Category Archives: Healthcare Solutions

TARCO – A Tool for Your Lifestyle Transformation

By Hui Xie-Zukauskas

Tools for Health Management_CPDYou say you want to have a healthy lifestyle to prevent cancer and heart disease, but abandoning unhealthy habits can be hard?

I hear you. So I want to suggest a tool I believe can help you achieve that healthy lifestyle you want and need. I call it TARCO, which stands for Trigger, Auto-Responder, Choice, and Outcome.

Before I show you how TARCO can help you ditch an old habit and transform to a new, more healthful one, let’s take a moment to talk about the horrible realities that can result when bad behavior is in play.

A few examples:

Smoking is a bloody wound. That wound hurts because you are bleeding, painful and injured, and worse, because deep inside and invisible it may be causing smoke-brewed cancer and/or the clogging of your arteries that can lead to heart attack.

Eating junk food is an addiction to SAD (Standard American Diet). The “toxic craving” may satisfy your taste or convenience, but it is dangerous because the prescription of animal fats, sweetness, and salts promotes weight gain and the development of many chronic diseases.

Tanning is a fever caused by vanity—caring about one’s appearance so much you allow yourself to be baked with UV radiation. It is dangerous because a hidden scar or lesion is roasted by a known carcinogen, and skin cancer finally surfaces.

So, how do you stop bleeding, the SAD addiction, or the burning? Stop the source. Specifically, to embrace a lifestyle change, work on the trigger (or triggers) to the unhealthy habit, and eliminate it or at least avoid it.

Triggers are ubiquitous in life, and inevitable.

Triggers that are relevant to health may consist of physical, psychological, or emotional signals, or inducements from the social environment.

For example, stress is often a major trigger, leading you automatically to smoke more or drink more or eat more fats and sweets. Any of these risky behaviors can be viewed as an auto-responder or a default mode that results in negative health consequences. At the same time, the behaviors themselves tend to make the stress worse, further exacerbating the unhealthy behaviors and their consequences.
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Now let’s switch to choices.

If you desire better health and are resolved to achieve it, you have various choices in responding to stress. Instead of reaching for that cigarette you feel you need, you can take a walk, take some deep breaths, or take a bath to alleviate the stress. Instead of going for that extra piece of cake you are craving, you can choose to keep a healthy, fiber-rich energy bar handy to substitute for the more harmful alternative. Choices are always available.

If you reinforce new behaviors so they develop into new habits, you improve your wellness in a new direction and with rewarding results.

Not all triggers are easily identified.

To find an original trigger, sometimes you need to retrace the steps, recount the environment or emotions, in order to discover what established the trigger in the first place. Then break away from the old “auto-responder” behavior.

For example, returning to stress, ask yourself what triggers your stress? Maybe it is anger with a situation, frustration from a demanding boss, or anxiety over your finances. Finding that trigger(s) may take some clear-eyed digging! Honest, not selective.

And remember: triggers are unavoidable, but they weaken when you identify them and realize that your choices are within your control.

Finally, as a sum-up for TARCO

Take some time to reflect on your work and personal life, examine what triggers initiate your auto-responders, and ask what can you do differently. Choose new choices that are specific, realistic, and immediately actionable. By fortifying a healthy lifestyle to counter an unhealthy one, you are bound to receive beneficial outcomes for your precious health and quality of life.

Cheers for your effort and success!

 

Color-Coded Foods Guide Your Immune System and Vitality

By Hui Xie-Zukauskas

Rainbow Color Foods_pixabay.comDoes the food color panel tell something about your diet and your body?

Are you fully aware how your daily diet contributes to chronic inflammation? — which has been proven to be a link to countless chronic diseases, especially heart disease and cancer.

Plant-based, colorful foods, i.e., red, orange, yellow, green, blue, purple vegetables and fruits, are filled with nutrients. The “food rainbow” contains not only vitamins and minerals, but most importantly, phytonutrients and antioxidants. Accumulated scientific evidence has shown their anti-inflammatory, anti-aging, anti-pollutant, and anti-cancer properties.
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Image credit: Pixabay

What Cancer Reminds Us of Today

By Hui Xie-Zukauskas

The-Topic-of-Cancer_re-CPDCancer, the word and the disease, has no voice but says much. It has destroyed past lives and gravely impacted the lives of those living. It brings tons of emotions—sadness, fear, anxiety, anger, and stress. We all know this about cancer and many have experienced it. It is the story of the painful suffering cancer survivors go through.

But beyond distressing emotions, cancer also reminds us of several other things:

Reality

Cancer reminds us of a troubling reality that is partly captured by a snapshot of sober statistics. Despite cutting-edge cancer therapies and declining cancer mortality, an estimated 1,735,350 new cancer cases will be diagnosed and 609,640 cancer deaths will occur in the U.S. in 2018, based on an American Cancer Society report. It can hit anybody regardless of age, gender or genetic makeup.

