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. 

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.

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.

 

Never Miss a Chance to Protect Children from Cancer

By Hui Xie-Zukauskas

Cancer Boy w-Ribbon_uthscsa.eduImagine that a tiny, precious life with a bright future was taken away by cancer, the “big C”… Nothing is more devastating than that.

That’s why I’m going to focus on what we can do about childhood cancers, so to prevent the worst loss by all means.

First, what exactly causes childhood cancers remains unclear. Risk factors of childhood cancers are different from those in adult cancers. For instance, lifestyle-related risk factors (such as tobacco smoking, alcohol intake, unhealthy diet, and sun overexposure) do not play a significant role in childhood cancers. Environmental factors have little influence, largely due to the lack of direct exposure of the fetus. Most childhood cancers result from genetic mutations, i.e. genetic errors occur randomly and unpredictably whether it’s inherited or acquired.

So, am I suggesting that there is nothing we can do to prevent childhood cancers or protect our children? No.

If you are not well-informed, you may miss a chance to prevent the unthinkable. Here is an example. Human papillomavirus (HPV) infection is linked to cancers of cervix, oropharynx, rectum, or at other body locations. Nearly 93% cancer due to HPV-infection could have been prevented with recommended HPV vaccine as routine immunization for adolescent girls and boys starting at ages 11 to 12 years, following specific guidelines.

Can you see how one could miss the chance by doing nothing? Let me expand a little more on preventative measures.

1.      Childhood cancer prevention can start before conception in young women.

The mother-to-be’s well-being has an impact on the babies. For example, a pregnant, smoking mom can affect the offspring’s health in a hazardous way. To say the least, alcohol consumption and drug abuse fall into the same category. To minimize a child’s risk of cancer, young women should stay healthy and fit, and avoid or limit the exposure to toxic chemicals and environmental pollutants in daily life. Detect cancer early by genetic testing or genetic consulting, especially when you have a history of familial cancers.

2.      Cancer prevention with a healthy lifestyle should begin early in childhood.

A lifestyle cannot be developed overnight. Lifestyle factors also take years or decades to influence a cancer risk. Fostering a lifestyle with nutrition-rich diet, regular exercises, and healthy weight from a young age forward can greatly lower the risk of several cancers in adults, as accumulating evidence shows. Childhood obesity prevention can produce considerable health benefits. Also, postpone the time for kids to use cell phone or mobile devices to prevent brain tumor, the leading cancer death in children. Growing studies reveal an association of radiation with pediatric brain tumors, especially when young kids have the thinner skulls, with still developing nervous system and brain.

3.      A long-term protection: prevent secondary cancer after childhood cancer.

Cancer treatment like radiation can harm young kids’ organs or tissues because of their vulnerability and developmental stages. Radiation or chemo therapies for childhood cancers increase a risk for secondary cancer as one ages. Particularly common are tumors of the brain, breast, skin or spine, and bones. The higher doses of radiation, the greater risk these individuals have. So, it’s important to detect cancer early in the population of childhood cancer survivors, and make sure they have regular visits or check-ups, in addition to living a healthy lifestyle.

Let me conclude with the Quote from Elizabeth Barrett Browning: Light tomorrow with today.All said and done, apply these outlined approaches today to protect every child, so that each child has a healthier, happier, and brighter life tomorrow.

 

Image credit: uthscsa.edu and CPD

5 Reasons for a Higher Awareness of Zika

By Hui Xie-Zukauskas

Zika_Pt.2_CPDZika virus continuously poses a public health threat in the U.S.. Since my last post “Zika Virus Infection and Cancer Care Indication”, as of August 24th, 29 people in Florida have been infected with Zika virus through local mosquito transmission, along with 2,487 travel-related cases across the country, according to the CDC.

This is a more alarming reality than that presented three months ago when all 544 Zika cases in the U.S. were travel-related. Regions along the Gulf Coast are at an elevated risk for Zika outbreak, especially Louisiana, because of recent devastating flooding.

