Who gets oral cancer and what are the risk factors for oral cancer?
According to the American Cancer Society, men face twice the risk of developing oral cancer as women, and men who are over age 50 face the greatest risk. The rate of development of cancer of the oral cavity and pharynx began to decline in the late 1970s and has continued to decline throughout the 1990s in both African Americans, and white males and females.
Risk factors for the development of oral cancer include:
Cigarette, cigar, or pipe smoking — Smokers are six times more likely than non-smokers to develop oral cancers.
Use of smokeless tobacco products (for example, dip, snuff, or chewing tobacco) — Use of these products increase the risk of cancers of the cheek, gums, and lining of the lips.
Excessive consumption of alcohol — Oral cancers are about six times more common in drinkers than in non-drinkers.
Family history of cancer
Excessive exposure to the sun — especially at a young age
It is important to note that more than 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.
Other Oral Cancer Facts
Oral cancer is the sixth most common cancer among men.
About 75% to 80% of people with oral cavity and pharynx cancer consume alcohol.
People who smoke and drink alcohol have an even higher risk of cancer than those who only drink or only use tobacco products.
The risk of developing oral cavity and pharynx cancers increases both with the amount as well as the length of time tobacco and alcohol products are used.
Survival:
The overall 1-year survival rate for patients with all stages of oral cavity and pharynx cancers is 81%. The 5 & 10-year survival rates are 56% and 41%, respectively.
Saturday, September 20, 2008
Wednesday, September 17, 2008
Tuesday, September 16, 2008
Our Vision
Welcome to the Together Society. Our mission is to eliminate cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from this disease. Would you like to be part of our work? We’d love to have you join us.
Many opportunities await!
With so many different ways to be part of our mission, you’re sure to find one that’s just right for you. We offer satisfying careers for people ready to bring their talent and skills to the fight against cancer. We also offer critically important volunteer opportunities that empower all kinds of people to share their unique gifts to help drive our mission forward.
No matter how you choose to join our team, you’ll experience the joy of working among people who are passionate about our cause. Everyone who works with the Together Society has a role in saving lives, and that means everyone has a chance to experience the fulfillment of making a difference. You, too, can make a difference – and an important personal commitment to the people in your community and around the world who courageously fight cancer everyday.
When you’re ready to explore your options, please mail us at together.ekprayaas@gmail.com about career and volunteer opportunities. To knowabout specific opportunities that are available right now, please mail us.
Sunday, September 14, 2008
Know Oral Cancer
Oral Cancer
Cancer is defined as the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Oral cancer appears as a growth or sore in the mouth that does not go away. Oral cancer, which includes cancers of the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat), can be life threatening if not diagnosed and treated early.
What Are the Symptoms of Oral Cancer?
The most common signs of oral cancer include:
Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums or other areas inside the mouth.
The development of velvety white, red, or speckled (white and red) patches in the mouth.
Unexplained bleeding in the mouth.
Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck.
Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks.
A soreness or feeling that something is caught in the back of the throat.
Difficulty chewing or swallowing, speaking, or moving the jaw or tongue.
Hoarseness, chronic sore throat, or change in voice.
Ear pain.
A change in the way your teeth or dentures fit together.
Dramatic weight loss.
If you notice any of these changes, contact your dentist or health care professional immediately for a professional examination.
Who Gets Oral Cancer?
According to the American Cancer Society, men face twice the risk of developing oral cancer as women, and men who are over age 50 face the greatest risk. In fact, oral cancer is the sixth most common cancer among men.
Risk factors for the development of oral cancer include:
Smoking. Cigarette, cigar, or pipe smokers are six times more likely than nonsmokers to develop oral cancers.
Smokeless tobacco users. Users of dip, snuff, or chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums and lining of the lips.
Excessive consumption of alcohol. Oral cancers are about six times more common in drinkers than in nondrinkers.
Family history of cancer.
Excessive sun exposure, especially at a young age.
It is important to note that over 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.
What Is the Outlook for People With Oral Cancer?
