Pancreatic cancer affects over 60,000 people in the United States. Continue reading to learn more about pancreatic cancer in honor of Pancreatic Cancer Awareness Month.
What is pancreatic cancer?
Pancreatic cancer is a cancer that develops in the pancreas. The pancreas helps regulate the metabolism of sugar and aids in the digestion of foods.
What causes pancreatic cancer?
Although the exact cause of pancreatic cancer is still unknown, some risk factors that may contribute to the development of pancreatic cancer include:
Repeated inflammation of the pancreas (chronic pancreatitis)
Physical symptoms of pancreatic cancer
Many of the symptoms of pancreatic cancer are also common with other types of cancers. These may include:
Loss of appetite
Unintended weight loss
How is pancreatic cancer diagnosed?
There are several ways that pancreatic cancer is diagnosed:
Three blood tests can help diagnose and treat pancreatic cancer:
Liver function test. Measures the amount of bilirubin in the blood. If high this may indicate a tumor is blocking the bile duct.
Carcinoembryonic antigen. Elevated levels in the blood are found in patients with cancers of the GI (gastrointestinal) tract.
CA 19-9. Individuals with pancreatic cancer often have an elevation of this protein in their blood.
If blood work and imaging indicate the possibility of having pancreatic cancer, a biopsy (a tissue sample from the pancreas) is taken to confirm the diagnosis. A biopsy is the gold standard for a definitive pancreatic cancer diagnosis.
How does hospice help pancreatic cancer patients
Pancreatic cancer can be extremely painful, making your quality of life more difficult toward the end of life. Hospice care allows people to live their final stages in peace by providing:
Comfort for end of life
The end of life can be a very stressful, uncomfortable, and anxiety-provoking time. A hospice team can help provide the comfort the patient needs physically, emotionally, and spiritually.
Hospice care takes care of you physically and emotionally during the end of life. The team consists of a social worker and chaplain who will work with you and your family to ensure your spiritual needs are met. Hospice provides compassionate care that is supportive of both the patient and their families through the end of life and throughout the grieving process.
Helps with family and loved ones
Caring for sick loved ones can be an exhausting endeavor, which is why hospice care takes over your care so that your family gets a much-needed break. Your hospice team can also coordinate respite periods for your caregiver.
COPD Awareness Month: Hospice Referral Guidelines
By: Laura Mantine, MD
Chronic lung disease is the 4th most common cause of death among older adults in the United States. More than 3 million people worldwide died of COPD in 2015, representing 6% of all deaths that year. People dying from COPD frequently experience difficult and uncomfortable symptoms that lead to distress and panic. They commonly have disabling respiratory symptoms including severe breathlessness, limited tolerance for activity, and intractable coughing. They are also usually oxygen dependent, often experience anorexia with weight loss, cachexia, and ultimately become dependent on others for their activities of daily living.
COPD and Hospice Care
Despite the symptomatic needs of individuals dying from end-stage COPD, only 30% of individuals receive hospice care before death. It is not clear why the rate of hospice use for patients with COPD is so low, but several explanations have been offered. The most important may be that few patients with severe COPD have discussed end-of-life planning with their clinician. Furthermore, many patients and clinicians do not view COPD as a terminal illness and feel it is more chronic in nature. Also, there may be a lack of awareness that patients enrolled in hospice can continue to receive treatments for COPD. Due to the fluctuating course of COPD, it is often difficult to accurately estimate a patient’s life expectancy which may contribute to low hospice utilization rates.
Hospice Eligibility Guidelines for COPD
While end-of-life-care is an appropriate topic to discuss with all patients, several factors have been suggested that should prompt a discussion with patients who have severe COPD. One factor is simply that a clinician would not be surprised if a patient with COPD were to die within the next 6-12 months. A clinician should consider hospice referral in a patient with COPD if they are dyspneic at rest or with minimal exertion, have progressed to the point where they spend most of their days at home, have experienced repeated ED visits (one or more each quarter) due to infection or episodes of respiratory failure, have endured repeated hospitalizations (one or more each quarter) and no longer wish to be admitted and the patient no longer wishes to be intubated.
