Lecture 7&8: PC in Cancer and Viral Disease Flashcards
Cancer is ranked what in leading causes of death globally?
2nd
T/F most of cancer deaths occur in high income countries
FALSE- 70% cancer deaths occur in LMIC
1/3 of cancer deaths are related to which 5 risk factors?
High BMI Low fruit/veggie diet Lack of exercise Tobacco use Alcohol use
What are 5 barriers to opioid access for PC?
- US produces + imports way more opioids than it needs resulting in less countries having access
- Lack of PC training for doctors
- Laws + police with strict rules
- opiophobia
- pharma companies uninterested in marketing generic opiates because they won’t make money
How does the US influence other countries’ opiophobia’?
Declaring the War on Drugs
$100 billion spent
We still produce/import excess opioids
T/F There are less cancer cases in the developing world so the death rate is much lower
FALSE
there ARE less cancer cases in developing world bc most people die of communicable diseases (increasing life expectancy–> increasing cancer rates)
HOWEVER, death rates are MUCH higher because of lack of screening/treatment
What are 3 types of preventable cancers that are rising in LMIC? And why?
Cervical- no HPV vaccine & HIV complications
Liver- no Hep B/C vaccine available
Stomach- h. pylori infection
T/F The mortality for AML and cervical cancer is the same in developing and developed countries
FALSE
HIGH disparity in survival rates
For AML and cervical cancer, survival in the US is ~90% and in Middle East/Africa, survival rates are under 20%
What are 3 main challenges to cancer care?
- lack of infrastructure (ex 385 radiotherapy machines for 1 BILLION people in africa)
- Poor distribution of resources (most radiotherapy machines are located in 3 African countries-SA, Egypt, Morocco)
- Lack of data
What country was successful in achieving opiate access for its people?
Uganda
11% of opioid needs met- considered successful bc it’s much higher than national average
What were 4 reasons why Uganda was successful in meeting opioid needs?
- People put pressure on authority (older doctors, etc) and president actually listened
- President acknowledged AIDS epidemic
- Specially trained nurses can prescribe morphine
- Outpatient setting: govt only allows oral morphine mixed with water
- –> it’s really difficult to become addicted to the oral morphine (morphine syrup) since you’d need a lottt to experience a high and the 2 doses people get are still effective
What are some developing world risk factors for cancer?
- HPV/Hepatitis/HIV
- Tobacco & alcohol
- Obesity
- Diet low in fruit/vegetable
- Sedentary lifestyle
- Occupational hazards
- UV exposure
- Urban air pollution
- Indoor smoke
- Harmful cultural behaviors
- Skin Bleaching
- Late Presentation
What are some reasons cancer presents later in developing world populations?
- Distrust of health services
- Different cultural beliefs about cancer
- Lack of knowledge about cancer
- Lack of knowledge about early warning signs
- Poor screening access
- Poor transportation infrastructure
- Poverty
- Lower assessment skill of local doctors
- Political/Economic/Social disenfranchisement
What are the 6 steps to addressing cancer in developed world?
- Planning- assess needs, capacity, social context
- Prevention- education, reduce risk factors
- Early Detection- screenings, self exams
- Better Treatment- equity of drug/tx distribution
- Palliative Care
- Policy and Advocacy
Why is early detection of cancer so important?
many patients are diagnosed at late stages when curative treatment may no longer be an option.
What are the 2 main components of early detection?
- Early diagnosis
- greater probability of surviving, less $$ treatment - Screening
-ex: VIA (vinegar method for cervical cancer)- low income
pap smears- middle/high income
mammography- for well developed systems
T/F Developed world solutions usually transfer to developing world
FALSEEEEEEE
No they don’t (Exhibit A the white girl group)
Cervical cancer PAP smear screening is not going to work in a super low income setting
Why is cervical cancer the most deadly cancer for women in the developing world?
- increased HPV risk
- inaccessible dx/treatment
- lack of access to contraceptives (women may not be able to insist on their use even if accessible)
What are traditional screening and treatment methods for cervical cancer and why don’t they work in super low income settings?
Screening: Pap smear
–> Requires FOLLOW UP and many women are unable to come
Treatment: Surgical
–>requires equipment, skilled surgeons, and hospital admission
T/F Early detection is always useful regardless of available treatment
FALSE
Early detection is only useful where effective treatment is feasible
What is the alternative “See and Treat” approach to cervical cancer? What are the pros of this method?
