Prof. Aaron Ciechanover, Nobel Prize Laureate and Honorary President of the Israel Cancer Association - 2015 "Door Knock" Fundraising Campaign Chairman - Chairman's Donation Given in Prof. Ciechanover's Honor
Prof. Aaron Ciechanover in his speech related to the fact that research is already showing promising signs for the future when scientific findings are translated into therapeutic interventions: 'from the bench to the bedside'. He called upon the public to open their doors and lend an outstretched hand, to donate toward the continued battle against cancer diseases - a potentially life-saving fight.
Excerpts from Prof. Ciechanover's speech opening the "Door Knock" Fundraising Campaign - "The Israel Cancer Association's annual fundraising campaign always coincides with the arrival of the New Year, and this is a tradition that is to be commended. According to this tradition, the individual who donates the first significant sum to the yearly campaign is the person who heads the campaign during that specific year. This year, a wonderful and humble man, who wishes to remain anonymous, will be at the helm of this campaign. I do not profess to represent him, nor can I do so, as anonymous giving/philanthropy take on a virtuous role, being one of the most important mitzvoth. I can only share a few of my thoughts and the little knowledge that I possess of this disease which scares us so much, and for no reason, because if we would apply the same logic as we do when dealing with all the other diseases that surround us, we would be able to overcome and eradicate it.
The triangle of cancer comprises three reciprocally interconnected components. First and foremost, the patients and their families, who cope with the disease very bravely; at the second apex are the caregivers - the healthcare professionals - nurses, physicians, technicians, social workers, everyone who personally fights for the cure of each and every patient and to better his or her condition, and at the third apex, are the researchers, those who try to understand the mechanisms of the disease, what disorder causes it, and once that cause is deciphered, it will lead to the development of drugs to eliminate the disease. And these three elements, even unknowingly, have entered into a pact; they are a team comprising components which are all essential to achieving the ultimate objective. This chain has a simple logic behind it - the researcher discovers the mechanism, and adapts a drug to it. This drug is improved by the pharmaceutical companies, and administered to the patient by the caregiver. Only the patient's response will tell us to what extent the treatment has succeeded and a new life-saving drug has indeed been born.
This past year has seen tremendous advancement in research and development of drugs to eradicate cancer. Researchers finally enlisted the immune system in the war on cancer. This insurmountable wall behind the question - why isn't a cancer tumor rejected by the immune system which is supposed to detect a foreign body - has finally been broken, and life-saving drugs - particularly for malignant melanoma - have already saved and extended the lives of many patients over the past year, and this is just the beginning. The release of the immune system to reject the cancer and to develop new drugs will expand beyond melanoma, and will cover many other malignancies, including lung cancer; the positive results of the initial treatment for this cancer type, using these drugs, instills great hope.
However, there is still a long road ahead. No solution has been found for many malignancies, success rates are also limited, and not all patients respond to these innovative treatments. Intense, prolonged efforts are required to close these large gaps. However, the fundamental breakthroughs have been achieved, and I am confident that the scope of diseases that modern medicine will combat and the number of patients who will be saved will expand and grow. Nearly 300,000 cancer patients living among us in Israel have been told that the light is flickering at the end of the tunnel, and it is our hope that it will illuminate the road to complete recovery and the best of health for the vast majority of them.
We in Israel are a part of the global fight against cancer. Our researchers and physicians are at the forefront of drug and treatment development, and Israeli research achievements bring a cure to the entire world, even to those who scheme against us.
The Israel Cancer Association is the foundation upon which this important triangle is based, and exists thanks to the public's kindhearted support.Lend a hand to the patients, caregivers and researchers to get cured, eradicate the disease, and live in a cancer-free world, this is a viable and doable objective."
*Prof. Ciechanover received a research fellowship from the ICA as a young scientist, and served on its Research Committee for nearly a decade. In 2004, he received the Noble Prize in Chemistry.
Key Statistics Presented at the Press Conference
Dr. Lital Keinan-Boker, Deputy Director of the National Disease Control Center of the Ministry of Health, and Advisor to the ICA, presents new statistics on childhood cancer:
There has been tremendous advancement in childhood cancer treatment results: in the 70s only 50% of children who were diagnosed with cancer in Israel survived 5 years later, in the 2000s, over 80% of children survive five years and more.
The incidence trends (number of new patients diagnosed each year) indicate stability in rates, since the 90s, in both sexes and among both population groups.
Relative survival - the five-year survival rates among individuals between the ages of 0 and 19 are high, and estimated at 85% (with the exception of Arab boys, among whom there is an estimated survival of 77%).
The trends in mortality indicate a steady decrease in rates in both sexes, and among both population groups.
The incidence of an additional primary tumor in childhood cancer survivors (ages 0-19), is 3.5 to 8 fold higher than that which is anticipated in the general population, in Israel as well, and that is why a survivorship follow up program is so important.
Most of the additional tumors are diagnosed over a decade after the diagnosis of the primary disease, and the most frequent tumors are brain, thyroid, and breast tumors, as well as leukemia.
Among those diagnosed in later years (2000s), the relative survival rates are higher.
As per 2012, there are 283,000 cancer patients and survivors living in Israel, of whom about 10,000 are children, who were diagnosed between the ages of 0 and 19.
Each year, 28,709 new patients are diagnosed, of whom 25,531 are diagnosed with invasive cancer.