The major hospice eligibility guidelines for COPD are:
dyspnea at rest and/or with minimal exertion while on oxygen therapy
dyspnea unresponsive or poorly responsive to bronchodilator therapy
progression of chronic pulmonary disease as evidenced by frequent use of medical services
frequent episodes of bronchitis or pneumonia
unintentional weight loss of ≥ 10% body weight over the preceding six months
progressive inability to independently perform various activities of daily living (ADLs)
There are other important clinical factors that also may support a patient’s hospice eligibility. These are:
need for continuous oxygen therapy
resting tachycardia > 100 beats/minute
Abnormal laboratory findings may also trigger a hospice referral such as:
FEV1 ≤ 30% predicted post-bronchodilator
serial decreases in FEV1 of at least 40 ml/year over several years
PO2 ≤ 55 on room air
O2 sat. ≤ 88% on room air or persistent hypercarbia (PCO2) ≥ 50 mm HG
While these laboratory studies may be helpful to the clinician when considering patient appropriateness for hospice services, they are not required for patient admission.
How Hospice Can Help COPD Patients
COPD is a significant health issue around the world. It is ultimately a fatal disease and patients are under-referred to hospice care. Hospice, with its strong interdisciplinary approach, has been shown to improve quality of life for patients with end-stage respiratory disorders like COPD.
Hospice Eligibility for Patients with COPD. Serena J. Scott, MD, Barry D. Weiss, MD, Ellyn Lee, MD, College of Medicine, University of Arizona. https://uofazcenteronaging.com. June 2017.
When to refer patients with advanced COPD to palliative care services. Rebecca Strutt. Breathe (Sheff). 2020 Sep; 16(3): 200061.
Referral to palliative care in COPD and other chronic diseases: A population-based study. Kim Beernaert; Joachim Cohen; Luc Deliens; Dirk Devroey; Katrien Vanthomme; Koen Pardon; Lieve Van den Block. Respiratory Medicine. Volume 107. Issue 11, P1731-1739. November 1, 2013.
Benefits of Yoga for Hospice Patients
We’ve all heard how good yoga is for you, but have you ever thought about the benefits of yoga for hospice patients? Yoga is defined as a spiritual discipline that is widely practiced for health and relaxation that includes breath control, simple meditation, and specific bodily postures. All of these things can be used to help hospice patients and their families navigate through an emotionally stressful time.
A brief history of yoga
Yoga is a combination of spiritual, mental, and physical practices that originated in ancient India approximately 5,000 years ago. It was originally practiced primarily to cultivate spiritual harmony and enlightenment.
It started to become more popular in the late 1800s as it spread west. New practitioners viewed it as a path to inner peace and better health. Then, we saw what is called the ‘Modern Yoga Renaissance’ in the 1920s where the physical practice of yoga dramatically changed. Prior to this point, it really only consisted of a few standing poses. Today, yoga has become a key component of holistic health.
Learn more about the history of yoga here.
What yoga looks like for hospice patients
When we think of yoga, we often think of poses like downward dog or child’s pose or even the more complex poses that turn a person into a pretzel. However, before you can learn to twist and turn and pose like that, you must focus on something you already know how to do. In fact, you do it all day, every day: breathe.
In yoga, breath control is referred to as pranayama [pränəˈyämə], and it is essential. There are several forms of pranayama that can be done from the seated position. One example of this is Adham Pranayama. It can be performed either sitting or lying down, whatever is most comfortable. The focus of Adham Pranayama is ‘belly breathing,’ or breathing deeply into your stomach.
So how do you do it, you ask. First, place one hand on your stomach and the other on your chest. Breathe in and out. Focus on moving only your abdomen, instead of inflating your chest. It’s as simple as that. Practicing Adham Pranayama has several benefits, including reducing insomnia, providing oxygen to the body, and relieving stress.
There are many other forms of pranayama that can be done anywhere and in comfortable, seated positions. You can learn more about them here.
Why hospice patients should consider yoga
Yoga can easily be adapted to fit the needs and ability of the person doing it. Plus, it can be done anywhere- from a yoga studio to the comfort of your own home, even from your bed! Not to mention the benefits of mindful breathing. This can be an incredibly difficult time for patients and their loved ones. Taking time to truly focus on your breathing can provide a break in the stress and anxiety you may be feeling. Plus, it can be done together, helping to reduce everyone’s stress while also creating peaceful memories you’ll have forever.
