The Princess of Wales wants to stay cancer-free. What does this mean?
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Catherine, Princess of Wales, has announced she has now completed a course of preventive chemotherapy.
The news comes nine months after the princess first revealed she was being treated for an unspecified form of cancer.
In the new video message released by Kensington Palace, Princess Catherine says she’s focused on doing what she can to stay “cancer-free”. She acknowledges her cancer journey is not over and the “path to recovery and healing is long”.
While we don’t know the details of the princess’s cancer or treatment, it raises some questions about how we declare someone fully clear of the disease. So what does being – and staying – “cancer-free” mean?
What’s the difference between being cancer-free and in remission?
Medically, “cancer-free” means two things. First, it means no cancer cells are able to be detected in a patient’s body using the available testing methods. Second, there is no cancer left in the patient.
These might sound basically the same. But this second aspect of “cancer-free” can be complicated, as it’s essentially impossible to be sure no cancer cells have survived a treatment.
It only takes a few surviving cells for the cancer to grow back. But these cells may not be detectable via testing, and can lie dormant for some time. The possibility of some cells still surviving means it is more accurate to say a patient is “in remission”, rather than “cancer-free”.
Remission means there is no detectable cancer left. Once a patient has been in remission for a certain period of time, they are often considered to be fully “cancer-free”.
Princess Catherine was not necessarily speaking in the strict medical sense. Nonetheless, she is clearly signalling a promising step in her recovery.
What happens during remission?
During remission, patients will usually undergo surveillance testing to make sure their cancer hasn’t returned. Detection tests can vary greatly depending on both the patient and their cancer type.
Many tests involve simply looking at different organs to see if there are cancer cells present, but at varying levels of complexity.
Some cancers can be detected with the naked eye, such as skin cancers. In other cases, technology is needed: colonoscopies for colorectal cancers, X-ray mammograms for breast cancers, or CT scans for lung cancers. There are also molecular tests, which test for the presence of cancer cells using protein or DNA from blood or tissue samples.
For most patients, testing will continue for years at regular intervals. Surveillance testing ensures any returning cancer is caught early, giving patients the best chance of successful treatment.
Remaining in remission for five years can be a huge milestone in a patient’s cancer journey. For most types of cancer, the chances of cancer returning drop significantly after five years of remission. After this point, surveillance testing may be performed less frequently, as the patients might be deemed to be at a lower risk of their cancer returning.
Measuring survival rates
Because it is very difficult to tell when a cancer is “cured”, clinicians may instead refer to a “five-year survival rate”. This measures how likely a cancer patient is to be alive five years after their diagnosis.
For example, data shows the five-year survival rate for bowel cancer among Australian women (of all ages) is around 70%. That means if you had 100 patients with bowel cancer, after five years you would expect 70 to still be alive and 30 to have succumbed to the disease.
These statistics can’t tell us much about individual cases. But comparing five-year survival rates between large groups of patients after different cancer treatments can help clinicians make the often complex decisions about how best to treat their patients.
The likelihood of cancer coming back, or recurring, is influenced by many factors which can vary over time. For instance, approximately 30% of people with lung cancer develop a recurrent disease, even after treatment. On the other hand, breast cancer recurrence within two years of the initial diagnosis is approximately 15%. Within five years it drops to 10%. After ten, it falls below 2%.
These are generalisations though – recurrence rates can vary greatly depending on things such as what kind of cancer the patient has, how advanced it is, and whether it has spread.
Staying cancer-free
Princess Catherine says her focus now is to “stay cancer-free”. What might this involve?
How a cancer develops and whether it recurs can be influenced by things we can’t control, such as age, ethnicity, gender, genetics and hormones.
However, there are sometimes environmental factors we can control. That includes things like exposure to UV radiation from the sun, or inhaling carcinogens like tobacco.
Lifestyle factors also play a role. Poor diet and nutrition, a lack of exercise and excessive alcohol consumption can all contribute to cancer development.
Research estimates more than half of all cancers could potentially be prevented through regular screening and maintaining a healthy lifestyle (not to mention preventing other chronic conditions such as heart disease and diabetes).
Recommendations to reduce cancer risk are the same for everyone, not just those who’ve had treatment like Princess Catherine. They include not smoking, eating a nutritious and balanced diet, exercising regularly, cutting down on alcohol and staying sun smart.
