MedicalResearch.com Interview with:
Ying Liu, MD, PhD
Assistant Professor
Washington University School of Medicine
Department of Surgery, Division of Public Health Sciences
St. Louis, MO
MedicalResearch.com: What is the background for this study? Response: Non-Hispanic African American women experience a disproportional burden of poor breast cancer outcomes than non-Hispanic White women, which is associated with a higher incidence of triple-negative breast cancer (TNBC), more advanced stages at diagnosis, and lower treatment adherence. However, the differences in clinical treatment and outcomes between African American women with TNBC and their White counterparts have not been well defined. (more…)
MedicalResearch.com Interview with:
Kelly de Ligt, PhD
Postdoctoral researcher | Project lead ‘PRO implementation in clinical care’
Psycho Social Research and Epidemiology (PSOE)
Netherlands Cancer Institute – Antoni van Leeuwenhoek
MedicalResearch.com: What is the background for this study? Response: Health-related Quality of Life (HRQoL) and survivorship has become increasingly important within breast cancer care, as the majority of women survives at least 10 years after breast cancer diagnosis. Breast cancer survivors may experience multiple co-existing symptoms that affect their health-related quality of life (HRQoL). Previous studies have mainly studied these symptoms as separate, independent items. However in reality, survivors usually experience multiple symptoms that can add up. We therefore studied the overall symptom burden in breast cancer survivors and tried to identify patterns in this. We believe this may be more relevant, as currently the needs of breast cancer survivors are not fully met and there is a growing demand for personalized follow-up care.
We selected breast cancer survivors from the Netherlands Cancer Registry, which contains comprehensive information about diagnosis and treatment for all cancer patients in the Netherlands. Women who had been surgically treated with or without adjuvant treatment for breast cancer stages I to III and between one and five years after diagnosis were invited to participate in our survey. A total of 404 participating survivors were questioned about their experienced burden for fatigue, nausea, pain, shortness of breath, insomnia, appetite, constipation, diarrhoea, as well as emotional and cognitive symptoms(more…)
MedicalResearch.com Interview with:
Jinhee Hur, PhD
Research Fellow
Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, MA 02115
MedicalResearch.com: What is the background for this study? Response: Early-onset colorectal cancer (EO-CRC, age <50 years at diagnosis) is rapidly rising in the US since the mid-1980s, with an unclear understanding of its etiology and contributors to the rise. Sugar-sweetened beverages (SSBs) exert adverse metabolic repercussions throughout the life course, including insulin resistance and inflammation. Higher SSB intake can induce obesity, which has been linked to risk of EO-CRC. A recent experimental study also suggests that high fructose corn syrup, a primary sweetener in SSBs, may promote colon tumor growth, independent of metabolic dysregulation. In the US, SSB consumption has dramatically increased during the 2nd half of the 20th century, and adolescents and young adults have been the heaviest SSB drinkers across all age groups. Thus, we expect SSBs may be an emerging risk factor for EO-CRC and likely contribute to the rising incidence of EO-CRC.
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MedicalResearch.com Interview with:
Saket Navlakha PhD
Simons Center for Quantitative Biology
Cold Spring Harbor Laboratory
Cold Spring Harbor, NYMedicalResearch.com: What is the background for this algorithm? How does it aide in patient care?Response: The machine learning algorithm helps to predict if and when a patient will develop severe COVID symptoms, based on information on how the patient presents on the day of infection. This could lead to improved patient outcomes, by getting a “heads up” on what may happen in the near future.
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MedicalResearch.com Interview with:
James Donald Byrne, Ph.D., M.D.
Department of Radiation Oncology
Massachusetts General Hospital
Boston, Massachusetts
MedicalResearch.com: What is the background for this study?
