Category Archives: Cancer Care

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.

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.

The cause of these changes can be lifestyle – such as smoking, environmental – such as exposure to toxins, and/or spontaneous – such as a result of mutations in genes or inherited genetic alterations. Furthermore, research findings show that the changes that occur in one person’s cancer may not occur in others who have the same type, and the same cancer-causing changes may be displayed in different types of cancer.

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

Key Takeaways for CMS Oncology Care Model

By Hui Xie-Zukauskas

For cancer patients, living a life with and beyond cancer faces various challenges. Consider physical illness, emotional pain, financial cost, and psychological burden, etc.

Here is good news for those who are not aware of new cancer treatment program.

To improve cancer care and reduce the cost, Center for Medicare and Medicaid Services (CMS), particularly its Innovation Center (CMMI), developed Oncology Care Model, which are participated by over 190 health care providers and some insurance companies.

OCM map_LHThis map shows the locations where oncology practice groups participate in Oncology Care Model. An interactive version that provides names of the practices or clinics is available on the CMMI site at this link.

This new five-year payment and practice reform initiative for cancer patients started July 1, 2016. Here are 5 key takeaways for cancer patients who use Medicare to receive chemotherapy:

  1. You don’t need to do anything, just seek the treatment at the practice of your choice.
  2. It’s an episode based approach – an episode starts when your chemotherapy starts, and each one lasts six months. If you need more treatment at the end of six months, start a new episode.
  3. Your Medicare payment will be either the same or lowered.
  4. Have 24/7 access to an oncologist or specialist. A patient navigator will be a consistent point person for each patent to help with patient support throughout their care.
  5. Physicians are paid by two ways or parts, but receive federal reimbursement by quality of care and performance of service they provide.

The Oncology Care Model aims at enhancing patient experience, by providing comprehensive care planning, shared decision-making, regular assessments for pain, distress and quality of life, and palliative care consultation, just to name a few among many other benefits.

Overall, CMS hope to achieve better health outcomes for Medicare beneficiaries not only through better coordinated, high-quality care with electronic health records sharing between practices, but also by shifting the provider’s compensation from quantity of services to quality of outcomes.

 

Image credit: Lukas Halim

22 Proactive Things You Can Do on World Cancer Day and Beyond

By Hui Xie-Zukauskas

Mid_Blue Globe Bkg. Red Ribbon for WCDFebruary 4th each year is designated as World Cancer Day. This day is significant because it

  • kicks off a drive to expand awareness of cancer and its prevention;
  • offers a chance to discover risk factors for cancer and take protective measures;
  • provides a time to reflect on what you can do to make a difference in the fight against cancer;
  • embraces people around the globe to fulfill whatever needs to be done to control this deadly disease; and
  • presents an opportunity to spread a message – We Can Save Millions of People from Preventable Deaths Each Year!

Lifestyle-centered cancer prevention is evidence-based and it’s science. It’s no longer a theory or hypothesis, or breaking news. Healthy lifestyle measures provide powerful ways to lower the risk for many types of cancer.

The theme of World Cancer Day for the current three years (2016-2018) is “We Can. I Can.” Surely, each of us can do something, no matter how small. So, I have compiled a list of actions you can take for World Cancer Day and every day after:

  1. Set a “Cancer Patients First” agenda: Whether from a note, gift, prayer, or—best of all—a visit, let your friend battling cancer know you are with him or her in this fight.
  2. Pack a tool kit for cancer awareness or a thoughtful kit for cancer care.
  3. Remind your loved one to get a cancer screening. Early detection saves lives.
  4. Change one unhealthy behavior, e.g., harmful sun exposure, intentional tanning, alcohol abuse, or tobacco smoking (smokeless tobacco causes cancer too). Importantly, stay on the right course.
  5. Do something about early childhood weight management, especially control obesity in childhood cancer survivors.  Unhealthy behaviors and overweight that develop early in life and persist over time can increase not only the risk for some types of cancer but also cancer-related mortality.
  6. Host a Veggies/Vegetarian party or gathering (the size doesn’t matter).  Alternatively, go on a Mediterranean diet. The point is to replace Western diet components, which are rich in refined grains, animal fats, excessive sugar, and processed meat but poor in fruits, vegetables, legumes, and whole wheat or whole grains. A substantial body of evidence has linked the Mediterranean diet to increased cardiovascular benefits and prevention of some chronic diseases.
  7. Make a “Cancer Prevention” family dinner, or make a “Cancer Prevention Salad.”  Family meals can be a cost-effective intervention for weight management. Evidence suggests that regular family meals protect against unhealthy eating and obesity in children. If time or schedule is challenging, get your teens and/or other family members involved.
  8. Start or improve your weight management plan and actions. Make sure to have a balanced diet and exercise regime.
  9. Enjoy an “Exercise Day” or “Move Day,” and at least, consider taking a 30-minute walk.
  10. Take a “NO JUNK FOOD Day,” and limit red meats. Then do it often.
  11. Drink filtered tap water at home. Drink plenty of filtered water away from home too.
  12. Drink tea to replace sugar-rich beverages.
  13. Better: Have a “Triple Combat” day, by combining three intensive but joyful actions together.
  14. Give your unexplained pain some TLC by paying attention to it, tracking its duration, frequency or pattern, and scheduling a visit to your doctor.
  15. Give cancer caregivers a token of love to honor their labor of love.
  16. Write or speak to your local/national legislator or lawmaker about a policy idea to make food systems safer or make the environment safer.
  17. Speak out or stand up against any external source that potentially promotes cancer.
  18. Volunteer for a cancer fundraising or a cancer care center.
  19. Support the great cause of fighting cancer in any form you can.
  20. Parents and teachers: Advise your girls and boys to vaccinate against HPV. Recommended vaccination starts at age 11 or 12.
  21. Go along with proven strategies to prevent cardiovascular disease (CVD). Why?  Because doing whatever is practical or plausible to lower your risk of CVD will enhance your potential to reduce the risk of cancer. For instance, research findings indicate that proven preventive measures for CVD are identical to preventive actions for prostate cancer.
  22. Take pancreatic cancer seriously. Based on the proposed “pancreatic injury−inflammation−cancer” pathway, it’s critical to avoid risk factors such as smoking, chronic pancreatitis, diabetes, and obesity.   Pancreatic cancer remains a complex, lethal malignancy with the worst prognosis, and a lack of early diagnostic symptoms. It’s also resistant to conventional chemo- and radiation therapies. The rate of its incidence is slowly increasing.

The list can go on and on…

By now, you likely see a clearly centered theme—prevention, which is the most cost-effective implement to fight cancer.

Remember: Cancer doesn’t develop overnight. It’s vitally essential to stick to a healthy lifestyle. Take protective measures such as enjoying a balanced diet, regular physical activity, and a healthy weight now and far beyond World Cancer Day.

And yes, every single small step counts! It’s a life-course approach.

 

Image credit: Designer at <a href=”http://www.freepik.com/free-photos-vectors/medical”>Medical vector designed by Ibrandify – Freepik.com</a>

A Year End Note: Let Bundle of Love and Ray of Hope Continue

By Hui Xie-Zukauskas

A Year End NoteAs we approach the New Year, thank you for your time, reading, likes, comments and feedback in this past year!

I reach out to you because many of you are healthy but fearful of getting cancer, some folks survive cancer, while some are struggling with cancer or other chronic illnesses now.

At the beginning of 2016, one New Year’s resolution from CancerPreventionDaily.com was to bring a theme of love and hope for cancer prevention and care. Throughout the year, the site delivered this theme by serving you with knowledge and solutions for cancer prevention. Here are highlighted areas of the posts:

  • Steered self-care and preventive measures in the ways that foster your well-being from the cells to the whole body and lifestyle choices, from kids to seniors and all ages.
  • Updated serious epidemic and environmental factors.
  • Facilitated clinical care, primarily patient safety and engagement.

Many cancers are preventable; and there are so many things we can do to prevent cancer. Start within.

Let bundle of love and ray of hope carry on in 2017 and future!

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/