Category Archives: General

When Cancer Spreads: Understanding Metastasis

By Louise Chang, MD

How does lung cancer reach other areas of my body? Why did breast cancer show up in my bones? What does it mean to have metastatic cancer?

It can be hard to understand how cancer starts in one place and also shows up in other places in the body that are far from where it started. The ability to spread, called metastasis, speaks to the aggressive nature of cancer and the challenge it poses.

Cancer starts from cells in our body that have gone rogue. The body has ways to monitor and dispose of abnormal cells that develop, but cancer cells are able to avoid the body’s defense system. They grow out of control and form into cancerous tumors.

As cancer cells multiply, they can get into the bloodstream and lymph system. This allows the cancer cells to travel and settle in other parts of the body. When cancer spreads like this, it is described as “metastatic” – because cancer cells have moved to a different location in the body. But metastatic tumors are still considered to be the same cancer type as where the cancer first started. This is why breast cancer that has spread to the bone or lungs is still breast cancer.… Continue reading →

Making End-of-Life Plans

By Agnes Beasley, MSN, RN, OCN

A lot of us are planners. We plan work projects, celebrations, careers, family vacations, and retirements. However, the one area that most of us avoid thinking about, much less planning, is the end of our life. After all, we don’t plan on having a terminal illness. We don’t plan on dying any time soon. Decisions about end-of-life care are deeply personal, and are based on personal values and beliefs. No one wants to think about end-of-life issues when there are so many other happier activities to fill our calendars.

Still, at some point in time many of us will face making decisions about the dying process. How do you bring up the topic? When do you bring up the topic? Who do you talk to? Thinking about your end-of-life wishes, also known as advance care planning, can be hard and overwhelming. Most people expect their doctors to start the conversation about end-of-life planning – but only when it’s necessary and not a moment sooner! That’s especially true for people with cancer, especially when treatment may no longer be working. Many cancer patients and close family members may be thinking about discussing end-of-life issues with their doctor when the time comes, but where do they begin?… Continue reading →

Palliative care is part of good cancer care

By Diane E. Meier, M.D., FACP

Deborah, a 36-year-old mother of two young children, was diagnosed with breast cancer 2 years ago, and the disease has metastasized (spread) to her bones. The pain is severe, making it hard to care for her children or get to work.

Like any young mother, Deborah is determined to fight her cancer and be present for her son and daughter as they grow up. Deborah’s oncologists, doctors at the top of their field, are intensely focused on controlling her cancer and identifying the chemotherapy plans that are most likely to work for her. But they have been unable to manage Deborah’s pain. It had become so bad that she was unable to sleep or eat, spending much of the day curled on her side in bed. She missed a course of chemotherapy because of her pain, and she had to hire outside help to get her kids to and from school.

Deborah’s long-time internist finally referred her to the palliative care team at her local hospital. They prescribed a low-dose opioid medicine and within 2 days, Deborah’s pain was well controlled, she was up and around, sleeping and eating, and back to normal life with her family.… Continue reading →

Less Food Marketing, Healthier Children

By Colleen Doyle, MS, RD

Have you seen all those fun and flashy commercials encouraging your kids to eat more fruits and vegetables? No? Neither have I. And there’s a reason for that. 

Out of the $1.79 billion that the Federal Trade Commission says major food and beverage companies spent marketing foods and beverages to kids and teens (in 2009 – the most recent data available), less than .05% was spent marketing fruits and vegetables. Unfortunately for those of us who care about children’s health – which I hope is all of us – the majority of those dollars was spent on marketing unhealthy foods and beverages. Forty percent was spent to market fast food and other restaurant foods, and another 22% was spent promoting high-sugar sodas and other carbonated beverages.

And consider these additional statistics:

  • Two BILLION advertisements for foods and drinks appeared on websites directed at kids in 2009, mostly for sugary cereals and fast food.
  • Dollars spent to market foods and drinks to kids via online games, mobile apps, social network ads, and other digital media increased by 51% from 2006 to 2009.
  • Companies spent $149 MILLION in 2009 to market sugary drinks and food in schools.
Continue reading →

Tips for your first oncologist’s appointment

By Francisca Alvarado, BSN, RN, OCN

The cancer journey brings about many overwhelming feelings. Many thoughts may go through your mind when you hear, “You have cancer and you need to be seen by an oncologist.” You may wonder how this will impact you, your family, and your friends. The possible anxiety caused by wondering what the oncologist will tell you at the appointment and which decisions you will have to make may take over your thinking. You may have trouble listening, understanding, or remembering what anyone is telling you during this time due to the very normal distress, uncertainty, fear, and anger you may be feeling.

Having a better understanding of what to expect, what to take with you, and which questions to ask at your first oncologist’s appointment may help you better prepare and lessen the anxiety. 

Get the logistics clear

Before your first appointment, make sure you know the answers to these questions. Although they seem obvious, it can be easy to overlook these details when you’re worried about your diagnosis:

  • What is the full name of the oncologist I will be seeing?
  • Does the oncologist take my insurance? What will I be expected to pay on the first visit?
Continue reading →

Adults Need Vaccines, Too

By William Schaffner, MD

As I like to tell my patients, the best approach to everyday health is a proactive one, and that means staying up-to-date on recommended vaccinations in addition to annual checkups.