Response: Radiation therapy is used as a treatment for more than half of all cancer patients and can be highly effective at shrinking tumors and killing cancer cells. But radiation treatment can also damage healthy tissue, including tissue in the mouth and gastrointestinal tract. This tissue injury can lead to oral mucositis, esophagitis, and proctitis — painful and sometimes debilitating tissue damage. It’s estimated that these injuries occur in over 200,000 patients in the U.S. each year. Our goal was to develop personalized shields that blocked radiation from affecting healthy GI tissue. (more…)
MedicalResearch.com Interview with:
Judy H. Cho, MD,
Dean of Translational Genetics
Director of The Charles Bronfman Institute for Personalized Medicine
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? Would you briefly describe Crohn's disease? Whom does it primarily affect?Response: Crohn’s disease is a chronic inflammatory intestinal disease, which affects ~3 million Americans a year. Its most typical age of onset ranges from 15-30 years, and many of those diagnosed also exhibit frequent abnormal healing and complications that constrict the digestive tract. The highest risk genetic mutations that increase risk for Crohn’s disease are found in the gene NOD2; these were first reported 20 years ago. Biological mechanisms by which NOD2 mutations drive Crohn’s disease, and especially fibrotic complications, have been incompletely described up until this point. Further, the reasons why many patients fail to respond to the commonly administered anti-TNF treatments also remain incompletely understood.
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MedicalResearch.com Interview with:
Sa Kan Yoo MD PhD
Division of Developmental Biology and Regenerative Medicine
Kobe University, Kobe, Japan
MedicalResearch.com: What is the background for this study? Response: Cancer is often considered as a disease of “overgrowth”. But, many known “cancer genes” in fact induce cell death rather than cell growth. Because of this phenomenon, it requires involvement of many genes, not a single “cancer gene”, for cells to become cancer. Although this protective phenomenon that cancer genes induce cell death has been known, its exact mechanism has remained unclear. We tackled this problem using the fruit fly, found its mechanism and discovered a way to manipulate it by dietary nutrition.
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MedicalResearch.com Interview with:
Michelle M. Chen, MD/MHS
Clinical Lecturer
Department of Otolaryngology-Head and Neck Surgery
University of Michigan
MedicalResearch.com: What is the background for this study? Response: HPV is the most common sexually transmitted infection in the United States and associated with several malignancies including oropharyngeal, cervical, vaginal, vulvar, penile, and anal cancers. In 2020, the FDA expanded the indications for HPV vaccination to include the prevention of oropharyngeal cancer, which is the most common HPV-associated malignancy and about 80% of oropharyngeal cancer patients are male.
HPV vaccination rates are closely tracked for adolescents but less is known about vaccination rates for young adults. The goal of our study was to understand HPV vaccinations for young adult men and women, ages 18-21.(more…)
MedicalResearch.com Interview with:Nishanth Ulhas Nair, Ph.D.
Affiliation: Staff Scientist at Cancer Data Science Laboratory, Center for Cancer Research
National Cancer Institute (NCI), National Institutes of Health (NIH)
Bethesda, Maryland, USA. Date: April 22, 2021
Dr. Raffit Hassan and Dr. Eytan Ruppin at the National Cancer Institute (NCI) are the senior authors of this study.MedicalResearch.com: What is the background for this study? Response: Malignant mesothelioma is an aggressive cancer with limited treatment options and poor prognosis. An in-depth knowledge of genetic, transcriptomic and immunogenic events involved in mesothelioma is critical for successful development of prognostics and therapeutic modalities. In this study we aim to address this by exploring a new large scale patient tumor dataset of 122 mesothelioma patients, called NCI mesothelioma patient data, along with their genomic, transcriptomic, and phenotypic information. Unlike previous large-scale studies which have been focused on malignant pleural mesothelioma patients, our dataset contains an approximately equal representation of malignant pleural and peritoneal mesothelioma patients which allows to identify any differences between them. (more…)
MedicalResearch.com Interview with:
Aditya Bardia MD, MPH
Director, Breast Cancer Research Program,
Attending Physician, Massachusetts General Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study? Response: Triple negative breast cancer (TNBC) represents an aggressive subtype of breast cancer associated with guarded prognosis. For patients with pre-treated metastatic TNBC, standard chemotherapy is associated with low response rate (5-10%) and poor progression-free survival (2-3 months), highlighting need for better therapies.
Sacituzumab govitecan is an antibody drug conjugate (ADC) which combines SN-38, an active metabolite of irinotecan, with an antibody against Trop-2, an antigen overexpressed in majority of triple negative breast cancer.
