The Best Defense is a Good Offense

The Arkansas Department of Health recently published their annual report, Cancer Facts & Figures 2011. It states that cancer remains the 2nd leading cause of death in Arkansas and the United States. The overall estimated cost of cancer in the U.S. in 2010 was $263.8 billion, with the highest costs being assocated with breast, colorectal, lymphoma, lung and prostate cancer. The American Cancer Society (ACS) predicts about 577,190 people will die of cancer in the U.S. this year. That averages out to approximately 1,500 each day. What are you doing to reduce your risk?

Cancers caused by environmental exposures are modifiable and can be prevented. The American Cancer Society estimates that in this country in 2010 approximately 171,000 cancer deaths were related to tobacco use and one-third of the 569,490 deaths were related to obesity and physical inactivity. Deaths from cancers caused by infectious agents, such as Hepatitis B, human immunodeficiency virus (HIV), human papillomavirus (HPV), and Helicobacter pylori (H. pylori) etc. could have been prevented through behavioral changes, vaccinations and antibiotics.

February is National Cancer Prevention Month, so in our weekly posts we'll be taking a closer look at a few specific ways to prevent cancer in yourself and your loved-ones. To get us started, here's a list created by the Mayo Clinic: 

1. Don't Use Tobacco 

Tobacco use is the single greatest avoidable risk factor for cancer mortality worldwide, causing an estimated 22% of cancer deaths per year. Smoking has been linked to various types of cancer — including cancer of the lung, bladder, cervix and kidney — and chewing tobacco has been linked to cancer of the oral cavity and pancreas. Exposure to secondhand smoke may also increase your risk of lung cancer.

Avoiding tobacco — or deciding to stop using it — is one of the most important health decisions you can make. If you need help quitting tobacco, our Certified Tobacco Treatment Specialist, Casey Shelor, can help. Contact her by email or at 479-361-5847 for a confidential appointment.

2. Eat a Healthy Diet 

Although making healthy selections at the grocery store and at mealtime can't guarantee cancer prevention, a diet heavy in fats and processed foods has been linked to several types of cancer. Consider these guidelines:

• Eat plenty of fruits and vegetables. Base your diet on fruits, vegetables and other foods from plant sources — such as whole grains and beans.
• Limit fat. Eat lighter and leaner by choosing fewer high-fat foods, particularly those from animal sources. High-fat diets tend to be higher in calories and may increase the risk of overweight or obesity — which can, in turn, increase cancer risk.
• If you choose to drink alcohol, do so only in moderation. The risk of various types of cancer — including cancer of the breast, colon, lung, kidney and liver — increases with the amount of alcohol you drink and the length of time you've been drinking regularly. 
  

3. Maintain a Healthy Weight & Include Physical Activity in Your Daily Routine

Maintaining a healthy weight may lower the risk of various types of cancer, including cancer of the breast, prostate, lung, colon and kidney. Physical activity counts, too. In addition to helping you control your weight, physical activity on its own may lower the risk of breast cancer and colon cancer. As a general goal, include at least 30 minutes of physical activity in your daily routine — and if you can do more, even better. Try a fitness class, rediscover a favorite sport or meet a friend for daily brisk walks.

4. Protect Yourself from the Sun

Skin cancer is one of the most common kinds of cancer — and one of the most preventable. Try these tips:

• Avoid midday sun. Stay out of the sun between 10 a.m. and 4 p.m., when the sun's rays are strongest.
• Stay in the shade. When you're outdoors, stay in the shade as much as possible. Sunglasses and a broad-rimmed hat help, too.
• Cover exposed areas. Wear tightly woven, loosefitting clothing that covers as much of your skin as possible. Opt for bright or dark colors, which reflect more ultraviolet radiation than pastels or bleached cotton.
• Don't skimp on sunscreen. Use generous amounts of sunscreen when you're outdoors, and reapply often.
• Avoid tanning beds and sunlamps. These are just as damaging as natural sunlight.

5. Get Immunized
Cancer prevention includes protection from certain viral infections. Talk to your doctor about immunization against:

• Hepatitis B. Hepatitis B can increase the risk of developing liver cancer. The hepatitis B vaccine is routinely given to infants. It's also recommended for certain high-risk adults — such as adults who are sexually active but not in a mutually monogamous relationship, men who have sex with men, and health care or public safety workers who might be exposed to infected blood or body fluids.
• Human papillomavirus (HPV). HPV is a sexually transmitted virus that can lead to cervical cancer. The HPV vaccine is available to both men and women age 26 or younger who didn't have the vaccine as an adolescent.(We covered this subject in detail in our recent post about HPV vaccines.)   

