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Better Health
CANCER CARE: Price of Progress, D3 MORNING STAPLE: Can your tea be too hot?, D4 TRAVEL: Oregon Wilderness, D5
The number of survivors of cancers has been on the increase in recent decades thanks to earlier detection and better treatment options. There were an estimated
15.5 million cancer survivors in the United
States in 2016, a number that is expected to increase to 20.3 million by 2026, according to the National Cancer Institute.
SURVIVORSHIP By Anne-Gerard Flynn
Special to The Republican
Baystate Medical Center’s Dr. Diane Dietzen is among the speakers at “Cancer Survivorship 101,” a day-long forum being presented Saturday, June 8, from 8:30 to 3 p.m. in Max’s Tavern conference room at the Naismith Memorial Basketball Hall of Fame. Survivorship refers to the growing number of individuals who have received a cancer diagnosis, have been or are in treatment and are living longer and thus raising the question – are they getting medical care informed by this history and their concerns? The event features presenters from some of the country’s top cancer centers addressing issues like fear of cancer recurrence, sexual intimacy after a cancer diagnosis and integrative medicine. It also features presentations by cancer survivors including former Boston Red Sox CEO Lawrence “Larry” Lucchino, principal owner and chair of the Worcester-headed Pawtucket Red Sox, who was treated in 1986 for non-Hodgkin’s lymphoma, a type of blood cancer, at Boston’s Dana-Farber Cancer Institute where he now chairs the Jimmy Fund. Organizer Dr. Jay Burton, an area primary care physician and blood cancer survivor as well, calls the event for survivors and caregivers “unique.” “This is a unique educational event,” said Burton, an Enfield-based primary care physician with Springfield Medical Associates and founder of the non-profit Survivor Journeys. “Having national leaders in
cancer survivorship gather together usually only happens at physician educational conferences. For them to gather to talk about survivorship to actual cancer survivors, their families and caregivers in a large forum really does not happen.” The number of survivors of cancers has been on the increase in recent decades thanks to earlier detection and better treatment options. There were an estimated 15.5 million cancer survivors in the United States in 2016, a number that is expected to increase to 20.3 million by 2026, according to the National Cancer Institute. The National Coalition for Cancer Survivorship has defined survivorship as something that starts at diagnosis and involves the patient’s loved ones. It can be an arduous journey and as it
focus for Dietzen who heads Baystate’s palliative care service. Her June 8th talk is on “What is Palliative Care and What Role Does It Play in Cancer Survivorship and Caregiving?” She is looking forward to sharing her perspective on taking care of survivors in the acute phase as well as hearing “what different people in this region can bring to bear to help survivors to have a coherent plan for what happens in follow-up.” “I am going to be interested to hear the other things that happen at the conference because I have seen at a national level people start to talk about the relation between palliative care and oncology care and survivor care and where does the primary care doctor fit into that and what does the continuum of that
some places their palliative care specialist may continue to follow them even if they do not have an active cancer diagnosis. It has grown up differently in each place just because they didn’t have a specific protocol or specific set of resources.” Palliative care grew out of hospice care and Dietzen noted that sometimes people confuse the two. Palliative care is given to support patients undergoing treatment or dealing with a chronic illness, while hospice care is given during the later stages of illness when disease-altering treatments are no longer considered beneficial. “There was a recognition many years ago now that doing really good comprehensive care for a patient and their family who had a life-limiting illness was
disciplinary care for patients and families who are dealing with chronic, serious illness regardless of whether it is imminently life-limiting or not. So that is what started the process of creating palliative care” She added, “Cancer patients were one of the first populations that palliative care was involved with although we now see lots of different kinds of patients with lots of different illnesses.” “Palliative care could be in the early stages of a cancer diagnosis or it could be intermediate stages of illness that might require dialysis or other aggressive treatments that can lead to discussions of what end of care might look like but it is by no means meant to focus on that,” Dietzen said. She said there are a “couple of different places in the Bay-
