Research – clinical trials
Research into new ways of treating cancer of the bladder is going on all the time.
When a new treatment is being developed, it goes through various stages of research. To begin with it will be looked at in the laboratory, and sometimes tested on cancer cells in a test tube. If the treatment seems as though it might be useful in treating cancer, it is then given to patients in research studies (clinical trials). These early studies are called phase 1 trials. They aim to:
- find a safe dose
- see what side effects the therapy may cause
- identify which cancers it might be used to treat.
If early studies suggest that a new treatment may be both safe and effective, further trials (phases 2 and 3) are done to answer these questions:
- Is it better than existing treatments?
- Does it have extra benefit when given together with existing treatments?
- How does it compare with the current best standard treatments?
Clinical trials take a long time. It usually takes some years from the time when a new treatment is first discovered (often with a lot of publicity in the papers and on TV) until the time when its true value is established.
You may be asked to take part in a research trial. There can be many benefits in doing this. You will be helping to improve knowledge about cancer and the development of new treatments. You will also be carefully monitored during and after the study.
It is important to bear in mind that some treatments that look promising at first are often later found not to be as good as existing treatments, or to have side effects that outweigh any benefits.
The process of trials is described in more detail in CancerBACUP’s section on cancer research trials.
As part of research you may be asked by your doctors for permission to store some of the samples of your tumour or blood, so that they can be used as part of trials to find the causes of cancer.
Radiotherapy and chemotherapy trials
The BC2001 trial is for people who have invasive bladder cancer. People in this trial have a higher than normal dose of radiotherapy to the cancer itself, but a lower dose to the unaffected areas of the bladder. This trial is also looking at whether giving chemotherapy during the radiotherapy can improve the results.
The BCON trial is researching whether cancer cells can be killed more effectively by radiotherapy if they have plenty of oxygen. This trial is trying two different ways of increasing the oxygen supply to the cancer cells. It is hoped that this will help to stop the cancer from coming back after treatment. It involves taking nicotinamide tablets and wearing a breathing mask for a few minutes before and during each radiotherapy treatment.
Trials are using some types of immunotherapy to see whether these may be effective in the treatment of bladder cancer. Immunotherapy drugs, such as interferon, stimulate the body’s immune system to destroy the cancer cells.
Studies have suggested that there is a link between smoking and bowel cancer. The evidence suggests that people who smoke for many years have are between one and a half and three times more likely to get a bowel cancer than non-smokers.
The increased chance of getting a bowel cancer does seem to be associated with long-term smoking, with people who have smoked for more than 35 to 40 years being at risk.
I am going to have a course of radiotherapy to treat my cancer. The doctors took a blood test today and when I asked about this they said it was important to make sure I wasn’t anaemic before I had the treatment? Why is this?
Radiotherapy uses a type of radiation, called ionising radiation, to destroy cancer cells. There are several types of ionising radiation including x-rays, gamma rays and beta rays. Most radiotherapy treatment for cancer use x-rays.
Ionising radiation works by releasing chemicals in the nucleus of cells. These chemicals, called free radicals, damage the DNA, the genetic material that is vital for the cell to multiply. If the DNA is sufficiently damaged by the radiation then it will not be able to divide and will die off.
In order for the radiotherapy to release the free radicals that damage the DNA there needs to be a good supply of oxygen in the cells. If the cells are starved of oxygen then this actually protects them against the effects of the x-rays and makes treatment less effective.
Oxygen is carried to the tissues and cells in our bodies by the haemoglobin in the red blood cells. If we are anaemic then the haemoglobin level in the blood is low, and so the amount of oxygen carried by the blood to our cells is reduced.
So in order to get the best results from a course of radiotherapy it is important to be sure that you are not very anaemic before you start treatment.
If you are anaemic then your doctors may well suggest a blood transfusion before you start your treatment. This will boost your haemoglobin level and will increase the oxygen in your blood, which will increase the chances of success from your radiotherapy treatment.
Last year I had surgery and radiotherapy for a bladder cancer. Recently I have had some bleeding and my specialist has told me that tests have show the cancer has come back and spread to other parts of my body. They have mentioned chemotherapy but I am not sure about this. What would happen if I don’t have treatment?
Many people are frightened about the prospect of chemotherapy, particularly because of all the publicity that has been given to possible side effects. However, modern chemotherapy and medications to avoid or reduce side effects have made chemotherapy better tolerated for most people.When a bladder cancer has spread to other organs in the body then treatment with chemotherapy, is designed to try and shrink the growth, improve symptoms, maintain a good quality of life and to prolong life, if possible. Unfortunately at this advanced stage of the cancer a cure isn’t possible, and making decisions about treatment in these circumstances is always difficult.
If you do have the chemotherapy it is possible that this will lead to control, and possibly shrinkage, of the cancer with relief of any symptoms, improvement in quality of life, and maybe even some prolongation of life. These benefits still cannot be guaranteed. Some people will have significant benefit while others will have no improvement at all and will therefore have the side-effects of the treatment without any benefit. The fitter a person is generally the more likely they are to have benefit and less likely to have side-effects.