6. Avoid Risky Behaviors

Another effective cancer prevention tactic is to avoid risky behaviors that can lead to infections that, in turn, may increase the risk of cancer. For example:

• Practice safe sex. Limit your number of sexual partners, and use a condom when you do have sex. The more sexual partners you have in your lifetime, the more likely you are to contract a sexually transmitted infection — such as HIV or HPV. People who have HIV or AIDS have a higher risk of cancer of the anus, cervix, lung and immune system. HPV is most often associated with cervical cancer, but it may also increase the risk of cancer of the anus, penis, throat, vulva and vagina.
• Don't share needles. Sharing needles with an infected drug user can lead to HIV, as well as hepatitis B and hepatitis C — which can increase the risk of liver cancer. If you're concerned about drug abuse or addiction, seek professional help.

7. Take Early Detection Seriously

Regular self-exams and professional screening for various types of cancers — such as cancer of the skin, colon, prostate, cervix and breast — can increase your chances of discovering cancer early, when treatment is most likely to be successful. Ask your doctor about the best cancer screening schedule for you.

If you have any questions about these tips, you can contact one of our Certified Health Education Specialists at 479-361-5847.

More Than a Mission Statement

When we created our mission statement back in 2009 we thought we covered the bases pretty well. But a mission statement is really just "the big picture" of the organization it represents. For those individuals fortunate enough to have never watched a loved one endure a battle with cancer, or gone through one themselves, it's hard to imagine exactly what "cancer support" can entail.

Our social workers work with patients to determine their immediate needs, as well as needs that may arise in the future as they are going through treatment. Since we meet with patients on their very first visit to the oncology clinic, it's common to hear "I'm fine, I won't be needing any help." But we still share our services and programs... just in case. And many times, we hear from them later when the reality sets in. Cancer treatment is extremely difficult - physically and emotionally. On both fronts, we meet patients' needs.

Here's a list of the opportunities for giving support that we encounter every day with the patients and families we serve:

Financial Assistance

Prescription Assistance: Hope Cancer Resources assists with the purchase of cancer-related prescriptions and will help find long-term drug assistance whenever possible. The medications used to treat cancer are not like those used to treat a case of strep-throat or a stomach bug. And you don't have to be uninsured to find yourself facing a financial struggle when diagnosed with cancer. When medical insurance covers a percentage of your prescription medications and your chemotherapy drug is $2000 for a 30-day supply, you could end up writing a check for $500. And that's just for one medication. In 2011, we purchased 981 individual prescriptions for patients at a total value of $45,035. In addition, we assisted in matching patients with pharmaceutical company programs that provided $173,414 in prescriptions to patients in Northwest Arkansas.

Emergency Financial Assistance: We provide direct, temporary assistance to cancer patients who are struggling financially due to their treatment, including payments for housing and/or transportation needs as well as dental needs associated with their cancer diagnosis. Just as with prescription medication costs, a cancer-related financial crisis can be completely unexpected. A patient undergoing cancer treatment may be forced to take time off work or incur travel expenses, or just have more medical bills than usual. We help alleviate the stress associated with making sure that bills are paid while medical necessities are provided. Last year, we provided $188,380 in emergency financial assistance and $56,175 in gasoline cards to help patients get through their treatment.

Emotional Assistance

Our services compliment each other in every way. Every time we interact with a cancer patient or their family members there is an opportunity to provide emotional support. Even the smallest thing - like providing a brochure - can reduce a patient's stress level. Licensed social workers help patients and caregivers cope with emotional distress through counseling, education and information on support groups offered in our community, including those facilitated by our staff. In 2011, we served 2,337 patients with 9,348 hours of emotional support through support groups, counseling, and intensive emotional support.

Spanish Interpretation

Imagine being faced with a diagnosis of cancer and not being able to speak the same language as the medical staff providing your treatment. Our Spanish interpreter is available to assist patients during appointments as requested by patients and their caregivers. Last year, our interpreter provided 599 hours of assistance to patients in need.

Tobacco Cessation
Every list ever published telling us how to be healthier and reduce our risk of cancer puts stopping smoking at the top. We all know it's a deadly habit, but it's a terrible one to try to quit on your own. Our Certified Health Education Specialists will meet one-on-one with patients to talk about strategies and resources to help you quit using tobacco products. In 2011, we provided smoking cessation counseling to 94 individuals who made the decision to quit.

