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Anchor lead: Does a common blood thinner reduce cancer risk? Elizabeth Tracey reports

Warfarin, or Coumadin, is a very common blood thinner. Now a new study has linked use of Coumadin to a decreased risk for breast, prostate and lung cancers. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says not so fast. Use of Coumadin may be simply a place holder for some other factor in those who are being treated with the drug.

Nelson: What biases are there among people who are taking Coumadin versus people who are not? The first obviously is if you’re taking Coumadin you have some kind of an illness. It’s related to blood clotting or the worry for blood clotting and that does two things. One, it engages you tightly with the health system cause you’re forever going in figuring out whether your blood clotting or warfarin levels effect on blood clotting is too much or too little, and then the health system is going to make decisions with this vigilance, about how hard they’re going to look for cancer.  :31

Nelson says this study does point toward another assessment of the cancer/Coumadin relationship, as well as discernment of how it might work. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Most of those undergoing care for cancer are concerned about costs, Elizabeth Tracey reports

Many people really aren’t aware of cancer risk factors, even common ones, a recent Gallup survey showed. The same survey also demonstrated just how financially burdensome cancer treatment is. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: They or their family member had tried to intentionally reduce the costs of the healthcare burden of suffering cancer in some way. It was roughly seven to nine percent each had either skipped doctor’s appointments, not filled prescriptions, skipped taking a medicine, cut pills in half to extend them, some kind of tactic to reduce the financial burden. Clearly there is a burden of cancer and cancer care what you see is people remarking in a survey like this that they’re taking steps, and maybe not very good ones, for cancer outcomes. :32

Nelson says cancer patients and their loved ones should bring financial concerns to their caregiver, since such stresses can impact treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can medication regimens be simplified to achieve patient goals? Elizabeth Tracey reports

Seniors with serious illness are troubled by their medication and healthcare regimens more than any other aspect of their care, a recent report from the Kaiser Family Foundation asserts. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says one response by caregivers may be to simplify things, based on the patient’s goals.

Arbaje: So if the person’s goal is to be able to get to church on Sundays and be mobile enough to be with their grandchildren then maybe we don’t want to be giving them medications for their blood pressure that might make them dizzy or fall. Even though we would like to see their blood pressure lower, I think having those really important conversations about what are your goals, what is it that we can best help you with. What are your top three concerns? And then let’s streamline the medications to really meet those concerns. I think that tailored approach is really what will get people on board to get them to take the medications we do want them to take.  :32

Arbaje applies this lens of patient concerns as primary in deciding which medicines are reasonable. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Home visits by medical professionals could help seniors understand their own care, Elizabeth Tracey reports

What’s the top problem for older people with chronic health conditions? A report by the Kaiser Family Foundation identifies confusions about medications and healthcare regimens as number one. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says she would address the problem with first gathering more information.

Arbaje: I would have older adults and their caregivers at home videotape what they’re doing, what the home looks like and where they’re keeping their medications so that we could really see with our own eyes. Then I would ideally have a pharmacist go into the home and really help people organize their medications or we could have nurses doing that as part of home health care. I’d really like for us to be able to do that every time a person is transitioning from one healthcare setting back to the other. Really understanding what their home environment is like before we start adding more medications. :32

Arbaje notes that video can easily be obtained with a smart phone, perhaps by a tech-savvy grandchild. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new report cites confusion about medical regimens as the biggest challenge to seniors, Elizabeth Tracey reports

Older people with chronic illnesses really don’t understand why they’re being prescribed certain medications or being told to adopt certain behaviors, a disturbing new report from the Kaiser Family Foundation states. Alicia Arbaje, a geriatrics expert at Johns Hopkins, comments.

Arbaje: Seniors reporting having difficulty understanding their medical instructions was actually the most frequent challenge they had even compared to paying for their own medical care. Patients really don’t understand why they’re taking a medication, what it’s for, and even whether it’s really doing them any good. I think that complicates medical instructions quite a bit and it tells us that we also need to be doing more in the home environment, when patients are actually doing this on a day to day basis.  :26

Arbaje notes that lots of research demonstrates that when people don’t get why they’re supposed to be doing things, they stop. And for management of chronic health conditions, that’s a decision fraught with danger. She recommends asking a lot of questions until you feel confident about care regimens. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Are you familiar with risk factors for cancer? Elizabeth Tracey reports

While some risk factors for cancer are known by many people, some common ones are less well-known, a recent Gallup survey for the American Society of Clinical Oncology found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes noteworthy findings.

Nelson: Seventy-eight percent of them said they understood that tobacco use could increase their risk for cancer. Somewhat disappointingly only about 30-31% displayed some understanding that alcohol use or overuse and obesity contribute to cancer risk. There are some estimates that this growing obesity epidemic in the country could be responsible for as many as 500,000 excess cancer cases over what would otherwise occur by 2030 in this country alone, so that only a third or less had that sense was concerning.   :33

Nelson says the numbers point to a clear need for better public awareness campaigns since the majority of these risk factors involve personal choice. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How aggressively should blood pressure be lowered during an operation in an older person? Elizabeth Tracey reports

A person’s blood pressure before surgery should be a consideration in how low to go during surgery, a recent study asserts, finding that the likelihood of delirium may be increased the more aggressively blood pressure is lowered in an older person. Kevin Gerold, an anesthesiologist at Johns Hopkins, comments.

Gerold: A healthy 80 year old is not the same as a healthy forty year old. Our ability to compensate around stressful events like surgery can be impaired. Our ability to maintain a normal perfusion state in response to a changing blood pressure may diminish. The exact numbers become difficult to predict but I think it’s safe to say that as we age we are probably less able to tolerate significant drops in our blood pressure without some change in cognitive function, at least temporarily.  :30

Gerold says families and loved ones can certainly include questions about blood pressure in their preoperative consult. At Johns Hopkins, I’m Elizabeth Tracey.

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