Hope

The good news is that cancer is no longer a “death sentence,” because we see new promise and hope in the fight against this terrible disease. Cancer genomic profiling and precision medicine have made remarkable progress on on cancer risk stratification and targeted cancer treatments. There are also other breakthroughs in the field of immune-oncology. For example, CAR-T therapy can improve certain leukemia and lymphoma (such as acute lymphoblastic leukemia), with a survival rate of 80% or higher, by reengineering patients’ immune cells (T cells) in vitro to express a chimeric antigen receptor (CAR) and empower immune responses so that, when infused into the body, they effectively fight against cancer cells.

Challenges

We also should be reminded of remaining challenges: there are still severe side effects from promising therapies and drugs, effective early screening tests remain underdeveloped, and more research and clinical trials needed.

Financial Strain

Cancer reminds us of the financial strains it often causes. We all know that cancer treatments are costly. How to pay for treatment, especially for those without health insurance, is a big issue. CAR-T therapy mentioned above was acknowledged as a “miracle cure,” but the whole package (infusion, diagnosis, hospitalization, etc.) costs reportedly more than $500,000. Imagine how much this burden adds to a person and family already dealing with overwhelming stress and illness at hand.

Risks & Concerns

Cancer reminds us of other health concerns. Thirteen million people live with cancer. There are health problems and comorbidities that come with or after cancer treatments. Of significance are cardiovascular conditions, heart attack, and stroke. Proposed explanations for these adverse effects include side effects from anti-cancer drugs or therapies, a by-product of cancer itself, or other as-yet unclear causes. So, it is important to consider the overall health and quality of life of those living with cancer and find ways to make them better.

Action & Prevention

Finally, cancer reminds us of positive critical actions that each individual can take to guard against this terrible disease.

  • Early detection is one action that is a key to successful treatment and saving lives.
  • Getting vaccinated is an action, because available immunizations offer protection from certain viral-infection-caused cancers.
  • Prevention is an action, because about 50% of cancers can be prevented by living a healthy, active lifestyle, quitting tobacco, limiting alcohol, and avoiding exposure to cancer-causing agents or toxins.

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These are actions that can be taken now and can make a real difference.

 

Image credit: https://pixabay.com – the-topic-of-cancer

Precision Medicine: From Buzzword to Promise or Reality (Part II)

By Hui Xie-Zukauskas

Target_Precision Prevention_CPDHappy New Year to All! This article is the continuation (Part Two) of Precision Medicine mini-series, with a focus on Precision Prevention intended to help foster and improve your health in the new year.

So, let’s dive right in.

From Precision Medicine to Precision Prevention

Prevention and medicine work side-by-side, as ancient wisdom signifies “Prevention is better than cure.”

Similarly, precision medicine and precision prevention play a joint role in cancer outcome. While precision medicine is targeting the genetic characteristics and genetic changes of each patient’s cancer, precision prevention is aimed at changing an individual’s behavior.

Precision prevention requires a better understanding of the molecular pathways of a particular disease at a level of each individual, which involves mapping out genomic profile, identifying individual’s risk, behavioral, social and environmental interactions. Then tailored interventions can be strategized to modify individual’s physical and biological characteristics.

Impact on Cancer Prevention

Precision medicine, together with precision prevention, has certainly facilitated/improved cancer prevention whether you realize it or not, particularly in early detection.

Colonoscopy screening is a good example. Let me highlight the steps:

First, there is a guideline to identify people at a risk for colon cancer and/or who need to be screened – e.g. starting 40 years old if having a family history, or 50 years old without a family history.

Second, this test can detect a growth in the entire colon through imaging.

Finally, doctors can implement treatments immediately to prevent or slow down cancer progression, e.g. to surgically remove a benign growth (polyp) or premalignant lesion during the screening, or to start an aggressive therapy for a cancerous tumor.

As a result of such a cancer prevention strategy, colon cancer is highly preventable if caught in a precancerous stage.

Meanwhile, additional findings should be taken into consideration. Recent clinical studies found that 80% of people with colorectal cancer have no known family history of this disease, which suggests that other risk factors (environmental, diet or lifestyle) play a role in colon cancer development, and that current colon cancer screening recommendation (mainly based on age and family history) could miss many individuals at risk.
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So, next prospective is how to improve precision prevention. Advances in precision risk stratification has done so. To identify who may benefit from preventive measures or early aggressive treatment or alternative therapies, precision risk stratification can separate individuals at a high risk from those at a low risk through innovative technologies, genetic profiling and multiple risk factors reporting. In colon cancer prevention, while those at higher risk benefit from colonoscopy, people at a lower risk can get screened through sigmoidoscopy, a non-colonoscopy screening with clinical value in detecting advanced growth. Subsequently, precision risk stratification-based screening for colorectal cancer will also reduce healthcare cost stemming from unnecessary colonoscopy screening.