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MedicalResearch.com Interview with:
Vivek Subbiah, MD
Department of Investigational Cancer Therapeutics
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
MedicalResearch.com: What is the background for this study? Response: RET fusions occur predominantly in 2% of lung cancers and 10-20% of thyroid cancers, and in low frequency in an increasing number of diverse cancers, including pancreatic cancer, salivary gland cancer, and colorectal cancer. The therapeutic relevance of RET fusions occurring outside of lung and thyroid cancers has not been well established..
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MedicalResearch.com Interview with:
Nicholas Mitsiades MD
Associate Professor of Medicine - Hematology and Oncology
Baylor College of Medicine
Oncologist at the Dan L Duncan Comprehensive Cancer CenterMedicalResearch.com: What is the background for this study? Response: African American men have higher risk of developing prostate cancer and up to 2.2-times higher mortality rate from prostate cancer relative to men of other ancestries. This is the largest health disparity across all cancers in the US. Socioeconomic factors, especially access to healthcare, definitely contribute to this disparity. African American men are diagnosed with prostate cancer at a more advanced stage than other races, and this is unfortunately very common at Ben Taub Hospital, our safety-net hospital in the Houston area, where we serve large racial and ethnic minority populations and patients who lack commercial insurance.
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MedicalResearch.com Interview with:
Gregory K. Friedman, MD
Associate Professor
Director, Developmental Therapeutics
Associate Scientist, O'Neal Comprehensive Cancer Center at UAB
Neuro-Oncology Program
Division of Pediatric Hematology-Oncology
University of Alabama at Birmingham
MedicalResearch.com: What is the background for this study? Response: This was a first-in-children trial to test the safety of an immunotherapy using an altered cold-sore virus (herpes virus or HSV-1), G207, infused directly via catheters into progressive or recurrent malignant brain tumors. Due to modifications in G207, the virus does not harm normal cells but can infect and directly kill tumor cells while also stimulating the patient’s own immune system to attack the tumor. We tested G207 at two dose levels alone and when combined with a single low dose of radiation, which was used to increase virus replication and spread throughout the tumor. The research is important because outcomes are very poor for children with progressive malignant brain tumors, and the toxicities caused by current standard therapies are unacceptably high. Therefore, we greatly need effective and less-toxic targeted therapies for children.
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MedicalResearch.com Interview with:
Dr. Anna Plym PhD
Postdoctoral Research Fellow
Brigham and Women's Hospital
Harvard T.H. Chan School of Public HealthMedicalResearch.com: What is the background for this study? What arethe main elements of the healthy lifestyle?Response: Prostate cancer is the most heritable of all cancers, with genetic factors accounting for a large proportion of cases. Although we do not currently know about all the genetic factors contributing, a recent study identified 269 genetic markers for prostate cancer, validated in multiple independent populations (Conti et al., Nature Genetics 2021, Plym et al, JNCI, 2021: https://academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djab058/6207974). Based on a polygenic risk score derived from these 269 markers, we observed that men with a high polygenic risk score have over a 50% risk of developing prostate cancer within their lifetime. With this excess risk in mind, we were interested in possible ways in which the genetic risk of prostate could be attenuated. An increasing number of studies have suggested that lifestyle factors can affect the risk of lethal prostate cancer – however, these studies have seldom incorporated genetic factors. We know from other diseases that a healthy lifestyle is of benefit for individuals at high genetic risk, and we hypothesized that this would be the case for prostate cancer as well. In this study, we examined a healthy lifestyle score for lethal prostate cancer consisting of six components: healthy weight (BMI < 30), not smoking (never smoked or quit > 10 years ago), vigorous physical exercise (3 or more hours per week), high intake of tomatoes or tomato-based products (7 servings or more per week), high intake of fatty fish (1 or more serving per week) and low intake of processed meat (less than 3 servings/week of beef or pork hot dogs, bacon, salami, bologna, or other processed meat sandwiches) (Kenfield et al, JCO, 2016).(more…)
MedicalResearch.com Interview with:
Anne Cust | PhD, Professor of Cancer Epidemiology
The University of Sydney
Faculty of Medicine and Health
Sydney School of Public Health
MedicalResearch.com: What is the background for this study? Are the screeners specially trained, use full body photographs, dermoscopy etc?Response: The Melanoma High-risk Clinic Study was developed to optimise the early detection of new melanomas in people at high risk of developing melanoma. A previous single-centre study observed fewer excisions and healthcare costs, thinner melanomas and better quality of life when surveillance of high risk patients was conducted in a melanoma dermatology clinic with a structured surveillance protocol involving 6-monthly full body examinations aided by total body photography (TBP) and sequential digital dermoscopy imaging (SDDI). The initial pilot study was performed in a single tertiary referral specialist centre using trained dermatologists who routinely used the diagnostic interventions.
