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Anchor lead: Palliative care may assure that end of life goals are met, Elizabeth Tracey reports

Is your physician comfortable talking about end of life issues? If not you could be in for a lot more intervention at the end of life than you want, a recent study showed. Rab Razzak, a palliative care expert at Johns Hopkins, says one strategy is to make sure you get a consult with the palliative care team, hopefully before you really need one.

Razzak: With palliative care there certainly could be a lot more support in addition to oncology care. Depending on where people are located and the type of palliative care there is. There are some home-based programs there are some programs that actually reach out via telehealth and other modalities. So I think depending on where people live you’ve got to find out what’s there. Doing some research, so getting on www.getpalliativecare.org can be very helpful it’s a great resource for patients. And there you can actually look up where programs are.  :33

Razzak says the need is greater than the availability in many places, so finding resources early is key. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: If you’re confronting end of life issues, a frank discussion with your physician is needed, Elizabeth Tracey reports

Depending on the physician, many more interventions may be used at the end of life, a recent study found, and this was based on a physician’s comfort level with end of life care. So if you or a loved one is facing end of life issues, what can you do to get care that reflects your goals? Rab Razzak, a palliative care expert at Johns Hopkins, says start with a frank discussion with your provider.

Razzak: When you recognize that someone’s having a hard time having these difficult discussions say I’d like to see the palliative care team. Asking for palliative care in advanced cancer is going to be really important. The other thing to say is these are my important goals. I’d like for you to help me achieve some of these goals. Can you? Or can I speak to someone else to help me get to these goals. That could be making sure my symptoms are controlled so I’m not short of breath, making sure I have the support at home, if someone’s prognosis is 6 months or less then that could be hospice.  :31

Razzak urges every patient to remember that the ultimate decision making power is theirs. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Places where physicians are not comfortable talking about end of life rendered their patients more likely to receive more expensive care before death, Elizabeth Tracey reports

What accounts for an almost two-fold difference in spending on end of life cancer care around the US? A recent Health Affairs study found it was all about the doctor. Rab Razzak, a palliative care expert at Johns Hopkins, explains.

Razzak: What this showed was that this is actually physician comfort level and understanding of these difficult discussions and lack of understanding of this care that directed some of these outcomes, and the cost issue. There were about close to 1200 patients looking at their cost of care. It turns out regionally, in areas where they had high costs with physicians in that region actually had less comfort in discussing end of life issues, DNR status, had less comfort addressing goals of care.   :30

Razzak says higher costs are simply a marker for additional care that may be inappropriate and that most patients say they don’t want, along with hospitalizations. He notes that when people are comfortable and their symptoms are managed, the vast majority indicate they’d rather be at home. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Modeling cancers over time may help predict resistance to treatment, Elizabeth Tracey reports

Using cells from head and neck cancers in conjunction with a mathematical model, Johns Hopkins researchers are able to develop a timeline over which cancer cells acquire resistance to therapy, a very important clinical milestone. Elana Fertig, senior author, explains.

Fertig: We created an experimental model where we monitored cells every single week as they acquired resistance to therapy. We did this by looking at which genes were changing over time, we coupled this with a new mathematical technique to visualize what’s going on in these very, very large datasets because you’re not measuring just one gene, you’re actually measuring tens of thousands of genes. So by merging those together we were able to figure out what were the molecular associations in this experimental model.    :32

Fertig says such a system may help clinicians anticipate the development of resistance in patients and change therapies pre-emptively. She says a better understanding of the biology of resistance will result in new therapeutic targets. At Johns Hopkins, I’m Elizabeth Tracey.

 

 

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Anchor lead: How does long term inflammation affect the brain? Elizabeth Tracey reports

Chronic inflammation in mid- and late life has been linked to compromised cognition and dementia in a long term study of more than 1500 people by Keenan Walker, a postdoctoral fellow at Johns Hopkins, and colleagues.

Walker:  We actually found that in people who maintain high levels of systemic inflammation, over what we found to be a 20 year period, that they are more likely to have reduced integrity within their brain white matter.  :12

Keenan notes that white matter is important in the brain’s communications.

Walker: White matter is important for insulating the neurons themselves. If the white matter is not there then the signal from one neuron to the next can’t be transmitted as well, as quickly, and as accurately. So if white matter degenerates or is reduced then that can have an influence on cognition.   :18

Walker says it may be possible to reduce inflammation and mitigate risk for dementia. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Some cells that are overreacting in the brain may be the culprit in Parkinson’s disease, Elizabeth Tracey reports

Your brain has what amounts to a specialized immune system, with two cell types, known as microglia and astrocytes, responsible for monitoring things continuously and taking action when things go awry. Ted Dawson, a Parkinson’s disease expert at Johns Hopkins and senior author of a recent paper in Nature Medicine, says this may be the mechanism by which Parkinson’s develops.

Dawson: When neurons are sick, for reasons we don’t fully understand, the microglia react in a bad way. And so it contributes to the degenerative process. When they react in a bad way to let’s say a sick neuron they turn on the astrocytes to also say hey, help me clean up this mess. And as part of that cleaning up the mess neurons are further destroyed because healthy neurons become innocent bystanders.   :28

Dawson is about to begin testing a drug that is very similar to ones already on the market to treat diabetes in Parkinson’s disease. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a drug class used to treat diabetes help in Parkinson’s disease? Elizabeth Tracey reports

A drug similar to diabetes drugs already on the market can slow the progression of Parkinson’s disease in both cells and an animal model of the disease, as well as relieve symptoms. That’s according to research published in Nature Medicine by Ted Dawson and colleagues at Johns Hopkins. Dawson says the drug works on cells in the brain called microglia and astrocytes.

Dawson: Microglial activation plays a substantial role in Parkinson’s disease but it also plays a major role in Alzheimer, MS, Huntingdon’s disease. So this compound we identified may also work in these other diseases. The thing about microglial astrocyte activation, it’s active from the beginning of your disease to the end, so it’s likely that if we can show that it works in early Parkinson’s disease, it will eventually be shown to work in later Parkinson’s.  :34

Dawson says clinical trials will start shortly. At Johns Hopkins, I’m Elizabeth Tracey.

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