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Cancer Treatment And Diagnosis Backlogs During COVID-19 May Affect Cancer Survival

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Cancer Treatment And Diagnosis Backlogs During COVID-19 May Affect Cancer Survival


Unlike the COVID-19 pandemic, the cancer pandemic has raged on for centuries, though it similarly afflicts people in all corners of the world. In 2020 alone, over 19 million people were diagnosed with cancer globally, and almost 10 million people die from cancer every year.

The COVID-19 pandemic has been devastating to those infected with the SARS-CoV-2 virus, with over 481 million confirmed cases and 6.1 million deaths.

The number of people who have fallen ill or died due to unintended consequences of pandemic control measures has yet to be determined, though these invisible costs of COVID-19 control measures are likely to be substantial.

I am a cancer doctor and health services researcher, and my team has found new evidence that will help count the invisible cost of the COVID-19 pandemic to the cancer pandemic.

Consequences for cancer

For people with cancer, the direct consequences of the pandemic include a potentially greater risk of severe COVID-19 infection. The indirect consequences include delayed diagnosis of cancer, deferred tests and treatment delay. For example, we observed a seven-fold drop in biopsies required for skin cancer diagnosis in Ontario early in the pandemic, with a backlog of over 45,000 cases remaining six months later.

Large drops in cancer diagnoses and cancer surgeries have been observed across Canada and internationally. For example, in Ontario, we saw a 34 per cent drop in cancer diagnoses and a 60 per cent drop in cancer surgeries at the start of the pandemic in 2020. Most concerning is the slow recovery of cancer services following lockdown, leading to diagnostic and treatment delays for those with cancer.

These delays in diagnosis and treatment have many consequences. There are effects on quality of life and mental health while awaiting care. Waiting for cancer care can lead to worsening symptoms and progression to a more advanced stage in some cases. Treatments for more advanced cancer can have more side-effects and may not be as successful.

Treatment delays and survival

To provide evidence to guide the health system response to cancer delays in the midst of the pandemic, our unit performed a study of high-quality evidence on the impact of cancer treatment delays on survival.

We used information from over 1.2 million cancer patients from 34 high-quality studies on 17 conditions where surgery, radiation or systemic therapy are routinely used. We studied seven types of cancer — bladder, breast, cervix, colon, rectum, lung and head and neck — that together represent 44 per cent of all cancers diagnosed worldwide, every year. We measured the survival impact per four-week delay.

Our report published in BMJ found that across seven cancer types, a delay of even four weeks could be associated with reduced survival. For example, cancer surgeries for breast, colon, bladder and head and neck sites were associated with a mortality increase between six and eight per cent for each four-week delay. Sex, advanced age and socio-economic factors were often associated with disparities in waiting times. As the delay increased, the impact on survival became even greater.

What does this mean in practical terms? A team from McGill University and the Canadian Partnership Against Cancer (CPAC) developed a model using information from our study on treatment delay and survival. They found that between 2020 and 2030, disruptions to cancer care during the COVID-19 pandemic could lead to about 20,000 additional deaths from cancer in Canada.

Given that the pandemic has affected global cancer care and that outside of Canada over 19 million people are diagnosed with cancer each year, the global additional deaths from cancer care delays could be substantial.

Implications for care

We now have standardized information covering seven cancers and all three major cancer treatment types demonstrating a link between waiting longer for cancer treatment and worse survival outcomes. If we had a new cancer drug that improved outcomes as much as timely treatment did in our study, societal precedent suggests we’d pay in the five figures per patient for it.

So now what? More research needs to occur in this space. The impact of cancer care delay on more conditions needs to be studied and methods need to be standardized. However, there are important implications for care now.

Given the massive backlog in health services due to the pandemic, investment is needed and is happening at the federal level. This is welcome and important. For example, a 10 per cent increase in treatment capacity could reduce the predicted mortality impact of the pandemic delay in Canada from about 20,000 to 4,000.

As we face other health emergencies and possibly further waves of the COVID-19 pandemic, caution needs to be taken when extending cancer waiting times for reasons unrelated to a patient’s health-care needs. The impact of these delays on cancer patients may take years to emerge, but they can be expected and must be factored into decisions on prioritizing and protecting limited health resources.