Our objective was to examine longer-term sustainability and expansion of the program to multiple practices including a primary care skin cancer clinic setting. The hypothesis was that the outcomes would be similar if using the same protocol and diagnostic tools. The participating doctors were trained to follow the protocol, which included instruction on how to respond and interpret changing lesions, but not in use of dermoscopy or skin examinations, which were routinely and consistently used in all clinics prior to the study commencing. There were 593 participants assessed as very high risk of melanoma who participated in the Melanoma High-risk Clinic Study from 2012-2018. Nearly all of the participants had had a previous melanoma and had additional melanoma risk factors. 57% were male and the median age at study entry was 58 years.
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MedicalResearch.com Interview with:
John B. Wong, M.D.
Chief Scientific Officer,
Vice Chair for Clinical Affairs
Chief of the Division of Clinical Decision Making
Primary Care Clinician
Department of Medicine
Tufts Medical CenterMedicalResearch.com: What is the background for this study? Response: Lung cancer is the leading cause of cancer death for both men and women in the United States. More than 200,000 people are diagnosed with this devastating disease each year. Smoking is the leading cause of lung cancer, resulting in the vast majority of lung cancers in the United States. (more…)
MedicalResearch.com Interview with:Nadia Koyratty PhD student
Department of Epidemiology and Environmental Health
University at Buffalo
State University of New York
MedicalResearch.com: What is the background for this study? Response: The literature suggests that sugars contribute to the incidence of breast cancer, but few exists on the prognosis after a breast cancer diagnosis.
MedicalResearch.com: What are the main findings?Response: Compared to breast cancer patients who never or rarely drank non-diet soda, those who reported drinking non-diet soda five times or more per week had a 62% higher likelihood of dying from any causes, and were 85% more likely to die from breast cancer specifically.
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MedicalResearch.com Interview with:
Khalid Shah, MS, PhD
Vice Chair of Research, Department of Neurosurgery
Director, Center for Stem Cell Therapeutics and Imaging
Director, Center for Excellence in Biomedicine
Brigham and Women's Hospital
Associate Professor, Harvard Medical School
Principal Faculty, Harvard Stem Cell InstituteMedicalResearch.com: What is the background for this study? Response: Approximately 15-to-30 percent of patients with metastatic breast cancer have brain metastasis (BM), with basal-like breast cancer (BLBC) metastasizing to the brain most frequently. The prognosis for BLBC-BM patients is poor, as the blood-brain barrier prevents most therapeutics from reaching the brain. Testing candidate therapies in clinical trials is also challenging because animal models that mimic BM are limited. In this study we engineered a bimodal tumor-suppressing and killing molecule that can be delivered to the brain by stem cells and tested them in mouse models of brain metastases that mimic clinical setting. (more…)
One of the main dangers of cancer is metastasizing. This process can affect any organ in the human body. The most frequent causes of liver metastases are tumors of the gastrointestinal tract, mammary glands, lungs, and pancreas.One of the modern methods of liver metastases treatment today is chemoembolization procedure. Its use allows doctors to fight cancer liver metastases with minimal harm to the patient. Statistics shows that this method is 30% more effective than traditional treatment of metastases with systemic chemotherapy.SymptomsAs a rule, secondary liver cancer has no symptoms for a long time. This makes it difficult to diagnose this type of oncology. However, with regular medical check-ups, you can avoid this. To know when you should see a doctor, you need to know the symptoms of liver metastases that are most commonly seen:
Abdominal bloating
Nausea and vomiting
Constipation or diarrhea
Decreased appetite
Severe weight loss
Persistent low-grade increase in body temperature
General weakness and fatigue
If you have one or more of these symptoms, it is better to see your doctor. This will allow the tumor to be diagnosed at an early stage, so you can improve your prognosis for treatment and also make it less harmful to your health.(more…)
MedicalResearch.com Interview with:
Catharina Svanborg M.D., Ph.D.
