Podcasts about population sciences

Jeffrey Ekoma, ASTHO Senior Director for Government Affairs, explains how he came to ASTHO and how his team provides value for members; Vish Viswanath, Professor of Health Communication and Population Sciences at the Harvard T.H. Chan School of Public Health and the Dana-Farber Cancer Institute, explains how an upcoming ASTHO webinar will prepare you to be a better crisis communicator; the Association of Immunization Managers, is celebrating its 25-year anniversary; and Jeff Brown, Acting Commissioner of Health for the State of New Jersey, is ASTHO's newest member. ASTHO Webinar: Don't Panic! A Panel on How to be an Effective Crisis Communicator Association of Immunization Managers Web Page: AIM 2024 Annual Report ASTHO Web Page: New Jersey | Jeff Brown  

The National Cancer Institute (NCI) is exploring how it can leverage artificial intelligence to enhance cancer screening techniques, ultimately improving patient outcomes across the nation. Dr. Katrina Goddard, director of the Division of Cancer Control and Population Sciences at NCI, explains how her division is leveraging AI, and other innovative solutions like the low-dose CT scan, to better detect lung cancer and enable better access to data.

Earlier this month, then U.S. Surgeon General Vivek Murthy called for alcoholic beverages to feature cancer-warning labels similar to the ones on packs of cigarettes. Dr. Ernest Hawk is vice president and head of the division of Cancer Prevention and Population Sciences at The University of Texas MD Anderson Cancer Center and holds the T. Boone Pickens Distinguished Chair for Early Prevention of Cancer. He talks with host Krys Boyd about the ways alcohol causes cancer and what your risk might be. And later in the hour, Isabella Cueto, who covers chronic disease for Stat, talks about the fight the alcohol lobby is waging to stop this idea. Learn about your ad choices: dovetail.prx.org/ad-choices

Andrew Hantel is an assistant professor of medicine at Harvard Medical School and a faculty member in the Divisions of Leukemia and Population Sciences at Dana-Farber Cancer Institute and at the HMS Center for Bioethics. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A. Hantel and Others. The Duffy Null Phenotype — Addressing a Source of Discrimination in Cancer Care. N Engl J Med 2024;391:1969-1972.

Host: Tracy Shuchart for MicDropMarketsGuests: Velina Tchakarova and Pyotr KurzinVelina Tchakarova-Founder of FACEWith over two decades of professional experience and academic background in security and defense, Velina Tchakarova is an expert in the field of geopolitics. As the former Director of the Austrian Institute for European and Security Policy (AIES) in Vienna, Austria, Velina has a wealth of knowledge and expertise in analyzing the geopolitical landscape and its impact on businesses and organizations.Currently serving as an instructor at the Real-World Risk Institute, a member of the Strategic and Security Policy Advisory Board of the Science Commission at the Austrian Federal Ministry of Defense, and a peer board member of the Austrian publication Defence Horizon JournalAt FACE, Velina Tchakarova utilizes her extensive network of experts and real-world experience to offer customized solutions for clients to navigate the geopolitical landscape and make informed decisions. Pyotr Kurzin Pyotr is a geopolitical and international policy professor with experience at the International Crisis Group, UN and World Bank. He obtained his BSc in Population Sciences & Geography from Southampton University and MA in Strategic Studies & International Economics from the Johns Hopkins School of Advanced International Studies.He is also the host of the popular podcast: The Global Gambit DISCLAIMER: This material is presented solely for informational and entertainment purposes and is not to be construed as a recommendation, solicitation, or an offer to buy or sell / long or short any securities, commodities, or any related financial instruments. Please contact a licensed professional before making any investment or trading decisions

Jerome I. Rotter, MD, The Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute, Department of Pediatrics, Harbor-UCLA Medical Center, discusses Genome-Wide Association Studies with JAMA Statistical Editor Roger J. Lewis, MD, PhD. Related Content: Genome-Wide Association Studies

Send us a Text Message.Welcome to a special bonus episode! Recorded live at the RCOG Annual Academic Meeting in January 2024, organised by the Blair Bell Research Society. Join us in conversation with Professor Lucilla Poston, co-hosted with the fabulous Dr Neil Ryan (a clinical academic and subspecialty trainee in gynae-oncology). This is also a chance to celebrate the RCOG Annual Academic Meeting and learn a bit more about the Blair Bell Research Society. With thanks to the RCOG and BBRS for permission to share the recording.  Professor Poston's bio:https://www.kcl.ac.uk/people/lucilla-postonProfessor Lucilla Poston CBE is a Professor of Maternal & Fetal Health in the School of Life Course & Population Sciences. Her research spans maternal nutrition, obesity and gestational diabetes with a focus on the short as well as longer term consequences for the health of mother and the child. Approaches include studies in mother -child cohorts and development of pragmatic interventions in pregnancy to improve pregnancy outcome and child health. Her team also interrogate the early life origins of disease through maternal and child electronic health record data linkages.Professor Poston is President of the International Society for Developmental Origins of Health and Disease, an Honorary Fellow of the Royal College of Obstetricians and Gynaecologists (FRCOG) and was elected Fellow of the Academy of Medical Sciences in 2009. She was appointed NIHR Senior Investigator, Emeritus in 2017, having succeeded twice in open competition. In 2017, Lucilla was awarded a CBE for services to Women's Health. In 2024 Lucilla was listed by Research.com as being one of the top 1000 female scientists in the world, according to the H Index.Previously Professor Poston was the Tommy's Chair of Maternal & Fetal Health and the Director of the Tommy's Maternal & Fetal Research Unit based at St Thomas' Hospital, and the Head of the School of Life Course & Population Sciences.RCOG Annual Academic Meeting info:The RCOG Annual Academic meeting ‘Save the date' and call for abstracts has just been announced! 6-7 Feb 2025https://rcog.eventsair.com/annual-academic-meeting-feb-2025Dr Neil Ryan's bio:https://www.ed.ac.uk/profile/neilryanNeil is the RCOG Subspecialty Trainee in Gynaecology Oncology at the Royal Infirmary of Edinburgh and a CSO/NES Clinical Lecturer at the University of Edinburgh.He was awarded a personal MRC fellowship to undertake a PhD at the University of Manchester (UoM) which he completed in 2020. His thesis was supervised by Professors Crosbie and Evans.His PhD led to a change in NICE guidelines relating to the testing of womb cancer along with numerous publications, presentations, invited lectures and awards.Neil's work was recognised by a President's Doctorial Scholarship and awarded the UoM's highest postgraduate award: The President's Medal. Neil was recently awarded the William Blair Bell Lecture by the RCOG.British Gynaecological Cancer Society (BGCS) podcast info:https://www.bgcs.org.uk/professionals/new-podcast-series/Podcast information:We have not included any patient identifiable information, and this podcast is intended for professional education rather than patient information (although welcome anyone interested in the field to listen). Please get in touch with feedback or suggestions for future guests or topics: conversationsinfetalmed@gmail.com, or via Twitter (X) or Instagram via @fetalmedcast.Music by Crowander ('Acoustic

BUFFALO, NY- August 14, 2024 – A new #editorial was #published in Aging (listed by MEDLINE/PubMed as "Aging (Albany NY)" and "Aging-US" by Web of Science), Volume 16, Issue 14 on July 17, 2024, entitled, “Recalibrate concepts of epigenetic aging clocks in human health.” As detailed in the opening of this editorial, DNA methylation-based epigenetic clocks are used as biomarkers of biological age in human health. Multiple epigenetic clocks have rapidly emerged in the past decade by modeling DNA methylation changes with age in large cohorts, primarily using peripheral blood samples. Despite efforts to understand the functional implications of features used to estimate biological age, the underlying mechanisms of these clocks remain poorly understood, leading to potential misinterpretations of their associations with health outcomes. Researchers Ze Zhang, Brock C. Christensen, and Lucas A. Salas from the Divisions of Population Sciences and Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, the Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, and the Department of Molecular and Systems Biology, Geisel School of Medicine, Dartmouth College explored the association of 12 immune cell types with epigenetic age acceleration (EAA) in both healthy and diseased populations. Their work sheds light on the complex interplay between immune cell composition and epigenetic aging, utilizing high-resolution methylation cytometry in blood samples. “In this editorial, we aim to address the key implications of our study on epigenetic aging clocks in human health from a broader perspective. While epigenetic clocks are widely hyped as aging biomarkers today, it's essential to recalibrate some fundamental concepts in this field.” DOI - https://doi.org/10.18632/aging.206027 Corresponding author - Lucas A. Salas - lucas.a.salas@dartmouth.edu Video short - https://www.youtube.com/watch?v=9lV-pkYm22M Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206027 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, epigenetics, DNA methylation, epigenetic clock, epigenetic age acceleration, methylation cytometry About Aging-US The mission of the journal is to understand the mechanisms surrounding aging and age-related diseases, including cancer as the main cause of death in the modern aged population. The journal aims to promote 1) treatment of age-related diseases by slowing down aging, 2) validation of anti-aging drugs by treating age-related diseases, and 3) prevention of cancer by inhibiting aging. (Cancer and COVID-19 are age-related diseases.) Please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Kathryn Schmitz, PhD, MPH, is the Associate Director of Population Sciences at Penn State University College of Medicine, and, jointly, serves as a Full Professor at the University of Pennsylvania's School of Medicine.  Dr. Kathryn Schmitz is a leading researcher in exercise oncology - the use of exercise in cancer prevention, control, and survivorship. Her research extends from the role of physical activity in the prevention and etiology of obesity-related cancers to the usefulness of activity for rehabilitation and health promotion in cancer survivors of all cancers. Dr. Schmitz serves on the expert panel for the YMCA/Livestrong Foundation Cancer Survivorship Collaborative, wrote the cancer survivorship section of the 2008 U.S. DHHS report of the Physical Activity Guidelines Advisory Committee, served on the ad hoc committee that developed the ACSM Cancer Exercise Trainer certification, and is the lead author of the ACSM Roundtable on Exercise for Cancer Survivors, which published guidance for exercise testing and prescription for cancer survivors in July 2010. --- This podcast episode is sponsored by Fibion Inc. | The New Gold Standard for Sedentary Behaviour and Physical Activity Monitoring Learn more about Fibion: fibion.com/research --- Collect, store, and manage SB and PA data easily and remotely - Discover new Fibion SENS Motion: https://sens.fibion.com/

In this episode, we talk to Dr Adam Geraghty, Associate Professor of Psychology and Behavioural Medicine within the School of Primary Care, Population Sciences and Medical Education at the University of Southampton. Title of paper: Distinguishing emotional distress from mental disorder: A qualitative exploration of the Four-Dimensional Symptom Questionnaire (4DSQ)Available at: https://doi.org/10.3399/BJGP.2023.0574A range of different approaches have been suggested to support primary care clinicians in the identification and management of mental health problems, from brief depression questionnaires, to approaches focusing on shared understanding within consultations. The Four-Dimensional Symptom Questionnaire (4DSQ) is a questionnaire developed in primary care that can support this process by distinguishing general distress from depressive or anxiety disorder. In this study we show that people recruited from primary care and community settings find completing a multidimensional questionnaire acceptable and find the splitting of general (potentially severe) distress from depression and anxiety helpful. Use of the 4DSQ may support collaborative diagnostic conversations as part of primary care consultations.

I didn't really know chemo brain is "real" until just recently. Dr. Todd Horowitz has done research on "chemo brain" - with the better term being "cancer-related cognitive impairments", or CRCI. CRCI is real, find out how it manifests, and what can help. (Spoiler alert: it is mental and physical exercise!) Todd Horowitz, PhD, is a prominent cognitive psychologist with a keen interest in understanding how the human mind processes visual information and the complexities of perception and attention. He has made significant contributions to our understanding of visual memory, visual search, and attentional mechanisms with over 70 peer-reviewed papers. He is currently Program Director in the Behavioral Research Program's Basic Biobehavioral and Psychological Sciences Branch, located in the Division of Cancer Control and Population Sciences at the National Cancer Institute. 

There is so much that we don't know in medicine, plus there is human error, and it would be great if AI could help. Dr. Todd Horowitz is an expert in attention and research on medical image perception. We talk about what you can see in a quick glance, how computer algorithms can fail, and how best to figure out how AI can help us. Dr. Todd Horowitz, PhD, is a prominent cognitive psychologist with a keen interest in understanding how the human mind processes visual information and the complexities of perception and attention. He has made significant contributions to our understanding of visual memory, visual search, and attentional mechanisms with over 70 peer-reviewed papers. He is currently Program Director in the Behavioral Research Program's Basic Biobehavioral and Psychological Sciences Branch, located in the Division of Cancer Control and Population Sciences at the National Cancer Institute. 