Instead of screening women and expecting them to follow up, we screen them and diagnose/treat at the same time
Screening: VIA (vinegar method) + colposcopy
Treatment: loop cryotherapy
-cheap, safe, and doesn’t require specialist surgeon or follow up
What are the 3 main global priorities in cancer prevention?
- Cancers with high burden but low preventability
(ex- breast + prostate) - Cancers with a known cause
(cervical- prioritize HPV vaccine) - Cancers preventable through established interventions
(liver cancer/lung cancer- prioritize admin of HBV vaccine + antismoking campaigns)
Kerala, India used a successful _______ approach for cancer that focused on _____.
community-based
education
cancer awareness program in schools, education of health care professionals, implementation of early detection centers
carried out through schools and media in villages
T/F Tobacco use is the most important risk factor for cancer
TRUE
causes 22% of cancer deaths
Burden just continues increasing more, especially in LMIC
What are some ways the WHO is helping to reduce the burden of cancer globally?
- Increase political commitment
- Conduct more research
- Implement cost effective prevention and tx strategies
- strengthen healthcare systems
- monitor and sustain local programs
Why do HIV patients have a high need for pain medication and PC?
- Increases in frequency & severity toward end of life
- Physical symptoms of HIV experienced early (ambulatory phase)
What is the time from HIV seroconversion to AIDS?
8-10 years
18-30 month survival after AIDS (avg)
Common symptoms of HIV
Cough (P. carnii pneumonia, Karposi sarcoma, TB, sinus infections)
Diarrhea (salmonella + C. diff)
Anorexia, Nausea, Vomiting (candida, constipation)
Pruritus (dry skin + itching)
Malaise, Weakness, Pyrexia
Psychological Distress (depression + dementia)
T/F HIV and AIDS patients die quickly from acute complications like P. carnii pneumonia
FALSE
They used to die quickly, but NOW earlier diagnosis and better treatment –> longer survival BUT more palliative care needs
What is the main palliative care issue for HIV?
- Rising Palliative Care Need
- Longer course of illness -> Higher total burden of pain & disease
- Comorbidities
- Psych issues
- Increasing # of non-HIV specialists need to become familiar with managing advanced/terminal cases
- Many more people choose to die at home –> more community services needed
Common Causes of Pain in AIDS?
Oropharyngeal: herpes, candida, etc Retrosternal: ulcers, pneumonia Headache: meningitis Abdominal : diarrhea, constipation Perianal and perineal: herpes, candida
Whats the difference between stigma and discrimination?
Stigma: = Unfavorable ATTITUDE directed at someone/something
Discrimination: ACTION: Treatment of an individual with partiality/prejudice
Whats the difference between internal and external stigma?
External: Avoidance, rejection, victimization, abuse of human rights
Internal: Self-exclusion, low self-esteem
What are the 4 manifestations of stigma?
- Physical Stigma: violence, isolated, shunned, neglected
- Social Stigma: voyeurism, social ‘death’, loss of standing
- Verbal: gossip, taunting
- Institutionalized: barred from jobs, housing, healthcare, police harassment
What does HIV stigma result in?
- Avoiding testing, treatment or disclosure
- avoid safe sex
- Inhibits access to counseling
A majority of child HIV is transmitted by___
90% mother-child transmission
Do kids or adults have a higher risk of severe symptoms from HIV?
KIDS get sicker Ear & Sinus infections Sepsis & meningitis Pneumonia & TB UTIs & Skin infections
How to treat child HIV and child HIV transmission?
Treat children with ART
Treat moms in pregnancy and breastfeeding
HIV PC should be ____
hollistic
How can hollistic PC for HIV be achieved?
Physical- tx of pain
Emotional- counseling and emotional support
Social- help with stigma, legal, financial issues
Spiritual
What is another virus that may need palliative care?
Rabies
(Lyssavirus)
100% Fatal, acute encephalomyelitis
How does measles result in death?
Starts off like flu…ends with coma/death within days
How can a good death be achieved in rabies?
A ‘Good Death’ can be achieved with simple, cheap antipsychotics- haloperidol
Prevention + treatment for rabies
Primary prevention or post-bite vaccination
