Category: Diseases and Conditions

Financial Toxicity

By Shauna Ayres MPH candidate 2017

CDC data estimates that 26.8% of families report significant financial burden due to medical costs (Cohen & Kirzinger, 2014) and this figure is expected to grow as insurance premiums, drug prices, medical procedures, and health facility overhead costs continue to rise each year. In addition, the aging US population is using more health services which drives everyone’s costs higher (Patton, 2015; Mitka, 2013).

Unfortunately, cancer is one of the most common and most expensive medical conditions. Cancer diagnosis, treatment, and rehabilitation are all lengthy, complex processes that require a variety of medical experts (Mitka, 2013). All of the visits, time, supplies, machines, therapies, medicines, personnel, etc. required adds to a patient’s out-of-pocket costs. (Zafar & Abernethy, 2013). However, there are not just monetary costs. Depending on the type and stage of cancer, thousands of dollars of lost wages can accumulate due to the time taken off from work to travel to appointments and receive treatments. This causes more financial stress on the patient because they are earning less income while their expenses are increasing (Zafar & Abernethy, 2013).

In the cancer community, the term financial toxicity has gained popularity. Financial toxicity refers to how the cost of a disease and its treatment impacts quality of life (University of Chicago, 2016), like how chemical toxicity effects health. Financial toxicity encompasses all aspects of wellness: physical, emotional, social, occupational, financial, and spiritual. Increased medical costs, and thus financial toxicity, is associated with decreased treatment adherence, worse patient outcomes, and lower self-reported quality of life (Shankaran & Ramsey, 2015; Zafar & Abernethy, 2013).

Financial toxicity should be treated as a symptom of cancer. Discussing personal finances in America is largely taboo, but this cultural norm should be challenged in the healthcare field. Doctor’s should assess the financial situations of their patients and use that information to help inform what the best mode of treatment will be (Shankaran & Ramsey, 2015). There are numerous ways to treat cancer and some are drastically more expensive than others. People may argue that the price tag of a treatment can never outweigh the price of life and that is valid; however, a health professionals must assess each patient’s priorities, both personally, medically, and financially to determine the healthiest individualized treatment path (Emanuel & Steinmetz, 2013; Shankaran & Ramsey, 2015). This does not necessarily mean that poor patients with receive cheaper and lower quality care. If a doctor is aware of a patient’s financial status, he/she can refer the patient to a hospital social worker who can assist in securing charitable funding or grant money to help pay for treatment (Shankaran & Ramsey, 2015). Until the issues of medical spending and insurance are solved, which will unfortunately not occur overnight, health professionals and patients must communicate more effectively to find the optimal comprehensive treatment to achieve the best overall quality of life for each individual (Emanuel & Steinmetz, 2013).

Resources:

Cohen, R.A. & Kirzinger, W.K. (2014) Financial burden of medical care: A family perspective. NCHS data brief, no 142. Hyattsville, MD: National Center for Health Statistics.

Emanuel, E.J., & Steinmetz, A. (2013) Will Physicians Lead on Controlling Health Care Costs?. JAMA; 310(4):374-375.

Mitka, M. (2013). IOM Report: Aging US Population, Rising Costs, and Complexity of Cases Add Up to Crisis in Cancer Care. JAMA; 310(15):1549-1550.

Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., William Hollingworth, W., & Overstreet, K. (2013) Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff; 10.1377/hlthaff.2012.1263.

Shankaran, V. & Ramsey, S. (2015) Addressing the Financial Burden of Cancer treatment from Copay to Can’t Pay. JAMA Oncol; 1(3):273-274.

Shankaran, V., Jolly, S., Blough, D. & Ramsey, S. (2012). Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: A population-bases exploratory analysis. J Clinical Onclology; 14:1608-1614.

Zafar, S.Y. & Abernethy, A.P. (2013). Financial toxicity, part I: A new name for a growing problem. Oncology; 27(2):80-149.

