How to Strengthen Bones Using Medication, Supplements, and Exercise

  • 06 Oct, 2020
  • 217

The cancers that affect bones are the ones that have started in another part of the body and have spread to the bone (secondary bone cancer). The most common types are breast, ovarian, prostate, and lung cancer, which increases the risk of osteoporosis in cancer patients. Also, people are at an increased risk for developing osteoporosis who have received or are actively receiving certain cancer therapies.
In osteoporosis, bone density decreases or "thinning" or weakening of the bone occurs which increases the risk of fracture in women and men:
Radiation therapy—weakens the bone and can cause osteoporosis.
Allogenic (receiving a donor’s) stem cell and bone marrow transplants.
Steroids are known as glucocorticoids.
Surgical removal of the stomach (gastrectomy).[2]
Chemotherapy and hormone therapies.[3]
 
Cancer survivors at risk for osteoporosis should learn to prevent it and have screening.[1]
 
Bone Health can be improved during cancer treatment by,
 
Early detection: A bone density scan can determine bone loss.
Calcium: Maintains bone health and strength. Calcium decreases as we age, so it's important to replace it in foods or with a supplement. 
Vitamin D: Helps the body absorb and hold on to calcium. It is created in the skin using energy from sunlight and can also be found in vitamin D-fortified foods like milk.
Bone Strengthening Drugs: such as bisphosphonate slow the rate of bone loss and may even help promote new bone growth.
Exercise: Weight-bearing physical activity (walking, dancing, stair climbing, and jumping rope) stimulates the production of bone-forming cells and also helps build muscles.
Maintain a Healthy Weight: A nutritionally balanced diet is crucial to healthy bones.[4]
 
Bone-Strengthening drugs 
 
They help prevent or treat bone damage from cancer that has spread. It also helps to reduce pain from cancer that has spread to the bone, slow the growth of cancer in the bone and prevent further bone loss and strengthen 
the bone to reduce the risk of bone damage, like fractures.[5] The medications include:
Alendronate 
Risedronate 
Ibandronate 
Zoledronate[2]
 
Bone strengthening drugs such as bisphosphonate are commonly given into a vein in a drip, from 15 minutes up to 3 hours every 3 to 4 weeks. Some are given as an injection just below the skin or in a tablet form.It is usually prescribed for several years if on hormone therapy for cancer but, if prescribed with other treatments such as chemotherapy or as part of a clinical trial, treatment may be of shorter duration.[5] Bisphosphonate treatment can stop some types of cancer from spreading into the bone. [1]
 
Calcium and Vitamin D Supplementation
 
Calcium
 One should get enough calcium from the diet as our bodies cannot produce calcium enough to support healthy bones. One should aim to get 1000-1200 mg of calcium per day.
It is best to get calcium in a balanced diet, including 4-8 servings of calcium-rich foods a day. If you cannot take in the recommended amount of calcium from the foods then, take calcium supplements. 
 Vitamin D
 Often called the "sunshine vitamin" as the skin converts ultraviolet rays from the sun into vitamin D. In general, 10-15 minutes of sun exposure on the hands, arms, and face create the needed amount. But avoiding the sun and using sunscreen limit the UV exposure one gets.
Vitamin D is available in two forms, D2 and D3 and supplements usually contain D3. A multivitamin contains 400 IU and some calcium supplements also include vitamin D. You should aim for 800-1000 IU per day. 
 
Your health care provider may check Vitamin D and calcium blood levels to see if one required the supplements.[3]
 
Exercise for Bone Health
 
Exercise helps maintain bone density and improves balance which makes one less likely to fall. During and after the cancer treatment, one may not have enough energy or flexibility as before the treatment started. Even though, try to move as much as one can.
Talk to the doctor before about what types of exercises are okay for now.[2] Physical activity is good for bone health:
 
Encourages the production of bone-forming cells.
Helps increase bone density.
Helps build muscles, providing more stability for the body.
Weight-bearing exercise is the best for bone health including tennis, football, and running, jogging, and dancing. Regular exercise will provide the greatest benefit.[6] 

Exercise tips,
30 minutes each day is recommended.
Do things that feel good and safe, like walking with friends, gardening, swimming or gentle yoga.
Try to add in some resistance exercises, like lifting weights and stretching with exercise bands. This builds muscle strength, which helps support your bones.
When you feel sick, exercise only as much or as strenuously as you feel comfortable.
Exercise gently, slowly, and for short amounts of time.
If very tired, try gentle, slow, and brief movements that are comfortable. 
If have trouble sleeping, exercise during the day to help sleep better at night.[2]
 

Reference:

 

 

  1. Bisphosphonates and cancer, https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/bisphosphonates/bisphosphonates-cancer, last accessed on 7th September 2020.
  2. Bone Health, https://www.cancersupportcommunity.org/article/bone-health, last accessed on 7th September 2020.
  3. Bone Health after Cancer, https://www.oncolink.org/print/pdf/8560?print_8560.pdf, last accessed on 7th September 2020.
  4. Bone Health & Cancer Treatment, https://www.mdanderson.org/patients-family/diagnosis-treatment/emotional-physical-effects/bone-health.html, last accessed on 7th September 2020.
  5. Bone-strengthening drugs, https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/coping-with-side-effects/bone-pain-and-weakened-bones/bone-strengthening-drugs, last accessed on 7th September 2020.
  6. Bone health and Cancer, https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/coping-with-side-effects/bone-pain-and-weakened-bones/bone-health-and-cancer, last accessed on 7th September 2020.

 


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Role of Vitamin D and Calcium in Bone Cancer

  • 29 Aug, 2020
  • 384

Bone cancer is not common cancer compared to many other types of cancer. It mainly includes two types; primary and secondary bone cancer. In primary bone cancer or bone sarcoma, cancer develops in the cells of the bone. Secondary bone cancer occurs when cancer somewhere else in the body spreads or metastasizes to the bones.[1]

 

According to the National Cancer Institute, primary bone cancer is rare, accounting for less than 1% of all cancers. Secondary bone cancer is much more common than primary bone cancer.[1] Because cancer has spread from its original location, doctors classify secondary bone cancer as advanced or stage 4 cancer. When cancer cells metastasize to the bone, they can cause changes to the bone by the process of osteolysis. Such lytic lesions can weaken the bones and increase the risk of breakage or other problems. It is also common for bone metastasis patients to experience pain with lesions.[2]

 

Several cancers can spread to the bones but prostate, colorectal, breast, and lung cancers are most likely to spread to the bone and accumulating evidence from epidemiological studies suggests that vitamin D deficiency might be a causal risk factor for several types of cancer such as colorectal, breast, ovarian and prostate which raises the further risk of incidence, morbidity, and mortality.[2],[3]

 

Vitamin D deficiency is the most common nutritional deficiency worldwide, included Indian prevalence ranging from 50% to 94%.[4]

 

The most important risk factors for developing vitamin D deficiency include low annual sunlight exposure, darker skin tone, and heavy sunscreen use, as Vitamin D is produced endogenously in the skin via a UVB-dependent mechanism.[5]

 

According to statistics,[6] 

 

  • Breast cancer death rates tended to be higher in areas with low winter sunlight levels and lower in sunny areas.


  • Individuals with 25(OH)D levels below 30 ng/mL also had a higher incidence of colonic adenomas.