Immunoprevention presents other successful examples. It can be demonstrated by hepatitis B virus (HBV) vaccination and human papilloma virus (HPV) vaccination in preventing related cancers. Immunoprevention can also draw in patients carrying cancer predisposition genes.

In addition, precision prevention may imply identifying novel genomic biomarkers for cancer detection and prevention, applying predictive biomarkers, and analyzing gene-environmental interactions especially associated with modifiable risk factors to develop target preventive strategies.

Precision Prevention beyond Cancer 

Undoubtedly, precision medicine, along with precision prevention, is transforming cancer diagnostics and treatment to reduce cancer incidence, morbidity and mortality in the near future. And one day, the promise of precision prevention for Alzheimer’s disease, metabolic syndromes, or other chronic illnesses can lead us to a remarkable horizon.

Imagine – the beauty alongside benefit of precision nutrition blossoms in your plate of food. As the prevalence of obesity, prediabetes and diabetes increases, tailored nutritional approaches are needed to manage and prevent these conditions. Precision nutritional interventions can be achieved via analyzing and monitoring your dietary habits, food eating behaviors, physical activity, microbiota profile, along with deep phenotyping (i.e. precise and comprehensive analysis of abnormalities in physical and biochemical characteristics).

End Note with Key Numbers

Lifestyle factors (smoking, diet, sedentary, etc.) contribute to over 40% of cancers, and infections, to about 18% of cancers. Thus, many cancers are preventable by lifestyle modification, preventing infections, having balanced diet and regular exercise, and maintaining a healthy weight.

Remember: Prevention is not a sprint, nor a marathon; is a sustained life-long journey. Prevention is not done through virtual world, but achieved in a real world and requires actions. If precision prevention is aimed at changing individual behaviors, the power of control is within each of us.

Going into 2018, imagine a year with your best well-being!

 

Image credit: CanStockPhoto & CPD

 

 

Precision Medicine: From Buzzword to Promise or Reality (Part I)

By Hui Xie-Zukauskas

Target for Precision Med_CPDIn a cheering spirit of the season, an amazing gift for each of us, in a perspective of health and future healthcare, is Precision Medicine. Precision medicine is no longer just a buzzword, its remarkable ability to impact detection, treatment and prevention has extended beyond cancer, and advanced clinical care for cardiovascular diseases, neurological disorders, and other acute or chronic illnesses.

This is an exciting era that treating a disease is transformed from following standard guidelines or the conventional “one-size-fits-all” approach to tailoring of medical treatment to individual characteristics of each patient.

So, what does it mean to cancer treatment and cancer prevention? I’ll provide some remarkable findings for you.

First, Let’s Clarify Precision Medicine vs Personalized Medicine

According to NIH, precision medicine refers to the tailoring of medical treatment to the individual characteristics of each patient, i.e. to identify what approaches will be effective for which patients based on their genetic, environmental, and lifestyle factors.

Precision medicine and “personalized medicine” are interchangeable sometimes. However, the term “personalized medicine” tends to be misinterpreted or misunderstood as the practice that treatments are uniquely designed for each individual. This is not always the case with precision medicine, and I’ll elaborate upon it more in cancer treatment later to help you understand better, so read on.

How Can Precision Medicine Steer Cancer Treatment Precisely?

Cancer is essentially a genetic disease. Errors, defects and malfunctions in the sequence of DNA or changes in the ways how genes are regulated can overthrow a cell’s apparatus, triggering uncontrolled cell growth, and eventually, tumor development.

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These genetic changes in cancer can be examined using extraordinary technologies such as DNA sequencing, genomic testing and tumor molecular profiling. Samples can be collected by biopsies from tumors or in some cases, circulating DNA from patients with premalignant lesions. Cancer molecular profiling can uncover patients’ genetic variations, transcriptomic or proteomic profiling, tumor metabolism and microenvironment, and tumor immunity.

Considerable evidence indicates that a specific sequence of acquired genomic events over many years characterizes the transition from a normal cell to invasive carcinoma, and that specific “driver” events, developed in a particular order, enable cells to progress from benign growth to a malignant cancer.

Traditionally, tumors from the same organ or anatomical site are treated as one tumor entity. With breakthrough advances in genomics and technology, molecular tumor profiling may identify cancer “drivers” that are shared among different cancer types, prompting an approach to target driver’s pathways across anatomical sites, and clinical trials (so-called umbrella trials) to test whether molecular alterations in one tumor entity can be extrapolated to all other cancers.