A 2020 Gallup study observed Americans’ identification as lesbian, gay, bisexual, or transgender (LGBT), by generation. The findings report that only 1.3% of the Traditionalist generation (born before 1946) and 2.0% of Baby Boomers (born 1946-1964) identify as LGBT. This number increases dramatically over the generations, reaching 15.9% for Generation Z (born 1997-2002). The question is – does the higher percentage of younger Americans reflect a true shift in sexual orientation? Or is it simply reflecting a greater willingness to identify as LGBT?
Although those who make up the younger generations were born into a world where huge progress has been made in the gay rights movement, the older generations of the LGBTQ community experienced much less accepting times. It wasn’t until 1961 that Illinois became the first state in the United States to get rid of its sodomy law. It then took another ten years before 20 more states followed their lead. So even though Traditionalists and Baby Boomers were around to witness the progress that has been made, many may still have the mindset that society will not accept them for who they are.
It is this fear of discrimination that may play a part in their hesitation to seek the help and support they need as they near the end of their life. As a result, the LGBTQ community has been historically underserved by hospice. A 2011 study reported that 20% of LGBTQ seniors that were surveyed did not even reveal their sexual orientation to their primary physician for fear of discrimination. Beyond hospice services for the patient, their grieving partner often misses out on bereavement support as they care for their partner in their final months and days.
Resources for the Aging LGBTQ Community
Hospices are now working harder than ever to understand the specific needs of the aging LGBTQ community and to do all they can to accommodate those needs. The National Resource Center on LGBT Aging is a resource center focused on improving the quality of services and support offered to lesbian, gay, bisexual, and/or transgender older adults. Their website includes resources that cover a variety of topics, including end of life decisions. You can also use the interactive map to find resources in your area.
No one should miss out on the benefits of hospice care for any reason, especially for fear of discrimination.
Happy Pride Month!
June is Alzheimer’s and Brain Awareness Month. This month-long celebration provides the opportunity to focus on raising awareness for the 50 million people worldwide living with Alzheimer’s and other dementias.
Alzheimer’s disease is a degenerative brain disease and the most common form of dementia. It causes a slow decline in memory, thinking, and reasoning skills. Schedule an appointment with your doctor if you notice any of these ten signs and symptoms:
Memory loss that disrupts daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion with time or place
Trouble understanding visual images and spatial relationships
New problems with words in speaking or writing
Misplacing things and losing the ability to retrace steps
Decreased or poor judgment
Withdrawal from work or social activities
Changes in mood and personality
Visit the website for the Alzheimer’s Association for more information on these signs and symptoms to be on the lookout for.
There are several ways to get involved in Alzheimer’s and Brain Awareness Month! On June 20th, join the cause by celebrating ‘The Longest Day’ through a fundraising activity of your choice! There are a variety of ways to get involved, including virtually and in-person.
So put on your purple gear, share your story of why you go purple, and join the fight to #EndAlz!
Soak Up the Sun…Safely
Summer is just around the corner, which mean barbeques, swimming, and SUN! And while most of us enjoy getting outside and soaking up a little Vitamin D, it is important to remember to be safe when heading outside into the sun. Per the American Academy of Dermatology Association, skin cancer is the most common cancer in the United States, and unprotected UV exposure is the most preventable risk factor for skin cancer.
With that being said, it is important to follow these three steps to protect your skin:
Seek shade: Remember, the sun’s rays are the strongest between 10AM and 2PM
Wear sun-protective clothing: Sunglasses and hats are key!
Apply sunscreen: Use a broad-spectrum, water-resistant sunscreen with at least SPF 30
Signs of Skin Cancer
Finding skin cancer early, before it has spread, makes it much easier to treat. If you know what to look for, you can often spot warning signs early on. Doctors recommend checking your own skin about once a month using a full-length mirror in a well-lit room. You can also use a hand mirror to check areas that are harder to see.