From 2000-2010, 62.6% of cancer patients in Israel survived, as opposed to 38.8% between 1960-1969.
In 2012, 417 new patients were diagnosed among children and teens, ages 0-19, and 54 children and teens succumbed to the disease.
An estimated 9,000 survivors who were diagnosed with childhood cancer (ages 0-19) from 1980-2012 are currently living in Israel.
The most frequent tumors are leukemia, malignant brain tumors, tumors of the central nervous system and lymphomas.
Malignant tumor mortality among individuals aged 0-19 is low and the rates are similar among both sexes and both population groups.
The most frequent tumors which are a cause of mortality are malignant brain tumors, central nervous system tumors, leukemia and bone tumors.
The overview of childhood cancer in Israel resembles data reported by other developed countries, and morbidity statistics for an additional primary tumor, among childhood cancer survivors are also similar.
Please click here to view statistics in detail (in Hebrew).
New Research Study in Israel - On Risk Behaviors and Healthy Behaviors among Childhood Cancer Survivors compared to Young Non-Ill People
The Researchers: Michal Dayan-Sharabi, Dr. Leora Findler and Prof. Isaac Yaniv
Research studies conducted over the past 15 years in Western countries (the U.S., Canada, UK, Switzerland) and in Korea, present conflicting findings regarding risk behaviors and healthy behaviors among childhood cancer survivors. Some of the research studies indicate a higher rate of risk behaviors among young childhood cancer survivors, in indicators such as smoking, alcohol consumption, abuse of illegal drugs, and low levels of health-promoting behaviors, compared to young people with no history of illness. On the other hand, other research studies demonstrate lower rates of risk behaviors. Yesterday saw the publication of a research study confirming risk-heightening behavior among survivors in the U.S. (specifics may be found in the expanded chapter).
In Israel, according to the research findings, there are no differences between the research group (survivors) and the control group (those who developed no illness during childhood), in terms of risk behavior and healthy behaviors. However, an interesting overall picture emerged regarding factors that predict risk behavior.
This research study was conducted upon the initiative and with the financial assistance of the Israel Cancer Association.
Please click here for more details (in Hebrew).
Dr. Shifra Ash, Chairperson of Pediatric Oncology Association
Treatments for childhood cancer have achieved success rates estimated at 80%. We are among the leading countries in the world in this field. However, pediatric cancer still constitutes a leading cause of childhood mortality in the Western world. For this very reason, morbidity and mortality deriving from treatment for children and which sometimes occur during the recovery period, still constitute an important target for continuing improvement and reinforce the importance of survivorship follow up care.
Dr. Ash explained how, at present, as part of the treatment for cancer patients, the [caregivers] try to provide personalized care for the child, tailored to the child's specific disease, disease stage, and degree of risk, in order to enhance the chances of a cure, and to avoid the administration of excess medication. This method can help prevent long term side effects to as great an extent as possible.
Children in Israel are treated according to their disease [as recorded] in the international protocols. As a case in point, for over a decade, the MRD test has been conducted for leukemia - the most prevalent childhood cancer - with financial assistance from the ICA. This is a special test which can potentially diagnose a minimal residue disease. Thanks to this test, only children diagnosed with residual disease beyond a certain limit receive particularly aggressive treatment, and other children will receive less aggressive treatment, and respectively, will suffer less from side effects associated with this treatment.
Dr. Ash briefly reported on new research studies as well, which have demonstrated that it is possible to avoid head radiation in certain diseases, or administering a drug that is prone to cause cardiotoxicity in other diseases.
This year saw the publication of a research study reporting that children who received radiation to the head as part of treatment for cancer, may suffer from a hormone deficiency for many years after they have completed treatment. In cases in which these statistics are unknown to the caregivers in the community, this may incur significant quality of life impairment among survivors, and may also lead to obesity, weakness, depression, sexual dysfunction, etc. In other words, the objective is not only curing children, but also maintaining their quality of life for many years.
A workshop and seminar on palliative care, generally speaking, and specifically, pain treatment, for childhood cancer patients, is scheduled for November, and will be held with the assistance of the Israel Cancer Association, and in association with the Pediatric Oncology Association and the Israel Association of Palliative Care.
Prof. Eliezer Robinson touches upon the "time bomb", as participants at the ESMO ECCO conference held in October in Vienna termed the issues of cancer survivorship
A report prepared by the Institute of Medicine (IOM) From Cancer Patient to Cancer Survivor: Lost in Transition in 2005, distinguished four main components that would constitute the basis for a Survivorship Care Plan - SCP; based on this report, trials are being conducted in the Western world, as well as in Israel on the following levels:
1. Prevention of recurrence, prevention of other primary cancer, and other late effects.
2. Surveillance and follow up to diagnose recurrence, other primary cancer and late side effects (medical and psychological).
3. Intervention to treat side effects of the disease and treatments (for example, medical problems that emerge, symptoms, emotional distress of survivors and those who support them, and labor-related issues, disability, etc.).
4. Coordination between healthcare specialists and community physicians, to confirm that the survivors' needs are being met.
It is important that each survivor receive a brief summary regarding the treatment he or she has received, with a summary from the family physician, indicating late side effects that may derive from the specific treatment, and recommendations on steps to be taken which may potentially decrease the risk of recurrence and/or development of an additional cancer.
This is an important tool for enhancing communication and coordinating survivors' treatment, particularly between oncologists and family physicians in community health centers.
