®, joined MJH Life Sciences in November 2020. Colleen is a graduate of Monmouth University, where she studied communication with a focus in journalism and public relations. In her free time, she enjoys learning to cook new meals, spending time with her adopted beagle, Molly, or sitting on the beach with a good book. Email her at 

Colleen Moretti

Patients with multiple myeloma may be able to sustain their MRD negativity and improve their long-term survival by eating a plant-based diet.

A healthier diet that consists of plant-based foods and seafood was associated with sustained minimal residual disease (MRD) negativity in patients with multiple myeloma, according to study results.

Sustained MRD (assessment of malignant cells or DNA remaining in a patient's body after treatment) negativity is important for patients with multiple myeloma because it is associated with improved long-term survival. The purpose of this study was to better understand whether modifiable risk factors, such as diet, were associated with this outcome, Dr. Urvi A. Shah, lead author on the study and assistant attending physician in myeloma service at Memorial Sloan Kettering Cancer Center in New York, said in an interview with CURE. Researchers did this through evaluating stool samples and dietary surveys from patients with multiple myeloma who were receiving Revlimid (lenalidomide) as maintenance therapy, which is a standard of care for this disease.

Savor the Flavor With Sauces for Cancer Survivors

Results, which were published in Clinical Cancer Research, demonstrated that healthier dietary protein, such as that derived from seafood and plants, correlated with higher stool butyrate levels, which in turn was associated with higher sustained MRD negativity rates. Butyrate is a short-chain fatty acid with anti-cancer and anti-inflammatory effects, and it is made by beneficial bacteria in the gut microbiome. Additionally, consumption of dietary flavonoids (plant nutrients with antioxidants) correlated with stool butyrate concentration, which was associated with sustained MRD negativity.

“Even though it’s a small study, it’s the first study to show an association that people who are eating healthy diets have higher amounts of healthier bacteria in the stool and higher sustained MRD negativity rates,” Shah said. “It could empower patients, because up until now, we just say, ‘Take this drug. There’s nothing else you can do.’ But now we can say, ‘Take this drug, but you also have this opportunity to further improve your outcomes through a healthier diet.’”

She also noted that in addition to it being a small study, it is a retrospective study, which means there was no intervention group and patients were only observed in what they were already eating. However, the results are still powerful, and the associations were significant. “Patients hearing about this could feel empowered and feel in control to potentially take measures beyond just the chemotherapy to improve their outcomes and lifestyle,” Shah said.

Moreover, even if a healthier diet did not affect a patient’s myeloma outcome, it is likely to positively affect other comorbidities, such as cardiovascular disease, diabetes and obesity that are associated with worse outcomes overall. “We have shown a direct mechanism in myeloma, but it will also help their overall health,” Shah said. “I don’t see any major downside to gradual healthier dietary switches.”

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Eating a plant-based diet has been associated with sustained MRD negativity for patients with multiple myeloma.

Taking Control of Diet May Improve Outcomes for Multiple Myeloma

Patients with breast cancer often face sleep disturbances. 

night’s sleep during breast cancer treatment is vital to a patient’s emotional, social and physical well-being. However, many patients struggle due to anxieties and side effects from treatment.

Patricia Carter, who holds a Ph.D. in nursing and is an associate professor at the UT Austin School of Nursing, part of UT Health San Antonio in Texas, spoke with CURE about why patients with breast cancer experience poor sleep, how it can affect them and ways to manage it.

Carter said patients with breast cancer often struggle with sleep during treatment. Besides experiencing poor quality of sleep in general, many patients may also develop insomnia or restless legs syndrome. Additionally, patients who had sleep disorders, such as sleep apnea, before a diagnosis may see the problem worsen during treatment.

“It’s really very common,” Carter said. “More than half of people going through cancer treatments (experience poor sleep).

“Especially people with breast cancer, since it tends to be mostly women, and women tend to have more of a difficulty sleeping anyway — this just accentuates that even more.”

Carter, who is also a sleep scientist, explained that because cancer is traumatic, patients may try to push aside their worries or anxieties during the day, only to have them creep back at night. Patients lie awake with worry; they become concerned about not sleeping, but cannot doze off because of their fears. The cycle feeds itself.