The National Coalition for Cancer Survivorship has defined survivorship as something that starts at diagnosis and involves the patient’s loved ones. It can be an arduous journey and as it moves away from treatment how a survivor should be monitored over the years has no one established medical protocol. How to comprehensively address the needs of cancer survivors has long been a focus for Dr. Diane Dietzen who heads Baystate’s palliative care service. moves away from treatment how a survivor should be monitored over the years has no one established medical protocol. How to comprehensively address the needs of cancer survivors has long been a
look like,” Dietzen said. “In different places, different people have that survivor long-term follow-up role. In some places it is clearly the primary care doctor. In other places they continue to be seen in oncology and in
helpful and beneficial on many levels,” said Dietzen of hospice care. “Then people said we should not be limiting that to the very last piece of life. We should try to do the same kind of comprehensive, inter-
state system where someone might come into contact with palliative care” as a cancer patient. “If the patient is being seen in our cancer center that is affiliated with the hospital there is a physician there that
they might be referred to or they could ask to be referred to if they wanted palliative care in that setting,” Dietzen said. “The Baystate VNA has a palliative care home nursing team that cares for patients with more complex illness at home under the direction of their physician or their cancer specialist. They might access palliative care in that way.” Dietzen said because she primarily works in the hospital “that is where I tend to see patients either when they have been admitted and a new diagnosis has been made or when they have developed a complication from their cancer and are admitted as a consequence.” She said it then becomes the job of the palliative care team “to pull everyone together” that the hospital team has called as needed to “help with the urgent symptoms” and to “try to help the patient and family understand” the possible implications of any recommendations for surgery, radiation or pharmacological management. “If you have surgery for this in addition to the other medical things you have going on, this is what that might look like,” said Dietzen of what members of her team might discuss with a patient. “If you have the treatment, this is how you might feel and this is what it might look like for you and your family.” Dietzen said this is done “so the patient can make the choice among the therapies that might be available to them of the one that feels most correct in terms of their goals.” SEE SURVIVORSHIP, PAGE D2
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D2 | SUNDAY, MAY 19, 2019
THE REPUBLICAN | MASSLIVE.COM
“We are not going to start from: ‘Here are the five treatments we can do.’ We are going to start from what is important to you? Where do you want to be? What things are quality of life for you and how do these treatments contribute to that...” Dr. Diane Dietzen Baystate Medical Center
Survivorship
She said the team then puts “together a specific plan based on what we have CONTINUED FROM PAGE D1 found out about that specific “We would sit and say we individual, the patient and are going to find out from their family.” you as the patient who is im“This approach makes a portant to you. Who is your huge difference in the unit health care proxy and who of care being the patient and are the other people who the family and the idea that support you and help you,” we are going to start from Dietzen said. what the goals of the patient “We are going to invite are,” Dietzen said. them to come in and sit “We are not going to start down and we are going to go from: ‘Here are the five over what is happening and treatments we can do.’ We what the concerns are and are going to start from what answer questions so that is important to you? Where we can work from what it is do you want to be? What that is important to you and things are quality of life for your family needs and the you and how do these treattreatment choices and put ments contribute to that that altogether.” rather than offering people Dietzen said it is this colmenus of choices which, laborative, patient-centered unfortunately, was a place nature that she likes about medicine had evolved into palliative care. in some parts of the prac“We often think that tice.” The June 8th forum, patients are making these which includes a box lunch, decisions in isolation and is free if registration is done they are not,” Dietzen said. online by June 2. It is $20 “They need to know what after June 2. kind of care they are going
Hospice Care 101 Many people mistakenly believe that hospice care is only intended for patients in their last few days of life. But there’s no reason to wait that long to seek hospice care; it’s intended to make your loved one’s final months more comfortable.
