There are numerous movies about adolescents living with cancer and overcoming it; The Fault in Our Stars, Me Earl and the Dying Girl, etc. Typically, they include a heartwarming love story or a monumental last hurrah and then receive a promising prognosis. The audience walks away after shedding a few tears and laughs and moves on with their own lives. However, what these movies don’t tell us is what happens after the credits roll and these adolescents continue their lifelong journey as a “cancer patient”.
Research has shown that adolescent cancer survivors tend to report lower quality of life compared to peers such as more general health concerns, mental health concerns and physical activity limitations. Additionally, many of them experience difficulties such as academic problems, low self esteem, anxiety and depression. Luckily, we are starting to see a trend of programs created specifically for this population to help ease the transition of cancer patient to returning to a “normal kid/teen lifestyle”. Dana- Farber and Boston Children’s Hospital have a unique program called the “Transition to Survivorship Program” to provide resources and opportunities to help ease this transition for children and adolescents and their families and caregivers. While the movie’s show a happy ending, for many of these patients it’s a quite a long road before arriving at their happy ending.
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).
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.
According to cancer.org, cancer is the second leading cause of death in men and that 1 in 7 will be diagnosed with prostate cancer. However, prostate cancer survival rates increases significantly if detected and treated early.
To increase public understanding of the disease, prevention tips, treatment options, and encourage men to proactively manage their health, the American Cancer Society has dubbed September as National Prostate Cancer Awareness Month.
For those of you that prefer to prepare your holiday meats using the grill, you may want to consider a couple of things before you begin your annual tradition.
Although we’ve been told in the past (not so long ago, actually) to ensure meat is cooked through and through, it now seems high-temperature cooking methods are linked to kidney cancer, according to a study published recently in the journal Cancer.
The risk is higher for those that consume a lot of meat. In fact, other studies have linked fried and charred meats to other cancers, including colorectal, pancreatic, and prostate.
So why are well-done meats so bad for us? It seems that as the outside of the meat browns and the temperature rises, a chemical reaction creates flavor and aroma compounds, which we have developed an affinity for over time. However, cooking the meat too long causes the chemical reaction to keep going and creates more compounds, known as heterocyclic amines (HCAs). Some of these HCAs can be carcinogenic if consumed frequently.
Exactly how the process works is unclear, but HCAs are found to be mutagenic – meaning they cause changes in DNA, thus, increasing the risk of cancer.
To determine if meat preparation and high temperatures were associated with increased cancer risk, researchers at MD Anderson Cancer Center looked at and documented the eating habits of patients with kidney cancer, compared with those of healthy, cancer-free individuals.
Results demonstrated that how folks prepared the meat is what mattered most. Although the cancer group consumed more meat overall, they were also more likely to employ cooking methods such as using an open flame, cooking until well-done, charring, or simply pan-frying meat at a high temperature. These methods resulted in a nearly two-fold increase of risk of kidney cancer, associated with HCA. The study concluded by suggesting that, “consumption of meats cooked at high temperatures may impact the risk of kidney cancer through mechanisms related to mutagenic cooking compounds.”
Although it’s difficult to associate HCA solely to kidney cancer through high meat consumption prepared at high temperatures, it might be wise to employ alternative cooking methods, such as baking or broiling meats. Another low temperature technique called sous vide involves preparing meat using a slow cooker at or around 300 degrees.
While these prep methods may not be as tasty to most food connoisseurs, it may however, be the best choice to ensure you spend a lifetime enjoying all that meat!
Despite the known health risks of UV overexposure, a surprising number of people still seek out tanning beds once summer fades away. In a 2010 survey, 5.6% of adults reported using indoor tanning services during the previous year.
Changing minds about indoor tanning starts with the facts. The most basic fact of all: Whether from the sun or an artificial source, UV rays are the cause of most skin cancers as well as long-term skin damage. Below are more facts:
Indoor tanning increases the likelihood of melanoma in young adults.
Use of a tanning bed is associated with a 20% higher risk of developing melanoma skin cancer (1). Indoor tanning before the age of 35 increases this risk by 87%.
Men are also at risk—even more so than women.