Pregnant women are particularly vulnerable to the Zika crisis. Of importance is to avoid traveling to Zika outbreak areas and stay self-protected to prevent mosquito bites. I won’t get into details here because plenty of information or guidance is available elsewhere.

Based on some new research and clinical findings, I’d like to emphasize FIVE reasons why we need a higher alert and responsiveness to Zika infection. Here goes:

1.      There are various ways for Zika virus transmission.

A person who has acquired the Zika infection could pass virus along through mosquito bites, maternal-fetal and/or sexual transmission. Unmistakably, blood transfusion also becomes a major concern as Zika-positive blood donation is evident. That’s why the FDA recently recommended nationwide screening of blood donations for Zika virus. Thank about it – why is it necessary to run such a costly and time-consuming testing for a massive blood donation system? Remember that people infected with Zika virus could be symptomless.

2.      Zika virus can damage not only a baby’s brain but also an adult’s brain cells.

Painful scan images have shown that Zika infects a fetus, causes brain calcification, and destroys a baby’s brain. Severe brain damage may bring about long-term developmental problems or neurological complications affecting vision, movement and epilepsy. On the other hand, new research reveals that Zika virus impacts a different area of adult mice’s brain, such as a specific neural cell, and it could affect long-term memory in some adults.

3.      Zika virus affects the immune response, particularly in those whose immune system has been compromised due to a chronic disease or cancer therapy.

Infections by viruses can suppress the immune system. Moreover, a person’s inflammatory response to mosquito bites may augment the severity of arbovirus infection (e.g. Zika). Studies suggest that mosquito bites, especially in individuals hypersensitive to mosquito bites, may be linked to cancer development through activating cancer cellular pathways by mosquito-feeding, and/or through influencing human metabolic pathways leading to the initiation of cancer.

4.      It’s challenging to control mosquitoes.

Mosquito population is measured in the millions, and usually in the hundreds of millions. There is no way to distinguish Zika-infected mosquitoes from the rest uninfected. It’s virtually impossible to eradicate them all. But it doesn’t mean we should give up our effort.

Aerial spraying and backpack fogging carried out by the professionals can help reduce mosquito populations in epidemic areas. There are also effect measures that individual citizens can take right at home or the backyard with little or no cost. For instance, the best ways to control local mosquito population is to eliminate the places where mosquitoes breed, such as water-filled buckets, flowerpots, containers, puddles or pools of standing water outdoors.

Using pesticides to kill mosquitoes is delicate. Be cautious about unintended consequence, because pesticides often contain some toxic chemicals that can be harmful to human health if inhaled or ingested. 

5.      Finally, keep in mind those young women whose newborns suffering from microcephaly, neurological abnormalities and birth defects. What would their hardship be? – raising their ill babies, caring for the infants with various disabilities, and likely dealing with their own stress, anxiety, depression or quality of life.

 

Image credit: physio-pedia.com and CPD

How Can Climate Change Impact Cancer Risk

By Hui Xie-Zukauskas

Climate change & Cancer_CPD comboMuch of the talk lately is about a heat wave. “Are you cooked?” “Are you baked?”

Yes, massive, harsh and dangerous heat waves that hit most regions of the country are certainly unwelcomed, and unexpected in its increasing intensity, frequency and duration. Sure, mother nature is something to blame, but climate change and consequential global warming cannot be ignored. Particularly, I’m going to weigh in an issue seemingly less visible yet closely related.

Global warming is no longer a theory or myth, rather a reality. Just look around – those extreme weather cases, more wildfires, more rainfalls and floods, especially the worst, deadly flooding in West Virginia in 1,000 years. A warming planet undoubtedly plays a role.

As an alarming and disturbing note, climate change posts the biggest threat to public health in the 21st century (Castello et al., Lancet 2009). Solid science has told us so. Now, a more specific question should be addressed – Is there a connection between climate change and cancer development? If so, how? My focus here is to explain how climate change affects a risk for cancer, directly and indirectly, in FIVE ways.