Despite the fact that over the past decade, several templates have been developed by different entities, with the aim of promoting the survivorship care plan, implementation has encountered difficulties on the ground, such that the entire subject is under review throughout the globe as well as in Israel.
An Expert Committee on Survivorship in Israel began operating in 2013, as part of the National Council of Oncology, and established the minimal components to be contained in a "summary and follow up plan" for survivors. This is a brief treatment summary aimed at meeting all the needs of survivors who have completed treatment for their disease, family members and healthcare staff within the community, indicating long term side effects that may derive from treatment, etc. Recommendations were formulated and forwarded to the Ministry of Health, so that a Director General's circular on this subject could be distributed (it is anticipated that it will be issued in the near future).
Israel Cancer Registry statistics on the status of survivors in Israel were also presented.
Orientation of Cancer Survivors in Israel and Absolute Survival Rates:
The numbers in this table represent patients, not cases; meaning, a patient who developed an additional primary cancer is counted only once, regarding his first cancer. In addition, due to the division into decades, the last decade will end in 2009 and not in 2012.
Decade Diagnosed with invasive cancer over the past decade Those who survived at the end of the decade % of survivors:
*This encompasses absolute survival, which does not take age-and sex-related mortality among the general population into account.
The graph demonstrates the increase in survival over the years, which in turn significantly increases the number of cancer survivors. This fact requires attention and a structured plan including survivor surveillance.
Please click here to view the complete article (in Hebrew).
Initial and Secondary Prevention among Breast Cancer Survivors in Israel
Prof. Sigal Sedetzky, Director of the Cancer and Radiology Epidemiology Unit, the Gartner Institute, Tel Hashomer
The aim of this new research study was to examine the implementation of initial and secondary prevention activities among the group of breast cancer survivors, compared to a similar group of women who were not diagnosed with breast cancer.
The research population comprised 250 breast cancer survivors, 8-12 years after diagnosis, and a comparison group consisting of 250 women with no history of the disease. All the participants in this study were members of Maccabi Healthcare Services, who reside in the central region of Israel. The average age of the population when they participated in the research interview was 10.3--+65.0
The research results show that the rate of survivors' participation in procedures related to early detection of breast cancer (mammography, ultra sound of the breast, and a manual breast examination), were much higher compared to the rates in the comparison group.
The research also discusses additional healthy behaviors of survivors, and refers to the family physician's recommendations regarding the maintenance of a healthy lifestyle.
Please click here to view the complete research study (in Hebrew).
New ICA Research Study conducted among 4 Target Groups:
Jews, Arabs ages 18+, Jews, Arabs ages 15-17.
Underscores issues that the public is already aware of, due to the extensive public information activity conducted by the ICA over the years, such as: Cancer is a preventable disease and is not necessarily predestined.
Once the disease is detected, it can be cured.
Smoking is the leading risk factor for cancer.
The association between risk factors such as obesity, physical inactivity and alcohol consumption, on the one hand, and the risk of developing cancers on the other hand.
The relationship between childhood obesity and incidence at an older age.
The importance of engaging in physical activity on a regular basis at any age.
The fact that environmental pollutants are not the main risk factors for cancer morbidity, such that a healthy lifestyle, which is the responsibility of each and every individual, encompasses risk factors associated with incidence and mortality, particularly, when it comes to preventable and/or detectable prevalent cancers in Israel. (According to the UICC and the WHO, leading a healthy lifestyle may help counteract over 60% of cancer caused mortality - including smoking prevention, healthy eating habits, physical activity and controlled alcohol consumption, vaccines and early detection).
The survey also demonstrates trends and changes in perceptions, attitudes and behaviors compared to previous surveys conducted by the ICA (2005,2012 vs. 2015).
Please click here for additional survey statistics (in Hebrew).
A unique collaboration between the ICA and Medivizor, an online service that enables the receipt of up-do-date medical information regarding research studies and scientific articles related to cancer.
The research studies and articles are adapted to each patient, according to his or type of cancer, in order to grant the patient access to specific scientific evidence-based information most relevant to him or her.
This service is provided free of charge, and will be available in English.
ICA Information Specialists will help patients who encounter difficult in reading the material in English (this is English that is adapted to the level attained upon completion of elementary school).
Please click here to view the new service, receive more information and register.
The ICA is proud to announce that it has been selected to receive a $20,000 USD grant awarded as part of the Seeding Progress and Resources for the Cancer Community (SPARC):
Metastatic Breast Cancer Challenge, a first-of-its-kind initiative launched by the Union for International Cancer Control (UICC) and Pfizer Inc. (Pfizer) that aims to address the unique challenges facing metastatic breast cancer patients worldwide.
The ICA was one of 20 organizations from 18 countries selected to receive funding totaling $765,000 (USD).
Through the SPARC MBC Challenge, the ICA will initiate support groups for metastatic breast cancer patients, and will also offer emotional support within these frameworks.
Please click here for further information.
A unique project was launched in Israel. With the approach of Breast Cancer Awareness Month, The Estée Lauder Companies Israel, has partnered with the Cofix coffee chain, to launch a new initiative.
As part of this collaboration, Cofix coffee will be sold in pink paper cups featuring the slogan: "Good coffee saves you in the morning-a simple test can save your life!"
In addition - packages containing two granola cookies will be sold at the franchise outlets for the price of 5 ILS, and proceeds from sales will be dedicated to ICA activity.
