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New evidence supports century-old theory of cancer spread

A Yale School of Medicine study in the December issue of Lancet Oncology challenges mainstream oncology researchers to consider tumor cell hybridization with white blood cells as a major reason that cancer metastasizes or spreads to other parts of the body.

"Cancer cells exhibit a remarkable number of traits normally attributed to white blood cells known as macrophages, including the ability to migrate to lymph nodes and distant organs and to form a new blood supply. Our data indicate that they do this by hybridizing with macrophages," said lead author John Pawelek, research affiliate in the Department of Dermatology at Yale School of Medicine and a member of Yale Cancer Center.

Pawelek said the idea of white blood cells hybridizing with tumor cells is not new. In the early 1900's the German pathologist Otto Aichel proposed that metastasis is caused by cancer cells fusing with macrophages. "There is now evidence to support all aspects of his proposition," said Pawelek. "Macrophages are among the most motile cells we have. By co-opting the macrophage's ability to move, the hybrid is very different from the original cancer cell. It is able to migrate away from the primary site of tumor formation and take up residence in other areas of the body while it continues to divide."

Working for more than a decade with a diverse team of scientists at the Yale School of Medicine and other research centers, Pawelek concludes that there is now sufficient evidence for Aichel's proposal to be taken seriously by the research community. Pawelek's group began testing the theory in 1993, when they created hybrids in the lab by fusing mouse melanoma cells with mouse macrophages.

"Their behavior was astonishing," said Pawelek. "In culture dishes, fused cells were extraordinarily motile compared to unfused melanoma cells. They spread rapidly when implanted in mice. Even though the idea is virtually unknown to cancer researchers today, many scientists worked on it in the 20th century. From the late 1960's up to today there have been many reports of tumor hybrids."

"Aichel implored future scientists to study cancer cells 'from all angles' for evidence of hybridization," Pawelek added. "It is remarkable that a century later we are doing just that. Were he alive today, Aichel would likely be both surprised and gratified, even though it might seem to be taking a rather long time."

Art therapy can reduce pain and anxiety in cancer patients

A study published today in the Journal of Pain and Symptom Management found that art therapy can reduce a broad spectrum of symptoms related to pain and anxiety in cancer patients. In the study done at Northwestern Memorial Hospital, cancer patients reported significant reductions in eight of nine symptoms measured by the Edmonton Symptom Assessment Scale (ESAS) after spending an hour working on art projects of their choice.

Fifty patients from the inpatient oncology unit at Northwestern Memorial were enrolled in the study over a four-month period. The ESAS is a numeric scale allowing patients to assess their symptoms of pain, tiredness, nausea, depression, anxiety, drowsiness, lack of appetite, well-being and shortness of breath. Eight of these nine symptoms improved; nausea was the only symptom that did not change as a result of the art therapy session.

"Cancer patients are increasingly turning to alternative and complementary therapies to reduce symptoms, improve quality of life and boost their ability to cope with stress," says Judith Paice, PhD, RN, director, Cancer Pain Program, Northwestern Memorial Hospital, and an author on the study. "We wanted to see if the creative process involved in making art is healing and life-enhancing. Our study provides beginning evidence for the important role art therapy can play in reducing symptoms. Art therapy provides a distraction that allows patients to focus on something positive instead of their health for a time, and it also gives patients something they can control."

Each art therapy session was individualized and patients were offered a choice of subject matter and media. When participants could not use their hands or were not comfortable using the art materials, the art therapist would do the art making under the direction of the subject or they could look at and discuss photographic images that were assembled into a book. Sessions ranged from light entertaining distraction to investigating deep psychological issues, says Nancy Nainis, MA, ATR, an art therapist at Northwestern Memorial Hospital, who is the lead author on the study. "We were especially surprised to find the reduction in 'tiredness'," says Ms. Nainis. "Several subjects made anecdotal comments that the art therapy had energized them. This is the first study to document a reduction in tiredness as a result of art therapy."

"Art provides a vehicle for expression," says Dr. Paice. "It may be preferential to some cancer patients who may be uncomfortable with conventional psychotherapy or those who find verbal expression difficult."