Amali Cooray, PhD Candidate in Genetic Engineering and Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research) ; John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research) , and Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research)
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Alzheimer’s: The Bad News And The Good
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Dr. Devi’s Spectrum of Hope
This is Dr. Gayatri Devi. She’s a neurologist, board-certified in neurology, pain medicine, psychiatry, brain injury medicine, and behavioral neurology.
She’s also a Clinical Professor of Neurology, and Director of Long Island Alzheimer’s Disease Center, Fellow of the American Academy of Neurology, and we could continue all day with her qualifications, awards and achievements but then we’d run out of space. Suffice it to say, she knows her stuff.
Especially when it comes to the optimal treatment of stroke, cognitive loss, and pain.
In her own words:
❝Helping folks live their best lives—by diagnosing and managing complex neurologic disorders—that’s my job. Few things are more fulfilling! For nearly thirty years, my focus has been on brain health, concussions, Alzheimer’s and other dementias, menopause related memory loss, and pain.❞
Alzheimer’s is more common than you might think
According to Dr. Devi,
❝97% of patients with mild Alzheimer’s disease don’t even get diagnosed in their internist offices, and half of patients with moderate Alzheimer’s don’t get diagnosed.
What that means is that the percentage of people that we think about when we think about Alzheimer’s—the people in the nursing home—that’s a very, very small fraction of the entirety of the people who have the condition❞
As for what she would consider the real figures, she puts it nearer 1 in 10 adults aged 65 and older.
Source: Neurologist dispels myths about Alzheimer’s disease
Her most critical advice? Reallocate your worry.
A lot of people understandably worry about a genetic predisposition to Alzheimer’s, especially if an older relative died that way.
See also: Alzheimer’s, Genes, & You
However, Dr. Devi points out that under 5% of Alzheimer’s cases are from genetics, and the majority of Alzheimer’s cases can be prevented be lifestyle interventions.
See also: Reduce Your Alzheimer’s Risk
Lastly, she wants us to skip the stigma
Outside of her clinical practice and academic work, this is one of the biggest things she works on, reducing the stigma attached to Alzheimer’s both publicly and professionally:
Alzheimer’s Disease in Physicians: Assessing Professional Competence and Tempering Stigma
Want more from Dr. Devi?
You might enjoy this interview:
Click Here If The Embedded Video Doesn’t Load Automatically!
And here’s her book:
Enjoy!
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The Borderline Personality Disorder Workbook – by Dr. Daniel Fox
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Personality disorders in general get a bad rep. In part, because their names and descriptions often focus on how the disorders affect other people, rather than how they affect the actual sufferer:
- “This disorder gives you cripplingly low self-esteem; we call it Evil Not-Quite-Human Disorder”
- “This disorder makes you feel unloveable; we call it Abusive Bitch Disorder”
- …etc
Putting aside the labels and stigma, it turns out that humans sometimes benefit from help. In the case of BPD, characterized by such things as difficult moods and self-sabotage, the advice in this book can help anyone struggling with those (and related) issues.
The style of the book is both textbook, and course. It’s useful to proceed through it methodically, and doing the exercises is good too. We recommend getting the print edition, not the Kindle edition, so that you can check off boxes, write in it (pencil, if you like!), etc.
Bottom line: if you or a loved one suffers from BPD symptoms (whether or not you/they would meet criteria for diagnosis), this book can help a lot.
Click here to check out the BPD Workbook, and retake control of your life!
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We’re only using a fraction of health workers’ skills. This needs to change
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Roles of health professionals are still unfortunately often stuck in the past. That is, before the shift of education of nurses and other health professionals into universities in the 1980s. So many are still not working to their full scope of practice.
There has been some expansion of roles in recent years – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.
But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.
These include workforce design (who does what, where and how roles interact), legislation and regulation (which often differs according to jurisdiction), and how health workers are funded and paid.
There is no simple quick fix for this type of reform. But we now have a sensible pathway to improve access to care, using all health professionals appropriately.
A new vision for general practice
I recently had a COVID booster. To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home. Nothing remarkable at all about that.
But that interaction required a host of facilitating factors. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.
The future of primary care is one involving more use of the range of health professionals, in addition to GPs.
It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this. This arrangement would need both health professionals to have access to my health record. There also needs to be trust and good communication between the two when the physio might think the GP needs to be alerted to any issues.