This collaborative effort will begin on October 13, and will run until the end of October at all Cofix outlets across Israel.
A unique and exceptional activity was coordinated between the ICA and vocalists who volunteered to sing a new and moving artists' song with the approach of the ICA's "55th 'Door Knock' Fundraising Campaign".
The words to the song 'Give us Strength' were written by Iris Mor whose father succumbed to cancer, and the music was composed by Idan David.
The song was recorded and produced as a video clip and may be currently downloaded on the social media networks and Youtube.
Statistics in Detail Dr. Lital Keinan-Boker, Deputy Director of the National Disease Control Center of the Ministry of Health, and Advisor to the ICA, presents new statistics on childhood cancer: Childhood Cancer Incidence (Morbidity) in Israel:
The highest morbidity rates are observed in the young age group (0-4), and the older age group (15-19).
In nearly all age groups , the rates among boys exceed those among girls; in the 15-19 year old age group, the rates among boys and girls were similar (in the Jewish population), or higher among girls than among boys (in the Arab population).
Among children and teens, there is no tangible difference in disease incidence - in the number of patients diagnosed each year, according to population group, while among adults, there is a difference (age-standardized incidence rates are usually higher in the Jewish population, compared to the Arab population).
Trends: since the early 90s, the trends in morbidity indicate stability, without a significant difference between the Jewish and Arab population and between boys and girls.
Mortality Rates among Children
Cancer is one of the leading causes of death in childhood.
In 0-19 year olds, tumors that required reporting constitute an estimated 6% of overall deaths, and were fourth in prevalence after congenital anomalies, perinatal mortality and external causes (including accidents, suicides, crime and wars).
In most of the age groups, the mortality rates were higher among boys in comparison to girls, and in most of the age groups, the rates among Jewish boys were lower than those among Arab boys.
New ICA Survey conducted among 4 Target Groups
Adults aged 18+, Jewish and Arab population Teens, ages 15-17, Jewish and Arab population
Among Arab men, the smoking rate is still very high, 2 fold higher than the percentage among Jewish men (46% as opposed to 24% respectively).
The smoking rate among Arab teens is 2-fold higher than among Jewish teens (19% as opposed to 9%).
Among Jewish teens, a minority of the smokers reported heavy smoking (over 10 cigarettes a day) (1%), compared to Arab teens (17%).
Men engage in more physical activity than women, 74%, as opposed to 65% respectively. 39% engage in activity 3 times a week and more, as opposed to 27% respectively.
In the Arab society as well, the percentage of men who engage in activity 3 times a week and more, is much higher than that of women, 32% as opposed to 20% respectively.
Differences are also evident among Jewish teens; there are differences between boys who engage in some sort of physical activity, as opposed to girls (80% as opposed to 69%).
Among Arab adults, a higher percentage of women reported that they are obese, compared to men, 11% as opposed to 1%.
The percentage of Jewish female teens who report excess weight and obesity is 2 fold higher than the percentage of male teens who report this, 19% as opposed to 9% respectively.
Contrary to the Jewish sector, among Arab teens, the percentage of teens who report excess weight exceeds that of female teens, 13% as opposed to 4% respectively.
Compared to an ICA survey dating from 2008, there has been a 10% decrease in adults' reporting excess weight (51% in 2008 and 41% in 2015).
Teens believe in cancer prevention more than adults: 87% as opposed to 74%.
Both Jewish adults and teens believe in prevention more than Arab interviewees. Adults 74%, as opposed to 64%, teens 87% as opposed to 67%.
Smoking was mentioned in first place by most of the Arab and the Jewish interviewees, adults and teens, as a most significant risk factor for cancer morbidity.
Significant increase in the consideration of smoking as a risk factor for cancer, compared to a survey dating from 2012. 58% of Jewish adults in 2012 as opposed to 71% today.
Compared to a survey dating from 2005, there has been an increase in the percentage of Jewish adults who believe that cancer is preventable (74% in 2015, as opposed to 66% in 2005).
Compared to a survey dating from 2012, there has been a significant increase in the consideration of alcohol consumption as a risk factor for cancer, particularly among teens, compared to a survey dating from 2012, there has been a significant increase in the consideration of alcohol consumption as a risk factor for cancer, mainly among teens.
Antennas and cellular phones: in a 2015 survey, they were reported as risk factors among 50% of Jewish adults and 58% of Jewish teens, and among 63% of Arab adults and 55% of Arab teens.
Air pollution: In a 2015 survey, it was reported as a risk factor in higher percentages among the Arab adult interviewees, 62% - as opposed to 45% of Jewish adults, and among Arab teens, 50% - as opposed to 38% among Jewish teens.
Please click here for detailed information (in Hebrew).
The ICA has been awarded a $20,000 (USD) grant through the Seeding Progress and Resources for the Cancer Community: Metastatic Breast Cancer Challenge (SPARC MBC Challenge), by the Union for International Cancer Control (UICC) and Pfizer Inc. (Pfizer)
As part of Breast Cancer Awareness Month, the ICA is proud to announce that it has been selected to receive a $20,000 USD grant awarded as part of the Seeding Progress and Resources for the Cancer Community (SPARC): Metastatic Breast Cancer Challenge, a first-of-its-kind initiative launched by the Union for International Cancer Control (UICC) and Pfizer Inc. (Pfizer) that aims to address the unique challenges facing metastatic breast cancer patients worldwide.
