Staying mindful and resilient during times of transition
February 7, 2017
Moira Mulhern, PhD
Co-Founder/Executive Director, Turning Point: The Center for Hope and Healing
We face many transitions throughout life. Sometimes, when we are confronted by one of these changes, we choose not to follow through and go another way. Other transitions cannot be bypassed.
Cancer is a transition that, once diagnosed, cannot be avoided. After diagnosis, you go into action, receive your treatment and begin the cure. It’s a time filled with uncertainty, fear and hope. You hope you will complete treatment and live the rest of your life as a survivor.
You may experience a roller coaster of emotions. This is where having resilience skills comes in handy. If you have the skills to meet your transitions and move through them, you will come out on the other side stronger, wiser and more resilient. If you are resilient, your life will seem easier and more peaceful.
Resilience is the ability to bounce back in the face of whatever comes your way. Resilient people may be strengthened by their experience with stress.
Key characteristics of resiliency
Resilient people share certain traits, including optimism, hope, hardiness and the ability to identify and express their emotions. Decades of research identifies 10 key characteristics of resilience:
- • The ability to self-calm
- • The ability to self-replenish
- • Hope
- • Optimism
- • Hardiness
- • Sense of coherence
- • Exercise and other self-care
- • Nonjudgment and self-supporting attitudes
- • The ability to express emotions
- • Social support
The good news is that there is considerable research showing that people can learn to be more resilient. Resiliency training benefits include greater personal balance, enhanced creativity, improved mood, increased effectiveness in the workplace and in personal relationships, and greater physical health. However, resilience training is like exercising or reducing caloric intake for weight loss. It only works if you incorporate it into your daily life.
Improving your resilience
Resilience is about maintaining inner reserves and focusing on what you need in the moment. Actions you take in response to stressful situations play a central role in determining how well you maintain and replenish reserves.
Some of the best ways to calm and replenish yourself:
- • Try exercise. A 10-15 minute brisk walk can have an effect comparable to a tranquilizer.
- • Employ mindfulness. This is the ability to focus on the moment. Research shows that people who can do this are happier. If you are driving, focus on driving. If you are cooking, focus on the activities of preparing your meal. Mindfulness meditation involves focusing on your breath, a word or phrase.
- • Apply relaxation. There are many techniques to help you relax, and deep relaxation greatly contributes to rebuilding your resources.
- • Use self-talk. Say calming and reassuring things to yourself. This can be considered a form of self-hypnosis, and is more powerful than most people think. Try it and observe the effects.
- • Visualize calming scenes. Imagine yourself in a calming situation, e.g., on a pristine beach listening to the surf, a beautiful mountain trail or next to a rippling stream. Find images that match your experience and interests.
- • Listen to a calming recording, music or voice. Select recordings that calm you and use them when needed to become more serene.
- • Connect with the energy of calming people. People range from those who are calming and comforting to those who aggravate your tension. When stressed, try to be around people who help you rebuild your resources and avoid those who make things worse.
- • Go into predictable calming routines. For example, something habitual that you love to do. One of the best ways to calm yourself and rebuild your resilience resources is to identify actions ahead of time that replenish you and be on the ready to put them to use when they are needed.
Through classes, activities and education, Turning Point: The Center for Hope and Healing, a community resource of The University of Kansas Health System, helps participants increase resilience so they may live life to the fullest, even while experiencing chronic disease. Learn more.
The power of social media and your health
January 13, 2017
Research shows that patients are increasingly seeking healthcare information on the Internet, making it the third most common online activity. Combined with social networking, which accounts for nearly one-fifth of all time spent online, it’s understandable to see social media’s powerful effect on the way people approach their health.
As an NCI-designated cancer center, The University of Kansas Cancer Center embraces these facts and recognizes the value social media can bring to those seeking information about cancer. By providing cancer patients, survivors and their families with rich resources for understanding their disease, we can empower and engage them to take greater control of their own health.
The number of people living with cancer exceeds 14 million. We all know someone affected by it. The University of Kansas Cancer Center is committed to communicating this indispensable information to as many people as possible. Consequently, I am issuing you a challenge. With your help, we can provide those affected by cancer with information, tools and support via The University of Kansas Cancer Center’s social media channels.