  1. Increased our exposure to toxic chemicals by heavy and long-lasting rainfalls or floods: Global warming followed by excessive rainfalls wash toxic chemicals into water and surrounding communities. Then what? Think about smoking. A cigarette releases plentiful chemicals (>7000); out of them about 70 are carcinogens (i.e. cancer-causing substances). These harmful agents damage almost every organ in the body by causing genetic or DNA mutation, leading to the development of cancer.
  2. More intensified exposure to toxins by higher temperature: Heat itself can make toxic chemicals either more poisonous or unstable with unpredictable fallouts.
  3. More bacterial growth driven by a warmer or higher temperature: Bacteria have been attributing to cancer through inducing chronic inflammation and generating bacterial metabolites as carcinogenic end-products.
  4. Increased diffusion of UV radiation by depleting stratospheric ozone (i.e. “good ozone”): As you know, the overexposure to UV radiation causes skin cancer. Noticeably, UV radiation also suppresses some aspects of immunity, as a result, weakening your defense against cancer.
  5. Reduced air quality we breathe by producing ground-level ozone (i.e. “bad ozone”): Increasing evidence suggests considerable or long-term exposure to air pollutants may lead to lung diseases, such as lung cancer and chronic obstructive pulmonary disease (COPD), though it’s not conclusive.

In addition, chronic exposure to air pollutants associated with global warming causes an increase in oxidative stress and inflammation that contribute to cancer. Research findings also reveal that sensitive individuals and vulnerable populations such as children and the elderly are more susceptible to air pollution related illness because of potential genetic predisposition.

So, collectively, climate change can impact cancer risk, cancer development, and for sure, cancer care. Any misconception of global warming is relatively naïve and potentially dangerous.

Climate change is largely man-made, which is beyond the scope of this article. However, it is clear that we must take responsibility to safeguard a healthy environment, because a healthy environment supports healthy living for each and every one of us.

 

Image credits: www.freeimages.com/; www.medicinenet.com/

Men’s Health Month Ends BUT Men’s Health Challenges Persist

By Hui Xie-Zukauskas

Happy father and son isolated on white backgroundA lot of men are “pull yourself up by your bootstraps” kind of guys and believe they can fix anything by themselves. This is true many times in life. But when it comes to health conditions, it could be a dangerous misconception.

Today, I’m going to highlight how men’s masculinity or “toughness” and emotional restraint may impede them from seeking medical or professional help, consequently having a negative or even grave effect on their health.

The Cover-Ups & Attitude

Sometimes, those “annoying” symptoms (e.g., snoring, bad breath, enlarged prostate, and unexplained weight gain or loss) show up and even persist; but a lot of guys would rather tough it out or put off a visit to the doctor with various excuses. I get that. But do you know – a quiet health crisis may be underway?

How about in the workplace? Masculinity may influence workplace health and safety particularly in male-dominated skilled trades as injured workers return to work too early and “tough” workers then reinforce dominant masculine norms. Results of a joint study from the University of Toronto showed, “A desire to be viewed as a strong, responsible, resilient worker may intersect with concerns about job loss, to influence participants’ decisions to not report safety issues and workplace accidents, to not disclose post-injury work challenges, and to not request workplace supports” (Stergiou-Kita et al., Work; 2016). Certainly, institutional identification and practices play a role too.

How about social or psychosocial beliefs? Some folks believe that cancer will inevitably lead to death (so-called cancer fatalism). A study by Mitchell et al. (Res. Aging; 2016) reported that among 1,666 African American males enrolled in Medicare, 76.5% felt helpless, 44.2% confused, and 40.7% pessimistic about the ability to prevent cancer. Despite a couple of limitations, the study reveals a challenging factor for cancer prevention and screening detection. Important to note, although African American males remain at greatest risk for dying from prostate, colorectal, and lung cancers compared to men of other races, early detection and treatment save lives.

The Facts & Evidence

Men are more vulnerable to various disorders at all ages across the lifespan. Also, men’s average life expectancy stays largely behind that of women’s. Primary physical health risks that are leading causes of death or are burdens for men include cardiovascular diseases (heart disease and stroke), cancer (especially prostate and lung cancer), diabetes, depression, and suicide. Fortunately, many of the top causes of death are preventable and can be treated, if found early.