For example, an inflammatory signature proved to be shared by seven cancer types including breast, prostate, colon, gastric, pancreatic, oral and lung.  Karyopherin alpha 2, a protein that plays a vital role in causing cancer, is uniformly up-regulated across these cancer types. Hence, a cancer-related molecular inflammatory pattern may position this protein as a uniform marker for poor prognostic cancers. Alternatively, oncologists can use specific drugs that target this protein to stop cancer growth.

Take a look at traditional chemotherapy, it works by killing cells that multiply quickly whether they are normal or cancerous. Precision medicine works differently. Because cancer cells need specific proteins or cancer-causing genes to survive, grow and spread, targeted therapies are designed to go after specific cancer-causing genes or proteins, leading to stopping or slowing down cancer progression.

Collectively, precision medicine can improve diagnostics, treatment, early detection and prevention. The goal of precision cancer medicine is to identify which mutation that drives a tumor, and to target therapies on what and how cancer-causing genetic changes occur in a tumor, no matter where the tumor develops in the body.

 

Image credit: CanStockPhoto & CPD

Lifestyle Interventions in the Midst of Three Health Crises

By Hui Xie-Zukauskas Healthy Lifestyle in Right direction_CPD-Clipart combo

As a nation, we are facing three health crises: (1) Chronic diseases, (2) Obesity, and (3) Opioid epidemic.

The facts and figures below tell a sad story.

Impact of three health crises in the U.S. (estimated in 2016)

 

 

Morbidity

 

Mortality

% of All Death

Chronic diseases 25% of adults had two/more chronic health conditions. 595,690 deaths (cancer);  610,000~ deaths (heart disease) 48%
Obesity epidemic 36.5% of adults were obese; 35.6%, overweight. 300,000+ deaths (obesity attributable) 18%
Opioid overdose   59,000 – 60,000 deaths  

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Chronic diseases not only affect health and quality of life, they also add economical and social burdens. Specifically, about 86 percent of all health care spending goes towards treating individuals with one or more chronic conditions.

On the bright side, just eliminating three risk factors – poor diet, inactivity, and smoking – would prevent: 80% of heart disease and stroke, 80% of type 2 diabetes, and 40% of cancer, according to the Centers for Disease Control and Prevention (CDC).

It’s clear that poor lifestyle choices are key contributors in developing preventable chronic diseases such as cardiovascular disease, hypertension, diabetes, several types of cancer, and obesity. Lifestyle modification or intervention is not something new. However, it’s quite challenging to achieve and sustain success. So, here I will emphasize some key strategies and points you can use to fight these health crises personally.  

1. Keep a healthy diet. Intake a diet rich in vegetables, fruits, fish, beans, whole grains, nuts and other nutrients.

-          Reduce fats, sugar and salt in your diet, which may be packed as hidden ingredients in processed foods.

-          Reduce red meat, animal meats consumption too.

2. Participate in physical activity. Aim for a minimum of 150 minute exercise each week.

A combination of diet and exercise is effective in maintaining healthy weight. Take advantage of summer outdoor activities (e.g. swimming, walking, or playing at beach).

3. Quit or avoid addictive behavior such as tobacco, alcohol and illicit drug use.

-          Tobacco smoking takes more than 480,000 lives each year.

-          Rather than seeking substances as a mean for momentary pleasure, living a healthy lifestyle is an excellent regimen for meeting one’s physical, emotional, and social needs.

4. Maintain healthy weight. Weight control is about energy balance, i.e. Energy In = Energy Out. When energy intake exceeds energy expenditure, weight gain occurs.

-          Do eat good breakfast, and consume enough fibers and proteins.

-          Avoid emotional eating.

-          Yes, it’s not easy to make a big change. One step at a time. Don’t go it alone, lock arms for support and motivation.

5. Manage stress. There are many techniques to relieve stress, but the best ones are enjoyable, self-help ways that work for you.

-          Importantly, keep counting your blessings, because gratitude is a secret to happiness.

6. Get a good night’s sleep. Many people overlook this issue.

-          Lack of sleep for a long time may increase your risk of obesity, diabetes, and cardiovascular disease.

-          Sleep hygiene is essential to getting sound sleep (see previous article)

All of above healthy habits will effectively reduce triglyceride levels, cut blood sugar levels, minimize waist circumference, and lower blood pressure. As a result, most chronic conditions and obesity are preventable, and some can even be reversed.

So, go for a healthy, vibrant lifestyle!

 

Image credits: https://openclipart.org/; CPD

Medication Adherence Is No Trivial Matter

By Hui Xie-Zukauskas

Med.Adherence n ProvidersPayers_CPDn2otherImagine you want that magic pill to lose weight or you just got the right drugs to effectively cure your illness, but in either case, you let the pills sit somewhere around your house… How would it help you?

Sadly, failure to take prescribed medications causes about 125,000 deaths annually, according to the CDC.