Dr. Shannon Westin and her guests, Dr. Emily S. Tonorezos and Dr. Michael Halpern, discuss their article, "Myths and Presumptions About Cancer Survivorship" recently published in the JCO. TRANSCRIPT The guests on this podcast episode have no disclosures to declare.   Shannon Westin:Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we go in depth on manuscripts published in the Journal of Clinical Oncology. I am your host, Social Media Editor of the JCO, Shannon Westin, and also a GYN Oncologist by trade. I'm thrilled to bring a topic that is very close to my heart. We're going to be talking about a Comments and Controversies article published in the JCO on November 16, 2023, entitled "Myths and Presumptions about Cancer Survivorship." I know you all will find this topic as enthralling as I have, and the authors do not have any conflicts of interest.  I'm joined by two of the authors on this important work. The first is Dr. Michael Halpern, he's the Medical Officer in the Health Assessment Research Branch of the Health Care Delivery Research Program. Welcome, Dr. Halpern. Dr. Michael Halpern: Thank you for having us on. Shannon Westin: We're also accompanied by Dr. Emily Tonorezos, the Director of the Office of Cancer Survivorship, and both of them work in the Division of Cancer Control and Population Sciences at the National Cancer Institute, National Institutes of Health. Welcome.  Dr. Emily Tonorezos: Thank you for having us. Shannon Westin: So, let's get right into it. I want to level set first. I would love for one or both of you to speak a little bit about the state of cancer survivorship currently. What's the prevalence of cancer survivors here in the US? Globally? What do we expect as time passes? Dr. Emily Tonorezos: Thank you for starting with this question. In the Office of Cancer Survivorship, we use a definition of cancer survivor that we got from the advocacy community many years ago. We use a definition that says “a person is a cancer survivor from the time of diagnosis through the balance of life.” That means in the United States, we estimate that we have a little over 18 million cancer survivors, and globally, it's a little more difficult to estimate those numbers. Not every country has a cancer registry to count the number of cases, but we think there are upwards of 53 million cancer survivors diagnosed within the last five years in the world. Shannon Westin: Wow. And so this is why it's so important, such a large number, and that's just an estimate. And we know this is only going to be growing. I personally learned so much from your manuscript, which is critically based on the understanding that our beliefs as practitioners truly impact the way we care for our cancer survivors. I admit, I definitely held or hold some of these beliefs, and I'm certainly grateful that you're providing that objective evidence to support or refute these claims.  So, with that being said, let's tackle the first one that you all approached: Shared care results in the best outcomes for cancer survivors. I think first I'd love to hear about what your definition of shared care is. What does that really mean in the context of cancer survivorship? Dr. Michael Halpern: Shared care is a deliberate process to coordinate and integrate components of survivorship care between specialty, in this case, oncology providers, and primary care providers. And part of the issues with this belief about shared care being the best have to do with the broad practice experience of survivorship care. While the ideal definition is this integrated and coordinated care, shared care can range from one extreme to being essentially oncologist-led care - where the oncologist also sends information to the primary care providers; and to the other extreme - care led by primary care providers and an oncologist is available to answer questions as needed. So part of the issue with the available literature is that there is a tremendous range in terms of the definition of shared care that's being used in studies. Shannon Westin: So, understanding those limitations, obviously, based on what you just said, what have we seen in some of the studies that have been exploring shared care and what it might mean for cancer survivors? Dr. Michael Halpern: So there have been some wonderful studies and some very well-done research in shared care. The majority of it indicates essentially no benefits, not any worse, but definitely not any better than other survivorship care models among multiple domains, quality of life, patient preference, clinical outcomes, in some cases, costs. So there isn't at this point a rationale for believing that shared care leads to better outcomes than does other types of models of care. And that's not to say that we don't think that shared care is a valuable model, that it's potentially very useful and beneficial for certain groups of cancer survivors. It's just that at this point, we don't have evidence to say who it is going to have optimal outcomes for compared to other kinds of survivorship care models.  Shannon Westin: And that makes sense. I mean, I think we're seeing this over and over again in all aspects of cancer care that one broad stroke or one broad plan isn't right for everybody, whether that's therapeutic or surgical or prevention, so it makes sense to me that that's what we're seeing here in survivorship as well. So I see this manuscript as a call to action about what are we missing, what data do we need to generate to really be able to move this care forward. So that makes total sense to me. And I guess in line with that, another belief, and I've heard this all the time from my patients, too, is this idea that primary care providers feel unable to provide survivorship care. They're not comfortable. “Oh, you have a diagnosis of cancer. You have to be seen there at the cancer center.” What does our evidence demonstrate here? Dr. Emily Tonorezos: This is another belief that was found to be a presumption. So that means that this is a belief that we think was true, but which convincing evidence does not confirm or disprove. So what the available evidence tells us is that primary care providers do have challenges in taking care of cancer survivors, particularly with regards to certain cancer-related care needs. But at the same time, we found lots of evidence that primary care providers are more than willing and able to take care of cancer survivors. They express confidence in their skills. They think that they are capable of taking care of cancer survivors. And especially for survivors of more common cancers, primary care providers, in general, express a lot of confidence in their ability to take care of those patients. What they might lack could be things along the lines of survivorship-specific knowledge. So that is a gap that we identified. But this idea that primary care feels unable to take care of survivors really was not supported by the evidence. Shannon Westin: I mean, and that makes sense, right? If we're seeing more and more cancer survivors, primary care is going to adapt to that. We adapt to the things we see commonly in our clinics, and that goes across all specialties. So that certainly makes sense. I guess you've already kind of said this, and I'll just highlight it for the listeners. You know, clear guidelines seem to be a clear, nice option to potentially improve this situation.  So let's discuss this next myth that you all identified, that oncology providers are hesitant to transition survivors to primary care. Now, I understand this one because I definitely, we get this a lot, and I'm a center medical director in GYN, and we've definitely tried to put patients that are free of disease out back in the community to be able to free up space for other patients. And we definitely get pushback because seeing patients that are in this state of being free of disease and they're living their life, it's inspiring. We remember why it is we're doing the things we do. What did the data show us about this myth? And are we creating barriers to this transition to survivorship care outside of the oncology centers? Dr. Emily Tonorezos: Exactly. So this belief is a myth. We found evidence that this belief is not true, and it seems to be one of those things that feels true, that oncologists want to take care of cancer survivors, that it contributes to the joy of medicine. But that evidence really does not suggest that that's the case. In fact, the opposite is true in the evidence. We found when we looked at the available research Oncologists want to take care of people who are diagnosed with cancer and need treatment. That is really what they think their role is. That's what they feel they're contributing. And so, even though there is a pleasure in seeing a person who has finished treatment, most oncologists say that the amount of time that they spend taking care of people who are done with treatment is appropriate - meaning they're not looking to expand their panel of post-treatment patients. They really want to take care of people who need treatment currently and then perhaps have a little bit mixed in of people who are done with treatment or who are in that survivorship phase. We found a lot of evidence, also hard evidence, that oncologists are, in fact, transitioning survivors to primary care. There is a lot of evidence that people who have been diagnosed with cancer are being seen in primary care and that that proportion increases over time. So if oncologists were really creating these insurmountable barriers to transition to primary care, we would not be seeing so many survivors in the primary care setting. But the fact is they're there, and they are being moved there by their providers. Shannon Westin: I love hard evidence. I do have a few patients that have said, "Can I just come see you every once in a while?" And I love seeing them, but I agree, we can't fill our panels with that. So that makes good sense.  So the next topic centers around finances, and this is the idea that survivorship clinics lose money. What truth did you all discover here regarding reimbursement for this type of care?  Dr. Michael Halpern: We discovered that this is a presumption. It's a belief that there isn't compelling evidence one way or the other. Part of the issue with this is probably some confusion about what constitutes survivorship care. There are certainly difficulties in obtaining reimbursement for certain survivorship services, such as sexual health and fertility counseling, and wellness and exercise services. It's understandable that there may be problems getting reimbursement or appropriate reimbursement for those. But when looking at overall survivorship care, there are actually very few studies that have done a financial analysis of the cost of providing that care versus the reimbursement. And those that have done more detailed analyses generally show that the reimbursement for survivorship care is greater than the cost. Survivorship care clinics actually do break even or make money.  Now, it's also true that providing survivorship care likely doesn't provide the same level of reimbursement as providing oncology treatments, which involves administering systemic agents and different kinds of imaging or diagnostic procedures. And so there are other streams of reimbursement possible for that. But overall, there really isn't compelling evidence to indicate that survivorship clinics lose money. There is a concern that having this widespread belief that they do may be a disincentive for hospitals or healthcare systems to start different kinds of survivorship clinics. Shannon Westin: I think this is an area where it would really behoove us to do more work so that we can encourage institutions to do this. And, I know in our center, the things that you're mentioning, it's exactly like the problems that these people are having around sexual health and fertility and exercise, wellness in general, I mean, those are the soft things that I feel like it's harder to kind of gain momentum to really develop established programs that really make an impact. And so I was so glad to see that you mentioned that in this paper, and I hope it will encourage people to really move that forward.  So finally, I was interested in this presumption around the shared electronic health records and how that might help with survivorship care coordination. Is this our solution for smooth communication and care of these people? Dr. Emily Tonorezos: This one was actually almost something that's sort of funny to think about, how naive we were about electronic health records. We found a number of examples from five or ten years ago where leaders in survivorship research and clinical care were saying, "Well, once we have electronic health records, we will not have these same problems of care coordination or communication." And that has just not been true, unfortunately. So this one was also a presumption, meaning the evidence of a benefit for electronic health records just was not out there. So we know that consolidation and transfer of diagnostic and treatment information can increase knowledge. So you can show that you can increase knowledge about diagnosis and treatment with a shared electronic health record. So the primary care provider is able to look, for example, at the pathology from the original diagnosis. But whether that actually results in anything in terms of improved care is an open question. Shannon Westin:I think that's what we've learned a lot about electronic health records in general. I remember when we were transitioning to our new system, and everyone thought, "Oh, this is going to be the end all, be all." And it has been good in a lot of ways, but it certainly hasn't been the cure for everything that ails us.  Well, I'm just so thrilled. Thank you all so much. This has been really educational and so important, given what we've already talked about, about the increasing population of cancer survivors that we're seeing in the clinic and globally. I think just to kind of tie a bow on it, I would just love to hear each of your bottom lines regarding kind of where we are right now with the care of our cancer survivors and what we need to be addressing maybe in the short term to move things forward. Dr. Emily Tonorezos: So I'll go first. I just want to say it's really important, I think, when we are around other investigators and in our meetings and talking about clinical care, that we think critically about the things that we hear people saying. This idea, especially the one that oncology providers don't want to transition their survivors to primary care, but the others as well. I think the way that we need to address this or carry this forward is to just be aware when we're in those settings and we hear people say things, to ask the question, "Is that really supported by the evidence?" And you may find that there are even more of these commonly held beliefs that really aren't supported by the evidence or that deserve a little bit of a deeper dive. Dr. Michael Halpern: I very much agree with that. And it's critical that we be willing to question some of these beliefs, be willing to discuss them, and not accept them as facts in order to be able to develop new research programs, hypotheses, to explore really what can help produce the best outcomes for survivors, because that's really what we're all about.   The other bottom-line issue, I think, one, Dr. Westing that you brought up, is that survivorship isn't a one-size-fits-all. The best survivorship care is the care that is tailored towards the survivor - the individual needs and wants. What kind of supports will be most effective in terms of enhancing their health? So, we really need to pay attention to the individual and, most importantly, what outcomes for survivorship care matter most to the survivor? What do they want to see happen? What do they want their subsequent future to look like? And how do we measure those outcomes to ensure that they get the best care on the terms that they want?  Shannon Westin: Well, great. I think that's a perfect place to end. I just want to, again, thank my guests. This went by so fast, and I learned a ton, and I hope all of you did as well. Again, we were discussing the Comments and Controversies manuscript "Myths and Presumptions about Cancer Survivorship" published in the JCO on November 16, 2023.  Thank you again to our listeners for joining JCO After Hours. And please do check out our other offerings wherever you get your podcasts. Have an awesome day.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Jane K. Steinberg, PhD, MPH is an Associate Professor in the Department of Population Sciences and Public Health in the Keck School of Medicine at USC. Trained as a behavioral scientist, her research focuses on determinants of multiple risk behaviors (alcohol/drug use, tobacco and cannabis use) among youth, and the development of effective programs and policy responses to reduce health risks and achieve health equity. Dr. Steinberg also serves as the Director of Public Health Practice for the department. She is currently a co-investigator on a HRSA workforce development grant to develop a career pipeline for MPH students into public health sector careers through scholarships, workforce training, mentorship and career placement opportunities. Dr. Steinberg received her B.A. in Psychology from the University of California, Davis, and her MPH and PhD in Community Health Sciences from the University California, Los Angeles.Learn more about Trojan Scholars for Advancement in Public HealthMore than a typical scholarship, Trojan Scholars for Advancement in Public Health is a merit-based scholarship and mentorship program that is aimed at training Master of Public Health students to attain knowledge and competencies that will enable them to secure positions in public health organizations that address health disparities and inequities among residents of Los Angeles County.The program will provide full scholarship to select recipients that covers up to 42 units of tuition required to complete MPH training. Scholarship recipients will participate in an academic and career building mentorship program focused on core public health functions and social determinants of health.As part of their training, MPH students will complete an applied practice experience (practicum) in one of the partner organizations that serve areas of Los Angeles County with high proportions of health disparities and underserved residents.Learn more about the Master of Public Health ProgramLearn more about this episode and others at keck.usc.edu/pphs/podcastStay in the loop - subscribe to the Preventive Dose newsletter for monthly news straight to your inbox.Follow us on social - find us at @uscpphs Instagram TikTok Facebook LinkedIn X YouTube

Jennifer Mack, MD, MPH from Dana-Farber Cancer Institute/Boston Children's and Harvard Medical School join us on OsteoBites to discuss best practices for engaging patients in research and clinical trials. Dr. Mack is also part of the PE-CGS Network (Participant Engagement and Cancer Genome Sequencing) Count Me In Research Center team and she will be discussing reasons that patients may or may not want to participate in research, ways to engage patients in designing and carrying out trials., and Count Me In as one model for engaging patients.Dr. Mack received her medical degree from Harvard Medical School in 1998. She subsequently completed her residency in Pediatrics and her fellowship in Pediatric Hematology Oncology at Boston Children's Hospital and the Dana-Farber Cancer Institute in Boston, MA. In 2005, Dr. Mack received a Master's Degree in Public Health from the Harvard School of Public Health. She is an attending physician at Dana-Farber Cancer Institute and Boston Children's Hospital, Director of the Center for Outcomes and Policy Research at Dana-Farber, Associate Chief of the Division of Population Sciences at Dana-Farber, Associate Chief for Pediatric Oncology Population Sciences at Dana-Farber/Boston Children's, and Faculty Vice President for the Office for Faculty Development, Professionalism, and Inclusion at Dana-Farber. She is also an Associate Professor of Pediatrics at Harvard Medical School. Her research interests are in parent-clinician and patient-clinician communication, health care equity and quality, and palliative care.

Beat Cancer hosts Chris Joyce and Stephanie Winn sit down with Dr. Shehnaz Hussain, molecular epidemiologist and Associate Director of Population Sciences at the ⁠⁠⁠UC Davis Comprehensive Cancer Center⁠⁠⁠ to discuss her study on wildfire smoke and how it leads to increased risk of cancer among firefighters. To learn more about the UC Davis Comprehensive Cancer Center, visit ⁠⁠⁠https://health.ucdavis.edu/cancer⁠⁠⁠. To learn more about Dr. Hussain's research study, visit: https://studypages.com/s/california-firefighter-cancer-research-study-215220/?ref=gallery

A variety of perspectives are explored as Dr. Westin speaks with Dr. Jennifer Mack, Dr. Chun Chao, and Mallory Casperson about end-of-life care planning in adolescent and young adult cancer. TRANSCRIPT The guest on this podcast episode has no disclosures to declare.  Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we get down and dirty with manuscripts that are being published in the Journal Clinical Oncology. And I am your host, Shannon Westin, GYN Oncologist and Social Media Editor of the Journal of Clinical Oncology. I am so very excited to have a number of guests with us today to discuss a very important paper entitled “Discussions About Goals of Care and Advanced Care Planning Among Adolescents and Young Adults with Cancer Approaching the End of Life.”  And I'm joined by several of the authors of this important paper. The first is Dr. Jennifer Mack. She is the Associate Chief in the Division of Population Sciences, an Associate Professor at Harvard Medical School and Senior Physician in Pediatric Hematology Oncology at the Dana-Farber Cancer Institute. Welcome, Dr. Mack. Dr. Jennifer Mack: Thank you. Dr. Shannon Westin: We also have Mallory Casperson. She is the cofounder and CEO of the Cactus Cancer Society. They provide online support programs and resources to young adult cancer survivors and caregivers in the comfort of their own homes. Welcome.   Mallory Casperson: Thanks for having me. Dr. Shannon Westin: And then, finally, last but not least, Dr. Chun Chao. She is a Senior Research Scientist in the Division of Epidemiologic Research in the Department of Research and Evaluation at Kaiser Permanente Southern California. Welcome.  Dr. Chun Chao: Thank you. It's a pleasure being here. Dr. Shannon Westin: So I want to get right into this. I think that there certainly has been a lot of discussion, at least at our institution as well as at the ASCO level, around advanced care planning across all patients with cancer and anyone with a diagnosis of cancer. And I would love to just start and level set and make sure all of our listeners are all on the same baseline around the incidence and prevalence of cancer in adolescents and young adults. Like, first, define what are the age groups that we're looking at here? How common is cancer in this population? Dr. Jennifer Mack: Right. For this study, we defined adolescents and young adults as individuals aged 12 to 39. And right now, about 90,000 adolescents and young adults are diagnosed with cancer in the United States each year. Those numbers are also rising, so more and more are diagnosed each year, and because of that, we think it's increasingly important to pay attention to the needs of this population. This population really experiences a whole range of different cancer types, some of which are more common in children, some of which are more common in adults, but the most common ones include breast and gastrointestinal cancers, sarcomas, germ cell tumors, leukemias, lymphomas, and brain tumors. Dr. Shannon Westin: And your manuscript notes that adolescents and young adults seem to receive medically intensive measures at the end of life. Now, how common is this across this group? And do you all have a sense of some of the reasons that we see this increased use of these measures? Dr. Jennifer Mack: That's a great question. We and others—actually, the early work that led to this study was done with Chun. We had previously found that most adolescents and young adults receive at least some kind of medically intensive care at the end of life. And that includes things like being hospitalized, being in the intensive care unit, receiving chemotherapy, and spending time in the emergency room near the end of life. And so, if you take all of those together, about two-thirds of adolescents and young adults receive at least one of these near the end of life.  And we don't know the reasons for this. There are probably complex reasons. Some adolescents and young adults may actually want to receive these kinds of measures, maybe because they're young and they want to do everything they can to live as long as they can. And some patients in this age group are parents to young children, and they may be making choices to prolong life and be there for their kids. But we also know that if we look at older adults, most people who know they're dying don't want to receive this type of care, which is also associated with more suffering and with poorer quality of life. So it's also possible they're making these choices because they don't fully recognize they're approaching the end of life or because they haven't had opportunity to plan for this time through conversations with their medical teams. Mallory Casperson: I think the conjecture, too, that a young adult is likely to focus on extending life, even in a situation where palliation is the stated goal, is a really great conjecture. This population is really burdened by these unique psychosocial issues that are driven by the extreme disruptions that cancer has on major life milestones. Like Jenny said, they may have young children at home, they may have a new spouse at home, still be trying to advance at work, you name it. So this period of young adulthood is really characterized by constant change. And it's possible that these young adults are being driven to stay present in their lives for really as long as possible to reach some of these goals or even just to support their young families as they reach their own goals. Dr. Shannon Westin: I really appreciate that context, and I'm going to always bring it back to what I know as a provider of gynecologic cancer care, where we see quite a bit of young people at the beginning of their life, at the beginning of their fertility. And I think it is so important to keep that context in mind as we're designing interventions and studies and things like that. So I really appreciate that, having the ability to kind of see from that standpoint. So I think you guys have convinced me this is important. We know the reasons. So why don't we just lay out the objectives of this particular study and give our listeners a brief review of how it was designed? Dr. Jennifer Mack: Great. We wanted to know how often adolescent and young adult patients with incurable cancer have discussions about prognosis and end-of-life care planning before they die. And a secondary goal was to understand whether having earlier discussions would change the type of care that's delivered. So, for example, having those discussions about goals of care earlier in their illness, could that make them less likely to receive intensive measures?  So, to do the study, we conducted a retrospective review of health records for nearly 2,000 adolescents and young adults who died between 2005 and 2019 after receiving care in one of three centers—the Dana-Farber Cancer Institute, Kaiser Permanente Southern California, Kaiser Permanente Northern California—and looked for documentation of discussions about care planning. For this study, we focused on patients who either had stage IV disease at diagnosis or who had experienced a recurrence because we wanted to ensure that we had a population of young people who were living with advanced disease and not people who might have died suddenly and unexpectedly during treatment, because they might not have had the same opportunity for end-of-life care planning. So we really wanted to focus on those who had the poorest prognoses. Dr. Shannon Westin: It's a really large group of people and, I think, hopefully fairly representative. I guess my question is, when you're looking at the group that you were able to kind of pull from in this retrospective database, which I think can sometimes be limited, do you feel like it was fairly representative of the population that's out kind of across the States, let's say? Dr. Chun Chao: So I think it's a real strength that we included two different care settings in this study, so a tertiary cancer center and community-based cancer care. Therefore, patients who seek care in each of these settings are representative in our study. I think this design really increased the generalizability of our findings. And on a further note, in this study, we actually observed very similar care patterns across all three study settings. So that was quite reassuring. Dr. Shannon Westin: So reassuring. And I think it brings up a point that I wanted to make, and I also agree was a strength of your study, is having that across the academic center and then a large integrated health plan. And I guess I'm just curious how your collaboration came to be to kind of come across different groups and, of course, the inclusion of Mallory from the patient advocate side. I think this is a testament to your powers of collaboration. I'd just be interested in how that kind of came to be. Dr. Chun Chao: So this goes back to almost 10 years ago. I think, at that time, people started to really recognize that adolescent and young adults with cancer were a very understudied group, but they are also very challenging to study. So, for example, AYA cancers, adolescent and young adult cancers, are fortunately not very common. Although the number is increasing, you do need a large population base to study them. So, at that time, researchers at Integrated Health Systems started to really see that we had an opportunity here to really contribute to this knowledge gap, leveraging the resources that we had at these health systems, especially the ones that have a very large membership and a long-term retention of these members and also a comprehensive electronic medical record system.  At that time, my colleague and I published a study that demonstrated the feasibility of using these resources to do follow-up studies of long-term health outcomes of AYAs with cancer. And I think that we might have attracted people's attention to utilizing the resources at these health systems to do such studies. So Jenny was the one who really saw the need or the lack of data or the need of high-quality data to really improve care for our AYAs who are at that end-of-life stage. So she reached out to a research network called the Cancer Research Network, who I think that the people there connected Jenny with me because I was also starting to work on long-term health outcomes of AYA cancer survivors, adolescent and young adults. After we talked, we were like, “We have to get this funded. We have to get these questions answered. These questions are so important.” So, as Jenny mentioned, we did a pilot study that really showed there is a lot of burden of medical intensive care at the end of life for our young patients. And, as often is true with research, this opens up a lot more additional questions that we needed answers for. So we have been working together since then.  Mallory Casperson: I came into this group sort of by accident. My background is in engineering. I was about halfway through a PhD when I needed to leave a couple years outside of my first cancer diagnosis. And I was at ASCO staffing a booth for my organization and just happened to meet a researcher from Kaiser Permanente Northern California, and the rest is history. That introduction sort of got me into this world, and, once you know one person, you get to meet others. And it's just been a really, really wonderful opportunity to help, I think, insert the patient voice. But also, for me, I just love research and data. And so getting to help advance the conversations happening around adolescent and young adult care in this research setting and in these settings where we are getting to look at very large datasets has just been really, really wonderful. Dr. Shannon Westin: These are my favorite parts of these podcasts, these stories of how things kind of came to be. And, at the risk of taking too much time there, I love the story, and I'm so in awe of you guys.  I guess, let's get to the bottom line. What did you guys find? Did you find what you expected in regards to advanced care planning and goals of care in this population? Dr. Jennifer Mack: So we felt that most patients had documented discussions about prognosis, about goals of care, about palliative care, hospice, and their preferred location of death before they died. Dr. Shannon Westin: So I was actually kind of impressed at that. It seemed like a lot. I was expecting—I don't know what I was expecting, but I think I was expecting less documented discussions because, in my own practice, I don't necessarily think I do a great job of this. So was that in line? Were you expecting to see such kind of high levels of documentation? Dr. Jennifer Mack: I really agree with you. I was impressed with the fact that most patients had these discussions. Many of them had more than one discussion about their goals of care. So their providers were going back and having follow-up discussions, making sure that their goals of care were the same and weren't changing over time. So I agree. I was pleasantly surprised with how often these were happening.   I would say I'd love to see these discussions either happening with everyone or at least offered to all patients so that they can say whether they want to have them or not. So, in this study, 17% of patients never had a discussion about goals of care. And non-white and Hispanic patients had lower rates of discussions than white patients. So there are some potentially important gaps here that need attention. But I also think you're right; there's a lot of good news here. Clinicians are making consistent efforts to talk with patients about their wishes for care, and then they're documenting them, which is an important thing because it allows those wishes to be known by everybody on the care team and helps to ensure that they're going to be carried out. Dr. Shannon Westin: I was also intrigued by the finding of the younger patients having earlier discussions around advanced care planning and hospice and goals of care. Any thoughts as to why that might be? Again, I felt like it was a little bit opposite of what I was expecting, not having a ton of background in the area.  Dr. Jennifer Mack: I was surprised, too. We had to check the numbers a couple of times just to be sure because it wasn't what I was expecting. And we don't know for sure what the reason for this is, but I think one possibility is that some of these discussions with the youngest patients, or for the youngest patients, are happening with family members, maybe their parents. And it's possible that clinicians are a little more comfortable or more likely to talk with parents than with the young patients themselves. And so that could actually increase rates of discussions for that group.  One thing we didn't assess was who was there for the discussions. It's not always documented. There's more to learn there about who was there and more about what was discussed. But that was our guess is that these may be family discussions more so than patient discussions. Dr. Shannon Westin: That really makes a lot of sense. And then I guess the next natural question is when we have these earlier goals-of-care discussions or when we have these discussions at all, what did you guys see on the impact of those kind of medical interventions that happened after? Dr. Jennifer Mack: Yeah. We found that when goals-of-care discussions happened earlier, more than a month before death, that adolescents and young adults were less likely to receive some of these intensive measures that we've talked about, so less likely to receive late-life chemotherapy, care in the intensive care unit and emergency room, and less likely to be hospitalized in the last month of life. So, even though these findings were observational, it creates the potential that having discussions earlier can help reduce some of these intensive measures and refocus care on palliation, if that's what patients are looking for. Dr. Shannon Westin: I think that's a really important point because we often bring our own thoughts and beliefs into the care of our patients and think, “Well, I wouldn't want those things.” And I think making sure we know where the patient is—and Mallory, I'd just be interested to get your thoughts here. How do we best approach those things and try to avoid—you know, we want to give advice where advice is needed, and we want to make it clear what the goals or what the potential successes might be. But I'd be really interested to hear your thoughts around framing those discussions and making sure that people understand what can be gained from those types of intensive treatments. Mallory Casperson: Yeah. I think it's important with patients in this situation—and it was discussed in the paper, but the idea of timing, how frequently are we having these care preference types of conversations, and how often are we reframing things with the patient based on how goals might be changing? I think that's a huge piece of the equation because, especially when we're talking about 30 days before death, 60 days before death, things might change quite rapidly from week to week and so having some of those things in mind.  And then it wasn't discussed as much on this paper, but it definitely has been in other work by both of these authors, as well as other just end-of-life research, but this idea of who is in the room for these conversations, I think, is another really important piece of this. Because a caregiver might have different preferences and goals than a patient. If a patient is 15 versus a patient is 25 versus a patient is 39 is also going to change things, and it's going to change the perspective that their caregivers bring to the equation. And so I think who is in the room and how are we doing that very difficult thing of weighing people's opinions in the situation, I think, is very complicated and also very important to figure out. Dr. Shannon Westin: And I think that that leads to my next question: How do we get more of that information? What do you think are the next steps for this particular work? And also, I would just say, how do we guide that? I mean, I struggle with these conversations. It doesn't matter if my patient is 22 or 82. I think trying to meet people where they are is one of the critical pieces. So what's next for this work? How do we help inform these discussions for the caregivers and for their providers? Dr. Jennifer Mack: I think you're right that we do think an important next step is promoting earlier discussions about goals of care and advanced care planning, partly because it gives patients time to reflect on what's important to them, to digest the news, and then make thoughtful decisions that are best for them. But from a research perspective, I think, as we do that, we need to understand more deeply what adolescents and young adults want from these conversations. What topics should be addressed, with whom, and how should they be discussed? And we've also learned from other work, including work that the three of us have done together, that goals of care for adolescents and young adults aren't always as simple as wanting care focused on palliation or prolonging life, this kind of binary thing. Often, there are these other equally important goals, like making sure their loved ones are okay, what's going to help them the most, having opportunities to nurture and deepen their relationships, and finding ways to attain their life goals and meaning while they're living with advanced disease.  So all of these different aspects, which aren't always a typical part of goals-of-care conversations, could be integrated to help support the kind of wider goals that are held by adolescents and young adults with cancer.   Mallory Casperson: I think, too, adding to that, we've talked about how AYA patients' goals of care have changed over time. So I think timing is a thing that could be added into future work, which is a difficult thing, I think, to gather from some of these records sometimes. But also, I think thinking through what these different words mean to different populations and how we're defining them is really important, too. So just an example outside of end-of-life care: When you tell a 30-year-old who's going through cancer that exercise is important during treatment and you talk to a 70-year-old going through cancer that exercise is different, that means different things, and they themselves have different context around what that word means in their normal life. And so I think when we throw out words like “palliation,” “palliative care,” and just general end-of-life conversations, that the same context applies. When an AYA agrees that maybe palliative care is the goal, what does that mean to them, and what are they bringing to the conversation in terms of their younger perspective than an older population that we're potentially more used to working with? So I think framing these ideas and how they might differ between populations is another thing that would serve as future work in this AYA end-of-life care space. Dr. Shannon Westin: Great. Well, thank you all so much. The time just flew by. This was such a great discussion of an incredible topic, and I just want to thank you all again for your hard work in this space.   And thank you to all of our listeners. Again, we were discussing the manuscript “Discussions About Goals of Care and Advanced Care Planning Among Adolescents and Young Adults With Cancer Approaching the End of Life.” And this is published in the JCO, so go check it out. And please do go check out our other podcast offerings and tell us what you think on Twitter. We'll see you next time. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

