It has been a while since I’ve posted here, and it is nice to be back again! I have been compiling a list of some interesting topics (to me) for future posts, so hopefully we can have some good discussions in the comments section. This particular topic is not specific to lung cancer, but certainly applies to lung cancer patients as much as any other malignancy so I think it will still be of interest.

For many years there has been a consistent observation made among cancer patients that married individuals tend to live significantly longer than do unmarried individuals. This observation holds true across different types of cancer including prostate, breast, and lung. For some reason, the warm support of the spouse at your side seems to be a broadly positive prognostic factor, in addition to the other numerous benefits…

There are any number of reasons for exactly why this might be so. Patients who are married tend to have better financial resources and also have better social support, two elements that independently seem to predict for patients doing better. Marriage also frequently results in children (although marriage not required), which can provide additional support at trying times for elderly patients. There are also reasons to think that patients who are NOT married may have problems that contribute to poor outcomes including psychological problems such as depression, substance abuse, and poor health for reasons other than their cancer. Loneliness is a big problem for my unmarried, elderly patients and I can see first hand that their lives are much harder during treatment than those with big families at their sides.

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   Any oncologist can testify to the difficulties facing family members of patients with cancer.  A recent study out of Canada examines the “biologic cost” of caring for a patient with cancer.  This was a small study in which the researchers compared saliva and blood samples from 18 primary caregivers of people who had just been diagnosed with brain tumors with those from 19 volunteers.  They also used questionnaires to measure perceived stress and depressive symptoms in the caregivers and the volunteers, who were all followed for one year.

   Salivary amylase was used as a proxy for studying activation of the sympathetic nervous system (a.k.a. adrenaline, responsible for the “fight or flight” response).  Normally, this enzyme in saliva declines sharply after awakening and then rises throughout the day.  As expected, this diurnal rhythm was preserved over time in the healthy volunteers.  Caregivers, on the other hand, experienced loss of this normal rhythm over time and then gradual recovery.  C-reactive protein is a measure of systemic inflammation and high levels are a well-documented risk factor for cardiovascular disease.  At the study entry, levels were similar in caregivers and volunteers; however, over time, the caregivers demonstrated increase in CRP.  In fact, half of them developed CRP levels >3 mg/L, a level considered to be a marker for high risk of cardiovascular disease.  CRP levels did not reach a plateau but continued to increase over the year of the study. Over time, caregivers also demonstrated lower expression of anti-inflammatory signaling molecules.

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Hello again; its’ definitely been a while since we’ve talked. A few days ago, Dr. West, our hero, asked me to comment on a GRACE reader’s question about a relative who was in complete denial. The state of her unfortunate lung cancer situation was so obvious to all that the friend wondered what the patient could possibly be thinking when she refused to consider her physician’s suggestion that she get her ‘affairs in order’.

Denial is one of our psychological defense mechanisms and, believe it or not, it works very well for those who need such a defense. Denial is actually very functional, and I am frankly surprised that more cancer patients don’t employ it. Freud once said, and I am paraphrasing, that no human being could face the fact of their imminent death for very long; truly coming to grips with the fact that one is going to die, and probably sooner rather than later is a terrifying thought. This is when denial really kicks in as the way to avoid looking at this reality. Another very wise man once said: Acceptance is hope co-existing with reality. Denial is hope masquerading as reality.

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Several of the people who have been following GRACE have read and provided comments on discussions initiated by Leah de Roulet, an oncology social worker who has recently stepped down as the head of the  very strong oncology social work group at Swedish Cancer Institute in Seattle, WA after many years, but still works several days per week in her semi-retirement.  She has been providing counseling and practical assistance to our patients for more than a decade, and she was kind enough to sit down with me to discuss some important aspects of oncology social work with me.

This interview will be presented in two parts, with the first half included here and covering topics ranging from an introduction to what oncology social workers do, to practical issues of getting cancer care for under-insured or uninsured patients, to coping with a cancer diagnosis.  Here is the audio podcast: Click to Listen

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