  • People with 25(OH)D levels below 16 ng/mL had a 70% higher incidence rate of prostate cancer than those with levels above 16 ng/mL.

 

Therefore, supplementation with Vitamin D or Calcitriol [1, 25(OH)2D3], an active form of vitamin D is very essential to prevent the risk of various cancers which may eventually cause bone metastasis. Both in-vitro and in-vivo studies have indicated its potential in the prevention and regression of colorectal, prostate, and breast cancers. 

 

  • Basically, bone resorption is crucial for cancer cell metastasis and survival and it is proven that this resorption can be modulated by 1, 25(OH)2D3, and calcium supplements.[7] 


  • The vitamin has also been found to interfere with the transduction pathways of various growth factors-activated receptors thereby modulating transcription and alteration of genomic functions resulting in inhibition of cell proliferation and angiogenesis and facilitation of cell differentiation and apoptosis. (Figure)[7],[8]


  • It also increases the level of an endogenous protein - cystatin D, which possesses antitumor and anti-metastatic property, by facilitation of the expression of the gene coding for it. 

 

Long-term studies have demonstrated the efficacy of moderate intake of vitamin D in reducing cancer risk and, when administered with calcium, in reducing the incidence of fractures.[6]

 

Generally, Vitamin D is produced endogenously when ultraviolet rays from sunlight strike the skin and trigger its synthesis but it can be supplemented through certain foods. 

Dietary sources include a few foods that naturally contain vitamin D, such as fatty fish, fish liver oil, and eggs. However, most dietary vitamin D comes from foods fortified with vitamin D, such as milk, juices, and breakfast cereals.[9] 

 

Indian Council of Medical Research (ICMR) recommends 400IU (10μg) vitamin D as a daily supplement under situations of minimal exposure to sunlight.[10]

 

ICMR also includes recommended daily allowance of calcium as per gender and every age group. (Table)[10]

 

Group and categories

Calcium (mg/Day)

Man

600

Woman 

600

Pregnant Woman

1200

Lactating women <6 months and 6-12 months

1200

Infant

500

Children (1-9 years)

600

Boys and Girls (10-17 years)

800

 

Though not as a primary anti-cancer agent, vitamin D and calcium may be used for the prevention of cancer and included as an adjuvant in combination chemotherapy for the treatment of cancer.

 

References:

 

  1. What to know about bone cancer available at https://www.medicalnewstoday.com/articles/171372, last accessed on 22nd July, 202

 

  1. Bone Metastasis, https://www.rogelcancercenter.org/bone-metastasis, last accessed on 22nd July 2020 

 

  1. http://ar.iiarjournals.org/content/35/2/1171.full Juzeniene A, Porojnicu AC, Baturaite Z, et al. Vitamin D levels and dietary intake among patients with benign soft tissue tumors and sarcomas. Anticancer Res. 2015;35(2):1171-1180 

 

  1. http://www.jfmpc.com/article.asp?issn=2249-4863;year=2018;volume=7;issue=2;spage=324;epage=330;aulast=Aparna Aparna P, Muthathal S, Nongkynrih B, Gupta SK. Vitamin D deficiency in India. J Family Med Prim Care. 2018;7(2):324-330

 

  1. https://europepmc.org/article/med/26504063 Maier GS, Horas K, Kurth AA, Lazovic D, Seeger JB, Maus U. Prevalence of Vitamin D Deficiency in Patients with Bone Metastases and Multiple Myeloma. Anticancer Res. 2015;35(11):6281-6285.

 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470481/ Garland CF, Garland FC, Gorham ED, et al. The role of vitamin D in cancer prevention. Am J Public Health. 2006;96(2):252-261

 

  1. https://pubmed.ncbi.nlm.nih.gov/21872801/ Vanoirbeek E, Krishnan A, Eelen G, et al. The anti-cancer and anti-inflammatory actions of 1,25(OH)D. Best Pract Res Clin Endocrinol Metab. 2011;25(4):593-604.

 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081446/ Chakraborti CK. Vitamin D as a promising anticancer agent. Indian J Pharmacol.2011;43(2):113-120

 

  1. What are the health benefits of vitamin D?, https://www.medicalnewstoday.com/articles/161618, last accessed on 22nd July 2020

 

  1. Note related to Recommended Dietary Allowance, FSSAI https://archive.fssai.gov.in/dam/jcr:651fb6ae-d530-4162-be1a-8bf38c3743c7/Note_Dietary_Allowance_27_02_2019.pdf, last accessed on 22nd July 2020


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Cervical Cancer: Causes, Symptoms, Treatment, and Prevention

  • 28 Aug, 2020
  • 484

Cervix is the part of the female reproductive system which connects the vagina to the upper part of the uterus. It has an outer surface that opens into the vagina and an inner surface that faces into the uterus. Cervical cancer forms when the cells that line the cervix begin to develop abnormal changes. Over time, these mutated cells may grow out of control and form a tumor.[1],[2]

 

The cervix has two distinct parts which are covered with two different types of cells: squamous cells and glandular cells. The part of the cervix closest to the body of the uterus is called endocervix which is covered with glandular cells.

 

The part adjacent to the vagina is called ectocervix and is covered with squamous cells.  The area where the squamous cells and glandular cells meet is called the transformation zone. This is the area where most cervical cancers begin to develop.

 

The cancer of squamous cells is known as squamous cell carcinoma and is responsible for 90% of cases of cervical cancer. Whereas, cancer of the glandular cells is called adenocarcinoma of the cervix which is comparatively less common but its incidences are increasing recently. Some cervical tumors may involve both squamous cells and glandular cells. [2],[3] 

 

According to WHO, cervical cancer is the fourth leading cause of cancer in women. An estimated 570 000 women were diagnosed with cervical cancer about 311 000 women died from the disease in 2018, globally. [3]

 

All women are at risk for cervical cancer. It occurs most often in women over age 30. Almost all cervical cancer cases (99%) are linked to infection with certain types of high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer. Long-lasting infection with HPV is the main cause of cervical cancer. Some of the other factors which can increase the risk of cervical cancer include: [1],[4]

 

  • HIV Infection

  • Smoking

  • Use of birth control pills for a longer duration of more than five years

  • Having multiple sexual partners

 

There are no symptoms of cervical cancer at an early stage. Symptoms at the advanced stage of cancer include: [2],[4] 

 

  • Vaginal bleeding between periods, after menopause or during or after sexual intercourse

  • An unusual vaginal discharge

  • Heavier periods or periods that last longer than usual

  • Pain during sexual intercourse

  • Pain in the pelvis

 

These symptoms are not specific to cervical cancer and can be seen with various other health complications. Thus, regular screening is essential for early diagnosis and preventing cervical cancer. The following tests are available to screen for cervical cancer or precancerous changes in people who don't have any symptoms.[1],[4]

 

  • Pap smear or Pap test: It is used for several decades to screen for cervical cancer. The test looks for pre-cancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. This test has helped to decrease cervical cancer incidences significantly. However, screening for HPV infection is a more effective way of preventing cervical cancer.

 

  • HPV test: HPV test looks for the HPV virus which is responsible for causing changes and cells of the cervix leading to cervical cancer in a longer duration. A positive HPV test indicates HPV infection that may be associated with cervical cancer. This does not indicate that the person has cervical cancer but provides warning of the risk of developing cervical cancer. The results of the screening test are used to predict the level of risk for precancerous cell changes or cervical cancer. 