difficult, emotional conversations with family members. Hospice volunteers round out the team. All of this care is done in conjunction with the patient’s usual doctor. “Their doctor stays as the main physician, but along with that, you get an interdisciplinary hospice team with its own medical director,” explains Picard. “The team is set up not to focus on the patient’s physical comfort alone, but also on their emotional and spiritual comfort. That’s why there are so many members.” Many people who seek hospice care have advanced forms of heart disease, lung disease, liver disease, neuromuscular disease, dementia “It’s for any end-of-life dior cancer, but anyone with a agnosis, for any disease when life-limiting health condition a person doesn’t want—or can qualify for hospice care. doesn’t have—any therapies “Usually, the doctor has available for a cure; if there’s to certify that a person is expected to live for six months nothing more that can be or less,” says Picard. “And done,” says Suzanne Picard, there is no end to the hosR.N., hospice nurse for pice benefit. As long Holyoke VNA Hospice Life Care. “It can be as soon as the as the person is person says, ‘No, I don’t want showing some to go to the hospital anymore. decline, they can I don’t want these aggressive continue in hospice, even after interventions.’” Each hospice patient six months.” receives a team of caregivHospice care doesn’t limit ers, led by a hospice team a patient from medical director. A nurse living life as oversees each patient’s fully as possible overall plan of care, includduring those ing pain management and final months. medication management. Home health aides help with “There are no restrictions,” bathing and personal care. Social workers and spiritual says Picard. counselors provide psycho“Patients social support, and they can can go out. help hospice patients initiate They can
participate in life as much as they want. They can get a haircut or go on vacation. We promote quality of life. We want patients to live as well as they can.” Health insurance pays for hospice care (either through Medicare or private insurance), so it isn’t cost-prohibitive and is accessible to most families. Having a team of caregivers is particularly important for family members who may otherwise experience caregiving burnout. Hospice volunteers provide family caregivers much-needed respite care. If you think that your loved one could benefit from hospice care, ask your doctor for a referral. To learn more about Holyoke VNA Hospice Life Care, call 413.533.3923 or visit www.holyokevna.org.
Afternoon breakout lifestyle sessions include Dr. Don Dizon, medical oncologist and director of women’s cancers, Lifespan Cancer Institute, Providence, R.I., Sex and Intimacy: How Does This Change After a Cancer
The team then puts “together a specific plan based on what we have found out about that specific individual, the patient and their family.” “This approach makes a huge difference in the unit of care being the patient and the family and the idea that we are going to start from what the goals of the patient are,” Dietzen said. to need. How that is going to impact their loved ones. Are they going to be in a nursing facility and what is that going to be like and they make decisions based on things that affect their entire family unit.” She said the palliative care team includes a chaplain and social worker in addition to nurses and physicians. “We occasionally pull in pharmacy and other disciplines,” Dietzen said. “We have a few providers that we can pull in who do things like Reiki or some other alternative therapies. We also pull in anyone else we need to in an individual situation.”
Suzanne Picard, R.N., hospice nurse for Holyoke VNA Hospice Life Care.
Lose Weight. Live Better.
Diagnosis, 12:45 p.m.; Dr. Darsha Mehta, Mass General’s Benson-Henry Institute for Mind Body Medicine, What is Integrative Medicine and How Can This Be Used in Cancer Survivorship Care?,1:10 p.m.; Maura Harrigan, oncology research registered dietitian, registered dietitian nutritionist, Survivorship Clinic, Yale Cancer Center, Nutrition Before and During Cancer Survivorship, 1:55 p.m.; Scott Capozza, physical therapist, Smilow Cancer Hospital Survivorship Clinic and cancer survivor who presented at last year’s forum, I Have Cancer: How Do I Exercise?, 2:20 p.m.
