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Keeping Cancer Survivors Healthy

Keeping Cancer Survivors Healthy

For more than 15 years, the “Eight Ways to Stay Healthy and Prevent Cancer” message campaign has provided an evidence-based, user-friendly approach to cancer prevention. Graham A. Colditz, MD, DrPH, and colleagues developed a parallel set of recommendations to help care for cancer survivors. The new recommendations, “Cancer Survivors’ Eight Ways to Stay Healthy After Cancer,” were published in Cancer Causes & Control. Eight Key Strategies Dr. Colditz recommends that providers remind cancer survivors that it is important, particularly toward the end of treatment, to revisit how they can pursue healthier lifestyle behaviors to improve their survival. The following actions are recommended: 1. Do not smoke: Patients with smoking-related cancer who quit the habit survive longer than those who keep smoking. For patients with cancers that are not smoking-related, the benefit from quitting smoking will translate through lower risk of heart disease, stroke, or even a second cancer. 2. Avoid secondhand smoke: Beyond its general health risk, “some patients may be particularly susceptible to the effects of secondhand smoke due to their treatment,” says Dr. Colditz. 3. Exercise regularly: There is concrete evidence for some specific cancers that the higher the level of physical activity after a cancer diagnosis, the better the cancer-specific survival. It also cuts the risk for heart disease and other chronic conditions. 4. Maintain a healthy weight: Gaining weight after cancer increases the risk of cancer recurrence and other chronic diseases, says Dr. Colditz. 5. Eat a healthy diet: Healthy eating for cancer survivors should be the same as for the general population. The focus should be on fruits, vegetables, whole grains, and healthy fats....
Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

In 2005, the American Society of Clinical Oncology (ASCO) first published evidence-based clinical practice guidelines for using sentinel node biopsy (SNB) in patients with early-stage breast cancer. In 2014, these guidelines were updated and published in the Journal of Clinical Oncology. “Since publication of the original guidelines, several new randomized trial results and additional cohort studies have become available,” says Gary H. Lyman, MD, MPH, who co-chaired the ASCO expert panels for both versions of the guidelines. “We now have more evidence from clinical trials supporting the use of SNB as a less invasive cancer-staging technique for a larger group of patients.” Developing the Guidelines To develop the guideline update, ASCO convened experts in medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and patient advocacy. A systematic review of the literature published from February 2004 to January 2013 in Medline was conducted. The subsequent recommendations were based on a review of the evidence. The update also includes an appendix on technical issues related to pathology. The ASCO guideline summarizes the updated literature search and analyzes new data related to the recommendations since the last systematic review. The update incorporates new evidence from more recent studies—including nine randomized controlled trials and 13 cohort studies—since 2005. Based on the results of these studies, more patients can now safely undergo SNB without axillary lymph node dissection (ALND). “The guidelines can help clinicians determine for whom SNB is appropriate,” says Dr. Lyman. “This may enable more women with early stage breast cancer to avoid ALND, which is more invasive and is associated with a greater risk of complications.” ALND can cause a...
Getting Third Parties Out Of The Exam Room

Getting Third Parties Out Of The Exam Room

Any physician, especially primary care physicians, can tell you that they are frequently forced to make a decision based on a third party’s opinion. Most often, this will be an insurance company denying a prescribed medication or test; the discussion in the exam room evolves into a discussion of what is covered by the patient’s health plan—and what is not. The goal of providing the best medical care is often overruled by some of those decisions. Of course, the insurance company will tell you that they are not making medical decisions, and the patient can pay out of pocket if they would still like the medication or the diagnostic test. Most patients will chose to go with what their plan covers, either for financial reasons, or they feel they are paying an insurance premium, and their insurer should be paying for their medical care. All too often, I find myself playing the appeals game with the insurance companies in order to get appropriate care for my patients. For example, I recently saw a young asthmatic patient who was controlled on a certain inhaler for many years. They had tried others, but those had all failed to relieve the asthmatic symptoms. The insurance company decided that the patient would have to fail on a trial of one of the inhalers they had already failed on in the past before covering the current inhaler. Well, patients can end up in the ER or even die from an exacerbation of asthma. Clearly, this was not in the patient’s best interest. Why should third parties not be allowed in the exam room? *...
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