Most Breast Cancer Patients May Not Be Getting Enough Exercise

Running_womanA new study in the journal CANCER, a peer-reviewed journal of the American Cancer Society, finds that most participants in a large breast cancer study did not meet national physical activity guidelines after diagnosis. African-American women were less likely to meet the guidelines than white women.

Physical activity after breast cancer diagnosis has been linked with prolonged survival and improved quality of life, and the findings indicate that efforts to promote physical activity in breast cancer patients may need to be significantly enhanced.

The US Department of Health and Human Services, as well as the American Cancer Society, recommends that adults engage in at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity (or an equivalent combination thereof) each week for general health benefits and for chronic disease prevention and management.

Brionna Hair, a doctoral candidate in epidemiology at the University of North Carolina at Chapel Hill, and her colleagues examined levels of and changes in physical activity following breast cancer diagnosis, overall and by race, in a population-based study of breast cancer patients. The study assessed pre- and post-diagnosis physical activity levels in 1,735 women aged 20 to 74 years who were diagnosed with invasive breast cancer between 2008 and 2011 in 44 counties of North Carolina.

The researchers found that only 35 percent of breast cancer survivors met current physical activity guidelines post-diagnosis. A decrease in activity approximately six months after diagnosis was reported by 59 percent of patients, with the average participant reducing activity by 15 metabolic equivalent hours—equivalent to about five hours per week of brisk walking.

When compared with white women, African-American women were about 40 percent less likely to meet national physical activity guidelines post-diagnosis, although their reported weekly post-diagnosis physical activity was not significantly different from that of White women (12 vs 14 metabolic equivalent hours). Ms. Hair noted that it’s important to realize that African-American women experience higher mortality from breast cancer than other groups in the United States.

“Medical care providers should discuss the role physical activity plays in improving breast cancer outcomes with their patients, and strategies that may be successful in increasing physical activity among breast cancer patients need to be comprehensively evaluated and implemented,” she said.


Tagged: Breast cancer, physical activity, survival

Our Aging Eyes

excerpted from my post at Covering Health, the blog of Association of Health Care Journalists

EyeExamSitting in the waiting room of my opthalmologist’s office was an an elderly man, who I later learned was 100 years old, perhaps 102, no one was sure.

He could walk with the help of his aide and a sturdy cane and his cognition seemed good. My doctor later told me that this gentleman’s eyesight was as good or better than someone 20 or 25 years younger.

It got me thinking about what happens to our eyes as we age.

Why do some people maintain good vision well into their 90s while others struggle with serious visual decline at a younger age? Loss of vision significantly impacts a senior’s independence, which in turn, may lead to depression.

The American Foundation for the Blind says that the risk of severe eye problems increases with age, especially after 65. Two-thirds of those who are legally blind are seniors suffering from aging-related eye diseases. The National Health Interview Survey (NHIS) found 12.2% of people 65 to 74 years of age and 15.2% of those 75 years of age and over reported having vision loss.

This Scientific American article provides a good overview of the basic structure of the human eye, and what happens as we get older. According to the Cleveland Clinic, retinal disorders from diabetes, age-related degeneration, or retinal detachment are the leading causes of blindness in the US.  Many people also suffer from glaucoma, cataracts, or macular degeneration.

So was mom right when she said “eat your carrots?” Sort of.

Claims about various nutrients, vitamins, and minerals as beneficial to eye health vary from evidence-based to absurd. Experts strongly advise due diligence before reporting on the latest supplement of the month or dietary wonder food.  Various studies show that foods high in Lutein and zeaxanthin (L/Z) such as cantaloupe, carrots, eggs, salmon, and orange/yellow peppers, do have protective properties linked with reduced risk of age-related macular degeneration and cataracts. This article in The Daily Mail contains a good synopsis of caretenoids, which are found in dark green and orange-yellow vegetables.

When it comes to nutritional supplements or “natural” alternatives,  the FDA does not require manufacturers to gain approval before distribution. In addition, companies are permitted to claim that products address a nutrient deficiency, support health or are linked to body functions.

Any manufacturer can make a health claim, as long as there is some kind of study — which are often industry sponsored — to back it up. Look for information from reputable sources, like in this Globe and Mail  article, which describes a well-regarded investigation of specific supplement concentrations — reminding readers that more isn’t necessarily better.