 

  • The other options for diagnosis include colonoscopy, biopsy, and imaging scans such as MRI, CT Scan, and PET scan. [1],[4]

 

Based on various diagnostic tools the treating gynecological oncologist will determine the stage of the disease depending on the spread of the disease. Cervical cancer is staged using the TNM system where T stands for a tumor that describes the size of the original tumor. N is for node and indicates whether the cancer is present in the lymph nodes. M is for metastasis which refers to whether cancer has spread to other parts of the body. Once the T, N, and M scores have been determined, an overall cervical cancer stage is assigned. Cervical cancer is staged 1 to 4 as follows:[2],[4]


 

Stage of Cervical Cancer

What happens?

Stage 1

The cancer is found only in the tissue of the cervix.

Stage 2

Cancer has spread outside the cervix to the upper two-thirds of the vagina or other tissue next to the cervix (parametrium).

Stage 3

Cancer has spread to the tissue on the side of the pelvis (pelvic sidewall) and/or the lower third of the vagina.

Stage 4

Cancer has spread to the bladder or rectum, or beyond the pelvis to the lungs, liver, or bones.

 

If diagnosed early and managed properly, cervical cancer is one of the most successfully treatable forms of cancer. The different treatment options include surgery, chemotherapy, and radiation therapy as well as immunotherapy. The choice of treatment depends on the spread of cancer, the size of the tumor, and whether the patient wants to become pregnant one day.[3],[4]

 

Reference:

 

  1. https://www.cdc.gov/cancer/cervical/basic_info/diagnosis_treatment.html Last accessed on 14th July 2020

 

  1. https://www.cancervic.org.au/cancer-information/types-of-cancer/cervical_cancer/diagnosing_cervical_cancer.html Last accessed on 14th July 2020 

 

  1. https://www.who.int/health-topics/cervical-cancer#tab=tab_1. Last accessed on 14th July 2020

 

  1. https://www.cancercenter.com/cancer-types/cervical-cancer/about. Last accessed on 14th July 2020

 



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Foods to Be Avoided During Colorectal Cancer

  • 14 Aug, 2020
  • 314

Patients with colorectal cancer may have a variety of nutrition-related symptoms, such as weight loss, anorexia, and taste changes, which affect their health. 


Therefore, good nutrition is essential to reduce symptoms and improve quality of life. A diet consisting of foods that will maintain a healthy weight and prevent the advancement of cancer may be useful for cancer patients.[1]

 

Certain foods and drinks may be harmful during and after colorectal cancer treatments and so should be avoided. Such food include: [2]

 

  • Foods and drinks which are high in simple sugars like candy and sugary desserts

  • Foods that are high in saturated fats and trans fats like lamb, butter, pork, and processed snacks

  • Caffeine

  • Greasy and fried foods

  • Carbonated drinks and soda. [2]

 

According to the National Cancer Institute, cancer patients should limit the consumption of foods high in saturated fat and sodium. High sodium foods include packaged and processed foods such as canned soups, crackers, pasta, frozen entrees, and condiments. Many snacks and bakery products contain sources of sodium and trans-fat and should therefore also be avoided. [1]

 

A juicy burger out of the grill can seduce the taste buds, but this can be bad news for the colon. Scientists know that regular red meat, such as beef, pork, and lamb; can increase the risk of colorectal cancer. This may be due to the meat itself or the formation of carcinogenic substances when cooking at high temperatures. [3

 

Some studies have shown that people who consume red meat frequently with eggs, cheese, and other fatty foods, as well as refined starches, were almost twice as likely to develop rectal or colon cancer as their peers who favored a plant-based diet. [4]


In addition to foods high in fat and sodium, alcohol and tobacco should also be avoided in patients with colon cancer. [1]

 

Processed meats are smoked, dried, salted, or preserved with added chemicals. Think of hot dogs, bacon, ham, bologna, and packaged meat. Eating this type of meat can often increase the risk of colorectal cancer, so it is also advisable not to consume processed meat. [3]

 

References:

 

  1. https://www.livestrong.com/article/335274-foods-colon-cancer-patients-should-not-eat/ last accessed on 8th April 2019

 

  1. https://www.healthline.com/health/colorectal-cancer-basics/diet-plan-colon-cancer-treatment#4 last accessed on 8th April 2019

 

  1. https://www.webmd.com/colorectal-cancer/ss/slideshow-foods-prevent last accessed on 8th April 2019

 

  1. https://www.medicalnewstoday.com/articles/321171.php last accessed on 8th April 2019

 



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Breastfeeding and Breast Cancer Risk

  • 07 Aug, 2020
  • 343


 

Breast cancer is the most common gynecological tumor among women, accounting for almost 1 in 4 cancer cases between women.[1] In India, accounts for 14% of all cancers among women.[2] 

 

Many clinical pieces of evidence have indicated that early age at menarche, later age at menopause, low-parity, late age at first pregnancy, excessive use of oral contraceptive and hormone replacement therapy, alcohol intake and lack of breastfeeding increases the risk of breast cancer. Although some risk reduction might be achieved with the prevention.[3]

 

The primary risk factors for breast cancer are not easily modifiable because they stem from prolonged endogenous hormonal exposures, although prevention through the promotion of breastfeeding, particularly with longer duration, may be beneficial. 

 

Importance of Breastfeeding

 

Breastfeeding plays a vital role in maintaining good physical and emotional health for the mother during the puerperium, the lactation period, and all her future life.

 

According to the National Cancer Institute, some research suggests that the risk of breast cancer is temporarily higher in the years following pregnancy and childbirth. This increased risk may be the result of hormonal changes during pregnancy. [4]

 

Can breastfeeding help reduce the risk of breast cancer?

 

In the long term, the protection offered by breastfeeding is greater for premenopausal women but also persists for postmenopausal women even after 50 years since the first lactation.

 

The months of pregnancy and breastfeeding will decrease the number of menstrual cycles that a woman has in her lifetime. This will reduce her exposure to hormones particularly androgens further reduces the rates of cell proliferation and differentiation.[5]

 

Cells with mutations arising in mammary tissues increase the risk of certain cancers. Tissue exfoliation and epithelial apoptosis at the end of the breastfeeding period may contribute to the reduction of the probability of these cells and may help in decreasing the cancer risk. [6]

 

Only 3% of women with breast cancer develop the condition when they are breastfeeding. [7]

 

It is estimated that the risk of breast cancer can be reduced by more than 4% for each year of breastfeeding.[6]

 

Protective effects of breastfeeding appear to be stronger, the longer a woman breastfeeds her first child and cumulative, such that increased lifetime duration of lactation over multiple children confers greater protection against breast cancer. 

 

Compared with women who did not breastfeed, lactating women reported:[7]

 

  • Seeking medical care less often.

  • A lower frequency of respiratory, cardiocirculatory, and gastrointestinal diseases.

  • Fewer symptoms related to emotional problems.

 

Breastfeeding also has additional short and long term effects on maternal health. (Table.1)[7]

 

Immediate

Long term

Uterine Involution, Reduced bleeding, reduced infection, and lactational amenorrhea

 

Reduced adiposity, and weight, reduced postpartum depression, reduced stress, and anxiety, Improved body image

Reduced Cancer(Breast, ovarian, endometrium), endometriosis, diabetes, osteoporosis, blood pressure, and cardiovascular diseases, metabolic syndrome, rheumatoid arthritis, Alzheimer disease, and multiple sclerosis

 

Does breastfeeding prevent any other cancers?

