Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?
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Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.”
“My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video.
No further details have been released about the Princess of Wales’ treatment.
But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment.
It’s not the same as preventing cancer
To prevent cancer developing, lifestyle changes such as diet, exercise and sun protection are recommended.
Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at high risk of breast cancer.
Aspirin can also be used for those at high risk of bowel and other cancers.
How can chemotherapy be used as preventive therapy?
In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning.
If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer.
If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate around the body .
The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer coming back. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later.
With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back.
If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer.
How effective is preventive therapy?
The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy.
Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The first chemotherapy tested improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%.
Preventive chemotherapy is usually given for three to six months.
How does chemotherapy work?
Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations.
Chemotherapy is not selective for cancer cells. It kills any dividing cells.
But cancers consist of a higher proportion of dividing cells than the normal body cells. A greater proportion of the cancer is killed with each course of chemotherapy.
Normal cells can recover between courses, which are usually given three to four weeks apart.
What are the side effects?
The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells.
The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection.
Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance.
Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet.
There are also generalised symptoms such as fatigue.
Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.
Ian Olver, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What Would a Second Trump Presidency Look Like for Health Care?
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On the presidential campaign trail, former President Donald Trump is, once again, promising to repeal and replace the Affordable Care Act — a nebulous goal that became one of his administration’s splashiest policy failures.
“We’re going to fight for much better health care than Obamacare. Obamacare is a catastrophe,” Trump said at a campaign stop in Iowa on Jan. 6.
The perplexing revival of one of Trump’s most politically damaging crusades comes at a time when the Obama-era health law is even more popular and widely used than it was in 2017, when Trump and congressional Republicans proved unable to pass their own plan to replace it. That failed effort was a big part of why Republicans lost control of the House of Representatives in the 2018 midterms.
Despite repeated promises, Trump never presented his own Obamacare replacement. And much of what Trump’s administration actually accomplished in health care has been reversed by the Biden administration.
Still, Trump secured some significant policy changes that remain in place today, including efforts to bring more transparency to prices charged by hospitals and paid by health insurers.
Trying to predict Trump’s priorities in a second term is even more difficult given that he frequently changes his positions on issues, sometimes multiple times.
The Trump campaign did not respond to a request for comment.
Perhaps Trump’s biggest achievement is something he rarely talks about on the campaign trail. His administration’s “Operation Warp Speed” managed to create, test, and bring to market a covid-19 vaccine in less than a year, far faster than even the most optimistic predictions.
Many of Trump’s supporters, though, don’t support — and some even vehemently oppose — covid vaccines.
Here is a recap of Trump’s health care record:
Public Health
Trump’s pandemic response dominates his overall record on health care.
More than 400,000 Americans died from covid over Trump’s last year in office. His travel bans and other efforts to prevent the global spread of the virus were ineffective, his administration was slower than other countries’ governments to develop a diagnostic test, and he publicly clashed with his own government’s health officials over the response.
Ahead of the 2020 election, Trump resumed large rallies and other public campaign events that many public health experts regarded as reckless in the face of a highly contagious, deadly virus. He personally flouted public health guidance after contracting covid himself and ending up hospitalized.
At the same time, despite what many saw as a politicization of public health by the White House, Trump signed a massive covid relief bill (after first threatening to veto it). He also presided over some of the largest boosts for the National Institutes of Health’s budget since the turn of the century. And the mRNA-based vaccines Operation Warp Speed helped develop were an astounding scientific breakthrough credited with helping save millions of lives while laying the groundwork for future shots to fight other diseases including cancer.
Abortion
Trump’s biggest contribution to abortion policy was indirect: He appointed three Supreme Court justices, who were instrumental in overturning the constitutional right to an abortion.
During his 2024 campaign, Trump has been all over the place on the red-hot issue. Since the Supreme Court overturned Roe v. Wade in 2022, Trump has bemoaned the issue as politically bad for Republicans; criticized one of his rivals, Florida Gov. Ron DeSantis, for signing a six-week abortion ban; and vowed to broker a compromise with “both sides” on abortion, promising that “for the first time in 52 years, you’ll have an issue that we can put behind us.”
He has so far avoided spelling out how he’d do that, or whether he’d support a national abortion ban after any number of weeks.