Finally, here is a list of Strategic Actions you or your loved ones can take for men’s health:

  • Check out critical numbers such as blood pressure, blood cholesterol, and blood sugar; keep them in normal ranges.
  • Schedule recommended screenings for prostate and colon cancer, and a routine testicle exam.
  • Schedule a routine medical care or physical examination.
  • Ladies, accompany your man to his doctor visit. This can be a great help with eliminating potential communication barrier(s) to disclosing a real problem or filling in a missing note.
  • Keep mentally active; for example, take new classes, play brain games, or learn something new.
  • Forge a close relationship with a circle of friends.
  • Never ignore some seemingly common symptoms such as snoring, bad breath, and enlarged prostate. Take note of it. If the problem persists, consult your physician to rule out any medical conditions.
  • Consult professional help if you (or your man) have symptoms of depression.

In summary, to prevent a quiet health crisis in men, we all need to step in by advancing men’s mental health, strengthening men’s workplace safety, and caring about men’s overall well-being, in addition to monitoring men’s physical health.

Saving His life—men’s lives—is one of the best things to do throughout the year!

Image credit: www.communitycarechemist.com.au/category/mens-health

Zika Virus Infection and Cancer Care Indication

By Hui Xie-Zukauskas

Zika in USA map_smAre you worried about Zika virus infection? Are you ready for Zika outbreak?

Consider again − after learning the public health threat highlighted here with eyes on the U.S. region.

Let’s start with a snapshot on the crucial timeline to see how Zika epidemic has been evolved after the 1st Zika case identified in Brazil in April 2015.

Snapshot on Timeline of Zika Outbreak

As you may know, Zika virus is transmitted to people primarily through the bite of an infected mosquito. Travel-associated cases imply individuals infected abroad and then returned to the country. No immediately mosquito-transmitted Zika infection has been reported in the 50 US states so far, but the CDC has alerted the epidemic is likely to change with mosquito season’s arrival.

How should you be concerned?

Birth defects (e.g. microcephaly, fetal malformations) have been linked to Zika virus. Thus, pregnant women are particularly vulnerable to this emerging infectious disease.

If you are a healthy adult, you’re still not Zika-proof. In most cases, Zika virus causes a brief, mild flu-like illness. As documented, adults have also suffered from severe neurological disorders such as meningitis, meningoencephalitis and Guillain-Barre syndrome. A rare complication may be internal bleeding, which caused the first US Zika-related death.

Here are a few key points:

  • There is no vaccine or effective treatment for this disease.
  • Zika-specific tests could be expensive and not readily available.
  • There is a lot of UNKNOWN, though more research is underway.

How would you possibly be impacted?

With summer approaching, mosquitoes are coming. But don’t panic, not all mosquitoes spread this disease.

Two mosquito species may carry Zika virus: 1) Aedes aegypti; and 2) Aedes albopictus, the latter is also known as Asian Tiger mosquito. However, there is no way to tell if a mosquito is Zika-infected.

Next, where would Zika-carrier mosquitoes likely to be found?

Places like Florida, Texas and Louisiana are home of the Aedes aegypti mosquito, whereas the Midwest and much of the East Coast happen to be climate or environment for Aedes albopictus (Asian tiger) mosquito. So, a “New Bug” is expected to be around.

What can you do?

Current strategic measure is Self-Prevention and Self-Protection, as briefly summarized in the following areas:

Travel cautions: Pregnant women are advised against travel to the affected countries, and if a trip is required, test the positivity of Zika virus presence once returning.

Personal protection: Extra vigilance and care for pregnant women, wearing long-sleeved clothes, gearing up with mosquito repellent (EPA-certified), and remember – The mosquito-biting time could be daytime!

Note that other routes of Zika infection include sexual or maternal-fetal transmission or blood transfusion.