 

The latest studies show that women who breastfeed also lower their risk of developing both endometrial and ovarian cancers. And, just like with breast cancer, the longer a woman breastfeeds, the lower her risk becomes.

 

Conclusion:

 

Significant reductions in the risk of developing breast cancer have been observed with longer periods of breastfeeding. non-breastfeeding mothers have been shown to have a higher risk of reproductive cancers. Hence, Women should be encouraged to breastfeed their babies as it improves the quality of life for mothers. 

 

References:

 

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424

              https://pubmed.ncbi.nlm.nih.gov/30207593/

 

  1. Breast cancer awareness month 2019, Available at: https://www.nhp.gov.in/breast-cancer-awareness-month2019_pg, last access on 14th July, 2020

 

  1. do Carmo França-Botelho A, Ferreira MC, França JL, França EL, Honório-França AC. Breastfeeding and its relationship with reduction of breast cancer: a review. Asian Pac J Cancer Prev. 2012;13(11):5327-5332.

              https://europepmc.org/article/med/23317179

 

  1. Reproductive history and cancer risk, available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/reproductive-history-fact-sheet#q5

 

  1. Lactation and risk of cancer, Available at:  https://www.wcrf.org/dietandcancer/exposures/lactation-breastfeeding,

 

  1. Del Ciampo LA, Del Ciampo IRL. Breastfeeding and the Benefits of Lactation for Women's Health. Aleitamento materno e seus benefícios para a saúde da mulher. Rev Bras Ginecol Obstet. 2018;40(6):354-359 

              https://pubmed.ncbi.nlm.nih.gov/15583764/

 

  1. Lyons TR, Schedin PJ, Borges VF. Pregnancy and breast cancer: when they collide. J Mammary Gland Biol Neoplasia. 2009;14(2):87-98. 

              https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693784/

 

 

 


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The Survivorship Care Plan - Assuring Quality of Care for Cancer Survivors

  • 02 Aug, 2020
  • 342

A cancer survivor refers to any person who has been diagnosed with cancer. For the purposes of this topic, we will focus on the post-treatment period of survivorship. The follow-up of cancer survivors can be shared among the primary care provider (PCP), medical oncologist, and other cancer specialists, and is often transitioned to the PCP after the period of highest risk for disease recurrence(often five years, but sometimes longer).

 

Following the completion of initial treatment, more than 60 percent of adults diagnosed with cancer are expected to become long-term cancer survivors, living five years or more following their cancer diagnosis. At present, it is estimated that there are close to 30 million globally.[1]

 

These gains in survival are not without cost, and cancer survivors are at risk for a broad array of potential long-term and late effects of treatment. These include recurrent and new malignancies; increased morbidity and mortality from cardiovascular, skeletal, and other diseases; myriad physical effects such as peripheral neuropathy and lymphedema; and psychosocial distress that may impact work and social relationships.

 

One-third of cancer survivors have persisting symptoms that are similar to those they suffered during active treatment; fatigue, pain, depression, and sleep disruption are the most common across different malignancies.

There are four essential components of survivorship care for patients who have completed primary therapy:[3]

  • Prevention of recurrent and new cancers, and of other late effects

  • Surveillance for cancer spread, recurrence, and secondary cancers; assessment of  medical and psychosocial late effects

  • Intervention for consequences of cancer and its treatment

  • Coordination between primary and specialty care

 

Recommendations to improve the quality of survivorship care from experts state that each patient should receive a cancer treatment summary and follow-up care plan, collectively called the survivorship care plan (SCP), to facilitate care transitions and guide the content and coordination of care following acute treatment, and foster greater self-management of health by cancer survivors[3]. SCPs are intended to provide critical information regarding diagnoses, treatments, and potential late effects, as well as recommended surveillance, preventive strategies, and education and referrals for management of other medical and psychosocial needs.

 

The most common cancer types among female survivors include the following:[4]

  • Breast cancer (44 percent)

  • Cancer of the uterine corpus (9 percent)

  • Cancer of the colon or rectum (9 percent)

  • Thyroid cancer (8 percent)

  • Melanoma (8 percent)

Among male survivors, the most common cancers include the following:[4]

  • Prostate cancer (45 percent)

  • Cancer of the colon or rectum (10 percent)

  • Melanoma (8 percent)

  • Bladder cancer (8 percent)

  • Non-Hodgkin lymphomas (5 percent)

 

 

Components of Post Treatment Follow Up

 

The transition from active treatment to post-treatment care is critical to long-term health. A committee established at the Institute of Medicine (IOM) to examine the range of medical and psychosocial issues faced by cancer survivors defined the following components of survivorship care:[3]

 

  • Prevention of recurrent and new cancers, and of other late effects.

  • Surveillance for cancer spread, recurrence, or second cancers.

  • Assessment of medical and psychosocial late effects.

  • Intervention for consequences of cancer and its treatment, for example, medical problems such as lymphedema and sexual dysfunction; symptoms, including pain and fatigue; and psychological distress experienced by cancer survivors and their caregivers.

  • Evaluation of concerns related to employment, insurance, and disability.

  • Coordination between specialists and primary care providers to ensure that all of the survivor's health needs are met.

 

"Thus, a survivorship care plan is imperative for each and every patient to ensure good coordination between the specialist and the primary care provider."

 

References:

 

  1. World estimated cancer prevalence, adult population: both sexes. http://globocan.iarc.fr.ezproxy.tmc.gov.in:2048/summary_table_pop_prev.asp?selection=225900&title=World&sex=0&window=1&sort=0&submit=%A0Execute%A0 (Accessed on February 13, 2013).

 

  1. Wu HS, Harden JK. Symptom burden and quality of life in survivorship: a review of the literature. Cancer Nurs 2015; 38:E29. https://pubmed.ncbi.nlm.nih.gov/24831042/

  2. Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition, The National Academies Press, Washington, DC2006.

https://www.nap.edu/catalog/11468/from-cancer-patient-to-cancer-survivor-lost-in-transition

 

  1. American Cancer Society. Cancer Treatment & Survivorship, Facts & Figures, 2016-2017. American Cancer Society; Atlanta, GA 2016.

   https://www.cancer.org/research/cancer-facts-statistics/survivor-facts-figures.html

 

 



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Living with Lung Cancer

  • 01 Aug, 2020
  • 403

Lung cancer is the major cause of oncologic-related death worldwide. Management includes surgery, adjuvant chemotherapy, and radiation therapy; however, it is burdened by many side effects[1]. A lung cancer diagnosis can bring up many emotions; further living with lung cancer can also impact the daily life of the patient.

 

Progress of the disease, severity of its symptoms, and side effects significantly affect the quality of life (QoL), well-being, and daily social functioning in these patients. (Table.1)[1]

 

Table 1: Factors Influencing The Quality of Life (QoL)

Factors Lowering Quality of Life(QoL):

 

  • Elderly people above 65 years of age 

  • Smokers

  • Low income

  • Severe symptoms: Chronic fatigue, dyspnea, cough, pain, nausea and vomiting, weight loss, loss of appetite

  • More symptoms

  • Skills of coping with the disease

 

A 2015 survey found that 64% of people who have the disease ranked things like self-care, body image, changing relationships, and meeting their own emotional needs as their biggest hurdles[2]. However, the more the patient may know about lung cancer, the better the patient will be able to manage their disease. The following can be the key strategies to cope up with condition[1]

 

  • Identification of factors influencing the quality of life

  • Limitation of the number and severity of disease symptoms with the use of pharmacological and non-pharmacological modalities

  • Psychological, social, and spiritual support

 

"Exercise, nutrition, smoking cessation, managing pain and shortness of breath, and getting recommended treatment and supportive care can benefit patients to improve quality of life."

