Benefits of Dogs

Healthier Living

Most people know that people who own dogs live longer, have lower blood pressure, less anxiety and better immune systems.  They also have more social interactions, Alzheimer’s patients with dogs in the home have fewer outbursts and men with dogs have lower triglycerides and cholesterol.  These are the scientific conclusions of research about family pets that can be easily found. 

But there are even more benefits and some of them are pretty astounding.  Dogs are being trained to assist in the medical field.  For instance, dogs can be trained to sniff out low blood sugar in diabetics, picking up odors beyond human capacity.  Dogs can also be taught to prod the diabetic with a cold nose, fetch a blood glucose testing equipment or press a phone button that calls 911.

It could be scent or it could be a subtle change in behavior, but some dogs are able to sense a seizure coming on as much as 30 minutes before it occurs.  This means the dog may be able to alert the person, go for help, move objects out of the way and lay down next the person during the seizure.

More and more people with post traumatic stress disorders, such as soldiers returning from war zones, are benefiting from dogs as companions because they can they can ease anxiety in a number of ways.

Dogs also have the remarkable ability to detect certain kinds of cancers.  One example is being able to reveal the presence of bladder or prostate cancer cells in urine.  Some researchers have shown that dogs can recognize lung and breast cancers by smelling the patient’s breath, and they can spot melanoma by licking a person’s skin.

A dog’s brain may be only one tenth the size of a human’s, but his nose more than makes up for it: dogs have 40 times as many scent receptors as humans.  It is truer than ever that dogs really are man’s best friend. 

References: My Health News Daily; Web MD.

This article was originally published in Pathways Residential Care Journal - Issue 4.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Acupuncture for COPD

It's Effective

Dyspnea during exercise can be debilitating.  This fact coupled with earlier findings that acupuncture has been shown to reduce dyspnea in cancer patients led a team of Japanese scientists to explore whether it would also help people with COPD.  They found that, in fact, it does help.

Researchers at Kyoto University conducted a randomized study of 68 patients who were taking standard medications for COPD in various stages.  They were randomly assigned to have actual acupuncture or a placebo treatment in which needles did not penetrate the skin.  Patients received treatment once a week for 12 weeks.

Results showed a statistically significant improvement in dyspnea ratings.  As their dyspnea subsided, patients also demonstrated in tests that they were able to tolerate exercise better and increase the distances they were able to walk.

The study was led by Masao Suzuki, PhD, and published in the Archives of Internal Medicine.

More information is available at: Suzuki M, et al “A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD): the COPD-acupuncture trial (CAT)” Arch Intern Med 2012; DOI: 10.1001/archinternmed.2012.1233.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Most Cancer Docs Reach Out to Bereaved

Seventy percent of cancer physicians contact bereaved family members and caregivers of their patients who die.  But of the 162 physicians surveyed, more than two thirds do not feel adequately trained to do this sort of reaching out.  These were the results of a study presented at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

Most of those surveyed sent condolence letters, and some called or attended funeral services.  One perceived barrier to bereavement follow-up is lack of time.  Another factor was uncertainty about which family member was the most appropriate person to contract.

“This study highlights the need to more clearly define the physicians’ role in bereavement activities and address bereavement activities in providers’ postgraduate training as we work to improve the multidisciplinary treatment of cancer patients and their families,” said lead author Aaron S. Kusano, MD, a radiation oncology resident at the University of Washington School of Medicine in Seattle. 

Source:  www.medicexchange.com/ASTRO-2011/most-cancer-physicians-reach-out-to-bereaved-family-caregivers-astro-2011.html.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

CT Scans in Lung Cancer Screening

New recommendations from the National Comprehensive Cancer Network (NCCN) say that patients determined to be at high risk for lung cancer should have regular screening with low-dose CT scans.

The NCCN guidelines define high-risk patients as:

• Age 55-74 plus ≥30 pack-year smoking history plus smoking cessation <15 years or
• Age ≥50 and ≥20 pack-year history of smoking and other risk factors besides second-hand smoke

A negative scan should be followed by annual low-dose CT scans for three years and then periodically until age 74.  If the baseline image reveals one lung nodule, the patient should have close follow up with additional low-dose CT scans, with the scan interval determined by the nodule’s characteristics.