“So that’s a combination of a psychological experience that they’re having with even just the trauma of the cancer diagnosis, and then all the worries and fears that come along with (it)," she said. "So, all of those worries come to us during that time we’ve psychologically experienced that, which disrupts our ability to sleep well.”

Moreover, sleep can be affected due to physical side effects of treatment. Many therapies can cause fatigue in patients; they also can affect hormone balance, which keeps everything in check. Carter noted that a lot of patients feel their days and nights have switched — because they are so fatigued from treatment, they are sleeping during the day but are awake all night.

Additionally, side effect management can cause sleep disturbance, such as Benadryl making patients drowsy during the day or steroids causing them to awaken at odd times during the night.

“So, there are a lot of things that go into how receiving cancer therapy to save your life actually really majorly disrupts your life and the pattern of your life,” Carter said. “And that disruption of the pattern of your life can disrupt your sleep, as well. It’s such a complex mosaic of, how do we perfectly balance all of these things so that we can achieve a cure, so that we can get our best rest and so that we can be our best person and live our best life? And it’s just a really delicate balance.”

Patients with breast cancer may be dealing with more than just a rough night of sleep that anyone can experience. What can make it more serious, or a disorder, is when it becomes a pattern of behavior, happening several nights a week for a few weeks in a row, Carter noted. Furthermore, it can become a significant problem by how much it affects the patient.

“We have to look at sleep similar to how we look at pain,” she explained. “The quality of sleep is what the individual defines it to be. We can look at all of these different objective measures ... but if all of that doesn’t come together and provide the individual with the energy that they need to do what they want to do during the day, then it’s not sufficient for them.”

Quality of life can be diminished because of this, Carter highlighted. Patients may feel so fatigued that they cannot do what they want, or their not sleeping at night leaves them without the energy for daytime tasks they need to accomplish. Fortunately, sleep is manageable, meaning it can be taken into the patient’s hands.

Carter said many patients have benefited from taking control of their sleep patterns and routine, improving their quality of life. They also find comfort in knowing it is something they can work on as their journey continues.

“With that freight train of cancer coming through their lives ... being able to have something, anything that they can have a little bit of control over makes them feel like they have a better quality of life for that moment,” she said. “And knowing that they can use those skills as they move throughout their therapy into survivorship, it helps them know that they can have just a little bit of control over something that they can wrap their hands around.”

Patients with breast cancer should care about their sleep and work to improve it because sleep affects every cell in the body. Growing research demonstrates that if a patient is sleeping well, their immune system function is improved — which in turn may fight the cancer better, Carter highlighted.

“So, if you’re sleeping well, your body is going to have a better chance; it’s going to have more energy literally to fight your cancer,” she added.

Moreover, a good night’s sleep will help a patient see “small rays of light,” and find more joy in life.

If a patient sleeps well, they will feel well and start to view the glass as half-full, Carter said.

“It affects you socially, emotionally, physically, psychologically, so it really impacts every single element of your life, every single day,” she concluded.

Breast cancer treatment can disrupt patients’ quality and quantity of sleep, leaving them fatigued and restless during the day.

The Wrong Side of the Bed: Breast Cancer and Sleep Disturbances

As part of its Speaking Out video series, on behalf of FORCE, CURE® spoke with genetic counselor Angela Trepanier about disparities in genetics services for breast cancer.

Some breast cancer mutations can be hereditary or passed down through family, such as the BRCA1/2 mutation. But if a patient’s family member can receive genetic counseling and testing to better understand their risk, they may be able to prevent cancer or mitigate the risk with treatment and strategies. Unfortunately, not all those who are affected have equal access to genetic services, leaving them unable to act promptly. 

Q: What are some disparities we see in genetic services for breast cancer?