 

Managing lung cancer symptoms[3],[4],[5],[6]

 

The severity and the number of symptoms such as fatigue, loss of appetite, cough, and pain can affect a patient's quality of life. Breathlessness can also be a symptom of the condition or a side effect of treatment. Feeling short of breath can cause anxiety.

 

  • Breathing in slowly through the nose and out through the mouth or breathing exercises like belly breathing, Pursed-lip breathing,  progressive muscle relaxation, or guided imagery can help calm the mind when anxiety hits further making daily activities easier.

 

  • People with advanced lung cancer may need treatment for pain as their cancer progresses.

 

Looking after yourself[3],[4],[5]

 

Having cancer can lead to a range of emotions such as irritation, distress, anxiety, and depression. 


Respiratory problems also reduce the psychological aspect of QoL, while sleep problems reduce cognitive functioning. Finally, most patients are unable to play their family and social roles. 

 

  • Talking to others may help the patient to lose the emotional burden

 

  • Getting enough sleep is a key component of keeping emotional energy up.

 

  • An oncology social worker, counselor, or psychologist can help them develop more effective ways of coping and talking about cancer.

 

  • Controlling the level of fatigue with the use of pharmacological and non-pharmacological modalities including physical activity, saving energy, rest, sleep, reducing stress, and a proper diet can be suggested.

 

  • Pulmonary rehabilitation and social and spiritual support are also recommended.

 

Traveling with lung cancer[4],[6]

 

For many people living with lung cancer, going on holiday or traveling will have little or no impact on how well you are. In fact, getting away can help improve patient mental health by taking a break from everyday pressures. 

 

It is important to plan any trips or holidays before you travel. Travelling can be tiring, and the further or longer you travel, the more you could be affected, particularly if your health isn’t good.

 

The patient may need to speak to a doctor before making any travel plans. They can tell the patient if lung cancer treatment may make traveling unsafe. They can also tell what you might need to consider when traveling abroad. 

 

It is a good idea to carry all medicines, covering letters and licenses for controlled drugs in hand luggage, as customs officers will usually need to see them. Also, try to keep medicines in their original packaging so they can be easily identified.

 

Conclusion:

 

Day-to-day life with lung cancer can be just as tough as the treatment for it. Strategies like managing symptoms, emotional and physical health can help the patient to improve their quality of life.

 

 

References:

 

 

  1. Polanski J, Jankowska-Polanska B, Rosinczuk J, Chabowski M, Szymanska-Chabowska A. Quality of life of patients with lung cancer. Onco Targets Ther. 2016;9:1023-1028. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778772/

 

  1. Practical Advice for Living With Lung Cancer, Available at: https://www.webmd.com/cancer/features/lung-cancer-life-advice#1, Last access on  14th July, 2020

 

  1. Coping with emotions when you have lung cancer, Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/patients/find-support/coping-with-emotions, Last access on  14th July, 2020

 

  1. Lung Cancer - Non-Small Cell: Coping with Treatment, Available at: https://www.cancer.net/cancer-types/lung-cancer-non-small-cell/coping-with-treatment, Last access on  14th July, 2020

 

  1. Living with lung cancer, https://www.nhs.uk/conditions/lung-cancer/living-with/, Last access on  14th July, 2020

 

  1. Living with lung cancer. Available at: https://www.roycastle.org/about-lung-cancer/living-with-lung-cancer/travelling-with-lung-cancer/, Last access on  14th July, 2020

 



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Telemedicine/Teleconsultation: Complete Guide [2020]

  • 07 Jul, 2020
  • 2390

Up until 2019, Telemedicine was a form of consultation that was used by a small number of people in India. But after the COVID-19 struck and forced us to stay put in our homes, the field of telemedicine has grown manifold.

 

There has been an unprecedented rise of users in teleconsultation platforms like


Uhapo, Practo, Docprime


all due to the unavailability of safe zones to consult doctors for health problems and ailments. (because hospitals have become hot zones of COVID-19)

 

Moreover, this has led the government to work on a set of new telemedicine guidelines for RMP’s in 2020 and beyond. This has proven that telemedicine is going to change the way we consult with doctors and vice versa. 

 

This guide will help you understand all about teleconsultation and how it is shaping up the healthcare industry. 

 

Let's try to understand teleconsultation and telemedicine in detail,

 

 Teleconsultation is the process of delivering medical services with the help of information and communication technologies. This

service is provided to patients by doctors and medical professionals when distance may be a constraint.

 

Teleconsultation can also be used in Instances where patients and caregivers cannot reach medical professionals due to external reasons.

 

 

For example:

 

COVID-19 has proved to be extremely challenging for patients to consult doctors in the hour of need. Especially under strict lockdown restrictions and when


hospitals are hot zones for the virus spread
Or, in case the mobility of the patient is restricted due to the disease. 

 

This is where medical professionals can leverage communication and information services to provide consultation over audio, video, or text-based services.

 

 

This has proved beneficial for millions of patients as they schedule a teleconsultation appointment and schedule their challenges from the comfort of their home.

 

Here’s why there will be a massive surge in teleconsultation in India

 

After the massive spread of the COVID-19 Pandemic, plenty of doctors and medical institutions have taken to teleconsultation appointments to provide for the needs of their patients.

 

In a time where doctors are losing their lives to the deadly virus, telemedicine and teleconsultation come in pretty handy, to conduct appointments without the risk of virus spread. Medical institutions are pushing doctors to take up Teleconsultation and telemedicine as a viable source forcing the Medical Council of India to finally update telemedicine in India.

 

 

Types of Telemedicine:

 

Three types of Teleconsultation help doctors consult their patients. RMP uses three basic types of teleconsultation which are Text, Audio, Video.

 

Let us take a look at these three types of telemedicine in detail.

 

VIDEO for Teleconsultation:

 

A video is a great tool that will help doctors and RMP's finish their consultation without much of a hassle. With a Visual tool for consultation, doctors can efficiently read the body language of the patient to identify their concerns.

 

A dedicated Video Teleconsultation application like UHAPO makes it possible for patients to discover doctors and connect with them quite efficiently.

 

Video Teleconsultation platforms for doctors make life easier to screen patients with the ultimate need to visit the hospital.

 

 Let’s take a look at the strengths and Drawbacks of Video for telemedicine

 

Strength:

 

·      Easy to identify Visual Clues

·      The consultation process is much efficient with the support of Video

·      RMPs can discuss with the caregiver and the patient at once with video teleconsultation

 

 

Drawbacks:

 

·      A high-Speed network connection is necessary to carry out teleconsultation through Video.

 

 

AUDIO for teleconsultation:

 

Audio works well for teleconsultation by doctors. It can be done with a normal phone call, VOIP, and dedicated applications like UHAPO.