The overall 1-year survival rate for patients with all stages of oral cavity and pharynx cancers is 81%. The 5- and 10-year survival rates are 56% and 41%, respectively.
How Is Oral Cancer Diagnosed?
As part of your routine dental examination, your dentist will conduct an oral cancer screening exam. More specifically, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue as well as check for any signs and symptoms mentioned above.
Your dentist may perform an oral brush biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue and analyzing it for abnormal cells. Alternatively, if the tissue looks more suspicious, your dentist may recommend a scalpel biopsy. This procedure usually requires local anesthesia and may be performed by your dentist or a specialist. These tests are necessary to detect oral cancer early, before it has had a chance to progress and spread
Cancer is defined as the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Oral cancer appears as a growth or sore in the mouth that does not go away. Oral cancer, which includes cancers of the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat), can be life threatening if not diagnosed and treated early.
What Are the Symptoms of Oral Cancer?
The most common signs of oral cancer include:
Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums or other areas inside the mouth.
The development of velvety white, red, or speckled (white and red) patches in the mouth.
Unexplained bleeding in the mouth.
Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck.
Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks.
A soreness or feeling that something is caught in the back of the throat.
Difficulty chewing or swallowing, speaking, or moving the jaw or tongue.
Hoarseness, chronic sore throat, or change in voice.
Ear pain.
A change in the way your teeth or dentures fit together.
Dramatic weight loss.
If you notice any of these changes, contact your dentist or health care professional immediately for a professional examination.
Who Gets Oral Cancer?
According to the American Cancer Society, men face twice the risk of developing oral cancer as women, and men who are over age 50 face the greatest risk. In fact, oral cancer is the sixth most common cancer among men.
Risk factors for the development of oral cancer include:
Smoking. Cigarette, cigar, or pipe smokers are six times more likely than nonsmokers to develop oral cancers.
Smokeless tobacco users. Users of dip, snuff, or chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums and lining of the lips.
Excessive consumption of alcohol. Oral cancers are about six times more common in drinkers than in nondrinkers.
Family history of cancer.
Excessive sun exposure, especially at a young age.
It is important to note that over 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.
What Is the Outlook for People With Oral Cancer?
The overall 1-year survival rate for patients with all stages of oral cavity and pharynx cancers is 81%. The 5- and 10-year survival rates are 56% and 41%, respectively.
How Is Oral Cancer Diagnosed?
As part of your routine dental examination, your dentist will conduct an oral cancer screening exam. More specifically, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue as well as check for any signs and symptoms mentioned above.
Your dentist may perform an oral brush biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue and analyzing it for abnormal cells. Alternatively, if the tissue looks more suspicious, your dentist may recommend a scalpel biopsy. This procedure usually requires local anesthesia and may be performed by your dentist or a specialist. These tests are necessary to detect oral cancer early, before it has had a chance to progress and spread
Tuesday, September 9, 2008
What is oral cancer?
Cancer is defined as the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Oral cancer appears as a growth or sore that does not go away. Oral cancer — which includes cancers of the lips, tongue, cheek, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat) — can be life-threatening if not diagnosed and treated early.
What are the signs and symptoms of oral cancer?
The following are the common signs and symptoms:
Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
The development of velvety white, red, or speckled (white and red) patches in the mouth
Unexplained bleeding in the mouth
Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
Persistent sores on the face, neck, or mouth that bleed easily and do not heal within two weeks
A soreness or feeling that something is caught in the back of the throat
Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
Hoarseness, chronic sore throat, or changes in the voice
Ear pain
A change in the way your teeth or dentures fit together – a change in your "bite"
Dramatic weight loss
If you notice any of these changes, contact your dentist immediately for a professional examination
What are the signs and symptoms of oral cancer?
The following are the common signs and symptoms:
Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
The development of velvety white, red, or speckled (white and red) patches in the mouth
Unexplained bleeding in the mouth
Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
Persistent sores on the face, neck, or mouth that bleed easily and do not heal within two weeks
A soreness or feeling that something is caught in the back of the throat
Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
Hoarseness, chronic sore throat, or changes in the voice
Ear pain
A change in the way your teeth or dentures fit together – a change in your "bite"
Dramatic weight loss
If you notice any of these changes, contact your dentist immediately for a professional examination
Monday, September 8, 2008
Recommendations for Cancer Prevention
These ten recommendations for cancer prevention are drawn from the WCRF/AICR Second Expert Report.
