According to an article in CANCER, mental illness and emotional distress in patients with advanced cancer is often overlooked by oncologists, but proper management can improve a patient's quality of life.

The review article was written by Dr. Michael Miovic and Dr. Susan Block from the Dana Farber Cancer Institute and Brigham and Women's Hospital in Boston.

Miovic and Block found that 50 percent or more of patients with advanced or terminal cancer suffer from at least one of three major disorders: adjustment disorders, anxiety disorders and depressive disorders. Medical management of cancer has improved in the last decade, but management of mental health issues has lagged, according to the authors. Studies show that depressive symptoms can even impact patients' lives even more than pain.

The authors recommend listening as the most important screening tool in the oncologist's toolkit.

Receiving a cancer diagnosis is a huge shocker, and like grief, people respond in different ways. But I hope it's not common for people to respond like this woman in Quebec City, who committed suicide by setting herself on fire on the day her chemo treatments were set to begin. She burned herself beyond recognition in a car alongside two propane tanks. Next to the the vehicle, police found some personal affects and a suicide note.

Apparently, this is not unheard of, as people are often at risk of suicide after receiving bad news. Still, considering all the advances that are happening each day in the medical field, it's a shame that she couldn't stick around to have her hope and health restored. My thoughts go out to her family.

I promised two weeks ago when I wrote Sunday Seven: Seven ways to fine-tune your health that I'd be back to offer seven more grand ideas for optimizing your physical and emotional well-being. Here I am, with a mini-list of suggestions I gathered a while back from a newspaper article. If you don't already practice these strategies, then why not give them a try.

Eat breakfast

It's the most important meal of the day -- really. A breakfast high in complex carbohydrates and protein creates energy. Energy kick-starts metabolism and helps our bodies burn fat. We all know what fat does. It weighs us down and contributes to all kinds of health problems.

Get your sleep

Sleep restores our bodies. Sleep-deprived folks secrete more leptin, a protein hormone that increases appetite. Larger appetites increase food consumption. Increased food consumption spikes the risk of obesity. And so on. You know the drill.

Writer Jeph Lobe has been working through the stages of grief in the most recent issues of Marvel Comics. You see, Captain America has been gunned down. And his buddies -- Wolverine, the Avengers, Iron Man, and Spider-Man -- are battling with denial, anger, bargaining, and depression. The whole story will be revealed when the latest issue, Fallen Son, hits newsstands July 5th, the day after Independence Day.

Loeb, also an executive producer for NBC's Heroes, chose his storyline to represent current politics.

"Part of it grew out of the fact that we are a country that's at war, we are being perceived differently in the world," he says. "He wears the flag and he is assassinated -- it's impossible not to have it at least be a metaphor for the complications of present day."

A new and official report shows cancer is the leading cause of death and disability in Australia.

The Australian Institute of Health and Welfare reveals that cancer is taking more lives -- about 19 percent -- than cardiovascular disease, currently at 18 percent. Cancer is the now to blame for Australia's burden of disease, according to the report, and the disease doesn't appear to be slowing anytime soon.

Burden of disease refers to not only mortality but also takes into account impact of illness and disability. Essentially, this means cancer takes away from healthy life years.

The one constant thing that gives people fighting cancer hope is the continued support of friends and family. Phone calls, emails, a surprise or planned visit at the door that has a big hug on the other side, a held hand over coffee or tea, or sitting patiently by their side as they go in for treatments. When that support falls by the wayside, it makes the determination to fight this disease or any other less worth the effort. In my humble opinion as someone fighting cancer, we sometimes fight harder to overcome disease for others more than ourselves. Because it is in their caring and the will in their eyes that gives us a much brighter hope than we find in ourselves. It is the lack of support or caring that sets off an internal depression that makes it ten times harder to find the will to fight. People seem to find it easier to hug a tree than a human. Try to imagine if you will sitting in a house alone and thinking about a disease that can run rampant through your body. It is hard to imagine and something that we do not want to think about. Yet many many people face that struggle every day of their lives.

So if you haven't reached out to someone you know, a neighbor, a friend, someone in your church or where you work, or even a family member that is struggling with cancer or any other disease, then find it in your heart to do so. It will make a difference. And if you have reached out to someone once or even twice, know that once is not enough and twice is not enough. No matter how much you think you are being a nuisance, that constant reminder of love and support is 95 percent of your friend's battle. The old saying "You never know who your true friends are until you go through a crisis and see who stands by our side" is very very true. So go stand by someone's side today, tomorrow, and for many days to come to offer support and encourage strength until their fight is successful. Even a phone call goes a long long way.

For those of you who stay in touch with me by phone and emails and that come knocking on my door in this time of need, I thank you very much for giving me the strength and will to survive.

Britney Spears, fresh out of rehab and back in the spotlight, is explaining why she publicly shaved her head back in February, following a rampage of bizarre behavior.

Think about this:

A friend of Spears says the pop star shaved her head as a tribute to her aunt who died from cancer. The pal states Spears was definitely suffering from postpartum depression at the time and the bold hair maneuver was an act of solidarity.