We know from looking at research that individuals who are White are more often the ones who present for genetic counseling and testing, especially based on family history versus having a personal history of cancer. When we look at other populations, such as people who are African American, Hispanic or Asian, more often if they’re referred for genetic counseling and testing is after they’ve had a cancer. And so that’s one disparity that affects people from different races and ethnicities. And then the other disparities that we see in other populations that have been traditionally marginalized, like individuals from the LGBTQIA+ population. The ones that affect them in all aspects of health care are also prevalent in genetic services. And so those are things that we need to address to make sure that everybody has equitable access.

Q: How can these disparities affect patients and their families?

 The main impact when somebody doesn’t get referred at all is that their family doesn’t have an opportunity to identify their risk for hereditary cancer and knowing that you’re at hereditary risk has a big impact on screening and the potential to take (preventive) measures. And so, if somebody isn’t informed about that, they don’t have those opportunities, and they’re more likely … to present with a cancer diagnosis, instead of finding out that they’re at risk and potentially preventing that cancer. And we have seen that in the literature and that’s why people who are Black, Hispanic or Asian have been shown to be more likely to present with a cancer diagnosis. And that means that that person has less of an opportunity to really prevent that cancer. And it also means that other people in the family might not find out about their risk until somebody is going through a cancer diagnosis, which can be a really hard time to make decisions about looking at your own risk when somebody that you’re close to is going through that kind of situation. 

So that is a huge deficit that we want to correct by making sure that people know what the risk factors are for being at risk. And there are things like early age of onset in the family, somebody who has multiple cancers that are related to one another like breast and ovarian cancer and there’s things like male breast cancer. Anybody who has a variant cancer, anybody who has pancreatic cancer, we want to make sure that if there’s that kind of family history or person that has any of those cancers, we want to get them referred as soon as possible so they can avail themselves of measures that might actually save their lives.

Q: What needs to be done to close those gaps and disparities?

 Some of them are policy things. I saw in the literature … that sometimes when people don’t have genetic counseling and testing, it’s because they don’t have adequate insurance coverage. So, we want to make sure that we have insurance coverage that really covers everyone who’s potentially at risk. So that’s one factor and we’re making some strides in that regard, but that’s really important.

And then another factor is just bias of providers. Some of the literature says that sometimes providers just think that people who are Hispanic or Black or Asian may not want genetic counseling and testing and so they don’t make that referral. Or they don’t ask about family history, or they assume that … somebody wouldn’t want genetic testing because they’re worried about discrimination, so we need to work with educating all of us, me included, about those potential biases and correcting those biases. And then organizations like FORCE, which can support people and provide them with information. The advocacy that they’re doing to help people recognize the risk factors and get them to actually ask for genetic counseling and testing and give them the tools to know how to do that. That is something that can address those disparities as well.

Q: What kind of resources can FORCE provide for those patients experiencing disparities in genetic testing?

 No. 1, FORCE provides a community of people who are experiencing hereditary cancer in some way, shape or form, so they have experience in talking to people about why they might want to consider genetic counseling and testing, how they might reach out to their primary care physician if they’re not getting the referral they want, what are good providers that can provide inclusive care. All of those things can help somebody access genetic counseling and testing and hopefully feel that they can trust the provider that they’re seeing. And then FORCE also provides information about, why do you want to know that information? Sometimes that’s the biggest barrier. Somebody might say, why would I want to know that I’m at risk, I would just worry about it. But there really are things that you can do to reduce your risk if you find out that your risk is increased, and FORCE has all that information. And then I think the other thing that FORCE really provides is heart. It’s a place for the people that are part of that organization. Everyone I’ve interacted with really understands what this means at a personal level, and they’re there to support people who want information and who might be starting this journey. So, knowing that you have somebody in your corner … really breaks down a lot of barriers to accessing services.

Transcript edited for clarity and conciseness.

An expert discusses the impact on patients and families lacking equal access to counseling and testing.  

Making Strides and Breaking Barriers in Breast Cancer

Branwyn Lee reminds other patients going through a breast cancer diagnosis that they are never alone in their journey.

Photo credit: MICHELLE KAFFKO/ OWNER OF ORGANIC HEADSHOTS

Branwyn Lee's life changed in an instant when she received a breast cancer diagnosis only months after an annual checkup at which she was completely healthy. Then she had to go through surgery and treatment alone due to COVID-19 pandemic precautions. 