Transportation
Sometimes a patient's biggest obstacle when trying to survive a cancer diagnosis is just getting to treatment. Some types of cancer or medications cause patients to be unable to drive for their own safety. Some patients simply don't have adequate transportation or anyone who can get them to and from their appointments. We provide rides to and from treatment and other cancer-related medical appointments when a patient has no other options available to them. Last year, our drivers made 2,299 trips totaling 129,043 miles to guarantee every patient had an equal shot at recovery.

Please visit the Hope Cancer Resources website for more on our services and contact information.

HPV Vaccines - Who Needs Them?

You may have heard about the HPV Vaccine, but do you know what HPV is? Human Papillomaviruses (HPV) are a group of more than 150 related viruses. They get their name because certain types may cause warts, or papillomas, which are non-cancerous growths. Persistent infections with high-risk HPVs are the primary cause of cervical and anal cancers. Genital HPV infection also causes some cancers of the vulva, vagina, and penis, as well as some cancers of the oropharynx (the middle part of the throat, including the soft palate, base of the tongue and tonsils.)

The FDA has approved two vaccines to prevent HPV infection - Gardasil® and Cervarix®. Both vaccines are highly effective in preventing infections with the strains of HPV that cause about 70% of cervical cancers. Garadsil also prevents infection with the types which cause 90% of genital warts, a non-cancerous sexually transmitted infection.

Gardasil is approved for girls and women ages 9 to 26. It is recommended that the vaccine be given routinely to girls at age 11 to 12 years old, although doctors may choose to vaccinate girls as young as 9. It requires three doses spread over several months. The vaccine can also be given to girls and women 13 to 26 who did not receive the vaccine at the recommended ages. However, if a girl or woman is already infected with HPV, the vaccine will not prevent that strain of HPV from causing disease. It will protect against new infections with other strains of HPV included in the vaccine.

The vaccine is also being studied in males, and was recently recommended by the Advisory Committee on Immunization Practices (ACIP) in men ages 11 to 21. Men can get HPV infections and pass the virus along to their sexual partners. HPV has caused genital warts and is associated with rare cases of cancer of the penis. It is also linked to anal cancers, primarily in homosexual men.

For more information on HPV vaccines or cervical cancer, contact Casey Shelor, one of our Certified Health Education Specialists, by email or by phone at 479-361-5847. Information for this article was gathered from WebMD and the National Cancer Institute.

When You Can't Afford the Test

You may have read recently that the American Cancer Society is reporting a decline in cancer deaths over the last two decades. Unfortunately, while many of the more common types of cancer are declining, some of the less-common types are actually on the rise. Many types of cancer can be found in early stages with screenings and tests that are prescribed by a physician, making successful treatment and recovery more likely. And, if a patient has health insurance coverage with a decent preventative component, chances are they won't pay anything for the procedure. Unfortunately, too many Americans have no access to health coverage that will pay for these tests. Even a co-pay or deductible for one of these tests can cost hundreds of dollars, making them impossible for many people to afford. This can lead to delayed care and late-stage, more deadly, diagnoses.

Hope Cancer Resources provides a program as a local resource in Northwest Arkansas for patients who need costly tests done, but who are under- or uninsured and unable to pay for them out-of-pocket. Our Save-A-Life program requires a simple financial application, and, if the applicant qualifies, a staff member will coordinate with a medical provider who will perform the screening and send the bill to us. In 2011 we paid for 503 screenings valued at $318,301. That's certainly an impressive number, but value aside...the reality is that many of the patients we assisted would not have had the screenings done at all if the Save-A-Life program had not been available, putting them at an increased risk for a late-stage (and more deadly) cancer diagnosis. 

January is Cervical Cancer Awareness Month. Many woman have a screening for cervical cancer every time they visit their gynecologist, called a Pap test. The pap test is the initial test for cancer screening, but an abnormal result does not necessarily mean that you have cervical cancer. There are other causes of abnormal pap tests; however, your doctor may feel that a colposcopy is needed to rule out cancer. During the colposcopy,which is done in a gynecologist's office, the doctor will take a small tissue sample for biopsy. Based on the results of the biopsy, another procedure may be needed, or the doctor may choose to do more frequent pap tests for a period of time to assure that the abnormal cells are clearing.