"Britney's aunt had just died of cancer," says this friend. "She was feeling very guilty because she hadn't been there with her, she was overwhelmingly depressed and she shaved her head in solidarity."

Way to go Wake Forest University scientists -- for adding to the body of evidence connecting stress to illness and for reporting before anyone else that the stress hormone epinephrine causes changes in prostate and breast cancer cells that may make them resistant to death.

Emotional stress contributes not only to the development of cancer, says lead researcher George Kulik, D.V.M., Ph.D, but it also reduces the effectiveness of cancer treatments.

Previous research shows levels of epinephrine, produced by the adrenal glands, are sharply increased during stressful situations and can stay elevated during long-term stress and depression.

During this study, published in the on-line Journal of Biological Chemistry, Kulik and colleagues found that a protein called BAD -- the cause of cell death -- becomes inactive when cancer cells are exposed to epinephrine.

This is huge for patients and researchers.

"It may be important for patients who have increased responses to stress to learn to manage the effects," said Kulik. "And, the results point to the possibility of developing an intervention to block the effects of epinephrine."

Partners of cancer survivors may be at risk for depression and are susceptible to the same stresses as cancer survivors themselves, says a new study in the Journal of Clinical Oncology.

The study showed that similar numbers of partners and survivors show signs of clinical depression, but partners were less likely to receive mental health treatment. Previous research has found that partners of cancer patients can experience as much anxiety, distress and depression as the patients themselves.

Michelle M. Bishop, Ph.D., Research Assistant Professor and the study's lead author says "We need to acknowledge that cancer occurs in the context of a family that is profoundly affected by the experience, and that needs intervention for their own well-being".

Cancer sent me into a state of depression. And it took more than a year of counseling and treatment with an anti-depressant to bring me back to a balanced and healthy level of functioning.

My type of depression -- the kind that shows up just after a cancer diagnosis -- is not uncommon. And neither is the spillover that depression can leave on the children of moms depressed because of their disease.

A study at the University of Pittsburgh -- the first to examine the relationship between children's concerns and a mother's cancer-related depression -- found children of depressed breast cancer patients were more likely to be concerned or anxious about their mother's cancer and about how the disease affects their families.

It's not surprising that kids worry about their moms during times of illness. What startled researchers, though, is the fact that children's' anxieties extended to concerns about the entire family.

The results of this study, funded by the National Cancer Institute, has clear implications. As a society, we need to think about how depression affects whole family units. Oncologists must learn to spot depression early and must swiftly assist women in finding appropriate treatment. And parents should talk openly about cancer and it's emotional side effects with their children in an effort to protect them from withdrawing, hiding their concerns, and suffering in silence.

Most estimates indicate nearly one quarter of women diagnosed with breast cancer have young children. And about 100,000 kids will be affected by a cancer diagnosis this year alone.

Physicians now have a tool that can diagnose depression in cancer patients. Patients sometimes will need additional treatment to enable them to cope with their cancer more effectively.

The problem has been that doctors might have a hard time telling what patients actually have clinical depression. The patient may be just showing normal signs of sadness, feelings which commonly result from being diagnosed with cancer.

A team from the University of Liverpool's Division of Primary Care has created this method of testing called Brief Edinburgh Depression Scale (BEDS). What this test does is assess the cancer patient's mental condition with a six-step scale. The test includes questions on worthlessness, guilt and suicidal thoughts.

Professor Mari Lloyd-Williams, lead researcher says "The effects of depression can be as difficult to cope with as the physical symptoms of a terminal illness such as cancer. Patients often feel useless, that they are to blame, and even experience suicidal thoughts during cancer - these are all signs of depression but rarely elicited."

The clinical trial that was conducted included 246 patients with advanced cancer. Twenty-five percent of those patients were shown to have depression that had previously not been diagnosed.

From houseplants to raised beds, to plant a seed, tend the soil, and watch a plant grow is one of the most inspiringly hopeful of activities. In hopefulness is found a kind of healing. According to the American Horticultural Therapy Association, horticulture therapy is defined as "a process utilizing plants and horticultural activities to improve social, educational, psychological and physical adjustment of persons thus improving their body, mind, and spirit." The American Cancer Society offers a list of some of horticulture therapy benefits one can expect from gardening that include:

• Feelings of hope.
• Stress reduction.
• Social interaction.
• Pain relief.
• Improved muscle tone, flexibility, and cardiopulmonary capability.
• Creativity and self-expression.
• Enhanced self-esteem and improved mood.
• Motor skill development.
  

As the New Year arrives, so do the gardening catalogs in the mail. Interested in receiving gardening catalogs but not certain where to start? Cyndi's Catalog of Garden Catalogs lists over 2,000 mail-order gardening catalogs for the home gardener.

Two of my favorite gardening websites and online catalogs are found at Seeds of Change and Seed Savers Exchange.

At Seeds of Change, you can find garden seeds, seed collections, cover crops, seedlings, fruit trees, garden tools, kitchen items, and a bookstore. All organic. In addition, Seeds of Change publishes a newsletter.