If you don’t already, follow The University of Kansas Cancer Center Facebook page, as well as our other social media channels including Twitter, Instagram, YouTube and Pinterest. Like, share and comment to help amplify these important messages within your own communities.
By following the cancer center’s Facebook page, you will have access to the latest cancer information and be one step closer to being entered for a Lunch & Learn session. We will select one winner and a guest to have lunch with me and tour one of our cancer center labs. You’ll meet some of our researchers and learn about the latest cutting-edge cancer research. Here’s how to become eligible:
Visit The University of Kansas Cancer Center Facebook page (or search for “The University of Kansas Cancer Center” on Facebook. Be sure to look for the gray badge next to our name)
- Click “Like” under the main image at the top of the page.
- Tag at least two friends in the comments of any of our posts.
You have the opportunity to help those suffering from the devastating effects of cancer. Help us make a difference in the health and wellness of our community. Like, share and comment to help amplify important cancer information within your own communities.
Lowering your risk for cervical cancer
January 6, 2017
Thirty-year-old women with babies in diapers, toddlers in daycare and children in grade school should not be fighting cervical cancer. Sadly, I have seen two of these young mothers in the last week.
Several months after giving birth to twins, Kelly* was having irregular bleeding. She saw her gynecologist, who noted mild changes on Kelly’s pap smear. But the bleeding wouldn’t stop. Within six months, Kelly was in my office with advanced cervical cancer.
Kelly, who recently completed chemotherapy and radiation therapy, brought her three-year-old daughter to our last visit. The adorable little blonde with big rosy cheeks was worried because her mommy was spending so much time at the doctor’s and needed to have another exam. I had good news for her mom. She had responded well to treatment and was in remission.
My second patient is not as fortunate. She came to me with progressive cervical cancer, which did not respond to chemotherapy or radiation therapy. Dana* lit up as she told me about a recent visit with her boys, ages 8 and 10. She showed me pictures of their adventures at the library and their paintings of the fall leaves.
Dana no longer has the strength to care for them herself and relies on her family for assistance. At 32, Dana is facing an incurable cervical cancer. When we meet, we work together to optimize her quality of life, address her pain and symptoms, discuss her future wishes and plans for herself and the boys. I address her palliative care needs to improve the quality of her life in the time she has remaining.
Cervical cancer is predominantly caused by the human papillomavirus (HPV), and today this is a preventable illness. Pap testing has reduced cervical cancer rates significantly in industrialized countries, but it hasn’t yet brought the number of cases to zero. Both of my patients had regular screening exams and yet their HPV-related cervical cancers were not caught in time.
We can, and must, do better.
A vaccine that targets cancer-causing HPV has been available since 2006. In October, an improved, two-dose version of the HPV vaccine which targets nine different types of the virus was approved by the FDA. For 10 years, we’ve had a vaccine that can prevent cervical cancer and multiple other HPV-related cancers. And yet, millions of adolescent girls and boys are not being vaccinated. Kansas and Missouri have two of the lowest rates of HPV vaccination in the country.
My hope for the future, and my challenge to the community during Cervical Health Awareness Month this January, is to support the vaccination of girls and boys against the HPV virus. We must do this so we do not have another 30-year-old mother facing an incurable cervical cancer diagnosis. We cannot allow our women and girls to slip through the cracks when we have a safe and proven method of preventing this horrible disease.
*Names are changed to protect patient confidentiality.
UKanQuit tobacco cessation program celebrates 10-year anniversary
November 3, 2016
Kimber P. Richter, PhD, MPH
Director, UKanQuit at The University of Kansas Hospital,
Joy McCann Professor of Women in Medicine & Science
Millions of tobacco users check into hospitals across the U.S. each year, but very few get help to quit smoking ̶ which is often the root cause of what put them in the hospital.
Rather than just treat the patient for their smoking-related health issues, The University of Kansas Hospital and The University of Kansas Medical Center’s Department of Preventive Medicine and Public Health developed a bedside tobacco cessation program. The service allows providers to proactively work with patients to help them kick their smoking habits.