West Africa's Sahel region is experiencing crisis, with outbreaks of violence, weak economies, and governance issues. These challenges are compounded by the impacts of climate change, leading to an increasing number of people being internally displaced or seeking refuge in other countries. What do migration flows look like? And how are governments in the region responding? In this episode, Migration Policy Institute Europe Associate Director Camille Le Coz discusses displacement in the Sahel with Alexandra Tapsoba, a development economist at the Higher Institute for Population Sciences at the University Joseph Ki-Zerbo in Ouagadougou, Burkina Faso. Tune in for an interesting conversation on an often overlooked region.

This mini-series of Careers in Your Ears is hosted by King's PhDs and researchers. In this episode, Tisha Dasgupta, Research Assistant and PhD student in the Department of Women's & Children's Health, School of Life Course and Population Sciences at KCL, interviews Sam Mukhopadhyay, Head of Programme Management Office and senior events lead at Department for Energy Security and Net Zero (ESNZ). Sam talks about her career to date in the Civil Service and shares what the civil service is looking for in recruits and importantly what attributes and skills researchers have to offer this type of work. Please note this episode was recorded in February 2023, when the UK Government had just newly formed the Department for Energy Security and Net Zero. If you would like a transcript of this episode, please email careers@kcl.ac.uk with 'Transcript, CinYE, S8,E3' in the title. KCL PhDs and Research staff can access specialist careers support: from 1-1 appointments and tailored workshops. More information is available on our KEATs page https://keats.kcl.ac.uk/mod/page/view.php?id=5279350&forceview=1

About 90% of nonmelanoma skin cancers are associated with ultraviolet radiation exposure. Sometimes prevention is straight forward: wear sunblock, stay shaded. But still, there are 1 million skin cancer diagnoses in the U.S. every year. Ultraviolet dosimeters are one of several technologies that are showing a lot of promise when it comes to preventing skin cancer. The tools collect personalized data about UV exposure and are linked to an app that allows people to enter information about their sun-protective behaviors like wearing sunscreen.  Psychologist Frank Perna, program director at the National Cancer Institute (NCI)'s Division of Cancer Control and Population Sciences, Behavioral Research Program, and Health Behaviors Research Branch, discusses how programs like the Surveillance, Epidemiology and End Results (SEER) Program and the Classification of Laws Associated with School Students (CLASS) are helpful in tracking melanoma as well as capturing data about state policies related to sun safety and sunscreen use in schools.

2023 will be a big year for the Surveillance, Epidemiology and End Results (SEER) Program as it celebrates 50 years of using data to monitor trends and support research on the diagnosis, treatment and prevention of cancer. The SEER Program, which is funded by the National Cancer Institute, is making significant strides to decrease the burden of cancer through a suite of analytical tools that better capture data and make it more accessible to the research community. Steve Friedman, senior advisor for operations with the Surveillance Research Program in the Division of Cancer Control and Population Sciences at NCI, unpacks two new data initiatives, the Virtual Bio-Repository and the Virtual Pool Registry, that will allow researchers to collect additional clinical data and remove barriers for conducting multi-site cancer studies.