 

 Let’s take a look at the strengths and drawbacks for audio-based teleconsultation

 

Strengths:

·      Audio is Convenient, fast and helpful for emergency cases

·      It helps with a real-time interaction without the danger of data privacy

·      Audio is simple and does not require any additional infrastructure for scaling

 

Drawbacks:

 

There is a high danger of imposters in the Consultation process

There is a risk of doctors and patients missing verbal cues

Moreover, it is not suitable for medical conditions that would require a visual inspection

 

TEXT for teleconsultation:

 

Text can also be used for teleconsultation and telemedicine procedures. Text-based communication can be used in most cases. 

 


Here are the basic principles of teleconsultation in India

 

The Medical council of India released a page of Telemedicine guidelines for RMP's on March 25, 2020. This has been a major directional pointer for RMP's, teleconsultation platforms, and patients in India.

 

Before we get into the rules of teleconsultation, some essential principles must be followed by every RMP before performing a teleconsultation appointment.

 

 Essential Principles for Teleconsultation in India

 

·      The RMP is responsible for deciding between a teleconsultation appointment or an In-person meeting for your medical condition. 

·      The RMP must also apply the same principles of consultation even though the process is carried out with the help of Audio, Video, Text, or a combination of all. In simple words, it is the responsibility of the RMP’s to maintain quality with their consultation services.

·      At any stage, the RMP has the right to cancel the teleconsultation and call for an in-person consultation

·       Likewise, the Patient or Caregiver can also cancel the teleconsultation at any point and go with a choice of In-person consultation

 

 

Rules to be Followed with a Teleconsultation appointment in India

 

Just like a common set of principles, the teleconsultation guidelines of March 2020 must also make sure that RMPs and Patients must always follow a set of rules. These rules must be followed very strictly for the safety of the patient/caregiver and the RMP alike.

 

Identification of Context:

 

The RMP should identify when and where teleconsultation comes into play. As a certified professional they should take note of the complexity of the medical situation and make a judgment that would be beneficial for both parties alike.

 

The Registered Medical Practitioner should take in mind the 

 

·      The complexity of the patient’s condition

·      Mode/ technologies available for teleconsultation

·      The Comfort levels of the patient for taking a teleconsultation

 

Mutual identification of patient and the RMP:

 

Both parties must mutually disclose their identities before they start with the process of teleconsultation.

 

For the Patient:

 

·      They should submit their Name, Age, Address, E-Mail Id, Phone Number

·      If required they must also submit proof for verification of their identity

·      If the patient is a minor, the presence of an adult is required during the process of teleconsultation.

 

The RMP must have a sound mechanism to get all these details with ease.

 

For the RMP:

·      The medical practitioner must identify themselves with their name and their professional qualification to the patient.

·      They must also disclose their professional registration number on Websites, prescriptions, and receipts given to the patients

 

Choosing the Mode of Teleconsultation:

 

There are three modes for legally carrying out consultation through the process of teleconsultation. The RMP must assess the patient and their condition before choosing a valid form of teleconsultation.

 

They must choose Audio, Video, and text based on the complexity of the patient and the necessity to treat the patient. Some conditions would require the use of Video to get Non-Verbal cues from the patient.

 

 Finally, the model is decided on the Judgement of the RMP.

 

Consent of the patient:

 

This is of utmost importance before carrying on with teleconsultation. 

 

When the patient approaches a medical professional for teleconsultation, then the consent is considered to be Implied.

 

If the RMP or a healthcare worker initiates teleconsultation, then there exists a need for Explicit consent.

 

For proof of explicit consent, the RMP must obtain a recorded form of consent from the patient. This includes Email, Audio, Video, and text form which is placed in the patient’s record before going forward with the procedure.

 

 This recording can include something like “Yes, I (Your name) accept to go forward and give my consent to teleconsultation with my doctor (The doctor’s name).

 

 

The telemedicine guidelines also state that RMP must take his utmost effort to gather the details and files about his patient before making a professional judgment.

 

 

 Identifying the Type of teleconsultation:

 

In a professional teleconsultation procedure, there are two types of consultation. 

 

1. First Consult

2. Follow - up Consult

 

Here’s the difference between the first consult and follow-up consult

 

Whenever a Registered Medical Practitioner (RMP) provides teleconsultation to a patient or a caregiver, the process is usually divided into one of two types,

 

First Consult:

 

Certain criteria define if whether your teleconsultation appointment is for the first consult.

·      When a patient is approaching an RMP through teleconsultation for the first time

·       When a patient is approaching the RMP for a second time, but it has been longer than 6 months since the last consultation

·       When a patient approaches the same RMP within six months, but for a different medical condition.

 

When a teleconsultation appointment falls under any of these categories, it is described as a First Consult.

 

Follow-up Consult:

 

Now that you have understood the criteria of a First consult, let’s take a look into what makes your teleconsultation appointment a follow-up consult.

 

·      If a patient or a caregiver consults the same RMP within 6 months, for the same medical condition.

 

This puts the teleconsultation appointment as a Follow - up a consult.

 

However, there are a few conditions here. If the below-mentioned conditions do qualify, then your teleconsultation appointment is not considered as a follow-up consult

 

·       RMP does not recall the context or if the RMP does not remember the previous teleconsultation appointment

·       There are new health symptoms that are not aligned with the medical condition for which you consulted with the RMP

 


When these conditions are qualified, your teleconsultation appointment is considered as a First Consult.

 


Understand the patient management guidelines for offering Health Education, Counselling and medication

 

 In a Teleconsultation appointment, the RMP can offer health education, counseling, and medication for a patient or caretaker if they

satisfy the previously mentioned rules and regulations.

 

 

Offering Health Education:

 

An RMP is approved to give proper Health Education to his patients in a teleconsultation appointment. They can offer advice regarding


·      Diet

·      Exercise

·      Contagious infection prevention

·      Hygiene practices

·      Steps to curb excessive smoking

·      Immunization practices Etc

 

 

As long as this advice is provided professionally with the help of a professional teleconsultation app like Uhapo, it is legal and safe.

 

 

Offering Health and Wellness counseling:

 

An RMP can also offer health counseling for patients who require the service for their comfort. This can include


·      Dosage of drugs like Anti-cancer drugs

·      Home physiotherapy exercises

·      Proper usage of additional support hearing aids

 

And most importantly

 

Advice and instructions that need to be carried out before the next investigation. This also includes support for additional counseling for the upcoming teleconsultation appointments.

 

For Prescribing medicines

 

The Telemedicine guidelines state that RMP’s must maintain the same level of integrity as an in-person consult when they are prescribing medicine. In short, this rule states that the quality of consultation remains the same as when a person would consult a doctor in their clinic or a hospital.

 

 

Limitations for prescribing medicines:

 

As far as it concerns the fact of prescribing medicine through a teleconsultation appointment, RMP's are required to follow many criteria.

 

The Medicines are categorized into four categories, depending upon their potency and the reason for which they are used.


·      List O

·      List A

·      List B

·      Prohibited List

 

 

To better understand them, let’s take a look at the four categories in detail.

 

List O:

 

This includes a list of over the counter medications that are used to cure common health issues.

 

 

Restriction:


They have no restrictions and can be prescribed through any mode of teleconsultation appointment (this includes Audio, Video, and Text).

 

Example of List O Medicines: Paracetamol, cough syrups, and lozenges.

 

 

 List A:

 

These medications can only be prescribed to patients on the first consult and again on the follow-up consult for a refill (If Needed)

 

Restriction

Can be Consulted in the First and Follow up consult, but only through a Video consultation appointment.