During the pandemic, keeping hospitals, clinics and staff safe from COVID-19 infection can ensure optimal resources for timely diagnosis and cancer care. Centralized waiting lists and team-based care for surgery and other services can ensure equitable waiting times for treatment.

Finally, innovation in how care is delivered (for example, learning health systems) and in the care provided (for example, treatments requiring fewer visits to hospital or less human resources) are very important.

It is crucial to treat the patients of the cancer pandemic on time, during the COVID-19 pandemic and beyond.

Timothy P Hanna, Associate Professor of Oncology and Public Health Sciences, Queen’s University, Ontario

This article is republished from The Conversation under a Creative Commons license. Read the original article.





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Feeling Tired All The Time? Possible Causes And Solutions

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Long days of work, lack of sleep, and stress at the office can be the most common factors that make you feel tired. However, feeling “tired all the time” (TATT) without known reasons can be an indication of an underlying health issue that needs immediate attention.

Finding the exact cause of the lingering tiredness can be the first step toward solving the symptom.

Health conditions that cause fatigue:

1. Anemia – Anemia is one of the most common causes of fatigue. A person who has anemia does not have enough red blood cells in the body, causing symptoms such as tiredness, dizziness, feeling cold and crankiness.

Most often, anemia is caused by iron deficiency. Hence, the condition can be best resolved by including iron-rich foods in the diet and use of iron supplements.

2. Sleep Apnea – It causes the body to stop breathing momentarily during sleep. The condition can affect the quality of sleep and hence make you feel fatigued.

For milder cases of sleep apnea, lifestyle changes such as losing weight or quitting smoking can help solve the sleep disorder. In more severe cases where there is an obstruction in breathing, surgeries and therapies can help.

3. Diabetes – A person who has diabetes has changes in blood sugar level, which can cause fatigue. A patient who is already on diabetic medication can also experience tiredness as a side effect of the medication.

Early identification and taking the correct treatment is the key to managing diabetes. Losing extra weight and having a healthy diet also help in the treatment.

4. Thyroid – Thyroid diseases can be due to an overactive or an underactive thyroid gland. In people who have an underactive thyroid (hypothyroidism), the metabolism slows down leading to symptoms such as lethargy and fatigue. In people with an overactive thyroid (hyperthyroidism), the metabolism speeds up leading to fatigue and difficulty sleeping.

Right diet and lifestyle choices, along with medications, can help in thyroid management.

5. Infections – A person can show symptoms of fatigue when the body is fighting a viral or bacterial infection. Infections ranging from the flu to HIV can cause tiredness.

Along with fatigue, other symptoms such as fever, headache, body aches, shortness of breath and appetite loss can also accompany the infection. Treating the symptoms and taking adequate rest helps in faster recovery.

6. Food allergies – Fatigue may be an early warning sign of hidden food allergies and autoimmune disorders such as celiac disease. Identifying the allergen using a food allergy test or through an elimination diet can help in allergy treatment.

7. Heart disease – If you feel exhausted from an activity that used to be easy, then it is good to check your heart health, as fatigue can be an indication of underlying heart disease.

8. Depression/ anxiety – Fatigue can also be an indicator of a mental health disorder such as depression or anxiety. A combination of medication and psychotherapy can help relieve symptoms.

Lifestyle causes

Apart from serious health conditions, certain lifestyle habits such as dehydration, poor diet, stress and insufficient sleep can cause exhaustion. Having a well-balanced diet, regular exercise and routine sleep can help solve fatigue caused by lifestyle habits.

Published by Medicaldaily.com



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How To Overcome Your Sleep Debt And Reclaim Energy

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Picture this: you’re burning the midnight oil, studying or binge-watching your favorite shows, all at the expense of a good night’s sleep. Have you ever stopped to think about the toll it takes on your body and mind? The consequences can be more serious than you might realize.

Not getting enough sleep can translate into a multitude of issues, including weight gain, lack of focus, tiredness, a haze of confusion, and even depression. If you too are encountering similar issues lately then chances are you have a sleep debt.

Wondering what is sleep debt?

People from 13-18 years of age need 8 hours of sleep, whilst adults beyond that age will require at least 7 hours of snooze.