Through the SPARC Metastatic Breast Cancer Challenge, the ICA offers support groups for metastatic breast cancer patients, which constitute a source of emotional support, while creating the conditions for reciprocal empathy, to reinforce solidarity and a sense of belonging, alleviate loneliness during the disease trajectory, bolster self-confidence, impart tools to cope with crisis and provide information for patients.
As mentioned, these groups and workshops are tailored to breast cancer patients with metastatic breast cancer.
The groups are led by psycho-oncology professionals and are held at the ICA "Strong Together" Support Centers in Haifa, Afula, Jerusalem, Tel Aviv, and Beer Sheva, and at ICA branches throughout Israel.
Based on the experience we have accumulated in Hebrew speaking groups, and with the help of this generous grant, we intend to expand and initiate this important activity for Arabic and Russian speaking metastatic breast cancer patients.
As part of this project, the ICA intends to hold the following support groups:
5 support groups for Arabic speaking women with metastatic breast cancer in towns and villages with a large Arab, Druze and Bedouin population, in the northern and southern regions of Israel.
2 support groups for Russian speaking metastatic breast cancer patients, residing in towns and cities with a large new immigrant population from the former Soviet Union.
There is no doubt that metastatic breast cancer patients have special needs, and in addition to these support groups, which are of the utmost humanitarian and professional significance, we hold a special yearly seminar geared towards patients coping with metastatic breast cancer. We also incorporate stories of how metastatic breast cancer patients are coping with the disease, such as a special radio announcement featuring a volunteer of ours who is coping with metastatic breast cancer. In addition, a special booklet on metastatic breast cancer is currently in the final stages.
The ICA is especially grateful to the UICC for shining a light on the issue of diagnosis of cancer at an advanced stage of disease.
This grant will enable us to raise the profile of metastatic breast cancer in Israel and we look forward to sharing our experiences with UICC and the rest of global cancer community.
The SPARC MBC Challenge aims to empower advocacy groups, hospital networks, support groups and other organizations worldwide as they initiate projects to close the gap in information, support, awareness, and policy between metastatic breast cancer and early breast cancer, as well as help reduce the number of women diagnosed at the metastatic stage of breast cancer.
Metastatic breast cancer (Stage IV) is the most advanced stage of breast cancer, where the cancer has left the breast and spread to other parts of the body. There is no cure for metastatic breast cancer, although sometimes, with the help of innovative treatment, this is a chronic illness of sorts. Diagnosis of the disease has a multitude of significant consequences impacting the patient, their loved ones, the healthcare system and society.
Despite the burden imposed by metastatic breast cancer, there are fewer patient and community resources available for those living with metastatic disease compared with early-stage breast cancer.
In Israel, 2% are diagnosed at the metastatic stage, and over 70% are diagnosed at a very early stage.
"Globally, there are wide disparities in the diagnosis, management and care of metastatic breast cancer, a disease that is clinically complex, emotionally burdensome, and socially misunderstood," said Professor Sanchia Aranda, President-Elect, UICC. "The SPARC MBC Challenge was established to create new projects in support of women living with metastatic breast cancer and we look forward to following the progress and tracking results for the funded projects."
For more information on the SPARC MBC Challenge visit www.uicc.org and the ICA website (in Hebrew and English)
1. American Cancer Society. Detailed Guide: Breast Cancer. http://www.cancer.org/acs/groups/cid/documents/webcontent/003090 -pdf.pdf. Accessed August 24, 2015.2 Coughlin SS, Ekwueme DU. Breast Cancer as a Global Health Concern. Cancer Epidemiol. 2009 Nov;33(5):315-8. doi: 10.1016/j.canep.2009.10.0033 Mayer M, Grober S. Silent Voices: Women with Advanced (Metastatic) Breast Cancer Share Their Needs and Preferences for Information, Support, and Practical Resources. http://www.lbbc.org/sites/default/files/LBBCsilentvoices.pdf. Accessed September 14, 2015.
On Risk Behaviors and Healthy Behaviors among Childhood Cancer Survivors compared to Young Non-Ill People
Michal Dayan-Sharabi (1), Dr. Leora Findler (2), Prof. Isaac Yaniv
1. The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University 2. The Hemato-oncology Department, Schneider Children's Medical Center
Risk behaviors include for instance: alcohol consumption and inebriety, drug abuse, speeding and reckless driving, trance parties, and unsafe sex.
Healthy behaviors include for instance: nutrition and healthy eating, limited sun exposure, avoiding smoking, physical exercise and sufficient sleep.
Research studies conducted over the past 15 years in Western countries (the U.S., Canada, UK, Switzerland) and in Korea, present conflicting findings regarding risk behaviors and healthy behaviors among childhood cancer survivors. Some of the research studies indicate a higher rate of risk behaviors among young childhood cancer survivors, in indicators such as smoking, alcohol consumption, abuse of illegal drugs and low levels of health-promoting behaviors, compared to young people with no history of illness.
On the other hand, other research studies demonstrate lower rates of risk behaviors and maintenance of a healthy lifestyle among childhood cancer survivors as opposed to non-ill young people. Additional research studies show that there are no differences between childhood cancer survivors and their healthy counterparts with regard to various risk behaviors.