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and foods processed with salt (sodium).
8. Don't use supplements to protect against cancer.
Special Population Recommendations
9. It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods.
10. After treatment, cancer survivors should follow the recommendations for cancer prevention.
And always remember – do not smoke or chew tobacco.
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and foods processed with salt (sodium).
8. Don't use supplements to protect against cancer.
Special Population Recommendations
9. It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods.
10. After treatment, cancer survivors should follow the recommendations for cancer prevention.
And always remember – do not smoke or chew tobacco.
Saturday, September 6, 2008
How to avoid cancer
It's the third biggest cause of death in India. And while death rates are coming down for some cancers, cancers are difficult to treat unless they're caught in the early stages. This is because by and large, we're still using surgery as the main treatment approach and when the cancer spreads, surgery is much less effective.
But a lot of cancer is preventable, according to a panel of experts who've reviewed the available scientific evidence about cancer, diet and exercise, and come up with some guidelines as to how we can lower cancer rates.
Over five years, scientists working for the World Cancer Research Fund (WCRF) from nine universities in four countries looked at the available research and published their findings in a report called Food, Nutrition, Physical Activity, and the Prevention of Cancer. There's a summary of it and an editorial in last month's British Medical Journal by a professor of cancer research at Oxford University. But if you don't have time to read that, or the report itself, here follows a summary.
What emerges is that for all our progress in medical science and technology, we still don't know much about cancer. We know how it happens – a genetic mutation in a cell's DNA causes it to reproduce out of control. But why it happens, and why some organs in some people and not others, is largely a mystery.
We do know that our lifestyle has a lot to do with whether this happens and in whom – very few cancers are actually inherited. So modifying our lifestyle will reduce our chances of cancer by up to a third.
First, we need to do something about obesity – it's a major cause of cancers of the oesophagus, colon and rectum, pancreas, breast, endometrium, and kidneys. Our body mass index should ideally lie between 21 and 23. So we need to shed those kilos with exercise and caloric restriction – a weight loss diet.
Secondly, exercise. Quite apart from helping to lose weight, being fit seems to have an anti-cancer effect in itself. The researchers recommend 30 minutes of moderate physical exercise – like brisk walking – a day, and once we're fit, then 30 minutes of vigorous physical activity or 60 minutes of moderate exercise a day.
Next, our dietary intake. We need to be careful about how much alcohol we drink – it increases the risk for cancers of the mouth, pharynx, larynx, oesophagus, colon and rectum, and breast; and also causes cirrhosis, which raises the risk of liver cancer. Men shouldn't drink more than two standard drinks of alcohol a day and women no more than one a day.
What about fruit and vegetables? They probably protect against several cancers, though it's hard to say just which ones or why fruit and vegetables are protective. We should eat at least five portions of vegetables and fruits each day, the researchers say. The Indian dietary recommendations suggest five serves of vegetables and two serves of fruit each day. Most people eat only about three portions a day.
Probably the most surprising finding was that red meat and processed meat were convincingly linked to colorectal cancer. On average, if you eat large amounts of red or processed meat you have about a 30 per cent increased risk of colorectal cancer compared with someone who eats little or none. And the more meat you eat, the greater the risk. On average you shouldn't eat more than 300 grams of red meat a week.
But a lot of cancer is preventable, according to a panel of experts who've reviewed the available scientific evidence about cancer, diet and exercise, and come up with some guidelines as to how we can lower cancer rates.
Over five years, scientists working for the World Cancer Research Fund (WCRF) from nine universities in four countries looked at the available research and published their findings in a report called Food, Nutrition, Physical Activity, and the Prevention of Cancer. There's a summary of it and an editorial in last month's British Medical Journal by a professor of cancer research at Oxford University. But if you don't have time to read that, or the report itself, here follows a summary.