"Mary" was a patient who contacted our office because she could not afford a pap test. Upon questioning, we learned that she did not have a primary care physician because she could not afford to see one. She was referred to an area community clinic that charges on a sliding scale according to income. Mary was established at the clinic with a primary care provider who performed a pap test. The results of the test were “abnormal” and the provider determined that she needed a colposcopy. Because she could not pay, the community clinic referred her to Save-A-Life. After determining that Mary was eligible, our Save-A-Life coordinator set up an appointment with a participating gynecologist and faxed a voucher stating that we would cover the cost of the colposcopy. The biopsy results revealed a low-grade level of abnormality and it was determined that she did not need further treatment at that time, but needed another pap test in six months. Because her financial situation was unchanged six months later, Save-A-Life paid for the follow-up pap test as well.

For many people in Northwest Arkansas and the surrounding region, not having access to healthcare increases their chances of being diagnosed with a late-stage cancer. By providing prevention education and information about our programs like Save-A-Life, we are working to be part of the solution for that challenge.

What Do You Know About Cervical Cancer?

The American Cancer Society estimated there would be over 12,000 new cases of invasive cervical cancer diagnosed in 2011. Between 1975 and 2003, incidences declined due to prevention efforts and early detection as a result of screening with the Pap test. However, since 2003 rates have been stable, and approximately 4,200 women were expected to die of the disease last year.


What is cervical cancer?
Cervical cancer occurs in the cells of the cervix - the lower part of the uterus that connects to the vagina. Symptoms don't usually appear until abnormal cells become cancerous and invade nearby tissue. Abnormal vaginal bleeding is the most common symptom, including spotting between regular menstrual periods or after sexual intercourse or a pelvic exam. Other possible signs are heavier-than-usual menstrual bleeding, unusual pelvic pain, increased vaginal discharge and bleeding after menopause.

Are there symptoms?
Early-stage cervical cancer usually produces no signs or symptoms, making it important to get regular screenings to be able to catch any abnormalities early when the disease is more easily treated. The current recommendation is for every woman over the age of 21 to get a Pap screening every two years. After age 30, if you've had a normal result for three years in a row, you can ask your doctor about spacing them out to every three years. Beyond age 65, discuss your need for continued testing with your doctor.

Am I at risk? 
There are a number of risk-factors involved with cervical cancer. The most common known risks are:

• Many sexual partners. The greater your number of sexual partners - and the greater your partner's number of sexual partners - the greater your chance of acquiring HPV. 
• Early sexual activity. Having sex before age 18 increases your risk of HPV.
• Other sexually transmitted infections (STIs). If you have other STIs - such as chlamydia, gonorrhea, syphilis or HIV/AIDS - the greater your chance is of also having HPV.
• A weak immune system. Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer.
• Cigarette smoking. Smoking and HPV infection may work together to cause cervical cancer.
• Your mother was exposed to diethylstilbestrol (DES) while pregnant.

As with any type of cancer, it is important to know your risks, be aware of the signs and symptoms, and speak to your doctor any time you have concerns or questions.

Information for this post was gathered from the Mayo Clinic and Women'sHealth.gov.

Defining "New Normal"

This week we're sharing a piece written by one of Hope Cancer Resources' Oncology Social Workers, Lisa Manzini-Pace, LCSW.

The term "New Normal" has a special connotation for people undergoing treatment and/or survivors of cancer.  Without their consent, they have been inducted into an intense and often baffling treatment regimen, one that changes their daily routines, expectations, interactions with others and ability to predict how they will fare during and after prescribed treatments.  This is a daunting trajectory and one best faced in small doses.

As human beings we seek to predict, quantify and control.  These instincts, while often previously successful, can be impediments to smoothly navigating the cancer treatment labyrinth.  Oncologists, who the patient seeks to trust implicitly, are often the first to admit that treatment involves commonalities but that each individual tends to respond in a somewhat unique manner.  The truth is that none of us working with cancer treatment have a crystal ball.  That said, here are a few observations noted by this writer courtesy of cancer patient wisdom and research.

Undergoing chemotherapy and/or radiation will test one’s metal.  Chemo induces various side effects but the overwhelming one mentioned is fatigue.  And a close second is chemo brain.  The former is a bone weary fatigue and the latter is a passing state of impaired memory and clarity.  It is essential that one lower his/her triathlon or quiz show expectations during these phases.  There will be good days and not-so-good days.  Learning to be gentle with oneself is as crucial as any pill one may swallow.  It is an art to be cultivated along with a stalwart sense of humor. 

One’s entire arsenal of healthy coping is there to be used.  This may include but is not limited to eating well, exercise (physical, mental and spiritual), common sense, resourcefulness, courage, compassion (self first!), joyfulness, intelligence, mirth, humility, faith, hope and love.  These are the aspects of you—unlike cells—that cancer cannot touch.  Use them in large doses.