Professor at Lund University Department of Laboratory Medicine,
Division of Microbiology, Immunology and Glycobiology
Founder/Chairman of the Board at HAMLET Pharma
MedicalResearch.com: What is the background for this study?
Response: Like many unexpected scientific developments, this finding was serendipitous. In our search for the molecular basis of host susceptibility to infection, we discovered that infection directly affects MYC levels.
Gene expression analysis revealed that MYC itself was inhibited and that genes regulated by MYC were affected in children with acute kidney infection. Rapid reductions in MYC levels was further confirmed by infecting human kidney cells with the pathogenic E. coli bacteria isolated from patients with acute pyelonephritis, allowing us to formulate the hypothesis that bacteria regulate host MYC levels during acute infection and to investigate the mechanism leading to this inhibition. This work was conducted by the Laboratory Medicine group at Lund University in Sweden led by Professor Catharina Svanborg. (more…)
MedicalResearch.com Interview with:
Andrea D. Branch PhD
Professor of Medicine
Division of Liver Diseases
Associate Professor of Surgery
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? Response: Liver cancer is a deadly condition with a high mortality rate. About 90% of people who develop liver cancer have cirrhosis (advanced liver scarring) due to a chronic underlying liver disease. Patients with cirrhosis are advised to undergo liver cancer surveillance. Early detection improves survival, but diagnosis requires more than a blood test, which makes surveillance complex and expensive. Black individuals are more likely to develop liver cancer than white individuals and are more likely to die from it. Black patients also have more advanced liver cancer at the time of diagnosis than Whites. We aimed to identify additional factors that distinguish liver cancer in African Americans, focusing on patients with hepatitis C virus infection, the most common chronic liver disease in people who die from liver cancer in the United States.
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MedicalResearch.com Interview with:
Jeffrey Skolnik, MD
Senior Vice President, Clinical Development
INOVIO
MedicalResearch.com: What is the background for this technology? Would you tell us a little about the brain tumor, Glioblastoma Multiforme? How common is it, whom does it primarily affect?Response: Glioblastoma (GBM) is the most common malignant brain tumor, affecting more than 10 thousand people each year in the United States. Most people diagnosed with GBM are above the age of 60 years, although GBM can be diagnosed at any age, including in children and young adults. Despite decades of research, GBM remains almost universally fatal. GBM is a tumor of the glial cells of the brain, and current therapies are directed at removing tumor with surgery and killing residual tumor cells with radiation and chemotherapy.
More recently, with the introduction of immunotherapies such as immune checkpoint inhibitors (ICI) for the treatment of cancer, clinical studies have tried to add this promising technology to the treatment of GBM. Unfortunately, despite success in other types of cancer, ICIs have not demonstrated any clinical benefit in treating GBM. Newer clinical studies aim at introducing a combination of newer therapies together to try to tackle this terrible disease, and INOVIO’s GBM-001 study is one such example of an innovative approach to treating GBM. (more…)
MedicalResearch.com Interview with:
Muhammed Murtaza M.B.B.S. (M.D.), Ph.D.