What emerges is that for all our progress in medical science and technology, we still don't know much about cancer. We know how it happens – a genetic mutation in a cell's DNA causes it to reproduce out of control. But why it happens, and why some organs in some people and not others, is largely a mystery.
We do know that our lifestyle has a lot to do with whether this happens and in whom – very few cancers are actually inherited. So modifying our lifestyle will reduce our chances of cancer by up to a third.
First, we need to do something about obesity – it's a major cause of cancers of the oesophagus, colon and rectum, pancreas, breast, endometrium, and kidneys. Our body mass index should ideally lie between 21 and 23. So we need to shed those kilos with exercise and caloric restriction – a weight loss diet.
Secondly, exercise. Quite apart from helping to lose weight, being fit seems to have an anti-cancer effect in itself. The researchers recommend 30 minutes of moderate physical exercise – like brisk walking – a day, and once we're fit, then 30 minutes of vigorous physical activity or 60 minutes of moderate exercise a day.
Next, our dietary intake. We need to be careful about how much alcohol we drink – it increases the risk for cancers of the mouth, pharynx, larynx, oesophagus, colon and rectum, and breast; and also causes cirrhosis, which raises the risk of liver cancer. Men shouldn't drink more than two standard drinks of alcohol a day and women no more than one a day.
What about fruit and vegetables? They probably protect against several cancers, though it's hard to say just which ones or why fruit and vegetables are protective. We should eat at least five portions of vegetables and fruits each day, the researchers say. The Indian dietary recommendations suggest five serves of vegetables and two serves of fruit each day. Most people eat only about three portions a day.
Probably the most surprising finding was that red meat and processed meat were convincingly linked to colorectal cancer. On average, if you eat large amounts of red or processed meat you have about a 30 per cent increased risk of colorectal cancer compared with someone who eats little or none. And the more meat you eat, the greater the risk. On average you shouldn't eat more than 300 grams of red meat a week.
So we need to eat less, and instead eat mostly foods of plant origin. (Cutting down meat intake is also good for the environment – meat production uses large amounts of agricultural land and water, the researchers say.) On the other hand, meat is a terrific source of protein, as the meat industry never tires of reminding us, so there is a role for meat in the diet, but it should be limited.
Legumes such as beans, lentils and soybeans, which contain protein, are good substitutes. Cut out processed and preserved meats such as bacon, sausages, pate and salami as much as possible. The sulfites and other additives may cause colorectal cancer.
Foods high in folate may reduce the risk of cancer of the pancreas, and diets high in calcium may reduce the risk of bowel cancer, say the researchers. Other recommendations include:
limit consumption of salt
don't take vitamin supplements – you don't need them and some have been linked to cancer
mothers should breastfeed babies for the first six months: breastfeeding protects women against breast and other cancers.
Getting people to adopt all of the lifestyle measures won't be easy, the researchers conceded. But do what you can. It beats palliative care.
Legumes such as beans, lentils and soybeans, which contain protein, are good substitutes. Cut out processed and preserved meats such as bacon, sausages, pate and salami as much as possible. The sulfites and other additives may cause colorectal cancer.
Foods high in folate may reduce the risk of cancer of the pancreas, and diets high in calcium may reduce the risk of bowel cancer, say the researchers. Other recommendations include:
limit consumption of salt
don't take vitamin supplements – you don't need them and some have been linked to cancer
mothers should breastfeed babies for the first six months: breastfeeding protects women against breast and other cancers.
Getting people to adopt all of the lifestyle measures won't be easy, the researchers conceded. But do what you can. It beats palliative care.
Wednesday, September 3, 2008
Detail Guide for Cancer
What Is Cancer?
Cancer is the general name for a group ofmore than 100 diseases in which cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because abnormal cells grow out of control. Untreated cancers can cause serious illness and even death.
How a normal cell becomes cancer ?
Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more quickly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries.