According to the guidelines, a solid or partly solid nodule ≤4 mm requires annual screening with low-dose CT for three years and until age 74. Larger nodules have shorter screening intervals, ranging to follow-up CT in one month for patients with solid endobronchial nodules. Patients who have nodules with a ground-glass appearance require follow-up CT at intervals ranging from three to six months to 12 months, depending on nodule size.

Patients with a low or moderate risk for lung cancer do not need routine lung cancer screening.  The NCCN defines moderate-risk patients as age ≥50, a smoking history of ≥20 pack-years, and no additional risk factors. A low-risk patients is younger than 50 and has less than a 20 pack-year smoking history.

“Lung cancer screening with CT should be part of a program of care and should not be performed in isolation as a free-standing test,” according to the guidelines available on the NCCN website.

“Given the high percentage of false-positive results and the downstream management that ensues for many patients, the risks and benefits of lung cancer screening should be discussed with the individual before doing a screening low-dose CT.

“It is recommended that institutions performing lung cancer screening use a multidisciplinary approach that may include specialties such as radiology, pulmonary medicine, internal medicine, thoracic oncology, and thoracic surgery. Management of downstream testing and follow up of small nodules are imperative and may require establishment of administrative processes to ensure the adequacy of follow up.”

The NCCN offers additional guidance for solid and ground-glass nodules, based on specific nodule characteristics.

NCCN is a consortium of major US cancer centers.   

Combating Fatigue in Cancer

Pilot Study

A team of researchers from Australia and New Zealand conducted a small pilot study to help determine an appropriate dose of methylphenidate hydrochloride, a central nervous system stimulant, to treat fatigue in patients with advanced cancer.

They reported in Journal of Palliative Medicine that 5 mg twice daily would be an appropriate dose to test in a definitive study. Ten patients provided consent.

After a three-day assessment, patients received titrated methylphenidate hydrochloride at doses ranging from 5 mg a day to 15mg twice a day. Nine patients completed eight days and five received the maximum dose at day 15. Three patients were satisfied with the results at a lower dose and were not willing to increase it.

The team noted a pattern of rapidly improving fatigue and depression at 5 mg twice daily.

Journal of Palliative Medicine, Volume 13, Number 10, Oct. 2010

Spiritual Pain in Advanced Cancer: Symptom for Hospice Chaplains to Address

Quality of Life Can Improve

A vast majority of advanced cancer patients receiving palliative care consider themselves spiritual and religious.  But spiritual pain is still common and is linked to lower quality of life.  This is another place in which the holistic hospice approach to mind and body may improve life’s final stage.

A study done by the Division of Geriatrics and Palliative Medicine, The University of Texas Medical School at Houston, Texas, examined the frequency and intensity of spirituality, religiosity, and spiritual pain, and how spiritual pain was associated with symptom expression, coping, and spiritual quality of life.

Researchers interviewed 100 patients with advanced cancer and had them complete questionnaires assessing their symptoms and ability to cope. 

Spiritual pain was reported in 44%, and was associated with lower spiritual quality of life. Patients with spiritual pain reported that it contributed adversely to their physical/emotional symptoms. There was a trend toward increased depression, anxiety, anorexia, and drowsiness among patients with spiritual pain, although this may not have been significant after corrections.

Every Pathways Hospice patient can have visits from extremely well qualified spiritual care counselors to give unbiased spiritual or religious support to patient or family members, to identify and resolve spiritual concerns, to explore the meaning of life, to administer sacraments, or to be a warm listening presence when needed.

This study can be found at J Pain Symptom Manage.  2011; 41(6):986-94 (ISSN: 1873-6513).

Fiber in Diet Reduces Risk of Breast Cancer

What do avocados, blackberries, oatmeal and black beans have in common?  They are all very high in fiber.  So?   

A study done at Soochow University in China has demonstrated that raising your fiber intake can significantly reduce your risk of breast cancer.

After examining 10 studies of dietary fiber intake and risk of breast cancer involving 16,848 cases and 712,195 participants, they found that the more fiber added to the diet, the lower the breast cancer risk fell.