That’s why I talk about medication adherence and the consequences of non-adherence. Medication adherence implies that a patient takes the medication(s) prescribed by his/her doctor, following the dosage, time or frequency, duration and direction.

Issues on taking medications have been an age-old yet multifaceted challenge, which has some across-the-board consequences. Adherence is especially low among patients with chronic illnesses. And it often happens among elderly people too.

It may surprise you how significant this matter is. Let’s start with reasons for adherence.

Why should a patient take medications faithfully and rigorously?

Medication adherence and therapeutic satisfaction are profoundly tied together.

  1. Your adherence to correctly prescribed medication is essential to clinical-efficiency, cost-effectiveness and positive outcomes.
  2. Adherence to the right regime or course of therapy prevents the development of adverse drug events (ADEs) or adverse drug reactions (ADRs) in many ways.
  3. In the sphere of “cost”, if you try to reduce medication cost by taking it irregularly or delaying the refills, the full therapeutic pay off will not be achieved, and worst, a risk of declining health and increasing cost will transpire.
  4. Non-adherence can lead to hospital readmission, esp. in cases of critical health problems, and potentially affecting clinical quality improvement.
  5. Non-adherence is a $ Multi-Billion problem. “Between $100 and $300 billion of avoidable health care costs have been attributed to nonadherence in the US annually.” (Iuga & McGuire. Risk Manag Healthc Policy. 2014; 7:35-44)

It’s worthy to emphasize that many biological events in the body take place between drug dose and its response, including the release of the drug, absorption, distribution, metabolism, secretion and clearance. Plus, drug interactions with coexisting substances or factors could be severe or subtle. So, non-adherence to medication could result in some unanticipated incidents.

So, what are likely roots of non-adherence?

They can be divided into TWO categories: System (external) and Patients (internal)

Systems / External to Patients – just name a few

  • Discontinuity of care – esp. from hospitalization to subsequent discharge home when lacking a proper direction
  • Multiple changes in medication regimens
  • Inadequate education or instruction of drug use to patients
  • Lack of information on side effects of drugs and preventative measures
  • Drug design itself: e.g. formulation, packaging, inconvenience or high cost, etc.

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Patients / Internal Causes

  • Failure to fill the prescription at the start
  • Failure to refill the medications consistently
  • Forgetfulness – esp. in older people
  • Exhaustion of multiple medications
  • Discontinuity due to a side effect, fear of side effects, finance or misled information
  • Inappropriate use of medication
  • Intentional decision to not take the medication
  • Lack of understanding diseases or poor health literacy
  • Physical difficulties, esp. with swallowing big tablets or capsules, opening bottles or containers, or obtaining prescriptions.

Understandably, non-adherence may occur above all when a patient’s expectation for therapeutic benefits goes beyond the actual benefits, or when medication cost is greater than a patient anticipated.

If non-adherence is an issue for you, it’s time to reflect and deal with the root problem following the explorative list above. Surely it could be something outside it.

Finally – How can you stick to your medications?

Medical adherence is one of keys to better health care. Interventions to reinforce adherence from clinicians and allied health professionals need to be improved. On the other hand, I’d like to highlight what you can do to stay on your medication regimen and optimize your health.

10 Strategies & Tips for Medication Adherence

  1. Take a driver’s seat for your care. Before a drug prescription, talk with your physician to understand why the medication is needed and what benefits it produces. By making a mutual agreement or decision, it will enhance your adherence in the beginning.
  2. Counsel with a pharmacist at your local pharmacy if you have any concern or trouble with your drugs, and they are happy to help with adequate knowledge and advice. Bonus – it’s free of charge.
  3. Comply with the instruction. This is very important as mentioned earlier that drug dosing can impact your body in various ways. For example, some drugs need to be taken in the morning and others in the evening; some once a day, others four times a day; some with a full stomach, others with an empty one…
  4. Have a self-management system – i.e. use a pillbox, take the medication at the same time each day and ideally couple it with a specific daily task or routine, color-code different time points, refill the medications at the same time each week, and order your medications 7-10 days ahead… you got the idea. It’s practical and effective, esp. for older people who use multiple drugs or drugs that must be taken several times a day.
  5. Find a creative way to remind yourself. It could be a sign, a framed memo or a decorated item/box, or an alarm. And make sure it’s absolutely visible.
  6. Take advantage of technology. It could be a medication reminder app or a dedicated digital calendar. Most helpful, set the alarms, esp. smartphone reminders or some cell phones allow you to set multiple alarms a day.
  7. Reduce financial stress by trimming costs down. If your meds cost too much, consult with your pharmacist for a generic brand or current regimen adjustment. In addition, you can switch to a mail-order pharmacy, which certainly offers more savings.
  8. Get help and support from family members, care givers or doctors whenever necessary, e.g. reminder, refilling, or ideas.
  9. Change attitude and take control of your health. Concerns, denials or doubts are real, but none of them is the right solution to your illness. Find a motivation to take that pill, and it should be bigger than you.
  10. When you travel, make sure to take an extra 1-2 days of medications in case of a delayed schedule. Always keep your meds in your carry-on bag. On a similar note, if you’re dining out, take the required meds with you.