Cancer cells develop because of damage to DNA. This substance is in every cell and directs all of the cell's activities. Most of the time when DNA becomes damaged, either the cell dies or is able to repair the DNA. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person’s DNA gets damaged by things in the environment, like,chemicals, viruses, tobacco smoke or too much sunlight.
How cancers differ ?
Cancers can begin in many different parts of the body. But, different types of cancer can act very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That's why people with cancer need treatment that is aimed at their particular kind of cancer.
How cancer spreads (metastasis) ?
Because cancer cells keep growing and dividing, they are different from normal cells. Instead of dying, they outlive normal cells and continue to grow and make new abnormal cells.
Cancer usually forms as a tumor (a lump or mass.) Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs, and circulate through other tissues where they grow.
Cancer cells often travel through the bloodstream or through the lymph system to other parts of the body where they begin to grow and replace normal tissue. This spreading process is called metastasis.
Even when cancer has spread to a different part of the body it is still named for the place in the body where it started. For example, breast cancer that has spread to the liver is metastatic breast cancer, not liver cancer. Prostate cancer that has spread to the bone is called metastatic prostate cancer, not bone cancer.
Remember that not all tumors are cancerous. Benign (non-cancerous) tumors do not spread to other parts of the body (metastasize) and are very rarely life-threatening.
How common is cancer?
Half of all men and one-third of all women in the US will develop cancer during their lifetimes. Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking, limiting time in the sun, being physically active, and eating a better diet. The sooner a cancer is found and treated, the better the chances are for living for many years.
*(Reference from Amerrican cancer Society)
Awareness and Early Cancer Detection
All too often, when the doctor utters the word "cancer", what the patient hears is "you are dying". The fact is it need not be so. Cancer is a dreaded disease, but the fear often arises out of ignorance and misconceptions, rather than any reality. Through its work at grass-root level, it came to realize that one of the main problems in India, in the control of cancer was lack of knowledge about lifestyles and societal practices that caused 70 per cent of its occurrence. With the highest incidence of cancers in the head and neck regions for men and cervix and breast for women, Our NGO woke up to the realization that many of these cancers were preventable and curable had they been caught at an early stage.
A New Approach for Treating Depression in Cancer Patients
(University of Edinburgh researchers have developed a new approach for treating depression in cancer patients, and results from the program's first trial were very encouraging. The program, which is given by specially-trained cancer nurses, is designed to work alongside a patient's usual cancer care. It emphasizes screening for depression, antidepressant medication, and teaching patients problem-solving skills.)
An Integrated Approach
The researchers screened patients for symptoms of depression who were being treated for breast, colorectal, gynecological, blood, lung, and other cancers at southeast Scotland-based clinics. Patients first completed a questionnaire, and those with high depression and anxiety scores were then interviewed by telephone.
Two hundred cancer patients participated in the trial. All of the patients were expected to live at least 6 months. The mean age was 56.6, and 141 (71%) were women. Eighty seven of the patients had breast cancer, 31 had gynecological cancer, and 13 had colorectal cancer. Sixty-nine of the participants had other cancer types, including prostate, blood, testicular, urinary tract, lung, skin cancer, and sarcoma.
Sharpe and his colleagues randomly assigned 99 of the participants to receive usual care and 101 to receive usual care and the depression program. Over a 3-month period, the latter participants had up to 10 45-minute sessions with the nurses.
The nurses were specifically trained in depression management and supervised by psychiatrists, but were not required to have formal academic training in psychiatric nursing. The heart of the program was a 76-page manual called Depression Care of People with Cancer authored by Sharpe and his colleagues. It covered topics like taking antidepressants appropriately, being active, and learning to cope with problems better.
At 3 months, scores for depression fell in both groups, though by a significantly greater amount in the group working with the nurses. The numbers held at 6- and 12-months. In both groups, there was a significant increase in antidepressant use. Patients in the intervention group reported less anxiety and fatigue at both 3 and 6 months compared to those receiving usual care only.
"Our results were encouraging, surprisingly long-lasting, and the costs were relatively modest," says lead researcher Sharpe. "This shows that treating depression can work well when it's part and parcel of a patient's cancer care. However, there's more work that needs to be done to show that this approach can work in practice before we can recommend implementation of this model on a large scale; we are doing that work now.”