On Sept. 1, 2006, the entire medical center campus, led by The University of Kansas Hospital, went smoke-free. That same day, the hospital launched its bedside tobacco treatment service, UKanQuit. Doing so made our hospital and university campuses among the first in Kansas to provide clean air ̶ inside and out ̶ to all visitors, students, patients, and staff. This year, the UKanQuit program celebrates 10 years of helping patients quit smoking.
UKanQuit was created to help inpatient smokers get symptom relief from their craving and withdrawal. It was also an opportunity for them to re-evaluate their tobacco habit and begin the journey to quit.
Edward Ellerbeck, MD, MPH, general internist and program director for The University of Kansas Cancer Center’s Cancer Control and Population Health program, and I were the proud parents of this groundbreaking partnership.
Research shows that hospital-based tobacco cessation is effective. Counseling that begins in the hospital and continues for at least one month after discharge can increase the odds of quitting by 37 percent.
Since its founding, UKanQuit has treated more than 12,000 patients, averaging more than 1,000 individuals per year, with a patient-reported quit rate of 25 percent. By comparison, 2010 data from the National Health Interview Survey shows that only 6.2 percent of all smokers quit in a given year, although 7 out of 10 people say they want to quit.
UKanQuit’s clinical home is in Patient Care Services, under the leadership of Chris Ruder, RN, vice president for Patient Care Services at The University of Kansas Hospital. It is fully integrated into the electronic health record and clinic workflows. Quitting smoking speeds recovery and prevents future illness.
UKanQuit works with patients’ healthcare teams to ensure patients get high-quality care to achieve optimal outcomes. Services include:
- • Identifying inpatients who smoke
- • Assessing dependence, craving and interest in quitting
- • Coordinating medication and counseling at bedside and at discharge
- • Documenting care
- • Conducting follow-up with patients at one-month postdischarge to assess outcomes
In addition, UKanQuit serves our teaching mission as a platform for training medical students, residents, master’s in public health students and PhD students. It’s a unique learning environment because it combines high-quality hospital treatment with extremely rigorous training in research methods. UKanQuit has been a platform for a number of large NIH-funded clinical trials to discover the best way to engage smokers in cessation services before they leave the hospital. In addition, nine peer-reviewed articles have been published on the program.
This is one of many cancer center endeavors that focuses on prevention. The Cancer Control and Population Health program was developed explicitly to identify better ways to introduce prevention strategies into high-risk and underserved communities.
To gain lung self-awareness, visit: kucancercenter.org/LCA.
Two-dose HPV vaccine awaits FDA approval
October 11, 2016
Completing the human papillomavirus (HPV) vaccination series could become much simpler in the near future as a reduced dose schedule is being considered.
Approximately 39,000 Americans develop an HPV-related cancer every year. For the past 10 years, a vaccine has been available to prevent several cancers, including penile, anal, cervical, vulvar and vaginal. As an anticancer vaccine, this series has the potential to prevent 90 percent of cervical cancers.
Currently in the U.S., patients receive their first HPV vaccination at month “zero,” a second dose two months later and a third and final dose six months after the first. However, at a recent meeting of the Advisory Committee on Immunization Practice (ACIP), members discussed changing the current three-dose schedule to two doses based on new clinical data.
Second generation HPV vaccine
In an unpublished clinical trial presented earlier this year to the ACIP, a federal advisory panel that makes vaccine policy in the U.S., results showed that immune response to the new HPV vaccine was observed. The new or second generation HPV vaccine is different from the HPV vaccine approved a decade ago. The new version of HPV is 9-valent. It protects against five additional cancer-causing HPV types.
In the study of the new 9-valent vaccine, several different dosing schedules were used in young adults and adolescents. The study showed that a two-dose schedule in adolescent boys and girls under age 15 had similar immune response to other groups that received three doses of the new HPV vaccine. These findings are similar to an earlier Canadian study, in which the youngest recipients of the HPV vaccine had equivalent immune responses when they received two or three doses of the vaccine. This strategy is called prime-boost. The initial dose of the vaccine primes the immune system. A second dose, given six to 12 months later, providers a booster dose of the vaccine.