Moreover, many of the research studies did not focus on the comparison between the groups, but rather reviewed factors that contribute to risk behaviors. In these research studies, a correlation emerged between high rates of depression symptoms, low rates of social and emotional support, lower life satisfaction, religious, education and income levels, on the one hand, and an increase in risk behaviors on the other hand. Based on the research studies in all countries, it emerged that even when survivors present low or similar rates of risk taking compared to other groups, they are still at a high risk for future morbidity and/or mortality.
Due to the conflicting findings that were presented above, the present preliminary research study was conducted in order to obtain an initial picture of risk behaviors and healthy behaviors among survivors in Israel, in order to investigate factors that contribute to risk behavior and health-promoting behavior.
To this end, 45 survivors were located (five years after recovery from childhood cancer), and 43 young people with no history of disease, at similar ages and with similar personal traits, who constituted the control group.
The participants answered the following questionnaires:
A risk behavior questionnaire.
A health-promoting behavior questionnaire.
A sense of coherence questionnaire (a personality trait that assists in coping with routine and stress, involving a perception that the inner and external environment of the individual is structured, consistent and predictable, and that the individual has strengths granting him or her control and management over his or her life).
The meaning in life questionnaire (philosophical musings regarding the meaning of one's personal existence, including a review of the valuable things in one's life. Meaning in life is the main force that drives human behavior).
Questionnaire measuring personal traits such as sex, age, education level, and more.
The research findings indicate that there are no differences between the research group and the control group in terms of risk behavior and healthy behaviors.
However, an interesting picture emerged regarding the factors that predict risk behavior: while among cancer survivors, a high sense of coherence - meaning a strong inner strength - contributes to fewer risk behaviors, in the group of healthy individuals the level of meaning in life does indeed play a significant role. In other words, the greater the meaning in life, the fewer risks young healthy individuals take.
While survivors at present need ego forces in order to preserve themselves and avoid risk behaviors when exposed to a threat to their lives, healthy young people need a look to the future and meaning in their lives, in order to take fewer risks.
The following are several new research studies which discuss healthy behaviors of cancer survivors (one of them was published and confirms that behavior increases risk among cancer survivors in the United States).
Primary and Secondary Prevention among Breast Cancer Survivors in Israel
Prof. Sigal Sadetzki, Director of the Cancer and Radiation Epidemiology Unit, Gertner Institute, Tel Hashomer.
In Israel, 20,000 women have been diagnosed with breast cancer during 2006-2010. In Israel, as in other western countries, it has been feared that female population-focused healthcare has mainly addressed cancer, while other morbidity has not received the proper attention. Respectively, there are reports demonstrating that among female cancer survivors, the risk of chronic disease mortality in general and cardiovascular disease mortality in particular, exceed the risk of cancer-caused mortality.
Respectively, the aim of the research presented was to evaluate the implementation of primary and secondary prevention activities among a group of breast cancer survivors compared to a group of similar women who were not diagnosed with cancer.
Last year, we reported on a portion of these research findings which demonstrate that female breast cancer survivors consume more health services than the comparison group. These findings were evidenced by a greater number of visits and longer visits to the family physician and other specialists. A higher consumption of healthcare services was also observed in calls to urgent care medicine call centers and emergency wards, as well as a higher percentage of hospitalizations over the past 5 years. An additional finding concerned the fact that about 50% of breast cancer survivors continue to consult with the oncologist as their main physician responsible for breast cancer follow up, even 10 years after diagnosis. It should be noted that an impressive improvement in adopting healthy lifestyle behaviors was observed among female survivors.
The research population comprised 250 breast cancer survivors, 8-12 years after cancer diagnosis, and a comparison group consisting of 250 women with no history of cancer. All the research participants were members of the "Maccabi Healthcare Service" healthcare fund, residing in the central region of Israel. The research was conducted in a population with a mean age of 65.0 +-10.3 years at participation in the interview.
The research findings illustrate that the percentage of survivors who undergo in breast cancer early detection procedures (mammography screening, breast ultra sound, and manual examination of the breasts) were much higher compared to percentages in the comparison group. When adjustment was made for age, religious affiliation, smoking and physical activity, 7-fold more breast cancer survivors underwent mammography screening over the past five years. An additional finding was 50% more female survivors than females belonging to the comparison group underwent screening for colorectal cancer. While being a female breast cancer survivor doubled the chances of participating in a bone density test and increased the compliance rate to undergo a flu vaccine, no differences were found between the groups in undergoing lipid tests, thyroid gland function tests, fecal occult blood tests and pap smears. Other factors which impacted undergoing a flu vaccine were older age and avoiding smoking. Women ages 60-69 during the interview, secular and/or traditional women who were educated, tended to undergo more colonoscopy tests.
Overall, it was observed that the family physician gave few guidelines on health promotion; no differences between the two research groups were observed. Only 24% and 22% among the survivors' group and the comparison group, respectively, reported discussing lifestyle and behavior changes, and only 8.8% of the survivors and 6% of the members of the control group reported discussing the subject of avoiding smoking.
Conclusion: according to these data, breast cancer survivors in Israel are more aware of primary and secondary prevention interventions; despite the fact that most of the survivors do not discuss guidelines for healthy lifestyle practices with their family physician, most of the survivors actually take the necessary steps [towards a healthy lifestyle], thanks to the expansive public information campaigns implemented by the ICA.
The research study was conducted by a team of researchers: Dr. Lori Mandelzweig, Angela Shitrit, Tova Amitai and Bernice Oberman, of the Cancer and Radiation Epidemiology Unit, Gertner Institute, in collaboration with Maccabi Healthcare Services.