Sleep debt is a collection of the total hours you haven’t slept or traded your sleep for something else. Sleep debt keeps piling up as a person falls short of the total hours of sleep recommended for an adult, according to the Centers for Disease Control and Prevention.

And when you keep letting go of your sleep for other activities, the body adapts to the new normal and effects start to reflect on the energy levels, which deplete.

“However, like every other debt out there, this too has a repayment option,” Dr. Kunal Kumar, medical director of the Sleep Center at Einstein Medical Center in Philadelphia, told Livestrong.

Below are some expert-vetted ways you can pay back the sleep debt. (Courtesy: Livestrong and Sleepfoundation)

Just like financial debt, imagine sleep debt as a debt you owe to your body. It needs to be repaid. The good news is that catching up on sleep is indeed possible.

  • Maintain a set sleep schedule: Overhauling the sleep schedule is a pretty difficult task to achieve, and it’s best to do that gradually. Create a set sleep schedule by making some small changes to your routine. Instead of making abrupt shifts in your bedtime or wake-up time, adjust them gradually by 15 to 30-minute increments.
  • Minimize your gadget usage: Wind down activities and minimize electronic usage before bed to promote better sleep. Relax and prepare for quality sleep by dimming the lights and setting an alarm for 30 minutes to an hour before bed.
  • Reshuffle your sleeping arrangements: Are you finding it hard to get a good night’s sleep due to excessive sweating? Well, here’s a handy solution: consider upgrading to a cooling mattress or opting for cooling sheets. These innovative sleep essentials can help regulate your body temperature, and keep you comfortably cool throughout the night, ensuring a more blissful slumber. Memory foam pillows can work wonders in relieving neck and back discomfort in case you are struggling with backache.
  • Improve the bedroom environment: Create a sleep-friendly bedroom environment by adjusting the temperature for comfort, and blocking out disruptive lights, or noises that might disturb your restful slumber. And if your mattress, pillow, or sheets are worn out or no longer providing the support you need, consider treating yourself to new ones.

Published by Medicaldaily.com



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Omega-3 Fatty Acids Slow The Progression Of Amyotrophic Lateral Sclerosis: Study

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Omega-3 fatty acids are known for a range of health benefits, from promoting brain and heart health to reducing inflammation and protection against several chronic conditions.

In a new study, researchers found that omega-3 acids, especially the type found in foods like flaxseeds, walnuts, chia seeds, canola oil and soybean oil, can slow down the progression of amyotrophic lateral sclerosis (ALS).

It is a debilitating nervous system disease that gradually worsens over time and can be fatal. The condition results in a loss of muscle control and affects the nerve cells in the brain and spinal cord. It is also known as Lou Gehrig’s disease after the baseball player who was diagnosed with it.

The initial symptoms of the disease include muscle weakness, difficulty in walking and hand movements. The symptoms can slowly progress to difficulties with chewing, swallowing, speaking and breathing.

The exact cause of ALS is not known. However, around 10% of people get it from a risk gene passed down from a family member. It is estimated that more than 32,000 people in the U.S. live with the condition.

In the latest study, researchers from Harvard T.H. Chan School of Public Health in Massachusetts evaluated 449 people living with ALS in a clinical trial. The team assessed the severity of their symptoms, the progression of their disease, along with the levels of omega-3 fatty acids in their blood, for 18 months.

The study suggested that alpha-linolenic acid (ALA), a type of omega-3 found in plants, is particularly beneficial in slowing the progression of ALS. The participants with the highest levels of ALA had a 50% reduced risk of death during the study period compared to those with the lowest levels of ALA.

Researchers also found a reduction in death risk in participants who had eicosapentaenoic acid, the type of omega-3 fatty acid found in fatty fish and fish oil, and linoleic acid found in vegetable oils, nuts and seeds.

A previous study conducted by the same team suggested that a diet high in ALA and higher blood levels of the nutrient could reduce the risk of developing the condition.

“In this study, we found that among people living with ALS, higher blood levels of ALA were also associated with a slower disease progression and a lower risk of death within the study period. These findings, along with our previous research suggest that this fatty acid may have neuroprotective effects that could benefit people with ALS,” said Kjetil Bjornevik, the lead author of the study.

Published by Medicaldaily.com



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