The Take-Home-Message:

#1  “Drugs don’t work in patients who don’t take them”. 

#2  Drugs don’t perform well in patients who don’t take them with a right dose, at a right time and in a right way.

#3  Medication adherence can maximize therapeutic benefits. Failure to do so causes considerable health, clinical and economic consequences.

 

Image Credits: Pharmaceuticalonline.com; Lifescript.com

 

Two Critical Matters in Colorectal Cancer Early Detection

By Hui Xie-Zukauskas

Time for cancer screening_Clipart library & CPDAccording to the American Cancer Society (ACS), an estimated 135,430 cases of colorectal cancer (CRC) will be diagnosed and an estimated 50,260 CRC deaths will occur in 2017 in the United States.

Zeroing in on the numbers: within the predicted colorectal cancer incidence, 71,420 will be men and 64,010 will be women, and deaths will be 27,150 among men and 23,110 among women. Consequently in cancer deaths, CRC is the second leading cause in men and the third leading cause in women among Americans. Worldwide, CRC is the third most common cancer.

These numbers make clear that CRC affects both men and women, in contrast to a myth that CRC is primarily a man’s cancer.

The good news is that most colon cancers are preventable! YES!

Yet, why are the statistics so large? Here are two areas many people often ignore or miss:

  •  Lack of adherence to the screening recommendation
  •  Delay in presenting symptoms to a physician/oncologist

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Let me weigh in a bit more on each of these issues.

Adherence to screening and the value of colonoscopy

Let’s start with ACS screening guidelines: “Starting at age 50, men and women at average risk for developing colorectal cancer should use one of the screening tests…” This is because about more than 90% of this disease is diagnosed after age 50. For individuals who have a 1st degree family member or relative with colon cancer, exams should start at an earlier age (e.g. ages 40).

One recommended screening test is colonoscopy, because it can not only detect cancers at their earliest, most treatable stages; it can also detect pre-cancerous polyps that can be removed during the exam before they become cancerous.

In reality, 50-60 percent of Americans who are recommended to get screened comply with the guidance. The lower screening rate might partially explain why only about 40 percent of colon cancers are diagnosed at an early stage (i.e. localized in colon or rectum).

Why should you go for a colonoscopy screening?

  1. You gain significant value. Your anxiety, fear, or even feelings of embarrassment may be understandable. However, consider this: Individuals undergo this exam of high quality under a comfortable, sedated condition, during which the entire colon and rectum are visualized by a qualified gastroenterologist. Pre-cancerous polyps can be found and removed safely. Can you see that this is a very valuable package of diagnosis and therapeutics for your colon health care? 
  2. You acquire rigorous clarity concerning your colon health. We want rigorous clarity in science, and surely, everyone wants thorough clarity when purchasing a house or insurance policy. It makes sense to seek rigorous clarity about a matter so critical to your health. If the result is normal, the colonoscopy should be repeated every 10 years up to the age of 75. If the test detects pre-cancerous polyps, the physician will recommend repeating the exam more frequently.
  3. You benefit from one of the most effective cancer prevention methods, and it is often covered by insurance.

Help your physician to help you by presenting any indications

In some cases, especially at an early stage, colon cancer may present no symptoms. Again, that’s why screening is vital to identify cancer early when prognosis and cure are optimistic.

Nevertheless, other folks may experience symptoms such as:

-          Blood in the stool or rectal bleeding

-          Abdominal pain or discomfort

-          Feeling the bowel incompletely empty, or bloating

-          Sudden changes in bowel habits (diarrhea, constipation, or oddly narrow stools)

-          Unexplained fatigue or weakness

-          Unexplained weight loss

Remember, nobody can read what’s on your mind or what’s going on in your life. If you don’t visit or communicate with your doctor, it’s likely he or she won’t know about your cramps or unexplained changes in your bowel movements.

So, devoting yourself to meeting screening guidelines is a key preventive measure, but another critical area is to counsel with your physician about possible warning signs.

In addition, an important step to preventing colorectal cancer is to know its risk factors. These factors can be categorized as:

-          Uncontrolled: age, colon polyps, family or personal history of cancer, esp. CRC

-          Pathological: obesity, diabetes, inflammatory bowel diseases

-          Controllable or Preventable: sedentary lifestyle, tobacco smoking, heavy alcohol consumption, diet with low-fiber but high-fat (esp. animal fats)

To conclude, for colorectal cancer early detection, as for all cancer risks:

#1 Cancer screening is your first crucial preventive step.