Environmental prevention: Eliminate potential mosquito’s egg-laying sites by emptying or drying water buckets, water storage units and other plant pots.

Medication alert: Although analgesics is a part of supportive management, avoid Aspirin and Non-steroidal anti-inflammatory drugs because of the risk for hemorrhage among patients with cancer or dengue or taking specific therapies at elevated danger of bleeding.

Last but not the least, because it’s unclear as how the course of Zika infection influences that of cancer, cancer patients should maintain close check-up or follow-up with your physicians and specialists, particularly for those with an immune-suppressed condition or with significant comorbidity.

Zika outbreak may come rapidly, so get prepared and get ready!

 

References: 1) Hepner and del Pilar Estevez Diz: Journal of Global Oncology. April 2016; and 2) Plourde and Bloch: EID journal. Vol.22, 2016

Image credit: physio-pedia.com and CPD

Skin Cancer and Aging: Causes and Solutions

By Hui Xie-Zukauskas

UV radition n Ozone layerHere comes the sun! And we all enjoy it. You may be heading for sunny beaches soon. I’d like to remind you of damage from the sun overexposure. By providing some key insights into harmful effects of the sun, and reflecting on skin aging, I am diving a little deeper into this subject, and will equip you with a sun protection tool kit – 5 Essentials or “SHADE”.

Numbers and Notions

First, do you know that more people suffered from skin cancer than all other cancers combined over the past three decades? Breaking down the statistics, it reveals approximately 40-50% of Americans who live to age 60+ will have one type of common skin cancers, and more than 90% of skin cancer is caused by excessive or unnecessary exposure to the sun?

Types of skin aging

If the above numbers cannot transmit the roles of aging and sun hazard in skin cancer, let me briefly elaborate what happened to our skin over our lifetime. As we age, our skin – the largest organ in the human body – goes through the same escalating loss of structure and function as other organs. But unlike other organs, the skin is openly exposed to environmental pollutants and lifestyle-related hazards (e.g. excessive sun, tanning, smoking, etc.). ALL is cumulative! Mostly concerning, ultraviolet (UV) radiation from sunlight causes so called “photoaging”.

I summarize here how photoaging differs from natural skin aging, to help you understand how biological evolution of the skin and adverse effects of the sun are interplayed.

Natural / Intrinsic Aging Photo- / Extrinsic Aging
Cumulative process Yes Yes
Common locations face, neck, forearm, and lower leg Yes
Cause Aging-related Sun damage overlaying natural aging
Visible characteristics Looseness, sagginess, fine wrinkles, dryness Increased pigmentation, deep wrinkles, harsh or rough skin
Structural alterations Epidermal − dermal area thinning and weakening, reduced elasticity, delay in wound healing Severe damage of dermal and connective tissues, promoting age-related skin diseases and skin cancer

Fundamental nature of Sun Damage

UV radiation is a known human carcinogen (i.e. cancer-causing agent). Let me expand further on UV radiation as a major causal factor of skin cancer and premature skin aging at cellular and molecular levels.

  1. UV radiation can modify DNA, intensify oxidative stress, and alter cellular antioxidant and immune defense, as well as other cellular structural or signal transduction pathways.
  2. UV-induced immune suppression contributes considerably to skin malignancies.
  3. UVB can directly cause specific DNA damage, when left unrepaired, it leads to mutations, consequently predisposing individuals to any cancer.

Importantly, bear in mind that UV exposure in children under age 10 has been linked to an increased risk of developing melanoma (malignant) and non-melanoma skin cancer later in life. Thus, childhood is a susceptible window for long-term dangerous effects of sun damage.

Sun safety with 5 Essentials – SHADE

Fortunately, skin cancer is one of the most preventable types of cancer. So, how can you protect yourself and your family? Employ this tool kit, i.e. the acronym “SHADE”.

S stands for “Sunscreen application”

A wide variety of sunscreens are available on the market but not all products are created equal. Make sure to use sunscreens that block both UVA and UVB. In addition, use a moisturizer with SPF 15 or higher on a daily basis.