The two-dose regimen for the new HPV vaccine is awaiting FDA approval. In 2014, the World Health Organization reviewed the existing data on two-dose regimens for the HPV vaccine. The two-dose schedule has been adopted in many European countries.
Streamlining vaccine schedule
Perhaps the biggest advantage of the two-dose vaccine schedule is that it fits nicely into current pediatric well-child visits. These visits are recommended annually in early adolescence. According to Lore Nelson, MD, associate professor of pediatrics at the University of Kansas Medical Center, while the modification may not seem significant “… it is.” She believes that compliance will be much higher if two doses of HPV vaccine are given 12 months apart. Dr. Nelson said that adolescents could receive both doses of the HPV vaccine during back-to-school checkups over two consecutive years. Additionally, since the number of vaccinations is reduced by one-third, the change is also cost effective.
The two-dose HPV vaccine schedule will be discussed at the Oct. 19, 2016, meeting of the ACIP in Atlanta, Georgia.
Vaccine can prevent HPV infection and HPV-related cancers in our community
August 24, 2016
Stephen J. Lauer, MD
Pediatrician, The University of Kansas Hospital
Modern Western medicine has benefited society with antibiotics, antihypertensive medications and vastly improved trauma management. These have resulted in dramatic decreases in morbidity and mortality for millions of patients. The concept of immunization was born in 1798 when Edward Jenner inoculated a young boy against smallpox. The vaccine process has since resulted in the eradication of smallpox, as well as dramatic reductions in the number of deaths due to infectious diseases, including measles, pertussis, polio, streptococcal and hemophilia meningitis.
Preventing cancer through vaccination
About thirty years ago, the vaccines took a dramatic new direction with the introduction of an inoculation that could prevent cancer: the hepatitis B vaccine. This vaccine targeted one of the leading causes of acute hepatitis and hepatocellular carcinoma, the hepatitis B virus. Infection with this virus can lead to acute symptoms (hepatitis), but can also move to a silent, carrier state in an infected person. If a woman who is a carrier becomes pregnant, she can pass the virus to her unborn child unknowingly. Eventually, both the mother and the child are at a greatly increased chance of developing liver cancer due to the hepatitis B virus. The hepatitis B vaccine was the first vaccination that was effective against cancer, an amazing advance in personal and public health.
In 2006, the second anti-cancer vaccine, the human papillomavirus (HPV) vaccine, was introduced. Most sexually active people will get HPV at some point in their lives. This means that everyone is at risk for the potential outcomes of HPV, including cervical, ovarian, anal, esophageal and penile cancer. In the United States, there are as many as 35,000 new HPV-related cancer cases diagnosed annually, leading to about 8,000 deaths. The worldwide burden of HPV-related cancers is much higher. These cancers are insidious and are very difficult to treat as they are often not detected until they are advanced. HPV-associated cancers are often diagnosed in younger patients - women with cervical cancer and men with esophageal cancer.
How does the HPV vaccine work?
Tina Hillhouse survived stage III squamous cell carcinoma, caused by HPV. Not wanting others to experience what she has, Tina is an advocate of the HPV vaccine.
While there are hundreds of types of HPV, the vaccines have been developed to fight the types of HPV associated with cancer. When introduced in 2007 in the United States, the vaccine was initially approved for girls ages 11 and older. As with the hepatitis B vaccine, it is essential to vaccinate people prior to exposure to the virus. However, once the virus has infected a cell, the vaccine is not effective at killing the virus. Instead, once inside a target cell, the virus can eventually cause cellular changes that turn a normal cell into a cancerous cell. Thus, while the HPV virus can be spread by several routes, including sexual contact, it is crucial that adolescents and young adults be vaccinated prior to virus exposure.
Because men are often silent carriers of HPV (leading to the spread of the virus among women or esophageal and penile cancer in men), the vaccination program was expanded to include males 11 years or older. Currently, the vaccination schedule calls for three doses to be administered to all eligible males and females beginning as early as age 9. Studies from several countries where the vaccine has been administered for more than 20 years are beginning to show the predicted reductions in cancers caused by the virus.
As more people are vaccinated against HPV, resistance to HPV infection will build and there will be a corresponding decline in the rates of cervical, ovarian, esophageal, anal and penile cancers. These cancers are predicted to decline in the same way that polio, smallpox, pertussis and other infectious diseases have as a result of vaccination.