Many adults don’t visit a doctor unless they feel ill, nor do they think about vaccination as part of their routine, preventive healthcare. This leaves them needlessly vulnerable to diseases that can cause severe health complications or even death. 

Vaccines are a safe, effective way to help prevent a number of diseases at any age-from 6 months to 60 years, and beyond. In fact, there are several vaccines recommended specifically for adults because of their risk for certain infections.

It’s important for all adults to check with a healthcare professional about which vaccines are recommended for them, as we all need some vaccinations as we age. For example, the chance of having complications from the flu, or getting shingles or pneumococcal disease (see below for more information) increases with age. In other cases, a weakened immune system or the presence of underlying illnesses like cancer, heart disease, or diabetes can make us more susceptible to diseases.

Many adult vaccines are readily available at primary care medical offices and in pharmacies, and the cost of vaccination is usually covered by Medicare and most private insurers.… Continue reading →

How electronic health records can help on your cancer journey

By Simone Myrie

Ed. note: This guest post by Simone Myrie of the Office of Consumer eHealth, Office of the National Coordinator (ONC) for Health Information technology, US Department of Health and Human Services. In it, she explains how electronic health records and Blue Button can help cancer patients, survivors, and caregivers as they navigate their cancer journey.

No two experiences with cancer are alike, but there are certain things that almost all cancer patients and their loved ones share in common. From getting a diagnosis, to coordinating care among doctors and at home, and on to long-term survivorship plans, the cancer experience is one centered around information. Some of the information we seek is mostly objective: What can I expect this disease to do? What are my treatment options? How can I improve my odds of beating cancer?

But some of the most important information you can gather, keep track of and share is information unique to you: Your own health records. The visit summaries, clinical notes, test results, medication lists, treatment histories, and other documents represent a critical picture of your individual cancer experience. This information has implications for your individual choices, your professional care, and the care you receive from loved ones.… Continue reading →

The Same, Only Scarier — The LGBT Cancer Experience

By Liz Margolies, LCSW

Getting a diagnosis of cancer is frightening for everyone. But for many lesbian, gay, bisexual, and transgender (LGBT) patients, the immediate concerns about treatment options and survival are compounded by an additional set of worries: 

  • “Should I come out to my healthcare providers?”
  • “Will I be safe if I do?”
  • “Will my chosen family be welcome?”
  • “Will I be able to find the information I need to take care of my relationship, my sexuality, my fertility and my family?”

LGBT cancer patients and survivors are underserved and that is partly as a result of being underreported. No cancer registries collect information about gender identity or sexual orientation, leaving LGBT cancer survivors buried in the data and often invisible to healthcare providers. Treatment facilities and social service organizations may also be unaware of the true number of LGBT people they serve because their intake forms do not invite disclosure (coming out as lesbian, gay, bisexual, transgender), and fear of discrimination keeps many patients in the closet. As a result, the healthcare system often fails to recognize LGBT patients and isn’t trained to meet their needs.  

The American Cancer Society estimated in January 2014 that there were approximately 14.5 million Americans living with a history of cancer.… Continue reading →

What to keep in mind when you see STUDIES SAY

By Alvaro Carrascal, MD, MPH

You may have seen some of these headlines recently in national newspapers and online:

More coffee linked to higher mortality rate: study

Four cups of coffee a day may raise early death risk in younger adults

4 Cups of Coffee a Day Can Be Deadly

New Study: Coffee Can Kill You

Under 55? Think twice before you reach for that extra cup of coffee, researchers say

After seeing these reports on the web and morning news, I had a thought as I reached for my morning cup of joe: Should I consider tea instead?

As a person who grew up drinking 2-3 cups of coffee a day, should I change my habits based on these news reports? What would happen if I don’t? Should these reports stop my life-long friendship with Juan Valdez? [more]

Then, I began to recall headlines from a few months ago.

Caffeine Linked to Lower Skin Cancer Risk

Moderate Coffee Consumption Lowers Heart Failure Risk

Moderate Coffee Consumption May Reduce Risk of Diabetes by Up to 25 Percent

What should we make of these contradictory reports? Who is right, who is wrong, and what should we believe?

Every day we are bombarded with reports about studies and occasionally these studies contradict each other.… Continue reading →

International Women’s Day, a Chance for Change

By Ambassador Sally G. Cowal


We celebrate International Women’s Day March 8. Originally, it was an event to promote equal political rights, including the right to vote, for women. As a Chicagoan I’m proud to say that one of the earliest Women’s Day observances was held in that city in 1908!

Today, although women have the right to vote almost everywhere, health inequalities and disparities between women in the developed and developing worlds — and between men and women in many countries and regions of the world — continue to exist.

Women’s health is important, not only for women, but for men and for families. Women are the caregivers in most places in the world, and when a woman is ill or dies prematurely, her family -particularly her children – carry the burden.  That is one of the reasons why it is so important to prevent premature illness and death in women from cancer. Although we think of cancer as a disease that affects people in high income countries, the reality is that 57% of cancer cases and 65% of cancer deaths are in low and middle income countries – that is 5.3 million deaths a year.  And the trends point to a continuing shift of the burden to lower income countries.… Continue reading →