prostate Cancer Foundation of Australia: Tel 1800 22 00 99</div> <bR> <div> Commonwealth Carelink Centres Tel  1800 052 222  </div> <div> Northern Beaches Neighbourhood Service, Inc.: Tel  9982 3044</div> <bR> <bR> <div> <B>5.     BOOK REVIEWS</B></div> <bR> <div> <B>Cancer for Two: Conquering a Cancer Together </B>by<B> David and Ann Bennett</B>, published<B> </B>by<B> Michelle Anderson Publishing</B>, </div> <div> Melbourne 2006. 146 pages (Available in bookshops)</div> <bR> <div> David Bennett is a senior barrister living in Melbourne, and his writing shows the clarity and orderliness of his mind. This is a brave book in which he and his wife, Ann, do not conceal the impact of their experience of his bowel cancer on their emotions and their lives. For those of us who have been rocked by our diagnosis, or emotionally overwhelmed at times by the momentousness of what was happening to us, or brought to tears by unexpected acts of kindness, or who have been tangibly supported by the love of a partner and family, this book is rewarding and highly readable. </div> <bR> <div> Although his cancer was not of the prostate, we can identify with his reactions at diagnosis, when telling his wife and when consulting with doctors; with the reactions of his family and friends to the news and their initial difficulties in knowing how to talk with him; and with his trepidation while awaiting surgery and his feelings when coping with post-operative difficulties and the weakness that took time to overcome. Many chapters end with a section by Ann, recounting her devastation on hearing the news, and her experiences and feelings in parallel with his. These provide a revealing glimpse of how she felt as a carer, and of her own need of support and of her appreciation of little acts of kindness to herself and to David - an important dimension of cancer often overlooked in the outpouring of concern for the patient. It is clear that David and Ann were partners in mutually supporting each other. </div> <bR> <div> He comments helpfully on what he found valuable in coping with the experience. In particular, he relates the advice he was given by eminent medicos about complementary approaches to help his recovery and to reduce the likelihood of recurrence of the cancer. In particular, he was advised about diet, exercise, control of stress, enjoyment of life, and the "spiritual" or metaphysical dimension to life (which may or may not be of a religious nature, as one is inclined). There is helpful guidance about how to relax one's body and mind very deeply. He was warned about the "Voodoo Trap", into which we can fall through fear, in which our anxiety makes us attuned to discouraging and life-destroying suggestions and ideas which can affect us and become self fulfilling like "bone pointing". Again, Ann once remarked to David<I>: </I><I>"I get things out. Maybe that's why I handle stress so well."</I> (Good advice for us all - better than bottling it up!) All this advice fits into the category of "taking control of one's life" rather than lying down and passively accepting what might happen. Good stuff ! It is worth reading the book for this sort of information alone, although we each ought to consult our own medicos about what is most appropriate in our particular cases. </div> <bR> <div> Some passages are very moving. One can identify with emotional situations which he and his wife encountered. Just two examples. On the day of his admission, he went to a florist in the morning to order flowers to be delivered to his wife on the next day while he was in surgery. (What a nice thought!) He wrote the greeting on the card to go with the flowers, but was suddenly so overcome by emotion that he choked up and was unable to speak to the florist for a moment. Then, writing about his discharge from hospital, he says<I> </I><I>"At last, with a feeling of relief that still moves me to tears as I write these words - we went home."</I><I> </I>By their honesty in revealing themselves, David and Ann help us to feel comfortable that it is normal to react in ways that we might previously have thought abnormal, weak or unseemly, i.e. it is OK to be emotional, to be unaccountably overcome with tears, to be moved by beauty in nature, to feel love and friendship with a heightened glow, and to express our appreciation warmly to those who stand with us.</div> <bR> <div> <I>(My rating for relevance for </I><I><U>prostate</U></I><I> cancer patients:</I>)</div> <div> <B>Life after Cancer </B>by <B>Ann Kent</B>,<B> </B>published by <B>Ward Lock</B>, London 1996; produced with the help of the Imperial Cancer Research </div> <div> Fund. 154 pages (Borrowed from the library at Jacaranda Lodge Cancer Support Centre, Sydney Adventist Hospital)</div> <bR> <div> The early chapters of this book are very heart-warming, addressing particularly the way in which a diagnosis of cancer changes our lives even after it has apparently been cured. The Introduction sets the scene well. In its second paragraph it notes: </div> <bR> <div> <I>"The diagnosis of a potentially fatal illness unsettles all our plans for the future, and forces us to confront our own mortality. Yet many people do not begin to deal with the implications of their illness until they are released from the protective cocoon of the hospital. …. The days of grapes and flowers and sympathy are over, and the rest of the world wants to forget, and wants the person with cancer to forget as well. If you are in this situation, you may feel depressed, helpless and convinced that your life is no longer under your control."</I></div> <bR> <div> <I>"All </I>(the cancer patients with whom the author spoke) <I>were marked by their experiences, but some had come to the remarkable conclusion that cancer had actually improved their lives."</I></div> <bR> <div> Making use of interviews with numerous cancer survivors and doctors, the book explores why we feel the way we do, our relationships to the doctors and the hospital, questions to ask our doctor, depression and its causes and approaches to climbing out of it, getting back to "normal", steps in self-help, dealing with other people including "avoiding poisonous people" (!), difficulties in confiding in others but the importance of doing so, the experience of being the carer, hidden sadness, etc., etc.</div> <bR> <div> The section on the health system is less helpful as it describes the UK National Health Service. However, some pointers on seeking second opinions, pressing for the appropriate help, are relevant. Similarly, the treatments described are largely a bit dated, but the suggestions on minimising side effects may be helpful.</div> <bR> <div> - HMT  <I>(My rating for relevance for </I><I><U>prostate</U></I><I> cancer patients:)</I></div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>Thank You </B></div> <bR> <div> A very important part of our meetings is the discussion time at supper. This is the time when we relax, and are able to talk with others about their condition and our own. It is this time that bonds us together as a group of friends, rather than an audience at a lecture. In my own case, I did not think I needed a support group, but I decided to come once to see what it was all about. I was attracted by the friendliness and the cheerfulness of everyone, and it is that that keeps me coming. </div> <bR> <div> This all depends on the great suppers that Jo-Ann and her helpers put together for us each evening, and by her quiet empathic presence among us.</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B> Well done, Jo-Ann & Co, and on behalf of us all:</B></div> <div> <I><B>"Thank you very much !" </B></I></div> <div>   </div> <bR> </td> </tr></table></body>