 

List B:

 

This includes a list of medications that can be prescribed to the patient in a follow up consult to the RMP.

 

Restriction:

This can only be prescribed by the RMP in a Follow up to consult and not in a First consult.

 

Prohibited List:

 

By all means, no RMP can prescribe the medicine in a prohibited list. Medicines in this list have a very high potential for abuse and should not be prescribed to the patient under any condition.

 

 

Here are the Frameworks for a teleconsultation appointment you should be aware of

 

The telemedicine Guideline states 5 frameworks for five different scenarios that might occur in a teleconsultation appointment.

 


·      RMP to patient

·      RMP to the caregiver

·      RMP to a health care worker

·      RMP to another RMP (for a professional opinion)

·      Emergency Situations

 

 

Let’s take a look at the framework of each of these types

 

RMP to patient

 

1.   First Consult

 

·      Start of teleconsultation with a suitable mode of communication

·       Patient Identification and Consent

·      Quick Assessment

·      Exchange of Information for Patient evaluation

·      Patient management

 

1.    Follow-Up Consult

 

·      Start of a teleconsultation appointment for follow-up

·      Patient Re-identification (If Required)

·      Re-approval of patient consent (If Required 

·      Quick Assessment for Emergency Condition (guidance will be provided by RMP

·      Routine Follow Up

·      Patient Management

 

RMP to Caregiver of patient

 

The caregiver in these terms could be anyone from a relative of the patient to any person authorized to take care of the patient.

 

In this form of Teleconsultation, there could be one of two possibilities.

 

1. The patient is present with the caregiver during the teleconsultation appointment

2. The patient is not present with the caregiver during the appointment

 

In the second condition where the patient is not present, we can divide it further down into 

 

·      The Patient is less than 16 years of age or has been incapacitated with a physical disability or dementia.

·       The caregiver has a registered and verified document that authorizes him to take the teleconsultation appointment for the patient

·       The Caregiver has been explicitly identified by the patient as their caregiver

 

NOTE: Whatever the case, the framework remains the same as the one between RMP and patient.

 

 

RMP to Healthcare Worker

 

This is the situation where a healthcare worker in a Mid-level or district level hospital seeks medical advice from an RMP in a higher level of qualification. In this case, the Healthcare worker is in the role of caretaker for the patient or a representative of the patient.

 

In essence, a Healthcare worker might be anyone from Nurse, Allied Health Professional, or a Mid-level health practitioner. 

 

The process of Teleconsultation appointment between an RMP and a Healthcare worker is as follows

 

1) Start of the teleconsultation by the healthcare worker

 

In this step, the healthcare worker is primarily responsible for taking the consent of the patient as well as educating them about the teleconsultation procedure.  The healthcare worker is also responsible for collecting all the details of the patient like the Patient's age, Name, Address, phone number, etc.

 

 

2) Patient Identification by RMP

 

After the healthcare worker has started the teleconsultation procedure, the doctor has to check with the identification of the patient. This is done to ensure that there is no duplicity of data or proxy at the pace of the patient.

 

 

3) Patient Consent recognition by RMP

 

The RMP must also reconfirm with the consent of the patient before starting the teleconsultation appointment.

 

Now there are two conditions here


·      In Case of Emergency

·      Not an Emergency

 

In case of an emergency, the healthcare worker would immediately contact the RMP and let him know about the emergency. The RMP would then suggest the first-aid procedure along with the next steps, like moving the patient to the hospital or getting them a session with Another experienced RMP for immediate measures.

 

If it is not the case of an Emergency, then the following steps are to be followed

 

4) Exchange for Information of Patient Evaluation

 

The patient would be required to share information about his illness along with medical reports, prescriptions, and previous check-ups (If Any ). The RMP will then make an informed decision with the data available at hand.

 

5) Appropriate Patient management by RMP

 

The RMP will provide appropriate health education and frequent checkups to manage the condition of the patient.

 

What is the role of the healthcare worker in all of this?


The healthcare worker helps the patient follow the advice and the procedures that have been suggested by the RMP. In times of emergency, they are responsible for contacting the RMP or applying the medical advice and the knowledge the RMP has imparted them.

 

RMP to another RMP:

 

There are cases in which an RMP might consult with another RMP for expert advice or a different opinion on a patient's health condition.  In this approach, the RMP seeking an external opinion will be held liable and responsible for the patient. Any advice he takes and implements with his patient from the external RMP will still be the responsibility of the RMP.

 

 

The Guidelines support some forms of technology for the management and prevention of diseases. This includes 


·      Tele-Radiology

·      Tele-Pathology

·      Tele-Ophthalmology

 

Emergency Situations;

 

This is considered to be the most important part of the telemedicine guidelines in India. Under an emergency Condition, the responsibility of the RMP is to

 

·      Advice Proper First-Aid Measures

·      Start a Counsel to identify the seriousness of the Injury/Illness

·       Facilitate Referral for the patient

 

However, in all emergency conditions, the RMP is required to advise the person for an In-Person interaction with a Doctor or Health Professional as soon as possible.

 

 

 

What are the Teleconsultation applications that will rule in the future of the Indian Health Industry?

 

 

As we have stated before the COVID-19 pandemic has transformed hospitals into virus hotspots thereby preventing patients from accessing these hospitals quite easily. Stuck up in their homes and unable to go to these hospitals, patients are now looking at telemedicine as a suitable alternative.

 

Moreover, the shortage of RMP’s and hospital beds has paved the way for teleconsultation apps to rule the future of the Industry. Some of them are

 

·      Practo

·      Docprime

·      Uhapo

·      mFine

·      CallHealth

 

These apps are helping patients with regular (and sometimes advance medical issues) to meet a doctor from the comfort of their home. They can seek professional guidance from RMP's with the Help of Audio, Video, text, or a hybrid of all to solve their health problems.

 

 

Teleconsultation in India is a sure-fire way to reduce the time and cost of medical consultations. Moreover, this can be beneficial for the rural areas, where distance stands as the main challenge for acquiring quality medical services from RMP's.

 

 

With a CAGR (Compound Annual Growth Rate) of 31% and an estimated growth of $5.4bn by 2025, teleconsultation is here to stay in India for a long time.

 

The Sooner we adapt ourselves to telemedicine, the better it is for our nation.

 

Jai Hind

 

 

References:

 

https://www.thehindu.com/sci-tech/science/why-hospitals-are-hotbeds-of-coronavirus-transmission/article31318113.ece

 

https://www.mohfw.gov.in/pdf/Telemedicine.pdf

 

https://arogyalegal.com/2020/article/indias-new-telemedicine-practice-guidelines-analysis-and-dos-and-donts-for-doctors-offering-teleconsultation/

 

https://mciindia.org/MCIRest/open/getDocument?path=/Documents/Public/Portal/LatestNews/Final_FAQ-TELEMEDICINE%20%206-4-2020..pdf

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618173/

 

 

 

 

 


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Telemedicine During Coronavirus: A hero in the Making

  • 03 Jul, 2020
  • 226

The Coronavirus has turned out to be the biggest shock of this decade,  dealing a severe blow to life and economy. With thousands of lives lost every single day and Millions of people losing their jobs and livelihoods, It is safe to say that Coronavirus has turned out to be one unexpected Global Crisis.


This stands true for the Healthcare Industry, which has also been affected by the Virus. To be precise, Healthcare is one of the Industries that has taken a major hit.