Potential side effects
There is no such thing as a completely risk-free therapy. Despite concerns about vaccination, vaccines have been an overwhelmingly positive influence on the health of people around the world. Similarly, there are concerns about the safety of the HPV vaccine. Such concerns are appropriate with any new medical intervention. Dozens of studies involving millions of patients have been conducted and, to date, have revealed no serious side effects associated with the HPV vaccine.
With more than 85 million doses of the vaccine administered in the United States alone, no serious side effect has been tied to receiving the vaccine. This does not mean that we won't continue to search for rare side effects that may affect a few patients. It does, however, indicate that the HPV vaccine is extremely safe and that the risk-to-benefit ratio clearly favors giving the vaccine to eligible patients. As with many vaccines, there are a few patients who should not receive the vaccine due to an underlying medical condition – for instance, an immunodeficiency that would not allow their body to respond effectively to the vaccine. However, those circumstances are rare and can be identified by appropriate screening.
The HPV Vaccine: it could be a matter of life or death
You have the opportunity to protect your children from certain kinds of cancers – and it’s in the form of a simple vaccine. Why wouldn’t you want to protect them? Currently, about 8,000 people die every year from HPV-related cancers. If everyone got the vaccine, over the next 20 to 30 years, we could see HPV cancers become a disease of medical history, much like smallpox.
New Kansas law reduces children's exposure to harmful UV rays
Roy Jensen, MD
Director, The University of Kansas Cancer Center; William R. Jewell Distinguished Masonic Professor
At The University of Kansas Cancer Center, we are committed to promoting policies that have the potential to save lives and decrease the incidence of cancer. Earlier this month, legislators passed a bill that prohibits people under the age of 18 from using tanning beds at tanning facilities. This is a huge step forward in decreasing the incidence of cancer, and I am proud that Kansas has joined more than a dozen other states in protecting our children from this known carcinogen.
Habitual use of a tanning bed is dangerous for anyone, but it is especially unsafe for young users because the earlier UV damage begins, the higher the risk of skin cancer. Individuals who use indoor tanning devices before the age of 35 increase their risk for melanoma – the most deadly type of skin cancer – by 59%. The number of skin cancer cases linked to tanning beds every year is two times the number of lung cancer cases associated with smoking, and the World Health Organization has classified tanning beds as a Level 1 carcinogen, the same as plutonium and cigarettes.
An estimated 820 new melanoma cases are expected in Kansas this year, but with this new law, we have an opportunity to cut the forecasted rates over the next several years.
Still think that tan gives you a “healthy” glow? I certainly don’t believe so, and I’m happy that the State of Kansas agrees with me.
Roy Jensen, MD
Director, The University of Kansas Cancer Center; William R. Jewell Distinguished Masonic Professor
It's time to dim the lights on indoor tanning
Kansas should pass HB 2369 prohibiting minors from using indoor tanning devices.
The number of skin cancer cases in the state of Kansas is growing at an alarming rate. Individuals who use indoor tanning devices before the age of 35 increase their risk for melanoma – the most deadly type of skin cancer – by 59%. An estimated 820 new melanoma cases are expected in Kansas in 2016, and about 100 Kansans will die from melanoma this year.
The American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society (ACS), advocates for public policies that will help reduce the risk of skin cancer, including those which prohibit the use of indoor tanning devices among minors. ACS CAN supports HB 2369, prohibiting minors from using indoor tanning devices.
It’s as plain and simple as this: indoor tanning causes cancer.
The World Health Organization (WHO) has classified UV-emitting indoor tanning devices with the highest level of cancer risk “carcinogenic to humans,” just like tobacco and asbestos. Young people are especially susceptible to damage from indoor tanning devices. Kansans agree: children under the age of 18 should be prohibited from using indoor tanning facilities.
We don’t let children smoke cigarettes, why should we let them tan?
Skin cancer is the number one cause of cancer in the United States, with melanoma being one of the most common cancers diagnosed among young adults In fact, in the last thirty years, the number of Americans who have had skin cancer is estimated to be higher than the number for all other cancers combined.