Translational Genomics Research Institute
Phoenix, AZ
MedicalResearch.com: What is the background for this study? Response: Liquid biopsies and cell-free DNA analysis using blood samples have transformed cancer diagnostics in recent years. We started this project wondering whether cell-free DNA in urine is a viable alternative to blood, since urine could be collected completed non-invasively. Our very first experiment showed the lengths of DNA fragments in urine very similar across healthy individuals, leading us to wonder whether urine was actually as randomly degraded as we had previously thought. (more…)
MedicalResearch.com Interview with:
Nathorn (Nui) Chaiyakunapruk PharmD, PhD
Professor, Department of Pharmacotherapy
University of Utah College of Pharmacy
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Colorectal cancer is one of the cancers for which we found that the risk can be significantly reduced by modifying diet. Individual components of your diet can contribute to an overall healthy diet pattern to lower the risk of colorectal cancer or increase it. Strong scientific evidence shows that limiting red meat and alcohol consumption, eating foods containing fiber and calcium, consumption of dairy products especially yogurt can help prevent colorectal cancer.(more…)
MedicalResearch.com Interview with:
Eirini Papapetrou, MD, PhD
Associate Professor
Department of Oncological Sciences
Icahn School of Medicine at Mount Sinai
New York, NY 10029
MedicalResearch.com: What is the background for this study? Would you tell us a little about acute myeloid leukemia?Response: Acute myeloid leukemia is a form of cancer of the blood. It is typically very aggressive and lethal without treatment. The main treatment is high-dose chemotherapy and it has not changed very much in decades. Some more recent "targeted" therapies that are less toxic help somewhat but still do not result in cures. We believe a reason for this might be that both chemotherapy and newer "targeted" therapies target the cells at the later stages of the disease and spare the earlier ones, which can then give rise to disease resistance and relapse.(more…)
MedicalResearch.com Interview with:
Jane Fang, MD
Clinical
Athenex, Inc.MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by actinic keratoses? How common are they and who is primarily affected?Response: Actinic keratosis is a very common precancerous skin condition that affects about 58 millions people in the US. Most commonly affected people are older (over 40 years old) men with fair skin type. Actinic keratosis lesions are red scaly bumps on sun-damaged skin mostly on the face, scalp, back of hands, forearms and legs. As there is a risk of 0.025-16% per year for each actinic keratosis to progress to skin cancer and it is not possible to predict which actinic keratosis will become cancerous, early treatment of actinic keratosis is generally recommended. Currently approved topical treatments require weeks or months of application and may lead to intolerable side effects that undermine compliance and reduce efficacy of treatment.
Tirbanibulin ointment is a novel anti-proliferative agent that inhibits tubulin polymerization and disrupts Src kinase signaling, and has the potential to inhibit growth of abnormal skin cells in actinic keratosis. The current report described two Phase 3 randomized vehicle or placebo-controlled clinical studies that demonstrated that a 5-day course of tirbanibulin ointment applied once daily by patients was safe, well-tolerated, and effective in clearing actinic keratosis on the face or scalp compared to vehicle control. (more…)
MedicalResearch.com Interview with:
David-Dan Nguyen
Research Fellow | Center for Surgery and Public Health, Brigham and Women's Hospital
MPH (Health Policy) Student | Harvard T.H. Chan School of Public Health
Medical Student | McGill University
MedicalResearch.com: What is the background for this study? Response: The COVID-19 pandemic has forced hospitals to delay the definitive treatment of cancers via surgery or radiation therapy. While previous evidence has shown that delaying the treatment of low-risk prostate cancer is not associated with worse outcomes, treatment delays for intermediate-risk and high-risk prostate cancer are more controversial. As such, we sought to determine if delays for these disease states negatively impacted oncological outcomes.
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Cancer occurs when cancerous cells in one area of the body reproduce rapidly and invade surrounding cells, tissue, and organs. Occasionally, these cells can spread to other parts of the body. Symptoms, treatments and the prognosis will depend on the type and stage of the cancer.
Give them emotional support
Your parent is probably as confused and overwhelmed as you are, if not more. Offer them a comforting ear and allow them to talk through how it is affecting them, their concerns, their treatment options, and their wishes.
Offer assistance, but don’t force it. Being too helpful could end up with your parent feeling a loss of control or independence. Organize what type and level of support you can offer, sustainable to their wellbeing, and yours.
Offer spontaneous and scheduled companionship to help them to feel a sense of normalcy and provide opportunities to spend time together. If you both decide you should accompany them to their physician’s appointments and treatments, take notes, and don’t be scared to speak up if you have a question.
Try to understand what they’re going through
Take the time to understand the individual symptoms that they are experiencing and suggest proven solutions to relieve and manage.
For example, the symptoms of mouth or esophageal cancer will be very different from that of any other part of the body. Namely, these cancers can cause loss of the ability to chew and swallow (medically referred to as dysphagia), which are alleviated using a thickener in food and beverages. In contrast, individuals suffering from cancer of the spine are more likely to have trouble mobilizing, which would be improved by a walking aid.
Managing conditions like cancer begin with a full understanding. Read about the origin of SimplyThick Easy Mix and see the value in understanding health conditions from a patient perspective.
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