One study found that 39% of males under age 40 reported using indoor tanning during their lifetime (2). Men have the highest risk for skin cancer due to many factors, such as more time spent outdoors and failure to get routine screenings.
Having a “base” tan does not prevent sunburn.
A recent study confirmed that tanning via an artificial UV source does not prevent sunburn. In fact, indoor tanning was linked with a slight increase in risk (3).
It’s critical that we continue to spread awareness of indoor tanning dangers—through advocacy, policy making, and face-to-face dialogue. Health care practitioners in particular have the opportunity to play a key role in helping young adults lower their risk of cancer and maximize their chances of a healthy future.
For some eye-opening tanning statistics, check out our infographic.
1 Boniol et al. “Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis.” BMJ, 345:e4757 (2012): 1–12. Print.
2 Blashill et al. “Indoor Tanning Use Among Adolescent Males: The Role of Perceived Weight and Bullying.” Annals of Behavioral Medicine, 46 (2013): 232–236. Print.
3 Dennis, Leslie K. et al. “Does artificial UV use prior to spring break protect students from sunburns during spring break?” Photodermatology, Photoimmunology & Photomedicine, (2013): 29, 140–148. Print.
It used to be a safe assumption that African American women had a relatively low risk getting of breast cancer, but a recent study published on behalf of the American Cancer Society (ACA) has found that black women now have an equal risk of developing the disease as white women.
Previously, the disease was most common among white women, but as rates among black women increase, researchers are seeing the rates for white and black women become more balanced. Since 2008, the risk of occurrence among African American women has increased 0.4 percent each year, translating into roughly 124 black women per 100,000 being diagnosed (the rate for white women still remains slightly higher, around 128 per 100,000). Incidence increased slightly for Asian and Pacific Islander women (88 per 100,000), while the rate for Hispanic women remained the same 91 per 100,000).
In terms of mortality, black women continue to be the most at-risk group, with nearly 32 per 100,000 women dying from the disease (compared to 22 per 100,000 white women). One significant reason for this is likely due to the fact that African American women tend to receive a later diagnosis, and thus, the cancer is more likely to have spread to other areas of the body. Another occurrence being looked at is the amount black women being diagnosed with estrogen-positive breast cancer. Researchers believe this could be due to an increase in obesity rates among black women, since more fat increases estrogen, a known risk factor for certain forms of breast cancer. According to ACA, in 2012, 58 percent of black women are obese, compared to only 33 percent of white women.
Another interesting fact resulting from the study’s results was that rates of breast cancer among black women tended to be higher in the South – Alabama, Kentucky, Louisiana, Mississippi, and Tennessee (rates were higher in Missouri and Oklahoma as well).
Of course, all women, regardless of race, should be aware of common risk factors for breast cancer, and should be proactive in maintaining a healthy weight, getting enough physical activity, and limiting their alcohol intake. One of the single most important acts a woman can take at decreasing her chances of developing the disease is by getting mammograms on a regular basis, to ensure treatment begins at the earliest stage possible.
“Too many survivors are lost in transition once they finish treatment. They move from an orderly system of care to a ‘non-system’ in which there are few guidelines to see them through the next stage of their life or help them overcome the medical and psychosocial problems that may arise”.
-Institute of Medicine
Has this happened to you? Do you know anyone in this position?
The American Cancer Society estimates that more than 14.5 million children and adults with a history of cancer were alive in 2014 in the United States. By 2024, this number is expected to increase to almost 19 million people—more than the combined population of New York City, Los Angeles, Houston and the state of Utah.
There have been many efforts to help survivors in this period of transition. One such effort is through the creation of survivor care plans. A survivor care plan is an individualized and coordinated plan that is created for the survivor and their healthcare team following active therapy.
A survivor care plan provides patients with a tool to guide their discussions with their primary care provider and explain needed follow up care. It is also a guide to help survivors identify important lifestyle modifications to help reduce the risks of having cancer again (e.g. weight management, smoking cessation, exercising regularly). Not only is this a good idea for helping patients, survivor care plans will soon be required for cancer centers to complete. The goal is that these plans can help to improve survivors’ health and quality of life.