Melanoma is one of the deadliest forms of skin cancer, while basal and squamous cell skin cancers are more common but are usually very treatable. The American Cancer Society’s website discusses these types of skin cancers and what to look out for.
Use the “ABCDE” rule to look for some of the common signs of melanoma:
Asymmetry – one part of a mole or birthmark doesn’t match the other
Border – the edges are irregular, ragged, notched, or blurred
Color – the color is not the same all over and may include shades of brown or black, sometimes with patches of pink, red, white, or blue
Diameter – the spot is larger than ¼ inch across (although melanomas can sometimes be smaller than this)
Evolving – the mole is changing in size, shape, or color
Basal Cell Carcinomas
These types of skin cancers typically grow on parts of the body that get the most sun, such as the face, head, and neck. However, they can still show up anywhere. Here is what you should look for:
Flat, firm, pale, or yellow areas (similar to a scar)
Raised reddish patches, might be itchy
Small shiny, pearly bumps that are pink or red
Pink growths with raised edges and a lower area in the center, which might have abnormal blood vessels spreading out like the spokes of a wheel
Open sores that may have oozing or crusted areas and do not heal, or heal and then come back
Squamous Cell Carcinomas
Similarly to basal cell carcinomas, these typically grow on the parts of the body that get the most sun but can appear anywhere. You should look for:
Rough or scaly red patches, which may crust or bleed
Raised growths or lumps, sometimes with a lower area in the center
Open sores that may have oozing or crusted areas and do not heal, or heal and then come back
Talk to Your Doctor
Although these are good examples of what to look for, some skin cancers may look different than these descriptions. It is important to talk to your doctor about anything you are concerned about, such as new spots and other skin changes.
Benefits of Physical Activity
Today is National Senior Health and Fitness Day, making it a perfect day to focus on the importance of exercise. There are plenty of benefits of physical activity for people of any age, but let’s highlight some specifically for seniors:
Improves physical ability for everyday tasks
Helps reduce the risk of falls
Helps control joint swelling and pain associated with arthritis
Improves heart health
Can help reduce blood pressure
Boosts mood to help combat anxiety and depression
Exercises for Seniors
We already know the importance of physical activity, but we also have to remember it is equally important to be safe while exercising. This means choosing exercises that work for you based on your age and physical fitness, while also considering any injuries or physical limitations that may impact your ability. It is also important to talk with your physician before jumping right into a new exercise routine.
Some of the best exercises for older adults include:
Seated exercises, such as toe taps and heel raises or seated yoga
Exercising is only part of what it takes to live a healthy lifestyle. A healthy diet is another very important part, and the definition of healthy eating changes a little as you age. The National Council on Aging put together a list of six tips for eating healthy as you get older.
Know what a healthy plate looks like
Look for important nutrients, such as lean protein, fruits and veggies, whole grains, and low-fat dairy
Each year, Better Hearing and Speech Month in May provides an opportunity to raise awareness about communication disorders and other hearing and speech problems. The event also serves as a reminder to people to get their hearing checked. Early identification and intervention is very important, and getting your hearing checked is the first step!
According to the CDC’s website, the World Health Organization’s first World Report on Hearing found that:
Noise is acknowledged as an important public health issue and a top environmental risk faced by the world today
Over 50% of people aged 12-35 years listen to music via personal audio devices at volumes that pose a risk to their hearing
Keeping the volume below 60% is a general rule of thumb for safety
You should consider using noise cancelling earphones or headphones rather than turning the volume up
Listening through personal audio devices should not exceed 80dB for adults or 75 dB for sensitive users, such as children, for 40 hours per week
“Building Connections” is the theme for 2021! You can find a variety of resources, broken down by week, on the American Speech-Language-Hearing Association’s website. Week 4’s focus is “Summer Skill Building, Hearing Protection for School-Aged Children.” Below are some examples of the resources available. Be sure to check out the ASHA’s website for more!
Joint Commission-accredited hospices are the partner of choice throughout the care continuum because of their deep abiding commitment to quality end-of-life care. Apreva Hospice is one of the few hospices in San Diego County with this distinct and honorable title.An accreditation from Joint Commission shows dedication to the optimum patient experience, commitment to strong interdisciplinary care management, and a robust patient safety initiative.