This research study was funded by the Israel National Institute for Health Policy Research
The ICA Information Center Presents New Research Studies:
A Healthy Diet, Weight Management, and Physical activity are Key Components of Prevention among Cancer Survivors
A team of researchers from different universities in the United States published up-to-date guidelines for healthy lifestyle practices for cancer survivors, based on a comprehensive survey of articles related to this field. The guidelines place an emphasis on recommendations that were published in the past by the American Cancer Society: a healthy diet, weight management and engaging in physical activity.
The researchers indicate that in view of the increase in the number of cancer survivors, improvements must be made in lifestyle behavior change in this population, in order to prevent recurrence and the development of additional cancers, and [to achieve this end] they specify the following recommendations:
a. Weight management
It is recommended to maintain a normal weight. In case of excess weight or obesity, one should reduce caloric food and beverage consumption, and physical activity should be increased in order to stabilize one's weight.Research testimonies: the researchers indicate that this recommendation relies on numerous studies which indicate the relationship between obesity and increased primary cancer morbidity, or recurrence (cancer that comes back). Similarly, obesity may lead to higher morbidity in additional diseases due to treatments and may have a negative impact, for instance, on the recovery time of wounds and infections following surgery.
b. Engaging in physical activityIt is recommended to engage in regular physical activity. Physical activity should not be avoided after cancer diagnosis; it is recommended to return to regular activity as quickly as possible after diagnosis. It is recommended to engage in physical activity for at least 150 minutes per week, and to also include power workouts at least twice a week.
Research testimonies: the researchers emphasize that there is evidence of a relationship between inactivity and breast and colorectal cancer morbidity, as well as studies that indicate that engaging in physical activity after cancer diagnosis reduces the risk of recurrence, reduces additional morbidity, and as a result, reduces mortality.
c. Maintaining a healthy and balanced dietIt is recommended to maintain a healthy diet rich in fruits, vegetables and whole grains. It is recommended to reduce processed meat and red meat intake, and to eat at least 2.5 cups of vegetables and fruits per day. It is recommended to consume whole grains and to reduce alcoholic beverage consumption: It is recommended that men drink no more than 2 servings of alcohol per day, and women no more than 1 serving.
Research testimonies: studies indicate a relationship between maintaining a balanced diet and reduced cancer-caused mortality as well as reduced all-cause mortality, among cancer survivors.
To conclude - studies indicate that many cancer survivors do not adopt healthy lifestyle behaviors, are obese, follow an unhealthy diet, and avoid physical exercise. In view of these findings, researchers suggest that oncology providers promote the adoption of these guidelines for changes in lifestyle behaviors, as part of the follow up care program for cancer survivors.
Published in the May-June 2015 issue of the CA: A Cancer Journal for Clinicians
A new research study, published in the reputed Cancer Journal, confirms the finding that cancer survivors in the United States do not consume a balanced and healthy diet.
In view of the fact that cancer survivors are at risk for various health-related problems, a healthy diet can change the progression of these health issues, and have an impact on survivors' continued recovery.
Cancer survivors adhere less to dietary guidelines than individuals without cancer. Particularly with regard to the consumption of green vegetables and whole grain foods.
Cancer survivors consume fewer nutritional fibers and more high- calorie foods that are high in fat and sugar.
Cancer survivors consume few foods that are rich in Vitamin D, calcium and potassium.
Adult cancer survivors consume a more balanced diet than younger survivors.
Cancer survivors with a lower level of education consumed a lower quality diet, as opposed to cancer survivors who had a higher level of education.
Cancer survivors who smoke consumed a lower quality diet as opposed to non-smoking survivors, or survivors who smoked in the past.
Among survivors of the most prevalent cancers in the United States - breast, prostate, lung, and colorectal cancer, breast cancer survivors consumed a higher quality diet, as opposed to lung cancer survivors who consumed a lower quality diet.
Conclusion: the researchers recommend advising cancer survivors of the importance of adherence to dietary guidelines, and that they consult with clinical dieticians to improve their health.
Researchers from several medical centers in Switzerland investigated the compliance of cancer survivors of childhood cancer with follow up care, and the relationship between this compliance and their health "beliefs".
465 male and female adolescents (with nearly proportional representation), aged 16-21 at study, completed the questionnaires, and only those 5 years after diagnosis and who developed cancer at under 16 years of age participated in this study.
The researchers discovered that:
56% of survivors reported attending follow up care.
80% of survivors rated their susceptibility for late effects over the next 10 years as "low".
92% believed that follow up care may detect and prevent late effects.
A mere 13% believe that follow up care is not necessary.
The health "beliefs" associated with follow up care attendance are:
The follow up care attendance among adolescent survivors who were diagnosed a relatively short period of time before completing the questionnaire, or who underwent bone marrow transplantation, was higher, as was that of those who experienced recurring disease.
No differences were observed between males and females, between survivors from different countries of origin, survivors of different levels of education, and with different demographic characteristics.
This study was published in the September 2015 issue of the Pediatric Blood & Cancer Journal
The Association between Patterns of Psychological Thought and Smoking Cessation among Cancer Survivors
Researchers from the University of Atlanta in the U.S. sought to examine the association between patterns of psychological thought on smoking and intentions to quit smoking among cancer survivors who continue to smoke, as opposed to non-smoking survivors.
Despite the fact that smoking may increase the risk of cancer-caused mortality, and/or cause various health-related problems among cancer survivors, some survivors continue to smoke even long after diagnosis.
