Swedish researchers have found a drug that inhibits a dangerous cell pathway while leaving a protective one intact pointing the way to preventing colon polyps from becoming cancerous.  In a large study, 8 out of 10 chemotherapy patients experienced symptoms of insomnia or outright insomnia after their first cycle of chemo.

A work team from the United Kingdom will help restore an elementary school in South Africa while simultaneously raising money for colon cancer research.

Connect to a poem by Elspeth Murray asking doctors to communicate clearly but with empathy and to an article about coping with cancer during the holidays.

Research Updates

• Researchers at the Karolinska Institute in Sweden have discovered a group of signalling proteins that both promote the growth of cells in the colon into polyps (adenomas) and, paradoxically, also inhibit the development of polyps into cancer.  EphB controls two pathways in the cell — one leading to cell division and another that curbs the cell’s progress toward cancer.  They have also found that imatinib (Gleevec®) can inhibit the first dangerous pathway while leaving the protective one in place.  So far the drug has kept cells from dividing in test tubes and in mice, but no human trials have been done.   Their studies were published in the November 13, 2009 issue of Cell.
• Nearly 8 out of ten patients receiving their first cycle of chemotherapy reported either symptoms of insomnia (36.6 percent) or insomnia syndrome (43 percent), where symptoms occurred at least 3 days a week for more than three weeks.  The combined rate  is three times what is seen in the general population. Insomnia symptoms included difficulty falling asleep, waking during the night for long periods, or waking up early.  There was no difference between men and women, but younger patients had more sleep problems. Lung cancer patients had the highest rates of insomnia while patients with colon cancer had the lowest.   Insomnia was connected to both fatigue and depression.   Oxana G. Palesh, PhD from the University of Rochester published the team’s results in the Journal of Clinical Oncology early release November 23, 2009.

Other Headlines

• Our friends in the UK will help raise funds for bowel cancer research and also aid children in South Africa. Forty people will work together to restore the Sandeberg primary school near Leipoldtsville.  During their  ten-day stay professional soccer players Luther Blissett and George Parris will coach local children. Money raised by trip participants will benefit the Bobby Moore Fund which raises money specifically for colorectal cancer research.  Moore led England to its only World Cup.  He died of colon cancer in 1993 at the age of 51.
• Poet Elspeth Murray recites her poem This is Bad Enough on YouTube, asking that doctors not give her gobblydegook but the information she needs to know because she says, “This is bad enough and hard and tough enough.” She also asks that they, “Show us the facts, some figures, and don’t forget our feelings.”
• Cancer.Net, ASCO’s website for people living with cancer, has a good article about coping with cancer during the holidays. They answer common questions like dealing with fatigue, honoring the memory of someone who died, coping with anxiety about cancer recurrence, and finding a gift for someone with cancer.  Some people worry about weight loss or thinning hair and how to explain it to visitors.  Others are looking for places to volunteer.  Cancer.Net says, “Make this holiday season about rediscovering peace and happiness in old and new ways.

Many sleeping medications make you sleep but don’t allow you to really rest. They take away your dream/REM pattern which is necessary to get the feeling of rest. Those who fall asleep easily and sleep through the night are the lucky ones.

By definition, insomnia is “difficulty initiating or maintaining sleep, or both” and it may be due to inadequate quality or quantity of sleep. It is typically followed by functional impairment while awake. The pattern of insomnia often is related to the etiology.  Insomnia affects 1 in 3 people.

1. Onset insomnia: Difficulty falling asleep at the beginning of the night, often associated with anxiety disorders.
2. Middle-of-the-night insomnia:  Insomnia characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning, also referred to as nocturnal awakenings, encompasses middle and terminal insomnia.
3. Middle insomnia: Waking during the middle of the night, difficulty maintaining sleep. Often associated with pain disorders or medical illness.
4. Terminal (or late) insomnia: Early morning waking. Often a characteristic of clinical depression.

Insomnia can be caused by many medications such as  psychoactive drugs or stimulants, including certain medications, herbs, caffeine, cocaine, ephedrine, amphetamines, methylphenidate, MDMA (also known as ecstasy), methamphetamine and modafinil. Some antibiotics can also cause chronic insomnia such as Levaquin® (levofloxin).

It is easy to understand that anxiety, stress (emotional, financial or sexual) and fear can cause you difficulty sleeping. We also know that jet lag or working night shifts can impact your sleep at some times of the day and cause excessive sleepiness at other times of the day.

If chronic insomnia exists specific medical conditions should be ruled out such as  hyperthyroidism or rheumatoid arthritis. Insomnia may be a symptom of magnesium deficiency, or low magnesium levels, but this has not yet been proven. A healthy diet containing magnesium may help to improve sleep in individuals without an adequate intake of magnesium.

Insomnia in women seems to be linked at least partly to lower estrogen levels, which is a potential reason why women often tend to develop insomnia at menopause. Estrogen helps with the uptake of magnesium into the soft tissues. If estrogen levels are low, magnesium deficiencies and conditions they can cause such as insomnia, heart palpitations, anxiety and fibromyalgia may become more problematic. Make sure you have seen your gynecologist to discuss estrogen replacement strategies.

As mentioned, insomnia can be caused by many other diseases, side effects from medications, or psychological problems. To be able to treat insomnia effectively, it is critical to find out all medical and psychological conditions before starting any medications. Obviously it is necessary to assure that there is an appropriate sleep hygiene which basically means no noise or other environmental factors leading to sleep disruptions.

Please discuss medication therapies with your oncologists.

However you might consider to explore some alternative options which you need to share with your treating physician. For example, when I am traveling I usually take 3 mg of melatonin to avoid jet lag, which seems to work for me. Melatonin is available over the counter but also in prescription form known as Rozerem® (ramelteon). These drugs seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation. While these drugs show good effects for the treatment of insomnia due to jet lag, the results for other forms of insomnia are less promising.

There are a number of herbal mixtures which have been suggested to have some modest effects including valerian, chamomille, hops, and passion-flower. Valerian has undergone multiple studies and appears to be modestly effective.

There is more you can try by changing the way you arrange your lifestyle. These include changing your sleep area or schedule, watching what and when you eat and drink, and being more active. It’s also important to keep regular bedtimes and wake times seven days a week and to try to avoid taking naps during the day.

A Harvard Medical School study found that yoga improved the study participants overall quality of sleep, including helping people to fall asleep easier and stay sleeping for longer periods. A study published in the Journal of the American Geriatrics Society found that elderly adults with moderate sleep complaints improved self-rated sleep quality through a low to moderate intensity Tai chi program conducted for six months.