Costs of Care
Treating depression this way does come with a price tag, however. It requires additional nursing positions and hiring nurses with advanced education. It also means higher costs for patients who may need to pay for prescription drugs.
The average cost of the intervention including nurse time and psychiatrist supervision, as well as higher costs for health care and antidepressant drug usage, was $670 per patient. Sharpe and colleagues did not include the cost of nurse training or the cost of screening the patients in this number. They're working on a detailed cost-analysis in a second trial.
"This is a good use of oncology nurses' qualifications," said Marcia Grant, RN, DNSc, FAAN, Professor and Director of the Department of Nursing Research and Education, Co-Director of the Program for Cancer Control and Population Science of the Cancer Center at the City of Hope Comprehensive Cancer Center. Grant, who was not involved in the research, felt that similar programs could be implemented in the United States -- "It's really what's needed for advancing the psychological well-being of cancer patients."
Additional research currently underway will also try this approach in patients with other cancer types. Sharpe is also planning a series of clinical trials that use a similar approach to simultaneously address pain and other symptoms.
An Integrated Approach
The researchers screened patients for symptoms of depression who were being treated for breast, colorectal, gynecological, blood, lung, and other cancers at southeast Scotland-based clinics. Patients first completed a questionnaire, and those with high depression and anxiety scores were then interviewed by telephone.
Two hundred cancer patients participated in the trial. All of the patients were expected to live at least 6 months. The mean age was 56.6, and 141 (71%) were women. Eighty seven of the patients had breast cancer, 31 had gynecological cancer, and 13 had colorectal cancer. Sixty-nine of the participants had other cancer types, including prostate, blood, testicular, urinary tract, lung, skin cancer, and sarcoma.
Sharpe and his colleagues randomly assigned 99 of the participants to receive usual care and 101 to receive usual care and the depression program. Over a 3-month period, the latter participants had up to 10 45-minute sessions with the nurses.
The nurses were specifically trained in depression management and supervised by psychiatrists, but were not required to have formal academic training in psychiatric nursing. The heart of the program was a 76-page manual called Depression Care of People with Cancer authored by Sharpe and his colleagues. It covered topics like taking antidepressants appropriately, being active, and learning to cope with problems better.
At 3 months, scores for depression fell in both groups, though by a significantly greater amount in the group working with the nurses. The numbers held at 6- and 12-months. In both groups, there was a significant increase in antidepressant use. Patients in the intervention group reported less anxiety and fatigue at both 3 and 6 months compared to those receiving usual care only.
"Our results were encouraging, surprisingly long-lasting, and the costs were relatively modest," says lead researcher Sharpe. "This shows that treating depression can work well when it's part and parcel of a patient's cancer care. However, there's more work that needs to be done to show that this approach can work in practice before we can recommend implementation of this model on a large scale; we are doing that work now.”
Costs of Care
Treating depression this way does come with a price tag, however. It requires additional nursing positions and hiring nurses with advanced education. It also means higher costs for patients who may need to pay for prescription drugs.
The average cost of the intervention including nurse time and psychiatrist supervision, as well as higher costs for health care and antidepressant drug usage, was $670 per patient. Sharpe and colleagues did not include the cost of nurse training or the cost of screening the patients in this number. They're working on a detailed cost-analysis in a second trial.
"This is a good use of oncology nurses' qualifications," said Marcia Grant, RN, DNSc, FAAN, Professor and Director of the Department of Nursing Research and Education, Co-Director of the Program for Cancer Control and Population Science of the Cancer Center at the City of Hope Comprehensive Cancer Center. Grant, who was not involved in the research, felt that similar programs could be implemented in the United States -- "It's really what's needed for advancing the psychological well-being of cancer patients."
Additional research currently underway will also try this approach in patients with other cancer types. Sharpe is also planning a series of clinical trials that use a similar approach to simultaneously address pain and other symptoms.
Subscribe to:
Posts (Atom)