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Anchor lead: How can you decide where to have an operation for cancer? Elizabeth Tracey reports

If you need complex cancer surgery, your outcome is likely to be better at a large academic hospital compared to affiliate hospitals, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says more robust data would help improve things all around.

Nelson: What we need are better methods to monitor and evaluate quality, to turn that information to the systems of care that are managing the surgeons doing them, and improve that quality. And the other is to have that data somehow available in ways that people can understand so that when you’re considering where to have an operation – by the way this isn’t just for cancer, it could be a hip replacement – that you have a sense of the what the quality of the surgeon doing the operation, the quality of the health system that supports you as you’re having your operation, so that you can have the best outcome.   :31

Nelson says for now, picking an experienced surgeon on an experienced team, with experienced care providers postoperatively is your best strategy. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: There may be help for astronomical hospital charges, Elizabeth Tracey reports

Now that the federal government has mandated that hospitals must publish a complete list of all of their charges so that patients can understand their bills, more work needs to be done. That’s according to Redonda Miller, president of the Johns Hopkins Hospital. The lists themselves must be rendered easier to navigate, and patients need to understand their options.

Miller: If you see a charge on a website that you don’t understand call your insurance company and go through the details of the procedure with your insurance company, so you have a true sense of what your plan covers and doesn’t. And that will be a better and more realistic picture. If you see a charge or you need a procedure and you’re worried and can’t pay it, please call the hospital. Our finance departments offer all kinds of plans, and financial assistance, that we can help you work through it so that you can afford the care you need. We are prepared to help.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Does publishing lists of hospital charges help people understand their medical bills? Elizabeth Tracey reports

Hospitals are now required to publish a complete list of all of their charges, the federal government has mandated, so that consumers can attempt to understand the often Byzantine bills and explanations of benefits they get after a hospitalization. Redonda Miller, president of the Johns Hopkins Hospital, applauds the effort.

Miller: Price transparency is pretty key nowadays. When you think about the average American and how much each of us are spending on healthcare, and over the last five years we have seen a huge rise in high deductible plans. Almost half of adults in the US now have a high deductible insurance plan, where they’re paying $1500 or more out of pocket, before their insurance even kicks in. So as a patient, who one could argue is purchasing and consuming healthcare, it is really important that you understand what you’re paying for, and how much.  :34

Miller notes that improvements to the so-called hospital charge masters are also underway to make them easier to navigate. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Many people with cancer don’t tell their cancer doctor they are also using complementary and alternative therapies, Elizabeth Tracey reports

Herbs, supplements, meditation…a range of what falls under the rubric ‘complementary and alternative therapies’ is used by many people with cancer, yet about one-third don’t tell their cancer doctor they are doing so, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the results.

Nelson: Twenty nine percent of them did not disclose that they were using complementary and alternative medicine to their treating cancer physician. The most common reason 57% of them gave was that the physician didn’t ask. The second most common reason which was 48% was  they didn’t think the physician needed to know. They were more likely to report the use of herbal supplements than they were to report the use of mindfulness and spirituality reports and massage therapy.  :30

Nelson says there can be interactions between such therapies and more mainstream treatments, so it’s important to advise your physician of your choices, and it’s important for physicians to ask. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When is it time to stop treatment for cancer or simply not start it? Elizabeth Tracey reports

Many people with advanced cancer end up in treatment, whether that’s surgery, radiation or chemotherapy, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says he understands why some treatments may take place, but says we need to look carefully at the rest.

Nelson: The worrisome statistic isn’t so much that these treatments were undertaken- there may have been reasons to think they may have offered a palliative benefit – the worrisome thing is if you looked at treatment differences between centers of excellence, the National Cancer Institute designated cancer centers, and community cancer center programs, there was 48% less radiation therapy administered in the National Cancer Institute centers where there’s a high level of focused expertise, so it suggests that at least some of this was unnecessary and perhaps even inappropriate.  :32

Nelson notes that goals of care really need to be defined before any cancer treatment is begun, at all disease stages. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a novel psychedelic drug have broader clinical use than more common agents? Elizabeth Tracey reports

Psilocybin and other drugs of this type are increasingly being found useful clinically, helping alleviate anxiety for end stage cancer patients or overcoming addiction. Now research by Alan Davis and colleagues at Johns Hopkins shows another, faster acting substance may also be useful.

Davis: What I found with this new investigation looking at a novel psychedelic substance called 5MEO-DMT, which is a substance found in a variety of plants and also in one specific version of toad. What we found is there are people using this substance who use the substance in a group setting. They use it with specific procedures that help guide a more ceremonial process and that people in that group reported that it helped alleviate problems related to depression and anxiety after use.  :30

Davis says much more research needs to be done on 5MEO-DMT to see where it may fit in the clinical armamentarium, but says the substance adds one more option that may be the best fit for some. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What can we learn from the prosecution of a nurse for a medication error? Elizabeth Tracey reports

Two medicines with names beginning with the same letter can be dispensed on an inpatient unit, one of them for anxiety and another for paralyzing muscles. A nurse dispenses the wrong medicine, resulting in the patient’s death. This real life story has resulted in criminal prosecution of the nurse, and Patricia Davidson, dean of the Johns Hopkins School of Nursing, says there are many lessons here.

Davidson: Just not putting drugs alphabetically in a dispensing machine. We think of how diligent we are about prescription of narcotics and how there’s countersigning mechanisms so I think in that case there’s a systems-based issue. There’s also this issue of disclosure. A very punitive stance taken on that nurse. We all know that with mistakes there are some disciplinary actions but I think no health professional walking into work has any intention of doing anything but good for people.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

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