Dr. Shannon Westin discusses ways to ensure continued employment for cancer patients with her guests, Dr. Cathy Bradley, Dr. Tina Shih, and Dr. Robin Yabroff. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast for the Journal of Clinical Oncology where we get in-depth on manuscripts that have been recently published in the journal. Today, we're going to be talking about a Comments and Controversies article titled “Ensuring Employment After Cancer Diagnosis: Are Workable Solutions Obvious?” This was published online November 3, 2020. And I'm thrilled that we're accompanied by all three of the fantastic authors of this manuscript, including Dr. Cathy Bradley, who is professor and Associate Dean for Research at the Colorado School of Public Health and Deputy Director of the University of Colorado Cancer Center. Welcome, Dr. Bradley.   Dr. Cathy Bradley: Thank you.   Dr. Shannon Westin: We're also joined by Dr. Tina Shih, who's professor chief of the Section of Cancer Economics and Policy in the Department of Health Services Research, the Division of Cancer Prevention and Population Sciences, at the University of Texas MD Anderson Cancer Center in Houston. Welcome. And then finally, we have Dr. Robin Yabroff, who's Scientific Vice President of Health Services Research at the American Cancer Society.   Dr. Robin Yabroff: Welcome. Thank you.   Dr. Shannon Westin: We're so excited to have the three of you, and I know this is going to be a lively discussion and such a timely and important topic that I really just don't think enough has been done in this area. So you guys are to be congratulated.   So let's start by level setting. How many survivors are of working age and may consider work continuation during treatment?   Dr. Cathy Bradley: Yeah, we don't have a perfect estimate of that. We know there are just over 18 million survivors, and half, maybe even 60%, are working age and possibly employed during their survivorship time.   Dr. Robin Yabroff: And I'll add to that and say that there are also a lot of informal caregivers who were taking care of patients receiving cancer treatment who are of working age. And so that includes spouses, children, and parents. Dr. Cathy Bradley: Excellent point.   Dr. Shannon Westin: It does bring up a good point because I think sometimes with this type of research, we're so focused on the survivor themselves. But when we really look at the definition of survivorship, it includes the caregivers and the people that are participating in the care of the actual patient.   Well, why don't you guys talk a little bit about some of the benefits of work continuation to cancer survivors? Like, why should we be even thinking about this?   Dr. Cathy Bradley: Yeah, I think there are a number of reasons. I mean, the two obvious, of course, are income and insurance. Income, in order to continue their daily lives, but also health insurance to continue their treatment and surveillance. And that health insurance is not just for them, but it's also for their dependents and for their entire families and sometimes for their caregivers and others as well. So there's being able to preserve income, and insurance is critical to cancer survivors, as it is to all of us.   And then there are all the other benefits of work, of continued career growth, to continue quality of life, that interaction, social interaction with others, and a sense of self-worth and identity that many of us have wrapped up in our jobs.   Dr. Tina Shih: Yeah, and I think the other issue to think about is income also tied to your retirement savings. So you don't want to stop your earning ability, so that makes continuing working also important. And then also to have a sense of achieving something so that you wouldn't be continuously thinking about only cancer treatment, but there's other aspects of life.   Dr. Shannon Westin: Yeah, I think what I've seen in my practice is that another benefit of continuing to work is they're not just focused on themselves as the patient. And I think you got at that a little bit with that idea of self-worth, but it's also a distraction, right? Like, not sitting at home thinking about what's going on with my cancer, what's the next step in my treatment. It's kind of just keeping your mind busy with other things. I also wonder if when we talk about chemotherapy brain, if continuing to work and stimulate your mind and things like that could potentially be helpful in that setting as well. Like, we tell patients to do puzzles and things like that, but staying busy at your job and pushing the envelope there sometimes could seem to be beneficial as well.   So I guess I want to back up a little bit and just see what kind of led you all to be interested in this area. What were the kind of inciting experiences that led you to start to explore this work?   Dr. Cathy Bradley: For me, it was just an observation over time and growing up and seeing people around me who had to make incredibly stark choices, whether or not to continue, to be diagnosed with a serious illness but not be able to get care without that health insurance. So it's a very stark choice that they have between being able to continue to work or take time off to care for their illness during this very acute phase. And that just struck me as such an important thing that we needed to shine a light on, that as we make advancements and treatment and early detection—and the thing with early detection is that you're going to pick up more people who are working age with cancer, and their source of insurance is their jobs. So looking at this stark choice, it just seemed critical to start to study these questions systematically and, as I said, shine a light on this issue.   Dr. Robin Yabroff: For me, I had the experience of my mother being diagnosed with cancer when I was in graduate school, and I was fortunate that I was working and I had a supportive employer. But everyone in my family, including my father and my sisters, were able to take leaves of absence with paid sick leave that allowed us to step up and care for my mother. But I realized that we were coming from such a place of privilege in having paid sick leave. As Cathy said, for many people who don't have the opportunity to continue working, it's a really stark decision. And then I'll also be a little bit of a fangirl; I saw Cathy give a talk a while ago, and I was so fascinated with her research related to this topic, so I approached her afterwards and asked if we could work together.   Dr. Cathy Bradley: You are too kind.   Dr. Robin Yabroff: I won't say how long ago it was, but it was a long time ago.   Dr. Tina Shih: I think, for me, I was trained as a labor economist in my Ph.D. program, and after that, I keep on wanting to connect cancer studies with labor market studies, but there's really not good data on that. So I'm also an admirer of Cathy's work, like she's able to build that connection. And, of course, it's been a lot of fun working with these two really accomplished researchers.   Dr. Cathy Bradley: It's been the best collaboration for the three of us to work together.   Dr. Robin Yabroff: Absolutely.   Dr. Shannon Westin: I love these cross-institution collaborations, and not even just institution, obviously, the ACS—well, I guess it's big enough to be an institution. But it really is inspiring to me because I think a lot of times we tend to collaborate within our own institution or within our own group even. So you all really have created a model of success here.   So, getting back to work continuation, what are some of the gaps of knowledge that we have in this area, and why do they exist?   Dr. Cathy Bradley: I think Tina said it best. There's just no good data sources out there. We're not like Scandinavian countries that can link our health system with our employment data and link it all up and understand what's going on, that this area, generally—I mean, from my studies—require primary data collection. And other studies. There are some surveys that are out there. Robin's done a great job publishing in this area using secondary data. We just don't have a single data source that ties it all together. So that is the biggest challenge in studying this area and leading to our gaps. We don't know which treatments lead to fewer or more side-effects. Work effects are not studied in clinical trials; they're not recorded in medical records. There's so much that we just don't know, that we can't say, and that providers can't have a conversation with their patients about how a particular treatment course will affect their ability to work.   Dr. Tina Shih: I think, to add to that, like for people who also are in the working age population, there's no equivalent data to see in Medicare. So a lot of time, you have to kind of guess what's happening with the cancer stage. A lot of time, you can only know what cancer patients have, but that kind of limits your ability to dig deeper into: Are they getting the right chemotherapy, or are they getting the right treatments? Because you don't really know at this stage.   Dr. Robin Yabroff: I'll just reiterate what both Cathy and Tina already stated, which is really the lack of comprehensive data, not only about cancer and the clinical details of treatment and diagnosis but also about the type of jobs that people have. So, many times, we know whether or not they had a job, but not how long they‘ve had it, how many hours they work a week. And so a lot of our data from national surveys are really pretty limited for exploring any of the longitudinal effects of the cancer diagnosis on work, which we think are really important, not only for patients but also for their informal caregivers and family members.   Dr. Shannon Westin: So I think I might know the answer to this based on what you all are saying, but how do we overcome these gaps to be able to increase research in this area?   Dr. Cathy Bradley: I think creating that data infrastructure and collecting the information is what's critical. And we know that providers and patients don't—not all of them have discussions about employment when they go in to make treatment decisions, that that's often not part of that shared decision-making about going forward, the employment component, and the patient is kind of left trying to figure it out. And I just think there are more opportunities to create that data infrastructure to stimulate that discussion and to have follow-up.   Dr. Tina Shih: And I want to add to that to say that a lot of time, the information we want to collect about employment, patients, they have the information. I think they would be willing to provide that information. I think the information is not as sensitive as, “Hey, what is your income level?” or things like that. I think we should be able to collect that information with really high-quality data just by asking patients.   Dr. Robin Yabroff: And I want to reiterate the importance of having longitudinal information about employment over time. Some people may take a brief or extended leave of absence from work while receiving cancer treatment, but what happens when they return? And what does that mean for career development and mobility and how they return to a fulfilling work life for both the patients and the family members? So, as Cathy said, many providers don't discuss employment and job tasks and things like that with patients.   And I think another advantage—and I don't remember if we mentioned this, but another advantage of these discussions is tailoring treatment so that patients will be most likely to complete the recommended treatment. Because you can imagine a situation where someone who is being treated for cancer cannot get time away from work and doesn't complete their treatment, or they can't get time from work because they don't have paid sick leave and they need the income and they can't complete their treatment.   Dr. Tina Shih: I want to add to that point being one of the studies we look at young women. We looked at the age of kids, and then we noticed that among those with lumpectomy, about 1 in 5, 20% of women, actually did not have radiation therapy follow-up after lumpectomy, so that's a big problem. And so that also reflects—you need to tailor your treatment based on your patient's needs.   Dr. Robin Yabroff: Yeah, I remember that study, Tina. I thought it was really clever, where you were looking at newly diagnosed patients with breast cancer who received breast-conserving surgery but did not complete the radiation treatment. And so thinking about childcare is really important too.   Dr. Cathy Bradley: Transportation, all of those things that play into treatment completion, especially for people who are employed and trying to balance their jobs with their treatment. And I think the scenario Robin laid out of someone taking leave and then coming back, but you also have the other scenario where people just try to gut it out and do everything at once and then later become the same. So this longitudinal data and understanding what's going on and the impact of whether or not they complete, as Tina has shown earlier and women in my studies have reported, they will miss treatment before they miss work if it jeopardizes their health insurance, especially if they have children. Going back to Tina's point, if they have kids and those kids are dependent on them, they are not going to risk health insurance and their family's wellbeing.   Dr. Shannon Westin: We see this quite a bit with patients with cervical cancer. Obviously, it's a problem across all cancer types, but there especially seems to be quite a bit of burden amongst survivors of cervical cancer. And they're required to have daily treatment for six weeks. And we know best outcomes occur when that timeline is kept very tight. And when we have multiple missed radiation treatments and the timeline extends out, say, past ten weeks, then you see worse outcomes. And so we definitely are living this every day in the clinic.   How can workplaces support survivors? Because I feel like a lot of what we're talking about is that fear of losing their job, that need to keep insurance. So what are some strategies or some suggestions, I guess, we should make to workplaces to help support their survivors?   Dr. Cathy Bradley: Of course, having benefits like paid sick leave and those things are critical. And being flexible, offering accommodations, flexible work schedules of when they come in and when they leave or if they're able to do their work in off hours or remotely, those things are all helpful. We've moved into more of a remote environment since COVID; those things can be very beneficial. But for somebody who does a job where that's not an option, I think there are other kinds of accommodations that employers can make. And being respectful and understanding of a patient who is going through this and valuing them as an employee, maybe not necessarily as a survivor, but as an employee who's dealing with something, that's pretty critical. And I'll let Robin speak for the caregiver component.   Dr. Robin Yabroff: As usual, you read my mind. That's exactly what I was going to say. The importance of offering paid sick leave and health insurance coverage for the patient and also for the informal caregivers and also those accommodations, because frequently informal caregivers are responsible for getting patients to and from treatment, which, when you think about daily radiation, for example, making sure that that caregiver has time away from work is also important.   Dr. Tina Shih: And I think the other issue is to be emotionally supportive for your workers so that they know they don't have to be afraid of losing their job after completing cancer treatments. Or if they have to take more sick leave than they have, they might be able to borrow some sick leave. Having cancer patients in small businesses is stressful for business owners. But I think that's just something that they need to think carefully about, not make cancer patients feel like you are increasing my company's premiums because you have cancer.   Dr. Cathy Bradley: Building off of what Tina just said, taking the long view. It's not a short-term thing, where let's take the long view. This is a valued employee who is going to continue to contribute to the company, to our organization, long term. Take the long view here, not make it so hard on them in the short term.   Dr. Shannon Westin: I love real strategies, and I think certainly those are things that people can do on the local level. We certainly need to discuss policy as well. It's hugely lacking.   What are the next steps, do you think, we could do from a policy standpoint to improve the lives of our survivors?   Dr. Cathy Bradley: I think there are a number of things that we can do: I mean, having health insurance outside of the employer-based mechanism as an alternative, having paid sick leave for someone who is ill as well as those who care for them, having a policy of accommodation. Currently, the ADA, or Americans with Disabilities Act, while it covers cancer survivors, it does not cover their caregivers. So there are things that we can do to extend. And then there are policies that are in place that are just cumbersome. You see this, I'm sure, in your own practice. For a person to qualify for disability benefits, it takes a year. Being able to do that quicker, expedite it. That's a huge deal. That's a protection we have in place that is just extremely cumbersome to use, such that by the time a year goes away, the patient could have passed away but yet still need those benefits for the family and income prior to that happening.   Dr. Robin Yabroff: I'll also add that we talked about occupational health and rehabilitation in our Comments and Controversies piece and the importance of making sure that health insurance coverage extends to occupational health and rehabilitation to ensure that patients can successfully return to work.   Dr. Tina Shih: I think, on the provider side, there might be things that providers can do to kind of somehow accommodate working population's schedule. I know this kind of adds to providers' burden; they might have to open evening clinic or weekends. But I think, for working population, they really cannot afford to be not at the office for the type of job. I think this kind of arrangement would be very helpful.   Dr. Robin Yabroff: Yeah. And I think for providers to be asking patients about their employment. Like, what type of job do you have? What types of job tasks do you need to do on a daily basis. Do you have health insurance coverage through your work, or is it through someone else in your family, or do you not have health insurance coverage at all? And then, importantly, do you have paid sick leave, and what types of accommodations will your employer offer you? And I know Cathy's done some really interesting work thinking about how patients can talk with their employers about work and what their options are.   Dr. Cathy Bradley: Yeah. Opening the discussion would be a huge step forward to figure out what kind of referrals they need, what kind of letters need to be written for employers. How can they expedite the process to get patients what they need rather than have it be an afterthought?   Dr. Tina Shih: And I think if this is too much for providers to take on, then I think mitigators can also share some of the workload or research nurse. I think those are information you can collect on patient intake.   Dr. Shannon Westin: Great. So I guess the final question I have for you is what are your next steps? Where does this go next?   Dr. Cathy Bradley: I think we have a number of things that are ongoing. I'm involved in a study now with the team here at the University of Colorado, the Total Worker Health Team, and they're looking at the impact of interventions with providers, the oncology care team, for things that they can do to be more supportive of the patient who is undergoing treatment. So it's a really unique perspective of how they apply Total Worker Health concepts to the oncology care team. And that study is just getting underway and hopefully will provide guidance for the oncology care team of how to interact with the patient in order to provide the support they need. I think it's somewhat of a black box, everyone being well-intentioned but not having the data to support them.   So that's one study that I'm involved in currently, and then the three of us are always looking at policies and implications and what's the downstream effect. Tina did some great work on looking at the impact on the financial hardships and long-term impact on people who are diagnosed with cancer, how it extends well into retirement. And I think understanding those impacts and being able to communicate it is an important role that we play as a team.   Dr. Robin Yabroff: I'll also add that we have other things underway, sort of thinking about the impact of disruptions in employment for any period of time or for any reason and what that means in terms of development of financial hardship. And thinking about outside of the cancer diagnosis, how the cancer diagnosis affects employment and then affects development of financial hardship later. I think it's a really important area, especially as there is more attention to medical financial hardship broadly. Many researchers I know are actively interested in the topic.   And then I'll also add, so we're talking about research, but I'm increasingly interested, and hopefully can work with Tina and Kathy on this, in benefits managers and how those decisions are made for employers. Many employers take up a set package of benefits to offer for their employees without carefully considering what it means for patients with cancer and their caregivers—so thinking a little bit more about the decision-making process that employers have and thinking about the benefits they offer their workers.   Dr. Tina Shih: So as a data geek, I think I'm still trying to figure out a way to collect the claims data with short-term disability and then to see can I figure out who took short-term disability and came back and what happened to those people? And it's been a difficult task because not many data collect those information. That goes back to the data infrastructure issues, that we really need to have better data to understand working-age cancer patients.   Dr. Shannon Westin: Well, thank you all so much. This has been incredibly fascinating. I learned so much. I just want to thank all three of you, Dr. Bradley, Dr. Yabroff, and Dr. Shih, for your exciting work, and I hope that we can continue to make strides in this area.   And just thank you to all of our listeners. Again, this has been a JCO After Hours on “Ensuring Employment After Cancer Diagnosis: Are Workable Solutions Obvious?” published online November 3, 2022. Please do check out our other podcast offerings on the JCO website, and we will see you next time. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

This episode features Matthew Loscalzo, Executive Director of People & Enterprise Transformation, Emeritus Professor of Supportive Care Medicine, & Professor Population Sciences at City of Hope. Here, he discusses physician burnout, his book that he's recently co authored with Linda A. Klein & Marshall Forstein - “Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals”, and more.

About Dr. Rania AwaadRania Awaad, M.D. is a Clinical Associate Professor of Psychiatry at the Stanford University School of Medicine where she is the Director of the Stanford Muslim Mental Health & Islamic Psychology Lab as well Stanford University's Affiliate Chaplain. She also serves as the Associate Division Chief for Public Mental Health and Population Sciences as well as the Section Co-Chief of Diversity and Cultural Mental Health. In addition, she is a faculty member of the Abbasi Program in Islamic Studies at Stanford University. She pursued her psychiatric residency training at Stanford where she also completed a postdoctoral clinical research fellowship with the National Institute of Mental Health (NIMH).As a nationally recognized leader in Muslim mental health, Dr. Awaad has been invited by Presidents Obama and Biden, the CDC, HHS and SAMHSA to present her work at national convenings in DC. She has pioneered by establishing the first Muslim Mental Health Community Advisory Board (BAMMH CAB) in the US. Dr. Awaad has also established multiple Muslim mental health clinics as well as custom-tailored clinical and educational training programs for clinicians, religious and community leaders to address the mental health needs of Muslim communities.Through community partnerships established by the Stanford Department of Psychiatry, Dr. Awaad is currently the Psychiatric Director of the El Camino Women's Medical Group where she pursues her interest in women's mental health. Additionally, she serves as the Executive Director of Maristan, a holistic mental health nonprofit serving Muslim communities. Previously, she served as the founding Clinical Director of the Bay Area branch of the Khalil Center.Her courses at Stanford range from teaching a pioneering course on Islamic Psychology (PSYC 144/244), to instructing medical students, psychiatry residents and clinical psychology trainees on implicit bias and integrating culture and religion into medical care (PAU's CLDV 700 and Stanford's PGY-3 “Culture and Religion in Psychiatry”), to teaching undergraduate and graduate students the psychology of xenophobia (PSYC 86Q). Some of her recent academic publications include an edited volume on "Islamophobia and Psychiatry" (Springer, 2019), "Applying Islamic Principles to Clinical Mental Health" (Routledge, 2020) and an upcoming clinical textbook on Muslim Mental Health for the American Psychiatric Association. She has also produced a toolkit, fact sheet, CME course on Muslim mental health for the APA.Dr. Awaad is particularly passionate about uncovering the historical roots of mental health care in the Islamic intellectual heritage and has two upcoming books on the topic. In addition, she is affiliate faculty of Islamic Psychology at the Cambridge Muslim College and The Islamic Seminary of America. She is also a Senior Fellow at the Yaqeen Institute and the Institute for Social Policy and Understanding. She also has an interest in refugee mental health and has traveled to Amman, Jordan multiple times with the Care Program for Refugees (CPR) sponsored by Al-Alusi Foundation. She worked on developing and presenting a "train the trainers" curriculum to aid workers and therapists in Amman working with Syrian and Iraqi refugees.Prior to studying medicine, she pursued classical Islamic studies in Damascus, Syria and holds certifications (ijaza) in Qur'an, Islamic Law and other branches of the Islamic Sciences. Dr. Awaad has also previously served as the first female Professor of Islamic Law at Zaytuna College, a Muslim Liberal Arts College in Berkeley, CA. In addition, she serves as the Director of The Rahmah Foundation, a non-profit organization dedicated to educating Muslim women and girls. Dr. Awaad been the recipient of several awards and grants for her work. She is a nationally recognized speaker, award-winning teacher, researcher and author in both the Islamic and medical sciences.

Electra Paskett, PhD, has a goal: Eliminate cervical cancer. It's possible, she explained, with increased HPV vaccinations, screenings and automatic follow-up care for women with abnormal screenings. Paskett is one of the nation's leading epidemiologists and the OSU associate director for Population Sciences and Community Outreach, co-leader of the Cancer Control Program and founding director of the Center for Cancer Health Equity. Epidemiologists design tests, interventions and screenings to “get people to do what they need to do to reduce their risk of getting or dying from cancer,” said Paskett, a three-time breast cancer survivor. In this episode, Paskett describes a few of the many statewide programs she and her team have developed to accomplish these goals. Paskett is driven to create these programs “because people are still dying from cancer and there are still disparities … I want to give people a message of hope, that even if you hear those words, ‘you have cancer,' there's hope.”

This week Bobbi Conner talks with Dr. Marvella Ford about efforts to address disparities in lung cancer screening in S.C. Dr. Ford is a Professor in the Department of Public Health Sciences and she's Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.

Dr. May Beydoun from the Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, in Baltimore, MD, discusses a research paper she co-authored that was published by Aging (Aging-US) as the cover for Volume 14, Issue 13, entitled, “Epigenetic clocks and their association with trajectories in perceived discrimination and depressive symptoms among US middle-aged and older adults.” DOI - https://doi.org/10.18632/aging.204150 Corresponding author - May A. Beydoun - baydounm@mail.nih.gov Video version - https://www.youtube.com/watch?v=gkiDhjTL0YY Abstract Background: Perceived discrimination may be associated with accelerated aging later in life, with depressive symptoms acting as potential mediator. Methods: A nationally representative sample of older adults was used [Health and Retirement Study 2010–2016, Age: 50–100 y in 2016, N = 2,806, 55.6% female, 82.3% Non-Hispanic White (NHW)] to evaluate associations of perceived discrimination measures [Experience of discrimination or EOD; and Reasons for Perceived discrimination or RPD) and depressive symptoms (DEP)] with 13 DNAm-based measures of epigenetic aging. Group-based trajectory and four-way mediation analyses were used. Results: Overall, and mostly among female and NHW participants, greater RPD in 2010–2012 had a significant adverse total effect on epigenetic aging [2016: DNAm GrimAge, DunedinPoAm38 (MPOA), Levine (PhenoAge) and Horvath 2], with 20–50% of this effect being explained by a pure indirect effect through DEP in 2014–2016. Among females, sustained elevated DEP (2010–2016) was associated with greater LIN DNAm age (β ± SE: +1.506 ± 0.559, p = 0.009, reduced model), patterns observed for elevated DEP (high vs. low) for GrimAge and MPOA DNAm markers. Overall and in White adults, the relationship of the Levine clock with perceived discrimination in general (both EOD and RPD) was mediated through elevated DEP. Conclusions: Sustained elevations in DEP and RPD were associated with select biological aging measures, consistently among women and White adults, with DEP acting as mediator in several RPD-EPICLOCK associations. Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.204150 Press release - https://www.aging-us.com/news_room/epigenetic-clocks-and-their-association-with-perceived-discrimination-and-depressive-symptoms Keywords - aging, DNA methylation, epigenetic clocks, biological age, perceived discrimination, depressive symptoms About Aging-US Launched in 2009, Aging-US publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging-US go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at https://www.Aging-US.com​​ and connect with us: SoundCloud - https://soundcloud.com/Aging-Us Facebook - https://www.facebook.com/AgingUS/ Twitter - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/agingus​ LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Media Contact 18009220957 MEDIA@IMPACTJOURNALS.COM

In this episode we talk to Dr Simon Fraser who is a GP and associate professor of public health at the School of Primary Care, Population Sciences, and Medical Education at the University of Southampton. Paper: Change in treatment burden among people with multimorbidity: a follow-up survey https://doi.org/10.3399/BJGP.2022.0103 (https://doi.org/10.3399/BJGP.2022.0103) The extent to which treatment burden changes over time and which groups of people are likely to experience increases or decreases in treatment burden is not known. This study identified that a third of older adults with multimorbidity experienced an increase in treatment burden category (overall 9% moving to the ‘high' treatment burden category), and that living more than 10 minutes away from their GP – particularly for those with limited health literacy - was associated with an increase in treatment burden. Improving patient access to primary care services and enhancing health literacy may help to mitigate increases in treatment burden. Our revised single-item measure performed moderately, suggesting a brief measure of treatment burden consisting of more than one item may be required for use in practice.

This week Bobbi Conner talks with Dr. Marvella Ford about a statewide project to increase HPV vaccination in children in underserved communities of South Carolina. Dr. Ford is a Professor in the Department of Public Health Sciences and she's the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.

Co-hosts Stephanie Winn and Chris Joyce sit down with Moon S. Chen, Jr., Ph.D., M.P.H. of the UC Davis Comprehensive Cancer Center. Dr. Chen is a nationally renowned expert in cancer health disparities, particularly as they affect Asian-American populations. He is the Cancer Center's Associate Director for Cancer Control, leading a research portfolio that addresses cancer risk determinants and their mitigation in human populations. He also co-leads the Population Sciences and Health Disparities research program for the Cancer Center. To find out more about the Office of Community Outreach and Engagement, visit https://ucdavis.health/ocoe. To learn more about the UC Davis Comprehensive Cancer Center, visit https://health.ucdavis.edu/cancer.