For more information call (413) 276-6100 or email survivorshipprogram@ gmail.com A continental breakfast will be served from 8 to 8:30 a.m. with Burton making opening remarks from 8:30 to 8:40 a.m. Morning presenters include Dr. Larissa Nekhlyudov of Brigham & Women’s Primary Care Associates who does survivorship care with both adults and children at Dana-Farber and teaches at Harvard Medical on After Treatment Ends: Juggling Your Health Care, 8:40 a.m.; Dr. Nirupa Raghunathan of New York’s Memorial Sloan Kettering Cancer Center, Long-Term
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Surveillance of Pediatric and Adult Cancers, 9:05 a.m.; Dr. Joseph Antin, chief, stem cell transplantation, emeritus, Dana-Farber, The Basics of Stem Cell Transplantation, 9:30 a.m.; Daniel Hall, clinical psychologist who works with research teams at Mass General Hospital in the area of behavioral health, cancer and mind-body medicine, Fear and Anxiety of Cancer Recurrence, 10 a.m.; Larry Lucchino, My View of Cancer Survivorship, 10:45 a.m. ; and Dr. Krishna Guntru, program director, cancer survivorship, Lahey Hospital & Medical Center, What is a Cancer Survivorship Program and Why Are There Not More of Them? at 11:20 a.m.
Afternoon breakout care-giving topic sessions include Judy Kasey Houlette, executive director, Friend for Life Cancer Support Network, What is Mentoring and How Can This Help the Cancer Survivor and Caregiver During Treatment and Beyond?, 12:45 p.m.; Ali Schaffer, licensed clinical social worker, Triage Cancer, Caregiving: It is OK to Take Care of Yourself and How to Do It, 1:10 p.m.; Ruth Bachman, Hourglass Fund, Triage Cancer and cancer survivor, What is Resiliency and How to Develop This?, 1:55 p.m.; Dr. Diane Dietzen, hospice and palliative care, Baystate Medical Center, What is Palliative Care and What Role Does It Play in Cancer Survivorship and Caregiving?, 2:25 p.m.
SUNDAY, MAY 19, 2019 | D3
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THE REPUBLICAN | MASSLIVE.COM
The Price of
Progress
Dr. Philip Glynn of Mercy Medical Center and Registered Nurse Rebecca DeJesus chat with a patient at the Sister Caritas Cancer Center. (DON TREEGER / THE REPUBLICAN)
The current state of cancer care has been described as the “Golden Age of Oncology.” That label may be well justified. Traditional standard of treatment included chemotherapy, radiation therapy, and surgery. Additionally we now have new tools such as targeted therapy and immunotherapy. These treatments are commonly more effective, less toxic and
more patient specific. The results are impressive. The American Society of clinical oncology reports that two out of every three people are alive at least five years after their cancer diagnosis. In the 1970s, this number was approximately one out of two. From the 1990s until now, the nation’s cancer death rate has dropped by over 15%. For some diseases such as breast cancer, testicular cancer, and childhood leukemia, the five year survival rate is greater than 90%. Our ability to get patients through treatment by managing pain, nausea, low blood counts, fever, and weakness is dramatically improved. In the 1970s, there
in reasonably good health. However, at the time that his pain started, he was without a job, insurance, and a primary care physician. Mike’s first evaluation came in the emergency room where his lab tests showed that he was mildly anemic, but far more concerning was a CT scan which demonstrated a large Progress is not tumor that involved not only the rectum but the majority of without cost. the pelvic region. Abnormal It was just over 2 years ago lymph nodes appeared along that Mike began noticing the back of the abdomen, some intermittent pain in extending all the way to the his lower abdomen. The diaphragm and there were pain escalated, his appetite declined and he began to lose multiple lesions in both lungs. The biopsy confirmed that weight, later experiencing significant constipation. At 30 this was colorectal cancer. years old, Mike was single and Whatever distress Mike had about his pain and weight were about three million cancer survivors in America, and today that number is nearly 12 million. Managing the long-term effects of treatment and careful monitoring for recurrence are essential parts of routine follow-up for today’s cancer survivor.
