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Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
Many men living with advanced prostate cancer receive treatment that includes lowering the level of testosterone in the blood, in order to starve the prostate cancer of the male hormone that makes it grow. The treatment often involves a combination of injections with tablets and is called androgen deprivation therapy, or ADT for short. While in can be effective for years or decades in controlling the cancer, ADT has unwanted physical effects, including reduced muscle mass, diminished physical strength, less stamina, thin bones and increased fat.
A review article in the Journal of Clinical Oncology on February 1, 2014, describes the benefits of exercise in men undergoing ADT. A review of 10 randomized clinical trials showed that the men who consciously undertook an exercise program, compared to those who did not, experienced improvements in muscle strength, muscle mass, endurance and fatigue. Although these randomized trials of exercise did not show that men who exercised lived longer, some observational studies have suggested that men with advanced prostate who exercise more do live longer.
Okay, so exercise is good for men with advanced prostate cancer. What kind and how much? The type of exercise recommended is mostly aerobic exercise, such as brisk walking, jogging, bicycling, or using a treadmill or elliptical trainer. The goal should be 30 minutes daily for five days per week for a total of 150 minutes per week. The other type of exercise recommended is resistance exercise, such has lifting hand-held weights with multiple repetitions. The goal is not to become the next Arnold Schwartzenagger but to gradually increase muscle tone and strength with two sets of 10 to 12 repetitions two or three times weekly.
The more time I spend with cancer survivors and the more I study the medical science, the more I realize the importance of regular exercise for cancer prevention and our general health. There are 1440 minutes in a 24-hour day, but I still have to budget my time carefully to make room for 30 minutes of exercise a day. How about you? It is easy or difficult to get in 30 minutes of exercise per day?
If you would like to know more about how exercise can help you and receive an exercise prescription individualized for you, call the Center for Integrative Oncology at (864) 455-1346 and ask for an integrative oncology consultation. Check us out on the web at www.ghs.org/cios.
Fatigue in cancer survivors is finally getting much deserved attention from the American Society of Clinical Oncology (ASCO). It is the international professional organization of cancer specialists, with over 35,000 members, including me. In April, ASCO published guidelines to help cancer specialists care for adult survivors of cancer who are experiencing fatigue. By publishing guidelines, ASCO is saying that cancer fatigue is a real and important problem, that cancer fatigue has identifiable causes, and that cancer fatigue can be helped.
The guidelines define cancer-related fatigue as a distressing, persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. In plain language, it is tiredness that makes you feel worse than you expect, that drags you down longer than you expect, and that slows you down more than you expect it should.
Fatigue in cancer survivors in common, with as many as 30 percent enduring persistent fatigue many years after cancer treatment. The guidelines recommend that doctors should screen cancer survivors for cancer fatigue, with questions and questionnaires. If moderate or severe fatigue is identified, the doctor should screen for medical causes for fatigue. These include heart disease, poorly controlled diabetes, low thyroid function, chronic obstructive pulmonary disease, anemia, arthritis, sleep disturbance, pain, anxiety and depression.
When fatigue has been identified and other medical conditions treated as well as they can be, what more can be done for fatigue? There are four strategies.
To learn more about living with cancer-related fatigue, call the Center for Integrative Oncology and Survivorship at (864) 455-1346.
Study after study is showing that excess body weight increases our risk for many cancers and the weight loss and control can lower our risk of cancer. It is interesting that obesity is rapidly overtaking tobacco as the leading preventable cause of cancer. (Recently, the American Society of Clinical Oncology announced a major initiative for cancer specialists to help cancer survivors lose weight. A free booklet for cancer survivors is available online by clicking here.)
At the GHS Center for Integrative Oncology and Survivorship, we put a lot of effort into helping people connect with their bodies through exercise, yoga, massage, acupuncture, meditation and even music therapy. For this reason, a recent column by Nanci Hellmuch in USA Today caught my eye because it points out how important getting enough sleep is to controlling your appetite and weight. Two opposing hormones control our appetite and contribute to fat intake and storage. The hunger hormone, ghrelin, stimulates the appetite, while the satiety/fullness hormone, leptin, diminishes the appetite. In laboratory studies, sleep deprivation causes fat cells to fail to respond to insulin in the bloodstream. This causes a decrease in leptin, which causes an increase in food consumption and weight gain.
Studies in humans have shown that lack of sleep increases the level of the hunger hormone in the blood and decreases the level of the satiety hormone. Sleep deprived people on average consume 300 calories more per day than when they are well rested. They also snack more and exercise less. Dr. Safwan Badr, a past president of the American Society of Sleep Medicine, says that sleep is so critical to good health that it should be thought of “as one of the components of a three-legged stool of wellness: nutrition, exercise and sleep.”
How much sleep every night is enough? For adults, it is usually seven to nine hours. For me, the lesson is that good health and reducing cancer risk include making adequate sleep a priority. We need to exercise regularly, eat healthy, and sleep well to maximize our health, feel our best physically, and be our best emotionally and mentally. If we can do this, we have a much better chance of controlling our appetites and weight.
“Hey, I just mopped the floor, so I’m skipping the gym today!” Sound familiar? Many folks confuse physical activity, exercise and physical fitness.
What’s wrong with household chores and why does this matter? All exercise (running, biking, swimming, resistance training, etc.) is some form of physical activity but not all physical activities (chores, gardening, knitting, dancing, etc.) are necessarily exercise. Many people think that they don’t need to exercise because they are already active. However, activity alone does not necessarily lead to improved physical fitness.
The American College of Sports Medicine (ACSM) guidelines for cancer patients/survivors does recommend physical activity. However, they specifically recommend 150 minutes per week of moderate intensity aerobic (cardiorespiratory) exercise along with strength building and flexibility exercises two to three days per week. Moderate aerobic activity increases both heart and respiratory rates. Moderate intensity activities allow you to talk but not sing while exercising…getting the picture?
So, what’s the answer? Studies show that a combined approach of an active lifestyle and a targeted exercise program achieve physical fitness goals best. That means parking at the end of the parking lot and walking to your final destination, carrying your own groceries and taking frequent movement breaks at work (and, yes, cleaning your house) are part of an active lifestyle. But it ALSO means maintaining a varied exercise program targeting at least 150 minutes of moderate aerobic activity weekly along with strengthening and flexibility sessions at least twice a week. As always, talk with your personal healthcare provider prior to starting an exercise regimen.
On July 14, 2014, the British Journal of Nutrition published a research article about the nutrition content of organic foods compared to conventional foods. The article reviewed 343 studies of organic compared to conventional foods. It concluded that the organic foods contained slightly more antioxidants, slightly fewer pesticide residues, and lower levels of the toxic metal cadmium. The next day, the Los Angeles Times published a story about the article with the headline, “Organic foods more nutritious, according to review of 343 studies.”
The LA Times article quoted the study co-author, Charles Benbrook, as saying, “This shows clearly that organically grown fruits, vegetables and grains deliver tangible nutrition and food safety benefits.” Dr. Benbrook went on to say, “Buying organic is the surest way of limiting exposure if you have health issues, but by all means, people need to increase their intake of fruits and vegetables whether it’s organic or conventional.”
There was, however, some disagreement with the conclusion that organic foods are more nutritious. The same day, Ian Musgrove, senior lecturer in pharmacology at the University of Adelaide in Australia, expressed an opposing opinion in a blog at www.theconversation.com. He pointed out that only a few of the many foods tested were more nutritious than conventional foods and those few that were better were only slightly better. He cited the slightly higher content of vitamin C, carotenoids and antioxidants in organic foods as examples where the difference between organic and conventional is too small to make a meaningful difference in a person’s diet. He went on to say that some organic foods do indeed have lower levels of pesticides and cadmium than conventional foods, but that the levels in both are far below the level at which they might cause harm in our diet.
I tend to agree that the advantages of organic foods are small and not significant enough to warrant the extra cost. One possible exception is milk for children. Organic milk may have less in the way of estrogen-like chemicals that are found in conventional milk and that may be linked to slightly increased rates of testicular, prostate and breast cancer. Any harm in conventional milk (from milk factories) compared to organic milk (from happy and contented, antibiotic-free cows) has yet to be proven, but it may be one case worthy of erring on the safe side.
How about you? Which argument is more persuasive? Are there certain foods for which you choose the organic option? Feel free to share your comments with the other readers.
Global recognition is coming to the Upstate Aug. 27 – Sept. 1 in the form of the 2014 UCI Para-Cycling Road World Championships. Greenville will play host to over 300 of the world’s best athletes for the first Para-Cycling Road World Championship in the United States since 1998. With over 40 countries represented, this five-day competition will bring diverse cultures and unrivaled talent to the Upstate for an unforgettable experience.
The world championships will begin with the Parade of Nations on Wednesday, August 27th at 6 p.m. at the TD Stage in downtown Greenville. The following four days will be packed with time trials and road races to cater to the athletes’ abilities.
There will be four categories of competition:
These events will take place at the Clemson University’s ICAR Millennium Campus and the BMW Performance Center. For a full list of the 2014 UCI Para-Cycling Road World Championship events and their locations, click here.
This event is the chance for these dedicated athletes to demonstrate their wide range of abilities and skill. Greenville Health System is proud to be the presenting sponsor for this world renowned event and is looking forward to a strong community turn out to support each athlete and especially the eight members of our own Team Roger C. Peace who are competing for Team USA.
We are thrilled to host the world for the 2014 UCI Para-Cycling Road World Championship. We look forward to seeing you in the crowds among the rest of the world supporting these strong and dedicated athletes.
Study after study has shown that exercise reduces the risk of cancer recurrence for cancer survivors. More than 200 studies have shown that the most physically active survivors have a lower risk of cancer recurrence than the least active cancer survivors. The data favoring exercise is strongest for survivors of breast cancer, colon cancer, endometrial cancer and prostate cancer.
The American Cancer Society recommendations for cancer survivors include 30 minutes of moderate to vigorous physical activity (above usual daily activities) five days a week for a total of 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise. The ACS also recommends strength training. Despite these expert recommendations, only 50% of Americans report that their weekly exercise meets these guidelines. The glass may be a lot less than half full because studies have shown that people frequently overestimate how much time and with how much intensity they exercise.
How much intensity is enough? Dr. Jennifer Trilk is an exercise physiologist at the USC School of Medicine Greenville. She reports that the talk test is a simple way to measure relative intensity. As a rule of thumb, if you’re doing moderate-intensity activity you can talk, but not sing, during the activity. If you’re doing vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath. Another way is to measure your heart rate. You can do this by feeling your wrist for your pulse, counting the heartbeats for 15 seconds and multiplying by four. Or you can purchase an inexpensive heart rate monitor. Moderate-to-vigorous exercise should raise your pulse to 50% to 85% of your maximum heart rate.
Your maximum heart rate is 220 minus your age in years. For example, if you are 60 years old, subtract 60 from 220 and that equals 160 beats per minute. Fifty percent of 160 is 80 beats per minute and 85% of 160 is 136 beats per minute. So the target heart rate for moderate-to-vigorous exercise for a sixty year old is between 80 and 136, with 103 in the middle. Overall, moderate intensity includes brisk walking, dancing, gardening and tennis. Vigorous intensity includes jogging, running, swimming laps and heavy gardening.
How much time is enough? The United States Physical Activity Guidelines recommend 150 minutes per week to obtain significant health benefits. That amounts to 30 minutes for an outing, five days per week. However, if you can’t reach 30 minutes per day, newer evidence suggests that any exercise is still beneficial. A recent study published in the Journal of the American College of Cardiology suggests that there may be some benefit to as little as five or 10 minutes of exercise per day. Researchers reviewed questionnaires filled out by 55,137 healthy men and women seen at the Cooper Clinic in Dallas, Texas, over 15 years. The 24% of the people who reported any running or jogging had a 30% lower rate of death compared to those who did not exercise. Among those who exercised at all, the benefits were the same for those who ran a lot or for those who ran for as little as five or 10 minutes per day. This encourages me to exercise at least five or 10 minutes on days when I cannot fit in 30 minutes.
If you are not exercising at all, I suggest that you start with a goal of five minutes per day and work your way up to 30 minutes. Exercising with a friend or with a group may help you establish a routine. If you would like to learn more about the benefits of exercise and nutrition for cancer survivors, call the Center for Integrative Oncology at (864) 455-1346. You may wish to schedule an integrative oncology consultation, where you can receive personalized exercise and nutrition recommendations.
On Jan. 25, 2010, my life changed forever. It started as a regular colonoscopy and endoscopy due to terrible acid reflux, with me thinking the worst outcome would be a stomach ulcer.
After I woke, I heard the doctor telling me he found a quarter-sized tumor in my colon that he was 95 percent sure was cancerous. It seemed impossible. I was 27 years old and two short months from marrying the love of my life. I was looking forward to starting our life together with years of happiness ahead, instead of facing a life-changing obstacle.
Fast-forward to the present more than four and a half years later. I have had about 300 rounds of chemotherapy. My original diagnosis of stage 3 has moved up to stage 4, and I’ve met some amazing people along the way.
Surprisingly, I wouldn’t change a thing. There have been times of great struggle, but also some amazing moments that wouldn’t have occurred without my cancer diagnosis.
The statistics for a diagnosis like mine are grim. I’m one of the lucky few to have made it as far as I have; in fact, most people are shocked to discover I have advanced colon cancer. I attribute this success to the efforts of my oncologist, nurses and the rest of the Greenville Health System Cancer Institute team. Their work inspired my wife and me to take a philanthropic approach to my situation through a foundation, started by friends of ours, called BrightLife. It was never a question whether the recipient of our annual fundraising efforts would be GHS’ Institute of Translational Oncology Research (ITOR).
Cancer takes away many things, including a sense of control, the feeling of safety and – most important to your survival – hope. We wanted a way to be able to give back to those playing such a huge role in our lives and to help others when it seems all hope is lost.
The GHS Cancer Institute and ITOR have become a second family to my wife Jenny and me. The patient care I have received is second to none. Our wish is that anyone diagnosed with cancer in the Upstate will be able to receive such a high standard of care.
The nearly $7 million National Cancer Institute grant awarded to the GHS Cancer Institute will allow patients like myself to receive this personalized care for many years to come. The GHS Cancer Institute is one of just 34 programs in the U.S. named by the NCI as a leader in community-site care delivery and research. GHS and MUSC are the state’s only NCI programs.
The advanced care available here allows patients to receive new groundbreaking treatments without travel far from home. A cancer diagnosis is challenging financially, emotionally and physically; having to also leave everything you know to receive treatment takes an extreme toll on body and mind.
“What if” is never far from the mind of a cancer patient. My wife and I have learned to take things one day at a time and try our best not to let this disease run our lives. We’re glad that this grant allows the hospital to provide patients hope and even more of a fighting chance.
This blog previously ran as a guest column in the Greenville Journal on August 15, 2014.
Recently, an article about aspirin and cancer risk was published in the medical journal Annals of Oncology. It has received a lot of attention in the press, including local television right here in Greenville. Headlines have said that an aspirin a day can “dramatically” reduce the risk of colon cancer. I want to review the study and take a closer look at the benefits and risks discussed in the study.
The Annals of Oncology study is not new research. It is a review of prior research of groups of people who participated in studies where they either took daily aspirin or did not for a number of years. The summary of the studies was that aspirin at between 75 and 325 mg per day for a minimum of five years would reduce the incidence of colon cancer by 30% and of esophagus and stomach cancer by 25%.
Before we all jump on the bandwagon, we need to consider the size of the benefits and the size of the risks. For example, the risk of getting colon cancer in the next ten years for a sixty-year-old man is 1.32%. A 30% reduction reduces the risk to 0.92%. That is, taking aspirin for 10 years reduces this man’s risk of getting colon cancer by only a fraction of 1%.
One of the complications of taking aspirin is bleeding from a stomach ulcer or from another place in the intestines. For the same sixty-year-old man with no history of stomach ulcer, the risk of intestinal bleeding in the next 10 years is 2.4%, which is the same or a little greater that the risk of colon cancer! The risk of intestinal bleeding is tripled if the person is taking an NSAID drug like ibuprofen or naproxen.
Having said this, there are some good reasons for some people to take aspirin. Some people at high risk of stroke or heart attack derive a great benefit compared to the risks of intestinal bleeding. My point is that this news about aspirin cutting the risk of colon cancer is a reason to check with your doctor, who can weigh your other medical factors that contribute to relative risks and benefits. With your medical situation in mind, your doctor is the best person to advise you about taking a daily aspirin.
The evidence that aspirin can reduce the risk of colon cancer is interesting, but it is not a reason for everyone to start taking a daily aspirin. The best (and safest) thing to do to prevent colon cancer is still to eat a high-fiber, low-fat diet with five or more servings of fruits and vegetables per day and to start getting screening colonoscopies at age 50. This information is not in the headlines and sound bites, but it is worth digesting.
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National Cancer Institute awards grant to GHS Cancer Institute.
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