In part one of a two-part conversation, Drs. Patrick Loehrer and David Johnson sit down with Dr. Deborah Schrag to discuss her roles as a leader, researcher, oncologist and public health expert. The current Chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York, Dr. Schrag discusses the joy and passion she has found throughout her career, and more. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org.   TRANSCRIPT Dr. Pat Loehrer: I'm Pat Loehrer. I'm the Director of the Center of Global Oncology and Health Equity at Indiana University. Dr. David Johnson: Yes. And hello, I'm David Johnson. I'm at UT Southwestern in Dallas, Texas. Dr. Pat Loehrer: And welcome to another version of Oncology, Etc. Dr. David Johnson: Yeah, great guest today, before we get started with our guests, though, Pat, what are you reading these days? What can you recommend to me? Dr. Pat Loehrer: Well, I'm reading Jamie Raskin's book, which is about his son and about the insurrection. It's really a wonderful read so far, particularly I think about the family nature and how much he deeply respected his son who unfortunately committed suicide. Dr. David Johnson: Right before one of the impeachment trials as I recall, right? Dr. Pat Loehrer: It was right before the January 6 insurrection. Dr. David Johnson: Yeah, terrible situation. I have a book I've been meaning to recommend for a while. It's one that I've given to all the chief residents I've worked with over the last several years. And today's guests made me think about this book. It's entitled, Osler: Inspirations from a Great Physician. It's written by Charles Bryan, who's the former Chair of Medicine at the University of South Carolina in Columbia. Dr. Pat Loehrer: You trained with Osler, didn't you? Dr. David Johnson: I was a couple of years behind him. He was my senior resident. For anyone who's an Oslerphile, it's a great book to have. But even if you're not, it's got some wonderful lessons to be learned about how to interact with one's colleagues, and a lot of information about leadership, which is why it made me think of today's guest, Dr. Deborah Schrag who we're really excited to welcome to Oncology, Etc. Dr. Schrag is the Chairman of the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York. She's a highly accomplished healthcare leader, clinician-researcher, and expert in public health and population science. Deborah received her medical degree from Columbia University and completed her residency in internal medicine at Brigham and Women's. She obtained her medical oncology training at Dana-Farber in Boston and also received an MPH degree from the Harvard School of Public Health. After a brief stint on the faculty at DFCI and Brigham and Women's, she joined the division of gastrointestinal Oncology at Memorial Sloan Kettering, where she was an associate member and Associate Professor of Public Health and Medicine. In 2007, I believe it was, she returned to Dana-Farber and Brigham, where she continued her work focused on improving the delivery, quality, and effectiveness of cancer care. While there, she served as chief of the Division of Population Sciences until this past year when she returned to Memorial to chair the Department of Medicine. I also think she's the first woman to hold this position, but we'll learn about that momentarily. Deb is internationally recognized as a pioneer for her work engaging patients in reporting outcomes as a way to improve care. She has led pragmatic trials using informatics strategies to optimize patient and clinician wellbeing, efficiency and quality, and equity of care. In short, she's a true superstar, leading the department, the major department, in one of the world's foremost Cancer Institutes. Deb, welcome to Oncology, Etc. Thank you so much for accepting our invitation. This is a relatively new oncology podcast, but already, we're known for our incisive, deeply penetrating questions. So, I have a question for you to start off. Do you have any carpentry skills? Dr. Deborah Schrag: Absolutely none whatsoever, Dave. None. Dr. David Johnson: I'm disappointed. It's my understanding that Schrag is German for cross or a slant and people who build cross-legged tables. So, I was hoping, my house was destroyed recently, and I'm looking for replacement furniture, and I was hoping you might be able to help me. Dr. Deborah Schrag: I apologize. But I'm not going to be able to help. The name, you're correct, though, David, is a German name. So, my family does hail from Germany and they made malt, which is the major ingredient in beer. I'm not sure where the name comes from. But they ran malt factories and shipped malt all over to all the beer, before there were craft beer distilleries, that's what they did. Dr. Pat Loehrer: That may come in handy by the end of this podcast, by the way. Dr. Deborah Schrag: Could be. Dr. David Johnson: Well, speaking of your family, tell us a little bit about your background and where you were raised, and your family members. Dr. Deborah Schrag: Sure! I'm glad you asked that because I really have been very influenced by where I grew up. And as I think about it, experiences that go back to first grade got me where I am today. So, I am from New York City. I grew up in Manhattan in the 1970s. And as you may know, that was a pretty rough time in the history of New York, what's often referred to as the 'bad old days', although it didn't feel that way to me. But I started out attending New York City public schools. And at that time in my neighborhood on the Upper West Side of Manhattan, my first-grade class had about 45 students, and one teacher, there were about five or six of us who spoke English, and everyone else was a recent Puerto Rican immigrant. I pretty much sat in the corner and read to myself. Now I didn't stay in the public school system for long, but I saw in first grade, how things weren't fair. And I saw and felt my own privilege, acutely. And even as a little kid, I had that sense. Eventually, my parents transferred me to private school later on. And there were kids in the neighborhood who didn't have the same privileges that I did. But living in New York, you walk around, you're confronted with disparities every day. We still see it today with homelessness on the streets. At that time, there was a lot of alcoholism and the use of drugs. And they were two blocks north that were safe to walk and two blocks east that were not safe to walk. So, this really stuck with me from a very early age. As a student in summer jobs, I worked lots of interesting jobs. I started at 14 scooping ice cream at Baskin Robbins, I worked at a famous Deli in New York called Zabar's, selling coffee. Lots of interesting jobs that I worked during holidays and vacation times. But one of my first jobs was working in an organization called the Floating Hospital, which was a big old ferry boat that circumnavigated Manhattan, and it provided a summer camp. And we would take 1800 people on a boat around Manhattan every day. And my job was to do lead testing. And I learned how to stick kids, test them for lead because there were incredible amounts of lead poisoning in New York City in the early 1980s. And then we would work on tracing the kids and these were toddlers, two-year-old, three years old. There were many families who were living in homeless shelters in New York City in the early 1980s. And that was really the beginning of my interest in public health and inequities. And really the marriage of medicine and public health. That had a deep and long-lasting impression on me and really stayed with me throughout my career. That early experience, I think it propelled me into medicine and to medical school and also to marry medicine and public health. Dr. Pat Loehrer: Tell me a little bit, Deb, about your parents. Dr. Deborah Schrag: Sure! My mother was born in the United States. She was a teacher who many years later after having three children went to law school and she became a litigator. And actually, her boss was Rudolph Giuliani. My father is a child of World War II. He was a child of German Jewish parents who had to flee the Nazis. Probably the most interesting story is that my paternal grandfather was an OB-GYN. So, I am a fifth-generation physician. My paternal grandfather was an OB-GYN at Charité, which is a very famous Hospital in Berlin. He was the head of OB-GYN there in the 1930s. But he had, I think he was half Jewish, and the Gestapo asked him to leave and he had to leave. He was an expert in version, which is essentially flipping babies and the setting of placenta previa. He then left for Lebanon, where he was in the French Resistance and had a thriving OB-GYN practice in Beirut, Lebanon, during World War II. And at night, there was a curfew, and he was part of the resistance and passed secrets around from the Russians to the French, so very dramatic. My father was born in this setting, and arrived as a new immigrant to the United States in the 1940s, where it was very hard to be a child whose parents had a German accent, given the prejudice against Germans at that time, but also went to New York City public schools, had a tremendous opportunity. It's really kind of the classic New York immigrant success story. You know, arrived in the United States with the shirts on their back and managed to work their way to a better life and achieve success and good education through public education for all their offspring. I will also say that my father had a public health stint. He worked in North Carolina as an alternative to going and serving in the Vietnam War, he was in the Public Health Service. And he worked in North Carolina in the textile mills and worked on a disease called byssinosis, which is also known as the brown lung. It's an occupational health disease that affects textile mill workers. As a child, I spent many dinners, hearing about byssinosis and brown lung, and black lung. I think at an early age I really came to understand how the world wasn't fair, and how it was instilled in me early on that it was important to work to try to make things better, particularly for people who didn't have privilege. And I think when you come from an immigrant family, and you realize how much privilege has been bestowed on you, that really leaves an indelible mark. I have to say, as Chair of Medicine at MSK, it is staggering to me the proportion of faculty here at MSK, but also at Dana-Farber, where I worked previously, we have lots and lots of immigrants who've been able to accomplish just amazing things through just motivation and drive and energy and creativity. And so, I'm a big believer in how much immigrants have powered this country. Dr. Pat Loehrer: Deborah, are your parents still alive? Dr. Deborah Schrag: My parents are still alive. They're both in their early 80s. And they both still live on the Upper West Side of Manhattan. So, I'm very privileged and fortunate to have living parents. Dr. Pat Loehrer: I can imagine the pride that they have for you. Dr. David Johnson: I just want to jump in and let our listeners know that Deb mentioned Charité in Berlin. That's the home of multiple Nobel laureates that all of us would know like Ernst Chain, who was one of the individuals involved in the development of penicillin, but Paul Ehrlich, Robert Koch, Hans Krebs, and for cancer doctors, Otto Warburg, among others. So, it truly is a world-renowned institution. Dr. Deborah Schrag: Well, my paternal grandfather was famous for this technique called version, which essentially involves putting your stethoscope next to the uterus, figuring out where the placenta was, and then essentially trying to flip the baby without disrupting the placenta or causing any harm, which required incredible skills with a stethoscope because you had to appreciate, I guess, the placental vessels. I'm not aware that this skill is still in existence, it was an important skill to have in the 1930s. When, if you did a C-section, there was a high probability of endometritis. So, you could save the baby, but you would often lose mom to endometritis. Or you could save mom, but you might not save the baby. So, at that time it was a big deal, but thankfully no longer. Dr. David Johnson: This is why we call it an Oncology, Etc. Our listeners didn't know that we're gonna get OB information in this particular podcast. Dr. Deborah Schrag: Or a digression on the history of medicine. I do find that, you know, I am inspired by the generations that came before me. I think it's also true that there are many physicians who are first-generation physicians in their families and some of us are privileged to have lots of healthcare professionals and sort of feel it as a calling. Dr. David Johnson: I think of you with many, many talents. But one of the things that I think stood out to me is, many years ago, you were in the van, talking about the financial cost of health care. I remember a very influential paper you wrote in the New England Journal, talking about the cost of treating GI cancer, colon cancer in particular. But where did your interest in that particular aspect of health care begin? What was the stimulus there? I mean, obviously you had a lot of stimulus from your family. What else? Dr. Deborah Schrag: That's really interesting. This is a little bit of a history of oncology. At that time, I was an assistant professor and assistant attending in the GI oncology service, seeing lots of patients with colorectal cancer. And we were working on a clinical trial of a drug called ImClone C225. And that was the name of the protocol. And we were putting patients in that clinical trial. And you know what? This drug was working. We were getting excited and the drug was moving ahead. We looked at the Phase 1 data and we launched Phase 2. We had meetings with the research protocol nurse and the research assistants, team meetings, and I would say there were about 50 people who were aware between the GI oncologists and the nurses and all the research assistants. You guys know that it takes a village and even though the villages were smaller then and it wasn't a particularly large trial, there are many, many people involved and everyone had the sense that this drug might be working. Just for context for our younger listeners, this is back in the early aughts, and basically, the drug that we had to treat colorectal cancer was 5-FU in many different formats and Irinotecan. And that was it. Some people thought mitomycin might work a little bit, but it was so horrible that it really barely worked. But that was what we had in our bag of tricks. So, the fact that we had this ImClone drug that eventually came to be known as Cetuximab, was remarkable. So, here's what happened. It turned out that this is the drug made by the company ImClone. And there were some shenanigans, some insider trading. And one of the people caught up in insider trading, in addition to some people involved with the company itself was none other than Martha Stewart, sort of the famous homemaker who still publishes magazines to this day. And you may know that she actually did some time in federal prison as a result of insider trading on this drug. I remember being a junior attending, and all the people involved in the trial and all the cancer professionals, we all knew this was working. But everyone respected the confidentiality of the situation, of the patients, and all the integrity that goes into academic medicine. And I remain inspired by the integrity of all the professionals, the doctors, the residents. These were not affluent people. I can tell you. we were not paying research assistants a whole hunk of money. They investigated every trade made by this company. There were absolutely no shenanigans or improprieties from the hard-working folks who helped bring this drug to market. So, as this was going on, we had many patients who were not eligible for the trial who were interested in getting the trial. So, of course, we followed as this drug got FDA approved and came to market. You could check me but I believe it was February 2004, it was FDA approved. It came out with a huge price tag. It was approximately $10,000 per month. I was mad because I was taking care of regular New Yorkers at that point. I had public school teachers, I had patients on Medicare and they couldn't afford the 20% copay. Because $10,000 a month for Cetuximab, if you have a 20% copay and you're New York City, public school cafeteria worker, is not yet eligible for Medicare with a typical plan that a New York City public school system employee would have, that was $2,000 a month. And that did not work for one of my patients who is essentially what we used to call a lunch lady. I was so mad that I decided to channel that anger into writing what I think is a perspective for the New England Journal called, “The Price Tag on Progress”. I wrote that piece. I know that many, many people and many of my esteemed colleagues have continued to work in that area and do research on the economics of drug pricing and there are many, many experts. I didn't stick with that. Not that it's not interesting, and not that it's not important. It's incredibly interesting and important, but I felt that the solution needed to happen in the legislature, state legislature, federal legislature. I think that this is about social policies, and we need to advocate for appropriate health insurance programs to make it possible for people to get coverage when they have catastrophic illnesses, and we need to think about the entire approach to drug pricing in this country. I still think that's important. I'm not convinced that what we need is more research on the topic. I think we need more policymaking and laws on the topic. I think we're still dealing with this. I'm sad to say that it's been nearly 20 years since I wrote that perspective. But I think it was motivated by frustration, not being able to get my patient what she needed, and many patients thereafter. And just the incongruity between some people benefiting from insider trading and all the good people who were doing the right thing. Dr. Pat Loehrer: I just want to throw in one thing if I can. Len Saltz, who's one of your partners, it was a piece of that trial that he presented at ASCO talking about ImClone C225. And ironically, it had a 22.5% response rate. And Len said, it's a bummer that ImClone didn't call it C995. Dr. Deborah Schrag: You have no idea how often we used to talk about that, joke about that in the clinic. I have another good story about that drug, which I think really illustrates something I believe and I think it's actually something that Osler said but it's also something I have to say I learned from both of you. And it has to do with listening to your patient. So, I had a patient named Matthew, who was a young man, 34 years old. He walked into my clinic with a diagnosis of diffuse metastatic colorectal cancer with multiple bilateral pulmonary metastases, which came to light when his tennis game was off. He was, at that time, an early employee of a newly started company called Google. And he was working on advertising algorithms, and Matt got the drug Cetuximab. And unfortunately, he was on it for quite some time. He was on it for about five or six months. But eventually, it was pretty clear that we were coming to the end of the road. And he and his wife planned a vacation. This was part of his end-of-life process planning. It was their fifth wedding anniversary in the Berkshires. We worked so hard to get Matt to the Berkshires to a beautiful inn, and on Saturday night, my pager goes off, and Matt cannot sit up. He's weak. And he'd been complaining of terrible fatigue for weeks, to me, and I really hadn't quite figured out why Matt was so fatigued. I mean, I just didn't understand it. And we get into this inn and I get a call from the Berkshire Medical Center, a small community hospital, 'Dr. Schrag, your patient is here. He's so weak and he can't sit up.' 'What's going on?' The ER doctor says, 'Well, he has a Chvostek sign', which is a sign of severe hypocalcemia. 'So, call me back with the calcium.' The calcium is low. Well, I think those of your listeners who are closer to medical school know that when the calcium is low, you have to check the mag. And Matt's magnesium was 0.2. And he got some magnesium in the Berkshire Medical Center. And all of a sudden, he felt great. He was able to go on and enjoy the second half of his fifth anniversary weekend at the Berkshire Inn and he came back. And I felt terrible because he'd been complaining to me of fatigue for six weeks and I hadn't checked his magnesium. I was like, 50 bilateral pulmonary metastases on chemotherapy. That's a fatigue explanation. Suffice it to say that we went on to start checking magnesium on everyone getting Cetuximab. Now mind you, the drug is FDA approved and FDA labeled at this point. So, we started checking magnesium, and we find that it was low. I start getting on the phone and calling my mentors. I called Dr. Bob Mayer, who was the head of my fellowship director and was like a revered mentor to me. 'Hey, Bob, does anyone up there in Boston have low magnesium from Cetuximab?' 'We don't check magnesium.' I said, 'But can you check?' I started calling around and that's a great example of the community of oncology. We are a community. I just started working the phones and calling friends and saying 'You guys checking magnesium for any of these folks on Cetuximab?' Suffice it to say, we figured out that their EGFR receptors in the ascending loop of Henle - so, again, back to biology and pathophysiology - the drug Cetuximab was blocking reabsorption of magnesium in the kidney, and it was Cetuximab that caused a terrible magnesium wasting. Oral magnesium did not work. You had to give it intravenously, repeatedly. And we helped eliminate fatigue for a bunch of patients. About six months later, I showed up at ASCO with these little cardboard slides and a little poster back in the corner and put up our little case series, very little. But I'm proud to say that we changed the label of Cetuximab and it's now on the label that it causes hypomagnesemia. It might be one of my more cited papers, paradoxically. But I think it's a principle that really has stuck with me, and I've tried to impart it to all the students and residents and fellows, 'Listen to your patients because - I think it comes from Osler- they're telling you something. We have to pay attention.' Again, I have never forgotten that. But really listening and trying to figure out how we can use our understanding of pathophysiology and what our patients tell us to ask questions and not just accept dogma and try to figure out what we can do. And you know, I couldn't have figured that out on my own. I happened to find a really smart nephrologist who happened to be able to sort of go to animal models and knew the right studies and the right people to talk to. Dr. David Johnson: It's one of the reasons why we are a multidisciplinary specialty. And we use the expertise of our colleagues. I think that's such a wonderful example of listening to one's patient and it really profoundly impacted our understanding of how that drug works and renal physiology, actually. That wraps up part one of our interview with Dr. Deborah Schrag, Chair of Medicine at Memorial Sloan Kettering Cancer Center. We hope you've enjoyed learning about her background and her early career. In part two of our conversation, Dr. Schrag will discuss her programmatic goals at Memorial Sloan Kettering, the importance of mentorship and leadership, and what it means to have joy in the profession of medicine, and, frankly, much more. So, please be sure to join us. As always, we want to thank you for tuning in to Oncology, Etc. an ASCO educational podcast, where we will talk about just about anything and everything. So, if you have an idea for our topic or a guest, please email us at education@asco.org. Unknown Speaker: Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

Dr. Emily Tonorezos is Director of the National Cancer Institute's (NCI) Office of Cancer Survivorship which is part of the Division of Cancer Control and Population Sciences. Dr. Tonorezos leads NCI's efforts to address challenges facing cancer survivors and their families. These efforts include preventing or mitigating adverse effects and improving the health and well-being […] The post Survivors? Choosing Words about People Who Have, or Have Had, a Serious Illness (HLOL #222) appeared first on Health Literacy Out Loud Podcast.