2,398 survivors of 10 cancers participated in this study, approximately 9 years post-diagnosis, at the average age of 65. They were recruited by stratified random sampling from U.S. cancer registries. All the participants participated in a comprehensive study on cancer survivors, and agreed for the purposes of this study, to report smoking habits: 272 participants indicated that they are smokers, 1,209 of the participants stopped smoking before or after diagnosis and 1,457 never smoked.
The participants were requested to complete a questionnaire regarding their perceptions on the health risks of smoking, psychological barriers to smoking cessation (for example, the participants were requested to rate to what extent they believe in the following statement: "Smoking helps me cope better with cancer"), questions regarding social pressure to quit smoking, and a belief regarding their self-efficacy to stop smoking.
Additional questions addressed the amount of cigarette smoking (daily, weekly), exposure to passive smoking in one's proximate environment, and intention to quit smoking.
Upon analyzing the research data, it emerged that survivors who are smokers perceived health problems caused by smoking as less severe, as opposed to survivors who stopped smoking. In addition, smoking survivors perceived fewer benefits of smoking cessation; they indicated more barriers to smoking cessation and reported a higher exposure to others' smoking, as opposed to survivors who reported that they had quit smoking. Smokers who indicated that they intend to quit smoking, perceived health problems caused by smoking as being more severe, saw fewer benefits in smoking, and reported greater social pressure to quit smoking, as opposed to those who indicated that they do not intend to quit smoking. Moreover, survivors who do not smoke on a daily basis reported a higher self-efficacy to quit smoking, and less exposure to others' smoking, as opposed to survivors who reported daily smoking.
Conclusion: the researchers indicate that these results may help develop intervention programs for smoking cessation among survivors, and recommend that that special attention be devoted to survivors who are exposed to passive smoking in their environment.
The research study was published in July 2015 in the Psycho-Oncology Journal
Sexual Health as a Survivorship Issue for Female Cancer Survivors
As part of a survey of the scientific literature published in the February 2014 issue of The Oncologist Journal, researchers from the reputed Massachusetts General Hospital (MGH) in Boston, U.S., surveyed research studies that dealt with the sexual health of female cancer survivors and the options that the healthcare systems provide on these issues.
Although studies show that the overall quality of life of survivors is quite good (especially in long-term survivors), a significant proportion of patients remain at risk for persistent or worsening symptoms, including symptoms related to sexual and intimacy.
The incidence of sexual dysfunction ranges from 30% to 100% among female cancer survivors.
In the past, "sexual quality of life" has been defined by researchers as a subject encompassing sexual attractiveness, sexual interest, and sexual function. Research documented significant disruption in sexual quality of life that was influenced by diagnosis, cancer treatments, and the presence of emotional distress rather than age of the patient.
The researchers specify the impact of cancer treatments - surgical, medicinal and radiation treatments - on sexuality and intimacy and emphasize that there are diverse treatments which may provide relief from symptoms resulting from impaired sexual function of survivors. The investigators place an emphasis on the need to ask about and clarify the needs of patients and provide them with the best solution possible, to be provided by the attending caregiving staff; or, alternately, refer them to a professional specializing in this field.
The researchers emphasize that it is important to provide support on this issue to women without a partner as well, in order to discuss issues that may be relevant if and when they develop new partnerships.
Conclusion: seeing as maintaining the sexual quality of life of survivors is an important objective, medical providers should proactively discuss sexual health with patients or refer them to a sexual health expert. They emphasize that it is important to address sexuality and intimacy alike at the outset of treatments, and to encourage patients to discuss these issues.
The ICA provides a free consultation service on sexuality and body image. For appointments and consultation, please call: +972-3-572.16.43.
To receive a free booklet on "Looking to the future - a manual for cancer survivors", "Female Sexuality and Fertility", "Intimacy and Couplehood - a manual for the religious female cancer patient", please contact the Telemeida, toll free teleinformation hotline at : 1-800-599-995.
The ICA offers a unique nationwide program that accompanies survivors called "Survivors towards a healthy life" as well as other support programs.
The Impact of Prostatic Biopsy on Sexual Function in Men
Researchers from the University of Kansas in the United States sought to evaluate the effects of transrectal ultrasonography (TRUS)-guided prostate biopsy.
Men who underwent the above procedure were given a questionnaire on their sexual function and other symptoms. The participants completed the questionnaire, at 1, 4, and 12 weeks after the biopsy.220 men participated in the research study, with a mean age of 64 and PSA level of 6.7.
At the outset of this study, and prior to the biopsy, 38.6% reported no erectile dysfunction, 22.3% reported mild erectile dysfunction, 15.5% reported mild-to-moderate erectile dysfunction, 10% moderate erectile dysfunction, and 13.6% reported severe erectile dysfunction.
According to the International Index of Erectile Function (IIEF-5) score, which the researchers "activated" to measure erectile function prior to the biopsy, and at intervals that were determined thereafter, a decline in function was observed:
18.2 vs 15.5 - 1 week after biopsy. 18.4 vs 17.3 - 4 weeks after biopsy. 18.4 vs 16.9 - 12 weeks after biopsy.
The researchers conclude that the effects of prostate biopsy on erectile dysfunction have been underestimated, and it is important to inform patients of the transient effects of this procedure.
This research study was published in the August 2015 issue of the British Journal of Urology