H stands for “Hide away from the sun”.

Whether you stroll under the sun or enjoy outdoor adventures, wear sunglasses, a hat, and cover up with loose clothing. Also, make sure your sunglasses have both UVA and UVB blocking properties. 

A stands for “Avoid the sun during its most intensive time”

Staying away from the sun is especially paramount between the hours of 11 a.m. and 3 p.m., because during this window of time, the sun is at its strongest, thereby making this time the riskiest for sun damage.

D stands for “Detect early and Defense daily”.

Skin cancer can occur just about anywhere on the skin, but most often on the areas exposed to the sun, of course, also in odd places. With that in mind, look out vigilantly for moles, bumps or spots, by following the “ABCDE” guidance from WebMD, and noticing pain or fluid as a red flag too, for early detection. Schedule an annual skin cancer screening if you are among those “high risk” individuals.

In addition, antioxidants are powerful weapons to fight or “catch” free radicals generated from UV. Hence, build up your antioxidant defense by eating plenty of fresh, colorful fruits and vegetables, and more salmon.

E stands for “Educate everyone”.

To emphasize, E is for educating, not entertaining under the sun! Start with children and young adults. Regardless of gender and age, we are all exposed to the same sun. Today, the sun is getting less merciful compared to three or more decades ago due to thinning of ozone protection.

Take home message: 

Keep a balance between sun pleasure and sun damage, and hold the value of proper skin care. At the end, healthy skin in the course of life may promote better mental and emotional health. And remember “SHADE”.

 

Reference (on the table): Quan & Fisher. Gerontology. 2015; 61:427-34.

Image credit: thezonehole.com

Aging, Cancer, and Age-associated Illnesses

By Hui Xie-Zukauskas

Happy Aging_No magic pill_CPDAging is inevitable. Aging is a complex process through a progressive loss of physiological integrity, which has a negative impact on various body systems and their functions. Aging is also a major risk factor for cancer.

As you age, accumulated damage to the cells put an increased burden on your immune response. Chronically stimulated inflammation, along with genetic, lifestyle and environmental risk factors, all intensify in your body and speed up the deleterious process. 

How well we age depends on many factors, including what we eat, how physically active we are, and how often and how long we are exposed to health risks such as smoking, over-consumption of alcohol, or harmful, toxic chemicals/substances.

In a parallel way, cancer is a disease of aging. Cancer is multifaceted and each one varies; but all cancers develop over time.

Interactions between aging and cancer occur at cellular, molecular, biological and physical levels via various intricate pathways. Along with “degenerative dysfunctions”, an initial cellular change becomes cumulative and collaborative to facilitate the accumulation of more or further alterations, thereby contributing to an exponential increase in age-associated cancer. Thus, cancer is a common health challenge among aging and especially elderly people. What could make this process worse are conditions like obesity and diabetes.

The good news: Cancer and other age-associated chronic diseases such as heart disease, stroke, and diabetes are mostly preventable! Prevention can be enhanced by lifestyle modifications, which is documented by both Western medicine and Traditional Chinese Medicine.

Traditional Chinese Medicine emphasizes human vitality. One principle in regard to aging is that Qi—your life energy—is crucial to longevity. Longevity is not about mere length of life. It is also about quality of life, i.e. living a life without suffering pain, distress, and diseases. Injury, physical suffering, and lack of proper nutrition cause Qi deficiency. Qi can be increased or decreased, replenished or drained, and balanced Qi promotes blood circulation, reduces inflammation, and regulates hormones. 

Here are some key strategies that keep your vital Qi protected and replenished:

  1. Maintain a healthy weight and avoid abdominal obesity. Excessive calorie intake and a sedentary lifestyle cause abdominal obesity.
  2. Have a diet rich in nutrients and antioxidants, such as fruits, vegetables, fish, beans, whole grains, nuts, and seeds.
  3. Avoid or limit high-fat, high-sugar foodstuffs and excessive salt intake from packaged or processed foods.
  4. Participate in physical activities regularly, age actively.
  5. Watch your numbers (cholesterol, blood pressure, blood sugar, etc), keep your blood pressure normal, and schedule routine cancer screenings.
  6. Remember to get a good night’s sleep.
  7. Practice gratitude. Gratitude is a secret to happiness, so keep counting your blessings.
  8. Love your age and love more. In addition to the love you show to your family, there are many ways to show your love, such as pursuing your passion, giving to your community, and caring and helping others. 