While the threat of climate change may conjure images of sea level rise, extreme weather patterns, and drought, the full picture of how climate change will impact oncology practice and care is still emerging. We do know that climate change will impact cancer risk, increase exposure to carcinogens, impede access to care, and ultimately effect survival.To discuss some of these impending changes and what oncologists and patients can do to prepare, Oncology Times interviewed Robert A. Hiatt, MD, PhD, Professor in the Department of Epidemiology and Biostatistics, and Associate Director of Population Sciences at the UCSF Helen Diller Family Comprehensive Cancer Center.

Corinne Leach, PhD, MPH, MS, who leads cancer survivorship research at the American Cancer Society, joined the podcast to discuss her recent publication on the rise of mental health distress during the COVID-19 pandemic. Using data from the American Cancer Society Cancer Prevention Study-3 (CPS-3) cohort, Dr. Leach and collaborators “identified factors associated with increased depression and anxiety during the pandemic, including sociodemographic characteristics, stressors, and comorbid conditions associated with increased risk for poor COVID-19 outcomes.”* They also presented findings related to financial stressors and looked at long-term implications. For resources and information to help you cope during and after cancer treatment, please visit: https://www.cancer.org/treatment/survivorship-during-and-after-treatment.html Dr. Leach is Senior Principal Scientist of Behavioral Research in the Population Sciences group at the American Cancer Society. She serves as the Principal Investigator of the American Cancer Society (ACS) survivorship cohorts, including the Studies of Cancer Survivors and the Cancer Survivor Transition Study. 3:13 –Pandemic-related stressors that have been associated with greater levels of anxiety and depression 8:09 – Her recent study on how our mental and physical health prior to the pandemic factored into our ability to deal with the psychological stress of the pandemic 10:57 – On long-term implications for mental health 12:45 – A snapshot of what cancer survivorship looks like in the United States 15:09 – On similarities between cancer survivors and participants her your study whose stressors were associated with anxiety and depression 17:25 – On post-treatment programs for cancer survivors 21:51 – Helpful ways to deal with significant life stressors * http://pressroom.cancer.org/StressorsPandemicPredictors

Kathryn Schmitz, PhD, MPH, is the Associate Director of Population Sciences at Penn State University College of Medicine, and, jointly, serves as Full Professor at the University of Pennsylvania's School of Medicine.  Dr. Kathryn Schmitz is a leading researcher in exercise oncology - the use of exercise in cancer prevention, control and survivorship. Her research extends from the role of physical activity in the prevention and etiology of obesity-related cancers to the usefulness of activity for rehabilitation and health promotion in cancer survivors of all cancers. Dr. Schmitz serves on the expert panel for the YMCA/Livestrong Foundation Cancer Survivorship Collaborative, wrote the cancer survivorship section of the 2008 U.S. DHHS report of the Physical Activity Guidelines Advisory Committee, served on the ad hoc committee that developed the ACSM Cancer Exercise Trainer certification, and is the lead author of the ACSM Roundtable on Exercise for Cancer Survivors, which published guidance for exercise testing and prescription for cancer survivors in July 2010. --- This podcast episode is sponsored by Fibion Inc. | The New Gold Standard for Sedentary Behaviour and Physical Activity Monitoring Learn more about Fibion: fibion.com/research --- Collect, store and manage SB and PA data easily and remotely - Discover new Fibion SENS Motion: https://sens.fibion.com/

Kathryn Schmitz, PhD, MPH, is the Associate Director of Population Sciences at Penn State University College of Medicine, and, jointly, serves as Full Professor at the University of Pennsylvania's School of Medicine.  Dr. Kathryn Schmitz is a leading researcher in exercise oncology - the use of exercise in cancer prevention, control and survivorship. Her research extends from the role of physical activity in the prevention and etiology of obesity-related cancers to the usefulness of activity for rehabilitation and health promotion in cancer survivors of all cancers. Dr. Schmitz serves on the expert panel for the YMCA/Livestrong Foundation Cancer Survivorship Collaborative, wrote the cancer survivorship section of the 2008 U.S. DHHS report of the Physical Activity Guidelines Advisory Committee, served on the ad hoc committee that developed the ACSM Cancer Exercise Trainer certification, and is the lead author of the ACSM Roundtable on Exercise for Cancer Survivors, which published guidance for exercise testing and prescription for cancer survivors in July 2010. --- This podcast episode is sponsored by Fibion Inc. | The New Gold Standard for Sedentary Behaviour and Physical Activity Monitoring Learn more about Fibion: fibion.com/research --- Collect, store and manage SB and PA data easily and remotely - Discover new Fibion SENS Motion: https://sens.fibion.com/

Dr. Corinne Leach, PhD, MPH, MS, is a gerontologist, digital health strategist, and behavioral scientist, who serves as the Senior Principal Scientist, Behavioral Research, at the American Cancer Society (https://www.cancer.org/). Dr. Leach, leads survivorship research on behalf of the Population Sciences group, serving as the Principal Investigator of the American Cancer Society (ACS) survivorship cohorts, and as the ACS-lead for the ACS-National Cancer Institute online self-management platform, Springboard Beyond Cancer, a novel eHealth tool that empowers cancer survivors to better manage their cancer-related symptoms, live healthier, and improve their communication skills about cancer (as well as other health conditions), during and after treatment. Dr. Leach's cancer survivorship research focuses in the areas of aging, cancer-related symptom assessment, and chronic disease self-management, and her research aims to improve the understanding of: behavioral factors that contribute to healthy aging and the best way to promote them, the unique experiences of older cancer survivors, such as physical late effects and psychosocial issues, and ways to improve survivors' self-management of cancer-related issues. Dr. Leach also studies accelerated aging after a cancer diagnosis, including the accumulation of multiple chronic conditions after a cancer diagnosis, and she evaluates the benefits of health behavior interventions, such as chronic disease self-management. Dr. Leach is also a Gerontological Society of America Fellow, member of the Cancer and Aging Research Group (CARG), Scientific Advisory Committee member for Pack Health and Dr. Susan Love Foundation for Breast Cancer Research, Adjunct Professor at Emory, Rollins School of Public Health, Susan B Anthony Aetna Award Winner for Excellence in Research on Older Women, American Public Health Association (APHA), and has authored over 70 peer-reviewed publications. Dr. Leach has an MPH from the Harvard T.H. Chan School of Public Health, a PhD in Gerontology from University of Kentucky, and an MS in Experimental Psychology from Villanova University.

This week Bobbi Conner talks with Dr. Marvella Ford about the SC AMEN program and efforts underway to help reduce prostate cancer mortality in Black men in SC. Dr. Ford is a Professor in the Department of Public Health Sciences and she's the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.

Welcome to the first two-part episode of “Mental Health Trailblazers: Psychiatric Nurses Speak Up,” where our host Indrias Kassaye will be connecting with two key guests to discuss essential aspects, important facts, and unknown surprises around Indigenous nurses.Queued up first is Dr. John Lowe, a Professor and Joseph Blades Centennial Memorial Professorship Chair at The University of Texas at Austin School of Nursing. Dr. Lowe's research career was launched from his doctoral dissertation “ Talking Circle Intervention” with a focus on the cultural values that contribute to Native American health and well-being.In a conversation guided by the issue of substance use impacting Native Americans, you'll hear how structural racism discrimination has impacted Native Americans, the effects of harmful or lacking data collection on these populations, and the importance of continuing cultural foundations to foster aspiration.Experience powerful stories and tools of the Native American customs first-hand from Dr. Lowe and learn how his PhD course on socio-cultural influences takes a unique approach into this far-reaching topic and offers insights into changing the narrative for younger populations. Together, Dr. Lowe and our host voice their concerns preparing the next generations of Native American nurses as well as growing the number of Native American nurses through the ANA Minority Fellowship Program.Rounding out the conversation, Indrias is then joined by Dr. Eugenia Millender, the Co-Founding Director and Associate Director of the Center for Population Sciences and Health Equity at Florida State University. The drive of her research program, and of her conversation, is to investigate ways to reduce mental health and substance use disparities related to stress and trauma among indigenous and vulnerable populations.Sparked from an early passion inspired by a personal family member's mental health journey, come along as Dr. Millender guides you on a journey through subjects such as potential parallels of mental and psychiatric problems within immigrant vs. indigenous communities, the dialogue of mental health across generations within communities, and the importance of as well as demand for mental health advocates despite economic or cultural inhibitors.Learn from Dr. Millender how genetics impact mental health issues such as inherited trauma, how early stages of research in testing are leading to innovative progress, and how new cutting-edge programs are in-development for community-based services to inspire change as well as new connections for indigenous nursing students.You don't want to miss experiencing this rich conversation featuring multiple perspectives and insights into indigenous nurses and populations as a whole. To learn more about Dr. John Lowe, visit https://nursing.utexas.edu/faculty/john-lowe and to learn more about Dr. Eugenia Millender visit https://nursing.fsu.edu/people/eugenia-millender.

Dr. Ford is Associate Director of Population Sciences and Cancer Disparities at the MUSC Hollings Cancer Center and the SmartState endowed chair in prostate cancer disparities for South Carolina State University. In this episode, Dr. Ford describes her experiences as a breast cancer patient not once but twice.

Welcome to 16 Minutes, our show where we talk about tech trends in the news. We have two segments today: 1) The announcement recently that Valve Software, which operates the massive gaming platform Steam, added a rule against games that use blockchain technologies or that allow users to exchange cryptocurrencies or NFTs – this rule appeared on its “What you shouldn't publish on Steam” onboarding list for developers. We go beyond the players to the trends at play here, putting the news in context — as is the premise of this show — because it not only immediately impacts gaming developers and gamers using the platform, but has implications for gaming business models and the arc of innovation in gaming as part of the web3 movement. Our expert guests are a16z partner Jonathan Lai and a16z partner Eddy Lazzarin. 2) The FDA's announcement last month that it authorized marketing of the “first artificial intelligence (AI)-based software designed to identify an area of interest on the prostate biopsy image with the highest likelihood of harboring cancer so it can be reviewed further by the pathologist if the area of concern has not been identified on initial review.” The FDA reviewed the technology from Paige Prostate through its De Novo regulatory pathway. We have three expert guests: Eli Van Allen, associate professor of Medicine at Harvard Medical School and chief of the Division of Population Sciences at the Dana-Farber Cancer Institute; a16z bio general partner Vineeta Agarwala; and a16z bio partner Jay Rughani.

Was starting this podcast academic suicide for Sarah and Dan? That remains to be seen, but interviewing Joanne Wolfe (@WolfePPC) and Chris Feudtner was definitely a good choice!  In this episode, hear two of the founding figures of pediatric palliative care in the USA discuss the rocky roads they traveled, individually and together, to establish themselves in a specialty that they were creating as they went. What's changed the most since the early days? What prognostications do they have for the future? Is Dan angling for a musical gig on GeriPal? Listen to Episode 7 to find out!---Chris Feudtner, MD, PhD, MPH, is the Division Chief of General Pediatrics, Attending Physician and Research Director of the Pediatric Advanced Care Team and Complex Care, Stephen D. Handler Endowed Chair and Director of the Department of Medical Ethics, and Director of the Academic General Pediatrics Fellowship Program at Children's Hospital of Philadelphia, as well as Professor of Pediatrics, Medical Ethics, and Health Policy at Perelman School of Medicine at the University of Pennsylvania. Chris is also the author of the recently published Light and Shadow: A Novel of Pediatric Internship.Joanne Wolfe, MD, MPH, is a Professor of Pediatrics at Harvard Medical School, Attending Physician in Population Sciences at Dana-Farber Cancer Institute, and Director of Pediatric Palliative Care and Medical Director of the Pediatric Advanced Care Team at Boston Children's Hospital. 

In a study by International Institute of Population Sciences, the areas with high pollution are more vulnerable to covid-19. The COVID-19 lockdown has led to cleaner air, but will do little to address the issue of air pollution in the long run. Tune in as RJ Rohini and Sachin discuss the news study in this episode.

Paul Han, MD, MA, MPH is Senior Scientist in the Division of Cancer Control and Population Sciences and Adjunct Investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute. Dr. Han's research focuses on understanding and improving the communication and management of uncertainty in health care. His clinical background is in […] The post Uncertainty: What It Is and Ways to Help (HLOL #213) appeared first on Health Literacy Out Loud Podcast.

This week Bobbi Conner talks with Dr. Marvella Ford about efforts underway to improve COVID-19 vaccination rates in communities of color in S.C. Dr. Ford is a Professor in the Department of Public Health Sciences and she's the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.

In this episode we talk to Dr Emily Donovan, a NIHR GP academic fellow from the School of Primary Care, Population Sciences and Medical Education at the University of Southampton. Paper: Domestic abuse among female doctors: thematic analysis of qualitative interviews in the UK Read the paper: https://doi.org/10.3399/BJGP.2020.0795 (https://doi.org/10.3399/BJGP.2020.0795) Previous qualitative research has focused on a doctor's role in supporting victim-survivors of domestic abuse (DA) reinforcing the stereotype in which the doctor helps others experiencing DA rather than being a victim-survivor themselves. This study explored single doctor mothers' lived experience of DA and identified several unique barriers to seeking help. Healthcare professionals need to be aware of these in order to better support patients who are medical doctors.

This week Bobbi Conner talks with Dr. Marvella Ford about the increased vulnerability and mortality from COVID-19 among people of color in S.C., and the urgent need for the COVID vaccine in this population. Dr. Ford is a Professor in the Department of Public Health Sciences and she’s the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.

This week Bobbi Conner talks with Dr. Marvella Ford about the increased vulnerability and mortality from COVID-19 among people of color in S.C., and the urgent need for the COVID vaccine in this population. Dr. Ford is a Professor in the Department of Public Health Sciences and she’s the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.

Our conversation today is with Rania Awaad, M.D.  She is a Clinical Associate Professor of Psychiatry at the Stanford University School of Medicine where she is the Director of the Muslim Mental Health Lab, Associate Chair of the Division of Public Mental Health and Population Sciences, and Chief of the Diversity Section in the Stanford Department of Psychiatry. Her research and clinical work are focused on the mental health needs of Muslims. Her most recent academic publications include an edited volume on "Islamophobia and Psychiatry" (Springer, 2019) and Applying Islamic Principles to Clinical Mental Health Care (Routledge, 2020). She has also produced a toolkit, fact sheet, CME course, and is now editing a clinical textbook on Muslim mental health for the APA (American Psychiatric Association).Through her outreach work at Stanford, she is also the Clinical Director of the San Francisco Bay Area branches of the Khalil Center, a spiritual wellness center pioneering the application of traditional Islamic spiritual healing methods to modern clinical psychology. Prior to studying medicine, she pursued classical Islamic studies in Damascus, Syria and holds certifications (ijaza) in Qur’an, Islamic Law and other branches of the Islamic Sciences. Dr. Awaad is a nationally recognized speaker, award-winning teacher, researcher and author in both the Islamic and medical sciences. In this day and age, with women choosing to bear children at a later age, it seems that infertility is on the rise. In this podcast, we discuss the perception vs reality of infertility, and how to navigate the journey. Everyone will enjoy this brief, but concise discussion because you or someone you know is trying to navigate infertility. Episode Highlights with Dr. Rania Awaad: How to encourage people to seek helpAdvice on how to navigate the relationshipTo implement what you learn, join our Facebook Group: Wellness Surge Family. Connect with Dr. Rania on Instagram @DrRaniaAwaad