University of Chicago (2016). Financial toxicity facts. Cost of Cancer Care. https://costofcancercare.uchicago.edu/page/financial-toxicity-facts

Patton, M. (2015, Jun 29) U.S. health care costs rise faster than inflation. Forbes. http://www.forbes.com/sites/mikepatton/2015/06/29/u-s-health-care-costs-rise-faster-than-inflation/#1226e08f6ad2

Study Drugs Limitless? More Like Limited: Know the Risks

By: Shauna Ayres MPH: Health Behavior candidate 2017

There has been much attention on the opioid and heroin epidemic in the last several years. Appalachian states in particular have suffered a great deal from a sharp rise in addiction and overdoses caused by opioid drugs. However, like many other addictive behaviors, there is silent rise in rates of “study drugs” on college campuses across the nation. Study drugs are prescription drugs, such as Adderall, Ritalin, and Vyvanse, that are used to treat Attention Deficient Hyperactivity Disorder (ADHD). Those with ADHD suffer from a brain abnormality that causes difficulties in concentration and increases impulsivity; but, college students without ADHD are using them to increase focus, sleep less, or do more academic, professional, and/or social activities.

The strong marketing and pressure by drug companies to prescribe and sell new ADHD drugs has resulted in more youth being diagnosed with this disorder and more prescriptions being written. There are currently 2.5 million Americans prescribed ADHD drugs and manufacturing of prescription stimulants has increased by 9 million percent in the past decade! I think the real questions are: Do more Americans suffer from ADHD? Or, has American’s need for drugs increased? The sad reality is that the more drugs available, the more opportunities there are to abuse those drugs.

It is estimated up to one third of college students have used study drugs. Common characteristics of users include being white, belonging to a fraternity or sorority, and having a grade point average of a B or lower. Interestingly, these drugs may keep students awake longer, but do not increase cognitive ability or capacity, or said another way, they do not make students smarter and are not like the magic pills in the movie Limitless. Most college students report getting or buying these types of drugs from a friend or peer with ADHD and a legit prescription.

Just because a drug is approved by the FDA, does not mean it does not have side effects, especially if it was prescribed to someone other than the person actually consuming it–every drug comes with risks. Some of the more common consequences of ADHD stimulant drugs are increased blood pressure, irregular heart rate, restlessness, anxiety, nervousness, paranoia, headache, dizziness, insomnia, dry mouth, changes in appetite, diarrhea, constipation, and changes in sex drive. Hallucinations, cardiac arrest, and death have been reported among people with prior heart conditions. In addition, ADHD stimulants are classified as a schedule II drug due to being highly addictive and the suggested sentence for distribution of schedule II drugs is 20 years in prison and a fine of 1 million dollars.

So, if you are using or considering using these types of drugs, please seek support from Campus Health Services or another health professional.

If you have these drugs for ADHD, do not share them with others. Here is a link to ways to “Protect Your Prescription”.

Resources

Cherney, Kristeen (2014). ADHD Medications List. Healthline. http://www.healthline.com/health/adhd/medication-list#Stimulants2

University of Texas at Austin, University Health Services. HealthyHorns: Study Drugs. https://healthyhorns.utexas.edu/studydrugs.html

University of North Carolina at Chapel Hill. Campus Health Services: Home. https://campushealth.unc.edu/

Drug Enforcement Administration. Federal Trafficking Penalties for Schedules I, II, III, IV, and V (except Marijuana): https://www.dea.gov/druginfo/ftp_chart1.pdf

Center on Young Adult Health and Development (n.d.) Nonmedical Use of Prescription Stimulants: What college administrators, parents, and student need to know. University of Maryland School of Public Health. http://medicineabuseproject.org/assets/documents/NPSFactSheet.pdf

Aberg, Simon Essig (2016). “Study Drug” Abuse by College Students: What you need to know. National Center for Health Research. http://center4research.org/child-teen-health/hyperactivity-and-adhd/study-drug-abuse-college-students/

GUEST BLOGGER: Why The United Nations General Assembly Declared Antibiotic Resistance a Global Health Threat

GUEST BLOGGER: John Rehm

On Sept. 21, the 193 member countries of the United Nation’s General Assembly (UNGA) unanimously agreed on a declaration that addresses the increasing threat of antibiotic-resistant bacteria across the globe.

In his opening remarks, UNGA President Peter Thomson stressed the importance of a global response because antibiotic resistance threatens not only people but also the environment, wildlife, access to sustainable and safe food, and agricultural production.

The U.N.’s report estimates that 700,000 people die each year from drug-resistant infections around the globe and hopes that by taking action now, it can prevent an uncontrollable health epidemic.

How does this relate to the United States?

According to the CDC, 2 million people become infected with antibiotic-resistant bacteria each year in the United States — and 23,000 of those infections are the direct cause of death. An example is Clostridium Difficile or C.diff, which accounted for almost half a million infections and an estimated 15,000 deaths in 2015.

How can we prevent further infections?