The alternative to having chemotherapy would be to have ‘supportive treatment’ which is aimed not at controlling the cancer itself but at easing any troublesome symptoms and maintaining quality of life. This would usually mean ‘non-chemotherapy’ medication like steroids and pain killers, and occasionally a short course of radiotherapy. There would still be contact with a medical and nursing team to oversee your care during this time. So not having chemotherapy does not mean that you would be left to cope on your own.
The choice of treatment is a difficult one and will depend on your own feelings at this time, so it is important to talk this through with your specialist, about the potential benefits of chemotherapy in your own situation.
When a good friend or a relative gets cancer it is often a very difficult time and people often handle the situation by cutting down the number of visits and meetings because they might be difficult or distressing. Although this is understandable it is often very upsetting for the person who has the cancer who can find themselves apparently deserted by long-time friends and members of the family at a time when they really need them. So the first way in which you can help is simply by keeping in touch and keeping up with your regular contacts just as you did before the cancer was discovered.
There are then two main ways in which you can make a difference: by giving emotional support and offering practical help. The best way to make a start with these is by talking, or perhaps even more importantly, by listening.
Everyone is different and some people with cancer will find it very helpful to talk about their illness and its treatment whilst others cope by acting as though everything was normal and life was going on as usual, so knowing just the right thing to say is difficult. If someone is happy to talk about how they feel and how they are coping then listening sympathetically can be very useful indeed and make a real difference. If they are less forthcoming and keeping things more to themselves then direct questions like ‘how are you feeling?’ or ‘how are you managing?’ will probably get short answers like ‘fine’ or ‘OK’ and lead nowhere. On the other hand using questions asking about specific aspects of well being, like ‘how are you sleeping?’, ‘do you get very tired?’, ‘what sort of things do you enjoy eating?’, can be easier to answer and can often get people talking more about how they are and what problems there might be.
This can also open opportunities for practical help, things like doing a bit of shopping, walking the dog, taking your friend to the hospital for their next appointment, taking the children to school one morning a week and a hundred and one other possible ways in which quite small things you could do would not only make the day to day chores of life a bit easier for your friend but also show her that you do care and are there to help her.
For a while at least your friendship may be under strain, especially if your friend is having great difficulty in coping and coming to terms with the diagnosis and its treatment but by keeping in touch, by ‘being there’ and letting them know they can rely on you then you will be making a real contribution to their quality of life at a time when it really matters. .
I have recently been told I have cancer. Since I had the news I’ve had difficulty sleeping at night. Is this normal and what can I do about it?
It is very common for people with cancer to have problems with sleeping at night. This may be because of general anxiety, fears about treatment or worries about the future. All of these reasons are very understandable but they can lead to insomnia with either difficulty in getting off to sleep or waking up during the night and having trouble dropping off again.
If this continues and starts to affect your quality of life then you could chat to your General Practitioner about the possibility of tablets to help you sleep. Many people, however, prefer to avoid sleeping pills and there are a number of tips to offer about ways of helping to get a good night’s rest which you might like to try as an alternative. These include:
- establish a regular routine of going to bed at about the same time each night and waking up about the same time each morning
- if you are able to manage some regular, gentle, exercise during the day (such as having a walk for half an hour) then this can help deepen sleep
- a warm bath just before bedtime, with the addition of soothing oils or essences (such as lavender oil or geranium oil) is very relaxing
- a warm, milky, drink just before bedtime will avoid hunger during the night, which can disturb sleep
- alcohol can make you feel sleepy but it often disrupts the sleeping pattern during the night so avoid large amounts of wine or spirits just before bedtime
- tea, coffee and cola drinks all act as stimulants and are best avoided for a few hours before going to bed as they tend to keep you awake
- some people find that a few drops of lavender oil sprinkled on their pillow helps them relax and sleep better
- if you sleep a lot during the day try seeing if you can cut back a bit on daytime naps
- work out just how much sleep you need in order to feel refreshed the next day and avoid spending too long in bed as trying to sleep too much can actually lead to disturbed and shallow sleep
- if you wake up during the night and can’t get back to sleep after a few minutes and are unable to relax (just lying quietly can still be very restful if you are relaxed but not if you are tense and worrying) then try reading a book or watching television for a while or listening to tapes, like talking books, on a personal stereo or make a hot drink
Although sleep disturbance is quite normal and understandable for people who are worried about their cancer occasionally insomnia can be a sign of underlying ‘clinical’ depression which does need medical treatment and can be very much helped by simple medication. Key symptoms of depression include:
- a low mood for most of the time
- not feeling your usual self
- not being able to be taken out of your low mood by yourself or your friends
- loss of interest or enjoyment in your favourite activities as pastimes
If you are experiencing these problems as well as your sleeping difficulty then it would definitely be worth having a word with your doctor to check on whether or not you are developing depression. .