Published: Oct. 17, 2006
Updated: Oct. 22, 2010
Imagine the seductively mysterious images of a Caribbean deep-sea diving exploration. The soothing, swirling warmth of a whirlpool bath. Or the tingling sensation of a gentle acupuncture treatment. None of these experiences is typically associated with breast cancer care. But, thanks to new therapies being developed at Duke, one day they just might be.
Every year, more than 190,000 women are diagnosed with breast cancer. Most of these cancers are treated with one or more of the standard therapies of chemotherapy, radiation, and surgery. Women receiving these therapies often suffer from side effects such as nausea, vomiting, and severe pain, and the stress and anxiety that accompany them. But several current Duke studies offer real potential to "cure the cure" and make the road to recovery much more comfortable for women with breast cancer.
Novel technologies are opening up some remarkable new ways to achieve this goal. One of the most intriguing is the use of virtual reality, which distracts patients from the stress and discomfort often associated with chemotherapy treatments by virtually immersing them in a completely different environment. Patients can, for example, choose an art museum tour, a deep-sea dive, or even the chance to solve a mystery on board the Titanic.
According to Duke's Susan Schneider, RN, PhD, who is pioneering virtual reality distraction therapy for breast cancer patients, the intervention reduces stress and fatigue during chemotherapy, and the effect often seems to last for days after the treatment. Patients are so pleased with the option they often request it on subsequent visits. In fact, women are more likely to complete their full chemotherapy treatment schedule if they experience less distress during the treatments. That means virtual reality--the ultimate distraction technique--is providing not only more comfortable sessions, but better clinical outcomes.
The innovative approach to delivering chemotherapy being studied by Duke oncologist Dr. Kimberly Blackwell and the Duke University Hyperthermia program could enhance the efficacy of breast cancer treatment. Propped on pillows and serenaded by the music of their choice, the women lie upon a massage-type table for one hour as radiofrequency energy warms their breasts, which lie in a sunken pool of water. The heat triggers the anti-cancer drug they have just been given to settle inside the tumor, where it trickles out of its protective coating--a tiny fat bubble called a liposome -- and attacks the tumor's genetic machinery. Heating the breast draws the liposomes out of the bloodstream and directly to the site of the tumor, thus concentrating the drug-packed liposomes where they are needed the most.
The hyperthermia approach is gentle within the patient as well. While being absorbed into the breast cancer cells quickly, the drug disperses more slowly through the unheated tissues in the rest of the body over a period of four to six weeks, giving the spleen and liver time to blunt most of the toxins’ side effects. The treatment has proven remarkably effective in halting, even reversing, the growth of tumors: Many of the women who received it have been spared the need to have mastectomies.For those women who do require breast cancer surgery, a new approach to controlling pain during the procedure is helping to ease the debilitating nausea and discomfort that often follow the use of general anesthesia. According to Susan Steele, MD, chief of ambulatory anesthesia at Duke, breast surgery using traditional general anesthesia has one of the highest rates of postoperative pain, nausea, and vomiting of all types of surgery. Duke physicians are now offering breast cancer patients the option of receiving regional pain relief through a procedure called paravertebral block, which involves a series of injections that numb the nerves connecting the spinal cord to the chest area without affecting heart or lung function. The procedure offers up to 30 hours of pain relief, causes little nausea, and, says Steele, "gives women time to recover, because the body has already begun to heal by the time the anesthetic wears off."
Ironically, one of the newest approaches to helping women recover from breast surgery is also the most ancient: Chinese acupuncture. Acupuncture involves the painless insertion of tiny needles into particular points on 14 different lines along the body. According to Chinese healing practices, chi, or the body’s vital energy, is believed to flow just under the skin along these points. Acupuncture is believed to bring this chi back into balance. At Duke, anesthesia teams are using a modern variation on this 5,000-year-old technique known as electroacupuncture, in which small electrical pulses rather than needles are delivered through the skin to the acupuncture points. Electroacupuncture is believed to enhance or heighten the effects of traditional acupuncture, and is widely used in modern China.
Ongoing studies suggest that the technique reduces nausea and vomiting in women recovering from breast surgery. It's also less expensive and has fewer side effects than medications currently used, such as ondansetron (Zofran). Says Duke anesthesiologist Dr. Tong Joo Gan, "Acupuncture turns out to be just as effective as the drugs or better, and our patients also reported much less pain after surgery--a finding that surprised us." While it is not completely known why either type of acupuncture works, recent research suggests that it might stimulate the release of hormones or the body's own painkillers, known as endorphins.
There are, doubtless, other surprises in store as breast cancer care continues to evolve at Duke. It may never be described as a walk in the park. But, then again, with innovations like virtual reality distraction…who knows?