“One way to describe my cancer journey: For me personally, it was like a whirlwind,” she said in an interview with CURE®. 

Lee, who works in insurance sales, was always educated about health matters and attentive to annual checkups. During an annual examination with her gynecologist in August 2021, she asked about mammograms because she was turning 40 in a few months. The doctor told her she had nothing to worry about and could get one the next year. In November 2021, a day before her 40th birthday, she felt a lump on her breast after adjusting a tank top strap. 

“And immediately you know what you think — ‘I have breast cancer’ — but I told myself to take a step back,” she said. 

She had her husband, Phil, take a look. At first, they thought it might not be a big deal. An hour later, they decided to call the doctor. She went for a mammogram a week later and the doctor called the images “suspicious.” A few days later she had a biopsy, and soon received the call from her doctor telling her it was cancer. 

That was when her husband walked into the room and they embraced, with tears. Her surgeon explained that she would need a full mastectomy on her left breast because there was more cancer in the area than originally thought. Lee opted for the full double mastectomy, to avoid anxiety that the cancer could return. 

During the surgery, it was determined that the cancer had spread to seven lymph nodes. This led to Lee receiving chemotherapy, which began in February 2022 and ended that May, and 33 rounds of radiation, which ended in August. Lee then started taking Nolvadex (tamoxifen) in August and with the help of her oncology team she will remain on a drug regimen for the next 10 years.

What made it all harder was that during Lee’s treatment the hospital was still following pandemic guidelines, so she was not allowed to bring anyone to appointments or treatments. 

“It was horrible,” Lee recalled. “Even though I knew I wasn’t alone, I was so alone. I had everyone, I had the nurses and my husband was right there waiting every time, (but) I had to do it alone. And then I had to come back and talk to him and tell him if he wasn’t on the phone. A lot of times I would just put them on the phone because I wouldn’t rehash everything, and it was so lonely. And so (it) just it made it that much scarier because I had no one to be there with me.” 

But Lee’s nurse navigator, Sarah, became her family. She was with Lee every step of the way from the mammogram to surgery day and through chemotherapy and radiation. Sarah was “essential” to her treatment journey, according to Lee, as she helped set up appointments and coordinate times with doctors. 

“I think there are people that are meant to do certain things, and she was meant to do that,” Lee said of Sarah. “She told me, ‘I’m going to be here every step of the way; we’re going to figure this out and you’re not alone here.’ ”

The day of her double mastectomy, Lee’s husband had to drop her off and couldn’t go in with her. Never having been in surgery or undergone anesthesia, she was terrified, but Sarah walked her into the hospital and stayed throughout the day. 

“She was holding me up,” Lee explained. “She said to me, ‘This is really horrible. I know I’m not your husband or your mom, but I’m your family today and I’m going to be with you.’” 

It meant a lot to Lee that someone would be with her when her family could not. She advises any patient going through a cancer journey to ask about a nurse navigator, or someone who can advocate on their behalf. 

“Because it’s hard to advocate for yourself when you’re scared and crying, and you don’t always know what to ask, and having that professional there that can coordinate and do things is important,” she added. 

Lee also reassures patients that they are not alone on their journey. Although they could not always be with her physically, her husband, children or any other family or friends she knew they were always there for her. 

“The big thing to know is that you are not alone,” Lee said. “No one fights alone.” Lee is now one year cancer free as of December 2022 and has found further help through support groups and therapy. “This is really hard; there’s nothing about it that’s pleasant,” she concluded. “Other than, for me, learning that things I was doing and worry about and taking so much for granted — that was a big eye opening for me because just like that everything changed. Absolutely everything.

Although the pandemic prevented Branwyn Lee's family from being with her during cancer treatment, she never felt alone on her journey. 

Colleen Moretti

Taking Control of Diet May Improve Outcomes for Multiple Myeloma

The Wrong Side of the Bed: Breast Cancer and Sleep Disturbances

Making Strides and Breaking Barriers in Breast Cancer

'No One Fights Cancer Alone'

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