CancerScope

We can help only 1 in 5 people who call. … People will make sacrifices in their health care to help their families. —Terry Music The faltering economy affects everyone, but it's especially hard on cancer patient—particularly those who have low incomes or are uninsured. Just ask Harold Freeman, MD, who observes patients struggling with these problems on a daily basis. Dr. Freeman, a leading authority on inter-relations among race, poverty, and cancer, is president and founder of the Ralph Lauren Center for Cancer Care and Prevention in East Harlem, New York. “Increasing numbers of people are losing their jobs, or they have jobs with basic health plans that get tested when they're diagnosed with cancer and need expensive treatments like chemotherapy and radiation,” Dr. Freeman says. “It's a devastating and worsening crisis in America right now—the worst I've seen since I've been in practice.” Dr. Freeman is chief architect of the American Cancer Society's (ACS's) initiative on cancer in the poor. He also served as chairman of the US President's Cancer Panel from 1991 to 2003. Dr. Freeman notes that 47 million Americans are uninsured, another 25 million are underinsured, and 32 million are on Medicaid. That means at least a third of the US population has a difficult time accessing the health care they need. Because of their many struggles to meet even their most basic needs, this group is less likely to be screened for certain cancers. “Everyone with cancer will get treated, but many of these patients will be diagnosed late when their disease is more advanced,” Dr. Freeman notes. “We as a society will end up paying for it.” It's clear that economic difficulties are making it harder for people to both get to and pay for their treatment, observes Terry Music, chief mission delivery officer at the ACS. Although the number of annual requests to the ACS for patient lodging and financial assistance had remained steady over the past 3 years, both types of requests increased significantly from fiscal year 2007 to 2008. Requests for financial assistance increased 18%—from approximately 35,000 to more than 41,000. Lodging requests increased 22%—from approximately 19,000 to nearly 24,000. In addition, ACS was unable to meet a total of 6209 financial, lodging, and transportation requests. (The highest number of unmet requests were for transportation—a total of 4460.) “Our ‘Road to Recovery’ volunteer driver program is based on our ability to recruit drivers at the local level,” Music says, noting that higher gas prices have affected that program. “We keep looking for ways to solve this problem.” In Florida, for example, ACS has an agreement with taxis and buses to provide free transportation to cancer treatment. In other areas, the organization purchases gas cards at a discounted rate. In addition, the organization has added a health insurance assistance service. This program is for patients for whom the system isn't working, whether it is because they've lost their jobs and don't have insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA), simply don't have insurance, or are underinsured. Those taking calls for this program have in-depth information on all 50 states' insurance assistance programs. The ACS also has an association with the Patient Advocacy Foundation, which can help with copayment of insurance deductibles. “We can help only 1 in 5 people who call,” Music says. “We hear all these stories, and it hasn't gotten any better. People will make sacrifices in their health care to help their families.” In Texas, the economy hasn't been as hard hit as it has in other regions, but some patients are still feeling the pinch, says Steve Paulson, MD, an oncologist and president of Texas Oncology Associates. The multispecialty group practice has about 280 oncologists and serves patients throughout Texas and parts of New Mexico and Oklahoma. “The biggest challenge is still financial,” Dr. Paulson says. “All the supportive issues cost more [when you] have cancer. You can't afford to run the thermostat at 85 degrees, [which is where you would like it to be] when you're not feeling well.” In addition, cancer treatments—such as daily radiation—have significantly high copayments. Dr. Paulson and his colleagues recognize these challenges and attempt to accommodate patients by extending their payment periods and by working with pharmaceutical companies that have drug replacement programs for patients who lose their insurance. The latter, however, do not pay for administrative costs, and there is generally a lag time before the drugs can be replaced. In addition, the drug companies require a social security number for all patients who seek drug replacement. “We won't send any patient away that we're providing care to,” Dr. Paulson says. “But I don't think we've seen the bottom of these problems yet. I think it will get worse before it gets better.” If a woman has a painless lump, and she perceives the system of treatment as more painful than the lump, she'll take the lump. If people in the community are helped through the system, it's a big plus. —Harold Freeman, MD Helping patients navigate the complex web of cancer care is the goal of patient navigation, a concept developed by Dr. Harold Freeman. The program is more important in today's difficult economic times