Tagged: aging, eyesight, vision

“As the interne…

“As the internet plays an increasingly central role in connecting Americans of all ages to news and information, government services, health resources, and opportunities for social support, these divisions are noteworthy—particularly for the many organizations and individual caregivers who serve the older adult population.”

–PewResearch Internet Project, Older Adults and Technology Use, April 2014

Read my blog post on Older Adults and the Digital Divide at the Center for Health, Media & Policy.

Will Virtual Consults Solve the Provider Shortage?

I’ve attended several health conferences over the past couple of months and whether the conversations are about the Affordable Care Act allowing more people to get preventive care, using more home care instead of institutional care, or caring for our aging population, one topic that consistently comes up is the projected shortage of primary health care providers.

There are numerous ideas on the table to address this: expand scope of practice for nurse practitioners and physician assistants, provide incentives or loan forgiveness for med students willing to go into primary care, or use telemedicine to improve efficiency. All reasonable ideas… but I wonder about the latest telemedicine venture from a company called Doctor on Demand..

laptop and stethoscopeThis virtual venture allows anyone to have a face-to-face consult with a physician for $40 per visit — about the same as many insurance co-pays. Users can access a licensed US provider 24/7 from any computer, tablet or smartphone. They can discuss symptoms, ask questions, get answers to non-emergency medical questions, specialist referrals, and even obtain short-term prescriptions or refills.

“We created Doctor On Demand to help modernize and transform the health care system,” Adam Jackson, co-founder and CEO, Doctor On Demand said in a press release. “Our main goal is to ease the stress patients encounter while navigating the U.S. health care system and bring the focus back to quality and convenience for both patients and doctors. We’re helping patients receive high-quality medical care without having to leave their homes or offices, therefore cutting down time, cost and worry.”said in a press release,

Some of the common health issues the company says it can address include colds, rashes, coughs, sinus infections, muscle and sports injuries, pediatric care including fever and vomiting, eye problems, and urinary tract infections. All this without a provider ever laying hands on a patient. Instead, patients can upload high-resolution photos to help with diagnosis.

I’m a strong proponent of telemedicine — under the right circumstances. Maybe I’m just skeptical by nature, but I question this approach.

Telemedicine works well when there is an existing relationship between a patient and a provider who knows and understands that patient’s quirks, pre-existing conditions, compliance issues, outliers or other important factors affecting a his or her well-being.

Telemedicine works when there’s clinical documentation that supports referral to a specialist who may be 100 miles away from a rural clinic, or when a home health care nurse has an opportunity to check up on that patient in his or her home and make a comprehensive visual assessment. The VA, among others, has been using telemedicine successfully for many years – as an adjunct, not a total replacement.

When a clinician knows and understands a patient’s dynamics, routine observations and video chats absolutely can save time and costs. There are currently several bills in Congress that support expansion of virtual visits. But I don’t know if this is what they had in mind.

Can telemedicine work like it’s supposed to when a clinician has no knowledge of the patient aside from what’s presented via Web cam in a 10 minute chat?

There are still many unanswered questions.

How does a professional diagnose an unfamiliar patient without actually doing some of the physical assessments — checking for swollen lymph nodes, for example, or peering down a patient’s sore throat or into the sinuses? How many prescriptions will be handed out unnecessarily? What if that “minor” issue is really more serious than the patient lets on?

Many people will see this type of “virtual” care as a plus — no travel or waiting times, instant gratification. Fast has its place. What about thorough?

I’ll be following the concept of virtual practices with curiosity. Perhaps they will prove to be just the panacea the health care world needs. Perhaps not. Stay tuned.

Photo credit: jfcherry / / CC BY-SA

Tagged: access, health IT, linkedin, physician shortage, providers, telemedicine, virtual visits

Red meat consumption may increase risk of diabetes

This one is for all of the carnivores out there: Eating even a half-serving more of  red meat over time is associated with an increased risk of type-2 diabetes mellitus (T2DM) in a follow-up of three studies of about 149,000 U.S. men and women, according to a report published Online First by JAMA Internal Medicine. While […]