This vision is one of integrated primary care, with health professionals working in a team. The nurse should be able to do more than vaccination and checking vital signs. Do I really need to see the GP every time I need a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.
How about pharmacists?
An integrated future is not the only future on the table. Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.
This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.
But a greater role for pharmacists has benefits for patients. It is often easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and this is one of the reasons why independent pharmacist prescribing is gaining traction.
It’s often easier for a patient to see a pharmacist than a GP. PeopleImages.com – Yuri A/Shutterstock Every five years or so the government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies will be paid for dispensing medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.
GPs don’t like competition from this new source, even though there will be plenty of work around for GPs into the foreseeable future. So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.
Who pays for all this?
Funding is at the heart of disputes about scope of practice. As with many policy debates, there is merit on both sides.
Clearly the government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical benefits payments must be redesigned and supplemented by payments that allow practices to engage a range of other health professionals to create health-care teams.
This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear. It must focus on the overall goal of better primary care, rather than simply the aspirations of individual health professionals, and working to a professional’s full scope of practice in a team, not a professional silo.
In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate better access to care from all appropriately qualified health professionals.
In the case of prescribing, it is possible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements could be that pharmacists can only renew medications if they have agreements with the GP and there is good communication between them. This may be easier in rural and suburban areas, where the pharmacists are better known to the GPs.
The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a sensible path to improve access to care using all health professionals appropriately.
Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Kidney Beans vs White Beans – Which is Healthier?
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Our Verdict
When comparing kidney beans to white beans, we picked the white.
Why?
It was close, and each has its strengths! Bear in mind, these are very closely-related beans. But as we say, there are distinguishing factors…
In terms of macros, kidney beans have very slightly more fiber and white beans have very slightly more protein. But both are close enough in both of those things to call this a tie in this category.
When it comes to vitamins, there are two ways of looking at this:
- kidney beans have more of vitamins B1, B2, B3, B6, B9, C, and K, while white beans have more vitamin B5, E, and choline
- kidney beans have slightly more of some vitamins that don’t usually see a deficiency, while white beans have 31x more vitamin E
Nevertheless, we’re sticking by our usual method of noting that this is a 7:3 win for kidney beans in this category; we just wanted to note that in practical health terms, an argument can be made for white beans on the vitamin front too.
In the category of minerals, kidney beans have slightly more phosphorus, while white beans have more calcium, copper, iron, magnesium, manganese, potassium, selenium, and zinc. An easy win for white beans this time.
(In case you’re wondering about the margin on phosphorus, it was 0.2x more, so we’re not seeing a situation like white beans’ 31x more vitamin E)
In short: both are great and both have their strengths. Enjoy both, together if you like! But if we have to pick one, we’re going with white beans.
Want to learn more?
You might like to read:
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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)
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Do We Simply Not Care About Old People?
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The covid-19 pandemic would be a wake-up call for America, advocates for the elderly predicted: incontrovertible proof that the nation wasn’t doing enough to care for vulnerable older adults.
The death toll was shocking, as were reports of chaos in nursing homes and seniors suffering from isolation, depression, untreated illness, and neglect. Around 900,000 older adults have died of covid-19 to date, accounting for 3 of every 4 Americans who have perished in the pandemic.
But decisive actions that advocates had hoped for haven’t materialized. Today, most people — and government officials — appear to accept covid as a part of ordinary life. Many seniors at high risk aren’t getting antiviral therapies for covid, and most older adults in nursing homes aren’t getting updated vaccines. Efforts to strengthen care quality in nursing homes and assisted living centers have stalled amid debate over costs and the availability of staff. And only a small percentage of people are masking or taking other precautions in public despite a new wave of covid, flu, and respiratory syncytial virus infections hospitalizing and killing seniors.
In the last week of 2023 and the first two weeks of 2024 alone, 4,810 people 65 and older lost their lives to covid — a group that would fill more than 10 large airliners — according to data provided by the CDC. But the alarm that would attend plane crashes is notably absent. (During the same period, the flu killed an additional 1,201 seniors, and RSV killed 126.)
“It boggles my mind that there isn’t more outrage,” said Alice Bonner, 66, senior adviser for aging at the Institute for Healthcare Improvement. “I’m at the point where I want to say, ‘What the heck? Why aren’t people responding and doing more for older adults?’”