12 Great Sources of Fiber

Avocados, artichokes, raspberries, blackberries, lentils, black beans, broccoli, vegetable beef soup, pears, apples, oatmeal, and barley.

  
The study was published in the American Journal of Nutrition, 2011; 94(3):900-5 (ISSN: 1938-3207).

Should I Tell My Patient Death Is Imminent?

Does Not Increase Anxiety

When your patient with cancer is terminally ill and you have a good sense of the short prognosis, should you tell him?  It is a well-established practice for American physicians to be forthcoming about prognosis, but not so well established when death is just around the corner.

A study recently published online suggests that keeping the patient fully informed in the final days means that they are more likely to have their preferences met and to die in their preferred place.  Their family members are also more likely to be prepared for the death and to be offered bereavement support.

Researchers in Sweden looked at more than 1,000 cases in which patients were informed of their imminent death and compared this with a similar number who were not informed.  Results showed no differences with regard to pain control, nausea, anxiety, confusion, respiratory tract secretions and other end-of-life symptoms.

“People vary about the extent they want to know the truth, if they want to know at all, and in their understanding of what constitutes telling the truth,” the authors wrote.  But, they concluded, “being informed about imminent death does not lead to more unrelieved pain and anxiety during the last week of life.”

The study concludes that, “providing information of imminent death to a patient with cancer at the end of life does not seem to increase pain or anxiety, but it does seem to be associated with improved care and to increase the likelihood of fulfilling the principles of a good death.”  

The study appears in the Journal of Clinical Oncology, July 2011.

Melanoma: Look for the Ugly Duckling

Atypical Even for Atypical

A group at Memorial Sloan-Kettering Cancer Center in New York found that moles in the same person tend to look alike, but a malignant melanoma will often look different from the individual’s mole pattern—the “ugly duckling sign.”

Identifying pigmented moles that look different from a person’s other moles—“even in those with multiple atypical nevi,” said Dr. Ashfaq A. Marghoob, is a practical way to spot malignant melanoma. His research was published in the Archives of Dermatology.

Marghoob and his colleagues had 34 people with varying levels of expertise identify ugly duckling moles in patients with several atypical moles. Participants included 8 mole experts, 13 dermatologists, 5 dermatology nurses, and 8 non-MD medical staff members.  They were shown photographs of the backs and close-ups of moles from 12 patients who had five melanomas, at least eight atypical moles and 140 benign pigmented moles.

All five melanomas and benign moles were identified as different by at least two thirds of the participants.  Investigators concluded that the usefulness of the ugly duckling method in malignant melanoma skin cancer screening by general health care providers and lay persons “should be further assessed.”

Early Discussions About Prognosis Urged

Individualizing Care

The American Society of Clinical Oncology (ASCO) is calling on physicians, medical schools, insurers, and others to help improve quality of life for people with advanced cancer by discussing the full range of palliative care and treatment options soon after patients are diagnosed with advanced, incurable cancer. 

Currently, physicians talk about prognosis early in the course of advanced disease less than 40% of the time. (In addition to guidelines for physicians, ASCO also released a guide to help patients broach the subject of prognosis and care options with physicians.) 

Critical issues are tackled in a comprehensive article published in the Journal of Clinical Oncology.  

They include:

• Consideration of clinical trials
• Initiating conversations about poor prognosis
• Guidelines for discontinuing cancer-directed treatments
• Individualizing approaches to care
• Empowering patients
• Maximizing quality of life

“Patients with advanced incurable cancer face complex physical, psychological, social, and spiritual consequences of disease and its treatment. Care for these patients should include an individualized assessment of the patient’s needs, goals, and preferences throughout the course of illness,” say the authors.  

The complete article can be accessed at:  http://jco.ascopubs.org/content/early/2011/01/24/JCO.2010.33.1744.full.pdf+html

Time for Hospice?

Pathways can assist you in managing the care  of complex patients, while providing care at home. 

We can help you determine the likely prognosis and if the life expectancy is six months or less, we can suggest ways to approach the patient and family about changing the focus of care from cure to comfort.

If you like, Pathways can have a nurse visit to explain hospice to appropriate patients and families, so that they will have sufficient information to make an informed decision about using their hospice benefit.