loss was immediately overshadowed by fear. He was told that this was an inoperable and incurable disease. While the biopsy showed the routine gene abnormalities that could be used for target of therapy were all negative, another panel of genetic testing demonstrated that Mike might benefit from a form of intravenous immunotherapy. He ultimately started that treatment, and the results have been nothing short of stunning. His appetite, energy and CT imagery are all strikingly improved and, for Mike, the treatment is not at all toxic. Just two months ago, William was admitted to the hos-
pital. At age 67, he considered himself to be in good health. A longtime pack-a-day former cigarette smoker, but he had managed to quit for good several years ago. William was severely short of breath when he came to the hospital. He had lost about 10 pounds over the prior few weeks and he was experiencing significant pain in his upper back. In the hospital he was given pain medicine, oxygen support and bronchodilators to help his breathing. A CT scan showed dreadful results. Nodular lesions were prominent in both lungs. The lymph nodes in the middle of the chest were markedly enlarged, fluid was SEE PROGRESS, PAGE D4
MercyCares.com
Your trust is our favorite seal of approval At Mercy Medical Center, providing our patients with an exceptional experience is at the heart of everything we do. Whether it’s a friendly greeting, a thorough answer, or the compassionate care we’re known for, we’re committed to treating each and every patient like our only one. We’re proud to be named as one of America’s Best Hospitals for cancer care and breast care by the Women’s Choice Award®, and while we appreciate being recognized for this accomplishment, your trust continues to be our most important seal of approval.
Mercy is honored to be recognized for excellence in our Sister Caritas Cancer Center and Breast Care Center. 3112314-01
271 Carew Street, Springfield, MA 01104 • 413-748-9000
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D4 | SUNDAY, MAY 19, 2019
Progress CONTINUED FROM PAGE D3
trapping his left lung and the bony structures of the spine appeared to be infiltrated with tumor. In addition, the visible portion of the liver showed even more evidence of tumor spread. A subsequent biopsy confirmed what William strongly suspected; he had an aggressive lung cancer. He was not shocked but quite disappointed. He was a recently retired businessman and although he was by no means wealthy, he had been careful and planning for some years of leisure with his close knit family. William began to emotionally prepare himself for what he envisioned would be a bleak and limited future but, then, some remarkable news. The full pathology report revealed that he was a true rarity; as a male and former heavy smoker it was very unlikely that his cancer would express a particular genetic mutation that could be targeted with a very tolerable oral therapy. This type of finding was far more common in female nonsmokers. Within 2 weeks of starting therapy William had no need for supplemental oxygen, his appetite returned, his pain resolved and his repeat CT scan was so good it made the radiologist recheck the name and date of birth on the chart to be sure it matched with that of the original study. This is the “Golden Age of Oncology” and the metaphor is apt. Treatment costs for Mike’s immunotherapy exceeded $200,000 a year. For William, that number
is close to the same. Mike, who was without insurance, needed extensive social service assistance and discounts from the drug manufacturer were requested. Even though William has insurance, his co-pay is an enormous out-of-pocket expense. He, too, will need some form of financial assistance. There is no easy answer to this problem and there is no doubt that the issue is only going to escalate as we find more genes to target with treatment, improve our immunotherapy, and couple these extremely expensive therapies with other agents. The results are often very impressive but, the cost is staggering and in some cases, prohibitive. Of enormous importance to patients like Mike and William, and to the providers who offer this care, is the government program referred to as 340B. A federal resource created in 1992, this program requires drug manufacturers to provide eligible organizations with outpatient therapies at a reduced cost. This is a program under threat and needs our political support. Our attention also needs to turn to the rising cost of cancer drugs; from 2012 to now our national spending on cancer drugs has doubled and currently stands in the range of $50 billion annually. Clearly, at this rate the cost of cancer drugs is unsustainable and will likely need some form of regulatory control. How we manage the “gold” during this “Golden Age of Oncology” will determine how effectively we can deliver care to future patients like Mike and William.