More recently, however, Trump appears to have mended fences over his criticism of Florida’s six-week ban and more with key abortion opponents, whose support helped him get elected in 2016 — and whom he repaid with a long list of policy changes during his presidency.
Among the anti-abortion actions taken by the Trump administration were a reinstatement of the “Mexico City Policy” that bars giving federal funds to international organizations that support abortion rights; a regulation to bar Planned Parenthood and other organizations that provide abortions from the federal family planning program, Title X; regulatory changes designed to make it easier for health care providers and employers to decline to participate in activities that violate their religious and moral beliefs; and other changes that made it harder for NIH scientists to conduct research using fetal tissue from elective abortions.
All of those policies have since been overturned by the Biden administration.
Health Insurance
Unlike Trump’s policies on reproductive health, many of his administration’s moves related to health insurance still stand.
For example, in 2020, Trump signed into law the No Surprises Act, a bipartisan measure aimed at protecting patients from unexpected medical bills stemming from payment disputes between health care providers and insurers. The bill was included in the $900 billion covid relief package he opposed before signing, though Trump had expressed support for ending surprise medical bills.
His administration also pushed — over the vehement objections of health industry officials — price transparency regulations that require hospitals to post prices and insurers to provide estimated costs for procedures. Those requirements also remain in place, although hospitals in particular have been slow to comply.
Medicaid
While first-time candidate Trump vowed not to cut popular entitlement programs like Medicare, Medicaid, and Social Security, his administration did not stick to that promise. The Affordable Care Act repeal legislation Trump supported in 2017 would have imposed major cuts to Medicaid, and his Department of Health and Human Services later encouraged states to require Medicaid recipients to prove they work in order to receive health insurance.
Drug Prices
One of the issues the Trump administration was most active on was reducing the price of prescription drugs for consumers — a top priority for both Democratic and Republican voters. But many of those proposals were blocked by the courts.
One Trump-era plan that never took effect would have pegged the price of some expensive drugs covered by Medicare to prices in other countries. Another would have required drug companies to include prices in their television advertisements.
A regulation allowing states to import cheaper drugs from Canada did take effect, in November 2020. However, it took until January 2024 for the FDA, under Trump’s successor, to approve the first importation plan, from Florida. Canada has said it won’t allow exports that risk causing drug shortages in that country, leaving unclear whether the policy is workable.
Trump also signed into law measures allowing pharmacists to disclose to patients when the cash price of a drug is lower than the cost using their insurance. Previously pharmacists could be barred from doing so under their contracts with insurers and pharmacy benefit managers.
Veterans’ Health
Trump is credited by some advocates for overhauling Department of Veterans Affairs health care. However, while he did sign a major bill allowing veterans to obtain care outside VA facilities, White House officials also tried to scuttle passage of the spending needed to pay for the initiative.
Medical Freedom
Trump scored a big win for the libertarian wing of the Republican Party when he signed into law the “Right to Try Act,” intended to make it easier for patients with terminal diseases to access drugs or treatments not yet approved by the FDA.
But it is not clear how many patients have managed to obtain treatment using the law because it is aimed at the FDA, which has traditionally granted requests for “compassionate use” of not-yet-approved drugs anyway. The stumbling block, which the law does not address, is getting drug companies to release doses of medicines that are still being tested and may be in short supply.
Trump said in a Jan. 10 Fox News town hall that the law had “saved thousands and thousands” of lives. There’s no evidence for the claim.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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The Yoga of Breath – by Richard Rosen
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You probably know to breathe through your nose, and to breathe with your diaphragm. But did you know you’re usually only breathing through one nostril at a time, and alternate between nostrils every few hours? And did you know how to breathe through both nostrils equally instead, and the benefits that can bring?
The above is one example of many, of things that make this book stand out from the crowd when it comes to breathing exercises. Author Richard Rosen has a deep expertise in this topic, and explains everything clearly and comprehensively, without leaving room for ambiguity.
While most of the book focuses on the mechanics and physical techniques of breathing, he does also cover some more mindstate-related things too—without which, it wouldn’t be yoga.
If the book has a downside, it’s that its comprehensive nature could be off-putting to readers new to breathing work in general. However, since he does explain everything from the ground up, that’s no reason to be put off this book, iff you’re serious about learning.