It’s a good question. Do we simply not care?
I put this big-picture question, which rarely gets asked amid debates over budgets and policies, to health care professionals, researchers, and policymakers who are older themselves and have spent many years working in the aging field. Here are some of their responses.
The pandemic made things worse. Prejudice against older adults is nothing new, but “it feels more intense, more hostile” now than previously, said Karl Pillemer, 69, a professor of psychology and gerontology at Cornell University.
“I think the pandemic helped reinforce images of older people as sick, frail, and isolated — as people who aren’t like the rest of us,” he said. “And human nature being what it is, we tend to like people who are similar to us and be less well disposed to ‘the others.’”
“A lot of us felt isolated and threatened during the pandemic. It made us sit there and think, ‘What I really care about is protecting myself, my wife, my brother, my kids, and screw everybody else,’” said W. Andrew Achenbaum, 76, the author of nine books on aging and a professor emeritus at Texas Medical Center in Houston.
In an environment of “us against them,” where everybody wants to blame somebody, Achenbaum continued, “who’s expendable? Older people who aren’t seen as productive, who consume resources believed to be in short supply. It’s really hard to give old people their due when you’re terrified about your own existence.”
Although covid continues to circulate, disproportionately affecting older adults, “people now think the crisis is over, and we have a deep desire to return to normal,” said Edwin Walker, 67, who leads the Administration on Aging at the Department of Health and Human Services. He spoke as an individual, not a government representative.
The upshot is “we didn’t learn the lessons we should have,” and the ageism that surfaced during the pandemic hasn’t abated, he observed.
Ageism is pervasive. “Everyone loves their own parents. But as a society, we don’t value older adults or the people who care for them,” said Robert Kramer, 74, co-founder and strategic adviser at the National Investment Center for Seniors Housing & Care.
Kramer thinks boomers are reaping what they have sown. “We have chased youth and glorified youth. When you spend billions of dollars trying to stay young, look young, act young, you build in an automatic fear and prejudice of the opposite.”
Combine the fear of diminishment, decline, and death that can accompany growing older with the trauma and fear that arose during the pandemic, and “I think covid has pushed us back in whatever progress we were making in addressing the needs of our rapidly aging society. It has further stigmatized aging,” said John Rowe, 79, professor of health policy and aging at Columbia University’s Mailman School of Public Health.
“The message to older adults is: ‘Your time has passed, give up your seat at the table, stop consuming resources, fall in line,’” said Anne Montgomery, 65, a health policy expert at the National Committee to Preserve Social Security and Medicare. She believes, however, that baby boomers can “rewrite and flip that script if we want to and if we work to change systems that embody the values of a deeply ageist society.”
Integration, not separation, is needed. The best way to overcome stigma is “to get to know the people you are stigmatizing,” said G. Allen Power, 70, a geriatrician and the chair in aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada. “But we separate ourselves from older people so we don’t have to think about our own aging and our own mortality.”
The solution: “We have to find ways to better integrate older adults in the community as opposed to moving them to campuses where they are apart from the rest of us,” Power said. “We need to stop seeing older people only through the lens of what services they might need and think instead of all they have to offer society.”
That point is a core precept of the National Academy of Medicine’s 2022 report Global Roadmap for Healthy Longevity. Older people are a “natural resource” who “make substantial contributions to their families and communities,” the report’s authors write in introducing their findings.
Those contributions include financial support to families, caregiving assistance, volunteering, and ongoing participation in the workforce, among other things.
“When older people thrive, all people thrive,” the report concludes.
Future generations will get their turn. That’s a message Kramer conveys in classes he teaches at the University of Southern California, Cornell, and other institutions. “You have far more at stake in changing the way we approach aging than I do,” he tells his students. “You are far more likely, statistically, to live past 100 than I am. If you don’t change society’s attitudes about aging, you will be condemned to lead the last third of your life in social, economic, and cultural irrelevance.”
As for himself and the baby boom generation, Kramer thinks it’s “too late” to effect the meaningful changes he hopes the future will bring.
“I suspect things for people in my generation could get a lot worse in the years ahead,” Pillemer said. “People are greatly underestimating what the cost of caring for the older population is going to be over the next 10 to 20 years, and I think that’s going to cause increased conflict.”
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.
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