Let’s face it. You cannot help aging, but you don’t have to get “old”. Hopefully, at the end, you will achieve one of humanity’s greatest dreams, which is to have a long, productive, and happy life in a healthy body.

So, happy aging through vibrant well-being!

Links between Obesity, Diabetes, and Colon Cancer

By Hui Xie-Zukauskas

Links 3 conditions_CPDColorectal cancer remains the 3rd most common cancer and is the 2nd leading cause of cancer-related deaths in the United States.

The causes of colon cancer are multi-factorial. They include cellular, molecular, and genetic factors, as well as dietary and lifestyle factors. Today, I’m going to focus on one significant yet modifiable risk factor, obesity.

We start with a glimpse at the numbers.

The incidence rate of obesity is alarmingly high among U.S. adults based on CDC data. Rates for different age groups include middle-aged (40.2%), older (37.0%), and younger (32.3%). Also, about 17% of children and adolescents (age 2-19) are obese.

More than 29 million adults and children in the U.S. have diabetes. 86 million Americans have pre-diabetes, a condition that can lead to type-2 diabetes. Note that an estimated one in two seniors has pre-diabetes.

Obesity may be a factor in approximately 300,000 deaths each year. Diabetes will cause an estimated 75,578 deaths and colorectal cancer, an expected 49,190 deaths in 2016.

A look beyond the numbers

Obesity is a leading cause of diabetes, a disease for which the body fails to control blood sugar levels. High blood sugar levels are characteristic of both obesity and diabetes. What is less well known is that diabetes and obesity are also linked to an increase in cancer risk.

In fact, obesity is linked to many types of cancer (colon, esophageal, thyroid, breast, prostate, uterine, kidney, pancreas, gallbladder and non-Hodgkins lymphoma) and, needless to say, heart disease, stroke, and other chronic illnesses.

Research shows that obesity and diabetes are associated with an increased risk of developing colon cancer.

Intrinsic links between obesity, diabetes, and colon cancer are vastly complicated. One clear tie is sugar. High levels of blood sugar are a characteristic in both obesity and diabetes. High blood sugar also makes us predisposed to cancer by increasing the activity of a gene involved in cancer progression. Apparently, dietary sugar is a link tying together obesity, diabetes, and colon cancer, and thus excess sugar has an impact on our risk for cancer.

Certainly, other links play a causal role. For instance, chronic inflammation is a central process that likely leads obese individuals to an elevated risk of diabetes and colon cancer, which all three conditions share a common inflammatory loop participated by multiple cell signaling molecules, growth and nuclear factors.

Highlighted Call for Actions

1. Colon Cancer screening

If you or your loved ones turn 50, you all should begin screening for colorectal cancer and then continue getting screened at regular intervals. This is because colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Colorectal polyps can be found by screening and then removed before they develop into cancers. Plus, any developing cancer can be found earlier by screening when treatment works best.

2. Diabetes Control

Early intervention is critical to preventing or delaying the onset of type-2 diabetes. Good news for our nation’s seniors is that Medicare will extend coverage for pre-diabetes care. Check out the National Diabetes Prevention Program, a preventive health initiative via the Center for Medicare & Medicaid Innovation.

3. Healthy Weight Management

Nutrition and balance diet, weight loss, daily physical activity and healthy lifestyle are all beneficial for keeping weight down. Look for further details in CancerPreventionDaily earlier posts.

In brief, obese people are at a higher risk for developing cancer. Also, an obese condition is often resistant to chemotherapy regimens. The bottom line is that obesity prevention is a key life-saving approach.

 

Image source: CancerPreventionDaily