Bottom line: if you’d like a deeper understanding of breathwork than “breathe slowly through your nose, using your diaphragm”, this book will teach you depths of breathing you probably didn’t know were possible.
Click here to check out The Yoga of Breath, and catch yours!
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How community health screenings get more people of color vaccinated
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U.S. preventive health screening rates dropped drastically at the height of the COVID-19 pandemic. They have yet to go back to pre-pandemic levels, especially for Black and Latine communities.
Screenings, or routine medical checkups, are important ways to avoid and treat disease. They’re key to finding problems early on and can even help save people’s lives.
Community health workers say screenings are also a key to getting more people vaccinated. Screening fairs provide health workers the chance to build rapport and trust with the communities they serve, while giving their clients the chance to ask questions and get personalized recommendations according to their age, gender, and family history.
But systemic barriers to health care can often keep people from marginalized communities from accessing recommended screenings, exacerbating racial health disparities.
Public Good News spoke with Dr. Marie-Jose Francois, president and chief executive officer, and April Johnson, outreach coordinator, at the Center for Multicultural Wellness and Prevention (CMWP), in Central Florida, to learn how they promote the benefits of screening and leverage screenings for vaccination outreach among their diverse communities.
Here’s what they said.
[Editor’s note: This content has been edited for clarity and length.]
PGN: What is CMWP’s mission? How does vaccine outreach fit into the work you do in the communities you serve?
Dr. Marie-Jose Francois: Since 1995, our mission has been to enhance the health, wellness, and quality of life for diverse populations in Central Florida. At the beginning, our main focus was education, wellness, and screening for HIV/AIDS, and we continue to do case management for HIV screening and testing.
When the issue of COVID-19 came into the picture, we included COVID-19 information and education and stressed the importance of screening and receiving vaccinations during all of our outreach activities.
We try to meet the community where they are. Because there is so much misconception—and taboo—in regard to immunization.
April Johnson: So our job is to disperse accurate information. And how we do that is we go into rural communities. We build partnerships with local apartment complexes, hair salons, nail salons, laundromats, and provide a little community engagement, where people just hang out in different areas.
We build gatekeepers in those communities because you first have to get in there. You have to know that they trust you. Being in this field for about 30 years, I’ve [learned that] flexibility is key. Because sometimes you can’t get them from 9 to 5, or [from] Monday through Friday. So, you have to be very flexible in doing the outreach portion in order to get what you need.
I’ve built collaborations with senior citizen centers, community centers, schools, clinics, churches in Orlando and [in] different areas in Orange, Osceola, Seminole, and Lake counties. And we also partner with other community-based organizations to try to make it like a one-stop shop. So, partnership is a big thing.
PGN: How do you promote the importance of preventive screenings in the communities you serve?
M.F.: We try to make them view their health in a more comprehensive way, for them to understand the importance of screening. [That] self care is key, and for them to not be afraid.
We empower them to know what to ask when they go to the doctor. We ask them, ‘Do you know your status? Do you know your numbers?’
For example, if you go to the doctor, do you know your blood pressure? If you’re diabetic? Do you know your hemoglobin (A1C)? Do you know your cholesterol levels?
And now, [we also ask them]: ‘Have you received your flu shot for the year? Have you received all of your vaccine doses for COVID-19?’ We are even adding the mpox vaccine now, based on risk factors.
[We recommend they] ask their provider. For women, [we ask], ‘When do you need to have your mammogram?’ For the men, ‘You need to ask about your PSA and also about when and when to have your colonoscopy based on your age.’
We also try to explain to the community that the more they know their family history, the more they can engage in their own health. Because sometimes you have mom and dad who have a history of cancer. They have a history of diabetes or blood pressure—and they don’t talk to their children. So, we try to [recommend they] talk to their children. Your own family needs to know what’s going on so they can be proactive in their screenings.
PGN: What strategies or methods have you found most effective in getting people screened?
M.F.: Not everybody wants to be screened, not everybody wants to receive vaccines.
But with patience, just give them the facts. It goes right back to education, people have to be assured.
When you talk to them about COVID, or even HIV, you may hear them say, ‘Oh, I don’t see myself at risk for HIV.’ But we have to repeat to them that the more they get screened to make sure they’re OK, the better it is for them. ‘The more you use condoms, [the] safer it is for you.’