As National Breast Cancer Awareness month comes to an end, it’s important to reflect on how far we’ve come. Breast cancer mortality has fallen by more than a third since its peak in the 1980s, and can be attributed to the vast improvements made in regards to breast cancer screening, treatment, and prevention over the last 20 years. Here is a quick look at some of the most effective advancements so far:
Screening- Early detection of breast cancer by mammography has a variety of benefits, including a greater range of treatment options. A combined effort of both the increase of programs designed to improve access to breast cancer screening and improvements with early detection testing techniques (mammograms, clinical breast exams, genetic testing and magnetic resonance imaging) has allowed for over 90 percent of breast cancers to be diagnosed at an early stage.
Treatment- When treatment for breast cancer first began, radical mastectomies were one of the only options, regardless of the stage of the disease. Now, many women have the option to receive much less evasive surgery, such as lumpectomies, with no loss in effectiveness for treatment. Refined chemotherapy regimens and improved radiation techniques have also allowed for women to safely undergo less extensive surgery and has overall improved the quality of life for patients.
Prevention- Recent clinical trials have shown that the drugs such as tamoxifen and raloxifene can significantly reduce the risk of breast cancer in women known to be at increased risk.  Preventative surgeries have also developed and been proven effective in reducing cancer risk.
 Nelson HD, Smith ME, Griffin JC, Fu R. (2013). Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 158(8):604-14
If you watched the State of the Union a few weeks ago, you may have heard chatter about the new “Precision Medicine Initiative” introduced by President Obama. But what really is “precision medicine”?
A White House fact sheet uses words like “bold,” “revolutionize,” and “accelerate” to describe the proposed initiative, which would launch with a $215 million chunk of the 2016 Budget. This sum would be allocated to the National Institutes of Health (NIH) for a voluntary national research cohort, to the National Cancer Institute (NCI) to scale up efforts in genomics and cancer treatment, to the Food & Drug Administration (FDA) to employ additional expertise in the development of more efficient databases, and to the Office of the National Coordinator for Health Information Technology (ONC) to improve the privacy and security of databases and electronic health records.
While this initiative seems exciting and innovative, some say this concept isn’t new; in fact, it’s been used to treat cystic fibrosis and it is sometimes referred to as “personalized medicine” (others try to distinguish between “precision” and “personalized,” which may cause more confusion).
Any way you name it, there seem to be a few vague goals we’ve heard before (i.e. “cure cancer”) and unsurprisingly limited conversation about the insufficient funding focused on prevention and better understanding of growing health disparities. While there’s certainly no drawback to funding more NIH research, crowdsourcing disease cohorts, and supporting efforts to understand the basis of disease, one has to wonder if concentrating resources on treating rare diseases will help ease the growing costs of healthcare, or if there should be more endeavors to integrate healthy behaviors and smart lifestyle choices into American culture. When will public health and prevention get its time in the limelight?
While technologies such as the Internet have drastically changed the world of advertising, traditional poster ads have also evolved, and some organizations have taken advantage in their health-related messages.
In 2013, the ANAR Foundation created an ad for a child abuse hotline that uses lenticular printing such that those who view the ad at less than about 4’3” will see a different message. Adults standing higher than 4’3” will only read, “Sometimes child abuse is only visible to the child suffering it” without bruising on the depicted child’s face. Children, on the other hand, standing lower than 4’3” will use the bruises and additional line reading “If somebody hurts you, phone us and we’ll help you” along with the hotline number.
The ad uses a very simple yet clever way to send a particular message to their target population without adults around them (potentially an abuser) being aware.
In 2014, a popular Swedish ad for shampoo was released in subway stations. Using sensors, the digital ad showed the depicted woman’s hair being blown whenever a subway arrived at the station, mimicking the wind produced by the train.
A similar ad was produced with a surprising twist—after the child’s hair was blown, the hair eventually flies off her head, revealing that it was a wig. Then the true message is revealed: “Every day a child is diagnosed with cancer” followed by instructions on how to text in a donation to the Swedish Childhood Cancer Foundation.
The innovations for marketing in health only show promise as we move forward.