than ever before, he notes. “We bring the energy of the community to bear on this problem,” Dr. Freeman says. “We select and train people from the local community who can communicate with patients and help them through the system.” First launched in 1990, patient navigation received a major boost in 2005 when the federal government allotted $75 million to help launch more than 600 programs around the country. Navigators guide patients through a variety of challenges, ranging from financial and communication issues to the complexity of a fragmented care system of radiation, chemotherapy, and surgery. They also help patients overcome fear and mistrust of the system. “If a woman has a painless lump, and she perceives the system of treatment as more painful than the lump, she'll take the lump,” Dr. Freeman says. “If people in the community are helped through the system, it's a big plus. This is a step in the right direction, even though it doesn't solve the problem of our broken health care system.” Before the program began at Harlem Hospital Center in New York (where the overwhelming majority of patients are poor and about half are uninsured), 39% of patients had a 5-year survival time from date of diagnosis. Since the program began, the number of patients surviving 5 years or more has risen to 70%, Dr. Freeman notes. He adds that the Canadian health care system has adopted patient navigation as a benefit for all citizens. New evidence suggests that regular exercise can lower a woman's overall cancer risk—if she also gets a good night's sleep. New findings in chemoprevention, genetics, lifestyle, screenings, and diet were featured during the Frontiers in Cancer Prevention Research conference, held November 2008 in Washington, DC. The seventh annual conference was sponsored by the American Association of Cancer Research (AACR). One heavily publicized announcement was the analysis of data from the Physicians Health Study II, which concluded that vitamin E did not have a significant effect on prostate cancer, the primary endpoint, or any type of cancer, the secondary endpoint. Researchers also found that vitamin C supplementation had a similar lack of effect on cancers. A final component of the Physicians Health Study II—testing of daily multivitamin supplementation—remains ongoing. “Perhaps the interaction of all the vitamins in the diet may have more of an effect,” says Howard Sesso, ScD, MPH, and assistant professor of medicine at Brigham and Women's Hospital in Boston, Massachusetts. “It may be that we've been focusing on a single piece of a much more complicated puzzle.” Dr. Sesso adds that although the door is not completely shut on vitamin E and vitamin C supplementation, researchers will have to be more careful about how they design future studies. Other findings included: Men who take aspirin have significantly lower prostatespecific antigen (PSA) levels. A large analysis of men referred to a urologist for a biopsy of their prostate showed that the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) is significantly associated with lower PSA levels, say researchers at Vanderbilt University in Nashville, Tennessee. Although these data suggest that aspirin and other NSAIDs have a beneficial effect on prostate cancer, researchers are also concerned that these medications could affect physicians' ability to detect the disease. “It would be important to understand which mechanism is in play because many men take NSAIDs for their cardiovascular health, so we need to know whether that reduces their prostate cancer risk or simply reduces PSA, which would then be even less reliable as a marker of prostate cancer risk,” says Jay Fowke, PhD, an assistant professor of medicine at Vanderbilt. Canadian researchers are attempting to learn why some former smokers develop lung cancer while others remain cancer free. The theory is that DNA methylation—an important event regulating gene expression during normal development—may be the reason. In cancer, proper patterns of DNA methylation become deregulated, throwing off the tight control of gene activity that normally exists. Researchers' results showed differences in methylation levels in lung epithelial cells between former smokers with and without lung cancer. “As methylation is a reversible DNA modification, this knowledge could prompt the development and application of chemopreventive agents and unique therapeutic strategies,” says Emily Vucic, a graduate student at the British Columbia Cancer Research Center in Vancouver, Canada. New evidence suggests that regular exercise can lower a woman's overall cancer risk—if she also gets a good night's sleep. Researchers analyzed the connection between physical activity, sleep duration, and incidence of overall, breast, and colon cancer in 5968 women at least 18 years old with no prior cancer diagnosis. Among women 65 years or younger who had the most physical activity, sleeping less than 7 hours a day increased the overall cancer risk—negating much of the protective effects of exercise, according to James McClain, PhD, cancer prevention fellow at the National Cancer Institute. The next step, he notes, is to confirm these findings and investigate possible mechanisms underlying the interaction between sleep and exercise.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.