In Haitian culture, they listen to the radio. So we use the radio as a tool to educate and deliver information [to] get vaccinated, wash your hands. ‘If you’re coughing, cover your mouth. If you have a fever, wear your masks. Call your doctor.’
In our target population, we have people who have chronic conditions. We have people with HIV. So, we have to motivate them to receive the flu vaccine, to receive the COVID vaccine, to receive that RSV [vaccine], or to get the mpox vaccine. We have people with diabetes, high blood pressure, high cholesterol, depressed immune systems. We have people with lupus, we have people with sickle cell disease.
So, this is a way to [ensure that] whomever you’re talking to one-on-one understands the value of being safe.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Behavioral Activation Against Depression & Anxiety
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Behavioral Activation Against Depression & Anxiety
Psychologists do love making fancy new names for things.
You thought you were merely “eating your breakfast”, but now it’s “Happiness-Oriented Basic Behavioral Intervention Therapy (HOBBIT)” or something.
This one’s quite simple, so we’ll keep it short for today, but it is one more tool for your toolbox:
What is Behavioral Activation?
Behavioral Activation is about improving our mood (something we can’t directly choose) by changing our behavior (something we usually can directly choose).
An oversimplified (and insufficient, as we will explain, but we’ll use this one to get us started) example would be “whistle a happy tune and you will be happy”.
Behavioral Activation is not a silver bullet
Or if it is, then it’s the kind you have to keep shooting, because one shot is not enough. However, this becomes easier than you might think, because Behavioral Activation works by…
Creating a Positive Feedback Loop
A lot of internal problems in depression and anxiety are created by the fact that necessary and otherwise desirable activities are being written off by the brain as:
- Pointless (depression)
- Dangerous (anxiety)
The inaction that results from these aversions creates a negative feedback loop as one’s life gradually declines (as does one’s energy, and interest in life), or as the outside world seems more and more unwelcoming/scary.
Instead, Behavioral Activation plans activities (usually with the help of a therapist, as depressed/anxious people are not the most inclined to plan activities) that will be:
- attainable
- rewarding
The first part is important, because the maximum of what is “attainable” to a depressed/anxious person can often be quite a small thing. So, small goals are ideal at first.
The second part is important, because there needs to be some way of jump-starting a healthier dopamine cycle. It also has to feel rewarding during/after doing it, not next year, so short term plans are ideal at first.
So, what behavior should we do?
That depends on you. Behavioral Activation calls for keeping track of our activities (bullet-journaling is fine, and there are apps* that can help you, too) and corresponding moods.
*This writer uses the pragmatic Daylio for its nice statistical analyses of bullet-journaling data-points, and the very cute Finch for more keyword-oriented insights and suggestions. Whatever works for you, works for you, though! It could even be paper and pen.
Sometimes the very thought of an activity fills us with dread, but the actual execution of it brings us relief. Bullet-journaling can track that sort of thing, and inform decisions about “what we should do” going forwards.
Want a ready-made brainstorm to jump-start your creativity?
Here’s list of activities suggested by TherapistAid (a resource hub for therapists)
Want to know more?
You might like:
- How To Use Behavioral Activation (guide for end users)
- Treatment Guide: Behavioral Activation (guide for clinicians)
Take care!
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Black Bean Burgers With Guacamole
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Once again proving that burgers do not have to be unhealthy, this one’s a nutritional powerhouse full of protein, fiber, vitamins, and minerals, as well as healthy fats and extra health-giving spices.
You will need
- 1 can black beans, drained and rinsed (or 1 cup same, cooked, drained, and rinsed)
- 3 oz walnuts (if allergic, substitute with pumpkin seeds)
- 1 tbsp chia seeds
- 1 tbsp flax seeds
- ½ red onion, finely chopped
- 1 small eggplant, diced small (e.g. ½” cubes or smaller)
- 1 small carrot, grated
- 3 tbsp finely chopped cilantro (or if you have the “this tastes like soap” gene, then substitute with parsley)
- 1 tbsp lemon juice
- 1 jalapeño pepper, finely chopped (adjust per heat preferences)
- ¼ bulb garlic, crushed
- 2 tsp black pepper
- 1 tsp smoked paprika
- 1 tsp cayenne pepper (adjust per heat preferences)
- ½ tsp MSG or 1 tsp low-sodium salt
- Burger buns (you can use our Delicious Quinoa Avocado Bread recipe if you like)
For the guacamole:
- 1 large ripe avocado, pitted, skinned, and chopped
- 1 tbsp lime juice
- 1 tomato, finely chopped
- ¼ red onion, finely chopped
- ¼ bulb garlic, crushed
- 1 tsp red chili pepper flakes (adjust per heat preferences)
Method
(we suggest you read everything at least once before doing anything)
1) Process the walnuts, chia seeds, and flax seeds in a food processor/blender, until they become a coarse mixture. Set aside.