The Hospital at Home model of care is emerging as a promising concept to deliver acute care to patients with cancer outside of hospitals and clinics, especially in the era of COVID-19.  In this episode, Kathi Mooney, PhD, RN,  a distinguished professor of nursing at the University of Utah and co-leader of the Cancer Control and Population Sciences Program at the Huntsman Cancer Institute, discusses the significant impact of the her institution’s program, the first of its kind in the United States. This new frontier in care offers the oncology care community a chance to rethink its methods and to consider what can be done safely in the home that provides additional support during the cancer experience.     Transcript ASCO Daily News: Hello and welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. I'm delighted to welcome Dr. Kathi Mooney to the podcast today Dr. Mooney is a distinguished professor of Nursing at the University of Utah and coleader of the Cancer Control and Population Sciences program at the Huntsman Cancer Institute. Dr. Mooney will discuss the emergence of the hospital at home model of care in the oncology setting and the promise of this concept to deliver acute care to patients, reduce hospitalizations, ER visits, and cost. Dr. Mooney reports no conflicts of interest relating to the issues discussed in this podcast. Full disclosures relating to all Daily News podcasts are available on our episode pages. Dr. Mooney, it's great to have you on the podcast today. Dr. Kathi Mooney: Thank you for inviting me, Geraldine. ASCO Daily News: Dr. Mooney, you have done a great deal of research on hospital at home models including your work on the Huntsman at home trial, the first adult oncology hospital at home program in the United States, led by the University of Utah Huntsman Cancer Institute. The results were really impressive and were featured at the ASCO Virtual Scientific Program earlier this year. Can you tell us why you believe this concept could truly move the needle in adopting more innovative patient-centered models of care? Dr. Kathi Mooney: Yes, thank you. Huntsman at home is a concept that is based on the hospital at home programs that are more widely known internationally in single-payer systems and have been in the United States mostly to support frail elderly at home and so has not previously been evaluated for oncology populations. At the Huntsman Cancer Institute, we have been interested in providing more models and testing models of care that are in the community. And so we were very interested in whether the hospital at home concept could address some of the challenges we have in oncology care. As you know, most oncology care is given on an outpatient basis. And so patients are at home for most of their treatment and extended survivor periods of time. And yet we don't have good models to reach out and support patients when they are at home. And as a result, we end up seeing very high levels of emergency department use and rehospitalization. So we were interested in looking at the hospital at home model for oncology and began that program. And once we had a number of patients in it, we looked at evaluating how it impacted those health care utilization factors we were interested in, both emergency department and rehospitalization. We started by studying 169 patients that had been admitted to our Huntsman at home program and compared them with 198 cancer patients who would have been eligible to be admitted to Huntsman at home but lived outside of our 20-mile service radius. And we found that indeed, it very much addressed the health care utilization issues and that, in the first 30 days after enrollment in the Huntsman at home or our comparison group, there was a 58% decrease in unplanned hospitalization. And for those who were hospitalized, they had a 1.2 less days of inpatient stay. We also found that it reduced emergency department visits by 48%. And the charges were also 48% less for the patients that were in Huntsman at home. ASCO Daily News: Well, as you say, the Huntsman at home trial showed that patients can truly benefit from receiving oncology care in their homes. But are there any limitations to this model of care in the oncology setting in particular? What are some of the challenges that typically arise for oncology clinicians providing care at home? Dr. Kathi Mooney: Well, one of the things is to really understand the care needs of oncology patients at home. And what we have found is that there is an initial acute care event for which Huntsman at home gets involved. And then once the patient is stabilized, then not too long afterwards, they may have an exacerbation of the problems that they were experiencing or new problems. So one of the things in the model for oncology care is how we identify and give high-intensity care for a short duration and then how we do more remote monitoring of how the patient is doing so we can get back in there again if indeed they have an exacerbation of some of their symptoms. ASCO Daily News: Is there a patient population that posed more challenges in this program in the trial than others? Dr. Kathi Mooney: Well, we only had a small number of patients that were bone marrow transplant. But that is a challenging group to work with in terms of their stabilization needs. We also had some acute postsurgical cases that had extenuating circumstances that occur during the hospital at home period. But overall, I don't think one group particularly stands out. It's in being able to be available to monitor patients carefully and then to be able to jump back in when they need additional support. ASCO Daily News: Right. Well, there are significant costs to staff a hospital at home program. Can you tell us about the payment model challenges that are associated with this model of care? Dr. Kathi Mooney: Yes. There are significant challenges in the US because most home care is based on a traditional home health model that restricts to several registered nurse visits over a period of time. And that, of course, does not fit at all with an acute care model of care rather than a home care model care. And so part of our demonstration of the hospital at home concept in oncology is to carefully evaluate and get data so that we can work with payers about alternate payment systems. To make the model sustainable, we can't have a fee for service or a traditional home health model of care. Our particular Huntsman at home model is led by oncology nurse practitioners. And we also work with a home health agency for registered nurse care. We also have backup by a medical director. And we have other interdisciplinary team members such as physical therapists involved. They work very closely with the patient's ongoing oncology team. ASCO Daily News: Well, the hospital at home model of care seems especially timely in the era of COVID-19. It was actually introduced in the United States more than 20 years ago but hasn't been widely adopted or tested in the oncology setting specifically. So why do you think it has taken a while for this concept to receive the attention it deserves? Dr. Kathi Mooney: Well, I think a couple of reasons. One as we just mentioned, the issue of reimbursement, makes it very difficult for a program and oncology center to start it and have adequate reimbursement for it. But also the model began really out of general hospitals, out of the focus on geriatrics. And therefore, there was a lot of thinking that it may not apply to oncology or cancer centers or cancer programs. And so it was more developed within the geriatric and also for health centers that had a broad number of other kinds of conditions for which they were providing hospital-level care. So it just was not focused on within the oncology community until now. ASCO Daily News: So what's next for this model of care following the Huntsman at home trial? What are the next steps for you? And how do you see the path forward for this model of care? Dr. Kathi Mooney: We were very excited about the response we got from the oncology community to the work we've done with Huntsman at home. We've been contacted by a number of people who are interested in learning more. And we hope that based on that that we can involve additional people in evaluating and piloting this new form of care for cancer patients. We're very interested in continuing to study and advance this model of care. And one of the things being in Utah is the fact that we have many rural communities. And one of the things that the Huntsman Cancer Institute is interested in is how we extend care into communities, rural communities, frontier communities. So the next thing that we are going to do is to extend the program into three rural counties in Utah. And this will be very interesting and definitely follows up on the idea of how do you provide care and outreach during a pandemic. And so we will use a lot of telehealth. We'll have home health nurses in the community, so a combination of people on the ground and also telehealth, in order to work with communities around providing better support to cancer patients when they're back in their rural communities. And we hope to decrease the amount of travel that is required to receive high-quality cancer care. ASCO Daily News: Absolutely. It'll be interesting to see how this concept evolves in a rural setting. Is there anything you'd like to add, Dr. Mooney, before we wrap up the podcast today? Dr. Kathi Mooney: I would just like to add that this is an exciting concept that I am hopeful that others' programs will consider adopting, piloting, also evaluating. I think we need an movement in oncology to look about how we provide comprehensive care not just here in clinics and hospitals and so how we can establish ourselves in the community by using a combination of telehealth and care within the site to improve the outcomes for cancer patients. It's been exciting to see how much we can address the problems we have in oncology with rehospitalization and emergency department. And yet for families, it's wonderful to be able to get their care locally and to be able to have support when they're at home. There is also some interest that we'll see how it develops that has come out of the COVID experience. We haven't specifically done that with the Huntsman at home program yet. But it's also to look about, is there safe chemotherapy that could be given at home and thus not have patients who are vulnerable have to come in to cancer centers or community oncology clinics to provide care? So there is a great opportunity for us to rethink about how we deliver care and rethink what can be safely done in the home that provides additional support during the cancer experience. ASCO Daily News: Absolutely. Well, thank you, Dr. Mooney, for sharing your insight with us today on this innovative patient-centered model of care. Dr. Kathi Mooney: Thank you very much for inviting me. ASCO Daily News: And thanks to our listeners for joining us today. If you're enjoying the content on the podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. COI:  Dr. Kathi Mooney No conflicts of interests  Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

This Podcast features the 7th session of #APCRSHR10 Virtual on the theme of "Population ageing and sexual and reproductive health and rights (SRHR) in Asia and the Pacific" (in lead up to #InternationalDayofOlderPersons #IDOP2020). Be welcome to listen on Apple Podcasts, Google Podcasts, Spotify, Stitcher, TuneIn, aCast, Podtail, BluBrry, Himalaya, and other podcast streaming platforms.Chair: Ms Sono AibePlenary Speakers:Sai Jyothirmai Racherla, Deputy Executive Director, Asian-Pacific Resource & Research Centre for Women (ARROW) | “Reclaiming and Redefining Rights -Older Women’s Health and Well-Being in Asia and the Pacific Region at ICPD+25”Caitlin Littleton, Regional Programme Adviser, HelpAge International Asia Pacific Regional Office | “Sexual health of older people: an overview”Krishna Gautam, founder and Chair of Ageing Nepal (UNESCO King Sejong Literacy Prize 2020 awardee) | “Not Leaving Older Adults Behind in the process of achieving SDG-2030”Abstract presentersDr Tey Nai Peng, Chairperson of National Population and Family Development Board Research Committee (Lembaga Penduduk dan Pembangunan Keluarga Negara) | Understanding the Sexual Behaviour of Older Men and Women in MalaysiaProf Xiaoming Sun, School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, China | Unmet Needs on Sexual and Reproductive Health among Women Aged 50-64 in Rural ChinaFor more information, please visit: www.bit.ly/apcrshr10virtual7 #APCRSHR10 virtualIn the wake of the ongoing coronavirus disease (COVID-19) pandemic situation, the 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10) has evolved from an in-person conference to an ongoing virtual series.On behalf of APCRSHR10 and Reproductive Health Association of Cambodia (RHAC) and CNS, #APCRSHR10 virtual is being hosted every fortnight in the form of 14 online sessions during June to December 2020. #APCRSHR10 Virtual features thematic online sessions with plenary speakers and top-ranking abstract presenters, among other insights and discussions around sexual and reproductive health and rights (SRHR), COVID-19 impact and SDGs in the Asia Pacific regional context.For more details, please visit: www.bit.ly/apcrshr10virtual or www.apcrshr10cambodia.orgThanksAPCRSHR10/ RHAC/ CNS teamsEmail: editor@citizen-news.org

This week Bobbi Conner talks with Dr. Marvella Ford about increased mortality in the SC African American population from COVID-19. Dr. Ford is a professor in the Department of Public Health Sciences and she’s the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.

For the final podcast of the year, we have managed to have a few consecutive ones, hopefully a good omen for the New Year. We are delighted to have Professor Ken Smith, Head of the Department of Pathobiology and Population Sciences here at the RVC. He is Professor of companion animal pathology and could speak about a great many things from Tasmanian devil facial tumour disease to theatre. Though we thought we’d ask Ken more about what anatomical pathologists do for us, and also how we can help them in achieving that. We hope that you enjoy and Happy New Year.     Some articles of interest: https://www.rvc.ac.uk/Media/Default/Pathology%20and%20Diagnostic%20Laboratories/Documents/rvc-labs-services-pricelist-2020.pdf https://www.rcpath.org/discover-pathology/careers-in-pathology/careers-in-medicine/become-a-veterinary-pathologist.html https://www.msdvetmanual.com/clinical-pathology-and-procedures/collection-and-submission-of-laboratory-samples/collection-and-submission-of-laboratory-samples-from-animals http://apha.defra.gov.uk/External_OV_Instructions/Essential_Skills_for_Official_Veterinarians/Notifiable_Diseases/index.htm http://apha.defra.gov.uk/apha-scientific/services/lab/index.htm If you have any comments about this podcast, plese get in touch: email dbarfield@rvc.ac.uk; tweet @dombarfield. We would greatly appreciate your time to rate us on Apple podcast or Acast and kindly write us a review.

For the final podcast of the year, we have managed to have a few consecutive ones, hopefully a good omen for the New Year. We are delighted to have Professor Ken Smith, Head of the Department of Pathobiology and Population Sciences here at the RVC. He is Professor of companion animal pathology and could speak about a great many things from Tasmanian devil facial tumour disease to theatre. Though we thought we’d ask Ken more about what anatomical pathologists do for us, and also how we can help them in achieving that. We hope that you enjoy and Happy New Year.     Some articles of interest: https://www.rvc.ac.uk/Media/Default/Pathology%20and%20Diagnostic%20Laboratories/Documents/rvc-labs-services-pricelist-2020.pdf https://www.rcpath.org/discover-pathology/careers-in-pathology/careers-in-medicine/become-a-veterinary-pathologist.html https://www.msdvetmanual.com/clinical-pathology-and-procedures/collection-and-submission-of-laboratory-samples/collection-and-submission-of-laboratory-samples-from-animals http://apha.defra.gov.uk/External_OV_Instructions/Essential_Skills_for_Official_Veterinarians/Notifiable_Diseases/index.htm http://apha.defra.gov.uk/apha-scientific/services/lab/index.htm If you have any comments about this podcast, plese get in touch: email dbarfield@rvc.ac.uk; tweet @dombarfield. We would greatly appreciate your time to rate us on Apple podcast or Acast and kindly write us a review.