One of the easiest ways is to have a conversation with your family doctor or family nurse practitioner on appropriate antibiotic use. In the United States, more than 150 million antibiotics were prescribed in 2015. According to the CDC, 30 percent of prescribed antibiotics are unnecessary.

Also, be mindful of how you interact with livestock. As much as 80 percent of all antibiotics is used on livestock and resistant bacteria can spread to people via:

Uncooked or improperly prepared animal food products

  • Direct contact with livestock infected with drug resistant bacteria
  • Waste runoff from livestock fecal matter or fertilizers that seep into a local water supply

By being aware of what antibiotic-resistant bacteria are and sources of exposure, we have the opportunity the join fight to prevent further infections. For more information on how antibiotic resistance occurs, check out Kevin Wu’s TED-Ed video here.

The Importance of Sticking to the Childhood Vaccination Schedule [infographic]

Guest Blogger: Carrington College

Childhood illnesses such as influenza can easily be prevented via a simple vaccine, and yet, as USA Today reports, nearly half of the American population skips their annual flu shot. Immunization rates are better for other diseases, but many children remain vulnerable to influenza, hepatitis, tetanus, and a whole host of other concerning illnesses. Thankfully, the risk of these diseases can be greatly diminished by sticking to the recommended vaccination schedule.

When Should Children Be Vaccinated?

Appropriate vaccination times vary based on the illness. Some vaccines only need to be administered once, while others require regular updates. For example, children ought to receive the influenza vaccine every year, beginning when they reach 6 months. The number of doses and the way the vaccine is administered may vary somewhat based on the child’s age and vaccine history.

Like the flu shot, many vaccinations start when the recipient is just a baby. The first dose of the hepatitis B vaccine should occur within 24 hours of the child’s birth. The rotavirus, inactivated poliovirus and DTaP (diphtheria, tetanus, and acellular pertussis) vaccinations typically occur around 2 months of age. Additional doses of these vaccines may be scheduled at 4 and 6 months.

Other vaccinations such as varicella begin a bit later (around 12 months), but continue with additional doses as late as 4 to 6 years old. For those caught up on their vaccines, a significant break in non-influenza immunization may occur between the ages of 6 and 11. Furthermore, the vaccination schedule recommends that all children between the ages of 11 and 12 receive the meningococcal vaccine.
Why Stick to the Vaccination Schedules?

Vaccination vigilance can keep even vulnerable children healthy. The best way to ensure that children are up to date on all of their vaccines is to begin a vaccination schedule early and stick to it throughout childhood. Parents should consider using the below childhood vaccination checklist created by Carrington College to keep track of their child’s vaccinations in order to protect them from dangerous diseases.

child-vaccine-schedule-checklist

I Love College, But Eyes Don’t

By: Shauna Ayres MPH: Health Behavior candidate 2017

Do you find yourself rubbing your eyes for relief in order to get through those last few pages of a journal article? The typical college student spends many hours each day reading and or staring at a screen. This is referred to as “near work” or activities that require your eyes to focus on text, pictures, or objects about arm’s length or closer. According to the American Academy of Ophthalmology, humans normally blink about 15 times per minute, but when engaging in near work, the number of blinks reduces to 5-8 times per minute which often results in eye strain. Eye strain is characterized by red, dry, and tired eyes, blurry or watery vision, headaches, and/or fatigue. There are a number of eye ergonomic tricks you can do to reduce the severity of eye strain when you can’t reduce the number of articles you have to read or assignments you have to complete.

  1. Sit about an arm’s length from your laptop or computer screen and position it so you are looking slightly downward.
  2. Glass screens cause glare. Try to reduce glare by using a matte screen filter.
  3. Take a break and practice the “20-20-20” rule: every 20 minutes, look at an object at least 20 feet away, for at least 20 seconds.
  4. Use eye drops when you feel your eyes are dry.
  5. Adjust the room lighting so that your screen and surrounding light are of equal brightness.
  6. Increase the contrast on your screen.
  7. If you wear contacts a lot, consider wearing your glasses more, never sleep in your contacts, and always clean them properly.

If you experience eye strain persistently, you should see an eye doctor for an eye exam and professional advice. If you wear glasses, contacts, or have any history of eye problems you should see an eye doctor once a year. If you don’t have any history of eye problems or troublesome symptoms, you should see an eye doctor every two years. Eyes are a very important organ and their health is often taken for granted until something goes wrong. So stop reading this and practice the 20-20-20 rule now.

For more information about eye health go to http://www.aoa.org/.