Today, millions of people are diagnosed with skin cancer each year. About 2 percent of those cases, or about 70,000 cases, are melanoma, the most deadly form of skin cancer. The cost of skin cancer is not cheap, with totals exceeding $8 billion each year - $3.3 billion of that total is for melanoma treatment.
It is estimated that over 400,000 skin cancer cases in the United States are attributed to indoor tanning each year...
- • 245,000 basal cell carcinomas
- • 168,000 squamous cell carcinomas
- • 6,000 melanomas
UV radiation from indoor tanning and other sources is cumulative over time. The earlier a person starts tanning, the greater the risk of getting melanoma and other skin cancers later in life.
You’d think that with all these facts about skin cancer, our youth would avoid indoor tanning. But that is, unfortunately not the case. There are several factors that increase youth tanning, including:
- • Youth get incorrect and false information from the indoor tanning industry about the risks of tanning.
- • A 2012 congressional committee report showed that tanning salons often deny the risks of tanning and indicate it is beneficial to a young person’s health.
- • Indoor tanning salons do not always follow recommended guidelines. For instance, 71 percent of tanning salons would allow a teen to tan more often than the three times per week recommended by the federal government.
A 2011 study published in the American Journal of Public Health found many factors that increase tanning among younger people. Youth were more likely to use a tanning device if they:
- • Believed people with a tan look more attractive (80 percent more likely)
- • Believed that their parents allowed them to use indoor tanning (80 percent more likely)
- • Had a parent who used indoor tanning (70 percent more likely)
- • Noticed advertisements for indoor tanning (70 percent more likely)
Because the science demonstrates that tanning devices cause cancer and that age restrictions can be effective at reducing teen tanning rates, ACS CAN supports HB 2369 to prohibit minors under the age of 18 from using indoor tanning devices, without any exceptions.
To date, eight states have passed similar comprehensive legislation prohibiting the use of tanning devices by minors, without exception, in order to protect their state’s youth. Similar age restrictions on harmful substances and services have been placed on tobacco products and alcohol. Restricting access to indoor tanning bed use based on age is no different.
Given what is known about the harmful effects of UV radiation from indoor tanning devices, especially among youth, Kansas should pass HB 2369 prohibiting minors from using indoor tanning devices.
In just seven months, The University of Kansas Cancer Center will submit its application to obtain Comprehensive Cancer Center designation from the National Cancer Institute (NCI). This level of designation is the highest honor a cancer center can achieve – just 45 cancer centers throughout the U.S. have received the award - and none are in our region.
In order for us to receive Comprehensive designation, KU Cancer Center must demonstrate that we are significantly improving the health of our communities. We must show that we are providing highly effective and wide-spanning outreach capabilities with dissemination into the general population.
And one of our biggest challenges is helping people to stop smoking.
Last year, cancer became the number one cause of death in Kansas, and lung cancer is the biggest culprit. More than 2,000 Kansans were diagnosed with lung cancer, one of the most preventable types of cancer, and most of these people will die for one reason alone: they smoked cigarettes.
The Healthy KC initiative, launched by the Greater Kansas City Chamber of Commerce, has put forward a Tobacco 21 proposal that would raise the age of purchase for tobacco products, including e-cigarettes, from 18 to 21 years of age. By raising the age of tobacco purchase to 21, we can have a dramatic impact on access to cigarettes in our schools. This will, in turn, reduce the number of children that get addicted to cigarettes and, subsequently, reduce the burden of lung cancer as well as cancer of the mouth, lips, sinuses, larynx, pharynx, esophagus, stomach, pancreas, kidney, colon and bladder.
KU Cancer Center stands firmly behind efforts to reduce cancer in our region. Our Cancer Control & Population Health Research Program scientists currently have recently received significant funding from the NCI to conduct smoking cessation trials throughout the state. We know 31 percent of all cancers could be eradicated if people no longer smoked and we strive to see a minimum of a 20 percent decrease in the use of tobacco over the next 15 years.
With the hope of Tobacco 21 being passed, we stand far better equipped to enhance our application for Comprehensive designation, which will allow us to continue to receive critical research funding to effectively prevent cancer as well as care for future cancer patients.