Priorities will change.  Things that once seemed important are relegated to the back seat of the caboose.  To quote Arthur Golden in Memoirs of a Geisha, “Adversity is a strong wind. It tears away from us all but the things that cannot be torn, so that we see ourselves as we really are.”  Most  patients say that such experiences were the awakening of new strength and understanding.

Avoid the naysayers.  Cancer, rather like pregnancy, invites unsolicited confidences from others.  Some will be little gems to be treasured while other “stories” will be about fear, pain and darkness.  You get to choose who you will listen to and who you will wish well and send on their merry way.

This disease touches everyone in contact with it:  patient, family, friends, co-workers, medical staff, clergy, etc.  For most of us this process is humbling and awe-inspiring.  We strive to take something substantive from it, many of us again and again.  There is one certainty - It will change us.  Let your new normal reflect your hope and courage as we begin this 2012.

Our Mission in Northwest Arkansas

We provide compassionate, professional cancer support and education in the Northwest Arkansas region today and tomorrow.

While our mission statement does state exactly what we do, it doesn't provide much detail. So here is more information about the role we play in Northwest Arkansas in keeping our neighbors healthy and supporting those who need a little help as they battle a cancer diagnosis.


Health Education Services
On any given day it seems there is a story in the news about cancer research, new treatments or screenings, and new theories on how to prevent cancer by changing your lifestyle. It would be a challenge for any one person to keep up, so we provide the latest information through our Cancer Prevention & Education staff.

Hope Cancer Resources employs two Certified Health Education Specialists who provide cancer prevention education at no cost to employers, schools, churches, businesses and civic organizations in Northwest Arkansas. Prevention education can be tailored to the needs of the group requesting our services, and can include breast self-examination instruction, skin wellness, informational seminars on the basics of cancer and tobacco cessation. Our programs are designed to be age-appropriate for all groups from elementary schools to retirement communities. Individual tobacco cessation counseling is also available with our certified Tobacco Treatment Specialist in a six-week long one-on-one program. For more information or to set up a cancer education seminar or counseling session contact Casey Shelor, M.S., CHES, CTTS at 479-361-5847 or by email. 

In addition to prevention education, our Save-A-Life program provides assistance to the underserved and uninsured (based on financial need) for screening and diagnostic tests for breast, cervical, colorectal, prostate and skin cancers. Throughout the year, with the assistance of local physicians who volunteer their time, we also hold free prostate (September) and skin cancer (April) screenings and provide free colon/rectal screening kits (March). These programs provide access to early detection, thereby offering a better chance for successful treatment and recovery. For more information, contact Christina Bostian at 479-361-5847 or by email.
For some individuals with a family history of cancer, a hereditary risk consultation may be in their best interest. Consultation is available to discuss risk factors for pertinent cancers. For more information or to set up a personal and confidential appointment, contact Sandy Prince at 479-361-5847 or by email. Patient Support Services When a cancer patient visits their oncologist for the first time, the experience can be a welcome relief, but it can also be a source of great stress and anxiety. All too often, the physical effects of cancer are only a part of the whole picture. Worries about finances, family, side-effects of treatment, and even death can be overwhelming to the point that treatment may seem unbearable and recovery unreachable. Our licensed Social Workers meet with patients and their caregivers - usually on the patient's very first visit to the oncology clinic - to determine what challenges they might face during their treatments. They address those that can be lessened or avoided with our assistance and refer patients to other resources as necessary. Our social workers are allies who are available to be called on as often as necessary on the journey toward recovery. Some of the services we provide include: Transportation – Our drivers provide rides in Hope Cancer Resources' vehicles to and from treatment and other cancer-related medical appointments when a patient is unable to drive. Prescription Assistance – We assist with the purchase of cancer-related prescriptions and will help find long-term drug assistance through pharmaceutical company assistance programs whenever possible. Emergency Assistance – We provide direct, temporary assistance to cancer patients who are struggling financially due to their treatment, including payments for housing and/or transportation needs as well as dental needs associated with their cancer diagnosis. Emotional Assistance - Licensed social workers help patients and caregivers cope with emotional distress. We offer counseling, education and information on support groups offered in our community, including those facilitated by our staff. Spanish Interpretation - Our Spanish interpreter is available to assist patients during appointments as requested by patients and their caregivers. Contact Kathy Taylor at 479-361-5847 or by email.  We are grateful for the support of our community and for our staff who provide such outstanding care. For more information on our services or how you can be involved, contact us at 479-361-5847.