#2 Recognizing risk factors and warning signs is your second vital protective weapon.

Image credit: Clipart library & CPD

The Power of Participation in Patient Surveys

By Hui Xie-Zukauskas

Survey-Feedback_CPD w-otherAfter a trip to the doctor, you or a family member may be requested to fill in a “patient satisfaction survey” or “patient experience survey.” Many folks, questioning what difference it would make whether they complete the survey or not, simply ignore it, as if there were more urgent issues in life at the moment. Sound familiar?

In a recent post, I talked about the issue of improving patient safety and quality of care. Well, participating in a patient experience survey is a key part of that issue. Here, I’m going to dive in a little deeper.

First, let’s start with difference between a “patient satisfaction survey” and a “patient experience survey”

Though wordings of the two are similar, a careful assessment reveals striking differences. Understanding these differences can help you collaborate with your providers effectively.

The essential difference between the two is that a patient satisfaction survey concentrates on making patients happy, while a patient experience survey focuses on making people well – beyond making them happy!

A patient satisfaction survey reflects perceptions or preferences of quality of care received, so it’s more subjective. In contrast, a patient experience survey exposes what happened during the care, so is more objective.

Experience reporting is a more reliable instrument because it tells about the patient’s actual experience of a specific service, clinician, or hospital incident. Questions are designed to be more meaningful to patients and more measurable for providers’ care, and the answers can be transformed into actions.

On the other hand, a satisfaction rating is merely a judgment on meeting one’s expectations. As you can understand, people’s expectations vary, and what matters to one person is different for another.

Take a particular example of waiting time:

When asked “How satisfied are you with the waiting time for your appointment” (e.g. setting up time for your visit, finally seeing your doctor), the results from a satisfaction survey could range from excellent through good, fair, and finally poor.

But in a patient experience survey, when asked “How long did you wait for an appointment when you needed care”, the choices are more concrete (e.g., 1 day, 2-3 days, 4-7 days, or longer than 7 days). To the question “How long did you wait to see your doctor”, the answers are specific (e.g., 15 minutes, 15-30 minutes, 30 minutes or longer).

In sum, to steer towards patient-centered care, it is better to ask patients to report their real experience rather than to put down their satisfaction ratings.

Next, how do patients benefit from patient experience surveys?

Patient experience is important because it not only stimulates a strong patient-provider relationship but also is a critical step toward improving quality of care.

In particular,

  1. Patient experience surveys communicate the best way to improve quality of care. Research indicates that improving patient satisfaction has not been linked to improving quality of care.
  2. Emphasizing patient experience means putting patients first, with healthcare providers being concerned more about “what matters to you” rather than “how are we doing”.
  3. Patient experience surveys value patients’ voices. With your voice, an actionable change can begin because your input reveals key indicators for delivering quality of care.

Eventually, greater patient experience will lead to greater quality of care, which will translate into greater patient satisfaction.

Good news for cancer patients ! – CAHPS for Cancer Care

The Agency for Healthcare Research and Quality (AHRQ) has advanced Consumer Assessment of Healthcare Providers and Systems (CAHPS®) to assess quality of care from the patient’s point of view in various healthcare settings.

CAHPS for Cancer Care has been developed by AHRQ to consistently measure and compare cancer care delivered by different providers and ultimately to provide information for quality improvement. CAHPS for Cancer Care includes three separate sets of questionnaires for surgical, radiation, and medical oncology respectively.

Although CAHPS® is the best tool for healthcare providers, patient engagement and participation are important parts of the process. More reasons for this survey, according to Dr. Caren Ginsberg, director of CAHPS® at AHRQ are:

  • CAHPS surveys are featured to capture information about patient experience rather than patient satisfaction;
  • The surveys are scientifically and statistically sound, thus the results are valid and reliable;
  • CAHPS is flexible to use and easily incorporated into any hospital existing surveys. 

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Overall, CAHPS® also serves as a massive database that offer measurable and actionable information, as the surveys have been implemented for over 20 years.

How can you participate and cooperate?

As a final point, remember: one survey cannot change health care or save a life, but it represents one voice and constitutes a worthy part of a large set of valuable data. So, when requested next time, please complete the survey (via innovative technology, direct mail, or telephone), because your voice will be heard, and you can help improve healthcare and save lives!

 

Image credit: http://earlylearningwa.org/ and http://knswb.org.au/

Work Together to Reduce Errors in Cancer Diagnosis

By Hui Xie-Zukauskas

Patient engage comm._CPDHave you or your family member ever gotten a wrong diagnosis from your doctor? Have you heard that a doctor treated your friend for a disease or disorder that he/she actually didn’t have? “It is likely that most of us will experience at least one diagnostic error in our lifetime, sometimes with devastating consequences,” according to the experts on diagnostic safety.