Seed Savers Exchange is a nonprofit organization that saves and shares heirloom seeds. According to Seed Savers Exchange, "Our organization is saving the world's diverse, but endangered, garden heritage for future generations by building a network of people committed to collecting, conserving and sharing heirloom seeds and plants, while educating people about the value of genetic and cultural diversity."

But, wherever you start, once you catch the gardening bug, you will understand why horticulture therapy is becoming an integrated part in healing programs adopted at some of the medical centers across the country.

Smoking is not an easy habit to break, and of the many methods tried, only a handful seem to work. Of the methods that do seem to work -- nicotine-replacement products; bupropion drugs; counseling; classes; calling a helpline or talking to a health professional -- younger smokers between the ages of 16 and 24 years who smoke and try to quit only use one of the recommended methods of help by talking to a professional. Because of this, younger smokers are less likely to be successful in quitting, according to the US Centers for Disease Control and Prevention (CDC).

During the 2003 National Youth Smoking Cessation Survey, the CDC found that younger smokers most often tried to quit smoking by cutting back on the number of cigarettes they smoked each day; not buying cigarettes; exercising; using the buddy system and trying to quit with a friend; telling others they were quitting and changing to a lighter brand of cigarette, switching to chewing tobacco, snuff, or other tobacco products. None of these methods are recommended by the US Public Health Service.

According to the National Youth Smoking Cessation Survey, 77 percent of younger smokers have tried to quit at least once without success. Over a third have tried to quit smoking numerous times without success. Researchers suggest that many younger smokers may need help with other high-risk behaviors such as binge drinking; depression or ADD/ADHD.

If you are a younger smoker who is trying to quit, the CDC encourages you to call 1-800-QUIT-NOW or talk to your physician about methods that might lead to more success. The 2-page summary of the National Youth Smoking Cessation Survey is available as a pdf document.

Nabilone, known as Cesamet, a synthetic imitation of an active ingredient found in marijuana, has been shown successful in treating cancer patients experiencing nausea, pain, anxiety and depression, according to University of Toronto researchers who conducted a study on the effectiveness of the synthetic drug.

During the study of 139 participants, a survey was conducted to rate how well the synthetic drug alleviated the adverse side-effects most commonly associated with chemotherapy. According to the study, cancer patients who were prescribed Cesamet indicated less pain, anxiety and depression.

A prescription drug approved for cancer patients who do not respond to traditional anti-nausea treatments, lead investigator Dr. Vincent Maida stated, "This is not a pot pill and has absolutely no street value."

The trouble with the synthetic drug, which is legal, is the stigma attached to marijuana use in general, even on the part of some physicians, who are said to be hesitant to prescribe a version of marijuana even if it is not marijuana. In our modern society, marijuana is sometimes associated with counter-culture populations, addiction and even as a gateway to more addictive drugs.

I would say I just do not get it when it comes to the denial of making cancer treatment for a cancer patient a little easier, but The Scientific American published a brief history of marijuana that brings us from ancient China to the present with, "In 1937 the U.S. Congress, against the advice of the American Medical Association, passed the Marijuana Tax Act, effectively banning use of the drug by making it expensive and difficult to obtain. Ever since, marijuana has remained one of the most controversial drugs in American society. Despite efforts to change its status, it remains federally classified as a Schedule 1 drug, along with heroin and LSD, considered dangerous and without utility."

As anyone who has undergone the grueling ordeal of chemotherapy can tell you, getting high is the last thing on their mind. However, alleviating the debilitating side effects of chemotherapy is critical.

Other medical marijuana-related posts include:

• Montel Williams: poster child for pot
  
• Medical marijuana pot pill approved for chemotherapy
• Breast cancer has made me a criminal patient story
• FDA rejects medical marijuana use
• Guru of Ganja: medical marijuana advocate faces new pot charges

Breast cancer statistics for 2003 are in, and researchers have announced that the number of breast cancer cases dropped by an impressive seven percent, with the greatest drop occurring in women between ages 50-69 diagnosed with estrogen receptor positive (ER-positive) breast cancer.

The University of Texas M. D. Anderson Cancer Center researchers attribute this good news to the fact that in the same time frame, millions of women stopped taking hormone replacement therapy (HRT) over concerns that HRT led to an increased risk for breast cancer.

If the statistics hold for upcoming years, HRT will have proven a greater causative effect leading to breast cancer than originally believed.

"Incidence of breast cancer had been increasing in the 20 or so years prior to July 2002, and this increase was over and above the known role of screening mammography," stated Donald Berry, Ph.D. "HRT had been proposed as a possible factor, although the magnitude of any HRT effect was not known. Now the possibility that the effect is much greater than originally thought all along is plausible, and that is a remarkable finding."

While the researchers best guesstimate is that HRT might be the contributing factor to the drop in ER-positive breast cancer cases for 2003, they cannot be 100 percent certain at this point. We will need to wait and see what the years 2004 and 2005 tell us about any continuing declines in breast cancer cases, and learn what other, if any, contributing factors are responsible for the decline.

Previous posts we have done regarding HRT and breast cancer:

• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks