Cancers unrecognized toll Time lost

Wed, 03 Jan 2007 03:38:15 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - The hours spent sitting in doctors' waiting rooms, in line for the CT scan, watching chemotherapy drip into veins: Battling cancer steals a lot of time — at least $2.3 billion worth for patients in the first year of treatment alone.
So says the first study to try to put a price tag to the time that people spend being treated for 11 of the most common cancers.

Even more sobering than the economic toll are the tallies, by government researchers, of the sheer hours lost to cancer care: 368 hours in that first year after diagnosis with ovarian cancer; 272 hours being treated for lung cancer, 193 hours for kidney cancer.

That doesn't count the days spent home in bed recovering from surgery or weak from chemo, just time spent actively getting care — chemo or radiation therapy, blood tests or cancer scans, surgery or checkups, driving to medical appointments and waiting your turn.

It's a study, to be published Wednesday in the Journal of the National Cancer Institute, that sheds new light on the human costs of cancer.

"What we see here is a measure of the patient's burden of commitment," wrote Drs. Larry Kessler of the Food and Drug Administration and Scott Ramsey of the Fred Hutchinson Cancer Center, in an accompanying editorial.

"Cancer is more than the just the dollars and cents for the medicines and the treatments and the doctors. It's also the lost opportunities for the patients," added Dr. Len Lichtenfeld of the American Cancer Society, who praised the research for attempting to quantify that often overlooked reality.

How much a disease costs society plays an important role in policy-making, such as how much to invest in medical research, but it's hard to calculate the value of a patient's time spent getting care.

NCI epidemiologist Robin Yabroff and colleagues culled the records of 763,000 cancer patients covered by Medicare, the government's insurance program for those 65 and older, and estimated the time involved in traveling to, waiting for and receiving both in-hospital and outpatient care. They compared the results to time spent in medical care by 1 million other Medicare recipients without cancer.

Although most of these patients were retired, the researchers assigned a monetary value to their time — $15.23 an hour, the median U.S. wage rate in 2002. Then they estimated the national toll by including the number of patients diagnosed with cancer in 2005.

It is almost certainly an underestimate, the researchers said, noting that younger cancer patients often receive more intensive treatment.

Whatever the dollar figure, the study showed something important to patients' day-to-day lives, Lichtenfeld noted: Cancers that often are diagnosed early, when they're more curable, require less treatment time.

Men with prostate cancer spent 55.3 more hours getting medical care in the first year after diagnosis, compared with similar people without cancer. Breast cancer patients spent 66.2 hours. Also, both groups spent about four days in the hospital.

Compare that to cancers with worse survival rates, largely because they're usually caught late: Ovarian cancer patients struggled the most, spending about 21 days in the hospital that first year, and 368 extra hours getting care. Gastric cancer and lung cancer patients fared almost as badly, spending about 21 days and 15 days in the hospital, respectively, and 351 and 272 hours in treatment.

The difference shows that investing in research for better early detection of cancer "has real benefits," Lichtenfeld stressed.

The study also highlights the importance of newer "targeted" cancer treatments that promise fewer severe side effects and often allow patients to be treated with pills at home instead of in a clinic, added Kessler and Ramsey. The pair called on manufacturers to do research on patients' time toll, and for insurers to better cover new drugs that reduce it.

One puzzling finding: The shortest treatment time was for melanoma, the deadliest form of skin cancer, at 17.8 hours the first year. Early-stage melanoma can be surgically removed with good survival, but it's often discovered late. The study didn't address if the shorter treatment time was because melanoma patients had fewer treatments to try, or some other reason.

Differences in patients' treatment times persisted during their last year of life, largely because of increased hospitalization, longest for gastric, lung and ovarian cancers — 35.4, 32.4 and 31.9 days, respectively.

Starbucks to drop trans fats from items

Wed, 03 Jan 2007 01:29:27 GMT
By CURT WOODWARD, Associated Press Writer
SEATTLE - Barb French has three good reasons to be happy Starbucks is banning artery-clogging trans fats from its food: her own health and the health of her two young daughters.
"I like my arteries, and I like theirs," French said Tuesday, as Adele Matter, 6, and her sister Daphne, 5, munched on a chewy rice cereal square in a Starbucks store here.

Starting Wednesday, all donuts, muffins and other treats sold in half of Starbucks Corp.'s standalone U.S. stores will be completely free of trans fats, the company said.

The world's largest specialty coffee retailer hopes to cut trans fats from the rest of its U.S. and Canadian stores by the end of the year, spokesman Brandon Borrman said.

"Our focus has always been on providing our customers with healthy and nutritious food options," he said.

Trans fats, listed on food labels as partially hydrogenated vegetable oil, are thought to boost "bad" cholesterol and decrease "good" cholesterol.

The fats have attracted attention from health regulators, most notably in New York, where city officials have approved a ban on trans fats in restaurants and eateries.

Borrman said Starbucks' move was not prompted by the New York ban. "This is something we've been working on, on our own, for a couple of years now," he said.

Company-owned Starbucks stores in Seattle, San Francisco, Chicago, Los Angeles, San Diego, Boston, New York, Philadelphia, Washington, D.C., and Portland, Ore. will have zero trans fats in their food as of Wednesday, Borrman said.

Getting the other half of those 5,600 company-owned stores to follow suit will take some time, as the company adjusts recipes with regional bakers and food suppliers.

Starbucks also licenses about 3,200 stores that are operated by other businesses, such as kiosks in airports and grocery stores. The company hopes to move those stores' menus to zero trans fats this year.

However, Starbucks already had quietly replaced the fats in its nationally distributed food products, such as its seasonal pumpkin muffins and gingerbread, Borrman said.

Starbucks said it hasn't heard many complaints about those items' taste, and the company hopes that the only thing tipping customers off to the recipe change will be signs announcing the switch.

"We've worked diligently to make sure we're making this conversion while keeping the same high quality that our customers expect," Borrman said.

He was unsure of trans-fat plans for locations outside the U.S. and Canada, but said stores in some countries already operate under local trans fat regulations. The Seattle-based company has more than 12,400 stores worldwide.

Some food makers stopped using trans fats voluntarily after the FDA began requiring trans-fat content on food labels.

Wendy's International Inc. introduced a zero-trans fat oil in August. Yum Brands Inc.'s KFC and Taco Bell said they also will cut the trans fats from many foods in their kitchens.

McDonald's has experimented with healthier oil blends for its french fries and has vowed to be ready for New York's ban, which takes effect for restaurant fryers on July 1.
Starbucks posted net fiscal fourth-quarter earnings of $117.3 million in October, on revenue of $2 billion. Stock markets were closed Tuesday in observance of former President Ford's funeral.
___
On the Net:
Starbucks: http://www.starbucks.com

N.D. conjoined twins to be separated

Wed, 03 Jan 2007 00:51:31 GMT

ROCHESTER, Minn. - Five-month-old conjoined twins Abygail and Madysen Fitterer, of Bismarck, N.D., will undergo separation surgery at the Mayo Clinic on Wednesday, the clinic announced Tuesday.
The girls are joined at the chest and share their front chest wall. In October, doctors implanted tissue expanders to stretch the girls' skin enough to close their incisions from the separation surgery.

"Abygail and Madysen have been growing in strength and size and character for weeks now," according to a Mayo video news release.

The surgical team will be led by Dr. Christopher Moir, who also led the teams that separated conjoined twin girls from Fargo, N.D., in May and twin boys from Mankato in November.

"Dr. Moir and the team believe there's a high likelihood of success — that's why they're going forward with it — but in any operation there's certainly risk," Mayo spokesman Lee Aase said.

The girls are the daughters of Stacy and Suzy Fitterer, who have not been granting interviews but said in the video distributed by Mayo that they were grateful for the moral support they've received from all over.

The girls' preparation for surgery has involved daily therapy and playing with their 2-year-old brother, Nicholas.

"They've got to work on range of motion and all that, so that when they are separated they'll be able to develop quicker and get back up to speed with kids their own age," said their father, Stacy Fitterer. "And I think they're overachievers, so they're going to do it."

The video showed the girls sitting in a special carrier that holds them upright, and a special chair designed by Mayo engineers to allow them to sit up and get their feet on the ground so they can develop their leg muscles.

"They've never been able to lay on their backs but Abby, if you watch her pivot her hips, I don't think it'll be too long before she'll be rolling," Suzy Fitterer said.

Abygail and Madysen will be the second set of conjoined twins from North Dakota to undergo separation surgery at Mayo's Eugenio Litta Children's Hospital. Abbigail and Isabelle Carlsen, of Fargo, have been doing well since they were separated in May. The Carlsen twins, now 13 months old, were born attached at the diaphragm, pancreas and liver, and shared a common bile duct and part of an intestine.

Aase said the main issue in the Fitterer twins' surgery will be separating and reconstructing their chest walls — though their livers are joined and they share some intestine — whereas the biggest challenge for the surgeons with the Carlsens was their common bile duct.

"It's complicated in a different way," Aase said.

The surgical team planned to hold a news conference Wednesday evening following the Fitterer twins' operation, which Aase said will be Mayo's fifth separation of conjoined twins. Besides the two sets last year, Mayo performed two other separations around 10 years ago, he said.

According to Mayo experts, conjoined twins may develop in as many as one in 50,000 pregnancies, but they account for only one in about 250,000 live births.

Stacy Fitterer said he and his wife wanted to thank everyone back home for all their prayers and good wishes. "Believe me, we know they're sending it," he said.

"We know we're getting it," Suzy Fitterer chimed in.

___
On the Net:
Mayo Clinic: http://www.mayoclinic.org/fitterer-twins

MTA Fainting dieters delay NYC subways

Wed, 03 Jan 2007 04:40:39 GMT

NEW YORK - Sick subway passengers, most of them dieters who faint from dizziness, are among the top causes of train delays, according to the Metropolitan Transportation Authority.
After track work and signal problems, ill passengers rated among the main reasons for subway disruptions between October 2005 and October 2006, according to an analysis of MTA statistics, AM New York reported Tuesday.

Asim Nelson, a transit emergency medical technician, told the paper that fainting dieters topped the "sick customer" list.

"Not eating for three or four days, you are going to go down," Nelson said. "If you don't eat for 12 hours, you are going to get weak."

Although the agency doesn't keep an official record of the nature of each rider's illness, the paper said that an average 395 delays each month are caused by sick customers.

The notion that fainting dieters are causing transit delays was previously reported by the newspaper Metro in a 2005 article.

Fainting spells caused by missed meals topped other "sick customer" causes, including flu symptoms, anxiety attacks, hangovers and heat exhaustion, according to Nelson.

Nelson is part of the MTA's "sick Customer Response Program," which consists of emergency medical technicians and registered nurses. When a rider becomes sick, the train conductor must stay with the passenger until emergency responders arrive.

Graying Japan opens door to Philippine nurses gingerly

Wed, 03 Jan 2007 07:06:33 GMT

TOKYO - Ask wheelchair-bound 81-year-old Hisae Kajiwara about the new workers at her nursing home and a smile comes to her face.
"They are really cheerful and make the atmosphere here very bright," she says.

Another woman, 79-year-old Mitsu Sekiguchi also confined to a wheelchair, chimes in: "And they always make the beds just perfectly."

Normally, the arrival of new nurses at the care facility in Tokyo's western fringes would be a mere question of personnel. But this time, it represents a fresh step for Japan.

Maria Falqueza, 25, and Olivia Pineda, 30, are among the first Filipinas at nursing facilities in Japan, which has signed a free-trade agreement with the Philippines that broke precedent by allowing workers to come in.

A handful of care support facilities have accepted 15 Filipinos including Falqueza and Pineda as trainees to brace for the full-fledged entry of Filipino nurses to Japan.

After intense negotiations, then Japanese prime minister Junichiro Koizumi and Philippine President Gloria Arroyo signed a deal in September for Japan to accept up to 1,000 care workers and nurses from the Philippines in two years.

The deal is more due to pressure from the Philippines -- whose economy relies on remittances from the one-tenth of its population working overseas -- than any desire by Japan.

Any changes to immigration policy, like elsewhere in the developed world, are controversial in Japan, but especially so as Asia's largest economy has strict regulations on foreign workers.

Under the agreement, the care workers are required to learn Japanese and to pass Japanese certification examinations, even if they are already legally qualified in the Philippines.

So every day, Falqueza and Pineda attend four hours of Japanese classes in the morning and then "literally rush to catch a rapid train to the care support facility" which is located some two and a half hours away, Falqueza says.

They work four hours there, and when they go home it is already 9:30 pm.

Two years later, they hope to get Japanese certification and re-enter with working visas.

"Our colleagues are nice and our elderly customers are kind, often teaching us Japanese customs," says Pineda. "I want to keep working as a caregiver in Japan."

Falqueza nods, adding: "I'd like to have a stable job here, have savings, and enjoy being young."

Despite the political sensitivities, officials say the care support industry faces a daunting shortage of workers in Japan, whose population began to shrink in 2005.

"Every facility is desperate to secure workers, because many workers, especially ones of good quality, are quick to leave due to tough working conditions involving night duties," says Hiromichi Mizuno, the president of a care home in the western city of Osaka.

The average annual salary for caregivers at public facilities funded through the insurance system is 2.2 million yen , well below the 3.8 million yen average for salaried workers, according to a government survey.
"Because the economy is recovering, we can't even compete with McDonald's in recruiting new workers," Mizuno says.
Solving the chronic shortage of workers boils down either to raising taxes -- which would require more public insurance money -- and accepting foreigners who are willing to work for less, facility managers say.
Japan's welfare costs are already snowballing due to its aging society.
So far, managers who have hired Filipino trainees see only the positive sides.
"Because they are hard-working and have warm personalities, they are accepted by colleagues and by customers," said Keiichi Kaneko of ZECS Community, a listed company which has accepted Filipino trainees for care support facilities.
Makoto Nanba, president of the Nanohana home where Falqueza and Pineda work, said the only major challenge he saw was the language barrier.
"If they can write and communicate more freely with colleagues and people in the facility, I don't mind hiring them," he says.
The tough requirement for Filipino caregivers -- and the comparatively small number who will be allowed to work here -- is seen by some as a deliberate attempt to avoid a political backlash.
"I think the conditions imposed reflect the Japanese government's intentions to limit the number of caregivers coming to Japan to a significantly low level," says Nanba.
"But I think it's also true that foreign labor could provide downward pressure on salaries for care workers," he adds, reflecting concerns that wages could lower even further.
Japan currently admits only foreign workers who are highly qualified in specific fields, such as computers.
In addition to the Philippines, Japan is currently talking with Thailand, Indonesia and Vietnam on free trade deals that could involve loosening conditions for working visas here.
"As the care industry always craves workers, I expect the immigration laws will have to be changed in the near future to allow more in," says Masahiro Hachiya of the non-governmental International Care Aid Organization, which supports Falqueza and Pineda financially and in their everyday lives.
"I think the essence of the issue is comprehensive support for immigrants in terms of finding flats, teaching Japanese social and business customs, and most importantly, overcoming cultural differences including religion," he says.

Cancer is down to fate Britons believe

Wed, 03 Jan 2007 10:23:04 GMT

LONDON - More than a quarter of people believe that fate alone will determine whether they get cancer, not their lifestyle choices, according to a survey conducted by charity Cancer Research UK.
The poll of more than 4,000 adults across the country asked people if they thought they could reduce their risk of getting cancer or whether it was out of their hands.

A total of 27 percent of people said cancer was down to fate, with more women than men believing cancer was a matter of destiny than prevention through measures such as quitting smoking or eating healthily.

Among those from the most deprived areas, the figure rose to 43 percent but fell to 14 percent in the most privileged areas.

The survey also found that smokers were 50 percent more likely than non-smokers to believe that getting cancer was the luck of the draw.

Cancer Research UK's director of cancer information, Dr Lesley Walker, described the results as "worrying".

She added: "It is alarming that such a large percentage of the British population do not realise that half of all cases of cancer can be prevented by lifestyle changes.

"We can all reduce our risk of cancer by stopping smoking, keeping a healthy weight and eating a balanced diet with plenty of fruit and vegetables and taking plenty of exercise.

"Enjoying the sun safely and avoiding sunburn also helps to reduce cancer risk."

The charity is currently running a campaign called "Reduce the Risk", which urges people to give up smoking, eat and drink healthily, protect themselves in the sun and visit their doctor if they notice anything abnormal.

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