Philip Glynn, M.D. is Medical Director at the Sister Caritas Cancer Center at Mercy Medical Center in Springfield. Dr. Glynn is board-certified in Medical Oncology, Internal Medicine, Palliative Care and Hospice. (DON TREEGER / THE REPUBLICAN)
THE REPUBLICAN | MASSLIVE.COM
How biking to work can
benefit your overall health
Commuting is a fact of life for millions of professionals. The U.S. Census Bureau reports that the average person in the United States spends 26.1 minutes getting to work, while Statistics Canada notes the average Canadian spends 26.2 minutes getting to the office. Few people enjoy commuting. In fact, a 2004 study published in the journal Science found that female commuters cited commuting as their least satisfying daily activity, ranking it below housework. Perhaps that’s because commuting, whether commuters recognize it or not, tends to have adverse effects on their overall health. A 2012 study published in the Journal of Urban Health found that longer commutes are associated with behavioral patterns that may contribute to obesity and other negative health conditions.
Commuters who live close to work can counter some of the negative effects of commuting by cycling to work. Cycling is a healthy activity that the Harvard Medical School notes can help people build muscle and increase bone density, which naturally decreases with age. And there are additional benefits to cycling to work that might compel some commuters to pedal their way to the office. · Biking can help you meet minimum exercise guidelines. The latest Physical Activity Guidelines from the U.S. Department of Health and Human Services recommend that adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity each week. Biking to work can help people meet and exceed those weekly guidelines, providing a strong foundation for a long, healthy life. · Biking to work can lower your risk of chronic disease. Regular physical activity like cycling can lower your risk of chronic diseases like cardiovascular disease, type 2 diabetes and certain cancers.
Adults who can’t find the time to exercise outside of work may find that exercising during their commutes by biking to work is their best and most effective means to lowering their risk for chronic disease. · Biking to work can im-
from researchers at Montreal’s Concordia University attempted to investigate the impact of various commuting modes on workers’ stress levels upon arrival to their workplace. The study found that such levels were lower among cyclists than they
Regular physical activity like cycling can lower your risk of chronic diseases like cardiovascular disease, type 2 diabetes and certain cancers. Adults who can’t find the time to exercise outside of work may find that exercising during their commutes by biking to work is their best and most effective means to lowering their risk for chronic disease.
prove cognition. The American Heart Association notes that regular physical activity like cycling has been linked to improved cognition, which can positively affect memory, attention and processing speed. · Biking to work may help reduce stress. A 2017 study
were among people who drove or took public transportation to the office. Biking to work may not help people reduce their commute times, but it might make those commutes less taxing on their overall health.
that repeated irritation of any body surface increases your risk of cancer.” So should hot tea be avoided? It seems the answer is yes if the tea is 140 F or higher. But that same rule should be applied to any hot beverage, not just tea. “Tea is the only drink consumed in the area (where the study was conducted), so the data relate to this beverage,” Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, told the Science Media
Centre. “It is also true that in this area of Iran, that tea is frequently drunk at high temperatures. They did not study any other drink, but other studies have, and it seems that it is the heat that is the issue rather than the actual beverage.” Simply waiting until the tea cools down or adding a cooling agent like milk to make the tea cool down instantly can help people indulge their love of tea without necessarily increasing their risk for esophageal cancer.
Can tea be
too hot? 3112496-01
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A piping hot cup of tea is a morning staple for millions of people across the globe. But can tea be so hot as to adversely affect tea drinkers’ overall health?
140 F (60 C) and consumed about two large cups per day had a 90 percent higher risk of esophageal cancer compared to people who consumed less tea at cooler temperatures. The authors of the study acknowledged more research is necessary to determine exactly why hot tea is linked with a higher risk of esophA 2019 study from reageal cancer. But scientists searchers with the American responding to the study susCancer Society found a link pect it’s the temperature and between drinking hot tea and not the tea that’s causing the esophageal cancer. The study, elevated risk for cancer. published in the International “This is valuable research Journal of Cancer, examined but not a ground-breaking more than 50,000 people discovery,” Dr. James Doidge, between the ages of 40 and Senior Research Associate, 75 in the Iranian province University College London, of Golestan for an average told the Science Media Cenof 10 years. Researchers tre. “Hot drinks are an estabdetermined that tea drinkers lished risk factor for oesophwho consumed their tea at ageal cancer and it doesn’t temperatures higher than take a scientist to appreciate