2) Heat a little oil in a skillet, and fry the red onion, aubergine, and carrot for 5 minutes stirring frequently, then add the garlic and jalapeño and stir for a further 1 minute. Set aside.
3) Combine both mixtures you set aside with the rest of the ingredients from the burger section of the recipe, except the buns, and process them in the food processor on a low setting if possible, until you have a coarse mixture—you still want some texture, not a paste.
4) Shape into patties; this recipe gives for 4 large patties or 8 small ones. When you’ve done this, put them in the fridge for at least 30 minutes, to firm up.
5) While you wait, make the guacamole by mashing the avocado with the lime juice, and then stirring into the onion, tomato, garlic, and pepper.
6) Cook the patties; you can do this on the grill, in a skillet, or in the oven, per your preference. Grilling or frying should take about 5 minutes on each side, give or take the size and shape of the patties. Baking in the oven should take 20–30 minutes at 400℉ / 200℃ turning over halfway through, but keep an eye on them, because again, the size and shape of the patties will affect this. You may be wondering: aren’t they all going to be patty-shaped? And yes, but for example a wide flat patty will cook more quickly than the same volume of burger mixture in a taller less wide patty.
7) Assemble! We recommend the order: bottom bun, guacamole, burger patty, any additional toppings you want to add (e.g. more salad, pickles, etc), top bun:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Chickpeas vs Black Beans – Which is Healthier?
- Kidney Beans or Black Beans – Which is Healthier?
- Coconut vs Avocado – Which is Healthier?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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The Best Kind Of Fiber For Overall Health?
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The Fiber Of Good Health
We’ve written before about how most people in industrialized nations in general, and N. America in particular, do not get nearly enough fiber:
Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
Fiber’s important for many aspects of health, not least of all the heart:
What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
As well, of course, as being critical for gut health:
Gut Health 101: Making Friends With Your Gut (You Can Thank Us Later)
But is all fiber “prebiotic fiber”, and/or are some better than others?
Beta-glucan
A recent study (it’s a mouse study, but promising in its applicability for humans) examined the health impacts of 5 different fiber types:
- pectin
- β-glucan
- wheat dextrin
- resistant starch
- cellulose (control)
As for health metrics, they measured:
- body weight
- adiposity
- indirect calorimetry
- glucose tolerance
- gut microbiota
- metabolites thereof
What they found was…
❝Only β-glucan supplementation during HFD-feeding decreased adiposity and body weight gain and improved glucose tolerance compared with HFD-cellulose, whereas all other fibers had no effect. This was associated with increased energy expenditure and locomotor activity in mice compared with HFD-cellulose.
All fibers supplemented into an HFD uniquely shifted the intestinal microbiota and cecal short-chain fatty acids; however, only β-glucan supplementation increased cecal butyrate concentrations. Lastly, all fibers altered the small-intestinal microbiota and portal bile acid composition. ❞
If you’d like to read more, the study itself is here:
If you’d like to read less, the short version is that they are all good but β-glucan scored best in several metrics.
It also acts indirectly as a GLP-1 agonist, by the way:
The right fiber may help you lose weight
You may be wondering: what is β-glucan found in?
It’s found in many (non-animal product) foods, but oats, barley, mushrooms, and yeasts are all good sources.
Is it available as a supplement?
More or less; there are supplements that contain it generously, here’s an example product on Amazon, a cordyceps extract, of which >30% is β-glucan.
As an aside, cordyceps itself has many other healthful properties too:
Cordyceps: Friend Or Foe? ← the answer is, it depends! If you’re human, it’s a friend.
Enjoy!
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