Imagine you were diagnosed with breast cancer and went through cancer treatment, then found out the diagnosis was wrong and the treatment should never have happened. That could spell enormous damage from one diagnostic error!

Cancer diagnostic errors can be the most harmful and costly type of diagnostic errors in various ways. As many cancers are complex and multifaceted, a timely and accurate diagnosis for cancer is still often challenging. That adds weight to preventing cancer altogether and urgency to detecting cancer early.

That’s why I bring your attention to this issue: A diagnosis is something that’s done for a patient (you) and the patient (you) needs to be a part of the team in that process.

1.      Basics and facts

What is a “diagnostic error”?

The Institute of Medicine (IOM) defines a diagnostic error as the failure to:

a. Establish an accurate and timely explanation of the patient’s health problem(s); or

b. Communicate that explanation to the patient. 

What is the reality?

40,000 – 80,000 deaths each year are due to diagnostic errors, as reports vary. However, national diagnostic safety experts, Drs. Graber and Schiff, emphasize that the frequency of diagnostic error is in the range of 10%.

Does it sound like misdiagnosis happens far more frequently than you thought?

2.      When does diagnostic error occur and who may be involved?

No doubt, human factors contribute to diagnosis errors. Studies have reported that communication problems are the most frequent root cause of serious events threatening patient safety. Today’s health-care systems are transforming toward not only integrated care practice but also enhanced patient engagement, to this end, everyone is involved.

Let me bring cancer diagnosis to the forefront. A delayed cancer diagnosis may occur at various stages of the journey to fight cancer. It could be a delay in:

  • symptom recognition or interpretation,
  • decision or action to seek medical attention (e.g., putting off making an appointment due to fear or feeling embarrassed),
  • a care system’s scheduling (e.g., not being seen by a doctor in a timely fashion),
  • clinical tests or subsequent consultations, or
  • receiving cancer treatment.

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In addition, putting off doing anything might simply be due to lack of insurance coverage.

Here is the key point: Delayed cancer diagnosis at an early stage may leave the cancer to progress or spread, leading to limited treatment options. Thus, a delay in cancer diagnosis can have devastating consequences, including poor clinical outcomes and a lower chance of survival.

3.      How can you help reduce or prevent diagnostic errors?

Here are 15 things you can do to enhance your communication with your doctor, medical care team, and health care system.

1)      Prepare for your visit: know or collect your medical records, medications, and family history.

2)      Remember your screenings and, importantly, follow up. Having a separate calendar can assist your memory.

3)      Always bring a list of questions or at least your top three questions when visiting your physician.

In case you don’t know where to start, Agency for Healthcare Research & Quality provides a list of questions to ask your doctor. You can also generate your own list using their Question Builder. It’s a fantastic tool!

4)      Bring your spouse or a family member to your doctor visit to facilitate communication and/or fill in missing information that might help with diagnosis or treatment.

5)      Use technology (e.g., a smartphone) to record the conversation or instructions.

6)      Feel free to ask the doctor to clarify terminology or procedure. If you don’t understand why a particular question is relevant to your situation, ask about it or let a family member do so.

7)      If you have a limited English proficiency, make sure you have a family member or a friend act as a translator.

8)      Participate in a patient experience survey to improve patient safety and care.

9)      Get involved in facilitating the chain of communication—e.g., in scheduling appointments, visits, follow-ups, and even questioning an insurance billing if you don’t understand it.

10)  Don’t self-diagnose, especially based on online information from an unreliable source.

11)  Do keep a diary or inventory of your symptoms for better recollections when needed.

12)  Seek a second opinion or multiple consultations on cancer diagnosis when in doubt or if necessary. The second opinion must be an expert’s one. Be proactive.

For example, if you have a lump in your breast but get a normal mammogram—after all, mammograms pick up only 80-90% of breast cancer. So, for your safety, you should ask for further screening, e.g., a breast ultrasound (sonogram) or even a test with a higher sensitivity like magnetic resonance image (MRI) to ensure accuracy if your physician doesn’t order such tests.

13)  If diagnosed with cancer, follow up vigorously and treat any referrals to specialists, tests, or care with urgency.

14)  Further the discussion about potentially discrepant diagnosis or different finding.

15)  When you have unintentional weight loss or unexplained pain, take it seriously and see your doctor.

One more point – Misdiagnosis may not be discovered for years if ever in some cases. That’s why I cannot emphasize enough how prevention and early diagnosis of cancer offer clear and significant benefits, especially concerning common cancers (the breast, prostate, colon, lung, and skin cancer).

Although I talked more about cancer, these principles can be applied to any other illnesses. And I’ll elaborate with more details in near the future. Stay tuned.

Finally, your take-home message: Actively engage in your health care!

Improving diagnosis for patient safety and for better health care is a responsibility of each of us. Doing that can alone save many lives.