But there is a Silent Hero who has been Helping the Healthcare industry get back on its feet and help patients and RMP’s - Telemedicine.


 Let’s take a look at telemedicine and how it is shaping the future of the Healthcare Industry.


Let’s Understand telemedicine


COVID-19 has laid a severe blow to the Healthcare industry, as Hospitals have become hotspots of the Virus. This prevents patients from visiting Hospitals for Frequent Checkups and Health Assessments.


This is when the ‘Infamous’ telemedicine came in as a Warrior to help RMP’s ( Registered Medical Practitioners ) and Patients connect with the Help of Technology.


Telemedicine uses the power of technology to Bridge the Gap between Doctors and patients across the country. It uses Text, Audio, and Video-based applications to help RMP’s set up a professional appointment and follow up appointments with their patients.


With telemedicine, a patient can reach a Registered Medical Practitioner that may be hard to meet, because of the travel constraints imposed by the Government. Telemedicine helps a Patient consult with RMP’s and seek a medical solution using the power of technology.


The Update of the Telemedicine Guidelines by Medical Council of India : 


As the Need for Telemedicine improved, the Medical Council of India Decided to update the Telemedicine Guidelines which must be used in a Teleconsultation process. This proves the point that Telemedicine is Going to achieve Immense growth and development in the Future.

Moreover, a Research from Inc 42 (https://inc42.com/datalab/telemedicine-preventive-healthcare-to-shape-indias-healthtech-landscape-in-post-covid-world/) states that “ Telemedicine and preventive healthcare are meant to boost health tech field to $21 billion by 2025 “.


This Proves that the spread of Coronavirus has had a direct impact on the presence of Tech in the Healthcare Industry. Quite unknowingly, the COVID-19 pandemic may have paved the way for an improved Digital Structure in the Healthcare Industry.


Is there a shift in the Mindset of Citizens of India?


There are a Good Number of reasons as to why Healthtech Startups will Succeed in the Future. But the best reason would be a major mindset shift of Citizens towards the Prevention of Diseases. 


To be precise, we are in a stage where we are ready and equipped to adopt the “ Prevention is better than cure “  Mindset. Telemedicine stands as the Best example of this  Phrase, as people are ready to use Telemedicine to prevent ill health and diseases before they Intensify.


Advantages of Telemedicine

But the change in Mindset isn’t the only reason why Telemedicine will cherish. There are a number of Advantages to telemedicine in India.


It helps RMP’s Improve the Quality of Services:


With Telemedicine as a Viable option, RMP’s can schedule Follow up sessions and Check-ins through an Audio or Video enabled service. This will make sure that the patient follows up with their doctor, without waiting periods or a visit to the Hospital.


Moreover, Telemedicine allows the RMP to consult with other RMP’s and if needed redirect their patient to provide an Expert Opinion. In Simple terms, Telemedicine improves the chance of Effective Collaboration and helps RMP’s deliver quality services.

Removes Distance as one of the constraints to quality Service


People from rural areas find it hard to access specialist doctors to solve their health problems. But with telemedicine, patients can access a Specialist and seek a better solution for their illness. Telemedicine allows people to consult as many RMP’s as they want, from the comfort of their home.


NOTE: Some Medical Conditions require patients to come for an In-person visit as it is Mandatory. 

Reduces Healthcare Costs


Telemedicine has proven to reduce healthcare costs at an average of 19%

( https://www.todaysgeriatricmedicine.com/archive/0313p20.shtml ), helping patients save money while getting access to better Health Care.


The Increased Efficiency of Providing treatments and the reduced costs of Patient care and Infrastructure will lower the overall healthcare costs for patients.


Verdict: Telemedicine isn’t an Alternative, It’s an Effective Option


Even though Telemedicine might sound like the perfect replacement to traditional Consultation, in reality, it is not. Telemedicine can help RMP’s deliver medical Advice and consultation for patients, but it will not completely replace traditional methods of In-person Consultation.


Some medical Conditions still require in-person Visits and In-person Follow-Ups to provide efficient treatment.


It is true that famous telemedicine platforms like Uhapo, Upchar, Practo, tattvan have seen an upsurge in the number of users and RMP’s in the past few months.


But this does not mean that Telemedicine will replace In-person consults in the Long run.



References:


https://inc42.com/datalab/telemedicine-preventive-healthcare-to-shape-indias-healthtech-landscape-in-post-covid-world/

https://timesofindia.indiatimes.com/city/madurai/coronavirus-in-madurai-telemedicine-centre-launched-to-monitor-health-condition-of-home-quarantined-patients/articleshow/76751619.cms

https://www.healtheuropa.eu/telehealth-and-coronavirus-reducing-the-impact-of-the-pandemic/99433/

https://doxy.me/en/advantages-of-telemedicine/



 


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Breast Cancer Effects On Mental Health

  • 23 Jun, 2020
  • 772

A diagnosis of cancer may have an intense psychological impact. Particularly, breast cancer treatments often cause long-term physical sequelae, impacting strongly on a women’s psychological health.1 

Being diagnosed with breast cancer can itself be a traumatic experience for most women. This may lead to emotional instability which includes anxiety, hopelessness, anger, and negative thoughts leading to suicidal tendencies. Some breast cancer treatments can have a very strong mental impact, for example, surgical treatment for breast cancer usually results in a lifelong scar due to breast shape alteration, persistent pain, and/or lymphoedema. Breast cancer diagnosis and treatment might also affect the woman’s family life, including intimacy with their partners and relationships with their children. Working women who return to their offices after treatments may also face new challenges, not only in the relationship with their work colleagues but also in their cognitive functioning. Many women fear the possibility of cancer recurrence and death. All of these factors may have a long-term negative impact on the mental health of breast cancer survivors. Many people who have pre-existing mental health problems such as anxiety or depression are exacerbated by the experience of breast cancer.1

Furthermore, women with breast cancer may start eating poorly, where they choose to eat fewer meals and eat foods with lower nutritional value. They may refrain from exercising. They may face difficulty in getting a sound sleep. And they may withdraw from family and friends due to low confidence. Additionally, these women may use alcohol, cigarettes, caffeine or other drugs in an attempt to calm and pacify themselves.2

The diagnosis of breast cancer can lead to depression, which can cause women to become so disheartened, that they decline to undergo surgery or undertake radiation or chemotherapy. Research has shown that depression can also decrease women's survival due to breast cancer. According to one analysis, mortality rates were as much as 26 times higher in patients with depressive symptoms and 39 times higher in patients who had been diagnosed with major depression.2

Thus, the mental and emotional response to a major life event like breast cancer may differ from person to person. 

References:

  1. https://www.ncbi.nlm.nih.gov/books/NBK4011/

 

  1. https://www.apa.org/helpcenter/breast-cancer.aspx as accessed on 18th November 2018.

  2. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/emotional-mood-changes.html

  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819720/#:~:text=DIRECT%20EFFECTS%20OF%20CANCER%20MEDICATION%20TREATMENTS%20ON%20COGNITION,chemotherapy%20can%20induce%20cognitive%20impairment.&text=It%20has%20been%20estimated%20that,chemotherapy%20have%20measurable%20cognitive%20impairment.

  4. https://onlinenursing.simmons.edu/nursing-blog/psychological-effects-of-breast-cancer/#:~:text=According%20to%20studies%20cited%20by,depression%20symptoms%20was%20associated%20with

 



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