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. In today’s podcast, Dr. Ryan Nipp and Dr. Electra Paskett will discuss their article “Overcoming Barriers to Clinical Trial Enrollment,” from the 2019 ASCO Educational Book. They discuss why it is important for people with cancer to participate in clinical trials and some of the reasons people may not be able to participate in clinical trials. They also discuss finding financial resources, the informed consent process, and the role of patient navigators. Dr. Nipp is a gastrointestinal oncologist and health services researcher at Massachusetts General Hospital Cancer Center. Dr. Paskett is the Marion N. Rowley Professor of Cancer Research at The Ohio State University. She is the Director of the Division of Cancer Prevention and Control in the College of Medicine, a professor in the Division of Epidemiology in the College of Public Health, and the associate director for Population Sciences and Program Leader of the Cancer Control Program in the Comprehensive Cancer Center of OSU. She is also the director of the Center for Cancer Health Equity at the James Cancer Hospital. Published annually, the Educational Book is a collection of articles written by ASCO Annual Meeting speakers and oncology experts. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology. ASCO would like to thank Dr. Nipp and Dr. Paskett for discussing this topic. Dr. Ryan Nipp: My name is Ryan Nipp. I work at Massachusetts General Hospital in Boston. I am a gastrointestinal oncologist. And I do research focused on palliative care, geriatrics, health services research. And I'm a part of the Cancer Outcomes Research team at Mass General. Dr. Electra Paskett: I'm Electra Paskett. I'm at the Ohio State University. I am a Professor in the Department of Internal Medicine, College of Medicine. And I'm also the associate director for population sciences and a community engagement. And my research focuses on prevention, early detection, and working with survivors, mainly in terms of developing interventions to get people to do things to prevent cancer, detect it earlier, or live longer. And I have a specific focus in underserved and minority populations focusing on disparities. Dr. Ryan Nipp: And we are talking about a podcast where we had done some discussion at this year's ASCO meeting about overcoming barriers to clinical trial enrollment. And we were just going to go through a few questions together and kind of give our thoughts on each of these. And the first question I wanted to ask you, Dr. Paskett, is why do you think it's important for patients to be involved in cancer clinical trials? Dr. Electra Paskett: I would say for 2 reasons. First of all, we know that patients on clinical trials actually get very close monitoring, and so they would get the best of standard of care at their institutions. And secondly, the way that we progress in terms of knowing how to treat cancer, how to detect cancer early, and how to prevent cancer is through what we learn in clinical trials. Therefore, it's really important for all of us to participate in clinical trials so we can move the innovations and the new treatments and prevention strategies forward. And the only way to do that is through evidence from clinical trials. Dr. Ryan Nipp: Absolutely. I agree. Just coming at this from a clinical standpoint as a gastrointestinal oncologist, we talk about this a lot in day-to-day practice where we have the standard of care option and then we have a clinical trial option. And as you brought out, that's exactly right. At the very least, everyone should be getting the absolute best standard of care and clinical trial. From our standpoint, the way we usually discuss it is it's what we're trying to do is advance knowledge, and this is, hopefully, going to benefit the patient currently, and then also, develop new knowledge for future patients. And ultimately, this is to advance the field forward. And that's one of the things I think is so exciting about oncology. The next question we were going to talk about was what are some of the barriers that might prevent a patient from participating in a clinical trial? Dr. Electra Paskett: So I can start with a few from my perspective. We have studied this quite extensively, and we categorize the barriers into various levels. There are barriers at the patient level, barriers at the provider or the physician level, barriers at the health care system level, and then, we think, barriers even at the community or society level. And if we're talking about barriers at the patient level, a lot of times, patients don't know that there is a clinical trial available. And so that kind of affects their even ability to join a trial if they don't know that there is a trial open for them. Patients sometimes don't know a lot about clinical trials, and they're worried about clinical trials and don't quite understand what all that means. There are some myths about clinical trials using patients as guinea pigs. And that is not at all what clinical trial research is about. And so we do have to dispel some myths. And so those are some of the barriers. There's also issues related to practical things like transportation and time. Sometimes, there are more visits that are entailed. And sometimes, people don't want to get an experimental drug. They just want to get the standard of care. However, the way clinical trials are designed, you always will get at least a standard of care. So you're not getting anything worse when you're on an oncology clinical trial. If we think of barriers at the provider level, sometimes the providers don't have enough time to talk about a clinical trial to patients because it does take some time to explain and to go through the consent process. But those are some of the reasons. And even if we move up to the system level, I like to call it, is that, sometimes, we don't have protocols available for every type of cancer that we see in every patient who has cancer. So I think that's a huge barrier. And then, a lot of times, the way the trials are written are that they exclude a lot of people, meaning a lot of people can't join because they're either too old or sometimes too sick or they already had 1 type of treatment started. So those exclude a lot of people and don't let them participate in clinical trials. And then if we go up to the society or community level, there still are a lot of myths in our communities about participating in research, and we need to work hard to dispel those and make sure that all people are treated fairly in any type of research study. There's also, in some places, different policies about paying for the treatments that people receive on clinical trial. And we have to make sure that those barriers are also removed. And the last thing I want to mention is that we know that children with cancer, almost 80% of those children with cancer go on clinical trials, whereas it's anywhere from 3 to 5 percent, sometimes 8% of adults with cancer that go on clinical trial. And the question is why is that? And there's a few reasons. The first is that there are very few types of childhood cancer versus the 200 plus types of cancers adults can get. So when you have few diseases, few cancers, you can develop protocols for the few. So there are many more protocols for the few cancers that children develop. Secondly, kids with cancer are usually treated at pediatric cancer facilities, of which there are few in the United States. So again, few diseases, few places that treat kids with cancer, and they treat them the same way. And all the people who treat kids with cancer have been trained the same way to know that putting a child on a clinical trial is the best treatment. So when you have similar standards, similar training modalities, similar protocols at these fewer institutions and fewer diseases, then you can have time and have the culture we talked about at the community level and at the provider level. You have the culture that we need to put these patients on clinical trials, and it facilitates accrual. So that's sort of a few of my thoughts about that question. Dr. Ryan Nipp: Yeah. That's fantastic. I can't add a lot to that. I'll just kind of go into some of the specifics. You mentioned most of these already, like financial issues potentially representing a barrier from both the system level and from the patient perspective. When you choose to participate in a clinical trial, much like you were mentioning with the children, usually, it's a larger cancer center that offers the trial and requires travel and lodging for patients to get to the trial site. So that's also a time away from work and then just the burden of getting there and driving and paying out of pocket for those expenses. Not to mention, potentially with trials, there may be more frequent visits. So that could also add to the financial barriers. And then just the only other point I would make is going into some more detail just from the clinician perspective, as you definitely mentioned, and it's very pertinent. The time it takes for discussing a clinical trial and going through the logistics, and in a time-limited visit, that's always a burden to try to get patients with enough information that you feel like you've given them what they need to know to make an informed decision about a trial, both the risks and the benefits, and then allowing you to also feel like you've understood the trial so that you can explain it to the patient. So there's a lot of work being done on how can we equip clinicians in the clinical setting so that we can make this less of a burden on that end so that you can identify patients a little easier, too, what trials might be available for them. And then, when they are identified as a trial candidate for certain trials, so that the clinician doesn't have to memorize 20 separate trials, you know what you can do. You can bring in potential trial navigators, something we'll talk about in a few other questions, where somebody who may know all the ins and outs of that specific trial so that you can at least introduce the idea of why scientifically this might make sense, but here's the very detailed logistics of what this trial is going to look like for that patient. So just wanted to go through a few of those higher level, more detailed issues, but it was incredibly thorough description of all the potential barriers. The next question that we wanted to discuss was what are some of the resources that may be available for patients who are concerned about participating in a clinical trial for financial reasons? So we've done a lot of work on this at Mass General where, a few years back, we had looked at certain interventions where could we be identifying patients who are experiencing financial burden who may be at risk for not completing a clinical trial or not even being interested in the clinical trial just because of those financial issues that I mentioned about traveling to a trial site, having to take off from work, having to stay in a city or go to some farther place and then stay in a hotel just to be a part of the trial. We developed a program at Mass General, a financial assistance program, where people could enroll in their trial and then, once they got enrolled in the trial, if our social workers or nurses or the clinicians identified that the patient might benefit from financial assistance, they could be sent to this program, which we call the cancer care equity program. And at that time, patients would still pay for the travel and lodging, and then we had a system set up where we could reimburse them for travel and lodging. And we studied this, and we looked at our clinical trial accrual over the years before we had this program and then after the program. We have not currently done a randomized controlled trial with this program. That would be a future study that we would love to do. But when we just did this natural experiment seeing pre and post when we had this program, it did look like we saw an increasing clinical trial accrual at our institution during those years after the program was instituted. But obviously, without a randomized trial, there's many reasons that could contribute to that. We also then, later on, gave patients surveys over time while they were participating in a clinical trial asking them about their financial burden over time just to see how are these patients' financial burden evolving over time on a trial, because you worry about when someone signs up for a trial, at that moment, they're willing to do anything just to get the appropriate best possible treatment. And then what happens with their finances from that point forward, you might not be thinking about from the beginning. So we surveyed a group of people who were enrolled in our program with financial assistance, and then we surveyed a group of control or usual care patients who were not getting the assistance but who were also on a clinical trial. Again, not a randomized trial for this, but we did see a trend where the group who was in the program had steady to improved levels of financial burden, whereas the group that was not getting the financial assistance, their financial burdens appeared to get worse over time. So that was some more evidence that having these financial assistance programs may help. And this is a growing idea in the community, but there's a lot more research that needs to be done there. Some other evidence or some other things that we can be doing, at least at the clinical level or for patients when they come to a clinic right now, that where we don't have studies like that open, I would argue that, at the very least, it would be helpful for patients to know kind of what's required of the trial, how often are the trial visits going to take place, what's going to be entailed in those visits, how long are those daily visits when they do come to the clinic for their trial visit, how long are they going to be there, things like that just so you can plan ahead and kind of know how much of an effort is this going to take. And then there's also resources at many community or many cancer centers where you can have social workers or community resources available to talk with patients about what other resources might be available to help with either financial assistance or just knowing what the expenses may be related to the supportive care medications, related to the trial, related to the labs and things like that just so that taking a little bit of the uncertainty out of the picture so that people have an idea of what may be to come and being able to plan ahead. Dr. Electra Paskett: Those are really great suggestions. And we have a very small grant from a foundation to provide up to $250 financial assistance for any cancer patient. And they have to qualify. There are income guidelines that qualify them. And we are just inundated with requests from our cancer patients. And this is irrespective of a clinical trial, but a lot of our patients are on clinical trials. And we can give them up to $250 each year. And the things that we might think are a little bit to help with gas or food or to get out of the parking lot are huge things to our patients. And I think that, sometimes, we don't fully appreciate the issues that our patients face when they come here to receive care. And I think being very astute and aware of that and trying proactively to, A, identify them. And we do that with our patient navigators. And it's actually a financial navigator that we have now that administers this money. And so being aware, asking about it, because it will make people, A, adherent, but B, just really one little thing from the stress that they're dealing with in being diagnosed and treated with cancer. Dr. Ryan Nipp: Absolutely agree. The next question for us to discuss is what do we think is important for patients to know about the informed consent process? Dr. Electra Paskett: Okay. So it is a process. That was your last word. Process. And a lot of times, we forget that it's a process. And we researchers sometimes just think about the informed consent document, but it's really a process. And the informed consent document or the consent form is a part of it. And it is a big part of it, but people need to be informed about the research. And I think it's very important when we, first of all, craft our consent forms, that they need to be in English, not in medical terms. They have to be in a good reading level, 5th to 8th grade if possible, and we should inform the patient by going through the subheadings on the consent form. And somebody needs to walk the patient through the subheadings on the consent form. A lot of consent forms, especially for treatment trials, have pictures to show the different treatments. And we definitely need to walk patients through the consent form, let them ask questions. If they want to take the consent form and talk to their family about it, we need to let them do that. But it really is an informed consent process, and we have to let that process occur. Dr. Ryan Nipp: Agree, 100%. The other issue I think about in clinic when we're doing this is, often, we're doing informed consent, at least as oncologists, when we do routine chemotherapy. And when you're doing a routine chemotherapy consent, you're usually talking about the potential risks and benefits. And with most routine chemotherapy, they've been through trials already, so we have an idea of what those potential risks and benefits could be. Something I should have mentioned earlier, one of the things that I think is interesting related to the barriers, like Dr. Paskett was mentioning, where if the patients that we enroll on trials are younger and healthier than real life, then you do have a little bit of variation as far as when you see a patient in clinic, they may look a little different than what the clinical trial population looked like. So that gives a little bit of a gray zone of do we absolutely know what the risks and benefits are? But then, when it comes to a clinical trial informed consent process, that's where I think there's some interesting ethical dilemma that you're in some ways that we run into where you would love to give people the potential risks and know exactly what to expect, and you'd love to be able to give the potential benefits, but that's somewhat the essence of a clinical trial where we don't quite yet know what the benefits will be. We hope that there's going to be benefits. That's why we design the trial the way we do. And so you can kind of go through those potential benefits, but you also don't want to overplay it and give false hope. And then, on the other hand, when you're talking about the risks, you want to be realistic and say that this is a treatment, and based on the mechanism, it could cause these risks, but we're not 100% sure. That's partly what we're going to be studying with the studies. So I find that an interesting part of the informed consent process when you're talking about a clinical trial where you're gaining new knowledge, and that's part of what you will be gaining are the risks and the benefits that you can inform future patients when this is no longer on a study and is part of routine care. Dr. Electra Paskett: Yep. Those are great points. And it's not meant to scare people, but it really does. People need to be informed. Dr. Ryan Nipp: And then the last question for us was how can patient navigators help patients overcome some of the barriers to enrolling in cancer clinical trials? Dr. Electra Paskett: So we've done a lot of work in patient navigation. And we use navigators now in many of our clinics. I talked about our financial navigators. But our navigators are people who are our laypeople, and they, a lot of times, come from the same background as the patients. And so they're able to gain trust of the patients and explain treatments in clinical trials and the things on the consent forms we've just been talking about to patients in a language that, sometimes, we as medical professionals don't use. And so navigators can help with that. And the job of navigator is to identify and then address the individual barriers that a patient has to completing their recommended treatment given them by their health care provider. And that's what navigators do. They can assess what the individual barriers are. And sometimes, they might be things like transportation. They might be childcare or eldercare or things like that. And the navigators have the resources and the connections in the institution and out in the community to address the individual barriers that a patient has. And every patient has different barriers. And so doing this intake assessment allows the navigators to identify and then tailor their strategies to each individual. Dr. Ryan Nipp: Yeah. And then just to add on what I've kind of been learning from you, Dr. Paskett, is financial navigators are, essentially, there to make the entire process more streamlined and smooth for the patient as well as, potentially, the clinician as we're going through this process. It's always nice. One thing I find that's helpful about a lot of the clinical trials when we have patients on them is that what comes along with a lot of clinical trials is that you also have the resources that come along with the trial, which are the research assistants or the research nurses who are helping schedule things and keeping things organized. And that's one of the things that I could see as a clinical trial navigator to have just another set of resources, another set of eyes paying attention to the details, which can only help. It's one of these amazing potential interventions where it's almost all we're doing is trying to help. And so one of the points I wanted to make is I think we need a lot more research in this area. And I think it's ripe for research, but it's also one of those things where it's a little complicated, a lot like when we had done the financial assistance program where you think almost anyone could benefit, so then you have this difficulty with randomizing because everyone, you would hope, would have access to this, but that's currently not the standard, and that's why I think we need to prove it with more research. Dr. Electra Paskett: Right. I agree. And one of the things when we first started offering navigation was our providers said, "Oh. I don't have to do that [laughter]." And so that they can spend more time working on the medical aspects versus these other aspects that the navigators are very competent to address. Dr. Ryan Nipp: Absolutely. Well, I think that's all the questions that we were expected to address. Any final thoughts, Dr. Paskett? Dr. Electra Paskett: No. Thank you. This has been fun. Been fun working with you and ASCO and the meeting and this. It's great. Dr. Ryan Nipp: Agree. Again, it's always a joy working with ASCO [laughter]. Thank you. Thank you, everybody. ASCO: Thank you Dr. Nipp and Dr. Paskett. Please visit ASCO.org/edbook to read the full article. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/support.

In this episode, I sip and talk with Dr. Rick Kittles. Dr. Kittles is a Professor and founding director of the Division of Health Equities within the Department of Population Sciences at the City of Hope. Dr. Kittles is well known for his research of prostate cancer and health disparities among African Americans. His research has focused on understanding the complex issues surrounding race, genetic ancestry, and health disparities. Dr. Kittles candidly shares his transition through his formal education and professional career.**Episode Notes**Follow Us on Instagram @tRXansition_podcastEmail: tRxansitionpodcast@protonmail.comFollow Dr. Kittles on Instagram @rkittles

ONS member Michelle Mollica, PhD, MPH, RN, OCN®, program director at the National Cancer Institute's Division of Cancer Control and Population Sciences, joins Chris Pirschel, ONS staff writer, to discuss the growing challenges of cancer survivorship, research opportunities for nurse scientists, and how oncology nurses can meet the needs of cancer survivors. Music Credit: "Fireflies and Stardust" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0 Episode Notes: Check out these resources from today's episode: Complete this evaluation for free nursing continuing professional development. Caring for Patients Through All Levels of Survivorship Equitably Improving Outcomes for Cancer Survivors and Supporting Caregivers: A Blueprint for Care Delivery, Research, Education, and Policy From Cancer Patient to Cancer Survivor: Lost in Transition Implementing Personalized Pathways for Cancer Follow-Up Care in the United States: Proceedings From an American Cancer Society–American Society of Clinical Oncology Summit Personalized Risk-Stratified Cancer Follow-Up Care: Its Potential for Healthier Survivors, Happier Clinicians, and Lower Costs The Handbook of Cancer Survivorship

The Institute of Policy Studies (IPS) held its annual flagship Singapore Perspectives (SP) conference on 22 January 2018. The theme of SP2018 was “Together” and it considered Singapore’s demographic challenges and opportunities as a global city-state without natural resources. The third panel considered the need to prioritise measuring and maximising human welfare over GDP per capita and challenged common misconceptions of aged persons as liabilities to society. The full programme, including presentation slides and speakers’ remarks, are available on our website: http://lkyspp2.nus.edu.sg/ips/event/s... Speakers: 08:11 mins: Professor David Canning, Richard Saltonstall Professor of Population Sciences and Professor of Economics and International Health, Harvard School of Public Health 29:02 mins: Dr Kanwaljit Soin, Practising Orthopaedic and Hand Surgeon Moderator: 50:22 mins: Q&A moderate by Associate Professor Corinne Ghoh, Next Age Institute, National University of Singapore.

The labor force 30 years from now will look very different as working-age populations in advanced economies start to shrink. While some today worry they’ll lose their jobs to robots, economists like Google’s Hal Varian, wonder if technology will boost productivity enough to compensate for the shifting demographics. Varian, and Harvard’s David Canning, discussed the topic during an IMF World-Bank Spring Meetings seminar earlier this month. Hal Varian, Google’s Chief Economist and an Emeritus Professor at UC Berkeley. David Canning, Professor of Population Sciences, Economics and Intl Health, Harvard University, Department of Global Health and Population.

Today's episode features Dr. Ruth Patterson, a professor in the UC San Diego Department of Family Medicine and Public Health as well as Associate Director of Population Sciences and leader of the Cancer Prevention program at Moores Cancer Center at UC San Diego Health. If you enjoyed my last episode with Dr. Satchin Panda, I have good news! This will also be a great episode for you, since we talk about some similar ideas, but focus more on the human side of things, especially when it comes to time-restricted eating, since Dr. Patterson does primarily clinical research. In this 45-minute podcast, we talk about... The importance of time-restricted eating as a practical public health intervention, mostly for it's ease of implementation, that may have a widespread impact on disease risk. Why you should probably make sure your time-restricted eating window occurs earlier in the day, rather than later. How the first 5% drop in weight loss can have disproportionately large effects on the metabolic factors associated with breast cancer risk when compared with subsequent weight loss. The association of longer fasting durations beginning earlier in the evening and improved sleep in humans, as well as spontaneous physical activity in their day-to-day lives. The relationship between metabolism and breast cancer risk. The effect of lifestyle factors, such as obesity, physical activity, what and even when you eat, whether or not you smoke tobacco... and how even modest changes, such as consuming food earlier in the day and only during an 11-hour window, can decrease breast cancer risk and recurrence by as much as 36%. The importance of starting your fast earlier in the evening, and how an earlier eating window has been shown to correlate to reductions in inflammatory markers. The association of higher circulating insulin levels with breast cancer risk, and how insulin itself has an important relationship with estrogen by affecting the levels of sex-hormone binding globulin. The dangers of having a cellular environment that is inflamed, as the case is with the obese, and simultaneously having elevated cellular growth signals, which is also characteristic of the hormonal milieu of the obese. The surprisingly small role heredity plays in determining overall risk of breast cancer when compared to lifestyle factors. How healthful lifestyle habits, like choosing to eat during the right window, ultimately helps us trend our risk for many of the diseases of old age in the correct direction instead of influencing only one or another. If the concept of time-restricted eating especially piques your interest, make sure to... Check out the podcast released just prior to this one: Dr. Satchin Panda on Time-Restricted Feeding and Its Effects on Obesity, Muscle Mass & Heart Health. Make sure your data points go to good use! Visit myCircadianClock.org to learn how you can, by committing to a minimum of a 14 week "intervention" and submitting pictures of your food from your iPhone or Android phone, move human research on time-restricted eating forward. Huge special thanks to Dr. Ruth Patterson for coming on. Enjoy the podcast!

Dr. Ruth Patterson Dr. Ruth Patterson, a professor in the UC San Diego Department of Family Medicine and Public Health as well as Associate Director of Population Sciences and leader of the Cancer Prevention program at Moores Cancer Center at UC San Diego Health. In this epsidode, we chat about: The importance of time-restricted eating as a practical public health intervention, mostly for it's ease of implementation, that may have a widespread impact on disease risk. Why you should probably make sure your time-restricted eating window occurs earlier in the day, rather than later. How the first 5% drop in weight loss can have disproportionately large effects on the metabolic factors associated with breast cancer risk when compared with subsequent weight loss. The association of longer fasting durations beginning earlier in the evening and improved sleep in humans, as well as spontaneous physical activity in their day-to-day lives. The relationship between metabolism and breast cancer risk. The effect of lifestyle factors, such as obesity, physical activity, what and even when you eat, whether or not you smoke tobacco... and how even modest changes, such as consuming food earlier in the day and only during an 11-hour window, can decrease breast cancer risk and recurrence by as much as 36%. The importance of starting your fast earlier in the evening, and how an earlier eating window has been shown to correlate to reductions in inflammatory markers. The association of higher circulating insulin levels with breast cancer risk, and how insulin itself has an important relationship with estrogen by affecting the levels of sex-hormone binding globulin. The dangers of having a cellular environment that is inflamed, as the case is with the obese, and simultaneously having elevated cellular growth signals, which is also characteristic of the hormonal milieu of the obese. The surprisingly small role heredity plays in determining overall risk of breast cancer when compared to lifestyle factors. How healthful lifestyle habits, like choosing to eat during the right window, ultimately helps us trend our risk for many of the diseases of old age in the correct direction instead of influencing only one or another.   If you're interested in learning more, you can read the full show notes here: https://www.foundmyfitness.com/episodes/ruth-patterson Join over 300,000 people and get the latest distilled information straight to your inbox weekly: https://www.foundmyfitness.com/newsletter Become a FoundMyFitness premium member to get access to exclusive episodes, emails, live Q+A's with Rhonda and more: https://www.foundmyfitness.com/crowdsponsor

Dr. Deborah Schrag is chief of the Division of Population Sciences at the Dana-Farber Cancer Institute. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. D. Schrag. Reimbursing Wisely? CMS’s Trial of Medicare Part B Drug Payment Reform. N Engl J Med 2016;374:2101-5.

Researchers in the Department of Population Sciences are working to better understand the causes of cancer, including hereditary (genetic) and environmental factors that may influence a person's risk of developing cancer.  Their job is to determine the health problems (after-effects) that can result from both cancer and its treatment.They work to identify groups of people who are at high risk for developing cancer and after-effects of cancer treatment, and find ways to best provide services to these people.Most importantly, to discover the most effective ways to prevent cancer, and to prevent the after-effects related to cancer and its treatment. Some of the most often asked questions to researchers are what actually is cancer?What causes cancer?How is cancer diagnosed and staged?How do genetics play a role in cancer?How do diet and physical activity affect cancer risk?These and other questions will be answered by Dr. Lacey, an associate professor at City of Hope's Division of Cancer Etiology.

You can reduce your cancer risk by following these simple guidelines from Ernest Hawk, M.D., vice president of Cancer Prevention and Population Sciences at MD Anderson Cancer Center. Many diseases can be avoided by changing your lifestyle. Learn what you can reduce your risk for cancer.

Join us for an exclusive broadcast spotlight on MD Anderson Cancer Center, one of the premiere global cancer centers serving over 115,000 patients annually, We'll be speaking with Ernest Hawk, MD, MPH (VP, Cancer Prevention and Population Sciences) and Anna Franklin, MD (Assistant Professor, Department of Pediatrics Patient Care, Medical Director, Adolescent and Young Adult Program). Survivor Kelly Herbert in the spotlight

Join us for an exclusive broadcast spotlight on MD Anderson Cancer Center, one of the premiere global cancer centers serving over 115,000 patients annually, We'll be speaking with Ernest Hawk, MD, MPH (VP, Cancer Prevention and Population Sciences) and Anna Franklin, MD (Assistant Professor, Department of Pediatrics Patient Care, Medical Director, Adolescent and Young Adult Program). Survivor Kelly Herbert in the spotlight See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

What is energy balance? It may sound like a strange term, but it basically means equalizing the amount of calories you take in with how much you burn through exercise, metabolism and body processes. Since obesity is one of the leading causes of cancer, Carrie Daniel-MacDougall, Ph.D., M.P.H. and Susan Schembre, Ph.D., R.D., both assistant professors in Cancer Prevention and Population Sciences at MD Anderson Cancer Center, study behaviors and biological processes associated with linking energy balance to cancer risk and survival. Listen to Daniel-MacDougall and Schembre share advice on how you can get the proper balance between eating and exercise to stay healthy.